Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. PCS (209464) for CS for SB 1712
       
       
       
       
       
       
                                Ì337470&Î337470                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/18/2019           .                                
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       The Committee on Appropriations (Harrell) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Effective July 1, 2024, subsections (9), (10),
    6  and (11) of section 395.003, Florida Statutes, as amended by
    7  this act, are amended to read:
    8         395.003 Licensure; denial, suspension, and revocation.—
    9         (9) A hospital may not be licensed or relicensed if:
   10         (a) The diagnosis-related groups for 65 percent or more of
   11  the discharges from the hospital, in the most recent year for
   12  which data is available to the Agency for Health Care
   13  Administration pursuant to s. 408.061, are for diagnosis, care,
   14  and treatment of patients who have:
   15         1. Cardiac-related diseases and disorders classified as
   16  diagnosis-related groups in major diagnostic category 5;
   17         2. Orthopedic-related diseases and disorders classified as
   18  diagnosis-related groups in major diagnostic category 8;
   19         3. Cancer-related diseases and disorders classified as
   20  discharges in which the principal diagnosis is neoplasm or
   21  carcinoma or is for an admission for radiotherapy or
   22  antineoplastic chemotherapy or immunotherapy; or
   23         4. Any combination of the above discharges.
   24         (b) The hospital restricts its medical and surgical
   25  services to primarily or exclusively cardiac, orthopedic,
   26  surgical, or oncology specialties.
   27         (c) A hospital classified as an exempt cancer center
   28  hospital pursuant to 42 C.F.R. s. 412.23(f) as of December 31,
   29  2005, is exempt from the licensure restrictions of this
   30  subsection.
   31         (10) A hospital licensed as of June 1, 2004, shall be
   32  exempt from subsection (8) as long as the hospital maintains the
   33  same ownership, facility street address, and range of services
   34  that were in existence on June 1, 2004. Any transfer of beds, or
   35  other agreements that result in the establishment of a hospital
   36  or hospital services within the intent of this section, shall be
   37  subject to subsection (8). Unless the hospital is otherwise
   38  exempt under subsection (8), the agency shall deny or revoke the
   39  license of a hospital that violates any of the criteria set
   40  forth in that subsection.
   41         (11) The agency may adopt rules implementing the licensure
   42  requirements set forth in subsection (8). Within 14 days after
   43  rendering its decision on a license application or revocation,
   44  the agency shall publish its proposed decision in the Florida
   45  Administrative Register. Within 21 days after publication of the
   46  agency’s decision, any authorized person may file a request for
   47  an administrative hearing. In administrative proceedings
   48  challenging the approval, denial, or revocation of a license
   49  pursuant to subsection (8), the hearing must be based on the
   50  facts and law existing at the time of the agency’s proposed
   51  agency action. Existing hospitals may initiate or intervene in
   52  an administrative hearing to approve, deny, or revoke licensure
   53  under subsection (8) based upon a showing that an established
   54  program will be substantially affected by the issuance or
   55  renewal of a license to a hospital within the same district or
   56  service area.
   57         Section 2. Effective July 1, 2024, subsection (10) of
   58  section 395.0191, Florida Statutes, is amended to read:
   59         395.0191 Staff membership and clinical privileges.—
   60         (10) Nothing herein shall be construed by the agency as
   61  requiring an applicant for a certificate of need to establish
   62  proof of discrimination in the granting of or denial of hospital
   63  staff membership or clinical privileges as a precondition to
   64  obtaining such certificate of need under the provisions of s.
   65  408.043.
   66         Section 3. Effective July 1, 2024, present subsection (12)
   67  of section 395.1055, Florida Statutes, is redesignated as
   68  subsection (15), paragraph (f) of subsection (1) and paragraph
   69  (b) of subsection (9) are amended, and a new subsection (12) and
   70  subsections (13) and (14) are added to that section, to read:
   71         395.1055 Rules and enforcement.—
   72         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
   73  and 120.54 to implement the provisions of this part, which shall
   74  include reasonable and fair minimum standards for ensuring that:
   75         (f) All hospitals submit such data as necessary to conduct
   76  certificate-of-need reviews required under part I of chapter
   77  408. Such data shall include, but shall not be limited to,
   78  patient origin data, hospital utilization data, type of service
   79  reporting, and facility staffing data. The agency may not
   80  collect data that identifies or could disclose the identity of
   81  individual patients. The agency shall utilize existing uniform
   82  statewide data sources when available and shall minimize
   83  reporting costs to hospitals.
   84         (9) The agency shall establish a technical advisory panel,
   85  pursuant to s. 20.052, to develop procedures and standards for
   86  measuring outcomes of pediatric cardiac catheterization programs
   87  and pediatric cardiovascular surgery programs.
   88         (b) Voting members of the panel shall include: 3 at-large
   89  members, including 1 cardiologist who is board certified in
   90  caring for adults with congenital heart disease and 2 board
   91  certified pediatric cardiologists, neither of whom may be
   92  employed by any of the hospitals specified in subparagraphs 1.
   93  10. or their affiliates, each of whom is appointed by the
   94  Secretary of Health Care Administration, and 10 members, and an
   95  alternate for each member, each of whom is a pediatric
   96  cardiologist or a pediatric cardiovascular surgeon, each
   97  appointed by the chief executive officer of the following
   98  hospitals:
   99         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
  100         2. Arnold Palmer Hospital for Children in Orlando.
  101         3. Joe DiMaggio Children’s Hospital in Hollywood.
  102         4. Nicklaus Children’s Hospital in Miami.
  103         5. St. Joseph’s Children’s Hospital in Tampa.
  104         6. University of Florida Health Shands Hospital in
  105  Gainesville.
  106         7. University of Miami Holtz Children’s Hospital in Miami.
  107         8. Wolfson Children’s Hospital in Jacksonville.
  108         9. Florida Hospital for Children in Orlando.
  109         10. Nemours Children’s Hospital in Orlando.
  110  
  111  Appointments made under subparagraphs 1.-10. are contingent upon
  112  the hospital’s maintenance of pediatric certificates of need and
  113  the hospital’s compliance with this section and rules adopted
  114  thereunder, as determined by the Secretary of Health Care
  115  Administration. A member appointed under subparagraphs 1.-10.
  116  whose hospital fails to maintain such certificates or comply
  117  with such standards may serve only as a nonvoting member until
  118  the hospital restores such certificates or complies with such
  119  standards.
  120         (12)Each provider of diagnostic cardiac catheterization
  121  services shall comply with rules adopted by the agency which
  122  establish licensure standards governing the operation of adult
  123  inpatient diagnostic cardiac catheterization programs. The rules
  124  must ensure that such programs:
  125         (a)Comply with the most recent guidelines of the American
  126  College of Cardiology and American Heart Association Guidelines
  127  for Cardiac Catheterization and Cardiac Catheterization
  128  Laboratories.
  129         (b)Perform only adult inpatient diagnostic cardiac
  130  catheterization services and will not provide therapeutic
  131  cardiac catheterization or any other cardiology services.
  132         (c)Maintain sufficient appropriate equipment and health
  133  care personnel to ensure quality and safety.
  134         (d)Maintain appropriate times of operation and protocols
  135  to ensure availability and appropriate referrals in the event of
  136  emergencies.
  137         (e)Demonstrate a plan to provide services to Medicaid and
  138  charity care patients.
  139         (13)Each provider of adult cardiovascular services or
  140  operator of a burn unit shall comply with rules adopted by the
  141  agency which establish licensure standards that govern the
  142  provision of adult cardiovascular services or the operation of a
  143  burn unit. Such rules shall consider, at a minimum, staffing,
  144  equipment, physical plant, operating protocols, the provision of
  145  services to Medicaid and charity care patients, accreditation,
  146  licensure period and fees, and enforcement of minimum standards.
  147         (14)In establishing rules for adult cardiovascular
  148  services, the agency shall include provisions that allow for:
  149         (a)Establishment of two hospital program licensure levels:
  150  a Level I program authorizing the performance of adult
  151  percutaneous cardiac intervention without onsite cardiac surgery
  152  and a Level II program authorizing the performance of
  153  percutaneous cardiac intervention with onsite cardiac surgery.
  154         (b)1.For a hospital seeking a Level I program,
  155  demonstration that, for the most recent 12-month period as
  156  reported to the agency, the hospital has provided a minimum of
  157  300 adult inpatient and outpatient diagnostic cardiac
  158  catheterizations or, for the most recent 12-month period, has
  159  discharged or transferred at least 300 patients with the
  160  principal diagnosis of ischemic heart disease and that it has a
  161  formalized, written transfer agreement with a hospital that has
  162  a Level II program, including written transport protocols to
  163  ensure safe and efficient transfer of a patient within 60
  164  minutes.
  165         2.a.A hospital located more than 100 road miles from the
  166  closest Level II adult cardiovascular services program does not
  167  need to meet the diagnostic cardiac catheterization volume and
  168  ischemic heart disease diagnosis volume requirements in
  169  subparagraph 1. if the hospital demonstrates that it has, for
  170  the most recent 12-month period as reported to the agency,
  171  provided a minimum of 100 adult inpatient and outpatient
  172  diagnostic cardiac catheterizations or that, for the most recent
  173  12-month period, it has discharged or transferred at least 300
  174  patients with the principal diagnosis of ischemic heart disease.
  175         b.A hospital located more than 100 road miles from the
  176  closest Level II adult cardiovascular services program does not
  177  need to meet the 60-minute transfer time protocol requirement in
  178  subparagraph 1. if the hospital demonstrates that it has a
  179  formalized, written transfer agreement with a hospital that has
  180  a Level II program. The agreement must include written transport
  181  protocols to ensure the safe and efficient transfer of a
  182  patient, taking into consideration the patient’s clinical and
  183  physical characteristics, road and weather conditions, and
  184  viability of ground and air ambulance service to transfer the
  185  patient.
  186         3.At a minimum, the rules for adult cardiovascular
  187  services must require nursing and technical staff to have
  188  demonstrated experience in handling acutely ill patients
  189  requiring intervention, based on the staff member’s previous
  190  experience in dedicated cardiac interventional laboratories or
  191  surgical centers. If a staff member’s previous experience is in
  192  a dedicated cardiac interventional laboratory at a hospital that
  193  does not have an approved adult open heart surgery program, the
  194  staff member’s previous experience qualifies only if, at the
  195  time the staff member acquired his or her experience, the
  196  dedicated cardiac interventional laboratory:
  197         a.Had an annual volume of 500 or more percutaneous cardiac
  198  intervention procedures.
  199         b.Achieved a demonstrated success rate of 95 percent or
  200  greater for percutaneous cardiac intervention procedures.
  201         c.Experienced a complication rate of less than 5 percent
  202  for percutaneous cardiac intervention procedures.
  203         d.Performed diverse cardiac procedures, including, but not
  204  limited to, balloon angioplasty and stenting, rotational
  205  atherectomy, cutting balloon atheroma remodeling, and procedures
  206  relating to left ventricular support capability.
  207         (c)For a hospital seeking a Level II program,
  208  demonstration that, for the most recent 12-month period as
  209  reported to the agency, the hospital has performed a minimum of
  210  1,100 adult inpatient and outpatient cardiac catheterizations,
  211  of which at least 400 must be therapeutic catheterizations, or,
  212  for the most recent 12-month period, has discharged at least 800
  213  patients with the principal diagnosis of ischemic heart disease.
  214         (d)Compliance with the most recent guidelines of the
  215  American College of Cardiology and American Heart Association
  216  guidelines for staffing, physician training and experience,
  217  operating procedures, equipment, physical plant, and patient
  218  selection criteria to ensure patient quality and safety.
  219         (e)Establishment of appropriate hours of operation and
  220  protocols to ensure availability and timely referral in the
  221  event of emergencies.
  222         (f)Demonstration of a plan to provide services to Medicaid
  223  and charity care patients.
  224         Section 4. Effective July 1, 2024, subsection (5) of
  225  section 395.1065, Florida Statutes, is amended to read:
  226         395.1065 Criminal and administrative penalties;
  227  moratorium.—
  228         (5) The agency shall impose a fine of $500 for each
  229  instance of the facility’s failure to provide the information
  230  required by rules adopted pursuant to s. 395.1055(1)(g) s.
  231  395.1055(1)(h).
  232         Section 5. Section 395.6025, Florida Statutes, is repealed.
  233         Section 6. Subsections (8) and (13) of section 408.032,
  234  Florida Statutes, are amended to read:
  235         408.032 Definitions relating to Health Facility and
  236  Services Development Act.—As used in ss. 408.031-408.045, the
  237  term:
  238         (8) “Health care facility” means a hospital, long-term care
  239  hospital, skilled nursing facility, hospice, or intermediate
  240  care facility for the developmentally disabled. A facility
  241  relying solely on spiritual means through prayer for healing is
  242  not included as a health care facility.
  243         (13) “Long-term care hospital” means a hospital licensed
  244  under chapter 395 which meets the requirements of 42 C.F.R. s.
  245  412.23(e) and seeks exclusion from the acute care Medicare
  246  prospective payment system for inpatient hospital services.
  247         Section 7. Effective July 1, 2024, subsections (8) through
  248  (17) of section 408.032, Florida Statutes, as amended by this
  249  act, are amended to read:
  250         408.032 Definitions relating to Health Facility and
  251  Services Development Act.—As used in ss. 408.031-408.045, the
  252  term:
  253         (8) “Health care facility” means a hospital, skilled
  254  nursing facility, hospice, or intermediate care facility for the
  255  developmentally disabled. A facility relying solely on spiritual
  256  means through prayer for healing is not included as a health
  257  care facility.
  258         (9)“Health services” means inpatient diagnostic, curative,
  259  or comprehensive medical rehabilitative services and includes
  260  mental health services. Obstetric services are not health
  261  services for purposes of ss. 408.031-408.045.
  262         (9)(10) “Hospice” or “hospice program” means a hospice as
  263  defined in part IV of chapter 400.
  264         (11)“Hospital” means a health care facility licensed under
  265  chapter 395.
  266         (10)(12) “Intermediate care facility for the
  267  developmentally disabled” means a residential facility licensed
  268  under part VIII of chapter 400.
  269         (13)Mental health services” means inpatient services
  270  provided in a hospital licensed under chapter 395 and listed on
  271  the hospital license as psychiatric beds for adults; psychiatric
  272  beds for children and adolescents; intensive residential
  273  treatment beds for children and adolescents; substance abuse
  274  beds for adults; or substance abuse beds for children and
  275  adolescents.
  276         (11)(14) “Nursing home geographically underserved area”
  277  means:
  278         (a) A county in which there is no existing or approved
  279  nursing home;
  280         (b) An area with a radius of at least 20 miles in which
  281  there is no existing or approved nursing home; or
  282         (c) An area with a radius of at least 20 miles in which all
  283  existing nursing homes have maintained at least a 95 percent
  284  occupancy rate for the most recent 6 months or a 90 percent
  285  occupancy rate for the most recent 12 months.
  286         (12)(15) “Skilled nursing facility” means an institution,
  287  or a distinct part of an institution, which is primarily engaged
  288  in providing, to inpatients, skilled nursing care and related
  289  services for patients who require medical or nursing care, or
  290  rehabilitation services for the rehabilitation of injured,
  291  disabled, or sick persons.
  292         (16)“Tertiary health service” means a health service
  293  which, due to its high level of intensity, complexity,
  294  specialized or limited applicability, and cost, should be
  295  limited to, and concentrated in, a limited number of hospitals
  296  to ensure the quality, availability, and cost-effectiveness of
  297  such service. Examples of such service include, but are not
  298  limited to, pediatric cardiac catheterization, pediatric open
  299  heart surgery, organ transplantation, neonatal intensive care
  300  units, comprehensive rehabilitation, and medical or surgical
  301  services which are experimental or developmental in nature to
  302  the extent that the provision of such services is not yet
  303  contemplated within the commonly accepted course of diagnosis or
  304  treatment for the condition addressed by a given service. The
  305  agency shall establish by rule a list of all tertiary health
  306  services.
  307         Section 8. Effective July 1, 2024, paragraph (b) of
  308  subsection (1) of section 408.033, Florida Statutes, is amended
  309  to read:
  310         408.033 Local and state health planning.—
  311         (1) LOCAL HEALTH COUNCILS.—
  312         (b) Each local health council may:
  313         1. Develop a district area health plan that permits each
  314  local health council to develop strategies and set priorities
  315  for implementation based on its unique local health needs.
  316         2. Advise the agency on health care issues and resource
  317  allocations.
  318         3. Promote public awareness of community health needs,
  319  emphasizing health promotion and cost-effective health service
  320  selection.
  321         4. Collect data and conduct analyses and studies related to
  322  health care needs of the district, including the needs of
  323  medically indigent persons, and assist the agency and other
  324  state agencies in carrying out data collection activities that
  325  relate to the functions in this subsection.
  326         5. Monitor the onsite construction progress, if any, of
  327  certificate-of-need approved projects and report council
  328  findings to the agency on forms provided by the agency.
  329         6. Advise and assist any regional planning councils within
  330  each district that have elected to address health issues in
  331  their strategic regional policy plans with the development of
  332  the health element of the plans to address the health goals and
  333  policies in the State Comprehensive Plan.
  334         7. Advise and assist local governments within each district
  335  on the development of an optional health plan element of the
  336  comprehensive plan provided in chapter 163, to assure
  337  compatibility with the health goals and policies in the State
  338  Comprehensive Plan and district health plan. To facilitate the
  339  implementation of this section, the local health council shall
  340  annually provide the local governments in its service area, upon
  341  request, with:
  342         a. A copy and appropriate updates of the district health
  343  plan;
  344         b. A report of health facility hospital and nursing home
  345  utilization statistics for facilities within the local
  346  government jurisdiction; and
  347         c. Applicable agency rules and calculated need
  348  methodologies for health facilities and services regulated under
  349  s. 408.034 for the district served by the local health council.
  350         8. Monitor and evaluate the adequacy, appropriateness, and
  351  effectiveness, within the district, of local, state, federal,
  352  and private funds distributed to meet the needs of the medically
  353  indigent and other underserved population groups.
  354         9. In conjunction with the Department of Health, plan for
  355  services at the local level for persons infected with the human
  356  immunodeficiency virus.
  357         10. Provide technical assistance to encourage and support
  358  activities by providers, purchasers, consumers, and local,
  359  regional, and state agencies in meeting the health care goals,
  360  objectives, and policies adopted by the local health council.
  361         11. Provide the agency with data required by rule for the
  362  review of certificate-of-need applications and the projection of
  363  need for health services and facilities in the district.
  364         Section 9. Subsection (2) of section 408.034, Florida
  365  Statutes, is amended to read:
  366         408.034 Duties and responsibilities of agency; rules.—
  367         (2) In the exercise of its authority to issue licenses to
  368  health care facilities and health service providers, as provided
  369  under chapters 393 and 395 and parts II, IV, and VIII of chapter
  370  400, the agency may not issue a license to any health care
  371  facility or health service provider that fails to receive a
  372  certificate of need or an exemption for the licensed facility or
  373  service, except that the agency may issue a license to a general
  374  hospital that has not been issued a certificate of need if that
  375  hospital meets the criteria established in s. 395.003(8).
  376         Section 10. Effective July 1, 2024, subsection (2) of
  377  section 408.034, Florida Statutes, as amended by this act, and
  378  subsection (3) of that section, are amended to read:
  379         408.034 Duties and responsibilities of agency; rules.—
  380         (2) In the exercise of its authority to issue licenses to
  381  health care facilities and health service providers, as provided
  382  under chapter chapters 393 and 395 and parts II, IV, and VIII of
  383  chapter 400, the agency may not issue a license to any health
  384  care facility or health service provider that fails to receive a
  385  certificate of need or an exemption for the licensed facility or
  386  service, except that the agency may issue a license to a general
  387  hospital that has not been issued a certificate of need if that
  388  hospital meets the criteria established in s. 395.003(8).
  389         (3) The agency shall establish, by rule, uniform need
  390  methodologies for health services and health facilities. In
  391  developing uniform need methodologies, the agency shall, at a
  392  minimum, consider the demographic characteristics of the
  393  population, the health status of the population, service use
  394  patterns, standards and trends, geographic accessibility, and
  395  market economics.
  396         Section 11. Section 408.035, Florida Statutes, is amended
  397  to read:
  398         408.035 Review criteria.—
  399         (1) The agency shall determine the reviewability of
  400  applications and shall review applications for certificate-of
  401  need determinations for health care facilities and health
  402  services in context with the following criteria, except for
  403  general hospitals as defined in s. 395.002:
  404         (1)(a) The need for the health care facilities and health
  405  services being proposed.
  406         (2)(b) The availability, quality of care, accessibility,
  407  and extent of utilization of existing health care facilities and
  408  health services in the service district of the applicant.
  409         (3)(c) The ability of the applicant to provide quality of
  410  care and the applicant’s record of providing quality of care.
  411         (4)(d) The availability of resources, including health
  412  personnel, management personnel, and funds for capital and
  413  operating expenditures, for project accomplishment and
  414  operation.
  415         (5)(e) The extent to which the proposed services will
  416  enhance access to health care for residents of the service
  417  district.
  418         (6)(f) The immediate and long-term financial feasibility of
  419  the proposal.
  420         (7)(g) The extent to which the proposal will foster
  421  competition that promotes quality and cost-effectiveness.
  422         (8)(h) The costs and methods of the proposed construction,
  423  including the costs and methods of energy provision and the
  424  availability of alternative, less costly, or more effective
  425  methods of construction.
  426         (9)(i) The applicant’s past and proposed provision of
  427  health care services to Medicaid patients and the medically
  428  indigent.
  429         (10)(j) The applicant’s designation as a Gold Seal Program
  430  nursing facility pursuant to s. 400.235, when the applicant is
  431  requesting additional nursing home beds at that facility.
  432         (2) For a general hospital, the agency shall consider only
  433  the criteria specified in paragraph (1)(a), paragraph (1)(b),
  434  except for quality of care in paragraph (1)(b), and paragraphs
  435  (1)(e), (g), and (i).
  436         Section 12. Effective July 1, 2024, section 408.035,
  437  Florida Statutes, as amended by this act, is amended to read:
  438         408.035 Review criteria.—
  439         The agency shall determine the reviewability of
  440  applications and shall review applications for certificate-of
  441  need determinations for health care facilities and health
  442  services in context with the following criteria:
  443         (1) The need for the health care facilities and health
  444  services being proposed.
  445         (2) The availability, quality of care, accessibility, and
  446  extent of utilization of existing health care facilities and
  447  health services in the service district of the applicant.
  448         (3) The ability of the applicant to provide quality of care
  449  and the applicant’s record of providing quality of care.
  450         (4) The availability of resources, including health
  451  personnel, management personnel, and funds for capital and
  452  operating expenditures, for project accomplishment and
  453  operation.
  454         (5) The extent to which the proposed services will enhance
  455  access to health care for residents of the service district.
  456         (6) The immediate and long-term financial feasibility of
  457  the proposal.
  458         (7) The extent to which the proposal will foster
  459  competition that promotes quality and cost-effectiveness.
  460         (8) The costs and methods of the proposed construction,
  461  including the costs and methods of energy provision and the
  462  availability of alternative, less costly, or more effective
  463  methods of construction.
  464         (9) The applicant’s past and proposed provision of health
  465  care services to Medicaid patients and the medically indigent.
  466         (10) The applicant’s designation as a Gold Seal Program
  467  nursing facility pursuant to s. 400.235, when the applicant is
  468  requesting additional nursing home beds at that facility.
  469         Section 13. Paragraphs (b) and (c) of subsection (1) of
  470  section 408.036, Florida Statutes, are amended to read:
  471         408.036 Projects subject to review; exemptions.—
  472         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  473  health-care-related projects, as described in paragraphs (a)
  474  (f), are subject to review and must file an application for a
  475  certificate of need with the agency. The agency is exclusively
  476  responsible for determining whether a health-care-related
  477  project is subject to review under ss. 408.031-408.045.
  478         (b) The new construction or establishment of additional
  479  health care facilities, except for the construction of or
  480  establishment of a general hospital or including a replacement
  481  health care facility when the proposed project site is not
  482  located on the same site as or within 1 mile of the existing
  483  health care facility, if the number of beds in each licensed bed
  484  category will not increase.
  485         (c) The conversion from one type of health care facility to
  486  another, including the conversion from a general hospital or, a
  487  specialty hospital, except that the conversion of a specialty
  488  hospital to a general hospital is not subject to review if, once
  489  converted, the hospital meets the licensure criteria in s.
  490  395.003(8) or a long-term care hospital.
  491         Section 14. Effective July 1, 2024, section 408.036,
  492  Florida Statutes, as amended by this act, is amended to read:
  493         408.036 Projects subject to review; exemptions.—
  494         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  495  health-care-related projects, as described in this subsection
  496  paragraphs (a)-(f), are subject to review and must file an
  497  application for a certificate of need with the agency. The
  498  agency is exclusively responsible for determining whether a
  499  health-care-related project is subject to review under ss.
  500  408.031-408.045.
  501         (a) The addition of beds in community nursing homes or
  502  intermediate care facilities for the developmentally disabled by
  503  new construction or alteration.
  504         (b) The new construction or establishment of additional
  505  health care facilities, except for the construction of or
  506  establishment of a general hospital or a replacement health care
  507  facility when the proposed project site is located on the same
  508  site as or within 1 mile of the existing health care facility if
  509  the number of beds in each licensed bed category will not
  510  increase.
  511         (c) The conversion from one type of health care facility to
  512  another, including the conversion from a general hospital or a
  513  specialty hospital except that the conversion of a specialty
  514  hospital to a general hospital is not subject to review if, once
  515  converted, the hospital meets the licensure criteria in s.
  516  395.003(8).
  517         (d) The establishment of a hospice or hospice inpatient
  518  facility, except as provided in s. 408.043.
  519         (e)An increase in the number of beds for comprehensive
  520  rehabilitation.
  521         (f)The establishment of tertiary health services,
  522  including inpatient comprehensive rehabilitation services.
  523         (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.—Unless exempt
  524  pursuant to subsection (3), the following projects are subject
  525  to expedited review:
  526         (a) Transfer of a certificate of need, except that when an
  527  existing hospital is acquired by a purchaser, all certificates
  528  of need issued to the hospital which are not yet operational
  529  shall be acquired by the purchaser without need for a transfer.
  530         (b) Replacement of a nursing home, if the proposed project
  531  site is within a 30-mile radius of the replaced nursing home. If
  532  the proposed project site is outside the subdistrict where the
  533  replaced nursing home is located, the prior 6-month occupancy
  534  rate for licensed community nursing homes in the proposed
  535  subdistrict must be at least 85 percent in accordance with the
  536  agency’s most recently published inventory.
  537         (c) Replacement of a nursing home within the same district,
  538  if the proposed project site is outside a 30-mile radius of the
  539  replaced nursing home but within the same subdistrict or a
  540  geographically contiguous subdistrict. If the proposed project
  541  site is in the geographically contiguous subdistrict, the prior
  542  6-month occupancy rate for licensed community nursing homes for
  543  that subdistrict must be at least 85 percent in accordance with
  544  the agency’s most recently published inventory.
  545         (d) Relocation of a portion of a nursing home’s licensed
  546  beds to another facility or to establish a new facility within
  547  the same district or within a geographically contiguous
  548  district, if the relocation is within a 30-mile radius of the
  549  existing facility and the total number of nursing home beds in
  550  the state does not increase.
  551         (e) New construction of a community nursing home in a
  552  retirement community as further provided in this paragraph.
  553         1. Expedited review under this paragraph is available if
  554  all of the following criteria are met:
  555         a. The residential use area of the retirement community is
  556  deed-restricted as housing for older persons as defined in s.
  557  760.29(4)(b).
  558         b. The retirement community is located in a county in which
  559  25 percent or more of its population is age 65 and older.
  560         c. The retirement community is located in a county that has
  561  a rate of no more than 16.1 beds per 1,000 persons age 65 years
  562  or older. The rate shall be determined by using the current
  563  number of licensed and approved community nursing home beds in
  564  the county per the agency’s most recent published inventory.
  565         d. The retirement community has a population of at least
  566  8,000 residents within the county, based on a population data
  567  source accepted by the agency.
  568         e. The number of proposed community nursing home beds in an
  569  application does not exceed the projected bed need after
  570  applying the rate of 16.1 beds per 1,000 persons aged 65 years
  571  and older projected for the county 3 years into the future using
  572  the estimates adopted by the agency reduced by the agency’s most
  573  recently published inventory of licensed and approved community
  574  nursing home beds in the county.
  575         2. No more than 120 community nursing home beds shall be
  576  approved for a qualified retirement community under each request
  577  for expedited review. Subsequent requests for expedited review
  578  under this process may not be made until 2 years after
  579  construction of the facility has commenced or 1 year after the
  580  beds approved through the initial request are licensed,
  581  whichever occurs first.
  582         3. The total number of community nursing home beds which
  583  may be approved for any single deed-restricted community
  584  pursuant to this paragraph may not exceed 240, regardless of
  585  whether the retirement community is located in more than one
  586  qualifying county.
  587         4. Each nursing home facility approved under this paragraph
  588  must be dually certified for participation in the Medicare and
  589  Medicaid programs.
  590         5. Each nursing home facility approved under this paragraph
  591  must be at least 1 mile, as measured over publicly owned
  592  roadways, from an existing approved and licensed community
  593  nursing home.
  594         6. A retirement community requesting expedited review under
  595  this paragraph shall submit a written request to the agency for
  596  expedited review. The request must include the number of beds to
  597  be added and provide evidence of compliance with the criteria
  598  specified in subparagraph 1.
  599         7. After verifying that the retirement community meets the
  600  criteria for expedited review specified in subparagraph 1., the
  601  agency shall publicly notice in the Florida Administrative
  602  Register that a request for an expedited review has been
  603  submitted by a qualifying retirement community and that the
  604  qualifying retirement community intends to make land available
  605  for the construction and operation of a community nursing home.
  606  The agency’s notice must identify where potential applicants can
  607  obtain information describing the sales price of, or terms of
  608  the land lease for, the property on which the project will be
  609  located and the requirements established by the retirement
  610  community. The agency notice must also specify the deadline for
  611  submission of the certificate-of-need application, which may not
  612  be earlier than the 91st day or later than the 125th day after
  613  the date the notice appears in the Florida Administrative
  614  Register.
  615         8. The qualified retirement community shall make land
  616  available to applicants it deems to have met its requirements
  617  for the construction and operation of a community nursing home
  618  but may sell or lease the land only to the applicant that is
  619  issued a certificate of need by the agency under this paragraph.
  620         a. A certificate-of-need application submitted under this
  621  paragraph must identify the intended site for the project within
  622  the retirement community and the anticipated costs for the
  623  project based on that site. The application must also include
  624  written evidence that the retirement community has determined
  625  that both the provider submitting the application and the
  626  project satisfy its requirements for the project.
  627         b. If the retirement community determines that more than
  628  one provider satisfies its requirements for the project, it may
  629  notify the agency of the provider it prefers.
  630         9. The agency shall review each submitted application. If
  631  multiple applications are submitted for a project published
  632  pursuant to subparagraph 7., the agency shall review the
  633  competing applications.
  634  
  635  The agency shall develop rules to implement the expedited review
  636  process, including time schedule, application content that may
  637  be reduced from the full requirements of s. 408.037(1), and
  638  application processing.
  639         (3) EXEMPTIONS.—Upon request, the following projects are
  640  subject to exemption from the provisions of subsection (1):
  641         (a) For hospice services or for swing beds in a rural
  642  hospital, as defined in s. 395.602, in a number that does not
  643  exceed one-half of its licensed beds, or for a hospice program
  644  established by an entity that shares a controlling interest, as
  645  defined in s. 408.803, with a not-for-profit retirement
  646  community that offers independent living, assisted living, and
  647  skilled nursing services provided in a facility on the same
  648  premises and designated by the agency as a teaching nursing home
  649  for a minimum of 5 years, in accordance with s. 430.80. Only one
  650  hospice program per teaching nursing home may be established
  651  under the exemption in this paragraph, and such program shall be
  652  limited to serving patients residing in communities located
  653  within the not-for-profit retirement community, including home
  654  and community-based service providers.
  655         (b)For the conversion of licensed acute care hospital beds
  656  to Medicare and Medicaid certified skilled nursing beds in a
  657  rural hospital, as defined in s. 395.602, so long as the
  658  conversion of the beds does not involve the construction of new
  659  facilities. The total number of skilled nursing beds, including
  660  swing beds, may not exceed one-half of the total number of
  661  licensed beds in the rural hospital as of July 1, 1993.
  662  Certified skilled nursing beds designated under this paragraph,
  663  excluding swing beds, shall be included in the community nursing
  664  home bed inventory. A rural hospital that subsequently
  665  decertifies any acute care beds exempted under this paragraph
  666  shall notify the agency of the decertification, and the agency
  667  shall adjust the community nursing home bed inventory
  668  accordingly.
  669         (b)(c) For the addition of nursing home beds at a skilled
  670  nursing facility that is part of a retirement community that
  671  provides a variety of residential settings and supportive
  672  services and that has been incorporated and operated in this
  673  state for at least 65 years on or before July 1, 1994. All
  674  nursing home beds must not be available to the public but must
  675  be for the exclusive use of the community residents.
  676         (c)(d) For an inmate health care facility built by or for
  677  the exclusive use of the Department of Corrections as provided
  678  in chapter 945. This exemption expires when such facility is
  679  converted to other uses.
  680         (d)(e) For the addition of nursing home beds licensed under
  681  chapter 400 in a number not exceeding 30 total beds or 25
  682  percent of the number of beds licensed in the facility being
  683  replaced under paragraph (2)(b), paragraph (2)(c), or paragraph
  684  (i) (m), whichever is less.
  685         (e)(f) For state veterans’ nursing homes operated by or on
  686  behalf of the Florida Department of Veterans’ Affairs in
  687  accordance with part II of chapter 296 for which at least 50
  688  percent of the construction cost is federally funded and for
  689  which the Federal Government pays a per diem rate not to exceed
  690  one-half of the cost of the veterans’ care in such state nursing
  691  homes. These beds shall not be included in the nursing home bed
  692  inventory.
  693         (f)(g) For combination within one nursing home facility of
  694  the beds or services authorized by two or more certificates of
  695  need issued in the same planning subdistrict. An exemption
  696  granted under this paragraph shall extend the validity period of
  697  the certificates of need to be consolidated by the length of the
  698  period beginning upon submission of the exemption request and
  699  ending with issuance of the exemption. The longest validity
  700  period among the certificates shall be applicable to each of the
  701  combined certificates.
  702         (g)(h) For division into two or more nursing home
  703  facilities of beds or services authorized by one certificate of
  704  need issued in the same planning subdistrict. An exemption
  705  granted under this paragraph shall extend the validity period of
  706  the certificate of need to be divided by the length of the
  707  period beginning upon submission of the exemption request and
  708  ending with issuance of the exemption.
  709         (i)For the addition of hospital beds licensed under
  710  chapter 395 for comprehensive rehabilitation in a number that
  711  may not exceed 10 total beds or 10 percent of the licensed
  712  capacity, whichever is greater.
  713         1.In addition to any other documentation otherwise
  714  required by the agency, a request for exemption submitted under
  715  this paragraph must:
  716         a.Certify that the prior 12-month average occupancy rate
  717  for the licensed beds being expanded meets or exceeds 80
  718  percent.
  719         b.Certify that the beds have been licensed and operational
  720  for at least 12 months.
  721         2.The timeframes and monitoring process specified in s.
  722  408.040(2)(a)-(c) apply to any exemption issued under this
  723  paragraph.
  724         3.The agency shall count beds authorized under this
  725  paragraph as approved beds in the published inventory of
  726  hospital beds until the beds are licensed.
  727         (h)(j) For the addition of nursing home beds licensed under
  728  chapter 400 in a number not exceeding 10 total beds or 10
  729  percent of the number of beds licensed in the facility being
  730  expanded, whichever is greater; or, for the addition of nursing
  731  home beds licensed under chapter 400 at a facility that has been
  732  designated as a Gold Seal nursing home under s. 400.235 in a
  733  number not exceeding 20 total beds or 10 percent of the number
  734  of licensed beds in the facility being expanded, whichever is
  735  greater.
  736         1. In addition to any other documentation required by the
  737  agency, a request for exemption submitted under this paragraph
  738  must certify that:
  739         a. The facility has not had any class I or class II
  740  deficiencies within the 30 months preceding the request.
  741         b. The prior 12-month average occupancy rate for the
  742  nursing home beds at the facility meets or exceeds 94 percent.
  743         c. Any beds authorized for the facility under this
  744  paragraph before the date of the current request for an
  745  exemption have been licensed and operational for at least 12
  746  months.
  747         2. The timeframes and monitoring process specified in s.
  748  408.040(2)(a)-(c) apply to any exemption issued under this
  749  paragraph.
  750         3. The agency shall count beds authorized under this
  751  paragraph as approved beds in the published inventory of nursing
  752  home beds until the beds are licensed.
  753         (k)For the establishment of:
  754         1.A Level II neonatal intensive care unit with at least 10
  755  beds, upon documentation to the agency that the applicant
  756  hospital had a minimum of 1,500 births during the previous 12
  757  months;
  758         2.A Level III neonatal intensive care unit with at least
  759  15 beds, upon documentation to the agency that the applicant
  760  hospital has a Level II neonatal intensive care unit of at least
  761  10 beds and had a minimum of 3,500 births during the previous 12
  762  months; or
  763         3.A Level III neonatal intensive care unit with at least 5
  764  beds, upon documentation to the agency that the applicant
  765  hospital is a verified trauma center pursuant to s.
  766  395.4001(15), and has a Level II neonatal intensive care unit,
  767  
  768  if the applicant demonstrates that it meets the requirements for
  769  quality of care, nurse staffing, physician staffing, physical
  770  plant, equipment, emergency transportation, and data reporting
  771  found in agency certificate-of-need rules for Level II and Level
  772  III neonatal intensive care units and if the applicant commits
  773  to the provision of services to Medicaid and charity patients at
  774  a level equal to or greater than the district average. Such a
  775  commitment is subject to s. 408.040.
  776         (l)For the addition of mental health services or beds if
  777  the applicant commits to providing services to Medicaid or
  778  charity care patients at a level equal to or greater than the
  779  district average. Such a commitment is subject to s. 408.040.
  780         (i)(m) For replacement of a licensed nursing home on the
  781  same site, or within 5 miles of the same site if within the same
  782  subdistrict, if the number of licensed beds does not increase
  783  except as permitted under paragraph (d) (e).
  784         (j)(n) For consolidation or combination of licensed nursing
  785  homes or transfer of beds between licensed nursing homes within
  786  the same planning district, by nursing homes with any shared
  787  controlled interest within that planning district, if there is
  788  no increase in the planning district total number of nursing
  789  home beds and the site of the relocation is not more than 30
  790  miles from the original location.
  791         (k)(o) For beds in state mental health treatment facilities
  792  defined in s. 394.455 and state mental health forensic
  793  facilities operated under chapter 916.
  794         (l)(p) For beds in state developmental disabilities centers
  795  as defined in s. 393.063.
  796         (m)(q) For the establishment of a health care facility or
  797  project that meets all of the following criteria:
  798         1. The applicant was previously licensed within the past 21
  799  days as a health care facility or provider that is subject to
  800  subsection (1).
  801         2. The applicant failed to submit a renewal application and
  802  the license expired on or after January 1, 2015.
  803         3. The applicant does not have a license denial or
  804  revocation action pending with the agency at the time of the
  805  request.
  806         4. The applicant’s request is for the same service type,
  807  district, service area, and site for which the applicant was
  808  previously licensed.
  809         5. The applicant’s request, if applicable, includes the
  810  same number and type of beds as were previously licensed.
  811         6. The applicant agrees to the same conditions that were
  812  previously imposed on the certificate of need or on an exemption
  813  related to the applicant’s previously licensed health care
  814  facility or project.
  815         7. The applicant applies for initial licensure as required
  816  under s. 408.806 within 21 days after the agency approves the
  817  exemption request. If the applicant fails to apply in a timely
  818  manner, the exemption expires on the 22nd day following the
  819  agency’s approval of the exemption.
  820  
  821  Notwithstanding subparagraph 1., an applicant whose license
  822  expired between January 1, 2015, and the effective date of this
  823  act may apply for an exemption within 30 days of this act
  824  becoming law.
  825         (4) REQUESTS FOR EXEMPTION.—A request for exemption under
  826  subsection (3) may be made at any time and is not subject to the
  827  batching requirements of this section. The request shall be
  828  supported by such documentation as the agency requires by rule.
  829  The agency shall assess a fee of $250 for each request for
  830  exemption submitted under subsection (3).
  831         (5) NOTIFICATION.—Health care facilities and providers must
  832  provide to the agency notification of:
  833         (a) replacement of a health care facility when the proposed
  834  project site is located in the same district and on the existing
  835  site or within a 1-mile radius of the replaced health care
  836  facility, if the number and type of beds do not increase.
  837         (b)The termination of a health care service, upon 30 days’
  838  written notice to the agency.
  839         (c)The addition or delicensure of beds. Notification under
  840  this subsection may be made by electronic, facsimile, or written
  841  means at any time before the described action has been taken.
  842         Section 15. Effective July 1, 2024, section 408.0361,
  843  Florida Statutes, is repealed.
  844         Section 16. Section 408.037, Florida Statutes, is amended
  845  to read:
  846         408.037 Application content.—
  847         (1) Except as provided in subsection (2) for a general
  848  hospital, An application for a certificate of need must contain:
  849         (a) A detailed description of the proposed project and
  850  statement of its purpose and need in relation to the district
  851  health plan.
  852         (b) A statement of the financial resources needed by and
  853  available to the applicant to accomplish the proposed project.
  854  This statement must include:
  855         1. A complete listing of all capital projects, including
  856  new health facility development projects and health facility
  857  acquisitions applied for, pending, approved, or underway in any
  858  state at the time of application, regardless of whether or not
  859  that state has a certificate-of-need program or a capital
  860  expenditure review program pursuant to s. 1122 of the Social
  861  Security Act. The agency may, by rule, require less-detailed
  862  information from major health care providers. This listing must
  863  include the applicant’s actual or proposed financial commitment
  864  to those projects and an assessment of their impact on the
  865  applicant’s ability to provide the proposed project.
  866         2. A detailed listing of the needed capital expenditures,
  867  including sources of funds.
  868         3. A detailed financial projection, including a statement
  869  of the projected revenue and expenses for the first 2 years of
  870  operation after completion of the proposed project. This
  871  statement must include a detailed evaluation of the impact of
  872  the proposed project on the cost of other services provided by
  873  the applicant.
  874         (c) An audited financial statement of the applicant or the
  875  applicant’s parent corporation if audited financial statements
  876  of the applicant do not exist. In an application submitted by an
  877  existing health care facility, health maintenance organization,
  878  or hospice, financial condition documentation must include, but
  879  need not be limited to, a balance sheet and a profit-and-loss
  880  statement of the 2 previous fiscal years’ operation.
  881         (2) An application for a certificate of need for a general
  882  hospital must contain a detailed description of the proposed
  883  general hospital project and a statement of its purpose and the
  884  needs it will meet. The proposed project’s location, as well as
  885  its primary and secondary service areas, must be identified by
  886  zip code. Primary service area is defined as the zip codes from
  887  which the applicant projects that it will draw 75 percent of its
  888  discharges. Secondary service area is defined as the zip codes
  889  from which the applicant projects that it will draw its
  890  remaining discharges. If, subsequent to issuance of a final
  891  order approving the certificate of need, the proposed location
  892  of the general hospital changes or the primary service area
  893  materially changes, the agency shall revoke the certificate of
  894  need. However, if the agency determines that such changes are
  895  deemed to enhance access to hospital services in the service
  896  district, the agency may permit such changes to occur. A party
  897  participating in the administrative hearing regarding the
  898  issuance of the certificate of need for a general hospital has
  899  standing to participate in any subsequent proceeding regarding
  900  the revocation of the certificate of need for a hospital for
  901  which the location has changed or for which the primary service
  902  area has materially changed. In addition, the application for
  903  the certificate of need for a general hospital must include a
  904  statement of intent that, if approved by final order of the
  905  agency, the applicant shall within 120 days after issuance of
  906  the final order or, if there is an appeal of the final order,
  907  within 120 days after the issuance of the court’s mandate on
  908  appeal, furnish satisfactory proof of the applicant’s financial
  909  ability to operate. The agency shall establish documentation
  910  requirements, to be completed by each applicant, which show
  911  anticipated provider revenues and expenditures, the basis for
  912  financing the anticipated cash-flow requirements of the
  913  provider, and an applicant’s access to contingency financing. A
  914  party participating in the administrative hearing regarding the
  915  issuance of the certificate of need for a general hospital may
  916  provide written comments concerning the adequacy of the
  917  financial information provided, but such party does not have
  918  standing to participate in an administrative proceeding
  919  regarding proof of the applicant’s financial ability to operate.
  920  The agency may require a licensee to provide proof of financial
  921  ability to operate at any time if there is evidence of financial
  922  instability, including, but not limited to, unpaid expenses
  923  necessary for the basic operations of the provider.
  924         (2)(3) The applicant must certify that it will license and
  925  operate the health care facility. For an existing health care
  926  facility, the applicant must be the licenseholder of the
  927  facility.
  928         Section 17. Paragraphs (c) and (d) of subsection (3),
  929  paragraphs (b) and (c) of subsection (5), and paragraph (d) of
  930  subsection (6) of section 408.039, Florida Statutes, are amended
  931  to read:
  932         408.039 Review process.—The review process for certificates
  933  of need shall be as follows:
  934         (3) APPLICATION PROCESSING.—
  935         (c) Except for competing applicants, in order to be
  936  eligible to challenge the agency decision on a general hospital
  937  application under review pursuant to paragraph (5)(c), existing
  938  hospitals must submit a detailed written statement of opposition
  939  to the agency and to the applicant. The detailed written
  940  statement must be received by the agency and the applicant
  941  within 21 days after the general hospital application is deemed
  942  complete and made available to the public.
  943         (d) In those cases where a written statement of opposition
  944  has been timely filed regarding a certificate of need
  945  application for a general hospital, the applicant for the
  946  general hospital may submit a written response to the agency.
  947  Such response must be received by the agency within 10 days of
  948  the written statement due date.
  949         (5) ADMINISTRATIVE HEARINGS.—
  950         (b) Hearings shall be held in Tallahassee unless the
  951  administrative law judge determines that changing the location
  952  will facilitate the proceedings. The agency shall assign
  953  proceedings requiring hearings to the Division of Administrative
  954  Hearings of the Department of Management Services within 10 days
  955  after the time has expired for requesting a hearing. Except upon
  956  unanimous consent of the parties or upon the granting by the
  957  administrative law judge of a motion of continuance, hearings
  958  shall commence within 60 days after the administrative law judge
  959  has been assigned. For an application for a general hospital,
  960  administrative hearings shall commence within 6 months after the
  961  administrative law judge has been assigned, and a continuance
  962  may not be granted absent a finding of extraordinary
  963  circumstances by the administrative law judge. All parties,
  964  except the agency, shall bear their own expense of preparing a
  965  transcript. In any application for a certificate of need which
  966  is referred to the Division of Administrative Hearings for
  967  hearing, the administrative law judge shall complete and submit
  968  to the parties a recommended order as provided in ss. 120.569
  969  and 120.57. The recommended order shall be issued within 30 days
  970  after the receipt of the proposed recommended orders or the
  971  deadline for submission of such proposed recommended orders,
  972  whichever is earlier. The division shall adopt procedures for
  973  administrative hearings which shall maximize the use of
  974  stipulated facts and shall provide for the admission of prepared
  975  testimony.
  976         (c) In administrative proceedings challenging the issuance
  977  or denial of a certificate of need, only applicants considered
  978  by the agency in the same batching cycle are entitled to a
  979  comparative hearing on their applications. Existing health care
  980  facilities may initiate or intervene in an administrative
  981  hearing upon a showing that an established program will be
  982  substantially affected by the issuance of any certificate of
  983  need, whether reviewed under s. 408.036(1) or (2), to a
  984  competing proposed facility or program within the same district.
  985  With respect to an application for a general hospital, competing
  986  applicants and only those existing hospitals that submitted a
  987  detailed written statement of opposition to an application as
  988  provided in this paragraph may initiate or intervene in an
  989  administrative hearing. Such challenges to a general hospital
  990  application shall be limited in scope to the issues raised in
  991  the detailed written statement of opposition that was provided
  992  to the agency. The administrative law judge may, upon a motion
  993  showing good cause, expand the scope of the issues to be heard
  994  at the hearing. Such motion shall include substantial and
  995  detailed facts and reasons for failure to include such issues in
  996  the original written statement of opposition.
  997         (6) JUDICIAL REVIEW.—
  998         (d) The party appealing a final order that grants a general
  999  hospital certificate of need shall pay the appellee’s attorney’s
 1000  fees and costs, in an amount up to $1 million, from the
 1001  beginning of the original administrative action if the appealing
 1002  party loses the appeal, subject to the following limitations and
 1003  requirements:
 1004         1. The party appealing a final order must post a bond in
 1005  the amount of $1 million in order to maintain the appeal.
 1006         2. Except as provided under s. 120.595(5), in no event
 1007  shall the agency be held liable for any other party’s attorney’s
 1008  fees or costs.
 1009         Section 18. Subsection (1) of section 408.043, Florida
 1010  Statutes, is amended to read:
 1011         408.043 Special provisions.—
 1012         (1) OSTEOPATHIC ACUTE CARE HOSPITALS.—When an application
 1013  is made for a certificate of need to construct or to expand an
 1014  osteopathic acute care hospital, the need for such hospital
 1015  shall be determined on the basis of the need for and
 1016  availability of osteopathic services and osteopathic acute care
 1017  hospitals in the district. When a prior certificate of need to
 1018  establish an osteopathic acute care hospital has been issued in
 1019  a district, and the facility is no longer used for that purpose,
 1020  the agency may continue to count such facility and beds as an
 1021  existing osteopathic facility in any subsequent application for
 1022  construction of an osteopathic acute care hospital.
 1023         Section 19. Subsection (3) of section 408.808, Florida
 1024  Statutes, is amended to read:
 1025         408.808 License categories.—
 1026         (3) INACTIVE LICENSE.—An inactive license may be issued to
 1027  a hospital or a health care provider subject to the certificate
 1028  of-need provisions in part I of this chapter when the provider
 1029  is currently licensed, does not have a provisional license, and
 1030  will be temporarily unable to provide services but is reasonably
 1031  expected to resume services within 12 months. Such designation
 1032  may be made for a period not to exceed 12 months but may be
 1033  renewed by the agency for up to 12 additional months upon
 1034  demonstration by the licensee of the provider’s progress toward
 1035  reopening. However, if after 20 months in an inactive license
 1036  status, a statutory rural hospital, as defined in s. 395.602,
 1037  has demonstrated progress toward reopening, but may not be able
 1038  to reopen prior to the inactive license expiration date, the
 1039  inactive designation may be renewed again by the agency for up
 1040  to 12 additional months. For purposes of such a second renewal,
 1041  if construction or renovation is required, the licensee must
 1042  have had plans approved by the agency and construction must have
 1043  already commenced pursuant to s. 408.032(4); however, if
 1044  construction or renovation is not required, the licensee must
 1045  provide proof of having made an enforceable capital expenditure
 1046  greater than 25 percent of the total costs associated with the
 1047  hiring of staff and the purchase of equipment and supplies
 1048  needed to operate the facility upon opening. A request by a
 1049  licensee for an inactive license or to extend the previously
 1050  approved inactive period must be submitted to the agency and
 1051  must include a written justification for the inactive license
 1052  with the beginning and ending dates of inactivity specified, a
 1053  plan for the transfer of any clients to other providers, and the
 1054  appropriate licensure fees. The agency may not accept a request
 1055  that is submitted after initiating closure, after any suspension
 1056  of service, or after notifying clients of closure or suspension
 1057  of service, unless the action is a result of a disaster at the
 1058  licensed premises. For the purposes of this section, the term
 1059  “disaster” means a sudden emergency occurrence beyond the
 1060  control of the licensee, whether natural, technological, or
 1061  manmade, which renders the provider inoperable at the premises.
 1062  Upon agency approval, the provider shall notify clients of any
 1063  necessary discharge or transfer as required by authorizing
 1064  statutes or applicable rules. The beginning of the inactive
 1065  license period is the date the provider ceases operations. The
 1066  end of the inactive license period shall become the license
 1067  expiration date. All licensure fees must be current, must be
 1068  paid in full, and may be prorated. Reactivation of an inactive
 1069  license requires the approval of a renewal application,
 1070  including payment of licensure fees and agency inspections
 1071  indicating compliance with all requirements of this part,
 1072  authorizing statutes, and applicable rules.
 1073         Section 20. Except as otherwise expressly provided in this
 1074  act, this act shall take effect July 1, 2021.
 1075  
 1076  ================= T I T L E  A M E N D M E N T ================
 1077  And the title is amended as follows:
 1078         Delete everything before the enacting clause
 1079  and insert:
 1080                        A bill to be entitled                      
 1081         An act relating to hospital licensure; amending s.
 1082         395.003, F.S.; deleting provisions relating to the
 1083         licensure of certain hospitals; amending s. 395.0191,
 1084         F.S.; deleting provisions relating to certificate of
 1085         need applications; amending s. 395.1055, F.S.;
 1086         revising the agency’s rulemaking authority with
 1087         respect to minimum standards for hospitals; requiring
 1088         hospitals that provide certain services to meet
 1089         specified licensure requirements; conforming
 1090         provisions to changes made by the act; amending s.
 1091         395.1065, F.S.; conforming a cross-reference;
 1092         repealing s. 395.6025, F.S., relating to rural
 1093         hospital replacement facilities; amending s. 408.032,
 1094         F.S.; revising and deleting definitions; amending s.
 1095         408.033, F.S.; conforming provisions to changes made
 1096         by the act; amending s. 408.034; authorizing the
 1097         agency to issue a license to a general hospital that
 1098         has not been issued a certificate of need under
 1099         certain circumstances; revising duties and
 1100         responsibilities of the agency relating to issuance of
 1101         licenses to health care facilities and health service
 1102         providers; conforming provisions to changes made by
 1103         the act; amending s. 408.035, F.S.; deleting
 1104         provisions related to the agency’s consideration and
 1105         review of applications for certificates of need for
 1106         general hospitals and health services; amending s.
 1107         408.036, F.S.; providing an exception from certificate
 1108         of need review requirements for the construction or
 1109         establishment of a general hospital and the conversion
 1110         of a specialty hospital to a general hospital;
 1111         revising health-care-related projects subject to
 1112         agency review for a certificate of need and exemptions
 1113         therefrom; deleting provisions requiring health care
 1114         facilities and providers to provide certain notice to
 1115         the agency upon termination of a health care service
 1116         or the addition or delicensure of beds; conforming a
 1117         provision to changes made by the act; repealing s.
 1118         408.0361, F.S., relating to cardiovascular services
 1119         and burn unit licensure; amending ss. 408.037 and
 1120         408.039, F.S.; deleting provisions relating to
 1121         certificate of need applications for general
 1122         hospitals; amending s. 408.043, F.S.; deleting
 1123         provisions relating to certificates of need for
 1124         osteopathic acute care hospitals; amending s. 408.808,
 1125         F.S.; authorizing the agency to issue an inactive
 1126         license to a certain hospital under certain
 1127         circumstances; providing effective dates.