August 13, 2020
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CS/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; conforming
14a cross-reference; amending s. 395.0193, F.S.; requiring a
15licensed facility to report certain peer review
16information and final disciplinary actions to the Division
17of Medical Quality Assurance of the Department of Health
18rather than the Division of Health Quality Assurance of
19the Agency for Health Care Administration; amending s.
20395.1023, F.S.; providing for the Department of Children
21and Family Services rather than the Department of Health
22to perform certain functions with respect to child
23protection cases; requiring certain hospitals to notify
24the Department of Children and Family Services of
25compliance; amending s. 395.1041, F.S., relating to
26hospital emergency services and care; deleting obsolete
27provisions; repealing s. 395.1046, F.S., relating to
28complaint investigation procedures; amending s. 395.1055,
29F.S.; requiring licensed facility beds to conform to
30standards specified by the Agency for Health Care
31Administration, the Florida Building Code, and the Florida
32Fire Prevention Code; amending s. 395.10972, F.S.;
33revising a reference to the Florida Society of Healthcare
34Risk Management to conform to the current designation;
35amending s. 395.2050, F.S.; revising a reference to the
36federal Health Care Financing Administration to conform to
37the current designation; amending s. 395.3036, F.S.;
38correcting a reference; repealing s. 395.3037, F.S.,
39relating to redundant definitions; amending ss. 154.11,
40394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
41627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
42F.S.; revising references to the Joint Commission on
43Accreditation of Healthcare Organizations, the Commission
44on Accreditation of Rehabilitation Facilities, and the
45Council on Accreditation to conform to their current
46designations; amending s. 395.602, F.S.; revising the
47definition of the term "rural hospital" to delete an
48obsolete provision; amending s. 400.021, F.S.; revising
49the definition of the term "geriatric outpatient clinic";
50amending s. 400.063, F.S.; deleting an obsolete provision;
51amending ss. 400.071 and 400.0712, F.S.; revising
52applicability of general licensure requirements under pt.
53II of ch. 408, F.S., to applications for nursing home
54licensure; revising provisions governing inactive
55licenses; amending s. 400.111, F.S.; providing for
56disclosure of controlling interest of a nursing home
57facility upon request by the Agency for Health Care
58Administration; amending s. 400.1183, F.S.; revising
59grievance record maintenance and reporting requirements
60for nursing homes; amending s. 400.141, F.S.; providing
61criteria for the provision of respite services by nursing
62homes; requiring a written plan of care; requiring a
63contract for services; requiring resident release to
64caregivers to be designated in writing; providing an
65exemption to the application of discharge planning rules;
66providing for residents' rights; providing for use of
67personal medications; providing terms of respite stay;
68providing for communication of patient information;
69requiring a physician order for care and proof of a
70physical examination; providing for services for respite
71patients and duties of facilities with respect to such
72patients; conforming a cross-reference; requiring
73facilities to maintain clinical records that meet
74specified standards; providing a fine relating to an
75admissions moratorium; deleting requirement for facilities
76to submit certain information related to management
77companies to the agency; deleting a requirement for
78facilities to notify the agency of certain bankruptcy
79filings to conform to changes made by the act; amending s.
80400.142, F.S.; deleting language relating to agency
81adoption of rules; amending 400.147, F.S.; revising
82reporting requirements for licensed nursing home
83facilities relating to adverse incidents; repealing s.
84400.148, F.S., relating to the Medicaid "Up-or-Out"
85Quality of Care Contract Management Program; amending s.
86400.162, F.S., requiring nursing homes to provide a
87resident property statement annually and upon request;
88amending s. 400.179, F.S.; revising requirements for
89nursing home lease bond alternative fees; deleting an
90obsolete provision; amending s. 400.19, F.S.; revising
91inspection requirements; repealing s. 400.195, F.S.,
92relating to agency reporting requirements; amending s.
93400.23, F.S.; deleting an obsolete provision; clarifying a
94reference; amending s. 400.275, F.S.; revising agency
95duties with regard to training nursing home surveyor
96teams; revising requirements for team members; amending s.
97400.484, F.S.; revising the schedule of home health agency
98inspection violations; amending s. 400.606, F.S.; revising
99the content requirements of the plan accompanying an
100initial or change-of-ownership application for licensure
101of a hospice; revising requirements relating to
102certificates of need for certain hospice facilities;
103amending s. 400.607, F.S.; revising grounds for agency
104action against a hospice; amending s. 400.931, F.S.;
105deleting a requirement that an applicant for a home
106medical equipment provider license submit a surety bond to
107the agency; amending s. 400.932, F.S.; revising grounds
108for the imposition of administrative penalties for certain
109violations by an employee of a home medical equipment
110provider; amending s. 400.967, F.S.; revising the schedule
111of inspection violations for intermediate care facilities
112for the developmentally disabled; providing a penalty for
113certain violations; amending s. 400.9905, F.S.; revising
114definitions under the Health Care Clinic Act; amending s.
115400.991, F.S.; conforming terminology; revising
116application requirements relating to documentation of
117financial ability to operate a mobile clinic; amending s.
118408.034, F.S.; revising agency authority relating to
119licensing of intermediate care facilities for the
120developmentally disabled; amending s. 408.036, F.S.;
121deleting an exemption from certain certificate-of-need
122review requirements for a hospice or a hospice inpatient
123facility; amending s. 408.043, F.S.; revising requirements
124for certain freestanding inpatient hospice care facilities
125to obtain a certificate of need; amending s. 408.061,
126F.S.; revising health care facility data reporting
127requirements; amending s. 408.10, F.S.; removing agency
128authority to investigate certain consumer complaints;
129amending s. 408.802, F.S.; removing applicability of pt.
130II of ch. 408, F.S., relating to general licensure
131requirements, to private review agents; amending s.
132408.804, F.S.; providing penalties for altering, defacing,
133or falsifying a license certificate issued by the agency
134or displaying such an altered, defaced, or falsified
135certificate; amending s. 408.806, F.S.; revising agency
136responsibilities for notification of licensees of
137impending expiration of a license; requiring payment of a
138late fee for a license application to be considered
139complete under certain circumstances; amending s. 408.810,
140F.S.; revising provisions relating to information required
141for licensure; requiring proof of submission of notice to
142a mortgagor or landlord regarding provision of services
143requiring licensure; requiring disclosure of information
144by a controlling interest of certain court actions
145relating to financial instability within a specified time
146period; amending s. 408.813, F.S.; authorizing the agency
147to impose fines for unclassified violations of pt. II of
148ch. 408, F.S.; amending s. 408.815, F.S.; authorizing the
149agency to extend a license expiration date under certain
150circumstances; amending s. 409.221, F.S.; deleting a
151reporting requirement relating to the consumer-directed
152care program; amending s. 429.07, F.S.; deleting the
153requirement for an assisted living facility to obtain an
154additional license in order to provide limited nursing
155services; deleting the requirement for the agency to
156conduct quarterly monitoring visits of facilities that
157hold a license to provide extended congregate care
158services; deleting the requirement for the department to
159report annually on the status of and recommendations
160related to extended congregate care; deleting the
161requirement for the agency to conduct monitoring visits at
162least twice a year to facilities providing limited nursing
163services; increasing the licensure fees and the maximum
164fee required for the standard license; increasing the
165licensure fees for the extended congregate care license;
166eliminating the license fee for the limited nursing
167services license; transferring from another provision of
168law the requirement that a biennial survey of an assisted
169living facility include specific actions to determine
170whether the facility is adequately protecting residents'
171rights; providing that an assisted living facility that
172has a class I or class II violation is subject to
173monitoring visits; requiring a registered nurse to
174participate in certain monitoring visits; amending s.
175429.11, F.S.; revising licensure application requirements
176for assisted living facilities to eliminate provisional
177licenses; amending s. 429.12, F.S.; revising notification
178requirements for the sale or transfer of ownership of an
179assisted living facility; amending s. 429.14, F.S.;
180removing a ground for the imposition of an administrative
181penalty; clarifying language relating to a facility's
182request for a hearing under certain circumstances;
183authorizing the agency to provide certain information
184relating to the licensure status of assisted living
185facilities electronically or through the agency's Internet
186website; amending s. 429.17, F.S.; deleting provisions
187relating to the limited nursing services license; revising
188agency responsibilities regarding the issuance of
189conditional licenses; amending s. 429.19, F.S.; clarifying
190that a monitoring fee may be assessed in addition to an
191administrative fine; amending s. 429.23, F.S.; deleting
192reporting requirements for assisted living facilities
193relating to liability claims; amending s. 429.255, F.S.;
194eliminating provisions authorizing the use of volunteers
195to provide certain health-care-related services in
196assisted living facilities; authorizing assisted living
197facilities to provide limited nursing services; requiring
198an assisted living facility to be responsible for certain
199recordkeeping and staff to be trained to monitor residents
200receiving certain health-care-related services; amending
201s. 429.28, F.S.; deleting a requirement for a biennial
202survey of an assisted living facility, to conform to
203changes made by the act; amending s. 429.35, F.S.;
204authorizing the agency to provide certain information
205relating to the inspections of assisted living facilities
206electronically or through the agency's Internet website;
207amending s. 429.41, F.S., relating to rulemaking;
208conforming provisions to changes made by the act; amending
209s. 429.53, F.S.; revising provisions relating to
210consultation by the agency; revising a definition;
211amending s. 429.54, F.S.; requiring licensed assisted
212living facilities to electronically report certain data
213semiannually to the agency in accordance with rules
214adopted by the department; amending s. 429.71, F.S.;
215revising schedule of inspection violations for adult
216family-care homes; amending s. 429.911, F.S.; deleting a
217ground for agency action against an adult day care center;
218amending s. 429.915, F.S.; revising agency
219responsibilities regarding the issuance of conditional
220licenses; amending s. 483.294, F.S.; revising frequency of
221agency inspections of multiphasic health testing centers;
222amending ss. 394.4787, 400.0239, 408.07, 430.80, and
223651.118, F.S.; conforming terminology and cross-
224references; revising a reference; providing an effective
225date.
226
227Be It Enacted by the Legislature of the State of Florida:
228
229     Section 1.  Present paragraph (e) of subsection (10) and
230paragraph (e) of subsection (14) of section 112.0455, Florida
231Statutes, are amended, and paragraphs (f) through (k) of
232subsection (10) of that section are redesignated as paragraphs
233(e) through (j), respectively, to read:
234     112.0455  Drug-Free Workplace Act.-
235     (10)  EMPLOYER PROTECTION.-
236     (e)  Nothing in this section shall be construed to operate
237retroactively, and nothing in this section shall abrogate the
238right of an employer under state law to conduct drug tests prior
239to January 1, 1990. A drug test conducted by an employer prior
240to January 1, 1990, is not subject to this section.
241     (14)  DISCIPLINE REMEDIES.-
242     (e)  Upon resolving an appeal filed pursuant to paragraph
243(c), and finding a violation of this section, the commission may
244order the following relief:
245     1.  Rescind the disciplinary action, expunge related
246records from the personnel file of the employee or job applicant
247and reinstate the employee.
248     2.  Order compliance with paragraph (10)(f)(g).
249     3.  Award back pay and benefits.
250     4.  Award the prevailing employee or job applicant the
251necessary costs of the appeal, reasonable attorney's fees, and
252expert witness fees.
253     Section 2.  Paragraph (n) of subsection (1) of section
254154.11, Florida Statutes, is amended to read:
255     154.11  Powers of board of trustees.-
256     (1)  The board of trustees of each public health trust
257shall be deemed to exercise a public and essential governmental
258function of both the state and the county and in furtherance
259thereof it shall, subject to limitation by the governing body of
260the county in which such board is located, have all of the
261powers necessary or convenient to carry out the operation and
262governance of designated health care facilities, including, but
263without limiting the generality of, the foregoing:
264     (n)  To appoint originally the staff of physicians to
265practice in any designated facility owned or operated by the
266board and to approve the bylaws and rules to be adopted by the
267medical staff of any designated facility owned and operated by
268the board, such governing regulations to be in accordance with
269the standards of The Joint Commission on the Accreditation of
270Hospitals which provide, among other things, for the method of
271appointing additional staff members and for the removal of staff
272members.
273     Section 3.  Subsection (15) of section 318.21, Florida
274Statutes, is amended to read:
275     318.21  Disposition of civil penalties by county courts.-
276All civil penalties received by a county court pursuant to the
277provisions of this chapter shall be distributed and paid monthly
278as follows:
279     (15)  Of the additional fine assessed under s. 318.18(3)(e)
280for a violation of s. 316.1893, 50 percent of the moneys
281received from the fines shall be remitted to the Department of
282Revenue and deposited into the Brain and Spinal Cord Injury
283Trust Fund of Department of Health and shall be appropriated to
284the Department of Health Agency for Health Care Administration
285as general revenue to provide an enhanced Medicaid payment to
286nursing homes that serve Medicaid recipients with spinal cord
287injuries that are medically complex and who are technologically
288and respiratory dependent with brain and spinal cord injuries.
289The remaining 50 percent of the moneys received from the
290enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
291the Department of Revenue and deposited into the Department of
292Health Administrative Trust Fund to provide financial support to
293certified trauma centers in the counties where enhanced penalty
294zones are established to ensure the availability and
295accessibility of trauma services. Funds deposited into the
296Administrative Trust Fund under this subsection shall be
297allocated as follows:
298     (a)  Fifty percent shall be allocated equally among all
299Level I, Level II, and pediatric trauma centers in recognition
300of readiness costs for maintaining trauma services.
301     (b)  Fifty percent shall be allocated among Level I, Level
302II, and pediatric trauma centers based on each center's relative
303volume of trauma cases as reported in the Department of Health
304Trauma Registry.
305     Section 4.  Section 383.325, Florida Statutes, is repealed.
306     Section 5.  Subsection (2) of section 394.741, Florida
307Statutes, is amended to read:
308     394.741  Accreditation requirements for providers of
309behavioral health care services.-
310     (2)  Notwithstanding any provision of law to the contrary,
311accreditation shall be accepted by the agency and department in
312lieu of the agency's and department's facility licensure onsite
313review requirements and shall be accepted as a substitute for
314the department's administrative and program monitoring
315requirements, except as required by subsections (3) and (4),
316for:
317     (a)  Any organization from which the department purchases
318behavioral health care services that is accredited by The Joint
319Commission on Accreditation of Healthcare Organizations or the
320Council on Accreditation for Children and Family Services, or
321has those services that are being purchased by the department
322accredited by the Commission on Accreditation of Rehabilitation
323Facilities CARF-the Rehabilitation Accreditation Commission.
324     (b)  Any mental health facility licensed by the agency or
325any substance abuse component licensed by the department that is
326accredited by The Joint Commission on Accreditation of
327Healthcare Organizations, the Commission on Accreditation of
328Rehabilitation Facilities CARF-the Rehabilitation Accreditation
329Commission, or the Council on Accreditation of Children and
330Family Services.
331     (c)  Any network of providers from which the department or
332the agency purchases behavioral health care services accredited
333by The Joint Commission on Accreditation of Healthcare
334Organizations, the Commission on Accreditation of Rehabilitation
335Facilities CARF-the Rehabilitation Accreditation Commission, the
336Council on Accreditation of Children and Family
337National Committee for Quality Assurance. A provider
338organization, which is part of an accredited network, is
339afforded the same rights under this part.
340     Section 6.  Present subsections (15) through (32) of
341section 395.002, Florida Statutes, are renumbered as subsections
342(14) through (28), respectively, and present subsections (1),
343(14), (24), (30), and (31), and paragraph (c) of present
344subsection (28) of that section are amended to read:
345     395.002  Definitions.-As used in this chapter:
346     (1)  "Accrediting organizations" means nationally
347recognized or approved accrediting organizations whose standards
348incorporate comparable licensure requirements as determined by
349the agency the Joint Commission on Accreditation of Healthcare
350Organizations, the American Osteopathic Association, the
351Commission on Accreditation of Rehabilitation Facilities, and
352the Accreditation Association for Ambulatory Health Care, Inc.
353     (14)  "Initial denial determination" means a determination
354by a private review agent that the health care services
355furnished or proposed to be furnished to a patient are
356inappropriate, not medically necessary, or not reasonable.
357     (24)  "Private review agent" means any person or entity
358which performs utilization review services for third-party
359payors on a contractual basis for outpatient or inpatient
360services. However, the term shall not include full-time
361employees, personnel, or staff of health insurers, health
362maintenance organizations, or hospitals, or wholly owned
363subsidiaries thereof or affiliates under common ownership, when
364performing utilization review for their respective hospitals,
365health maintenance organizations, or insureds of the same
366insurance group. For this purpose, health insurers, health
367maintenance organizations, and hospitals, or wholly owned
368subsidiaries thereof or affiliates under common ownership,
369include such entities engaged as administrators of self-
370insurance as defined in s. 624.031.
371     (26)(28)  "Specialty hospital" means any facility which
372meets the provisions of subsection (12), and which regularly
373makes available either:
374     (c)  Intensive residential treatment programs for children
375and adolescents as defined in subsection (14) (15).
376     (30)  "Utilization review" means a system for reviewing the
377medical necessity or appropriateness in the allocation of health
378care resources of hospital services given or proposed to be
379given to a patient or group of patients.
380     (31)  "Utilization review plan" means a description of the
381policies and procedures governing utilization review activities
382performed by a private review agent.
383     Section 7.  Paragraph (c) of subsection (1) and paragraph
384(b) of subsection (2) of section 395.003, Florida Statutes, are
385amended to read:
386     395.003  Licensure; denial, suspension, and revocation.-
387     (1)
388     (c)  Until July 1, 2006, additional emergency departments
389located off the premises of licensed hospitals may not be
390authorized by the agency.
391     (2)
392     (b)  The agency shall, at the request of a licensee that is
393a teaching hospital as defined in s. 408.07(45), issue a single
394license to a licensee for facilities that have been previously
395licensed as separate premises, provided such separately licensed
396facilities, taken together, constitute the same premises as
397defined in s. 395.002(22)(23). Such license for the single
398premises shall include all of the beds, services, and programs
399that were previously included on the licenses for the separate
400premises. The granting of a single license under this paragraph
401shall not in any manner reduce the number of beds, services, or
402programs operated by the licensee.
403     Section 8.  Paragraph (e) of subsection (2) and subsection
404(4) of section 395.0193, Florida Statutes, are amended to read:
405     395.0193  Licensed facilities; peer review; disciplinary
406powers; agency or partnership with physicians.-
407     (2)  Each licensed facility, as a condition of licensure,
408shall provide for peer review of physicians who deliver health
409care services at the facility. Each licensed facility shall
410develop written, binding procedures by which such peer review
411shall be conducted. Such procedures shall include:
412     (e)  Recording of agendas and minutes which do not contain
413confidential material, for review by the Division of Medical
414Quality Assurance of the department Health Quality Assurance of
415the agency.
416     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
417actions taken under subsection (3) shall be reported in writing
418to the Division of Medical Quality Assurance of the department
419Health Quality Assurance of the agency within 30 working days
420after its initial occurrence, regardless of the pendency of
421appeals to the governing board of the hospital. The notification
422shall identify the disciplined practitioner, the action taken,
423and the reason for such action. All final disciplinary actions
424taken under subsection (3), if different from those which were
425reported to the department agency within 30 days after the
426initial occurrence, shall be reported within 10 working days to
427the Division of Medical Quality Assurance of the department
428Health Quality Assurance of the agency in writing and shall
429specify the disciplinary action taken and the specific grounds
430therefor. The division shall review each report and determine
431whether it potentially involved conduct by the licensee that is
432subject to disciplinary action, in which case s. 456.073 shall
433apply. The reports are not subject to inspection under s.
434119.07(1) even if the division's investigation results in a
435finding of probable cause.
436     Section 9.  Section 395.1023, Florida Statutes, is amended
437to read:
438     395.1023  Child abuse and neglect cases; duties.-Each
439licensed facility shall adopt a protocol that, at a minimum,
440requires the facility to:
441     (1)  Incorporate a facility policy that every staff member
442has an affirmative duty to report, pursuant to chapter 39, any
443actual or suspected case of child abuse, abandonment, or
444neglect; and
445     (2)  In any case involving suspected child abuse,
446abandonment, or neglect, designate, at the request of the
447Department of Children and Family Services, a staff physician to
448act as a liaison between the hospital and the Department of
449Children and Family Services office which is investigating the
450suspected abuse, abandonment, or neglect, and the child
451protection team, as defined in s. 39.01, when the case is
452referred to such a team.
453
454Each general hospital and appropriate specialty hospital shall
455comply with the provisions of this section and shall notify the
456agency and the Department of Children and Family Services of its
457compliance by sending a copy of its policy to the agency and the
458Department of Children and Family Services as required by rule.
459The failure by a general hospital or appropriate specialty
460hospital to comply shall be punished by a fine not exceeding
461$1,000, to be fixed, imposed, and collected by the agency. Each
462day in violation is considered a separate offense.
463     Section 10.  Subsection (2) and paragraph (d) of subsection
464(3) of section 395.1041, Florida Statutes, are amended to read:
465     395.1041  Access to emergency services and care.-
466     (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
467shall establish and maintain an inventory of hospitals with
468emergency services. The inventory shall list all services within
469the service capability of the hospital, and such services shall
470appear on the face of the hospital license. Each hospital having
471emergency services shall notify the agency of its service
472capability in the manner and form prescribed by the agency. The
473agency shall use the inventory to assist emergency medical
474services providers and others in locating appropriate emergency
475medical care. The inventory shall also be made available to the
476general public. On or before August 1, 1992, the agency shall
477request that each hospital identify the services which are
478within its service capability. On or before November 1, 1992,
479the agency shall notify each hospital of the service capability
480to be included in the inventory. The hospital has 15 days from
481the date of receipt to respond to the notice. By December 1,
4821992, the agency shall publish a final inventory. Each hospital
483shall reaffirm its service capability when its license is
484renewed and shall notify the agency of the addition of a new
485service or the termination of a service prior to a change in its
486service capability.
487     (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
488FACILITY OR HEALTH CARE PERSONNEL.-
489     (d)1.  Every hospital shall ensure the provision of
490services within the service capability of the hospital, at all
491times, either directly or indirectly through an arrangement with
492another hospital, through an arrangement with one or more
493physicians, or as otherwise made through prior arrangements. A
494hospital may enter into an agreement with another hospital for
495purposes of meeting its service capability requirement, and
496appropriate compensation or other reasonable conditions may be
497negotiated for these backup services.
498     2.  If any arrangement requires the provision of emergency
499medical transportation, such arrangement must be made in
500consultation with the applicable provider and may not require
501the emergency medical service provider to provide transportation
502that is outside the routine service area of that provider or in
503a manner that impairs the ability of the emergency medical
504service provider to timely respond to prehospital emergency
505calls.
506     3.  A hospital shall not be required to ensure service
507capability at all times as required in subparagraph 1. if, prior
508to the receiving of any patient needing such service capability,
509such hospital has demonstrated to the agency that it lacks the
510ability to ensure such capability and it has exhausted all
511reasonable efforts to ensure such capability through backup
512arrangements. In reviewing a hospital's demonstration of lack of
513ability to ensure service capability, the agency shall consider
514factors relevant to the particular case, including the
515following:
516     a.  Number and proximity of hospitals with the same service
517capability.
518     b.  Number, type, credentials, and privileges of
519specialists.
520     c.  Frequency of procedures.
521     d.  Size of hospital.
522     4.  The agency shall publish proposed rules implementing a
523reasonable exemption procedure by November 1, 1992. Subparagraph
5241. shall become effective upon the effective date of said rules
525or January 31, 1993, whichever is earlier. For a period not to
526exceed 1 year from the effective date of subparagraph 1., a
527hospital requesting an exemption shall be deemed to be exempt
528from offering the service until the agency initially acts to
529deny or grant the original request. The agency has 45 days from
530the date of receipt of the request to approve or deny the
531request. After the first year from the effective date of
532subparagraph 1., If the agency fails to initially act within the
533time period, the hospital is deemed to be exempt from offering
534the service until the agency initially acts to deny the request.
535     Section 11.  Section 395.1046, Florida Statutes, is
536repealed.
537     Section 12.  Paragraph (e) of subsection (1) of section
538395.1055, Florida Statutes, is amended to read:
539     395.1055  Rules and enforcement.-
540     (1)  The agency shall adopt rules pursuant to ss.
541120.536(1) and 120.54 to implement the provisions of this part,
542which shall include reasonable and fair minimum standards for
543ensuring that:
544     (e)  Licensed facility beds conform to minimum space,
545equipment, and furnishings standards as specified by the agency,
546the Florida Building Code, and the Florida Fire Prevention Code
547department.
548     Section 13.  Subsection (1) of section 395.10972, Florida
549Statutes, is amended to read:
550     395.10972  Health Care Risk Manager Advisory Council.-The
551Secretary of Health Care Administration may appoint a seven-
552member advisory council to advise the agency on matters
553pertaining to health care risk managers. The members of the
554council shall serve at the pleasure of the secretary. The
555council shall designate a chair. The council shall meet at the
556call of the secretary or at those times as may be required by
557rule of the agency. The members of the advisory council shall
558receive no compensation for their services, but shall be
559reimbursed for travel expenses as provided in s. 112.061. The
560council shall consist of individuals representing the following
561areas:
562     (1)  Two shall be active health care risk managers,
563including one risk manager who is recommended by and a member of
564the Florida Society for of Healthcare Risk Management and
565Patient Safety.
566     Section 14.  Subsection (3) of section 395.2050, Florida
567Statutes, is amended to read:
568     395.2050  Routine inquiry for organ and tissue donation;
569certification for procurement activities; death records review.-
570     (3)  Each organ procurement organization designated by the
571federal Centers for Medicare and Medicaid Services Health Care
572Financing Administration and licensed by the state shall conduct
573an annual death records review in the organ procurement
574organization's affiliated donor hospitals. The organ procurement
575organization shall enlist the services of every Florida licensed
576tissue bank and eye bank affiliated with or providing service to
577the donor hospital and operating in the same service area to
578participate in the death records review.
579     Section 15.  Subsection (2) of section 395.3036, Florida
580Statutes, is amended to read:
581     395.3036  Confidentiality of records and meetings of
582corporations that lease public hospitals or other public health
583care facilities.-The records of a private corporation that
584leases a public hospital or other public health care facility
585are confidential and exempt from the provisions of s. 119.07(1)
586and s. 24(a), Art. I of the State Constitution, and the meetings
587of the governing board of a private corporation are exempt from
588s. 286.011 and s. 24(b), Art. I of the State Constitution when
589the public lessor complies with the public finance
590accountability provisions of s. 155.40(5) with respect to the
591transfer of any public funds to the private lessee and when the
592private lessee meets at least three of the five following
593criteria:
594     (2)  The public lessor and the private lessee do not
595commingle any of their funds in any account maintained by either
596of them, other than the payment of the rent and administrative
597fees or the transfer of funds pursuant to s. 155.40(2)
598subsection (2).
599     Section 16.  Section 395.3037, Florida Statutes, is
600repealed.
601     Section 17.  Subsections (1), (4), and (5) of section
602395.3038, Florida Statutes, are amended to read:
603     395.3038  State-listed primary stroke centers and
604comprehensive stroke centers; notification of hospitals.-
605     (1)  The agency shall make available on its website and to
606the department a list of the name and address of each hospital
607that meets the criteria for a primary stroke center and the name
608and address of each hospital that meets the criteria for a
609comprehensive stroke center. The list of primary and
610comprehensive stroke centers shall include only those hospitals
611that attest in an affidavit submitted to the agency that the
612hospital meets the named criteria, or those hospitals that
613attest in an affidavit submitted to the agency that the hospital
614is certified as a primary or a comprehensive stroke center by
615The Joint Commission on Accreditation of Healthcare
616Organizations.
617     (4)  The agency shall adopt by rule criteria for a primary
618stroke center which are substantially similar to the
619certification standards for primary stroke centers of The Joint
620Commission on Accreditation of Healthcare Organizations.
621     (5)  The agency shall adopt by rule criteria for a
622comprehensive stroke center. However, if The Joint Commission on
623Accreditation of Healthcare Organizations establishes criteria
624for a comprehensive stroke center, the agency shall establish
625criteria for a comprehensive stroke center which are
626substantially similar to those criteria established by The Joint
627Commission on Accreditation of Healthcare Organizations.
628     Section 18.  Paragraph (e) of subsection (2) of section
629395.602, Florida Statutes, is amended to read:
630     395.602  Rural hospitals.-
631     (2)  DEFINITIONS.-As used in this part:
632     (e)  "Rural hospital" means an acute care hospital licensed
633under this chapter, having 100 or fewer licensed beds and an
634emergency room, which is:
635     1.  The sole provider within a county with a population
636density of no greater than 100 persons per square mile;
637     2.  An acute care hospital, in a county with a population
638density of no greater than 100 persons per square mile, which is
639at least 30 minutes of travel time, on normally traveled roads
640under normal traffic conditions, from any other acute care
641hospital within the same county;
642     3.  A hospital supported by a tax district or subdistrict
643whose boundaries encompass a population of 100 persons or fewer
644per square mile;
645     4.  A hospital in a constitutional charter county with a
646population of over 1 million persons that has imposed a local
647option health service tax pursuant to law and in an area that
648was directly impacted by a catastrophic event on August 24,
6491992, for which the Governor of Florida declared a state of
650emergency pursuant to chapter 125, and has 120 beds or less that
651serves an agricultural community with an emergency room
652utilization of no less than 20,000 visits and a Medicaid
653inpatient utilization rate greater than 15 percent;
654     4.5.  A hospital with a service area that has a population
655of 100 persons or fewer per square mile. As used in this
656subparagraph, the term "service area" means the fewest number of
657zip codes that account for 75 percent of the hospital's
658discharges for the most recent 5-year period, based on
659information available from the hospital inpatient discharge
660database in the Florida Center for Health Information and Policy
661Analysis at the Agency for Health Care Administration; or
662     5.6.  A hospital designated as a critical access hospital,
663as defined in s. 408.07(15).
664
665Population densities used in this paragraph must be based upon
666the most recently completed United States census. A hospital
667that received funds under s. 409.9116 for a quarter beginning no
668later than July 1, 2002, is deemed to have been and shall
669continue to be a rural hospital from that date through June 30,
6702015, if the hospital continues to have 100 or fewer licensed
671beds and an emergency room, or meets the criteria of
672subparagraph 4. An acute care hospital that has not previously
673been designated as a rural hospital and that meets the criteria
674of this paragraph shall be granted such designation upon
675application, including supporting documentation to the Agency
676for Health Care Administration.
677     Section 19.  Subsection (8) of section 400.021, Florida
678Statutes, is amended to read:
679     400.021  Definitions.-When used in this part, unless the
680context otherwise requires, the term:
681     (8)  "Geriatric outpatient clinic" means a site for
682providing outpatient health care to persons 60 years of age or
683older, which is staffed by a registered nurse or a physician
684assistant, or a licensed practical nurse under the direct
685supervision of a registered nurse, advanced registered nurse
686practitioner, or physician assistant.
687     Section 20.  Subsection (2) of section 400.063, Florida
688Statutes, is amended to read:
689     400.063  Resident protection.-
690     (2)  The agency is authorized to establish for each
691facility, subject to intervention by the agency, a separate bank
692account for the deposit to the credit of the agency of any
693moneys received from the Health Care Trust Fund or any other
694moneys received for the maintenance and care of residents in the
695facility, and the agency is authorized to disburse moneys from
696such account to pay obligations incurred for the purposes of
697this section. The agency is authorized to requisition moneys
698from the Health Care Trust Fund in advance of an actual need for
699cash on the basis of an estimate by the agency of moneys to be
700spent under the authority of this section. Any bank account
701established under this section need not be approved in advance
702of its creation as required by s. 17.58, but shall be secured by
703depository insurance equal to or greater than the balance of
704such account or by the pledge of collateral security in
705conformance with criteria established in s. 18.11. The agency
706shall notify the Chief Financial Officer of any such account so
707established and shall make a quarterly accounting to the Chief
708Financial Officer for all moneys deposited in such account.
709     Section 21.  Subsections (1) and (5) of section 400.071,
710Florida Statutes, are amended to read:
711     400.071  Application for license.-
712     (1)  In addition to the requirements of part II of chapter
713408, the application for a license shall be under oath and must
714contain the following:
715     (a)  The location of the facility for which a license is
716sought and an indication, as in the original application, that
717such location conforms to the local zoning ordinances.
718     (b)  A signed affidavit disclosing any financial or
719ownership interest that a controlling interest as defined in
720part II of chapter 408 has held in the last 5 years in any
721entity licensed by this state or any other state to provide
722health or residential care which has closed voluntarily or
723involuntarily; has filed for bankruptcy; has had a receiver
724appointed; has had a license denied, suspended, or revoked; or
725has had an injunction issued against it which was initiated by a
726regulatory agency. The affidavit must disclose the reason any
727such entity was closed, whether voluntarily or involuntarily.
728     (c)  The total number of beds and the total number of
729Medicare and Medicaid certified beds.
730     (b)(d)  Information relating to the applicant and employees
731which the agency requires by rule. The applicant must
732demonstrate that sufficient numbers of qualified staff, by
733training or experience, will be employed to properly care for
734the type and number of residents who will reside in the
735facility.
736     (c)(e)  Copies of any civil verdict or judgment involving
737the applicant rendered within the 10 years preceding the
738application, relating to medical negligence, violation of
739residents' rights, or wrongful death. As a condition of
740licensure, the licensee agrees to provide to the agency copies
741of any new verdict or judgment involving the applicant, relating
742to such matters, within 30 days after filing with the clerk of
743the court. The information required in this paragraph shall be
744maintained in the facility's licensure file and in an agency
745database which is available as a public record.
746     (5)  As a condition of licensure, each facility must
747establish and submit with its application a plan for quality
748assurance and for conducting risk management.
749     Section 22.  Section 400.0712, Florida Statutes, is amended
750to read:
751     400.0712  Application for inactive license.-
752     (1)  As specified in this section, the agency may issue an
753inactive license to a nursing home facility for all or a portion
754of its beds. Any request by a licensee that a nursing home or
755portion of a nursing home become inactive must be submitted to
756the agency in the approved format. The facility may not initiate
757any suspension of services, notify residents, or initiate
758inactivity before receiving approval from the agency; and a
759licensee that violates this provision may not be issued an
760inactive license.
761     (1)(2)  In addition to the powers granted under part II of
762chapter 408, the agency may issue an inactive license to a
763nursing home that chooses to use an unoccupied contiguous
764portion of the facility for an alternative use to meet the needs
765of elderly persons through the use of less restrictive, less
766institutional services.
767     (a)  An inactive license issued under this subsection may
768be granted for a period not to exceed the current licensure
769expiration date but may be renewed by the agency at the time of
770licensure renewal.
771     (b)  A request to extend the inactive license must be
772submitted to the agency in the approved format and approved by
773the agency in writing.
774     (c)  Nursing homes that receive an inactive license to
775provide alternative services shall not receive preference for
776participation in the Assisted Living for the Elderly Medicaid
777waiver.
778     (2)(3)  The agency shall adopt rules pursuant to ss.
779120.536(1) and 120.54 necessary to implement this section.
780     Section 23.  Section 400.111, Florida Statutes, is amended
781to read:
782     400.111  Disclosure of controlling interest.-In addition to
783the requirements of part II of chapter 408, when requested by
784the agency, the licensee shall submit a signed affidavit
785disclosing any financial or ownership interest that a
786controlling interest has held within the last 5 years in any
787entity licensed by the state or any other state to provide
788health or residential care which entity has closed voluntarily
789or involuntarily; has filed for bankruptcy; has had a receiver
790appointed; has had a license denied, suspended, or revoked; or
791has had an injunction issued against it which was initiated by a
792regulatory agency. The affidavit must disclose the reason such
793entity was closed, whether voluntarily or involuntarily.
794     Section 24.  Subsection (2) of section 400.1183, Florida
795Statutes, is amended to read:
796     400.1183  Resident grievance procedures.-
797     (2)  Each facility shall maintain records of all grievances
798for agency inspection and shall report to the agency at the time
799of relicensure the total number of grievances handled during the
800prior licensure period, a categorization of the cases underlying
801the grievances, and the final disposition of the grievances.
802     Section 25.  Paragraphs (o) through (w) of subsection (1)
803of section 400.141, Florida Statutes, are redesignated as
804paragraphs (n) through (u), respectively, and present paragraphs
805(f), (g), (j), (n), (o), and (r) of that subsection are amended,
806to read:
807     400.141  Administration and management of nursing home
808facilities.-
809     (1)  Every licensed facility shall comply with all
810applicable standards and rules of the agency and shall:
811     (f)  Be allowed and encouraged by the agency to provide
812other needed services under certain conditions. If the facility
813has a standard licensure status, and has had no class I or class
814II deficiencies during the past 2 years or has been awarded a
815Gold Seal under the program established in s. 400.235, it may be
816encouraged by the agency to provide services, including, but not
817limited to, respite and adult day services, which enable
818individuals to move in and out of the facility. A facility is
819not subject to any additional licensure requirements for
820providing these services.
821     1.  Respite care may be offered to persons in need of
822short-term or temporary nursing home services. For each person
823admitted under the respite care program, the facility licensee
824must:
825     a.  Have a written abbreviated plan of care that, at a
826minimum, includes nutritional requirements, medication orders,
827physician orders, nursing assessments, and dietary preferences.
828The nursing or physician assessments may take the place of all
829other assessments required for full-time residents.
830     b.  Have a contract that, at a minimum, specifies the
831services to be provided to the respite resident, including
832charges for services, activities, equipment, emergency medical
833services, and the administration of medications. If multiple
834respite admissions for a single person are anticipated, the
835original contract is valid for 1 year after the date of
836execution.
837     c.  Ensure that each resident is released to his or her
838caregiver or an individual designated in writing by the
839caregiver.
840     2.  A person admitted under the respite care program is:
841     a.  Exempt from requirements in rule related to discharge
842planning.
843     b.  Covered by the resident's rights set forth in s.
844400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
845shall not be considered trust funds subject to the requirements
846of s. 400.022(1)(h) until the resident has been in the facility
847for more than 14 consecutive days.
848     c.  Allowed to use his or her personal medications for the
849respite stay if permitted by facility policy. The facility must
850obtain a physician's orders for the medications. The caregiver
851may provide information regarding the medications as part of the
852nursing assessment, which must agree with the physician's
853orders. Medications shall be released with the resident upon
854discharge in accordance with current orders.
855     3.  A person receiving respite care is entitled to a total
856of 60 days in the facility within a contract year or a calendar
857year if the contract is for less than 12 months. However, each
858single stay may not exceed 14 days. If a stay exceeds 14
859consecutive days, the facility must comply with all assessment
860and care planning requirements applicable to nursing home
861residents.
862     4.  A person receiving respite care must reside in a
863licensed nursing home bed.
864     5.  A prospective respite resident must provide medical
865information from a physician, a physician assistant, or a nurse
866practitioner and other information from the primary caregiver as
867may be required by the facility prior to or at the time of
868admission to receive respite care. The medical information must
869include a physician's order for respite care and proof of a
870physical examination by a licensed physician, physician
871assistant, or nurse practitioner. The physician's order and
872physical examination may be used to provide intermittent respite
873care for up to 12 months after the date the order is written.
874     6.  The facility must assume the duties of the primary
875caregiver. To ensure continuity of care and services, the
876resident is entitled to retain his or her personal physician and
877must have access to medically necessary services such as
878physical therapy, occupational therapy, or speech therapy, as
879needed. The facility must arrange for transportation to these
880services if necessary. Respite care must be provided in
881accordance with this part and rules adopted by the agency.
882However, the agency shall, by rule, adopt modified requirements
883for resident assessment, resident care plans, resident
884contracts, physician orders, and other provisions, as
885appropriate, for short-term or temporary nursing home services.
886     7.  The agency shall allow for shared programming and staff
887in a facility which meets minimum standards and offers services
888pursuant to this paragraph, but, if the facility is cited for
889deficiencies in patient care, may require additional staff and
890programs appropriate to the needs of service recipients. A
891person who receives respite care may not be counted as a
892resident of the facility for purposes of the facility's licensed
893capacity unless that person receives 24-hour respite care. A
894person receiving either respite care for 24 hours or longer or
895adult day services must be included when calculating minimum
896staffing for the facility. Any costs and revenues generated by a
897nursing home facility from nonresidential programs or services
898shall be excluded from the calculations of Medicaid per diems
899for nursing home institutional care reimbursement.
900     (g)  If the facility has a standard license or is a Gold
901Seal facility, exceeds the minimum required hours of licensed
902nursing and certified nursing assistant direct care per resident
903per day, and is part of a continuing care facility licensed
904under chapter 651 or a retirement community that offers other
905services pursuant to part III of this chapter or part I or part
906III of chapter 429 on a single campus, be allowed to share
907programming and staff. At the time of inspection and in the
908semiannual report required pursuant to paragraph (n) (o), a
909continuing care facility or retirement community that uses this
910option must demonstrate through staffing records that minimum
911staffing requirements for the facility were met. Licensed nurses
912and certified nursing assistants who work in the nursing home
913facility may be used to provide services elsewhere on campus if
914the facility exceeds the minimum number of direct care hours
915required per resident per day and the total number of residents
916receiving direct care services from a licensed nurse or a
917certified nursing assistant does not cause the facility to
918violate the staffing ratios required under s. 400.23(3)(a).
919Compliance with the minimum staffing ratios shall be based on
920total number of residents receiving direct care services,
921regardless of where they reside on campus. If the facility
922receives a conditional license, it may not share staff until the
923conditional license status ends. This paragraph does not
924restrict the agency's authority under federal or state law to
925require additional staff if a facility is cited for deficiencies
926in care which are caused by an insufficient number of certified
927nursing assistants or licensed nurses. The agency may adopt
928rules for the documentation necessary to determine compliance
929with this provision.
930     (j)  Keep full records of resident admissions and
931discharges; medical and general health status, including medical
932records, personal and social history, and identity and address
933of next of kin or other persons who may have responsibility for
934the affairs of the residents; and individual resident care plans
935including, but not limited to, prescribed services, service
936frequency and duration, and service goals. The records shall be
937open to inspection by the agency. The facility must maintain
938clinical records on each resident in accordance with accepted
939professional standards and practices that are complete,
940accurately documented, readily accessible, and systematically
941organized.
942     (n)  Submit to the agency the information specified in s.
943400.071(1)(b) for a management company within 30 days after the
944effective date of the management agreement.
945     (n)(o)1.  Submit semiannually to the agency, or more
946frequently if requested by the agency, information regarding
947facility staff-to-resident ratios, staff turnover, and staff
948stability, including information regarding certified nursing
949assistants, licensed nurses, the director of nursing, and the
950facility administrator. For purposes of this reporting:
951     a.  Staff-to-resident ratios must be reported in the
952categories specified in s. 400.23(3)(a) and applicable rules.
953The ratio must be reported as an average for the most recent
954calendar quarter.
955     b.  Staff turnover must be reported for the most recent 12-
956month period ending on the last workday of the most recent
957calendar quarter prior to the date the information is submitted.
958The turnover rate must be computed quarterly, with the annual
959rate being the cumulative sum of the quarterly rates. The
960turnover rate is the total number of terminations or separations
961experienced during the quarter, excluding any employee
962terminated during a probationary period of 3 months or less,
963divided by the total number of staff employed at the end of the
964period for which the rate is computed, and expressed as a
965percentage.
966     c.  The formula for determining staff stability is the
967total number of employees that have been employed for more than
96812 months, divided by the total number of employees employed at
969the end of the most recent calendar quarter, and expressed as a
970percentage.
971     d.  A nursing facility that has failed to comply with state
972minimum-staffing requirements for 2 consecutive days is
973prohibited from accepting new admissions until the facility has
974achieved the minimum-staffing requirements for a period of 6
975consecutive days. For the purposes of this sub-subparagraph, any
976person who was a resident of the facility and was absent from
977the facility for the purpose of receiving medical care at a
978separate location or was on a leave of absence is not considered
979a new admission. Failure to impose such an admissions moratorium
980is subject to a $1,000 fine constitutes a class II deficiency.
981     e.  A nursing facility which does not have a conditional
982license may be cited for failure to comply with the standards in
983s. 400.23(3)(a)1.a. only if it has failed to meet those
984standards on 2 consecutive days or if it has failed to meet at
985least 97 percent of those standards on any one day.
986     f.  A facility which has a conditional license must be in
987compliance with the standards in s. 400.23(3)(a) at all times.
988     2.  This paragraph does not limit the agency's ability to
989impose a deficiency or take other actions if a facility does not
990have enough staff to meet the residents' needs.
991     (r)  Report to the agency any filing for bankruptcy
992protection by the facility or its parent corporation,
993divestiture or spin-off of its assets, or corporate
994reorganization within 30 days after the completion of such
995activity.
996     Section 26.  Subsection (3) of section 400.142, Florida
997Statutes, is amended to read:
998     400.142  Emergency medication kits; orders not to
999resuscitate.-
1000     (3)  Facility staff may withhold or withdraw
1001cardiopulmonary resuscitation if presented with an order not to
1002resuscitate executed pursuant to s. 401.45. The agency shall
1003adopt rules providing for the implementation of such orders.
1004Facility staff and facilities shall not be subject to criminal
1005prosecution or civil liability, nor be considered to have
1006engaged in negligent or unprofessional conduct, for withholding
1007or withdrawing cardiopulmonary resuscitation pursuant to such an
1008order and rules adopted by the agency. The absence of an order
1009not to resuscitate executed pursuant to s. 401.45 does not
1010preclude a physician from withholding or withdrawing
1011cardiopulmonary resuscitation as otherwise permitted by law.
1012     Section 27.  Subsections (11) through (15) of section
1013400.147, Florida Statutes, are renumbered as subsections (10)
1014through (14), respectively, and present subsection (10) is
1015amended to read:
1016     400.147  Internal risk management and quality assurance
1017program.-
1018     (10)  By the 10th of each month, each facility subject to
1019this section shall report any notice received pursuant to s.
1020400.0233(2) and each initial complaint that was filed with the
1021clerk of the court and served on the facility during the
1022previous month by a resident or a resident's family member,
1023guardian, conservator, or personal legal representative. The
1024report must include the name of the resident, the resident's
1025date of birth and social security number, the Medicaid
1026identification number for Medicaid-eligible persons, the date or
1027dates of the incident leading to the claim or dates of
1028residency, if applicable, and the type of injury or violation of
1029rights alleged to have occurred. Each facility shall also submit
1030a copy of the notices received pursuant to s. 400.0233(2) and
1031complaints filed with the clerk of the court. This report is
1032confidential as provided by law and is not discoverable or
1033admissible in any civil or administrative action, except in such
1034actions brought by the agency to enforce the provisions of this
1035part.
1036     Section 28.  Section 400.148, Florida Statutes, is
1037repealed.
1038     Section 29.  Paragraph (f) of subsection (5) of section
1039400.162, Florida Statutes, is amended to read:
1040     400.162  Property and personal affairs of residents.-
1041     (5)
1042     (f)  At least every 3 months, the licensee shall furnish
1043the resident and the guardian, trustee, or conservator, if any,
1044for the resident a complete and verified statement of all funds
1045and other property to which this subsection applies, detailing
1046the amounts and items received, together with their sources and
1047disposition. For resident property, the licensee shall furnish
1048such a statement annually and within 7 calendar days after a
1049request for a statement. In any event, the licensee shall
1050furnish such statements a statement annually and upon the
1051discharge or transfer of a resident. Any governmental agency or
1052private charitable agency contributing funds or other property
1053on account of a resident also shall be entitled to receive such
1054statements statement annually and upon discharge or transfer and
1055such other report as it may require pursuant to law.
1056     Section 30.  Paragraphs (d) and (e) of subsection (2) of
1057section 400.179, Florida Statutes, are amended to read:
1058     400.179  Liability for Medicaid underpayments and
1059overpayments.-
1060     (2)  Because any transfer of a nursing facility may expose
1061the fact that Medicaid may have underpaid or overpaid the
1062transferor, and because in most instances, any such underpayment
1063or overpayment can only be determined following a formal field
1064audit, the liabilities for any such underpayments or
1065overpayments shall be as follows:
1066     (d)  Where the transfer involves a facility that has been
1067leased by the transferor:
1068     1.  The transferee shall, as a condition to being issued a
1069license by the agency, acquire, maintain, and provide proof to
1070the agency of a bond with a term of 30 months, renewable
1071annually, in an amount not less than the total of 3 months'
1072Medicaid payments to the facility computed on the basis of the
1073preceding 12-month average Medicaid payments to the facility.
1074     2.  A leasehold licensee may meet the requirements of
1075subparagraph 1. by payment of a nonrefundable fee, paid at
1076initial licensure, paid at the time of any subsequent change of
1077ownership, and paid annually thereafter, in the amount of 1
1078percent of the total of 3 months' Medicaid payments to the
1079facility computed on the basis of the preceding 12-month average
1080Medicaid payments to the facility. If a preceding 12-month
1081average is not available, projected Medicaid payments may be
1082used. The fee shall be deposited into the Grants and Donations
1083Trust Fund and shall be accounted for separately as a Medicaid
1084nursing home overpayment account. These fees shall be used at
1085the sole discretion of the agency to repay nursing home Medicaid
1086overpayments. Payment of this fee shall not release the licensee
1087from any liability for any Medicaid overpayments, nor shall
1088payment bar the agency from seeking to recoup overpayments from
1089the licensee and any other liable party. As a condition of
1090exercising this lease bond alternative, licensees paying this
1091fee must maintain an existing lease bond through the end of the
109230-month term period of that bond. The agency is herein granted
1093specific authority to promulgate all rules pertaining to the
1094administration and management of this account, including
1095withdrawals from the account, subject to federal review and
1096approval. This provision shall take effect upon becoming law and
1097shall apply to any leasehold license application. The financial
1098viability of the Medicaid nursing home overpayment account shall
1099be determined by the agency through annual review of the account
1100balance and the amount of total outstanding, unpaid Medicaid
1101overpayments owing from leasehold licensees to the agency as
1102determined by final agency audits. By March 31 of each year, the
1103agency shall assess the cumulative fees collected under this
1104subparagraph, minus any amounts used to repay nursing home
1105Medicaid overpayments. If the net cumulative collections, minus
1106amounts utilized to repay nursing home Medicaid overpayments,
1107exceed $25 million, the provisions of this paragraph shall not
1108apply for the subsequent fiscal year.
1109     3.  The leasehold licensee may meet the bond requirement
1110through other arrangements acceptable to the agency. The agency
1111is herein granted specific authority to promulgate rules
1112pertaining to lease bond arrangements.
1113     4.  All existing nursing facility licensees, operating the
1114facility as a leasehold, shall acquire, maintain, and provide
1115proof to the agency of the 30-month bond required in
1116subparagraph 1., above, on and after July 1, 1993, for each
1117license renewal.
1118     5.  It shall be the responsibility of all nursing facility
1119operators, operating the facility as a leasehold, to renew the
112030-month bond and to provide proof of such renewal to the agency
1121annually.
1122     6.  Any failure of the nursing facility operator to
1123acquire, maintain, renew annually, or provide proof to the
1124agency shall be grounds for the agency to deny, revoke, and
1125suspend the facility license to operate such facility and to
1126take any further action, including, but not limited to,
1127enjoining the facility, asserting a moratorium pursuant to part
1128II of chapter 408, or applying for a receiver, deemed necessary
1129to ensure compliance with this section and to safeguard and
1130protect the health, safety, and welfare of the facility's
1131residents. A lease agreement required as a condition of bond
1132financing or refinancing under s. 154.213 by a health facilities
1133authority or required under s. 159.30 by a county or
1134municipality is not a leasehold for purposes of this paragraph
1135and is not subject to the bond requirement of this paragraph.
1136     (e)  For the 2009-2010 fiscal year only, the provisions of
1137paragraph (d) shall not apply. This paragraph expires July 1,
11382010.
1139     Section 31.  Subsection (3) of section 400.19, Florida
1140Statutes, is amended to read:
1141     400.19  Right of entry and inspection.-
1142     (3)  The agency shall every 15 months conduct at least one
1143unannounced inspection to determine compliance by the licensee
1144with statutes, and with rules promulgated under the provisions
1145of those statutes, governing minimum standards of construction,
1146quality and adequacy of care, and rights of residents. The
1147survey shall be conducted every 6 months for the next 2-year
1148period if the facility has been cited for a class I deficiency,
1149has been cited for two or more class II deficiencies arising
1150from separate surveys or investigations within a 60-day period,
1151or has had three or more substantiated complaints within a 6-
1152month period, each resulting in at least one class I or class II
1153deficiency. In addition to any other fees or fines in this part,
1154the agency shall assess a fine for each facility that is subject
1155to the 6-month survey cycle. The fine for the 2-year period
1156shall be $6,000, one-half to be paid at the completion of each
1157survey. The agency may adjust this fine by the change in the
1158Consumer Price Index, based on the 12 months immediately
1159preceding the increase, to cover the cost of the additional
1160surveys. The agency shall verify through subsequent inspection
1161that any deficiency identified during inspection is corrected.
1162However, the agency may verify the correction of a class III or
1163class IV deficiency unrelated to resident rights or resident
1164care without reinspecting the facility if adequate written
1165documentation has been received from the facility, which
1166provides assurance that the deficiency has been corrected. The
1167giving or causing to be given of advance notice of such
1168unannounced inspections by an employee of the agency to any
1169unauthorized person shall constitute cause for suspension of not
1170fewer than 5 working days according to the provisions of chapter
1171110.
1172     Section 32.  Section 400.195, Florida Statutes, is
1173repealed.
1174     Section 33.  Subsection (5) of section 400.23, Florida
1175Statutes, is amended to read:
1176     400.23  Rules; evaluation and deficiencies; licensure
1177status.-
1178     (5)  The agency, in collaboration with the Division of
1179Children's Medical Services Network of the Department of Health,
1180must, no later than December 31, 1993, adopt rules for minimum
1181standards of care for persons under 21 years of age who reside
1182in nursing home facilities. The rules must include a methodology
1183for reviewing a nursing home facility under ss. 408.031-408.045
1184which serves only persons under 21 years of age. A facility may
1185be exempt from these standards for specific persons between 18
1186and 21 years of age, if the person's physician agrees that
1187minimum standards of care based on age are not necessary.
1188     Section 34.  Subsection (1) of section 400.275, Florida
1189Statutes, is amended to read:
1190     400.275  Agency duties.-
1191     (1)  The agency shall ensure that each newly hired nursing
1192home surveyor, as a part of basic training, is assigned full-
1193time to a licensed nursing home for at least 2 days within a 7-
1194day period to observe facility operations outside of the survey
1195process before the surveyor begins survey responsibilities. Such
1196observations may not be the sole basis of a deficiency citation
1197against the facility. The agency may not assign an individual to
1198be a member of a survey team for purposes of a survey,
1199evaluation, or consultation visit at a nursing home facility in
1200which the surveyor was an employee within the preceding 2 5
1201years.
1202     Section 35.  Subsection (2) of section 400.484, Florida
1203Statutes, is amended to read:
1204     400.484  Right of inspection; violations deficiencies;
1205fines.-
1206     (2)  The agency shall impose fines for various classes of
1207violations deficiencies in accordance with the following
1208schedule:
1209     (a)  Class I violations are defined in s. 408.813. A class
1210I deficiency is any act, omission, or practice that results in a
1211patient's death, disablement, or permanent injury, or places a
1212patient at imminent risk of death, disablement, or permanent
1213injury. Upon finding a class I violation deficiency, the agency
1214shall impose an administrative fine in the amount of $15,000 for
1215each occurrence and each day that the violation deficiency
1216exists.
1217     (b)  Class II violations are defined in s. 408.813. A class
1218II deficiency is any act, omission, or practice that has a
1219direct adverse effect on the health, safety, or security of a
1220patient. Upon finding a class II violation deficiency, the
1221agency shall impose an administrative fine in the amount of
1222$5,000 for each occurrence and each day that the violation
1223deficiency exists.
1224     (c)  Class III violations are defined in s. 408.813. A
1225class III deficiency is any act, omission, or practice that has
1226an indirect, adverse effect on the health, safety, or security
1227of a patient. Upon finding an uncorrected or repeated class III
1228violation deficiency, the agency shall impose an administrative
1229fine not to exceed $1,000 for each occurrence and each day that
1230the uncorrected or repeated violation deficiency exists.
1231     (d)  Class IV violations are defined in s. 408.813. A class
1232IV deficiency is any act, omission, or practice related to
1233required reports, forms, or documents which does not have the
1234potential of negatively affecting patients. These violations are
1235of a type that the agency determines do not threaten the health,
1236safety, or security of patients. Upon finding an uncorrected or
1237repeated class IV violation deficiency, the agency shall impose
1238an administrative fine not to exceed $500 for each occurrence
1239and each day that the uncorrected or repeated violation
1240deficiency exists.
1241     Section 36.  Paragraph (i) of subsection (1) and subsection
1242(4) of section 400.606, Florida Statutes, are amended to read:
1243     400.606  License; application; renewal; conditional license
1244or permit; certificate of need.-
1245     (1)  In addition to the requirements of part II of chapter
1246408, the initial application and change of ownership application
1247must be accompanied by a plan for the delivery of home,
1248residential, and homelike inpatient hospice services to
1249terminally ill persons and their families. Such plan must
1250contain, but need not be limited to:
1251     (i)  The projected annual operating cost of the hospice.
1252
1253If the applicant is an existing licensed health care provider,
1254the application must be accompanied by a copy of the most recent
1255profit-loss statement and, if applicable, the most recent
1256licensure inspection report.
1257     (4)  A freestanding hospice facility that is primarily
1258engaged in providing inpatient and related services and that is
1259not otherwise licensed as a health care facility shall be
1260required to obtain a certificate of need. However, a
1261freestanding hospice facility with six or fewer beds shall not
1262be required to comply with institutional standards such as, but
1263not limited to, standards requiring sprinkler systems, emergency
1264electrical systems, or special lavatory devices.
1265     Section 37.  Subsection (2) of section 400.607, Florida
1266Statutes, is amended to read:
1267     400.607  Denial, suspension, revocation of license;
1268emergency actions; imposition of administrative fine; grounds.-
1269     (2)  A violation of this part, part II of chapter 408, or
1270applicable rules Any of the following actions by a licensed
1271hospice or any of its employees shall be grounds for
1272administrative action by the agency against a hospice.:
1273     (a)  A violation of the provisions of this part, part II of
1274chapter 408, or applicable rules.
1275     (b)  An intentional or negligent act materially affecting
1276the health or safety of a patient.
1277     Section 38.  Subsection (1) of section 400.925, Florida
1278Statutes, is amended to read:
1279     400.925  Definitions.-As used in this part, the term:
1280     (1)  "Accrediting organizations" means The Joint Commission
1281on Accreditation of Healthcare Organizations or other national
1282accreditation agencies whose standards for accreditation are
1283comparable to those required by this part for licensure.
1284     Section 39.  Subsections (3) through (6) of section
1285400.931, Florida Statutes, are renumbered as subsections (2)
1286through (5), respectively, and present subsection (2) of that
1287section is amended to read:
1288     400.931  Application for license; fee; provisional license;
1289temporary permit.-
1290     (2)  As an alternative to submitting proof of financial
1291ability to operate as required in s. 408.810(8), the applicant
1292may submit a $50,000 surety bond to the agency.
1293     Section 40.  Subsection (2) of section 400.932, Florida
1294Statutes, is amended to read:
1295     400.932  Administrative penalties.-
1296     (2)  A violation of this part, part II of chapter 408, or
1297applicable rules Any of the following actions by an employee of
1298a home medical equipment provider shall be are grounds for
1299administrative action or penalties by the agency.:
1300     (a)  Violation of this part, part II of chapter 408, or
1301applicable rules.
1302     (b)  An intentional, reckless, or negligent act that
1303materially affects the health or safety of a patient.
1304     Section 41.  Subsection (3) of section 400.967, Florida
1305Statutes, is amended to read:
1306     400.967  Rules and classification of violations
1307deficiencies.-
1308     (3)  The agency shall adopt rules to provide that, when the
1309criteria established under this part and part II of chapter 408
1310are not met, such violations deficiencies shall be classified
1311according to the nature of the violation deficiency. The agency
1312shall indicate the classification on the face of the notice of
1313deficiencies as follows:
1314     (a)  Class I violations deficiencies are defined in s.
1315408.813 those which the agency determines present an imminent
1316danger to the residents or guests of the facility or a
1317substantial probability that death or serious physical harm
1318would result therefrom. The condition or practice constituting a
1319class I violation must be abated or eliminated immediately,
1320unless a fixed period of time, as determined by the agency, is
1321required for correction. A class I violation deficiency is
1322subject to a civil penalty in an amount not less than $5,000 and
1323not exceeding $10,000 for each violation deficiency. A fine may
1324be levied notwithstanding the correction of the violation
1325deficiency.
1326     (b)  Class II violations deficiencies are defined in s.
1327408.813 those which the agency determines have a direct or
1328immediate relationship to the health, safety, or security of the
1329facility residents, other than class I deficiencies. A class II
1330violation deficiency is subject to a civil penalty in an amount
1331not less than $1,000 and not exceeding $5,000 for each violation
1332deficiency. A citation for a class II violation deficiency shall
1333specify the time within which the violation deficiency must be
1334corrected. If a class II violation deficiency is corrected
1335within the time specified, no civil penalty shall be imposed,
1336unless it is a repeated offense.
1337     (c)  Class III violations deficiencies are defined in s.
1338408.813 those which the agency determines to have an indirect or
1339potential relationship to the health, safety, or security of the
1340facility residents, other than class I or class II deficiencies.
1341A class III violation deficiency is subject to a civil penalty
1342of not less than $500 and not exceeding $1,000 for each
1343deficiency. A citation for a class III violation deficiency
1344shall specify the time within which the violation deficiency
1345must be corrected. If a class III violation deficiency is
1346corrected within the time specified, no civil penalty shall be
1347imposed, unless it is a repeated offense.
1348     (d)  Class IV violations are defined in s. 408.813. Upon
1349finding an uncorrected or repeated class IV violation, the
1350agency shall impose an administrative fine not to exceed $500
1351for each occurrence and each day that the uncorrected or
1352repeated violation exists.
1353     Section 42.  Subsections (4) and (7) of section 400.9905,
1354Florida Statutes, are amended to read:
1355     400.9905  Definitions.-
1356     (4)  "Clinic" means an entity at which health care services
1357are provided to individuals and which tenders charges for
1358reimbursement for such services, including a mobile clinic and a
1359portable health service or equipment provider. For purposes of
1360this part, the term does not include and the licensure
1361requirements of this part do not apply to:
1362     (a)  Entities licensed or registered by the state under
1363chapter 395; or entities licensed or registered by the state and
1364providing only health care services within the scope of services
1365authorized under their respective licenses granted under ss.
1366383.30-383.335, chapter 390, chapter 394, chapter 397, this
1367chapter except part X, chapter 429, chapter 463, chapter 465,
1368chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1369chapter 651; end-stage renal disease providers authorized under
137042 C.F.R. part 405, subpart U; or providers certified under 42
1371C.F.R. part 485, subpart B or subpart H; or any entity that
1372provides neonatal or pediatric hospital-based health care
1373services or other health care services by licensed practitioners
1374solely within a hospital licensed under chapter 395.
1375     (b)  Entities that own, directly or indirectly, entities
1376licensed or registered by the state pursuant to chapter 395; or
1377entities that own, directly or indirectly, entities licensed or
1378registered by the state and providing only health care services
1379within the scope of services authorized pursuant to their
1380respective licenses granted under ss. 383.30-383.335, chapter
1381390, chapter 394, chapter 397, this chapter except part X,
1382chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1383part I of chapter 483, chapter 484, chapter 651; end-stage renal
1384disease providers authorized under 42 C.F.R. part 405, subpart
1385U; or providers certified under 42 C.F.R. part 485, subpart B or
1386subpart H; or any entity that provides neonatal or pediatric
1387hospital-based health care services by licensed practitioners
1388solely within a hospital licensed under chapter 395.
1389     (c)  Entities that are owned, directly or indirectly, by an
1390entity licensed or registered by the state pursuant to chapter
1391395; or entities that are owned, directly or indirectly, by an
1392entity licensed or registered by the state and providing only
1393health care services within the scope of services authorized
1394pursuant to their respective licenses granted under ss. 383.30-
1395383.335, chapter 390, chapter 394, chapter 397, this chapter
1396except part X, chapter 429, chapter 463, chapter 465, chapter
1397466, chapter 478, part I of chapter 483, chapter 484, or chapter
1398651; end-stage renal disease providers authorized under 42
1399C.F.R. part 405, subpart U; or providers certified under 42
1400C.F.R. part 485, subpart B or subpart H; or any entity that
1401provides neonatal or pediatric hospital-based health care
1402services by licensed practitioners solely within a hospital
1403under chapter 395.
1404     (d)  Entities that are under common ownership, directly or
1405indirectly, with an entity licensed or registered by the state
1406pursuant to chapter 395; or entities that are under common
1407ownership, directly or indirectly, with an entity licensed or
1408registered by the state and providing only health care services
1409within the scope of services authorized pursuant to their
1410respective licenses granted under ss. 383.30-383.335, chapter
1411390, chapter 394, chapter 397, this chapter except part X,
1412chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1413part I of chapter 483, chapter 484, or chapter 651; end-stage
1414renal disease providers authorized under 42 C.F.R. part 405,
1415subpart U; or providers certified under 42 C.F.R. part 485,
1416subpart B or subpart H; or any entity that provides neonatal or
1417pediatric hospital-based health care services by licensed
1418practitioners solely within a hospital licensed under chapter
1419395.
1420     (e)  An entity that is exempt from federal taxation under
142126 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1422under 26 U.S.C. s. 409 that has a board of trustees not less
1423than two-thirds of which are Florida-licensed health care
1424practitioners and provides only physical therapy services under
1425physician orders, any community college or university clinic,
1426and any entity owned or operated by the federal or state
1427government, including agencies, subdivisions, or municipalities
1428thereof.
1429     (f)  A sole proprietorship, group practice, partnership, or
1430corporation that provides health care services by physicians
1431covered by s. 627.419, that is directly supervised by one or
1432more of such physicians, and that is wholly owned by one or more
1433of those physicians or by a physician and the spouse, parent,
1434child, or sibling of that physician.
1435     (g)  A sole proprietorship, group practice, partnership, or
1436corporation that provides health care services by licensed
1437health care practitioners under chapter 457, chapter 458,
1438chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1439chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1440chapter 490, chapter 491, or part I, part III, part X, part
1441XIII, or part XIV of chapter 468, or s. 464.012, which are
1442wholly owned by one or more licensed health care practitioners,
1443or the licensed health care practitioners set forth in this
1444paragraph and the spouse, parent, child, or sibling of a
1445licensed health care practitioner, so long as one of the owners
1446who is a licensed health care practitioner is supervising the
1447business activities and is legally responsible for the entity's
1448compliance with all federal and state laws. However, a health
1449care practitioner may not supervise services beyond the scope of
1450the practitioner's license, except that, for the purposes of
1451this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1452provides only services authorized pursuant to s. 456.053(3)(b)
1453may be supervised by a licensee specified in s. 456.053(3)(b).
1454     (h)  Clinical facilities affiliated with an accredited
1455medical school at which training is provided for medical
1456students, residents, or fellows.
1457     (i)  Entities that provide only oncology or radiation
1458therapy services by physicians licensed under chapter 458 or
1459chapter 459 or entities that provide oncology or radiation
1460therapy services by physicians licensed under chapter 458 or
1461chapter 459 which are owned by a corporation whose shares are
1462publicly traded on a recognized stock exchange.
1463     (j)  Clinical facilities affiliated with a college of
1464chiropractic accredited by the Council on Chiropractic Education
1465at which training is provided for chiropractic students.
1466     (k)  Entities that provide licensed practitioners to staff
1467emergency departments or to deliver anesthesia services in
1468facilities licensed under chapter 395 and that derive at least
146990 percent of their gross annual revenues from the provision of
1470such services. Entities claiming an exemption from licensure
1471under this paragraph must provide documentation demonstrating
1472compliance.
1473     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1474perinatology clinical facilities that are a publicly traded
1475corporation or that are wholly owned, directly or indirectly, by
1476a publicly traded corporation. As used in this paragraph, a
1477publicly traded corporation is a corporation that issues
1478securities traded on an exchange registered with the United
1479States Securities and Exchange Commission as a national
1480securities exchange.
1481     (7)  "Portable health service or equipment provider" means
1482an entity that contracts with or employs persons to provide
1483portable health care services or equipment to multiple locations
1484performing treatment or diagnostic testing of individuals, that
1485bills third-party payors for those services, and that otherwise
1486meets the definition of a clinic in subsection (4).
1487     Section 43.  Paragraph (b) of subsection (1) and paragraph
1488(c) of subsection (4) of section 400.991, Florida Statutes, are
1489amended to read:
1490     400.991  License requirements; background screenings;
1491prohibitions.-
1492     (1)
1493     (b)  Each mobile clinic must obtain a separate health care
1494clinic license and must provide to the agency, at least
1495quarterly, its projected street location to enable the agency to
1496locate and inspect such clinic. A portable health service or
1497equipment provider must obtain a health care clinic license for
1498a single administrative office and is not required to submit
1499quarterly projected street locations.
1500     (4)  In addition to the requirements of part II of chapter
1501408, the applicant must file with the application satisfactory
1502proof that the clinic is in compliance with this part and
1503applicable rules, including:
1504     (c)  Proof of financial ability to operate as required
1505under ss. s. 408.810(8) and 408.8065. As an alternative to
1506submitting proof of financial ability to operate as required
1507under s. 408.810(8), the applicant may file a surety bond of at
1508least $500,000 which guarantees that the clinic will act in full
1509conformity with all legal requirements for operating a clinic,
1510payable to the agency. The agency may adopt rules to specify
1511related requirements for such surety bond.
1512     Section 44.  Paragraph (g) of subsection (1) and paragraph
1513(a) of subsection (7) of section 400.9935, Florida Statutes, are
1514amended to read:
1515     400.9935  Clinic responsibilities.-
1516     (1)  Each clinic shall appoint a medical director or clinic
1517director who shall agree in writing to accept legal
1518responsibility for the following activities on behalf of the
1519clinic. The medical director or the clinic director shall:
1520     (g)  Conduct systematic reviews of clinic billings to
1521ensure that the billings are not fraudulent or unlawful. Upon
1522discovery of an unlawful charge, the medical director or clinic
1523director shall take immediate corrective action. If the clinic
1524performs only the technical component of magnetic resonance
1525imaging, static radiographs, computed tomography, or positron
1526emission tomography, and provides the professional
1527interpretation of such services, in a fixed facility that is
1528accredited by The Joint Commission on Accreditation of
1529Healthcare Organizations or the Accreditation Association for
1530Ambulatory Health Care, and the American College of Radiology;
1531and if, in the preceding quarter, the percentage of scans
1532performed by that clinic which was billed to all personal injury
1533protection insurance carriers was less than 15 percent, the
1534chief financial officer of the clinic may, in a written
1535acknowledgment provided to the agency, assume the responsibility
1536for the conduct of the systematic reviews of clinic billings to
1537ensure that the billings are not fraudulent or unlawful.
1538     (7)(a)  Each clinic engaged in magnetic resonance imaging
1539services must be accredited by The Joint Commission on
1540Accreditation of Healthcare Organizations, the American College
1541of Radiology, or the Accreditation Association for Ambulatory
1542Health Care, within 1 year after licensure. A clinic that is
1543accredited by the American College of Radiology or is within the
1544original 1-year period after licensure and replaces its core
1545magnetic resonance imaging equipment shall be given 1 year after
1546the date on which the equipment is replaced to attain
1547accreditation. However, a clinic may request a single, 6-month
1548extension if it provides evidence to the agency establishing
1549that, for good cause shown, such clinic cannot be accredited
1550within 1 year after licensure, and that such accreditation will
1551be completed within the 6-month extension. After obtaining
1552accreditation as required by this subsection, each such clinic
1553must maintain accreditation as a condition of renewal of its
1554license. A clinic that files a change of ownership application
1555must comply with the original accreditation timeframe
1556requirements of the transferor. The agency shall deny a change
1557of ownership application if the clinic is not in compliance with
1558the accreditation requirements. When a clinic adds, replaces, or
1559modifies magnetic resonance imaging equipment and the
1560accreditation agency requires new accreditation, the clinic must
1561be accredited within 1 year after the date of the addition,
1562replacement, or modification but may request a single, 6-month
1563extension if the clinic provides evidence of good cause to the
1564agency.
1565     Section 45.  Subsection (2) of section 408.034, Florida
1566Statutes, is amended to read:
1567     408.034  Duties and responsibilities of agency; rules.-
1568     (2)  In the exercise of its authority to issue licenses to
1569health care facilities and health service providers, as provided
1570under chapters 393 and 395 and parts II, and IV, and VIII of
1571chapter 400, the agency may not issue a license to any health
1572care facility or health service provider that fails to receive a
1573certificate of need or an exemption for the licensed facility or
1574service.
1575     Section 46.  Paragraph (d) of subsection (1) of section
1576408.036, Florida Statutes, is amended to read:
1577     408.036  Projects subject to review; exemptions.-
1578     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1579health-care-related projects, as described in paragraphs (a)-
1580(g), are subject to review and must file an application for a
1581certificate of need with the agency. The agency is exclusively
1582responsible for determining whether a health-care-related
1583project is subject to review under ss. 408.031-408.045.
1584     (d)  The establishment of a hospice or hospice inpatient
1585facility, except as provided in s. 408.043.
1586     Section 47.  Subsection (2) of section 408.043, Florida
1587Statutes, is amended to read:
1588     408.043  Special provisions.-
1589     (2)  HOSPICES.-When an application is made for a
1590certificate of need to establish or to expand a hospice, the
1591need for such hospice shall be determined on the basis of the
1592need for and availability of hospice services in the community.
1593The formula on which the certificate of need is based shall
1594discourage regional monopolies and promote competition. The
1595inpatient hospice care component of a hospice which is a
1596freestanding facility, or a part of a facility, which is
1597primarily engaged in providing inpatient care and related
1598services and is not licensed as a health care facility shall
1599also be required to obtain a certificate of need. Provision of
1600hospice care by any current provider of health care is a
1601significant change in service and therefore requires a
1602certificate of need for such services.
1603     Section 48.  Paragraph (k) of subsection (3) of section
1604408.05, Florida Statutes, is amended to read:
1605     408.05  Florida Center for Health Information and Policy
1606Analysis.-
1607     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1608produce comparable and uniform health information and statistics
1609for the development of policy recommendations, the agency shall
1610perform the following functions:
1611     (k)  Develop, in conjunction with the State Consumer Health
1612Information and Policy Advisory Council, and implement a long-
1613range plan for making available health care quality measures and
1614financial data that will allow consumers to compare health care
1615services. The health care quality measures and financial data
1616the agency must make available shall include, but is not limited
1617to, pharmaceuticals, physicians, health care facilities, and
1618health plans and managed care entities. The agency shall submit
1619the initial plan to the Governor, the President of the Senate,
1620and the Speaker of the House of Representatives by January 1,
16212006, and shall update the plan and report on the status of its
1622implementation annually thereafter. The agency shall also make
1623the plan and status report available to the public on its
1624Internet website. As part of the plan, the agency shall identify
1625the process and timeframes for implementation, any barriers to
1626implementation, and recommendations of changes in the law that
1627may be enacted by the Legislature to eliminate the barriers. As
1628preliminary elements of the plan, the agency shall:
1629     1.  Make available patient-safety indicators, inpatient
1630quality indicators, and performance outcome and patient charge
1631data collected from health care facilities pursuant to s.
1632408.061(1)(a) and (2). The terms "patient-safety indicators" and
1633"inpatient quality indicators" shall be as defined by the
1634Centers for Medicare and Medicaid Services, the National Quality
1635Forum, The Joint Commission on Accreditation of Healthcare
1636Organizations, the Agency for Healthcare Research and Quality,
1637the Centers for Disease Control and Prevention, or a similar
1638national entity that establishes standards to measure the
1639performance of health care providers, or by other states. The
1640agency shall determine which conditions, procedures, health care
1641quality measures, and patient charge data to disclose based upon
1642input from the council. When determining which conditions and
1643procedures are to be disclosed, the council and the agency shall
1644consider variation in costs, variation in outcomes, and
1645magnitude of variations and other relevant information. When
1646determining which health care quality measures to disclose, the
1647agency:
1648     a.  Shall consider such factors as volume of cases; average
1649patient charges; average length of stay; complication rates;
1650mortality rates; and infection rates, among others, which shall
1651be adjusted for case mix and severity, if applicable.
1652     b.  May consider such additional measures that are adopted
1653by the Centers for Medicare and Medicaid Studies, National
1654Quality Forum, The Joint Commission on Accreditation of
1655Healthcare Organizations, the Agency for Healthcare Research and
1656Quality, Centers for Disease Control and Prevention, or a
1657similar national entity that establishes standards to measure
1658the performance of health care providers, or by other states.
1659
1660When determining which patient charge data to disclose, the
1661agency shall include such measures as the average of
1662undiscounted charges on frequently performed procedures and
1663preventive diagnostic procedures, the range of procedure charges
1664from highest to lowest, average net revenue per adjusted patient
1665day, average cost per adjusted patient day, and average cost per
1666admission, among others.
1667     2.  Make available performance measures, benefit design,
1668and premium cost data from health plans licensed pursuant to
1669chapter 627 or chapter 641. The agency shall determine which
1670health care quality measures and member and subscriber cost data
1671to disclose, based upon input from the council. When determining
1672which data to disclose, the agency shall consider information
1673that may be required by either individual or group purchasers to
1674assess the value of the product, which may include membership
1675satisfaction, quality of care, current enrollment or membership,
1676coverage areas, accreditation status, premium costs, plan costs,
1677premium increases, range of benefits, copayments and
1678deductibles, accuracy and speed of claims payment, credentials
1679of physicians, number of providers, names of network providers,
1680and hospitals in the network. Health plans shall make available
1681to the agency any such data or information that is not currently
1682reported to the agency or the office.
1683     3.  Determine the method and format for public disclosure
1684of data reported pursuant to this paragraph. The agency shall
1685make its determination based upon input from the State Consumer
1686Health Information and Policy Advisory Council. At a minimum,
1687the data shall be made available on the agency's Internet
1688website in a manner that allows consumers to conduct an
1689interactive search that allows them to view and compare the
1690information for specific providers. The website must include
1691such additional information as is determined necessary to ensure
1692that the website enhances informed decisionmaking among
1693consumers and health care purchasers, which shall include, at a
1694minimum, appropriate guidance on how to use the data and an
1695explanation of why the data may vary from provider to provider.
1696The data specified in subparagraph 1. shall be released no later
1697than January 1, 2006, for the reporting of infection rates, and
1698no later than October 1, 2005, for mortality rates and
1699complication rates. The data specified in subparagraph 2. shall
1700be released no later than October 1, 2006.
1701     4.  Publish on its website undiscounted charges for no
1702fewer than 150 of the most commonly performed adult and
1703pediatric procedures, including outpatient, inpatient,
1704diagnostic, and preventative procedures.
1705     Section 49.  Paragraph (a) of subsection (1) of section
1706408.061, Florida Statutes, is amended to read:
1707     408.061  Data collection; uniform systems of financial
1708reporting; information relating to physician charges;
1709confidential information; immunity.-
1710     (1)  The agency shall require the submission by health care
1711facilities, health care providers, and health insurers of data
1712necessary to carry out the agency's duties. Specifications for
1713data to be collected under this section shall be developed by
1714the agency with the assistance of technical advisory panels
1715including representatives of affected entities, consumers,
1716purchasers, and such other interested parties as may be
1717determined by the agency.
1718     (a)  Data submitted by health care facilities, including
1719the facilities as defined in chapter 395, shall include, but are
1720not limited to: case-mix data, patient admission and discharge
1721data, hospital emergency department data which shall include the
1722number of patients treated in the emergency department of a
1723licensed hospital reported by patient acuity level, data on
1724hospital-acquired infections as specified by rule, data on
1725complications as specified by rule, data on readmissions as
1726specified by rule, with patient and provider-specific
1727identifiers included, actual charge data by diagnostic groups,
1728financial data, accounting data, operating expenses, expenses
1729incurred for rendering services to patients who cannot or do not
1730pay, interest charges, depreciation expenses based on the
1731expected useful life of the property and equipment involved, and
1732demographic data. The agency shall adopt nationally recognized
1733risk adjustment methodologies or software consistent with the
1734standards of the Agency for Healthcare Research and Quality and
1735as selected by the agency for all data submitted as required by
1736this section. Data may be obtained from documents such as, but
1737not limited to: leases, contracts, debt instruments, itemized
1738patient bills, medical record abstracts, and related diagnostic
1739information. Reported data elements shall be reported
1740electronically and in accordance with rule 59E-7.012, Florida
1741Administrative Code. Data submitted shall be certified by the
1742chief executive officer or an appropriate and duly authorized
1743representative or employee of the licensed facility that the
1744information submitted is true and accurate.
1745     Section 50.  Section 408.10, Florida Statutes, is amended
1746to read:
1747     408.10  Consumer complaints.-The agency shall:
1748     (1)  publish and make available to the public a toll-free
1749telephone number for the purpose of handling consumer complaints
1750and shall serve as a liaison between consumer entities and other
1751private entities and governmental entities for the disposition
1752of problems identified by consumers of health care.
1753     (2)  Be empowered to investigate consumer complaints
1754relating to problems with health care facilities' billing
1755practices and issue reports to be made public in any cases where
1756the agency determines the health care facility has engaged in
1757billing practices which are unreasonable and unfair to the
1758consumer.
1759     Section 51.  Subsections (12) through (30) of section
1760408.802, Florida Statutes, are renumbered as subsections (11)
1761through (29), respectively, and present subsection (11) of that
1762section is amended to read:
1763     408.802  Applicability.-The provisions of this part apply
1764to the provision of services that require licensure as defined
1765in this part and to the following entities licensed, registered,
1766or certified by the agency, as described in chapters 112, 383,
1767390, 394, 395, 400, 429, 440, 483, and 765:
1768     (11)  Private review agents, as provided under part I of
1769chapter 395.
1770     Section 52.  Subsection (3) is added to section 408.804,
1771Florida Statutes, to read:
1772     408.804  License required; display.-
1773     (3)  Any person who knowingly alters, defaces, or falsifies
1774a license certificate issued by the agency, or causes or
1775procures any person to commit such an offense, commits a
1776misdemeanor of the second degree, punishable as provided in s.
1777775.082 or s 775.083. Any licensee or provider who displays an
1778altered, defaced, or falsified license certificate is subject to
1779the penalties set forth in s. 408.815 and an administrative fine
1780of $1,000 for each day of illegal display.
1781     Section 53.  Paragraph (d) of subsection (2) of section
1782408.806, Florida Statutes, is amended, present subsections (3)
1783through (8) are renumbered as subsections (4) through (9),
1784respectively, and a new subsection (3) is added to that section,
1785to read:
1786     408.806  License application process.-
1787     (2)
1788     (d)  The agency shall notify the licensee by mail or
1789electronically at least 90 days before the expiration of a
1790license that a renewal license is necessary to continue
1791operation. The licensee's failure to timely file submit a
1792renewal application and license application fee with the agency
1793shall result in a $50 per day late fee charged to the licensee
1794by the agency; however, the aggregate amount of the late fee may
1795not exceed 50 percent of the licensure fee or $500, whichever is
1796less. The agency shall provide a courtesy notice to the licensee
1797by United States mail, electronically, or by any other manner at
1798its address of record or mailing address, if provided, at least
179990 days prior to the expiration of a license informing the
1800licensee of the expiration of the license. If the agency does
1801not provide the courtesy notice or the licensee does not receive
1802the courtesy notice, the licensee continues to be legally
1803obligated to timely file the renewal application and license
1804application fee with the agency and is not excused from the
1805payment of a late fee. If an application is received after the
1806required filing date and exhibits a hand-canceled postmark
1807obtained from a United States post office dated on or before the
1808required filing date, no fine will be levied.
1809     (3)  Payment of the late fee is required to consider any
1810late application complete, and failure to pay the late fee is
1811considered an omission from the application.
1812     Section 54.  Subsections (6) and (9) of section 408.810,
1813Florida Statutes, are amended to read:
1814     408.810  Minimum licensure requirements.-In addition to the
1815licensure requirements specified in this part, authorizing
1816statutes, and applicable rules, each applicant and licensee must
1817comply with the requirements of this section in order to obtain
1818and maintain a license.
1819     (6)(a)  An applicant must provide the agency with proof of
1820the applicant's legal right to occupy the property before a
1821license may be issued. Proof may include, but need not be
1822limited to, copies of warranty deeds, lease or rental
1823agreements, contracts for deeds, quitclaim deeds, or other such
1824documentation.
1825     (b)  In the event the property is encumbered by a mortgage
1826or is leased, an applicant must provide the agency with proof
1827that the mortgagor or landlord has been provided written notice
1828of the applicant's intent as mortgagee or tenant to provide
1829services that require licensure and instruct the mortgagor or
1830landlord to serve the agency by certified mail with copies of
1831any foreclosure or eviction actions initiated by the mortgagor
1832or landlord against the applicant.
1833     (9)  A controlling interest may not withhold from the
1834agency any evidence of financial instability, including, but not
1835limited to, checks returned due to insufficient funds,
1836delinquent accounts, nonpayment of withholding taxes, unpaid
1837utility expenses, nonpayment for essential services, or adverse
1838court action concerning the financial viability of the provider
1839or any other provider licensed under this part that is under the
1840control of the controlling interest. A controlling interest
1841shall notify the agency within 10 days after a court action to
1842initiate bankruptcy, foreclosure, or eviction proceedings
1843concerning the provider, in which the controlling interest is a
1844petitioner or defendant. Any person who violates this subsection
1845commits a misdemeanor of the second degree, punishable as
1846provided in s. 775.082 or s. 775.083. Each day of continuing
1847violation is a separate offense.
1848     Section 55.  Subsection (3) is added to section 408.813,
1849Florida Statutes, to read:
1850     408.813  Administrative fines; violations.-As a penalty for
1851any violation of this part, authorizing statutes, or applicable
1852rules, the agency may impose an administrative fine.
1853     (3)  The agency may impose an administrative fine for a
1854violation that does not qualify as a class I, class II, class
1855III, or class IV violation. Unless otherwise specified by law,
1856the amount of the fine shall not exceed $500 for each violation.
1857Unclassified violations may include:
1858     (a)  Violating any term or condition of a license.
1859     (b)  Violating any provision of this part, authorizing
1860statutes, or applicable rules.
1861     (c)  Exceeding licensed capacity.
1862     (d)  Providing services beyond the scope of the license.
1863     (e)  Violating a moratorium imposed pursuant to s. 408.814.
1864     Section 56.  Subsection (5) is added to section 408.815,
1865Florida Statutes, to read:
1866     408.815  License or application denial; revocation.-
1867     (5)  In order to ensure the health, safety, and welfare of
1868clients when a license has been denied, revoked, or is set to
1869terminate, the agency may extend the license expiration date for
1870a period of up to 30 days for the sole purpose of allowing the
1871safe and orderly discharge of clients. The agency may impose
1872conditions on the extension, including, but not limited to,
1873prohibiting or limiting admissions, expedited discharge
1874planning, required status reports, and mandatory monitoring by
1875the agency or third parties. In imposing these conditions, the
1876agency shall take into consideration the nature and number of
1877clients, the availability and location of acceptable alternative
1878placements, and the ability of the licensee to continue
1879providing care to the clients. The agency may terminate the
1880extension or modify the conditions at any time. This authority
1881is in addition to any other authority granted to the agency
1882under chapter 120, this part, and authorizing statutes but
1883creates no right or entitlement to an extension of a license
1884expiration date.
1885     Section 57.  Paragraph (k) of subsection (4) of section
1886409.221, Florida Statutes, is amended to read:
1887     409.221  Consumer-directed care program.-
1888     (4)  CONSUMER-DIRECTED CARE.-
1889     (k)  Reviews and reports.-The agency and the Departments of
1890Elderly Affairs, Health, and Children and Family Services and
1891the Agency for Persons with Disabilities shall each, on an
1892ongoing basis, review and assess the implementation of the
1893consumer-directed care program. By January 15 of each year, the
1894agency shall submit a written report to the Legislature that
1895includes each department's review of the program and contains
1896recommendations for improvements to the program.
1897     Section 58.  Subsections (3) and (4) of section 429.07,
1898Florida Statutes, are amended, and subsections (6) and (7) are
1899added to that section, to read:
1900     429.07  License required; fee; inspections.-
1901     (3)  In addition to the requirements of s. 408.806, each
1902license granted by the agency must state the type of care for
1903which the license is granted. Licenses shall be issued for one
1904or more of the following categories of care: standard, extended
1905congregate care, limited nursing services, or limited mental
1906health.
1907     (a)  A standard license shall be issued to a facility
1908facilities providing one or more of the personal services
1909identified in s. 429.02. Such licensee facilities may also
1910employ or contract with a person licensed under part I of
1911chapter 464 to administer medications and perform other tasks as
1912specified in s. 429.255.
1913     (b)  An extended congregate care license shall be issued to
1914a licensee facilities providing, directly or through contract,
1915services beyond those authorized in paragraph (a), including
1916acts performed pursuant to part I of chapter 464 by persons
1917licensed thereunder, and supportive services defined by rule to
1918persons who otherwise would be disqualified from continued
1919residence in a facility licensed under this part.
1920     1.  In order for extended congregate care services to be
1921provided in a facility licensed under this part, the agency must
1922first determine that all requirements established in law and
1923rule are met and must specifically designate, on the facility's
1924license, that such services may be provided and whether the
1925designation applies to all or part of a facility. Such
1926designation may be made at the time of initial licensure or
1927relicensure, or upon request in writing by a licensee under this
1928part and part II of chapter 408. Notification of approval or
1929denial of such request shall be made in accordance with part II
1930of chapter 408. An existing licensee facilities qualifying to
1931provide extended congregate care services must have maintained a
1932standard license and may not have been subject to administrative
1933sanctions during the previous 2 years, or since initial
1934licensure if the facility has been licensed for less than 2
1935years, for any of the following reasons:
1936     a.  A class I or class II violation;
1937     b.  Three or more repeat or recurring class III violations
1938of identical or similar resident care standards as specified in
1939rule from which a pattern of noncompliance is found by the
1940agency;
1941     c.  Three or more class III violations that were not
1942corrected in accordance with the corrective action plan approved
1943by the agency;
1944     d.  Violation of resident care standards resulting in a
1945requirement to employ the services of a consultant pharmacist or
1946consultant dietitian;
1947     e.  Denial, suspension, or revocation of a license for
1948another facility under this part in which the applicant for an
1949extended congregate care license has at least 25 percent
1950ownership interest; or
1951     f.  Imposition of a moratorium pursuant to this part or
1952part II of chapter 408 or initiation of injunctive proceedings.
1953     2.  A licensee Facilities that is are licensed to provide
1954extended congregate care services shall maintain a written
1955progress report for on each person who receives such services,
1956and the which report must describe describes the type, amount,
1957duration, scope, and outcome of services that are rendered and
1958the general status of the resident's health. A registered nurse,
1959or appropriate designee, representing the agency shall visit
1960such facilities at least quarterly to monitor residents who are
1961receiving extended congregate care services and to determine if
1962the facility is in compliance with this part, part II of chapter
1963408, and rules that relate to extended congregate care. One of
1964these visits may be in conjunction with the regular survey. The
1965monitoring visits may be provided through contractual
1966arrangements with appropriate community agencies. A registered
1967nurse shall serve as part of the team that inspects such
1968facility. The agency may waive one of the required yearly
1969monitoring visits for a facility that has been licensed for at
1970least 24 months to provide extended congregate care services,
1971if, during the inspection, the registered nurse determines that
1972extended congregate care services are being provided
1973appropriately, and if the facility has no class I or class II
1974violations and no uncorrected class III violations. Before such
1975decision is made, the agency shall consult with the long-term
1976care ombudsman council for the area in which the facility is
1977located to determine if any complaints have been made and
1978substantiated about the quality of services or care. The agency
1979may not waive one of the required yearly monitoring visits if
1980complaints have been made and substantiated.
1981     3.  Licensees Facilities that are licensed to provide
1982extended congregate care services shall:
1983     a.  Demonstrate the capability to meet unanticipated
1984resident service needs.
1985     b.  Offer a physical environment that promotes a homelike
1986setting, provides for resident privacy, promotes resident
1987independence, and allows sufficient congregate space as defined
1988by rule.
1989     c.  Have sufficient staff available, taking into account
1990the physical plant and firesafety features of the building, to
1991assist with the evacuation of residents in an emergency, as
1992necessary.
1993     d.  Adopt and follow policies and procedures that maximize
1994resident independence, dignity, choice, and decisionmaking to
1995permit residents to age in place to the extent possible, so that
1996moves due to changes in functional status are minimized or
1997avoided.
1998     e.  Allow residents or, if applicable, a resident's
1999representative, designee, surrogate, guardian, or attorney in
2000fact to make a variety of personal choices, participate in
2001developing service plans, and share responsibility in
2002decisionmaking.
2003     f.  Implement the concept of managed risk.
2004     g.  Provide, either directly or through contract, the
2005services of a person licensed pursuant to part I of chapter 464.
2006     h.  In addition to the training mandated in s. 429.52,
2007provide specialized training as defined by rule for facility
2008staff.
2009     4.  Licensees Facilities licensed to provide extended
2010congregate care services are exempt from the criteria for
2011continued residency as set forth in rules adopted under s.
2012429.41. Licensees Facilities so licensed shall adopt their own
2013requirements within guidelines for continued residency set forth
2014by rule. However, such licensees facilities may not serve
2015residents who require 24-hour nursing supervision. Licensees
2016Facilities licensed to provide extended congregate care services
2017shall provide each resident with a written copy of facility
2018policies governing admission and retention.
2019     5.  The primary purpose of extended congregate care
2020services is to allow residents, as they become more impaired,
2021the option of remaining in a familiar setting from which they
2022would otherwise be disqualified for continued residency. A
2023facility licensed to provide extended congregate care services
2024may also admit an individual who exceeds the admission criteria
2025for a facility with a standard license, if the individual is
2026determined appropriate for admission to the extended congregate
2027care facility.
2028     6.  Before admission of an individual to a facility
2029licensed to provide extended congregate care services, the
2030individual must undergo a medical examination as provided in s.
2031429.26(4) and the facility must develop a preliminary service
2032plan for the individual.
2033     7.  When a licensee facility can no longer provide or
2034arrange for services in accordance with the resident's service
2035plan and needs and the licensee's facility's policy, the
2036licensee facility shall make arrangements for relocating the
2037person in accordance with s. 429.28(1)(k).
2038     8.  Failure to provide extended congregate care services
2039may result in denial of extended congregate care license
2040renewal.
2041     9.  No later than January 1 of each year, the department,
2042in consultation with the agency, shall prepare and submit to the
2043Governor, the President of the Senate, the Speaker of the House
2044of Representatives, and the chairs of appropriate legislative
2045committees, a report on the status of, and recommendations
2046related to, extended congregate care services. The status report
2047must include, but need not be limited to, the following
2048information:
2049     a.  A description of the facilities licensed to provide
2050such services, including total number of beds licensed under
2051this part.
2052     b.  The number and characteristics of residents receiving
2053such services.
2054     c.  The types of services rendered that could not be
2055provided through a standard license.
2056     d.  An analysis of deficiencies cited during licensure
2057inspections.
2058     e.  The number of residents who required extended
2059congregate care services at admission and the source of
2060admission.
2061     f.  Recommendations for statutory or regulatory changes.
2062     g.  The availability of extended congregate care to state
2063clients residing in facilities licensed under this part and in
2064need of additional services, and recommendations for
2065appropriations to subsidize extended congregate care services
2066for such persons.
2067     h.  Such other information as the department considers
2068appropriate.
2069     (c)  A limited nursing services license shall be issued to
2070a facility that provides services beyond those authorized in
2071paragraph (a) and as specified in this paragraph.
2072     1.  In order for limited nursing services to be provided in
2073a facility licensed under this part, the agency must first
2074determine that all requirements established in law and rule are
2075met and must specifically designate, on the facility's license,
2076that such services may be provided. Such designation may be made
2077at the time of initial licensure or relicensure, or upon request
2078in writing by a licensee under this part and part II of chapter
2079408. Notification of approval or denial of such request shall be
2080made in accordance with part II of chapter 408. Existing
2081facilities qualifying to provide limited nursing services shall
2082have maintained a standard license and may not have been subject
2083to administrative sanctions that affect the health, safety, and
2084welfare of residents for the previous 2 years or since initial
2085licensure if the facility has been licensed for less than 2
2086years.
2087     2.  Facilities that are licensed to provide limited nursing
2088services shall maintain a written progress report on each person
2089who receives such nursing services, which report describes the
2090type, amount, duration, scope, and outcome of services that are
2091rendered and the general status of the resident's health. A
2092registered nurse representing the agency shall visit such
2093facilities at least twice a year to monitor residents who are
2094receiving limited nursing services and to determine if the
2095facility is in compliance with applicable provisions of this
2096part, part II of chapter 408, and related rules. The monitoring
2097visits may be provided through contractual arrangements with
2098appropriate community agencies. A registered nurse shall also
2099serve as part of the team that inspects such facility.
2100     3.  A person who receives limited nursing services under
2101this part must meet the admission criteria established by the
2102agency for assisted living facilities. When a resident no longer
2103meets the admission criteria for a facility licensed under this
2104part, arrangements for relocating the person shall be made in
2105accordance with s. 429.28(1)(k), unless the facility is licensed
2106to provide extended congregate care services.
2107     (4)  In accordance with s. 408.805, an applicant or
2108licensee shall pay a fee for each license application submitted
2109under this part, part II of chapter 408, and applicable rules.
2110The amount of the fee shall be established by rule.
2111     (a)  The biennial license fee required of a facility is
2112$356 $300 per license, with an additional fee of $67.50 $50 per
2113resident based on the total licensed resident capacity of the
2114facility, except that no additional fee will be assessed for
2115beds designated for recipients of optional state supplementation
2116payments provided for in s. 409.212. The total fee may not
2117exceed $18,000 $10,000.
2118     (b)  In addition to the total fee assessed under paragraph
2119(a), the agency shall require facilities that are licensed to
2120provide extended congregate care services under this part to pay
2121an additional fee per licensed facility. The amount of the
2122biennial fee shall be $501 $400 per license, with an additional
2123fee of $10 per resident based on the total licensed resident
2124capacity of the facility.
2125     (c)  In addition to the total fee assessed under paragraph
2126(a), the agency shall require facilities that are licensed to
2127provide limited nursing services under this part to pay an
2128additional fee per licensed facility. The amount of the biennial
2129fee shall be $250 per license, with an additional fee of $10 per
2130resident based on the total licensed resident capacity of the
2131facility.
2132     (6)  In order to determine whether the facility is
2133adequately protecting residents' rights as provided in s.
2134429.28, the biennial survey shall include private informal
2135conversations with a sample of residents and consultation with
2136the ombudsman council in the planning and service area in which
2137the facility is located to discuss residents' experiences within
2138the facility.
2139     (7)  An assisted living facility that has been cited within
2140the previous 24-month period for a class I or class II
2141violation, regardless of the status of any enforcement or
2142disciplinary action, is subject to periodic unannounced
2143monitoring to determine if the facility is in compliance with
2144this part, part II of chapter 408, and applicable rules.
2145Monitoring may occur through a desk review or an onsite
2146assessment. If the class I or class II violation relates to
2147providing or failing to provide nursing care, a registered nurse
2148must participate in at least two onsite monitoring visits within
2149a 12-month period.
2150     Section 59.  Subsection (7) of section 429.11, Florida
2151Statutes, is renumbered as subsection (6), and present
2152subsection (6) of that section is amended to read:
2153     429.11  Initial application for license; provisional
2154license.-
2155     (6)  In addition to the license categories available in s.
2156408.808, a provisional license may be issued to an applicant
2157making initial application for licensure or making application
2158for a change of ownership. A provisional license shall be
2159limited in duration to a specific period of time not to exceed 6
2160months, as determined by the agency.
2161     Section 60.  Section 429.12, Florida Statutes, is amended
2162to read:
2163     429.12  Sale or transfer of ownership of a facility.-It is
2164the intent of the Legislature to protect the rights of the
2165residents of an assisted living facility when the facility is
2166sold or the ownership thereof is transferred. Therefore, in
2167addition to the requirements of part II of chapter 408, whenever
2168a facility is sold or the ownership thereof is transferred,
2169including leasing:.
2170     (1)  The transferee shall notify the residents, in writing,
2171of the change of ownership within 7 days after receipt of the
2172new license.
2173     (2)  The transferor of a facility the license of which is
2174denied pending an administrative hearing shall, as a part of the
2175written change-of-ownership contract, advise the transferee that
2176a plan of correction must be submitted by the transferee and
2177approved by the agency at least 7 days before the change of
2178ownership and that failure to correct the condition which
2179resulted in the moratorium pursuant to part II of chapter 408 or
2180denial of licensure is grounds for denial of the transferee's
2181license.
2182     Section 61.  Paragraphs (b) through (l) of subsection (1)
2183of section 429.14, Florida Statutes, are redesignated as
2184paragraphs (a) through (k), respectively, and present paragraph
2185(a) of subsection (1) and subsections (5) and (6) of that
2186section are amended to read:
2187     429.14  Administrative penalties.-
2188     (1)  In addition to the requirements of part II of chapter
2189408, the agency may deny, revoke, and suspend any license issued
2190under this part and impose an administrative fine in the manner
2191provided in chapter 120 against a licensee of an assisted living
2192facility for a violation of any provision of this part, part II
2193of chapter 408, or applicable rules, or for any of the following
2194actions by a licensee of an assisted living facility, for the
2195actions of any person subject to level 2 background screening
2196under s. 408.809, or for the actions of any facility employee:
2197     (a)  An intentional or negligent act seriously affecting
2198the health, safety, or welfare of a resident of the facility.
2199     (5)  An action taken by the agency to suspend, deny, or
2200revoke a facility's license under this part or part II of
2201chapter 408, in which the agency claims that the facility owner
2202or an employee of the facility has threatened the health,
2203safety, or welfare of a resident of the facility shall be heard
2204by the Division of Administrative Hearings of the Department of
2205Management Services within 120 days after receipt of the
2206facility's request for a hearing, unless that time limitation is
2207waived by both parties. The administrative law judge must render
2208a decision within 30 days after receipt of a proposed
2209recommended order.
2210     (6)  The agency shall provide to the Division of Hotels and
2211Restaurants of the Department of Business and Professional
2212Regulation, on a monthly basis, a list of those assisted living
2213facilities that have had their licenses denied, suspended, or
2214revoked or that are involved in an appellate proceeding pursuant
2215to s. 120.60 related to the denial, suspension, or revocation of
2216a license. This information may be provided electronically or
2217through the agency's Internet website.
2218     Section 62.  Subsections (1), (4), and (5) of section
2219429.17, Florida Statutes, are amended to read:
2220     429.17  Expiration of license; renewal; conditional
2221license.-
2222     (1)  Limited nursing, Extended congregate care, and limited
2223mental health licenses shall expire at the same time as the
2224facility's standard license, regardless of when issued.
2225     (4)  In addition to the license categories available in s.
2226408.808, a conditional license may be issued to an applicant for
2227license renewal if the applicant fails to meet all standards and
2228requirements for licensure. A conditional license issued under
2229this subsection shall be limited in duration to a specific
2230period of time not to exceed 6 months, as determined by the
2231agency, and shall be accompanied by an agency-approved plan of
2232correction.
2233     (5)  When an extended congregate care or limited nursing
2234license is requested during a facility's biennial license
2235period, the fee shall be prorated in order to permit the
2236additional license to expire at the end of the biennial license
2237period. The fee shall be calculated as of the date the
2238additional license application is received by the agency.
2239     Section 63.  Subsection (7) of section 429.19, Florida
2240Statutes, is amended to read:
2241     429.19  Violations; imposition of administrative fines;
2242grounds.-
2243     (7)  In addition to any administrative fines imposed, the
2244agency may assess a survey or monitoring fee, equal to the
2245lesser of one half of the facility's biennial license and bed
2246fee or $500, to cover the cost of conducting initial complaint
2247investigations that result in the finding of a violation that
2248was the subject of the complaint or to monitor the health,
2249safety, or security of residents under s. 429.07(7) monitoring
2250visits conducted under s. 429.28(3)(c) to verify the correction
2251of the violations.
2252     Section 64.  Subsections (6) through (10) of section
2253429.23, Florida Statutes, are renumbered as subsections (5)
2254through (9), respectively, and present subsection (5) of that
2255section is amended to read:
2256     429.23  Internal risk management and quality assurance
2257program; adverse incidents and reporting requirements.-
2258     (5)  Each facility shall report monthly to the agency any
2259liability claim filed against it. The report must include the
2260name of the resident, the dates of the incident leading to the
2261claim, if applicable, and the type of injury or violation of
2262rights alleged to have occurred. This report is not discoverable
2263in any civil or administrative action, except in such actions
2264brought by the agency to enforce the provisions of this part.
2265     Section 65.  Paragraph (a) of subsection (1) and subsection
2266(2) of section 429.255, Florida Statutes, are amended to read:
2267     429.255  Use of personnel; emergency care.-
2268     (1)(a)  Persons under contract to the facility or, facility
2269staff, or volunteers, who are licensed according to part I of
2270chapter 464, or those persons exempt under s. 464.022(1), and
2271others as defined by rule, may administer medications to
2272residents, take residents' vital signs, manage individual weekly
2273pill organizers for residents who self-administer medication,
2274give prepackaged enemas ordered by a physician, observe
2275residents, document observations on the appropriate resident's
2276record, report observations to the resident's physician, and
2277contract or allow residents or a resident's representative,
2278designee, surrogate, guardian, or attorney in fact to contract
2279with a third party, provided residents meet the criteria for
2280appropriate placement as defined in s. 429.26. Persons under
2281contract to the facility or facility staff who are licensed
2282according to part I of chapter 464 may provide limited nursing
2283services. Nursing assistants certified pursuant to part II of
2284chapter 464 may take residents' vital signs as directed by a
2285licensed nurse or physician. The facility is responsible for
2286maintaining documentation of services provided under this
2287paragraph as required by rule and ensuring that staff are
2288adequately trained to monitor residents receiving these
2289services.
2290     (2)  In facilities licensed to provide extended congregate
2291care, persons under contract to the facility or, facility staff,
2292or volunteers, who are licensed according to part I of chapter
2293464, or those persons exempt under s. 464.022(1), or those
2294persons certified as nursing assistants pursuant to part II of
2295chapter 464, may also perform all duties within the scope of
2296their license or certification, as approved by the facility
2297administrator and pursuant to this part.
2298     Section 66.  Subsection (3) of section 429.28, Florida
2299Statutes, is amended to read:
2300     429.28  Resident bill of rights.-
2301     (3)(a)  The agency shall conduct a survey to determine
2302general compliance with facility standards and compliance with
2303residents' rights as a prerequisite to initial licensure or
2304licensure renewal.
2305     (b)  In order to determine whether the facility is
2306adequately protecting residents' rights, the biennial survey
2307shall include private informal conversations with a sample of
2308residents and consultation with the ombudsman council in the
2309planning and service area in which the facility is located to
2310discuss residents' experiences within the facility.
2311     (c)  During any calendar year in which no survey is
2312conducted, the agency shall conduct at least one monitoring
2313visit of each facility cited in the previous year for a class I
2314or class II violation, or more than three uncorrected class III
2315violations.
2316     (d)  The agency may conduct periodic followup inspections
2317as necessary to monitor the compliance of facilities with a
2318history of any class I, class II, or class III violations that
2319threaten the health, safety, or security of residents.
2320     (e)  The agency may conduct complaint investigations as
2321warranted to investigate any allegations of noncompliance with
2322requirements required under this part or rules adopted under
2323this part.
2324     Section 67.  Subsection (2) of section 429.35, Florida
2325Statutes, is amended to read:
2326     429.35  Maintenance of records; reports.-
2327     (2)  Within 60 days after the date of the biennial
2328inspection visit required under s. 408.811 or within 30 days
2329after the date of any interim visit, the agency shall forward
2330the results of the inspection to the local ombudsman council in
2331whose planning and service area, as defined in part II of
2332chapter 400, the facility is located; to at least one public
2333library or, in the absence of a public library, the county seat
2334in the county in which the inspected assisted living facility is
2335located; and, when appropriate, to the district Adult Services
2336and Mental Health Program Offices. This information may be
2337provided electronically or through the agency's Internet
2338website.
2339     Section 68.  Paragraphs (i) and (j) of subsection (1) of
2340section 429.41, Florida Statutes, are amended to read:
2341     429.41  Rules establishing standards.-
2342     (1)  It is the intent of the Legislature that rules
2343published and enforced pursuant to this section shall include
2344criteria by which a reasonable and consistent quality of
2345resident care and quality of life may be ensured and the results
2346of such resident care may be demonstrated. Such rules shall also
2347ensure a safe and sanitary environment that is residential and
2348noninstitutional in design or nature. It is further intended
2349that reasonable efforts be made to accommodate the needs and
2350preferences of residents to enhance the quality of life in a
2351facility. The agency, in consultation with the department, may
2352adopt rules to administer the requirements of part II of chapter
2353408. In order to provide safe and sanitary facilities and the
2354highest quality of resident care accommodating the needs and
2355preferences of residents, the department, in consultation with
2356the agency, the Department of Children and Family Services, and
2357the Department of Health, shall adopt rules, policies, and
2358procedures to administer this part, which must include
2359reasonable and fair minimum standards in relation to:
2360     (i)  Facilities holding an a limited nursing, extended
2361congregate care, or limited mental health license.
2362     (j)  The establishment of specific criteria to define
2363appropriateness of resident admission and continued residency in
2364a facility holding a standard, limited nursing, extended
2365congregate care, and limited mental health license.
2366     Section 69.  Subsections (1) and (2) of section 429.53,
2367Florida Statutes, are amended to read:
2368     429.53  Consultation by the agency.-
2369     (1)  The area offices of licensure and certification of the
2370agency shall provide consultation to the following upon request:
2371     (a)  A licensee of a facility.
2372     (b)  A person interested in obtaining a license to operate
2373a facility under this part.
2374     (2)  As used in this section, "consultation" includes:
2375     (a)  An explanation of the requirements of this part and
2376rules adopted pursuant thereto;
2377     (b)  An explanation of the license application and renewal
2378procedures;
2379     (c)  The provision of a checklist of general local and
2380state approvals required prior to constructing or developing a
2381facility and a listing of the types of agencies responsible for
2382such approvals;
2383     (d)  An explanation of benefits and financial assistance
2384available to a recipient of supplemental security income
2385residing in a facility;
2386     (c)(e)  Any other information which the agency deems
2387necessary to promote compliance with the requirements of this
2388part; and
2389     (f)  A preconstruction review of a facility to ensure
2390compliance with agency rules and this part.
2391     Section 70.  Subsections (1) and (2) of section 429.54,
2392Florida Statutes, are renumbered as subsections (2) and (3),
2393respectively, and a new subsection (1) is added to that section
2394to read:
2395     429.54  Collection of information; local subsidy.-
2396     (1)  A facility that is licensed under this part must
2397report electronically to the agency semiannually, or more
2398frequently as determined by rule, data related to the facility,
2399including, but not limited to, the total number of residents,
2400the number of residents who are receiving limited mental health
2401services, the number of residents who are receiving extended
2402congregate care services, the number of residents who are
2403receiving limited nursing services, funding sources of the
2404residents, and professional staffing employed by or under
2405contract with the licensee to provide resident services. The
2406department, in consultation with the agency, shall adopt rules
2407to administer this subsection.
2408     Section 71.  Subsections (1) and (5) of section 429.71,
2409Florida Statutes, are amended to read:
2410     429.71  Classification of violations deficiencies;
2411administrative fines.-
2412     (1)  In addition to the requirements of part II of chapter
2413408 and in addition to any other liability or penalty provided
2414by law, the agency may impose an administrative fine on a
2415provider according to the following classification:
2416     (a)  Class I violations are defined in s. 408.813 those
2417conditions or practices related to the operation and maintenance
2418of an adult family-care home or to the care of residents which
2419the agency determines present an imminent danger to the
2420residents or guests of the facility or a substantial probability
2421that death or serious physical or emotional harm would result
2422therefrom. The condition or practice that constitutes a class I
2423violation must be abated or eliminated within 24 hours, unless a
2424fixed period, as determined by the agency, is required for
2425correction. A class I violation deficiency is subject to an
2426administrative fine in an amount not less than $500 and not
2427exceeding $1,000 for each violation. A fine may be levied
2428notwithstanding the correction of the deficiency.
2429     (b)  Class II violations are defined in s. 408.813 those
2430conditions or practices related to the operation and maintenance
2431of an adult family-care home or to the care of residents which
2432the agency determines directly threaten the physical or
2433emotional health, safety, or security of the residents, other
2434than class I violations. A class II violation is subject to an
2435administrative fine in an amount not less than $250 and not
2436exceeding $500 for each violation. A citation for a class II
2437violation must specify the time within which the violation is
2438required to be corrected. If a class II violation is corrected
2439within the time specified, no civil penalty shall be imposed,
2440unless it is a repeated offense.
2441     (c)  Class III violations are defined in s. 408.813 those
2442conditions or practices related to the operation and maintenance
2443of an adult family-care home or to the care of residents which
2444the agency determines indirectly or potentially threaten the
2445physical or emotional health, safety, or security of residents,
2446other than class I or class II violations. A class III violation
2447is subject to an administrative fine in an amount not less than
2448$100 and not exceeding $250 for each violation. A citation for a
2449class III violation shall specify the time within which the
2450violation is required to be corrected. If a class III violation
2451is corrected within the time specified, no civil penalty shall
2452be imposed, unless it is a repeated violation offense.
2453     (d)  Class IV violations are defined in s. 408.813 those
2454conditions or occurrences related to the operation and
2455maintenance of an adult family-care home, or related to the
2456required reports, forms, or documents, which do not have the
2457potential of negatively affecting the residents. A provider that
2458does not correct A class IV violation within the time limit
2459specified by the agency is subject to an administrative fine in
2460an amount not less than $50 and not exceeding $100 for each
2461violation. Any class IV violation that is corrected during the
2462time the agency survey is conducted will be identified as an
2463agency finding and not as a violation, unless it is a repeat
2464violation.
2465     (5)  As an alternative to or in conjunction with an
2466administrative action against a provider, the agency may request
2467a plan of corrective action that demonstrates a good faith
2468effort to remedy each violation by a specific date, subject to
2469the approval of the agency.
2470     Section 72.  Paragraphs (b) through (e) of subsection (2)
2471of section 429.911, Florida Statutes, are redesignated as
2472paragraphs (a) through (d), respectively, and present paragraph
2473(a) of that subsection is amended to read:
2474     429.911  Denial, suspension, revocation of license;
2475emergency action; administrative fines; investigations and
2476inspections.-
2477     (2)  Each of the following actions by the owner of an adult
2478day care center or by its operator or employee is a ground for
2479action by the agency against the owner of the center or its
2480operator or employee:
2481     (a)  An intentional or negligent act materially affecting
2482the health or safety of center participants.
2483     Section 73.  Section 429.915, Florida Statutes, is amended
2484to read:
2485     429.915  Conditional license.-In addition to the license
2486categories available in part II of chapter 408, the agency may
2487issue a conditional license to an applicant for license renewal
2488or change of ownership if the applicant fails to meet all
2489standards and requirements for licensure. A conditional license
2490issued under this subsection must be limited to a specific
2491period not exceeding 6 months, as determined by the agency, and
2492must be accompanied by an approved plan of correction.
2493     Section 74.  Subsection (7) of section 394.4787, Florida
2494Statutes, is amended to read:
2495     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
2496and 394.4789.-As used in this section and ss. 394.4786,
2497394.4788, and 394.4789:
2498     (7)  "Specialty psychiatric hospital" means a hospital
2499licensed by the agency pursuant to s. 395.002(26)(28) and part
2500II of chapter 408 as a specialty psychiatric hospital.
2501     Section 75.  Paragraph (g) of subsection (2) of section
2502400.0239, Florida Statutes, is amended to read:
2503     400.0239  Quality of Long-Term Care Facility Improvement
2504Trust Fund.-
2505     (2)  Expenditures from the trust fund shall be allowable
2506for direct support of the following:
2507     (g)  Other initiatives authorized by the Centers for
2508Medicare and Medicaid Services for the use of federal civil
2509monetary penalties, including projects recommended through the
2510Medicaid "Up-or-Out" Quality of Care Contract Management Program
2511pursuant to s. 400.148.
2512     Section 76.  Subsection (43) of section 408.07, Florida
2513Statutes, is amended to read:
2514     408.07  Definitions.-As used in this chapter, with the
2515exception of ss. 408.031-408.045, the term:
2516     (43)  "Rural hospital" means an acute care hospital
2517licensed under chapter 395, having 100 or fewer licensed beds
2518and an emergency room, and which is:
2519     (a)  The sole provider within a county with a population
2520density of no greater than 100 persons per square mile;
2521     (b)  An acute care hospital, in a county with a population
2522density of no greater than 100 persons per square mile, which is
2523at least 30 minutes of travel time, on normally traveled roads
2524under normal traffic conditions, from another acute care
2525hospital within the same county;
2526     (c)  A hospital supported by a tax district or subdistrict
2527whose boundaries encompass a population of 100 persons or fewer
2528per square mile;
2529     (d)  A hospital with a service area that has a population
2530of 100 persons or fewer per square mile. As used in this
2531paragraph, the term "service area" means the fewest number of
2532zip codes that account for 75 percent of the hospital's
2533discharges for the most recent 5-year period, based on
2534information available from the hospital inpatient discharge
2535database in the Florida Center for Health Information and Policy
2536Analysis at the Agency for Health Care Administration; or
2537     (e)  A critical access hospital.
2538
2539Population densities used in this subsection must be based upon
2540the most recently completed United States census. A hospital
2541that received funds under s. 409.9116 for a quarter beginning no
2542later than July 1, 2002, is deemed to have been and shall
2543continue to be a rural hospital from that date through June 30,
25442015, if the hospital continues to have 100 or fewer licensed
2545beds and an emergency room, or meets the criteria of s.
2546395.602(2)(e)4. An acute care hospital that has not previously
2547been designated as a rural hospital and that meets the criteria
2548of this subsection shall be granted such designation upon
2549application, including supporting documentation, to the Agency
2550for Health Care Administration.
2551     Section 77.  Paragraphs (b) and (h) of subsection (3) of
2552section 430.80, Florida Statutes, are amended to read:
2553     430.80  Implementation of a teaching nursing home pilot
2554project.-
2555     (3)  To be designated as a teaching nursing home, a nursing
2556home licensee must, at a minimum:
2557     (b)  Participate in a nationally recognized accreditation
2558program and hold a valid accreditation, such as the
2559accreditation awarded by The Joint Commission on Accreditation
2560of Healthcare Organizations;
2561     (h)  Maintain insurance coverage pursuant to s.
2562400.141(1)(q)(s) or proof of financial responsibility in a
2563minimum amount of $750,000. Such proof of financial
2564responsibility may include:
2565     1.  Maintaining an escrow account consisting of cash or
2566assets eligible for deposit in accordance with s. 625.52; or
2567     2.  Obtaining and maintaining pursuant to chapter 675 an
2568unexpired, irrevocable, nontransferable and nonassignable letter
2569of credit issued by any bank or savings association organized
2570and existing under the laws of this state or any bank or savings
2571association organized under the laws of the United States that
2572has its principal place of business in this state or has a
2573branch office which is authorized to receive deposits in this
2574state. The letter of credit shall be used to satisfy the
2575obligation of the facility to the claimant upon presentment of a
2576final judgment indicating liability and awarding damages to be
2577paid by the facility or upon presentment of a settlement
2578agreement signed by all parties to the agreement when such final
2579judgment or settlement is a result of a liability claim against
2580the facility.
2581     Section 78.  Paragraph (a) of subsection (2) of section
2582440.13, Florida Statutes, is amended to read:
2583     440.13  Medical services and supplies; penalty for
2584violations; limitations.-
2585     (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2586     (a)  Subject to the limitations specified elsewhere in this
2587chapter, the employer shall furnish to the employee such
2588medically necessary remedial treatment, care, and attendance for
2589such period as the nature of the injury or the process of
2590recovery may require, which is in accordance with established
2591practice parameters and protocols of treatment as provided for
2592in this chapter, including medicines, medical supplies, durable
2593medical equipment, orthoses, prostheses, and other medically
2594necessary apparatus. Remedial treatment, care, and attendance,
2595including work-hardening programs or pain-management programs
2596accredited by the Commission on Accreditation of Rehabilitation
2597Facilities or The Joint Commission on the Accreditation of
2598Health Organizations or pain-management programs affiliated with
2599medical schools, shall be considered as covered treatment only
2600when such care is given based on a referral by a physician as
2601defined in this chapter. Medically necessary treatment, care,
2602and attendance does not include chiropractic services in excess
2603of 24 treatments or rendered 12 weeks beyond the date of the
2604initial chiropractic treatment, whichever comes first, unless
2605the carrier authorizes additional treatment or the employee is
2606catastrophically injured.
2607
2608Failure of the carrier to timely comply with this subsection
2609shall be a violation of this chapter and the carrier shall be
2610subject to penalties as provided for in s. 440.525.
2611     Section 79.  Section 483.294, Florida Statutes, is amended
2612to read:
2613     483.294  Inspection of centers.-In accordance with s.
2614408.811, the agency shall biennially, at least once annually,
2615inspect the premises and operations of all centers subject to
2616licensure under this part.
2617     Section 80.  Subsection (1) of section 627.645, Florida
2618Statutes, is amended to read:
2619     627.645  Denial of health insurance claims restricted.-
2620     (1)  No claim for payment under a health insurance policy
2621or self-insured program of health benefits for treatment, care,
2622or services in a licensed hospital which is accredited by The
2623Joint Commission on the Accreditation of Hospitals, the American
2624Osteopathic Association, or the Commission on the Accreditation
2625of Rehabilitative Facilities shall be denied because such
2626hospital lacks major surgical facilities and is primarily of a
2627rehabilitative nature, if such rehabilitation is specifically
2628for treatment of physical disability.
2629     Section 81.  Paragraph (c) of subsection (2) of section
2630627.668, Florida Statutes, is amended to read:
2631     627.668  Optional coverage for mental and nervous disorders
2632required; exception.-
2633     (2)  Under group policies or contracts, inpatient hospital
2634benefits, partial hospitalization benefits, and outpatient
2635benefits consisting of durational limits, dollar amounts,
2636deductibles, and coinsurance factors shall not be less favorable
2637than for physical illness generally, except that:
2638     (c)  Partial hospitalization benefits shall be provided
2639under the direction of a licensed physician. For purposes of
2640this part, the term "partial hospitalization services" is
2641defined as those services offered by a program accredited by The
2642Joint Commission on Accreditation of Hospitals (JCAH) or in
2643compliance with equivalent standards. Alcohol rehabilitation
2644programs accredited by The Joint Commission on Accreditation of
2645Hospitals or approved by the state and licensed drug abuse
2646rehabilitation programs shall also be qualified providers under
2647this section. In any benefit year, if partial hospitalization
2648services or a combination of inpatient and partial
2649hospitalization are utilized, the total benefits paid for all
2650such services shall not exceed the cost of 30 days of inpatient
2651hospitalization for psychiatric services, including physician
2652fees, which prevail in the community in which the partial
2653hospitalization services are rendered. If partial
2654hospitalization services benefits are provided beyond the limits
2655set forth in this paragraph, the durational limits, dollar
2656amounts, and coinsurance factors thereof need not be the same as
2657those applicable to physical illness generally.
2658     Section 82.  Subsection (3) of section 627.669, Florida
2659Statutes, is amended to read:
2660     627.669  Optional coverage required for substance abuse
2661impaired persons; exception.-
2662     (3)  The benefits provided under this section shall be
2663applicable only if treatment is provided by, or under the
2664supervision of, or is prescribed by, a licensed physician or
2665licensed psychologist and if services are provided in a program
2666accredited by The Joint Commission on Accreditation of Hospitals
2667or approved by the state.
2668     Section 83.  Paragraph (a) of subsection (1) of section
2669627.736, Florida Statutes, is amended to read:
2670     627.736  Required personal injury protection benefits;
2671exclusions; priority; claims.-
2672     (1)  REQUIRED BENEFITS.-Every insurance policy complying
2673with the security requirements of s. 627.733 shall provide
2674personal injury protection to the named insured, relatives
2675residing in the same household, persons operating the insured
2676motor vehicle, passengers in such motor vehicle, and other
2677persons struck by such motor vehicle and suffering bodily injury
2678while not an occupant of a self-propelled vehicle, subject to
2679the provisions of subsection (2) and paragraph (4)(e), to a
2680limit of $10,000 for loss sustained by any such person as a
2681result of bodily injury, sickness, disease, or death arising out
2682of the ownership, maintenance, or use of a motor vehicle as
2683follows:
2684     (a)  Medical benefits.-Eighty percent of all reasonable
2685expenses for medically necessary medical, surgical, X-ray,
2686dental, and rehabilitative services, including prosthetic
2687devices, and medically necessary ambulance, hospital, and
2688nursing services. However, the medical benefits shall provide
2689reimbursement only for such services and care that are lawfully
2690provided, supervised, ordered, or prescribed by a physician
2691licensed under chapter 458 or chapter 459, a dentist licensed
2692under chapter 466, or a chiropractic physician licensed under
2693chapter 460 or that are provided by any of the following persons
2694or entities:
2695     1.  A hospital or ambulatory surgical center licensed under
2696chapter 395.
2697     2.  A person or entity licensed under ss. 401.2101-401.45
2698that provides emergency transportation and treatment.
2699     3.  An entity wholly owned by one or more physicians
2700licensed under chapter 458 or chapter 459, chiropractic
2701physicians licensed under chapter 460, or dentists licensed
2702under chapter 466 or by such practitioner or practitioners and
2703the spouse, parent, child, or sibling of that practitioner or
2704those practitioners.
2705     4.  An entity wholly owned, directly or indirectly, by a
2706hospital or hospitals.
2707     5.  A health care clinic licensed under ss. 400.990-400.995
2708that is:
2709     a.  Accredited by The Joint Commission on Accreditation of
2710Healthcare Organizations, the American Osteopathic Association,
2711the Commission on Accreditation of Rehabilitation Facilities, or
2712the Accreditation Association for Ambulatory Health Care, Inc.;
2713or
2714     b.  A health care clinic that:
2715     (I)  Has a medical director licensed under chapter 458,
2716chapter 459, or chapter 460;
2717     (II)  Has been continuously licensed for more than 3 years
2718or is a publicly traded corporation that issues securities
2719traded on an exchange registered with the United States
2720Securities and Exchange Commission as a national securities
2721exchange; and
2722     (III)  Provides at least four of the following medical
2723specialties:
2724     (A)  General medicine.
2725     (B)  Radiography.
2726     (C)  Orthopedic medicine.
2727     (D)  Physical medicine.
2728     (E)  Physical therapy.
2729     (F)  Physical rehabilitation.
2730     (G)  Prescribing or dispensing outpatient prescription
2731medication.
2732     (H)  Laboratory services.
2733
2734The Financial Services Commission shall adopt by rule the form
2735that must be used by an insurer and a health care provider
2736specified in subparagraph 3., subparagraph 4., or subparagraph
27375. to document that the health care provider meets the criteria
2738of this paragraph, which rule must include a requirement for a
2739sworn statement or affidavit.
2740
2741Only insurers writing motor vehicle liability insurance in this
2742state may provide the required benefits of this section, and no
2743such insurer shall require the purchase of any other motor
2744vehicle coverage other than the purchase of property damage
2745liability coverage as required by s. 627.7275 as a condition for
2746providing such required benefits. Insurers may not require that
2747property damage liability insurance in an amount greater than
2748$10,000 be purchased in conjunction with personal injury
2749protection. Such insurers shall make benefits and required
2750property damage liability insurance coverage available through
2751normal marketing channels. Any insurer writing motor vehicle
2752liability insurance in this state who fails to comply with such
2753availability requirement as a general business practice shall be
2754deemed to have violated part IX of chapter 626, and such
2755violation shall constitute an unfair method of competition or an
2756unfair or deceptive act or practice involving the business of
2757insurance; and any such insurer committing such violation shall
2758be subject to the penalties afforded in such part, as well as
2759those which may be afforded elsewhere in the insurance code.
2760     Section 84.  Subsection (12) of section 641.495, Florida
2761Statutes, is amended to read:
2762     641.495  Requirements for issuance and maintenance of
2763certificate.-
2764     (12)  The provisions of part I of chapter 395 do not apply
2765to a health maintenance organization that, on or before January
27661, 1991, provides not more than 10 outpatient holding beds for
2767short-term and hospice-type patients in an ambulatory care
2768facility for its members, provided that such health maintenance
2769organization maintains current accreditation by The Joint
2770Commission on Accreditation of Health Care Organizations, the
2771Accreditation Association for Ambulatory Health Care, or the
2772National Committee for Quality Assurance.
2773     Section 85.  Subsection (13) of section 651.118, Florida
2774Statutes, is amended to read:
2775     651.118  Agency for Health Care Administration;
2776certificates of need; sheltered beds; community beds.-
2777     (13)  Residents, as defined in this chapter, are not
2778considered new admissions for the purpose of s.
2779400.141(1)(n)(o)1.d.
2780     Section 86.  Subsection (2) of section 766.1015, Florida
2781Statutes, is amended to read:
2782     766.1015  Civil immunity for members of or consultants to
2783certain boards, committees, or other entities.-
2784     (2)  Such committee, board, group, commission, or other
2785entity must be established in accordance with state law or in
2786accordance with requirements of The Joint Commission on
2787Accreditation of Healthcare Organizations, established and duly
2788constituted by one or more public or licensed private hospitals
2789or behavioral health agencies, or established by a governmental
2790agency. To be protected by this section, the act, decision,
2791omission, or utterance may not be made or done in bad faith or
2792with malicious intent.
2793     Section 87.  This act shall take effect July 1, 2010.


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