Florida agencies detail new rural emergency‑hospital rules and non‑emergent care plans; no facilities yet designated

Florida’s Agency for Health Care Administration briefed the Senate Health Policy Committee on its work to implement two components of 2024 health legislation: a new state licensing classification for “rural emergency hospitals” and the non‑emergent care access plan requirement for emergency departments.

AHCA deputy secretary Kimberly Smoak said the agency adopted rule changes that became effective June 1, 2025, to create a new Class 4 license for rural emergency hospitals and to require hospitals with emergency departments to submit non‑emergent care access plans at licensure or renewal. “As of June 1 this year … these rules were adopted and became effective June 1,” Smoak said. She told the committee the state had no designated rural emergency hospitals at present but had updated licensure procedures and other hospital rules to enable conversions.

The federal Consolidated Appropriations Act of 2021 and Centers for Medicare & Medicaid Services guidance established the federal rural emergency hospital designation; Smoak said the state rules mirror key federal criteria, including a 50‑bed maximum, continuous 24/7 emergency services, adequate staffing and transfer agreements with level‑1 or level‑2 trauma centers. Under AHCA’s process, a hospital seeking the designation would submit a revised licensure application, remove inpatient beds from its inventory if converting and attest to compliance with federal criteria.

On non‑emergent care access plans, Smoak described required plan elements the agency is reviewing: patient education about appropriate care settings; links to urgent care centers, federally qualified health centers and physician offices; outreach or assistance to help patients obtain primary‑care appointments; and managed‑care coordination for Medicaid enrollees. AHCA told senators it received 83 plans between July 1 and Sept. 30 and has approved 63; 20 remain in review as part of standard licensure processing.

Committee members pressed AHCA on Health Information Exchange capacity and who would perform federal surveys for the new licenses. Vice Chair Senator Harrell asked whether the state expected hospitals to convert and who would perform accreditation. Smoak said there currently is no approved national accreditor for federal rural emergency hospitals and that AHCA — the state survey agency — would carry out state licensing and surveys: “On the state side, we would go out and we would license them just as we license other hospitals now,” she said.

Senators also sought details about how AHCA will hold managed‑care plans and hospitals accountable if patterns emerge — for example, high volumes of avoidable ED use tied to one managed‑care organization. Smoak said AHCA will coordinate with the Medicaid managed‑care oversight team and that NCAPs must include implementation steps and data elements that will permit monitoring.

Public health advocates and FQHC representatives speaking during the public comment period praised the plans AHCA had approved and cited early local results. Elodie Dorso of Ever Health said NCAPs have “strengthened relationships between hospitals and health centers” and cited an example of reduced ED recidivism after hospital‑based navigators engaged patients.

What’s next: AHCA will continue reviewing NCAPs during license renewals and expects hospitals to file required data elements so the agency and managed‑care plans can monitor outcomes. The state is prepared to receive applications for rural emergency hospital licensure but officials said no facility has completed conversion as of the agency’s Sept. 30 report to the committee.