Florida
Florida requires CONs within three broad categories—beds outside hospitals, facilities and EMTs. In 2019, Florida passed sweeping CON law reforms and eliminated many of its CON requirements. See sidebar on p. 40. Post-reform, the minimum CON application fee in Florida is $10,000—the highest minimum standard application fee in the country.
Florida’s COVID-19 Response
As of May 15, 2020, Florida had not suspended any CON requirements in response to COVID-19.
Application Process
In Florida, the main CON application process takes at least 60 days after an application is deemed complete, although the process often takes much longer. Fla. Stat. § 408.039(4)(b); Fla. Admin Code r. 59C-1.010. Applications can be submitted biannually. Fla. Admin Code r. 59C-1.008(1). The fee for an application ranges from $10,000 to $50,000. Fla. Stat. § 408.038. Competitors can intervene in the application process and can offer evidence or argument as to why an application should be denied. Fla. Stat. § 408.039(5)(c), (6).
Types of CONs in Florida
| CON? | CON applies with expenditure of: | Temporary COVID-19 response: | |
| Hospital Beds | No | – | – |
| Beds Outside Hospitals | Yes | Any amount | – |
| Equipment | No | - | – |
| Facilities/Buildings | Yes | Any amount | – |
| Services | No | – | – |
| Emergency Medical Transport | Yes | Any amount | – |
Florida CONs in Detail
| Category | Types of CONs | Citation |
| Hospital Beds | No CONs in this category. | |
| Beds Outside Hospitals | The addition of beds in intermediate care facilities for the developmentally disabled by new construction or alteration. The addition of beds in community nursing homes by new construction or alteration. | Fla. Stat. § 408.036(1)(a) |
| Equipment | No CONs in this category. | |
| Category | Types of CONs | Citation |
| Facilities/Buildings | New construction or establishment of additional hospitals. New construction or establishment of additional skilled nursing facilities. New construction or establishment of additional intermediate care facilities for the developmentally disabled. | Fla. Stat. §§ 408.036(1)(b), 408.032(8) |
| The conversion from one type of health care facility to another. | Fla. Stat. § 408.036(1)(c) | |
| The establishment of a hospice or hospice inpatient facility. | Fla. Stat. § 408.036(1)(d) | |
| Services | No CONs in this category. | |
| Emergency Medical Transport | EMT providers must obtain a CON from each county in which they operate. | Fla. Stat. § 401.25(2)(d), (6); Fla. Admin. Code r. 64J-1.002(2)(b) |
On June 26, 2019, Governor DeSantis ushered in large-scale CON reform in Florida by signing HB 21.ª
a Available at https://ij.org/wp-content/uploads/2020/06/HB-21.pdf.
The bill immediately eliminated CON requirements for general hospitals, complex rehabilitation beds and tertiary hospital services, including neonatal intensive care services and organ transplant centers.
Additionally, the bill will sunset other CON requirements on July 1, 2021. The CONs that will be phased out are largely aimed at specialty facilities and providers, such as hospitals aimed at particular age groups or services aimed at treating patients with “specific categories” of illnesses or disorders. Florida’s reforms, however, leave CON requirements in place for nursing homes, skilled nursing facilities, hospice programs and intermediate care facilities.
Florida CON Exceptions
| No CON Required For: | Citation |
| The construction of or establishment of a general hospital when the proposed project site is located on the same site as or within one mile of the existing health care facility if the number of beds in each licensed bed category will not increase. The construction of or establishment of a replacement health care facility when the proposed project site is located on the same site as or within one mile of the existing health care facility if the number of beds in each licensed bed category will not increase. | Fla. Stat. § 408.036(1)(b)^ |
| The conversion of a specialty hospital to a general hospital is not subject to review. | Fla. Stat. § 408.036(1)(c)^ |
| A facility relying solely on spiritual means through prayer for healing is not included as a health care facility. | Fla. Stat. § 408.032(8) |
| Hospice services or swing beds in a rural hospital in a number that does not exceed one-half of its licensed beds, or for a hospice program established by an entity that shares a controlling interest with a not-for-profit retirement community that offers independent living, assisted living and skilled nursing services provided in a facility on the same premises and designated by the agency as a teaching nursing home for a minimum of five years. Only one hospice program per teaching nursing home may be established under the exemption in this paragraph, and such program shall be limited to serving patients residing in communities located within the not-for-profit retirement community, including home and community-based service providers. | Fla. Stat. § 408.036(3)(a); Fla. Admin. Code r. 59C-1.005 |
| The conversion of licensed acute care hospital beds to Medicare and Medicaid certified skilled nursing beds in a rural hospital so long as the conversion of the beds does not involve the construction of new facilities. | Fla. Stat. § 408.036(3)(b); Fla. Admin. Code r. 59C-1.005 |
| The addition of nursing home beds at a skilled nursing facility that is part of a retirement community that provides a variety of residential settings and supportive services and that has been incorporated and operated in Florida for at least 65 years on or before July 1, 1994. All nursing home beds must not be available to the public but must be for the exclusive use of the community residents. | Fla. Stat. § 408.036(3)(c); Fla. Admin. Code r. 59C-1.005 |
| An inmate health care facility built by or for the exclusive use of the Florida Department of Corrections. | Fla. Stat. § 408.036(3)(d); Fla. Admin. Code r. 59C-1.005 |
| The addition of nursing home beds in a number not exceeding 30 total beds or 25 percent of the number of beds licensed in the facility, whichever is less. | Fla. Stat. § 408.036(3)(e); Fla. Admin. Code r. 59C-1.005 |
| State veterans’ nursing homes operated by or on behalf of the Florida Department of Veterans’ Affairs. | Fla. Stat. § 408.036(3)(f); Fla. Admin. Code r. 59C-1.005 |
| Combination within one nursing home facility of the beds or services authorized by two or more CONs issued in the same planning subdistrict. | Fla. Stat. § 408.036(3)(g); Fla. Admin. Code r. 59C-1.005 |
| Division into two or more nursing home facilities of beds or services authorized by one CON issued in the same planning subdistrict. | Fla. Stat. § 408.036(3)(h); Fla. Admin. Code r. 59C-1.005 |
| No CON Required For: | Citation |
| The addition of nursing home beds in a number not exceeding 10 total beds or 10% of the number of beds licensed in the facility being expanded, whichever is greater; or, for the addition of nursing home beds at a facility that has been designated as a Gold Seal nursing home in a number not exceeding 20 total beds or 10% of the number of licensed beds in the facility being expanded, whichever is greater. | Fla. Stat. § 408.036(3)(i); Fla. Admin. Code r. 59C-1.005 |
| Replacement of a licensed nursing home on the same site, or within five miles of the same site if within the same subdistrict, if the number of licensed beds does not increase except as otherwise permitted by this section. | Fla. Stat. § 408.036(3)(j); Fla. Admin. Code r. 59C-1.005 |
| Consolidation or combination of licensed nursing homes or transfer of beds between licensed nursing homes within the same planning district, by nursing homes with any shared controlled interest within that planning district, if there is no increase in the planning district total number of nursing home beds and the site of the relocation is not more than 30 miles from the original location. | Fla. Stat. § 408.036(3)(k); Fla. Admin. Code r. 59C-1.005 |
| Beds in state mental health treatment facilities and state mental health forensic facilities. | Fla. Stat. § 408.036(3)(l)^; Fla. Admin. Code r. 59C-1.005 |
| Beds in state developmental disabilities centers. | Fla. Stat. § 408.036(3)(m) |
| The renewal of a license for a healthcare provider or facility where the applicant failed to submit a renewal applicant within the past 21 days and where the previous license expired after January 1, 2015 and where applicant meets all other requirements listed in this section. | Fla. Stat. § 408.036(3)(n)^; Fla. Admin. Code r. 59C-1.005 |