Senate Bill sb1252e2

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    CS for CS for SB 1252                         Second Engrossed



  1                      A bill to be entitled

  2         An act relating to health care facilities;

  3         creating s. 400.244, F.S.; allowing nursing

  4         homes to convert beds to alternative uses as

  5         specified; providing restrictions on uses of

  6         funding under assisted-living Medicaid waivers;

  7         providing procedures; providing for the

  8         applicability of certain fire and life safety

  9         codes; providing applicability of certain laws;

10         requiring a nursing home to submit to the

11         Agency for Health Care Administration a written

12         request for permission to convert beds to

13         alternative uses; providing conditions for

14         disapproving such a request; providing for

15         periodic review; providing for retention of

16         nursing home licensure for converted beds;

17         providing for reconversion of the beds;

18         providing applicability of licensure fees;

19         requiring a report to the agency; amending s.

20         400.021, F.S.; redefining the term "resident

21         care plan," as used in part I of ch. 400, F.S.;

22         amending s. 400.23, F.S.; providing that

23         certain information from the Agency for Health

24         Care Administration must reflect the most

25         current agency actions; amending s. 400.147,

26         F.S.; amending the definition of the term

27         "adverse incident"; requiring certain reports

28         to be filed; revising requirements for a

29         facility's report to the agency on adverse

30         incidents; providing guidelines for the

31         agency's report to a regulatory board that the


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    CS for CS for SB 1252                         Second Engrossed



 1         agency has a reasonable belief that there are

 2         grounds for regulatory action; amending s.

 3         400.211, F.S.; revising inservice training

 4         requirements for persons employed as nursing

 5         assistants in a nursing home facility; amending

 6         s. 408.032, F.S.; revising the definition of

 7         "tertiary health service" under the Health

 8         Facility and Services Development Act; amending

 9         s. 408.034, F.S.; requiring the

10         nursing-home-bed-need methodology established

11         by the Agency for Health Care Administration by

12         rule to include a goal of maintaining a

13         specified district average occupancy rate;

14         amending s. 408.036, F.S., relating to

15         health-care-related projects subject to review

16         for a certificate of need; removing certain

17         projects from and subjecting certain projects

18         to expedited review and revising requirements

19         for other projects subject to expedited review;

20         removing the exemption from review for certain

21         projects; revising requirements for certain

22         projects that are exempt from review; exempting

23         certain projects from review; amending s.

24         408.038, F.S.; increasing fees of the

25         certificate-of-need program; amending s.

26         408.039, F.S.; providing for approval of

27         recommended orders of the Division of

28         Administrative Hearings when the Agency for

29         Health Care Administration fails to take action

30         on an application for a certificate of need

31         within a specified time period; creating the


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    CS for CS for SB 1252                         Second Engrossed



 1         Hospital Statutory and Regulatory Reform

 2         Council; providing for review of an application

 3         for a certificate of need pending on the

 4         effective date of the act; providing

 5         legislative intent; providing for membership

 6         and duties of the council; amending s. 409.904,

 7         F.S.; postponing the effective date of changes

 8         to standards for eligibility for certain

 9         optional medical assistance, including coverage

10         under the medically needy program; providing

11         appropriations; providing for retroactive

12         application; providing effective dates.

13  

14  Be It Enacted by the Legislature of the State of Florida:

15  

16         Section 1.  Section 400.244, Florida Statutes, is

17  created to read:

18         400.244  Alternative uses of nursing home beds; funding

19  limitations; applicable codes and requirements; procedures;

20  reconversion.--

21         (1)  It is the intent of the Legislature to allow

22  nursing home facilities to use licensed nursing home facility

23  beds for alternative uses other than nursing home care for

24  extended periods of time exceeding 48 hours.

25         (2)  A nursing home may use a contiguous portion of the

26  nursing home facility to meet the needs of the elderly through

27  the use of less restrictive and less institutional methods of

28  long-term care, including, but not limited to, adult day care,

29  assisted living, extended congregate care, or limited nursing

30  services.

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         (3)  Funding under assisted-living Medicaid waivers for

 2  nursing home facility beds that are used to provide extended

 3  congregate care or limited nursing services under this section

 4  may be provided only for residents who have resided in the

 5  nursing home facility for a minimum of 90 consecutive days.

 6         (4)  Nursing home facility beds that are used in

 7  providing alternative services may share common areas,

 8  services, and staff with beds that are designated for nursing

 9  home care. Fire codes and life safety codes applicable to

10  nursing home facilities also apply to beds used for

11  alternative purposes under this section. Any alternative use

12  must meet other requirements specified by law for that use.

13         (5)  In order to take beds out of service for nursing

14  home care and use them to provide alternative services under

15  this section, a nursing home must submit a written request for

16  approval to the Agency for Health Care Administration in a

17  format specified by the agency. The agency shall approve the

18  request unless it determines that such action will adversely

19  affect access to nursing home care in the geographical area in

20  which the nursing home is located. The agency shall, in its

21  review, consider a district average occupancy of 94 percent or

22  greater at the time of the application as an indicator of an

23  adverse impact. The agency shall review the request for

24  alternative use at each annual license renewal.

25         (6)  A nursing home facility that converts beds to an

26  alternative use under this section retains its license for all

27  of the nursing home facility beds and may return those beds to

28  nursing home operation upon 60 days' written notice to the

29  agency unless notice requirements are specified elsewhere in

30  law. The nursing home facility shall continue to pay all

31  licensure fees as required by s. 400.062 and applicable rules


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    CS for CS for SB 1252                         Second Engrossed



 1  but is not required to pay any other state licensure fee for

 2  the alternative service.

 3         (7)  Within 45 days after the end of each calendar

 4  quarter, each facility that has nursing facility beds licensed

 5  under chapter 400 shall report to the agency or its designee

 6  the total number of patient days which occurred in each month

 7  of the quarter and the number of such days which were Medicaid

 8  patient days.

 9         Section 2.  Subsection (17) of section 400.021, Florida

10  Statutes, is amended to read:

11         400.021  Definitions.--When used in this part, unless

12  the context otherwise requires, the term:

13         (17)  "Resident care plan" means a written plan

14  developed, maintained, and reviewed not less than quarterly by

15  a registered nurse, with participation from other facility

16  staff and the resident or his or her designee or legal

17  representative, which includes a comprehensive assessment of

18  the needs of an individual resident; the type and frequency of

19  services required to provide the necessary care for the

20  resident to attain or maintain the highest practicable

21  physical, mental, and psychosocial well-being; a listing of

22  services provided within or outside the facility to meet those

23  needs; and an explanation of service goals. The resident care

24  plan must be signed by the director of nursing or another

25  registered nurse employed by the facility to whom

26  institutional responsibilities have been delegated and by the

27  resident, the resident's designee, or the resident's legal

28  representative. The facility may not use an agency or

29  temporary registered nurse to satisfy the foregoing

30  requirement and must document the institutional

31  


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    CS for CS for SB 1252                         Second Engrossed



 1  responsibilities that have been delegated to the registered

 2  nurse.

 3         Section 3.  Subsection (10) is added to section 400.23,

 4  Florida Statutes, to read:

 5         400.23  Rules; evaluation and deficiencies; licensure

 6  status.--

 7         (10)  Agency records, reports, ranking systems,

 8  Internet information, and publications must reflect the most

 9  current agency actions.

10         Section 4.  Subsections (5), (7), and (12) of section

11  400.147, Florida Statutes are amended to read:

12         400.147  Internal risk management and quality assurance

13  program.--

14         (5)  For purposes of reporting to the agency under this

15  section, the term "adverse incident" means:

16         (a)  An event over which facility personnel could

17  exercise control and which is associated in whole or in part

18  with the facility's intervention, rather than the condition

19  for which such intervention occurred, and which results in one

20  of the following:

21         1.  Death;

22         2.  Brain or spinal damage;

23         3.  Permanent disfigurement;

24         4.  Fracture or dislocation of bones or joints;

25         5.  A limitation of neurological, physical, or sensory

26  function;

27         6.  Any condition that required medical attention to

28  which the resident has not given his or her informed consent,

29  including failure to honor advanced directives; or

30         7.  Any condition that required the transfer of the

31  resident, within or outside the facility, to a unit providing


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    CS for CS for SB 1252                         Second Engrossed



 1  a more acute level of care due to the adverse incident, rather

 2  than the resident's condition prior to the adverse incident;

 3         (b)  Abuse, sexual abuse, neglect, or exploitation as

 4  defined in s. 415.102;

 5         (c)  Abuse, neglect and harm as defined in s. 39.01;

 6         (d)  Resident elopement; or

 7         (e)  An event that is reported to law enforcement for

 8  investigation.

 9         (7)  The facility shall initiate an investigation and

10  shall notify the agency within 1 business day after the risk

11  manager or his or her designee has received a report pursuant

12  to paragraph (1)(d). The notification must be made in writing

13  and be provided electronically, by facsimile device or

14  overnight mail delivery. The notification must include

15  information regarding the identity of the affected resident,

16  the type of adverse incident, the initiation of an

17  investigation by the facility, and whether the events causing

18  or resulting in the adverse incident represent a potential

19  risk to any other resident. The notification is confidential

20  as provided by law and is not discoverable or admissible in

21  any civil or administrative action, except in disciplinary

22  proceedings by the agency or the appropriate regulatory board.

23  The agency may investigate, as it deems appropriate, any such

24  incident and prescribe measures that must or may be taken in

25  response to the incident. The agency shall review each

26  incident and determine whether it potentially involved conduct

27  by the health care professional who is subject to disciplinary

28  action, in which case the provisions of s. 456.073 shall

29  apply.

30         (12)  If the agency, through its receipt of the adverse

31  incident reports prescribed in subsection (7), or prescribed


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    CS for CS for SB 1252                         Second Engrossed



 1  in subsection (8), or through any investigation, has a

 2  reasonable belief that conduct by a staff member or employee

 3  of a facility is grounds for disciplinary action by the

 4  appropriate regulatory board, the agency shall report this

 5  fact to the regulatory board.

 6         Section 5.  Subsection (4) of section 400.211, Florida

 7  Statutes, is amended to read:

 8         400.211  Persons employed as nursing assistants;

 9  certification requirement.--

10         (4)  When employed by a nursing home facility for a

11  12-month period or longer, a nursing assistant, to maintain

12  certification, shall submit to a performance review every 12

13  months and must receive regular inservice education based on

14  the outcome of such reviews. The inservice training must:

15         (a)  Be sufficient to ensure the continuing competence

16  of nursing assistants and must meet the standard specified in

17  s. 464.203(7), must be at least 18 hours per year, and may

18  include hours accrued under s. 464.203(8);

19         (b)  Include, at a minimum:

20         1.  Techniques for assisting with eating and proper

21  feeding;

22         2.  Principles of adequate nutrition and hydration;

23         3.  Techniques for assisting and responding to the

24  cognitively impaired resident or the resident with difficult

25  behaviors;

26         4.  Techniques for caring for the resident at the

27  end-of-life; and

28         5.  Recognizing changes that place a resident at risk

29  for pressure ulcers and falls; and

30         (c)  Address areas of weakness as determined in nursing

31  assistant performance reviews and may address the special


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    CS for CS for SB 1252                         Second Engrossed



 1  needs of residents as determined by the nursing home facility

 2  staff.

 3  

 4  Costs associated with this training may not be reimbursed from

 5  additional Medicaid funding through interim rate adjustments.

 6         Section 6.  Subsection (17) of section 408.032, Florida

 7  Statutes, is amended to read:

 8         408.032  Definitions relating to Health Facility and

 9  Services Development Act.--As used in ss. 408.031-408.045, the

10  term:

11         (17)  "Tertiary health service" means a health service

12  which, due to its high level of intensity, complexity,

13  specialized or limited applicability, and cost, should be

14  limited to, and concentrated in, a limited number of hospitals

15  to ensure the quality, availability, and cost-effectiveness of

16  such service. Examples of such service include, but are not

17  limited to, organ transplantation, adult and pediatric open

18  heart surgery, specialty burn units, neonatal intensive care

19  units, comprehensive rehabilitation, and medical or surgical

20  services which are experimental or developmental in nature to

21  the extent that the provision of such services is not yet

22  contemplated within the commonly accepted course of diagnosis

23  or treatment for the condition addressed by a given service.

24  The agency shall establish by rule a list of all tertiary

25  health services.

26         Section 7.  Subsection (5) of section 408.034, Florida

27  Statutes, is amended to read:

28         408.034  Duties and responsibilities of agency;

29  rules.--

30         (5)  The agency shall establish by rule a

31  nursing-home-bed-need methodology that has a goal of


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    CS for CS for SB 1252                         Second Engrossed



 1  maintaining a district average occupancy rate of 94 percent

 2  and that reduces the community nursing home bed need for the

 3  areas of the state where the agency establishes pilot

 4  community diversion programs through the Title XIX aging

 5  waiver program.

 6         Section 8.  Section 408.036, Florida Statutes, is

 7  amended to read:

 8         408.036  Projects subject to review; exemptions.--

 9         (1)  APPLICABILITY.--Unless exempt under subsection

10  (3), all health-care-related projects, as described in

11  paragraphs (a)-(h), are subject to review and must file an

12  application for a certificate of need with the agency. The

13  agency is exclusively responsible for determining whether a

14  health-care-related project is subject to review under ss.

15  408.031-408.045.

16         (a)  The addition of beds by new construction or

17  alteration.

18         (b)  The new construction or establishment of

19  additional health care facilities, including a replacement

20  health care facility when the proposed project site is not

21  located on the same site as the existing health care facility.

22         (c)  The conversion from one type of health care

23  facility to another.

24         (d)  An increase in the total licensed bed capacity of

25  a health care facility.

26         (e)  The establishment of a hospice or hospice

27  inpatient facility, except as provided in s. 408.043.

28         (f)  The establishment of inpatient health services by

29  a health care facility, or a substantial change in such

30  services.

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         (g)  An increase in the number of beds for acute care,

 2  nursing home care beds, specialty burn units, neonatal

 3  intensive care units, comprehensive rehabilitation, mental

 4  health services, or hospital-based distinct part skilled

 5  nursing units, or at a long-term care hospital.

 6         (h)  The establishment of tertiary health services.

 7         (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless

 8  exempt pursuant to subsection (3), projects subject to an

 9  expedited review shall include, but not be limited to:

10         (a)  Research, education, and training programs.

11         (b)  Shared services contracts or projects.

12         (b)(c)  A transfer of a certificate of need, except

13  when an existing hospital is acquired by a purchaser, in which

14  case all pending certificates of need filed by the existing

15  hospital and all approved certificates of need owned by that

16  hospital would be acquired by the purchaser.

17         (c)(d)  A 50-percent increase in nursing home beds for

18  a facility incorporated and operating in this state for at

19  least 60 years on or before July 1, 1988, which has a licensed

20  nursing home facility located on a campus providing a variety

21  of residential settings and supportive services. The increased

22  nursing home beds shall be for the exclusive use of the campus

23  residents. Any application on behalf of an applicant meeting

24  this requirement shall be subject to the base fee of $5,000

25  provided in s. 408.038.

26         (d)(e)  Replacement of a health care facility when the

27  proposed project site is located in the same district and

28  within a 1-mile radius of the replaced health care facility.

29         (e)(f)  The conversion of mental health services beds

30  licensed under chapter 395 or hospital-based distinct part

31  conversion of skilled nursing unit beds to general acute care


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    CS for CS for SB 1252                         Second Engrossed



 1  beds; the mental health services beds between or among the

 2  licensed bed categories defined as beds for mental health

 3  services; or the conversion of general acute care beds to beds

 4  for mental health services.

 5         1.  Conversion under this paragraph shall not establish

 6  a new licensed bed category at the hospital but shall apply

 7  only to categories of beds licensed at that hospital.

 8         2.  Beds converted under this paragraph must be

 9  licensed and operational for at least 12 months before the

10  hospital may apply for additional conversion affecting beds of

11  the same type.

12         (f)  Replacement of a nursing home within the same

13  district, provided the proposed project site is located within

14  a geographic area that contains at least 65 percent of the

15  facility's current residents and is within a 30-mile radius of

16  the replaced nursing home.

17         (g)  Relocation of a portion of a nursing home's

18  licensed beds to a replacement facility within the same

19  district, provided the relocation is within a 30-mile radius

20  of the existing facility and the total number of nursing home

21  beds in the district does not increase.

22  

23  The agency shall develop rules to implement the provisions for

24  expedited review, including time schedule, application content

25  which may be reduced from the full requirements of s.

26  408.037(1), and application processing.

27         (3)  EXEMPTIONS.--Upon request, the following projects

28  are subject to exemption from the provisions of subsection

29  (1):

30  

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         (a)  For replacement of a licensed health care facility

 2  on the same site, provided that the number of beds in each

 3  licensed bed category will not increase.

 4         (b)  For hospice services or for swing beds in a rural

 5  hospital, as defined in s. 395.602, in a number that does not

 6  exceed one-half of its licensed beds.

 7         (c)  For the conversion of licensed acute care hospital

 8  beds to Medicare and Medicaid certified skilled nursing beds

 9  in a rural hospital, as defined in s. 395.602, so long as the

10  conversion of the beds does not involve the construction of

11  new facilities. The total number of skilled nursing beds,

12  including swing beds, may not exceed one-half of the total

13  number of licensed beds in the rural hospital as of July 1,

14  1993. Certified skilled nursing beds designated under this

15  paragraph, excluding swing beds, shall be included in the

16  community nursing home bed inventory.  A rural hospital which

17  subsequently decertifies any acute care beds exempted under

18  this paragraph shall notify the agency of the decertification,

19  and the agency shall adjust the community nursing home bed

20  inventory accordingly.

21         (d)  For the addition of nursing home beds at a skilled

22  nursing facility that is part of a retirement community that

23  provides a variety of residential settings and supportive

24  services and that has been incorporated and operated in this

25  state for at least 65 years on or before July 1, 1994. All

26  nursing home beds must not be available to the public but must

27  be for the exclusive use of the community residents.

28         (e)  For an increase in the bed capacity of a nursing

29  facility licensed for at least 50 beds as of January 1, 1994,

30  under part II of chapter 400 which is not part of a continuing

31  care facility if, after the increase, the total licensed bed


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    CS for CS for SB 1252                         Second Engrossed



 1  capacity of that facility is not more than 60 beds and if the

 2  facility has been continuously licensed since 1950 and has

 3  received a superior rating on each of its two most recent

 4  licensure surveys.

 5         (f)  For an inmate health care facility built by or for

 6  the exclusive use of the Department of Corrections as provided

 7  in chapter 945. This exemption expires when such facility is

 8  converted to other uses.

 9         (g)  For the termination of an inpatient health care

10  service, upon 30 days' written notice to the agency.

11         (h)  For the delicensure of beds, upon 30 days' written

12  notice to the agency. A request for exemption submitted under

13  this paragraph must identify the number, the category of beds,

14  and the name of the facility in which the beds to be

15  delicensed are located.

16         (i)  For the provision of adult inpatient diagnostic

17  cardiac catheterization services in a hospital.

18         1.  In addition to any other documentation otherwise

19  required by the agency, a request for an exemption submitted

20  under this paragraph must comply with the following criteria:

21         a.  The applicant must certify it will not provide

22  therapeutic cardiac catheterization pursuant to the grant of

23  the exemption.

24         b.  The applicant must certify it will meet and

25  continuously maintain the minimum licensure requirements

26  adopted by the agency governing such programs pursuant to

27  subparagraph 2.

28         c.  The applicant must certify it will provide a

29  minimum of 2 percent of its services to charity and Medicaid

30  patients.

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         2.  The agency shall adopt licensure requirements by

 2  rule which govern the operation of adult inpatient diagnostic

 3  cardiac catheterization programs established pursuant to the

 4  exemption provided in this paragraph. The rules shall ensure

 5  that such programs:

 6         a.  Perform only adult inpatient diagnostic cardiac

 7  catheterization services authorized by the exemption and will

 8  not provide therapeutic cardiac catheterization or any other

 9  services not authorized by the exemption.

10         b.  Maintain sufficient appropriate equipment and

11  health personnel to ensure quality and safety.

12         c.  Maintain appropriate times of operation and

13  protocols to ensure availability and appropriate referrals in

14  the event of emergencies.

15         d.  Maintain appropriate program volumes to ensure

16  quality and safety.

17         e.  Provide a minimum of 2 percent of its services to

18  charity and Medicaid patients each year.

19         3.a.  The exemption provided by this paragraph shall

20  not apply unless the agency determines that the program is in

21  compliance with the requirements of subparagraph 1. and that

22  the program will, after beginning operation, continuously

23  comply with the rules adopted pursuant to subparagraph 2.  The

24  agency shall monitor such programs to ensure compliance with

25  the requirements of subparagraph 2.

26         b.(I)  The exemption for a program shall expire

27  immediately when the program fails to comply with the rules

28  adopted pursuant to sub-subparagraphs 2.a., b., and c.

29         (II)  Beginning 18 months after a program first begins

30  treating patients, the exemption for a program shall expire

31  


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    CS for CS for SB 1252                         Second Engrossed



 1  when the program fails to comply with the rules adopted

 2  pursuant to sub-subparagraphs 2.d. and e.

 3         (III)  If the exemption for a program expires pursuant

 4  to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the

 5  agency shall not grant an exemption pursuant to this paragraph

 6  for an adult inpatient diagnostic cardiac catheterization

 7  program located at the same hospital until 2 years following

 8  the date of the determination by the agency that the program

 9  failed to comply with the rules adopted pursuant to

10  subparagraph 2.

11         (j)  For the provision of percutaneous coronary

12  intervention for patients presenting with emergency myocardial

13  infarctions in a hospital without an approved adult open heart

14  surgery program. In addition to any other documentation

15  required by the agency, a request for an exemption submitted

16  under this paragraph must comply with the following:

17         1.  The applicant must certify that it will meet and

18  continuously maintain the requirements adopted by the agency

19  for the provision of these services. These licensure

20  requirements are to be adopted by rule pursuant to ss.

21  120.536(1) and 120.54 and are to be consistent with the

22  guidelines published by the American College of Cardiology and

23  the American Heart Association for the provision of

24  percutaneous coronary interventions in hospitals without adult

25  open heart services. At a minimum, the rules shall require the

26  following:

27         a.  Cardiologists must be experienced

28  interventionalists who have performed a minimum of 75

29  interventions within the previous 12 months.

30  

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         b.  The hospital must provide a minimum of 36 emergency

 2  interventions annually in order to continue to provide the

 3  service.

 4         c.  The hospital must offer sufficient physician,

 5  nursing, and laboratory staff to provide the services 24 hours

 6  a day, 7 days a week.

 7         d.  Nursing and technical staff must have demonstrated

 8  experience in handling acutely ill patients requiring

 9  intervention based on previous experience in dedicated

10  interventional laboratories or surgical centers.

11         e.  Cardiac care nursing staff must be adept in

12  hemodynamic monitoring and Intra-aortic Balloon Pump (IABP)

13  management.

14         f.  Formalized written transfer agreements must be

15  developed with a hospital with an adult open heart surgery

16  program, and written transport protocols must be in place to

17  ensure safe and efficient transfer of a patient within 60

18  minutes. Transfer and transport agreements must be reviewed

19  and tested, with appropriate documentation maintained at least

20  every 3 months.

21         g.  Hospitals implementing the service must first

22  undertake a training program of 3 to 6 months which includes

23  establishing standards, testing logistics, creating quality

24  assessment and error management practices, and formalizing

25  patient selection criteria.

26         2.  The applicant must certify that it will utilize at

27  all times the patient selection criteria for the performance

28  of primary angioplasty at hospitals without adult open heart

29  surgery programs issued by the American College of Cardiology

30  and the American Heart Association. At a minimum, these

31  criteria would provide for the following:


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    CS for CS for SB 1252                         Second Engrossed



 1         a.  Avoidance of interventions in hemodynamically

 2  stable patients presenting with identified symptoms or medical

 3  histories.

 4         b.  Transfer of patients presenting with a history of

 5  coronary disease and clinical presentation of hemodynamic

 6  instability.

 7         3.  The applicant must agree to submit a quarterly

 8  report to the agency detailing patient characteristics,

 9  treatment, and outcomes for all patients receiving emergency

10  percutaneous coronary interventions pursuant to this

11  paragraph. This report must be submitted within 15 days after

12  the close of each calendar quarter.

13         4.  The exemption provided by this paragraph shall not

14  apply unless the agency determines that the hospital has taken

15  all necessary steps to be in compliance with all requirements

16  of this paragraph, including the training program required

17  pursuant to sub-subparagraph 1.g.

18         5.  Failure of the hospital to continuously comply with

19  the requirements of sub-subparagraphs 1.c.-f. and

20  subparagraphs 2. and 3. will result in the immediate

21  expiration of this exemption.

22         6.  Failure of the hospital to meet the volume

23  requirements of sub-subparagraphs 1.a.-b. within 18 months

24  after the program begins offering the service will result in

25  the immediate expiration of the exemption.

26         7.  If the exemption for this service expires pursuant

27  to subparagraph 5. or subparagraph 6., the agency shall not

28  grant another exemption for this service to the same hospital

29  for a period of 2 years and then only upon a showing that the

30  hospital will remain in compliance with the requirements of

31  this paragraph through a demonstration of corrections to the


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    CS for CS for SB 1252                         Second Engrossed



 1  deficiencies which caused expiration of the exemption.

 2  Compliance with the requirements of this paragraph includes

 3  compliance with the rules adopted pursuant to this paragraph.

 4         (k)(j)  For mobile surgical facilities and related

 5  health care services provided under contract with the

 6  Department of Corrections or a private correctional facility

 7  operating pursuant to chapter 957.

 8         (l)(k)  For state veterans' nursing homes operated by

 9  or on behalf of the Florida Department of Veterans' Affairs in

10  accordance with part II of chapter 296 for which at least 50

11  percent of the construction cost is federally funded and for

12  which the Federal Government pays a per diem rate not to

13  exceed one-half of the cost of the veterans' care in such

14  state nursing homes. These beds shall not be included in the

15  nursing home bed inventory.

16         (m)(l)  For combination within one nursing home

17  facility of the beds or services authorized by two or more

18  certificates of need issued in the same planning subdistrict.

19  An exemption granted under this paragraph shall extend the

20  validity period of the certificates of need to be consolidated

21  by the length of the period beginning upon submission of the

22  exemption request and ending with issuance of the exemption.

23  The longest validity period among the certificates shall be

24  applicable to each of the combined certificates.

25         (n)(m)  For division into two or more nursing home

26  facilities of beds or services authorized by one certificate

27  of need issued in the same planning subdistrict.  An exemption

28  granted under this paragraph shall extend the validity period

29  of the certificate of need to be divided by the length of the

30  period beginning upon submission of the exemption request and

31  ending with issuance of the exemption.


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    CS for CS for SB 1252                         Second Engrossed



 1         (o)(n)  For the addition of hospital beds licensed

 2  under chapter 395 for acute care, mental health services, or a

 3  hospital-based distinct part skilled nursing unit in a number

 4  that may not exceed 10 total beds or 10 percent of the

 5  licensed capacity of the bed category being expanded,

 6  whichever is greater; for the addition of medical

 7  rehabilitation beds licensed under chapter 395 in a number

 8  that may not exceed eight total beds or 10 percent of

 9  capacity, whichever is greater; or for the addition of mental

10  health services beds licensed under chapter 395 in a number

11  that may not exceed 10 total beds or 10 percent of the

12  licensed capacity of the bed category being expended,

13  whichever is greater. Beds for specialty burn units or,

14  neonatal intensive care units, or comprehensive

15  rehabilitation, or at a long-term care hospital, may not be

16  increased under this paragraph.

17         1.  In addition to any other documentation otherwise

18  required by the agency, a request for exemption submitted

19  under this paragraph must:

20         a.  Certify that the prior 12-month average occupancy

21  rate for the category of licensed beds being expanded at the

22  facility meets or exceeds 75 80 percent or, for a

23  hospital-based distinct part skilled nursing unit, the prior

24  12-month average occupancy rate meets or exceeds 96 percent

25  or, for medical rehabilitation beds, the prior 12-month

26  average occupancy meets or exceeds 90 percent.

27         b.  Certify that any beds of the same type authorized

28  for the facility under this paragraph before the date of the

29  current request for an exemption have been licensed and

30  operational for at least 12 months.

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         2.  The timeframes and monitoring process specified in

 2  s. 408.040(2)(a)-(c) apply to any exemption issued under this

 3  paragraph.

 4         3.  The agency shall count beds authorized under this

 5  paragraph as approved beds in the published inventory of

 6  hospital beds until the beds are licensed.

 7         (p)(o)  For the addition of acute care beds, as

 8  authorized by rule consistent with s. 395.003(4), in a number

 9  that may not exceed 30 10 total beds or 10 percent of licensed

10  bed capacity, whichever is greater, for temporary beds in a

11  hospital that has experienced high seasonal occupancy within

12  the prior 12-month period or in a hospital that must respond

13  to emergency circumstances.

14         (q)(p)  For the addition of nursing home beds licensed

15  under chapter 400 in a number not exceeding 10 total beds or

16  10 percent of the number of beds licensed in the facility

17  being expanded, whichever is greater.

18         1.  In addition to any other documentation required by

19  the agency, a request for exemption submitted under this

20  paragraph must:

21         a.  Effective until June 30, 2001, Certify that the

22  facility has not had any class I or class II deficiencies

23  within the 30 months preceding the request for addition.

24         b.  Effective on July 1, 2001, certify that the

25  facility has been designated as a Gold Seal nursing home under

26  s. 400.235.

27         b.c.  Certify that the prior 12-month average occupancy

28  rate for the nursing home beds at the facility meets or

29  exceeds 96 percent.

30         e.d.  Certify that any beds authorized for the facility

31  under this paragraph before the date of the current request


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    CS for CS for SB 1252                         Second Engrossed



 1  for an exemption have been licensed and operational for at

 2  least 12 months.

 3         2.  The timeframes and monitoring process specified in

 4  s. 408.040(2)(a)-(c) apply to any exemption issued under this

 5  paragraph.

 6         3.  The agency shall count beds authorized under this

 7  paragraph as approved beds in the published inventory of

 8  nursing home beds until the beds are licensed.

 9         (q)  For establishment of a specialty hospital offering

10  a range of medical service restricted to a defined age or

11  gender group of the population or a restricted range of

12  services appropriate to the diagnosis, care, and treatment of

13  patients with specific categories of medical illnesses or

14  disorders, through the transfer of beds and services from an

15  existing hospital in the same county.

16         (r)  For the conversion of hospital-based Medicare and

17  Medicaid certified skilled nursing beds to acute care beds, if

18  the conversion does not involve the construction of new

19  facilities.

20         (s)  For the replacement of a statutory rural hospital

21  when the proposed project site is located in the same district

22  and within 10 miles of the existing facility and within the

23  current primary service area, defined as the least number of

24  zip codes comprising 75 percent of the hospital's inpatient

25  admissions. For fiscal year 2001-2002 only, for transfer by a

26  health care system of existing services and not more than 100

27  licensed and approved beds from a hospital in district 1,

28  subdistrict 1, to another location within the same subdistrict

29  in order to establish a satellite facility that will improve

30  access to outpatient and inpatient care for residents of the

31  district and subdistrict and that will use new medical


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    CS for CS for SB 1252                         Second Engrossed



 1  technologies, including advanced diagnostics, computer

 2  assisted imaging, and telemedicine to improve care. This

 3  paragraph is repealed on July 1, 2002.

 4         (t)  For the conversion of mental health services beds

 5  licensed under chapter 395 or hospital-based distinct part

 6  skilled nursing unit beds to general acute care beds; the

 7  conversion of mental health services beds between or among the

 8  licensed bed categories defined as beds for mental health

 9  services; or the conversion of general acute care beds to beds

10  for mental health services.

11         1.  Conversion under this paragraph does not establish

12  a new licensed bed category at the hospital but applies only

13  to categories of beds licensed at that hospital.

14         2.  Beds converted under this paragraph must be

15  licensed and operational for at least 12 months before the

16  hospital may apply for additional conversion affecting beds of

17  the same type.

18         (u)  For the creation of at least a 10-bed Level II

19  neonatal intensive care unit upon demonstrating to the agency

20  that the applicant hospital had a minimum of 1,500 live births

21  during the previous 12 months.

22         (v)  For the addition of Level II or Level III neonatal

23  intensive care beds in a number not to exceed six beds or 10

24  percent of licensed capacity in that category, whichever is

25  greater, provided that the hospital certifies that the prior

26  12-month average occupancy rate for the category of licensed

27  neonatal intensive care beds meets or exceeds 75 percent.

28         (w)  For replacement of a licensed nursing home on the

29  same site, or within 3 miles of the same site, provided the

30  number of licensed beds does not increase.

31  


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    CS for CS for SB 1252                         Second Engrossed



 1         (x)  For consolidation or combination of licensed

 2  nursing homes or transfer of beds between licensed nursing

 3  homes within the same district, by providers that operate

 4  multiple nursing homes within that district, provided there is

 5  no increase in the district total of nursing home beds and the

 6  relocation does not exceed 30 miles from the original

 7  location.

 8         (4)  A request for exemption under subsection (3) may

 9  be made at any time and is not subject to the batching

10  requirements of this section. The request shall be supported

11  by such documentation as the agency requires by rule. The

12  agency shall assess a fee of $250 for each request for

13  exemption submitted under subsection (3).

14         Section 9.  Section 408.038, Florida Statutes, is

15  amended to read:

16         408.038  Fees.--The agency shall assess fees on

17  certificate-of-need applications.  Such fees shall be for the

18  purpose of funding the functions of the local health councils

19  and the activities of the agency and shall be allocated as

20  provided in s. 408.033. The fee shall be determined as

21  follows:

22         (1)  A minimum base fee of $10,000 $5,000.

23         (2)  In addition to the base fee of $10,000 $5,000,

24  0.015 of each dollar of proposed expenditure, except that a

25  fee may not exceed $50,000 $22,000.

26         Section 10.  Paragraph (e) of subsection (5) and

27  paragraph (c) of subsection (6) of section 408.039, Florida

28  Statutes, are amended to read:

29         408.039  Review process.--The review process for

30  certificates of need shall be as follows:

31         (5)  ADMINISTRATIVE HEARINGS.--


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    CS for CS for SB 1252                         Second Engrossed



 1         (e)  The agency shall issue its final order within 45

 2  days after receipt of the recommended order. If the agency

 3  fails to take action within 45 days, the recommended order of

 4  the Division of Administrative Hearings is deemed approved

 5  such time, or as otherwise agreed to by the applicant and the

 6  agency, the applicant may take appropriate legal action to

 7  compel the agency to act. When making a determination on an

 8  application for a certificate of need, the agency is

 9  specifically exempt from the time limitations provided in s.

10  120.60(1).

11         (6)  JUDICIAL REVIEW.--

12         (c)  The court, in its discretion, may award reasonable

13  attorney's fees and costs to the prevailing party if the court

14  finds that there was a complete absence of a justiciable issue

15  of law or fact raised by the losing party. If the losing party

16  is a hospital, the court shall order it to pay the reasonable

17  attorney's fees and costs, which shall include fees and costs

18  incurred as a result of the administrative hearing and the

19  judicial appeal, of the prevailing hospital party.

20         Section 11.  This act shall not preclude review and

21  final agency actions on any certificate of need application

22  that was filed with the Agency for Health Care Administration

23  before the effective date of this act.

24         Section 12.  Hospital Statutory and Regulatory Reform

25  Council; legislative intent; creation; membership; duties.--

26         (1)  It is the intent of the Legislature to provide for

27  the protection of the public health and safety in the

28  establishment, construction, maintenance, and operation of

29  hospitals. However, the Legislature further intends that the

30  police power of the state be exercised toward that purpose

31  only to the extent necessary and that regulation remain


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    CS for CS for SB 1252                         Second Engrossed



 1  current with the ever-changing standard of care and not

 2  restrict the introduction and use of new medical technologies

 3  and procedures.

 4         (2)  In order to achieve the purposes expressed in

 5  subsection (1), it is necessary that the state establish a

 6  mechanism for the ongoing review and updating of laws

 7  regulating hospitals. The Hospital Statutory and Regulatory

 8  Reform Council is created and located, for administrative

 9  purposes only, within the Agency for Health Care

10  Administration. The council shall consist of no more than 15

11  members, including:

12         (a)  Nine members appointed by the Florida Hospital

13  Association who represent acute care, teaching, specialty,

14  rural, government-owned, for-profit, and not-for-profit

15  hospitals.

16         (b)  Two members appointed by the Governor who

17  represent patients.

18         (c)  Two members appointed by the President of the

19  Senate who represent private businesses that provide health

20  insurance coverage for their employees, one of whom represents

21  small private businesses and one of whom represents large

22  private businesses. As used in this paragraph, the term

23  "private business" does not include an entity licensed under

24  chapter 627, Florida Statutes, or chapter 641, Florida

25  Statutes, or otherwise licensed or authorized to provide

26  health insurance services, either directly or indirectly, in

27  this state.

28         (d)  Two members appointed by the Speaker of the House

29  of Representatives who represent physicians.

30         (3)  Council members shall be appointed to serve 2-year

31  terms and may be reappointed. A member shall serve until his


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    CS for CS for SB 1252                         Second Engrossed



 1  or her successor is appointed. The council shall annually

 2  elect from among its members a chair and a vice chair. The

 3  council shall meet at least twice a year and shall hold

 4  additional meetings as it considers necessary. Members

 5  appointed by the Florida Hospital Association may not receive

 6  compensation or reimbursement of expenses for their services.

 7  Members appointed by the Governor, the President of the

 8  Senate, or the Speaker of the House of Representatives may be

 9  reimbursed for travel expenses by the agency.

10         (4)  The council, as its first priority, shall review

11  chapters 395 and 408, Florida Statutes, and shall make

12  recommendations to the Legislature for the repeal of

13  regulatory provisions that are no longer necessary or that

14  fail to promote cost-efficient, high-quality medicine.

15         (5)  The council, as its second priority, shall

16  recommend to the Secretary of Health and the Secretary of

17  Health Care Administration regulatory changes relating to

18  hospital licensure and regulation to assist the Department of

19  Health and the Agency for Health Care Administration in

20  carrying out their duties and to ensure that the intent of the

21  Legislature as expressed in this section is carried out.

22         (6)  In determining whether a statute or rule is

23  appropriate or necessary, the council shall consider whether:

24         (a)  The statute or rule is necessary to prevent

25  substantial harm, which is recognizable and not remote, to the

26  public health, safety, or welfare.

27         (b)  The statute or rule restricts the use of new

28  medical technologies or encourages the implementation of more

29  cost-effective medical procedures.

30         (c)  The statute or rule has an unreasonable effect on

31  job creation or job retention in the state.


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    CS for CS for SB 1252                         Second Engrossed



 1         (d)  The public is or can be effectively protected by

 2  other means.

 3         (e)  The overall cost-effectiveness and economic effect

 4  of the proposed statute or rule, including the indirect costs

 5  to consumers, will be favorable.

 6         (f)  A lower-cost regulatory alternative to the statute

 7  or rule could be adopted.

 8         Section 13.  Effective May 1, 2003, subsection (2) of

 9  section 409.904, Florida Statutes, is amended to read:

10         409.904  Optional payments for eligible persons.--The

11  agency may make payments for medical assistance and related

12  services on behalf of the following persons who are determined

13  to be eligible subject to the income, assets, and categorical

14  eligibility tests set forth in federal and state law.  Payment

15  on behalf of these Medicaid eligible persons is subject to the

16  availability of moneys and any limitations established by the

17  General Appropriations Act or chapter 216.

18         (2)  A caretaker relative or parent, a pregnant woman,

19  a child under age 19 who would otherwise qualify for Florida

20  Kidcare Medicaid, a child up to age 21 who would otherwise

21  qualify under s. 409.903(1), a person age 65 or over, or a

22  blind or disabled person, who would otherwise be eligible for

23  Florida Medicaid, except that the income or assets of such

24  family or person exceed established limitations. For a family

25  or person in one of these coverage groups, medical expenses

26  are deductible from income in accordance with federal

27  requirements in order to make a determination of eligibility.

28  Expenses used to meet spend-down liability are not

29  reimbursable by Medicaid. Effective July May 1, 2003, when

30  determining the eligibility of a pregnant woman, a child, or

31  an aged, blind, or disabled individual, $270 shall be deducted


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    CS for CS for SB 1252                         Second Engrossed



 1  from the countable income of the filing unit. When determining

 2  the eligibility of the parent or caretaker relative as defined

 3  by Title XIX of the Social Security Act, the additional income

 4  disregard of $270 does not apply. A family or person eligible

 5  under the coverage known as the "medically needy," is eligible

 6  to receive the same services as other Medicaid recipients,

 7  with the exception of services in skilled nursing facilities

 8  and intermediate care facilities for the developmentally

 9  disabled.

10         Section 14.  The non-recurring sums of $8,265,777 from

11  the General Revenue Fund, $2,505,224 from the Grants and

12  Donations Trust Fund, and $11,727,287 from the Medical Care

13  Trust Fund are appropriated to the Agency for Health Care

14  Administration to implement section 14 of this act during the

15  2002-2003 fiscal year. This section takes effect May 1, 2003.

16         Section 15.  Except as otherwise expressly provided,

17  this act shall take July 1, 2003, but if it becomes a law

18  after May 1, 2003, sections 14 and 15 of this act shall

19  operate retroactively to that date.

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  


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