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Proposed Legislative Language |
DRAFT BILL |
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Definitions relating to Health Facility and Services
Development: "Tertiary health service" means a health service
which, due to its high level of intensity, complexity, specialized or limited
applicability, and cost, should be limited to, and concentrated in, a limited
number of hospitals to ensure the quality, availability, and
cost-effectiveness of such service. Examples of such service include, but are
not limited to, organ transplantation, adult and pediatric open heart
surgery, specialty burn units, neonatal intensive care units,
comprehensive rehabilitation, and medical or surgical services which are
experimental or developmental in nature to the extent that the provision of
such services is not yet contemplated within the commonly accepted course of
diagnosis or treatment for the condition addressed by a given service. The
agency shall establish by rule a list of all tertiary health services. |
page 2 lines 6-17 408.032(17) |
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The agency shall establish by rule a
nursing-home-bed-need methodology that reduces the community nursing home bed
need for the areas of the state where the agency establishes pilot community
diversion programs through the Title XIX aging waiver program. The bed need methodology AMENDED TO MAINTAIN DISTRICT
AVERAGE AT 94% RATHER THAN STATEWIDE. |
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2 lines 21-25 408.034(5) |
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Unless exempt under
subsection (3), all health-care-related projects, as described in paragraphs
(a)-(h), are subject to review and must file an application for a certificate
of need with the agency. The agency is exclusively responsible for
determining whether a health-care-related project is subject to review under
ss. 408.031-408.045. The establishment of a hospice |
page 3 lines 4-5 and page 12 lines 6-16 408.036(1)(e) and 408.043(2) |
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PROJECTS SUBJECT TO
EXPEDITED REVIEW.-- … |
page 3 line 13 408.036(2)(b) deleted |
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A transfer of a certificate of need except
when an existing hospital is acquired by a purchaser, all pending
certificates of need filed by the existing hospital and all approved
certificates of need owned by that hospital would be acquired by the
purchaser. |
page 3 lines 14-17 and page 10 lines 22-27 408.036(2)new(b)
and 408.037(2) |
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Proposed Legislative Language |
DRAFT BILL |
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The conversion of mental health services
beds licensed under chapter 395 |
page 3 line 28 through page 4 line 9 408.036(2)(e) |
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PROJECTS SUBJECT TO EXPEDITED REVIEW Replacement of a health care facility when the
proposed project site is located within the geographic area that contains at
least 65 percent of the facility’s current patients/residents in the same
district and within a AMENDED TO APPLY ONLY TO NURSING
HOMES. |
page 4 lines 10-13 408.036(2)(f) |
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The moving of a portion of a provider’s licensed
beds to a replacement facility within the same nursing home district (not to
exceed 30 mile radius) provided the total number of beds in the district does
not increase. |
page 4 lines 14-17 408.036(2)(g) |
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For the addition of hospital beds
licensed under chapter 395 for acute care In addition to any other documentation
otherwise required by the agency, a request for exemption submitted under
this paragraph must: Certify that the prior 12-month average
occupancy rate for the category of licensed beds being expanded at the
facility meets or exceeds 75 80 percent or, for a hospital-based distinct
part skilled nursing unit, the prior 12-month average occupancy rate meets or
exceeds 96 percent. AMENDED TO RAISE THE OCCUPANCY RATE TO 90 PERCENT FOR
INPATIENT REHAB. |
page 4 line 26 through page 6 line 5 408.036(3)(n) |
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Proposed Legislative Language |
DRAFT BILL |
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For the addition of acute care beds, as
authorized by rule consistent with s. 395.003(4), in a number that may not
exceed 30 |
page 6 lines 6-11 408.036(3)(o) |
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For the addition of nursing home beds licensed under
chapter 400 in a number not exceeding 10 total beds or 10 percent of the
number of beds licensed in the facility being expanded, whichever is greater.
In addition to any other documentation required by
the agency, a request for exemption submitted under this paragraph must:
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page 6 line 12 through page 7 line 3 408.036(3)(p) |
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page 7 lines 4-9 408.036(3)(q)deleted |
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EXEMPTIONS.—Upon request, the following projects are
subject to exemption from the provisions of subsection (1): For the conversion of mental health
services beds between or among the licensed bed categories defined as beds
for mental health services. |
page 7 lines 21-25 408.036(3)(r) |
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Proposed Legislative Language |
DRAFT BILL |
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1. For the provision of percutaneous coronary
intervention for patients presenting with emergency myocardial infarctions in
a hospital without an approved adult open heart surgery program. In addition
to any other documentation otherwise required by the agency, a request for an
exemption submitted under this paragraph must comply with the following: 2. The applicant must certify that it will
meet and continuously maintain the requirements adopted by the agency for the
provision of these services. These licensure requirements are to be adopted
by rule and are to be consistent with the guidelines published by the
American College of Cardiology and the American Heart Association for the
provision of percutaneous coronary interventions in hospitals without adult
open heart services. At a minimum, the rules shall require the following: a.
Cardiologists must be experienced interventionalists who have performed a
minimum of 75 interventions within the previous 12 months; b. The
hospital must provide a minimum of 36 emergency interventions annually, in
order to continue to provide the service; c. The hospital must offer sufficient
physician, nursing and laboratory staff to provide the services twenty four
hours daily, seven days a week; d. Nursing and technical staff must have
demonstrated experience in handling acutely ill patients requiring
intervention based on previous experience in dedicated interventional
laboratories or surgical centers; e. Cardiac care nursing staff must be adept
in hemodynamic monitoring and IABP management; f. Formalized written transfer agreements
must be developed with a hospital with an adult open heart surgery program
and written transport protocols must be in place to ensure safe and efficient
transfer of a patient within 60 minutes . Transfer and transport agreements
must reviewed and tested, with appropriate documentation maintained at least
every 3 months; g.
Hospitals implementing the service, must first undertake a 3 to 6
month training program which includes establishing standards, testing
logistics, creating quality assessment and error management practices and
formalizing patient selection criteria.
3..The
applicant must certify that it will utilize at all times the patient
selection criteria for the performance of primary angioplasty at hospitals
without adult open heart surgery programs issued by the American College of
Cardiology and the American Heart Association. At a minimum, these criteria
would provide for the following: a. Avoidance of interventions in
hemodynamically stable patients presenting with identified symptoms or medical
histories; b.
Transfer of patients presenting with a history of coronary disease and
clinical presentation of hemodaynamic instability. 4. The
applicant must agree to submit a quarterly report to the agency detailing
patient characteristics, treatment and outcomes for all patients receiving
emergency percutaneous coronary interventions pursuant to this exemption.
This report must be submitted within 15 days of the close of each calendar
quarter. The exemption
provided by the paragraph shall not apply unless the agency determines that
the hospital has taken all necessary steps to be in compliance with these
paragraphs, including the training program required pursuant to paragraph (1)
subsection (g). 5. Failure of the hospital to continuously
comply with the rules adopted pursuant to paragraph 1.sub-paragraphs c.d.e.f.
and paragraphs 2 and 3 will result in the immediate expiration of this
exemption. 6. Failure of the hospital to meet the
volume requirements of paragraph1. subparagraphs a and b within 18monts after
the programs begins offering the service will result in the immediate
expiration of this exemption. |
page 7 line 26 through page 9 line 21 408.036(3)(s) |
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Proposed Legislative Language |
DRAFT BILL |
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For the replacement of a statutory rural
hospital when the proposed project site is located in the same district and
within 10 miles of the existing facility and within the current primary
service area, defined as the least number of zip codes comprising 75 percent
of the hospital’s inpatient admissions.
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page 9 lines 22-26 408.036(3)(t) |
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For the creation of at least a 10 bed
Level II neonatal intensive care unit upon demonstrating to the agency that
the applicant hospital had a minimum of 1500 births during the previous 12
months. |
page 9 lines 27-29 408.036(3)(u) |
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For the addition of Level II or Level III
neonatal intensive care beds in a number not to exceed 6 beds or 10 percent
of licensed capacity in that category whichever is greater, provided that the
hospital certifies that the prior 12-month average occupancy rate for the
category of licensed neonatal intensive care beds meets or exceeds 75
percent. |
included in page 4 line 26 through page 6 line 5 408.036(3)(n) |
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EXEMPTIONS.--Upon request,
the following projects are subject to exemption from the provisions of
subsection (1): For replacement of a licensed health care facility |
page 10 lines 1-3 408.036(3)(v) |
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Providers that operate multiple nursing home
facilities within the same nursing home district should be allowed to
consolidate facilities, combine facilities or transfer beds between
facilities provided the aforementioned action does not increase the net bed
inventory in the district and the relocation does not exceed 30 miles from
the original site. |
page 10 lines 4-8 408.036(3)(w) |
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An
audited financial statement of the applicant or, if the applicant is part
of a consolidated audit which breaks out each entity separately, an audited
financial statement of the parent company. In an application submitted by
an existing health care facility, health maintenance organization, or
hospice, financial condition documentation must include, but need not be
limited to, a balance sheet and a profit-and-loss statement of the 2 previous
fiscal years' operation. |
page 10 lines 12-18 408.037(1)(c) |
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Proposed Legislative Language |
DRAFT BILL |
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A transfer of a certificate of need except
when an existing hospital is acquired by a purchaser, all pending
certificates of need filed by the existing hospital and all approved
certificates of need owned by that hospital would be acquired by the
purchaser. |
page 10 lines 22-27 and page 3 lines 14-17 408.036(2)new(b) and 408.037(2) |
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FEES.--The agency shall
assess fees on certificate-of-need applications. Such fees shall be for the
purpose of funding A minimum base fee of $10,000 |
page 10 line 28 through page 11 line 10 408.038 |
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In addition to the base fee of $10,000
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same as above |
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The Legislature intends that the cost of local health councils
be borne by The
motion as written failed. The
workgroup voted unanimously that any incremental increase in CON fees would
not result in an incremental increase in funding support for the local health
councils. Funding for the support of
local health councils should continue from CON fees and should be frozen at the
current level of $150,000/year/council until such time as the Legislature
identifies some other funding source within the state's budget for the
continuation of local health councils. |
same as above |
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ADMINISTRATIVE
HEARINGS.— The agency shall issue its final order
within 45 days after receipt of the recommended order. If the agency fails to
take action within 45 days, the Division of Administrative Hearing
recommended order is deemed approved. |
page 11 line 14-21 408.039(5)(e) |
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Proposed Legislative Language |
DRAFT BILL |
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The court, in its discretion, may award
reasonable attorney's fees and costs to the prevailing party if the court
finds that there was a complete absence of a justiciable issue of law or fact raised by the losing party. If the
losing party is a hospital, the court
shall order it to pay the reasonable attorney’s fees and costs, which shall
include fees and costs incurred as a result of the administrative hearing and
the judicial appeal, of the
prevailing hospital party. AMENDMENT TO INCLUDE ALL PROVIDER TYPES FAILED. INTENDED TO APPLY TO HOSPITALS ONLY AT THE
DCA ONLY. |
page 11 line 25 through page 12 line 2 408.039(6)(c) |
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There is hereby created a
Certificate of Need Nursing Home Advisory Panel to serve as a body of experts
to guide the agency in its development of policy related to nursing home
certificate of need issues. The
agency shall provide staff support to the Panel. The Panel shall be
composed of the following members: (a) The designee of the
Deputy Secretary of Managed Care and Health Quality, (b) The designee of the
Deputy Secretary of Medicaid, (c) The designee of the
Secretary of Department of Elder Affairs, (d) Two representatives of
the Local Health Councils, (e) One representative of
the Florida Association of Homes for the Aging, (f) One representative of
the Florida Health Care Association, (g) One nonprofit nursing
home representative, and (h) One for profit nursing
home representative. The Panel shall meet at
least quarterly and advise the agency regarding: (a) Long term care needs of Florida’s elderly, (b) Issues specific to
different Districts or subdistrict, (c) Options for ensuring
access to long term care for Medicaid eligible and other individuals, (d) Reimbursement policy
that will encourage development of alternative long term care initiatives, (e) Development of a
timely utilization reporting schedule for assisted living facilities and home
and community based services, Changes for a more
viable nursing home bed formula which will ensure access, and takes into
account the alternatives to nursing home care available in each District or
subdistrict using information from the reports submitted by such providers. AMENDED TO INCLUDE A REPRESENTATIVE OF
FLORIDA HOSPICES AND PALLIATIVE CARE, INC. |
page 12 line 18 through page 13 line 15 |
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ENTIRE
MORRISON PROPOSAL FAILED DUE TO LACK OF A SECOND. LATER PROPOSAL DIRECTS AHCA TO DEVELOP LICENSURE STANDARDS FOR
INTERVENTIONAL CARDIOLOGY |
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13 lines 16-18 |