59C-1.040. Hospital Inpatient General Psychiatric Services

(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 × PPA) / (365 × .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 × PPCA) / (365 × .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. History–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.