Certificate of Need Related Laws
Continuing
Care Retirement Communities
651.118
Agency
for Health Care Administration; certificates of need; sheltered beds; community
beds.—
(1) The provisions
of this section shall control in the case of conflict with the provisions of
the Health Facility and Services Development Act, ss. 408.031-408.045; the provisions of
chapter 395; the provisions of part II of chapter 400; or the provisions of
part I of chapter 429.
(2) The Agency for Health Care Administration shall issue a
certificate of need to any holder of a provisional certificate of authority
pursuant to s. 651.022 to construct
nursing home beds for the exclusive use of the prospective residents of the
proposed continuing care facility if the holder of the provisional certificate
of authority meets the agency’s applicable review criteria, utilizing the bed
need provisions of subsection (4).
(3) Nursing home beds
located within a continuing care facility for which a certificate of need is
issued pursuant to subsection (2) shall be known as sheltered nursing home
beds.
(4) Not including the residences of residents residing outside
the facility pursuant to a continuing care at-home contract, the Agency for
Health Care Administration shall approve one sheltered nursing home bed for
every four proposed residential units, including those that are licensed under
part I of chapter 429, in the continuing care facility unless the provider
demonstrates the need for a lesser number of sheltered nursing home beds based
on proposed utilization by prospective residents or demonstrates the need for
additional sheltered nursing home beds based on actual utilization and demand
by current residents.
(5) Construction on any
sheltered nursing home beds may not begin until the holder of the provisional
certificate of authority has been issued a certificate of authority under s. 651.021 and a
certificate of need from the Agency for Health Care Administration.
(6) Unless the provider
already has a component that is to be a part of the continuing care facility
and that is licensed under chapter 395, part II of chapter 400, or part I of
chapter 429 at the time of construction of the continuing care facility, the
provider must construct the nonnursing home portion
of the facility and the nursing home portion of the facility at the same time.
If a provider constructs less than the number of residential units approved in
the certificate of authority, the number of licensed sheltered nursing home
beds shall be reduced by a proportionate share.
(7) Notwithstanding
subsection (2), at the discretion of the provider, sheltered nursing home beds
may be used for persons who are not residents of the continuing care facility
and who are not parties to a continuing care contract for up to 5 years after
the date of issuance of the initial nursing home license. A provider whose
5-year period has expired or is expiring may request an extension from the
Agency for Health Care Administration, not to exceed 30 percent of the total
sheltered nursing home beds or 30 sheltered beds, whichever is greater, if the
utilization by residents of the nursing home facility in the sheltered beds
will not generate sufficient income to cover nursing home facility expenses, as
evidenced by one of the following:
(a) The nursing home
facility has a net loss for the most recent fiscal year as determined under
generally accepted accounting principles, excluding the effects of
extraordinary or unusual items, as demonstrated in the most recently audited
financial statement.
(b) The nursing home
facility would have had a pro forma loss for the most recent fiscal year,
excluding the effects of extraordinary or unusual items, if revenues were
reduced by the amount of revenues from persons in sheltered beds who were not
residents, as reported by a certified public accountant.
The Agency for Health Care Administration may grant an
extension to the provider based on the evidence required in this subsection.
The Agency for Health Care Administration may request a continuing care facility
to use up to 25 percent of the patient days generated by new admissions of
nonresidents during the extension period to serve Medicaid recipients for those
beds authorized for extended use if there is a demonstrated need in the
respective service area and if funds are available. A provider who obtains an
extension is prohibited from applying for additional sheltered beds under
subsection (2), unless additional residential units are built or the provider
can demonstrate need by continuing care facility residents to the Agency for
Health Care Administration. The 5-year limit does not apply to up to five
sheltered beds designated for inpatient hospice care as part of a contractual
arrangement with a hospice licensed under part IV of chapter 400. A continuing
care facility that uses such beds after the 5-year period shall report such use
to the Agency for Health Care Administration. For purposes of this subsection,
“resident” means a person who, upon admission to the continuing care facility,
initially resides in a part of the continuing care facility not licensed under
part II of chapter 400, or who contracts for continuing care at-home.
(8) A provider may
petition the Agency for Health Care Administration to use a designated number
of sheltered nursing home beds to provide extended congregate care as defined
in s. 429.02 if the beds are in
a distinct area of the nursing home which can be adapted to meet the
requirements for extended congregate care. The provider may subsequently use
such beds as sheltered beds after notifying the agency of the intended change.
Any sheltered beds used to provide extended congregate care pursuant to this
subsection may not qualify for funding under the Medicaid waiver. Any sheltered
beds used to provide extended congregate care pursuant to this subsection may
share common areas, services, and staff with beds designated for nursing home
care, provided that all of the beds are under common ownership. For the
purposes of this subsection, fire and life safety codes applicable to nursing
home facilities shall apply.
(9) This section does not
preclude a provider from applying to the Agency for Health Care Administration
for a certificate of need for community nursing home beds or a combination of
community and sheltered nursing home beds. Any nursing home bed located in a
continuing care facility which is or has been issued for nonrestrictive use
retains its legal status as a community nursing home bed unless the provider
requests a change in status. Any nursing home bed located in a continuing care
facility and not issued as a sheltered nursing home bed before 1979 must be
classified as a community bed. The Agency for Health Care Administration may
require continuing care facilities to submit bed utilization reports for the
purpose of determining community and sheltered nursing home bed inventories
based on historical utilization by residents and nonresidents.
(10) Whenever the
department has been appointed receiver of a provider pursuant to the provisions
of part I of chapter 631, the receiver may petition, upon approval of the court
having jurisdiction as being in the best interest of the residents, the Agency
for Health Care Administration for the conversion of sheltered nursing home
beds of the facility to community nursing home beds. The agency shall, upon
petition of the receiver and through an expedited review, issue a certificate
of need converting the sheltered nursing home beds to community nursing home
beds. The court having jurisdiction of the delinquency proceeding shall enforce
the provisions of this section.
(11) For a provider
issued a provisional certificate of authority after July 1, 1986, to operate a
facility not previously regulated under this chapter, the following criteria
must be met in order to obtain a certificate of need for sheltered beds
pursuant to subsections (2), (3), (4), (5), (6), and (7):
(a) Seventy percent or more of the current residents hold
continuing care or continuing care at-home contracts or, if the facility is not
occupied, 70 percent or more of the prospective residents will hold such
contracts as projected in the feasibility study and demonstrated by the
provider’s marketing practices; and
(b) The continuing care
or continuing care at-home contracts entered into or to be entered into by 70
percent or more of the current residents or prospective residents must provide
nursing home care for a minimum of 360 cumulative days, and such residents
shall be charged at rates that are 80 percent or less than the rates charged by
the provider to persons receiving nursing home care who have not entered into
such contracts.
(12) A facility
that is under administrative supervision for financial problems pursuant to s. 651.018 may petition the
Agency for Health Care Administration for the conversion of sheltered beds to
community nursing home beds in accordance with the corrective action plan
approved by the office. The agency shall, upon petition by the facility and
through an expedited review, issue a certificate of need converting the
sheltered nursing home beds to community nursing home beds.
(13) Residents, as
defined in this chapter, are not considered new admissions for the purpose of
s. 400.141(1)(o)1.d.
History.—ss. 11, 12, ch. 86-209; s. 48, ch. 87-92; s.
12, ch. 93-22; s. 1, ch.
94-206; s. 4, ch. 96-363; s. 13, ch.
97-82; s. 24, ch. 97-229; s. 15, ch.
2000-256; s. 16, ch. 2000-318; s. 4, ch. 2002-222; s. 1692, ch.
2003-261; s. 13, ch. 2004-298; s. 104, ch. 2006-197; s. 73, ch.
2009-223; s. 15, ch. 2011-193.
