Introduction

Florida’s 2001-2003 Certificate of Need (CON) workgroup was established in Chapter 2000-318 Laws of Florida. The 2000 Legislature directed the Agency for Health Care Administration to staff a workgroup to “study issues pertaining to the Certificate of Need program, including the impact of trends in health care delivery and financing” and to “study issues relating to implementation of the CON Program.”

The workgroup was directed to prepare an interim report by December 31, 2001 and a final report by December 31, 2002. This document is the required final report.

Workgroup members were appointed by the Governor, the President of the Senate and the Speaker of the House of Representatives. A complete list of the workgroup members and the category under which they were appointed is included in Appendix 1.

The group met for the first time in April 2001 in Orlando. Richard Morrison, Vice President for Government Affairs at Florida Hospital in Orlando was elected Samira Beckwith, President of Hope Hospice and Palliative Care of Lee County (Fort Myers) was elected Vice Chair. The workgroup met again in June and every intervening month through December 2001.

Throughout the summer months, sub-committees focusing on hospitals, nursing homes and hospices met half-days and came together as a full workgroup for the remainder of the meeting.

The 2001 Legislature added to the workgroup’s charge by asking them to evaluate issues related to 24-hour admissions in ambulatory surgical centers. A 24-hour admissions policy would allow physicians to admit patients to ambulatory surgical centers at any hour of the day and allow them to stay in the facility for up to 24 hours. Presently, ambulatory surgical center patients must be admitted early enough to be discharged before midnight of the same day.

In November 2001, the workgroup hosted a public meeting in Orlando to allow interested members of the public to comment on the draft report.

The workgroup submitted its Interim Report of the Florida Certificate of Need Workgroup in December 2001 as required.  The interim report includes extensive historical and background material about the CON program and is available on the Internet at /MCHQ/CON_FA/overview/conreport.shtml. Bound copies of the interim report are available upon request by contacting the Agency for Health Care Administration at (850) 922-0791 or via e-mail at colvinl@ahca.myflorida.com.

Readers of this final workgroup report who may be unfamiliar with the Florida CON program are encouraged to review the program’s website and read the interim report as referenced above.

The workgroup met three times in 2002 in preparation for submission of this final report. The first meeting was held in January and focused on the issue of CON review of open heart surgery programs in Florida hospitals. At that time the workgroup voted to maintain CON review of open heart surgery programs without any change to existing statutes or rules. Workgroup Chairman Richard Morrison reported this position to House and Senate legislative committees in presentations during the 2002 session.

At the workgroup’s July 2002 meeting, Mr. Morrison suggested that the Final Report of the Florida Certificate of Need Workgroup should focus on a proposed bill that could be presented to the Legislature for consideration in the 2003 session. The workgroup approved the chairman’s proposal and this report includes the proposed legislation.Mr. Morrison invited individual workgroup members, workgroup subcommittees and provider associations to prepare legislative proposals for consideration at the final workgroup meeting. By October, workgroup staff had received six proposals that were then formatted in a common style and forwarded to workgroup members for review prior to their gathering in Orlando for a final meeting on November 1, 2002.The six proposals, as submitted to workgroup members, are included in Appendix 2.

The workgroup considered the six reform proposals at its November 2002 meeting. The proposals were presented in descending order from those that proposed the greatest changes to the CON program to those that proposed the most limited change. The six proposals are briefly summarized in the following table in the order in which they were considered.

 

Brief Summary

Proposal by workgroup member Andrea Eliscu

Eliminated the CON Program

Proposal by workgroup chairman Richard Morrison

Provided deadlines (not later than 2005) for AHCA to develop hospital licensure standards for tertiary services (excluding organ transplant programs) now regulated by CON; required AHCA to develop outcome-oriented licensure standards for tertiary services in hospitals and a system to delicense tertiary hospital services when hospitals failed to meet a majority of the outcome-oriented licensure standards; provided a back-up system for licensure standards for hospital tertiary services in the event of legal challenges to administrative rule processes; eliminated CON funding for local health councils and related contract management positions at the Department of Health; eliminated the role of local health councils in statewide health planning; required proposals for new hospitals to be general hospitals rather than specialty hospitals, with the exception of comprehensive inpatient medical rehab hospitals; increased flexibilities for highly utilized hospitals to add beds (including NICU and rehab) without CON review; increased fees for CON exemptions; increased CON fees; provided a phase out schedule for the CON program by 2006 or when licensure standards are implemented; required tertiary services to be provided only in general hospitals; provided limits to CON challenges.

Proposal by the Florida Hospital Association

Added open heart surgery to the statutory list of tertiary services; eliminated CON funding for local health councils and eliminated their role in statewide health planning; increased flexibilities for highly utilized hospitals to add beds (including NICU and rehab) without CON review; eliminated CON review of shared programs between hospitals; enabled hospital purchasers to acquire unimplemented CONs; enabled hospitals to convert among categories of mental health beds without CON review; created hospital licensure requirements to enable hospitals that do not have open heart surgery programs to offer emergency angioplasty; eliminated the ability of hospitals to create specialty hospitals through bed transfers; increased the flexibility for rural hospitals to build replacement facilities without CON review; increased CON fees; required AHCA to issue a final order in a CON appeal within 45 days of a DOAH recommended order or the recommended order is deemed approved; in appeals of CON cases to the district court, required the challenger in a CON appeal to pay the attorney’s fees and costs of the approved CON applicant if the court finds in favor of the approved applicant.

Proposal by workgroup member Tom Panza

Enabled 24-hour admissions at ambulatory surgical centers; enabled hospitals with highly utilized comprehensive rehab services to add beds without CON review; eliminated CON review of open heart surgery programs and replaced it with regulation through the hospital licensure program, including the ability to revoke authority to operate an open heart program.

Proposal by the workgroup’s nursing home subcommittee

Increased flexibilities for nursing homes to replace or transfer beds among facilities within districts without adding to the overall number of beds; created a CON advisory panel for nursing home issues; increased the occupancy standard in the current CON bed need methodology for nursing home beds; deleted the requirement for Gold Seal designation for highly utilized nursing homes to seek additional beds without CON review; changed requirements related to the submission of audited financial statements used in CON reviews.

Proposal by the workgroup’s hospice subcommittee

Eliminated CON review when existing hospice programs want to add inpatient units


The workgroup heard brief summaries of the first two proposals (Eliscu and Morrison) but declined to consider either in detail. Later, a proposal to direct AHCA to develop outcome-oriented licensure standards for open heart and related interventional cardiology programs that was similar to Mr. Morrison’s earlier proposal was approved by the workgroup.

The Florida Hospital Association’s proposal was considered in detail with much discussion. Most of its recommendations were approved with the exception of those related to local health councils. The final position on local health councils did not recommend a change in their health planning function, but specified that funds derived from proposed CON fee increases should only be applied to the operation of the CON program at AHCA. Funds derived from existing CON fees would continue to be partially allocated to local health councils as they are now.

The three parts of Mr. Panza’s proposal were considered separately. The workgroup declined to approve the proposal to allow 24-hour admissions at ambulatory surgical centers. Mr. Panza explained that the 2002 Legislature established a pilot project to test the proposal and the workgroup concluded that it would be appropriate to wait until the report of the pilot project is completed and reviewed before making any recommendation. That report is expected in late 2003.

Mr. Panza’s proposal for the limited expansion of inpatient rehab beds at highly utilized facilities without CON review was approved. It was actually discussed as an amendment to a similar proposal by the Florida Hospital Association. Earlier, the workgroup had rejected a proposal submitted in the public comment period that advocated the ability to convert hospital skilled nursing beds to inpatient rehab beds without CON review. Mr. Panza’s proposal for the elimination of CON review for adult open heart surgery programs was rejected.

The workgroup approved proposals by the nursing home and hospice subcommittees largely as presented. The nursing home proposals were considered separately and amended with minor technical changes.The workgroup rejected a proposal to exempt CON proposals for nursing home projects from the proposed fee increases.The hospice proposal was approved as presented. Appendices 3 and 4 provide detailed information about all of the proposals considered by the workgroup, including information about action taken to amend the proposals.

As a result of these actions, the workgroup directed staff to create a proposed bill that includes all of the approved language. This proposed bill was circulated to workgroup members for their review prior to publication.

back to Table of Content Page
CON main page