Current through Reg. 50, No. 187; September 24, 2024
(1) Letters of Intent and applications
subject to comparative review shall be accepted in two batching cycles annually
each for hospice programs and freestanding inpatient hospice facilities and for
nursing homes and intermediate care facilities for the developmentally disabled
(ICF/DD), as specified in paragraph (g) of this subsection. The category
"hospice" includes proposals for new hospice programs and hospice inpatient
facilities. The category "nursing homes and ICF/DDs" includes proposals for
community nursing home projects unless the project meets criteria in Section
408.036(2) or Section
408.036(3),
F.S., and intermediate care facilities for the developmentally disabled.
(a) Letter of Intent. A letter of intent
shall state with specificity the type of project proposed with sufficient
clarity to notify the public of the intention to file a Certificate of Need
application. A separate letter of intent is required for each type of project
and for each type of bed, program or facility having a separate need
methodology or licensing category. At least 30 days prior to the applicable
batching cycle application due date, an applicant shall file a letter of intent
respecting the development of a proposal in the following manner:
1. The letter of intent must be actually
received by the Agency by 5:00 p.m. (local time). The original of the letter of
intent must be submitted to the Agency at the address in paragraph
59C-1.008(1)(f),
F.A.C.
2. A letter of intent is for
a specific project within a specific geographic planning area as defined by
rule or statute for an established planning horizon. When no planning area is
defined, the District should be specified.
3. A prospective applicant submitting a
letter of intent is solely responsible for its conformity with any and all
statutory and rule criteria.
4. If
an application is not filed on or before the earliest subsequent due date for
filing applications of the same type as that specified in the letter of intent,
the letter of intent will be considered invalid and a new letter of intent must
be timely filed in a subsequent batching cycle before an application may be
filed.
(b) The contents
of the letter of intent shall be consistent with Section
408.039(2)(c),
F.S., and must be a written communication with an original signature. The
applicant is solely responsible for the content and clarity of the letter of
intent. The Agency shall not assume any facts not clearly stated. Applications
should be submitted with one bound copy and one unbound print copy.
(c) As to content, the letter of intent shall
describe the proposal with specificity by indicating clearly and unequivocally
the following information:
1. Identification
of the applicant means the legal name, mailing address, and telephone number of
the applicant.
a. If an existing health care
facility seeks to undertake a project subject to a comparative review, then the
legal name of the license holder must be stated and the license holder must be
the applicant except when the applicant has a pending application to become the
new licensee of the existing health care facility filed with the applicable
licensure unit within the Agency's Bureau of Health Facility Regulation. In
addition, the license number and date of expiration must be stated. It is the
responsibility of the person issued a license to keep licensure information
current. If Agency records indicate information different from that presented
in the letter of intent with respect to the identification of the holder of the
license and the licensure status, then the Agency records create a rebuttable
presumption as to the correctness of those records and therefore the letter of
intent is not valid.
b. If the
proposal is for a project which will result in licensure of a new health care
facility, the applicant seeking the Certificate of Need must be in existence at
the time the letter of intent is submitted. If the applicant is a corporation,
Limited Partnership, or otherwise organized, it must have filed an application
with the Florida Department of State authorizing the applicant to conduct
business in Florida.
2.
The letter of intent must identify the type of project proposed and shall
contain only one project type as described in Section
408.036(1),
F.S.
3. The number of beds sought
is indicated by the numerical representation of how many beds of a specific
type will compose the proposed project.
4. Location refers to the health planning
subdistricts adopted in Chapter 59C-2, F.A.C., for nursing home projects or the
service areas adopted in Rule
59C-1.0355, F.A.C., for hospice
projects. The applicant must indicate the subdistrict or service area by name
or number. Applicants must also give the name of the county where the proposed
project will be located.
(d) Letter of Intent Deadline Extension. In
order to provide for a mechanism by which applications may be filed to compete
with the proposals described in filed letters of intent the following
provisions apply:
1. In cases where a letter
of intent for a specific type of project has been received by the Agency 30
calendar days or more prior to the appropriate application filing due date as
set forth in paragraph
59C-1.008(1)(g),
F.A.C., and been initially accepted by the Agency, a grace period shall be
established.
2. The grace period
provides an opportunity for applicants applying for beds, programs or
facilities having the same Certificate of Need need methodology or health care
facility licensing category proposed in the initially accepted letter of intent
in the same applicable subdistrict or district to file a proposed competing
letter of intent. Under this grace period, a competing letter of intent must be
filed not later than 16 days after the letter of intent deadline promulgated
under paragraph 59C-1.008(1)(g),
F.A.C.
3. It shall be the sole
responsibility of the Agency to determine if a letter of intent is competing
with any other letter of intent.
4.
The application filing due date shall not be extended for any applicant filing
a letter of intent under the requirements of this paragraph unless specified
under the provisions of subparagraph
59C-1.008(1)(g)
1., F.A.C.
5. The Agency shall
publish notices of filing of letters of intent in the Florida Administrative
Register in accordance with Section
408.039(2)(d),
F.S.
(e) Failure to
comply with the applicable provisions of subsection (1) of this rule will
result in the Agency's rejecting the submitted document as a letter of intent.
If rejected by the Agency, the submitted document may not be amended or
corrected but a new proposed letter of intent may be submitted if time allows.
An application will not be accepted for review in a batching cycle for which a
letter of intent has not been accepted by the Agency.
(f) Certificate of Need Application
Submission.
An application for a Certificate of Need shall be submitted
on AHCA Forms 3150-0001, August 2021 Application For A Certificate of Need,
which includes a Cover Page, Schedules A, B, C, D, D-1, 1, 2, 3, 4, 5, 6, 6A,
7, 7A, 7B, 8, 8A, 9, 10 and 11, which are incorporated by reference herein
http://www.flrules.org/Gateway/reference.asp?No=Ref-13972.
An application for a transfer of a Certificate of Need shall be submitted on
AHCA Form 3150-0003, August 2021 Transfer Of A Certificate of Need which
includes Schedules 1(TRN), 10(TRN), 11(TRN), 12(TRN), B(TRN), D(TRN), D-1(TRN),
in addition to a Cover (TRN) Page, which are incorporated by reference herein
http://www.flrules.org/Gateway/reference.asp?No=Ref-13973.
Paper copies or copies on electronic media of AHCA Form 3150-0001, August 2021
Application For A Certificate of Need, or AHCA Form 3150-0003, August 2021
Transfer of A Certificate of Need, and the Schedules may be obtained
from:
Agency for Health Care Administration
Certificate of Need
2727 Mahan Drive, Mail Stop #28
Tallahassee, FL 32308
Electronic versions of AHCA Forms 3150-0001 and 3150-0003 and
the Schedules are also available at
http://ahca.myflorida.com/MCHQ/CON_FA/Application/index.shtml.
1. The application must be actually received
by the Agency by 5:00 p.m. (local time) on or before the application due
date.
2. Applications for projects
which exceed the proposed number of beds contained in the letter of intent
shall not be deemed complete for review by the Agency and shall be withdrawn
from further review.
3.
Applications may propose a lesser number of beds than that contained in the
letter of intent.
(g)
Applications Subject to Comparative Review - Batching Cycles. In order that
applications pertaining to similar types of programs or facilities affecting
the same service area, district or subdistrict may be considered in relation to
each other for purposes of comparative review, letters of intent and
applications shall be received by the agency no later than dates prescribed in
the following schedule, unless the date is a designated state holiday then it
shall be received by the agency the next business day:
|
Hospice
1st Batching Cycle
|
|
Summary Need Projections Published in the
F.A.R.
|
First Friday in February
|
|
Letter of Intent Deadline
|
Fourth Monday in February
|
|
Application Deadline
|
Last Wednesday in March
|
|
Completeness Review Deadline
|
First Wednesday in April
|
|
Application Omissions Deadline
|
Fourth Wednesday in April
|
|
Agency Initial Decision Deadline
|
Third Friday in June
|
|
Hospice
2nd Batching Cycle
|
|
Summary Need Projections Published in the
F.A.R.
|
First Friday in August
|
|
Letter of Intent Deadline
|
Fourth Monday in August
|
|
Application Deadline
|
Last Wednesday in September
|
|
Completeness Review Deadline
|
First Wednesday in October
|
|
Application Omissions Deadline
|
Fourth Wednesday in October
|
|
Agency Initial Decision Deadline
|
Third Friday in December
|
|
Nursing Homes and ICF/DDs
1st Batching Cycle
|
|
Summary Need Projections Published in the
F.A.R.
|
First Friday in April
|
|
Letter of Intent Deadline
|
Third Monday in April
|
|
Application Deadline
|
Third Wednesday in May
|
|
Completeness Review Deadline
|
Fourth Wednesday in May
|
|
Application Omissions Deadline
|
Third Wednesday in June
|
|
Agency Initial Decision Deadline
|
Second Friday in August
|
|
Nursing Homes and ICF/DDs
2nd Batching Cycle
|
|
Summary Need Projections Published in the
F.A.R.
|
First Friday in October
|
|
Letter of Intent Deadline
|
Third Monday in October
|
|
Application Deadline
|
Third Wednesday in November
|
|
Completeness Review Deadline
|
Fourth Wednesday in November
|
|
Application Omissions Deadline
|
Third Wednesday in December
|
|
Agency Initial Decision Deadline
|
Second Friday in February
|
1. Section
408.039 (2)(a),
F.S. prevails in cases of conflict. In months when the application deadline is
less than thirty days from the letter of intent deadline, the application
deadline, the completeness review deadline, and the application omissions
deadline will be extended by one week. The Agency initial decision deadline
will remain the same.
2. Paragraph
59C-1.008 (1)(d), F.A.C., prevails in cases of conflict and summary need
projections published in the Florida Administrative Register (F.A.R.) shall be
published one week earlier than identified above with all other dates in the
batching cycle remaining unchanged.
3. All dates shall be posted by January 1 of
each calendar year on the Agency website at
http://ahca.myflorida.com/MCHQ/CON_FA/Batching/index.shtml.
(h) An applicant for a project subject to
Certificate of Need review which affects an existing licensed health care
facility must be the license holder. The legal name of the license holder must
be stated. In addition, the license number and date of expiration must be
stated. It is the responsibility of the person issued a license to keep
licensure information current. If Agency records indicate information different
from that presented in the letter of intent with respect to the identification
of the holder of the license and the licensure status, then the Agency records
create a rebuttable presumption as to the correctness of those records and
therefore the application will be rejected.
(i) The applicant for a project shall not
change from the time a letter of intent is filed, or from the time an
application is filed in the case of an expedited review project, through the
time of the actual issuance of a Certificate of Need. Properly executed
corporate mergers or changes in the corporate name are not a change in the
applicant.
(2) Fixed Need
Pools.
(a) Publication of Fixed Need Pools.
1. The Agency shall publish in the Florida
Administrative Register at least 15 days prior to the letter of intent deadline
for a particular batching cycle the Fixed Need Pools for the applicable
planning horizon specified for each bed or program in applicable Agency rules
contained in Rules 59C-1.0355 and
59C-1.036, F.A.C. In cases of
conflict with paragraph
59C-1.008(1)(g),
F.A.C., subparagraph 59C-1.008(2)(a)
1., F.A.C., prevails, and the summary need projections published in the F.A.R.
shall be published one week earlier with all other dates in the batching cycle
remaining as noticed in paragraph
59C-1.008(1)(g),
F.A.C.
2. Any person who identifies
a mathematical or data input error made by the Agency in its calculation of the
Fixed Need Pool numbers must advise the Agency of the error within ten (10)
days of the date the Fixed Need Pool was published in the Florida
Administrative Register. As used in this section, the term "error" does not
include inaccuracies in reports which provide the underlying data required to
calculated the Fixed Need Pool numbers if such reports were not produced by the
Agency. If the Agency concurs in the error, the Fixed Need Pool number will be
adjusted and re-published in the first available edition of the Florida
Administrative Register. Failure to notify the Agency of the error during this
time period will result in no adjustment to the Fixed Need Pool number for that
batching cycle.
3. Except as
provided in subparagraph 2. above, the batching cycle specific Fixed Need Pools
shall not be changed or adjusted in the future regardless of any future changes
in need methodologies, population estimates, bed inventories, or other factors
which would lead to different projections of need, if retroactively
applied.
(b) Counting
Beds and Programs. For the purpose of establishing a Fixed Need Pool, all
existing and approved beds at the time the Fixed Need Pool is computed will be
included in the beds or program inventory. If a specific substantive rule
addresses the date upon which existing and approved beds and programs will be
counted, those rules will take precedence over this rule. In all other cases:
1. Beds and programs will be counted as
approved on the date a Certificate of Need is issued or a written decision of
intent to award a Certificate of Need is made, whichever occurs
first.
2. Beds or programs
initially denied by the Agency and subsequently granted in Administrative
Hearing or by stipulated agreement will be counted as approved when the final
order granting them is rendered. No beds or programs previously denied will be
included in the inventory based on a recommended order.
(c) Deleting Beds or Programs. Beds or
programs will be included in the inventory as long as there is a valid intent
to grant or a valid Certificate of Need outstanding. Beds or programs will not
be deleted from the inventory until an intent to grant is overturned in a final
order or judicial review of the final order. Beds or programs will not be
deleted from the inventory until a Certificate of Need is rescinded, revoked,
modified, voided, or voluntarily surrendered by an applicant. Licensed beds and
programs will be deleted when the license is no longer in effect. The effective
date for the deletion will be the date the license was voluntarily surrendered
by the license holder, the date of final Agency action in the case of a final
order or the date of a court order if a final order is appealed.
(d) The Agency will follow these procedures
when awarding beds or programs identified in a Fixed Need Pool:
1. Beds or programs will be awarded based on
the availability of a qualified applicant and proposed project which meets
statutory review criteria.
2. In
the absence of a qualified applicant and a project which meets statutory review
criteria, the Agency may elect not to approve any applications for beds or
services.
3. If a qualified
applicant exists but the proposed project exceeds the beds or programs
identified in the Fixed Need Pool, the Agency may award beds or programs in
excess of the pool when warranted by special circumstances as defined in the
applicable section of Chapter 59C-1, F.A.C., for the particular type of bed or
program.
(e) Comparative
Review. Applications submitted to the Agency in the same batching cycle for the
same program or beds having the same Certificate of Need methodology in the
same district or subdistrict, as defined in applicable rules, shall be
comparatively reviewed through final Agency action against the same Fixed Need
Pools in existence at the initial review. The Fixed Need Pools and other
relevant planning information shall be used by the Agency to review the
application against all applicable statutory review criteria contained in
Section 408.035, F.S., and applicable
rules, and policies. If an Agency need methodology does not exist for the
proposed project:
1. The Agency will provide
to the applicant, if one exists, any policy upon which to determine need for
the proposed beds or program. The applicant is not precluded from using other
methodologies to compare and contrast with the Agency policy.
2. If no Agency policy exists, the applicant
will be responsible for demonstrating need through a needs assessment
methodology which must include, at a minimum, consideration of the following
topics, except where they are inconsistent with the applicable statutory or
rule criteria:
a. Population demographics and
dynamics;
b. Availability,
utilization and quality of like services in the district, subdistrict or
both;
c. Medical treatment trends;
and,
d. Market
conditions.
(3) Filing Fees. Certificate of Need
applications shall not be accepted by the Agency at the time of filing unless
accompanied by the minimum base Certificate of Need application filing fee in
accordance with Section
408.038, F.S. The minimum base
fee shall be $10, 000. In addition to the base fee of $10, 000, the fee shall
be 0.015 of each dollar of the proposed expenditure, except that no fee shall
exceed $50, 000.
(a) For the sole purpose of
calculating the application fee, the proposed expenditure includes only the
items of cost contributing to the capital expenditures of the proposed project.
An application filing fee is non-refundable, unless the application is not
accepted by the Agency; or unless an accepted application is deemed incomplete
and withdrawn by the Agency as a result of the omissions review, and the
withdrawal is not challenged by the applicant, in which case all but the $10,
000 base fee shall be refunded. No fees shall be refunded for applications
deemed complete by the Agency but subsequently voluntarily withdrawn by the
applicant, or for applications deemed incomplete as a result of a legal
challenge.
(b) The Agency will
review the application to determine if the fee is correct.
1. If the check for an application is
insufficient to cover the fee, the Agency staff will notify the applicant in
the omissions request letter.
2. If
the correct fee is not received by the Agency staff by the close of business on
the promulgated applicant omissions deadline, the application will be deemed
incomplete and deemed withdrawn from further review.
3. If the check was for more than the correct
amount, the Agency staff will process a request for a refund to be returned to
the applicant with a letter explaining the refunded amount.
(c) Checks that are returned by the bank for
insufficient funds.
1. For an expedited review
application, when a check is returned by the bank for insufficient funds, the
Agency or designee will send a letter to the applicant, stating that the
application is incomplete due to failure to pay the Certificate of Need filing
fee and that, until the appropriate fee is received, the application cannot be
further processed. Notification to the applicant will also state that a service
charge of $15 or 5% of the face amount of the check, whichever is less, must be
added to the amount due pursuant to Section
215.34(2), F.S.
The application will be withdrawn from review if the correct fee is not
received twenty-one (21) days from the date of the letter informing the
applicant of the insufficient fee.
2. For a batched review application, when a
check is returned by the bank for insufficient funds, the Agency or designee
will send the applicant a letter advising the applicant that the application is
incomplete and is deemed withdrawn from review.
(4) Certificate of Need Application Contents.
An application for a Certificate of Need shall contain the following items:
(a) All requirements set forth in Sections
408.037(1) and
(2), F.S.
(b) The correct application fee.
(c) An audited financial statement of the
applicant or the applicant's parent corporation if the applicant's audited
financial statements do not exist. The following provisions apply to audited
financial statements:
1. The audited
financial statement of the applicant, or the applicant's parent corporation,
must be for the most current fiscal year. If the most recent fiscal year ended
within 120 days prior to the application filing deadline and the audited
financial statements are not yet available, then the prior fiscal year will be
considered the most recent.
2.
Existing health care facilities must provide audited financial statements for
the two most recent consecutive fiscal years in accordance with subparagraph
1., above.
3. Only audited
financial statements of the applicant, or the applicant's parent corporation,
will be accepted. Audited financial statements of any part of the applicant or
the applicant's parent corporation, including but not limited to subsidiaries,
divisions, specific facilities or cost centers, will not qualify as an audit of
the applicant or the applicant's parent corporation.
(d) To comply with Section 408.037(1)(b)1.,
F.S., which requires a listing of all capital projects, an applicant shall
provide the total approximate amount of anticipated expenditures for capital
projects which meet the definition in subsection
59C-1.002(6),
F.A.C., at the time of initial application submission, or state that there are
none. An itemized list or grouping of capital projects is not required,
although an applicant may choose to itemize or group its capital projects. The
applicant shall also indicate the actual or proposed financial commitment to
those projects, and include an assessment of the impact of those projects on
the applicant's ability to provide the proposed project; and,
(e) Responses to applicable questions
contained in the application forms.
(5) Identifiable Portions. If an applicant
would like to be considered for an award of an identifiable portion of the
project, the application, at the time of submission, must include responses to
the applicable questions on the identifiable portion. The Agency may make a
partial award only if the applicant included responses to the applicable
questions in the application.
(6)
This rule is in effect for five years from its effective
date.
Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law
Implemented 408.033, 408.034, 408.035, 408.036, 408.037, 408.038, 408.039,
408.040, 408.042 FS.
New 1-1-77, Amended 11-1-77, 9-1-78, 6-5-79, 2-1-81,
4-1-82, 7-29-82, 9-6-84, Formerly 10-5.08, Amended 11-24-86, 3-2-87, 6-11-87,
11-17-87, 3-23-88, 5-30-90, 12-20-90, 1-31-91, 9-9-91, 5-12-92, 7-1-92, 8-9-92,
Formerly 10-5.008, Amended 4-19-93, 6-23-94, 10-12-94, 10-18-95, 2-12-96,
7-18-96, 9-16-96, 11-4-97, 7-21-98, 12-12-00, 4-2-01, 1-10-02, 6-26-03,
12-13-04, 9-28-05, 10-9-07, 4-21-10, 2-13-12, 8-15-13, 10-29-15, 10-17-19,
12-30-20, 8-28-22.
