The Agency is proposing to amend Rules 59C-1.040 and 59C-1.041, F.A.C., to remove, update and condense language regarding new hospital inpatient psychiatric services and hospital inpatient substance abuse services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Certificate of Need

RULE NOS.:RULE TITLES:

59C-1.040Hospital Inpatient General Psychiatric Services

59C-1.041Hospital Inpatient Substance Abuse Services

PURPOSE AND EFFECT: The Agency is proposing to amend Rules 59C-1.040 and 59C-1.041, F.A.C., to remove, update and condense language regarding new hospital inpatient psychiatric services and hospital inpatient substance abuse services.

SUMMARY: The proposed amendments to this rule include: updates to definitions, updates to language on excluded hospitals, updating statutory language, improving/condensing the language for the needs assessment methodology, removing references to State and Local Health Council District health plans, removing language citing Rule 59C-1.038, F.A.C. (repealed), removing language requiring accreditation pursuant to Section 408.043(4), F.S., removing obsolete language and items from the utilization reporting requirement, removing language regarding amended licenses and removing language regarding the applicability of the amended rule.

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.

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: A checklist was prepared by the Agency to determine the need for a SERC. As there will be no impact on economic growth, job creation or employment, private-sector investment, or business competitiveness and no increase in regulatory costs—no adverse impact is likely.

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), 408.15(8) FS.

LAW IMPLEMENTED: 408.034(3), 408.035, 408.036(1)(b), (c), 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:

DATE AND TIME: February 26, 2015, 8:30 a.m.

PLACE: The Agency for Health Care Administration, 2828 Mahan Drive, Building Three, Conference Room C, 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, 2727 Mahan Drive, Mail Stop 28, Building 1, Tallahassee, Florida or call [phone] or email at [e-mail]. 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, 2727 Mahan Drive, Mail Stop 28, Building 1, Tallahassee, Florida or call [phone] or email at [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59C-1.040 New Hospital Inpatient General Psychiatric Services.

(1) Agency Intent. This rule implements the provisions of Sections 408.032(9), 408.034(3), 408.034(6), 408.036(1)(b), (c), 395.002(15) and 395.003(4), F.S. It is the intent of the Agency to ensure the availability of hHospital iInpatient General pPsychiatric sServices 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 Hospital iInpatient General pPsychiatric hospitals and new inpatient intensive residential treatment facilities for children and adolescents Services, the construction or addition of new hospital inpatient general psychiatric beds, the conversion of licensed hospital beds to hospital inpatient general psychiatric beds, and specifies which services can be provided by licensed or approved providers of  hHospital iInpatient General pPsychiatric sServices.

(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)(c) “Approved Hospital Inpatient General Psychiatric Bed.” A proposed hospital inpatient general psychiatric bed for which an exemption pursuant to paragraph 59C-1.005(6)(i), F.A.C., or notification pursuant to subsection 59C-1.0085(2), F.A.C. a Certificate of Need, a letter of intent to grant a cCertificate of nNeed, a signed stipulated agreement, or a final order granting a cCertificate of nNeed 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 fFixed nNeed pPool, as specified in paragraph 59C-1.008(1)(g), F.A.C.

(e)(d) “Charity Care.” Is defined the same as in Section 409.911 (1), F.S. The portion of hospital charges for which there is no compensation, for care provided to patients whose family income as applicable for the 12 months preceding the determination does not exceed 150% percent of the current Federal Poverty Guidelines, or for care provided to patients for whom the hospital charges are greater than 25% percent of an annual family income which does not exceed four times the current Federal Poverty Level for a family of four, as defined in the Health Care Board’s Florida Hospital Uniform Reporting System Manual, Chapter III, Section 3223.

(f)(e) “Child.” A person under the age of 14 years.

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

(g) “District.” A District of the Agency defined in Section 408.032(5), F.S.

(h) “Fixed Bed Need Pool.” The numerical hospital inpatient general 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) “General Hospital.” A hospital which provides services to the general population and does not restrict its services to any specified medical or psychiatric illness or to any specified age or gender group of the population, as defined in Section 395.002(10), F.S.

(i)(j) “Gross Bed Need.” The number of hospital inpatient general psychiatric beds projected for a District for the applicable planning horizon under paragraphs (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)(k) “Hospital Inpatient General Psychiatric Bed.” A bed designated for the exclusive use of patients receiving hHospital iInpatient General pPsychiatric sServices as defined by this rule.

(k)(l) “Hospital Inpatient General 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 as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) is a psychiatric disorder defined in paragraph (2)(p) of this rule.

(l)(m) “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., including 24-hour care and diagnosis and treatment of patients under the age of 18 having psychiatric disorders. A facility may seek Certificate of Need approval for an intensive residential treatment program for children and adolescents in order to have the program beds licensed as specialty hospital beds for Hospital Inpatient General Psychiatric Services, in accordance with Section 395.003(2)(f), F.S. and Chapter 59A-3, F.A.C. 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 hHospital iInpatient General pPsychiatric bBeds for cChildren and aAdolescents calculated under paragraph (4)(f) of this rule.

(n) “Local Health Council.” The council referenced in Section 408.033, F.S.

(m)(o) “Planning Horizon.” The projected date by which a proposed hospital inpatient general 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)(p) “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. disorder coded in any sub-classification of category 290 or coded in any sub-classification of categories 293 through 302 or coded in any sub-classification of categories 306 through 316, in Axis I or Axis II, consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 290, 293 through 302 or 306 through 316.

(o)(q) “Separately Organized Unit.” A specific section, ward, wing, or floor with a separate nursing station designated exclusively for the care of hHospital iInpatient General pPsychiatric sServices patients.

(p)(r) “Specialty Beds.” Specialty beds include comprehensive medical rehabilitation beds, hospital inpatient substance abuse beds, and the hospital inpatient general psychiatric beds and beds in iIntensive rResidential tTreatment pPrograms for cChildren and aAdolescents licensed as specialty hospital beds which are regulated under this rule.

(q)(s) “Specialty Hospital.” A specialty hospital hospital is as defined by subsection 395.002(28), F.S. which restricts its services to a specified category of medical or psychiatric illness or to a specified age or gender group of the population, as defined in Section 395.002(28), F.S., including a facility with an intensive residential treatment program for children and adolescents which is licensed as a specialty hospital.

(r)(t) “Substance Abuse.” The misuse or abuse of, or dependence on alcohol, illicit drugs, or prescription medications which requires inpatient hospitalization. A disorder coded in any sub-classification of categories 291, 292, 303, 304 or 305 in Axis I or Axis II consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in any sub-classification of categories 291, 292, 303, 304 or 305 consistent with the diagnostic categories defined in the International Classification of Diseases (ICD 9), incorporated herein by reference.

(3) General Provisions.

(a) Admissions to Hospital Inpatient General Psychiatric Services. Admission to facilities with a cCertificate of nNeed for hHospital iInpatient General pPsychiatric sServices 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 paragraph (2). in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) is a disorder coded in any sub-classification of category 290 or coded in any sub-classification of categories 293 through 302 or coded in any sub-classification of categories 306 through 316, in Axis I or Axis II, consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 290, 293 through 302 or 306 through 316. 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 The Hospital Inpatient General Psychiatric Services regulated under this rule may be provided in a hospital licensed as a general hospital or licensed as a 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 hHospital iInpatient General pPsychiatric sServices, those services which are used for general psychiatric treatment of adults, and those services used for general psychiatric treatment of children and adolescents. Certificate of nNeed applications for the establishment of hHospital iInpatient General pPsychiatric sServices for adults shall be reviewed separately from cCertificate of nNeed applications for hHospital iInpatient General pPsychiatric sServices for children and adolescents. A separate cCertificate of nNeed shall be issued for each service.

(d) Separately Organized Units. Hospital iInpatient General pPsychiatric sServices for aAdults shall be provided in one or more separately organized units within a general hospital or specialty hospital. Hospital iInpatient General pPsychiatric sServices for cChildren and aAdolescents shall be provided in one or more separately organized units within a general hospital or specialty hospital.

(e) Minimum Size of Specialty Hospitals. A specialty hospital providing hHospital iInpatient General pPsychiatric sServices, or an intensive residential treatment program for children and adolescents licensed as a specialty hospital, shall have a minimum total capacity of 40 beds. The minimum capacity of a specialty hospital providing hHospital iInpatient General pPsychiatric sServices may include beds used for hHospital iInpatient sSubstance aAbuse sServices regulated under Rule 59C-1.041, F.A.C. The separately organized units for hHospital iInpatient General pPsychiatric sServices 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 cCertificate of nNeed for the establishment of new Hospital iInpatient General pPsychiatric specialty hospital sServices, or the expansion of existing services by addition of beds, shall not normally be approved unless the applicant meets the applicable review criteria in Section 408.035, F.S., and the standards and need determination criteria set forth in this rule.

(g) Accreditation of Intensive Residential Treatment Programs for Children and Adolescents. A Licensed Intensive Residential Treatment Program for children and adolescents applying for a Certificate of Need in order to have the program beds licensed as specialty hospital beds shall be accredited by the Joint Commission on Accreditation for Healthcare Organizations prior to submitting a Certificate of Need application.

(g)(h) Required Services. Hospital iInpatient General pPsychiatric sServices 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)(i) Excluded Hospitals. Hospitals operated by the State of Florida or the federal government are not regulated under this rule pursuant to Section 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 or expanded hHospital Inpatient General Psychiatric sServices shall not normally be made unless a bed need exists according to the numeric need methodology specified in paragraphs (4)(c) or (4)(f) of this rule.  

(b) Fixed Bed Need Pool. The future need for hHospital iInpatient General pPsychiatric sServices for adults shall be determined twice a year and published by the Agency as a fFixed bBed nNeed pPool for the applicable planning horizon. The future need for hHospital iInpatient General pPsychiatric sServices for cChildren and aAdolescents shall be determined twice a year and published by the Agency as a fFixed bBed nNeed pPool for the applicable planning horizon.

(c) Need Formula for Hospital Inpatient General Psychiatric Beds for Adults. The net bed need for hHospital iInpatient General pPsychiatric bBeds for aAdults 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 hHospital iInpatient General pPsychiatric bBeds for aAdults in a district.

2. PDA equals the number of inpatient days in hHospital iInpatient General pPsychiatric bBeds for aAdults in a district for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the fFixed bBed nNeed pPool.

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 fFixed bBed nNeed pPool.

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 fFixed bBed nNeed pPool.

5. .75 equals the desired average annual occupancy rate for hHospital iInpatient General pPsychiatric bBeds for aAdults in the district.

6. LBA equals the District’s number of licensed hHospital iInpatient General pPsychiatric bBeds for aAdults as of the most recent published deadline for Agency initial decisions prior to publication of the fFixed bBed nNeed pPool.

7. ABA equals the District’s number of approved hHospital iInpatient General pPsychiatric bBeds for aAdults, as determined consistent with the provisions of paragraph (2)(c) 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: Special Circumstances for Approval of Expanded Capacity at Hospitals with Licensed Hospital Inpatient General Psychiatric Services for Adults. Need for additional Hospital Inpatient General Psychiatric Beds for Adults is demonstrated at a hospital with licensed Hospital Inpatient General Psychiatric Services for adults in the absence of need shown under the formula in paragraph (4)(c), or the provision specified in subparagraph (4)(e)3., and regardless of the average annual district occupancy rate determined under subparagraph (4)(e)4., if the occupancy rate or the hospital’s inpatient general psychiatric beds for adults equalled or exceeded 85% percent for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

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 paragraph (2)(c) 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 fFactors to be cConsidered in the rReview of cCertificate of nNeed aApplications for hHospital iInpatient General pPsychiatric sServices for children and adolescents Adults.

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.

1. Applicants shall provide evidence in their applications that their proposal is consistent with the needs of the community and other criteria contained in Local Health Council Plans, the District Alcohol, Drug Abuse and Mental Health Plan, and the State Health Plan.

2. Applications from general hospitals for new or expanded Hospital Inpatient General Psychiatric Beds for Adults 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 Hospital Inpatient General Psychiatric Beds for Adults proposed, unless the applicant can reasonably project an annual occupancy rate of 75% percent for the applicable planning horizon, based on historical utilization patterns, for all acute care beds, excluding specialty beds. If conversion of the number of acute care beds which equals the number of proposed Hospital Inpatient General Psychiatric Beds for Adults would result in an annual 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 annual 75% percent acute care occupancy for the applicable planning horizon, excluding specialty beds.

3. In order to ensure access to Hospital Inpatient General Psychiatric Services for Medicaid-eligible and charity care adults, 40% percent of the gross bed need allocated to each district for Hospital Inpatient General Psychiatric Services for adults should be allocated to general hospitals.

4. Regardless of whether bed need is shown under the need formula in paragraph (4)(c), no additional Hospital Inpatient General Psychiatric Beds for Adults shall normally be approved in a district unless the average annual occupancy rate of the licensed Hospital Inpatient General Psychiatric Beds for Adults in the district equals or exceeds 75 percent for the 12 month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(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: Need Formula for Hospital Inpatient General Psychiatric Beds for Children and Adolescents. The net bed need for Hospital Inpatient General 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. 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. NNCA equals the net need for Hospital Inpatient General 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. 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. PDCA equals the number of inpatient days in Hospital Inpatient General 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. Propose to serve Medicaid-eligible persons. 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. Propose to serve individuals without regard to their ability to pay. 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. Agree to be a designated public or private receiving facility. .75 equals the desired average annual occupancy rate for Hospital Inpatient General 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. Provide a continuum of psychiatric services for children and adolescents, including services following discharge. LBCA equals the district’s number of licensed Hospital Inpatient General 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 General Psychiatric Beds for Children and Adolescents, as determined consistent with the provisions of paragraph (2)(c) 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.

(g) Non-Competitive Applicants. The factors contained in paragraph (i) shall also be considered in the review of a single non-competitive certificate of need application within the district. Special Circumstances for Approval of Expanded Capacity at Hospitals with Licensed Hospital Inpatient General Psychiatric Services for Children and Adolescents. Need for additional Hospital Inpatient General Psychiatric Beds for Children and Adolescents is demonstrated at a hospital with licensed Hospital Inpatient General Psychiatric Services for children and adolescents, or in a facility with an intensive residential treatment program for children and adolescents having beds licensed as specialty hospital beds, in the absence of need shown under the formula in paragraph (4)(f) and regardless of the average annual district occupancy rate determined under subparagraph (4)(h)4., if the occupancy rate of the hospital’s inpatient general psychiatric beds for children and adolescents or occupancy rate of the facility with intensive residential treatment program beds for children and adolescents equalled or exceeded 85% percent for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(h) Other Factors to be Considered in the Review of Certificate of Need Applications for Hospital Inpatient General Psychiatric Services for Children and Adolescents.

1. Applicants shall provide evidence in their applications that their proposal is consistent with the need of the community and other criteria contained in Local Health Council Plans, the District Alcohol, Drug Abuse and Mental Health Plan, and the State Health Plan.

2. Applications from general hospitals for new or expanded Hospital Inpatient General Psychiatric Beds for Children and Adolescents 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 Hospital Inpatient General Psychiatric Beds for Children and Adolescents proposed, unless the applicant can reasonably project an annual occupancy rate of 75% percent for the applicable planning horizon, based on historical utilization patterns, for all acute care beds, excluding specialty beds. If conversion of the number of acute care beds which equals the number of proposed Hospital Inpatient General Psychiatric Beds for Children and Adolescents would result in an annual 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 annual 75% percent acute care occupancy for the applicable planning horizon, excluding specialty beds.

3. In order to ensure access to Hospital Inpatient General Psychiatric Services for Medicaid-eligible and charity care children and adolescents, 40% percent of the gross bed need allocated to each district for Hospital Inpatient General Psychiatric Services for children and adolescents should be allocated to general hospitals.

4. Regardless of whether bed need is shown under the need formula in paragraph (4)(f), no additional Hospital Inpatient General Psychiatric Beds for Children and Adolescents or additional beds in an intensive residential treatment program for children and adolescents seeking to have the program beds licensed as specialty hospital beds shall normally be approved in a district unless the average annual occupancy rate of the licensed Hospital Inpatient General Psychiatric Beds for Children and Adolescents in the District, including beds in Intensive Residential Treatment Programs for Children and Adolescents licensed as specialty hospital beds, equals or exceeds 75% percent for the 12 month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

5. 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.

(i) Preferences Among Competing Applicants for Hospital Inpatient General 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 for the most recent calendar year prior to the year of the application for which data are available from the Health Care Board.

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.

(j) Non-Competitive Applicants. The factors contained in paragraph (i) shall also be considered in the review of a single non-competitive Certificate of Need application within the district.

(5) Unit Size. A separately organized unit for hHospital iInpatient General pPsychiatric sServices for adults shall have a minimum of 15 beds. A separately organized unit for hHospital iInpatient General pPsychiatric sServices for cChildren and aAdolescents shall have a minimum of 10 beds. Facilities inventoried consistent with the provisions of subsection (11) of this rule are exempt from meeting the minimum unit size requirements of this subsection unless or until they submit a proposal which would modify the number of beds listed in the inventory.

(6) Access Standard. Hospital iInpatient General pPsychiatric sServices 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 iInpatient General pPsychiatric sServices 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 rResidential tTreatment pPrograms for cChildren and aAdolescents 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 cCertificate of nNeed application that they will meet applicable Agency licensure standards are deemed to be in compliance with this provision.

(b) Hospital Inpatient General Psychiatric Services for Children. As required by Section 394.4785 (2), F.S., facilities providing hHospital iInpatient General pPsychiatric sServices 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 hHospital iInpatient General pPsychiatric sServices if the admitting physician indicates that such placement is medically indicated, or for reasons of safety.

(c) Accreditation. Applicants proposing to add beds to a licensed hospital inpatient general psychiatric service shall be accredited by the Joint Commission on Accreditation of Healthcare Organizations consistent with the standards applicable to psychiatric services provided in inpatient settings for adults or for children and adolescents. 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-3.300, F.A.C., meet the accreditation standards of the Joint Commission on Accreditation of Healthcare Organizations applicable to the establishment of a new inpatient psychiatric hospital psychiatric services provided in inpatient settings for adults or for children and adolescents.

(d) Continuity. Providers of hHospital iInpatient General pPsychiatric sServices 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 hHospital iInpatient General pPsychiatric sServices 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 paragraph (2)(p) and substance abuse, as defined in paragraph (2)(t), 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 a new Hospital iInpatient General pPsychiatric hospital sServices shall provide a detailed program description in its cCertificate of nNeed 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 by primary diagnosis ICD 9 code 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 hHospital iInpatient General pPsychiatric sServices discharges by age group.

(h) Projected number of hHospital iInpatient General pPsychiatric sServices 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). Applications from Licensed Providers of Hospital Inpatient Psychiatric Services or Intensive Residential Treatment Programs for Children and Adolescents. A facility providing licensed Hospital Inpatient General Psychiatric Services seeking Certificate of Need approval for additional hospital inpatient general psychiatric beds, or a Licensed Intensive Residential Treatment Program for children and adolescents seeking Certificate of Need approval in order to have the program beds licensed as specialty hospital beds, shall provide the following information in its Certificate of Need application in addition to the information required by subsection (8):

(a) Number of Hospital Inpatient General Psychiatric Services admissions and patient days or number of intensive residential treatment program admissions and patient days by age group and primary diagnosis ICD-9 code for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(b) Number of Hospital Inpatient General Psychiatric Services patient days or intensive residential treatment program patient days by payer type, including Medicare, Medicaid, Baker Act, private insurance, self-pay and charity care patient days, for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(c) Gross revenues by payer source for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(d) Patient days by primary diagnosis ICD 9 code for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(e) Current staffing.

(f) Current specialized treatment programs (e.g. eating disorders, stress management, autism).

(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. Quarterly Reports. Facilities providing licensed Hospital Inpatient General 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 General Psychiatric Services admissions and patient days by age and primary diagnosis ICD 9 code.

(11) Establishment of An Inventory of Hospital Inpatient General Psychiatric Beds for Adults and Hospital Inpatient General Psychiatric Beds for Children and Adolescents.

(a) Inventory Process. The Agency shall inventory the number of Hospital Inpatient General Psychiatric Beds for Adults and the number of Hospital Inpatient General Psychiatric Beds for Children and Adolescents, including the number of beds in Intensive Residential Treatment Programs for Children and Adolescents which are licensed as specialty hospital beds. The inventory shall be based on information in certificates of need and an Agency survey of facilities with short-term hospital inpatient psychiatric beds or long-term psychiatric beds that were licensed prior to the effective date of this rule. Facilities with intensive residential treatment program beds for children and adolescents which were licensed as specialty hospital beds prior to the effective date of this rule will also be surveyed. All information reported in the Agency survey shall be subject to verification by the Agency.

(b) Separate Identification of Beds for Children or Adolescents Required. The determination of the number of Hospital Inpatient General Psychiatric Beds for Adults and for Children and Adolescents shall be based on the Certificate of Need issued or the provider’s survey response. Providers who designate hospital inpatient general psychiatric beds for children or adolescents shall document that these beds are located in units which are organized separately from units with Hospital Inpatient General Psychiatric Beds for Adults. All hospital inpatient general psychiatric beds which are not located in documented separately organized units for children or adolescents will be listed in the inventory as Hospital Inpatient General Psychiatric Beds for Adults. All beds in Intensive Residential Treatment Programs for Children and Adolescents which are licensed as specialty hospital beds will be deemed to meet the requirement for separate identification of beds for children and adolescents.

(c) Current Restrictions on Age Groups Treated. Any restrictions imposed by a Certificate of Need issued prior to the effective date of this rule regarding age groups treated in a facility’s short-term hospital inpatient psychiatric services or long-term psychiatric services will be reflected in the inventory.

(d) Approved Hospital Inpatient General Psychiatric Beds. Short-term hospital inpatient psychiatric beds and long-term psychiatric beds which are approved but not licensed as of the effective date of this rule will be listed in the inventory as Hospital Inpatient General Psychiatric Beds for Adults unless the application for the Certificate of Need which was approved identified a specific number of beds to be used for children or adolescents. Beds in approved Intensive Residential Treatment Programs for Children and Adolescents seeking to have the program beds licensed as specialty hospital beds will be listed in the inventory as approved Hospital Inpatient General Psychiatric Beds for Children and Adolescents.

(e) Publication. The Agency shall publish a preliminary inventory of the licensed or approved Hospital Inpatient General Psychiatric Services for Adults and for Children and Adolescents in the Florida Administrative Register. 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 preliminary inventory, the Agency shall publish a final inventory.

(12) Facilities with Short-Term or Long-Term Psychiatric Services. Facilities currently licensed for the provision of short-term or long-term psychiatric services shall be issued an amended license authorizing the provision of Hospital Inpatient General Psychiatric Services to Adults or Hospital Inpatient General Psychiatric Services to Children and Adolescents, regardless of the length of stay, based on the inventory established by this rule.

(13) 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.

(14) Applicability of this amended rule. This amended rule shall not be applied to applications that are pending final Agency action as of the effective date of the rule.

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.034(3), 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,_______.

 

59C-1.041 New Hospital Inpatient Substance Abuse Services .

(1) Agency Intent. This rule implements the provisions of Sections 408.032(9), 408.034(3), 408.034(6), 408.036(1)(b), (c) and 395.003(4), F.S. It is the intent of the Agency to ensure the availability of hHospital iInpatient sSubstance aAbuse sServices for cChildren, aAdolescents and aAdults in nNeed of these services regardless of their ability to pay. This rule regulates the establishment of new Hospital iInpatient sSubstance aAbuse hospitals Services, the construction or addition of new hospital inpatient substance abuse beds, the conversion of licensed hospital beds to hospital inpatient substance abuse beds, and specifies which services can be provided by licensed or approved providers of hHospital iInpatient sSubstance aAbuse sServices.

(2) Definitions.

(a) “Acute Detoxification Services.” Hospital inpatient services provided under the direction of a physician intended to treat the physiological effects of acute alcohol or drug intoxication during or immediately after the acute intoxication.

(b) “Acute Severe Psychiatric Disorder.” A psychiatric disorder not currently in full remission coded in any sub-classification of categories 293 through 295, except for 293.00, or coded as 296.24, 296.34, 296.44, 296.54 or 296.64, or coded in any sub-classification of categories 297 through 299, or coded as 310.10, in Axis I or Axis II, consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 293 through 295, except for 293.00, or coded as 296.24, 296.34, 296.44, 296.54 or 296.64, 297 through 299 or 310.10.

(a)(c) “Adolescent.” A person age 14 through 17.

(b)(d) “Adult.” A person age 18 and over.

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

(d)(e) “Approved Hospital Inpatient Substance Abuse Bed.” A proposed hospital inpatient substance abuse bed for which an exemption, notification, a cCertificate of nNeed, a letter of intent to grant a cCertificate of nNeed, a signed stipulated agreement, or a final order granting a cCertificate of nNeed 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 fFixed nNeed pPool, as specified in paragraph 59C-1.008(1)(g), F.A.C.

(e)(f) “Charity Care.” Is defined the same as in Section 409.911 (1), F.S. The portion of hospital charges for which there is no compensation for care provided to patients whose family income as applicable for the 12 months preceding the determination does not exceed 150% percent of the current Federal Poverty Guidelines, or for care provided to patients for whom the hospital charges are greater than 25% percent of an annual family income which does not exceed four times the current Federal Poverty Level for a family of four, as defined in the Health Care Board’s Florida Hospital Uniform Reporting System Manual, Chapter III, Section 3223.

(f)(g) “Child.” A person under the age of 14 years.

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

(g)(i) “District.” A District of the Agency defined in Section 408.032(5), F.S.

(h)(j) “Fixed Bed Need Pool.” The numerical hospital inpatient substance abuse bed need for adults 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)(k) “General Hospital.” Means any facility which meets the provision of Section 395.002(12), F.S.  A hospital which provides services to the general population and does not restrict its services to any specified medical or psychiatric illness or to any specified age or gender group of the population, as defined in Section 395.002(4), F.S.

(l) “Gross Bed Need.” The number of hospital inpatient substance abuse beds for adults projected for a district for the applicable planning horizon under paragraph (4)(c) of this rule, except that the number of licensed beds and approved beds is not subtracted from the projected total.

(j)(m) “Hospital Inpatient Substance Abuse Bed.” A bed designated for the exclusive use of patients receiving hHospital iInpatient sSubstance aAbuse sServices as defined by this rule.

(k)(n) “Hospital Inpatient Substance Abuse Services.” Services provided under the direction of a professional trained and experienced in substance abuse services, including a psychiatrist, a physician certified by the American Society of Addiction Medicine, a Certified Addictions Professional, a clinical psychologist, a clinical social worker (as defined in Section 491.003(2), F.S.) or a certified master social worker (as defined in Section 491.0145, F.S.) to persons whose sole diagnosis, or in the event of more than one diagnosis, the principal diagnosis is a substance abuse disorder defined in paragraph (2)(s) of this rule. as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) is a substance abuse disorder defined in paragraph (2)(u) of this rule.

(o) “Local Health Council.” The council referenced in Section 408.033, F.S.

(l)(p) “Planning Horizon.” The projected date by which a proposed hospital inpatient substance abuse 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.

(m)(q) “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. disorder coded in any sub-classification of category 290 or coded in any sub-classification of categories 293 through 302 or coded in any sub-classification of categories 306 through 316, in Axis I or Axis II, consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 290, 293 through 302 or 306 through 316.

(n)(r) “Separately Organized Unit.” A specific section, ward, wing, or floor with a separate nursing station designated exclusively for the care of hHospital iInpatient sSubstance aAbuse sServices patients.

(s) “Specialty Beds.” Specialty beds include comprehensive medical rehabilitation beds, hospital inpatient general psychiatric beds, and the hospital inpatient substance abuse beds regulated under this rule.

(o)(t) “Specialty Hospital.” A specialty hospital is as defined by subsection 395.002(28), F.S.  A hospital which restricts its services to a specified category of medical or psychiatric illness or to a specified age or gender group of the population, as defined in Section 395.002(28), F.S.

(p)(u) “Substance Abuse.” The misuse or abuse of, or a dependence on alchohol, illicit drugs or prescription medications which requires inpatient hospitalization. A disorder coded in any sub-classification of categories 291, 292, 303, 304 or 305 in Axis I or Axis II consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), incorporated herein by reference; or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 291, 292, 303, 304 or 305.

(3) General Provisions.

(a) Admissions to Hospital Inpatient Substance Abuse Services. Admission to facilities with a cCertificate of nNeed for hHospital iInpatient sSubstance aAbuse sServices is limited to persons whose sole diagnosis, or in the event of more than one diagnosis, the principal diagnosis is a substance abuse disorder as defined in paragraph (2) the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) is a disorder coded in any sub-classification of categories 291, 292, 303, 304 or 305 in Axis I or Axis II consistent with the diagnostic categories defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R); or equivalent codes in the following sub-classifications in the International Classification of Disease (ICD 9), incorporated herein by reference: category 291, 292, 303, 304 or 305.

(b) Service Location. The hHospital iInpatient sSubstance aAbuse sServices regulated under this rule may be provided in a hospital licensed as a general hospital or licensed as a specialty hospital.

(c) Separate Regulation of Age Categories. The Agency regulates two types of hHospital iInpatient sSubstance aAbuse sServices, those services which are used for substance abuse treatment of adults, and those services used for substance abuse treatment of children and adolescents. Certificate of nNeed applications for the establishment of hHospital iInpatient sSubstance aAbuse sServices for adults shall be reviewed separately from cCertificate of nNeed applications for hHospital iInpatient sSubstance aAbuse sServices for children and adolescents. A separate cCertificate of nNeed shall be issued for each service.

(d) Separately Organized Units. Hospital iInpatient sSubstance aAbuse sServices for adults shall be provided in one or more separately organized units within a general hospital or specialty hospital. Hospital iInpatient sSubstance aAbuse sServices for children and adolescents shall be provided in one or more separately organized units within a general hospital or specialty hospital.

(e) Minimum Size of Specialty Hospitals. A specialty hospital providing hHospital iInpatient sSubstance aAbuse sServices shall have a minimum total capacity of 40 beds, which may include beds used for hHospital iInpatient General pPsychiatric sServices regulated under Rule 59C-1.040, F.A.C. The separately organized units for hHospital iInpatient sSubstance aAbuse sServices 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) Beds for Acute Detoxification. Beds used for acute detoxification services in general hospitals shall be considered a subset of the total number of medical surgical beds allocated to each district under Rule 59C-1.038, F.A.C. Beds used for acute detoxification services in specialty hospitals shall be considered a subset of the number of beds allocated to each district under subsection (4) of this rule.

(f)(g) Conformance with the Criteria for Approval. A cCertificate of nNeed for the establishment of new Hospital iInpatient sSubstance aAbuse hospitals Services , or the expansion of existing services by the addition of beds, shall not normally be approved unless the applicant meets the applicable review criteria in Section 408.035, F.S., and the standards and need determination criteria set forth in this rule.

(g)(h) Required Services. Hospital iInpatient sSubstance aAbuse sServices whether provided directly by the hospital or under contract shall include, at a minimum, emergency screening services; treatment planning services; pharmacology, if appropriate; individual therapy; family therapy; discharge planning; referral services, including written referral agreements for educational and vocational services; and occupational and recreational therapies.

(h)(i) Excluded Hospitals. Hospitals operated by the State of Florida or the federal government are not regulated under this rule pursuant to Section 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 or expanded Hospital iInpatient sSubstance aAbuse hospitals Services for adults shall not normally be made unless a bed need exists according to the numeric need methodology in paragraph (4)(c) of this rule. A favorable need determination for proposed new Hospital Inpatient Substance Abuse Services for children and adolescents shall not normally be made unless a bed need exists according to the requirements of paragraph (4)(f) of this rule.

(b) Fixed Bed Need Pool. The future need for hHospital iInpatient sSubstance aAbuse sServices for adults shall be determined twice a year and published by the Agency as a fFixed bBed nNeed pPool for the applicable planning horizon.

(c) Need Formula for Hospital Inpatient Substance Abuse Beds for Adults. The net bed need for hospital inpatient substance abuse 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 substance abuse beds for adults in a district.

2. PDA equals the number of inpatient days in hospital inpatient substance abuse 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 fFixed bBed nNeed pPool.

3. PA equals the estimated population age 18 or 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 fFixed bBed nNeed pPool. 

4. PPA equals the estimated population age 18 or 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 fFixed bBed nNeed pPool.

5. .75 equals the desired average annual occupancy rate for hospital inpatient substance abuse beds for adults in the district.

6. LBA equals the district’s number of licensed hospital inpatient substance abuse beds for adults as of the most recent published deadline for Agency initial decisions prior to publication of the fFixed bBed nNeed pPool.

7. ABA equals the district’s number of approved hospital inpatient substance abuse beds for adults, as determined consistent with the provisions of paragraph (2)(e) of this rule.

(d) Need for Hospital Inpatient Substance Abuse Services for Children and Adolescents. The need for proposed hospital inpatient substance abuse services for children and adolescents shall be determined consistent with the following: Special Circumstances for Approval of Expanded Capacity at Hospitals with Licensed Hospital Inpatient Substance Abuse Services for Adults. Need for additional hospital inpatient substance abuse beds for adults is demonstrated at a hospital with licensed Hospital Inpatient Substance Abuse Services for adults in the absence of need shown under the formula in paragraph (4)(c), or the provision specified in subparagraph (4)(e)3., and regardless of the average annual district occupancy rate determined under subparagraph (4)(e)4., if the occupancy rate of the hospital’s inpatient substance abuse beds for adults equalled or exceeded 85 percent for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

1. The Agency shall consider the need for hospital inpatient substance abuse services for children and adolescents within the context of licensed or approved hospital inpatient substance abuse services for children and adolescents and licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders. The applicant for hospital inpatient substance abuse services for children and adolescents shall provide documentation that the district’s licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders do not meet the need for the proposed service.

2. No additional hospital inpatient substance abuse beds for children and adolescents shall normally be approved in a district having one or more facilities with hospital inpatient substance abuse services for children and adolescents unless the average annual occupancy rate of all licensed hospital inpatient substance abuse beds for children and adolescents in the district equalled or exceeded 75 percent during the 12 month period ending 6 months prior to the application submission deadline.

(e) Preferences among competing applicants for hospital inpatient substance abuse services. In weighing and balancing statutory and rule review criteria, preference will be given to applicants who: Other Factors to be Considered in the Review of cCertificate of nNeed Applications for Hospital Inpatient Substance Abuse Services for Adults.

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 six months prior to the beginning date of the quarter of the publication of the fixed bed need pool. Applicants shall provide evidence in their applications that their proposal is consistent with the needs of the community and other criteria contained in Local Health Council Plans, the District Alcohol, Drug Abuse and Mental Health Plan, and the State Health Plan.

2. Propose to serve Medicaid-eligible persons. Applications from general hospitals for new or expanded hospital inpatient substance abuse beds for adults 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 hospital inpatient substance abuse beds for adults proposed, unless the applicant can reasonably project an annual occupancy rate of 75% percent for the applicable planning horizon, based on historical utilization patterns, for all acute care beds, excluding specialty beds. If conversion of the number of acute care beds which equals the number of proposed hospital inpatient substance abuse beds for adults would result in an annual 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 annual 75% percent acute care occupancy for the applicable planning horizon, excluding specialty beds.

3. Propose to serve substance-abusing pregnant and post-partum women regardless of their ability to pay. In order to ensure access to Hospital Inpatient Substance Abuse Services for Medicaid-eligible and charity care adults, 40% percent of the gross bed need allocated to each District for Hospital Inpatient Substance Abuse Services for adults should be allocated to general hospitals.

4. Propose to serve individuals without regard to their ability to pay. Regardless of whether bed need is shown under the need formula in paragraph (4)(c), no additional hospital inpatient substance abuse beds for adults shall normally be approved for a District unless the average annual occupancy rate of the licensed hospital inpatient substance abuse beds for adults in the district equals or exceeds 75% percent for the 12 month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(f) Non-Competitive Applicants. The factors contained in paragraph (e) shall also be considered in the review of a single non-competitive certificate of need application within the district. Need for Hospital Inpatient Substance Abuse Services for Children and Adolescents. The need for proposed Hospital Inpatient Substance Abuse Services  for children and adolescents shall be determined consistent with the following:

1. The Agency shall consider the need for Hospital Inpatient Substance Abuse Services for children and adolescents within the context of licensed or approved Hospital Inpatient Substance Abuse Services  for children and adolescents and licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders. The applicant for Hospital Inpatient Substance Abuse Services for children and adolescents shall provide documentation that the District’s licensed non-hospital residential treatment programs for children and adolescents with substance abuse disorders do not meet the need for the proposed service.

2. No additional hospital inpatient substance abuse beds for children and adolescents shall normally be approved in a district having one or more facilities with Hospital Inpatient Substance Abuse Services for Children and Adolescents unless the average annual occupancy rate of all licensed hospital inpatient substance abuse beds for children and adolescents in the district equalled or exceeded 75% percent during the 12 month period ending 6 months prior to the application submission deadline.

3. Under special circumstances, need for additional hospital inpatient substance abuse beds for children and adolescents is demonstrated at a hospital with licensed Hospital Inpatient Substance Abuse Services for Children and Adolescents regardless of the average annual occupancy rate determined under subparagraph (4)(f)2. if the occupancy of the hospital’s inpatient substance abuse beds for children and adolescents equalled or exceeded 85% percent during the 12 month period ending 6 months prior to the application submission deadline.

(g) Other Factors to be Considered in the Review of cCertificate of nNeed Applications for Hospital Inpatient Substance Abuse Services for Children and Adolescents.

1. Applicants shall provide evidence in their applications that their proposal is consistent with the needs of the community and other criteria contained in Local Health Council Plans, the District Alcohol, Drug Abuse and Mental Health Plan, and the State Health Plan.

2. Applications from general hospitals for new or expanded hospital inpatient substance abuse beds for children and adolescents 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 hospital inpatient substance abuse beds proposed, unless the applicant can reasonably project an annual occupancy rate of 75% percent for the applicable planning horizon, based on historical utilization patterns, for all acute care beds, excluding specialty beds. If conversion of the number of acute care beds which equals the number of proposed hospital inpatient substance abuse beds for children and adolescents would result in an annual 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 annual 75% percent acute care occupancy for the applicable planning horizon, excluding specialty beds.

(h) Preferences Among Competing Applicants for Hospital Inpatient Substance Abuse 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 for the most recent calendar year prior to the year of the application for which data are available from the Health Care Board.

2. Propose to serve Medicaid-eligible persons.

3. Propose to serve substance-abusing pregnant and post-partum women regardless of their ability to pay.

4. Propose to serve individuals without regard to their ability to pay.

(i) Non-Competitive Applicants. The factors contained in paragraph (h) shall also be considered in the review of a single non-competitive Certificate of Need application within the district.

(5) Unit Size. A separately organized unit for hHospital iInpatient sSubstance aAbuse sServices for adults shall have a minimum of 10 beds. A separately organized unit for hHospital iInpatient sSubstance aAbuse sServices for cChildren and aAdolescents shall have a minimum of five beds. Facilities inventoried consistent with the provisions of subsection (11) of this rule are exempt from meeting the minimum unit size requirements of this subsection unless or until they submit a proposal which would modify the number of beds listed in the inventory.

(6) Access Standard. Hospital iInpatient sSubstance aAbuse sServices 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 Substance Abuse 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. Applicants who include a statement in their cCertificate of nNeed application that they will meet applicable Agency departmental licensure standards are deemed to be in compliance with this provision.

(b) Hospital Inpatient Substance Abuse Services for Children. Facilities providing Hospital Inpatient Substance Abuse 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 hHospital iInpatient sSubstance aAbuse sServices if the admitting physician indicates that such placement is medically indicated, or for reasons of safety.

(c) Accreditation. Applicants proposing to add beds to a licensed hospital inpatient substance abuse service shall be accredited by the Joint Commission on Accreditation of Healthcare Organizations consistent with the standards applicable to substance abuse services provided in inpatient settings for adults or for children and adolescents. Applicants proposing a new hospital inpatient substance abuse service shall state how they will comply with the provisions of hospital licensure as defined in Rule 59A-3.300, F.A.C. meet the accreditation standards of the Joint Commission on Accreditation of Healthcare Organizations applicable to substance abuse services provided in inpatient settings for adults or for children and adolescents.

(d) Continuity. Providers of Hospital iInpatient sSubstance aAbuse sServices shall also provide outpatient or referral services, either directly or through written agreements with community outpatient substance abuse programs, such as local psychiatrists, other physicians trained in the treatment of psychiatric or substance abuse disorders, local psychologists, community mental health programs, or other local substance abuse outpatient programs.

(e) Screening Program. All facilities providing hHospital iInpatient sSubstance aAbuse sServices shall have a screening program to assess the most appropriate treatment for the patient. Patients with a dual diagnosis of substance abuse, as defined in paragraph (2)(u), and a psychiatric disorder, as defined in paragraph (2)(q), shall be evaluated to determine the types of treatment needed, the appropriate treatment setting, and, if necessary, the appropriate sequence of treatment for the substance abuse and psychiatric disorders. Provided, however, that persons with a dual diagnosis which includes an acute severe psychiatric disorder, as defined in paragraph (2)(b), shall be referred to a hospital inpatient general psychiatric service for treatment of the acute severe psychiatric disorder.

(8) Services Description. An applicant for an Hospital iInpatient sSubstance aAbuse hospital Services shall provide a detailed program description in its cCertificate of nNeed application including:

(a) Age groups to be served.

(b) Specialty programs to be provided (e.g. alcoholism treatment programs, drug abuse treatment programs).

(c) Proposed staffing, including qualifications of the clinical director, a description of staffing appropriate for any specialty program, and a discussion of the training and experience requirements for all staff who will provide substance abuse services.

(d) Therapeutic approaches to be used.

(e) Expected sources of patient referrals.

(f) Expected average length of stay for the hHospital iInpatient sSubstance aAbuse sServices discharges by age group.

(g) Projected number of hHospital iInpatient sSubstance aAbuse sServices patient days by payer type, including Medicare, Medicaid, private insurance, self-pay and charity care patient days for the first 2 years of operation after completion of the proposed project.

(h) Admission policies of the facility with regard to charity care patients.

(9) Quarterly Reports. Facilities providing licensed hospital inpatient substance abuse services shall report to the Agency or its designee, within 45 days after the end of each calendar quarter, the number of hospital inpatient substance abuse services admissions and patient days by age groups (patients under age 18 years and adults). Applications from Licensed Providers of Hospital Inpatient Substance Abuse Services. A facility providing licensed Hospital Inpatient Substance Abuse Services seeking cCertificate of nNeed approval for additional hospital inpatient substance abuse beds shall provide the following information in its cCertificate of nNeed application in addition to the information required by subsection (8):

(a) Number of Hospital Inpatient Substance Abuse Services admissions and patient days by age group and primary diagnosis ICD-9 code for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(b) Number of Hospital Inpatient Substance Abuse Services patient days by payer type, including Medicare, Medicaid, private insurance, self-pay and charity care patient days, for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(c) Gross revenues by payer source for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(d) Patient days by primary diagnosis ICD-9 code for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

(e) Current staffing.

(f) Current specialized treatment programs (e.g. alcoholism treatment; drug abuse treatment).

(10) Quarterly Reports. Facilities providing licensed Hospital Inpatient Substance Abuse Services shall report to the Agency or its designee, within 45 days after the end of each calendar quarter, the number of Hospital Inpatient Substance Abuse Services admissions and patient days by age and primary diagnosis ICD-9 code.

(11) Establishment of an Inventory of Hospital Inpatient Substance Abuse Beds for Adults and Hospital Inpatient Substance Abuse Beds for Children and Adolescents.

(a) Inventory Process. The Agency shall inventory the number of hospital inpatient substance abuse beds for adults and the number of hospital inpatient substance abuse beds for children and adolescents. The inventory shall be based on information in certificates of need and an Agency survey of facilities with short-term or long-term hospital inpatient substance abuse beds that were licensed prior to the effective date of this rule. All information reported in the Agency survey shall be subject to verification by the Agency.

(b) Separate Identification of Beds for Children or Adolescents Required. The determination of the number of hospital inpatient substance abuse beds for adults and for children and adolescents shall be based on the cCertificate of nNeed issued or the provider’s survey response. Providers who designate hospital inpatient substance abuse beds for children or adolescents shall document that these beds are located in units which are organized separately from units with hospital inpatient substance abuse beds for adults. All hospital inpatient substance abuse beds which are not located in documented separately organized units for children or adolescents will be listed in the inventory as hospital inpatient substance abuse beds for adults.

(c) Current Restrictions on Age Groups Treated. Any restrictions imposed by a cCertificate of nNeed issued prior to the effective date of this rule regarding age groups treated in a facility’s short-term or long-term Hospital Inpatient Substance Abuse Services will be reflected in the inventory.

(d) Approved Hospital Inpatient Substance Abuse Beds. Short-term or long-term hospital inpatient substance abuse beds which are approved but not licensed as of the effective date of this rule will be listed in the inventory as hospital inpatient substance abuse beds for adults unless the application for the cCertificate of nNeed which was approved identified a specific number of beds to be used for children or adolescents.

(e) Publication. The Agency shall publish a preliminary inventory of the licensed or approved Hospital Inpatient Substance Abuse Services for adults and for children and adolescents in the Florida Administrative Register. 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 preliminary inventory, the Agency shall publish a final inventory.

(12) Facilities with Short-Term or Long-Term Hospital Inpatient Substance Abuse Services. Facilities currently licensed for the provision of short-term or long-term Hospital Inpatient Substance Abuse Services shall be issued an amended license authorizing the provision of Hospital Inpatient Substance Abuse Services to adults or Hospital Inpatient Substance Abuse Services to Children and Adolescents, regardless of the length of stay, based on the inventory established by this rule.

(13) Applicability of this amended rule. This amended rule shall not be applied to applications that are pending final Agency action as of the effective date of the rule.

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.034(3), 408.034(8), 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)(q), 10-5.041, Amended 8-24-93, 2-22-95,              .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Marisol Fitch

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 21, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: November 22, 2015