The Agency is proposing to amend 59C-1.039 to remove, update and condense language regarding comprehensive medical rehabilitation inpatient services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Certificate of Need

RULE NO.:RULE TITLE:

59C-1.039Comprehensive Medical Rehabilitation Inpatient Services

PURPOSE AND EFFECT: The Agency is proposing to amend 59C-1.039, F.A.C., to remove, update and condense language regarding comprehensive medical rehabilitation inpatient services.

SUMMARY: This rule is being amended to update definitions, update language regarding excluded hospitals, update other required services to ensure consistency with hospital licensure (59A-3.066, F.A.C.), condense language addressing needs assessment methodology, remove references to State and Local Health Council District health plans, remove language referencing 59C-1.038, F.A.C., (repealed), remove language requiring accreditation, remove obsolete language from the utilization reporting requirement, and remove language regarding the applicability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 SERC has not been prepared by the agency.

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) and (8) and 408.15 (8) FS.

LAW IMPLEMENTED: 408.034 (3), 408.035, 408.039 (4)(a) and 408.036 (1)(b), (c) and (f) 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: April 11, 2017 from 8:30-10:00 a.m.

PLACE: Agency for Health Care Administration, Building Three, Conference Room C, 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, Tallahassee, Florida, [phone].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59C-1.039 Comprehensive Medical Rehabilitation Inpatient Services.

(1) Agency Intent. This rule implements the provisions of Sections 408.034(3), 408.034(6), 408.036(1), (b), (c), (e), (f) and 395.003(4), F.S. It is the intent of the Agency to ensure the availability of Comprehensive Medical Rehabilitation Inpatient Services for persons in need of these services, including Medicaid and charity care patients. This rule regulates the establishment of new Comprehensive Medical Rehabilitation Inpatient Services, the construction or addition of new Comprehensive Medical Rehabilitation Inpatient Beds, and the conversion of licensed hospital acute care beds to Comprehensive Medical Rehabilitation Inpatient Beds.

(2) Definitions.

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

(b)(a) “Approved Comprehensive Medical Rehabilitation Inpatient Bed.” A proposed Comprehensive Medical Rehabilitation Inpatient 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)(b) “Charity Care.” As defined in Sections 409.2663(2) and 409.911(1), F.S., charity care is that portion of hospital charges for which there is no compensation for care provided to a patient whose family income for the 12 months preceding the determination is less than or equal to 150% percent of the current Federal Poverty Guidelines (FPG), as published in the Federal Register; or for which there is no compensation for care provided to a patient whose family income for the 12 months preceding the determination is greater than 150% percent of the current FPG but not more than four times the current FPG for a family of four and the amount of hospital charges due from the patient exceeds 25% percent of the 12-month family income. Charity care does not include bad debt, which is the portion of health care provider charges for which there is no compensation for care provided to a patient who fails to qualify for charity care; and does not include administrative or courtesy discounts, contractual allowances to third-party payors, or failure of the hospital to collect full charges due to partial payment by government programs.

(d)(c) “Comprehensive Medical Rehabilitation Inpatient Services.” An organized program of integrated intensive care services provided by a coordinated multidisciplinary team to patients with severe physical disabilities, such as stroke; spinal cord injury; congenital deformity; amputation; major multiple trauma; fracture of femur (hip fracture); brain injury; polyarthritis, including rheumatoid arthritis; neurological disorders, including multiple sclerosis, motor neuron diseases, polyneuropathy, muscular dystrophy, and Parkinson’s disease; and burns.

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

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

(f) “Fixed Bed Need Pool.” The numerical Comprehensive Medical Rehabilitation Inpatient Bed need for the applicable planning horizon, as established by the Agency in accordance with this rule and subsection 59C-1.008(2), F.A.C.

(g) “General Hospital.” Any facility A hospital which meets the provisions of Section 395.002(12), F.S. provides services to the general population and does not restrict its services to any specified category of disorders or to any specified age or gender group of the population, as defined in Section 395.002(4), F.S.

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

(i) “Planning Horizon.” The projected date by which a proposed comprehensive medical rehabilitation inpatient 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. For example, an application submitted in March 2016 1991 would have a planning horizon of July 2021 1996; an application submitted in September 2016 1991 would have a planning horizon of January 2022 1997.

(j) “Separately Organized Unit.” A specific section, ward, wing, or floor with a separate nursing station designated exclusively for the care of comprehensive medical rehabilitation patients.

(k) “Specialty Bed.” A category of hospital inpatient beds for which the Agency has promulgated a separate rule specifying need determination criteria, including burn unit beds, hospital inpatient general psychiatric beds, hospital inpatient substance abuse beds, Level II and Level III Neonatal Intensive Care UInit Beds; and the Comprehensive Medical Rehabilitation Inpatient Beds regulated under this rule.

(l) “Specialty Hospital.” As hospital which restricts its services to a specified category of disorders or to a specified age or gender group of the population, as defined in Section 395.002(28), F.S., a specialty hospital is any facility which meets the provisions of Section 395.002(12) F.S., and which regularly makes available either:

1.The range of medical services offered by general hospitals, but restricted to a defined age or gender group of the population, or

2. A restricted range of services appropriate to the diagnosis, care and treatment of patients with specific categories of medical or psychiatric illnesses or disorders, or

3. Intensive residential treatment programs for children and adolescents as defined in Section 395.002(15), F.S.

(3) General Provisions.

(a) through (f) No change.

(g) Excluded Hospitals. Hospitals operated by the State of Florida are not regulated under this rule pursuant to Section 408.036(3)(d), (r) and (s), F.S. or the federal government are not regulated under this rule.

(4) Required Staffing and Services.

(a) Director of Rehabilitation. Comprehensive Medical Rehabilitation Inpatient Services must be provided under a medical director of rehabilitation who is a Board certified or Board eligible physiatrist and has had at least 2 years of experience in the medical management of inpatients requiring rehabilitation services.

(b) Other Required Services. In addition to the physician services in paragraph (4)(a), Comprehensive Medical Rehabilitation Inpatient Services shall include at least the following services provided by qualified personnel:

1. Rehabilitation nursing;

2. Physical therapy;

3. Occupational therapy;

4. Speech pathology and audiology therapy;

5. Social services;

6. Psychological services; or

7. Orthotic and prosthetic services.

(5) Criteria for Determination of Need.

(a)through (d) No change. 

(e) Special Circumstances for Approval of Expanded Capacity at Hospitals with Licensed Comprehensive Medical Rehabilitation Inpatient Services should the applicant not meet the exemption criteria in Section 408.036(3)(j), F.S.

1. Subject to the provisions of paragraph (7)(b) of this rule and subparagraph 2. of this paragraph, need for additional Comprehensive Medical Rehabilitation Inpatient Beds is demonstrated at a hospital with licensed Comprehensive Medical Rehabilitation Inpatient Services in the absence of need shown under the formula in paragraph (5)(c), and regardless of the most recent average annual district occupancy rate determined under paragraph (5)(d), if the applicant demonstrates need through a need assessment methodology which must include, at a minimum, consideration of the following topics: occupancy rate of the hospital’s licensed Comprehensive Medical Rehabilitation Inpatient Beds was at least 90% percent for at least two consecutive calendar quarters during the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool; and at least one of the following conditions is also met:

a. Population demographics and dynamics; The applicant submits evidence that it has a specialty inpatient rehabilitation service, accredited as a specialty by the Commission on Accreditation of Rehabilitation Facilities (CARF), that is not available elsewhere in the district, and the applicant’s high occupancy occurred in the specialty rehabilitation service beds; or

b. Availability, utilization, and quality of like services in the district; The applicant is a disproportionate share hospital as determined consistent with the provisions of Section 409.911, F.S., and the applicant submits evidence that it has been providing both Medicaid and charity care days in its Comprehensive Medical Rehabilitation Inpatient Beds.

c. Medical treatment trends; and,

d. Market conditions.

2. The existence of unmet need will not be based solely on the absence of Comprehensive Medical Rehabilitation services or beds in the district. The maximum number of additional Comprehensive Medical Rehabilitation Inpatient Beds which may be approved at an applicant’s facility under the provisions of subparagraph 1. shall not normally exceed the number determined in accordance with the following formula:

ADD = ((HPD/PD) × PPD / (365 × .85)) - HLB - HAB

where:

a. ADD equals the net number of additional Comprehensive Medical Rehabilitation Inpatient Beds which may be approved under the provisions of subparagraph 1.

b. HPD equals the hospital’s number of comprehensive medical rehabilitation inpatient days that were included within PD for the District.

c. PPD equals the total of comprehensive medical rehabilitation inpatient days projected for the district at the planning horizon, defined as (PD/P) × PP.

d. .85 equals the desired annual Comprehensive Medical Rehabilitation Inpatient Bed occupancy rate for the hospital at the planning horizon.

e. HLB equals the hospital’s number of licensed Comprehensive Medical Rehabilitation Inpatient Beds included within LB.

f. HAB equals the hospital’s number of approved Comprehensive Medical Rehabilitation Inpatient Beds included within AB.

(f) Other Factors to be Considered in the Review of Certificate of Need Applications for Comprehensive Medical Rehabilitation Inpatient Services.

1. Applicants shall provide evidence in their applications that their proposal is consistent with the needs of the community and other criteria contained in:

a. Local Health Council District Health Plans, including the Certificate of Need Allocation Factors Reports; and,

b. The State Health Plan.

2. Applications from general hospitals for new or expanded Comprehensive Medical Rehabilitation Inpatient Beds shall not normally be approved unless 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 Comprehensive Medical Rehabilitation Inpatient Beds, 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 Comprehensive Medical Rehabilitation Inpatient Beds 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.

(f)(g) Renumbered only. No change

(6) No change.

(7) Quality of Care.

(a) No change.

(b) Licensure Provisions. Accreditation. Applicants proposing a new Ccomprehensive Mmedical Rrehabilitation Iinpatient Sservice shall state how they will comply with the provisions of hospital licensure as defined in 59A-3.066, F.A.C. meet the accreditation standards of the Commission on Accreditation of Rehabilitation Facilities (CARF) and shall state that they will seek accreditation by CARF. Applicants proposing to add beds to a licensed Comprehensive Medical Rehabilitation Inpatient Service shall be accredited by CARF consistent with the standards applicable to comprehensive inpatient rehabilitation or specialized inpatient rehabilitation, as applicable to the facility; or, if not yet eligible for CARF accreditation, the applicants shall have received full Medicare certification as a rehabilitation hospital or rehabilitation unit, as applicable to the facility.

(8) through (9) No change.

(10) Utilization Reports. Facilities providing licensed Comprehensive Medical Rehabilitation Inpatient Services shall provide utilization reports to the Agency department or its designee, as follows: within 45 days after the end of each calendar quarter, facilities shall provide a report of the number of Comprehensive Medical Rehabilitation Inpatient Services discharges and patient days which occurred during the quarter.

(a) Within 45 days after the end of each calendar quarter, facilities shall provide a report of the number of Comprehensive Medical Rehabilitation Inpatient Services discharges and patient days which occurred during the quarter.

(b) Within 45 days after the end of each calendar year, facilities shall provide a report of the number of comprehensive medical rehabilitation inpatient days which occurred during the year, by principal diagnosis coded consistent with the International Classification of Disease (ICD-9).

(11) 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, but shall be applied in the first review cycle commencing subsequent to the effective date of this rule.

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.034(3), 408.035, 408.036(1)(b), (c), (e), (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)(n), Amended 4-30-92, Formerly 10-5.039, Amended 8-24-93, 2-22-95,                            .

 

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: February 24, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 5, 2016