1. Certificate of Need (CON) Introductory Presentation to the State Consumer Health Information and Policy Advisory Council September 13, 2012

2. What is CON? CON means a written statement issued by the agency evidencing community need for a new, converted, expanded, or otherwise significantly modified health care facility, health service, or hospice. 2

3. Brief History of CON in Florida Program has been in operation since July 1973. From 1974 through 1986, the program was largely controlled by federal law, which established the type of services subject to CON review, review procedures and review criteria. Each state was expected to have a CON program in compliance with federal standards as a condition for obtaining federal funds (Medicare and Medicaid). Federal health planning legislation was repealed in 1986. Major amendments to the Florida CON program occurred in 1987, 1997, 2000, 2004, 2007 and 2008. 3

4. 4 Which Florida Health Care Providers Need CONs Hospices Hospitals Skilled Nursing Facilities Intermediate Care Facilities for the Developmentally Disabled

5. Types of CON Review Comparative review Expedited review Exemptions Notifications 5

6. Projects Subject to Comparative CON Review Hospital Beds & Facilities Batching Cycle New Hospital facilities Replacement hospital facilities if being replaced more than a mile away New neonatal level II and level III units unless exempt per s. 408.036(3)(l) F.S. Comprehensive medical rehabilitation beds unless exempt per s. 408.036(3)(j) F.S. General Hospital as provided in s. 408.037(2) F.S. 6

7. Other Beds and Programs Batching Cycle Hospice Programs, New Hospice Inpatient Facilities Organ Transplantation (Heart, Lung, Kidney, Liver, Pancreas & Islet Cells, Intestines, and Bone Marrow) Pediatric Open Heart Surgery & Pediatric Cardiac Catheterization Community Nursing Home Projects, unless exempt Replacement Nursing Home Projects if being replaced more than three miles away Intermediate Care Facilities for the Developmentally Disabled 7 Projects Subject to Comparative CON Review

8. Comparative Review Process (Initial Phase) AgencyProvider 1.Calculates and publishes need by service and planning area 2.Receives and publishes letters of intent from providers Submits letter of intent 3.Receives and publishes “grace period” letters of intent from competitors Submits competing letter of intent 4.Receives initial application and feeSubmits application and fee or declines to submit 5.Analyzes application and prepares list of omissions 6.Receives final application and feePrepares and submits final application and fee or declines to submit 7.Analyzes application and prepares report with initial application Receives initial agency decision 8.Issues CONDecides whether to appeal a denial or challenge a competitor’s approval 8

9. Comparative Review Process (Litigation Phase) ProviderAgency 1.Appeals CON denial or challenges a competitor’s approval Case referred to hearing at Division of Administrative Hearings (DOAH) 2.Defends CON approval or challenges a denial in DOAH hearing Defends AHCA decision in hearing DOAH issues recommended order Agency analyzes recommended order and issues final order 3.Appeals CON denial or challenges a competitor’s approval in District Court AHCA issues CON 4.Defends a CON approval or challenges a denial in District Court Defends AHCA decision in District Court 9

10. CON Review Activity Hospitals & Nursing Homes Calendar Year2000200520102011 Hospital Applications74391715 10 Calendar Year2000200520102011 Nursing Home Applications 17514

11. CON Review Activity Hospice Programs & New Inpatient Facilities Calendar Year 2000200520102011 New Programs 614180 Inpatient Units41015 11

12. Thank you and any questions The CON Website has a wealth of information. CON Website james.mclemore@ahca.myflorida.com 12