59C-1.039. Comprehensive Medical Rehabilitation Inpatient Services

(1) Agency Intent. 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) “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) “Charity Care.” As defined in Section 409.911(1), F.S.

(d) “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.

(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 which meets the provisions of Section 395.002(12), 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 would have a planning horizon of July 2021; an application submitted in September 2016 would have a planning horizon of January 2022.

(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 hospital inpatient general psychiatric beds, hospital inpatient substance abuse beds, Level II and Level III Neonatal Intensive Care Unit Beds; and the Comprehensive Medical Rehabilitation Inpatient Beds regulated under this rule.

(l) “Specialty Hospital.” 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) Service Location. The Comprehensive Medical Rehabilitation Inpatient Services regulated under this rule may be provided in a hospital licensed as a general hospital or licensed as a specialty hospital.

(b) Separately Organized Units. Comprehensive Medical Rehabilitation Inpatient Services shall be provided in one or more separately organized units within a general hospital or specialty hospital.

(c) Minimum Number of Beds. A general hospital providing Comprehensive Medical Rehabilitation Inpatient Services should normally have a minimum of 20 Comprehensive Medical Rehabilitation Inpatient Beds. A specialty hospital providing Comprehensive Medical Rehabilitation Inpatient Services shall have a minimum of 60 Comprehensive Medical Rehabilitation Inpatient Beds. Hospitals with licensed or approved Comprehensive Medical Rehabilitation Inpatient Beds as of the effective date of this rule are exempt from meeting the requirements for a minimum number of beds.

(d) Conformance with the Criteria for Approval. A Certificate of Need for the establishment of new Comprehensive Medical Rehabilitation Inpatient Services, the construction or addition of new Comprehensive Medical Rehabilitation Inpatient Beds, or the conversion of licensed hospital acute care beds to Comprehensive Medical Rehabilitation Inpatient 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.

(e) Medicare and Medicaid Participation. An applicant proposing to increase the number of licensed Comprehensive Medical Rehabilitation Inpatient Beds at its facility shall participate in the Medicare and Medicaid programs. Applicants proposing to establish a new comprehensive medical rehabilitation inpatient service shall state in their application that they will participate in the Medicare and Medicaid programs.

(f) Comparative Review. A Certificate of Need application submitted for review under this rule will be subject to a comparative review with all other Certificate of Need applications subject to review under this rule that propose to serve the same district and which were submitted during the same review cycle.

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

(4) 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,

5. Social services,

6. Psychological services, or

7. Orthotic and prosthetic services.

(5) Criteria for Determination of Need.

(a) Bed Need. A favorable need determination for proposed new or expanded Comprehensive Medical Rehabilitation Inpatient Services shall not normally be made unless a bed need exists according to the numeric need methodology in paragraph (5)(c) of this rule.

(b) Fixed Bed Need Pool. The future need for Comprehensive Medical Rehabilitation Inpatient Services shall be determined twice a year and published by the Agency as a Fixed Bed Need Pool for the applicable planning horizon.

(c) Need Formula for Comprehensive Medical Rehabilitation Inpatient Beds. The net bed need for Comprehensive Medical Rehabilitation Inpatient Beds in each District shall be calculated in accordance with the following formula:

NN = ((PD/P) × PP / (365 × .85))

– LB – AB

where:

1. NN equals the net need for Comprehensive Medical Rehabilitation Inpatient Beds in a District.

2. PD equals the number of inpatient days in Comprehensive Medical Rehabilitation Inpatient Beds in a district for the 12-month period ending 6 months prior to the beginning date of the quarter of the publication of the Fixed Bed Need Pool.

3. P equals the estimated population in the district. For applications submitted between January 1 and June 30, P is the population estimate for January of the preceding year; for applications submitted between July 1 and December 31, P 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 Department at least 4 weeks prior to publication of the Fixed Bed Need Pool.

4. PP equals the estimated population 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 Department at least 4 weeks prior to publication of the Fixed Bed Need Pool.

5. .85 equals the desired average annual occupancy rate for Comprehensive Medical Rehabilitation Inpatient Beds in the district.

6. LB equals the district’s number of licensed Comprehensive Medical Rehabilitation Inpatient Beds as of the most recent published deadline for Agency initial decisions prior to publication of the Fixed Bed Need Pool.

7. AB equals the district’s number of approved Comprehensive Medical Rehabilitation Inpatient Beds, as determined consistent with the provisions of paragraph (2)(a) of this rule.

(d) Most Recent Average Annual District Occupancy Rate. Regardless of whether bed need is shown under the need formula in paragraph (5)(c), no additional Comprehensive Medical Rehabilitation Inpatient Beds shall normally be approved for a district unless the average annual occupancy rate of the licensed Comprehensive Medical Rehabilitation Inpatient Beds in the district was at least 80% 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.

(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:

a. Population demographics and dynamics,

b. Availability, utilization, and quality of like services in the district,

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.

(f) Priority Considerations for Comprehensive Medical Rehabilitation Inpatient Services Applicants. In weighing and balancing statutory and rule review criteria, the Agency will give priority consideration to:

1. An applicant that is a disproportionate share hospital as determined consistent with the provisions of Section 409.911, F.S.

2. An applicant proposing to serve Medicaid-eligible persons.

3. An applicant that is a designated trauma center, as defined in Rule 64J-2.011, F.A.C.

(6) Access Standard. Comprehensive Medical Rehabilitation Inpatient Services should be available within a maximum ground travel time of 2 hours under average travel conditions for at least 90 percent of the district’s total population.

(7) Quality of Care.

(a) Compliance with Agency Standards. Comprehensive Medical Rehabilitation Inpatient Services shall comply with the Agency standards for program licensure described in Chapter 59A-3, F.A.C. Applicants who submit an application that is consistent with the Agency licensure standards are deemed to be in compliance with this provision.

(b) Licensure Provisions. Applicants proposing a new Comprehensive Medical Rehabilitation Inpatient Service shall state how they will comply with the provisions of hospital licensure as defined in Rule 59A-3.066, F.A.C.

(8) Services Description. An applicant for Comprehensive Medical Rehabilitation Inpatient Services shall provide a detailed program description in its Certificate of Need application including:

(a) Age groups to be served.

(b) Specialty inpatient rehabilitation services to be provided, if any (e.g. spinal cord injury; brain injury).

(c) Proposed staffing, including qualifications of the medical 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 Comprehensive Medical Rehabilitation Inpatient Services.

(d) A plan for recruiting staff, showing expected sources of staff.

(e) Expected sources of patient referrals.

(f) Projected number of Comprehensive Medical Rehabilitation Inpatient Services 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.

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

(9) Applications from Licensed Providers of Comprehensive Medical Rehabilitation Inpatient Services. A facility providing licensed Comprehensive Medical Rehabilitation Inpatient Services seeking Certificate of Need approval for additional Comprehensive Medical Rehabilitation Inpatient Beds shall provide the following information in its Certificate of Need application in addition to the information required by subsection (8):

(a) Number of Comprehensive Medical Rehabilitation Inpatient Services admissions and 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.

(b) Number of Comprehensive Medical Rehabilitation Inpatient 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) Current staffing.

(e) Current specialty inpatient rehabilitation services, if any (e.g. spinal cord injury; brain injury).

(10) Utilization Reports. Facilities providing licensed Comprehensive Medical Rehabilitation Inpatient Services shall provide utilization reports to the Agency or its designee 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.

Rulemaking Authority 408.034(3), (8), 408.15(8) FS. Law Implemented 408.034(3), 408.035, 408.036(1)(b), (c), (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, 7-2-17.