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-1.040 - New Hospital Inpatient Psychiatric Services
Universal Citation: FL Admin Code R 59C-1.040
Current through Reg. 50, No. 187; September 24, 2024
(1) Agency Intent. It is the intent of the Agency to ensure the availability of hospital inpatient psychiatric services as defined in this rule for children, adolescents and adults in need of these services regardless of their ability to pay. This rule regulates the establishment of new inpatient psychiatric hospitals and new inpatient intensive residential treatment facilities for children and adolescents, and specifies which services can be provided by licensed or approved providers of hospital inpatient psychiatric services.
(2) Definitions.
(a) "Adolescent." A person age 14 through
17.
(b) "Adult." A person age 18
and over.
(c) "Agency." The Agency
for Health Care Administration.
(d)
"Approved Hospital Inpatient Psychiatric Bed." A proposed hospital inpatient
psychiatric bed for which an exemption pursuant to paragraph
59C-1.005(6)(i),
F.A.C., or notification pursuant to paragraph
59C-1.0085(2)(b),
F.A.C., 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.
(e) "Charity Care." Is
defined the same as in Section
409.911(1),
F.S.
(f) "Child." A person under
the age of 14 years.
(g)
"District." A District of the Agency defined in Section
408.032(5),
F.S.
(h) "Fixed Bed Need Pool." The
numerical hospital inpatient psychiatric bed need for adults, or for children
and adolescents, for the applicable planning horizon, as established by the
Agency in accordance with this rule and subsection
59C-1.008(2),
F.A.C.
(i) "Gross Bed Need." The
number of hospital inpatient psychiatric beds projected for a District for the
applicable planning horizon under paragraph (4)(c) or (4)(f) of this rule,
except that the number of licensed beds and approved beds is not subtracted
from the projected total.
(j)
"Hospital Inpatient Psychiatric Bed." A bed designated for the exclusive use of
patients receiving hospital inpatient psychiatric services as defined by this
rule.
(k) "Hospital Inpatient
Psychiatric Services." Services provided under the direction of a psychiatrist
or clinical psychologist to persons whose sole diagnosis, or in the event of
more than one diagnosis, the principal diagnosis is a psychiatric disorder
defined in subsection (2) of this rule.
(l) "Intensive Residential Treatment Program
for Children and Adolescents." An inpatient program which provides intensive
residential treatment services for children and adolescents, as described in
Section 395.002(15),
F.S. The net need for intensive residential treatment program beds for children
and adolescents in facilities seeking to have the beds licensed as specialty
hospital beds is included in the net need for hospital inpatient psychiatric
beds for children and adolescents calculated under paragraph (4)(f) of this
rule.
(m) "Planning Horizon." The
projected date by which a proposed hospital inpatient psychiatric 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.
(n) "Psychiatric
Disorder." For purposes of this rule, a psychiatric disorder is a mental
illness as defined in Section
394.455(18),
F.S., which requires inpatient hospitalization.
(o) "Separately Organized Unit." A specific
section, ward, wing, or floor with a separate nursing station designated
exclusively for the care of hospital inpatient psychiatric services
patients.
(p) "Specialty Beds."
Specialty beds include hospital inpatient substance abuse beds, hospital
inpatient psychiatric beds and beds in intensive residential treatment programs
for children and adolescents licensed as specialty hospital beds.
(q) "Specialty Hospital." A specialty
hospital as defined by subsection
395.002(28),
F.S.
(r) "Substance Abuse." The
misuse or abuse of, or dependence on alcohol, illicit drugs, or prescription
medications which requires inpatient hospitalization.
(3) General Provisions.
(a) Admissions to Hospital Inpatient
Psychiatric Services. Admission to facilities with a certificate of need for
hospital inpatient psychiatric services is limited to persons whose sole
diagnosis, or in the event of more than one diagnosis, the principal diagnosis,
is a psychiatric disorder as defined in subsection (2). Psychiatric patients in
need of medical/surgical care may be treated in acute care medical/surgical
beds for their medical/surgical care needs or in a psychiatric services unit if
the unit is properly staffed and equipped to care for the medical/surgical
problem.
(b) Service Location. This
rule applies to the establishment of new psychiatric inpatient specialty
hospitals, including a facility with an intensive residential treatment program
for children and adolescents which is licensed as a specialty
hospital.
(c) Separate Regulation
of Age Categories. The Agency regulates two types of hospital inpatient
psychiatric services, those services which are used for psychiatric treatment
of adults, and those services used for psychiatric treatment of children and
adolescents. Certificate of need applications for the establishment of hospital
inpatient psychiatric services for adults shall be reviewed separately from
certificate of need applications for hospital inpatient psychiatric services
for children and adolescents. A separate certificate of need shall be issued
for each service.
(d) Separately
Organized Units. Hospital inpatient psychiatric services for adults shall be
provided in one or more separately organized units within a specialty hospital.
Hospital inpatient psychiatric services for children and adolescents shall be
provided in one or more separately organized units within a specialty
hospital.
(e) Minimum Size of
Specialty Hospitals. A specialty hospital providing hospital inpatient
psychiatric services, or an intensive residential treatment program for
children and adolescents licensed as a specialty hospital, shall have a minimum
capacity of 40 beds. The minimum capacity of a specialty hospital providing
hospital inpatient psychiatric services may include beds used for hospital
inpatient substance abuse services regulated under Rule
59C-1.041, F.A.C. The separately
organized units for hospital inpatient psychiatric services for adults or for
children and adolescents in specialty hospitals shall meet the minimum size
requirements stated in subsection (5) of this rule. Hospitals inventoried
consistent with the provisions of subsection (11) of this rule are exempt from
meeting the minimum capacity and minimum unit size requirements of this
paragraph unless or until they submit a proposal which would modify the number
of beds listed in the inventory.
(f) Conformance with the Criteria for
Approval. A certificate of need for the establishment of new inpatient
psychiatric specialty hospital services 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.
(g) Required Services. Hospital inpatient
psychiatric services whether provided directly by the hospital or under
contract shall include, at a minimum, emergency screening services,
pharmacology, individual therapy, family therapy, activities therapy, discharge
planning, and referral services.
(h) 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) Criteria for Determination of Need.
(a) Bed Need. A favorable need determination
for proposed new inpatient psychiatric hospital services shall not normally be
made unless a bed need exists according to the numeric need methodology
specified in paragraph (4)(c) or (4)(f) of this rule.
(b) Fixed Bed Need Pool. The future need for
hospital inpatient psychiatric services for adults shall be determined twice a
year and published by the Agency as a fixed bed need pool for the applicable
planning horizon. The future need for hospital inpatient psychiatric services
for children and adolescents 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
Hospital Inpatient Psychiatric Beds for Adults. The net bed need for hospital
inpatient psychiatric beds for adults in each District shall be calculated in
accordance with the following formula:
NNA = ((PDA/PA x PPA) / (365 x .75)) - LBA - ABA
where:
1. NNA equals
the net need for hospital inpatient psychiatric beds for adults in a
district.
2. PDA equals the number
of inpatient days in hospital inpatient psychiatric beds for adults 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. PA equals the estimated population age 18
and over in the District. For applications submitted between January 1 and June
30, PA is the population estimate for January of the preceding year; for
applications submitted between July 1 and December 31, PA 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 Agency at least 6 weeks prior to publication of the fixed bed need
pool.
4. PPA equals the estimated
population age 18 and over 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 Agency at least 6 weeks prior to
publication of the fixed bed need pool.
5. .75 equals the desired average annual
occupancy rate for hospital inpatient psychiatric beds for adults in the
district.
6. LBA equals the
District's number of licensed hospital inpatient psychiatric beds for adults as
of the most recent published deadline for Agency initial decisions prior to
publication of the fixed bed need pool.
7. ABA equals the District's number of
approved hospital inpatient psychiatric beds for adults, as determined
consistent with the provisions of subsection (2) of this
rule.
(d) Need formula
for hospital inpatient psychiatric beds for children and adolescents. The net
bed need for hospital inpatient psychiatric beds for children and adolescents
in each district, including beds in intensive residential treatment programs
for children and adolescents seeking to have the program beds licensed as
specialty hospital beds, shall be calculated in accordance with the following
formula:
NNCA = ((PDCA/PCA x PPCA) / (365 x .75)) - LBCA - ABCA
where:
1. NNCA
equals the net need for hospital inpatient psychiatric beds for children and
adolescents in a district, including beds in intensive residential treatment
programs for children and adolescents seeking to have the program beds licensed
as specialty hospital beds.
2. PDCA
equals the number of inpatient days in hospital inpatient psychiatric beds for
children and adolescents in a district, including days in intensive residential
treatment program beds for children and adolescents which are licensed as
specialty hospital beds, 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. PCA equals the estimated
population under age 18 in the district. For applications submitted between
January 1 and June 30 of each year, PCA is the population estimate for January
of the preceding year; for applications submitted between July 1 and December
31 of each year, PCA 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 agency at least 6 weeks prior to
publication of the fixed bed need pool.
4. PPCA equals the estimated population under
age 18 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 Agency at least 6 weeks prior to publication of
the fixed bed need pool.
5. .75
equals the desired average annual occupancy rate for hospital inpatient
psychiatric beds for children and adolescents in the district, including beds
in intensive residential treatment programs for children and adolescents which
are licensed as specialty hospital beds.
6. LBCA equals the district's number of
licensed hospital inpatient psychiatric beds for children and adolescents as of
the most recent published deadline for agency initial decisions prior to
publication of the fixed bed need pool, including beds in intensive residential
treatment programs for children and adolescents which are licensed as specialty
hospital beds.
7. ABCA equals the
district's number of approved hospital inpatient psychiatric beds for children
and adolescents, as determined consistent with the provisions of subsection (2)
of this rule, including beds in intensive residential treatment programs for
children and adolescents which are seeking to have the program beds licensed as
specialty hospital beds.
(e) Other factors to be considered in the
review of certificate of need applications for hospital inpatient psychiatric
services for children and adolescents.
The applicant for an intensive residential treatment program for children and adolescents seeking to have the program beds licensed as specialty hospital beds shall provide documentation that the district's licensed non-hospital residential treatment programs for children and adolescents with psychiatric disorders do not meet the need for the proposed service. This documentation shall include the number of residential facilities and beds in the district, the type of clients served, and the type of program provided. In addition, the applicant shall provide letters of support from other mental health professionals in the district for the proposed facility.
(f) Preferences
Among Competing Applicants for Hospital Inpatient Psychiatric Services. In
weighing and balancing statutory and rule review criteria, preference will be
given to applicants who:
1. Provide Medicaid
and charity care days as a percentage of their total patient days equal to or
greater than the average percentage of Medicaid and charity care patient days
of total patient days provided by other hospitals in the district, as
determined by the Florida Center for Health Information and Policy Analysis
hospital discharge data 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.
2. Propose to serve the most
seriously mentally ill patients (e.g. suicidal patients; patients with acute
schizophrenia; patients with severe depression) to the extent that these
patients can benefit from a hospital-based organized inpatient treatment
program.
3. Propose to serve
Medicaid-eligible persons.
4.
Propose to serve individuals without regard to their ability to pay.
5. Agree to be a designated public or private
receiving facility.
6. Provide a
continuum of psychiatric services for children and adolescents, including
services following discharge.
(5) Unit Size. A separately organized unit for hospital inpatient psychiatric services for adults shall have a minimum of 15 beds. A separately organized unit for hospital inpatient psychiatric services for children and adolescents shall have a minimum of 10 beds.
(6) Access Standard. Hospital inpatient psychiatric services should be available within a maximum ground travel time of 45 minutes under average travel conditions for at least 90% percent of the district's total population.
(7) Quality of Care.
(a) Compliance with Agency Standards.
Hospital inpatient psychiatric services for adults or for children and
adolescents shall comply with the Agency standards for program licensure
described in Chapter 59A-3, F.A.C. Intensive residential treatment programs for
children and adolescents with beds licensed as specialty hospital beds shall
comply with the Agency standards for program licensure described in Chapter
59A-3, F.A.C. Applicants who include a statement in their certificate of need
application that they will meet applicable Agency licensure standards are
deemed to be in compliance with this provision.
(b) Hospital Inpatient Psychiatric Services
for Children. As required by Section
394.4785(2),
F.S., facilities providing hospital inpatient psychiatric services to children
must have beds and common areas designated for children which cannot be used by
adults. Adolescents may be treated in the units designated for children.
Adolescents may only be treated in units designated for adult hospital
inpatient psychiatric services if the admitting physician indicates that such
placement is medically indicated, or for reasons of safety.
(c) Applicants proposing a new hospital
inpatient general psychiatric service shall state how they will comply with the
provisions of hospital licensure as defined in Rule
59A-3.066, F.A.C., applicable to
the establishment of a new inpatient psychiatric hospital.
(d) Continuity. Providers of hospital
inpatient psychiatric services shall also provide outpatient services, either
directly or through written agreements with community outpatient mental health
programs, such as local psychiatrists, local psychologists, community mental
health programs, or other local mental health outpatient programs.
(e) Screening Program. All facilities
providing hospital inpatient psychiatric services shall have a screening
program to assess the most appropriate treatment for the patient. Patients with
a dual diagnosis of a psychiatric disorder, as defined in subsection (2) and
substance abuse, as defined in subsection (2), shall be evaluated to determine
the types of treatment needed, the appropriate treatment setting, and, if
necessary, the appropriate sequence of treatment for the psychiatric and
substance abuse disorders.
(8) Services Description. An applicant for new inpatient psychiatric hospital services shall provide a detailed program description in its certificate of need application including:
(a) Age groups to be served.
(b) Specialty programs to be provided (e.g.,
programs for eating disorders, stress management programs).
(c) Proposed staffing, including the
qualifications of the clinical director and a description of staffing
appropriate for any specialty program.
(d) Patient groups that will be excluded from
treatment.
(e) Therapeutic
approaches to be used.
(f) Expected
sources of patient referrals.
(g)
Expected average length of stay for the hospital inpatient psychiatric services
discharges by age group.
(h)
Projected number of hospital inpatient psychiatric services patient days by
payer type, including Medicare, Medicaid, Baker Act, private insurance,
self-pay and charity care patient days for the first 2 years of operation after
completion of the proposed project.
(i) Admission policies of the facility with
regard to charity care patients.
(9) Quarterly Reports. Facilities providing licensed hospital inpatient psychiatric services, including facilities with intensive residential treatment program beds for children and adolescents licensed as specialty hospital beds, shall report to the Agency or its designee, within 45 days after the end of each calendar quarter, the number of hospital inpatient psychiatric services admissions and patient days by age groups (patients under age 18 years and adults).
(10) Intensive Residential Treatment Programs for Children and Adolescents. An intensive residential treatment program for children and adolescents which is licensed as a specialty hospital consistent with the requirements of Chapter 59A-3, F.A.C., or a provider who has received certificate of need approval for an intensive residential treatment program for children and adolescents which is not yet licensed, may apply to the Agency for licensure of the program as a psychiatric hospital with services restricted to children and adolescents if it complies with the requirements specified in Chapter 59A-3, F.A.C., which are applicable to licensure of a psychiatric hospital.
Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.035, 408.036(1)(b), (c), 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)(o), 10-5.040, Amended 8-24-93, 2-22-95, 6-23-16.
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