The Agency is proposing to amend 59C-1.042 to remove, update and condense language regarding neonatal intensive care services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Certificate of Need

RULE NO.:RULE TITLE:

59C-1.042Neonatal Intensive Care Services

PURPOSE AND EFFECT: The Agency is proposing to amend 59C-1.042 to remove, update and condense language regarding neonatal intensive care services.

SUMMARY: The proposed amendments to this rule include: updates to definitions, removal of references to Regional Perinatal Intensive Care Center Program (RPICC), improving/condensing the language for the needs assessment methodology, removal of obsolete language and items from the utilization reporting requirement, and removal of outdated language regarding providers of this service prior to the CON requirement.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 408.034 (3), (8); and 408.15 (8), FS.

LAW IMPLEMENTED: 408.032 (17), 408.034 (3), 408.035, 408.036 (1)(f) and 408.039 (4) (a), FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: January 4, 2017, 8:30-10:00 a.m.

PLACE: Agency for Health Care Administration, Building Three, Conference Room B, 2727 Mahan Drive, Tallahassee, Florida 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Marisol Fitch, Certificate of Need and Commercial Managed Care Unit Supervisor, 2727 Mahan Drive, Tallahassee, Florida, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Marisol Fitch, Certificate of Need and Commercial Managed Care Unit Supervisor, 2727 Mahan Drive, Mail Stop 28, Building 1, Tallahassee, Florida or call [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59C-1.042 Neonatal Intensive Care Services.

(1) Agency Intent. This rule implements the provisions of Sections 408.032(17) and 408.034(3), F.S. In addition, Section 408.036(1)(f), F.S., specifically requires the Agency to regulate the establishment of tertiary health services, which include Neonatal Intensive Care Services, under the Certificate of Need program. It is the intent of the Agency to regulate the establishment of Level II and Level III Neonatal Intensive Care Services as defined in this rule. This rule defines the minimum requirements for personnel, equipment, and support services for the two levels of Neonatal Intensive Care Services as defined in this rule. In addition, this rule includes need methodologies for determining the need for additional neonatal intensive care unit beds for each level of care. A separate inventory for each level of neonatal intensive care unit beds shall be established by the Agency. It is the intent of the Agency to regulate the establishment of Neonatal Intensive Care Services which include ventilation to preterm and severely ill neonates.

(2) Definitions.

(a) “Agency.” The Agency for Health Care Administration.

(b)(a) “Approved Neonatal Intensive Care Bed.” A proposed Level II bed or Level III 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)(b) “Complex Neonatal Surgery.” Any surgical procedure performed upon a neonate by a surgically-credentialled practitioner licensed under the provisions of Chapters 458 or 459, F.S., which is associated with entry into or traversing a body cavity, such as the abdomen, thorax, or cranium, with a requirement for either general anesthesia or conscious sedation. Such procedures shall be performed only in hospitals licensed under the provisions of Chapter 395, F.S., which are also authorized to provide Level III Neonatal Services. under the provisions of Rules 59A-3.200-.231, F.A.C.

(c) “Department.” The Agency for Health Care Administration.

(e)(d) “District.” A district of the Agency as defined in Section 408.032(5), F.S.

(f)(e) “Fixed Bed Need Pool.” The Fixed Bed Need Pool defined in subsection 59C-1.002(19), F.A.C.

(g)(f) “Local Health Councils.” The councils referenced in Section 408.033, F.S.

(h)(g) “Neonatal Care Services.” The aspect of perinatal medicine pertaining to the care of neonates. Hospital units providing neonatal care are classified according to the intensity and specialization of the care which can be provided. The Agency distinguishes three levels of neonatal care services:

1. “Level I Neonatal Services.” Well-baby care services which include sub-ventilation care, intravenous feedings, and gavage to neonates are defined as Level I Neonatal Services. Level I Neonatal Services do not include ventilator assistance except for resuscitation and stabilization. Upon beginning ventilation, the hospital shall implement a patient treatment plan which shall include the transfer of the neonate to a Level II or Level III Neonatal Intensive Care Service at such time that it becomes apparent that ventilation assistance will be required beyond the neonate’s resuscitation and stabilization. The hospital shall establish a triage procedure to assess the need for transfer of obstetrical patients to facilities with Level II or Level III Neonatal Intensive Care Services prior to their delivery where there is an obstetrical indication that resuscitation will be required for their neonates. Facilities with Level I neonatal services may only perform Level I neonatal services.

2. “Level II Neonatal Intensive Care Services.” Services which include the provision of ventilator services, and at least 6 hours of nursing care per day, shall be defined as Level II Neonatal Intensive Care Services. Level II services shall be restricted to neonates of 1000 grams birth weight and over with the following exception. Ventilation may be provided in a facility with Level II Neonatal Intensive Care Services for neonates of less than 1,000 grams birth weight only while waiting to transport the baby to a facility with Level III Neonatal Intensive Care Services. All neonates of 1,000 grams birth weight or less shall be transferred to a facility with Level III Neonatal Intensive Care Services. Neonates weighing more than 1,000 grams requiring one or more of the Level III services, as defined by this rule, shall also be transferred to a facility with Level III Neonatal Intensive Care Services. If a facility with a Level III Neonatal Intensive Care Service refuses to accept the transfer patient, the facility with the Level II Neonatal Intensive Care Service will be found in compliance with this subparagraph upon a showing of continuous good faith effort to transfer the patient as documented in the patient’s medical record. Facilities with Level II Neonatal Intensive Care Services may perform only Level I Neonatal Services and Level II Neonatal Intensive Care Services as defined by this rule.

3. “Level III Neonatal Intensive Care Services.” Services which include the provision of continuous cardiopulmonary support services, 12 or more hours of nursing care per day, complex neonatal surgery, neonatal cardiovascular surgery, pediatric neurology and neurosurgery, and pediatric cardiac catheterization, shall be classified as Level III Neonatal Intensive Care Services. These services cannot be performed in a facility with Level II Neonatal Intensive Care Services only. Facilities with Level III Neonatal Intensive Care Services may perform all neonatal care services. A facility with a Level III Neonatal Intensive Care Service that does not provide treatment of complex major congenital anomalies that require the services of a pediatric surgeon, or pediatric cardiac catheterization and cardiovascular surgery shall enter into a written agreement with a facility providing Level III Neonatal Intensive Care Services in the same or nearest service area for the provision of these services. All other services shall be provided at each facility with Level III Neonatal Intensive Care Services. The provision of pediatric cardiac catheterization or pediatric open heart surgery each requires a separate Certificate of Need.

(i)(h) “Neonatal Intensive Care Unit Bed.” A patient care station within a Level II neonatal intensive care unit or Level III Neonatal Intensive Care Unit that includes, at a minimum, an incubator or other moveable or stationary devices which support the ill neonate. Beds in Level II or Level III Neonatal Intensive Care Units shall be separately listed in a hospital’s licensed bed inventory.

1. “Level II Bed.” A patient care station within a neonatal intensive care unit with the capability of providing Neonatal Intensive Care Services to ill neonates of 1,000 grams birth weight or over, and which is staffed to provide at least 6 hours of nursing care per neonate per day, and which has the capability of providing ventilator assistance, and the services as defined in subparagraph (2)(he)2. of this rule.

2. “Level III Bed.” A patient care station within a neonatal intensive care unit with the capability of providing Neonatal Intensive Care Services to severely ill neonates regardless of birth weight, and which is staffed to provide 12 or more hours of nursing care per neonate per day, and the services as defined in subparagraph (2)(he)3. of this rule.

(j)(i) “Neonatologist.” A physician who is certified, or is eligible for certification, by an appropriate board in the area of neonatal-perinatal medicine.

(k)(j) “Planning Horizon.” The planning horizon for applications submitted between January 1 and June 30 of each year shall be July 2 years into the future subsequent to the application submission deadline; the planning horizon for applications submitted between July 1 and December 31 of each year shall be January 2 years into the future subsequent to the application deadline.

(k) “Regional Perinatal Intensive Care Center Program (RPICC).” The program authorized by Section 383.17, F.S.

(l) “Specialty Beds.” Specialty beds include comprehensive medical rehabilitation beds, psychiatric beds, substance abuse beds, as specified in subsection 59C-1.002(1), F.A.C, and Neonatal Intensive Care Services beds as specified by this rule.

(m) “Specialty Children’s Hospitals.” The hospitals referenced in subparagraph 59A-3.252(1)(b)12., F.A.C., without maternity units in the same facility.

(n) “Step-Down Neonatal Special Care Unit.” The step-down neonatal special care units affiliated with the Regional Perinatal Intensive Care Center Program.

(3) Need Determination.

(a)through (f) No change. 

(g) Special Circumstances for the Approval of Additional Neonatal Intensive Care Unit Beds at Existing Providers. Need for additional Level II Neonatal Intensive Care Unit Beds at hospitals with Level II Neonatal Intensive Care Services seeking additional Level II beds is demonstrated in the absence of need shown under the formula specified in paragraph (3)(c) of this rule if the occupancy rate for their Level II beds exceeded an average of 90% percent as computed by the Agency for the same time period specified in subparagraph (3)(c)2. Need for additional Level III Neonatal Intensive Care Beds at hospitals with Level III Neonatal Intensive Care Services seeking additional Level III beds is demonstrated in the absence of need shown under the formula specified in paragraph (3)(e) of this rule if occupancy rate for their Level III beds exceeded an average of 90% percent as computed by the Agency for the same time period specified in subparagraph (3)(e)2.

(h) Consistency With Local Health Council and State Health Plans. Applicants shall provide evidence in their applications that the number of proposed Level II or Level III Neonatal Intensive Care Unit Beds is consistent with the needs of the community as stated in Local Health Council Plans and the State Health Plan.

(i) Regional Perinatal Intensive Care Centers and Step-Down Neonatal Special Care Units. Hospitals which are under contract with the Department of Health, Children’s Medical Services Program for the provision of regional perinatal intensive care center or step-down neonatal special care unit care will be given priority over other applicants to expand or establish new Neonatal Intensive Care Services when a need is indicated for additional Level II or Level III Neonatal Intensive Care Unit Beds.

(j) Conversion of Under-utilized Acute Care Beds. New Level II or Level III Neonatal Intensive Care Unit Beds shall normally be approved only if the applicant converts a number of acute care beds as defined in Rule 59C-1.038, F.A.C., excluding specialty beds, which is equal to the number of Level II or Level III beds proposed, unless the applicant can reasonably project an occupancy rate of 75% percent for the applicable planning horizon, based on historical utilization patterns, for all acute care beds, excluding specialty beds. If the conversion of the number of acute care beds which equals the number of proposed Level II or Level III beds would result in an acute care occupancy exceeding 75% percent for the applicable planning horizon, the applicant shall only be required to convert the number of beds necessary to achieve a projected 75% percent acute care occupancy for the applicable planning horizon, excluding specialty beds.

(g)(k) Services to Medically Indigent and Medicaid Patients. In a comparative review, preference shall be given to hospitals which propose to provide Neonatal Intensive Care Services to Children’s Medical Services patients, Medicaid patients, and non-children’s medical services patients who are defined as charity care patients according to the Health Care Board, Florida Hospital Uniform Reporting System Manual, Chapter III, Section 3223. The applicant shall estimate, based on its historical patient data by type of payer, the percentage of Neonatal Intensive Care Services patient days that will be allocated to:

1. Charity Care Patients;

2. Medicaid patients; and

3. Private pay patients, including self pay.; and,

4. Regional Perinatal Intensive Care Center Program and Step Down Neonatal Special Care Unit patients.

(4) Level II and Level III Service Continuity. To help assure the continuity of services provided to Neonatal Intensive Care Services patients:

(a) The establishment of Level III Neonatal Intensive Care Services shall not normally be approved unless the hospital also provides Level II Neonatal Intensive Care Services. Hospitals may be approved for Level II Neonatal Intensive Care Services without providing Level III services. In a comparative review, preference for the approval of Level II beds shall be given to hospitals which have both Level II neonatal intensive care unit beds and Level III Neonatal Intensive Care Unit Beds.

(b) Applicants proposing to provide Level II or Level III Neonatal Intensive Care Services shall ensure developmental follow-up on patients after discharge to monitor the outcome of care and assure necessary referrals to community resources.

(5) Minimum Unit Size. Hospitals proposing the establishment of new Level III Neonatal Intensive Care Services shall propose a Level III Neonatal Intensive Care Unit of at least 15 beds, and should have 1015 or more Level II neonatal intensive care unit beds. A provider shall not normally be approved for Level III Neonatal Intensive Care Services only. Hospitals proposing the establishment of new Level II Neonatal Intensive Care Services only shall propose a Level II Neonatal Intensive Care Unit with a minimum of 10 beds. Hospitals under contract with the Department of Health, Children’s Medical Services Program for the provision of regional perinatal intensive care center or step-down neonatal special care unit care are exempt from these requirements.

(6)  through (12) No change.

(13) Data Reporting Requirements. All hospitals with Level II or Level III Neonatal Intensive Care Services shall provide the Agency or its designee with patient utilization and fiscal reports which contain data relating to patient utilization of Level II and Level III Neonatal Intensive Care Services. The following data shall be provided to the Agency or its designee.

(a) Utilization Data. Level II or Level III Neonatal Intensive Care Services providers shall report the number of admissions and patient days by type of payer for Level II and Level III Neonatal Intensive Care Services. Payer types shall include Medicaid, Regional Perinatal Intensive Care Center Program, Insurance, Self-Pay, and Charity Care as defined by the Health Care Board, Florida Hospital Uniform Reporting Manual, Chapter III, Section 3223. These Ddata shall be reported to the Agency or its designee within 45 days after the end of each calendar quarter.

(b) Patient Origin Data. Level II or Level III Neonatal Intensive Care Services providers shall report patient origin data for Level II and Level III Neonatal Intensive Care Services patients. The mother’s county of residence shall be reported for patients born in the hospital and also for patients who were transferred to the hospital from other hospitals. These data shall be reported to the Agency or its designee within 45 days after the end of each calendar quarter.

(14) Providers Authorized by the Agency to Operate Level II and Level III Neonatal Intensive Care Services. Providers shall be authorized by the Agency to implement, or to continue to operate Level II or Level III Neonatal Intensive Care Services if they are found to be in compliance with the conditions specified in paragraphs (14)(a), (14)(b) or (14)(f) below.

(a) Providers Holding a Valid Certificate of Need or Providers with Approved Construction Documents. Providers which have obtained a Certificate of Need for provision of services regulated under this rule or providers with construction documents approved by the Department of Health and Rehabilitative Services prior to October 1, 1987, which show neonatal intensive care beds shall be restricted to the total number of Neonatal Intensive Care Unit Beds by level of care for which Certificate of Need or construction document approval was granted unless the provisions of paragraph (14)(d) authorize a greater number. The authorization in this paragraph based on construction document approval shall not apply to a provider who initiated and subsequently terminated Neonatal Intensive Care Services prior to October 1, 1987.

(b) Providers With Licensed Acute Care Beds Which Include Level II or Level III Neonatal Intensive Care Unit Beds. Facilities providing Level II or Level III Neonatal Intensive Care Services prior to October 1, 1987 and continuously since then under the direction of a neonatologist or a group of neonatologists, as described in subparagraphs (14)(f)1. and (14)(f)2. below, shall be limited to the total number of neonatal intensive care unit beds accepted by the Agency in its approval of the most recent application for a license, unless the provisions of paragraph (14)(d) authorize a greater number.

(c) Number of Neonatal Intensive Care Unit Beds on October 1, 1988. In establishing the number of Level II or Level III Neonatal Intensive Care Unit Beds to be authorized for a facility, the Agency will determine the number of beds by level of care on October 1, 1988 based on the following calculation:

PD = Number of Beds by Level of Care

365 × .80

where:

1. PD equals the number of Level II or Level III Neonatal Intensive Care Services patient days at the facility for the period October 1, 1987 through September 30, 1988.

2. .80 equals the desired occupancy standard.

(d) Authorized Number of Neonatal Intensive Care Unit Beds. The number of neonatal intensive care unit beds authorized by level of care for the facilities meeting the requirement of paragraphs (14)(a) or (14)(b) will be the largest of the three numbers identified in paragraphs (14)(a), (14)(b) or (14)(c), except that:

1. In all cases the number of beds authorized for Level II or Level III Neonatal Intensive Care Services will be at least five; and,

2. In no case will a facility’s combined number of authorized Level II and Level III neonatal intensive care unit beds be greater than the largest of the combined totals of Level II and Level III Neonatal Intensive Care Unit Beds identified in paragraphs (14)(a), (14)(b) and (14)(c). The allocation of the combined total to the separate levels of Neonatal Intensive Care at a facility will be the same as the allocation in paragraphs (14)(a), (14)(b) or (14)(c), whichever is the basis for the total authorized. Provided, however, that an authorized combined total based on an application for licensure which identified all Neonatal Intensive Care Unit Beds as one level of care will be allocated in the same proportions as the number of beds calculated by the formula in paragraph (14)(c).

(e) Existing Providers Which were in Operation prior to October 1, 1987. Providers claiming to have operated Level II or Level III Neonatal Intensive Care Services, as defined under this rule, continuously since October 1, 1987, shall submit the following documentation to the Agency, which shall be subject to verification by the Agency:

1. The number of Level II and Level III Neonatal Intensive Care Unit Beds as of September 30, 1987.

2. The number of Level II and Level III Neonatal Intensive Care Services admissions and total patient days for the period October 1, 1986 through September 30, 1987.

3. Staffing and equipment for each level of care for the period October 1, 1986 through September 30, 1987.

4. Proof that the hospital prior to October 1, 1987 and continuously since October 1, 1987 has provided Level II or Level III Neonatal Intensive Care Services, as defined by this rule, and that the services have been directed by a board certified or board eligible neonatologist or group of neonatologists, consistent with the provisions of paragraph (8)(a).

5. Medicaid and Charity Care Patient Days for the period October 1, 1986 through September 30, 1987.

6. Number of Level II and Level III Neonatal Intensive Care Services admissions by DRG and ICD codes.

7. Number of admissions to Level II and Level III Neonatal Intensive Care Services of less than 1,000 grams birth-weight and equal to or greater than 1,000 grams birth-weight for the period October 1, 1986 through September 30, 1987.

8. Number of Level II and Level III Neonatal Intensive Care Services patients transferred to Level II or Level III beds at other facilities providing Neonatal Intensive Care Services, for the period October 1, 1986 through September 30, 1987.

9. Number of Level II and Level III Neonatal Intensive Care Services patient days by level of care for the period October 1, 1987 through September 30, 1988.

(f) Providers Not Authorized Under Certificate of Need, Construction Document Approval, or Licensure Provisions. Providers claiming to have provided Level II or Level III Neonatal Intensive Care Services prior to October 1, 1987, and continuously since then, but which were not authorized by Certificate of Need or construction document approval consistent with paragraph (14)(a) or by license consistent with paragraph (14)(b), will be authorized to provide Level II or Level III Neonatal Intensive Care Services provided the conditions of subparagraphs (14)(f)1. or (14)(f)2., below, are met.

1. A provider will be deemed to have had operational Level II Neonatal Intensive Care Services prior to October 1, 1987, if Level II Neonatal Intensive Care Services were being provided on or before September 30, 1987, under the direction of a neonatologist or a group of neonatologists who were on the active staff of the hospital with unlimited privileges and provided 24-hour coverage, and who were either board certified or board eligible in neonatal-perinatal medicine.

2. A provider will be deemed to have had operational Level III Neonatal Intensive Care Services prior to October 1, 1987 if:

a. Level III Neonatal Intensive Care Services were being provided on or before September 30, 1987, under the direction of a neonatologist or a group of neonatologists who were on the active staff of the hospital with unlimited privileges and provided 24-hour coverage, and who were either board certified or board eligible in neonatal-perinatal medicine; and,

b. The provider submits documentation that for the period October 1, 1986 through September 30, 1987, at least one of the following was true:

(I) The average length of stay for all Neonatal Intensive Care Services patients, regardless of reported Level II or III status, was at least 10 days; or

(II) At least 5 percent of all neonates admitted to Neonatal Intensive Care Services, regardless of reported Level II or Level III status, weighed less than 1000 grams at birth; or

(III) At least 50 percent of all neonates admitted to Neonatal Intensive Care Services, regardless of reported Level II or Level III status, were classified into Diagnosis Related Groups (DRGs) 385, 386, 387 or 388.

(g) Neonatal Intensive Care Unit Beds Authorized for Providers Not Having Previous Approval. For providers deemed to have been providing Level II or Level III Neonatal Intensive Care Services consistent with the provisions of paragraph (14)(f) above, the number of authorized Level II or Level III neonatal intensive care unit beds on October 1, 1988 will be determined consistent with the formula in paragraph (14)(c) above, except that in all cases the number of beds authorized for Level II Neonatal Intensive Care Services or Level III Neonatal Intensive Care Services will be at least five.

(h) Licensing of Authorized Neonatal Intensive Care Unit Beds. The number of neonatal intensive care unit beds authorized by this subsection shall be included in the facility’s acute care bed complement and shall not increase the total number of licensed hospital beds.

(i) Time Limit for Compliance With the Provisions of this rule. Facilities authorized to provide Level II or Level III Neonatal Intensive Care Services under the provisions of this subsection shall have 1 year subsequent to the effective date of this rule to come in compliance with the provisions specified in subsections (8), (9), (10), (11) and (12).

(15) Inventorying Process of Level II and Level III Neonatal Intensive Care Services. The Agency shall notify all hospitals providing obstetrical services and specialty children’s hospitals by mail and through publication in the Florida Administrative Register of its intent to file this rule. Providers claiming to operate Neonatal Intensive Care Services as defined by this rule shall provide the Agency with documentation as specified in paragraph (14)(e), within 45 days of the publication of this rule in the Florida Administrative Register. The Agency shall publish a preliminary inventory in the Florida Administrative Register of all facilities with authorized Neonatal Intensive Care Services based on the provisions of paragraphs (14)(a) through (14)(g). Providers shall have 21 days after the initial publication of the inventory to contest the inventory. Subsequent to the resolution of any issues pertaining to the authorization to provide Neonatal Intensive Care Services the Agency shall publish a final inventory. Hospitals without authorization shall not provide Level II or Level III Neonatal Intensive Care Services.

(16) Providers Required to Apply for a Certificate of Need. Providers who did not have authorized Level II or Level III Neonatal Intensive Care Services as of September 30, 1987, and continuously-operated Level II or Level III Neonatal Intensive Care Services since October 1, 1987, as determined by the Agency under this rule shall be subject to Certificate of Need review.

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.032(17), 408.034(3), 408.035, 408.036(1)(f), 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)(v), 10-5.042, Amended 1-4-93, 8-24-93, 2-22-95, 4-10-96,           .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Marisol Fitch

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Justin M. Senior

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 11/22/2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 6/14/2016