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zip codes. Unpopulated zip codes such as P.O. Boxes, Post Office Substations, and unique zip codes are excluded.

Nursing Facility Preference Statements

In addition to the generic preference statements that apply to all CON applications, the Council has adopted the following preference statements specific to nursing homes. For both competing and non-competing applications, preference shall be given to:

1. Applicants that will locate in a county or a geographic area defined in the state rules (Chapter 59C-2.200 (3) (d) of Florida Administrative Code) in which more than one-third of the residents age 65 and older live below poverty level based on the latest U.S. census report and the proposed nursing home will be located well within a low income area (a low income area within a zip code or census tract where at least one-third of the senior citizens live below poverty level).

2. Applicants that document to locate in a county or defined sub county area within a county as defined in the state rules (Chapter 59C-2.200 (3) (d) of Florida Administrative Code) in which there is a net outflow of at least 20 percent of nursing home patients leaving the Subregion for nursing home placement, based on the Local Health Council's most recent nursing home patient origin study. Net outflow equals the number of nursing home residents leaving the Subregion minus the number coming into the county or geographic area for nursing home care. Based on a nursing facility patient origin study conducted during March 2003, north Duval County in Subregion 1qualifies for special consideration. A summary of where residents of Northeast Florida seek nursing home care is provided in Appendix Table G-2.

3. For urban areas, applicants who will locate in an area highly accessible in terms of public and private transportation-within one mile from a major artery or within three blocks from a bus stop.

4. Applicants who propose to expand a nursing home with less than 120 beds (if applicant can conclusively demonstrate that economies of scale will result).

5. Extenuating Circumstances - Subregion 1. Florida Administrative Code provides that additional beds may be considered in a Subregion when the number of persons with a documented need exceeds the number of licensed but unoccupied and currently approved nursing home beds (Chapter 59C-1.030, F.A.C.). Even if no bed need is shown, special consideration may be given to an applicant proposing additional beds in Subregion 1, north Duval County based on the access criteria in rule 59C-1.030. It is a high poverty area. Large numbers are leaving the Subregion for placement due to a lack of beds.

6. Applicants who include in their CON application specific plans detailing how they intend to address the mental health needs of their clients including having a skilled provider in the recognition and treatment of mental health problems.

7. Applicants who document that there project address an unmet need for the nursing home placement of persons with a specific debilitating illness. Applicant must document that a need exists. (Previously, hospital discharge planners reported having difficulty placing ventilator and tracheotomy patients.)

8. Applicants who have current JCAHO accreditation or the Gold Seal Award in existing facilities.

9. Applicants who propose to locate in or transfer beds to an existing or replacement facility in a county or defined sub county area within a subregion (such as north, southwest, or

southeast Duval), with a licensed bed occupancy rate of at least 91 percent for the most recent 12 -month period prior to their initial written request to the state and no additional beds are approved.

10. Applicants who represent large retirement complexes that are not regulated under Chapter 651, F.S. as continuing care retirement communities (CCRCs) and who can demonstrate major difficulty and/or inconvenience in placing their residents into nursing homes. A commendable intent of most large retirement complexes is to provide a wide range of services to elderly frail persons at one location. The criteria reinforce this effort, especially when alternative community resources are not readily available to the retirement center clients.

Hospital-Based Skilled Nursing Units

A hospital-based skilled nursing unit (SNU) is a distinct part of a hospital licensed under chapter 395, F.S. containing Medicare and Medicaid certified skilled nursing inpatient beds, and used for the provision of skilled nursing and related services to patient who require medical or nursing care, or services for the rehabilitation of injured, disabled, or sick persons.

Service Areas

Region IV has been divided into five subregions for the purpose of planning for hospital-based skilled nursing unit bed need. These subregions identified below correspond with the acute care subregions described in F.A.C. Chapter 59C-2.100 as stated in the Hospital-Based Skilled Nursing Units rules by the Agency for Health Care Administration effective April 7, 2002.

Subregion 1 includes Nassau County and the northern portion of Duval County. North Duval

County includes zip codes 32202, 32206, 32208, 32209, 32218, 32219, 32220, 32226 and 32254.

Subregion 2 includes Baker County, Clay County and the southwestern portion of Duval County.

Southwest Duval includes zip codes 32204, 32205, 32210, 32212, 32215, 32221, 32222, 32234, and 32244.

codes 32207, 32211, 32216, 32217, 32223, 32224, 32225, 32228, 32233, 32246, 32250, 32256, 32257, 32258, 32266 and 32277.

Subregion 4 includes Flagler County and east Volusia County. Little Haw Creek and Deep Creek

form the western boundaries for east Volusia County. East Volusia County includes zip codes 32114, 32117, 32118, 32119, 32124, 32127, 32132, 32141, 32168, 32169, 32174, 32176, and 32759.

Subregion 5 consists of west Volusia County, which is that portion of Volusia County located west

of Little Haw Creek and Deep Creek. West Volusia County includes zip codes 32130, 32180, 32190, 32706, 32713, 32720, 32724, 32725, 32738, 32744, 32763, and 32764.

The zip codes used to define subregion areas reflect established U.S. Postal Service mail delivery zip codes. Unpopulated zip codes such as P.O. Boxes, Post Office Substations, and unique zip codes are excluded.

Hospital-Based Skilled Nursing Unit Preference Statements

1. Applicants who propose to convert unused hospital beds to skilled nursing care beds when approval does not bring their occupancy rate for the existing hospital service above 70 percent.

2. Applicants who do not currently have skilled care beds.

3. Applicants who would have no more than 25 skilled care beds or one skilled care bed for every 10 acute care beds (whichever is lower) when the project is completed.

4. The applicant with the subregion’s lowest ratio of hospital-based skilled nursing beds to acute care beds.

5. Applicants who have written continuity of care agreements (included in their CON application) with area nursing homes, assisted living facilities, etc.

6. Applicants who document in their CON request that they frequently have difficulty placing patients into nursing homes.

Hospice Program

Hospice programs as described in Florida Statues provide a continuum of palliative and supportive care for the terminally ill patient and his family. Hospice services are available 24 hours a day, 7 days a week, and must be available to all terminally ill persons and their families without regard to age, gender, national origin, sexual orientation, disability, diagnosis, cost of therapy, ability to pay or life circumstances. The table for Hospice admissions by county for calendar year 2002 is provided in Appendix G-3.

Service Areas

The Agency has designated specific service areas for each region in the state. Region IV has been divided into two service areas for the purpose of planning for hospice programs. Service Area 4A consists of Baker, Clay, Duval, Nassau and St. Johns Counties. Service Area 4B consists of Flagler and Volusia Counties.

Hospice Program Preference Statements

In addition to the generic preference statements, which apply to all CON applications, the Council has adopted the following preference statements specific to hospice programs. For both competing and non-competing applications, preference shall be given to:

1. Applicants who propose in their CON application to be based in a county that has the lowest rate of hospice clients per 100 resident cancer deaths, based on the most current Vital

Statistic Report published by the Department of Health.

2. Applicants who propose to use existing licensed hospital and skilled nursing facility beds. 3. Applicants who document in their CON proposal that they have written agreements with a

broad spectrum of service providers, for the purpose of ensuring continuity of care.

Long Term Care Hospitals

Long-term care hospitals are designed to provide extended medical and rehabilitative care for patients who are clinically complex and have multiple acute or chronic conditions. Long-term care hospitals are licensed under Chapter 395, F.S., and are free standing facilities or designated as a hospital within a hospital.

Service Areas

The state and the Health Planning Council of Northeast Florida plan for long term care beds on a region wide basis.

1. Applicants who propose to convert licensed unused beds or use existing space rather than new construction, including space created by previous voluntary delicensure of unused beds.

2. Existing facilities that have experienced an average occupancy rate over 90% for the

most current 12-month period when the number of beds requested is 20 beds or less. For the purpose of this preference, the specific time periods and the formula to calculate occupancy rates is provided in the current proposed rule 59C-1.045 Long-Term Care Hospital Beds. 3. Applicants proposing to acquire or consolidate facilities where it can be demonstrated that

services will be improved and cost to the public will be reduced.

4. Applicants who submit copies in their CON application of current written patient transfer agreements with providers of health care health services that may include, short-term general hospitals, skilled nursing facilities, intermediate care facilities, home health agencies, hospice programs or other types of institution.

5. Applicants who have demonstrated quality of care standards by achieving and maintaining JCAHO accreditation. This preference only applies to existing facilities.

6. Applicants who formally commit to provide Medicaid and/or charity care and specify the annual amount of Medicaid and/or charity care to be provided in their CON application.

APPENDICES