HB 1699

1	A bill to be entitled
2	An act relating to certificates of need; amending s.
3	395.003, F.S.; prohibiting the Agency for Health Care
4	Administration from issuing or renewing a hospital's
5	license if more than a specified percentage of the
6	hospital's patients receive care and treatment classified
7	in specified diagnostic-related groups; providing an
8	exemption; authorizing the agency to adopt rules; amending
9	s. 408.032, F.S.; revising definitions relating to health
10	facilities and services; amending s. 408.033, F.S.;
11	requiring that local health councils serve counties in a
12	health service planning district; directing the local
13	health council to develop a plan for services at the local
14	level with the Department of Health; providing for the
15	costs of operating a local health council to come from
16	assessments imposed on selected health care facilities;
17	directing the department to enter into contracts with the
18	local health councils for certain services; amending s.
19	408.034, F.S.; conforming provisions to changes made by
20	the act; amending s. 408.035, F.S.; revising criteria for
21	reviewing an application for a certificate-of-need;
22	amending s. 408.036, F.S.; revising health-care-related
23	projects that are subject to the certificate-of-need
24	process; revising health-care-related projects that are
25	subject to an expedited certificate-of-need process;
26	revising the list of projects exempt from the certificate-
27	of-need process; requiring health care facilities and
28	providers to notify the agency of certain specified
29	activities; amending s. 408.0361, F.S.; requiring the
30	agency to adopt rules for licensure standards for adult
31	interventional cardiology services and burn units;
32	providing minimum criteria for inclusion in the rules;
33	providing that certain health care providers of adult
34	interventional cardiology services are exempt from
35	complying with the rules for 2 years following the date of
36	their next license renewal, but must meet the licensure
37	standards thereafter; requiring the agency to license two
38	levels of treatment for adult interventional cardiology
39	services; providing criteria for the two levels of
40	licensure; directing the Secretary of Health Care
41	Administration to appoint an advisory group to study the
42	issue of replacing certificate-of-need review of organ
43	transplant programs operating under ch. 408, F.S., with
44	licensure regulation of organ transplant programs under
45	ch. 395, F.S.; providing for membership; requiring the
46	advisory group to make certain recommendations; directing
47	the advisory group to submit a report to the Governor, the
48	secretary, and the Legislature by a specific date;
49	amending s. 408.038, F.S.; increasing fees for
50	certificate-of-need applications; amending s. 408.039,
51	F.S.; providing for an annual review cycle for
52	certificate-of-need applications; revising the review
53	procedures; amending s. 408.040, F.S.; providing for
54	conditions and monitoring for holders of a certificate of
55	need or an exemption certificate; providing that failure
56	to report to the agency constitutes noncompliance with
57	conditions of the certificate; amending s. 408.0455, F.S.;
58	providing that rules of the agency in effect on June 30,
59	2004, shall remain in effect until amended or repealed;
60	repealing s. 408.043(2), F.S., relating to special
61	provisions for hospice facilities; repealing s. 408.045,
62	F.S., relating to the use of a competitive sealed proposal
63	to obtain a certificate of need for an intermediate care
64	facility for the developmentally disabled; providing an
65	effective date.
66
67	WHEREAS, the Legislature finds that it is essential for the
68	public health and safety of this state that general hospitals be
69	available to serve the residents of this state, and
70	WHEREAS, the Legislature finds that over 60 general
71	hospitals have closed in this state and the Legislature is
72	concerned that more hospitals may close, and
73	WHEREAS, the Legislature finds that creating hospitals that
74	provide limited services will serve only paying patients and may
75	cause harm to the continued existence of general hospitals
76	serving broad populations of this state, and
77	WHEREAS, the Legislature finds that creating hospitals that
78	provide limited services may limit or eliminate competitive
79	alternatives in the health care service market; may result in
80	over-utilization of certain high-cost health care services, such
81	as cardiac, orthopedic, and cancer services; may increase costs
82	to the health care system; and may adversely affect the quality
83	of health care, NOW, THEREFORE,
84
85	Be It Enacted by the Legislature of the State of Florida:
86
87	Section 1.  Subsection (9) is added to section 395.003,
88	Florida Statutes, to read:
89	395.003  Licensure; issuance, renewal, denial,
90	modification, suspension, and revocation.--
91	(9)(a)  A hospital may not be licensed under this part, or
92	have its license renewed, if 65 percent or more of its
93	discharged patients, as reported to the Agency for Health Care
94	Administration under s. 408.061, received diagnosis, care, and
95	treatment within the following diagnostic-related groups:
96	1.  Cardiac-related diseases and disorders classified as
97	DRGs 103-145, 478-479, 514-518, 525-527;
98	2.  Orthopedic-related diseases and disorders classified as
99	DRGs 209-256, 471, 491, 496-503, 519-520;
100	3.  Cancer-related diseases and disorders classified as
101	DRGs 64, 82, 172, 173, 199, 200, 203, 257-260, 274, 275, 303,
102	306, 307, 318, 319, 338, 344, 346, 347, 363, 366, 367, 400-414,
103	473, 492; or
104	4.  Any combination of the above discharges.
105
106	The agency may not issue or renew a hospital's license if the
107	hospital's actual discharges in the most recent year for which
108	data is available, or the projected discharges over the next 12
109	months, meet the criteria of this subsection. The agency shall
110	revoke a hospital's license if the hospital fails to meet these
111	criteria during any year of operation.
112	(b)  Hospitals licensed on or before June 1, 2004, shall be
113	exempt from the requirements in this subsection if the hospital
114	maintains the same ownership, facility street address, and range
115	of services provided on June 1, 2004.
116	(c)  The agency may adopt rules to administer this
117	subsection. However, the statutory requirements are applicable
118	on July 1, 2004. In any administrative proceeding challenging
119	the denial or revocation of a hospital's license under this
120	subsection, the hearing shall be based on the facts and law in
121	effect at the time of the agency's proposed agency action. Any
122	hospital may initiate or intervene in an administrative hearing
123	to deny or revoke the license of a competing hospital located
124	within the same district or service area on a showing that one
125	of the hospital's established programs will be substantially
126	affected if a license is issued to the competing hospital.
127	Section 2.  Section 408.032, Florida Statutes, is amended
128	to read:
129	408.032  Definitions relating to Health Facility and
130	Services Development Act.--As used in ss. 408.031-408.045, the
131	term:
132	(1)  "Agency" means the Agency for Health Care
133	Administration.
134	(2)  "Capital expenditure" means an expenditure, including
135	an expenditure for a construction project undertaken by a health
136	care facility as its own contractor, which, under generally
137	accepted accounting principles, is not properly chargeable as an
138	expense of operation and maintenance, which is made to change
139	the bed capacity of the facility, or substantially change the
140	services or service area of the health care facility, health
141	service provider, or hospice, and which includes the cost of the
142	studies, surveys, designs, plans, working drawings,
143	specifications, initial financing costs, and other activities
144	essential to acquisition, improvement, expansion, or replacement
145	of the plant and equipment.
146	(3)  "Certificate of need" means a written statement issued
147	by the agency evidencing community need for a new, converted,
148	expanded, or otherwise significantly modified health care
149	facility, health service, or hospice.
150	(4)  "Commenced construction" means initiation of and
151	continuous activities beyond site preparation associated with
152	erecting or modifying a health care facility, including
153	procurement of a building permit applying the use of agency-
154	approved construction documents, proof of an executed
155	owner/contractor agreement or an irrevocable or binding forced
156	account, and actual undertaking of foundation forming with steel
157	installation and concrete placing.
158	(5)  "District" means a health service planning district
159	composed of the following counties:
160	District 1.--Escambia, Santa Rosa, Okaloosa, and Walton
161	Counties.
162	District 2.--Holmes, Washington, Bay, Jackson, Franklin,
163	Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla, Jefferson,
164	Madison, and Taylor Counties.
165	District 3.--Hamilton, Suwannee, Lafayette, Dixie,
166	Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,
167	Marion, Citrus, Hernando, Sumter, and Lake Counties.
168	District 4.--Baker, Nassau, Duval, Clay, St. Johns,
169	Flagler, and Volusia Counties.
170	District 5.--Pasco and Pinellas Counties.
171	District 6.--Hillsborough, Manatee, Polk, Hardee, and
172	Highlands Counties.
173	District 7.--Seminole, Orange, Osceola, and Brevard
174	Counties.
175	District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,
176	Hendry, and Collier Counties.
177	District 9.--Indian River, Okeechobee, St. Lucie, Martin,
178	and Palm Beach Counties.
179	District 10.--Broward County.
180	District 11.--Dade and Monroe Counties.
181	(6)  "Exemption" means the process by which a proposal that
182	would otherwise require a certificate of need may proceed
183	without a certificate of need.
184	(7)  "Expedited review" means the process by which certain
185	types of applications are not subject to the review cycle
186	requirements contained in s. 408.039(1), and the letter of
187	intent requirements contained in s. 408.039(2).
188	(8)  "Health care facility" means a hospital, long-term
189	care hospital, skilled nursing facility, hospice, or
190	intermediate care facility for the developmentally disabled. A
191	facility relying solely on spiritual means through prayer for
192	healing is not included as a health care facility.
193	(9)  "Health services" means inpatient diagnostic,
194	curative, or comprehensive medical rehabilitative services and
195	includes mental health services. Obstetric services are not
196	health services for purposes of ss. 408.031-408.045.
197	(10)  "Hospice" or "hospice program" means a hospice as
198	defined in part VI of chapter 400.
199	(11)  "Hospital" means a health care facility licensed
200	under chapter 395.
201	(12)  "Intermediate care facility for the developmentally
202	disabled" means a residential facility licensed under chapter
203	393 and certified by the Federal Government under pursuant to
204	the Social Security Act as a provider of Medicaid services to
205	persons who are mentally retarded or who have a related
206	condition.
207	(13)  "Long-term care hospital" means a hospital licensed
208	under chapter 395 which meets the requirements of 42 C.F.R. s.
209	412.23(e) and seeks exclusion from the acute care Medicare
210	prospective payment system for inpatient hospital services.
211	(14)  "Mental health services" means inpatient services
212	provided in a hospital licensed under chapter 395 and listed on
213	the hospital license as psychiatric beds for adults; psychiatric
214	beds for children and adolescents; intensive residential
215	treatment beds for children and adolescents; substance abuse
216	beds for adults; or substance abuse beds for children and
217	adolescents.
218	(15)  "Nursing home geographically underserved area" means:
219	(a)  A county in which there is no existing or approved
220	nursing home;
221	(b)  An area with a radius of at least 20 miles in which
222	there is no existing or approved nursing home; or
223	(c)  An area with a radius of at least 20 miles in which
224	all existing nursing homes have maintained at least a 95 percent
225	occupancy rate for the most recent 6 months or a 90 percent
226	occupancy rate for the most recent 12 months.
227	(16)  "Skilled nursing facility" means an institution, or a
228	distinct part of an institution, which is primarily engaged in
229	providing, to inpatients, skilled nursing care and related
230	services for patients who require medical or nursing care, or
231	rehabilitation services for the rehabilitation of injured,
232	disabled, or sick persons.
233	(17)  "Tertiary health service" means a health service
234	which, due to its high level of intensity, complexity,
235	specialized or limited applicability, and cost, should be
236	limited to, and concentrated in, a limited number of hospitals
237	to ensure the quality, availability, and cost-effectiveness of
238	the such service. Examples of this such service include, but are
239	not limited to, pediatric cardiac catheterization, pediatric
240	open-heart surgery, organ transplantation, specialty burn units,
241	neonatal intensive care units, comprehensive rehabilitation, and
242	medical or surgical services that which are experimental or
243	developmental in nature to the extent that providing the the
244	provision of such services is not yet contemplated within the
245	commonly accepted course of diagnosis or treatment for the
246	condition addressed by a given service.  The agency shall
247	establish by rule a list of all tertiary health services.
248	(18)  "Regional area" means any of those regional health
249	planning areas established by the agency to which local and
250	district health planning funds are directed to local health
251	councils through the General Appropriations Act.
252	Section 3.  Section 408.033, Florida Statutes, is amended
253	to read:
254	408.033  Local and state health planning.--
255	(1)  LOCAL HEALTH COUNCILS.--
256	(a)  Local health councils are hereby established as public
257	or private nonprofit agencies serving the counties of a district
258	or regional area of the agency.  The members of each council
259	shall be appointed in an equitable manner by the county
260	commissions having jurisdiction in the respective district. Each
261	council shall be composed of a number of persons equal to 1 1/2
262	times the number of counties that which compose the district or
263	12 members, whichever is greater.  Each county in a district
264	shall be entitled to at least one member on the council.  The
265	balance of the membership of the council shall be allocated
266	among the counties of the district on the basis of population
267	rounded to the nearest whole number; except that in a district
268	composed of only two counties, no county shall have fewer than
269	four members. The appointees shall be representatives of health
270	care providers, health care purchasers, and nongovernmental
271	health care consumers, but not excluding elected government
272	officials.  The members of the consumer group shall include a
273	representative number of persons over 60 years of age.  A
274	majority of council members shall consist of health care
275	purchasers and health care consumers.  The local health council
276	shall provide each county commission a schedule for appointing
277	council members to ensure that council membership complies with
278	the requirements of this paragraph.  The members of the local
279	health council shall elect a chair. Members shall serve for
280	terms of 2 years and may be eligible for reappointment.
281	(b)  Each local health council may:
282	1.  Develop a district or regional area health plan that
283	permits each local health council to develop strategies and set
284	priorities for implementation based on its unique local health
285	needs.  The district or regional area health plan must contain
286	preferences for the development of health services and
287	facilities, which may be considered by the agency in its review
288	of certificate-of-need applications.  The district health plan
289	shall be submitted to the agency and updated periodically. The
290	district health plans shall use a uniform format and be
291	submitted to the agency according to a schedule developed by the
292	agency in conjunction with the local health councils. The
293	schedule must provide for the development of district health
294	plans by major sections over a multiyear period.  The elements
295	of a district plan which are necessary to the review of
296	certificate-of-need applications for proposed projects within
297	the district may be adopted by the agency as a part of its
298	rules.
299	2.  Advise the agency on health care issues and resource
300	allocations.
301	3.  Promote public awareness of community health needs,
302	emphasizing health promotion and cost-effective health service
303	selection.
304	4.  Collect data and conduct analyses and studies related
305	to health care needs of the district, including the needs of
306	medically indigent persons, and assist the agency and other
307	state agencies in carrying out data collection activities that
308	relate to the functions in this subsection.
309	5.  Monitor the onsite construction progress, if any, of
310	certificate-of-need approved projects and report council
311	findings to the agency on forms provided by the agency.
312	6.  Advise and assist any regional planning councils within
313	each district that have elected to address health issues in
314	their strategic regional policy plans with the development of
315	the health element of the plans to address the health goals and
316	policies in the State Comprehensive Plan.
317	7.  Advise and assist local governments within each
318	district on the development of an optional health plan element
319	of the comprehensive plan provided in chapter 163, to assure
320	compatibility with the health goals and policies in the State
321	Comprehensive Plan and district health plan.  To facilitate the
322	implementation of this section, the local health council shall
323	annually provide the local governments in its service area, upon
324	request, with:
325	a.  A copy and appropriate updates of the district health
326	plan;
327	b.  A report of hospital and nursing home utilization
328	statistics for facilities within the local government
329	jurisdiction; and
330	c.  Applicable agency rules and calculated need
331	methodologies for health facilities and services regulated under
332	s. 408.034 for the district served by the local health council.
333	8.  Monitor and evaluate the adequacy, appropriateness, and
334	effectiveness, within the district, of local, state, federal,
335	and private funds distributed to meet the needs of the medically
336	indigent and other underserved population groups.
337	9.  In conjunction with the Department of Health Agency for
338	Health Care Administration, plan for services at the local level
339	for persons infected with the human immunodeficiency virus.
340	10.  Provide technical assistance to encourage and support
341	activities by providers, purchasers, consumers, and local,
342	regional, and state agencies in meeting the health care goals,
343	objectives, and policies adopted by the local health council.
344	11.  Provide the agency with data required by rule for the
345	review of certificate-of-need applications and the projection of
346	need for health services and facilities in the district.
347	(c)  Local health councils may conduct public hearings
348	under pursuant to s. 408.039(3)(b).
349	(d)  Each local health council shall enter into a
350	memorandum of agreement with each regional planning council in
351	its district that elects to address health issues in its
352	strategic regional policy plan.  In addition, each local health
353	council shall enter into a memorandum of agreement with each
354	local government that includes an optional health element in its
355	comprehensive plan. Each memorandum of agreement must specify
356	the manner in which each local government, regional planning
357	council, and local health council will coordinate its activities
358	to ensure a unified approach to health planning and
359	implementation efforts.
360	(e)  Local health councils may employ personnel or contract
361	for staffing services with persons who possess appropriate
362	qualifications to carry out the councils' purposes.  However,
363	these such personnel are not state employees.
364	(f)  Personnel of the local health councils shall provide
365	an annual orientation to council members about council member
366	responsibilities. The orientation shall include presentations
367	and participation by agency staff.
368	(g)  Each local health council is authorized to accept and
369	receive, in furtherance of its health planning functions, funds,
370	grants, and services from governmental agencies and from private
371	or civic sources and to perform studies related to local health
372	planning in exchange for such funds, grants, or services. Each
373	local health council shall, no later than January 30 of each
374	year, render an accounting of the receipt and disbursement of
375	such funds received by it to the Department of Health agency.
376	The Department of Health agency shall consolidate all such
377	reports and submit such consolidated report to the Legislature
378	no later than March 1 of each year.  Funds received by a local
379	health council pursuant to this paragraph shall not be deemed to
380	be a substitute for, or an offset against, any funding provided
381	pursuant to subsection (2).
382	(2)  FUNDING.--
383	(a)  The Legislature intends that the cost of local health
384	councils be borne by application fees for certificates of need
385	and by assessments on selected health care facilities subject to
386	facility licensure by the Agency for Health Care Administration,
387	including abortion clinics, assisted living facilities,
388	ambulatory surgical centers, birthing centers, clinical
389	laboratories except community nonprofit blood banks and clinical
390	laboratories operated by practitioners for exclusive use
391	regulated under s. 483.035, home health agencies, hospices,
392	hospitals, intermediate care facilities for the developmentally
393	disabled, nursing homes, and multiphasic testing centers and by
394	assessments on organizations subject to certification by the
395	agency under pursuant to chapter 641, part III, including health
396	maintenance organizations and prepaid health clinics.
397	(b)1.  A hospital licensed under chapter 395, a nursing
398	home licensed under chapter 400, and an assisted living facility
399	licensed under chapter 400 shall be assessed an annual fee based
400	on number of beds.
401	2.  All other facilities and organizations listed in
402	paragraph (a) shall each be assessed an annual fee of $150.
403	3.  Facilities operated by the Department of Children and
404	Family Services, the Department of Health, or the Department of
405	Corrections and any hospital that which meets the definition of
406	rural hospital under pursuant to s. 395.602 are exempt from the
407	assessment required in this subsection.
408	(c)1.  The agency shall, by rule, establish fees for
409	hospitals and nursing homes based on an assessment of $2 per
410	bed. However, no such facility shall be assessed more than a
411	total of $500 under this subsection.
412	2.  The agency shall, by rule, establish fees for assisted
413	living facilities based on an assessment of $1 per bed. However,
414	no such facility shall be assessed more than a total of $150
415	under this subsection.
416	3.  The agency shall, by rule, establish an annual fee of
417	$150 for all other facilities and organizations listed in
418	paragraph (a).
419	(d)  The agency shall, by rule, establish a facility
420	billing and collection process for the billing and collection of
421	the health facility fees authorized by this subsection.
422	(e)  A health facility which is assessed a fee under this
423	subsection is subject to a fine of $100 per day for each day in
424	which the facility is late in submitting its annual fee up to
425	maximum of the annual fee owed by the facility.  A facility
426	which refuses to pay the fee or fine is subject to the
427	forfeiture of its license.
428	(f)  The agency shall deposit in the Health Care Trust Fund
429	all health care facility assessments that are assessed under
430	this subsection and proceeds from the certificate-of-need
431	application fees. The agency shall transfer these funds to the
432	Department of Health for an amount sufficient to maintain the
433	aggregate funding of level for the local health councils as
434	specified in the General Appropriations Act. The remaining
435	certificate-of-need application fees shall be used only for the
436	purpose of administering the certificate-of-need program Health
437	Facility and Services Development Act.
438	(3)  DUTIES AND RESPONSIBILITIES OF THE AGENCY.--
439	(a)  The agency, in conjunction with the local health
440	councils, is responsible for the coordinated planning of health
441	care services in the state.
442	(b)  The agency shall develop and maintain a comprehensive
443	health care database for the purpose of health planning and for
444	certificate-of-need determinations.  The agency or its
445	contractor is authorized to require the submission of
446	information from health facilities, health service providers,
447	and licensed health professionals which is determined by the
448	agency, through rule, to be necessary for meeting the agency's
449	responsibilities as established in this section.
450	(c)  The agency shall assist personnel of the local health
451	councils in providing an annual orientation to council members
452	about council member responsibilities.
453	(c)(d)  The Department of Health agency shall contract with
454	the local health councils for the services specified in
455	subsection (1). All contract funds shall be distributed
456	according to an allocation plan developed by the Department of
457	Health agency that provides for a minimum and equal funding base
458	for each local health council.  Any remaining funds shall be
459	distributed based on adjustments for workload.  The agency may
460	also make grants to or reimburse local health councils from
461	federal funds provided to the state for activities related to
462	those functions set forth in this section. The Department of
463	Health agency may withhold funds from a local health council or
464	cancel its contract with a local health council which does not
465	meet performance standards agreed upon by the Department of
466	Health agency and local health councils.
467	Section 4.  Subsections (1) and (2) of section 408.034,
468	Florida Statutes, are amended to read:
469	408.034  Duties and responsibilities of agency; rules.--
470	(1)  The agency is designated as the single state agency to
471	issue, revoke, or deny certificates of need and to issue,
472	revoke, or deny exemptions from certificate-of-need review in
473	accordance with the district plans and present and future
474	federal and state statutes.  The agency is designated as the
475	state health planning agency for purposes of federal law.
476	(2)  In the exercise of its authority to issue licenses to
477	health care facilities and health service providers, as provided
478	under chapters 393, 395, and parts II and VI of chapter 400, the
479	agency may not issue a license to any health care facility or,
480	health service provider that, hospice, or part of a health care
481	facility which fails to receive a certificate of need or an
482	exemption for the licensed facility or service.
483	Section 5.  Section 408.035, Florida Statutes, is amended
484	to read:
485	408.035  Review criteria.--The agency shall determine the
486	reviewability of applications and shall review applications for
487	certificate-of-need determinations for health care facilities
488	and health services in context with the following criteria:
489	(1)  The need for the health care facilities and health
490	services being proposed in relation to the applicable district
491	health plan.
492	(2)  The availability, quality of care, accessibility, and
493	extent of utilization of existing health care facilities and
494	health services in the service district of the applicant.
495	(3)  The ability of the applicant to provide quality of
496	care and the applicant's record of providing quality of care.
497	(4)  The need in the service district of the applicant for
498	special health care services that are not reasonably and
499	economically accessible in adjoining areas.
500	(5)  The needs of research and educational facilities,
501	including, but not limited to, facilities with institutional
502	training programs and community training programs for health
503	care practitioners and for doctors of osteopathic medicine and
504	medicine at the student, internship, and residency training
505	levels.
506	(4)(6)  The availability of resources, including health
507	personnel, management personnel, and funds for capital and
508	operating expenditures, for project accomplishment and
509	operation.
510	(5)(7)  The extent to which the proposed services will
511	enhance access to health care for residents of the service
512	district.
513	(6)(8)  The immediate and long-term financial feasibility
514	of the proposal.
515	(7)(9)  The extent to which the proposal will foster
516	competition that promotes quality and cost-effectiveness.
517	(8)(10)  The costs and methods of the proposed
518	construction, including the costs and methods of energy
519	provision and the availability of alternative, less costly, or
520	more effective methods of construction.
521	(9)(11)  The applicant's past and proposed provision of
522	health care services to Medicaid patients and the medically
523	indigent.
524	(10)(12)  The applicant's designation as a Gold Seal
525	Program nursing facility under pursuant to s. 400.235, when the
526	applicant is requesting additional nursing home beds at that
527	facility.
528	Section 6.  Section 408.036, Florida Statutes, is amended
529	to read:
530	408.036  Projects subject to review; exemptions.--
531	(1)  APPLICABILITY.--Unless exempt under subsection (3),
532	all health-care-related projects, as described in paragraphs
533	(a)-(e) (a)-(h), are subject to review and must file an
534	application for a certificate of need with the agency. The
535	agency is exclusively responsible for determining whether a
536	health-care-related project is subject to review under ss.
537	408.031-408.045.
538	(a)  The addition of community nursing home or ICF/DD beds
539	by new construction or alteration.
540	(b)  The new construction or establishment of additional
541	health care facilities, including a replacement health care
542	facility when the proposed project site is not located on the
543	same site as, or within 1 mile of, the existing health care
544	facility, if the number of beds in each licensed bed category
545	will not increase.
546	(c)  The conversion from one type of health care facility
547	to another, including the conversion from a general hospital, a
548	specialty hospital, or long-term care hospital.
549	(d)  An increase in the total licensed bed capacity of a
550	health care facility.
551	(d)(e)  The establishment of a hospice or hospice inpatient
552	facility, except as provided in s. 408.043.
553	(f)  The establishment of inpatient health services by a
554	health care facility, or a substantial change in such services.
555	(g)  An increase in the number of beds for acute care,
556	nursing home care beds, specialty burn units, neonatal intensive
557	care units, comprehensive rehabilitation, mental health
558	services, or hospital-based distinct part skilled nursing units,
559	or at a long-term care hospital.
560	(e)(h)  The establishment of tertiary health services.
561	(2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
562	under pursuant to subsection (3), projects subject to an
563	expedited review shall include, but not be limited to:
564	(a)  Research, education, and training programs.
565	(b)  Shared services contracts or projects.
566	(a)(c)  A transfer of a certificate of need, except that,
567	when an existing hospital is acquired by a purchaser, all
568	certificates of need issued to the hospital which are not yet
569	operational are acquired by the purchaser without need for a
570	transfer.
571	(b)  Replacement of a community nursing home or ICF/DD when
572	the proposed project site is located within the same district
573	and the same planning area of the health care facility being
574	replaced, if the number of licensed beds in the proposed project
575	is the same as that of the facility being replaced.
576	(d)  A 50-percent increase in nursing home beds for a
577	facility incorporated and operating in this state for at least
578	60 years on or before July 1, 1988, which has a licensed nursing
579	home facility located on a campus providing a variety of
580	residential settings and supportive services.  The increased
581	nursing home beds shall be for the exclusive use of the campus
582	residents.  Any application on behalf of an applicant meeting
583	this requirement shall be subject to the base fee of $5,000
584	provided in s. 408.038.
585	(e)  Replacement of a health care facility when the
586	proposed project site is located in the same district and within
587	a 1-mile radius of the replaced health care facility.
588	(f)  The conversion of mental health services beds licensed
589	under chapter 395 or hospital-based distinct part skilled
590	nursing unit beds to general acute care beds; the conversion of
591	mental health services beds between or among the licensed bed
592	categories defined as beds for mental health services; or the
593	conversion of general acute care beds to beds for mental health
594	services.
595	1.  Conversion under this paragraph shall not establish a
596	new licensed bed category at the hospital but shall apply only
597	to categories of beds licensed at that hospital.
598	2.  Beds converted under this paragraph must be licensed
599	and operational for at least 12 months before the hospital may
600	apply for additional conversion affecting beds of the same type.
601
602	The agency shall develop rules to implement the provisions for
603	expedited review, including time schedule, application content
604	which may be reduced from the full requirements of s.
605	408.037(1), and application processing.
606	(3)  EXEMPTIONS.--Upon request, the following projects are
607	subject to exemption from the provisions of subsection (1):
608	(a)  For replacement of a licensed health care facility on
609	the same site, provided that the number of beds in each licensed
610	bed category will not increase.
611	(a)(b)  For hospice services or for swing beds in a rural
612	hospital, as defined in s. 395.602, in a number that does not
613	exceed one-half of its licensed beds.
614	(b)(c)  For the conversion of licensed acute care hospital
615	beds to Medicare and Medicaid certified skilled nursing beds in
616	a rural hospital, as defined in s. 395.602, so long as the
617	conversion of the beds does not involve the construction of new
618	facilities. The total number of skilled nursing beds, including
619	swing beds, may not exceed one-half of the total number of
620	licensed beds in the rural hospital as of July 1, 1993.
621	Certified skilled nursing beds designated under this paragraph,
622	excluding swing beds, shall be included in the community nursing
623	home bed inventory.  A rural hospital which subsequently
624	decertifies any acute care beds exempted under this paragraph
625	shall notify the agency of the decertification, and the agency
626	shall adjust the community nursing home bed inventory
627	accordingly.
628	(c)(d)  For the addition of nursing home beds at a skilled
629	nursing facility that is part of a retirement community that
630	provides a variety of residential settings and supportive
631	services and that has been incorporated and operated in this
632	state for at least 65 years on or before July 1, 1994. All
633	nursing home beds must not be available to the public but must
634	be for the exclusive use of the community residents.
635	(e)  For an increase in the bed capacity of a nursing
636	facility licensed for at least 50 beds as of January 1, 1994,
637	under part II of chapter 400 which is not part of a continuing
638	care facility if, after the increase, the total licensed bed
639	capacity of that facility is not more than 60 beds and if the
640	facility has been continuously licensed since 1950 and has
641	received a superior rating on each of its two most recent
642	licensure surveys.
643	(d)(f)  For an inmate health care facility built by or for
644	the exclusive use of the Department of Corrections as provided
645	in chapter 945. This exemption expires when the such facility is
646	converted to other uses.
647	(g)  For the termination of an inpatient health care
648	service, upon 30 days' written notice to the agency.
649	(h)  For the delicensure of beds, upon 30 days' written
650	notice to the agency. A request for exemption submitted under
651	this paragraph must identify the number, the category of beds,
652	and the name of the facility in which the beds to be delicensed
653	are located.
654	(e)(i)  For the provision of adult inpatient diagnostic
655	cardiac catheterization services in a hospital.
656	1.  In addition to any other documentation otherwise
657	required by the agency, a request for an exemption submitted
658	under this paragraph must comply with the following criteria:
659	a.  The applicant must certify it will not provide
660	therapeutic cardiac catheterization pursuant to the grant of the
661	exemption.
662	b.  The applicant must certify it will meet and
663	continuously maintain the minimum licensure requirements adopted
664	by the agency governing such programs under pursuant to
665	subparagraph 2.
666	c.  The applicant must certify it will provide a minimum of
667	2 percent of its services to charity and Medicaid patients.
668	2.  The agency shall adopt licensure requirements by rule
669	which govern the operation of adult inpatient diagnostic cardiac
670	catheterization programs established under pursuant to the
671	exemption provided in this paragraph. The rules shall ensure
672	that the such programs:
673	a.  Perform only adult inpatient diagnostic cardiac
674	catheterization services authorized by the exemption and will
675	not provide therapeutic cardiac catheterization or any other
676	services not authorized by the exemption.
677	b.  Maintain sufficient appropriate equipment and health
678	personnel to ensure quality and safety.
679	c.  Maintain appropriate times of operation and protocols
680	to ensure availability and appropriate referrals in the event of
681	emergencies.
682	d.  Maintain appropriate program volumes to ensure quality
683	and safety.
684	e.  Provide a minimum of 2 percent of its services to
685	charity and Medicaid patients each year.
686	3.a.  The exemption provided by this paragraph shall not
687	apply unless the agency determines that the program is in
688	compliance with the requirements of subparagraph 1. and that the
689	program will, after beginning operation, continuously comply
690	with the rules adopted under pursuant to subparagraph 2.  The
691	agency shall monitor the such programs to ensure compliance with
692	the requirements of subparagraph 2.
693	b.(I)  The exemption for a program expires shall expire
694	immediately when the program fails to comply with the rules
695	adopted under pursuant to sub-subparagraphs 2.a., b., and c.
696	(II)  Beginning 18 months after a program first begins
697	treating patients, the exemption for a program expires shall
698	expire when the program fails to comply with the rules adopted
699	under pursuant to sub-subparagraphs 2.d. and e.
700	(III)  If the exemption for a program expires under
701	pursuant to sub-sub-subparagraph (I) or sub-sub-subparagraph
702	(II), the agency may shall not grant an exemption under pursuant
703	to this paragraph for an adult inpatient diagnostic cardiac
704	catheterization program located at the same hospital until 2
705	years following the date of the determination by the agency that
706	the program failed to comply with the rules adopted under
707	pursuant to subparagraph 2.
708	(f)(j)  For mobile surgical facilities and related health
709	care services provided under contract with the Department of
710	Corrections or a private correctional facility operating under
711	pursuant to chapter 957.
712	(g)(k)  For state veterans' nursing homes operated by or on
713	behalf of the Florida Department of Veterans' Affairs in
714	accordance with part II of chapter 296 for which at least 50
715	percent of the construction cost is federally funded and for
716	which the Federal Government pays a per diem rate not to exceed
717	one-half of the cost of the veterans' care in the such state
718	nursing homes. These beds shall not be included in the nursing
719	home bed inventory.
720	(h)(l)  For combination within one nursing home facility of
721	the beds or services authorized by two or more certificates of
722	need issued in the same planning subdistrict.  An exemption
723	granted under this paragraph shall extend the validity period of
724	the certificates of need to be consolidated by the length of the
725	period beginning upon submission of the exemption request and
726	ending with issuance of the exemption.  The longest validity
727	period among the certificates shall be applicable to each of the
728	combined certificates.
729	(i)(m)  For division into two or more nursing home
730	facilities of beds or services authorized by one certificate of
731	need issued in the same planning subdistrict.  An exemption
732	granted under this paragraph shall extend the validity period of
733	the certificate of need to be divided by the length of the
734	period beginning upon submission of the exemption request and
735	ending with issuance of the exemption.
736	(n)  For the addition of hospital beds licensed under
737	chapter 395 for acute care, mental health services, or a
738	hospital-based distinct part skilled nursing unit in a number
739	that may not exceed 10 total beds or 10 percent of the licensed
740	capacity of the bed category being expanded, whichever is
741	greater. Beds for specialty burn units, neonatal intensive care
742	units, or comprehensive rehabilitation, or at a long-term care
743	hospital, may not be increased under this paragraph.
744	1.  In addition to any other documentation otherwise
745	required by the agency, a request for exemption submitted under
746	this paragraph must:
747	a.  Certify that the prior 12-month average occupancy rate
748	for the category of licensed beds being expanded at the facility
749	meets or exceeds 80 percent or, for a hospital-based distinct
750	part skilled nursing unit, the prior 12-month average occupancy
751	rate meets or exceeds 96 percent.
752	b.  Certify that any beds of the same type authorized for
753	the facility under this paragraph before the date of the current
754	request for an exemption have been licensed and operational for
755	at least 12 months.
756	2.  The timeframes and monitoring process specified in s.
757	408.040(2)(a)-(c) apply to any exemption issued under this
758	paragraph.
759	3.  The agency shall count beds authorized under this
760	paragraph as approved beds in the published inventory of
761	hospital beds until the beds are licensed.
762	(o)  For the addition of acute care beds, as authorized by
763	rule consistent with s. 395.003(4), in a number that may not
764	exceed 10 total beds or 10 percent of licensed bed capacity,
765	whichever is greater, for temporary beds in a hospital that has
766	experienced high seasonal occupancy within the prior 12-month
767	period or in a hospital that must respond to emergency
768	circumstances.
769	(j)(p)  For the addition of nursing home beds licensed
770	under chapter 400 in a number not exceeding 10 total beds or 10
771	percent of the number of beds licensed in the facility being
772	expanded, whichever is greater.
773	1.  In addition to any other documentation required by the
774	agency, a request for exemption submitted under this paragraph
775	must:
776	a.  Effective until June 30, 2001, certify that the
777	facility has not had any class I or class II deficiencies within
778	the 30 months preceding the request for addition.
779	b.  Effective on July 1, 2001, certify that the facility
780	has been designated as a Gold Seal nursing home under s.
781	400.235.
782	c.  Certify that the prior 12-month average occupancy rate
783	for the nursing home beds at the facility meets or exceeds 96
784	percent.
785	d.  Certify that any beds authorized for the facility under
786	this paragraph before the date of the current request for an
787	exemption have been licensed and operational for at least 12
788	months.
789	2.  The timeframes and monitoring process specified in s.
790	408.040(2)(a)-(c) apply to any exemption issued under this
791	paragraph.
792	3.  The agency shall count beds authorized under this
793	paragraph as approved beds in the published inventory of nursing
794	home beds until the beds are licensed.
795	(k)  For establishing a Level II neonatal intensive care
796	unit with at least 10 beds, upon documentation to the agency
797	that the applicant hospital had a minimum of 1,500 births during
798	the previous 12 months, or establishing a Level III neonatal
799	intensive care unit with at least 15 beds, upon documentation to
800	the agency that the applicant hospital has a Level II neonatal
801	intensive care unit of at least 10 beds and had a minimum of
802	3,500 births during the previous 12 months, if the applicant
803	commits to providing services to Medicaid and charity care
804	patients at a level equal to or greater than the district
805	average. This commitment is subject to s. 408.040.
806	(l)  For adding comprehensive medical rehabilitation or
807	mental health services or beds, if the applicant commits to
808	providing services to Medicaid or charity care patients at a
809	level equal to or greater than the district average. This
810	commitment is subject to s. 408.040.
811	(q)  For establishment of a specialty hospital offering a
812	range of medical service restricted to a defined age or gender
813	group of the population or a restricted range of services
814	appropriate to the diagnosis, care, and treatment of patients
815	with specific categories of medical illnesses or disorders,
816	through the transfer of beds and services from an existing
817	hospital in the same county.
818	(r)  For the conversion of hospital-based Medicare and
819	Medicaid certified skilled nursing beds to acute care beds, if
820	the conversion does not involve the construction of new
821	facilities.
822	(s)1.  For an adult open-heart-surgery program to be
823	located in a new hospital provided the new hospital is being
824	established in the location of an existing hospital with an
825	adult open-heart-surgery program, the existing hospital and the
826	existing adult open-heart-surgery program are being relocated to
827	a replacement hospital, and the replacement hospital will
828	utilize a closed-staff model. A hospital is exempt from the
829	certificate-of-need review for the establishment of an open-
830	heart-surgery program if the application for exemption submitted
831	under this paragraph complies with the following criteria:
832	a.  The applicant must certify that it will meet and
833	continuously maintain the minimum Florida Administrative Code
834	and any future licensure requirements governing adult open-heart
835	programs adopted by the agency, including the most current
836	guidelines of the American College of Cardiology and American
837	Heart Association Guidelines for Adult Open Heart Programs.
838	b.  The applicant must certify that it will maintain
839	sufficient appropriate equipment and health personnel to ensure
840	quality and safety.
841	c.  The applicant must certify that it will maintain
842	appropriate times of operation and protocols to ensure
843	availability and appropriate referrals in the event of
844	emergencies.
845	d.  The applicant is a newly licensed hospital in a
846	physical location previously owned and licensed to a hospital
847	performing more than 300 open-heart procedures each year,
848	including heart transplants.
849	e.  The applicant must certify that it can perform more
850	than 300 diagnostic cardiac catheterization procedures per year,
851	combined inpatient and outpatient, by the end of the third year
852	of its operation.
853	f.  The applicant's payor mix at a minimum reflects the
854	community average for Medicaid, charity care, and self-pay
855	patients or the applicant must certify that it will provide a
856	minimum of 5 percent of Medicaid, charity care, and self-pay to
857	open-heart-surgery patients.
858	g.  If the applicant fails to meet the established criteria
859	for open-heart programs or fails to reach 300 surgeries per year
860	by the end of its third year of operation, it must show cause
861	why its exemption should not be revoked.
862	h.  In order to ensure continuity of available services,
863	the applicant of the newly licensed hospital may apply for this
864	certificate-of-need before taking possession of the physical
865	facilities. The effective date of the certificate-of-need will
866	be concurrent with the effective date of the newly issued
867	hospital license.
868	2.  By December 31, 2004, and annually thereafter, the
869	agency shall submit a report to the Legislature providing
870	information concerning the number of requests for exemption
871	received under this paragraph and the number of exemptions
872	granted or denied.
873	3.  This paragraph is repealed effective January 1, 2008.
874	(t)1.  For the provision of adult open-heart services in a
875	hospital located within the boundaries of Palm Beach, Polk,
876	Martin, St. Lucie, and Indian River Counties if the following
877	conditions are met: The exemption must be based upon objective
878	criteria and address and solve the twin problems of geographic
879	and temporal access. A hospital shall be exempt from the
880	certificate-of-need review for the establishment of an open-
881	heart-surgery program when the application for exemption
882	submitted under this paragraph complies with the following
883	criteria:
884	a.  The applicant must certify that it will meet and
885	continuously maintain the minimum licensure requirements adopted
886	by the agency governing adult open-heart programs, including the
887	most current guidelines of the American College of Cardiology
888	and American Heart Association Guidelines for Adult Open Heart
889	Programs.
890	b.  The applicant must certify that it will maintain
891	sufficient appropriate equipment and health personnel to ensure
892	quality and safety.
893	c.  The applicant must certify that it will maintain
894	appropriate times of operation and protocols to ensure
895	availability and appropriate referrals in the event of
896	emergencies.
897	d.  The applicant can demonstrate that it is referring 300
898	or more patients per year from the hospital, including the
899	emergency room, for cardiac services at a hospital with cardiac
900	services, or that the average wait for transfer for 50 percent
901	or more of the cardiac patients exceeds 4 hours.
902	e.  The applicant is a general acute care hospital that is
903	in operation for 3 years or more.
904	f.  The applicant is performing more than 300 diagnostic
905	cardiac catheterization procedures per year, combined inpatient
906	and outpatient.
907	g.  The applicant's payor mix at a minimum reflects the
908	community average for Medicaid, charity care, and self-pay
909	patients or the applicant must certify that it will provide a
910	minimum of 5 percent of Medicaid, charity care, and self-pay to
911	open-heart-surgery patients.
912	h.  If the applicant fails to meet the established criteria
913	for open-heart programs or fails to reach 300 surgeries per year
914	by the end of its third year of operation, it must show cause
915	why its exemption should not be revoked.
916	2.  By December 31, 2004, and annually thereafter, the
917	Agency for Health Care Administration shall submit a report to
918	the Legislature providing information concerning the number of
919	requests for exemption received under this paragraph and the
920	number of exemptions granted or denied.
921	(4)  A request for exemption under subsection (3) may be
922	made at any time and is not subject to the batching requirements
923	of this section. The request shall be supported by such
924	documentation as the agency requires by rule. The agency shall
925	assess a fee of $250 for each request for exemption submitted
926	under subsection (3).
927	(5)  NOTIFICATION.--Health care facilities and providers
928	must notify the agency of the following:
929	(a)  Replacement of a health care facility when the
930	proposed project site is located in the same district and on the
931	existing health care facility site or within a 1-mile radius of
932	the replaced health care facility, if the number and type of
933	beds do not increase.
934	(b)  The termination of a health care service, upon 30
935	days' written notice to the agency.
936	(c)  The addition or delicensure of beds.
937
938	Notification under this subsection may be made at any time
939	before the action described, by electronic, facsimile, or
940	written means.
941	Section 7.  Section 408.0361, Florida Statutes, is amended
942	to read:
943	408.0361  Diagnostic cardiac catheterization services
944	providers; compliance with guidelines and requirements.--
945	(1)  Each provider of diagnostic cardiac catheterization
946	services shall comply with the requirements of s.
947	408.036(3)(e)2.a.-d. s. 408.036(3)(i)2.a.-d., and rules of the
948	agency for Health Care Administration governing the operation of
949	adult inpatient diagnostic cardiac catheterization programs,
950	including the most recent guidelines of the American College of
951	Cardiology and American Heart Association Guidelines for Cardiac
952	Catheterization and Cardiac Catheterization Laboratories.
953	(2)  The agency shall adopt rules for licensure standards
954	for adult interventional cardiology services and burn units
955	licensed under chapter 395. The rules shall consider at a
956	minimum:
957	(a)  Staffing;
958	(b)  Equipment;
959	(c)  Physical plant;
960	(d)  Operating protocols;
961	(e)  Provision of services to Medicaid and charity care
962	patients;
963	(f)  Accreditation;
964	(g)  Licensure period;
965	(h)  Fees; and
966	(i)  Enforcement of minimum standards.
967
968	Any provider holding a certificate of need on July 1, 2004, and
969	any provider in receipt of a notice of intent to grant a
970	certificate of need or a final order of the agency granting a
971	certificate of need for an adult interventional cardiology
972	service or burn unit shall be exempt from complying with the
973	rules for 2 years following the date of its next license
974	renewal. Thereafter, each provider must meet the licensure
975	standards for each license renewal.
976	(3)  When adopting rules for adult interventional
977	cardiology services, the agency shall include rules that allow
978	for:
979	(a)  The establishment of two hospital program licensure
980	levels: a Level I program authorizing the performance of adult
981	percutaneous cardiac intervention without on-site cardiac
982	surgery and a Level II program authorizing the performance of
983	percutaneous cardiac intervention with on-site cardiac surgery.
984	(b)  A hospital seeking a Level I program, demonstration
985	that for the most recent 12-month period as reported to the
986	agency it has provided a minimum of 300 adult inpatient and
987	outpatient diagnostic cardiac catheterizations and that it has a
988	formalized, written transfer agreement with a hospital that has
989	a Level II program, including written transport protocols to
990	ensure safe and efficient transfer of a patient within 60
991	minutes.
992	(c)  A hospital seeking a Level II program, demonstration
993	that for the most recent 12-month period as reported to the
994	agency that it has performed a minimum of 1,100 adult inpatient
995	and outpatient diagnostic cardiac catheterizations, or has
996	discharged at least 800 patients with the primary diagnosis of
997	ischemic heart disease.
998	(d)  A demonstration of sufficient trained staff,
999	equipment, and operating procedures to assure patient quality
1000	and safety.
1001	(e)  The establishment of appropriate hours of operation
1002	and protocols to ensure availability and timely referral in the
1003	event of emergencies.
1004	(f)  A demonstration of a plan to provide services to
1005	Medicaid and charity care patients.
1006	(4)  After a hospital's cardiac interventional program has
1007	been operational for 12 consecutive months, and the risk-
1008	adjusted mortality for coronary bypass surgery for any
1009	successive 12-month period exceeds, by more than 1.75 times, the
1010	national risk-adjusted mortality rate for coronary bypass
1011	surgery, as reported to the American Society of Thoracic
1012	Surgeons, in the first 2 years of operation of the hospital's
1013	Level II program, or by more than 1.25 times the national risk
1014	adjusted mortality rate for coronary bypass surgery, as reported
1015	by the American Society of Thoracic Surgeons, in any successive
1016	12-month period after the second year of operation, the hospital
1017	shall perform a 30-day focused review of its Level II program
1018	with the intention of reducing the risk-adjusted mortality rate
1019	to reasonably acceptable levels. If mortality levels do not
1020	return to reasonably acceptable levels, the agency may initiate
1021	action up to and including suspension or revocation of licensure
1022	of the Level II program.
1023	Section 8.  The Secretary of Health Care Administration
1024	shall appoint an advisory group to study the issue of replacing
1025	certificate-of-need review of organ transplant programs
1026	operating under chapter 408, Florida Statutes, with licensure
1027	regulation of organ transplant programs under chapter 395,
1028	Florida Statutes. The advisory group must include three
1029	representatives of organ transplant providers, one
1030	representative of an organ procurement organization, one
1031	representative of the Division of Health Quality Assurance, one
1032	representative of the Medicaid program, and one organ transplant
1033	patient advocate. The advisory group shall, at a minimum, make
1034	recommendations regarding access to organs, delivery of services
1035	to Medicaid and charity care patients, staff training, and
1036	resource requirements for organ transplant programs in a report
1037	submitted to the Governor, the Secretary of Health Care
1038	Administration, and the Legislature by July 1, 2005.
1039	Section 9.  Section 408.038, Florida Statutes, is amended
1040	to read:
1041	408.038  Fees.--The agency shall assess fees on
1042	certificate-of-need applications.  The Such fees shall be for
1043	the purpose of funding the functions of the local health
1044	councils and the activities of the agency and shall be allocated
1045	as provided in s. 408.033. The fee shall be determined as
1046	follows:
1047	(1)  A minimum base fee of $10,000 $5,000.
1048	(2)  In addition to the base fee of $10,000 $5,000, 0.015
1049	of each dollar of proposed expenditure, except that a fee may
1050	not exceed $50,000 $22,000.
1051	Section 10.  Section 408.039, Florida Statutes, is amended
1052	to read:
1053	408.039  Review process.--The review process for
1054	certificates of need shall be as follows:
1055	(1)  REVIEW CYCLES.--The agency by rule shall provide for
1056	applications to be submitted on a timetable or cycle basis;
1057	provide for review on a timely basis; and provide for all
1058	completed applications pertaining to similar types of services
1059	or facilities affecting the same service district to be
1060	considered in relation to each other no less often than annually
1061	two times a year.
1062	(2)  LETTERS OF INTENT.--
1063	(a)  At least 30 days before prior to filing an
1064	application, a letter of intent shall be filed by the applicant
1065	with the agency, respecting the development of a proposal
1066	subject to review.  No letter of intent is required for
1067	expedited projects as defined by rule by the agency.
1068	(b)  The agency shall provide a mechanism by which
1069	applications may be filed to compete with proposals described in
1070	filed letters of intent.
1071	(c)  Letters of intent must describe the proposal; specify
1072	the number of beds sought, if any; identify the services to be
1073	provided and the specific subdistrict location; and identify the
1074	applicant.
1075	(d)  Within 21 days after filing a letter of intent, the
1076	agency shall publish notice of the filing of letters of intent
1077	in the Florida Administrative Weekly and notice that, if
1078	requested, a public hearing shall be held at the local level
1079	within 21 days after the application is deemed complete. Notices
1080	under this paragraph must contain due dates applicable to the
1081	cycle for filing applications and for requesting a hearing.
1082	(3)  APPLICATION PROCESSING.--
1083	(a)  An applicant shall file an application with the
1084	agency, and shall furnish a copy of the application to the local
1085	health council and the agency. Within 15 days after the
1086	applicable application filing deadline established by agency
1087	rule, the staff of the agency shall determine if the application
1088	is complete.  If the application is incomplete, the staff shall
1089	request specific information from the applicant necessary for
1090	the application to be complete; however, the staff may make only
1091	one such request. If the requested information is not filed with
1092	the agency within 21 days of the receipt of the staff's request,
1093	the application shall be deemed incomplete and deemed withdrawn
1094	from consideration.
1095	(b)  Upon the request of any applicant or substantially
1096	affected person within 14 days after notice that an application
1097	has been filed, a public hearing may be held at the agency's
1098	discretion if the agency determines that a proposed project
1099	involves issues of great local public interest. The public
1100	hearing shall allow applicants and other interested parties
1101	reasonable time to present their positions and to present
1102	rebuttal information. A recorded verbatim record of the hearing
1103	shall be maintained. The public hearing shall be held at the
1104	local level within 21 days after the application is deemed
1105	complete.
1106	(4)  STAFF RECOMMENDATIONS.--
1107	(a)  The agency's review of and final agency action on
1108	applications shall be in accordance with the district health
1109	plan, and statutory criteria, and the implementing
1110	administrative rules.  In the application review process, the
1111	agency shall give a preference, as defined by rule of the
1112	agency, to an applicant that which proposes to develop a nursing
1113	home in a nursing home geographically underserved area.
1114	(b)  Within 60 days after all the applications in a review
1115	cycle are determined to be complete, the agency shall issue its
1116	State Agency Action Report and Notice of Intent to grant a
1117	certificate of need for the project in its entirety, to grant a
1118	certificate of need for identifiable portions of the project, or
1119	to deny a certificate of need.  The State Agency Action Report
1120	shall set forth in writing its findings of fact and
1121	determinations upon which its decision is based. If a finding of
1122	fact or determination by the agency is counter to the district
1123	health plan of the local health council, the agency shall
1124	provide in writing its reason for its findings, item by item, to
1125	the local health council. If the agency intends to grant a
1126	certificate of need, the State Agency Action Report or the
1127	Notice of Intent shall also include any conditions which the
1128	agency intends to attach to the certificate of need. The agency
1129	shall designate by rule a senior staff person, other than the
1130	person who issues the final order, to issue State Agency Action
1131	Reports and Notices of Intent.
1132	(c)  The agency shall publish its proposed decision set
1133	forth in the Notice of Intent in the Florida Administrative
1134	Weekly within 14 days after the Notice of Intent is issued.
1135	(d)  If no administrative hearing is requested under
1136	pursuant to subsection (5), the State Agency Action Report and
1137	the Notice of Intent shall become the final order of the agency.
1138	The agency shall provide a copy of the final order to the
1139	appropriate local health council.
1140	(5)  ADMINISTRATIVE HEARINGS.--
1141	(a)  Within 21 days after publication of notice of the
1142	State Agency Action Report and Notice of Intent, any person
1143	authorized under paragraph (c) to participate in a hearing may
1144	file a request for an administrative hearing; failure to file a
1145	request for hearing within 21 days of publication of notice
1146	shall constitute a waiver of any right to a hearing and a waiver
1147	of the right to contest the final decision of the agency.  A
1148	copy of the request for hearing shall be served on the
1149	applicant.
1150	(b)  Hearings shall be held in Tallahassee unless the
1151	administrative law judge determines that changing the location
1152	will facilitate the proceedings. The agency shall assign
1153	proceedings requiring hearings to the Division of Administrative
1154	Hearings of the Department of Management Services within 10 days
1155	after the time has expired for requesting a hearing.  Except
1156	upon unanimous consent of the parties or upon the granting by
1157	the administrative law judge of a motion of continuance,
1158	hearings shall commence within 60 days after the administrative
1159	law judge has been assigned. All parties, except the agency,
1160	shall bear their own expense of preparing a transcript. In any
1161	application for a certificate of need which is referred to the
1162	Division of Administrative Hearings for hearing, the
1163	administrative law judge shall complete and submit to the
1164	parties a recommended order as provided in ss. 120.569 and
1165	120.57.  The recommended order shall be issued within 30 days
1166	after the receipt of the proposed recommended orders or the
1167	deadline for submission of the such proposed recommended orders,
1168	whichever is earlier.  The division shall adopt procedures for
1169	administrative hearings which shall maximize the use of
1170	stipulated facts and shall provide for the admission of prepared
1171	testimony.
1172	(c)  In administrative proceedings challenging the issuance
1173	or denial of a certificate of need, only applicants considered
1174	by the agency in the same batching cycle are entitled to a
1175	comparative hearing on their applications. Existing health care
1176	facilities may initiate or intervene in an administrative
1177	hearing upon a showing that an established program will be
1178	substantially affected by the issuance of any certificate of
1179	need, whether reviewed under s. 408.036(1) or (2), to a
1180	competing proposed facility or program within the same district.
1181	(d)  The applicant's failure to strictly comply with the
1182	requirements of s. 408.037(1) or paragraph (2)(c) is not cause
1183	for dismissal of the application, unless the failure to comply
1184	impairs the fairness of the proceeding or affects the
1185	correctness of the action taken by the agency.
1186	(e)  The agency shall issue its final order within 45 days
1187	after receipt of the recommended order. If the agency fails to
1188	take action within this such time, or as otherwise agreed to by
1189	the applicant and the agency, the applicant may take appropriate
1190	legal action to compel the agency to act. When making a
1191	determination on an application for a certificate of need, the
1192	agency is specifically exempt from the time limitations provided
1193	in s. 120.60(1).
1194	(6)  JUDICIAL REVIEW.--
1195	(a)  A party to an administrative hearing for an
1196	application for a certificate of need has the right, within not
1197	more than 30 days after the date of the final order, to seek
1198	judicial review in the District Court of Appeal under pursuant
1199	to s. 120.68.  The agency shall be a party to this in any such
1200	proceeding.
1201	(b)  In the such judicial review, the court shall affirm
1202	the final order of the agency, unless the decision is arbitrary,
1203	capricious, or not in compliance with ss. 408.031-408.045.
1204	(c)  The court, in its discretion, may award reasonable
1205	attorney's fees and costs to the prevailing party if the court
1206	finds that there was a complete absence of a justiciable issue
1207	of law or fact raised by the losing party.
1208	Section 11.  Section 408.040, Florida Statutes, is amended
1209	to read:
1210	408.040  Conditions and monitoring.--
1211	(1)(a)  The agency may issue a certificate of need or an
1212	exemption predicated upon statements of intent expressed by an
1213	applicant in the application for a certificate of need or
1214	exemption. Any conditions imposed on a certificate of need or an
1215	exemption based on such statements of intent shall be stated on
1216	the face of the certificate of need or in the exemption
1217	approval.
1218	(b)  The agency may consider, in addition to the other
1219	criteria specified in s. 408.035, a statement of intent by the
1220	applicant that a specified percentage of the annual patient days
1221	at the facility will be utilized by patients eligible for care
1222	under Title XIX of the Social Security Act. Any certificate of
1223	need issued to a nursing home in reliance upon an applicant's
1224	statements that a specified percentage of annual patient days
1225	will be utilized by residents eligible for care under Title XIX
1226	of the Social Security Act must include a statement that this
1227	such certification is a condition of issuance of the certificate
1228	of need. The certificate-of-need program shall notify the
1229	Medicaid program office and the Department of Elderly Affairs
1230	when it imposes conditions as authorized in this paragraph in an
1231	area in which a community diversion pilot project is
1232	implemented.
1233	(c)  A certificateholder or exemption holder may apply to
1234	the agency for a modification of conditions imposed under
1235	paragraph (a) or paragraph (b). If the holder of a certificate
1236	of need or exemption demonstrates good cause why the certificate
1237	or exemption should be modified, the agency shall reissue the
1238	certificate of need or exemption with such modifications as may
1239	be appropriate.  The agency shall by rule define the factors
1240	constituting good cause for modification.
1241	(d)  If the holder of a certificate of need or certificate-
1242	of-need exemption fails to comply with a condition upon which
1243	the issuance of the certificate or exemption was predicated, the
1244	agency shall may assess an administrative fine against the
1245	certificateholder or exemption holder in an amount not to exceed
1246	$1,000 per failure per day. Failure to annually report
1247	compliance with any condition upon which the issuance of the
1248	certificate or exemption was predicated constitutes
1249	noncompliance. In assessing the penalty, the agency shall take
1250	into account as mitigation the degree of noncompliance relative
1251	lack of severity of a particular failure.  Proceeds of such
1252	penalties shall be deposited in the Public Medical Assistance
1253	Trust Fund.
1254	(2)(a)  Unless the applicant has commenced construction, if
1255	the project provides for construction, unless the applicant has
1256	incurred an enforceable capital expenditure commitment for a
1257	project, if the project does not provide for construction, or
1258	unless subject to paragraph (b), a certificate of need shall
1259	terminate 18 months after the date of issuance. The agency shall
1260	monitor the progress of the holder of the certificate of need in
1261	meeting the timetable for project development specified in the
1262	application with the assistance of the local health council as
1263	specified in s. 408.033(1)(b)5., and may revoke the certificate
1264	of need, if the holder of the certificate is not meeting such
1265	timetable and is not making a good-faith effort, as defined by
1266	rule, to meet it.
1267	(b)  A certificate of need issued to an applicant holding a
1268	provisional certificate of authority under chapter 651 shall
1269	terminate 1 year after the applicant receives a valid
1270	certificate of authority from the Office of Insurance Regulation
1271	of the Financial Services Commission.
1272	(c)  The certificate-of-need validity period for a project
1273	shall be extended by the agency, to the extent that the
1274	applicant demonstrates to the satisfaction of the agency that
1275	good-faith commencement of the project is being delayed by
1276	litigation or by governmental action or inaction with respect to
1277	regulations or permitting precluding commencement of the
1278	project.
1279	(3)  The agency shall require the submission of an executed
1280	architect's certification of final payment for each certificate-
1281	of-need project approved by the agency.  Each project that
1282	involves construction shall submit such certification to the
1283	agency within 30 days following completion of construction.
1284	Section 12.  Section 408.0455, Florida Statutes, is amended
1285	to read:
1286	408.0455  Rules; pending proceedings.--The rules of the
1287	agency in effect on June 30, 2004 1997, shall remain in effect
1288	and shall be enforceable by the agency with respect to ss.
1289	408.031-408.045 until the such rules are repealed or amended by
1290	the agency, and no judicial or administrative proceeding pending
1291	on July 1, 1997, shall be abated as a result of the provisions
1292	of ss. 408.031-408.043(1) and (2); s. 408.044; or s. 408.045.
1293	Section 13.  Subsection (2) of section 408.043, and section
1294	408.045, Florida Statutes, are repealed.
1295	Section 14.  This act shall take effect July 1, 2004.

CODING: Words stricken are deletions; words underlined are additions.