Florida Senate - 2019                             CS for SB 1712
       By the Committee on Health Policy; and Senator Harrell
       588-03679-19                                          20191712c1
    1                        A bill to be entitled                      
    2         An act relating to hospital licensure; amending s.
    3         395.003, F.S.; deleting an obsolete provision;
    4         providing applicability; requiring certain hospitals
    5         licensed after a specified date to submit a notice to
    6         the Agency for Health Care Administration which
    7         contains specified information before filing for
    8         approval of plans and specifications to establish a
    9         new general hospital; prohibiting the agency from
   10         licensing a new general hospital unless certain
   11         criteria are met; requiring certain hospitals to
   12         participate in the Medicaid program and the Medicare
   13         program and to provide a certain amount of charity
   14         care; defining the terms “charity care” and
   15         “district”; providing a separate calculation of
   16         required charity care for such hospitals located in a
   17         medically underserved area; authorizing such hospitals
   18         to provide a certain donation the agency’s Grants and
   19         Donations Trust Fund in lieu of providing the required
   20         charity care; requiring such hospitals to annually
   21         report compliance to the agency; requiring the agency
   22         to impose a specified administrative fine for
   23         noncompliance; requiring the agency to adopt rules;
   24         repealing s. 395.6025, F.S., relating to rural
   25         hospital replacement facilities; amending s. 408.032,
   26         F.S.; revising the definition of the term “health care
   27         facility” to eliminate a reference to long-term care
   28         hospitals; deleting the definition of the term “long
   29         term care hospital”; amending s. 408.034; authoring
   30         the agency to issue a license to a general hospital
   31         that has not been issued a certificate of need under
   32         certain circumstances; amending s. 408.035, F.S.;
   33         deleting provisions related to the agency’s
   34         consideration and review of certificates of need for
   35         general hospitals; amending s. 408.036, F.S.;
   36         providing an exception for the construction or
   37         establishment of a general hospital and the conversion
   38         of a specialty hospital to a general hospital from
   39         certificate of need review requirements; amending ss.
   40         408.037 and 408.039, F.S.; deleting provisions
   41         relating to certificate of need applications for
   42         general hospitals; amending s. 408.040, F.S.;
   43         requiring the agency to assess a specified
   44         administrative fine against the holder of a
   45         certificate of need or the holder of an exemption
   46         which fails to comply with specified conditions;
   47         requiring a general hospital that was issued a
   48         certificate of need with certain conditions to
   49         continue to meet those conditions to maintain
   50         licensure; amending s. 408.043, F.S.; deleting
   51         provisions relating to certificates of need for
   52         osteopathic acute care hospitals; prohibiting the
   53         agency from initiating a review cycle or from
   54         accepting letters of intent or applications for the
   55         issuance of certificate of need for the new
   56         construction or the establishment of a freestanding
   57         hospital; requiring the agency to issue such a
   58         certificate of need to certain applicants, regardless
   59         of litigation status; providing applicability;
   60         providing effective dates.
   62  Be It Enacted by the Legislature of the State of Florida:
   64         Section 1. Present subsections (8), (9), and (10) of
   65  section 395.003, Florida Statutes, are redesignated as
   66  subsections (9), (10), and (11), respectively, paragraph (c) of
   67  subsection (1) and present subsections (9) and (10) of that
   68  section are amended, and a new subsection (8) is added to that
   69  section, to read:
   70         395.003 Licensure; denial, suspension, and revocation.—
   71         (1)
   72         (c) Until July 1, 2006, additional emergency departments
   73  located off the premises of licensed hospitals may not be
   74  authorized by the agency.
   75         (8) Applicable only to a general hospital that is, or will
   76  be, newly licensed on or after July 1, 2019; that does not hold
   77  a certificate of need issued by the agency; and that is not
   78  replacing a currently operating general hospital located within
   79  1 mile of the newly licensed hospital:
   80         (a)When proposing a new general hospital project subject
   81  to this subsection and before filing for approval of plans and
   82  specifications under s. 395.0163, each prospective applicant for
   83  licensure must submit a notice to the agency of its intent to
   84  establish a newly licensed hospital which includes the location
   85  for the proposed hospital, the number and types of beds to be
   86  licensed, and the services that the hospital will offer.
   87         (b) Other than a long-term care hospital, the agency may
   88  not license a new general hospital subject to this subsection
   89  unless:
   90         1. The hospital has at least 100 beds and has intensive
   91  care, progressive care, and medical-surgical beds. This
   92  requirement does not apply if the hospital is a rural hospital,
   93  as defined in s. 395.602, or is located in a medically
   94  underserved area; and
   95         2. The hospital has an onsite emergency department that
   96  will operate 24 hours per day, 7 days per week.
   97         (c) Each such hospital must participate in the state
   98  Medicaid program and the Medicare program.
   99         (d) Except as provided in paragraph (e), each such hospital
  100  must provide charity care in an amount equal to or greater than
  101  the district average for hospitals in the applicable district.
  102  The agency shall adopt by rule a method for calculating the
  103  district average for charity care for each district. For
  104  purposes of this subsection, the term “charity care” has the
  105  same meaning as in s. 409.911(1) and the term “district” has the
  106  same meaning as in s. 408.032.
  107         (e) If such a hospital is located in a medically
  108  underserved area, the amount of charity care required to be
  109  provided by the hospital under paragraph (d) is equivalent in
  110  percentage to the medically underserved area’s Index of Medical
  111  Underservice score as calculated by the federal Health Resources
  112  and Services Administration within the Department of Health and
  113  Human Services.
  114         (f) In lieu of providing charity care under paragraph (d)
  115  or paragraph (e), each such hospital may donate an amount
  116  determined by the agency to be functionally equivalent to the
  117  amounts required under those paragraphs to the agency’s Grants
  118  and Donations Trust Fund.
  119         (g) Each such hospital shall annually report to the agency
  120  its compliance with paragraphs (c)-(f). Failure to report
  121  compliance constitutes noncompliance. The agency shall assess an
  122  administrative fine on a hospital that fails to comply with this
  123  subsection in the amount of 1 percent of its net revenue for
  124  each 0.5 percent of the required amount of charity care not
  125  provided pursuant to paragraph (d) or paragraph (e) or the
  126  required amount as determined by the agency pursuant to
  127  paragraph (f).
  128         (h) The agency shall adopt rules to implement this
  129  subsection.
  130         (10)(9) A hospital licensed as of June 1, 2004, is shall be
  131  exempt from subsection (9) (8) as long as the hospital maintains
  132  the same ownership, facility street address, and range of
  133  services that were in existence on June 1, 2004. Any transfer of
  134  beds, or other agreements that result in the establishment of a
  135  hospital or hospital services within the intent of this section,
  136  shall be subject to subsection (9) (8). Unless the hospital is
  137  otherwise exempt under subsection (9) (8), the agency shall deny
  138  or revoke the license of a hospital that violates any of the
  139  criteria set forth in that subsection.
  140         (11)(10) The agency may adopt rules implementing the
  141  licensure requirements set forth in subsection (9) (8). Within
  142  14 days after rendering its decision on a license application or
  143  revocation, the agency shall publish its proposed decision in
  144  the Florida Administrative Register. Within 21 days after
  145  publication of the agency’s decision, any authorized person may
  146  file a request for an administrative hearing. In administrative
  147  proceedings challenging the approval, denial, or revocation of a
  148  license pursuant to subsection (9) (8), the hearing must be
  149  based on the facts and law existing at the time of the agency’s
  150  proposed agency action. Existing hospitals may initiate or
  151  intervene in an administrative hearing to approve, deny, or
  152  revoke licensure under subsection (9) (8) based upon a showing
  153  that an established program will be substantially affected by
  154  the issuance or renewal of a license to a hospital within the
  155  same district or service area.
  156         Section 2. Section 395.6025, Florida Statutes, is repealed.
  157         Section 3. Subsections (8) and (13) of section 408.032,
  158  Florida Statutes, are amended to read:
  159         408.032 Definitions relating to Health Facility and
  160  Services Development Act.—As used in ss. 408.031-408.045, the
  161  term:
  162         (8) “Health care facility” means a hospital, long-term care
  163  hospital, skilled nursing facility, hospice, or intermediate
  164  care facility for the developmentally disabled. A facility
  165  relying solely on spiritual means through prayer for healing is
  166  not included as a health care facility.
  167         (13) “Long-term care hospital” means a hospital licensed
  168  under chapter 395 which meets the requirements of 42 C.F.R. s.
  169  412.23(e) and seeks exclusion from the acute care Medicare
  170  prospective payment system for inpatient hospital services.
  171         Section 4. Subsection (2) of section 408.034, Florida
  172  Statutes, is amended to read:
  173         408.034 Duties and responsibilities of agency; rules.—
  174         (2) In the exercise of its authority to issue licenses to
  175  health care facilities and health service providers, as provided
  176  under chapters 393 and 395 and parts II, IV, and VIII of chapter
  177  400, the agency may not issue a license to any health care
  178  facility or health service provider that fails to receive a
  179  certificate of need or an exemption for the licensed facility or
  180  service, except that the agency may issue a license to a general
  181  hospital that has not been issued a certificate of need if that
  182  hospital meets the criteria established in s. 395.003(8).
  183         Section 5. Section 408.035, Florida Statutes, is amended to
  184  read:
  185         408.035 Review criteria.—
  186         (1) The agency shall determine the reviewability of
  187  applications and shall review applications for certificate-of
  188  need determinations for health care facilities and health
  189  services in context with the following criteria, except for
  190  general hospitals as defined in s. 395.002:
  191         (1)(a) The need for the health care facilities and health
  192  services being proposed.
  193         (2)(b) The availability, quality of care, accessibility,
  194  and extent of utilization of existing health care facilities and
  195  health services in the service district of the applicant.
  196         (3)(c) The ability of the applicant to provide quality of
  197  care and the applicant’s record of providing quality of care.
  198         (4)(d) The availability of resources, including health
  199  personnel, management personnel, and funds for capital and
  200  operating expenditures, for project accomplishment and
  201  operation.
  202         (5)(e) The extent to which the proposed services will
  203  enhance access to health care for residents of the service
  204  district.
  205         (6)(f) The immediate and long-term financial feasibility of
  206  the proposal.
  207         (7)(g) The extent to which the proposal will foster
  208  competition that promotes quality and cost-effectiveness.
  209         (8)(h) The costs and methods of the proposed construction,
  210  including the costs and methods of energy provision and the
  211  availability of alternative, less costly, or more effective
  212  methods of construction.
  213         (9)(i) The applicant’s past and proposed provision of
  214  health care services to Medicaid patients and the medically
  215  indigent.
  216         (10)(j) The applicant’s designation as a Gold Seal Program
  217  nursing facility pursuant to s. 400.235, when the applicant is
  218  requesting additional nursing home beds at that facility.
  219         (2) For a general hospital, the agency shall consider only
  220  the criteria specified in paragraph (1)(a), paragraph (1)(b),
  221  except for quality of care in paragraph (1)(b), and paragraphs
  222  (1)(e), (g), and (i).
  223         Section 6. Paragraphs (b) and (c) of subsection (1) of
  224  section 408.036, Florida Statutes, are amended to read:
  225         408.036 Projects subject to review; exemptions.—
  226         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  227  health-care-related projects, as described in paragraphs (a)
  228  (f), are subject to review and must file an application for a
  229  certificate of need with the agency. The agency is exclusively
  230  responsible for determining whether a health-care-related
  231  project is subject to review under ss. 408.031-408.045.
  232         (b) The new construction or establishment of additional
  233  health care facilities, except for the construction of or
  234  establishment of a general hospital or including a replacement
  235  health care facility when the proposed project site is not
  236  located on the same site as or within 1 mile of the existing
  237  health care facility, if the number of beds in each licensed bed
  238  category will not increase.
  239         (c) The conversion from one type of health care facility to
  240  another, including the conversion from a general hospital or, a
  241  specialty hospital, or a long-term care hospital except that the
  242  conversion of a specialty hospital to a general hospital is not
  243  subject to review if, once converted, the hospital meets the
  244  licensure criteria in s. 395.003(8).
  245         Section 7. Section 408.037, Florida Statutes, is amended to
  246  read:
  247         408.037 Application content.—
  248         (1) Except as provided in subsection (2) for a general
  249  hospital, An application for a certificate of need must contain:
  250         (a) A detailed description of the proposed project and
  251  statement of its purpose and need in relation to the district
  252  health plan.
  253         (b) A statement of the financial resources needed by and
  254  available to the applicant to accomplish the proposed project.
  255  This statement must include:
  256         1. A complete listing of all capital projects, including
  257  new health facility development projects and health facility
  258  acquisitions applied for, pending, approved, or underway in any
  259  state at the time of application, regardless of whether or not
  260  that state has a certificate-of-need program or a capital
  261  expenditure review program pursuant to s. 1122 of the Social
  262  Security Act. The agency may, by rule, require less-detailed
  263  information from major health care providers. This listing must
  264  include the applicant’s actual or proposed financial commitment
  265  to those projects and an assessment of their impact on the
  266  applicant’s ability to provide the proposed project.
  267         2. A detailed listing of the needed capital expenditures,
  268  including sources of funds.
  269         3. A detailed financial projection, including a statement
  270  of the projected revenue and expenses for the first 2 years of
  271  operation after completion of the proposed project. This
  272  statement must include a detailed evaluation of the impact of
  273  the proposed project on the cost of other services provided by
  274  the applicant.
  275         (c) An audited financial statement of the applicant or the
  276  applicant’s parent corporation if audited financial statements
  277  of the applicant do not exist. In an application submitted by an
  278  existing health care facility, health maintenance organization,
  279  or hospice, financial condition documentation must include, but
  280  need not be limited to, a balance sheet and a profit-and-loss
  281  statement of the 2 previous fiscal years’ operation.
  282         (2) An application for a certificate of need for a general
  283  hospital must contain a detailed description of the proposed
  284  general hospital project and a statement of its purpose and the
  285  needs it will meet. The proposed project’s location, as well as
  286  its primary and secondary service areas, must be identified by
  287  zip code. Primary service area is defined as the zip codes from
  288  which the applicant projects that it will draw 75 percent of its
  289  discharges. Secondary service area is defined as the zip codes
  290  from which the applicant projects that it will draw its
  291  remaining discharges. If, subsequent to issuance of a final
  292  order approving the certificate of need, the proposed location
  293  of the general hospital changes or the primary service area
  294  materially changes, the agency shall revoke the certificate of
  295  need. However, if the agency determines that such changes are
  296  deemed to enhance access to hospital services in the service
  297  district, the agency may permit such changes to occur. A party
  298  participating in the administrative hearing regarding the
  299  issuance of the certificate of need for a general hospital has
  300  standing to participate in any subsequent proceeding regarding
  301  the revocation of the certificate of need for a hospital for
  302  which the location has changed or for which the primary service
  303  area has materially changed. In addition, the application for
  304  the certificate of need for a general hospital must include a
  305  statement of intent that, if approved by final order of the
  306  agency, the applicant shall within 120 days after issuance of
  307  the final order or, if there is an appeal of the final order,
  308  within 120 days after the issuance of the court’s mandate on
  309  appeal, furnish satisfactory proof of the applicant’s financial
  310  ability to operate. The agency shall establish documentation
  311  requirements, to be completed by each applicant, which show
  312  anticipated provider revenues and expenditures, the basis for
  313  financing the anticipated cash-flow requirements of the
  314  provider, and an applicant’s access to contingency financing. A
  315  party participating in the administrative hearing regarding the
  316  issuance of the certificate of need for a general hospital may
  317  provide written comments concerning the adequacy of the
  318  financial information provided, but such party does not have
  319  standing to participate in an administrative proceeding
  320  regarding proof of the applicant’s financial ability to operate.
  321  The agency may require a licensee to provide proof of financial
  322  ability to operate at any time if there is evidence of financial
  323  instability, including, but not limited to, unpaid expenses
  324  necessary for the basic operations of the provider.
  325         (2)(3) The applicant must certify that it will license and
  326  operate the health care facility. For an existing health care
  327  facility, the applicant must be the licenseholder of the
  328  facility.
  329         Section 8. Paragraphs (c) and (d) of subsection (3),
  330  paragraphs (b) and (c) of subsection (5), and paragraph (d) of
  331  subsection (6) of section 408.039, Florida Statutes, are amended
  332  to read:
  333         408.039 Review process.—The review process for certificates
  334  of need shall be as follows:
  335         (3) APPLICATION PROCESSING.—
  336         (c) Except for competing applicants, in order to be
  337  eligible to challenge the agency decision on a general hospital
  338  application under review pursuant to paragraph (5)(c), existing
  339  hospitals must submit a detailed written statement of opposition
  340  to the agency and to the applicant. The detailed written
  341  statement must be received by the agency and the applicant
  342  within 21 days after the general hospital application is deemed
  343  complete and made available to the public.
  344         (d) In those cases where a written statement of opposition
  345  has been timely filed regarding a certificate of need
  346  application for a general hospital, the applicant for the
  347  general hospital may submit a written response to the agency.
  348  Such response must be received by the agency within 10 days of
  349  the written statement due date.
  351         (b) Hearings shall be held in Tallahassee unless the
  352  administrative law judge determines that changing the location
  353  will facilitate the proceedings. The agency shall assign
  354  proceedings requiring hearings to the Division of Administrative
  355  Hearings of the Department of Management Services within 10 days
  356  after the time has expired for requesting a hearing. Except upon
  357  unanimous consent of the parties or upon the granting by the
  358  administrative law judge of a motion of continuance, hearings
  359  shall commence within 60 days after the administrative law judge
  360  has been assigned. For an application for a general hospital,
  361  administrative hearings shall commence within 6 months after the
  362  administrative law judge has been assigned, and a continuance
  363  may not be granted absent a finding of extraordinary
  364  circumstances by the administrative law judge. All parties,
  365  except the agency, shall bear their own expense of preparing a
  366  transcript. In any application for a certificate of need which
  367  is referred to the Division of Administrative Hearings for
  368  hearing, the administrative law judge shall complete and submit
  369  to the parties a recommended order as provided in ss. 120.569
  370  and 120.57. The recommended order shall be issued within 30 days
  371  after the receipt of the proposed recommended orders or the
  372  deadline for submission of such proposed recommended orders,
  373  whichever is earlier. The division shall adopt procedures for
  374  administrative hearings which shall maximize the use of
  375  stipulated facts and shall provide for the admission of prepared
  376  testimony.
  377         (c) In administrative proceedings challenging the issuance
  378  or denial of a certificate of need, only applicants considered
  379  by the agency in the same batching cycle are entitled to a
  380  comparative hearing on their applications. Existing health care
  381  facilities may initiate or intervene in an administrative
  382  hearing upon a showing that an established program will be
  383  substantially affected by the issuance of any certificate of
  384  need, whether reviewed under s. 408.036(1) or (2), to a
  385  competing proposed facility or program within the same district.
  386  With respect to an application for a general hospital, competing
  387  applicants and only those existing hospitals that submitted a
  388  detailed written statement of opposition to an application as
  389  provided in this paragraph may initiate or intervene in an
  390  administrative hearing. Such challenges to a general hospital
  391  application shall be limited in scope to the issues raised in
  392  the detailed written statement of opposition that was provided
  393  to the agency. The administrative law judge may, upon a motion
  394  showing good cause, expand the scope of the issues to be heard
  395  at the hearing. Such motion shall include substantial and
  396  detailed facts and reasons for failure to include such issues in
  397  the original written statement of opposition.
  398         (6) JUDICIAL REVIEW.—
  399         (d) The party appealing a final order that grants a general
  400  hospital certificate of need shall pay the appellee’s attorney’s
  401  fees and costs, in an amount up to $1 million, from the
  402  beginning of the original administrative action if the appealing
  403  party loses the appeal, subject to the following limitations and
  404  requirements:
  405         1. The party appealing a final order must post a bond in
  406  the amount of $1 million in order to maintain the appeal.
  407         2. Except as provided under s. 120.595(5), in no event
  408  shall the agency be held liable for any other party’s attorney’s
  409  fees or costs.
  410         Section 9. Subsection (1) of section 408.040, Florida
  411  Statutes, is amended, to read:
  412         408.040 Conditions and monitoring.—
  413         (1)(a) The agency may issue a certificate of need, or an
  414  exemption, predicated upon statements of intent expressed by an
  415  applicant in the application for a certificate of need or an
  416  exemption. Any conditions imposed on a certificate of need or an
  417  exemption based on such statements of intent shall be stated on
  418  the face of the certificate of need or in the exemption
  419  approval.
  420         (b) The agency may consider, in addition to the other
  421  criteria specified in s. 408.035, a statement of intent by the
  422  applicant that a specified percentage of the annual patient days
  423  at the facility will be utilized by patients eligible for care
  424  under Title XIX of the Social Security Act. Any certificate of
  425  need issued to a nursing home in reliance upon an applicant’s
  426  statements that a specified percentage of annual patient days
  427  will be utilized by residents eligible for care under Title XIX
  428  of the Social Security Act must include a statement that such
  429  certification is a condition of issuance of the certificate of
  430  need. The certificate-of-need program shall notify the Medicaid
  431  program office and the Department of Elderly Affairs when it
  432  imposes conditions as authorized in this paragraph in an area in
  433  which a community diversion pilot project is implemented.
  434  Effective July 1, 2012, the agency may not impose sanctions
  435  related to patient day utilization by patients eligible for care
  436  under Title XIX of the Social Security Act for nursing homes.
  437         (c) A certificateholder or an exemption holder may apply to
  438  the agency for a modification of conditions imposed under
  439  paragraph (a) or paragraph (b). If the holder of a certificate
  440  of need or an exemption demonstrates good cause why the
  441  certificate or exemption should be modified, the agency shall
  442  reissue the certificate of need or exemption with such
  443  modifications as may be appropriate. The agency shall by rule
  444  define the factors constituting good cause for modification.
  445         (d) If the holder of a certificate of need or the holder of
  446  an exemption fails to comply with a condition that is unrelated
  447  to the provision of charity care or the provision of care under
  448  the Florida Medicaid program upon which the issuance of the
  449  certificate or exemption was predicated, the agency may assess
  450  an administrative fine against the certificateholder or
  451  exemption holder in an amount not to exceed $1,000 per failure
  452  per day. If the holder of a certificate of need or the holder of
  453  an exemption fails to comply with a condition related to the
  454  provision of charity care or the provision of care under the
  455  Florida Medicaid program upon which the issuance of the
  456  certificate or exemption was predicated, the agency must assess
  457  an administrative fine against the certificateholder or
  458  exemption holder in the amount of $2,500 per day for each
  459  instance of noncompliance. Failure to annually report compliance
  460  with any condition upon which the issuance of the certificate or
  461  exemption was predicated constitutes noncompliance. In assessing
  462  the penalty, the agency shall take into account as mitigation
  463  the degree of noncompliance. Proceeds of such penalties shall be
  464  deposited in the Public Medical Assistance Trust Fund.
  465         (e) A general hospital that was issued a certificate of
  466  need with conditions imposed as described in paragraph (a) or
  467  paragraph (b), relating to the provision of charity care or the
  468  provision of care under the Florida Medicaid program, must
  469  continue to meet those conditions to maintain licensure
  470  regardless of the status of that hospital’s certificate of need
  471  unless such conditions are modified by the agency pursuant to
  472  paragraph (c).
  473         Section 10. Subsection (1) of section 408.043, Florida
  474  Statutes, is amended to read:
  475         408.043 Special provisions.—
  476         (1) OSTEOPATHIC ACUTE CARE HOSPITALS.—When an application
  477  is made for a certificate of need to construct or to expand an
  478  osteopathic acute care hospital, the need for such hospital
  479  shall be determined on the basis of the need for and
  480  availability of osteopathic services and osteopathic acute care
  481  hospitals in the district. When a prior certificate of need to
  482  establish an osteopathic acute care hospital has been issued in
  483  a district, and the facility is no longer used for that purpose,
  484  the agency may continue to count such facility and beds as an
  485  existing osteopathic facility in any subsequent application for
  486  construction of an osteopathic acute care hospital.
  487         Section 11. Effective upon this act becoming a law:
  488         (1) The Agency for Health Care Administration may not
  489  initiate a review cycle or accept letters of intent or
  490  applications for the issuance of a certificate of need for the
  491  new construction or establishment of a freestanding general
  492  hospital.
  493         (2) The agency shall issue a certificate of need to any
  494  pending applicant for a certificate of need for the new
  495  construction of or establishment of a freestanding general
  496  hospital:
  497         (a) With intensive care, progressive care, and medical
  498  surgical beds;
  499         (b) With an onsite emergency department that will be
  500  operational 24 hours per day, 7 days per week; and
  501         (c) Whose application for a certificate of need has been
  502  approved by the agency, regardless of the litigation status of
  503  the application.
  504         (3) For an applicant seeking a certificate of need for the
  505  new construction or establishment of a freestanding general
  506  hospital that does not meet the criteria in subsection (2),
  507  including an applicant whose application is pending approval or
  508  denial by the agency and an applicant whose application was
  509  initially denied by the agency but such denial is under appeal,
  510  ss. 395.6025, 408.032, 408.034, 408.035, 408.036, 408.037,
  511  408.039, and 408.043, Florida Statutes (2018), and any rules
  512  adopted thereunder remain in effect until such time as the
  513  agency has either issued the applicant a certificate of need,
  514  the agency has denied the application and all appeals of the
  515  denial have been exhausted, or the application has been
  516  withdrawn.
  517         Section 12. Except as otherwise expressly provided in this
  518  act and except for this section, which shall take effect upon
  519  this act becoming a law, this act shall take effect July 1,
  520  2019.