August 13, 2020
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HB 1143

1
A bill to be entitled
2An act relating to the reduction and simplification of
3health care provider regulation; amending s. 112.0455,
4F.S., relating to the Drug-Free Workplace Act; deleting an
5obsolete provision; amending s. 318.21, F.S.; revising
6distribution of funds from civil penalties imposed for
7traffic infractions by county courts; repealing s.
8383.325, F.S., relating to confidentiality of inspection
9reports of licensed birth center facilities; amending s.
10395.002, F.S.; revising and deleting definitions
11applicable to regulation of hospitals and other licensed
12facilities; conforming a cross-reference; amending s.
13395.003, F.S.; deleting an obsolete provision; amending s.
14395.0193, F.S.; requiring a licensed facility to report
15certain peer review information and final disciplinary
16actions to the Division of Medical Quality Assurance of
17the Department of Health rather than the Division of
18Health Quality Assurance of the Agency for Health Care
19Administration; amending s. 395.1023, F.S.; providing for
20the Department of Children and Family Services rather than
21the Department of Health to perform certain functions with
22respect to child protection cases; requiring certain
23hospitals to notify the Department of Children and Family
24Services of compliance; amending s. 395.1041, F.S.,
25relating to hospital emergency services and care; deleting
26obsolete provisions; repealing s. 395.1046, F.S., relating
27to complaint investigation procedures; amending s.
28395.1055, F.S.; requiring licensed facility beds to
29conform to standards specified by the Agency for Health
30Care Administration, the Florida Building Code, and the
31Florida Fire Prevention Code; amending s. 395.10972, F.S.;
32revising a reference to the Florida Society of Healthcare
33Risk Management to conform to the current designation;
34amending s. 395.2050, F.S.; revising a reference to the
35federal Health Care Financing Administration to conform to
36the current designation; amending s. 395.3036, F.S.;
37correcting a reference; repealing s. 395.3037, F.S.,
38relating to redundant definitions; amending ss. 154.11,
39394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
40627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
41F.S.; revising references to the Joint Commission on
42Accreditation of Healthcare Organizations and the Council
43on Accreditation of Children and Family Services to
44conform to the current designation; amending s. 395.602,
45F.S.; revising the definition of the term "rural hospital"
46to delete an obsolete provision; amending s. 400.021,
47F.S.; revising the definition of the term "geriatric
48outpatient clinic"; amending s. 400.063, F.S.; deleting an
49obsolete provision; amending ss. 400.071 and 400.0712,
50F.S.; revising applicability of general licensure
51requirements under pt. II of ch. 408, F.S., to
52applications for nursing home licensure; revising
53provisions governing inactive licenses; amending s.
54400.111, F.S.; providing for disclosure of controlling
55interest of a nursing home facility upon request by the
56Agency for Health Care Administration; amending s.
57400.1183, F.S.; revising grievance record maintenance and
58reporting requirements for nursing homes; amending s.
59400.141, F.S.; conforming a reference; requiring
60facilities to maintain clinical records that meet
61specified standards; providing a fine; deleting
62requirement for facilities to submit certain information
63related to management companies to the agency; amending s.
64400.142, F.S.; deleting language relating to agency
65adoption of rules; amending 400.147, F.S.; revising
66reporting requirements for licensed nursing home
67facilities relating to adverse incidents; repealing s.
68400.148, F.S., relating to the Medicaid "Up-or-Out"
69Quality of Care Contract Management Program; amending s.
70400.162, F.S., requiring nursing homes to provide a
71resident property statement annually and upon request;
72amending s. 400.179, F.S.; revising requirements for
73nursing home lease bond alternative fees; deleting an
74obsolete provision; amending s. 400.19, F.S.; revising
75inspection requirements; repealing s. 400.195, F.S.,
76relating to agency reporting requirements; amending s.
77400.23, F.S.; deleting an obsolete provision; clarifying a
78reference; amending s. 400.275, F.S.; revising agency
79duties with regard to training nursing home surveyor
80teams; revising requirements for team members; amending s.
81400.484, F.S.; revising the schedule of home health agency
82inspection violations; amending s. 400.606, F.S.; revising
83the content requirements of the plan accompanying an
84initial or change-of-ownership application for licensure
85of a hospice; revising requirements relating to
86certificates of need for certain hospice facilities;
87amending s. 400.607, F.S.; revising grounds for agency
88action against a hospice; amending s. 400.931, F.S.;
89deleting a requirement that an applicant for a home
90medical equipment provider license submit a surety bond to
91the agency; amending s. 400.932, F.S.; revising grounds
92for the imposition of administrative penalties for certain
93violations by an employee of a home medical equipment
94provider; amending s. 400.967, F.S.; revising the schedule
95of inspection violations for intermediate care facilities
96for the developmentally disabled; providing a penalty for
97certain violations; amending s. 400.9905, F.S.; revising
98definitions under the Health Care Clinic Act; amending s.
99400.991, F.S.; conforming terminology; revising
100application requirements relating to documentation of
101financial ability to operate a mobile clinic; amending s.
102408.034, F.S.; revising agency authority relating to
103licensing of intermediate care facilities for the
104developmentally disabled; amending s. 408.036, F.S.;
105deleting an exemption from certain certificate-of-need
106review requirements for a hospice or a hospice inpatient
107facility; amending s. 408.043, F.S.; revising requirements
108for certain freestanding inpatient hospice care facilities
109to obtain a certificate of need; amending s. 408.061,
110F.S.; revising health care facility data reporting
111requirements; amending s. 408.10, F.S.; removing agency
112authority to investigate certain consumer complaints;
113amending s. 408.802, F.S.; removing applicability of pt.
114II of ch. 408, F.S., relating to general licensure
115requirements, to private review agents; amending s.
116408.804, F.S.; providing penalties for altering, defacing,
117or falsifying a license certificate issued by the agency
118or displaying such an altered, defaced, or falsified
119certificate; amending s. 408.806, F.S.; revising agency
120responsibilities for notification of licensees of
121impending expiration of a license; removing an exception
122from the imposition of a fee for late filing of an
123application for renewal of a license; requiring payment of
124a late fee for a license application to be considered
125complete under certain circumstances; amending s. 408.810,
126F.S.; revising provisions relating to information required
127for licensure; requiring proof of submission of notice to
128a mortgagor or landlord regarding provision of services
129requiring licensure; requiring disclosure of information
130by a controlling interest of certain court actions
131relating to financial instability within a specified time
132period; amending s. 408.813, F.S.; authorizing the agency
133to impose fines for unclassified violations of pt. II of
134ch. 408, F.S.; amending s. 408.815, F.S.; authorizing the
135agency to extend a license expiration date under certain
136circumstances; amending s. 409.221, F.S.; deleting a
137reporting requirement relating to the consumer-directed
138care program; amending s. 429.07, F.S.; deleting the
139requirement for an assisted living facility to obtain an
140additional license in order to provide limited nursing
141services; deleting the requirement for the agency to
142conduct quarterly monitoring visits of facilities that
143hold a license to provide extended congregate care
144services; deleting the requirement for the department to
145report annually on the status of and recommendations
146related to extended congregate care; deleting the
147requirement for the agency to conduct monitoring visits at
148least twice a year to facilities providing limited nursing
149services; increasing the licensure fees and the maximum
150fee required for the standard license; increasing the
151licensure fees for the extended congregate care license;
152eliminating the license fee for the limited nursing
153services license; transferring from another provision of
154law the requirement that a biennial survey of an assisted
155living facility include specific actions to determine
156whether the facility is adequately protecting residents'
157rights; providing that an assisted living facility that
158has a class I or class II violation is subject to
159monitoring visits; requiring a registered nurse to
160participate in certain monitoring visits; amending s.
161429.11, F.S.; revising licensure application requirements
162for assisted living facilities to eliminate provisional
163licenses; amending s. 429.12, F.S.; revising notification
164requirements for the sale or transfer of ownership of an
165assisted living facility; amending s. 429.14, F.S.;
166removing a ground for the imposition of an administrative
167penalty; clarifying language relating to a facility's
168request for a hearing under certain circumstances;
169authorizing the agency to provide certain information
170relating to the licensure status of assisted living
171facilities electronically or through the agency's Internet
172website; amending s. 429.17, F.S.; deleting provisions
173relating to the limited nursing services license; revising
174agency responsibilities regarding the issuance of
175conditional licenses; amending s. 429.19, F.S.; clarifying
176that a monitoring fee may be assessed in addition to an
177administrative fine; amending s. 429.23, F.S.; deleting
178reporting requirements for assisted living facilities
179relating to liability claims; amending s. 429.255, F.S.;
180eliminating provisions authorizing the use of volunteers
181to provide certain health-care-related services in
182assisted living facilities; authorizing assisted living
183facilities to provide limited nursing services; requiring
184an assisted living facility to be responsible for certain
185recordkeeping and staff to be trained to monitor residents
186receiving certain health-care-related services; amending
187s. 429.28, F.S.; deleting a requirement for a biennial
188survey of an assisted living facility, to conform to
189changes made by the act; amending s. 429.35, F.S.;
190authorizing the agency to provide certain information
191relating to the inspections of assisted living facilities
192electronically or through the agency's Internet website;
193amending s. 429.41, F.S., relating to rulemaking;
194conforming provisions to changes made by the act; amending
195s. 429.53, F.S.; revising provisions relating to
196consultation by the agency; revising a definition;
197amending s. 429.54, F.S.; requiring licensed assisted
198living facilities to electronically report certain data
199semiannually to the agency in accordance with rules
200adopted by the department; amending s. 429.71, F.S.;
201revising schedule of inspection violations for adult
202family-care homes; amending s. 429.911, F.S.; deleting a
203ground for agency action against an adult day care center;
204amending s. 429.915, F.S.; revising agency
205responsibilities regarding the issuance of conditional
206licenses; amending s. 483.294, F.S.; revising frequency of
207agency inspections of multiphasic health testing centers;
208amending ss. 394.4787, 400.0239, 408.07, 430.80, and
209651.118, F.S.; conforming terminology and cross-
210references; revising a reference; providing an effective
211date.
212
213Be It Enacted by the Legislature of the State of Florida:
214
215     Section 1.  Present paragraph (e) of subsection (10) and
216paragraph (e) of subsection (14) of section 112.0455, Florida
217Statutes, are amended, and paragraphs (f) through (k) of
218subsection (10) of that section are redesignated as paragraphs
219(e) through (j), respectively, to read:
220     112.0455  Drug-Free Workplace Act.-
221     (10)  EMPLOYER PROTECTION.-
222     (e)  Nothing in this section shall be construed to operate
223retroactively, and nothing in this section shall abrogate the
224right of an employer under state law to conduct drug tests prior
225to January 1, 1990. A drug test conducted by an employer prior
226to January 1, 1990, is not subject to this section.
227     (14)  DISCIPLINE REMEDIES.-
228     (e)  Upon resolving an appeal filed pursuant to paragraph
229(c), and finding a violation of this section, the commission may
230order the following relief:
231     1.  Rescind the disciplinary action, expunge related
232records from the personnel file of the employee or job applicant
233and reinstate the employee.
234     2.  Order compliance with paragraph (10)(f)(g).
235     3.  Award back pay and benefits.
236     4.  Award the prevailing employee or job applicant the
237necessary costs of the appeal, reasonable attorney's fees, and
238expert witness fees.
239     Section 2.  Paragraph (n) of subsection (1) of section
240154.11, Florida Statutes, is amended to read:
241     154.11  Powers of board of trustees.-
242     (1)  The board of trustees of each public health trust
243shall be deemed to exercise a public and essential governmental
244function of both the state and the county and in furtherance
245thereof it shall, subject to limitation by the governing body of
246the county in which such board is located, have all of the
247powers necessary or convenient to carry out the operation and
248governance of designated health care facilities, including, but
249without limiting the generality of, the foregoing:
250     (n)  To appoint originally the staff of physicians to
251practice in any designated facility owned or operated by the
252board and to approve the bylaws and rules to be adopted by the
253medical staff of any designated facility owned and operated by
254the board, such governing regulations to be in accordance with
255the standards of The Joint Commission on the Accreditation of
256Hospitals which provide, among other things, for the method of
257appointing additional staff members and for the removal of staff
258members.
259     Section 3.  Subsection (15) of section 318.21, Florida
260Statutes, is amended to read:
261     318.21  Disposition of civil penalties by county courts.-
262All civil penalties received by a county court pursuant to the
263provisions of this chapter shall be distributed and paid monthly
264as follows:
265     (15)  Of the additional fine assessed under s. 318.18(3)(e)
266for a violation of s. 316.1893, 50 percent of the moneys
267received from the fines shall be remitted to the Department of
268Revenue and deposited into the Brain and Spinal Cord Injury
269Trust Fund of Department of Health and shall be appropriated to
270the Department of Health Agency for Health Care Administration
271as general revenue to provide an enhanced Medicaid payment to
272nursing homes that serve Medicaid recipients with spinal cord
273injuries that are medically complex and who are technologically
274and respiratory dependent with brain and spinal cord injuries.
275The remaining 50 percent of the moneys received from the
276enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
277the Department of Revenue and deposited into the Department of
278Health Administrative Trust Fund to provide financial support to
279certified trauma centers in the counties where enhanced penalty
280zones are established to ensure the availability and
281accessibility of trauma services. Funds deposited into the
282Administrative Trust Fund under this subsection shall be
283allocated as follows:
284     (a)  Fifty percent shall be allocated equally among all
285Level I, Level II, and pediatric trauma centers in recognition
286of readiness costs for maintaining trauma services.
287     (b)  Fifty percent shall be allocated among Level I, Level
288II, and pediatric trauma centers based on each center's relative
289volume of trauma cases as reported in the Department of Health
290Trauma Registry.
291     Section 4.  Section 383.325, Florida Statutes, is repealed.
292     Section 5.  Subsection (2) of section 394.741, Florida
293Statutes, is amended to read:
294     394.741  Accreditation requirements for providers of
295behavioral health care services.-
296     (2)  Notwithstanding any provision of law to the contrary,
297accreditation shall be accepted by the agency and department in
298lieu of the agency's and department's facility licensure onsite
299review requirements and shall be accepted as a substitute for
300the department's administrative and program monitoring
301requirements, except as required by subsections (3) and (4),
302for:
303     (a)  Any organization from which the department purchases
304behavioral health care services that is accredited by The Joint
305Commission on Accreditation of Healthcare Organizations or the
306Council on Accreditation for Children and Family Services, or
307has those services that are being purchased by the department
308accredited by CARF-the Rehabilitation Accreditation Commission.
309     (b)  Any mental health facility licensed by the agency or
310any substance abuse component licensed by the department that is
311accredited by The Joint Commission on Accreditation of
312Healthcare Organizations, CARF-the Rehabilitation Accreditation
313Commission, or the Council on Accreditation of Children and
314Family Services.
315     (c)  Any network of providers from which the department or
316the agency purchases behavioral health care services accredited
317by The Joint Commission on Accreditation of Healthcare
318Organizations, CARF-the Rehabilitation Accreditation Commission,
319the Council on Accreditation of Children and Family Services, or
320the National Committee for Quality Assurance. A provider
321organization, which is part of an accredited network, is
322afforded the same rights under this part.
323     Section 6.  Present subsections (15) through (32) of
324section 395.002, Florida Statutes, are renumbered as subsections
325(14) through (28), respectively, and present subsections (1),
326(14), (24), (30), and (31), and paragraph (c) of present
327subsection (28) of that section are amended to read:
328     395.002  Definitions.-As used in this chapter:
329     (1)  "Accrediting organizations" means nationally
330recognized or approved accrediting organizations whose standards
331incorporate comparable licensure requirements as determined by
332the agency the Joint Commission on Accreditation of Healthcare
333Organizations, the American Osteopathic Association, the
334Commission on Accreditation of Rehabilitation Facilities, and
335the Accreditation Association for Ambulatory Health Care, Inc.
336     (14)  "Initial denial determination" means a determination
337by a private review agent that the health care services
338furnished or proposed to be furnished to a patient are
339inappropriate, not medically necessary, or not reasonable.
340     (24)  "Private review agent" means any person or entity
341which performs utilization review services for third-party
342payors on a contractual basis for outpatient or inpatient
343services. However, the term shall not include full-time
344employees, personnel, or staff of health insurers, health
345maintenance organizations, or hospitals, or wholly owned
346subsidiaries thereof or affiliates under common ownership, when
347performing utilization review for their respective hospitals,
348health maintenance organizations, or insureds of the same
349insurance group. For this purpose, health insurers, health
350maintenance organizations, and hospitals, or wholly owned
351subsidiaries thereof or affiliates under common ownership,
352include such entities engaged as administrators of self-
353insurance as defined in s. 624.031.
354     (26)(28)  "Specialty hospital" means any facility which
355meets the provisions of subsection (12), and which regularly
356makes available either:
357     (c)  Intensive residential treatment programs for children
358and adolescents as defined in subsection (14) (15).
359     (30)  "Utilization review" means a system for reviewing the
360medical necessity or appropriateness in the allocation of health
361care resources of hospital services given or proposed to be
362given to a patient or group of patients.
363     (31)  "Utilization review plan" means a description of the
364policies and procedures governing utilization review activities
365performed by a private review agent.
366     Section 7.  Paragraph (c) of subsection (1) of section
367395.003, Florida Statutes, is amended to read:
368     395.003  Licensure; denial, suspension, and revocation.-
369     (1)
370     (c)  Until July 1, 2006, additional emergency departments
371located off the premises of licensed hospitals may not be
372authorized by the agency.
373     Section 8.  Paragraph (e) of subsection (2) and subsection
374(4) of section 395.0193, Florida Statutes, are amended to read:
375     395.0193  Licensed facilities; peer review; disciplinary
376powers; agency or partnership with physicians.-
377     (2)  Each licensed facility, as a condition of licensure,
378shall provide for peer review of physicians who deliver health
379care services at the facility. Each licensed facility shall
380develop written, binding procedures by which such peer review
381shall be conducted. Such procedures shall include:
382     (e)  Recording of agendas and minutes which do not contain
383confidential material, for review by the Division of Medical
384Quality Assurance of the department Health Quality Assurance of
385the agency.
386     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
387actions taken under subsection (3) shall be reported in writing
388to the Division of Medical Quality Assurance of the department
389Health Quality Assurance of the agency within 30 working days
390after its initial occurrence, regardless of the pendency of
391appeals to the governing board of the hospital. The notification
392shall identify the disciplined practitioner, the action taken,
393and the reason for such action. All final disciplinary actions
394taken under subsection (3), if different from those which were
395reported to the department agency within 30 days after the
396initial occurrence, shall be reported within 10 working days to
397the Division of Medical Quality Assurance of the department
398Health Quality Assurance of the agency in writing and shall
399specify the disciplinary action taken and the specific grounds
400therefor. The division shall review each report and determine
401whether it potentially involved conduct by the licensee that is
402subject to disciplinary action, in which case s. 456.073 shall
403apply. The reports are not subject to inspection under s.
404119.07(1) even if the division's investigation results in a
405finding of probable cause.
406     Section 9.  Section 395.1023, Florida Statutes, is amended
407to read:
408     395.1023  Child abuse and neglect cases; duties.-Each
409licensed facility shall adopt a protocol that, at a minimum,
410requires the facility to:
411     (1)  Incorporate a facility policy that every staff member
412has an affirmative duty to report, pursuant to chapter 39, any
413actual or suspected case of child abuse, abandonment, or
414neglect; and
415     (2)  In any case involving suspected child abuse,
416abandonment, or neglect, designate, at the request of the
417Department of Children and Family Services, a staff physician to
418act as a liaison between the hospital and the Department of
419Children and Family Services office which is investigating the
420suspected abuse, abandonment, or neglect, and the child
421protection team, as defined in s. 39.01, when the case is
422referred to such a team.
423
424Each general hospital and appropriate specialty hospital shall
425comply with the provisions of this section and shall notify the
426agency and the Department of Children and Family Services of its
427compliance by sending a copy of its policy to the agency and the
428Department of Children and Family Services as required by rule.
429The failure by a general hospital or appropriate specialty
430hospital to comply shall be punished by a fine not exceeding
431$1,000, to be fixed, imposed, and collected by the agency. Each
432day in violation is considered a separate offense.
433     Section 10.  Subsection (2) and paragraph (d) of subsection
434(3) of section 395.1041, Florida Statutes, are amended to read:
435     395.1041  Access to emergency services and care.-
436     (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
437shall establish and maintain an inventory of hospitals with
438emergency services. The inventory shall list all services within
439the service capability of the hospital, and such services shall
440appear on the face of the hospital license. Each hospital having
441emergency services shall notify the agency of its service
442capability in the manner and form prescribed by the agency. The
443agency shall use the inventory to assist emergency medical
444services providers and others in locating appropriate emergency
445medical care. The inventory shall also be made available to the
446general public. On or before August 1, 1992, the agency shall
447request that each hospital identify the services which are
448within its service capability. On or before November 1, 1992,
449the agency shall notify each hospital of the service capability
450to be included in the inventory. The hospital has 15 days from
451the date of receipt to respond to the notice. By December 1,
4521992, the agency shall publish a final inventory. Each hospital
453shall reaffirm its service capability when its license is
454renewed and shall notify the agency of the addition of a new
455service or the termination of a service prior to a change in its
456service capability.
457     (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
458FACILITY OR HEALTH CARE PERSONNEL.-
459     (d)1.  Every hospital shall ensure the provision of
460services within the service capability of the hospital, at all
461times, either directly or indirectly through an arrangement with
462another hospital, through an arrangement with one or more
463physicians, or as otherwise made through prior arrangements. A
464hospital may enter into an agreement with another hospital for
465purposes of meeting its service capability requirement, and
466appropriate compensation or other reasonable conditions may be
467negotiated for these backup services.
468     2.  If any arrangement requires the provision of emergency
469medical transportation, such arrangement must be made in
470consultation with the applicable provider and may not require
471the emergency medical service provider to provide transportation
472that is outside the routine service area of that provider or in
473a manner that impairs the ability of the emergency medical
474service provider to timely respond to prehospital emergency
475calls.
476     3.  A hospital shall not be required to ensure service
477capability at all times as required in subparagraph 1. if, prior
478to the receiving of any patient needing such service capability,
479such hospital has demonstrated to the agency that it lacks the
480ability to ensure such capability and it has exhausted all
481reasonable efforts to ensure such capability through backup
482arrangements. In reviewing a hospital's demonstration of lack of
483ability to ensure service capability, the agency shall consider
484factors relevant to the particular case, including the
485following:
486     a.  Number and proximity of hospitals with the same service
487capability.
488     b.  Number, type, credentials, and privileges of
489specialists.
490     c.  Frequency of procedures.
491     d.  Size of hospital.
492     4.  The agency shall publish proposed rules implementing a
493reasonable exemption procedure by November 1, 1992. Subparagraph
4941. shall become effective upon the effective date of said rules
495or January 31, 1993, whichever is earlier. For a period not to
496exceed 1 year from the effective date of subparagraph 1., a
497hospital requesting an exemption shall be deemed to be exempt
498from offering the service until the agency initially acts to
499deny or grant the original request. The agency has 45 days from
500the date of receipt of the request to approve or deny the
501request. After the first year from the effective date of
502subparagraph 1., If the agency fails to initially act within the
503time period, the hospital is deemed to be exempt from offering
504the service until the agency initially acts to deny the request.
505     Section 11.  Section 395.1046, Florida Statutes, is
506repealed.
507     Section 12.  Paragraph (e) of subsection (1) of section
508395.1055, Florida Statutes, is amended to read:
509     395.1055  Rules and enforcement.-
510     (1)  The agency shall adopt rules pursuant to ss.
511120.536(1) and 120.54 to implement the provisions of this part,
512which shall include reasonable and fair minimum standards for
513ensuring that:
514     (e)  Licensed facility beds conform to minimum space,
515equipment, and furnishings standards as specified by the agency,
516the Florida Building Code, and the Florida Fire Prevention Code
517department.
518     Section 13.  Subsection (1) of section 395.10972, Florida
519Statutes, is amended to read:
520     395.10972  Health Care Risk Manager Advisory Council.-The
521Secretary of Health Care Administration may appoint a seven-
522member advisory council to advise the agency on matters
523pertaining to health care risk managers. The members of the
524council shall serve at the pleasure of the secretary. The
525council shall designate a chair. The council shall meet at the
526call of the secretary or at those times as may be required by
527rule of the agency. The members of the advisory council shall
528receive no compensation for their services, but shall be
529reimbursed for travel expenses as provided in s. 112.061. The
530council shall consist of individuals representing the following
531areas:
532     (1)  Two shall be active health care risk managers,
533including one risk manager who is recommended by and a member of
534the Florida Society for of Healthcare Risk Management and
535Patient Safety.
536     Section 14.  Subsection (3) of section 395.2050, Florida
537Statutes, is amended to read:
538     395.2050  Routine inquiry for organ and tissue donation;
539certification for procurement activities; death records review.-
540     (3)  Each organ procurement organization designated by the
541federal Centers for Medicare and Medicaid Services Health Care
542Financing Administration and licensed by the state shall conduct
543an annual death records review in the organ procurement
544organization's affiliated donor hospitals. The organ procurement
545organization shall enlist the services of every Florida licensed
546tissue bank and eye bank affiliated with or providing service to
547the donor hospital and operating in the same service area to
548participate in the death records review.
549     Section 15.  Subsection (2) of section 395.3036, Florida
550Statutes, is amended to read:
551     395.3036  Confidentiality of records and meetings of
552corporations that lease public hospitals or other public health
553care facilities.-The records of a private corporation that
554leases a public hospital or other public health care facility
555are confidential and exempt from the provisions of s. 119.07(1)
556and s. 24(a), Art. I of the State Constitution, and the meetings
557of the governing board of a private corporation are exempt from
558s. 286.011 and s. 24(b), Art. I of the State Constitution when
559the public lessor complies with the public finance
560accountability provisions of s. 155.40(5) with respect to the
561transfer of any public funds to the private lessee and when the
562private lessee meets at least three of the five following
563criteria:
564     (2)  The public lessor and the private lessee do not
565commingle any of their funds in any account maintained by either
566of them, other than the payment of the rent and administrative
567fees or the transfer of funds pursuant to s. 155.40(2)
568subsection (2).
569     Section 16.  Section 395.3037, Florida Statutes, is
570repealed.
571     Section 17.  Subsections (1), (4), and (5) of section
572395.3038, Florida Statutes, are amended to read:
573     395.3038  State-listed primary stroke centers and
574comprehensive stroke centers; notification of hospitals.-
575     (1)  The agency shall make available on its website and to
576the department a list of the name and address of each hospital
577that meets the criteria for a primary stroke center and the name
578and address of each hospital that meets the criteria for a
579comprehensive stroke center. The list of primary and
580comprehensive stroke centers shall include only those hospitals
581that attest in an affidavit submitted to the agency that the
582hospital meets the named criteria, or those hospitals that
583attest in an affidavit submitted to the agency that the hospital
584is certified as a primary or a comprehensive stroke center by
585The Joint Commission on Accreditation of Healthcare
586Organizations.
587     (4)  The agency shall adopt by rule criteria for a primary
588stroke center which are substantially similar to the
589certification standards for primary stroke centers of The Joint
590Commission on Accreditation of Healthcare Organizations.
591     (5)  The agency shall adopt by rule criteria for a
592comprehensive stroke center. However, if The Joint Commission on
593Accreditation of Healthcare Organizations establishes criteria
594for a comprehensive stroke center, the agency shall establish
595criteria for a comprehensive stroke center which are
596substantially similar to those criteria established by The Joint
597Commission on Accreditation of Healthcare Organizations.
598     Section 18.  Paragraph (e) of subsection (2) of section
599395.602, Florida Statutes, is amended to read:
600     395.602  Rural hospitals.-
601     (2)  DEFINITIONS.-As used in this part:
602     (e)  "Rural hospital" means an acute care hospital licensed
603under this chapter, having 100 or fewer licensed beds and an
604emergency room, which is:
605     1.  The sole provider within a county with a population
606density of no greater than 100 persons per square mile;
607     2.  An acute care hospital, in a county with a population
608density of no greater than 100 persons per square mile, which is
609at least 30 minutes of travel time, on normally traveled roads
610under normal traffic conditions, from any other acute care
611hospital within the same county;
612     3.  A hospital supported by a tax district or subdistrict
613whose boundaries encompass a population of 100 persons or fewer
614per square mile;
615     4.  A hospital in a constitutional charter county with a
616population of over 1 million persons that has imposed a local
617option health service tax pursuant to law and in an area that
618was directly impacted by a catastrophic event on August 24,
6191992, for which the Governor of Florida declared a state of
620emergency pursuant to chapter 125, and has 120 beds or less that
621serves an agricultural community with an emergency room
622utilization of no less than 20,000 visits and a Medicaid
623inpatient utilization rate greater than 15 percent;
624     4.5.  A hospital with a service area that has a population
625of 100 persons or fewer per square mile. As used in this
626subparagraph, the term "service area" means the fewest number of
627zip codes that account for 75 percent of the hospital's
628discharges for the most recent 5-year period, based on
629information available from the hospital inpatient discharge
630database in the Florida Center for Health Information and Policy
631Analysis at the Agency for Health Care Administration; or
632     5.6.  A hospital designated as a critical access hospital,
633as defined in s. 408.07(15).
634
635Population densities used in this paragraph must be based upon
636the most recently completed United States census. A hospital
637that received funds under s. 409.9116 for a quarter beginning no
638later than July 1, 2002, is deemed to have been and shall
639continue to be a rural hospital from that date through June 30,
6402015, if the hospital continues to have 100 or fewer licensed
641beds and an emergency room, or meets the criteria of
642subparagraph 4. An acute care hospital that has not previously
643been designated as a rural hospital and that meets the criteria
644of this paragraph shall be granted such designation upon
645application, including supporting documentation to the Agency
646for Health Care Administration.
647     Section 19.  Subsection (8) of section 400.021, Florida
648Statutes, is amended to read:
649     400.021  Definitions.-When used in this part, unless the
650context otherwise requires, the term:
651     (8)  "Geriatric outpatient clinic" means a site for
652providing outpatient health care to persons 60 years of age or
653older, which is staffed by a registered nurse or a physician
654assistant, or a licensed practical nurse under the direct
655supervision of a registered nurse, advanced registered nurse
656practitioner, or physician assistant.
657     Section 20.  Subsection (2) of section 400.063, Florida
658Statutes, is amended to read:
659     400.063  Resident protection.-
660     (2)  The agency is authorized to establish for each
661facility, subject to intervention by the agency, a separate bank
662account for the deposit to the credit of the agency of any
663moneys received from the Health Care Trust Fund or any other
664moneys received for the maintenance and care of residents in the
665facility, and the agency is authorized to disburse moneys from
666such account to pay obligations incurred for the purposes of
667this section. The agency is authorized to requisition moneys
668from the Health Care Trust Fund in advance of an actual need for
669cash on the basis of an estimate by the agency of moneys to be
670spent under the authority of this section. Any bank account
671established under this section need not be approved in advance
672of its creation as required by s. 17.58, but shall be secured by
673depository insurance equal to or greater than the balance of
674such account or by the pledge of collateral security in
675conformance with criteria established in s. 18.11. The agency
676shall notify the Chief Financial Officer of any such account so
677established and shall make a quarterly accounting to the Chief
678Financial Officer for all moneys deposited in such account.
679     Section 21.  Subsections (1) and (5) of section 400.071,
680Florida Statutes, are amended to read:
681     400.071  Application for license.-
682     (1)  In addition to the requirements of part II of chapter
683408, the application for a license shall be under oath and must
684contain the following:
685     (a)  The location of the facility for which a license is
686sought and an indication, as in the original application, that
687such location conforms to the local zoning ordinances.
688     (b)  A signed affidavit disclosing any financial or
689ownership interest that a controlling interest as defined in
690part II of chapter 408 has held in the last 5 years in any
691entity licensed by this state or any other state to provide
692health or residential care which has closed voluntarily or
693involuntarily; has filed for bankruptcy; has had a receiver
694appointed; has had a license denied, suspended, or revoked; or
695has had an injunction issued against it which was initiated by a
696regulatory agency. The affidavit must disclose the reason any
697such entity was closed, whether voluntarily or involuntarily.
698     (c)  The total number of beds and the total number of
699Medicare and Medicaid certified beds.
700     (b)(d)  Information relating to the applicant and employees
701which the agency requires by rule. The applicant must
702demonstrate that sufficient numbers of qualified staff, by
703training or experience, will be employed to properly care for
704the type and number of residents who will reside in the
705facility.
706     (c)(e)  Copies of any civil verdict or judgment involving
707the applicant rendered within the 10 years preceding the
708application, relating to medical negligence, violation of
709residents' rights, or wrongful death. As a condition of
710licensure, the licensee agrees to provide to the agency copies
711of any new verdict or judgment involving the applicant, relating
712to such matters, within 30 days after filing with the clerk of
713the court. The information required in this paragraph shall be
714maintained in the facility's licensure file and in an agency
715database which is available as a public record.
716     (5)  As a condition of licensure, each facility must
717establish and submit with its application a plan for quality
718assurance and for conducting risk management.
719     Section 22.  Section 400.0712, Florida Statutes, is amended
720to read:
721     400.0712  Application for inactive license.-
722     (1)  As specified in this section, the agency may issue an
723inactive license to a nursing home facility for all or a portion
724of its beds. Any request by a licensee that a nursing home or
725portion of a nursing home become inactive must be submitted to
726the agency in the approved format. The facility may not initiate
727any suspension of services, notify residents, or initiate
728inactivity before receiving approval from the agency; and a
729licensee that violates this provision may not be issued an
730inactive license.
731     (1)(2)  In addition to the powers granted under part II of
732chapter 408, the agency may issue an inactive license to a
733nursing home that chooses to use an unoccupied contiguous
734portion of the facility for an alternative use to meet the needs
735of elderly persons through the use of less restrictive, less
736institutional services.
737     (a)  An inactive license issued under this subsection may
738be granted for a period not to exceed the current licensure
739expiration date but may be renewed by the agency at the time of
740licensure renewal.
741     (b)  A request to extend the inactive license must be
742submitted to the agency in the approved format and approved by
743the agency in writing.
744     (c)  Nursing homes that receive an inactive license to
745provide alternative services shall not receive preference for
746participation in the Assisted Living for the Elderly Medicaid
747waiver.
748     (2)(3)  The agency shall adopt rules pursuant to ss.
749120.536(1) and 120.54 necessary to implement this section.
750     Section 23.  Section 400.111, Florida Statutes, is amended
751to read:
752     400.111  Disclosure of controlling interest.-In addition to
753the requirements of part II of chapter 408, when requested by
754the agency, the licensee shall submit a signed affidavit
755disclosing any financial or ownership interest that a
756controlling interest has held within the last 5 years in any
757entity licensed by the state or any other state to provide
758health or residential care which entity has closed voluntarily
759or involuntarily; has filed for bankruptcy; has had a receiver
760appointed; has had a license denied, suspended, or revoked; or
761has had an injunction issued against it which was initiated by a
762regulatory agency. The affidavit must disclose the reason such
763entity was closed, whether voluntarily or involuntarily.
764     Section 24.  Subsection (2) of section 400.1183, Florida
765Statutes, is amended to read:
766     400.1183  Resident grievance procedures.-
767     (2)  Each facility shall maintain records of all grievances
768for agency inspection and shall report to the agency at the time
769of relicensure the total number of grievances handled during the
770prior licensure period, a categorization of the cases underlying
771the grievances, and the final disposition of the grievances.
772     Section 25.  Paragraphs (o) through (w) of subsection (1)
773of section 400.141, Florida Statutes, are redesignated as
774paragraphs (n) through (u), respectively, and present paragraphs
775(g), (j), (n), and (o) of that subsection are amended, to read:
776     400.141  Administration and management of nursing home
777facilities.-
778     (1)  Every licensed facility shall comply with all
779applicable standards and rules of the agency and shall:
780     (g)  If the facility has a standard license or is a Gold
781Seal facility, exceeds the minimum required hours of licensed
782nursing and certified nursing assistant direct care per resident
783per day, and is part of a continuing care facility licensed
784under chapter 651 or a retirement community that offers other
785services pursuant to part III of this chapter or part I or part
786III of chapter 429 on a single campus, be allowed to share
787programming and staff. At the time of inspection and in the
788semiannual report required pursuant to paragraph (n) (o), a
789continuing care facility or retirement community that uses this
790option must demonstrate through staffing records that minimum
791staffing requirements for the facility were met. Licensed nurses
792and certified nursing assistants who work in the nursing home
793facility may be used to provide services elsewhere on campus if
794the facility exceeds the minimum number of direct care hours
795required per resident per day and the total number of residents
796receiving direct care services from a licensed nurse or a
797certified nursing assistant does not cause the facility to
798violate the staffing ratios required under s. 400.23(3)(a).
799Compliance with the minimum staffing ratios shall be based on
800total number of residents receiving direct care services,
801regardless of where they reside on campus. If the facility
802receives a conditional license, it may not share staff until the
803conditional license status ends. This paragraph does not
804restrict the agency's authority under federal or state law to
805require additional staff if a facility is cited for deficiencies
806in care which are caused by an insufficient number of certified
807nursing assistants or licensed nurses. The agency may adopt
808rules for the documentation necessary to determine compliance
809with this provision.
810     (j)  Keep full records of resident admissions and
811discharges; medical and general health status, including medical
812records, personal and social history, and identity and address
813of next of kin or other persons who may have responsibility for
814the affairs of the residents; and individual resident care plans
815including, but not limited to, prescribed services, service
816frequency and duration, and service goals. The records shall be
817open to inspection by the agency. The facility must maintain
818clinical records on each resident in accordance with accepted
819professional standards and practices that are complete,
820accurately documented, readily accessible, and systematically
821organized.
822     (n)  Submit to the agency the information specified in s.
823400.071(1)(b) for a management company within 30 days after the
824effective date of the management agreement.
825     (n)(o)1.  Submit semiannually to the agency, or more
826frequently if requested by the agency, information regarding
827facility staff-to-resident ratios, staff turnover, and staff
828stability, including information regarding certified nursing
829assistants, licensed nurses, the director of nursing, and the
830facility administrator. For purposes of this reporting:
831     a.  Staff-to-resident ratios must be reported in the
832categories specified in s. 400.23(3)(a) and applicable rules.
833The ratio must be reported as an average for the most recent
834calendar quarter.
835     b.  Staff turnover must be reported for the most recent 12-
836month period ending on the last workday of the most recent
837calendar quarter prior to the date the information is submitted.
838The turnover rate must be computed quarterly, with the annual
839rate being the cumulative sum of the quarterly rates. The
840turnover rate is the total number of terminations or separations
841experienced during the quarter, excluding any employee
842terminated during a probationary period of 3 months or less,
843divided by the total number of staff employed at the end of the
844period for which the rate is computed, and expressed as a
845percentage.
846     c.  The formula for determining staff stability is the
847total number of employees that have been employed for more than
84812 months, divided by the total number of employees employed at
849the end of the most recent calendar quarter, and expressed as a
850percentage.
851     d.  A nursing facility that has failed to comply with state
852minimum-staffing requirements for 2 consecutive days is
853prohibited from accepting new admissions until the facility has
854achieved the minimum-staffing requirements for a period of 6
855consecutive days. For the purposes of this sub-subparagraph, any
856person who was a resident of the facility and was absent from
857the facility for the purpose of receiving medical care at a
858separate location or was on a leave of absence is not considered
859a new admission. Failure to impose such an admissions moratorium
860is subject to a $1,000 fine constitutes a class II deficiency.
861     e.  A nursing facility which does not have a conditional
862license may be cited for failure to comply with the standards in
863s. 400.23(3)(a)1.a. only if it has failed to meet those
864standards on 2 consecutive days or if it has failed to meet at
865least 97 percent of those standards on any one day.
866     f.  A facility which has a conditional license must be in
867compliance with the standards in s. 400.23(3)(a) at all times.
868     2.  This paragraph does not limit the agency's ability to
869impose a deficiency or take other actions if a facility does not
870have enough staff to meet the residents' needs.
871     Section 26.  Subsection (3) of section 400.142, Florida
872Statutes, is amended to read:
873     400.142  Emergency medication kits; orders not to
874resuscitate.-
875     (3)  Facility staff may withhold or withdraw
876cardiopulmonary resuscitation if presented with an order not to
877resuscitate executed pursuant to s. 401.45. The agency shall
878adopt rules providing for the implementation of such orders.
879Facility staff and facilities shall not be subject to criminal
880prosecution or civil liability, nor be considered to have
881engaged in negligent or unprofessional conduct, for withholding
882or withdrawing cardiopulmonary resuscitation pursuant to such an
883order and rules adopted by the agency. The absence of an order
884not to resuscitate executed pursuant to s. 401.45 does not
885preclude a physician from withholding or withdrawing
886cardiopulmonary resuscitation as otherwise permitted by law.
887     Section 27.  Subsections (11) through (15) of section
888400.147, Florida Statutes, are renumbered as subsections (10)
889through (14), respectively, and present subsection (10) is
890amended to read:
891     400.147  Internal risk management and quality assurance
892program.-
893     (10)  By the 10th of each month, each facility subject to
894this section shall report any notice received pursuant to s.
895400.0233(2) and each initial complaint that was filed with the
896clerk of the court and served on the facility during the
897previous month by a resident or a resident's family member,
898guardian, conservator, or personal legal representative. The
899report must include the name of the resident, the resident's
900date of birth and social security number, the Medicaid
901identification number for Medicaid-eligible persons, the date or
902dates of the incident leading to the claim or dates of
903residency, if applicable, and the type of injury or violation of
904rights alleged to have occurred. Each facility shall also submit
905a copy of the notices received pursuant to s. 400.0233(2) and
906complaints filed with the clerk of the court. This report is
907confidential as provided by law and is not discoverable or
908admissible in any civil or administrative action, except in such
909actions brought by the agency to enforce the provisions of this
910part.
911     Section 28.  Section 400.148, Florida Statutes, is
912repealed.
913     Section 29.  Paragraph (f) of subsection (5) of section
914400.162, Florida Statutes, is amended to read:
915     400.162  Property and personal affairs of residents.-
916     (5)
917     (f)  At least every 3 months, the licensee shall furnish
918the resident and the guardian, trustee, or conservator, if any,
919for the resident a complete and verified statement of all funds
920and other property to which this subsection applies, detailing
921the amounts and items received, together with their sources and
922disposition. For resident property, the licensee shall furnish
923such a statement annually and within 7 calendar days after a
924request for a statement. In any event, the licensee shall
925furnish such statements a statement annually and upon the
926discharge or transfer of a resident. Any governmental agency or
927private charitable agency contributing funds or other property
928on account of a resident also shall be entitled to receive such
929statements statement annually and upon discharge or transfer and
930such other report as it may require pursuant to law.
931     Section 30.  Paragraphs (d) and (e) of subsection (2) of
932section 400.179, Florida Statutes, are amended to read:
933     400.179  Liability for Medicaid underpayments and
934overpayments.-
935     (2)  Because any transfer of a nursing facility may expose
936the fact that Medicaid may have underpaid or overpaid the
937transferor, and because in most instances, any such underpayment
938or overpayment can only be determined following a formal field
939audit, the liabilities for any such underpayments or
940overpayments shall be as follows:
941     (d)  Where the transfer involves a facility that has been
942leased by the transferor:
943     1.  The transferee shall, as a condition to being issued a
944license by the agency, acquire, maintain, and provide proof to
945the agency of a bond with a term of 30 months, renewable
946annually, in an amount not less than the total of 3 months'
947Medicaid payments to the facility computed on the basis of the
948preceding 12-month average Medicaid payments to the facility.
949     2.  A leasehold licensee may meet the requirements of
950subparagraph 1. by payment of a nonrefundable fee, paid at
951initial licensure, paid at the time of any subsequent change of
952ownership, and paid annually thereafter, in the amount of 1
953percent of the total of 3 months' Medicaid payments to the
954facility computed on the basis of the preceding 12-month average
955Medicaid payments to the facility. If a preceding 12-month
956average is not available, projected Medicaid payments may be
957used. The fee shall be deposited into the Grants and Donations
958Trust Fund and shall be accounted for separately as a Medicaid
959nursing home overpayment account. These fees shall be used at
960the sole discretion of the agency to repay nursing home Medicaid
961overpayments. Payment of this fee shall not release the licensee
962from any liability for any Medicaid overpayments, nor shall
963payment bar the agency from seeking to recoup overpayments from
964the licensee and any other liable party. As a condition of
965exercising this lease bond alternative, licensees paying this
966fee must maintain an existing lease bond through the end of the
96730-month term period of that bond. The agency is herein granted
968specific authority to promulgate all rules pertaining to the
969administration and management of this account, including
970withdrawals from the account, subject to federal review and
971approval. This provision shall take effect upon becoming law and
972shall apply to any leasehold license application. The financial
973viability of the Medicaid nursing home overpayment account shall
974be determined by the agency through annual review of the account
975balance and the amount of total outstanding, unpaid Medicaid
976overpayments owing from leasehold licensees to the agency as
977determined by final agency audits. By March 31 of each year, the
978agency shall assess the cumulative fees collected under this
979subparagraph, minus any amounts used to repay nursing home
980Medicaid overpayments. If the net cumulative collections, minus
981amounts utilized to repay nursing home Medicaid overpayments,
982exceed $25 million, the provisions of this paragraph shall not
983apply for the subsequent fiscal year.
984     3.  The leasehold licensee may meet the bond requirement
985through other arrangements acceptable to the agency. The agency
986is herein granted specific authority to promulgate rules
987pertaining to lease bond arrangements.
988     4.  All existing nursing facility licensees, operating the
989facility as a leasehold, shall acquire, maintain, and provide
990proof to the agency of the 30-month bond required in
991subparagraph 1., above, on and after July 1, 1993, for each
992license renewal.
993     5.  It shall be the responsibility of all nursing facility
994operators, operating the facility as a leasehold, to renew the
99530-month bond and to provide proof of such renewal to the agency
996annually.
997     6.  Any failure of the nursing facility operator to
998acquire, maintain, renew annually, or provide proof to the
999agency shall be grounds for the agency to deny, revoke, and
1000suspend the facility license to operate such facility and to
1001take any further action, including, but not limited to,
1002enjoining the facility, asserting a moratorium pursuant to part
1003II of chapter 408, or applying for a receiver, deemed necessary
1004to ensure compliance with this section and to safeguard and
1005protect the health, safety, and welfare of the facility's
1006residents. A lease agreement required as a condition of bond
1007financing or refinancing under s. 154.213 by a health facilities
1008authority or required under s. 159.30 by a county or
1009municipality is not a leasehold for purposes of this paragraph
1010and is not subject to the bond requirement of this paragraph.
1011     (e)  For the 2009-2010 fiscal year only, the provisions of
1012paragraph (d) shall not apply. This paragraph expires July 1,
10132010.
1014     Section 31.  Subsection (3) of section 400.19, Florida
1015Statutes, is amended to read:
1016     400.19  Right of entry and inspection.-
1017     (3)  The agency shall every 15 months conduct at least one
1018unannounced inspection to determine compliance by the licensee
1019with statutes, and with rules promulgated under the provisions
1020of those statutes, governing minimum standards of construction,
1021quality and adequacy of care, and rights of residents. The
1022survey shall be conducted every 6 months for the next 2-year
1023period if the facility has been cited for a class I deficiency,
1024has been cited for two or more class II deficiencies arising
1025from separate surveys or investigations within a 60-day period,
1026or has had three or more substantiated complaints within a 6-
1027month period, each resulting in at least one class I or class II
1028deficiency. In addition to any other fees or fines in this part,
1029the agency shall assess a fine for each facility that is subject
1030to the 6-month survey cycle. The fine for the 2-year period
1031shall be $6,000, one-half to be paid at the completion of each
1032survey. The agency may adjust this fine by the change in the
1033Consumer Price Index, based on the 12 months immediately
1034preceding the increase, to cover the cost of the additional
1035surveys. The agency shall verify through subsequent inspection
1036that any deficiency identified during inspection is corrected.
1037However, the agency may verify the correction of a class III or
1038class IV deficiency unrelated to resident rights or resident
1039care without reinspecting the facility if adequate written
1040documentation has been received from the facility, which
1041provides assurance that the deficiency has been corrected. The
1042giving or causing to be given of advance notice of such
1043unannounced inspections by an employee of the agency to any
1044unauthorized person shall constitute cause for suspension of not
1045fewer than 5 working days according to the provisions of chapter
1046110.
1047     Section 32.  Section 400.195, Florida Statutes, is
1048repealed.
1049     Section 33.  Subsection (5) of section 400.23, Florida
1050Statutes, is amended to read:
1051     400.23  Rules; evaluation and deficiencies; licensure
1052status.-
1053     (5)  The agency, in collaboration with the Division of
1054Children's Medical Services Network of the Department of Health,
1055must, no later than December 31, 1993, adopt rules for minimum
1056standards of care for persons under 21 years of age who reside
1057in nursing home facilities. The rules must include a methodology
1058for reviewing a nursing home facility under ss. 408.031-408.045
1059which serves only persons under 21 years of age. A facility may
1060be exempt from these standards for specific persons between 18
1061and 21 years of age, if the person's physician agrees that
1062minimum standards of care based on age are not necessary.
1063     Section 34.  Subsection (1) of section 400.275, Florida
1064Statutes, is amended to read:
1065     400.275  Agency duties.-
1066     (1)  The agency shall ensure that each newly hired nursing
1067home surveyor, as a part of basic training, is assigned full-
1068time to a licensed nursing home for at least 2 days within a 7-
1069day period to observe facility operations outside of the survey
1070process before the surveyor begins survey responsibilities. Such
1071observations may not be the sole basis of a deficiency citation
1072against the facility. The agency may not assign an individual to
1073be a member of a survey team for purposes of a survey,
1074evaluation, or consultation visit at a nursing home facility in
1075which the surveyor was an employee within the preceding 2 5
1076years.
1077     Section 35.  Subsection (2) of section 400.484, Florida
1078Statutes, is amended to read:
1079     400.484  Right of inspection; violations deficiencies;
1080fines.-
1081     (2)  The agency shall impose fines for various classes of
1082violations deficiencies in accordance with the following
1083schedule:
1084     (a)  Class I violations are defined in s. 408.813. A class
1085I deficiency is any act, omission, or practice that results in a
1086patient's death, disablement, or permanent injury, or places a
1087patient at imminent risk of death, disablement, or permanent
1088injury. Upon finding a class I violation deficiency, the agency
1089shall impose an administrative fine in the amount of $15,000 for
1090each occurrence and each day that the violation deficiency
1091exists.
1092     (b)  Class II violations are defined in s. 408.813. A class
1093II deficiency is any act, omission, or practice that has a
1094direct adverse effect on the health, safety, or security of a
1095patient. Upon finding a class II violation deficiency, the
1096agency shall impose an administrative fine in the amount of
1097$5,000 for each occurrence and each day that the violation
1098deficiency exists.
1099     (c)  Class III violations are defined in s. 408.813. A
1100class III deficiency is any act, omission, or practice that has
1101an indirect, adverse effect on the health, safety, or security
1102of a patient. Upon finding an uncorrected or repeated class III
1103violation deficiency, the agency shall impose an administrative
1104fine not to exceed $1,000 for each occurrence and each day that
1105the uncorrected or repeated violation deficiency exists.
1106     (d)  Class IV violations are defined in s. 408.813. A class
1107IV deficiency is any act, omission, or practice related to
1108required reports, forms, or documents which does not have the
1109potential of negatively affecting patients. These violations are
1110of a type that the agency determines do not threaten the health,
1111safety, or security of patients. Upon finding an uncorrected or
1112repeated class IV violation deficiency, the agency shall impose
1113an administrative fine not to exceed $500 for each occurrence
1114and each day that the uncorrected or repeated violation
1115deficiency exists.
1116     Section 36.  Paragraph (i) of subsection (1) and subsection
1117(4) of section 400.606, Florida Statutes, are amended to read:
1118     400.606  License; application; renewal; conditional license
1119or permit; certificate of need.-
1120     (1)  In addition to the requirements of part II of chapter
1121408, the initial application and change of ownership application
1122must be accompanied by a plan for the delivery of home,
1123residential, and homelike inpatient hospice services to
1124terminally ill persons and their families. Such plan must
1125contain, but need not be limited to:
1126     (i)  The projected annual operating cost of the hospice.
1127
1128If the applicant is an existing licensed health care provider,
1129the application must be accompanied by a copy of the most recent
1130profit-loss statement and, if applicable, the most recent
1131licensure inspection report.
1132     (4)  A freestanding hospice facility that is primarily
1133engaged in providing inpatient and related services and that is
1134not otherwise licensed as a health care facility shall be
1135required to obtain a certificate of need. However, a
1136freestanding hospice facility with six or fewer beds shall not
1137be required to comply with institutional standards such as, but
1138not limited to, standards requiring sprinkler systems, emergency
1139electrical systems, or special lavatory devices.
1140     Section 37.  Subsection (2) of section 400.607, Florida
1141Statutes, is amended to read:
1142     400.607  Denial, suspension, revocation of license;
1143emergency actions; imposition of administrative fine; grounds.-
1144     (2)  A violation of this part, part II of chapter 408, or
1145applicable rules Any of the following actions by a licensed
1146hospice or any of its employees shall be grounds for
1147administrative action by the agency against a hospice.:
1148     (a)  A violation of the provisions of this part, part II of
1149chapter 408, or applicable rules.
1150     (b)  An intentional or negligent act materially affecting
1151the health or safety of a patient.
1152     Section 38.  Subsection (1) of section 400.925, Florida
1153Statutes, is amended to read:
1154     400.925  Definitions.-As used in this part, the term:
1155     (1)  "Accrediting organizations" means The Joint Commission
1156on Accreditation of Healthcare Organizations or other national
1157accreditation agencies whose standards for accreditation are
1158comparable to those required by this part for licensure.
1159     Section 39.  Subsections (3) through (6) of section
1160400.931, Florida Statutes, are renumbered as subsections (2)
1161through (5), respectively, and present subsection (2) of that
1162section is amended to read:
1163     400.931  Application for license; fee; provisional license;
1164temporary permit.-
1165     (2)  As an alternative to submitting proof of financial
1166ability to operate as required in s. 408.810(8), the applicant
1167may submit a $50,000 surety bond to the agency.
1168     Section 40.  Subsection (2) of section 400.932, Florida
1169Statutes, is amended to read:
1170     400.932  Administrative penalties.-
1171     (2)  A violation of this part, part II of chapter 408, or
1172applicable rules Any of the following actions by an employee of
1173a home medical equipment provider shall be are grounds for
1174administrative action or penalties by the agency.:
1175     (a)  Violation of this part, part II of chapter 408, or
1176applicable rules.
1177     (b)  An intentional, reckless, or negligent act that
1178materially affects the health or safety of a patient.
1179     Section 41.  Subsection (3) of section 400.967, Florida
1180Statutes, is amended to read:
1181     400.967  Rules and classification of violations
1182deficiencies.-
1183     (3)  The agency shall adopt rules to provide that, when the
1184criteria established under this part and part II of chapter 408
1185are not met, such violations deficiencies shall be classified
1186according to the nature of the violation deficiency. The agency
1187shall indicate the classification on the face of the notice of
1188deficiencies as follows:
1189     (a)  Class I violations deficiencies are defined in s.
1190408.813 those which the agency determines present an imminent
1191danger to the residents or guests of the facility or a
1192substantial probability that death or serious physical harm
1193would result therefrom. The condition or practice constituting a
1194class I violation must be abated or eliminated immediately,
1195unless a fixed period of time, as determined by the agency, is
1196required for correction. A class I violation deficiency is
1197subject to a civil penalty in an amount not less than $5,000 and
1198not exceeding $10,000 for each violation deficiency. A fine may
1199be levied notwithstanding the correction of the violation
1200deficiency.
1201     (b)  Class II violations deficiencies are defined in s.
1202408.813 those which the agency determines have a direct or
1203immediate relationship to the health, safety, or security of the
1204facility residents, other than class I deficiencies. A class II
1205violation deficiency is subject to a civil penalty in an amount
1206not less than $1,000 and not exceeding $5,000 for each violation
1207deficiency. A citation for a class II violation deficiency shall
1208specify the time within which the violation deficiency must be
1209corrected. If a class II violation deficiency is corrected
1210within the time specified, no civil penalty shall be imposed,
1211unless it is a repeated offense.
1212     (c)  Class III violations deficiencies are defined in s.
1213408.813 those which the agency determines to have an indirect or
1214potential relationship to the health, safety, or security of the
1215facility residents, other than class I or class II deficiencies.
1216A class III violation deficiency is subject to a civil penalty
1217of not less than $500 and not exceeding $1,000 for each
1218deficiency. A citation for a class III violation deficiency
1219shall specify the time within which the violation deficiency
1220must be corrected. If a class III violation deficiency is
1221corrected within the time specified, no civil penalty shall be
1222imposed, unless it is a repeated offense.
1223     (d)  Class IV violations are defined in s. 408.813. Upon
1224finding an uncorrected or repeated class IV violation, the
1225agency shall impose an administrative fine not to exceed $500
1226for each occurrence and each day that the uncorrected or
1227repeated violation exists.
1228     Section 42.  Subsections (4) and (7) of section 400.9905,
1229Florida Statutes, are amended to read:
1230     400.9905  Definitions.-
1231     (4)  "Clinic" means an entity at which health care services
1232are provided to individuals and which tenders charges for
1233reimbursement for such services, including a mobile clinic and a
1234portable health service or equipment provider. For purposes of
1235this part, the term does not include and the licensure
1236requirements of this part do not apply to:
1237     (a)  Entities licensed or registered by the state under
1238chapter 395; or entities licensed or registered by the state and
1239providing only health care services within the scope of services
1240authorized under their respective licenses granted under ss.
1241383.30-383.335, chapter 390, chapter 394, chapter 397, this
1242chapter except part X, chapter 429, chapter 463, chapter 465,
1243chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1244chapter 651; end-stage renal disease providers authorized under
124542 C.F.R. part 405, subpart U; or providers certified under 42
1246C.F.R. part 485, subpart B or subpart H; or any entity that
1247provides neonatal or pediatric hospital-based health care
1248services or other health care services by licensed practitioners
1249solely within a hospital licensed under chapter 395.
1250     (b)  Entities that own, directly or indirectly, entities
1251licensed or registered by the state pursuant to chapter 395; or
1252entities that own, directly or indirectly, entities licensed or
1253registered by the state and providing only health care services
1254within the scope of services authorized pursuant to their
1255respective licenses granted under ss. 383.30-383.335, chapter
1256390, chapter 394, chapter 397, this chapter except part X,
1257chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1258part I of chapter 483, chapter 484, chapter 651; end-stage renal
1259disease providers authorized under 42 C.F.R. part 405, subpart
1260U; or providers certified under 42 C.F.R. part 485, subpart B or
1261subpart H; or any entity that provides neonatal or pediatric
1262hospital-based health care services by licensed practitioners
1263solely within a hospital licensed under chapter 395.
1264     (c)  Entities that are owned, directly or indirectly, by an
1265entity licensed or registered by the state pursuant to chapter
1266395; or entities that are owned, directly or indirectly, by an
1267entity licensed or registered by the state and providing only
1268health care services within the scope of services authorized
1269pursuant to their respective licenses granted under ss. 383.30-
1270383.335, chapter 390, chapter 394, chapter 397, this chapter
1271except part X, chapter 429, chapter 463, chapter 465, chapter
1272466, chapter 478, part I of chapter 483, chapter 484, or chapter
1273651; end-stage renal disease providers authorized under 42
1274C.F.R. part 405, subpart U; or providers certified under 42
1275C.F.R. part 485, subpart B or subpart H; or any entity that
1276provides neonatal or pediatric hospital-based health care
1277services by licensed practitioners solely within a hospital
1278under chapter 395.
1279     (d)  Entities that are under common ownership, directly or
1280indirectly, with an entity licensed or registered by the state
1281pursuant to chapter 395; or entities that are under common
1282ownership, directly or indirectly, with an entity licensed or
1283registered by the state and providing only health care services
1284within the scope of services authorized pursuant to their
1285respective licenses granted under ss. 383.30-383.335, chapter
1286390, chapter 394, chapter 397, this chapter except part X,
1287chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1288part I of chapter 483, chapter 484, or chapter 651; end-stage
1289renal disease providers authorized under 42 C.F.R. part 405,
1290subpart U; or providers certified under 42 C.F.R. part 485,
1291subpart B or subpart H; or any entity that provides neonatal or
1292pediatric hospital-based health care services by licensed
1293practitioners solely within a hospital licensed under chapter
1294395.
1295     (e)  An entity that is exempt from federal taxation under
129626 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1297under 26 U.S.C. s. 409 that has a board of trustees not less
1298than two-thirds of which are Florida-licensed health care
1299practitioners and provides only physical therapy services under
1300physician orders, any community college or university clinic,
1301and any entity owned or operated by the federal or state
1302government, including agencies, subdivisions, or municipalities
1303thereof.
1304     (f)  A sole proprietorship, group practice, partnership, or
1305corporation that provides health care services by physicians
1306covered by s. 627.419, that is directly supervised by one or
1307more of such physicians, and that is wholly owned by one or more
1308of those physicians or by a physician and the spouse, parent,
1309child, or sibling of that physician.
1310     (g)  A sole proprietorship, group practice, partnership, or
1311corporation that provides health care services by licensed
1312health care practitioners under chapter 457, chapter 458,
1313chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1314chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1315chapter 490, chapter 491, or part I, part III, part X, part
1316XIII, or part XIV of chapter 468, or s. 464.012, which are
1317wholly owned by one or more licensed health care practitioners,
1318or the licensed health care practitioners set forth in this
1319paragraph and the spouse, parent, child, or sibling of a
1320licensed health care practitioner, so long as one of the owners
1321who is a licensed health care practitioner is supervising the
1322business activities and is legally responsible for the entity's
1323compliance with all federal and state laws. However, a health
1324care practitioner may not supervise services beyond the scope of
1325the practitioner's license, except that, for the purposes of
1326this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1327provides only services authorized pursuant to s. 456.053(3)(b)
1328may be supervised by a licensee specified in s. 456.053(3)(b).
1329     (h)  Clinical facilities affiliated with an accredited
1330medical school at which training is provided for medical
1331students, residents, or fellows.
1332     (i)  Entities that provide only oncology or radiation
1333therapy services by physicians licensed under chapter 458 or
1334chapter 459 or entities that provide oncology or radiation
1335therapy services by physicians licensed under chapter 458 or
1336chapter 459 which are owned by a corporation whose shares are
1337publicly traded on a recognized stock exchange.
1338     (j)  Clinical facilities affiliated with a college of
1339chiropractic accredited by the Council on Chiropractic Education
1340at which training is provided for chiropractic students.
1341     (k)  Entities that provide licensed practitioners to staff
1342emergency departments or to deliver anesthesia services in
1343facilities licensed under chapter 395 and that derive at least
134490 percent of their gross annual revenues from the provision of
1345such services. Entities claiming an exemption from licensure
1346under this paragraph must provide documentation demonstrating
1347compliance.
1348     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1349perinatology clinical facilities that are a publicly traded
1350corporation or that are wholly owned, directly or indirectly, by
1351a publicly traded corporation. As used in this paragraph, a
1352publicly traded corporation is a corporation that issues
1353securities traded on an exchange registered with the United
1354States Securities and Exchange Commission as a national
1355securities exchange.
1356     (7)  "Portable health service or equipment provider" means
1357an entity that contracts with or employs persons to provide
1358portable health care services or equipment to multiple locations
1359performing treatment or diagnostic testing of individuals, that
1360bills third-party payors for those services, and that otherwise
1361meets the definition of a clinic in subsection (4).
1362     Section 43.  Paragraph (b) of subsection (1) and paragraph
1363(c) of subsection (4) of section 400.991, Florida Statutes, are
1364amended to read:
1365     400.991  License requirements; background screenings;
1366prohibitions.-
1367     (1)
1368     (b)  Each mobile clinic must obtain a separate health care
1369clinic license and must provide to the agency, at least
1370quarterly, its projected street location to enable the agency to
1371locate and inspect such clinic. A portable health service or
1372equipment provider must obtain a health care clinic license for
1373a single administrative office and is not required to submit
1374quarterly projected street locations.
1375     (4)  In addition to the requirements of part II of chapter
1376408, the applicant must file with the application satisfactory
1377proof that the clinic is in compliance with this part and
1378applicable rules, including:
1379     (c)  Proof of financial ability to operate as required
1380under ss. s. 408.810(8) and 408.8065. As an alternative to
1381submitting proof of financial ability to operate as required
1382under s. 408.810(8), the applicant may file a surety bond of at
1383least $500,000 which guarantees that the clinic will act in full
1384conformity with all legal requirements for operating a clinic,
1385payable to the agency. The agency may adopt rules to specify
1386related requirements for such surety bond.
1387     Section 44.  Paragraph (g) of subsection (1) and paragraph
1388(a) of subsection (7) of section 400.9935, Florida Statutes, are
1389amended to read:
1390     400.9935  Clinic responsibilities.-
1391     (1)  Each clinic shall appoint a medical director or clinic
1392director who shall agree in writing to accept legal
1393responsibility for the following activities on behalf of the
1394clinic. The medical director or the clinic director shall:
1395     (g)  Conduct systematic reviews of clinic billings to
1396ensure that the billings are not fraudulent or unlawful. Upon
1397discovery of an unlawful charge, the medical director or clinic
1398director shall take immediate corrective action. If the clinic
1399performs only the technical component of magnetic resonance
1400imaging, static radiographs, computed tomography, or positron
1401emission tomography, and provides the professional
1402interpretation of such services, in a fixed facility that is
1403accredited by The Joint Commission on Accreditation of
1404Healthcare Organizations or the Accreditation Association for
1405Ambulatory Health Care, and the American College of Radiology;
1406and if, in the preceding quarter, the percentage of scans
1407performed by that clinic which was billed to all personal injury
1408protection insurance carriers was less than 15 percent, the
1409chief financial officer of the clinic may, in a written
1410acknowledgment provided to the agency, assume the responsibility
1411for the conduct of the systematic reviews of clinic billings to
1412ensure that the billings are not fraudulent or unlawful.
1413     (7)(a)  Each clinic engaged in magnetic resonance imaging
1414services must be accredited by The Joint Commission on
1415Accreditation of Healthcare Organizations, the American College
1416of Radiology, or the Accreditation Association for Ambulatory
1417Health Care, within 1 year after licensure. A clinic that is
1418accredited by the American College of Radiology or is within the
1419original 1-year period after licensure and replaces its core
1420magnetic resonance imaging equipment shall be given 1 year after
1421the date on which the equipment is replaced to attain
1422accreditation. However, a clinic may request a single, 6-month
1423extension if it provides evidence to the agency establishing
1424that, for good cause shown, such clinic cannot be accredited
1425within 1 year after licensure, and that such accreditation will
1426be completed within the 6-month extension. After obtaining
1427accreditation as required by this subsection, each such clinic
1428must maintain accreditation as a condition of renewal of its
1429license. A clinic that files a change of ownership application
1430must comply with the original accreditation timeframe
1431requirements of the transferor. The agency shall deny a change
1432of ownership application if the clinic is not in compliance with
1433the accreditation requirements. When a clinic adds, replaces, or
1434modifies magnetic resonance imaging equipment and the
1435accreditation agency requires new accreditation, the clinic must
1436be accredited within 1 year after the date of the addition,
1437replacement, or modification but may request a single, 6-month
1438extension if the clinic provides evidence of good cause to the
1439agency.
1440     Section 45.  Subsection (2) of section 408.034, Florida
1441Statutes, is amended to read:
1442     408.034  Duties and responsibilities of agency; rules.-
1443     (2)  In the exercise of its authority to issue licenses to
1444health care facilities and health service providers, as provided
1445under chapters 393 and 395 and parts II, and IV, and VIII of
1446chapter 400, the agency may not issue a license to any health
1447care facility or health service provider that fails to receive a
1448certificate of need or an exemption for the licensed facility or
1449service.
1450     Section 46.  Paragraph (d) of subsection (1) of section
1451408.036, Florida Statutes, is amended to read:
1452     408.036  Projects subject to review; exemptions.-
1453     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1454health-care-related projects, as described in paragraphs (a)-
1455(g), are subject to review and must file an application for a
1456certificate of need with the agency. The agency is exclusively
1457responsible for determining whether a health-care-related
1458project is subject to review under ss. 408.031-408.045.
1459     (d)  The establishment of a hospice or hospice inpatient
1460facility, except as provided in s. 408.043.
1461     Section 47.  Subsection (2) of section 408.043, Florida
1462Statutes, is amended to read:
1463     408.043  Special provisions.-
1464     (2)  HOSPICES.-When an application is made for a
1465certificate of need to establish or to expand a hospice, the
1466need for such hospice shall be determined on the basis of the
1467need for and availability of hospice services in the community.
1468The formula on which the certificate of need is based shall
1469discourage regional monopolies and promote competition. The
1470inpatient hospice care component of a hospice which is a
1471freestanding facility, or a part of a facility, which is
1472primarily engaged in providing inpatient care and related
1473services and is not licensed as a health care facility shall
1474also be required to obtain a certificate of need. Provision of
1475hospice care by any current provider of health care is a
1476significant change in service and therefore requires a
1477certificate of need for such services.
1478     Section 48.  Paragraph (k) of subsection (3) of section
1479408.05, Florida Statutes, is amended to read:
1480     408.05  Florida Center for Health Information and Policy
1481Analysis.-
1482     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1483produce comparable and uniform health information and statistics
1484for the development of policy recommendations, the agency shall
1485perform the following functions:
1486     (k)  Develop, in conjunction with the State Consumer Health
1487Information and Policy Advisory Council, and implement a long-
1488range plan for making available health care quality measures and
1489financial data that will allow consumers to compare health care
1490services. The health care quality measures and financial data
1491the agency must make available shall include, but is not limited
1492to, pharmaceuticals, physicians, health care facilities, and
1493health plans and managed care entities. The agency shall submit
1494the initial plan to the Governor, the President of the Senate,
1495and the Speaker of the House of Representatives by January 1,
14962006, and shall update the plan and report on the status of its
1497implementation annually thereafter. The agency shall also make
1498the plan and status report available to the public on its
1499Internet website. As part of the plan, the agency shall identify
1500the process and timeframes for implementation, any barriers to
1501implementation, and recommendations of changes in the law that
1502may be enacted by the Legislature to eliminate the barriers. As
1503preliminary elements of the plan, the agency shall:
1504     1.  Make available patient-safety indicators, inpatient
1505quality indicators, and performance outcome and patient charge
1506data collected from health care facilities pursuant to s.
1507408.061(1)(a) and (2). The terms "patient-safety indicators" and
1508"inpatient quality indicators" shall be as defined by the
1509Centers for Medicare and Medicaid Services, the National Quality
1510Forum, The Joint Commission on Accreditation of Healthcare
1511Organizations, the Agency for Healthcare Research and Quality,
1512the Centers for Disease Control and Prevention, or a similar
1513national entity that establishes standards to measure the
1514performance of health care providers, or by other states. The
1515agency shall determine which conditions, procedures, health care
1516quality measures, and patient charge data to disclose based upon
1517input from the council. When determining which conditions and
1518procedures are to be disclosed, the council and the agency shall
1519consider variation in costs, variation in outcomes, and
1520magnitude of variations and other relevant information. When
1521determining which health care quality measures to disclose, the
1522agency:
1523     a.  Shall consider such factors as volume of cases; average
1524patient charges; average length of stay; complication rates;
1525mortality rates; and infection rates, among others, which shall
1526be adjusted for case mix and severity, if applicable.
1527     b.  May consider such additional measures that are adopted
1528by the Centers for Medicare and Medicaid Studies, National
1529Quality Forum, The Joint Commission on Accreditation of
1530Healthcare Organizations, the Agency for Healthcare Research and
1531Quality, Centers for Disease Control and Prevention, or a
1532similar national entity that establishes standards to measure
1533the performance of health care providers, or by other states.
1534
1535When determining which patient charge data to disclose, the
1536agency shall include such measures as the average of
1537undiscounted charges on frequently performed procedures and
1538preventive diagnostic procedures, the range of procedure charges
1539from highest to lowest, average net revenue per adjusted patient
1540day, average cost per adjusted patient day, and average cost per
1541admission, among others.
1542     2.  Make available performance measures, benefit design,
1543and premium cost data from health plans licensed pursuant to
1544chapter 627 or chapter 641. The agency shall determine which
1545health care quality measures and member and subscriber cost data
1546to disclose, based upon input from the council. When determining
1547which data to disclose, the agency shall consider information
1548that may be required by either individual or group purchasers to
1549assess the value of the product, which may include membership
1550satisfaction, quality of care, current enrollment or membership,
1551coverage areas, accreditation status, premium costs, plan costs,
1552premium increases, range of benefits, copayments and
1553deductibles, accuracy and speed of claims payment, credentials
1554of physicians, number of providers, names of network providers,
1555and hospitals in the network. Health plans shall make available
1556to the agency any such data or information that is not currently
1557reported to the agency or the office.
1558     3.  Determine the method and format for public disclosure
1559of data reported pursuant to this paragraph. The agency shall
1560make its determination based upon input from the State Consumer
1561Health Information and Policy Advisory Council. At a minimum,
1562the data shall be made available on the agency's Internet
1563website in a manner that allows consumers to conduct an
1564interactive search that allows them to view and compare the
1565information for specific providers. The website must include
1566such additional information as is determined necessary to ensure
1567that the website enhances informed decisionmaking among
1568consumers and health care purchasers, which shall include, at a
1569minimum, appropriate guidance on how to use the data and an
1570explanation of why the data may vary from provider to provider.
1571The data specified in subparagraph 1. shall be released no later
1572than January 1, 2006, for the reporting of infection rates, and
1573no later than October 1, 2005, for mortality rates and
1574complication rates. The data specified in subparagraph 2. shall
1575be released no later than October 1, 2006.
1576     4.  Publish on its website undiscounted charges for no
1577fewer than 150 of the most commonly performed adult and
1578pediatric procedures, including outpatient, inpatient,
1579diagnostic, and preventative procedures.
1580     Section 49.  Paragraph (a) of subsection (1) of section
1581408.061, Florida Statutes, is amended to read:
1582     408.061  Data collection; uniform systems of financial
1583reporting; information relating to physician charges;
1584confidential information; immunity.-
1585     (1)  The agency shall require the submission by health care
1586facilities, health care providers, and health insurers of data
1587necessary to carry out the agency's duties. Specifications for
1588data to be collected under this section shall be developed by
1589the agency with the assistance of technical advisory panels
1590including representatives of affected entities, consumers,
1591purchasers, and such other interested parties as may be
1592determined by the agency.
1593     (a)  Data submitted by health care facilities, including
1594the facilities as defined in chapter 395, shall include, but are
1595not limited to: case-mix data, patient admission and discharge
1596data, hospital emergency department data which shall include the
1597number of patients treated in the emergency department of a
1598licensed hospital reported by patient acuity level, data on
1599hospital-acquired infections as specified by rule, data on
1600complications as specified by rule, data on readmissions as
1601specified by rule, with patient and provider-specific
1602identifiers included, actual charge data by diagnostic groups,
1603financial data, accounting data, operating expenses, expenses
1604incurred for rendering services to patients who cannot or do not
1605pay, interest charges, depreciation expenses based on the
1606expected useful life of the property and equipment involved, and
1607demographic data. The agency shall adopt nationally recognized
1608risk adjustment methodologies or software consistent with the
1609standards of the Agency for Healthcare Research and Quality and
1610as selected by the agency for all data submitted as required by
1611this section. Data may be obtained from documents such as, but
1612not limited to: leases, contracts, debt instruments, itemized
1613patient bills, medical record abstracts, and related diagnostic
1614information. Reported data elements shall be reported
1615electronically and in accordance with rule 59E-7.012, Florida
1616Administrative Code. Data submitted shall be certified
1617chief executive officer or an appropriate and duly authorized
1618representative or employee of the licensed facility that the
1619information submitted is true and accurate.
1620     Section 50.  Section 408.10, Florida Statutes, is amended
1621to read:
1622     408.10  Consumer complaints.-The agency shall:
1623     (1)  publish and make available to the public a toll-free
1624telephone number for the purpose of handling consumer complaints
1625and shall serve as a liaison between consumer entities and other
1626private entities and governmental entities for the disposition
1627of problems identified by consumers of health care.
1628     (2)  Be empowered to investigate consumer complaints
1629relating to problems with health care facilities' billing
1630practices and issue reports to be made public in any cases where
1631the agency determines the health care facility has engaged in
1632billing practices which are unreasonable and unfair to the
1633consumer.
1634     Section 51.  Subsections (12) through (30) of section
1635408.802, Florida Statutes, are renumbered as subsections (11)
1636through (29), respectively, and present subsection (11) of that
1637section is amended to read:
1638     408.802  Applicability.-The provisions of this part apply
1639to the provision of services that require licensure as defined
1640in this part and to the following entities licensed, registered,
1641or certified by the agency, as described in chapters 112, 383,
1642390, 394, 395, 400, 429, 440, 483, and 765:
1643     (11)  Private review agents, as provided under part I of
1644chapter 395.
1645     Section 52.  Subsection (3) is added to section 408.804,
1646Florida Statutes, to read:
1647     408.804  License required; display.-
1648     (3)  Any person who knowingly alters, defaces, or falsifies
1649a license certificate issued by the agency, or causes or
1650procures any person to commit such an offense, commits a
1651misdemeanor of the second degree, punishable as provided in s.
1652775.082 or s 775.083. Any licensee or provider who displays an
1653altered, defaced, or falsified license certificate is subject to
1654the penalties set forth in s. 408.815 and an administrative fine
1655of $1,000 for each day of illegal display.
1656     Section 53.  Paragraph (d) of subsection (2) of section
1657408.806, Florida Statutes, is amended, present subsections (3)
1658through (8) are renumbered as subsections (4) through (9),
1659respectively, and a new subsection (3) is added to that section,
1660to read:
1661     408.806  License application process.-
1662     (2)
1663     (d)  The agency shall notify the licensee by mail or
1664electronically at least 90 days before the expiration of a
1665license that a renewal license is necessary to continue
1666operation. The licensee's failure to timely file submit a
1667renewal application and license application fee with the agency
1668shall result in a $50 per day late fee charged to the licensee
1669by the agency; however, the aggregate amount of the late fee may
1670not exceed 50 percent of the licensure fee or $500, whichever is
1671less. The agency shall provide a courtesy notice to the licensee
1672by United States mail, electronically, or by any other manner at
1673its address of record or mailing address, if provided, at least
167490 days prior to the expiration of a license informing the
1675licensee of the expiration of the license. If the agency does
1676not provide the courtesy notice or the licensee does not receive
1677the courtesy notice, the licensee continues to be legally
1678obligated to timely file the renewal application and license
1679application fee with the agency and is not excused from the
1680payment of a late fee. If an application is received after the
1681required filing date and exhibits a hand-canceled postmark
1682obtained from a United States post office dated on or before the
1683required filing date, no fine will be levied.
1684     (3)  Payment of the late fee is required to consider any
1685late application complete, and failure to pay the late fee is
1686considered an omission from the application.
1687     Section 54.  Subsections (6) and (9) of section 408.810,
1688Florida Statutes, are amended to read:
1689     408.810  Minimum licensure requirements.-In addition to the
1690licensure requirements specified in this part, authorizing
1691statutes, and applicable rules, each applicant and licensee must
1692comply with the requirements of this section in order to obtain
1693and maintain a license.
1694     (6)(a)  An applicant must provide the agency with proof of
1695the applicant's legal right to occupy the property before a
1696license may be issued. Proof may include, but need not be
1697limited to, copies of warranty deeds, lease or rental
1698agreements, contracts for deeds, quitclaim deeds, or other such
1699documentation.
1700     (b)  In the event the property is encumbered by a mortgage
1701or is leased, an applicant must provide the agency with proof
1702that the mortgagor or landlord has been provided written notice
1703of the applicant's intent as mortgagee or tenant to provide
1704services that require licensure and instruct the mortgagor or
1705landlord to serve the agency by certified mail with copies of
1706any foreclosure or eviction actions initiated by the mortgagor
1707or landlord against the applicant.
1708     (9)  A controlling interest may not withhold from the
1709agency any evidence of financial instability, including, but not
1710limited to, checks returned due to insufficient funds,
1711delinquent accounts, nonpayment of withholding taxes, unpaid
1712utility expenses, nonpayment for essential services, or adverse
1713court action concerning the financial viability of the provider
1714or any other provider licensed under this part that is under the
1715control of the controlling interest. A controlling interest
1716shall notify the agency within 10 days after a court action to
1717initiate bankruptcy, foreclosure, or eviction proceedings
1718concerning the provider, in which the controlling interest is a
1719petitioner or defendant. Any person who violates this subsection
1720commits a misdemeanor of the second degree, punishable as
1721provided in s. 775.082 or s. 775.083. Each day of continuing
1722violation is a separate offense.
1723     Section 55.  Subsection (3) is added to section 408.813,
1724Florida Statutes, to read:
1725     408.813  Administrative fines; violations.-As a penalty for
1726any violation of this part, authorizing statutes, or applicable
1727rules, the agency may impose an administrative fine.
1728     (3)  The agency may impose an administrative fine for a
1729violation that does not qualify as a class I, class II, class
1730III, or class IV violation. The amount of the fine shall not
1731exceed $500 for each violation. Unclassified violations may
1732include:
1733     (a)  Violating any term or condition of a license.
1734     (b)  Violating any provision of this part, authorizing
1735statutes, or applicable rules.
1736     (c)  Exceeding licensed capacity.
1737     (d)  Providing services beyond the scope of the license.
1738     (e)  Violating a moratorium imposed pursuant to s. 408.814.
1739     Section 56.  Subsection (5) is added to section 408.815,
1740Florida Statutes, to read:
1741     408.815  License or application denial; revocation.-
1742     (5)  In order to ensure the health, safety, and welfare of
1743clients when a license has been denied, revoked, or is set to
1744terminate, the agency may extend the license expiration date for
1745a period of up to 60 days for the sole purpose of allowing the
1746safe and orderly discharge of clients. The agency may impose
1747conditions on the extension, including, but not limited to,
1748prohibiting or limiting admissions, expedited discharge
1749planning, required status reports, and mandatory monitoring by
1750the agency or third parties. In imposing these conditions, the
1751agency shall take into consideration the nature and number of
1752clients, the availability and location of acceptable alternative
1753placements, and the ability of the licensee to continue
1754providing care to the clients. The agency may terminate the
1755extension or modify the conditions at any time. This authority
1756is in addition to any other authority granted to the agency
1757under chapter 120, this part, and authorizing statutes but
1758creates no right or entitlement to an extension of a license
1759expiration date.
1760     Section 57.  Paragraph (k) of subsection (4) of section
1761409.221, Florida Statutes, is amended to read:
1762     409.221  Consumer-directed care program.-
1763     (4)  CONSUMER-DIRECTED CARE.-
1764     (k)  Reviews and reports.-The agency and the Departments of
1765Elderly Affairs, Health, and Children and Family Services and
1766the Agency for Persons with Disabilities shall each, on an
1767ongoing basis, review and assess the implementation of the
1768consumer-directed care program. By January 15 of each year, the
1769agency shall submit a written report to the Legislature that
1770includes each department's review of the program and contains
1771recommendations for improvements to the program.
1772     Section 58.  Subsections (3) and (4) of section 429.07,
1773Florida Statutes, are amended, and subsections (6) and (7) are
1774added to that section, to read:
1775     429.07  License required; fee; inspections.-
1776     (3)  In addition to the requirements of s. 408.806, each
1777license granted by the agency must state the type of care for
1778which the license is granted. Licenses shall be issued for one
1779or more of the following categories of care: standard, extended
1780congregate care, limited nursing services, or limited mental
1781health.
1782     (a)  A standard license shall be issued to a facility
1783facilities providing one or more of the personal services
1784identified in s. 429.02. Such licensee facilities may also
1785employ or contract with a person licensed under part I of
1786chapter 464 to administer medications and perform other tasks as
1787specified in s. 429.255.
1788     (b)  An extended congregate care license shall be issued to
1789a licensee facilities providing, directly or through contract,
1790services beyond those authorized in paragraph (a), including
1791acts performed pursuant to part I of chapter 464 by persons
1792licensed thereunder, and supportive services defined by rule to
1793persons who otherwise would be disqualified from continued
1794residence in a facility licensed under this part.
1795     1.  In order for extended congregate care services to be
1796provided in a facility licensed under this part, the agency must
1797first determine that all requirements established in law and
1798rule are met and must specifically designate, on the facility's
1799license, that such services may be provided and whether the
1800designation applies to all or part of a facility. Such
1801designation may be made at the time of initial licensure or
1802relicensure, or upon request in writing by a licensee under this
1803part and part II of chapter 408. Notification of approval or
1804denial of such request shall be made in accordance with part II
1805of chapter 408. An existing licensee facilities qualifying to
1806provide extended congregate care services must have maintained a
1807standard license and may not have been subject to administrative
1808sanctions during the previous 2 years, or since initial
1809licensure if the facility has been licensed for less than 2
1810years, for any of the following reasons:
1811     a.  A class I or class II violation;
1812     b.  Three or more repeat or recurring class III violations
1813of identical or similar resident care standards as specified in
1814rule from which a pattern of noncompliance is found by the
1815agency;
1816     c.  Three or more class III violations that were not
1817corrected in accordance with the corrective action plan approved
1818by the agency;
1819     d.  Violation of resident care standards resulting in a
1820requirement to employ the services of a consultant pharmacist or
1821consultant dietitian;
1822     e.  Denial, suspension, or revocation of a license for
1823another facility under this part in which the applicant for an
1824extended congregate care license has at least 25 percent
1825ownership interest; or
1826     f.  Imposition of a moratorium pursuant to this part or
1827part II of chapter 408 or initiation of injunctive proceedings.
1828     2.  A licensee Facilities that is are licensed to provide
1829extended congregate care services shall maintain a written
1830progress report for on each person who receives such services,
1831and the which report must describe describes the type, amount,
1832duration, scope, and outcome of services that are rendered and
1833the general status of the resident's health. A registered nurse,
1834or appropriate designee, representing the agency shall visit
1835such facilities at least quarterly to monitor residents who are
1836receiving extended congregate care services and to determine if
1837the facility is in compliance with this part, part II of chapter
1838408, and rules that relate to extended congregate care. One of
1839these visits may be in conjunction with the regular survey. The
1840monitoring visits may be provided through contractual
1841arrangements with appropriate community agencies. A registered
1842nurse shall serve as part of the team that inspects such
1843facility. The agency may waive one of the required yearly
1844monitoring visits for a facility that has been licensed for at
1845least 24 months to provide extended congregate care services,
1846if, during the inspection, the registered nurse determines that
1847extended congregate care services are being provided
1848appropriately, and if the facility has no class I or class II
1849violations and no uncorrected class III violations. Before such
1850decision is made, the agency shall consult with the long-term
1851care ombudsman council for the area in which the facility is
1852located to determine if any complaints have been made and
1853substantiated about the quality of services or care. The agency
1854may not waive one of the required yearly monitoring visits if
1855complaints have been made and substantiated.
1856     3.  Licensees Facilities that are licensed to provide
1857extended congregate care services shall:
1858     a.  Demonstrate the capability to meet unanticipated
1859resident service needs.
1860     b.  Offer a physical environment that promotes a homelike
1861setting, provides for resident privacy, promotes resident
1862independence, and allows sufficient congregate space as defined
1863by rule.
1864     c.  Have sufficient staff available, taking into account
1865the physical plant and firesafety features of the building, to
1866assist with the evacuation of residents in an emergency, as
1867necessary.
1868     d.  Adopt and follow policies and procedures that maximize
1869resident independence, dignity, choice, and decisionmaking to
1870permit residents to age in place to the extent possible, so that
1871moves due to changes in functional status are minimized or
1872avoided.
1873     e.  Allow residents or, if applicable, a resident's
1874representative, designee, surrogate, guardian, or attorney in
1875fact to make a variety of personal choices, participate in
1876developing service plans, and share responsibility in
1877decisionmaking.
1878     f.  Implement the concept of managed risk.
1879     g.  Provide, either directly or through contract, the
1880services of a person licensed pursuant to part I of chapter 464.
1881     h.  In addition to the training mandated in s. 429.52,
1882provide specialized training as defined by rule for facility
1883staff.
1884     4.  Licensees Facilities licensed to provide extended
1885congregate care services are exempt from the criteria for
1886continued residency as set forth in rules adopted under s.
1887429.41. Licensees Facilities so licensed shall adopt their own
1888requirements within guidelines for continued residency set forth
1889by rule. However, such licensees facilities may not serve
1890residents who require 24-hour nursing supervision. Licensees
1891Facilities licensed to provide extended congregate care services
1892shall provide each resident with a written copy of facility
1893policies governing admission and retention.
1894     5.  The primary purpose of extended congregate care
1895services is to allow residents, as they become more impaired,
1896the option of remaining in a familiar setting from which they
1897would otherwise be disqualified for continued residency. A
1898facility licensed to provide extended congregate care services
1899may also admit an individual who exceeds the admission criteria
1900for a facility with a standard license, if the individual is
1901determined appropriate for admission to the extended congregate
1902care facility.
1903     6.  Before admission of an individual to a facility
1904licensed to provide extended congregate care services, the
1905individual must undergo a medical examination as provided in s.
1906429.26(4) and the facility must develop a preliminary service
1907plan for the individual.
1908     7.  When a licensee facility can no longer provide or
1909arrange for services in accordance with the resident's service
1910plan and needs and the licensee's facility's policy, the
1911licensee facility shall make arrangements for relocating the
1912person in accordance with s. 429.28(1)(k).
1913     8.  Failure to provide extended congregate care services
1914may result in denial of extended congregate care license
1915renewal.
1916     9.  No later than January 1 of each year, the department,
1917in consultation with the agency, shall prepare and submit to the
1918Governor, the President of the Senate, the Speaker of the House
1919of Representatives, and the chairs of appropriate legislative
1920committees, a report on the status of, and recommendations
1921related to, extended congregate care services. The status report
1922must include, but need not be limited to, the following
1923information:
1924     a.  A description of the facilities licensed to provide
1925such services, including total number of beds licensed under
1926this part.
1927     b.  The number and characteristics of residents receiving
1928such services.
1929     c.  The types of services rendered that could not be
1930provided through a standard license.
1931     d.  An analysis of deficiencies cited during licensure
1932inspections.
1933     e.  The number of residents who required extended
1934congregate care services at admission and the source of
1935admission.
1936     f.  Recommendations for statutory or regulatory changes.
1937     g.  The availability of extended congregate care to state
1938clients residing in facilities licensed under this part and in
1939need of additional services, and recommendations for
1940appropriations to subsidize extended congregate care services
1941for such persons.
1942     h.  Such other information as the department considers
1943appropriate.
1944     (c)  A limited nursing services license shall be issued to
1945a facility that provides services beyond those authorized in
1946paragraph (a) and as specified in this paragraph.
1947     1.  In order for limited nursing services to be provided in
1948a facility licensed under this part, the agency must first
1949determine that all requirements established in law and rule are
1950met and must specifically designate, on the facility's license,
1951that such services may be provided. Such designation may be made
1952at the time of initial licensure or relicensure, or upon request
1953in writing by a licensee under this part and part II of chapter
1954408. Notification of approval or denial of such request shall be
1955made in accordance with part II of chapter 408. Existing
1956facilities qualifying to provide limited nursing services shall
1957have maintained a standard license and may not have been subject
1958to administrative sanctions that affect the health, safety, and
1959welfare of residents for the previous 2 years or since initial
1960licensure if the facility has been licensed for less than 2
1961years.
1962     2.  Facilities that are licensed to provide limited nursing
1963services shall maintain a written progress report on each person
1964who receives such nursing services, which report describes the
1965type, amount, duration, scope, and outcome of services that are
1966rendered and the general status of the resident's health. A
1967registered nurse representing the agency shall visit such
1968facilities at least twice a year to monitor residents who are
1969receiving limited nursing services and to determine if the
1970facility is in compliance with applicable provisions of this
1971part, part II of chapter 408, and related rules. The monitoring
1972visits may be provided through contractual arrangements with
1973appropriate community agencies. A registered nurse shall also
1974serve as part of the team that inspects such facility.
1975     3.  A person who receives limited nursing services under
1976this part must meet the admission criteria established by the
1977agency for assisted living facilities. When a resident no longer
1978meets the admission criteria for a facility licensed under this
1979part, arrangements for relocating the person shall be made in
1980accordance with s. 429.28(1)(k), unless the facility is licensed
1981to provide extended congregate care services.
1982     (4)  In accordance with s. 408.805, an applicant or
1983licensee shall pay a fee for each license application submitted
1984under this part, part II of chapter 408, and applicable rules.
1985The amount of the fee shall be established by rule.
1986     (a)  The biennial license fee required of a facility is
1987$356 $300 per license, with an additional fee of $67.50 $50 per
1988resident based on the total licensed resident capacity of the
1989facility, except that no additional fee will be assessed for
1990beds designated for recipients of optional state supplementation
1991payments provided for in s. 409.212. The total fee may not
1992exceed $18,000 $10,000.
1993     (b)  In addition to the total fee assessed under paragraph
1994(a), the agency shall require facilities that are licensed to
1995provide extended congregate care services under this part to pay
1996an additional fee per licensed facility. The amount of the
1997biennial fee shall be $501 $400 per license, with an additional
1998fee of $10 per resident based on the total licensed resident
1999capacity of the facility.
2000     (c)  In addition to the total fee assessed under paragraph
2001(a), the agency shall require facilities that are licensed to
2002provide limited nursing services under this part to pay an
2003additional fee per licensed facility. The amount of the biennial
2004fee shall be $250 per license, with an additional fee of $10 per
2005resident based on the total licensed resident capacity of the
2006facility.
2007     (6)  In order to determine whether the facility is
2008adequately protecting residents' rights as provided in s.
2009429.28, the biennial survey shall include private informal
2010conversations with a sample of residents and consultation with
2011the ombudsman council in the planning and service area in which
2012the facility is located to discuss residents' experiences within
2013the facility.
2014     (7)  An assisted living facility that has been cited within
2015the previous 24-month period for a class I or class II
2016violation, regardless of the status of any enforcement or
2017disciplinary action, is subject to periodic unannounced
2018monitoring to determine if the facility is in compliance with
2019this part, part II of chapter 408, and applicable rules.
2020Monitoring may occur through a desk review or an onsite
2021assessment. If the class I or class II violation relates to
2022providing or failing to provide nursing care, a registered nurse
2023must participate in at least two onsite monitoring visits within
2024a 12-month period.
2025     Section 59.  Subsection (7) of section 429.11, Florida
2026Statutes, is renumbered as subsection (6), and present
2027subsection (6) of that section is amended to read:
2028     429.11  Initial application for license; provisional
2029license.-
2030     (6)  In addition to the license categories available in s.
2031408.808, a provisional license may be issued to an applicant
2032making initial application for licensure or making application
2033for a change of ownership. A provisional license shall be
2034limited in duration to a specific period of time not to exceed 6
2035months, as determined by the agency.
2036     Section 60.  Section 429.12, Florida Statutes, is amended
2037to read:
2038     429.12  Sale or transfer of ownership of a facility.-It is
2039the intent of the Legislature to protect the rights of the
2040residents of an assisted living facility when the facility is
2041sold or the ownership thereof is transferred. Therefore, in
2042addition to the requirements of part II of chapter 408, whenever
2043a facility is sold or the ownership thereof is transferred,
2044including leasing:.
2045     (1)  The transferee shall notify the residents, in writing,
2046of the change of ownership within 7 days after receipt of the
2047new license.
2048     (2)  The transferor of a facility the license of which is
2049denied pending an administrative hearing shall, as a part of the
2050written change-of-ownership contract, advise the transferee that
2051a plan of correction must be submitted by the transferee and
2052approved by the agency at least 7 days before the change of
2053ownership and that failure to correct the condition which
2054resulted in the moratorium pursuant to part II of chapter 408 or
2055denial of licensure is grounds for denial of the transferee's
2056license.
2057     Section 61.  Paragraphs (b) through (l) of subsection (1)
2058of section 429.14, Florida Statutes, are redesignated as
2059paragraphs (a) through (k), respectively, and present paragraph
2060(a) of subsection (1) and subsections (5) and (6) of that
2061section are amended to read:
2062     429.14  Administrative penalties.-
2063     (1)  In addition to the requirements of part II of chapter
2064408, the agency may deny, revoke, and suspend any license issued
2065under this part and impose an administrative fine in the manner
2066provided in chapter 120 against a licensee of an assisted living
2067facility for a violation of any provision of this part, part II
2068of chapter 408, or applicable rules, or for any of the following
2069actions by a licensee of an assisted living facility, for the
2070actions of any person subject to level 2 background screening
2071under s. 408.809, or for the actions of any facility employee:
2072     (a)  An intentional or negligent act seriously affecting
2073the health, safety, or welfare of a resident of the facility.
2074     (5)  An action taken by the agency to suspend, deny, or
2075revoke a facility's license under this part or part II of
2076chapter 408, in which the agency claims that the facility owner
2077or an employee of the facility has threatened the health,
2078safety, or welfare of a resident of the facility shall be heard
2079by the Division of Administrative Hearings of the Department of
2080Management Services within 120 days after receipt of the
2081facility's request for a hearing, unless that time limitation is
2082waived by both parties. The administrative law judge must render
2083a decision within 30 days after receipt of a proposed
2084recommended order.
2085     (6)  The agency shall provide to the Division of Hotels and
2086Restaurants of the Department of Business and Professional
2087Regulation, on a monthly basis, a list of those assisted living
2088facilities that have had their licenses denied, suspended, or
2089revoked or that are involved in an appellate proceeding pursuant
2090to s. 120.60 related to the denial, suspension, or revocation of
2091a license. This information may be provided electronically or
2092through the agency's Internet website.
2093     Section 62.  Subsections (1), (4), and (5) of section
2094429.17, Florida Statutes, are amended to read:
2095     429.17  Expiration of license; renewal; conditional
2096license.-
2097     (1)  Limited nursing, Extended congregate care, and limited
2098mental health licenses shall expire at the same time as the
2099facility's standard license, regardless of when issued.
2100     (4)  In addition to the license categories available in s.
2101408.808, a conditional license may be issued to an applicant for
2102license renewal if the applicant fails to meet all standards and
2103requirements for licensure. A conditional license issued under
2104this subsection shall be limited in duration to a specific
2105period of time not to exceed 6 months, as determined by the
2106agency, and shall be accompanied by an agency-approved plan of
2107correction.
2108     (5)  When an extended congregate care or limited nursing
2109license is requested during a facility's biennial license
2110period, the fee shall be prorated in order to permit the
2111additional license to expire at the end of the biennial license
2112period. The fee shall be calculated as of the date the
2113additional license application is received by the agency.
2114     Section 63.  Subsection (7) of section 429.19, Florida
2115Statutes, is amended to read:
2116     429.19  Violations; imposition of administrative fines;
2117grounds.-
2118     (7)  In addition to any administrative fines imposed, the
2119agency may assess a survey or monitoring fee, equal to the
2120lesser of one half of the facility's biennial license and bed
2121fee or $500, to cover the cost of conducting initial complaint
2122investigations that result in the finding of a violation that
2123was the subject of the complaint or to monitor the health,
2124safety, or security of residents under s. 429.07(7) monitoring
2125visits conducted under s. 429.28(3)(c) to verify the correction
2126of the violations.
2127     Section 64.  Subsections (6) through (10) of section
2128429.23, Florida Statutes, are renumbered as subsections (5)
2129through (9), respectively, and present subsection (5) of that
2130section is amended to read:
2131     429.23  Internal risk management and quality assurance
2132program; adverse incidents and reporting requirements.-
2133     (5)  Each facility shall report monthly to the agency any
2134liability claim filed against it. The report must include the
2135name of the resident, the dates of the incident leading to the
2136claim, if applicable, and the type of injury or violation of
2137rights alleged to have occurred. This report is not discoverable
2138in any civil or administrative action, except in such actions
2139brought by the agency to enforce the provisions of this part.
2140     Section 65.  Paragraph (a) of subsection (1) and subsection
2141(2) of section 429.255, Florida Statutes, are amended to read:
2142     429.255  Use of personnel; emergency care.-
2143     (1)(a)  Persons under contract to the facility or, facility
2144staff, or volunteers, who are licensed according to part I of
2145chapter 464, or those persons exempt under s. 464.022(1), and
2146others as defined by rule, may administer medications to
2147residents, take residents' vital signs, manage individual weekly
2148pill organizers for residents who self-administer medication,
2149give prepackaged enemas ordered by a physician, observe
2150residents, document observations on the appropriate resident's
2151record, report observations to the resident's physician, and
2152contract or allow residents or a resident's representative,
2153designee, surrogate, guardian, or attorney in fact to contract
2154with a third party, provided residents meet the criteria for
2155appropriate placement as defined in s. 429.26. Persons under
2156contract to the facility or facility staff who are licensed
2157according to part I of chapter 464 may provide limited nursing
2158services. Nursing assistants certified pursuant to part II of
2159chapter 464 may take residents' vital signs as directed by a
2160licensed nurse or physician. The facility is responsible for
2161maintaining documentation of services provided under this
2162paragraph as required by rule and ensuring that staff are
2163adequately trained to monitor residents receiving these
2164services.
2165     (2)  In facilities licensed to provide extended congregate
2166care, persons under contract to the facility or, facility staff,
2167or volunteers, who are licensed according to part I of chapter
2168464, or those persons exempt under s. 464.022(1), or those
2169persons certified as nursing assistants pursuant to part II of
2170chapter 464, may also perform all duties within the scope of
2171their license or certification, as approved by the facility
2172administrator and pursuant to this part.
2173     Section 66.  Subsection (3) of section 429.28, Florida
2174Statutes, is amended to read:
2175     429.28  Resident bill of rights.-
2176     (3)(a)  The agency shall conduct a survey to determine
2177general compliance with facility standards and compliance with
2178residents' rights as a prerequisite to initial licensure or
2179licensure renewal.
2180     (b)  In order to determine whether the facility is
2181adequately protecting residents' rights, the biennial survey
2182shall include private informal conversations with a sample of
2183residents and consultation with the ombudsman council in the
2184planning and service area in which the facility is located to
2185discuss residents' experiences within the facility.
2186     (c)  During any calendar year in which no survey is
2187conducted, the agency shall conduct at least one monitoring
2188visit of each facility cited in the previous year for a class I
2189or class II violation, or more than three uncorrected class III
2190violations.
2191     (d)  The agency may conduct periodic followup inspections
2192as necessary to monitor the compliance of facilities with a
2193history of any class I, class II, or class III violations that
2194threaten the health, safety, or security of residents.
2195     (e)  The agency may conduct complaint investigations as
2196warranted to investigate any allegations of noncompliance with
2197requirements required under this part or rules adopted under
2198this part.
2199     Section 67.  Subsection (2) of section 429.35, Florida
2200Statutes, is amended to read:
2201     429.35  Maintenance of records; reports.-
2202     (2)  Within 60 days after the date of the biennial
2203inspection visit required under s. 408.811 or within 30 days
2204after the date of any interim visit, the agency shall forward
2205the results of the inspection to the local ombudsman council in
2206whose planning and service area, as defined in part II of
2207chapter 400, the facility is located; to at least one public
2208library or, in the absence of a public library, the county seat
2209in the county in which the inspected assisted living facility is
2210located; and, when appropriate, to the district Adult Services
2211and Mental Health Program Offices. This information may be
2212provided electronically or through the agency's Internet
2213website.
2214     Section 68.  Paragraphs (i) and (j) of subsection (1) of
2215section 429.41, Florida Statutes, are amended to read:
2216     429.41  Rules establishing standards.-
2217     (1)  It is the intent of the Legislature that rules
2218published and enforced pursuant to this section shall include
2219criteria by which a reasonable and consistent quality of
2220resident care and quality of life may be ensured and the results
2221of such resident care may be demonstrated. Such rules shall also
2222ensure a safe and sanitary environment that is residential and
2223noninstitutional in design or nature. It is further intended
2224that reasonable efforts be made to accommodate the needs and
2225preferences of residents to enhance the quality of life in a
2226facility. The agency, in consultation with the department, may
2227adopt rules to administer the requirements of part II of chapter
2228408. In order to provide safe and sanitary facilities and the
2229highest quality of resident care accommodating the needs and
2230preferences of residents, the department, in consultation with
2231the agency, the Department of Children and Family Services, and
2232the Department of Health, shall adopt rules, policies, and
2233procedures to administer this part, which must include
2234reasonable and fair minimum standards in relation to:
2235     (i)  Facilities holding an a limited nursing, extended
2236congregate care, or limited mental health license.
2237     (j)  The establishment of specific criteria to define
2238appropriateness of resident admission and continued residency in
2239a facility holding a standard, limited nursing, extended
2240congregate care, and limited mental health license.
2241     Section 69.  Subsections (1) and (2) of section 429.53,
2242Florida Statutes, are amended to read:
2243     429.53  Consultation by the agency.-
2244     (1)  The area offices of licensure and certification of the
2245agency shall provide consultation to the following upon request:
2246     (a)  A licensee of a facility.
2247     (b)  A person interested in obtaining a license to operate
2248a facility under this part.
2249     (2)  As used in this section, "consultation" includes:
2250     (a)  An explanation of the requirements of this part and
2251rules adopted pursuant thereto;
2252     (b)  An explanation of the license application and renewal
2253procedures;
2254     (c)  The provision of a checklist of general local and
2255state approvals required prior to constructing or developing a
2256facility and a listing of the types of agencies responsible for
2257such approvals;
2258     (d)  An explanation of benefits and financial assistance
2259available to a recipient of supplemental security income
2260residing in a facility;
2261     (c)(e)  Any other information which the agency deems
2262necessary to promote compliance with the requirements of this
2263part; and
2264     (f)  A preconstruction review of a facility to ensure
2265compliance with agency rules and this part.
2266     Section 70.  Subsections (1) and (2) of section 429.54,
2267Florida Statutes, are renumbered as subsections (2) and (3),
2268respectively, and a new subsection (1) is added to that section
2269to read:
2270     429.54  Collection of information; local subsidy.-
2271     (1)  A facility that is licensed under this part must
2272report electronically to the agency semiannually, or more
2273frequently as determined by rule, data related to the facility,
2274including, but not limited to, the total number of residents,
2275the number of residents who are receiving limited mental health
2276services, the number of residents who are receiving extended
2277congregate care services, the number of residents who are
2278receiving limited nursing services, funding sources of the
2279residents, and professional staffing employed by or under
2280contract with the licensee to provide resident services. The
2281department, in consultation with the agency, shall adopt rules
2282to administer this subsection.
2283     Section 71.  Subsections (1) and (5) of section 429.71,
2284Florida Statutes, are amended to read:
2285     429.71  Classification of violations deficiencies;
2286administrative fines.-
2287     (1)  In addition to the requirements of part II of chapter
2288408 and in addition to any other liability or penalty provided
2289by law, the agency may impose an administrative fine on a
2290provider according to the following classification:
2291     (a)  Class I violations are defined in s. 408.813 those
2292conditions or practices related to the operation and maintenance
2293of an adult family-care home or to the care of residents which
2294the agency determines present an imminent danger to the
2295residents or guests of the facility or a substantial probability
2296that death or serious physical or emotional harm would result
2297therefrom. The condition or practice that constitutes a class I
2298violation must be abated or eliminated within 24 hours, unless a
2299fixed period, as determined by the agency, is required for
2300correction. A class I violation deficiency is subject to an
2301administrative fine in an amount not less than $500 and not
2302exceeding $1,000 for each violation. A fine may be levied
2303notwithstanding the correction of the deficiency.
2304     (b)  Class II violations are defined in s. 408.813 those
2305conditions or practices related to the operation and maintenance
2306of an adult family-care home or to the care of residents which
2307the agency determines directly threaten the physical or
2308emotional health, safety, or security of the residents, other
2309than class I violations. A class II violation is subject to an
2310administrative fine in an amount not less than $250 and not
2311exceeding $500 for each violation. A citation for a class II
2312violation must specify the time within which the violation is
2313required to be corrected. If a class II violation is corrected
2314within the time specified, no civil penalty shall be imposed,
2315unless it is a repeated offense.
2316     (c)  Class III violations are defined in s. 408.813 those
2317conditions or practices related to the operation and maintenance
2318of an adult family-care home or to the care of residents which
2319the agency determines indirectly or potentially threaten the
2320physical or emotional health, safety, or security of residents,
2321other than class I or class II violations. A class III violation
2322is subject to an administrative fine in an amount not less than
2323$100 and not exceeding $250 for each violation. A citation for a
2324class III violation shall specify the time within which the
2325violation is required to be corrected. If a class III violation
2326is corrected within the time specified, no civil penalty shall
2327be imposed, unless it is a repeated violation offense.
2328     (d)  Class IV violations are defined in s. 408.813 those
2329conditions or occurrences related to the operation and
2330maintenance of an adult family-care home, or related to the
2331required reports, forms, or documents, which do not have the
2332potential of negatively affecting the residents. A provider that
2333does not correct A class IV violation within the time limit
2334specified by the agency is subject to an administrative fine in
2335an amount not less than $50 and not exceeding $100 for each
2336violation. Any class IV violation that is corrected during the
2337time the agency survey is conducted will be identified as an
2338agency finding and not as a violation, unless it is a repeat
2339violation.
2340     (5)  As an alternative to or in conjunction with an
2341administrative action against a provider, the agency may request
2342a plan of corrective action that demonstrates a good faith
2343effort to remedy each violation by a specific date, subject to
2344the approval of the agency.
2345     Section 72.  Paragraphs (b) through (e) of subsection (2)
2346of section 429.911, Florida Statutes, are redesignated as
2347paragraphs (a) through (d), respectively, and present paragraph
2348(a) of that subsection is amended to read:
2349     429.911  Denial, suspension, revocation of license;
2350emergency action; administrative fines; investigations and
2351inspections.-
2352     (2)  Each of the following actions by the owner of an adult
2353day care center or by its operator or employee is a ground for
2354action by the agency against the owner of the center or its
2355operator or employee:
2356     (a)  An intentional or negligent act materially affecting
2357the health or safety of center participants.
2358     Section 73.  Section 429.915, Florida Statutes, is amended
2359to read:
2360     429.915  Conditional license.-In addition to the license
2361categories available in part II of chapter 408, the agency may
2362issue a conditional license to an applicant for license renewal
2363or change of ownership if the applicant fails to meet all
2364standards and requirements for licensure. A conditional license
2365issued under this subsection must be limited to a specific
2366period not exceeding 6 months, as determined by the agency, and
2367must be accompanied by an approved plan of correction.
2368     Section 74.  Subsection (7) of section 394.4787, Florida
2369Statutes, is amended to read:
2370     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
2371and 394.4789.-As used in this section and ss. 394.4786,
2372394.4788, and 394.4789:
2373     (7)  "Specialty psychiatric hospital" means a hospital
2374licensed by the agency pursuant to s. 395.002(26)(28) and part
2375II of chapter 408 as a specialty psychiatric hospital.
2376     Section 75.  Paragraph (g) of subsection (2) of section
2377400.0239, Florida Statutes, is amended to read:
2378     400.0239  Quality of Long-Term Care Facility Improvement
2379Trust Fund.-
2380     (2)  Expenditures from the trust fund shall be allowable
2381for direct support of the following:
2382     (g)  Other initiatives authorized by the Centers for
2383Medicare and Medicaid Services for the use of federal civil
2384monetary penalties, including projects recommended through the
2385Medicaid "Up-or-Out" Quality of Care Contract Management Program
2386pursuant to s. 400.148.
2387     Section 76.  Subsection (43) of section 408.07, Florida
2388Statutes, is amended to read:
2389     408.07  Definitions.-As used in this chapter, with the
2390exception of ss. 408.031-408.045, the term:
2391     (43)  "Rural hospital" means an acute care hospital
2392licensed under chapter 395, having 100 or fewer licensed beds
2393and an emergency room, and which is:
2394     (a)  The sole provider within a county with a population
2395density of no greater than 100 persons per square mile;
2396     (b)  An acute care hospital, in a county with a population
2397density of no greater than 100 persons per square mile, which is
2398at least 30 minutes of travel time, on normally traveled roads
2399under normal traffic conditions, from another acute care
2400hospital within the same county;
2401     (c)  A hospital supported by a tax district or subdistrict
2402whose boundaries encompass a population of 100 persons or fewer
2403per square mile;
2404     (d)  A hospital with a service area that has a population
2405of 100 persons or fewer per square mile. As used in this
2406paragraph, the term "service area" means the fewest number of
2407zip codes that account for 75 percent of the hospital's
2408discharges for the most recent 5-year period, based on
2409information available from the hospital inpatient discharge
2410database in the Florida Center for Health Information and Policy
2411Analysis at the Agency for Health Care Administration; or
2412     (e)  A critical access hospital.
2413
2414Population densities used in this subsection must be based upon
2415the most recently completed United States census. A hospital
2416that received funds under s. 409.9116 for a quarter beginning no
2417later than July 1, 2002, is deemed to have been and shall
2418continue to be a rural hospital from that date through June 30,
24192015, if the hospital continues to have 100 or fewer licensed
2420beds and an emergency room, or meets the criteria of s.
2421395.602(2)(e)4. An acute care hospital that has not previously
2422been designated as a rural hospital and that meets the criteria
2423of this subsection shall be granted such designation upon
2424application, including supporting documentation, to the Agency
2425for Health Care Administration.
2426     Section 77.  Paragraphs (b) and (h) of subsection (3) of
2427section 430.80, Florida Statutes, are amended to read:
2428     430.80  Implementation of a teaching nursing home pilot
2429project.-
2430     (3)  To be designated as a teaching nursing home, a nursing
2431home licensee must, at a minimum:
2432     (b)  Participate in a nationally recognized accreditation
2433program and hold a valid accreditation, such as the
2434accreditation awarded by The Joint Commission on Accreditation
2435of Healthcare Organizations;
2436     (h)  Maintain insurance coverage pursuant to s.
2437400.141(1)(r)(s) or proof of financial responsibility in a
2438minimum amount of $750,000. Such proof of financial
2439responsibility may include:
2440     1.  Maintaining an escrow account consisting of cash or
2441assets eligible for deposit in accordance with s. 625.52; or
2442     2.  Obtaining and maintaining pursuant to chapter 675 an
2443unexpired, irrevocable, nontransferable and nonassignable letter
2444of credit issued by any bank or savings association organized
2445and existing under the laws of this state or any bank or savings
2446association organized under the laws of the United States that
2447has its principal place of business in this state or has a
2448branch office which is authorized to receive deposits in this
2449state. The letter of credit shall be used to satisfy the
2450obligation of the facility to the claimant upon presentment of a
2451final judgment indicating liability and awarding damages to be
2452paid by the facility or upon presentment of a settlement
2453agreement signed by all parties to the agreement when such final
2454judgment or settlement is a result of a liability claim against
2455the facility.
2456     Section 78.  Paragraph (a) of subsection (2) of section
2457440.13, Florida Statutes, is amended to read:
2458     440.13  Medical services and supplies; penalty for
2459violations; limitations.-
2460     (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2461     (a)  Subject to the limitations specified elsewhere in this
2462chapter, the employer shall furnish to the employee such
2463medically necessary remedial treatment, care, and attendance for
2464such period as the nature of the injury or the process of
2465recovery may require, which is in accordance with established
2466practice parameters and protocols of treatment as provided for
2467in this chapter, including medicines, medical supplies, durable
2468medical equipment, orthoses, prostheses, and other medically
2469necessary apparatus. Remedial treatment, care, and attendance,
2470including work-hardening programs or pain-management programs
2471accredited by the Commission on Accreditation of Rehabilitation
2472Facilities or The Joint Commission on the Accreditation of
2473Health Organizations or pain-management programs affiliated with
2474medical schools, shall be considered as covered treatment only
2475when such care is given based on a referral by a physician as
2476defined in this chapter. Medically necessary treatment, care,
2477and attendance does not include chiropractic services in excess
2478of 24 treatments or rendered 12 weeks beyond the date of the
2479initial chiropractic treatment, whichever comes first, unless
2480the carrier authorizes additional treatment or the employee is
2481catastrophically injured.
2482
2483Failure of the carrier to timely comply with this subsection
2484shall be a violation of this chapter and the carrier shall be
2485subject to penalties as provided for in s. 440.525.
2486     Section 79.  Section 483.294, Florida Statutes, is amended
2487to read:
2488     483.294  Inspection of centers.-In accordance with s.
2489408.811, the agency shall biennially, at least once annually,
2490inspect the premises and operations of all centers subject to
2491licensure under this part.
2492     Section 80.  Subsection (1) of section 627.645, Florida
2493Statutes, is amended to read:
2494     627.645  Denial of health insurance claims restricted.-
2495     (1)  No claim for payment under a health insurance policy
2496or self-insured program of health benefits for treatment, care,
2497or services in a licensed hospital which is accredited by The
2498Joint Commission on the Accreditation of Hospitals, the American
2499Osteopathic Association, or the Commission on the Accreditation
2500of Rehabilitative Facilities shall be denied because such
2501hospital lacks major surgical facilities and is primarily of a
2502rehabilitative nature, if such rehabilitation is specifically
2503for treatment of physical disability.
2504     Section 81.  Paragraph (c) of subsection (2) of section
2505627.668, Florida Statutes, is amended to read:
2506     627.668  Optional coverage for mental and nervous disorders
2507required; exception.-
2508     (2)  Under group policies or contracts, inpatient hospital
2509benefits, partial hospitalization benefits, and outpatient
2510benefits consisting of durational limits, dollar amounts,
2511deductibles, and coinsurance factors shall not be less favorable
2512than for physical illness generally, except that:
2513     (c)  Partial hospitalization benefits shall be provided
2514under the direction of a licensed physician. For purposes of
2515this part, the term "partial hospitalization services" is
2516defined as those services offered by a program accredited by The
2517Joint Commission on Accreditation of Hospitals (JCAH) or in
2518compliance with equivalent standards. Alcohol rehabilitation
2519programs accredited by The Joint Commission on Accreditation of
2520Hospitals or approved by the state and licensed drug abuse
2521rehabilitation programs shall also be qualified providers under
2522this section. In any benefit year, if partial hospitalization
2523services or a combination of inpatient and partial
2524hospitalization are utilized, the total benefits paid for all
2525such services shall not exceed the cost of 30 days of inpatient
2526hospitalization for psychiatric services, including physician
2527fees, which prevail in the community in which the partial
2528hospitalization services are rendered. If partial
2529hospitalization services benefits are provided beyond the limits
2530set forth in this paragraph, the durational limits, dollar
2531amounts, and coinsurance factors thereof need not be the same as
2532those applicable to physical illness generally.
2533     Section 82.  Subsection (3) of section 627.669, Florida
2534Statutes, is amended to read:
2535     627.669  Optional coverage required for substance abuse
2536impaired persons; exception.-
2537     (3)  The benefits provided under this section shall be
2538applicable only if treatment is provided by, or under the
2539supervision of, or is prescribed by, a licensed physician or
2540licensed psychologist and if services are provided in a program
2541accredited by The Joint Commission on Accreditation of Hospitals
2542or approved by the state.
2543     Section 83.  Paragraph (a) of subsection (1) of section
2544627.736, Florida Statutes, is amended to read:
2545     627.736  Required personal injury protection benefits;
2546exclusions; priority; claims.-
2547     (1)  REQUIRED BENEFITS.-Every insurance policy complying
2548with the security requirements of s. 627.733 shall provide
2549personal injury protection to the named insured, relatives
2550residing in the same household, persons operating the insured
2551motor vehicle, passengers in such motor vehicle, and other
2552persons struck by such motor vehicle and suffering bodily injury
2553while not an occupant of a self-propelled vehicle, subject to
2554the provisions of subsection (2) and paragraph (4)(e), to a
2555limit of $10,000 for loss sustained by any such person as a
2556result of bodily injury, sickness, disease, or death arising out
2557of the ownership, maintenance, or use of a motor vehicle as
2558follows:
2559     (a)  Medical benefits.-Eighty percent of all reasonable
2560expenses for medically necessary medical, surgical, X-ray,
2561dental, and rehabilitative services, including prosthetic
2562devices, and medically necessary ambulance, hospital, and
2563nursing services. However, the medical benefits shall provide
2564reimbursement only for such services and care that are lawfully
2565provided, supervised, ordered, or prescribed by a physician
2566licensed under chapter 458 or chapter 459, a dentist licensed
2567under chapter 466, or a chiropractic physician licensed under
2568chapter 460 or that are provided by any of the following persons
2569or entities:
2570     1.  A hospital or ambulatory surgical center licensed under
2571chapter 395.
2572     2.  A person or entity licensed under ss. 401.2101-401.45
2573that provides emergency transportation and treatment.
2574     3.  An entity wholly owned by one or more physicians
2575licensed under chapter 458 or chapter 459, chiropractic
2576physicians licensed under chapter 460, or dentists licensed
2577under chapter 466 or by such practitioner or practitioners and
2578the spouse, parent, child, or sibling of that practitioner or
2579those practitioners.
2580     4.  An entity wholly owned, directly or indirectly, by a
2581hospital or hospitals.
2582     5.  A health care clinic licensed under ss. 400.990-400.995
2583that is:
2584     a.  Accredited by The Joint Commission on Accreditation of
2585Healthcare Organizations, the American Osteopathic Association,
2586the Commission on Accreditation of Rehabilitation Facilities, or
2587the Accreditation Association for Ambulatory Health Care, Inc.;
2588or
2589     b.  A health care clinic that:
2590     (I)  Has a medical director licensed under chapter 458,
2591chapter 459, or chapter 460;
2592     (II)  Has been continuously licensed for more than 3 years
2593or is a publicly traded corporation that issues securities
2594traded on an exchange registered with the United States
2595Securities and Exchange Commission as a national securities
2596exchange; and
2597     (III)  Provides at least four of the following medical
2598specialties:
2599     (A)  General medicine.
2600     (B)  Radiography.
2601     (C)  Orthopedic medicine.
2602     (D)  Physical medicine.
2603     (E)  Physical therapy.
2604     (F)  Physical rehabilitation.
2605     (G)  Prescribing or dispensing outpatient prescription
2606medication.
2607     (H)  Laboratory services.
2608
2609The Financial Services Commission shall adopt by rule the form
2610that must be used by an insurer and a health care provider
2611specified in subparagraph 3., subparagraph 4., or subparagraph
26125. to document that the health care provider meets the criteria
2613of this paragraph, which rule must include a requirement for a
2614sworn statement or affidavit.
2615
2616Only insurers writing motor vehicle liability insurance in this
2617state may provide the required benefits of this section, and no
2618such insurer shall require the purchase of any other motor
2619vehicle coverage other than the purchase of property damage
2620liability coverage as required by s. 627.7275 as a condition for
2621providing such required benefits. Insurers may not require that
2622property damage liability insurance in an amount greater than
2623$10,000 be purchased in conjunction with personal injury
2624protection. Such insurers shall make benefits and required
2625property damage liability insurance coverage available through
2626normal marketing channels. Any insurer writing motor vehicle
2627liability insurance in this state who fails to comply with such
2628availability requirement as a general business practice shall be
2629deemed to have violated part IX of chapter 626, and such
2630violation shall constitute an unfair method of competition or an
2631unfair or deceptive act or practice involving the business of
2632insurance; and any such insurer committing such violation shall
2633be subject to the penalties afforded in such part, as well as
2634those which may be afforded elsewhere in the insurance code.
2635     Section 84.  Subsection (12) of section 641.495, Florida
2636Statutes, is amended to read:
2637     641.495  Requirements for issuance and maintenance of
2638certificate.-
2639     (12)  The provisions of part I of chapter 395 do not apply
2640to a health maintenance organization that, on or before January
26411, 1991, provides not more than 10 outpatient holding beds for
2642short-term and hospice-type patients in an ambulatory care
2643facility for its members, provided that such health maintenance
2644organization maintains current accreditation by The Joint
2645Commission on Accreditation of Health Care Organizations, the
2646Accreditation Association for Ambulatory Health Care, or the
2647National Committee for Quality Assurance.
2648     Section 85.  Subsection (13) of section 651.118, Florida
2649Statutes, is amended to read:
2650     651.118  Agency for Health Care Administration;
2651certificates of need; sheltered beds; community beds.-
2652     (13)  Residents, as defined in this chapter, are not
2653considered new admissions for the purpose of s.
2654400.141(1)(n)(o)1.d.
2655     Section 86.  Subsection (2) of section 766.1015, Florida
2656Statutes, is amended to read:
2657     766.1015  Civil immunity for members of or consultants to
2658certain boards, committees, or other entities.-
2659     (2)  Such committee, board, group, commission, or other
2660entity must be established in accordance with state law or in
2661accordance with requirements of The Joint Commission on
2662Accreditation of Healthcare Organizations, established and duly
2663constituted by one or more public or licensed private hospitals
2664or behavioral health agencies, or established by a governmental
2665agency. To be protected by this section, the act, decision,
2666omission, or utterance may not be made or done in bad faith or
2667with malicious intent.
2668     Section 87.  This act shall take effect July 1, 2010.


CODING: Words stricken are deletions; words underlined are additions.
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