HB 1931 2003
1	A bill to be entitled
2	An act relating to health care; amending s. 395.002, F.S.;
3	providing definitions applicable to provisions regulating
4	hospitals and other licensed facilities; conforming cross
5	references; amending s. 395.003, F.S.; specifying that
6	only the applicant is entitled to an administrative
7	hearing on its application; conforming a cross reference;
8	creating s. 395.0095, F.S.; establishing licensing
9	criteria for cardiac programs; requiring reporting;
10	amending s. 408.034, F.S.; providing a nursing-home-bed
11	need methodology that has a goal of maintaining a
12	specified district average occupancy rate; amending s.
13	408.036, F.S., relating to health-care-related projects
14	subject to review for a certificate of need; deleting
15	hospice inpatient facilities from the projects subject to
16	review; deleting shared services contracts or projects
17	from expedited review; modifying circumstances requiring
18	transfer of a certificate of need; providing expedited
19	review for replacement of a nursing home and for
20	relocation of a portion of a nursing home's beds; adding
21	or revising exemptions for addition of acute care beds,
22	hospital-based distinct part skilled nursing unit beds,
23	comprehensive medical rehabilitation beds, Level II or
24	Level III neonatal intensive care beds, mental health
25	services beds, and nursing home beds; adding exemptions
26	for conversion of mental health services beds, replacement
27	of a statutory rural hospital, establishment of a Level II
28	neonatal intensive care unit, replacement of a licensed
29	nursing home, consolidation or combination of nursing
30	homes or transfer of beds between nursing homes by
31	providers that operate multiple nursing homes, and
32	establishment of certain adult open-heart programs;
33	deleting exemptions relating to establishment of certain
34	specialty hospitals and a satellite facility for new
35	medical technologies; amending s. 408.037, F.S.; allowing
36	a consolidated audit of a parent company; providing that
37	the acquisition of a licensed hospital includes
38	acquisition of any pending certificate-of-need
39	application; amending s. 408.038, F.S.; increasing fees to
40	fund the activities of the certificate-of-need program;
41	amending s. 408.039, F.S.; eliminating the right of
42	existing health care facilities to initiate or intervene
43	in an administrative hearing pertaining to the issuance or
44	denial of a certificate of need; providing that without
45	agency action within a specified time period the
46	recommended order of the Division of Administrative
47	Hearings becomes the final order; removing the requirement
48	that the court must find a complete absence of a
49	judiciable issue of law or fact prior to awarding
50	attorney's fees and costs; requiring a hospital that is
51	the losing party in a judicial review to pay the
52	reasonable attorney's fees and costs of the prevailing
53	hospital; amending s. 408.043, F.S.; deleting a provision
54	requiring a certificate of need for a hospice inpatient
55	facility, to conform to changes made by the act; amending
56	s. 408.05, F.S.; providing quality outcome measure
57	reporting requirements and standards for cardiac programs;
58	amending s. 52, ch. 2001-45, Laws of Florida; establishing
59	criteria for which the imposed moratorium on certificates
60	of need for nursing homes does not apply; amending ss.
61	383.50, 394.4787, 395.602, 395.701, 400.051, 409.905,
62	468.505, 766.316, and 812.014, F.S.; conforming cross
63	references; providing a grandfather clause for cardiac
64	programs; amending s. 408.043, F.S.; including the
65	additional beds at certain acute care hospitals in high
66	growth counties in the inventory of hospital beds used in
67	the calculation of the fixed-bed-need pool for acute care
68	hospitals; providing an effective date.
69
70	Be It Enacted by the Legislature of the State of Florida:
71
72	Section 1. Section 395.002, Florida Statutes, is amended
73	to read:
74	395.002 Definitions.--As used in this chapter:
75	(1) "Accrediting organizations" means the Joint Commission
76	on Accreditation of Healthcare Organizations, the American
77	Osteopathic Association, the Commission on Accreditation of
78	Rehabilitation Facilities, and the Accreditation Association for
79	Ambulatory Health Care, Inc.
80	(2) "Adult" mean a person who is 18 years of age or older.
81	(3)(2)"Agency" means the Agency for Health Care
82	Administration.
83	(4)(3)"Ambulatory surgical center" or "mobile surgical
84	facility" means a facility the primary purpose of which is to
85	provide elective surgical care, in which the patient is admitted
86	to and discharged from such facility within the same working day
87	and is not permitted to stay overnight, and which is not part of
88	a hospital. However, a facility existing for the primary purpose
89	of performing terminations of pregnancy, an office maintained by
90	a physician for the practice of medicine, or an office
91	maintained for the practice of dentistry shall not be construed
92	to be an ambulatory surgical center, provided that any facility
93	or office which is certified or seeks certification as a
94	Medicare ambulatory surgical center shall be licensed as an
95	ambulatory surgical center pursuant to s. 395.003. Any structure
96	or vehicle in which a physician maintains an office and
97	practices surgery, and which can appear to the public to be a
98	mobile office because the structure or vehicle operates at more
99	than one address, shall be construed to be a mobile surgical
100	facility.
101	(5)(4)"Applicant" means an individual applicant, or any
102	officer, director, or agent, or any partner or shareholder
103	having an ownership interest equal to a 5-percent or greater
104	interest in the corporation, partnership, or other business
105	entity.
106	(6)(5)"Biomedical waste" means any solid or liquid waste
107	as defined in s. 381.0098(2)(a).
108	(7) "Cardiac surgery program" means a health service that
109	is provided by or on behalf of a health care facility in which
110	surgical procedures occur that treat conditions such as
111	congenital heart defects and heart and coronary artery diseases,
112	including replacement of heart valves, cardiac vascularization,
113	and cardiac trauma. One cardiac surgery operation equals one
114	patient admission to the hospital during which one or more
115	cardiac surgeries are performed. Cardiac surgery operations are
116	classified under the following Medicare diagnostic-related
117	groups: 104, 105, 106, 107, 108, and 109.
118	(8)(6)"Clinical privileges" means the privileges granted
119	to a physician or other licensed health care practitioner to
120	render patient care services in a hospital, but does not include
121	the privilege of admitting patients.
122	(9)(7)"Department" means the Department of Health.
123	(10) "Diagnostic cardiac catheterization program" means a
124	health service that is provided by or on behalf of a health care
125	facility, that consists of one or more laboratories comprised of
126	a room or suite of rooms, and that has the equipment and staff
127	required to perform diagnostic cardiac catheterization serving
128	inpatients and outpatients.
129	(11)(8)"Director" means any member of the official board
130	of directors as reported in the organization's annual corporate
131	report to the Florida Department of State, or, if no such report
132	is made, any member of the operating board of directors. The
133	term excludes members of separate, restricted boards that serve
134	only in an advisory capacity to the operating board.
135	(12) "Elective percutaneous coronary care program" means a
136	health service that is provided by or on behalf of a health care
137	facility for cardiac patients with procedures involving the use
138	of a coronary artery catheter that is for more than diagnostic
139	purposes. Such procedures include, but are not limited to,
140	rotational atherectomy, directional atherectomy, extraction of
141	atherectomy, laser angioplasty, ablation, and implementation of
142	intracoronary stents. Each elective percutaneous coronary care
143	program shall have a formal agreement for offsite surgical
144	backup.
145	(13)(9)"Emergency medical condition" means:
146	(a) A medical condition manifesting itself by acute
147	symptoms of sufficient severity, which may include severe pain,
148	such that the absence of immediate medical attention could
149	reasonably be expected to result in any of the following:
150	1. Serious jeopardy to patient health, including a
151	pregnant woman or fetus.
152	2. Serious impairment to bodily functions.
153	3. Serious dysfunction of any bodily organ or part.
154	(b) With respect to a pregnant woman:
155	1. That there is inadequate time to effect safe transfer
156	to another hospital prior to delivery;
157	2. That a transfer may pose a threat to the health and
158	safety of the patient or fetus; or
159	3. That there is evidence of the onset and persistence of
160	uterine contractions or rupture of the membranes.
161	(14) "Emergency/primary percutaneous coronary intervention
162	program" means a health service that is provided by or on behalf
163	of a health care facility providing cardiac care, which includes
164	procedures involving the use of a coronary artery catheter that
165	is for more than diagnostic purposes, and that is applicable
166	only to patients presenting with an acute myocardial infarction
167	or similar condition in an emergency department. Such procedures
168	include, but are not limited to, rotational atherectomy,
169	directional atherectomy, extraction of atherectomy, laser
170	angioplasty, ablation, and implementation of intracoronary stents
171	for patients with an emergency condition. Each emergency/primary
172	percutaneous coronary intervention program shall have in place a
173	transfer agreement to a facility with a licensed cardiac surgery
174	program.
175	(15)(10)"Emergency services and care" means medical
176	screening, examination, and evaluation by a physician, or, to
177	the extent permitted by applicable law, by other appropriate
178	personnel under the supervision of a physician, to determine if
179	an emergency medical condition exists and, if it does, the care,
180	treatment, or surgery by a physician necessary to relieve or
181	eliminate the emergency medical condition, within the service
182	capability of the facility.
183	(16)(11)"General hospital" means any facility which meets
184	the provisions of subsection (18)(13)and which regularly makes
185	its facilities and services available to the general population.
186	(17)(12)"Governmental unit" means the state or any
187	county, municipality, or other political subdivision, or any
188	department, division, board, or other agency of any of the
189	foregoing.
190	(18)(13)"Hospital" means any establishment that:
191	(a) Offers services more intensive than those required for
192	room, board, personal services, and general nursing care, and
193	offers facilities and beds for use beyond 24 hours by
194	individuals requiring diagnosis, treatment, or care for illness,
195	injury, deformity, infirmity, abnormality, disease, or
196	pregnancy; and
197	(b) Regularly makes available at least clinical laboratory
198	services, diagnostic X-ray services, and treatment facilities
199	for surgery or obstetrical care, or other definitive medical
200	treatment of similar extent.
201
202	However, the provisions of this chapter do not apply to any
203	institution conducted by or for the adherents of any well-
204	recognized church or religious denomination that depends
205	exclusively upon prayer or spiritual means to heal, care for, or
206	treat any person. For purposes of local zoning matters, the term
207	"hospital" includes a medical office building located on the
208	same premises as a hospital facility, provided the land on which
209	the medical office building is constructed is zoned for use as a
210	hospital; provided the premises were zoned for hospital purposes
211	on January 1, 1992.
212	(19)(14)"Hospital bed" means a hospital accommodation
213	which is ready for immediate occupancy, or is capable of being
214	made ready for occupancy within 48 hours, excluding provision of
215	staffing, and which conforms to minimum space, equipment, and
216	furnishings standards as specified by rule of the agency for the
217	provision of services specified in this section to a single
218	patient.
219	(20)(15)"Initial denial determination" means a
220	determination by a private review agent that the health care
221	services furnished or proposed to be furnished to a patient are
222	inappropriate, not medically necessary, or not reasonable.
223	(21)(16)"Intensive residential treatment programs for
224	children and adolescents" means a specialty hospital accredited
225	by the Joint Commission on Accreditation of Healthcare
226	Organizations which provides 24-hour care and which has the
227	primary functions of diagnosis and treatment of patients under
228	the age of 18 having psychiatric disorders in order to restore
229	such patients to an optimal level of functioning.
230	(22)(17)"Licensed facility" means a hospital, ambulatory
231	surgical center, or mobile surgical facility licensed in
232	accordance with this chapter.
233	(23)(18)"Lifesafety" means the control and prevention of
234	fire and other life-threatening conditions on a premises for the
235	purpose of preserving human life.
236	(24)(19)"Managing employee" means the administrator or
237	other similarly titled individual who is responsible for the
238	daily operation of the facility.
239	(25)(20)"Medical staff" means physicians licensed under
240	chapter 458 or chapter 459 with privileges in a licensed
241	facility, as well as other licensed health care practitioners
242	with clinical privileges as approved by a licensed facility's
243	governing board.
244	(26)(21)"Medically necessary transfer" means a transfer
245	made necessary because the patient is in immediate need of
246	treatment for an emergency medical condition for which the
247	facility lacks service capability or is at service capacity.
248	(27)(22)"Mobile surgical facility" is a mobile facility
249	in which licensed health care professionals provide elective
250	surgical care under contract with the Department of Corrections
251	or a private correctional facility operating pursuant to chapter
252	957 and in which inmate patients are admitted to and discharged
253	from said facility within the same working day and are not
254	permitted to stay overnight. However, mobile surgical facilities
255	may only provide health care services to the inmate patients of
256	the Department of Corrections, or inmate patients of a private
257	correctional facility operating pursuant to chapter 957, and not
258	to the general public.
259	(28) "Pediatric patient" means a patient who is under 18
260	years of age.
261	(29) "Percutaneous coronary intervention" means any
262	procedure involving the use of a coronary artery catheter that is
263	for more than diagnostic purposes. Such procedures include, but
264	are not limited to, rotational atherectomy, directional
265	atherectomy, extraction of atherectomy, laser angioplasty,
266	ablation, and implementation of intracoronary stents.
267	(30)(23)"Person" means any individual, partnership,
268	corporation, association, or governmental unit.
269	(31)(24)"Premises" means those buildings, beds, and
270	equipment located at the address of the licensed facility and
271	all other buildings, beds, and equipment for the provision of
272	hospital, ambulatory surgical, or mobile surgical care located
273	in such reasonable proximity to the address of the licensed
274	facility as to appear to the public to be under the dominion and
275	control of the licensee. For any licensee that is a teaching
276	hospital as defined in s. 408.07(44), reasonable proximity
277	includes any buildings, beds, services, programs, and equipment
278	under the dominion and control of the licensee that are located
279	at a site with a main address that is within 1 mile of the main
280	address of the licensed facility; and all such buildings, beds,
281	and equipment may, at the request of a licensee or applicant, be
282	included on the facility license as a single premises.
283	(32)(25)"Private review agent" means any person or entity
284	which performs utilization review services for third-party
285	payors on a contractual basis for outpatient or inpatient
286	services. However, the term shall not include full-time
287	employees, personnel, or staff of health insurers, health
288	maintenance organizations, or hospitals, or wholly owned
289	subsidiaries thereof or affiliates under common ownership, when
290	performing utilization review for their respective hospitals,
291	health maintenance organizations, or insureds of the same
292	insurance group. For this purpose, health insurers, health
293	maintenance organizations, and hospitals, or wholly owned
294	subsidiaries thereof or affiliates under common ownership,
295	include such entities engaged as administrators of self-
296	insurance as defined in s. 624.031.
297	(33)(26)"Service capability" means all services offered
298	by the facility where identification of services offered is
299	evidenced by the appearance of the service in a patient's
300	medical record or itemized bill.
301	(34)(27)"At service capacity" means the temporary
302	inability of a hospital to provide a service which is within the
303	service capability of the hospital, due to maximum use of the
304	service at the time of the request for the service.
305	(35)(28)"Specialty bed" means a bed, other than a general
306	bed, designated on the face of the hospital license for a
307	dedicated use.
308	(36)(29)"Specialty hospital" means any facility which
309	meets the provisions of subsection (18)(13), and which
310	regularly makes available either:
311	(a) The range of medical services offered by general
312	hospitals, but restricted to a defined age or gender group of
313	the population;
314	(b) A restricted range of services appropriate to the
315	diagnosis, care, and treatment of patients with specific
316	categories of medical or psychiatric illnesses or disorders; or
317	(c) Intensive residential treatment programs for children
318	and adolescents as defined in subsection (21)(16).
319	(37)(30)"Stabilized" means, with respect to an emergency
320	medical condition, that no material deterioration of the
321	condition is likely, within reasonable medical probability, to
322	result from the transfer of the patient from a hospital.
323	(38) "Tertiary health service" means a health service
324	which, due to its high level of intensity, complexity,
325	specialized or limited applicability, and cost, should be limited
326	to, and concentrated in, a limited number of hospitals to ensure
327	the quality, availability, and cost-effectiveness of such
328	service. Such services include, and are limited to, organ
329	transplantation, specialty burn units, neonatal intensive care
330	units, comprehensive rehabilitation, and cardiac surgery.
331	(39)(31)"Utilization review" means a system for reviewing
332	the medical necessity or appropriateness in the allocation of
333	health care resources of hospital services given or proposed to
334	be given to a patient or group of patients.
335	(40)(32)"Utilization review plan" means a description of
336	the policies and procedures governing utilization review
337	activities performed by a private review agent.
338	(41)(33)"Validation inspection" means an inspection of
339	the premises of a licensed facility by the agency to assess
340	whether a review by an accrediting organization has adequately
341	evaluated the licensed facility according to minimum state
342	standards.
343	Section 2. Paragraph (e) of subsection (2) of section
344	395.003, Florida Statutes, is amended, and subsection (9) is
345	added to said section, to read:
346	395.003 Licensure; issuance, renewal, denial,
347	modification, suspension, and revocation.--
348	(2)
349	(e) The agency shall, at the request of a licensee that is
350	a teaching hospital as defined in s. 408.07(44), issue a single
351	license to a licensee for facilities that have been previously
352	licensed as separate premises, provided such separately licensed
353	facilities, taken together, constitute the same premises as
354	defined in s. 395.002(31)(24). Such license for the single
355	premises shall include all of the beds, services, and programs
356	that were previously included on the licenses for the separate
357	premises. The granting of a single license under this paragraph
358	shall not in any manner reduce the number of beds, services, or
359	programs operated by the licensee.
360	(9) In administrative proceedings on an application to
361	license any health care facility or program or to provide any
362	service or take any other action requiring health care facility
363	licensure authority, only the applicant is entitled to an
364	administrative hearing on its application. No other person may
365	initiate or intervene in any action to determine whether such an
366	application should be approved or denied.
367	Section 3. Section 395.0095, Florida Statutes, is created
368	to read:
369	395.0095 Licensed cardiac programs.--
370	(1) LICENSED CARDIAC PROGRAMS.--The following inpatient
371	services when provided by a hospital licensed under this chapter
372	shall be subject to the requirements as specified in this
373	section and in ss. 395.003 and 408.05 and shall be separately
374	listed on the hospital license and specify whether the service
375	is for adults or pediatric patients for:
376	(a) Diagnostic cardiac catheterization programs.
377	(b) Emergency/primary percutaneous coronary intervention
378	programs.
379	(c) Elective percutaneous coronary intervention programs.
380	(d) Cardiac surgery programs.
381	(2) REQUIRMENTS FOR LICENSED CARDIAC PROGRAMS.--Each
382	hospital providing diagnostic cardiac catheterization,
383	emergency/primary percutaneous coronary interventions, elective
384	percutaneous interventions, or cardiac surgery shall be subject
385	to the following provisions:
386	(a) The hospital shall document for each program it
387	provides that sufficient numbers of properly trained personnel
388	shall be available for the specific service offered to ensure
389	quality of care and patient safety, providing services 24 hours
390	a day, 7 days a week, in accordance with the guidelines
391	established by the American College of Cardiology and the
392	American Heart Association.
393	(b) The hospital shall be fully accredited by the Joint
394	Commission on Accreditation of Health Care Organizations in
395	accordance with evidence-based standards and core measures for
396	cardiac programs.
397	(c) The hospital shall ensure that each program it
398	provides shall possess the capability for emergency services,
399	which includes rapid mobilization of the surgical and medical
400	support teams for emergency cases, 24 hours a day, 7 days a
401	week.
402	(3) MINIMUM STANDARDS FOR QUALITY OUTCOME MEASURES AND
403	PUBLIC REPORTING.--Beginning January 1, 2004, each hospital with
404	a cardiac program as defined in this section shall submit the
405	data elements required by s. 408.05(9). As of July 1, 2005, each
406	hospital with a cardiac program as defined in this section shall
407	be subject to the quality outcome standards established pursuant
408	to s. 408.05(9).
409	(a) After July 1, 2006, and before December 30, 2006, all
410	hospitals with cardiac programs shall be notified by the
411	department of their standing in the various quality measures.
412	(b) Any hospital whose service or services fail to achieve
413	an acceptable rating pursuant to s. 408.05, when adjusted for,
414	but not limited to, age, sex, and severity of patients, shall be
415	directed by the agency, within 30 days after its receipt of the
416	hospital's quality outcome scores, to submit a plan for quality
417	improvements within 60 days.
418	(4) REQUIREMENTS FOR DIAGNOSTIC CARDIAC CATHETERIZATION
419	PROGRAMS.--
420	(a) Each diagnostic cardiac catheterization program shall:
421	1. Have the capability of providing immediate endocardiac
422	catheter pacemaking, in case of cardiac arrest or heart failure,
423	and pressure recording for monitoring and evaluating valvular
424	disease.
425	2. Provide a full range of noninvasive cardiac or
426	circulatory diagnostic services within the hospital itself.
427	3. Have the capability of rapid mobilization of the study
428	team within 30 minutes after emergency procedures, 24 hours a
429	day, 7 days a week.
430	4. Provide a minimum of 500 catheterizations annually.
431	(b) Diagnostic cardiac catheterization programs licensed
432	in a facility not licensed for a cardiac surgery program must
433	submit, as part of their licensure application, a written
434	protocol for the transfer of emergency patients to a hospital
435	providing cardiac surgery that is within 30 minutes' travel time
436	via air or ground transportation vehicle under average travel
437	conditions.
438	(c) Pediatric cardiac catheterization programs must be
439	located in a hospital in which pediatric cardiac surgery is
440	being performed.
441	(5) REQUIRMENTS FOR EMERGENCY/PRIMARY PERCUTANEOUS
442	CORONARY INTERVENTION PROGRAMS.--
443	(a) Each hospital providing emergency/primary percutaneous
444	coronary intervention for patients presenting with emergency
445	myocardial infarctions in a hospital without an operational
446	cardiac surgery program must comply with the following:
447	1. Provide a cardiologist or cardiovascular surgeon who is
448	an experienced interventionalist who has performed a minimum of
449	75 interventions within the previous 12 months.
450	2. Provide a minimum of 36 emergency interventions
451	annually, in order to continue to provide the service.
452	3. Provide nursing and technical staff who have
453	demonstrated experience in handling acutely ill patients
454	requiring intervention based on previous experience in dedicated
455	interventional laboratories or surgical centers and cardiac care
456	nursing staff who are adept in hemodynamic monitoring and Intra
457	Aortic Balloon Pump (IABP) management.
458	4. Provide formalized written transfer agreements,
459	developed with a hospital with an adult cardiac surgery program,
460	and put in place written transport protocols to ensure safe and
461	efficient transfer of a patient within 60 minutes. Transfer and
462	transport agreements must be reviewed and tested, with
463	appropriate documentation maintained at least every 3 months.
464	5. Certify that the facility implementing the service
465	undertook a 3-month to 6-month training program that includes
466	establishing standards, testing logistics, providing quality
467	assessment and error management practices, and formalizing
468	patient selection criteria.
469	6. Certify that it will utilize at all times at hospitals
470	without adult cardiac surgery programs the patient selection
471	criteria for the performance of primary angioplasty issued by
472	the American College of Cardiology and the American Heart
473	Association.
474	(b) The applicant must agree to submit a quarterly report
475	to the agency detailing patient characteristics and treatment
476	and outcomes for all patients receiving emergency/primary
477	percutaneous coronary interventions pursuant to this licensure
478	category. The specialty license provided by this subsection
479	shall not apply unless the agency determines that the hospital
480	has taken all necessary steps to comply with the requirements of
481	this subsection, including the training program required
482	pursuant to subparagraph (a)5.
483	(6) REQUIRMENTS FOR ELECTIVE PERCUTANEOUS CORONARY
484	INTERVENTION PROGRAMS.--
485	(a) Each hospital providing elective percutaneous coronary
486	intervention for patients in a hospital without an operational
487	adult cardiac surgery program must comply with the following:
488	1. Provide a cardiologist or cardiovascular surgeon who is
489	an experienced interventionalist who has performed a minimum of
490	150 interventions within the previous 12 months.
491	2. Provide a minimum of 400 elective interventions
492	annually, in order to continue to provide the service.
493	3. Provide nursing and technical staff who have
494	demonstrated experience in handling acutely ill patients
495	requiring intervention based on previous experience in dedicated
496	interventional laboratories or surgical centers and cardiac care
497	nursing staff who are adept in hemodynamic monitoring and Intra-
498	aortic Balloon Pump (IABP) management.
499	4. Provide formalized written transfer agreements,
500	developed with a hospital with an adult cardiac surgery program,
501	and put in place written transport protocols to ensure safe and
502	efficient transfer of a patient within 30 minutes. Transfer and
503	transport agreements must be reviewed and tested, with
504	appropriate documentation maintained at least every 3 months.
505	5. Certify that the facility implementing the service
506	undertook a 3-month to 6-month training program that includes
507	establishing standards, testing logistics, providing quality
508	assessment and error management practices, and formalizing
509	patient selection criteria.
510	6. Certify that it will utilize at all times at hospitals
511	without adult cardiac surgery programs the patient selection
512	criteria for the performance of primary angioplasty issued by
513	the American College of Cardiology and the American Heart
514	Association.
515	(b) The applicant must agree to submit a quarterly report
516	to the agency detailing patient characteristics and treatment
517	and outcomes for all patients receiving elective percutaneous
518	coronary interventions pursuant to this licensure category. This
519	report must be submitted within 45 days after the close of each
520	calendar quarter. The specialty license provided by this
521	subsection shall not apply unless the agency determines that the
522	hospital has taken all necessary steps to comply with the
523	requirements of this subsection, including the training program
524	required pursuant to subparagraph (a)5.
525	(c) Pediatric percutaneous coronary intervention programs
526	must be located in a hospital in which pediatric cardiac surgery
527	is being performed.
528	(7) REQUIRMENTS FOR CARDIAC SURGERY PROGRAMS.--
529	(a) Each hospital providing a cardiac surgery program must
530	have the capability to provide a full range of cardiac surgery
531	operations, including, at a minimum:
532	1. Repair or replacement of heart valves.
533	2. Repair of congenital heart defects.
534	3. Cardiac revascularization.
535	4. Repair or reconstruction of intrathoracic vessels.
536	5. Treatment of cardiac trauma.
537	(b) Each cardiac surgery program must document its ability
538	to implement and apply circulatory assist devices such as intra-
539	aortic balloon assist and prolonged cardiopulmonary partial
540	bypass.
541	(c) Each hospital with a cardiac surgery program shall
542	provide the following services:
543	1. Cardiology, gastroenterology, hematology, nephrology,
544	pulmonary medicine, general surgery, and treatment of infectious
545	diseases.
546	2. Pathology, including anatomical, clinical, blood bank,
547	and coagulation laboratory services.
548	3. Anesthesiology, including respiratory therapy.
549	4. Radiology, including diagnostic nuclear medicine.
550	5. Neurology.
551	6. Inpatient cardiac catheterization.
552	7. Noninvasive cardiographics, including
553	electrocardiography, exercise stress testing, and
554	echocardiography.
555	8. Intensive care.
556	9. Emergency care available 24 hours a day, 7 days a week,
557	for cardiac emergencies.
558	(d) For emergency services:
559	1. Each cardiac surgery program shall be available for
560	elective cardiac operations 8 hours a day, 5 days a week. Each
561	cardiac surgery program shall possess the capability for rapid
562	mobilization of the surgical and medical support teams for
563	emergency cases, 24 hours a day, 7 days a week.
564	2. Cardiac surgery shall routinely be available for
565	emergency cardiac surgery operations within a maximum waiting
566	period of 2 hours.
567	(e) Each cardiac surgery program shall provide a minimum
568	of 300 cardiac surgeries within the first 3 years of operation
569	and annually thereafter.
570	(f) Each hospital applying for licensure of a cardiac
571	surgery program must be a licensed general acute care hospital
572	that is in operation for 3 years or more. This section shall not
573	be construed as allowing single-service hospitals to apply for
574	licensure.
575	(g) Each cardiac surgery program shall provide nursing and
576	technical staff who have demonstrated experience in handling
577	acutely ill patients requiring intervention based on previous
578	experience in dedicated interventional laboratories or surgical
579	centers and cardiac care nursing staff who are adept in
580	hemodynamic monitoring and Intra Aortic Balloon Pump (IABP)
581	management.
582	Section 4. Subsection (5) of section 408.034, Florida
583	Statutes, is amended to read:
584	408.034 Duties and responsibilities of agency; rules.--
585	(5) The agency shall establish by rule a nursing-home-bed-
586	need methodology that has a goal of maintaining a district
587	average occupancy rate of 94 percent andthat reduces the
588	community nursing home bed need for the areas of the state where
589	the agency establishes pilot community diversion programs
590	through the Title XIX aging waiver program.
591	Section 5. Section 408.036, Florida Statutes, is amended
592	to read:
593	408.036 Projects subject to review; exemptions.--
594	(1) APPLICABILITY.--Unless exempt under subsection (3),
595	all health-care-related projects, as described in paragraphs
596	(a)-(h), are subject to review and must file an application for
597	a certificate of need with the agency. The agency is exclusively
598	responsible for determining whether a health-care-related
599	project is subject to review under ss. 408.031-408.045.
600	(a) The addition of beds by new construction or
601	alteration.
602	(b) The new construction or establishment of additional
603	health care facilities, including a replacement health care
604	facility when the proposed project site is not located on the
605	same site as the existing health care facility.
606	(c) The conversion from one type of health care facility
607	to another.
608	(d) An increase in the total licensed bed capacity of a
609	health care facility.
610	(e) The establishment of a hospice or hospice inpatient
611	facility, except as provided in s. 408.043.
612	(f) The establishment of inpatient health services by a
613	health care facility, or a substantial change in such services.
614	(g) An increase in the number of beds for acute care,
615	nursing home care beds, specialty burn units, neonatal intensive
616	care units, comprehensive rehabilitation, mental health
617	services, or hospital-based distinct part skilled nursing units,
618	or at a long-term care hospital.
619	(h) The establishment of tertiary health services.
620	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
621	pursuant to subsection (3), projects subject to an expedited
622	review shall include, but not be limited to:
623	(a) Research, education, and training programs.
624	(b) Shared services contracts or projects.
625	(b)(c) A transfer of a certificate of need, except that
626	when an existing hospital is acquired by a purchaser, all
627	certificates of need issued to the hospital which are not yet
628	operational shall be acquired by the purchaser without the need
629	for a transfer.
630	(c)(d)A 50-percent increase in nursing home beds for a
631	facility incorporated and operating in this state for at least
632	60 years on or before July 1, 1988, which has a licensed nursing
633	home facility located on a campus providing a variety of
634	residential settings and supportive services. The increased
635	nursing home beds shall be for the exclusive use of the campus
636	residents. Any application on behalf of an applicant meeting
637	this requirement shall be subject to the base fee of $5,000
638	provided in s. 408.038.
639	(d)(e)Replacement of a health care facility when the
640	proposed project site is located in the same district and within
641	a 1-mile radius of the replaced health care facility.
642	(e)(f)The conversion of mental health services beds
643	licensed under chapter 395 or hospital-based distinct part
644	skilled nursing unit beds to general acute care beds; the
645	conversion of mental health services beds between or among the
646	licensed bed categories defined as beds for mental health
647	services;or the conversion of general acute care beds to beds
648	for mental health services.
649	1. Conversion under this paragraph shall not establish a
650	new licensed bed category at the hospital but shall apply only
651	to categories of beds licensed at that hospital.
652	2. Beds converted under this paragraph must be licensed
653	and operational for at least 12 months before the hospital may
654	apply for additional conversion affecting beds of the same type.
655	(f) Replacement of a nursing home within the same
656	district, provided the proposed project site is located within a
657	geographic area that contains at least 65 percent of the
658	facility's current residents and is within a 30-mile radius of
659	the replaced nursing home.
660	(g) Relocation of a portion of a nursing home's licensed
661	beds to a replacement facility within the same district,
662	provided the relocation is within a 30-mile radius of the
663	existing facility and the total number of nursing home beds in
664	the district does not increase.
665
666	The agency shall develop rules to implement the provisions for
667	expedited review, including time schedule, application content
668	which may be reduced from the full requirements of s.
669	408.037(1), and application processing.
670	(3) EXEMPTIONS.--Upon request, the following projects are
671	subject to exemption from the provisions of subsection (1):
672	(a) For replacement of a licensed health care facility on
673	the same site, provided that the number of beds in each licensed
674	bed category will not increase.
675	(b) For hospice services or for swing beds in a rural
676	hospital, as defined in s. 395.602, in a number that does not
677	exceed one-half of its licensed beds.
678	(c) For the conversion of licensed acute care hospital
679	beds to Medicare and Medicaid certified skilled nursing beds in
680	a rural hospital, as defined in s. 395.602, so long as the
681	conversion of the beds does not involve the construction of new
682	facilities. The total number of skilled nursing beds, including
683	swing beds, may not exceed one-half of the total number of
684	licensed beds in the rural hospital as of July 1, 1993.
685	Certified skilled nursing beds designated under this paragraph,
686	excluding swing beds, shall be included in the community nursing
687	home bed inventory. A rural hospital which subsequently
688	decertifies any acute care beds exempted under this paragraph
689	shall notify the agency of the decertification, and the agency
690	shall adjust the community nursing home bed inventory
691	accordingly.
692	(d) For the addition of nursing home beds at a skilled
693	nursing facility that is part of a retirement community that
694	provides a variety of residential settings and supportive
695	services and that has been incorporated and operated in this
696	state for at least 65 years on or before July 1, 1994. All
697	nursing home beds must not be available to the public but must
698	be for the exclusive use of the community residents.
699	(e) For an increase in the bed capacity of a nursing
700	facility licensed for at least 50 beds as of January 1, 1994,
701	under part II of chapter 400 which is not part of a continuing
702	care facility if, after the increase, the total licensed bed
703	capacity of that facility is not more than 60 beds and if the
704	facility has been continuously licensed since 1950 and has
705	received a superior rating on each of its two most recent
706	licensure surveys.
707	(f) For an inmate health care facility built by or for the
708	exclusive use of the Department of Corrections as provided in
709	chapter 945. This exemption expires when such facility is
710	converted to other uses.
711	(g) For the termination of an inpatient health care
712	service, upon 30 days' written notice to the agency.
713	(h) For the delicensure of beds, upon 30 days' written
714	notice to the agency. A request for exemption submitted under
715	this paragraph must identify the number, the category of beds,
716	and the name of the facility in which the beds to be delicensed
717	are located.
718	(i) For the provision of adult inpatient diagnostic
719	cardiac catheterization services in a hospital.
720	1. In addition to any other documentation otherwise
721	required by the agency, a request for an exemption submitted
722	under this paragraph must comply with the following criteria:
723	a. The applicant must certify it will not provide
724	therapeutic cardiac catheterization pursuant to the grant of the
725	exemption.
726	b. The applicant must certify it will meet and
727	continuously maintain the minimum licensure requirements adopted
728	by the agency governing such programs pursuant to subparagraph
729	2.
730	c. The applicant must certify it will provide a minimum of
731	2 percent of its services to charity and Medicaid patients.
732	2. The agency shall adopt licensure requirements by rule
733	which govern the operation of adult inpatient diagnostic cardiac
734	catheterization programs established pursuant to the exemption
735	provided in this paragraph. The rules shall ensure that such
736	programs:
737	a. Perform only adult inpatient diagnostic cardiac
738	catheterization services authorized by the exemption and will
739	not provide therapeutic cardiac catheterization or any other
740	services not authorized by the exemption.
741	b. Maintain sufficient appropriate equipment and health
742	personnel to ensure quality and safety.
743	c. Maintain appropriate times of operation and protocols
744	to ensure availability and appropriate referrals in the event of
745	emergencies.
746	d. Maintain appropriate program volumes to ensure quality
747	and safety.
748	e. Provide a minimum of 2 percent of its services to
749	charity and Medicaid patients each year.
750	3.a. The exemption provided by this paragraph shall not
751	apply unless the agency determines that the program is in
752	compliance with the requirements of subparagraph 1. and that the
753	program will, after beginning operation, continuously comply
754	with the rules adopted pursuant to subparagraph 2. The agency
755	shall monitor such programs to ensure compliance with the
756	requirements of subparagraph 2.
757	b.(I) The exemption for a program shall expire immediately
758	when the program fails to comply with the rules adopted pursuant
759	to sub-subparagraphs 2.a., b., and c.
760	(II) Beginning 18 months after a program first begins
761	treating patients, the exemption for a program shall expire when
762	the program fails to comply with the rules adopted pursuant to
763	sub-subparagraphs 2.d. and e.
764	(III) If the exemption for a program expires pursuant to
765	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
766	agency shall not grant an exemption pursuant to this paragraph
767	for an adult inpatient diagnostic cardiac catheterization
768	program located at the same hospital until 2 years following the
769	date of the determination by the agency that the program failed
770	to comply with the rules adopted pursuant to subparagraph 2.
771	(j) For mobile surgical facilities and related health care
772	services provided under contract with the Department of
773	Corrections or a private correctional facility operating
774	pursuant to chapter 957.
775	(k) For state veterans' nursing homes operated by or on
776	behalf of the Florida Department of Veterans' Affairs in
777	accordance with part II of chapter 296 for which at least 50
778	percent of the construction cost is federally funded and for
779	which the Federal Government pays a per diem rate not to exceed
780	one-half of the cost of the veterans' care in such state nursing
781	homes. These beds shall not be included in the nursing home bed
782	inventory.
783	(l) For combination within one nursing home facility of
784	the beds or services authorized by two or more certificates of
785	need issued in the same planning subdistrict. An exemption
786	granted under this paragraph shall extend the validity period of
787	the certificates of need to be consolidated by the length of the
788	period beginning upon submission of the exemption request and
789	ending with issuance of the exemption. The longest validity
790	period among the certificates shall be applicable to each of the
791	combined certificates.
792	(m) For division into two or more nursing home facilities
793	of beds or services authorized by one certificate of need issued
794	in the same planning subdistrict. An exemption granted under
795	this paragraph shall extend the validity period of the
796	certificate of need to be divided by the length of the period
797	beginning upon submission of the exemption request and ending
798	with issuance of the exemption.
799	(n) For the addition of hospital beds licensed under
800	chapter 395.
801	1. Beds in the following licensed categories may be
802	increased under this paragraph:
803	a.for Acute care beds, mental health services, or a
804	hospital-based distinct part skilled nursing unitin a number
805	that may not exceed 3010total beds or 10 percent of the
806	licensed capacity of acute care bedsthe bed category being
807	expanded, whichever is greater;
808	b. Hospital-based distinct part skilled nursing unit beds,
809	in a number that may not exceed 10 total beds or 10 percent of
810	the licensed capacity of skilled nursing unit beds, whichever is
811	greater;
812	c. Comprehensive medical rehabilitation beds in a number
813	that may not exceed 8 total beds or 10 percent of the licensed
814	capacity of comprehensive medical rehabilitation beds, whichever
815	is greater;
816	d. Level II or Level III neonatal intensive care beds, in
817	a number that may not exceed 6 total beds or 10 percent of the
818	licensed capacity of Level II or Level III neonatal intensive
819	care beds, whichever is greater; or
820	e. Mental health services beds, in a number that may not
821	exceed 10 total beds or 10 percent of the licensed capacity of
822	mental health services beds, whichever is greater.
823	2. Beds for specialty burn units, neonatal intensive care
824	units, or comprehensive rehabilitation,or at a long-term care
825	hospital,may not be increased under this paragraph.
826	3.1.In addition to any other documentation otherwise
827	required by the agency, a request for exemption submitted under
828	this paragraph must:
829	a. Certify that the prior 12-month average occupancy rate
830	is at least 75 percent for acute care beds, at least 96 percent
831	for the category of licensed beds being expanded at the facility
832	meets or exceeds 80 percent or, for ahospital-based distinct
833	part skilled nursing unit beds, at least 90 percent for
834	comprehensive medical rehabilitation beds, or at least 75 percent
835	for the level of neonatal intensive care beds being expandedthe
836	prior 12-month average occupancy rate meets or exceeds 96
837	percent.
838	b. Certify that any beds of the same type authorized for
839	the facility under this paragraph before the date of the current
840	request for an exemption have been licensed and operational for
841	at least 12 months.
842	4.2.The timeframes and monitoring process specified in s.
843	408.040(2)(a)-(c) apply to any exemption issued under this
844	paragraph.
845	5.3.The agency shall count beds authorized under this
846	paragraph as approved beds in the published inventory of
847	hospital beds until the beds are licensed.
848	(o) For the addition of acute care beds, as authorized by
849	rule consistent with s. 395.003(4), in a number that may not
850	exceed 3010total beds or 10 percent of licensed bed capacity,
851	whichever is greater, for temporary beds in a hospital that has
852	experienced high seasonal occupancy within the prior 12-month
853	period or in a hospital that must respond to emergency
854	circumstances.
855	(p) For the addition of nursing home beds licensed under
856	chapter 400 in a number not exceeding 10 total beds or 10
857	percent of the number of beds licensed in the facility being
858	expanded, whichever is greater.
859	1. In addition to any other documentation required by the
860	agency, a request for exemption submitted under this paragraph
861	must:
862	a. Effective until June 30, 2001,Certify that the
863	facility has not had any class I or class II deficiencies within
864	the 30 months preceding the request for addition.
865	b. Effective on July 1, 2001, certify that the facility
866	has been designated as a Gold Seal nursing home under s.
867	400.235.
868	b.c.Certify that the prior 12-month average occupancy
869	rate for the nursing home beds at the facility meets or exceeds
870	96 percent.
871	c.d.Certify that any beds authorized for the facility
872	under this paragraph before the date of the current request for
873	an exemption have been licensed and operational for at least 12
874	months.
875	2. The timeframes and monitoring process specified in s.
876	408.040(2)(a)-(c) apply to any exemption issued under this
877	paragraph.
878	3. The agency shall count beds authorized under this
879	paragraph as approved beds in the published inventory of nursing
880	home beds until the beds are licensed.
881	(q) For establishment of a specialty hospital offering a
882	range of medical service restricted to a defined age or gender
883	group of the population or a restricted range of services
884	appropriate to the diagnosis, care, and treatment of patients
885	with specific categories of medical illnesses or disorders,
886	through the transfer of beds and services from an existing
887	hospital in the same county.
888	(q)(r)For the conversion of hospital-based Medicare and
889	Medicaid certified skilled nursing beds to acute care beds, if
890	the conversion does not involve the construction of new
891	facilities.
892	(r) For the conversion of mental health services beds
893	between or among the licensed bed categories defined as beds for
894	mental health services, provided that conversion under this
895	paragraph shall not establish a new licensed bed category at the
896	hospital but shall apply only to categories of beds licensed at
897	that hospital.
898	(s) For the replacement of a statutory rural hospital
899	within the same district, provided the proposed project site is
900	within 10 miles of the existing facility and is within the
901	current primary service area, defined as the least number of zip
902	codes comprising 75 percent of the hospital's inpatient
903	admissions.
904	(t) For the establishment of a Level II neonatal intensive
905	care unit with at least 10 beds, upon documentation to the
906	agency that the applicant hospital had a minimum of 1,500 births
907	during the previous 12 months.
908	(u) For replacement of a licensed nursing home on the same
909	site, or within 3 miles of the same site, provided the number of
910	licensed beds does not increase.
911	(v) For consolidation or combination of licensed nursing
912	homes or transfer of beds between licensed nursing homes within
913	the same district, by providers that operate multiple nursing
914	homes within that district, provided there is no increase in the
915	district total of nursing home beds and the relocation does not
916	exceed 30 miles from the original location.
917	(w) For the establishment of an adult open-heart program
918	in a facility located in a municipality without an open-heart
919	program which has a population of 225,000 or more.
920	(s) For fiscal year 2001-2002 only, for transfer by a
921	health care system of existing services and not more than 100
922	licensed and approved beds from a hospital in district 1,
923	subdistrict 1, to another location within the same subdistrict
924	in order to establish a satellite facility that will improve
925	access to outpatient and inpatient care for residents of the
926	district and subdistrict and that will use new medical
927	technologies, including advanced diagnostics, computer assisted
928	imaging, and telemedicine to improve care. This paragraph is
929	repealed on July 1, 2002.
930	(4) A request for exemption under subsection (3) may be
931	made at any time and is not subject to the batching requirements
932	of this section. The request shall be supported by such
933	documentation as the agency requires by rule. The agency shall
934	assess a fee of $250 for each request for exemption submitted
935	under subsection (3).
936	Section 6. Paragraph (c) of subsection (1) and subsection
937	(2) of section 408.037, Florida Statutes, are amended to read:
938	408.037 Application content.--
939	(1) An application for a certificate of need must contain:
940	(c) An audited financial statement of the applicant; or,
941	if the applicant is included in a parent company's consolidated
942	audit which details each entity separately, an audited financial
943	statement of the parent company. In an application submitted by
944	an existing health care facility, health maintenance
945	organization, or hospice, financial condition documentation must
946	include, but need not be limited to, a balance sheet and a
947	profit-and-loss statement of the 2 previous fiscal years'
948	operation.
949	(2) The applicant must certify that it will license and
950	operate the health care facility. For an existing health care
951	facility, the applicant must be the licenseholder of the
952	facility. However, acquisition of a licensed hospital prior to
953	final agency action on its application for a certificate of need
954	shall transfer the application to the new owner and
955	licenseholder.
956	Section 7. Section 408.038, Florida Statutes, is amended
957	to read:
958	408.038 Fees.--
959	(1)The agency shall assess fees on certificate-of-need
960	applications. Such fees shall be for the purpose of funding the
961	functions of the local health councils andthe activities of the
962	agency. Except as otherwise provided in subsection (2), such
963	feesandshall be allocated as provided in s. 408.033. The fee
964	shall be determined as follows:
965	(a)(1) A minimum base fee of $10,000$5,000.
966	(b)(2) In addition to the base fee of $10,000$5,000,
967	0.015 of each dollar of proposed expenditure, except that a fee
968	may not exceed $50,000$22,000.
969	(2) The proceeds from half of each minimum base fee under
970	paragraph (1)(a) and the proceeds from each additional amount
971	assessed under paragraph (1)(b) which is in excess of $22,000
972	shall be used to fund activities of the certificate-of-need
973	program.
974	Section 8. Paragraphs (c) and (e) of subsection (5) and
975	paragraph (c) of subsection (6) of section 408.039, Florida
976	Statutes, are amended to read:
977	408.039 Review process.--The review process for
978	certificates of need shall be as follows:
979	(5) ADMINISTRATIVE HEARINGS.--
980	(c) In administrative proceedings challenging the issuance
981	or denial of a certificate of need, only applicants considered
982	by the agency in the same batching cycle are entitled to a
983	comparative hearing on their applications. Existing health care
984	facilities may initiate or intervene in an administrative
985	hearing upon a showing that an established program will be
986	substantially affected by the issuance of any certificate of
987	need, whether reviewed under s. 408.036(1) or (2), to a
988	competing proposed facility or program within the same district.
989	(e) The agency shall issue its final order within 45 days
990	after receipt of the recommended order. If the agency fails to
991	take action within 45 days, the recommended order of the
992	Division of Administrative Hearings becomes the agency's final
993	ordersuch time, or as otherwise agreed to by the applicant and
994	the agency, the applicant may take appropriate legal action to
995	compel the agency to act. When making a determination on an
996	application for a certificate of need, the agency is
997	specifically exempt from the time limitations provided in s.
998	120.60(1).
999	(6) JUDICIAL REVIEW.--
1000	(c) The court, in its discretion, may award reasonable
1001	attorney's fees and costs to the prevailing party. If the losing
1002	party is a hospital, the court shall order it to pay the
1003	reasonable attorney's fees and costs of the prevailing hospital
1004	party, which shall include fees and costs incurred as a result
1005	of the administrative hearing and the judicial appealif the
1006	court finds that there was a complete absence of a justiciable
1007	issue of law or fact raised by the losing party.
1008	Section 9. Subsection (2) of section 408.043, Florida
1009	Statutes, is amended to read:
1010	408.043 Special provisions.--
1011	(2) HOSPICES.--When an application is made for a
1012	certificate of need to establish or to expand a hospice, the
1013	need for such hospice shall be determined on the basis of the
1014	need for and availability of hospice services in the community.
1015	The formula on which the certificate of need is based shall
1016	discourage regional monopolies and promote competition. The
1017	inpatient hospice care component of a hospice which is a
1018	freestanding facility, or a part of a facility, which is
1019	primarily engaged in providing inpatient care and related
1020	services and is not licensed as a health care facility shall
1021	also be required to obtain a certificate of need.Provision of
1022	hospice care by any current provider of health care is a
1023	significant change in service and therefore requires a
1024	certificate of need for such services.
1025	Section 10. Subsection (9) of section 408.05, Florida
1026	Statutes, is renumbered as subsection (10) and amended, and a
1027	new subsection (9) is added to said section, to read:
1028	408.05 State Center for Health Statistics.--
1029	(9) OUTCOME MEASURES.--The agency shall establish,
1030	implement, and evaluate scientifically sound and clinically
1031	relevant quality outcome measures for cardiac programs in order
1032	to reduce unwarranted variation in the delivery of cardiac care,
1033	improve the quality of cardiac care, and promote the appropriate
1034	utilization of cardiac services.
1035	(a) The agency, in conjunction with the Florida Hospital
1036	Association, the Florida Society of Thoracic and Cardiovascular
1037	Surgeons, the Florida Chapter of the American College of
1038	Cardiology, and the Florida Chapter of the American Heart
1039	Association shall develop and adopt by rule state quality
1040	outcome measures based on data received pursuant to this
1041	subsection, as well as on nationally developed quality outcome
1042	measures.
1043	(b) The outcome measures shall be based on the data
1044	elements reported by hospitals licensed under s. 395.0095,
1045	simultaneously to the Society of Thoracic Surgeons' data base
1046	and the agency. The data shall be aggregated to establish
1047	statewide norms for cardiac programs and cardiac surgery. The
1048	data shall be adjusted by risk and used to determine morbidity
1049	and mortality rates for operative categories by surgical
1050	urgency. Other measures shall include, but not be limited to,
1051	infection rates, nonfatal myocardial infarctions, lengths of
1052	stay, postoperative bleeds, and returns to surgery for operative
1053	categories by surgical urgency. Where appropriate, the rates
1054	shall be adjusted for age.
1055	(c) Every hospital with a licensed cardiac program, in
1056	conjunction with the hospital medical staff, shall produce
1057	quality outcome data pursuant to the criteria developed in this
1058	subsection. The hospital shall forward such data to the agency
1059	in a manner consistent with s. 408.061 on a quarterly basis
1060	beginning July 1, 2003. As used in this subsection, "hospital"
1061	means an acute care hospital licensed under chapter 395.
1062	(d) The agency shall summarize the quality outcome
1063	measures for cardiac procedures by hospital, by district, by
1064	region, and across the state. The agency shall make the report
1065	available to the public and all hospitals throughout the state
1066	on an annual basis beginning December 31, 2006. The agency shall
1067	also make detail data submitted pursuant to this subsection
1068	available for analysis by others, subject to protection of
1069	confidentiality pursuant to s. 408.061.
1070	(e) Parameters developed pursuant to this subsection shall
1071	be made available to the public, all hospitals, and health
1072	professionals by publication on the agency's website or in
1073	writing upon written request.
1074	(f) Procedures shall be instituted which provide for the
1075	periodic review and revision of quality outcome measures based
1076	on the latest outcome data, research findings, technological
1077	advancements, and clinical experiences, at least once every 2
1078	years.
1079	(10)(9)SECTION NOT LIMITING.--Nothing in this section
1080	shall limit, restrict, affect, or control the collection,
1081	analysis, release, or publication of data by any state agency
1082	pursuant to its statutory authority, duties, or
1083	responsibilities.
1084	Section 11. Section 52 of chapter 2001-45, Laws of
1085	Florida, is amended to read:
1086	Section 52. (1)Notwithstanding the establishment of need
1087	as provided for in chapter 408, Florida Statutes, no certificate
1088	of need for additional community nursing home beds shall be
1089	approved by the agency until July 1, 2006.
1090	(2)The Legislature finds that the continued growth in the
1091	Medicaid budget for nursing home care has constrained the
1092	ability of the state to meet the needs of its elderly residents
1093	through the use of less restrictive and less institutional
1094	methods of long-term care. It is therefore the intent of the
1095	Legislature to limit the increase in Medicaid nursing home
1096	expenditures in order to provide funds to invest in long-term
1097	care that is community-based and provides supportive services in
1098	a manner that is both more cost-effective and more in keeping
1099	with the wishes of the elderly residents of this state.
1100	(3)This moratorium on certificates of need shall not
1101	apply to sheltered nursing home beds in a continuing care
1102	retirement community certified by the Department of Insurance
1103	pursuant to chapter 651, Florida Statutes.
1104	(4)(a) This moratorium on certificates of need shall not
1105	apply, and a certificate of need for additional community nursing
1106	home beds may be approved, for a county that meets the following
1107	circumstances:
1108	1. The county has no community nursing home beds.
1109	2. The lack of community nursing home beds occurs because
1110	all nursing home beds in the county that were licensed on July
1111	1, 2001, have subsequently closed.
1112	(b) The certificate-of-need review for such circumstances
1113	shall be subject to the comparative review process consistent
1114	with the provisions of s. 408.039, Florida Statutes, and the
1115	number of beds may not exceed the number of beds lost by the
1116	county after July 1, 2001.
1117	Section 12. Subsection (4) of section 383.50, Florida
1118	Statutes, is amended to read:
1119	383.50 Treatment of abandoned newborn infant.--
1120	(4) Each hospital of this state subject to s. 395.1041
1121	shall, and any other hospital may, admit and provide all
1122	necessary emergency services and care, as defined in s.
1123	395.002(15)(10), to any newborn infant left with the hospital in
1124	accordance with this section. The hospital or any of its
1125	licensed health care professionals shall consider these actions
1126	as implied consent for treatment, and a hospital accepting
1127	physical custody of a newborn infant has implied consent to
1128	perform all necessary emergency services and care. The hospital
1129	or any of its licensed health care professionals is immune from
1130	criminal or civil liability for acting in good faith in
1131	accordance with this section. Nothing in this subsection limits
1132	liability for negligence.
1133	Section 13. Subsection (7) of section 394.4787, Florida
1134	Statutes, is amended to read:
1135	394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788,
1136	and 394.4789.--As used in this section and ss. 394.4786,
1137	394.4788, and 394.4789:
1138	(7) "Specialty psychiatric hospital" means a hospital
1139	licensed by the agency pursuant to s. 395.002(36)(29)as a
1140	specialty psychiatric hospital.
1141	Section 14. Paragraph (c) of subsection (2) of section
1142	395.602, Florida Statutes, is amended to read:
1143	395.602 Rural hospitals.--
1144	(2) DEFINITIONS.--As used in this part:
1145	(c) "Inactive rural hospital bed" means a licensed acute
1146	care hospital bed, as defined in s. 395.002(19)(14), that is
1147	inactive in that it cannot be occupied by acute care inpatients.
1148	Section 15. Paragraph (c) of subsection (1) of section
1149	395.701, Florida Statutes, is amended to read:
1150	395.701 Annual assessments on net operating revenues for
1151	inpatient and outpatient services to fund public medical
1152	assistance; administrative fines for failure to pay assessments
1153	when due; exemption.--
1154	(1) For the purposes of this section, the term:
1155	(c) "Hospital" means a health care institution as defined
1156	in s. 395.002(18)(13), but does not include any hospital
1157	operated by the agency or the Department of Corrections.
1158	Section 16. Paragraph (b) of subsection (1) of section
1159	400.051, Florida Statutes, is amended to read:
1160	400.051 Homes or institutions exempt from the provisions
1161	of this part.--
1162	(1) The following shall be exempt from the provisions of
1163	this part:
1164	(b) Any hospital, as defined in s. 395.002(16)(11), that
1165	is licensed under chapter 395.
1166	Section 17. Subsection (8) of section 409.905, Florida
1167	Statutes, is amended to read:
1168	409.905 Mandatory Medicaid services.--The agency may make
1169	payments for the following services, which are required of the
1170	state by Title XIX of the Social Security Act, furnished by
1171	Medicaid providers to recipients who are determined to be
1172	eligible on the dates on which the services were provided. Any
1173	service under this section shall be provided only when medically
1174	necessary and in accordance with state and federal law.
1175	Mandatory services rendered by providers in mobile units to
1176	Medicaid recipients may be restricted by the agency. Nothing in
1177	this section shall be construed to prevent or limit the agency
1178	from adjusting fees, reimbursement rates, lengths of stay,
1179	number of visits, number of services, or any other adjustments
1180	necessary to comply with the availability of moneys and any
1181	limitations or directions provided for in the General
1182	Appropriations Act or chapter 216.
1183	(8) NURSING FACILITY SERVICES.--The agency shall pay for
1184	24-hour-a-day nursing and rehabilitative services for a
1185	recipient in a nursing facility licensed under part II of
1186	chapter 400 or in a rural hospital, as defined in s. 395.602, or
1187	in a Medicare certified skilled nursing facility operated by a
1188	hospital, as defined by s. 395.002(16)(11), that is licensed
1189	under part I of chapter 395, and in accordance with provisions
1190	set forth in s. 409.908(2)(a), which services are ordered by and
1191	provided under the direction of a licensed physician. However,
1192	if a nursing facility has been destroyed or otherwise made
1193	uninhabitable by natural disaster or other emergency and another
1194	nursing facility is not available, the agency must pay for
1195	similar services temporarily in a hospital licensed under part I
1196	of chapter 395 provided federal funding is approved and
1197	available.
1198	Section 18. Paragraph (l) of subsection (1) of section
1199	468.505, Florida Statutes, is amended to read:
1200	468.505 Exemptions; exceptions.--
1201	(1) Nothing in this part may be construed as prohibiting
1202	or restricting the practice, services, or activities of:
1203	(l) A person employed by a nursing facility exempt from
1204	licensing under s. 395.002(18)(13), or a person exempt from
1205	licensing under s. 464.022.
1206	Section 19. Section 766.316, Florida Statutes, is amended
1207	to read:
1208	766.316 Notice to obstetrical patients of participation in
1209	the plan.--Each hospital with a participating physician on its
1210	staff and each participating physician, other than residents,
1211	assistant residents, and interns deemed to be participating
1212	physicians under s. 766.314(4)(c), under the Florida Birth-
1213	Related Neurological Injury Compensation Plan shall provide
1214	notice to the obstetrical patients as to the limited no-fault
1215	alternative for birth-related neurological injuries. Such notice
1216	shall be provided on forms furnished by the association and
1217	shall include a clear and concise explanation of a patient's
1218	rights and limitations under the plan. The hospital or the
1219	participating physician may elect to have the patient sign a
1220	form acknowledging receipt of the notice form. Signature of the
1221	patient acknowledging receipt of the notice form raises a
1222	rebuttable presumption that the notice requirements of this
1223	section have been met. Notice need not be given to a patient
1224	when the patient has an emergency medical condition as defined
1225	in s. 395.002(13)(9)(b) or when notice is not practicable.
1226	Section 20. Paragraph (b) of subsection (2) of section
1227	812.014, Florida Statutes, is amended to read:
1228	812.014 Theft.--
1229	(2)
1230	(b)1. If the property stolen is valued at $20,000 or more,
1231	but less than $100,000;
1232	2. The property stolen is cargo valued at less than
1233	$50,000 that has entered the stream of interstate or intrastate
1234	commerce from the shipper's loading platform to the consignee's
1235	receiving dock; or
1236	3. The property stolen is emergency medical equipment,
1237	valued at $300 or more, that is taken from a facility licensed
1238	under chapter 395 or from an aircraft or vehicle permitted under
1239	chapter 401,
1240
1241	the offender commits grand theft in the second degree,
1242	punishable as a felony of the second degree, as provided in s.
1243	775.082, s. 775.083, or s. 775.084. Emergency medical equipment
1244	means mechanical or electronic apparatus used to provide
1245	emergency services and care as defined in s. 395.002(15)(10)or
1246	to treat medical emergencies.
1247	Section 21. (1) A facility authorized by the state to
1248	provide services under any of the following authorized programs
1249	pursuant to state authorization or a valid certificate of need
1250	on June 30, 2003, shall continue to be licensed to provide such
1251	service on and after the effective date of this act:
1252	(a) Diagnostic cardiac catheterization program.
1253	(b) Emergency percutaneous coronary intervention program.
1254	(c) Percutaneous coronary intervention program.
1255	(d) Cardiac surgery program.
1256	(2) Facilities applying for relicensure to provide such
1257	services pursuant to the provisions of this act are authorized
1258	to continue to operate until the Agency for Health Care
1259	Administration takes final action on the licensure application.
1260	Section 22. Subsection (5) of section 408.043, Florida
1261	Statutes, as created by section 1 of Senate Bill 1568, 2003
1262	Regular Session, is amended to read:
1263	408.043 Special provisions.--
1264	(5) SOLE ACUTE CARE HOSPITALS IN HIGH GROWTH
1265	COUNTIES.--Notwithstanding any other provision of law, an acute
1266	care hospital licensed under chapter 395 may add up to 180
1267	additional beds without agency review if such hospital is
1268	located in a county that has experienced at least a 60-percent
1269	growth rate for the most recent 10-year period for which data
1270	are available as determined by using the population statistics
1271	published in the most recent edition of the Florida Statistical
1272	Abstract, is the sole acute care hospital in the county, and is
1273	the only acute care hospital within a 10-mile radius of another
1274	hospital. A hospital shall provide written notice to the agency
1275	that it qualifies under this subsection prior to the addition of
1276	beds. Such projects shall not be subject to challenge under s.
1277	408.039 or chapter 120. Acute care beds added under this
1278	subsection shall notbe included in the inventory of hospital
1279	beds used by the agency in the calculation of the fixed-bed-need
1280	pool for acute care hospitals.
1281	Section 23. This act shall take effect July 1, 2003.