Florida Senate - 2016                                    SB 1144
       By Senator Gaetz
       1-00103B-16                                           20161144__
    1                        A bill to be entitled                      
    2         An act relating to certificates of need for health
    3         care-related projects; amending s. 408.036, F.S.;
    4         providing an exemption from certificate of need review
    5         for certain health care-related projects; specifying
    6         conditions and requirements for the exemption;
    7         requiring a certain agreement between the project
    8         applicant and the Agency for Health Care
    9         Administration; providing penalties for failure to
   10         comply with certain requirements for an exemption to a
   11         certificate of need review; providing an effective
   12         date.
   14  Be It Enacted by the Legislature of the State of Florida:
   16         Section 1. Present paragraphs (a) through (t) of subsection
   17  (3) of section 408.036, Florida Statutes, are redesignated as
   18  paragraphs (b) through (u), respectively, a new paragraph (a) is
   19  added to that subsection, present subsections (4) and (5) of
   20  that section are redesignated as subsections (5) and (6),
   21  respectively, and a new subsection (4) is added to that section,
   22  to read:
   23         408.036 Projects subject to review; exemptions.—
   24         (3) EXEMPTIONS.—Upon request, the following projects are
   25  subject to exemption from the provisions of subsection (1):
   26         (a) Any project conditioned upon a significant, active, and
   27  continuing commitment to improved access to care for uninsured
   28  and low-income residents of the applicable service district.
   29  Such commitment is demonstrated by compliance with the following
   30  conditions and requirements which the project applicant must
   31  accept in a signed agreement with the agency:
   32         1. The project licensee must contribute, once the project
   33  is operational and at the end of each of the first four calendar
   34  quarters of the project’s operations, an amount equal to 1.5
   35  percent of the gross revenues earned by the exempt project.
   36  Contributions shall be made to the agency and deposited in the
   37  Public Medical Assistance Trust Fund.
   38         2.a. Beginning in the fifth calendar quarter of the exempt
   39  project’s operations, the licensee must provide charity care in
   40  an amount equal to or greater than the applicable district
   41  average among licensed providers of similar services. For
   42  purposes of this section, the term “charity care” means
   43  uncompensated care delivered to uninsured patients having
   44  incomes at or below 200 percent of the federal poverty level
   45  when such services are preauthorized by the licensee and not
   46  subject to collection procedures. The valuation of charity care
   47  must be based on Medicaid reimbursement rates.
   48         b. Alternatively, if the licensee provides less charity
   49  care than is required by sub-subparagraph a., the licensee must
   50  donate:
   51         (I) Pursuant to a written agreement with a charity care
   52  provider in the service district, payments for charity care
   53  provided to residents of the service district in total amounts
   54  equal to or greater than the difference between the value of the
   55  charity care provided in sub-subparagraph a. and the applicable
   56  district average among licensed providers of similar services;
   57  or
   58         (II) Payments to Florida Health Choices for health care
   59  coverage financial assistance in total amounts equal to or
   60  greater than the difference between the value of the charity
   61  care provided in sub-subparagraph a. and the applicable district
   62  average among licensed providers of similar services. The
   63  payments for financial assistance must be made in increments
   64  sufficient to purchase silver-level health care coverage for an
   65  individual for at least 1 year. The individual receiving this
   66  assistance must have been uninsured during the previous 12
   67  months. The licensee and Florida Health Choices shall cooperate
   68  to identify individuals from the service district who are
   69  qualified to receive the available assistance.
   70         c. The agreement between the agency and the applicant for
   71  an exemption must require the licensee to submit reports and
   72  data necessary to monitor compliance with the charity care
   73  threshold.
   74         (4) PENALTIES.—A facility licensed based on the exemption
   75  established in subsection (3)(a) is subject to the following
   76  penalties for noncompliance with its specific commitment to
   77  improve access to care for uninsured and low-income persons in
   78  the service district:
   79         (a) For the first quarter in which the value of services,
   80  donations, and financial assistance falls below the specified
   81  threshold, the fine is equal to twice the amount of the
   82  shortfall. The fine is doubled in each subsequent quarter of
   83  noncompliance up to a maximum of four quarters.
   84         (b) Following a fifth quarter of noncompliance, the exempt
   85  license shall be suspended until the licensee implements a
   86  corrective action plan that the agency has approved.
   87         (c) Failure by the facility to maintain compliance
   88  following the implementation of a corrective action plan shall
   89  result in revocation of the exempt license.
   90         Section 2. This act shall take effect July 1, 2016.