HB 1699

CS

CHAMBER ACTION

1	The Committee on Health Care recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to certificates of need; amending s.
7	395.003, F.S.; providing certain restrictions on the
8	licensure of hospitals; providing exceptions; authorizing
9	rulemaking; amending s. 408.032, F.S.; revising
10	definitions; amending s. 408.033, F.S.; revising
11	provisions relating to local health councils; deleting
12	provisions relating to regional areas; revising funding
13	provisions; making the Agency for Health Care
14	Administration solely responsible for coordinated planning
15	of health care services; transferring certain duties from
16	the agency to the Department of Health; amending ss.
17	408.034 and 408.035, F.S., to conform; amending s.
18	408.036, F.S.; revising the list of projects subject to
19	review; including beds in community nursing homes and
20	intermediate care facilities for the developmentally
21	disabled in project review requirements; including
22	conversion from a general hospital to another form of
23	hospital in project review requirements; revising the list
24	of projects subject to expedited review; revising the list
25	of projects subject to exemption from review; specifying
26	certain facility or provider notice requirements; amending
27	s. 408.0361, F.S.; requiring the agency to adopt rules to
28	develop licensing standards for cardiology services and
29	burn units; providing criteria for such rules; requiring
30	certain providers to comply with such rules; requiring the
31	agency to include certain provisions in establishing the
32	rules; requiring the agency to establish a technical
33	advisory panel and adopt rules based on the panel's
34	recommendations; requiring the secretary of the agency to
35	appoint an advisory group; providing membership criteria
36	for such group; requiring the group to make certain
37	recommendations; requiring the secretary to appoint a
38	workgroup; providing the components of such workgroup's
39	assessment; requiring a report; amending s. 408.038, F.S.;
40	providing for a higher application fee; amending s.
41	408.039, F.S.; specifying an annual review cycle; amending
42	s. 408.040, F.S.; providing that failure to report
43	compliance constitutes noncompliance; amending s. 408.043,
44	F.S.; deleting special provisions relating to sole acute
45	care hospitals in high-growth counties; amending s.
46	408.0455, F.S.; deleting an obsolete judicial or
47	administrative abatement provision; providing an effective
48	date.
49
50	WHEREAS, the Legislature finds that it is essential for the
51	public health and safety of this state that general hospitals
52	providing emergency services be available in our communities,
53	and
54	WHEREAS, the Legislature finds that a substantial number of
55	hospitals have closed in this state and is concerned that more
56	hospitals may close, and
57	WHEREAS, the Legislature finds the creation of hospitals
58	with limited services will serve only paying patients and may
59	cause harm to the existence of general hospitals serving broad
60	populations, including the medically indigent of this state, and
61	WHEREAS, the Legislature finds that the creation of
62	hospitals with limited services may limit or eliminate
63	competitive alternatives in the health care service market, may
64	result in overutilization of certain high-cost health care
65	services such as cardiac, orthopedic, surgical, and oncology
66	services, may increase costs to the health care system, and may
67	adversely affect the quality of health care, NOW, THEREFORE,
68
69	Be It Enacted by the Legislature of the State of Florida:
70
71	Section 1.  Subsections (9), (10), and (11) are added to
72	section 395.003, Florida Statutes, to read:
73	395.003  Licensure; issuance, renewal, denial,
74	modification, suspension, and revocation.--
75	(9)  A hospital shall not be licensed or relicensed if:
76	(a)  The diagnostic-related groups for 65 percent or more
77	of the discharges from the hospital, in the most recent year for
78	which data is available to the Agency for Health Care
79	Administration pursuant to s. 408.061, are for diagnosis, care,
80	and treatment of patients with:
81	1.  Cardiac-related diseases and disorders classified as
82	diagnostic-related groups 103-145, 478-479, 514-518, or 525-527;
83	2.  Orthopedic-related diseases and disorders classified as
84	diagnostic-related groups 209-256, 471, 491, 496-503, or 519-
85	520;
86	3.  Cancer-related diseases and disorders classified as
87	diagnostic-related groups 64, 82, 172, 173, 199, 200, 203, 257-
88	260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363,
89	366, 367, 400-414, 473, or 492; or
90	4.  Any combination of the above discharges.
91	(b)  The hospital restricts its medical and surgical
92	services to primarily or exclusively cardiac, orthopedic,
93	surgical, or oncology specialties.
94	(10)  A hospital licensed as of June 1, 2004, shall be
95	exempt from the requirements in subsection (9) so long as the
96	hospital maintains the same ownership, facility street address,
97	and range of services that were in existence on June 1, 2004.
98	Any transfer of beds, or other agreements that result in the
99	establishment of a hospital or hospital services within the
100	intent of this section, shall be subject to these provisions.
101	Unless otherwise exempt under subsection (9), the agency shall
102	deny or revoke a license if a hospital violates any of the
103	criteria under subsection (9).
104	(11)  The agency may adopt rules implementing the licensure
105	requirements set forth in subsection (9). Within 14 days after
106	rendering its decision on a license application or revocation,
107	the agency shall publish its proposed decision in the Florida
108	Administrative Weekly. Within 21 days after publication of the
109	agency's decision, any authorized person may file a request for
110	an administrative hearing. In administrative proceedings
111	challenging the approval, denial, or revocation of a license
112	pursuant to subsection (9), the hearing will be based on the
113	facts and law existing at the time of the agency's proposed
114	agency action. Existing hospitals may initiate or intervene in
115	an administrative hearing to approve, deny, or revoke licensure
116	under subsection (9) based upon a showing that an established
117	program will be substantially affected by the issuance or
118	renewal of a license to a hospital within the same district or
119	service area.
120	Section 2.  Subsections (9), (13), (17), and (18) of
121	section 408.032, Florida Statutes, are amended to read:
122	408.032  Definitions relating to Health Facility and
123	Services Development Act.--As used in ss. 408.031-408.045, the
124	term:
125	(9)  "Health services" means inpatient diagnostic,
126	curative, or comprehensive medical rehabilitative services and
127	includes mental health services. Obstetric services are not
128	health services for purposes of ss. 408.031-408.045.
129	(13)  "Long-term care hospital" means a hospital licensed
130	under chapter 395 which meets the requirements of 42 C.F.R. s.
131	412.23(e) and seeks exclusion from the acute care Medicare
132	prospective payment system for inpatient hospital services.
133	(17)  "Tertiary health service" means a health service
134	which, due to its high level of intensity, complexity,
135	specialized or limited applicability, and cost, should be
136	limited to, and concentrated in, a limited number of hospitals
137	to ensure the quality, availability, and cost-effectiveness of
138	such service. Examples of such service include, but are not
139	limited to, pediatric cardiac catheterization, pediatric open-
140	heart surgery, organ transplantation, specialty burn units,
141	neonatal intensive care units, comprehensive rehabilitation, and
142	medical or surgical services which are experimental or
143	developmental in nature to the extent that the provision of such
144	services is not yet contemplated within the commonly accepted
145	course of diagnosis or treatment for the condition addressed by
146	a given service. The agency shall establish by rule a list of
147	all tertiary health services.
148	(18)  "Regional area" means any of those regional health
149	planning areas established by the agency to which local and
150	district health planning funds are directed to local health
151	councils through the General Appropriations Act.
152	Section 3.  Section 408.033, Florida Statutes, is amended
153	to read:
154	408.033  Local and state health planning.--
155	(1)  LOCAL HEALTH COUNCILS.--
156	(a)  Local health councils are hereby established as public
157	or private nonprofit agencies serving the counties of a district
158	or regional area of the agency. The members of each council
159	shall be appointed in an equitable manner by the county
160	commissions having jurisdiction in the respective district. Each
161	council shall be composed of a number of persons equal to 11/2
162	times the number of counties which compose the district or 12
163	members, whichever is greater. Each county in a district shall
164	be entitled to at least one member on the council. The balance
165	of the membership of the council shall be allocated among the
166	counties of the district on the basis of population rounded to
167	the nearest whole number; except that in a district composed of
168	only two counties, no county shall have fewer than four members.
169	The appointees shall be representatives of health care
170	providers, health care purchasers, and nongovernmental health
171	care consumers, but not excluding elected government officials.
172	The members of the consumer group shall include a representative
173	number of persons over 60 years of age. A majority of council
174	members shall consist of health care purchasers and health care
175	consumers. The local health council shall provide each county
176	commission a schedule for appointing council members to ensure
177	that council membership complies with the requirements of this
178	paragraph. The members of the local health council shall elect a
179	chair. Members shall serve for terms of 2 years and may be
180	eligible for reappointment.
181	(b)  Each local health council may:
182	1.  Develop a district or regional area health plan that
183	permits each local health council to develop strategies and set
184	priorities for implementation based on its unique local health
185	needs. The district or regional area health plan must contain
186	preferences for the development of health services and
187	facilities, which may be considered by the agency in its review
188	of certificate-of-need applications. The district health plan
189	shall be submitted to the agency and updated periodically. The
190	district health plans shall use a uniform format and be
191	submitted to the agency according to a schedule developed by the
192	agency in conjunction with the local health councils. The
193	schedule must provide for the development of district health
194	plans by major sections over a multiyear period. The elements of
195	a district plan which are necessary to the review of
196	certificate-of-need applications for proposed projects within
197	the district may be adopted by the agency as a part of its
198	rules.
199	2.  Advise the agency on health care issues and resource
200	allocations.
201	3.  Promote public awareness of community health needs,
202	emphasizing health promotion and cost-effective health service
203	selection.
204	4.  Collect data and conduct analyses and studies related
205	to health care needs of the district, including the needs of
206	medically indigent persons, and assist the agency and other
207	state agencies in carrying out data collection activities that
208	relate to the functions in this subsection.
209	5.  Monitor the onsite construction progress, if any, of
210	certificate-of-need approved projects and report council
211	findings to the agency on forms provided by the agency.
212	6.  Advise and assist any regional planning councils within
213	each district that have elected to address health issues in
214	their strategic regional policy plans with the development of
215	the health element of the plans to address the health goals and
216	policies in the State Comprehensive Plan.
217	7.  Advise and assist local governments within each
218	district on the development of an optional health plan element
219	of the comprehensive plan provided in chapter 163, to assure
220	compatibility with the health goals and policies in the State
221	Comprehensive Plan and district health plan. To facilitate the
222	implementation of this section, the local health council shall
223	annually provide the local governments in its service area, upon
224	request, with:
225	a.  A copy and appropriate updates of the district health
226	plan;
227	b.  A report of hospital and nursing home utilization
228	statistics for facilities within the local government
229	jurisdiction; and
230	c.  Applicable agency rules and calculated need
231	methodologies for health facilities and services regulated under
232	s. 408.034 for the district served by the local health council.
233	8.  Monitor and evaluate the adequacy, appropriateness, and
234	effectiveness, within the district, of local, state, federal,
235	and private funds distributed to meet the needs of the medically
236	indigent and other underserved population groups.
237	9.  In conjunction with the Department of Health Agency for
238	Health Care Administration, plan for services at the local level
239	for persons infected with the human immunodeficiency virus.
240	10.  Provide technical assistance to encourage and support
241	activities by providers, purchasers, consumers, and local,
242	regional, and state agencies in meeting the health care goals,
243	objectives, and policies adopted by the local health council.
244	11.  Provide the agency with data required by rule for the
245	review of certificate-of-need applications and the projection of
246	need for health services and facilities in the district.
247	(c)  Local health councils may conduct public hearings
248	pursuant to s. 408.039(3)(b).
249	(d)  Each local health council shall enter into a
250	memorandum of agreement with each regional planning council in
251	its district that elects to address health issues in its
252	strategic regional policy plan. In addition, each local health
253	council shall enter into a memorandum of agreement with each
254	local government that includes an optional health element in its
255	comprehensive plan. Each memorandum of agreement must specify
256	the manner in which each local government, regional planning
257	council, and local health council will coordinate its activities
258	to ensure a unified approach to health planning and
259	implementation efforts.
260	(e)  Local health councils may employ personnel or contract
261	for staffing services with persons who possess appropriate
262	qualifications to carry out the councils' purposes. However,
263	such personnel are not state employees.
264	(f)  Personnel of the local health councils shall provide
265	an annual orientation to council members about council member
266	responsibilities. The orientation shall include presentations
267	and participation by agency staff.
268	(g)  Each local health council is authorized to accept and
269	receive, in furtherance of its health planning functions, funds,
270	grants, and services from governmental agencies and from private
271	or civic sources and to perform studies related to local health
272	planning in exchange for such funds, grants, or services. Each
273	local health council shall, no later than January 30 of each
274	year, render an accounting of the receipt and disbursement of
275	such funds received by it to the Department of Health agency.
276	The department agency shall consolidate all such reports and
277	submit such consolidated report to the Legislature no later than
278	March 1 of each year. Funds received by a local health council
279	pursuant to this paragraph shall not be deemed to be a
280	substitute for, or an offset against, any funding provided
281	pursuant to subsection (2).
282	(2)  FUNDING.--
283	(a)  The Legislature intends that the cost of local health
284	councils be borne by application fees for certificates of need
285	and by assessments on selected health care facilities subject to
286	facility licensure by the Agency for Health Care Administration,
287	including abortion clinics, assisted living facilities,
288	ambulatory surgical centers, birthing centers, clinical
289	laboratories except community nonprofit blood banks and clinical
290	laboratories operated by practitioners for exclusive use
291	regulated under s. 483.035, home health agencies, hospices,
292	hospitals, intermediate care facilities for the developmentally
293	disabled, nursing homes, and multiphasic testing centers and by
294	assessments on organizations subject to certification by the
295	agency pursuant to chapter 641, part III, including health
296	maintenance organizations and prepaid health clinics.
297	(b)1.  A hospital licensed under chapter 395, a nursing
298	home licensed under chapter 400, and an assisted living facility
299	licensed under chapter 400 shall be assessed an annual fee based
300	on number of beds.
301	2.  All other facilities and organizations listed in
302	paragraph (a) shall each be assessed an annual fee of $150.
303	3.  Facilities operated by the Department of Children and
304	Family Services, the Department of Health, or the Department of
305	Corrections and any hospital which meets the definition of rural
306	hospital pursuant to s. 395.602 are exempt from the assessment
307	required in this subsection.
308	(c)1.  The agency shall, by rule, establish fees for
309	hospitals and nursing homes based on an assessment of $2 per
310	bed. However, no such facility shall be assessed more than a
311	total of $500 under this subsection.
312	2.  The agency shall, by rule, establish fees for assisted
313	living facilities based on an assessment of $1 per bed. However,
314	no such facility shall be assessed more than a total of $150
315	under this subsection.
316	3.  The agency shall, by rule, establish an annual fee of
317	$150 for all other facilities and organizations listed in
318	paragraph (a).
319	(d)  The agency shall, by rule, establish a facility
320	billing and collection process for the billing and collection of
321	the health facility fees authorized by this subsection.
322	(e)  A health facility which is assessed a fee under this
323	subsection is subject to a fine of $100 per day for each day in
324	which the facility is late in submitting its annual fee up to
325	maximum of the annual fee owed by the facility. A facility which
326	refuses to pay the fee or fine is subject to the forfeiture of
327	its license.
328	(f)  The agency shall deposit in the Health Care Trust Fund
329	all health care facility assessments that are assessed under
330	this subsection and proceeds from the certificate-of-need
331	application fees. The agency shall transfer such funds to the
332	Department of Health an amount sufficient to maintain the
333	aggregate for funding of level for the local health councils as
334	specified in the General Appropriations Act. The remaining
335	certificate-of-need application fees shall be used only for the
336	purpose of administering the certificate-of-need program Health
337	Facility and Services Development Act.
338	(3)  DUTIES AND RESPONSIBILITIES OF THE AGENCY.--
339	(a)  The agency, in conjunction with the local health
340	councils, is responsible for the coordinated planning of health
341	care services in the state.
342	(b)  The agency shall develop and maintain a comprehensive
343	health care database for the purpose of health planning and for
344	certificate-of-need determinations. The agency or its contractor
345	is authorized to require the submission of information from
346	health facilities, health service providers, and licensed health
347	professionals which is determined by the agency, through rule,
348	to be necessary for meeting the agency's responsibilities as
349	established in this section.
350	(c)  The agency shall assist personnel of the local health
351	councils in providing an annual orientation to council members
352	about council member responsibilities.
353	(c)(d)  The Department of Health agency shall contract with
354	the local health councils for the services specified in
355	subsection (1). All contract funds shall be distributed
356	according to an allocation plan developed by the department
357	agency that provides for a minimum and equal funding base for
358	each local health council. Any remaining funds shall be
359	distributed based on adjustments for workload. The agency may
360	also make grants to or reimburse local health councils from
361	federal funds provided to the state for activities related to
362	those functions set forth in this section. The department agency
363	may withhold funds from a local health council or cancel its
364	contract with a local health council which does not meet
365	performance standards agreed upon by the department agency and
366	local health councils.
367	Section 4.  Subsections (1) and (2) of section 408.034,
368	Florida Statutes, are amended to read:
369	408.034  Duties and responsibilities of agency; rules.--
370	(1)  The agency is designated as the single state agency to
371	issue, revoke, or deny certificates of need and to issue,
372	revoke, or deny exemptions from certificate-of-need review in
373	accordance with the district plans and present and future
374	federal and state statutes. The agency is designated as the
375	state health planning agency for purposes of federal law.
376	(2)  In the exercise of its authority to issue licenses to
377	health care facilities and health service providers, as provided
378	under chapters 393, 395, and parts II and VI of chapter 400, the
379	agency may not issue a license to any health care facility or,
380	health service provider, hospice, or part of a health care
381	facility which fails to receive a certificate of need or an
382	exemption for the licensed facility or service.
383	Section 5.  Section 408.035, Florida Statutes, is amended
384	to read:
385	408.035  Review criteria.--The agency shall determine the
386	reviewability of applications and shall review applications for
387	certificate-of-need determinations for health care facilities
388	and health services in context with the following criteria:
389	(1)  The need for the health care facilities and health
390	services being proposed in relation to the applicable district
391	health plan.
392	(2)  The availability, quality of care, accessibility, and
393	extent of utilization of existing health care facilities and
394	health services in the service district of the applicant.
395	(3)  The ability of the applicant to provide quality of
396	care and the applicant's record of providing quality of care.
397	(4)  The need in the service district of the applicant for
398	special health care services that are not reasonably and
399	economically accessible in adjoining areas.
400	(5)  The needs of research and educational facilities,
401	including, but not limited to, facilities with institutional
402	training programs and community training programs for health
403	care practitioners and for doctors of osteopathic medicine and
404	medicine at the student, internship, and residency training
405	levels.
406	(4)(6)  The availability of resources, including health
407	personnel, management personnel, and funds for capital and
408	operating expenditures, for project accomplishment and
409	operation.
410	(5)(7)  The extent to which the proposed services will
411	enhance access to health care for residents of the service
412	district.
413	(6)(8)  The immediate and long-term financial feasibility
414	of the proposal.
415	(7)(9)  The extent to which the proposal will foster
416	competition that promotes quality and cost-effectiveness.
417	(8)(10)  The costs and methods of the proposed
418	construction, including the costs and methods of energy
419	provision and the availability of alternative, less costly, or
420	more effective methods of construction.
421	(9)(11)  The applicant's past and proposed provision of
422	health care services to Medicaid patients and the medically
423	indigent.
424	(10)(12)  The applicant's designation as a Gold Seal
425	Program nursing facility pursuant to s. 400.235, when the
426	applicant is requesting additional nursing home beds at that
427	facility.
428	Section 6.  Section 408.036, Florida Statutes, is amended
429	to read:
430	408.036  Projects subject to review; exemptions.--
431	(1)  APPLICABILITY.--Unless exempt under subsection (3),
432	all health-care-related projects, as described in paragraphs
433	(a)-(e) (a)-(h), are subject to review and must file an
434	application for a certificate of need with the agency. The
435	agency is exclusively responsible for determining whether a
436	health-care-related project is subject to review under ss.
437	408.031-408.045.
438	(a)  The addition of beds in community nursing homes or
439	intermediate care facilities for the developmentally disabled by
440	new construction or alteration.
441	(b)  The new construction or establishment of additional
442	health care facilities, including a replacement health care
443	facility when the proposed project site is not located on the
444	same site as or within 1 mile of the existing health care
445	facility provided that the number of beds in each licensed bed
446	category will not increase.
447	(c)  The conversion from one type of health care facility
448	to another, including the conversion from a general hospital, a
449	specialty hospital, or a long-term care hospital.
450	(d)  An increase in the total licensed bed capacity of a
451	health care facility.
452	(d)(e)  The establishment of a hospice or hospice inpatient
453	facility, except as provided in s. 408.043.
454	(f)  The establishment of inpatient health services by a
455	health care facility, or a substantial change in such services.
456	(g)  An increase in the number of beds for acute care,
457	nursing home care beds, specialty burn units, neonatal intensive
458	care units, comprehensive rehabilitation, mental health
459	services, or hospital-based distinct part skilled nursing units,
460	or at a long-term care hospital.
461	(e)(h)  The establishment of tertiary health services.
462	(2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
463	pursuant to subsection (3), projects subject to an expedited
464	review shall include, but not be limited to:
465	(a)  Research, education, and training programs.
466	(b)  Shared services contracts or projects.
467	(a)(c)  A transfer of a certificate of need, except that
468	when an existing hospital is acquired by a purchaser, all
469	certificates of need issued to the hospital which are not yet
470	operational shall be acquired by the purchaser, without need for
471	a transfer.
472	(b)  Replacement of a community nursing home or
473	intermediate care facility for the developmentally disabled when
474	the proposed project site is located within the same district
475	and within the same planning area of the replaced health care
476	facility provided the number of licensed beds is the same as
477	that of the facility being replaced.
478	(d)  A 50-percent increase in nursing home beds for a
479	facility incorporated and operating in this state for at least
480	60 years on or before July 1, 1988, which has a licensed nursing
481	home facility located on a campus providing a variety of
482	residential settings and supportive services. The increased
483	nursing home beds shall be for the exclusive use of the campus
484	residents. Any application on behalf of an applicant meeting
485	this requirement shall be subject to the base fee of $5,000
486	provided in s. 408.038.
487	(e)  Replacement of a health care facility when the
488	proposed project site is located in the same district and within
489	a 1-mile radius of the replaced health care facility.
490	(f)  The conversion of mental health services beds licensed
491	under chapter 395 or hospital-based distinct part skilled
492	nursing unit beds to general acute care beds; the conversion of
493	mental health services beds between or among the licensed bed
494	categories defined as beds for mental health services; or the
495	conversion of general acute care beds to beds for mental health
496	services.
497	1.  Conversion under this paragraph shall not establish a
498	new licensed bed category at the hospital but shall apply only
499	to categories of beds licensed at that hospital.
500	2.  Beds converted under this paragraph must be licensed
501	and operational for at least 12 months before the hospital may
502	apply for additional conversion affecting beds of the same type.
503
504	The agency shall develop rules to implement the provisions for
505	expedited review, including time schedule, application content
506	which may be reduced from the full requirements of s.
507	408.037(1), and application processing.
508	(3)  EXEMPTIONS.--Upon request, the following projects are
509	subject to exemption from the provisions of subsection (1):
510	(a)  For replacement of a licensed health care facility on
511	the same site, provided that the number of beds in each licensed
512	bed category will not increase.
513	(a)(b)  For hospice services or for swing beds in a rural
514	hospital, as defined in s. 395.602, in a number that does not
515	exceed one-half of its licensed beds.
516	(b)(c)  For the conversion of licensed acute care hospital
517	beds to Medicare and Medicaid certified skilled nursing beds in
518	a rural hospital, as defined in s. 395.602, so long as the
519	conversion of the beds does not involve the construction of new
520	facilities. The total number of skilled nursing beds, including
521	swing beds, may not exceed one-half of the total number of
522	licensed beds in the rural hospital as of July 1, 1993.
523	Certified skilled nursing beds designated under this paragraph,
524	excluding swing beds, shall be included in the community nursing
525	home bed inventory. A rural hospital which subsequently
526	decertifies any acute care beds exempted under this paragraph
527	shall notify the agency of the decertification, and the agency
528	shall adjust the community nursing home bed inventory
529	accordingly.
530	(c)(d)  For the addition of nursing home beds at a skilled
531	nursing facility that is part of a retirement community that
532	provides a variety of residential settings and supportive
533	services and that has been incorporated and operated in this
534	state for at least 65 years on or before July 1, 1994. All
535	nursing home beds must not be available to the public but must
536	be for the exclusive use of the community residents.
537	(e)  For an increase in the bed capacity of a nursing
538	facility licensed for at least 50 beds as of January 1, 1994,
539	under part II of chapter 400 which is not part of a continuing
540	care facility if, after the increase, the total licensed bed
541	capacity of that facility is not more than 60 beds and if the
542	facility has been continuously licensed since 1950 and has
543	received a superior rating on each of its two most recent
544	licensure surveys.
545	(d)(f)  For an inmate health care facility built by or for
546	the exclusive use of the Department of Corrections as provided
547	in chapter 945. This exemption expires when such facility is
548	converted to other uses.
549	(g)  For the termination of an inpatient health care
550	service, upon 30 days' written notice to the agency.
551	(h)  For the delicensure of beds, upon 30 days' written
552	notice to the agency. A request for exemption submitted under
553	this paragraph must identify the number, the category of beds,
554	and the name of the facility in which the beds to be delicensed
555	are located.
556	(i)  For the provision of adult inpatient diagnostic
557	cardiac catheterization services in a hospital.
558	1.  In addition to any other documentation otherwise
559	required by the agency, a request for an exemption submitted
560	under this paragraph must comply with the following criteria:
561	a.  The applicant must certify it will not provide
562	therapeutic cardiac catheterization pursuant to the grant of the
563	exemption.
564	b.  The applicant must certify it will meet and
565	continuously maintain the minimum licensure requirements adopted
566	by the agency governing such programs pursuant to subparagraph
567	2.
568	c.  The applicant must certify it will provide a minimum of
569	2 percent of its services to charity and Medicaid patients.
570	2.  The agency shall adopt licensure requirements by rule
571	which govern the operation of adult inpatient diagnostic cardiac
572	catheterization programs established pursuant to the exemption
573	provided in this paragraph. The rules shall ensure that such
574	programs:
575	a.  Perform only adult inpatient diagnostic cardiac
576	catheterization services authorized by the exemption and will
577	not provide therapeutic cardiac catheterization or any other
578	services not authorized by the exemption.
579	b.  Maintain sufficient appropriate equipment and health
580	personnel to ensure quality and safety.
581	c.  Maintain appropriate times of operation and protocols
582	to ensure availability and appropriate referrals in the event of
583	emergencies.
584	d.  Maintain appropriate program volumes to ensure quality
585	and safety.
586	e.  Provide a minimum of 2 percent of its services to
587	charity and Medicaid patients each year.
588	3.a.  The exemption provided by this paragraph shall not
589	apply unless the agency determines that the program is in
590	compliance with the requirements of subparagraph 1. and that the
591	program will, after beginning operation, continuously comply
592	with the rules adopted pursuant to subparagraph 2. The agency
593	shall monitor such programs to ensure compliance with the
594	requirements of subparagraph 2.
595	b.(I)  The exemption for a program shall expire immediately
596	when the program fails to comply with the rules adopted pursuant
597	to sub-subparagraphs 2.a., b., and c.
598	(II)  Beginning 18 months after a program first begins
599	treating patients, the exemption for a program shall expire when
600	the program fails to comply with the rules adopted pursuant to
601	sub-subparagraphs 2.d. and e.
602	(III)  If the exemption for a program expires pursuant to
603	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
604	agency shall not grant an exemption pursuant to this paragraph
605	for an adult inpatient diagnostic cardiac catheterization
606	program located at the same hospital until 2 years following the
607	date of the determination by the agency that the program failed
608	to comply with the rules adopted pursuant to subparagraph 2.
609	(e)(j)  For mobile surgical facilities and related health
610	care services provided under contract with the Department of
611	Corrections or a private correctional facility operating
612	pursuant to chapter 957.
613	(f)(k)  For state veterans' nursing homes operated by or on
614	behalf of the Florida Department of Veterans' Affairs in
615	accordance with part II of chapter 296 for which at least 50
616	percent of the construction cost is federally funded and for
617	which the Federal Government pays a per diem rate not to exceed
618	one-half of the cost of the veterans' care in such state nursing
619	homes. These beds shall not be included in the nursing home bed
620	inventory.
621	(g)(l)  For combination within one nursing home facility of
622	the beds or services authorized by two or more certificates of
623	need issued in the same planning subdistrict. An exemption
624	granted under this paragraph shall extend the validity period of
625	the certificates of need to be consolidated by the length of the
626	period beginning upon submission of the exemption request and
627	ending with issuance of the exemption. The longest validity
628	period among the certificates shall be applicable to each of the
629	combined certificates.
630	(h)(m)  For division into two or more nursing home
631	facilities of beds or services authorized by one certificate of
632	need issued in the same planning subdistrict. An exemption
633	granted under this paragraph shall extend the validity period of
634	the certificate of need to be divided by the length of the
635	period beginning upon submission of the exemption request and
636	ending with issuance of the exemption.
637	(n)  For the addition of hospital beds licensed under
638	chapter 395 for acute care, mental health services, or a
639	hospital-based distinct part skilled nursing unit in a number
640	that may not exceed 10 total beds or 10 percent of the licensed
641	capacity of the bed category being expanded, whichever is
642	greater. Beds for specialty burn units, neonatal intensive care
643	units, or comprehensive rehabilitation, or at a long-term care
644	hospital, may not be increased under this paragraph.
645	1.  In addition to any other documentation otherwise
646	required by the agency, a request for exemption submitted under
647	this paragraph must:
648	a.  Certify that the prior 12-month average occupancy rate
649	for the category of licensed beds being expanded at the facility
650	meets or exceeds 80 percent or, for a hospital-based distinct
651	part skilled nursing unit, the prior 12-month average occupancy
652	rate meets or exceeds 96 percent.
653	b.  Certify that any beds of the same type authorized for
654	the facility under this paragraph before the date of the current
655	request for an exemption have been licensed and operational for
656	at least 12 months.
657	2.  The timeframes and monitoring process specified in s.
658	408.040(2)(a)-(c) apply to any exemption issued under this
659	paragraph.
660	3.  The agency shall count beds authorized under this
661	paragraph as approved beds in the published inventory of
662	hospital beds until the beds are licensed.
663	(o)  For the addition of acute care beds, as authorized by
664	rule consistent with s. 395.003(4), in a number that may not
665	exceed 10 total beds or 10 percent of licensed bed capacity,
666	whichever is greater, for temporary beds in a hospital that has
667	experienced high seasonal occupancy within the prior 12-month
668	period or in a hospital that must respond to emergency
669	circumstances.
670	(i)(p)  For the addition of nursing home beds licensed
671	under chapter 400 in a number not exceeding 10 total beds or 10
672	percent of the number of beds licensed in the facility being
673	expanded, whichever is greater.
674	1.  In addition to any other documentation required by the
675	agency, a request for exemption submitted under this paragraph
676	must:
677	a.  Effective until June 30, 2001, certify that the
678	facility has not had any class I or class II deficiencies within
679	the 30 months preceding the request for addition.
680	b.  Effective on July 1, 2001, certify that the facility
681	has been designated as a Gold Seal nursing home under s.
682	400.235.
683	c.  Certify that the prior 12-month average occupancy rate
684	for the nursing home beds at the facility meets or exceeds 96
685	percent.
686	d.  Certify that any beds authorized for the facility under
687	this paragraph before the date of the current request for an
688	exemption have been licensed and operational for at least 12
689	months.
690	2.  The timeframes and monitoring process specified in s.
691	408.040(2)(a)-(c) apply to any exemption issued under this
692	paragraph.
693	3.  The agency shall count beds authorized under this
694	paragraph as approved beds in the published inventory of nursing
695	home beds until the beds are licensed.
696	(j)  For the establishment of a Level II neonatal intensive
697	care unit with at least 10 beds, upon documentation to the
698	agency that the applicant hospital had a minimum of 1,500 births
699	during the previous 12 months; or the establishment of a Level
700	III neonatal intensive care unit with at least 15 beds, upon
701	documentation to the agency that the applicant hospital has a
702	Level II neonatal intensive care unit of at least 10 beds and
703	had a minimum of 3,500 births during the previous 12 months;
704	provided the applicant demonstrates that it meets the quality of
705	care, nurse staffing, physician staffing, physical plant,
706	equipment, emergency transportation, and data reporting
707	requirements as found in agency certificate-of-need rules for
708	Level II and Level III neonatal intensive care units and that
709	the applicant commits to the provision of services to Medicaid
710	and charity care patients at a level equal to or greater than
711	the district average. Such commitment shall be subject to the
712	provisions of s. 408.040.
713	(q)  For establishment of a specialty hospital offering a
714	range of medical service restricted to a defined age or gender
715	group of the population or a restricted range of services
716	appropriate to the diagnosis, care, and treatment of patients
717	with specific categories of medical illnesses or disorders,
718	through the transfer of beds and services from an existing
719	hospital in the same county.
720	(r)  For the conversion of hospital-based Medicare and
721	Medicaid certified skilled nursing beds to acute care beds, if
722	the conversion does not involve the construction of new
723	facilities.
724	(s)1.  For an adult open-heart-surgery program to be
725	located in a new hospital provided the new hospital is being
726	established in the location of an existing hospital with an
727	adult open-heart-surgery program, the existing hospital and the
728	existing adult open-heart-surgery program are being relocated to
729	a replacement hospital, and the replacement hospital will
730	utilize a closed-staff model. A hospital is exempt from the
731	certificate-of-need review for the establishment of an open-
732	heart-surgery program if the application for exemption submitted
733	under this paragraph complies with the following criteria:
734	a.  The applicant must certify that it will meet and
735	continuously maintain the minimum Florida Administrative Code
736	and any future licensure requirements governing adult open-heart
737	programs adopted by the agency, including the most current
738	guidelines of the American College of Cardiology and American
739	Heart Association Guidelines for Adult Open Heart Programs.
740	b.  The applicant must certify that it will maintain
741	sufficient appropriate equipment and health personnel to ensure
742	quality and safety.
743	c.  The applicant must certify that it will maintain
744	appropriate times of operation and protocols to ensure
745	availability and appropriate referrals in the event of
746	emergencies.
747	d.  The applicant is a newly licensed hospital in a
748	physical location previously owned and licensed to a hospital
749	performing more than 300 open-heart procedures each year,
750	including heart transplants.
751	e.  The applicant must certify that it can perform more
752	than 300 diagnostic cardiac catheterization procedures per year,
753	combined inpatient and outpatient, by the end of the third year
754	of its operation.
755	f.  The applicant's payor mix at a minimum reflects the
756	community average for Medicaid, charity care, and self-pay
757	patients or the applicant must certify that it will provide a
758	minimum of 5 percent of Medicaid, charity care, and self-pay to
759	open-heart-surgery patients.
760	g.  If the applicant fails to meet the established criteria
761	for open-heart programs or fails to reach 300 surgeries per year
762	by the end of its third year of operation, it must show cause
763	why its exemption should not be revoked.
764	h.  In order to ensure continuity of available services,
765	the applicant of the newly licensed hospital may apply for this
766	certificate-of-need before taking possession of the physical
767	facilities. The effective date of the certificate-of-need will
768	be concurrent with the effective date of the newly issued
769	hospital license.
770	2.  By December 31, 2004, and annually thereafter, the
771	agency shall submit a report to the Legislature providing
772	information concerning the number of requests for exemption
773	received under this paragraph and the number of exemptions
774	granted or denied.
775	3.  This paragraph is repealed effective January 1, 2008.
776	(t)1.  For the provision of adult open-heart services in a
777	hospital located within the boundaries of Palm Beach, Polk,
778	Martin, St. Lucie, and Indian River Counties if the following
779	conditions are met: The exemption must be based upon objective
780	criteria and address and solve the twin problems of geographic
781	and temporal access. A hospital shall be exempt from the
782	certificate-of-need review for the establishment of an open-
783	heart-surgery program when the application for exemption
784	submitted under this paragraph complies with the following
785	criteria:
786	a.  The applicant must certify that it will meet and
787	continuously maintain the minimum licensure requirements adopted
788	by the agency governing adult open-heart programs, including the
789	most current guidelines of the American College of Cardiology
790	and American Heart Association Guidelines for Adult Open Heart
791	Programs.
792	b.  The applicant must certify that it will maintain
793	sufficient appropriate equipment and health personnel to ensure
794	quality and safety.
795	c.  The applicant must certify that it will maintain
796	appropriate times of operation and protocols to ensure
797	availability and appropriate referrals in the event of
798	emergencies.
799	d.  The applicant can demonstrate that it is referring 300
800	or more patients per year from the hospital, including the
801	emergency room, for cardiac services at a hospital with cardiac
802	services, or that the average wait for transfer for 50 percent
803	or more of the cardiac patients exceeds 4 hours.
804	e.  The applicant is a general acute care hospital that is
805	in operation for 3 years or more.
806	f.  The applicant is performing more than 300 diagnostic
807	cardiac catheterization procedures per year, combined inpatient
808	and outpatient.
809	g.  The applicant's payor mix at a minimum reflects the
810	community average for Medicaid, charity care, and self-pay
811	patients or the applicant must certify that it will provide a
812	minimum of 5 percent of Medicaid, charity care, and self-pay to
813	open-heart-surgery patients.
814	h.  If the applicant fails to meet the established criteria
815	for open-heart programs or fails to reach 300 surgeries per year
816	by the end of its third year of operation, it must show cause
817	why its exemption should not be revoked.
818	2.  By December 31, 2004, and annually thereafter, the
819	Agency for Health Care Administration shall submit a report to
820	the Legislature providing information concerning the number of
821	requests for exemption received under this paragraph and the
822	number of exemptions granted or denied.
823	(k)  For the addition of comprehensive medical
824	rehabilitation or mental health services or beds provided the
825	applicant commits to the provision of services to Medicaid or
826	charity care patients at a level equal to or greater than the
827	district average. Such commitment shall be subject to the
828	provisions of s. 408.040.
829	(4)  REQUESTS FOR EXEMPTIONS.--A request for exemption
830	under subsection (3) may be made at any time and is not subject
831	to the batching requirements of this section. The request shall
832	be supported by such documentation as the agency requires by
833	rule. The agency shall assess a fee of $250 for each request for
834	exemption submitted under subsection (3).
835	(5)  NOTIFICATION.--Health care facilities and providers
836	must provide notification to the agency of the following:
837	(a)  Replacement of a health care facility when the
838	proposed project site is located in the same district and on the
839	existing site or within a 1-mile radius of the replaced health
840	care facility, provided that the number and type of beds do not
841	increase.
842	(b)  For the termination of a health care service, upon 30
843	days' written notice to the agency.
844	(c)  For the addition or delicensure of beds.
845
846	Notification under this subsection may be made at any time,
847	prior to the action described, by electronic, facsimile, or
848	written means.
849	Section 7.  Section 408.0361, Florida Statutes, is amended
850	to read:
851	408.0361  Cardiology services and burn unit licensure
852	Diagnostic cardiac catheterization services providers;
853	compliance with guidelines and requirements.--
854	(1)  Each provider of diagnostic cardiac catheterization
855	services shall comply with the requirements of s.
856	408.036(3)(i)2.a.-d., and rules adopted by of the agency that
857	establish licensure standards for Health Care Administration
858	governing the operation of adult inpatient diagnostic cardiac
859	catheterization programs. The rules shall ensure that such
860	programs:
861	(a)  Comply with, including the most recent guidelines of
862	the American College of Cardiology and American Heart
863	Association Guidelines for Cardiac Catheterization and Cardiac
864	Catheterization Laboratories.
865	(b)  Perform only adult inpatient diagnostic cardiac
866	catheterization services and will not provide therapeutic
867	cardiac catheterization or any other cardiology services.
868	(c)  Maintain sufficient appropriate equipment and health
869	care personnel to ensure quality and safety.
870	(d)  Maintain appropriate times of operation and protocols
871	to ensure availability and appropriate referrals in the event of
872	emergencies.
873	(e)  Demonstrate a plan to provide services to Medicaid and
874	charity care patients.
875	(2)  Each provider of adult interventional cardiology
876	services or operator of a burn unit shall comply with rules
877	adopted by the agency that establish licensure standards that
878	govern the provision of adult interventional cardiology services
879	or the operation of a burn unit. Such rules shall consider, at a
880	minimum, staffing, equipment, physical plant, operating
881	protocols, the provision of services to Medicaid and charity
882	care patients, accreditation, licensure period and fees, and
883	enforcement of minimum standards. The certificate-of-need rules
884	for adult interventional cardiology services and burn units in
885	effect on June 30, 2004, are authorized pursuant to this
886	subsection and shall remain in effect and shall be enforceable
887	by the agency until the licensure rules are adopted. Existing
888	providers and any provider with a notice of intent to grant a
889	certificate of need or a final order of the agency granting a
890	certificate of need for adult interventional cardiology services
891	or burn units shall be considered grandfathered and receive a
892	license for their programs effective on the effective date of
893	this act. The grandfathered licensure shall be for at least 2
894	years or a period specified in the rule, whichever is longer,
895	but shall be required to meet licensure standards applicable to
896	existing programs for every subsequent licensure period.
897	(3)  In establishing rules for adult interventional
898	cardiology services, the agency shall include provisions that
899	allow for:
900	(a)  Establishment of two hospital program licensure
901	levels: a Level I program authorizing the performance of adult
902	percutaneous cardiac intervention without onsite cardiac surgery
903	and a Level II program authorizing the performance of
904	percutaneous cardiac intervention with onsite cardiac surgery.
905	(b)  For a hospital seeking a Level I program,
906	demonstration that, for the most recent 12-month period as
907	reported to the agency, it has provided a minimum of 300 adult
908	inpatient and outpatient diagnostic cardiac catheterizations or
909	transferred at least 300 inpatients with the principal diagnosis
910	of ischemic heart disease and that it has a formalized, written
911	transfer agreement with a hospital that has a Level II program,
912	including written transport protocols to ensure safe and
913	efficient transfer of a patient within 60 minutes.
914	(c)  For a hospital seeking a Level II program,
915	demonstration that, for the most recent 12-month period as
916	reported to the agency, it has performed a minimum of 1,100
917	adult inpatient and outpatient diagnostic cardiac
918	catheterizations, of which at least 400 must be therapeutic
919	catheterizations, or has discharged at least 800 patients with
920	the principal diagnosis of ischemic heart disease.
921	(d)  Compliance with the most recent guidelines of the
922	American College of Cardiology and American Heart Association
923	guidelines for staffing, physician training and experience,
924	operating procedures, equipment, physical plant, and patient
925	selection criteria to ensure patient quality and safety.
926	(e)  Establishment of appropriate hours of operation and
927	protocols to ensure availability and timely referral in the
928	event of emergencies.
929	(f)  Demonstration of a plan to provide services to
930	Medicaid and charity care patients.
931	(4)  The agency shall establish a technical advisory panel
932	to develop procedures and standards for measuring outcomes of
933	interventional cardiac programs. Members of the panel shall
934	include representatives of the Florida Hospital Association, the
935	Florida Society of Thoracic and Cardiovascular Surgeons, the
936	Florida Chapter of the American College of Cardiology, and the
937	Florida Chapter of the American Heart Association and others
938	with experience in statistics and outcome measurement. Based on
939	recommendations from the panel, the agency shall develop and
940	adopt rules for the interventional cardiac programs that include
941	at least the following:
942	(a)  A standard data set consisting primarily of data
943	elements reported to the agency in accordance with s. 408.061.
944	(b)  A risk adjustment procedure that accounts for the
945	variations in severity and case mix found in hospitals in this
946	state.
947	(c)  Outcome standards specifying expected levels of
948	performance in Level I and Level II adult interventional
949	cardiology services. Such standards may include, but shall not
950	be limited to, in-hospital mortality, infection rates, nonfatal
951	myocardial infarctions, length of stay, postoperative bleeds,
952	and returns to surgery.
953	(d)  Specific steps to be taken by the agency and licensed
954	hospitals that do not meet the outcome standards within
955	specified time periods, including time periods for detailed case
956	reviews and development and implementation of corrective action
957	plans.
958	(5)  The Secretary of Health Care Administration shall
959	appoint an advisory group to study the issue of replacing
960	certificate-of-need review of organ transplant programs under
961	this chapter with licensure regulation of organ transplant
962	programs under chapter 395. The advisory group shall include
963	three representatives of organ transplant providers, one
964	representative of an organ procurement organization, one
965	representative of the Division of Health Quality Assurance, one
966	representative of Medicaid, and one organ transplant patient
967	advocate. The advisory group shall, at minimum, make
968	recommendations regarding access to organs, delivery of services
969	to Medicaid and charity care patients, staff training, and
970	resource requirements for organ transplant programs in a report
971	due to the secretary and the Legislature by July 1, 2005.
972	(6)  The Secretary of Health Care Administration shall
973	appoint a workgroup to study certificate-of-need regulations and
974	changing market conditions related to the supply and
975	distribution of hospital beds. The assessment by the workgroup
976	shall include, but not be limited to, the following:
977	(a)  The appropriateness of current certificate-of-need
978	methodologies and other criteria for evaluating proposals for
979	new hospitals and transfer of beds to new sites.
980	(b)  Additional factors that should be considered,
981	including the viability of safety net services, the extent of
982	market competition, and the accessibility of hospital services.
983
984	The workgroup shall submit a report by January 1, 2005, to the
985	secretary and the Legislature identifying specific problem areas
986	and recommending needed changes in statutes or rules.
987	Section 8.  Section 408.038, Florida Statutes, is amended
988	to read:
989	408.038  Fees.--The agency shall assess fees on
990	certificate-of-need applications. Such fees shall be for the
991	purpose of funding the functions of the local health councils
992	and the activities of the agency and shall be allocated as
993	provided in s. 408.033. The fee shall be determined as follows:
994	(1)  A minimum base fee of $10,000 $5,000.
995	(2)  In addition to the base fee of $10,000 $5,000, 0.015
996	of each dollar of proposed expenditure, except that a fee may
997	not exceed $50,000 $22,000.
998	Section 9.  Subsection (1), paragraph (a) of subsection
999	(3), and paragraphs (a) and (b) of subsection (4) of section
1000	408.039, Florida Statutes, are amended to read:
1001	408.039  Review process.--The review process for
1002	certificates of need shall be as follows:
1003	(1)  REVIEW CYCLES.--The agency by rule shall provide for
1004	applications to be submitted on a timetable or cycle basis;
1005	provide for review on a timely basis; and provide for all
1006	completed applications pertaining to similar types of services
1007	or facilities affecting the same service district to be
1008	considered in relation to each other no less often than annually
1009	two times a year.
1010	(3)  APPLICATION PROCESSING.--
1011	(a)  An applicant shall file an application with the
1012	agency, and shall furnish a copy of the application to the local
1013	health council and the agency. Within 15 days after the
1014	applicable application filing deadline established by agency
1015	rule, the staff of the agency shall determine if the application
1016	is complete. If the application is incomplete, the staff shall
1017	request specific information from the applicant necessary for
1018	the application to be complete; however, the staff may make only
1019	one such request. If the requested information is not filed with
1020	the agency within 21 days after of the receipt of the staff's
1021	request, the application shall be deemed incomplete and deemed
1022	withdrawn from consideration.
1023	(4)  STAFF RECOMMENDATIONS.--
1024	(a)  The agency's review of and final agency action on
1025	applications shall be in accordance with the district health
1026	plan, and statutory criteria, and the implementing
1027	administrative rules. In the application review process, the
1028	agency shall give a preference, as defined by rule of the
1029	agency, to an applicant which proposes to develop a nursing home
1030	in a nursing home geographically underserved area.
1031	(b)  Within 60 days after all the applications in a review
1032	cycle are determined to be complete, the agency shall issue its
1033	State Agency Action Report and Notice of Intent to grant a
1034	certificate of need for the project in its entirety, to grant a
1035	certificate of need for identifiable portions of the project, or
1036	to deny a certificate of need. The State Agency Action Report
1037	shall set forth in writing its findings of fact and
1038	determinations upon which its decision is based. If a finding of
1039	fact or determination by the agency is counter to the district
1040	health plan of the local health council, the agency shall
1041	provide in writing its reason for its findings, item by item, to
1042	the local health council. If the agency intends to grant a
1043	certificate of need, the State Agency Action Report or the
1044	Notice of Intent shall also include any conditions which the
1045	agency intends to attach to the certificate of need. The agency
1046	shall designate by rule a senior staff person, other than the
1047	person who issues the final order, to issue State Agency Action
1048	Reports and Notices of Intent.
1049	Section 10.  Section 408.040, Florida Statutes, is amended
1050	to read:
1051	408.040  Conditions and monitoring.--
1052	(1)(a)  The agency may issue a certificate of need or an
1053	exemption predicated upon statements of intent expressed by an
1054	applicant in the application for a certificate of need or
1055	exemption. Any conditions imposed on a certificate of need or an
1056	exemption based on such statements of intent shall be stated on
1057	the face of the certificate of need or in the exemption
1058	approval.
1059	(b)  The agency may consider, in addition to the other
1060	criteria specified in s. 408.035, a statement of intent by the
1061	applicant that a specified percentage of the annual patient days
1062	at the facility will be utilized by patients eligible for care
1063	under Title XIX of the Social Security Act. Any certificate of
1064	need issued to a nursing home in reliance upon an applicant's
1065	statements that a specified percentage of annual patient days
1066	will be utilized by residents eligible for care under Title XIX
1067	of the Social Security Act must include a statement that such
1068	certification is a condition of issuance of the certificate of
1069	need. The certificate-of-need program shall notify the Medicaid
1070	program office and the Department of Elderly Affairs when it
1071	imposes conditions as authorized in this paragraph in an area in
1072	which a community diversion pilot project is implemented.
1073	(c)  A certificateholder or exemption holder may apply to
1074	the agency for a modification of conditions imposed under
1075	paragraph (a) or paragraph (b). If the holder of a certificate
1076	of need or exemption demonstrates good cause why the certificate
1077	or exemption should be modified, the agency shall reissue the
1078	certificate of need or exemption with such modifications as may
1079	be appropriate. The agency shall by rule define the factors
1080	constituting good cause for modification.
1081	(d)  If the holder of a certificate of need or exemption
1082	fails to comply with a condition upon which the issuance of the
1083	certificate or exemption was predicated, the agency shall may
1084	assess an administrative fine against the certificate or
1085	exemption holder certificateholder in an amount not to exceed
1086	$1,000 per failure per day. Failure to annually report
1087	compliance with any condition upon which the issuance of the
1088	certificate or exemption was predicated constitutes
1089	noncompliance. In assessing the penalty, the agency shall take
1090	into account as mitigation the degree of noncompliance relative
1091	lack of severity of a particular failure. Proceeds of such
1092	penalties shall be deposited in the Public Medical Assistance
1093	Trust Fund.
1094	(2)(a)  Unless the applicant has commenced construction, if
1095	the project provides for construction, unless the applicant has
1096	incurred an enforceable capital expenditure commitment for a
1097	project, if the project does not provide for construction, or
1098	unless subject to paragraph (b), a certificate of need shall
1099	terminate 18 months after the date of issuance. The agency shall
1100	monitor the progress of the holder of the certificate of need in
1101	meeting the timetable for project development specified in the
1102	application with the assistance of the local health council as
1103	specified in s. 408.033(1)(b)5., and may revoke the certificate
1104	of need, if the holder of the certificate is not meeting such
1105	timetable and is not making a good-faith effort, as defined by
1106	rule, to meet it.
1107	(b)  A certificate of need issued to an applicant holding a
1108	provisional certificate of authority under chapter 651 shall
1109	terminate 1 year after the applicant receives a valid
1110	certificate of authority from the Office of Insurance Regulation
1111	of the Financial Services Commission.
1112	(c)  The certificate-of-need validity period for a project
1113	shall be extended by the agency, to the extent that the
1114	applicant demonstrates to the satisfaction of the agency that
1115	good-faith commencement of the project is being delayed by
1116	litigation or by governmental action or inaction with respect to
1117	regulations or permitting precluding commencement of the
1118	project.
1119	(3)  The agency shall require the submission of an executed
1120	architect's certification of final payment for each certificate-
1121	of-need project approved by the agency. Each project that
1122	involves construction shall submit such certification to the
1123	agency within 30 days following completion of construction.
1124	Section 11.  Section 408.043, Florida Statutes, is amended
1125	to read:
1126	408.043  Special provisions.--
1127	(1)  OSTEOPATHIC ACUTE CARE HOSPITALS.--When an application
1128	is made for a certificate of need to construct or to expand an
1129	osteopathic acute care hospital, the need for such hospital
1130	shall be determined on the basis of the need for and
1131	availability of osteopathic services and osteopathic acute care
1132	hospitals in the district. When a prior certificate of need to
1133	establish an osteopathic acute care hospital has been issued in
1134	a district, and the facility is no longer used for that purpose,
1135	the agency may continue to count such facility and beds as an
1136	existing osteopathic facility in any subsequent application for
1137	construction of an osteopathic acute care hospital.
1138	(2)  HOSPICES.--When an application is made for a
1139	certificate of need to establish or to expand a hospice, the
1140	need for such hospice shall be determined on the basis of the
1141	need for and availability of hospice services in the community.
1142	The formula on which the certificate of need is based shall
1143	discourage regional monopolies and promote competition. The
1144	inpatient hospice care component of a hospice which is a
1145	freestanding facility, or a part of a facility, which is
1146	primarily engaged in providing inpatient care and related
1147	services and is not licensed as a health care facility shall
1148	also be required to obtain a certificate of need. Provision of
1149	hospice care by any current provider of health care is a
1150	significant change in service and therefore requires a
1151	certificate of need for such services.
1152	(3)  RURAL HEALTH NETWORKS.--Preference shall be given in
1153	the award of a certificate of need to members of certified rural
1154	health networks, as provided for in s. 381.0406, subject to the
1155	following conditions:
1156	(a)  Need must be shown pursuant to s. 408.035.
1157	(b)  The proposed project must:
1158	1.  Strengthen health care services in rural areas through
1159	partnerships between rural care providers; or
1160	2.  Increase access to inpatient health care services for
1161	Medicaid recipients or other low-income persons who live in
1162	rural areas.
1163	(c)  No preference shall be given under this section for
1164	the establishment of skilled nursing facility services by a
1165	hospital.
1166	(4)  PRIVATE ACCREDITATION NOT REQUIRED.--Accreditation by
1167	any private organization may not be a requirement for the
1168	issuance or maintenance of a certificate of need under ss.
1169	408.031-408.045.
1170	(5)  SOLE ACUTE CARE HOSPITALS IN HIGH GROWTH
1171	COUNTIES.--Notwithstanding any other provision of law, an acute
1172	Notwithstanding any other provision of law, an acute care
1173	hospital licensed under chapter 395 may add up to 180 additional
1174	beds without agency review if such hospital is located in a
1175	county that has experienced at least a 60-percent growth rate
1176	for the most recent 10-year period for which data are available
1177	as determined by using the population statistics published in
1178	the most recent edition of the Florida Statistical Abstract, is
1179	the sole acute care hospital in the county, and is the only
1180	acute care hospital within a 10-mile radius of another hospital.
1181	A hospital shall provide written notice to the agency that it
1182	qualifies under this subsection prior to the addition of beds.
1183	Such projects shall not be subject to challenge under s. 408.039
1184	or chapter 120. Acute care beds added under this subsection
1185	shall not be included in the inventory of hospital beds used by
1186	the agency in the calculation of the fixed-bed-need pool for
1187	acute care hospitals.
1188	Section 12.  Section 408.0455, Florida Statutes, is amended
1189	to read:
1190	408.0455  Rules; pending proceedings.--The rules of the
1191	agency in effect on June 30, 2004 1997, shall remain in effect
1192	and shall be enforceable by the agency with respect to ss.
1193	408.031-408.045 until such rules are repealed or amended by the
1194	agency, and no judicial or administrative proceeding pending on
1195	July 1, 1997, shall be abated as a result of the provisions of
1196	ss. 408.031-408.043(1) and (2); s. 408.044; or s. 408.045.
1197	Section 13.  This act shall take effect July 1, 2004.

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