Bill Text: FL S1712 | 2019 | Regular Session | Comm Sub


Bill Title: Hospital Licensure

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced) 2019-04-26 - Laid on Table, refer to CS/HB 21 [S1712 Detail]

Download: Florida-2019-S1712-Comm_Sub.html
       Florida Senate - 2019                      CS for CS for SB 1712
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senator Harrell
       
       
       
       
       576-04593-19                                          20191712c2
    1                        A bill to be entitled                      
    2         An act relating to hospital licensure; amending s.
    3         395.003, F.S.; deleting provisions relating to the
    4         licensure of certain hospitals; amending s. 395.0191,
    5         F.S.; deleting provisions relating to certificate of
    6         need applications; amending s. 395.1055, F.S.;
    7         revising the Agency for Health Care Administration’s
    8         rulemaking authority with respect to minimum standards
    9         for hospitals; requiring hospitals that provide
   10         certain services to meet specified licensure
   11         requirements; conforming provisions to changes made by
   12         the act; amending s. 395.1065, F.S.; conforming a
   13         cross-reference; repealing s. 395.6025, F.S., relating
   14         to rural hospital replacement facilities; amending s.
   15         408.032, F.S.; revising and deleting definitions;
   16         amending s. 408.033, F.S.; conforming provisions to
   17         changes made by the act; amending s. 408.034, F.S.;
   18         authorizing the agency to issue a license to a general
   19         hospital that has not been issued a certificate of
   20         need under certain circumstances; revising duties and
   21         responsibilities of the agency relating to issuance of
   22         licenses to health care facilities and health service
   23         providers; conforming provisions to changes made by
   24         the act; amending s. 408.035, F.S.; deleting
   25         provisions related to the agency’s consideration and
   26         review of applications for certificates of need for
   27         general hospitals and health services; amending s.
   28         408.036, F.S.; providing an exception from certificate
   29         of need review requirements for the construction or
   30         establishment of a general hospital and the conversion
   31         of a specialty hospital to a general hospital;
   32         revising health-care-related projects subject to
   33         agency review for a certificate of need and exemptions
   34         therefrom; deleting provisions requiring health care
   35         facilities and providers to provide certain notice to
   36         the agency upon termination of a health care service
   37         or the addition or delicensure of beds; conforming a
   38         provision to changes made by the act; repealing s.
   39         408.0361, F.S., relating to cardiovascular services
   40         and burn unit licensure; amending ss. 408.037 and
   41         408.039, F.S.; deleting provisions relating to
   42         certificate of need applications for general
   43         hospitals; amending s. 408.043, F.S.; deleting
   44         provisions relating to certificates of need for
   45         osteopathic acute care hospitals; amending s. 408.808,
   46         F.S.; authorizing the agency to issue an inactive
   47         license to a certain hospital under certain
   48         circumstances; providing effective dates.
   49          
   50  Be It Enacted by the Legislature of the State of Florida:
   51  
   52         Section 1. Effective July 1, 2024, subsections (8), (9),
   53  and (10) of section 395.003, Florida Statutes, are amended to
   54  read:
   55         395.003 Licensure; denial, suspension, and revocation.—
   56         (8) A hospital may not be licensed or relicensed if:
   57         (a) The diagnosis-related groups for 65 percent or more of
   58  the discharges from the hospital, in the most recent year for
   59  which data is available to the Agency for Health Care
   60  Administration pursuant to s. 408.061, are for diagnosis, care,
   61  and treatment of patients who have:
   62         1. Cardiac-related diseases and disorders classified as
   63  diagnosis-related groups in major diagnostic category 5;
   64         2. Orthopedic-related diseases and disorders classified as
   65  diagnosis-related groups in major diagnostic category 8;
   66         3. Cancer-related diseases and disorders classified as
   67  discharges in which the principal diagnosis is neoplasm or
   68  carcinoma or is for an admission for radiotherapy or
   69  antineoplastic chemotherapy or immunotherapy; or
   70         4. Any combination of the above discharges.
   71         (b) The hospital restricts its medical and surgical
   72  services to primarily or exclusively cardiac, orthopedic,
   73  surgical, or oncology specialties.
   74         (c) A hospital classified as an exempt cancer center
   75  hospital pursuant to 42 C.F.R. s. 412.23(f) as of December 31,
   76  2005, is exempt from the licensure restrictions of this
   77  subsection.
   78         (9) A hospital licensed as of June 1, 2004, shall be exempt
   79  from subsection (8) as long as the hospital maintains the same
   80  ownership, facility street address, and range of services that
   81  were in existence on June 1, 2004. Any transfer of beds, or
   82  other agreements that result in the establishment of a hospital
   83  or hospital services within the intent of this section, shall be
   84  subject to subsection (8). Unless the hospital is otherwise
   85  exempt under subsection (8), the agency shall deny or revoke the
   86  license of a hospital that violates any of the criteria set
   87  forth in that subsection.
   88         (10) The agency may adopt rules implementing the licensure
   89  requirements set forth in subsection (8). Within 14 days after
   90  rendering its decision on a license application or revocation,
   91  the agency shall publish its proposed decision in the Florida
   92  Administrative Register. Within 21 days after publication of the
   93  agency’s decision, any authorized person may file a request for
   94  an administrative hearing. In administrative proceedings
   95  challenging the approval, denial, or revocation of a license
   96  pursuant to subsection (8), the hearing must be based on the
   97  facts and law existing at the time of the agency’s proposed
   98  agency action. Existing hospitals may initiate or intervene in
   99  an administrative hearing to approve, deny, or revoke licensure
  100  under subsection (8) based upon a showing that an established
  101  program will be substantially affected by the issuance or
  102  renewal of a license to a hospital within the same district or
  103  service area.
  104         Section 2. Effective July 1, 2024, subsection (10) of
  105  section 395.0191, Florida Statutes, is amended to read:
  106         395.0191 Staff membership and clinical privileges.—
  107         (10) Nothing herein shall be construed by the agency as
  108  requiring an applicant for a certificate of need to establish
  109  proof of discrimination in the granting of or denial of hospital
  110  staff membership or clinical privileges as a precondition to
  111  obtaining such certificate of need under the provisions of s.
  112  408.043.
  113         Section 3. Effective July 1, 2024, present subsection (12)
  114  of section 395.1055, Florida Statutes, is redesignated as
  115  subsection (15), and a new subsection (12) and subsections (13)
  116  and (14) are added to that section, and paragraph (f) of
  117  subsection (1) and paragraph (b) of subsection (9) of that
  118  section are amended, to read:
  119         395.1055 Rules and enforcement.—
  120         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  121  and 120.54 to implement the provisions of this part, which shall
  122  include reasonable and fair minimum standards for ensuring that:
  123         (f) All hospitals submit such data as necessary to conduct
  124  certificate-of-need reviews required under part I of chapter
  125  408. Such data shall include, but shall not be limited to,
  126  patient origin data, hospital utilization data, type of service
  127  reporting, and facility staffing data. The agency may not
  128  collect data that identifies or could disclose the identity of
  129  individual patients. The agency shall utilize existing uniform
  130  statewide data sources when available and shall minimize
  131  reporting costs to hospitals.
  132         (9) The agency shall establish a technical advisory panel,
  133  pursuant to s. 20.052, to develop procedures and standards for
  134  measuring outcomes of pediatric cardiac catheterization programs
  135  and pediatric cardiovascular surgery programs.
  136         (b) Voting members of the panel shall include: 3 at-large
  137  members, including 1 cardiologist who is board certified in
  138  caring for adults with congenital heart disease and 2 board
  139  certified pediatric cardiologists, neither of whom may be
  140  employed by any of the hospitals specified in subparagraphs 1.
  141  10. or their affiliates, each of whom is appointed by the
  142  Secretary of Health Care Administration, and 10 members, and an
  143  alternate for each member, each of whom is a pediatric
  144  cardiologist or a pediatric cardiovascular surgeon, each
  145  appointed by the chief executive officer of the following
  146  hospitals:
  147         1. Johns Hopkins All Children’s Hospital in St. Petersburg.
  148         2. Arnold Palmer Hospital for Children in Orlando.
  149         3. Joe DiMaggio Children’s Hospital in Hollywood.
  150         4. Nicklaus Children’s Hospital in Miami.
  151         5. St. Joseph’s Children’s Hospital in Tampa.
  152         6. University of Florida Health Shands Hospital in
  153  Gainesville.
  154         7. University of Miami Holtz Children’s Hospital in Miami.
  155         8. Wolfson Children’s Hospital in Jacksonville.
  156         9. Florida Hospital for Children in Orlando.
  157         10. Nemours Children’s Hospital in Orlando.
  158  
  159  Appointments made under subparagraphs 1.-10. are contingent upon
  160  the hospital’s maintenance of pediatric certificates of need and
  161  the hospital’s compliance with this section and rules adopted
  162  thereunder, as determined by the Secretary of Health Care
  163  Administration. A member appointed under subparagraphs 1.-10.
  164  whose hospital fails to maintain such certificates or comply
  165  with such standards may serve only as a nonvoting member until
  166  the hospital restores such certificates or complies with such
  167  standards.
  168         (12)Each provider of diagnostic cardiac catheterization
  169  services shall comply with rules adopted by the agency which
  170  establish licensure standards governing the operation of adult
  171  inpatient diagnostic cardiac catheterization programs. The rules
  172  must ensure that such programs:
  173         (a)Comply with the most recent guidelines of the American
  174  College of Cardiology and American Heart Association Guidelines
  175  for Cardiac Catheterization and Cardiac Catheterization
  176  Laboratories.
  177         (b)Perform only adult inpatient diagnostic cardiac
  178  catheterization services and will not provide therapeutic
  179  cardiac catheterization or any other cardiology services.
  180         (c)Maintain sufficient appropriate equipment and health
  181  care personnel to ensure quality and safety.
  182         (d)Maintain appropriate times of operation and protocols
  183  to ensure availability and appropriate referrals in the event of
  184  emergencies.
  185         (e)Demonstrate a plan to provide services to Medicaid and
  186  charity care patients.
  187         (13)Each provider of adult cardiovascular services or
  188  operator of a burn unit shall comply with rules adopted by the
  189  agency which establish licensure standards that govern the
  190  provision of adult cardiovascular services or the operation of a
  191  burn unit. Such rules shall consider, at a minimum, staffing,
  192  equipment, physical plant, operating protocols, the provision of
  193  services to Medicaid and charity care patients, accreditation,
  194  licensure period and fees, and enforcement of minimum standards.
  195         (14)In establishing rules for adult cardiovascular
  196  services, the agency shall include provisions that allow for:
  197         (a)Establishment of two hospital program licensure levels:
  198  a Level I program authorizing the performance of adult
  199  percutaneous cardiac intervention without onsite cardiac surgery
  200  and a Level II program authorizing the performance of
  201  percutaneous cardiac intervention with onsite cardiac surgery.
  202         (b)1.For a hospital seeking a Level I program,
  203  demonstration that, for the most recent 12-month period as
  204  reported to the agency, the hospital has provided a minimum of
  205  300 adult inpatient and outpatient diagnostic cardiac
  206  catheterizations or, for the most recent 12-month period, has
  207  discharged or transferred at least 300 patients with the
  208  principal diagnosis of ischemic heart disease and that it has a
  209  formalized, written transfer agreement with a hospital that has
  210  a Level II program, including written transport protocols to
  211  ensure safe and efficient transfer of a patient within 60
  212  minutes.
  213         2.a.A hospital located more than 100 road miles from the
  214  closest Level II adult cardiovascular services program does not
  215  need to meet the diagnostic cardiac catheterization volume and
  216  ischemic heart disease diagnosis volume requirements in
  217  subparagraph 1. if the hospital demonstrates that it has, for
  218  the most recent 12-month period as reported to the agency,
  219  provided a minimum of 100 adult inpatient and outpatient
  220  diagnostic cardiac catheterizations or that, for the most recent
  221  12-month period, it has discharged or transferred at least 300
  222  patients with the principal diagnosis of ischemic heart disease.
  223         b.A hospital located more than 100 road miles from the
  224  closest Level II adult cardiovascular services program does not
  225  need to meet the 60-minute transfer time protocol requirement in
  226  subparagraph 1. if the hospital demonstrates that it has a
  227  formalized, written transfer agreement with a hospital that has
  228  a Level II program. The agreement must include written transport
  229  protocols to ensure the safe and efficient transfer of a
  230  patient, taking into consideration the patient’s clinical and
  231  physical characteristics, road and weather conditions, and
  232  viability of ground and air ambulance service to transfer the
  233  patient.
  234         3.At a minimum, the rules for adult cardiovascular
  235  services must require nursing and technical staff to have
  236  demonstrated experience in handling acutely ill patients
  237  requiring intervention, based on the staff member’s previous
  238  experience in dedicated cardiac interventional laboratories or
  239  surgical centers. If a staff member’s previous experience is in
  240  a dedicated cardiac interventional laboratory at a hospital that
  241  does not have an approved adult open heart surgery program, the
  242  staff member’s previous experience qualifies only if, at the
  243  time the staff member acquired his or her experience, the
  244  dedicated cardiac interventional laboratory:
  245         a.Had an annual volume of 500 or more percutaneous cardiac
  246  intervention procedures.
  247         b.Achieved a demonstrated success rate of 95 percent or
  248  greater for percutaneous cardiac intervention procedures.
  249         c.Experienced a complication rate of less than 5 percent
  250  for percutaneous cardiac intervention procedures.
  251         d.Performed diverse cardiac procedures, including, but not
  252  limited to, balloon angioplasty and stenting, rotational
  253  atherectomy, cutting balloon atheroma remodeling, and procedures
  254  relating to left ventricular support capability.
  255         (c)For a hospital seeking a Level II program,
  256  demonstration that, for the most recent 12-month period as
  257  reported to the agency, the hospital has performed a minimum of
  258  1,100 adult inpatient and outpatient cardiac catheterizations,
  259  of which at least 400 must be therapeutic catheterizations, or,
  260  for the most recent 12-month period, has discharged at least 800
  261  patients with the principal diagnosis of ischemic heart disease.
  262         (d)Compliance with the most recent guidelines of the
  263  American College of Cardiology and American Heart Association
  264  guidelines for staffing, physician training and experience,
  265  operating procedures, equipment, physical plant, and patient
  266  selection criteria to ensure patient quality and safety.
  267         (e)Establishment of appropriate hours of operation and
  268  protocols to ensure availability and timely referral in the
  269  event of emergencies.
  270         (f)Demonstration of a plan to provide services to Medicaid
  271  and charity care patients.
  272         Section 4. Effective July 1, 2024, subsection (5) of
  273  section 395.1065, Florida Statutes, is amended to read:
  274         395.1065 Criminal and administrative penalties;
  275  moratorium.—
  276         (5) The agency shall impose a fine of $500 for each
  277  instance of the facility’s failure to provide the information
  278  required by rules adopted pursuant to s. 395.1055(1)(g) s.
  279  395.1055(1)(h).
  280         Section 5. Section 395.6025, Florida Statutes, is repealed.
  281         Section 6. Subsections (8) and (13) of section 408.032,
  282  Florida Statutes, are amended to read:
  283         408.032 Definitions relating to Health Facility and
  284  Services Development Act.—As used in ss. 408.031-408.045, the
  285  term:
  286         (8) “Health care facility” means a hospital, long-term care
  287  hospital, skilled nursing facility, hospice, or intermediate
  288  care facility for the developmentally disabled. A facility
  289  relying solely on spiritual means through prayer for healing is
  290  not included as a health care facility.
  291         (13) “Long-term care hospital” means a hospital licensed
  292  under chapter 395 which meets the requirements of 42 C.F.R. s.
  293  412.23(e) and seeks exclusion from the acute care Medicare
  294  prospective payment system for inpatient hospital services.
  295         Section 7. Effective July 1, 2024, subsections (8) through
  296  (16) of section 408.032, Florida Statutes, as amended by this
  297  act, are amended to read:
  298         408.032 Definitions relating to Health Facility and
  299  Services Development Act.—As used in ss. 408.031-408.045, the
  300  term:
  301         (8) “Health care facility” means a hospital, skilled
  302  nursing facility, hospice, or intermediate care facility for the
  303  developmentally disabled. A facility relying solely on spiritual
  304  means through prayer for healing is not included as a health
  305  care facility.
  306         (9)“Health services” means inpatient diagnostic, curative,
  307  or comprehensive medical rehabilitative services and includes
  308  mental health services. Obstetric services are not health
  309  services for purposes of ss. 408.031-408.045.
  310         (9)(10) “Hospice” or “hospice program” means a hospice as
  311  defined in part IV of chapter 400.
  312         (11)“Hospital” means a health care facility licensed under
  313  chapter 395.
  314         (10)(12) “Intermediate care facility for the
  315  developmentally disabled” means a residential facility licensed
  316  under part VIII of chapter 400.
  317         (13)Mental health services” means inpatient services
  318  provided in a hospital licensed under chapter 395 and listed on
  319  the hospital license as psychiatric beds for adults; psychiatric
  320  beds for children and adolescents; intensive residential
  321  treatment beds for children and adolescents; substance abuse
  322  beds for adults; or substance abuse beds for children and
  323  adolescents.
  324         (11)(14) “Nursing home geographically underserved area”
  325  means:
  326         (a) A county in which there is no existing or approved
  327  nursing home;
  328         (b) An area with a radius of at least 20 miles in which
  329  there is no existing or approved nursing home; or
  330         (c) An area with a radius of at least 20 miles in which all
  331  existing nursing homes have maintained at least a 95 percent
  332  occupancy rate for the most recent 6 months or a 90 percent
  333  occupancy rate for the most recent 12 months.
  334         (12)(15) “Skilled nursing facility” means an institution,
  335  or a distinct part of an institution, which is primarily engaged
  336  in providing, to inpatients, skilled nursing care and related
  337  services for patients who require medical or nursing care, or
  338  rehabilitation services for the rehabilitation of injured,
  339  disabled, or sick persons.
  340         (16)“Tertiary health service” means a health service
  341  which, due to its high level of intensity, complexity,
  342  specialized or limited applicability, and cost, should be
  343  limited to, and concentrated in, a limited number of hospitals
  344  to ensure the quality, availability, and cost-effectiveness of
  345  such service. Examples of such service include, but are not
  346  limited to, pediatric cardiac catheterization, pediatric open
  347  heart surgery, organ transplantation, neonatal intensive care
  348  units, comprehensive rehabilitation, and medical or surgical
  349  services which are experimental or developmental in nature to
  350  the extent that the provision of such services is not yet
  351  contemplated within the commonly accepted course of diagnosis or
  352  treatment for the condition addressed by a given service. The
  353  agency shall establish by rule a list of all tertiary health
  354  services.
  355         Section 8. Effective July 1, 2024, paragraph (b) of
  356  subsection (1) of section 408.033, Florida Statutes, is amended
  357  to read:
  358         408.033 Local and state health planning.—
  359         (1) LOCAL HEALTH COUNCILS.—
  360         (b) Each local health council may:
  361         1. Develop a district area health plan that permits each
  362  local health council to develop strategies and set priorities
  363  for implementation based on its unique local health needs.
  364         2. Advise the agency on health care issues and resource
  365  allocations.
  366         3. Promote public awareness of community health needs,
  367  emphasizing health promotion and cost-effective health service
  368  selection.
  369         4. Collect data and conduct analyses and studies related to
  370  health care needs of the district, including the needs of
  371  medically indigent persons, and assist the agency and other
  372  state agencies in carrying out data collection activities that
  373  relate to the functions in this subsection.
  374         5. Monitor the onsite construction progress, if any, of
  375  certificate-of-need approved projects and report council
  376  findings to the agency on forms provided by the agency.
  377         6. Advise and assist any regional planning councils within
  378  each district that have elected to address health issues in
  379  their strategic regional policy plans with the development of
  380  the health element of the plans to address the health goals and
  381  policies in the State Comprehensive Plan.
  382         7. Advise and assist local governments within each district
  383  on the development of an optional health plan element of the
  384  comprehensive plan provided in chapter 163, to assure
  385  compatibility with the health goals and policies in the State
  386  Comprehensive Plan and district health plan. To facilitate the
  387  implementation of this section, the local health council shall
  388  annually provide the local governments in its service area, upon
  389  request, with:
  390         a. A copy and appropriate updates of the district health
  391  plan;
  392         b. A report of health facility hospital and nursing home
  393  utilization statistics for facilities within the local
  394  government jurisdiction; and
  395         c. Applicable agency rules and calculated need
  396  methodologies for health facilities and services regulated under
  397  s. 408.034 for the district served by the local health council.
  398         8. Monitor and evaluate the adequacy, appropriateness, and
  399  effectiveness, within the district, of local, state, federal,
  400  and private funds distributed to meet the needs of the medically
  401  indigent and other underserved population groups.
  402         9. In conjunction with the Department of Health, plan for
  403  services at the local level for persons infected with the human
  404  immunodeficiency virus.
  405         10. Provide technical assistance to encourage and support
  406  activities by providers, purchasers, consumers, and local,
  407  regional, and state agencies in meeting the health care goals,
  408  objectives, and policies adopted by the local health council.
  409         11. Provide the agency with data required by rule for the
  410  review of certificate-of-need applications and the projection of
  411  need for health services and facilities in the district.
  412         Section 9. Subsection (2) of section 408.034, Florida
  413  Statutes, is amended to read:
  414         408.034 Duties and responsibilities of agency; rules.—
  415         (2) In the exercise of its authority to issue licenses to
  416  health care facilities and health service providers, as provided
  417  under chapters 393 and 395 and parts II, IV, and VIII of chapter
  418  400, the agency may not issue a license to any health care
  419  facility or health service provider that fails to receive a
  420  certificate of need or an exemption for the licensed facility or
  421  service, except that the agency may issue a license to a general
  422  hospital that has not been issued a certificate of need.
  423         Section 10. Effective July 1, 2024, subsection (2), as
  424  amended by this act, and subsection (3) of section 408.034,
  425  Florida Statutes, are amended to read:
  426         408.034 Duties and responsibilities of agency; rules.—
  427         (2) In the exercise of its authority to issue licenses to
  428  health care facilities and health service providers, as provided
  429  under chapter chapters 393 and 395 and parts II, IV, and VIII of
  430  chapter 400, the agency may not issue a license to any health
  431  care facility or health service provider that fails to receive a
  432  certificate of need or an exemption for the licensed facility or
  433  service, except that the agency may issue a license to a general
  434  hospital that has not been issued a certificate of need.
  435         (3) The agency shall establish, by rule, uniform need
  436  methodologies for health services and health facilities. In
  437  developing uniform need methodologies, the agency shall, at a
  438  minimum, consider the demographic characteristics of the
  439  population, the health status of the population, service use
  440  patterns, standards and trends, geographic accessibility, and
  441  market economics.
  442         Section 11. Section 408.035, Florida Statutes, is amended
  443  to read:
  444         408.035 Review criteria.—
  445         (1) The agency shall determine the reviewability of
  446  applications and shall review applications for certificate-of
  447  need determinations for health care facilities and health
  448  services in context with the following criteria, except for
  449  general hospitals as defined in s. 395.002:
  450         (1)(a) The need for the health care facilities and health
  451  services being proposed.
  452         (2)(b) The availability, quality of care, accessibility,
  453  and extent of utilization of existing health care facilities and
  454  health services in the service district of the applicant.
  455         (3)(c) The ability of the applicant to provide quality of
  456  care and the applicant’s record of providing quality of care.
  457         (4)(d) The availability of resources, including health
  458  personnel, management personnel, and funds for capital and
  459  operating expenditures, for project accomplishment and
  460  operation.
  461         (5)(e) The extent to which the proposed services will
  462  enhance access to health care for residents of the service
  463  district.
  464         (6)(f) The immediate and long-term financial feasibility of
  465  the proposal.
  466         (7)(g) The extent to which the proposal will foster
  467  competition that promotes quality and cost-effectiveness.
  468         (8)(h) The costs and methods of the proposed construction,
  469  including the costs and methods of energy provision and the
  470  availability of alternative, less costly, or more effective
  471  methods of construction.
  472         (9)(i) The applicant’s past and proposed provision of
  473  health care services to Medicaid patients and the medically
  474  indigent.
  475         (10)(j) The applicant’s designation as a Gold Seal Program
  476  nursing facility pursuant to s. 400.235, when the applicant is
  477  requesting additional nursing home beds at that facility.
  478         (2) For a general hospital, the agency shall consider only
  479  the criteria specified in paragraph (1)(a), paragraph (1)(b),
  480  except for quality of care in paragraph (1)(b), and paragraphs
  481  (1)(e), (g), and (i).
  482         Section 12. Effective July 1, 2024, section 408.035,
  483  Florida Statutes, as amended by this act, is amended to read:
  484         408.035 Review criteria.—The agency shall determine the
  485  reviewability of applications and shall review applications for
  486  certificate-of-need determinations for health care facilities
  487  and health services in context with the following criteria:
  488         (1) The need for the health care facilities and health
  489  services being proposed.
  490         (2) The availability, quality of care, accessibility, and
  491  extent of utilization of existing health care facilities and
  492  health services in the service district of the applicant.
  493         (3) The ability of the applicant to provide quality of care
  494  and the applicant’s record of providing quality of care.
  495         (4) The availability of resources, including health
  496  personnel, management personnel, and funds for capital and
  497  operating expenditures, for project accomplishment and
  498  operation.
  499         (5) The extent to which the proposed services will enhance
  500  access to health care for residents of the service district.
  501         (6) The immediate and long-term financial feasibility of
  502  the proposal.
  503         (7) The extent to which the proposal will foster
  504  competition that promotes quality and cost-effectiveness.
  505         (8) The costs and methods of the proposed construction,
  506  including the costs and methods of energy provision and the
  507  availability of alternative, less costly, or more effective
  508  methods of construction.
  509         (9) The applicant’s past and proposed provision of health
  510  care services to Medicaid patients and the medically indigent.
  511         (10) The applicant’s designation as a Gold Seal Program
  512  nursing facility pursuant to s. 400.235, when the applicant is
  513  requesting additional nursing home beds at that facility.
  514         Section 13. Paragraphs (b) and (c) of subsection (1) of
  515  section 408.036, Florida Statutes, are amended to read:
  516         408.036 Projects subject to review; exemptions.—
  517         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  518  health-care-related projects, as described in paragraphs (a)
  519  (f), are subject to review and must file an application for a
  520  certificate of need with the agency. The agency is exclusively
  521  responsible for determining whether a health-care-related
  522  project is subject to review under ss. 408.031-408.045.
  523         (b) The new construction or establishment of additional
  524  health care facilities, except for the construction of or
  525  establishment of a general hospital or including a replacement
  526  health care facility when the proposed project site is not
  527  located on the same site as or within 1 mile of the existing
  528  health care facility, if the number of beds in each licensed bed
  529  category will not increase.
  530         (c) The conversion from one type of health care facility to
  531  another, including the conversion from a general hospital or, a
  532  specialty hospital, except that the conversion of a specialty
  533  hospital to a general hospital is not subject to review or a
  534  long-term care hospital.
  535         Section 14. Effective July 1, 2024, section 408.036,
  536  Florida Statutes, as amended by this act, is amended to read:
  537         408.036 Projects subject to review; exemptions.—
  538         (1) APPLICABILITY.—Unless exempt under subsection (3), all
  539  health-care-related projects, as described in this subsection
  540  paragraphs (a)-(f), are subject to review and must file an
  541  application for a certificate of need with the agency. The
  542  agency is exclusively responsible for determining whether a
  543  health-care-related project is subject to review under ss.
  544  408.031-408.045.
  545         (a) The addition of beds in community nursing homes or
  546  intermediate care facilities for the developmentally disabled by
  547  new construction or alteration.
  548         (b) The new construction or establishment of additional
  549  health care facilities, except for the construction of or
  550  establishment of a general hospital or a replacement health care
  551  facility when the proposed project site is located on the same
  552  site as or within 1 mile of the existing health care facility if
  553  the number of beds in each licensed bed category will not
  554  increase.
  555         (c) The conversion from one type of health care facility to
  556  another, including the conversion from a general hospital or a
  557  specialty hospital except that the conversion of a specialty
  558  hospital to a general hospital is not subject to review.
  559         (d) The establishment of a hospice or hospice inpatient
  560  facility, except as provided in s. 408.043.
  561         (e)An increase in the number of beds for comprehensive
  562  rehabilitation.
  563         (f)The establishment of tertiary health services,
  564  including inpatient comprehensive rehabilitation services.
  565         (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.—Unless exempt
  566  pursuant to subsection (3), the following projects are subject
  567  to expedited review:
  568         (a) Transfer of a certificate of need, except that when an
  569  existing hospital is acquired by a purchaser, all certificates
  570  of need issued to the hospital which are not yet operational
  571  shall be acquired by the purchaser without need for a transfer.
  572         (b) Replacement of a nursing home, if the proposed project
  573  site is within a 30-mile radius of the replaced nursing home. If
  574  the proposed project site is outside the subdistrict where the
  575  replaced nursing home is located, the prior 6-month occupancy
  576  rate for licensed community nursing homes in the proposed
  577  subdistrict must be at least 85 percent in accordance with the
  578  agency’s most recently published inventory.
  579         (c) Replacement of a nursing home within the same district,
  580  if the proposed project site is outside a 30-mile radius of the
  581  replaced nursing home but within the same subdistrict or a
  582  geographically contiguous subdistrict. If the proposed project
  583  site is in the geographically contiguous subdistrict, the prior
  584  6-month occupancy rate for licensed community nursing homes for
  585  that subdistrict must be at least 85 percent in accordance with
  586  the agency’s most recently published inventory.
  587         (d) Relocation of a portion of a nursing home’s licensed
  588  beds to another facility or to establish a new facility within
  589  the same district or within a geographically contiguous
  590  district, if the relocation is within a 30-mile radius of the
  591  existing facility and the total number of nursing home beds in
  592  the state does not increase.
  593         (e) New construction of a community nursing home in a
  594  retirement community as further provided in this paragraph.
  595         1. Expedited review under this paragraph is available if
  596  all of the following criteria are met:
  597         a. The residential use area of the retirement community is
  598  deed-restricted as housing for older persons as defined in s.
  599  760.29(4)(b).
  600         b. The retirement community is located in a county in which
  601  25 percent or more of its population is age 65 and older.
  602         c. The retirement community is located in a county that has
  603  a rate of no more than 16.1 beds per 1,000 persons age 65 years
  604  or older. The rate shall be determined by using the current
  605  number of licensed and approved community nursing home beds in
  606  the county per the agency’s most recent published inventory.
  607         d. The retirement community has a population of at least
  608  8,000 residents within the county, based on a population data
  609  source accepted by the agency.
  610         e. The number of proposed community nursing home beds in an
  611  application does not exceed the projected bed need after
  612  applying the rate of 16.1 beds per 1,000 persons aged 65 years
  613  and older projected for the county 3 years into the future using
  614  the estimates adopted by the agency reduced by the agency’s most
  615  recently published inventory of licensed and approved community
  616  nursing home beds in the county.
  617         2. No more than 120 community nursing home beds shall be
  618  approved for a qualified retirement community under each request
  619  for expedited review. Subsequent requests for expedited review
  620  under this process may not be made until 2 years after
  621  construction of the facility has commenced or 1 year after the
  622  beds approved through the initial request are licensed,
  623  whichever occurs first.
  624         3. The total number of community nursing home beds which
  625  may be approved for any single deed-restricted community
  626  pursuant to this paragraph may not exceed 240, regardless of
  627  whether the retirement community is located in more than one
  628  qualifying county.
  629         4. Each nursing home facility approved under this paragraph
  630  must be dually certified for participation in the Medicare and
  631  Medicaid programs.
  632         5. Each nursing home facility approved under this paragraph
  633  must be at least 1 mile, as measured over publicly owned
  634  roadways, from an existing approved and licensed community
  635  nursing home.
  636         6. A retirement community requesting expedited review under
  637  this paragraph shall submit a written request to the agency for
  638  expedited review. The request must include the number of beds to
  639  be added and provide evidence of compliance with the criteria
  640  specified in subparagraph 1.
  641         7. After verifying that the retirement community meets the
  642  criteria for expedited review specified in subparagraph 1., the
  643  agency shall publicly notice in the Florida Administrative
  644  Register that a request for an expedited review has been
  645  submitted by a qualifying retirement community and that the
  646  qualifying retirement community intends to make land available
  647  for the construction and operation of a community nursing home.
  648  The agency’s notice must identify where potential applicants can
  649  obtain information describing the sales price of, or terms of
  650  the land lease for, the property on which the project will be
  651  located and the requirements established by the retirement
  652  community. The agency notice must also specify the deadline for
  653  submission of the certificate-of-need application, which may not
  654  be earlier than the 91st day or later than the 125th day after
  655  the date the notice appears in the Florida Administrative
  656  Register.
  657         8. The qualified retirement community shall make land
  658  available to applicants it deems to have met its requirements
  659  for the construction and operation of a community nursing home
  660  but may sell or lease the land only to the applicant that is
  661  issued a certificate of need by the agency under this paragraph.
  662         a. A certificate-of-need application submitted under this
  663  paragraph must identify the intended site for the project within
  664  the retirement community and the anticipated costs for the
  665  project based on that site. The application must also include
  666  written evidence that the retirement community has determined
  667  that both the provider submitting the application and the
  668  project satisfy its requirements for the project.
  669         b. If the retirement community determines that more than
  670  one provider satisfies its requirements for the project, it may
  671  notify the agency of the provider it prefers.
  672         9. The agency shall review each submitted application. If
  673  multiple applications are submitted for a project published
  674  pursuant to subparagraph 7., the agency shall review the
  675  competing applications.
  676  
  677  The agency shall develop rules to implement the expedited review
  678  process, including time schedule, application content that may
  679  be reduced from the full requirements of s. 408.037(1), and
  680  application processing.
  681         (3) EXEMPTIONS.—Upon request, the following projects are
  682  subject to exemption from the provisions of subsection (1):
  683         (a) For hospice services or for swing beds in a rural
  684  hospital, as defined in s. 395.602, in a number that does not
  685  exceed one-half of its licensed beds, or for a hospice program
  686  established by an entity that shares a controlling interest, as
  687  defined in s. 408.803, with a not-for-profit retirement
  688  community that offers independent living, assisted living, and
  689  skilled nursing services provided in a facility on the same
  690  premises and designated by the agency as a teaching nursing home
  691  for a minimum of 5 years, in accordance with s. 430.80. Only one
  692  hospice program per teaching nursing home may be established
  693  under the exemption in this paragraph, and such program shall be
  694  limited to serving patients residing in communities located
  695  within the not-for-profit retirement community, including home
  696  and community-based service providers.
  697         (b)For the conversion of licensed acute care hospital beds
  698  to Medicare and Medicaid certified skilled nursing beds in a
  699  rural hospital, as defined in s. 395.602, so long as the
  700  conversion of the beds does not involve the construction of new
  701  facilities. The total number of skilled nursing beds, including
  702  swing beds, may not exceed one-half of the total number of
  703  licensed beds in the rural hospital as of July 1, 1993.
  704  Certified skilled nursing beds designated under this paragraph,
  705  excluding swing beds, shall be included in the community nursing
  706  home bed inventory. A rural hospital that subsequently
  707  decertifies any acute care beds exempted under this paragraph
  708  shall notify the agency of the decertification, and the agency
  709  shall adjust the community nursing home bed inventory
  710  accordingly.
  711         (b)(c) For the addition of nursing home beds at a skilled
  712  nursing facility that is part of a retirement community that
  713  provides a variety of residential settings and supportive
  714  services and that has been incorporated and operated in this
  715  state for at least 65 years on or before July 1, 1994. All
  716  nursing home beds must not be available to the public but must
  717  be for the exclusive use of the community residents.
  718         (c)(d) For an inmate health care facility built by or for
  719  the exclusive use of the Department of Corrections as provided
  720  in chapter 945. This exemption expires when such facility is
  721  converted to other uses.
  722         (d)(e) For the addition of nursing home beds licensed under
  723  chapter 400 in a number not exceeding 30 total beds or 25
  724  percent of the number of beds licensed in the facility being
  725  replaced under paragraph (2)(b), paragraph (2)(c), or paragraph
  726  (i) (m), whichever is less.
  727         (e)(f) For state veterans’ nursing homes operated by or on
  728  behalf of the Florida Department of Veterans’ Affairs in
  729  accordance with part II of chapter 296 for which at least 50
  730  percent of the construction cost is federally funded and for
  731  which the Federal Government pays a per diem rate not to exceed
  732  one-half of the cost of the veterans’ care in such state nursing
  733  homes. These beds shall not be included in the nursing home bed
  734  inventory.
  735         (f)(g) For combination within one nursing home facility of
  736  the beds or services authorized by two or more certificates of
  737  need issued in the same planning subdistrict. An exemption
  738  granted under this paragraph shall extend the validity period of
  739  the certificates of need to be consolidated by the length of the
  740  period beginning upon submission of the exemption request and
  741  ending with issuance of the exemption. The longest validity
  742  period among the certificates shall be applicable to each of the
  743  combined certificates.
  744         (g)(h) For division into two or more nursing home
  745  facilities of beds or services authorized by one certificate of
  746  need issued in the same planning subdistrict. An exemption
  747  granted under this paragraph shall extend the validity period of
  748  the certificate of need to be divided by the length of the
  749  period beginning upon submission of the exemption request and
  750  ending with issuance of the exemption.
  751         (i)For the addition of hospital beds licensed under
  752  chapter 395 for comprehensive rehabilitation in a number that
  753  may not exceed 10 total beds or 10 percent of the licensed
  754  capacity, whichever is greater.
  755         1.In addition to any other documentation otherwise
  756  required by the agency, a request for exemption submitted under
  757  this paragraph must:
  758         a.Certify that the prior 12-month average occupancy rate
  759  for the licensed beds being expanded meets or exceeds 80
  760  percent.
  761         b.Certify that the beds have been licensed and operational
  762  for at least 12 months.
  763         2.The timeframes and monitoring process specified in s.
  764  408.040(2)(a)-(c) apply to any exemption issued under this
  765  paragraph.
  766         3.The agency shall count beds authorized under this
  767  paragraph as approved beds in the published inventory of
  768  hospital beds until the beds are licensed.
  769         (h)(j) For the addition of nursing home beds licensed under
  770  chapter 400 in a number not exceeding 10 total beds or 10
  771  percent of the number of beds licensed in the facility being
  772  expanded, whichever is greater; or, for the addition of nursing
  773  home beds licensed under chapter 400 at a facility that has been
  774  designated as a Gold Seal nursing home under s. 400.235 in a
  775  number not exceeding 20 total beds or 10 percent of the number
  776  of licensed beds in the facility being expanded, whichever is
  777  greater.
  778         1. In addition to any other documentation required by the
  779  agency, a request for exemption submitted under this paragraph
  780  must certify that:
  781         a. The facility has not had any class I or class II
  782  deficiencies within the 30 months preceding the request.
  783         b. The prior 12-month average occupancy rate for the
  784  nursing home beds at the facility meets or exceeds 94 percent.
  785         c. Any beds authorized for the facility under this
  786  paragraph before the date of the current request for an
  787  exemption have been licensed and operational for at least 12
  788  months.
  789         2. The timeframes and monitoring process specified in s.
  790  408.040(2)(a)-(c) apply to any exemption issued under this
  791  paragraph.
  792         3. The agency shall count beds authorized under this
  793  paragraph as approved beds in the published inventory of nursing
  794  home beds until the beds are licensed.
  795         (k)For the establishment of:
  796         1.A Level II neonatal intensive care unit with at least 10
  797  beds, upon documentation to the agency that the applicant
  798  hospital had a minimum of 1,500 births during the previous 12
  799  months;
  800         2.A Level III neonatal intensive care unit with at least
  801  15 beds, upon documentation to the agency that the applicant
  802  hospital has a Level II neonatal intensive care unit of at least
  803  10 beds and had a minimum of 3,500 births during the previous 12
  804  months; or
  805         3.A Level III neonatal intensive care unit with at least 5
  806  beds, upon documentation to the agency that the applicant
  807  hospital is a verified trauma center pursuant to s.
  808  395.4001(15), and has a Level II neonatal intensive care unit,
  809  
  810  if the applicant demonstrates that it meets the requirements for
  811  quality of care, nurse staffing, physician staffing, physical
  812  plant, equipment, emergency transportation, and data reporting
  813  found in agency certificate-of-need rules for Level II and Level
  814  III neonatal intensive care units and if the applicant commits
  815  to the provision of services to Medicaid and charity patients at
  816  a level equal to or greater than the district average. Such a
  817  commitment is subject to s. 408.040.
  818         (l)For the addition of mental health services or beds if
  819  the applicant commits to providing services to Medicaid or
  820  charity care patients at a level equal to or greater than the
  821  district average. Such a commitment is subject to s. 408.040.
  822         (i)(m) For replacement of a licensed nursing home on the
  823  same site, or within 5 miles of the same site if within the same
  824  subdistrict, if the number of licensed beds does not increase
  825  except as permitted under paragraph (d) (e).
  826         (j)(n) For consolidation or combination of licensed nursing
  827  homes or transfer of beds between licensed nursing homes within
  828  the same planning district, by nursing homes with any shared
  829  controlled interest within that planning district, if there is
  830  no increase in the planning district total number of nursing
  831  home beds and the site of the relocation is not more than 30
  832  miles from the original location.
  833         (k)(o) For beds in state mental health treatment facilities
  834  defined in s. 394.455 and state mental health forensic
  835  facilities operated under chapter 916.
  836         (l)(p) For beds in state developmental disabilities centers
  837  as defined in s. 393.063.
  838         (m)(q) For the establishment of a health care facility or
  839  project that meets all of the following criteria:
  840         1. The applicant was previously licensed within the past 21
  841  days as a health care facility or provider that is subject to
  842  subsection (1).
  843         2. The applicant failed to submit a renewal application and
  844  the license expired on or after January 1, 2015.
  845         3. The applicant does not have a license denial or
  846  revocation action pending with the agency at the time of the
  847  request.
  848         4. The applicant’s request is for the same service type,
  849  district, service area, and site for which the applicant was
  850  previously licensed.
  851         5. The applicant’s request, if applicable, includes the
  852  same number and type of beds as were previously licensed.
  853         6. The applicant agrees to the same conditions that were
  854  previously imposed on the certificate of need or on an exemption
  855  related to the applicant’s previously licensed health care
  856  facility or project.
  857         7. The applicant applies for initial licensure as required
  858  under s. 408.806 within 21 days after the agency approves the
  859  exemption request. If the applicant fails to apply in a timely
  860  manner, the exemption expires on the 22nd day following the
  861  agency’s approval of the exemption.
  862  
  863  Notwithstanding subparagraph 1., an applicant whose license
  864  expired between January 1, 2015, and the effective date of this
  865  act may apply for an exemption within 30 days of this act
  866  becoming law.
  867         (4) REQUESTS FOR EXEMPTION.—A request for exemption under
  868  subsection (3) may be made at any time and is not subject to the
  869  batching requirements of this section. The request shall be
  870  supported by such documentation as the agency requires by rule.
  871  The agency shall assess a fee of $250 for each request for
  872  exemption submitted under subsection (3).
  873         (5) NOTIFICATION.—Health care facilities and providers must
  874  provide to the agency notification of:
  875         (a) replacement of a health care facility when the proposed
  876  project site is located in the same district and on the existing
  877  site or within a 1-mile radius of the replaced health care
  878  facility, if the number and type of beds do not increase.
  879         (b)The termination of a health care service, upon 30 days’
  880  written notice to the agency.
  881         (c)The addition or delicensure of beds. Notification under
  882  this subsection may be made by electronic, facsimile, or written
  883  means at any time before the described action has been taken.
  884         Section 15. Effective July 1, 2024, section 408.0361,
  885  Florida Statutes, is repealed.
  886         Section 16. Section 408.037, Florida Statutes, is amended
  887  to read:
  888         408.037 Application content.—
  889         (1) Except as provided in subsection (2) for a general
  890  hospital, An application for a certificate of need must contain:
  891         (a) A detailed description of the proposed project and
  892  statement of its purpose and need in relation to the district
  893  health plan.
  894         (b) A statement of the financial resources needed by and
  895  available to the applicant to accomplish the proposed project.
  896  This statement must include:
  897         1. A complete listing of all capital projects, including
  898  new health facility development projects and health facility
  899  acquisitions applied for, pending, approved, or underway in any
  900  state at the time of application, regardless of whether or not
  901  that state has a certificate-of-need program or a capital
  902  expenditure review program pursuant to s. 1122 of the Social
  903  Security Act. The agency may, by rule, require less-detailed
  904  information from major health care providers. This listing must
  905  include the applicant’s actual or proposed financial commitment
  906  to those projects and an assessment of their impact on the
  907  applicant’s ability to provide the proposed project.
  908         2. A detailed listing of the needed capital expenditures,
  909  including sources of funds.
  910         3. A detailed financial projection, including a statement
  911  of the projected revenue and expenses for the first 2 years of
  912  operation after completion of the proposed project. This
  913  statement must include a detailed evaluation of the impact of
  914  the proposed project on the cost of other services provided by
  915  the applicant.
  916         (c) An audited financial statement of the applicant or the
  917  applicant’s parent corporation if audited financial statements
  918  of the applicant do not exist. In an application submitted by an
  919  existing health care facility, health maintenance organization,
  920  or hospice, financial condition documentation must include, but
  921  need not be limited to, a balance sheet and a profit-and-loss
  922  statement of the 2 previous fiscal years’ operation.
  923         (2) An application for a certificate of need for a general
  924  hospital must contain a detailed description of the proposed
  925  general hospital project and a statement of its purpose and the
  926  needs it will meet. The proposed project’s location, as well as
  927  its primary and secondary service areas, must be identified by
  928  zip code. Primary service area is defined as the zip codes from
  929  which the applicant projects that it will draw 75 percent of its
  930  discharges. Secondary service area is defined as the zip codes
  931  from which the applicant projects that it will draw its
  932  remaining discharges. If, subsequent to issuance of a final
  933  order approving the certificate of need, the proposed location
  934  of the general hospital changes or the primary service area
  935  materially changes, the agency shall revoke the certificate of
  936  need. However, if the agency determines that such changes are
  937  deemed to enhance access to hospital services in the service
  938  district, the agency may permit such changes to occur. A party
  939  participating in the administrative hearing regarding the
  940  issuance of the certificate of need for a general hospital has
  941  standing to participate in any subsequent proceeding regarding
  942  the revocation of the certificate of need for a hospital for
  943  which the location has changed or for which the primary service
  944  area has materially changed. In addition, the application for
  945  the certificate of need for a general hospital must include a
  946  statement of intent that, if approved by final order of the
  947  agency, the applicant shall within 120 days after issuance of
  948  the final order or, if there is an appeal of the final order,
  949  within 120 days after the issuance of the court’s mandate on
  950  appeal, furnish satisfactory proof of the applicant’s financial
  951  ability to operate. The agency shall establish documentation
  952  requirements, to be completed by each applicant, which show
  953  anticipated provider revenues and expenditures, the basis for
  954  financing the anticipated cash-flow requirements of the
  955  provider, and an applicant’s access to contingency financing. A
  956  party participating in the administrative hearing regarding the
  957  issuance of the certificate of need for a general hospital may
  958  provide written comments concerning the adequacy of the
  959  financial information provided, but such party does not have
  960  standing to participate in an administrative proceeding
  961  regarding proof of the applicant’s financial ability to operate.
  962  The agency may require a licensee to provide proof of financial
  963  ability to operate at any time if there is evidence of financial
  964  instability, including, but not limited to, unpaid expenses
  965  necessary for the basic operations of the provider.
  966         (2)(3) The applicant must certify that it will license and
  967  operate the health care facility. For an existing health care
  968  facility, the applicant must be the licenseholder of the
  969  facility.
  970         Section 17. Paragraphs (c) and (d) of subsection (3),
  971  paragraphs (b) and (c) of subsection (5), and paragraph (d) of
  972  subsection (6) of section 408.039, Florida Statutes, are amended
  973  to read:
  974         408.039 Review process.—The review process for certificates
  975  of need shall be as follows:
  976         (3) APPLICATION PROCESSING.—
  977         (c) Except for competing applicants, in order to be
  978  eligible to challenge the agency decision on a general hospital
  979  application under review pursuant to paragraph (5)(c), existing
  980  hospitals must submit a detailed written statement of opposition
  981  to the agency and to the applicant. The detailed written
  982  statement must be received by the agency and the applicant
  983  within 21 days after the general hospital application is deemed
  984  complete and made available to the public.
  985         (d) In those cases where a written statement of opposition
  986  has been timely filed regarding a certificate of need
  987  application for a general hospital, the applicant for the
  988  general hospital may submit a written response to the agency.
  989  Such response must be received by the agency within 10 days of
  990  the written statement due date.
  991         (5) ADMINISTRATIVE HEARINGS.—
  992         (b) Hearings shall be held in Tallahassee unless the
  993  administrative law judge determines that changing the location
  994  will facilitate the proceedings. The agency shall assign
  995  proceedings requiring hearings to the Division of Administrative
  996  Hearings of the Department of Management Services within 10 days
  997  after the time has expired for requesting a hearing. Except upon
  998  unanimous consent of the parties or upon the granting by the
  999  administrative law judge of a motion of continuance, hearings
 1000  shall commence within 60 days after the administrative law judge
 1001  has been assigned. For an application for a general hospital,
 1002  administrative hearings shall commence within 6 months after the
 1003  administrative law judge has been assigned, and a continuance
 1004  may not be granted absent a finding of extraordinary
 1005  circumstances by the administrative law judge. All parties,
 1006  except the agency, shall bear their own expense of preparing a
 1007  transcript. In any application for a certificate of need which
 1008  is referred to the Division of Administrative Hearings for
 1009  hearing, the administrative law judge shall complete and submit
 1010  to the parties a recommended order as provided in ss. 120.569
 1011  and 120.57. The recommended order shall be issued within 30 days
 1012  after the receipt of the proposed recommended orders or the
 1013  deadline for submission of such proposed recommended orders,
 1014  whichever is earlier. The division shall adopt procedures for
 1015  administrative hearings which shall maximize the use of
 1016  stipulated facts and shall provide for the admission of prepared
 1017  testimony.
 1018         (c) In administrative proceedings challenging the issuance
 1019  or denial of a certificate of need, only applicants considered
 1020  by the agency in the same batching cycle are entitled to a
 1021  comparative hearing on their applications. Existing health care
 1022  facilities may initiate or intervene in an administrative
 1023  hearing upon a showing that an established program will be
 1024  substantially affected by the issuance of any certificate of
 1025  need, whether reviewed under s. 408.036(1) or (2), to a
 1026  competing proposed facility or program within the same district.
 1027  With respect to an application for a general hospital, competing
 1028  applicants and only those existing hospitals that submitted a
 1029  detailed written statement of opposition to an application as
 1030  provided in this paragraph may initiate or intervene in an
 1031  administrative hearing. Such challenges to a general hospital
 1032  application shall be limited in scope to the issues raised in
 1033  the detailed written statement of opposition that was provided
 1034  to the agency. The administrative law judge may, upon a motion
 1035  showing good cause, expand the scope of the issues to be heard
 1036  at the hearing. Such motion shall include substantial and
 1037  detailed facts and reasons for failure to include such issues in
 1038  the original written statement of opposition.
 1039         (6) JUDICIAL REVIEW.—
 1040         (d) The party appealing a final order that grants a general
 1041  hospital certificate of need shall pay the appellee’s attorney’s
 1042  fees and costs, in an amount up to $1 million, from the
 1043  beginning of the original administrative action if the appealing
 1044  party loses the appeal, subject to the following limitations and
 1045  requirements:
 1046         1. The party appealing a final order must post a bond in
 1047  the amount of $1 million in order to maintain the appeal.
 1048         2. Except as provided under s. 120.595(5), in no event
 1049  shall the agency be held liable for any other party’s attorney’s
 1050  fees or costs.
 1051         Section 18. Subsection (1) of section 408.043, Florida
 1052  Statutes, is amended to read:
 1053         408.043 Special provisions.—
 1054         (1) OSTEOPATHIC ACUTE CARE HOSPITALS.—When an application
 1055  is made for a certificate of need to construct or to expand an
 1056  osteopathic acute care hospital, the need for such hospital
 1057  shall be determined on the basis of the need for and
 1058  availability of osteopathic services and osteopathic acute care
 1059  hospitals in the district. When a prior certificate of need to
 1060  establish an osteopathic acute care hospital has been issued in
 1061  a district, and the facility is no longer used for that purpose,
 1062  the agency may continue to count such facility and beds as an
 1063  existing osteopathic facility in any subsequent application for
 1064  construction of an osteopathic acute care hospital.
 1065         Section 19. Subsection (3) of section 408.808, Florida
 1066  Statutes, is amended to read:
 1067         408.808 License categories.—
 1068         (3) INACTIVE LICENSE.—An inactive license may be issued to
 1069  a hospital or a health care provider subject to the certificate
 1070  of-need provisions in part I of this chapter when the provider
 1071  is currently licensed, does not have a provisional license, and
 1072  will be temporarily unable to provide services but is reasonably
 1073  expected to resume services within 12 months. Such designation
 1074  may be made for a period not to exceed 12 months but may be
 1075  renewed by the agency for up to 12 additional months upon
 1076  demonstration by the licensee of the provider’s progress toward
 1077  reopening. However, if after 20 months in an inactive license
 1078  status, a statutory rural hospital, as defined in s. 395.602,
 1079  has demonstrated progress toward reopening, but may not be able
 1080  to reopen prior to the inactive license expiration date, the
 1081  inactive designation may be renewed again by the agency for up
 1082  to 12 additional months. For purposes of such a second renewal,
 1083  if construction or renovation is required, the licensee must
 1084  have had plans approved by the agency and construction must have
 1085  already commenced pursuant to s. 408.032(4); however, if
 1086  construction or renovation is not required, the licensee must
 1087  provide proof of having made an enforceable capital expenditure
 1088  greater than 25 percent of the total costs associated with the
 1089  hiring of staff and the purchase of equipment and supplies
 1090  needed to operate the facility upon opening. A request by a
 1091  licensee for an inactive license or to extend the previously
 1092  approved inactive period must be submitted to the agency and
 1093  must include a written justification for the inactive license
 1094  with the beginning and ending dates of inactivity specified, a
 1095  plan for the transfer of any clients to other providers, and the
 1096  appropriate licensure fees. The agency may not accept a request
 1097  that is submitted after initiating closure, after any suspension
 1098  of service, or after notifying clients of closure or suspension
 1099  of service, unless the action is a result of a disaster at the
 1100  licensed premises. For the purposes of this section, the term
 1101  “disaster” means a sudden emergency occurrence beyond the
 1102  control of the licensee, whether natural, technological, or
 1103  manmade, which renders the provider inoperable at the premises.
 1104  Upon agency approval, the provider shall notify clients of any
 1105  necessary discharge or transfer as required by authorizing
 1106  statutes or applicable rules. The beginning of the inactive
 1107  license period is the date the provider ceases operations. The
 1108  end of the inactive license period shall become the license
 1109  expiration date. All licensure fees must be current, must be
 1110  paid in full, and may be prorated. Reactivation of an inactive
 1111  license requires the approval of a renewal application,
 1112  including payment of licensure fees and agency inspections
 1113  indicating compliance with all requirements of this part,
 1114  authorizing statutes, and applicable rules.
 1115         Section 20. Except as otherwise expressly provided in this
 1116  act, this act shall take effect July 1, 2021.

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