Florida Senate - 2019                        COMMITTEE AMENDMENT
       Bill No. SB 1712
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       The Committee on Health Policy (Harrell) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present subsections (8), (9), and (10) of
    6  section 395.003, Florida Statutes, are redesignated as
    7  subsections (9), (10), and (11), respectively, paragraph (c) of
    8  subsection (1) and present subsections (9) and (10) of that
    9  section are amended, and a new subsection (8) is added to that
   10  section, to read:
   11         395.003 Licensure; denial, suspension, and revocation.—
   12         (1)
   13         (c) Until July 1, 2006, additional emergency departments
   14  located off the premises of licensed hospitals may not be
   15  authorized by the agency.
   16         (8) Applicable only to a general hospital that is, or will
   17  be, newly licensed on or after July 1, 2019; that does not hold
   18  a certificate of need issued by the agency; and that is not
   19  replacing a currently operating general hospital located within
   20  1 mile of the newly licensed hospital:
   21         (a)When proposing a new general hospital project subject
   22  to this subsection and before filing for approval of plans and
   23  specifications under s. 395.0163, each prospective applicant for
   24  licensure must submit a notice to the agency of its intent to
   25  establish a newly licensed hospital which includes the location
   26  for the proposed hospital, the number and types of beds to be
   27  licensed, and the services that the hospital will offer.
   28         (b) Other than a long-term care hospital, the agency may
   29  not license a new general hospital subject to this subsection
   30  unless:
   31         1. The hospital has at least 80 beds and has intensive
   32  care, progressive care, and medical-surgical beds. This
   33  requirement does not apply if the hospital is a rural hospital,
   34  as defined in s. 395.602, or is located in a medically
   35  underserved area; and
   36         2. The hospital has an onsite emergency department that
   37  will operate 24 hours per day, 7 days per week.
   38         (c) Each such hospital must participate in the state
   39  Medicaid program and the Medicare program.
   40         (d) Except as provided in paragraph (e), each such hospital
   41  must provide charity care in an amount equal to or greater than
   42  the district average for hospitals in the applicable district.
   43  The agency shall adopt by rule a method for calculating the
   44  district average for charity care for each district. For
   45  purposes of this subsection, the term “charity care” means
   46  uncompensated care delivered to uninsured patients having an
   47  income at or below 200 percent of the federal poverty level when
   48  such services are preauthorized by the licensee and not subject
   49  to collection procedures, and “district” has the same meaning as
   50  in s. 408.032(5). The valuation of charity care must be based on
   51  Medicaid reimbursement rates.
   52         (e) If such a hospital is located in a medically
   53  underserved area, the amount of charity care required to be
   54  provided by the hospital under paragraph (d) is equivalent in
   55  percentage to the medically underserved area’s Index of Medical
   56  Underservice score as calculated by the federal Health Resources
   57  and Services Administration within the Department of Health and
   58  Human Services.
   59         (f) In lieu of providing charity care under paragraph (d)
   60  or paragraph (e), each such hospital may donate an amount
   61  determined by the agency to be functionally equivalent to the
   62  amounts required under those paragraphs to the agency’s Grants
   63  and Donations Trust Fund.
   64         (g) Each such hospital shall annually report to the agency
   65  its compliance with paragraphs (c)-(f). Failure to report
   66  compliance constitutes noncompliance. The agency shall assess an
   67  administrative fine on a hospital that fails to comply with this
   68  subsection in the amount of 1 percent of its net revenue for
   69  each 0.5 percent of the required amount of charity care not
   70  provided pursuant to paragraph (d) or paragraph (e) or the
   71  required amount as determined by the agency pursuant to
   72  paragraph (f).
   73         (h) The agency shall adopt rules to implement this
   74  subsection.
   75         (10)(9) A hospital licensed as of June 1, 2004, is shall be
   76  exempt from subsection (9) (8) as long as the hospital maintains
   77  the same ownership, facility street address, and range of
   78  services that were in existence on June 1, 2004. Any transfer of
   79  beds, or other agreements that result in the establishment of a
   80  hospital or hospital services within the intent of this section,
   81  shall be subject to subsection (9) (8). Unless the hospital is
   82  otherwise exempt under subsection (9) (8), the agency shall deny
   83  or revoke the license of a hospital that violates any of the
   84  criteria set forth in that subsection.
   85         (11)(10) The agency may adopt rules implementing the
   86  licensure requirements set forth in subsection (9) (8). Within
   87  14 days after rendering its decision on a license application or
   88  revocation, the agency shall publish its proposed decision in
   89  the Florida Administrative Register. Within 21 days after
   90  publication of the agency’s decision, any authorized person may
   91  file a request for an administrative hearing. In administrative
   92  proceedings challenging the approval, denial, or revocation of a
   93  license pursuant to subsection (9) (8), the hearing must be
   94  based on the facts and law existing at the time of the agency’s
   95  proposed agency action. Existing hospitals may initiate or
   96  intervene in an administrative hearing to approve, deny, or
   97  revoke licensure under subsection (9) (8) based upon a showing
   98  that an established program will be substantially affected by
   99  the issuance or renewal of a license to a hospital within the
  100  same district or service area.
  101         Section 2. Section 395.6025, Florida Statutes, is repealed.
  102         Section 3. Subsections (8) and (13) of section 408.032,
  103  Florida Statutes, are amended to read:
  104         408.032 Definitions relating to Health Facility and
  105  Services Development Act.—As used in ss. 408.031-408.045, the
  106  term:
  107         (8) “Health care facility” means a hospital, long-term care
  108  hospital, skilled nursing facility, hospice, or intermediate
  109  care facility for the developmentally disabled. A facility
  110  relying solely on spiritual means through prayer for healing is
  111  not included as a health care facility.
  112         (13) “Long-term care hospital” means a hospital licensed
  113  under chapter 395 which meets the requirements of 42 C.F.R. s.
  114  412.23(e) and seeks exclusion from the acute care Medicare
  115  prospective payment system for inpatient hospital services.
  116         Section 4. Subsection (2) of section 408.034, Florida
  117  Statutes, is amended to read:
  118         408.034 Duties and responsibilities of agency; rules.—
  119         (2) In the exercise of its authority to issue licenses to
  120  health care facilities and health service providers, as provided
  121  under chapters 393 and 395 and parts II, IV, and VIII of chapter
  122  400, the agency may not issue a license to any health care
  123  facility or health service provider that fails to receive a
  124  certificate of need or an exemption for the licensed facility or
  125  service, except that the agency may issue a license to a general
  126  hospital that has not been issued a certificate of need if that
  127  hospital meets the criteria established in s. 395.003(8).
  128         Section 5. Section 408.035, Florida Statutes, is amended to
  129  read:
  130         408.035 Review criteria.—
  131         (1) The agency shall determine the reviewability of
  132  applications and shall review applications for certificate-of
  133  need determinations for health care facilities and health
  134  services in context with the following criteria, except for
  135  general hospitals as defined in s. 395.002:
  136         (1)(a) The need for the health care facilities and health
  137  services being proposed.
  138         (2)(b) The availability, quality of care, accessibility,
  139  and extent of utilization of existing health care facilities and
  140  health services in the service district of the applicant.
  141         (3)(c) The ability of the applicant to provide quality of
  142  care and the applicant’s record of providing quality of care.
  143         (4)(d) The availability of resources, including health
  144  personnel, management personnel, and funds for capital and
  145  operating expenditures, for project accomplishment and
  146  operation.
  147         (5)(e) The extent to which the proposed services will
  148  enhance access to health care for residents of the service
  149  district.
  150         (6)(f) The immediate and long-term financial feasibility of
  151  the proposal.
  152         (7)(g) The extent to which the proposal will foster
  153  competition that promotes quality and cost-effectiveness.
  154         (8)(h) The costs and methods of the proposed construction,
  155  including the costs and methods of energy provision and the
  156  availability of alternative, less costly, or more effective
  157  methods of construction.
  158         (9)(i) The applicant’s past and proposed provision of
  159  health care services to Medicaid patients and the medically
  160  indigent.
  161         (10)(j) The applicant’s designation as a Gold Seal Program
  162  nursing facility pursuant to s. 400.235, when the applicant is
  163  requesting additional nursing home beds at that facility.
  164         (2) For a general hospital, the agency shall consider only
  165  the criteria specified in paragraph (1)(a), paragraph (1)(b),
  166  except for quality of care in paragraph (1)(b), and paragraphs
  167  (1)(e), (g), and (i).
  168         Section 6. Paragraphs (b) and (c) of subsection (1) of
  169  section 408.036, Florida Statutes, are amended to read:
  170         408.036 Projects subject to review; exemptions.—
  171         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  172  health-care-related projects, as described in paragraphs (a)
  173  (f), are subject to review and must file an application for a
  174  certificate of need with the agency. The agency is exclusively
  175  responsible for determining whether a health-care-related
  176  project is subject to review under ss. 408.031-408.045.
  177         (b) The new construction or establishment of additional
  178  health care facilities, except for the construction of or
  179  establishment of a general hospital or including a replacement
  180  health care facility when the proposed project site is not
  181  located on the same site as or within 1 mile of the existing
  182  health care facility, if the number of beds in each licensed bed
  183  category will not increase.
  184         (c) The conversion from one type of health care facility to
  185  another, including the conversion from a general hospital or, a
  186  specialty hospital, or a long-term care hospital except that the
  187  conversion of a specialty hospital to a general hospital is not
  188  subject to review if, once converted, the hospital meets the
  189  licensure criteria in s. 395.003(8).
  190         Section 7. Section 408.037, Florida Statutes, is amended to
  191  read:
  192         408.037 Application content.—
  193         (1) Except as provided in subsection (2) for a general
  194  hospital, An application for a certificate of need must contain:
  195         (a) A detailed description of the proposed project and
  196  statement of its purpose and need in relation to the district
  197  health plan.
  198         (b) A statement of the financial resources needed by and
  199  available to the applicant to accomplish the proposed project.
  200  This statement must include:
  201         1. A complete listing of all capital projects, including
  202  new health facility development projects and health facility
  203  acquisitions applied for, pending, approved, or underway in any
  204  state at the time of application, regardless of whether or not
  205  that state has a certificate-of-need program or a capital
  206  expenditure review program pursuant to s. 1122 of the Social
  207  Security Act. The agency may, by rule, require less-detailed
  208  information from major health care providers. This listing must
  209  include the applicant’s actual or proposed financial commitment
  210  to those projects and an assessment of their impact on the
  211  applicant’s ability to provide the proposed project.
  212         2. A detailed listing of the needed capital expenditures,
  213  including sources of funds.
  214         3. A detailed financial projection, including a statement
  215  of the projected revenue and expenses for the first 2 years of
  216  operation after completion of the proposed project. This
  217  statement must include a detailed evaluation of the impact of
  218  the proposed project on the cost of other services provided by
  219  the applicant.
  220         (c) An audited financial statement of the applicant or the
  221  applicant’s parent corporation if audited financial statements
  222  of the applicant do not exist. In an application submitted by an
  223  existing health care facility, health maintenance organization,
  224  or hospice, financial condition documentation must include, but
  225  need not be limited to, a balance sheet and a profit-and-loss
  226  statement of the 2 previous fiscal years’ operation.
  227         (2) An application for a certificate of need for a general
  228  hospital must contain a detailed description of the proposed
  229  general hospital project and a statement of its purpose and the
  230  needs it will meet. The proposed project’s location, as well as
  231  its primary and secondary service areas, must be identified by
  232  zip code. Primary service area is defined as the zip codes from
  233  which the applicant projects that it will draw 75 percent of its
  234  discharges. Secondary service area is defined as the zip codes
  235  from which the applicant projects that it will draw its
  236  remaining discharges. If, subsequent to issuance of a final
  237  order approving the certificate of need, the proposed location
  238  of the general hospital changes or the primary service area
  239  materially changes, the agency shall revoke the certificate of
  240  need. However, if the agency determines that such changes are
  241  deemed to enhance access to hospital services in the service
  242  district, the agency may permit such changes to occur. A party
  243  participating in the administrative hearing regarding the
  244  issuance of the certificate of need for a general hospital has
  245  standing to participate in any subsequent proceeding regarding
  246  the revocation of the certificate of need for a hospital for
  247  which the location has changed or for which the primary service
  248  area has materially changed. In addition, the application for
  249  the certificate of need for a general hospital must include a
  250  statement of intent that, if approved by final order of the
  251  agency, the applicant shall within 120 days after issuance of
  252  the final order or, if there is an appeal of the final order,
  253  within 120 days after the issuance of the court’s mandate on
  254  appeal, furnish satisfactory proof of the applicant’s financial
  255  ability to operate. The agency shall establish documentation
  256  requirements, to be completed by each applicant, which show
  257  anticipated provider revenues and expenditures, the basis for
  258  financing the anticipated cash-flow requirements of the
  259  provider, and an applicant’s access to contingency financing. A
  260  party participating in the administrative hearing regarding the
  261  issuance of the certificate of need for a general hospital may
  262  provide written comments concerning the adequacy of the
  263  financial information provided, but such party does not have
  264  standing to participate in an administrative proceeding
  265  regarding proof of the applicant’s financial ability to operate.
  266  The agency may require a licensee to provide proof of financial
  267  ability to operate at any time if there is evidence of financial
  268  instability, including, but not limited to, unpaid expenses
  269  necessary for the basic operations of the provider.
  270         (2)(3) The applicant must certify that it will license and
  271  operate the health care facility. For an existing health care
  272  facility, the applicant must be the licenseholder of the
  273  facility.
  274         Section 8. Paragraphs (c) and (d) of subsection (3),
  275  paragraphs (b) and (c) of subsection (5), and paragraph (d) of
  276  subsection (6) of section 408.039, Florida Statutes, are amended
  277  to read:
  278         408.039 Review process.—The review process for certificates
  279  of need shall be as follows:
  280         (3) APPLICATION PROCESSING.—
  281         (c) Except for competing applicants, in order to be
  282  eligible to challenge the agency decision on a general hospital
  283  application under review pursuant to paragraph (5)(c), existing
  284  hospitals must submit a detailed written statement of opposition
  285  to the agency and to the applicant. The detailed written
  286  statement must be received by the agency and the applicant
  287  within 21 days after the general hospital application is deemed
  288  complete and made available to the public.
  289         (d) In those cases where a written statement of opposition
  290  has been timely filed regarding a certificate of need
  291  application for a general hospital, the applicant for the
  292  general hospital may submit a written response to the agency.
  293  Such response must be received by the agency within 10 days of
  294  the written statement due date.
  296         (b) Hearings shall be held in Tallahassee unless the
  297  administrative law judge determines that changing the location
  298  will facilitate the proceedings. The agency shall assign
  299  proceedings requiring hearings to the Division of Administrative
  300  Hearings of the Department of Management Services within 10 days
  301  after the time has expired for requesting a hearing. Except upon
  302  unanimous consent of the parties or upon the granting by the
  303  administrative law judge of a motion of continuance, hearings
  304  shall commence within 60 days after the administrative law judge
  305  has been assigned. For an application for a general hospital,
  306  administrative hearings shall commence within 6 months after the
  307  administrative law judge has been assigned, and a continuance
  308  may not be granted absent a finding of extraordinary
  309  circumstances by the administrative law judge. All parties,
  310  except the agency, shall bear their own expense of preparing a
  311  transcript. In any application for a certificate of need which
  312  is referred to the Division of Administrative Hearings for
  313  hearing, the administrative law judge shall complete and submit
  314  to the parties a recommended order as provided in ss. 120.569
  315  and 120.57. The recommended order shall be issued within 30 days
  316  after the receipt of the proposed recommended orders or the
  317  deadline for submission of such proposed recommended orders,
  318  whichever is earlier. The division shall adopt procedures for
  319  administrative hearings which shall maximize the use of
  320  stipulated facts and shall provide for the admission of prepared
  321  testimony.
  322         (c) In administrative proceedings challenging the issuance
  323  or denial of a certificate of need, only applicants considered
  324  by the agency in the same batching cycle are entitled to a
  325  comparative hearing on their applications. Existing health care
  326  facilities may initiate or intervene in an administrative
  327  hearing upon a showing that an established program will be
  328  substantially affected by the issuance of any certificate of
  329  need, whether reviewed under s. 408.036(1) or (2), to a
  330  competing proposed facility or program within the same district.
  331  With respect to an application for a general hospital, competing
  332  applicants and only those existing hospitals that submitted a
  333  detailed written statement of opposition to an application as
  334  provided in this paragraph may initiate or intervene in an
  335  administrative hearing. Such challenges to a general hospital
  336  application shall be limited in scope to the issues raised in
  337  the detailed written statement of opposition that was provided
  338  to the agency. The administrative law judge may, upon a motion
  339  showing good cause, expand the scope of the issues to be heard
  340  at the hearing. Such motion shall include substantial and
  341  detailed facts and reasons for failure to include such issues in
  342  the original written statement of opposition.
  343         (6) JUDICIAL REVIEW.—
  344         (d) The party appealing a final order that grants a general
  345  hospital certificate of need shall pay the appellee’s attorney’s
  346  fees and costs, in an amount up to $1 million, from the
  347  beginning of the original administrative action if the appealing
  348  party loses the appeal, subject to the following limitations and
  349  requirements:
  350         1. The party appealing a final order must post a bond in
  351  the amount of $1 million in order to maintain the appeal.
  352         2. Except as provided under s. 120.595(5), in no event
  353  shall the agency be held liable for any other party’s attorney’s
  354  fees or costs.
  355         Section 9. Subsection (1) of section 408.040, Florida
  356  Statutes, is amended, to read:
  357         408.040 Conditions and monitoring.—
  358         (1)(a) The agency may issue a certificate of need, or an
  359  exemption, predicated upon statements of intent expressed by an
  360  applicant in the application for a certificate of need or an
  361  exemption. Any conditions imposed on a certificate of need or an
  362  exemption based on such statements of intent shall be stated on
  363  the face of the certificate of need or in the exemption
  364  approval.
  365         (b) The agency may consider, in addition to the other
  366  criteria specified in s. 408.035, a statement of intent by the
  367  applicant that a specified percentage of the annual patient days
  368  at the facility will be utilized by patients eligible for care
  369  under Title XIX of the Social Security Act. Any certificate of
  370  need issued to a nursing home in reliance upon an applicant’s
  371  statements that a specified percentage of annual patient days
  372  will be utilized by residents eligible for care under Title XIX
  373  of the Social Security Act must include a statement that such
  374  certification is a condition of issuance of the certificate of
  375  need. The certificate-of-need program shall notify the Medicaid
  376  program office and the Department of Elderly Affairs when it
  377  imposes conditions as authorized in this paragraph in an area in
  378  which a community diversion pilot project is implemented.
  379  Effective July 1, 2012, the agency may not impose sanctions
  380  related to patient day utilization by patients eligible for care
  381  under Title XIX of the Social Security Act for nursing homes.
  382         (c) A certificateholder or an exemption holder may apply to
  383  the agency for a modification of conditions imposed under
  384  paragraph (a) or paragraph (b). If the holder of a certificate
  385  of need or an exemption demonstrates good cause why the
  386  certificate or exemption should be modified, the agency shall
  387  reissue the certificate of need or exemption with such
  388  modifications as may be appropriate. The agency shall by rule
  389  define the factors constituting good cause for modification.
  390         (d) If the holder of a certificate of need or the holder of
  391  an exemption fails to comply with a condition that is unrelated
  392  to the provision of charity care or the provision of care under
  393  the Florida Medicaid program upon which the issuance of the
  394  certificate or exemption was predicated, the agency may assess
  395  an administrative fine against the certificateholder or
  396  exemption holder in an amount not to exceed $1,000 per failure
  397  per day. If the holder of a certificate of need or the holder of
  398  an exemption fails to comply with a condition related to the
  399  provision of charity care or the provision of care under the
  400  Florida Medicaid program upon which the issuance of the
  401  certificate or exemption was predicated, the agency must assess
  402  an administrative fine against the certificateholder or
  403  exemption holder in the amount of $2,500 per day for each
  404  instance of noncompliance. Failure to annually report compliance
  405  with any condition upon which the issuance of the certificate or
  406  exemption was predicated constitutes noncompliance. In assessing
  407  the penalty, the agency shall take into account as mitigation
  408  the degree of noncompliance. Proceeds of such penalties shall be
  409  deposited in the Public Medical Assistance Trust Fund.
  410         (e) A general hospital that was issued a certificate of
  411  need with conditions imposed as described in paragraph (a) or
  412  paragraph (b), relating to the provision of charity care or the
  413  provision of care under the Florida Medicaid program, must
  414  continue to meet those conditions to maintain licensure
  415  regardless of the status of that hospital’s certificate of need
  416  unless such conditions are modified by the agency pursuant to
  417  paragraph (c).
  418         Section 10. Subsection (1) of section 408.043, Florida
  419  Statutes, is amended to read:
  420         408.043 Special provisions.—
  421         (1) OSTEOPATHIC ACUTE CARE HOSPITALS.—When an application
  422  is made for a certificate of need to construct or to expand an
  423  osteopathic acute care hospital, the need for such hospital
  424  shall be determined on the basis of the need for and
  425  availability of osteopathic services and osteopathic acute care
  426  hospitals in the district. When a prior certificate of need to
  427  establish an osteopathic acute care hospital has been issued in
  428  a district, and the facility is no longer used for that purpose,
  429  the agency may continue to count such facility and beds as an
  430  existing osteopathic facility in any subsequent application for
  431  construction of an osteopathic acute care hospital.
  432         Section 11. Effective upon this act becoming a law:
  433         (1) The Agency for Health Care Administration may not
  434  initiate a review cycle or accept letters of intent or
  435  applications for the issuance of a certificate of need for the
  436  new construction or establishment of a freestanding general
  437  hospital.
  438         (2) The agency shall issue a certificate of need to any
  439  pending applicant for a certificate of need for the new
  440  construction of or establishment of a freestanding general
  441  hospital:
  442         (a) With intensive care, progressive care, and medical
  443  surgical beds;
  444         (b) With an onsite emergency department that will be
  445  operational 24 hours per day, 7 days per week; and
  446         (c) Whose application for a certificate of need has been
  447  approved by the agency, regardless of the litigation status of
  448  the application.
  449         (3) For an applicant seeking a certificate of need for the
  450  new construction or establishment of a freestanding general
  451  hospital that does not meet the criteria in subsection (2),
  452  including an applicant whose application is pending approval or
  453  denial by the agency and an applicant whose application was
  454  initially denied by the agency but such denial is under appeal,
  455  ss. 395.6025, 408.032, 408.034, 408.035, 408.036, 408.037,
  456  408.039, and 408.043, Florida Statutes (2018), and any rules
  457  adopted thereunder remain in effect until such time as the
  458  agency has either issued the applicant a certificate of need,
  459  the agency has denied the application and all appeals of the
  460  denial have been exhausted, or the application has been
  461  withdrawn.
  462         Section 12. Except as otherwise expressly provided in this
  463  act and except for this section, which shall take effect upon
  464  this act becoming a law, this act shall take effect July 1,
  465  2019.
  467  ================= T I T L E  A M E N D M E N T ================
  468  And the title is amended as follows:
  469         Delete everything before the enacting clause
  470  and insert:
  471                        A bill to be entitled                      
  472         An act relating to hospital licensure; amending s.
  473         395.003, F.S.; deleting an obsolete provision;
  474         providing applicability; requiring certain hospitals
  475         licensed after a specified date to submit a notice to
  476         the Agency for Health Care Administration which
  477         contains specified information before filing for
  478         approval of plans and specifications to establish a
  479         new general hospital; prohibiting the agency from
  480         licensing a new general hospital unless certain
  481         criteria are met; requiring certain hospitals to
  482         participate in the Medicaid program and the Medicare
  483         program and to provide a certain amount of charity
  484         care; defining the terms “charity care” and
  485         “district”; providing a separate calculation of
  486         required charity care for such hospitals located in a
  487         medically underserved area; authorizing such hospitals
  488         to provide a certain donation the agency’s Grants and
  489         Donations Trust Fund in lieu of providing the required
  490         charity care; requiring such hospitals to annually
  491         report compliance to the agency; requiring the agency
  492         to impose a specified administrative fine for
  493         noncompliance; requiring the agency to adopt rules;
  494         repealing s. 395.6025, F.S., relating to rural
  495         hospital replacement facilities; amending s. 408.032,
  496         F.S.; revising the definition of the term “health care
  497         facility” to exclude hospitals and long-term care
  498         hospitals for purposes of the Health Facility and
  499         Services Development Act; deleting the definition of
  500         the term “long-term care hospital”; amending s.
  501         408.034; authoring the agency to issue a license to a
  502         general hospital that has not been issued a
  503         certificate of need under certain circumstances;
  504         amending s. 408.035, F.S.; deleting provisions related
  505         to the agency’s consideration and review of
  506         certificates of need for general hospitals; amending
  507         s. 408.036, F.S.; providing an exception for the
  508         construction or establishment of a general hospital
  509         and the conversion of a specialty hospital to a
  510         general hospital from certificate of need review
  511         requirements; amending ss. 408.037 and 408.039, F.S.;
  512         deleting provisions relating to certificate of need
  513         applications for general hospitals; amending s.
  514         408.040, F.S.; requiring the agency to assess a
  515         specified administrative fine against the holder of a
  516         certificate of need or the holder of an exemption
  517         which fails to comply with specified conditions;
  518         requiring a general hospital that was issued a
  519         certificate of need with certain conditions to
  520         continue to meet those conditions to maintain
  521         licensure; amending s. 408.043, F.S.; deleting
  522         provisions relating to certificates of need for
  523         osteopathic acute care hospitals; prohibiting the
  524         agency from initiating a review cycle or from
  525         accepting letters of intent or applications for the
  526         issuance of certificate of need for the new
  527         construction or the establishment of a freestanding
  528         hospital; requiring the agency to issue such a
  529         certificate of need to certain applicants, regardless
  530         of litigation status; providing applicability;
  531         providing effective dates.