AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NO.:RULE TITLE:
59A-3.065Definitions
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 45 No. 61, March 28, 2019 issue of the Florida Administrative Register.
59A-3.065 Definitions.
In addition to definitions contained in chapters 395 and 408, part II, F.S., the following definitions shall apply specifically to hospitals, as used in rules 59A-3.065-.310, F.A.C.:
(1) “Adult congenital patient” means a person who is age 18 years or and over, and who previously received pediatric cardiac services for congenital heart disease, or who was referred for specialized procedures for congenital heart disease. A hospital authorized to provide pediatric cardiac services may provide those the services to adult congenital patients regardless of the age of the patient.
(2) “Adult” means a person who is age 18 years or and older.
(3) through (10) No change.
(11) “Complex Neonatal Surgery” means any surgical procedure performed upon a neonate by a practitioner licensed under the provisions of Chapters 458 or 459, F.S., and credentialed to perform pediatric surgical procedures licensed under the provisions of Chapters 458 or 459, F.S., which are is associated with entry into or traversing a body cavity, such as the abdomen, thorax, or cranium, with a requirement for either general anesthesia or conscious sedation. Such procedures shall only be performed in hospitals licensed under the provisions of Chapter 395, F.S., providing Level III or Level IV Neonatal Intensive Care Services. Specific licensure pursuant to Rules 59A-3.246 or 59A-3.248 is required to perform pediatric transplants or pediatric cardiac services, respectively.
(12) through (14) No change.
(15) “Diagnostic cardiac catheterization procedure” means a medical procedure requiring the passage of a catheter into one or more cardiac chambers of the left and right heart, with or without coronary arteriograms, for the purpose of diagnosing congenital or acquired cardiovascular diseases, or for measuring determining measurement of blood pressure and flow. Cardiac catheterization also includes the selective catheterization of the coronary ostia with injection of contrast medium into the coronary arteries. A single session with a patient in the hospital’s cardiac catheterization procedure room, irrespective of the number of specific procedures performed during the session shall be counted as one procedure.
(16) through (24) No change.
(25) “Immediately available” means on the premises where pediatric cardiac services are being performed.
(26) “Inpatient beds” means accommodations with supporting services for patients who are admitted by physician order with the expectation that the patient would stay in excess of 24 hours and occupy a bed. Bed types include:
(a) No change.
(b) “Adult psychiatric bed” means a bed within a physically and functionally distinct unit of a hospital and for the exclusive provision use of inpatient psychiatric services to adult patients whose sole diagnosis or principal diagnosis is a psychiatric disorder;
(c) “Adult substance abuse bed” means a bed within a physically and functionally distinct unit of a hospital and for the exclusive provision use of inpatient substance abuse services to adult patients whose sole diagnosis or principal diagnosis is a substance abuse disorder;
(d) “Child psychiatric bed” means a bed within a physically and functionally distinct unit of a hospital and for the exclusive provision use of inpatient psychiatric services to pediatric patients whose sole diagnosis or principal diagnosis is a psychiatric disorder;
(e) “Child substance abuse bed” means a bed within a physically and functionally distinct unit of a hospital and for the exclusive provision use of providing hospital inpatient substance abuse services to pediatric patients whose sole diagnosis or principal diagnosis is a substance abuse disorder;
(f) “Comprehensive medical rehabilitation bed” means a bed in a rehabilitation hospital or within a physically and functionally distinct unit of a hospital for the exclusive use of providing 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, 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;
(g) No change.
(h) “Long term care bed” means an acute care bed within a Class I long term care hospital for the treatment of medically complex patients;
(i) “Neonatal intensive care unit bed or NICU bed” means a patient care station within a physically and functionally distinct unit in which Level II, III, or IV nNeonatal iIntensive cCare sServices are provided;
(j) “Skilled nursing unit bed” means an acute care bed within a physically and functionally distinct unit of a hospital in which short term care and rehabilitation services are provided by licensed practical nurses and registered professional nurses.
(27) through (30) No change.
(31) “Neonatal Care Services” means the aspect of perinatal medicine pertaining to the care of neonates. Hospitals providing neonatal care are classified according to the following intensity and specialization of the care that can be provided:
(a) “Level I Neonatal Services” means well-baby care services, which include sub-ventilation care, intravenous feedings, intravenous medications, and gavage to neonates. Level I services are restricted to neonates born at 35 weeks gestation or later and considered low risk. Level I Neonatal Services do not include ventilation assistance except for resuscitation and stabilization. Upon beginning ventilation, the hospital shall implement a patient treatment plan which shall include the transfer of the neonate to a hospital with Level II, III, or IV Neonatal Intensive Care Services at such time that it becomes apparent that ventilation assistance will be required beyond the neonate’s resuscitation and stabilization. The hospital shall establish a triage procedure to assess the need for transfer of obstetrical patients to hospitals with Level II, III, or IV Neonatal Intensive Care Services prior to their delivery where there is an obstetrical indication that resuscitation will be required for their neonates. Hospitals that do not have licensed NICU beds may only perform Level I neonatal services.
(b) “Level II Neonatal Intensive Care Services” means Level I neonatal services plus mechanical ventilation or continuous positive airway pressure for less than 24 hours. A Level II NICU must have at least one person at all times capable of providing either continuous positive airway pressure and/or mechanical ventilation for a brief period. Level II services are restricted to neonates born at greater than or equal to 32 weeks gestation, weigh greater than or equal to 1,500 grams birth weight, and/or who have physiologic immaturity or are moderately ill, but are expected to recover rapidly and not require any subspecialty services. All neonates born earlier than 32 weeks gestation, weigh less than 1,500 grams birth weight, and/or require one or more of the Level III or Level IV services shall be transferred to a hospital with Level III or Level IV Neonatal Intensive Care Services. Level II Neonatal Intensive Care Services may be provided for neonates born earlier than 32 weeks gestation, less than 1,500 grams birth weight, or require subspecialty services, but only while waiting to transport the neonate to a hospital with Level III or IV Neonatal Intensive Care Services.
(c) “Level III Neonatal Intensive Care Services” means Level II services plus the capability of providing sustained life support and ongoing assisted ventilation for periods longer than 24 hours, which include continuous conventional ventilation, high-frequency ventilation, and/or inhaled nitric oxide. Level III services must include advanced imaging capabilities with urgent interpretation. Level III services are restricted to infants born less than or equal to 32 weeks of gestation, weigh less than 1,500 grams birth weight, and/or have a critical illness regardless of gestational age or birth weight. Hospitals with Level III services must have the staff listed in subsection 59A-3.249(3), F.A.C. available to provide emergency care as needed, and may provide complex neonatal surgery excluding pediatric cardiac services as defined in this rule.
(d) “Level IV Neonatal Intensive Care Services” means Level III services plus the hospital must have the capability to provide continuous onsite surgical repair of complex congenital or acquired conditions in neonates.
(31)(32) “Neonatal intensive care unit” or “NICU” means a physically and functionally distinct unit of a hospital and for the exclusive provision of neonatal intensive care services Neonatal Intensive Care Unit.
(33) through (39) renumbered (32) through (38) No change.
(39)(40) “Pediatric cardiac services” means integrated hospital services providing age-appropriate diagnostic and interventional cardiac catheterization and cardiovascular surgical services on the premises of the hospital and available 24 hours per day, 7 days per week to pediatric and adult congenital patients. Hospitals providing pediatric cardiac services must have the capability to provide treatment of penetrating and blunt force cardiac injury, valvuloplasty, echocardiography, cardiac electrophysiology, advanced cardiac imaging, post-operative intensive care, and outpatient cardiac clinic services. For the purpose of Rule 59A-3.248, F.A.C., cardiovascular surgical services do not include heart transplantation.
(41) through (64) renumbered to (40) through (63) No change.
(64)(65) “Transplantation Program” means the offering of administrative, medical, surgical, and support services by a hospital through which one or more types of organ transplants are provided to one or more patients; and/or and the offering of some or all phases of bone marrow transplantation.
(66) through (67) renumbered to (65) through (66) No change.
Rulemaking Authority 395.1055 FS. Law Implemented 395.1023, 395.1055 FS. History–New 9-4-95, Formerly 59A-3.201, Amended 10-16-14,_______.
