Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59C - Certificate of Need
Chapter 59C-1 - PROCEDURES FOR THE ADMINISTRATION OF SECTIONS 408.031-408.045, FLORIDA STATUTES, HEALTH FACILITY AND SERVICES DEVELOPMENT ACT
Section 59C-1.039 - Comprehensive Medical Rehabilitation Inpatient Services
Universal Citation: FL Admin Code R 59C-1.039
Current through Reg. 50, No. 187; September 24, 2024
(1) Agency Intent. It is the intent of the Agency to ensure the availability of Comprehensive Medical Rehabilitation Inpatient Services for persons in need of these services, including Medicaid and charity care patients. This rule regulates the establishment of new Comprehensive Medical Rehabilitation Inpatient Services, the construction or addition of new Comprehensive Medical Rehabilitation Inpatient Beds, and the conversion of licensed hospital acute care beds to Comprehensive Medical Rehabilitation Inpatient Beds.
(2) Definitions.
(a) "Agency." The Agency for
Health Care Administration.
(b)
"Approved Comprehensive Medical Rehabilitation Inpatient Bed." A proposed
Comprehensive Medical Rehabilitation Inpatient Bed for which a Certificate of
Need, a letter of intent to grant a Certificate of Need, a signed stipulated
agreement, or a final order granting a Certificate of Need was issued,
consistent with the provisions of paragraph
59C-1.008(2)(b),
F.A.C., as of the most recent published deadline for Agency initial decisions
prior to publication of the Fixed Need Pool, as specified in paragraph
59C-1.008(1)(g),
F.A.C.
(c) "Charity Care." As
defined in Section 409.911(1),
F.S.
(d) "Comprehensive Medical
Rehabilitation Inpatient Services." An organized program of integrated
intensive care services provided by a coordinated multidisciplinary team to
patients with severe physical disabilities, such as stroke; spinal cord injury;
congenital deformity; amputation; major multiple trauma; fracture of femur (hip
fracture); brain injury; polyarthritis, including rheumatoid arthritis;
neurological disorders, including multiple sclerosis, motor neuron diseases,
polyneuropathy, muscular dystrophy, and Parkinson's disease; and
burns.
(e) "District." A district
of the Agency defined in Section
408.032(5),
F.S.
(f) "Fixed Bed Need Pool." The
numerical Comprehensive Medical Rehabilitation Inpatient Bed need for the
applicable planning horizon, as established by the Agency in accordance with
this rule and subsection
59C-1.008(2),
F.A.C.
(g) "General Hospital." Any
facility which meets the provisions of Section
395.002(12),
F.S.
(h) "Local Health Council."
The council referenced in Section
408.033, F.S.
(i) "Planning Horizon." The projected date by
which a proposed comprehensive medical rehabilitation inpatient service would
be initiated. For purposes of this rule, the planning horizon for applications
submitted between January 1 and June 30 is July of the year 5 years subsequent
to the year the application is submitted; the planning horizon for applications
submitted between July 1 and December 31 is January of the year 5 years
subsequent to the year which follows the year the application is submitted. For
example, an application submitted in March 2016 would have a planning horizon
of July 2021; an application submitted in September 2016 would have a planning
horizon of January 2022.
(j)
"Separately Organized Unit." A specific section, ward, wing, or floor with a
separate nursing station designated exclusively for the care of comprehensive
medical rehabilitation patients.
(k) "Specialty Bed." A category of hospital
inpatient beds for which the Agency has promulgated a separate rule specifying
need determination criteria, including hospital inpatient general psychiatric
beds, hospital inpatient substance abuse beds, Level II and Level III Neonatal
Intensive Care Unit Beds; and the Comprehensive Medical Rehabilitation
Inpatient Beds regulated under this rule.
(l) "Specialty Hospital." As defined in
Section 395.002(28),
F.S., a specialty hospital is any facility which meets the provisions of
Section 395.002(12)
F.S., and which regularly makes available either:
1. The range of medical services offered by
general hospitals, but restricted to a defined age or gender group of the
population, or
2. A restricted
range of services appropriate to the diagnosis, care and treatment of patients
with specific categories of medical or psychiatric illnesses or disorders,
or
3. Intensive residential
treatment programs for children and adolescents as defined in Section
395.002(15),
F.S.
(3) General Provisions.
(a) Service Location. The
Comprehensive Medical Rehabilitation Inpatient Services regulated under this
rule may be provided in a hospital licensed as a general hospital or licensed
as a specialty hospital.
(b)
Separately Organized Units. Comprehensive Medical Rehabilitation Inpatient
Services shall be provided in one or more separately organized units within a
general hospital or specialty hospital.
(c) Minimum Number of Beds. A general
hospital providing Comprehensive Medical Rehabilitation Inpatient Services
should normally have a minimum of 20 Comprehensive Medical Rehabilitation
Inpatient Beds. A specialty hospital providing Comprehensive Medical
Rehabilitation Inpatient Services shall have a minimum of 60 Comprehensive
Medical Rehabilitation Inpatient Beds. Hospitals with licensed or approved
Comprehensive Medical Rehabilitation Inpatient Beds as of the effective date of
this rule are exempt from meeting the requirements for a minimum number of
beds.
(d) Conformance with the
Criteria for Approval. A Certificate of Need for the establishment of new
Comprehensive Medical Rehabilitation Inpatient Services, the construction or
addition of new Comprehensive Medical Rehabilitation Inpatient Beds, or the
conversion of licensed hospital acute care beds to Comprehensive Medical
Rehabilitation Inpatient Beds shall not normally be approved unless the
applicant meets the applicable review criteria in Section
408.035, F.S., and the standards
and need determination criteria set forth in this rule.
(e) Medicare and Medicaid Participation. An
applicant proposing to increase the number of licensed Comprehensive Medical
Rehabilitation Inpatient Beds at its facility shall participate in the Medicare
and Medicaid programs. Applicants proposing to establish a new comprehensive
medical rehabilitation inpatient service shall state in their application that
they will participate in the Medicare and Medicaid programs.
(f) Comparative Review. A Certificate of Need
application submitted for review under this rule will be subject to a
comparative review with all other Certificate of Need applications subject to
review under this rule that propose to serve the same district and which were
submitted during the same review cycle.
(g) Excluded Hospitals. Hospitals operated by
the State of Florida are not regulated under this rule pursuant to Sections
408.036(3)(d), (r) and
(s), F.S.
(4) Required Staffing and Services.
(a) Director of Rehabilitation. Comprehensive
Medical Rehabilitation Inpatient Services must be provided under a medical
director of rehabilitation who is a Board certified or Board eligible
physiatrist and has had at least 2 years of experience in the medical
management of inpatients requiring rehabilitation services.
(b) Other Required Services. In addition to
the physician services in paragraph (4)(a), Comprehensive Medical
Rehabilitation Inpatient Services shall include at least the following services
provided by qualified personnel:
1.
Rehabilitation nursing,
2. Physical
therapy,
3. Occupational
therapy,
4. Speech pathology and
audiology,
5. Social services,
6. Psychological services,
or
7. Orthotic and prosthetic
services.
(5) Criteria for Determination of Need.
(a) Bed
Need. A favorable need determination for proposed new or expanded Comprehensive
Medical Rehabilitation Inpatient Services shall not normally be made unless a
bed need exists according to the numeric need methodology in paragraph (5)(c)
of this rule.
(b) Fixed Bed Need
Pool. The future need for Comprehensive Medical Rehabilitation Inpatient
Services shall be determined twice a year and published by the Agency as a
Fixed Bed Need Pool for the applicable planning horizon.
(c) Need Formula for Comprehensive Medical
Rehabilitation Inpatient Beds. The net bed need for Comprehensive Medical
Rehabilitation Inpatient Beds in each District shall be calculated in
accordance with the following formula:
NN = ((PD/P) x PP / (365 x .85))
- LB - AB
where:
1. NN equals
the net need for Comprehensive Medical Rehabilitation Inpatient Beds in a
District.
2. PD equals the number
of inpatient days in Comprehensive Medical Rehabilitation Inpatient Beds in a
district for the 12-month period ending 6 months prior to the beginning date of
the quarter of the publication of the Fixed Bed Need Pool.
3. P equals the estimated population in the
district. For applications submitted between January 1 and June 30, P is the
population estimate for January of the preceding year; for applications
submitted between July 1 and December 31, P is the population estimate for July
of the preceding year. The population estimate shall be the most recent
estimate published by the Office of the Governor and available to the
Department at least 4 weeks prior to publication of the Fixed Bed Need
Pool.
4. PP equals the estimated
population in the district for the applicable planning horizon. The population
estimate shall be the most recent estimate published by the Office of the
Governor and available to the Department at least 4 weeks prior to publication
of the Fixed Bed Need Pool.
5. .85
equals the desired average annual occupancy rate for Comprehensive Medical
Rehabilitation Inpatient Beds in the district.
6. LB equals the district's number of
licensed Comprehensive Medical Rehabilitation Inpatient Beds as of the most
recent published deadline for Agency initial decisions prior to publication of
the Fixed Bed Need Pool.
7. AB
equals the district's number of approved Comprehensive Medical Rehabilitation
Inpatient Beds, as determined consistent with the provisions of paragraph
(2)(a) of this rule.
(d)
Most Recent Average Annual District Occupancy Rate. Regardless of whether bed
need is shown under the need formula in paragraph (5)(c), no additional
Comprehensive Medical Rehabilitation Inpatient Beds shall normally be approved
for a district unless the average annual occupancy rate of the licensed
Comprehensive Medical Rehabilitation Inpatient Beds in the district was at
least 80% percent for the 12 month period ending 6 months prior to the
beginning date of the quarter of the publication of the Fixed Bed Need
Pool.
(e) Special Circumstances for
Approval of Expanded Capacity at Hospitals with Licensed Comprehensive Medical
Rehabilitation Inpatient Services should the applicant not meet the exemption
criteria in Section 408.036(3)(j),
F.S.
1. Subject to the provisions of paragraph
(7)(b) of this rule, and subparagraph 2. of this paragraph, need for additional
Comprehensive Medical Rehabilitation Inpatient Beds is demonstrated at a
hospital with licensed Comprehensive Medical Rehabilitation Inpatient Services
in the absence of need shown under the formula in paragraph (5)(c), and
regardless of the most recent average annual district occupancy rate determined
under paragraph (5)(d), if the applicant demonstrates need through a need
assessment methodology which must include, at a minimum, consideration of the
following topics:
a. Population demographics
and dynamics,
b. Availability,
utilization, and quality of like services in the district,
c. Medical treatment trends; and,
d. Market conditions.
2. The existence of unmet need will not be
based solely on the absence of Comprehensive Medical Rehabilitation services or
beds in the district.
(f)
Priority Considerations for Comprehensive Medical Rehabilitation Inpatient
Services Applicants. In weighing and balancing statutory and rule review
criteria, the Agency will give priority consideration to:
1. An applicant that is a disproportionate
share hospital as determined consistent with the provisions of Section
409.911, F.S.
2. An applicant proposing to serve
Medicaid-eligible persons.
3. An
applicant that is a designated trauma center, as defined in Rule
64J-2.011,
F.A.C.
(6) Access Standard. Comprehensive Medical Rehabilitation Inpatient Services should be available within a maximum ground travel time of 2 hours under average travel conditions for at least 90 percent of the district's total population.
(7) Quality of Care.
(a) Compliance with Agency Standards.
Comprehensive Medical Rehabilitation Inpatient Services shall comply with the
Agency standards for program licensure described in Chapter 59A-3, F.A.C.
Applicants who submit an application that is consistent with the Agency
licensure standards are deemed to be in compliance with this
provision.
(b) Licensure
Provisions. Applicants proposing a new Comprehensive Medical Rehabilitation
Inpatient Service shall state how they will comply with the provisions of
hospital licensure as defined in Rule
59A-3.066,
F.A.C.
(8) Services Description. An applicant for Comprehensive Medical Rehabilitation Inpatient Services shall provide a detailed program description in its Certificate of Need application including:
(a) Age groups to
be served.
(b) Specialty inpatient
rehabilitation services to be provided, if any (e.g. spinal cord injury; brain
injury).
(c) Proposed staffing,
including qualifications of the medical director, a description of staffing
appropriate for any specialty program, and a discussion of the training and
experience requirements for all staff who will provide Comprehensive Medical
Rehabilitation Inpatient Services.
(d) A plan for recruiting staff, showing
expected sources of staff.
(e)
Expected sources of patient referrals.
(f) Projected number of Comprehensive Medical
Rehabilitation Inpatient Services patient days by payer type, including
Medicare, Medicaid, private insurance, self-pay and charity care patient days
for the first 2 years of operation after completion of the proposed
project.
(g) Admission policies of
the facility with regard to charity care patients.
(9) Applications from Licensed Providers of Comprehensive Medical Rehabilitation Inpatient Services. A facility providing licensed Comprehensive Medical Rehabilitation Inpatient Services seeking Certificate of Need approval for additional Comprehensive Medical Rehabilitation Inpatient Beds shall provide the following information in its Certificate of Need application in addition to the information required by subsection (8):
(a) Number of Comprehensive
Medical Rehabilitation Inpatient Services admissions and patient days for the
12-month period ending 6 months prior to the beginning date of the quarter of
the publication of the Fixed Bed Need Pool.
(b) Number of Comprehensive Medical
Rehabilitation Inpatient Services patient days by payer type, including
Medicare, Medicaid, private insurance, self-pay and charity care patient days,
for the 12-month period ending 6 months prior to the beginning date of the
quarter of the publication of the Fixed Bed Need Pool.
(c) Gross revenues by payer source for the
12-month period ending 6 months prior to the beginning date of the quarter of
the publication of the Fixed Bed Need Pool.
(d) Current staffing.
(e) Current specialty inpatient
rehabilitation services, if any (e.g. spinal cord injury; brain
injury).
(10) Utilization Reports. Facilities providing licensed Comprehensive Medical Rehabilitation Inpatient Services shall provide utilization reports to the Agency or its designee within 45 days after the end of each calendar quarter, facilities shall provide a report of the number of Comprehensive Medical Rehabilitation Inpatient Services discharges and patient days which occurred during the quarter.
Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.034(3), 408.035, 408.036(1)(b), (c), (f), 408.039(4)(a) 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)(n), Amended 4-30-92, Formerly 10-5.039, Amended 8-24-93, 2-22-95, 7-2-17.
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