[Footnote 1] (1) APPLICABILITY. Unless exempt pursuant to subsection (3), all health-care-related projects, as described in paragraphs (a)-(n), are subject to review and must file an application for a certificate of need with the department. The department is exclusively responsible for determining whether a health-care-related project is subject to review under [Footnote 2] ss. 381.701-381.715.

(a) The addition of beds by new construction or alteration.

(b) The new construction or establishment of additional health care facilities.

(c) A capital expenditure of $1 million or more by or on behalf of a health care facility or hospice for a purpose directly related to the furnishing of health services at such facility; provided that a certificate of need shall not be required for an expenditure to provide an outpatient health service, or to acquire equipment or refinance debt, for which a certificate of need is not otherwise required pursuant to this subsection. The department shall, by rule, adjust the capital expenditure threshold annually using an appropriate inflation index.

(d) The conversion from one type of health care facility to another, including the conversion from one level of care to another, in a skilled or intermediate nursing facility, if such conversion effects a change in the level of care of 10 beds or 10 percent of total bed capacity of such skilled or intermediate nursing facility within a 2-year period. If such nursing facility is certified for both skilled and intermediate nursing care, the provisions of this paragraph do not apply.

(e) Any change in licensed bed capacity.

(f) The establishment of a home health agency or hospice, or the direct provision of such services by a health care facility or health maintenance organization for those other than the subscribers of the health maintenance organization.

(g) An acquisition by or on behalf of a health care facility or health maintenance organization, by any means, which acquisition would have required review if the acquisition had been by purchase, including an acquisition at less than fair market value if the fair market value is greater than the capital expenditure threshold.

(h) The establishment of inpatient institutional health services by a health care facility, or a substantial change in such services, or the obligation of capital expenditures for the offering of, or a substantial change in, any such services which entails a capital expenditure in any amount, or an annual operating cost of $500,000 or more. The department shall, by rule, adjust the annual operating cost threshold annually using an appropriate inflation index.

(i) The acquisition by any means of an existing health care facility by any person, unless such person provides the department with at least 30 days' written notice of the proposed acquisition, which notice is to include the services to be offered and the bed capacity of the facility, and unless the department does not determine, within 30 days of receipt of such letter of intent, that the services to be provided and the bed capacity of the facility will be changed.

[Footnote 3] (j) The acquisition, by any means, of major medical equipment by a health maintenance organization or health care facility to the extent that the health maintenance organization or health care facility is not exempt under former s. 381.713(1).

(k) An increase in the cost of a project for which a certificate of need has been issued when such increase in cost exceeds the limits set forth in paragraph (c), paragraph (h), or [Footnote 4] s. 381.702, or 10 percent of the originally approved cost of the project, whichever is less, except that no cost overrun review is necessary when the cost overrun is less than $10,000.

(l) A change in the number of psychiatric or rehabilitation beds.

(m) The establishment of tertiary health services.

(n) A transfer of a certificate of need, in which case an expedited review shall be conducted according to rule and in accordance with [Footnote 5] s. 381.712.

(2) PROJECTS SUBJECT TO EXPEDITED REVIEW. Unless exempt pursuant to subsection (3), projects subject to an expedited review shall include, but not be limited to:

(a) Cost overruns, unless such cost overruns are caused by a change in service or scope which the department determines are otherwise reviewable.

(b) Research, education, and training programs.

(c) Donations, when market value equals or exceeds the applicable capital expenditure thresholds for operating expenditures, or major medical equipment, as defined in this act.

(d) Acquisition of land which is to be used for the construction of a health care facility, or office facilities for health care providers.

(e) Termination of a health care service.

(f) Shared services contracts or projects.

(g) A transfer of a certificate of need.

(h) Emergency projects and unforeseen major public health hazards.

(i) A 50-percent increase in nursing home beds for a facility incorporated and operating in this state for at least 60 years on or before July 1, 1988, which has a licensed nursing home facility located on a campus providing a variety of residential settings and supportive services. The increased nursing home beds shall be for the exclusive use of the campus residents. Any application on behalf of an applicant meeting this requirement shall be subject to the base fee of $5,000 provided in s. 408.038.

(j) Combination within one nursing home facility of the beds or services authorized by two or more certificates of need issued in the same planning subdistrict.

(k) Division into two or more nursing home facilities of beds or services authorized by one certificate of need issued in the same planning subdistrict. Such division shall not be approved if it would adversely affect the original certificate's approved cost. The department shall develop rules to implement the provisions for expedited review, including time schedule, application content, and application processing.

[Footnote 1] (3) EXEMPTIONS. Upon request, supported by such documentation as the department may require, the department shall grant an exemption from the provisions of subsection (1):

(a) For any expenditure by or on behalf of a health care facility for any part of the physical plant which is not to be directly utilized for providing health services or housing health care providers. This exemption shall apply to expenditures for parking facilities, meeting rooms, cafeterias, administrative data processing facilities, research buildings, landscaping, and similar projects, but shall not apply to expenditures for office facilities for health care providers.

(b) For any expenditure to eliminate or prevent safety hazards as defined by federal, state, or local codes.

(c) For any expenditure to replace any part of a facility or equipment which is destroyed as a result of fire, civil disturbance, or storm or any other act of God.

(d) For any expenditure to acquire major medical equipment which is a substantially identical replacement for existing equipment being taken out of service.

(e) For the initiation or expansion of obstetric services after July 1, 1988.

(f) For any expenditure to replace or renovate any part of a licensed nursing facility, provided that the number of licensed beds will not increase and, in the case of a replacement facility, the project site is the same as the facility being replaced.

(g) For providing respite care services. "Respite care" means short-term care in a licensed health care facility which is personal or custodial in nature and is provided by reason of chronic illness, physical infirmity, or advanced age for the purpose of temporarily relieving family members of the burden of providing care and attendance in the home. In providing respite care, the health care facility shall become the primary caregiver. An individual may be admitted to a respite care program in a hospital without regard to inpatient requirements relating to admitting order and attendance of a member of a medical staff.

(h) For hospice or home health services provided by a rural hospital, as defined in s. 395.602, or for swing beds in such rural hospital in a number that does not exceed one-half of its licensed beds.

(i) For the conversion of licensed acute care hospital beds to Medicare and Medicaid certified skilled nursing beds in a rural hospital as defined in s. 395.602, so long as the conversion of the beds does not involve the construction of new facilities. The total number of skilled nursing beds, including swing beds, may not exceed one-half of the total number of licensed beds in the rural hospital as of July 1, 1993. Certified skilled nursing beds designated under this paragraph, excluding swing beds, shall be included in the community nursing home bed inventory. A rural hospital which subsequently decertifies any acute care beds exempted under this paragraph shall notify the agency of the decertification, and the agency shall adjust the community nursing home bed inventory accordingly.

(j) For the addition of nursing home beds at a skilled nursing facility that is part of a retirement community that provides a variety of residential settings and supportive services and that has been incorporated and operated in this state for at least 65 years on or before July 1, 1994. All nursing home beds must not be available to the public, but must be for the exclusive use of the community residents.

(k) For an increase in the bed capacity of a nursing facility licensed for at least 50 beds as of January 1, 1994, under part II of chapter 400 which is not part of a continuing care facility if, after the increase, the total licensed bed capacity of that facility is not more than 60 beds and if the facility has been continuously licensed since 1950 and has received a superior rating on each of its two most recent licensure surveys. A request for exemption pursuant to this subsection may be made at any time and is not subject to the batching requirements of this section. History: s. 23, ch. 87-92; s. 21, ch. 88-294; s. 2, ch. 89-527; ss. 3, 16, ch. 91-282; s. 15, ch. 92-33; s. 67, ch. 92-289; s. 30, ch. 93-129; s. 19, ch. 93-214; s. 38, ch. 93-217; ss. 3, 4, ch. 94-206; s. 58, ch. 95-144; s. 143, ch. 95-418. [Footnote 1] Note. Section 19, ch. 93-214, as amended by s. 4, ch. 94-206, amended subsections (1) and (3), and that version is to take effect July 1, 1997, pursuant to s. 143, ch. 95-418, to read: (1) APPLICABILITY. Unless exempt under subsection (3), all health-care-related projects, as described in paragraphs (a)-(n), are subject to review and must file an application for a certificate of need with the department. The department is exclusively responsible for determining whether a health-care-related project is subject to review under ss. 408.031-408.045. (a) The addition of beds by new construction or alteration. (b) The new construction or establishment of additional health care facilities. (c) A capital expenditure of $1 million or more by or on behalf of a health care facility or hospice for a purpose directly related to the furnishing of health services at such facility; provided that a certificate of need is not required for an expenditure to provide an outpatient health service, or to acquire equipment or refinance debt, for which a certificate of need is not otherwise required under this subsection. The department shall, by rule, adjust the capital expenditure threshold annually using an appropriate inflation index. (d) The conversion from one type of health care facility to another, including the conversion from one level of care to another, in a skilled or intermediate nursing facility, if the conversion effects a change in the level of care of 10 beds or 10 percent of total bed capacity of the skilled or intermediate nursing facility within a 2-year period. If the nursing facility is certified for both skilled and intermediate nursing care, the provisions of this paragraph do not apply. (e) Any change in licensed bed capacity. (f) The establishment of a hospice, or the direct provision of such services by a health care facility or health maintenance organization for those other than the subscribers of the health maintenance organization. (g) An acquisition by or on behalf of a health care facility or health maintenance organization, by any means, which acquisition would have required review if the acquisition had been by purchase, including an acquisition at less than fair market value if the fair market value is greater than the capital expenditure threshold. (h) The establishment of inpatient institutional health services by a health care facility, or a substantial change in such services, or the obligation of capital expenditures for the offering of, or a substantial change in, any such services which entails a capital expenditure in any amount, or an annual operating cost of $500,000 or more. The department shall, by rule, adjust the annual operating cost threshold annually using an appropriate inflation index. (i) The acquisition by any means of an existing health care facility by any person, unless the person provides the department with at least 30 days' written notice of the proposed acquisition, which notice is to include the services to be offered and the bed capacity of the facility, and unless the department does not determine, within 30 days after receipt of such notice, that the services to be provided and the bed capacity of the facility will be changed. (j) The acquisition, by any means, of major medical equipment by a health maintenance organization or health care facility to the extent that the health maintenance organization or health care facility is not exempt under former s. 381.713(1). (k) An increase in the cost of a project for which a certificate of need has been issued when the increase in cost exceeds the limits set forth in paragraph (c), paragraph (h), or s. 408.032, or 10 percent of the originally approved cost of the project, whichever is less, except that a cost overrun review is not necessary when the cost overrun is less than $10,000. (l) A change in the number of psychiatric or rehabilitation beds. (m) The establishment of tertiary health services. (n) A transfer of a certificate of need, in which case an expedited review must be conducted according to rule and in accordance with s. 408.042. (3) EXEMPTIONS. Upon request, supported by such documentation as the department requires, the department shall grant an exemption from the provisions of subsection (1): (a) For any expenditure by or on behalf of a health care facility for any part of the physical plant which is not to be directly used for providing health services or housing health care providers. This exemption applies to expenditures for parking facilities, meeting rooms, cafeterias, administrative data processing facilities, research buildings, landscaping, and similar projects, but does not apply to expenditures for office facilities for health care providers. (b) For any expenditure to eliminate or prevent safety hazards as defined by federal, state, or local codes. (c) For any expenditure to replace any part of a facility or equipment which is destroyed as a result of fire, civil disturbance, or storm or any other act of God. (d) For any expenditure to acquire major medical equipment that is a substantially identical replacement for existing equipment being taken out of service. (e) For the initiation or expansion of obstetric services after July 1, 1988. (f) For any expenditure to replace or renovate any part of a licensed nursing facility, provided that the number of licensed beds will not increase and, in the case of a replacement facility, the project site is the same as the facility being replaced. (g) For providing respite care services. As used in this paragraph, the term "respite care" means short-term care in a licensed health care facility which is personal or custodial in nature and is provided by reason of chronic illness, physical infirmity, or advanced age for the purpose of temporarily relieving family members of the burden of providing care and attendance in the home. In providing respite care, the health care facility must be the primary caregiver. An individual may be admitted to a respite care program in a hospital without regard to inpatient requirements relating to admitting order and attendance of a member of a medical staff. (h) For hospice services provided by a rural hospital, as defined in s. 395.602, or for swing beds in such rural hospital in a number that does not exceed one-half of its licensed beds. (i) For the conversion of licensed acute care hospital beds to Medicare and Medicaid certified skilled nursing beds in a rural hospital as defined in s. 395.602, so long as the conversion of the beds does not involve the construction of new facilities. The total number of skilled nursing beds, including swing beds, may not exceed one-half of the total number of licensed beds in the rural hospital as of July 1, 1993. Certified skilled nursing beds designated under this paragraph, excluding swing beds, shall be included in the community nursing home bed inventory. A rural hospital which subsequently decertifies any acute care beds exempted under this paragraph shall notify the agency of the decertification, and the agency shall adjust the community nursing home bed inventory accordingly. (j) For the addition of nursing home beds at a skilled nursing facility that is part of a retirement community that provides a variety of residential settings and supportive services and that has been incorporated and operated in this state for at least 65 years on or before July 1, 1994. All nursing home beds must not be available to the public but must be for the exclusive use of the community residents. (k) For an increase in the bed capacity of a nursing facility licensed for at least 50 beds as of January 1, 1994, under part II of chapter 400 which is not part of a continuing care facility if, after the increase, the total licensed bed capacity of that facility is not more than 60 beds and if the facility has been continuously licensed since 1950 and has received a superior rating on each of its two most recent licensure surveys. A request for exemption under this subsection may be made at any time and is not subject to the batching requirements of this section. [Footnote 2] Note. Transferred to ss. 408.031-408.045 by s. 15, ch. 92-33. [Footnote 3] Note. As amended by s. 58, ch. 95-144, effective July 1, 1995; s. 58, ch. 95-144, amended paragraph (1)(j) as that paragraph was amended by s. 19, ch. 93-214. The amendment by s. 19, ch. 93-214, will be effective July 1, 1997, pursuant to s. 58, ch. 95-144. The only change to paragraph (1)(j) by s. 19, ch. 93-214, was substitution of the word "under" for the words "pursuant to." Section 58, ch. 95-144, added the word "former" before the cite to s. 381.713(1). [Footnote 4] Note. Transferred to s. 408.032 by ss. 15 and 16, ch. 92-33. [Footnote 5] Note. Transferred to s. 408.042 by s. 15, ch. 92-33. Note. Former s. 381.706.