Fla. Admin. Code Ann. R. 59A-3.066 - Licensure Procedure

(1) No person or entity shall establish, conduct, or maintain a hospital in this state without first obtaining a license.

(2) All applicants or licensees requesting licensure for the operation of a hospital under the provisions of Chapter 395, F.S., must make application to the Agency as required by Rule 59A-35.040 and 59A-35.060, F.A.C.

(a) The following documents must be available for review by the Agency at the licensure inspection:

1. Governing authority bylaws, rules and regulations, or other written organization plan;

2. Organized professional staff bylaws, rules and regulations;

3. The hospital's fire and Comprehensive Emergency Management Plans;

4. Roster of organized medical staff members;

5. Nursing procedure manual;

6. Roster of registered nurses, licensed practical nurses, emergency medical technicians and paramedics with current registration number; and

7. A copy of the child abuse and neglect policy as specified in Rule 59A-3.280, F.A.C.

(b) An application for initial licensure will not be accepted unless plans and specifications as required by Section 395.0163, F.S., have been received by the Agency's Office of Plans and Construction.

(c) An application for a change of ownership will not be approved until the Agency receives written confirmation signed by the buyer and the seller that the ownership transfer is complete and specifying the effective date.

(d) An application for change during licensure period is required to amend the classification, addresses, emergency services, licensed programs, bed capacity and type, administrative personnel, board members, and less than 51% change of controlling interests.

(e) All permanent changes to the street address, hospital-based off-campus emergency departments and outpatient surgical center addresses, and the constructed bed capacity or bed type must be:

1. Approved by the Agency's Office of Plans and Construction, pursuant to Section 395.0163, F.S., and Rule 59A-3.080, F.A.C.;

2. In compliance with life safety codes pursuant to Sections 408.811 and 395.0161, F.S., except the life safety code inspection for a change in bed type in which life safety requirements are identical may be postponed until the next scheduled inspection; and,

3. Amended on the license prior to occupancy.

(f) Evidence of medical malpractice insurance as provided for under Section 395.1061, F.S., must be submitted annually to the Agency.

(g) Upon receipt of a completed initial application the Agency will conduct an inspection of the facility to determine compliance with Chapter 395, Part I, F.S., and Rules 69A-3.012 and 59A-3.065 -.310, F.A.C.

(h) When the applicant and hospital are in compliance with Chapter 395, Part I, F.S., and Rules 69A-3.012 and 59A-3.065 through 59A-3.310, F.A.C., and have received all approvals required by law, the Agency will issue a license.

(i) A single license number will be issued to a licensee for facilities located on separate premises, upon request of the applicant in accordance with Section 395.003(2), F.S. Each license certificate issued under a single license number will include the information listed in subsection (3) and shall have a common mailing address. There shall be one chief executive officer and one medical staff for the facilities issued a single license number.

(3) Each license will specifically state the name of the licensed operator of the hospital, the class of hospital, the emergency services, if applicable, licensed programs, bed capacity, and the name and location of the hospital.

(4) No licensed facility shall continuously operate a number of hospital beds greater than the number indicated by the Agency on the face of the license.

(5) Hospitals shall not lease a portion of their licensed beds to another entity or facility, except for hospices licensed pursuant to Chapter 400, Part IV, F.S.

(6) The collocation of any residential program on the premises of a licensed hospital requires prior approval from the agency, based on the following criteria:

(a) Health, safety, and welfare cannot be jeopardized for any individual;

(b) The essential needs of patients must be met; and,

(c) The facility must be staffed to meet the essential needs of patients.

(7) All hospitals must make available on their Internet websites a description of and link to the Agency's webpage which contains the hospital patient charge and performance outcome data that is collected pursuant to Section 408.061(1), F.S. and, if requested, hospitals must provide a hard copy of the description and the link.

(8) Each hospital must designate a mailing address and a street address. All additional addresses under the administrative control of the hospital and operated as a department of the hospital must be identified as hospital-based off-campus emergency departments, outpatient surgery centers, urgent care centers, or off-site outpatient locations.

(9) Each hospital must be designated by a distinctive name, and the name may not be changed without first notifying the Agency's licensing unit and receiving approval in writing. Duplication of an existing hospital name is prohibited in new hospitals. Fictitious names must be registered with the Florida Department of State Division of Corporations, as required by the Department of State.

(10) A hospital may be designated as a statutory teaching hospital, behavioral health teaching hospital, or family practice teaching hospital upon documentation of the qualifications to the satisfaction of the Agency.

(a) Statutory Teaching Hospital (STH). A hospital meeting the definition of teaching hospital per s. 408.07, F.S. may petition the Secretary of the Agency for STH designation. The petition must contain evidence of:

1. A contract or other document confirming an affiliation with an accredited Florida medical school;

2. At least seven accredited graduate medical education programs verifying the number of approved resident slots, number of currently filled resident slots, training locations, and length of training at each location for the program year(s) for each program; and

3. Presence of 100 or more full-time equivalent (FTE) residents verifying the name and license number of each resident by program, program year, and allocated FTE value.

(b) Behavioral Health Teaching Hospital (BHTH). To be designated as BHTH, a hospital currently designated as STH must submit a change during licensure period application with documentaion verifying that the requirements of (b) through (e) of Section 395.902(2), F.S. are met.

(c) Family Practice Teaching Hospital (FPTH). To be designated as FPTH, a hospital must submit a change during licensure period application with documentaion of all graduate medical education programs offered at the hospital, verifying the number of approved resident slots and number of filled resident slots for each program. To maintain the designation, the hospital must document meeting the requirements of Section 395.806(1)(c) and (2), F.S

(11) A hospital meeting the qualifications per Section 395.607, F.S. may apply to convert its current classification to Class V rural emergency hospital by submitting a change during licensure period application. The application will not be approved unless the hospital:

(a) Removes inpatient beds from its licensed bed inventory, except for skilled nursing beds;

(b) Has a current transfer agreement with a Level I or Level II trauma center;

(c) Submits a plan outlining the hospital's actions for conversion to and operation as a rural emergency hospital, including;

1. A transition plan identifying the hospital services retained, modified, added, and discontinued;

2. A service plan identifying staffing provisions and number and type of qualified staff to provide emergency services, observation care, outpatient services, and other medical and health services provided by the hospital;

3. A financial plan detailing how the hospital intends to use the additional Medicare facility payment to support such services as operation and maintenance of the facility and the provision of outpatient and support services; and

(d) Submits an attestation of compliance for rural emergency hospital enrollment and conversion, stating the hospital is currently enrolled in the Medicare program as a rural hospital with not more than 50 beds, or a critical access hospital, and is in compliance with the Conditions of Participatieon in 42 C.F.R., Part 485, Subpart E.

(12) Effective July 1, 2025, each hospital offering emergency services and care shall submit a nonemergent care access plan (NCAP) as part of the hospital's initial, renewal, or change of ownership application.

(a) The NCAP must meet the criteria specified in Section 395.1055(1)(j), F.S.

(b) For each subsequent renewal, the hospital shall provide its NCAP, updated as needed, with a narrative demonstrating the implentation and results of the plan. The narrative must:

1. Include the number of patients presenting to the emergency department indicating a lack of regular access to primary care;

2. Must reflect activities during at least 18 months of the current license biennium.

Notes

Fla. Admin. Code Ann. R. 59A-3.066

Rulemaking Authority 395.003, 395.004, 395.1055, 395.902, 408.033, 408.819 FS. Law Implemented 395.003, 395.004, 395.0161, 395.1055, 395.607, 395.806, 395.902, 408.033, 408.805, 408.806, 408.809, 408.811 FS.

New 9-4-95, Amended 6-18-96, Formerly 59A-3.203, Amended by Florida Register Volume 40, Number 190, September 30, 2014 effective 10/16/2014, Amended by Florida Register Volume 49, Number 002, January 4, 2023 effective 1/16/2023, Amended by Florida Register Volume 51, Number 098, May 20, 2025 effective 6/1/2025.

New 9-4-95, Amended 6-18-96, Formerly 59A-3.203, Amended 10-16-14, 1-16-23.