Current through Reg. 50, No. 187; September 24, 2024
(1)
Agency Intent. This rule implements Section
408.034(3),
F.S., which requires the Agency to develop uniform need methodologies for
Certificate of Need (CON) review of proposals, and Section
408.036(1)(a),
F.S., which requires Certificate of Need review of proposals for the addition
of nursing facility beds licensed under Chapter 400, F.S. The rule regulates
the construction of new nursing facilities, the addition of new nursing
facility beds, and conversion of other health care facility bed types to
nursing facility beds, including conversion of licensed sheltered nursing
facility beds in continuing care facilities regulated under Section
651.118, F.S. Projects for the
addition of sheltered nursing home beds are excluded from this rule and
regulated under Rule 59C-1.037, F.A.C. It is the
intent of the Agency to ensure the availability of nursing facility services to
all persons needing such services, regardless of ability to pay. Nothing in
this rule is intended to interpret, modify, limit or expand Florida law
regarding standing, or the right of an existing health care provider to
initiate or intervene in a formal Administrative Hearing challenging intended
Agency action on a Certificate of Need application for nursing facility beds
regulated under this rule.
(2) CON
Reviews. Proposals for nursing facility beds seeking licensure under Chapter
400, F.S., will be comparatively reviewed to each other. This rule contains a
methodology for determining the numeric need for nursing facility beds proposed
to be licensed under Chapter 400, F.S. An application for nursing facility beds
seeking licensure under Chapter 400, F.S., will not be approved in the absence
or insufficiency of a numeric need indicated by the formula in subsection (4)
of this rule, unless the absence or insufficiency of numeric need is outweighed
by other information presented in a Certificate of Need application showing
special circumstances consistent with applicable and relevant criteria in
Section 408.035, F.S.
(3) General Provisions.
(a) Planning Horizon. The future need for
nursing facility beds shall be determined twice a year and published by the
Agency as a Fixed Bed Need Pool for the applicable planning horizon. The
planning horizon for applications submitted between January 1 and June 30 is
January of the year 3 years subsequent to the year the application is
submitted; the planning horizon for applications submitted between July 1 and
December 31 is July of the year 3 years subsequent to the year the application
is submitted.
(b) Batching Cycles.
Proposals for nursing facility beds seeking licensure under Chapter 400, F.S.,
will be reviewed in the batching cycles for "Other Beds and Programs" described
in paragraph 59C-1.008(1)(g),
F.A.C.
(c) Population Estimates.
The estimates of current and projected population used in this rule shall be
the most recent estimates published by the Executive Office of the Governor and
available to the Agency at least 3 weeks prior to publication of the Fixed Bed
Need Pool. The estimate of projected population is the estimate for the
planning horizon. The estimate of current population is the estimate for
January of the year the application is submitted when the planning horizon is
January; the estimate of current population is the estimate for July of the
year the application is submitted when the planning horizon is July.
(d) Subdistrict Need Determination. The
Agency will use the subdistrict designation shown in Rule
59C-2.200, F.A.C., for Agency
service Districts 1 through 11 respectively in projecting need for nursing
facility beds licensed under Chapter 400, F.S.
(e) Geographically Contiguous Subdistricts
within a District. If nursing home need is determined by the bed need formula
contained in this rule in continguous subdistricts within a District, the
applicant may aggregate the subdistrict's need for a new community nursing home
pursuant to Section 408.034(6),
F.S.
1. If need is aggregated from two
subdistricts, the proposed nursing home site must be located in the subdistrict
with the greatest published need as determined by the bed need formula
contained in this rule.
2. If need
is aggregated from more than two subdistricts, the location of the proposed
nursing home site must provide reasonable geographic access for residents in
the aggregated subdistricts given the relative bed need in each
subdistrict.
(f)
Geographically Underserved Areas. In a competitive Certificate of Need review
within the nursing facility subdistrict as defined in Rule
59C-2.200, F.A.C., the Agency
shall award a Certificate of Need if the applicant meets all applicable
criteria for a geographically underserved area as specified in Section
408.032(15),
F.S., and if the applicant meets applicable statutory Certificate of Need
review criteria specified in Section
408.035, F.S., including bed
need according to the relevant bed need formula contained in this rule. If an
applicant is awarded a Certificate of Need based on the provisions of this
paragraph, the applicant shall agree that the nursing facility will be located
in a county without a nursing facility, or in the center of an area within the
subdistrict with a radius of at least 20 miles which meets the definition of a
geographically underserved area. The center of the geographically underserved
area shall be the proposed nursing facility location in the
application.
(4) Numeric
Need for Nursing Facility Beds Seeking Licensure under Chapter 400, F.S.
(a) Projected Need. In addition to the other
relevant statutory and rule criteria used in considering the allocation of new
or additional nursing facility beds to be licensed under Chapter 400, F.S., the
Agency will determine if there is a projected need for new or additional beds
at the planning horizon according to the definitions and methodology specified
in this subsection.
(b) Summary of
Need Formula. The need formula for nursing facility beds seeking licensure
under Chapter 400, F.S., links the projected subdistrict need to a projected
increase in the district need for beds licensed under Chapter 400, F.S. The
District increase is based on the expected increase in the district population
age 65 to 74 and age 75 and over, with the age group 75 and over given 6 times
more weight in projecting the population increase. The projected district bed
need total is then allocated to its subdistricts consistent with the current
subdistrict distribution of the total. The result for a given subdistrict is
adjusted to reflect the current subdistrict occupancy of beds licensed under
Chapter 400, F.S., and a desired standard of 92 percent occupancy. This
subdistrict total of allocated beds is then reduced by the current number of
Chapter 400, F.S., beds in the subdistrict that are licensed or approved,
resulting in the net need for additional nursing facility beds to be licensed
under Chapter 400, F.S. The rule also provides that if current occupancy of
beds licensed under Chapter 400, F.S., is less than 85 percent, the net need in
the subdistrict is zero regardless of whether the formula otherwise would show
a net need.
(c) Need Formula. The
formula for determining the net need in a subdistrict for nursing facility beds
licensed under Chapter 400, F.S., is as follows:
1. A = (POPA x BA) + (POPB x BB)
where:
A is the projected age-adjusted total number of nursing
facility beds to be licensed under Chapter 400, F.S., at the planning horizon
for the district in which the subdistrict is located.
POPA is the projected population age 65-74 years in the
district.
POPB is the projected population age 75 years and older in
the district.
BA is the estimated current bed rate for facilities licensed
under Chapter 400, F.S., for the population age 65-74 years in the
district.
BB is the estimated current bed rate for facilities licensed
under Chapter 400, F.S., for the population age 75 years and over in the
district.
2. BA = LB / (POPC
+ (6 x POPD))
where:
LB is the number of nursing facility beds licensed under
Chapter 400, F.S., in the District as of January 1, for fixed bed need pools
published between January 1 and June 30, or as of July 1 for fixed bed need
pools published between July 1 and December 31.
POPC is the current population age 65-74 years in the
district.
POPD is the current population age 75 years and over in the
district.
3. BB = 6 x
BA
4. SA = A x (LBD/LB) x (OR/.92)
where:
SA is the subdistrict allocation of community nursing
facility beds to be licensed under Chapter 400, F.S., at the planning
horizon.
LBD is the number of nursing facility beds licensed under
Chapter 400, F.S., in the subdistrict as of January 1, for fixed bed need pools
published between January 1 and June 30, or as of July 1 for fixed bed need
pools published between July 1 and December 31.
Or is the average 6 month occupancy rate for nursing facility
beds licensed in the subdistrict under Chapter 400, F.S. For fixed bed need
pools published between January 1 and June 30, occupancy rates shall be based
upon patient days in nursing facilities licensed under Chapter 400, F.S., for
the 6 month period from July 1 through December 31 of the previous year; for
fixed bed need pools published between July 1 and December 31, occupancy rates
shall be based upon patient days in nursing facilities licensed under Chapter
400, F.S., for the 6 month period from January 1 through June 30 of the year
the fixed bed need pool is published.
.92 equals the desired average 6 month occupancy rate for
nursing facility beds licensed under Chapter 400, F.S., in the
subdistrict.
5. The net bed
need allocation for a subdistrict at the planning horizon is determined by
subtracting the total number of licensed and approved beds for facilities
licensed under Chapter 400, F.S., in the subdistrict from the bed allocation
determined under subparagraphs (c)1. through (c)4. unless, as defined in
subparagraph (c)4. is less than 85% percent, in which case the net bed need
allocation is zero. The number of licensed beds that is subtracted from the bed
need allocation shall be the number licensed under Chapter 400, F.S., as of the
most recent published deadline for Agency initial decisions prior to
publication of the Fixed Bed Need Pool. The number of approved beds that is
subtracted shall be the number for which the Agency has issued a Certificate of
Need, a letter stating the Agency's intent to issue a Certificate of Need, a
signed stipulated agreement, or a final order granting a Certificate of Need,
as of the most recent published deadline for Agency initial decisions prior to
publication of the Fixed Bed Need Pool.
(d) Proposed Services. Applicants proposing
the establishment of Medicare-certified nursing facility beds to be licensed
under Chapter 400, F.S., shall provide a detailed description of the services
to be provided, staffing pattern, patient characteristics, expected average
length of stay, ancillary services, patient assessment tools, admission
policies, and discharge policies.
(e) Quality of Care. In assessing the
applicant's ability to provide quality of care pursuant to Section
408.035(1)(c),
F.S., the Agency shall evaluate the following facts and circumstances:
1. Whether the applicant has had a Chapter
400, F.S., nursing facility license denied, revoked, or suspended within the 36
months prior to the application.
2.
Whether the applicant has had a nursing facility placed into receivership at
any time during the period of ownership, management, or leasing of a nursing
facility in the 36 months prior to the current application.
3. The extent to which the conditions
identified within subparagraphs 1. and 2. threatened or resulted in direct,
significant harm to the health, safety or welfare of the nursing facility
residents.
4. The extent to which
the conditions identified within subparagraph 3. were corrected within the time
frames allowed by the appropriate state Agency in each respective state and in
a manner satisfactory to the Agency.
(f) Harmful Conditions. The Agency shall
question the ability of the applicant to provide quality of care within any
nursing facility when the conditions identified in subparagraphs (e)1. and
(e)2. resulted in direct, significant harm to the health, safety or welfare of
a nursing facility resident, and were not corrected within the time frames
allowed by the appropriate state Agency in each respective state and in a
manner satisfactory to the Agency.
(g) Other Factors to be Considered in the
Review of Certificate of Need Applications for nursing facility beds. An
applicant who agrees to voluntarily relinquish licensed community nursing home
beds in one or more subdistricts where there is no calculated need, may be
recognized as a postitive application factor when applying for nursing facility
beds in a subdistrict with published need. The applicant must demonstrate that
it operates or has a controlled interest as defined in subparagraph
59C-1.005(6)(j)
3., F.A.C., or has an agreement with another licensed community nursing home to
ensure that beds are voluntarily relinquished if the application is approved.
The nursing home from which the beds are being relinquished must submit a
letter certifying that the identified number of beds at its facility will be
delicensed no later than initial licensure of the proposed facility should the
CON be awarded to the applicant. The relocation of beds under this paragraph
must be limited to a portion of beds such that the occupancy rate of the
remaining licensed beds of the facility from which the beds are being
relinquished does not exceed 92 percent.
(5) Utilization Reports. Within 45 days after
the end of each calendar quarter, facilities with nursing facility beds
licensed under Chapter 400 or 395, F.S., shall report to the Agency, or its
designee, the total number of patient days which occurred in each month of the
quarter and the number of such days which were Medicaid patient
days.
Rulemaking Authority 408.034(3), (5), (8), 408.15(8) FS.
Law Implemented 408.034(3), (5), (6), (7), 408.036(1)(a), (b), (c)
FS.
New 1-1-77, Amended 11-1-77, 6-5-79, 4-24-80, 2-1-81,
4-1-82, 11-9-82, 2-14-83, 4-7-83, 6-9-83, 6-10-83, 12-12-83, 3-5-84, 5-14-84,
7-16-84, 8-30-84, 10-15-84, 12-25-84, 4-9-85, Formerly 10-5.11, Amended
6-19-86, 11-24-86, 1-25-87, 3-2-87, 3-12-87, 8-11-87, 8-7-88, 8-28-88, 9-12-88,
4-19-89, 10-19-89, 5-30-90, 7-11-90, 8-6-90, 10-10-90, 12-23-90, Formerly
10-5.011(1)(k), Amended 8-9-92, Formerly 10-5.036, Amended 10-6-92, 8-24-93,
6-11-98, 4-7-02, 8-1-05, 3-16-16.
