November 30, 2020
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CS/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; amending s.
8381.0072, F.S.; limiting Department of Health food service
9inspections in nursing homes; requiring the department to
10coordinate inspections with the Agency for Health Care
11Administration; repealing s. 383.325, F.S., relating to
12confidentiality of inspection reports of licensed birth
13center facilities; amending s. 395.002, F.S.; revising and
14deleting definitions applicable to regulation of hospitals
15and other licensed facilities; conforming a cross-
16reference; amending s. 395.003, F.S.; deleting an obsolete
17provision; conforming a cross-reference; amending s.
18395.0193, F.S.; requiring a licensed facility to report
19certain peer review information and final disciplinary
20actions to the Division of Medical Quality Assurance of
21the Department of Health rather than the Division of
22Health Quality Assurance of the Agency for Health Care
23Administration; amending s. 395.1023, F.S.; providing for
24the Department of Children and Family Services rather than
25the Department of Health to perform certain functions with
26respect to child protection cases; requiring certain
27hospitals to notify the Department of Children and Family
28Services of compliance; amending s. 395.1041, F.S.,
29relating to hospital emergency services and care; deleting
30obsolete provisions; repealing s. 395.1046, F.S., relating
31to complaint investigation procedures; amending s.
32395.1055, F.S.; requiring licensed facility beds to
33conform to standards specified by the Agency for Health
34Care Administration, the Florida Building Code, and the
35Florida Fire Prevention Code; amending s. 395.10972, F.S.;
36revising a reference to the Florida Society of Healthcare
37Risk Management to conform to the current designation;
38amending s. 395.2050, F.S.; revising a reference to the
39federal Health Care Financing Administration to conform to
40the current designation; amending s. 395.3036, F.S.;
41correcting a reference; repealing s. 395.3037, F.S.,
42relating to redundant definitions; amending ss. 154.11,
43394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
44627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
45F.S.; revising references to the Joint Commission on
46Accreditation of Healthcare Organizations, the Commission
47on Accreditation of Rehabilitation Facilities, and the
48Council on Accreditation to conform to their current
49designations; amending s. 395.602, F.S.; revising the
50definition of the term "rural hospital" to delete an
51obsolete provision; amending s. 400.021, F.S.; revising
52the definition of the term "geriatric outpatient clinic";
53amending s. 400.063, F.S.; deleting an obsolete provision;
54amending ss. 400.071 and 400.0712, F.S.; revising
55applicability of general licensure requirements under pt.
56II of ch. 408, F.S., to applications for nursing home
57licensure; revising provisions governing inactive
58licenses; amending s. 400.111, F.S.; providing for
59disclosure of controlling interest of a nursing home
60facility upon request by the Agency for Health Care
61Administration; amending s. 400.1183, F.S.; revising
62grievance record maintenance and reporting requirements
63for nursing homes; amending s. 400.141, F.S.; providing
64criteria for the provision of respite services by nursing
65homes; requiring a written plan of care; requiring a
66contract for services; requiring resident release to
67caregivers to be designated in writing; providing an
68exemption to the application of discharge planning rules;
69providing for residents' rights; providing for use of
70personal medications; providing terms of respite stay;
71providing for communication of patient information;
72requiring a physician order for care and proof of a
73physical examination; providing for services for respite
74patients and duties of facilities with respect to such
75patients; conforming a cross-reference; requiring
76facilities to maintain clinical records that meet
77specified standards; providing a fine relating to an
78admissions moratorium; deleting requirement for facilities
79to submit certain information related to management
80companies to the agency; deleting a requirement for
81facilities to notify the agency of certain bankruptcy
82filings to conform to changes made by the act; amending s.
83400.142, F.S.; deleting language relating to agency
84adoption of rules; amending 400.147, F.S.; revising
85reporting requirements for licensed nursing home
86facilities relating to adverse incidents; repealing s.
87400.148, F.S., relating to the Medicaid "Up-or-Out"
88Quality of Care Contract Management Program; amending s.
89400.162, F.S., requiring nursing homes to provide a
90resident property statement annually and upon request;
91amending s. 400.179, F.S.; revising requirements for
92nursing home lease bond alternative fees; deleting an
93obsolete provision; amending s. 400.19, F.S.; revising
94inspection requirements; repealing s. 400.195, F.S.,
95relating to agency reporting requirements; amending s.
96400.23, F.S.; deleting an obsolete provision; clarifying a
97reference; amending s. 400.275, F.S.; revising agency
98duties with regard to training nursing home surveyor
99teams; revising requirements for team members; amending s.
100400.484, F.S.; revising the schedule of home health agency
101inspection violations; amending s. 400.606, F.S.; revising
102the content requirements of the plan accompanying an
103initial or change-of-ownership application for licensure
104of a hospice; revising requirements relating to
105certificates of need for certain hospice facilities;
106amending s. 400.607, F.S.; revising grounds for agency
107action against a hospice; amending s. 400.931, F.S.;
108deleting a requirement that an applicant for a home
109medical equipment provider license submit a surety bond to
110the agency; amending s. 400.932, F.S.; revising grounds
111for the imposition of administrative penalties for certain
112violations by an employee of a home medical equipment
113provider; amending s. 400.967, F.S.; revising the schedule
114of inspection violations for intermediate care facilities
115for the developmentally disabled; providing a penalty for
116certain violations; amending s. 400.9905, F.S.; providing
117that pt. X of ch, 400, F.S., the Health Care Clinic Act,
118does not apply to an entity owned by a corporation with a
119specified amount of annual sales of health care services
120under certain circumstances; amending s. 400.991, F.S.;
121conforming terminology; revising application requirements
122relating to documentation of financial ability to operate
123a mobile clinic; amending s. 408.034, F.S.; revising
124agency authority relating to licensing of intermediate
125care facilities for the developmentally disabled; amending
126s. 408.036, F.S.; deleting an exemption from certain
127certificate-of-need review requirements for a hospice or a
128hospice inpatient facility; amending s. 408.043, F.S.;
129revising requirements for certain freestanding inpatient
130hospice care facilities to obtain a certificate of need;
131amending s. 408.061, F.S.; revising health care facility
132data reporting requirements; amending s. 408.10, F.S.;
133removing agency authority to investigate certain consumer
134complaints; amending s. 408.802, F.S.; removing
135applicability of pt. II of ch. 408, F.S., relating to
136general licensure requirements, to private review agents;
137amending s. 408.804, F.S.; providing penalties for
138altering, defacing, or falsifying a license certificate
139issued by the agency or displaying such an altered,
140defaced, or falsified certificate; amending s. 408.806,
141F.S.; revising agency responsibilities for notification of
142licensees of impending expiration of a license; requiring
143payment of a late fee for a license application to be
144considered complete under certain circumstances; amending
145s. 408.810, F.S.; revising provisions relating to
146information required for licensure; requiring proof of
147submission of notice to a mortgagor or landlord regarding
148provision of services requiring licensure; requiring
149disclosure of information by a controlling interest of
150certain court actions relating to financial instability
151within a specified time period; amending s. 408.813, F.S.;
152authorizing the agency to impose fines for unclassified
153violations of pt. II of ch. 408, F.S.; amending s.
154408.815, F.S.; authorizing the agency to extend a license
155expiration date under certain circumstances; amending s.
156409.221, F.S.; deleting a reporting requirement relating
157to the consumer-directed care program; amending s. 429.07,
158F.S.; deleting the requirement for an assisted living
159facility to obtain an additional license in order to
160provide limited nursing services; deleting the requirement
161for the agency to conduct quarterly monitoring visits of
162facilities that hold a license to provide extended
163congregate care services; deleting the requirement for the
164department to report annually on the status of and
165recommendations related to extended congregate care;
166deleting the requirement for the agency to conduct
167monitoring visits at least twice a year to facilities
168providing limited nursing services; increasing the
169licensure fees and the maximum fee required for the
170standard license; increasing the licensure fees for the
171extended congregate care license; eliminating the license
172fee for the limited nursing services license; transferring
173from another provision of law the requirement that a
174biennial survey of an assisted living facility include
175specific actions to determine whether the facility is
176adequately protecting residents' rights; providing that an
177assisted living facility that has a class I or class II
178violation is subject to monitoring visits; requiring a
179registered nurse to participate in certain monitoring
180visits; amending s. 429.11, F.S.; revising licensure
181application requirements for assisted living facilities to
182eliminate provisional licenses; amending s. 429.12, F.S.;
183revising notification requirements for the sale or
184transfer of ownership of an assisted living facility;
185amending s. 429.14, F.S.; removing a ground for the
186imposition of an administrative penalty; clarifying
187language relating to a facility's request for a hearing
188under certain circumstances; authorizing the agency to
189provide certain information relating to the licensure
190status of assisted living facilities electronically or
191through the agency's Internet website; amending s. 429.17,
192F.S.; deleting provisions relating to the limited nursing
193services license; revising agency responsibilities
194regarding the issuance of conditional licenses; amending
195s. 429.19, F.S.; clarifying that a monitoring fee may be
196assessed in addition to an administrative fine; amending
197s. 429.23, F.S.; deleting reporting requirements for
198assisted living facilities relating to liability claims;
199amending s. 429.255, F.S.; eliminating provisions
200authorizing the use of volunteers to provide certain
201health-care-related services in assisted living
202facilities; authorizing assisted living facilities to
203provide limited nursing services; requiring an assisted
204living facility to be responsible for certain
205recordkeeping and staff to be trained to monitor residents
206receiving certain health-care-related services; amending
207s. 429.28, F.S.; deleting a requirement for a biennial
208survey of an assisted living facility, to conform to
209changes made by the act; amending s. 429.35, F.S.;
210authorizing the agency to provide certain information
211relating to the inspections of assisted living facilities
212electronically or through the agency's Internet website;
213amending s. 429.41, F.S., relating to rulemaking;
214conforming provisions to changes made by the act; amending
215s. 429.53, F.S.; revising provisions relating to
216consultation by the agency; revising a definition;
217amending s. 429.54, F.S.; requiring licensed assisted
218living facilities to electronically report certain data
219semiannually to the agency in accordance with rules
220adopted by the department; amending s. 429.71, F.S.;
221revising schedule of inspection violations for adult
222family-care homes; amending s. 429.911, F.S.; deleting a
223ground for agency action against an adult day care center;
224amending s. 429.915, F.S.; revising agency
225responsibilities regarding the issuance of conditional
226licenses; amending s. 483.294, F.S.; revising frequency of
227agency inspections of multiphasic health testing centers;
228amending s. 499.003, F.S.; removing a requirement that
229certain prescription drug purchasers maintain a separate
230inventory of certain prescription drugs; amending s.
231499.01212, F.S.; exempting prescription drugs contained in
232sealed medical convenience kits from the pedigree paper
233requirements under specified circumstances; amending s.
234633.081, F.S.; limiting Fire Marshal inspections of
235nursing homes to once a year; providing for additional
236inspections based on complaints and violations identified
237in the course of orientation or training activities;
238amending s. 766.202, F.S.; adding persons licensed under
239pt. XIV of ch. 468, F.S., to the definition of "health
240care provider"; amending ss. 394.4787, 400.0239, 408.07,
241430.80, and 651.118, F.S.; conforming terminology and
242cross-references; revising a reference; providing an
243effective date.
244
245Be It Enacted by the Legislature of the State of Florida:
246
247     Section 1.  Present paragraph (e) of subsection (10) and
248paragraph (e) of subsection (14) of section 112.0455, Florida
249Statutes, are amended, and paragraphs (f) through (k) of
250subsection (10) of that section are redesignated as paragraphs
251(e) through (j), respectively, to read:
252     112.0455  Drug-Free Workplace Act.-
253     (10)  EMPLOYER PROTECTION.-
254     (e)  Nothing in this section shall be construed to operate
255retroactively, and nothing in this section shall abrogate the
256right of an employer under state law to conduct drug tests prior
257to January 1, 1990. A drug test conducted by an employer prior
258to January 1, 1990, is not subject to this section.
259     (14)  DISCIPLINE REMEDIES.-
260     (e)  Upon resolving an appeal filed pursuant to paragraph
261(c), and finding a violation of this section, the commission may
262order the following relief:
263     1.  Rescind the disciplinary action, expunge related
264records from the personnel file of the employee or job applicant
265and reinstate the employee.
266     2.  Order compliance with paragraph (10)(f)(g).
267     3.  Award back pay and benefits.
268     4.  Award the prevailing employee or job applicant the
269necessary costs of the appeal, reasonable attorney's fees, and
270expert witness fees.
271     Section 2.  Paragraph (n) of subsection (1) of section
272154.11, Florida Statutes, is amended to read:
273     154.11  Powers of board of trustees.-
274     (1)  The board of trustees of each public health trust
275shall be deemed to exercise a public and essential governmental
276function of both the state and the county and in furtherance
277thereof it shall, subject to limitation by the governing body of
278the county in which such board is located, have all of the
279powers necessary or convenient to carry out the operation and
280governance of designated health care facilities, including, but
281without limiting the generality of, the foregoing:
282     (n)  To appoint originally the staff of physicians to
283practice in any designated facility owned or operated by the
284board and to approve the bylaws and rules to be adopted by the
285medical staff of any designated facility owned and operated by
286the board, such governing regulations to be in accordance with
287the standards of The Joint Commission on the Accreditation of
288Hospitals which provide, among other things, for the method of
289appointing additional staff members and for the removal of staff
290members.
291     Section 3.  Subsection (15) of section 318.21, Florida
292Statutes, is amended to read:
293     318.21  Disposition of civil penalties by county courts.-
294All civil penalties received by a county court pursuant to the
295provisions of this chapter shall be distributed and paid monthly
296as follows:
297     (15)  Of the additional fine assessed under s. 318.18(3)(e)
298for a violation of s. 316.1893, 50 percent of the moneys
299received from the fines shall be remitted to the Department of
300Revenue and deposited into the Brain and Spinal Cord Injury
301Trust Fund of Department of Health and shall be appropriated to
302the Department of Health Agency for Health Care Administration
303as general revenue to provide an enhanced Medicaid payment to
304nursing homes that serve Medicaid recipients with spinal cord
305injuries that are medically complex and who are technologically
306and respiratory dependent with brain and spinal cord injuries.
307The remaining 50 percent of the moneys received from the
308enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
309the Department of Revenue and deposited into the Department of
310Health Administrative Trust Fund to provide financial support to
311certified trauma centers in the counties where enhanced penalty
312zones are established to ensure the availability and
313accessibility of trauma services. Funds deposited into the
314Administrative Trust Fund under this subsection shall be
315allocated as follows:
316     (a)  Fifty percent shall be allocated equally among all
317Level I, Level II, and pediatric trauma centers in recognition
318of readiness costs for maintaining trauma services.
319     (b)  Fifty percent shall be allocated among Level I, Level
320II, and pediatric trauma centers based on each center's relative
321volume of trauma cases as reported in the Department of Health
322Trauma Registry.
323     Section 4.  Paragraph (e) is added to subsection (2) of
324section 381.0072, Florida Statutes, to read:
325     381.0072  Food service protection.-It shall be the duty of
326the Department of Health to adopt and enforce sanitation rules
327consistent with law to ensure the protection of the public from
328food-borne illness. These rules shall provide the standards and
329requirements for the storage, preparation, serving, or display
330of food in food service establishments as defined in this
331section and which are not permitted or licensed under chapter
332500 or chapter 509.
333     (2)  DUTIES.-
334     (e)  The department shall inspect food service
335establishments in nursing homes licensed under part II of
336chapter 400 twice each year. The department may make additional
337inspections only in response to complaints. The department shall
338coordinate inspections with the Agency for Health Care
339Administration, such that the department's inspection is at
340least 60 days after a recertification visit by the Agency for
341Health Care Administration.
342     Section 5.  Section 383.325, Florida Statutes, is repealed.
343     Section 6.  Subsection (7) of section 394.4787, Florida
344Statutes, is amended to read:
345     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
346and 394.4789.-As used in this section and ss. 394.4786,
347394.4788, and 394.4789:
348     (7)  "Specialty psychiatric hospital" means a hospital
349licensed by the agency pursuant to s. 395.002(26)(28) and part
350II of chapter 408 as a specialty psychiatric hospital.
351     Section 7.  Subsection (2) of section 394.741, Florida
352Statutes, is amended to read:
353     394.741  Accreditation requirements for providers of
354behavioral health care services.-
355     (2)  Notwithstanding any provision of law to the contrary,
356accreditation shall be accepted by the agency and department in
357lieu of the agency's and department's facility licensure onsite
358review requirements and shall be accepted as a substitute for
359the department's administrative and program monitoring
360requirements, except as required by subsections (3) and (4),
361for:
362     (a)  Any organization from which the department purchases
363behavioral health care services that is accredited by The Joint
364Commission on Accreditation of Healthcare Organizations or the
365Council on Accreditation for Children and Family Services, or
366has those services that are being purchased by the department
367accredited by the Commission on Accreditation of Rehabilitation
368Facilities CARF-the Rehabilitation Accreditation Commission.
369     (b)  Any mental health facility licensed by the agency or
370any substance abuse component licensed by the department that is
371accredited by The Joint Commission on Accreditation of
372Healthcare Organizations, the Commission on Accreditation of
373Rehabilitation Facilities CARF-the Rehabilitation Accreditation
374Commission, or the Council on Accreditation of Children and
375Family Services.
376     (c)  Any network of providers from which the department or
377the agency purchases behavioral health care services accredited
378by The Joint Commission on Accreditation of Healthcare
379Organizations, the Commission on Accreditation of Rehabilitation
380Facilities CARF-the Rehabilitation Accreditation Commission, the
381Council on Accreditation of Children and Family Services, or the
382National Committee for Quality Assurance. A provider
383organization, which is part of an accredited network, is
384afforded the same rights under this part.
385     Section 8.  Present subsections (15) through (32) of
386section 395.002, Florida Statutes, are renumbered as subsections
387(14) through (28), respectively, and present subsections (1),
388(14), (24), (30), and (31), and paragraph (c) of present
389subsection (28) of that section are amended to read:
390     395.002  Definitions.-As used in this chapter:
391     (1)  "Accrediting organizations" means nationally
392recognized or approved accrediting organizations whose standards
393incorporate comparable licensure requirements as determined by
394the agency the Joint Commission on Accreditation of Healthcare
395Organizations, the American Osteopathic Association, the
396Commission on Accreditation of Rehabilitation Facilities, and
397the Accreditation Association for Ambulatory Health Care, Inc.
398     (14)  "Initial denial determination" means a determination
399by a private review agent that the health care services
400furnished or proposed to be furnished to a patient are
401inappropriate, not medically necessary, or not reasonable.
402     (24)  "Private review agent" means any person or entity
403which performs utilization review services for third-party
404payors on a contractual basis for outpatient or inpatient
405services. However, the term shall not include full-time
406employees, personnel, or staff of health insurers, health
407maintenance organizations, or hospitals, or wholly owned
408subsidiaries thereof or affiliates under common ownership, when
409performing utilization review for their respective hospitals,
410health maintenance organizations, or insureds of the same
411insurance group. For this purpose, health insurers, health
412maintenance organizations, and hospitals, or wholly owned
413subsidiaries thereof or affiliates under common ownership,
414include such entities engaged as administrators of self-
415insurance as defined in s. 624.031.
416     (26)(28)  "Specialty hospital" means any facility which
417meets the provisions of subsection (12), and which regularly
418makes available either:
419     (c)  Intensive residential treatment programs for children
420and adolescents as defined in subsection (14) (15).
421     (30)  "Utilization review" means a system for reviewing the
422medical necessity or appropriateness in the allocation of health
423care resources of hospital services given or proposed to be
424given to a patient or group of patients.
425     (31)  "Utilization review plan" means a description of the
426policies and procedures governing utilization review activities
427performed by a private review agent.
428     Section 9.  Paragraph (c) of subsection (1) and paragraph
429(b) of subsection (2) of section 395.003, Florida Statutes, are
430amended to read:
431     395.003  Licensure; denial, suspension, and revocation.-
432     (1)
433     (c)  Until July 1, 2006, additional emergency departments
434located off the premises of licensed hospitals may not be
435authorized by the agency.
436     (2)
437     (b)  The agency shall, at the request of a licensee that is
438a teaching hospital as defined in s. 408.07(45), issue a single
439license to a licensee for facilities that have been previously
440licensed as separate premises, provided such separately licensed
441facilities, taken together, constitute the same premises as
442defined in s. 395.002(22)(23). Such license for the single
443premises shall include all of the beds, services, and programs
444that were previously included on the licenses for the separate
445premises. The granting of a single license under this paragraph
446shall not in any manner reduce the number of beds, services, or
447programs operated by the licensee.
448     Section 10.  Paragraph (e) of subsection (2) and subsection
449(4) of section 395.0193, Florida Statutes, are amended to read:
450     395.0193  Licensed facilities; peer review; disciplinary
451powers; agency or partnership with physicians.-
452     (2)  Each licensed facility, as a condition of licensure,
453shall provide for peer review of physicians who deliver health
454care services at the facility. Each licensed facility shall
455develop written, binding procedures by which such peer review
456shall be conducted. Such procedures shall include:
457     (e)  Recording of agendas and minutes which do not contain
458confidential material, for review by the Division of Medical
459Quality Assurance of the department Health Quality Assurance of
460the agency.
461     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
462actions taken under subsection (3) shall be reported in writing
463to the Division of Medical Quality Assurance of the department
464Health Quality Assurance of the agency within 30 working days
465after its initial occurrence, regardless of the pendency of
466appeals to the governing board of the hospital. The notification
467shall identify the disciplined practitioner, the action taken,
468and the reason for such action. All final disciplinary actions
469taken under subsection (3), if different from those which were
470reported to the department agency within 30 days after the
471initial occurrence, shall be reported within 10 working days to
472the Division of Medical Quality Assurance of the department
473Health Quality Assurance of the agency in writing and shall
474specify the disciplinary action taken and the specific grounds
475therefor. The division shall review each report and determine
476whether it potentially involved conduct by the licensee that is
477subject to disciplinary action, in which case s. 456.073 shall
478apply. The reports are not subject to inspection under s.
479119.07(1) even if the division's investigation results in a
480finding of probable cause.
481     Section 11.  Section 395.1023, Florida Statutes, is amended
482to read:
483     395.1023  Child abuse and neglect cases; duties.-Each
484licensed facility shall adopt a protocol that, at a minimum,
485requires the facility to:
486     (1)  Incorporate a facility policy that every staff member
487has an affirmative duty to report, pursuant to chapter 39, any
488actual or suspected case of child abuse, abandonment, or
489neglect; and
490     (2)  In any case involving suspected child abuse,
491abandonment, or neglect, designate, at the request of the
492Department of Children and Family Services, a staff physician to
493act as a liaison between the hospital and the Department of
494Children and Family Services office which is investigating the
495suspected abuse, abandonment, or neglect, and the child
496protection team, as defined in s. 39.01, when the case is
497referred to such a team.
498
499Each general hospital and appropriate specialty hospital shall
500comply with the provisions of this section and shall notify the
501agency and the Department of Children and Family Services of its
502compliance by sending a copy of its policy to the agency and the
503Department of Children and Family Services as required by rule.
504The failure by a general hospital or appropriate specialty
505hospital to comply shall be punished by a fine not exceeding
506$1,000, to be fixed, imposed, and collected by the agency. Each
507day in violation is considered a separate offense.
508     Section 12.  Subsection (2) and paragraph (d) of subsection
509(3) of section 395.1041, Florida Statutes, are amended to read:
510     395.1041  Access to emergency services and care.-
511     (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
512shall establish and maintain an inventory of hospitals with
513emergency services. The inventory shall list all services within
514the service capability of the hospital, and such services shall
515appear on the face of the hospital license. Each hospital having
516emergency services shall notify the agency of its service
517capability in the manner and form prescribed by the agency. The
518agency shall use the inventory to assist emergency medical
519services providers and others in locating appropriate emergency
520medical care. The inventory shall also be made available to the
521general public. On or before August 1, 1992, the agency shall
522request that each hospital identify the services which are
523within its service capability. On or before November 1, 1992,
524the agency shall notify each hospital of the service capability
525to be included in the inventory. The hospital has 15 days from
526the date of receipt to respond to the notice. By December 1,
5271992, the agency shall publish a final inventory. Each hospital
528shall reaffirm its service capability when its license is
529renewed and shall notify the agency of the addition of a new
530service or the termination of a service prior to a change in its
531service capability.
532     (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
533FACILITY OR HEALTH CARE PERSONNEL.-
534     (d)1.  Every hospital shall ensure the provision of
535services within the service capability of the hospital, at all
536times, either directly or indirectly through an arrangement with
537another hospital, through an arrangement with one or more
538physicians, or as otherwise made through prior arrangements. A
539hospital may enter into an agreement with another hospital for
540purposes of meeting its service capability requirement, and
541appropriate compensation or other reasonable conditions may be
542negotiated for these backup services.
543     2.  If any arrangement requires the provision of emergency
544medical transportation, such arrangement must be made in
545consultation with the applicable provider and may not require
546the emergency medical service provider to provide transportation
547that is outside the routine service area of that provider or in
548a manner that impairs the ability of the emergency medical
549service provider to timely respond to prehospital emergency
550calls.
551     3.  A hospital shall not be required to ensure service
552capability at all times as required in subparagraph 1. if, prior
553to the receiving of any patient needing such service capability,
554such hospital has demonstrated to the agency that it lacks the
555ability to ensure such capability and it has exhausted all
556reasonable efforts to ensure such capability through backup
557arrangements. In reviewing a hospital's demonstration of lack of
558ability to ensure service capability, the agency shall consider
559factors relevant to the particular case, including the
560following:
561     a.  Number and proximity of hospitals with the same service
562capability.
563     b.  Number, type, credentials, and privileges of
564specialists.
565     c.  Frequency of procedures.
566     d.  Size of hospital.
567     4.  The agency shall publish proposed rules implementing a
568reasonable exemption procedure by November 1, 1992. Subparagraph
5691. shall become effective upon the effective date of said rules
570or January 31, 1993, whichever is earlier. For a period not to
571exceed 1 year from the effective date of subparagraph 1., a
572hospital requesting an exemption shall be deemed to be exempt
573from offering the service until the agency initially acts to
574deny or grant the original request. The agency has 45 days from
575the date of receipt of the request to approve or deny the
576request. After the first year from the effective date of
577subparagraph 1., If the agency fails to initially act within the
578time period, the hospital is deemed to be exempt from offering
579the service until the agency initially acts to deny the request.
580     Section 13.  Section 395.1046, Florida Statutes, is
581repealed.
582     Section 14.  Paragraph (e) of subsection (1) of section
583395.1055, Florida Statutes, is amended to read:
584     395.1055  Rules and enforcement.-
585     (1)  The agency shall adopt rules pursuant to ss.
586120.536(1) and 120.54 to implement the provisions of this part,
587which shall include reasonable and fair minimum standards for
588ensuring that:
589     (e)  Licensed facility beds conform to minimum space,
590equipment, and furnishings standards as specified by the agency,
591the Florida Building Code, and the Florida Fire Prevention Code
592department.
593     Section 15.  Subsection (1) of section 395.10972, Florida
594Statutes, is amended to read:
595     395.10972  Health Care Risk Manager Advisory Council.-The
596Secretary of Health Care Administration may appoint a seven-
597member advisory council to advise the agency on matters
598pertaining to health care risk managers. The members of the
599council shall serve at the pleasure of the secretary. The
600council shall designate a chair. The council shall meet at the
601call of the secretary or at those times as may be required by
602rule of the agency. The members of the advisory council shall
603receive no compensation for their services, but shall be
604reimbursed for travel expenses as provided in s. 112.061. The
605council shall consist of individuals representing the following
606areas:
607     (1)  Two shall be active health care risk managers,
608including one risk manager who is recommended by and a member of
609the Florida Society for of Healthcare Risk Management and
610Patient Safety.
611     Section 16.  Subsection (3) of section 395.2050, Florida
612Statutes, is amended to read:
613     395.2050  Routine inquiry for organ and tissue donation;
614certification for procurement activities; death records review.-
615     (3)  Each organ procurement organization designated by the
616federal Centers for Medicare and Medicaid Services Health Care
617Financing Administration and licensed by the state shall conduct
618an annual death records review in the organ procurement
619organization's affiliated donor hospitals. The organ procurement
620organization shall enlist the services of every Florida licensed
621tissue bank and eye bank affiliated with or providing service to
622the donor hospital and operating in the same service area to
623participate in the death records review.
624     Section 17.  Subsection (2) of section 395.3036, Florida
625Statutes, is amended to read:
626     395.3036  Confidentiality of records and meetings of
627corporations that lease public hospitals or other public health
628care facilities.-The records of a private corporation that
629leases a public hospital or other public health care facility
630are confidential and exempt from the provisions of s. 119.07(1)
631and s. 24(a), Art. I of the State Constitution, and the meetings
632of the governing board of a private corporation are exempt from
633s. 286.011 and s. 24(b), Art. I of the State Constitution when
634the public lessor complies with the public finance
635accountability provisions of s. 155.40(5) with respect to the
636transfer of any public funds to the private lessee and when the
637private lessee meets at least three of the five following
638criteria:
639     (2)  The public lessor and the private lessee do not
640commingle any of their funds in any account maintained by either
641of them, other than the payment of the rent and administrative
642fees or the transfer of funds pursuant to s. 155.40(2)
643subsection (2).
644     Section 18.  Section 395.3037, Florida Statutes, is
645repealed.
646     Section 19.  Subsections (1), (4), and (5) of section
647395.3038, Florida Statutes, are amended to read:
648     395.3038  State-listed primary stroke centers and
649comprehensive stroke centers; notification of hospitals.-
650     (1)  The agency shall make available on its website and to
651the department a list of the name and address of each hospital
652that meets the criteria for a primary stroke center and the name
653and address of each hospital that meets the criteria for a
654comprehensive stroke center. The list of primary and
655comprehensive stroke centers shall include only those hospitals
656that attest in an affidavit submitted to the agency that the
657hospital meets the named criteria, or those hospitals that
658attest in an affidavit submitted to the agency that the hospital
659is certified as a primary or a comprehensive stroke center by
660The Joint Commission on Accreditation of Healthcare
661Organizations.
662     (4)  The agency shall adopt by rule criteria for a primary
663stroke center which are substantially similar to the
664certification standards for primary stroke centers of The Joint
665Commission on Accreditation of Healthcare Organizations.
666     (5)  The agency shall adopt by rule criteria for a
667comprehensive stroke center. However, if The Joint Commission on
668Accreditation of Healthcare Organizations establishes criteria
669for a comprehensive stroke center, the agency shall establish
670criteria for a comprehensive stroke center which are
671substantially similar to those criteria established by The Joint
672Commission on Accreditation of Healthcare Organizations.
673     Section 20.  Paragraph (e) of subsection (2) of section
674395.602, Florida Statutes, is amended to read:
675     395.602  Rural hospitals.-
676     (2)  DEFINITIONS.-As used in this part:
677     (e)  "Rural hospital" means an acute care hospital licensed
678under this chapter, having 100 or fewer licensed beds and an
679emergency room, which is:
680     1.  The sole provider within a county with a population
681density of no greater than 100 persons per square mile;
682     2.  An acute care hospital, in a county with a population
683density of no greater than 100 persons per square mile, which is
684at least 30 minutes of travel time, on normally traveled roads
685under normal traffic conditions, from any other acute care
686hospital within the same county;
687     3.  A hospital supported by a tax district or subdistrict
688whose boundaries encompass a population of 100 persons or fewer
689per square mile;
690     4.  A hospital in a constitutional charter county with a
691population of over 1 million persons that has imposed a local
692option health service tax pursuant to law and in an area that
693was directly impacted by a catastrophic event on August 24,
6941992, for which the Governor of Florida declared a state of
695emergency pursuant to chapter 125, and has 120 beds or less that
696serves an agricultural community with an emergency room
697utilization of no less than 20,000 visits and a Medicaid
698inpatient utilization rate greater than 15 percent;
699     4.5.  A hospital with a service area that has a population
700of 100 persons or fewer per square mile. As used in this
701subparagraph, the term "service area" means the fewest number of
702zip codes that account for 75 percent of the hospital's
703discharges for the most recent 5-year period, based on
704information available from the hospital inpatient discharge
705database in the Florida Center for Health Information and Policy
706Analysis at the Agency for Health Care Administration; or
707     5.6.  A hospital designated as a critical access hospital,
708as defined in s. 408.07(15).
709
710Population densities used in this paragraph must be based upon
711the most recently completed United States census. A hospital
712that received funds under s. 409.9116 for a quarter beginning no
713later than July 1, 2002, is deemed to have been and shall
714continue to be a rural hospital from that date through June 30,
7152015, if the hospital continues to have 100 or fewer licensed
716beds and an emergency room, or meets the criteria of
717subparagraph 4. An acute care hospital that has not previously
718been designated as a rural hospital and that meets the criteria
719of this paragraph shall be granted such designation upon
720application, including supporting documentation to the Agency
721for Health Care Administration.
722     Section 21.  Subsection (8) of section 400.021, Florida
723Statutes, is amended to read:
724     400.021  Definitions.-When used in this part, unless the
725context otherwise requires, the term:
726     (8)  "Geriatric outpatient clinic" means a site for
727providing outpatient health care to persons 60 years of age or
728older, which is staffed by a registered nurse or a physician
729assistant, or a licensed practical nurse under the direct
730supervision of a registered nurse, advanced registered nurse
731practitioner, or physician.
732     Section 22.  Paragraph (g) of subsection (2) of section
733400.0239, Florida Statutes, is amended to read:
734     400.0239  Quality of Long-Term Care Facility Improvement
735Trust Fund.-
736     (2)  Expenditures from the trust fund shall be allowable
737for direct support of the following:
738     (g)  Other initiatives authorized by the Centers for
739Medicare and Medicaid Services for the use of federal civil
740monetary penalties, including projects recommended through the
741Medicaid "Up-or-Out" Quality of Care Contract Management Program
742pursuant to s. 400.148.
743     Section 23.  Subsection (2) of section 400.063, Florida
744Statutes, is amended to read:
745     400.063  Resident protection.-
746     (2)  The agency is authorized to establish for each
747facility, subject to intervention by the agency, a separate bank
748account for the deposit to the credit of the agency of any
749moneys received from the Health Care Trust Fund or any other
750moneys received for the maintenance and care of residents in the
751facility, and the agency is authorized to disburse moneys from
752such account to pay obligations incurred for the purposes of
753this section. The agency is authorized to requisition moneys
754from the Health Care Trust Fund in advance of an actual need for
755cash on the basis of an estimate by the agency of moneys to be
756spent under the authority of this section. Any bank account
757established under this section need not be approved in advance
758of its creation as required by s. 17.58, but shall be secured by
759depository insurance equal to or greater than the balance of
760such account or by the pledge of collateral security in
761conformance with criteria established in s. 18.11. The agency
762shall notify the Chief Financial Officer of any such account so
763established and shall make a quarterly accounting to the Chief
764Financial Officer for all moneys deposited in such account.
765     Section 24.  Subsections (1) and (5) of section 400.071,
766Florida Statutes, are amended to read:
767     400.071  Application for license.-
768     (1)  In addition to the requirements of part II of chapter
769408, the application for a license shall be under oath and must
770contain the following:
771     (a)  The location of the facility for which a license is
772sought and an indication, as in the original application, that
773such location conforms to the local zoning ordinances.
774     (b)  A signed affidavit disclosing any financial or
775ownership interest that a controlling interest as defined in
776part II of chapter 408 has held in the last 5 years in any
777entity licensed by this state or any other state to provide
778health or residential care which has closed voluntarily or
779involuntarily; has filed for bankruptcy; has had a receiver
780appointed; has had a license denied, suspended, or revoked; or
781has had an injunction issued against it which was initiated by a
782regulatory agency. The affidavit must disclose the reason any
783such entity was closed, whether voluntarily or involuntarily.
784     (c)  The total number of beds and the total number of
785Medicare and Medicaid certified beds.
786     (b)(d)  Information relating to the applicant and employees
787which the agency requires by rule. The applicant must
788demonstrate that sufficient numbers of qualified staff, by
789training or experience, will be employed to properly care for
790the type and number of residents who will reside in the
791facility.
792     (c)(e)  Copies of any civil verdict or judgment involving
793the applicant rendered within the 10 years preceding the
794application, relating to medical negligence, violation of
795residents' rights, or wrongful death. As a condition of
796licensure, the licensee agrees to provide to the agency copies
797of any new verdict or judgment involving the applicant, relating
798to such matters, within 30 days after filing with the clerk of
799the court. The information required in this paragraph shall be
800maintained in the facility's licensure file and in an agency
801database which is available as a public record.
802     (5)  As a condition of licensure, each facility must
803establish and submit with its application a plan for quality
804assurance and for conducting risk management.
805     Section 25.  Section 400.0712, Florida Statutes, is amended
806to read:
807     400.0712  Application for inactive license.-
808     (1)  As specified in this section, the agency may issue an
809inactive license to a nursing home facility for all or a portion
810of its beds. Any request by a licensee that a nursing home or
811portion of a nursing home become inactive must be submitted to
812the agency in the approved format. The facility may not initiate
813any suspension of services, notify residents, or initiate
814inactivity before receiving approval from the agency; and a
815licensee that violates this provision may not be issued an
816inactive license.
817     (1)(2)  In addition to the powers granted under part II of
818chapter 408, the agency may issue an inactive license to a
819nursing home that chooses to use an unoccupied contiguous
820portion of the facility for an alternative use to meet the needs
821of elderly persons through the use of less restrictive, less
822institutional services.
823     (a)  An inactive license issued under this subsection may
824be granted for a period not to exceed the current licensure
825expiration date but may be renewed by the agency at the time of
826licensure renewal.
827     (b)  A request to extend the inactive license must be
828submitted to the agency in the approved format and approved by
829the agency in writing.
830     (c)  Nursing homes that receive an inactive license to
831provide alternative services shall not receive preference for
832participation in the Assisted Living for the Elderly Medicaid
833waiver.
834     (2)(3)  The agency shall adopt rules pursuant to ss.
835120.536(1) and 120.54 necessary to implement this section.
836     Section 26.  Section 400.111, Florida Statutes, is amended
837to read:
838     400.111  Disclosure of controlling interest.-In addition to
839the requirements of part II of chapter 408, when requested by
840the agency, the licensee shall submit a signed affidavit
841disclosing any financial or ownership interest that a
842controlling interest has held within the last 5 years in any
843entity licensed by the state or any other state to provide
844health or residential care which entity has closed voluntarily
845or involuntarily; has filed for bankruptcy; has had a receiver
846appointed; has had a license denied, suspended, or revoked; or
847has had an injunction issued against it which was initiated by a
848regulatory agency. The affidavit must disclose the reason such
849entity was closed, whether voluntarily or involuntarily.
850     Section 27.  Subsection (2) of section 400.1183, Florida
851Statutes, is amended to read:
852     400.1183  Resident grievance procedures.-
853     (2)  Each facility shall maintain records of all grievances
854for agency inspection and shall report to the agency at the time
855of relicensure the total number of grievances handled during the
856prior licensure period, a categorization of the cases underlying
857the grievances, and the final disposition of the grievances.
858     Section 28.  Paragraphs (o) through (w) of subsection (1)
859of section 400.141, Florida Statutes, are redesignated as
860paragraphs (n) through (u), respectively, and present paragraphs
861(f), (g), (j), (n), (o), and (r) of that subsection are amended,
862to read:
863     400.141  Administration and management of nursing home
864facilities.-
865     (1)  Every licensed facility shall comply with all
866applicable standards and rules of the agency and shall:
867     (f)  Be allowed and encouraged by the agency to provide
868other needed services under certain conditions. If the facility
869has a standard licensure status, and has had no class I or class
870II deficiencies during the past 2 years or has been awarded a
871Gold Seal under the program established in s. 400.235, it may be
872encouraged by the agency to provide services, including, but not
873limited to, respite and adult day services, which enable
874individuals to move in and out of the facility. A facility is
875not subject to any additional licensure requirements for
876providing these services.
877     1.  Respite care may be offered to persons in need of
878short-term or temporary nursing home services. For each person
879admitted under the respite care program, the facility licensee
880must:
881     a.  Have a written abbreviated plan of care that, at a
882minimum, includes nutritional requirements, medication orders,
883physician orders, nursing assessments, and dietary preferences.
884The nursing or physician assessments may take the place of all
885other assessments required for full-time residents.
886     b.  Have a contract that, at a minimum, specifies the
887services to be provided to the respite resident, including
888charges for services, activities, equipment, emergency medical
889services, and the administration of medications. If multiple
890respite admissions for a single person are anticipated, the
891original contract is valid for 1 year after the date of
892execution.
893     c.  Ensure that each resident is released to his or her
894caregiver or an individual designated in writing by the
895caregiver.
896     2.  A person admitted under the respite care program is:
897     a.  Exempt from requirements in rule related to discharge
898planning.
899     b.  Covered by the resident's rights set forth in s.
900400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
901shall not be considered trust funds subject to the requirements
902of s. 400.022(1)(h) until the resident has been in the facility
903for more than 14 consecutive days.
904     c.  Allowed to use his or her personal medications for the
905respite stay if permitted by facility policy. The facility must
906obtain a physician's orders for the medications. The caregiver
907may provide information regarding the medications as part of the
908nursing assessment, which must agree with the physician's
909orders. Medications shall be released with the resident upon
910discharge in accordance with current orders.
911     3.  A person receiving respite care is entitled to a total
912of 60 days in the facility within a contract year or a calendar
913year if the contract is for less than 12 months. However, each
914single stay may not exceed 14 days. If a stay exceeds 14
915consecutive days, the facility must comply with all assessment
916and care planning requirements applicable to nursing home
917residents.
918     4.  A person receiving respite care must reside in a
919licensed nursing home bed.
920     5.  A prospective respite resident must provide medical
921information from a physician, a physician assistant, or a nurse
922practitioner and other information from the primary caregiver as
923may be required by the facility prior to or at the time of
924admission to receive respite care. The medical information must
925include a physician's order for respite care and proof of a
926physical examination by a licensed physician, physician
927assistant, or nurse practitioner. The physician's order and
928physical examination may be used to provide intermittent respite
929care for up to 12 months after the date the order is written.
930     6.  The facility must assume the duties of the primary
931caregiver. To ensure continuity of care and services, the
932resident is entitled to retain his or her personal physician and
933must have access to medically necessary services such as
934physical therapy, occupational therapy, or speech therapy, as
935needed. The facility must arrange for transportation to these
936services if necessary. Respite care must be provided in
937accordance with this part and rules adopted by the agency.
938However, the agency shall, by rule, adopt modified requirements
939for resident assessment, resident care plans, resident
940contracts, physician orders, and other provisions, as
941appropriate, for short-term or temporary nursing home services.
942     7.  The agency shall allow for shared programming and staff
943in a facility which meets minimum standards and offers services
944pursuant to this paragraph, but, if the facility is cited for
945deficiencies in patient care, may require additional staff and
946programs appropriate to the needs of service recipients. A
947person who receives respite care may not be counted as a
948resident of the facility for purposes of the facility's licensed
949capacity unless that person receives 24-hour respite care. A
950person receiving either respite care for 24 hours or longer or
951adult day services must be included when calculating minimum
952staffing for the facility. Any costs and revenues generated by a
953nursing home facility from nonresidential programs or services
954shall be excluded from the calculations of Medicaid per diems
955for nursing home institutional care reimbursement.
956     (g)  If the facility has a standard license or is a Gold
957Seal facility, exceeds the minimum required hours of licensed
958nursing and certified nursing assistant direct care per resident
959per day, and is part of a continuing care facility licensed
960under chapter 651 or a retirement community that offers other
961services pursuant to part III of this chapter or part I or part
962III of chapter 429 on a single campus, be allowed to share
963programming and staff. At the time of inspection and in the
964semiannual report required pursuant to paragraph (n) (o), a
965continuing care facility or retirement community that uses this
966option must demonstrate through staffing records that minimum
967staffing requirements for the facility were met. Licensed nurses
968and certified nursing assistants who work in the nursing home
969facility may be used to provide services elsewhere on campus if
970the facility exceeds the minimum number of direct care hours
971required per resident per day and the total number of residents
972receiving direct care services from a licensed nurse or a
973certified nursing assistant does not cause the facility to
974violate the staffing ratios required under s. 400.23(3)(a).
975Compliance with the minimum staffing ratios shall be based on
976total number of residents receiving direct care services,
977regardless of where they reside on campus. If the facility
978receives a conditional license, it may not share staff until the
979conditional license status ends. This paragraph does not
980restrict the agency's authority under federal or state law to
981require additional staff if a facility is cited for deficiencies
982in care which are caused by an insufficient number of certified
983nursing assistants or licensed nurses. The agency may adopt
984rules for the documentation necessary to determine compliance
985with this provision.
986     (j)  Keep full records of resident admissions and
987discharges; medical and general health status, including medical
988records, personal and social history, and identity and address
989of next of kin or other persons who may have responsibility for
990the affairs of the residents; and individual resident care plans
991including, but not limited to, prescribed services, service
992frequency and duration, and service goals. The records shall be
993open to inspection by the agency. The facility must maintain
994clinical records on each resident in accordance with accepted
995professional standards and practices that are complete,
996accurately documented, readily accessible, and systematically
997organized.
998     (n)  Submit to the agency the information specified in s.
999400.071(1)(b) for a management company within 30 days after the
1000effective date of the management agreement.
1001     (n)(o)1.  Submit semiannually to the agency, or more
1002frequently if requested by the agency, information regarding
1003facility staff-to-resident ratios, staff turnover, and staff
1004stability, including information regarding certified nursing
1005assistants, licensed nurses, the director of nursing, and the
1006facility administrator. For purposes of this reporting:
1007     a.  Staff-to-resident ratios must be reported in the
1008categories specified in s. 400.23(3)(a) and applicable rules.
1009The ratio must be reported as an average for the most recent
1010calendar quarter.
1011     b.  Staff turnover must be reported for the most recent 12-
1012month period ending on the last workday of the most recent
1013calendar quarter prior to the date the information is submitted.
1014The turnover rate must be computed quarterly, with the annual
1015rate being the cumulative sum of the quarterly rates. The
1016turnover rate is the total number of terminations or separations
1017experienced during the quarter, excluding any employee
1018terminated during a probationary period of 3 months or less,
1019divided by the total number of staff employed at the end of the
1020period for which the rate is computed, and expressed as a
1021percentage.
1022     c.  The formula for determining staff stability is the
1023total number of employees that have been employed for more than
102412 months, divided by the total number of employees employed at
1025the end of the most recent calendar quarter, and expressed as a
1026percentage.
1027     d.  A nursing facility that has failed to comply with state
1028minimum-staffing requirements for 2 consecutive days is
1029prohibited from accepting new admissions until the facility has
1030achieved the minimum-staffing requirements for a period of 6
1031consecutive days. For the purposes of this sub-subparagraph, any
1032person who was a resident of the facility and was absent from
1033the facility for the purpose of receiving medical care at a
1034separate location or was on a leave of absence is not considered
1035a new admission. Failure to impose such an admissions moratorium
1036is subject to a $1,000 fine constitutes a class II deficiency.
1037     e.  A nursing facility which does not have a conditional
1038license may be cited for failure to comply with the standards in
1039s. 400.23(3)(a)1.a. only if it has failed to meet those
1040standards on 2 consecutive days or if it has failed to meet at
1041least 97 percent of those standards on any one day.
1042     f.  A facility which has a conditional license must be in
1043compliance with the standards in s. 400.23(3)(a) at all times.
1044     2.  This paragraph does not limit the agency's ability to
1045impose a deficiency or take other actions if a facility does not
1046have enough staff to meet the residents' needs.
1047     (r)  Report to the agency any filing for bankruptcy
1048protection by the facility or its parent corporation,
1049divestiture or spin-off of its assets, or corporate
1050reorganization within 30 days after the completion of such
1051activity.
1052     Section 29.  Subsection (3) of section 400.142, Florida
1053Statutes, is amended to read:
1054     400.142  Emergency medication kits; orders not to
1055resuscitate.-
1056     (3)  Facility staff may withhold or withdraw
1057cardiopulmonary resuscitation if presented with an order not to
1058resuscitate executed pursuant to s. 401.45. The agency shall
1059adopt rules providing for the implementation of such orders.
1060Facility staff and facilities shall not be subject to criminal
1061prosecution or civil liability, nor be considered to have
1062engaged in negligent or unprofessional conduct, for withholding
1063or withdrawing cardiopulmonary resuscitation pursuant to such an
1064order and rules adopted by the agency. The absence of an order
1065not to resuscitate executed pursuant to s. 401.45 does not
1066preclude a physician from withholding or withdrawing
1067cardiopulmonary resuscitation as otherwise permitted by law.
1068     Section 30.  Subsections (11) through (15) of section
1069400.147, Florida Statutes, are renumbered as subsections (10)
1070through (14), respectively, and present subsection (10) is
1071amended to read:
1072     400.147  Internal risk management and quality assurance
1073program.-
1074     (10)  By the 10th of each month, each facility subject to
1075this section shall report any notice received pursuant to s.
1076400.0233(2) and each initial complaint that was filed with the
1077clerk of the court and served on the facility during the
1078previous month by a resident or a resident's family member,
1079guardian, conservator, or personal legal representative. The
1080report must include the name of the resident, the resident's
1081date of birth and social security number, the Medicaid
1082identification number for Medicaid-eligible persons, the date or
1083dates of the incident leading to the claim or dates of
1084residency, if applicable, and the type of injury or violation of
1085rights alleged to have occurred. Each facility shall also submit
1086a copy of the notices received pursuant to s. 400.0233(2) and
1087complaints filed with the clerk of the court. This report is
1088confidential as provided by law and is not discoverable or
1089admissible in any civil or administrative action, except in such
1090actions brought by the agency to enforce the provisions of this
1091part.
1092     Section 31.  Section 400.148, Florida Statutes, is
1093repealed.
1094     Section 32.  Paragraph (f) of subsection (5) of section
1095400.162, Florida Statutes, is amended to read:
1096     400.162  Property and personal affairs of residents.-
1097     (5)
1098     (f)  At least every 3 months, the licensee shall furnish
1099the resident and the guardian, trustee, or conservator, if any,
1100for the resident a complete and verified statement of all funds
1101and other property to which this subsection applies, detailing
1102the amounts and items received, together with their sources and
1103disposition. For resident property, the licensee shall furnish
1104such a statement annually and within 7 calendar days after a
1105request for a statement. In any event, the licensee shall
1106furnish such statements a statement annually and upon the
1107discharge or transfer of a resident. Any governmental agency or
1108private charitable agency contributing funds or other property
1109on account of a resident also shall be entitled to receive such
1110statements statement annually and upon discharge or transfer and
1111such other report as it may require pursuant to law.
1112     Section 33.  Paragraphs (d) and (e) of subsection (2) of
1113section 400.179, Florida Statutes, are amended to read:
1114     400.179  Liability for Medicaid underpayments and
1115overpayments.-
1116     (2)  Because any transfer of a nursing facility may expose
1117the fact that Medicaid may have underpaid or overpaid the
1118transferor, and because in most instances, any such underpayment
1119or overpayment can only be determined following a formal field
1120audit, the liabilities for any such underpayments or
1121overpayments shall be as follows:
1122     (d)  Where the transfer involves a facility that has been
1123leased by the transferor:
1124     1.  The transferee shall, as a condition to being issued a
1125license by the agency, acquire, maintain, and provide proof to
1126the agency of a bond with a term of 30 months, renewable
1127annually, in an amount not less than the total of 3 months'
1128Medicaid payments to the facility computed on the basis of the
1129preceding 12-month average Medicaid payments to the facility.
1130     2.  A leasehold licensee may meet the requirements of
1131subparagraph 1. by payment of a nonrefundable fee, paid at
1132initial licensure, paid at the time of any subsequent change of
1133ownership, and paid annually thereafter, in the amount of 1
1134percent of the total of 3 months' Medicaid payments to the
1135facility computed on the basis of the preceding 12-month average
1136Medicaid payments to the facility. If a preceding 12-month
1137average is not available, projected Medicaid payments may be
1138used. The fee shall be deposited into the Grants and Donations
1139Trust Fund and shall be accounted for separately as a Medicaid
1140nursing home overpayment account. These fees shall be used at
1141the sole discretion of the agency to repay nursing home Medicaid
1142overpayments. Payment of this fee shall not release the licensee
1143from any liability for any Medicaid overpayments, nor shall
1144payment bar the agency from seeking to recoup overpayments from
1145the licensee and any other liable party. As a condition of
1146exercising this lease bond alternative, licensees paying this
1147fee must maintain an existing lease bond through the end of the
114830-month term period of that bond. The agency is herein granted
1149specific authority to promulgate all rules pertaining to the
1150administration and management of this account, including
1151withdrawals from the account, subject to federal review and
1152approval. This provision shall take effect upon becoming law and
1153shall apply to any leasehold license application. The financial
1154viability of the Medicaid nursing home overpayment account shall
1155be determined by the agency through annual review of the account
1156balance and the amount of total outstanding, unpaid Medicaid
1157overpayments owing from leasehold licensees to the agency as
1158determined by final agency audits. By March 31 of each year, the
1159agency shall assess the cumulative fees collected under this
1160subparagraph, minus any amounts used to repay nursing home
1161Medicaid overpayments and amounts transferred to contribute to
1162the General Revenue Fund pursuant to s. 215.20. If the net
1163cumulative collections, minus amounts utilized to repay nursing
1164home Medicaid overpayments, exceed $25 million, the provisions
1165of this paragraph shall not apply for the subsequent fiscal
1166year.
1167     3.  The leasehold licensee may meet the bond requirement
1168through other arrangements acceptable to the agency. The agency
1169is herein granted specific authority to promulgate rules
1170pertaining to lease bond arrangements.
1171     4.  All existing nursing facility licensees, operating the
1172facility as a leasehold, shall acquire, maintain, and provide
1173proof to the agency of the 30-month bond required in
1174subparagraph 1., above, on and after July 1, 1993, for each
1175license renewal.
1176     5.  It shall be the responsibility of all nursing facility
1177operators, operating the facility as a leasehold, to renew the
117830-month bond and to provide proof of such renewal to the agency
1179annually.
1180     6.  Any failure of the nursing facility operator to
1181acquire, maintain, renew annually, or provide proof to the
1182agency shall be grounds for the agency to deny, revoke, and
1183suspend the facility license to operate such facility and to
1184take any further action, including, but not limited to,
1185enjoining the facility, asserting a moratorium pursuant to part
1186II of chapter 408, or applying for a receiver, deemed necessary
1187to ensure compliance with this section and to safeguard and
1188protect the health, safety, and welfare of the facility's
1189residents. A lease agreement required as a condition of bond
1190financing or refinancing under s. 154.213 by a health facilities
1191authority or required under s. 159.30 by a county or
1192municipality is not a leasehold for purposes of this paragraph
1193and is not subject to the bond requirement of this paragraph.
1194     (e)  For the 2009-2010 fiscal year only, the provisions of
1195paragraph (d) shall not apply. This paragraph expires July 1,
11962010.
1197     Section 34.  Subsection (3) of section 400.19, Florida
1198Statutes, is amended to read:
1199     400.19  Right of entry and inspection.-
1200     (3)  The agency shall every 15 months conduct at least one
1201unannounced inspection to determine compliance by the licensee
1202with statutes, and with rules promulgated under the provisions
1203of those statutes, governing minimum standards of construction,
1204quality and adequacy of care, and rights of residents. The
1205survey shall be conducted every 6 months for the next 2-year
1206period if the facility has been cited for a class I deficiency,
1207has been cited for two or more class II deficiencies arising
1208from separate surveys or investigations within a 60-day period,
1209or has had three or more substantiated complaints within a 6-
1210month period, each resulting in at least one class I or class II
1211deficiency. In addition to any other fees or fines in this part,
1212the agency shall assess a fine for each facility that is subject
1213to the 6-month survey cycle. The fine for the 2-year period
1214shall be $6,000, one-half to be paid at the completion of each
1215survey. The agency may adjust this fine by the change in the
1216Consumer Price Index, based on the 12 months immediately
1217preceding the increase, to cover the cost of the additional
1218surveys. The agency shall verify through subsequent inspection
1219that any deficiency identified during inspection is corrected.
1220However, the agency may verify the correction of a class III or
1221class IV deficiency unrelated to resident rights or resident
1222care without reinspecting the facility if adequate written
1223documentation has been received from the facility, which
1224provides assurance that the deficiency has been corrected. The
1225giving or causing to be given of advance notice of such
1226unannounced inspections by an employee of the agency to any
1227unauthorized person shall constitute cause for suspension of not
1228fewer than 5 working days according to the provisions of chapter
1229110.
1230     Section 35.  Section 400.195, Florida Statutes, is
1231repealed.
1232     Section 36.  Subsection (5) of section 400.23, Florida
1233Statutes, is amended to read:
1234     400.23  Rules; evaluation and deficiencies; licensure
1235status.-
1236     (5)  The agency, in collaboration with the Division of
1237Children's Medical Services Network of the Department of Health,
1238must, no later than December 31, 1993, adopt rules for minimum
1239standards of care for persons under 21 years of age who reside
1240in nursing home facilities. The rules must include a methodology
1241for reviewing a nursing home facility under ss. 408.031-408.045
1242which serves only persons under 21 years of age. A facility may
1243be exempt from these standards for specific persons between 18
1244and 21 years of age, if the person's physician agrees that
1245minimum standards of care based on age are not necessary.
1246     Section 37.  Subsection (1) of section 400.275, Florida
1247Statutes, is amended to read:
1248     400.275  Agency duties.-
1249     (1)  The agency shall ensure that each newly hired nursing
1250home surveyor, as a part of basic training, is assigned full-
1251time to a licensed nursing home for at least 2 days within a 7-
1252day period to observe facility operations outside of the survey
1253process before the surveyor begins survey responsibilities. Such
1254observations may not be the sole basis of a deficiency citation
1255against the facility. The agency may not assign an individual to
1256be a member of a survey team for purposes of a survey,
1257evaluation, or consultation visit at a nursing home facility in
1258which the surveyor was an employee within the preceding 2 5
1259years.
1260     Section 38.  Subsection (2) of section 400.484, Florida
1261Statutes, is amended to read:
1262     400.484  Right of inspection; violations deficiencies;
1263fines.-
1264     (2)  The agency shall impose fines for various classes of
1265violations deficiencies in accordance with the following
1266schedule:
1267     (a)  Class I violations are defined in s. 408.813. A class
1268I deficiency is any act, omission, or practice that results in a
1269patient's death, disablement, or permanent injury, or places a
1270patient at imminent risk of death, disablement, or permanent
1271injury. Upon finding a class I violation deficiency, the agency
1272shall impose an administrative fine in the amount of $15,000 for
1273each occurrence and each day that the violation deficiency
1274exists.
1275     (b)  Class II violations are defined in s. 408.813. A class
1276II deficiency is any act, omission, or practice that has a
1277direct adverse effect on the health, safety, or security of a
1278patient. Upon finding a class II violation deficiency, the
1279agency shall impose an administrative fine in the amount of
1280$5,000 for each occurrence and each day that the violation
1281deficiency exists.
1282     (c)  Class III violations are defined in s. 408.813. A
1283class III deficiency is any act, omission, or practice that has
1284an indirect, adverse effect on the health, safety, or security
1285of a patient. Upon finding an uncorrected or repeated class III
1286violation deficiency, the agency shall impose an administrative
1287fine not to exceed $1,000 for each occurrence and each day that
1288the uncorrected or repeated violation deficiency exists.
1289     (d)  Class IV violations are defined in s. 408.813. A class
1290IV deficiency is any act, omission, or practice related to
1291required reports, forms, or documents which does not have the
1292potential of negatively affecting patients. These violations are
1293of a type that the agency determines do not threaten the health,
1294safety, or security of patients. Upon finding an uncorrected or
1295repeated class IV violation deficiency, the agency shall impose
1296an administrative fine not to exceed $500 for each occurrence
1297and each day that the uncorrected or repeated violation
1298deficiency exists.
1299     Section 39.  Paragraph (i) of subsection (1) and subsection
1300(4) of section 400.606, Florida Statutes, are amended to read:
1301     400.606  License; application; renewal; conditional license
1302or permit; certificate of need.-
1303     (1)  In addition to the requirements of part II of chapter
1304408, the initial application and change of ownership application
1305must be accompanied by a plan for the delivery of home,
1306residential, and homelike inpatient hospice services to
1307terminally ill persons and their families. Such plan must
1308contain, but need not be limited to:
1309     (i)  The projected annual operating cost of the hospice.
1310
1311If the applicant is an existing licensed health care provider,
1312the application must be accompanied by a copy of the most recent
1313profit-loss statement and, if applicable, the most recent
1314licensure inspection report.
1315     (4)  A freestanding hospice facility that is primarily
1316engaged in providing inpatient and related services and that is
1317not otherwise licensed as a health care facility shall be
1318required to obtain a certificate of need. However, a
1319freestanding hospice facility with six or fewer beds shall not
1320be required to comply with institutional standards such as, but
1321not limited to, standards requiring sprinkler systems, emergency
1322electrical systems, or special lavatory devices.
1323     Section 40.  Subsection (2) of section 400.607, Florida
1324Statutes, is amended to read:
1325     400.607  Denial, suspension, revocation of license;
1326emergency actions; imposition of administrative fine; grounds.-
1327     (2)  A violation of this part, part II of chapter 408, or
1328applicable rules Any of the following actions by a licensed
1329hospice or any of its employees shall be grounds for
1330administrative action by the agency against a hospice.:
1331     (a)  A violation of the provisions of this part, part II of
1332chapter 408, or applicable rules.
1333     (b)  An intentional or negligent act materially affecting
1334the health or safety of a patient.
1335     Section 41.  Subsection (1) of section 400.925, Florida
1336Statutes, is amended to read:
1337     400.925  Definitions.-As used in this part, the term:
1338     (1)  "Accrediting organizations" means The Joint Commission
1339on Accreditation of Healthcare Organizations or other national
1340accreditation agencies whose standards for accreditation are
1341comparable to those required by this part for licensure.
1342     Section 42.  Subsections (3) through (6) of section
1343400.931, Florida Statutes, are renumbered as subsections (2)
1344through (5), respectively, and present subsection (2) of that
1345section is amended to read:
1346     400.931  Application for license; fee; provisional license;
1347temporary permit.-
1348     (2)  As an alternative to submitting proof of financial
1349ability to operate as required in s. 408.810(8), the applicant
1350may submit a $50,000 surety bond to the agency.
1351     Section 43.  Subsection (2) of section 400.932, Florida
1352Statutes, is amended to read:
1353     400.932  Administrative penalties.-
1354     (2)  A violation of this part, part II of chapter 408, or
1355applicable rules Any of the following actions by an employee of
1356a home medical equipment provider shall be are grounds for
1357administrative action or penalties by the agency.:
1358     (a)  Violation of this part, part II of chapter 408, or
1359applicable rules.
1360     (b)  An intentional, reckless, or negligent act that
1361materially affects the health or safety of a patient.
1362     Section 44.  Subsection (3) of section 400.967, Florida
1363Statutes, is amended to read:
1364     400.967  Rules and classification of violations
1365deficiencies.-
1366     (3)  The agency shall adopt rules to provide that, when the
1367criteria established under this part and part II of chapter 408
1368are not met, such violations deficiencies shall be classified
1369according to the nature of the violation deficiency. The agency
1370shall indicate the classification on the face of the notice of
1371deficiencies as follows:
1372     (a)  Class I violations deficiencies are defined in s.
1373408.813 those which the agency determines present an imminent
1374danger to the residents or guests of the facility or a
1375substantial probability that death or serious physical harm
1376would result therefrom. The condition or practice constituting a
1377class I violation must be abated or eliminated immediately,
1378unless a fixed period of time, as determined by the agency, is
1379required for correction. A class I violation deficiency is
1380subject to a civil penalty in an amount not less than $5,000 and
1381not exceeding $10,000 for each violation deficiency. A fine may
1382be levied notwithstanding the correction of the violation
1383deficiency.
1384     (b)  Class II violations deficiencies are defined in s.
1385408.813 those which the agency determines have a direct or
1386immediate relationship to the health, safety, or security of the
1387facility residents, other than class I deficiencies. A class II
1388violation deficiency is subject to a civil penalty in an amount
1389not less than $1,000 and not exceeding $5,000 for each violation
1390deficiency. A citation for a class II violation deficiency shall
1391specify the time within which the violation deficiency must be
1392corrected. If a class II violation deficiency is corrected
1393within the time specified, no civil penalty shall be imposed,
1394unless it is a repeated offense.
1395     (c)  Class III violations deficiencies are defined in s.
1396408.813 those which the agency determines to have an indirect or
1397potential relationship to the health, safety, or security of the
1398facility residents, other than class I or class II deficiencies.
1399A class III violation deficiency is subject to a civil penalty
1400of not less than $500 and not exceeding $1,000 for each
1401deficiency. A citation for a class III violation deficiency
1402shall specify the time within which the violation deficiency
1403must be corrected. If a class III violation deficiency is
1404corrected within the time specified, no civil penalty shall be
1405imposed, unless it is a repeated offense.
1406     (d)  Class IV violations are defined in s. 408.813. Upon
1407finding an uncorrected or repeated class IV violation, the
1408agency shall impose an administrative fine not to exceed $500
1409for each occurrence and each day that the uncorrected or
1410repeated violation exists.
1411     Section 45.  Subsections (4) and (7) of section 400.9905,
1412Florida Statutes, are amended to read:
1413     400.9905  Definitions.-
1414     (4)  "Clinic" means an entity at which health care services
1415are provided to individuals and which tenders charges for
1416reimbursement for such services, including a mobile clinic and a
1417portable health service or equipment provider. For purposes of
1418this part, the term does not include and the licensure
1419requirements of this part do not apply to:
1420     (a)  Entities licensed or registered by the state under
1421chapter 395; or entities licensed or registered by the state and
1422providing only health care services within the scope of services
1423authorized under their respective licenses granted under ss.
1424383.30-383.335, chapter 390, chapter 394, chapter 397, this
1425chapter except part X, chapter 429, chapter 463, chapter 465,
1426chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1427chapter 651; end-stage renal disease providers authorized under
142842 C.F.R. part 405, subpart U; or providers certified under 42
1429C.F.R. part 485, subpart B or subpart H; or any entity that
1430provides neonatal or pediatric hospital-based health care
1431services or other health care services by licensed practitioners
1432solely within a hospital licensed under chapter 395.
1433     (b)  Entities that own, directly or indirectly, entities
1434licensed or registered by the state pursuant to chapter 395; or
1435entities that own, directly or indirectly, entities licensed or
1436registered by the state and providing only health care services
1437within the scope of services authorized pursuant to their
1438respective licenses granted under ss. 383.30-383.335, chapter
1439390, chapter 394, chapter 397, this chapter except part X,
1440chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1441part I of chapter 483, chapter 484, chapter 651; end-stage renal
1442disease providers authorized under 42 C.F.R. part 405, subpart
1443U; or providers certified under 42 C.F.R. part 485, subpart B or
1444subpart H; or any entity that provides neonatal or pediatric
1445hospital-based health care services by licensed practitioners
1446solely within a hospital licensed under chapter 395.
1447     (c)  Entities that are owned, directly or indirectly, by an
1448entity licensed or registered by the state pursuant to chapter
1449395; or entities that are owned, directly or indirectly, by an
1450entity licensed or registered by the state and providing only
1451health care services within the scope of services authorized
1452pursuant to their respective licenses granted under ss. 383.30-
1453383.335, chapter 390, chapter 394, chapter 397, this chapter
1454except part X, chapter 429, chapter 463, chapter 465, chapter
1455466, chapter 478, part I of chapter 483, chapter 484, or chapter
1456651; end-stage renal disease providers authorized under 42
1457C.F.R. part 405, subpart U; or providers certified under 42
1458C.F.R. part 485, subpart B or subpart H; or any entity that
1459provides neonatal or pediatric hospital-based health care
1460services by licensed practitioners solely within a hospital
1461under chapter 395.
1462     (d)  Entities that are under common ownership, directly or
1463indirectly, with an entity licensed or registered by the state
1464pursuant to chapter 395; or entities that are under common
1465ownership, directly or indirectly, with an entity licensed or
1466registered by the state and providing only health care services
1467within the scope of services authorized pursuant to their
1468respective licenses granted under ss. 383.30-383.335, chapter
1469390, chapter 394, chapter 397, this chapter except part X,
1470chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1471part I of chapter 483, chapter 484, or chapter 651; end-stage
1472renal disease providers authorized under 42 C.F.R. part 405,
1473subpart U; or providers certified under 42 C.F.R. part 485,
1474subpart B or subpart H; or any entity that provides neonatal or
1475pediatric hospital-based health care services by licensed
1476practitioners solely within a hospital licensed under chapter
1477395.
1478     (e)  An entity that is exempt from federal taxation under
147926 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1480under 26 U.S.C. s. 409 that has a board of trustees not less
1481than two-thirds of which are Florida-licensed health care
1482practitioners and provides only physical therapy services under
1483physician orders, any community college or university clinic,
1484and any entity owned or operated by the federal or state
1485government, including agencies, subdivisions, or municipalities
1486thereof.
1487     (f)  A sole proprietorship, group practice, partnership, or
1488corporation that provides health care services by physicians
1489covered by s. 627.419, that is directly supervised by one or
1490more of such physicians, and that is wholly owned by one or more
1491of those physicians or by a physician and the spouse, parent,
1492child, or sibling of that physician.
1493     (g)  A sole proprietorship, group practice, partnership, or
1494corporation that provides health care services by licensed
1495health care practitioners under chapter 457, chapter 458,
1496chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1497chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1498chapter 490, chapter 491, or part I, part III, part X, part
1499XIII, or part XIV of chapter 468, or s. 464.012, which are
1500wholly owned by one or more licensed health care practitioners,
1501or the licensed health care practitioners set forth in this
1502paragraph and the spouse, parent, child, or sibling of a
1503licensed health care practitioner, so long as one of the owners
1504who is a licensed health care practitioner is supervising the
1505business activities and is legally responsible for the entity's
1506compliance with all federal and state laws. However, a health
1507care practitioner may not supervise services beyond the scope of
1508the practitioner's license, except that, for the purposes of
1509this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1510provides only services authorized pursuant to s. 456.053(3)(b)
1511may be supervised by a licensee specified in s. 456.053(3)(b).
1512     (h)  Clinical facilities affiliated with an accredited
1513medical school at which training is provided for medical
1514students, residents, or fellows.
1515     (i)  Entities that provide only oncology or radiation
1516therapy services by physicians licensed under chapter 458 or
1517chapter 459 or entities that provide oncology or radiation
1518therapy services by physicians licensed under chapter 458 or
1519chapter 459 which are owned by a corporation whose shares are
1520publicly traded on a recognized stock exchange.
1521     (j)  Clinical facilities affiliated with a college of
1522chiropractic accredited by the Council on Chiropractic Education
1523at which training is provided for chiropractic students.
1524     (k)  Entities that provide licensed practitioners to staff
1525emergency departments or to deliver anesthesia services in
1526facilities licensed under chapter 395 and that derive at least
152790 percent of their gross annual revenues from the provision of
1528such services. Entities claiming an exemption from licensure
1529under this paragraph must provide documentation demonstrating
1530compliance.
1531     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1532perinatology clinical facilities that are a publicly traded
1533corporation or that are wholly owned, directly or indirectly, by
1534a publicly traded corporation. As used in this paragraph, a
1535publicly traded corporation is a corporation that issues
1536securities traded on an exchange registered with the United
1537States Securities and Exchange Commission as a national
1538securities exchange.
1539     (m)  Entities that are owned by a corporation that has $250
1540million or more in total annual sales of health care services
1541provided by licensed health care practitioners if one or more of
1542the owners of the entity is a health care practitioner who is
1543licensed in this state, is responsible for supervising the
1544business activities of the entity, and is legally responsible
1545for the entity's compliance with state law for purposes of this
1546section.
1547     (7)  "Portable health service or equipment provider" means
1548an entity that contracts with or employs persons to provide
1549portable health care services or equipment to multiple locations
1550performing treatment or diagnostic testing of individuals, that
1551bills third-party payors for those services, and that otherwise
1552meets the definition of a clinic in subsection (4).
1553     Section 46.  Paragraph (b) of subsection (1) and paragraph
1554(c) of subsection (4) of section 400.991, Florida Statutes, are
1555amended to read:
1556     400.991  License requirements; background screenings;
1557prohibitions.-
1558     (1)
1559     (b)  Each mobile clinic must obtain a separate health care
1560clinic license and must provide to the agency, at least
1561quarterly, its projected street location to enable the agency to
1562locate and inspect such clinic. A portable health service or
1563equipment provider must obtain a health care clinic license for
1564a single administrative office and is not required to submit
1565quarterly projected street locations.
1566     (4)  In addition to the requirements of part II of chapter
1567408, the applicant must file with the application satisfactory
1568proof that the clinic is in compliance with this part and
1569applicable rules, including:
1570     (c)  Proof of financial ability to operate as required
1571under ss. s. 408.810(8) and 408.8065. As an alternative to
1572submitting proof of financial ability to operate as required
1573under s. 408.810(8), the applicant may file a surety bond of at
1574least $500,000 which guarantees that the clinic will act in full
1575conformity with all legal requirements for operating a clinic,
1576payable to the agency. The agency may adopt rules to specify
1577related requirements for such surety bond.
1578     Section 47.  Paragraph (g) of subsection (1) and paragraph
1579(a) of subsection (7) of section 400.9935, Florida Statutes, are
1580amended to read:
1581     400.9935  Clinic responsibilities.-
1582     (1)  Each clinic shall appoint a medical director or clinic
1583director who shall agree in writing to accept legal
1584responsibility for the following activities on behalf of the
1585clinic. The medical director or the clinic director shall:
1586     (g)  Conduct systematic reviews of clinic billings to
1587ensure that the billings are not fraudulent or unlawful. Upon
1588discovery of an unlawful charge, the medical director or clinic
1589director shall take immediate corrective action. If the clinic
1590performs only the technical component of magnetic resonance
1591imaging, static radiographs, computed tomography, or positron
1592emission tomography, and provides the professional
1593interpretation of such services, in a fixed facility that is
1594accredited by The Joint Commission on Accreditation of
1595Healthcare Organizations or the Accreditation Association for
1596Ambulatory Health Care, and the American College of Radiology;
1597and if, in the preceding quarter, the percentage of scans
1598performed by that clinic which was billed to all personal injury
1599protection insurance carriers was less than 15 percent, the
1600chief financial officer of the clinic may, in a written
1601acknowledgment provided to the agency, assume the responsibility
1602for the conduct of the systematic reviews of clinic billings to
1603ensure that the billings are not fraudulent or unlawful.
1604     (7)(a)  Each clinic engaged in magnetic resonance imaging
1605services must be accredited by The Joint Commission on
1606Accreditation of Healthcare Organizations, the American College
1607of Radiology, or the Accreditation Association for Ambulatory
1608Health Care, within 1 year after licensure. A clinic that is
1609accredited by the American College of Radiology or is within the
1610original 1-year period after licensure and replaces its core
1611magnetic resonance imaging equipment shall be given 1 year after
1612the date on which the equipment is replaced to attain
1613accreditation. However, a clinic may request a single, 6-month
1614extension if it provides evidence to the agency establishing
1615that, for good cause shown, such clinic cannot be accredited
1616within 1 year after licensure, and that such accreditation will
1617be completed within the 6-month extension. After obtaining
1618accreditation as required by this subsection, each such clinic
1619must maintain accreditation as a condition of renewal of its
1620license. A clinic that files a change of ownership application
1621must comply with the original accreditation timeframe
1622requirements of the transferor. The agency shall deny a change
1623of ownership application if the clinic is not in compliance with
1624the accreditation requirements. When a clinic adds, replaces, or
1625modifies magnetic resonance imaging equipment and the
1626accreditation agency requires new accreditation, the clinic must
1627be accredited within 1 year after the date of the addition,
1628replacement, or modification but may request a single, 6-month
1629extension if the clinic provides evidence of good cause to the
1630agency.
1631     Section 48.  Subsection (2) of section 408.034, Florida
1632Statutes, is amended to read:
1633     408.034  Duties and responsibilities of agency; rules.-
1634     (2)  In the exercise of its authority to issue licenses to
1635health care facilities and health service providers, as provided
1636under chapters 393 and 395 and parts II, and IV, and VIII of
1637chapter 400, the agency may not issue a license to any health
1638care facility or health service provider that fails to receive a
1639certificate of need or an exemption for the licensed facility or
1640service.
1641     Section 49.  Paragraph (d) of subsection (1) of section
1642408.036, Florida Statutes, is amended to read:
1643     408.036  Projects subject to review; exemptions.-
1644     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1645health-care-related projects, as described in paragraphs (a)-
1646(g), are subject to review and must file an application for a
1647certificate of need with the agency. The agency is exclusively
1648responsible for determining whether a health-care-related
1649project is subject to review under ss. 408.031-408.045.
1650     (d)  The establishment of a hospice or hospice inpatient
1651facility, except as provided in s. 408.043.
1652     Section 50.  Subsection (2) of section 408.043, Florida
1653Statutes, is amended to read:
1654     408.043  Special provisions.-
1655     (2)  HOSPICES.-When an application is made for a
1656certificate of need to establish or to expand a hospice, the
1657need for such hospice shall be determined on the basis of the
1658need for and availability of hospice services in the community.
1659The formula on which the certificate of need is based shall
1660discourage regional monopolies and promote competition. The
1661inpatient hospice care component of a hospice which is a
1662freestanding facility, or a part of a facility, which is
1663primarily engaged in providing inpatient care and related
1664services and is not licensed as a health care facility shall
1665also be required to obtain a certificate of need. Provision of
1666hospice care by any current provider of health care is a
1667significant change in service and therefore requires a
1668certificate of need for such services.
1669     Section 51.  Paragraph (k) of subsection (3) of section
1670408.05, Florida Statutes, is amended to read:
1671     408.05  Florida Center for Health Information and Policy
1672Analysis.-
1673     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1674produce comparable and uniform health information and statistics
1675for the development of policy recommendations, the agency shall
1676perform the following functions:
1677     (k)  Develop, in conjunction with the State Consumer Health
1678Information and Policy Advisory Council, and implement a long-
1679range plan for making available health care quality measures and
1680financial data that will allow consumers to compare health care
1681services. The health care quality measures and financial data
1682the agency must make available shall include, but is not limited
1683to, pharmaceuticals, physicians, health care facilities, and
1684health plans and managed care entities. The agency shall submit
1685the initial plan to the Governor, the President of the Senate,
1686and the Speaker of the House of Representatives by January 1,
16872006, and shall update the plan and report on the status of its
1688implementation annually thereafter. The agency shall also make
1689the plan and status report available to the public on its
1690Internet website. As part of the plan, the agency shall identify
1691the process and timeframes for implementation, any barriers to
1692implementation, and recommendations of changes in the law that
1693may be enacted by the Legislature to eliminate the barriers. As
1694preliminary elements of the plan, the agency shall:
1695     1.  Make available patient-safety indicators, inpatient
1696quality indicators, and performance outcome and patient charge
1697data collected from health care facilities pursuant to s.
1698408.061(1)(a) and (2). The terms "patient-safety indicators" and
1699"inpatient quality indicators" shall be as defined by the
1700Centers for Medicare and Medicaid Services, the National Quality
1701Forum, The Joint Commission on Accreditation of Healthcare
1702Organizations, the Agency for Healthcare Research and Quality,
1703the Centers for Disease Control and Prevention, or a similar
1704national entity that establishes standards to measure the
1705performance of health care providers, or by other states. The
1706agency shall determine which conditions, procedures, health care
1707quality measures, and patient charge data to disclose based upon
1708input from the council. When determining which conditions and
1709procedures are to be disclosed, the council and the agency shall
1710consider variation in costs, variation in outcomes, and
1711magnitude of variations and other relevant information. When
1712determining which health care quality measures to disclose, the
1713agency:
1714     a.  Shall consider such factors as volume of cases; average
1715patient charges; average length of stay; complication rates;
1716mortality rates; and infection rates, among others, which shall
1717be adjusted for case mix and severity, if applicable.
1718     b.  May consider such additional measures that are adopted
1719by the Centers for Medicare and Medicaid Studies, National
1720Quality Forum, The Joint Commission on Accreditation of
1721Healthcare Organizations, the Agency for Healthcare Research and
1722Quality, Centers for Disease Control and Prevention, or a
1723similar national entity that establishes standards to measure
1724the performance of health care providers, or by other states.
1725
1726When determining which patient charge data to disclose, the
1727agency shall include such measures as the average of
1728undiscounted charges on frequently performed procedures and
1729preventive diagnostic procedures, the range of procedure charges
1730from highest to lowest, average net revenue per adjusted patient
1731day, average cost per adjusted patient day, and average cost per
1732admission, among others.
1733     2.  Make available performance measures, benefit design,
1734and premium cost data from health plans licensed pursuant to
1735chapter 627 or chapter 641. The agency shall determine which
1736health care quality measures and member and subscriber cost data
1737to disclose, based upon input from the council. When determining
1738which data to disclose, the agency shall consider information
1739that may be required by either individual or group purchasers to
1740assess the value of the product, which may include membership
1741satisfaction, quality of care, current enrollment or membership,
1742coverage areas, accreditation status, premium costs, plan costs,
1743premium increases, range of benefits, copayments and
1744deductibles, accuracy and speed of claims payment, credentials
1745of physicians, number of providers, names of network providers,
1746and hospitals in the network. Health plans shall make available
1747to the agency any such data or information that is not currently
1748reported to the agency or the office.
1749     3.  Determine the method and format for public disclosure
1750of data reported pursuant to this paragraph. The agency shall
1751make its determination based upon input from the State Consumer
1752Health Information and Policy Advisory Council. At a minimum,
1753the data shall be made available on the agency's Internet
1754website in a manner that allows consumers to conduct an
1755interactive search that allows them to view and compare the
1756information for specific providers. The website must include
1757such additional information as is determined necessary to ensure
1758that the website enhances informed decisionmaking among
1759consumers and health care purchasers, which shall include, at a
1760minimum, appropriate guidance on how to use the data and an
1761explanation of why the data may vary from provider to provider.
1762The data specified in subparagraph 1. shall be released no later
1763than January 1, 2006, for the reporting of infection rates, and
1764no later than October 1, 2005, for mortality rates and
1765complication rates. The data specified in subparagraph 2. shall
1766be released no later than October 1, 2006.
1767     4.  Publish on its website undiscounted charges for no
1768fewer than 150 of the most commonly performed adult and
1769pediatric procedures, including outpatient, inpatient,
1770diagnostic, and preventative procedures.
1771     Section 52.  Paragraph (a) of subsection (1) of section
1772408.061, Florida Statutes, is amended to read:
1773     408.061  Data collection; uniform systems of financial
1774reporting; information relating to physician charges;
1775confidential information; immunity.-
1776     (1)  The agency shall require the submission by health care
1777facilities, health care providers, and health insurers of data
1778necessary to carry out the agency's duties. Specifications for
1779data to be collected under this section shall be developed by
1780the agency with the assistance of technical advisory panels
1781including representatives of affected entities, consumers,
1782purchasers, and such other interested parties as may be
1783determined by the agency.
1784     (a)  Data submitted by health care facilities, including
1785the facilities as defined in chapter 395, shall include, but are
1786not limited to: case-mix data, patient admission and discharge
1787data, hospital emergency department data which shall include the
1788number of patients treated in the emergency department of a
1789licensed hospital reported by patient acuity level, data on
1790hospital-acquired infections as specified by rule, data on
1791complications as specified by rule, data on readmissions as
1792specified by rule, with patient and provider-specific
1793identifiers included, actual charge data by diagnostic groups,
1794financial data, accounting data, operating expenses, expenses
1795incurred for rendering services to patients who cannot or do not
1796pay, interest charges, depreciation expenses based on the
1797expected useful life of the property and equipment involved, and
1798demographic data. The agency shall adopt nationally recognized
1799risk adjustment methodologies or software consistent with the
1800standards of the Agency for Healthcare Research and Quality and
1801as selected by the agency for all data submitted as required by
1802this section. Data may be obtained from documents such as, but
1803not limited to: leases, contracts, debt instruments, itemized
1804patient bills, medical record abstracts, and related diagnostic
1805information. Reported data elements shall be reported
1806electronically and in accordance with rule 59E-7.012, Florida
1807Administrative Code. Data submitted shall be certified by the
1808chief executive officer or an appropriate and duly authorized
1809representative or employee of the licensed facility that the
1810information submitted is true and accurate.
1811     Section 53.  Subsection (43) of section 408.07, Florida
1812Statutes, is amended to read:
1813     408.07  Definitions.-As used in this chapter, with the
1814exception of ss. 408.031-408.045, the term:
1815     (43)  "Rural hospital" means an acute care hospital
1816licensed under chapter 395, having 100 or fewer licensed beds
1817and an emergency room, and which is:
1818     (a)  The sole provider within a county with a population
1819density of no greater than 100 persons per square mile;
1820     (b)  An acute care hospital, in a county with a population
1821density of no greater than 100 persons per square mile, which is
1822at least 30 minutes of travel time, on normally traveled roads
1823under normal traffic conditions, from another acute care
1824hospital within the same county;
1825     (c)  A hospital supported by a tax district or subdistrict
1826whose boundaries encompass a population of 100 persons or fewer
1827per square mile;
1828     (d)  A hospital with a service area that has a population
1829of 100 persons or fewer per square mile. As used in this
1830paragraph, the term "service area" means the fewest number of
1831zip codes that account for 75 percent of the hospital's
1832discharges for the most recent 5-year period, based on
1833information available from the hospital inpatient discharge
1834database in the Florida Center for Health Information and Policy
1835Analysis at the Agency for Health Care Administration; or
1836     (e)  A critical access hospital.
1837
1838Population densities used in this subsection must be based upon
1839the most recently completed United States census. A hospital
1840that received funds under s. 409.9116 for a quarter beginning no
1841later than July 1, 2002, is deemed to have been and shall
1842continue to be a rural hospital from that date through June 30,
18432015, if the hospital continues to have 100 or fewer licensed
1844beds and an emergency room, or meets the criteria of s.
1845395.602(2)(e)4. An acute care hospital that has not previously
1846been designated as a rural hospital and that meets the criteria
1847of this subsection shall be granted such designation upon
1848application, including supporting documentation, to the Agency
1849for Health Care Administration.
1850     Section 54.  Section 408.10, Florida Statutes, is amended
1851to read:
1852     408.10  Consumer complaints.-The agency shall:
1853     (1)  publish and make available to the public a toll-free
1854telephone number for the purpose of handling consumer complaints
1855and shall serve as a liaison between consumer entities and other
1856private entities and governmental entities for the disposition
1857of problems identified by consumers of health care.
1858     (2)  Be empowered to investigate consumer complaints
1859relating to problems with health care facilities' billing
1860practices and issue reports to be made public in any cases where
1861the agency determines the health care facility has engaged in
1862billing practices which are unreasonable and unfair to the
1863consumer.
1864     Section 55.  Subsections (12) through (30) of section
1865408.802, Florida Statutes, are renumbered as subsections (11)
1866through (29), respectively, and present subsection (11) of that
1867section is amended to read:
1868     408.802  Applicability.-The provisions of this part apply
1869to the provision of services that require licensure as defined
1870in this part and to the following entities licensed, registered,
1871or certified by the agency, as described in chapters 112, 383,
1872390, 394, 395, 400, 429, 440, 483, and 765:
1873     (11)  Private review agents, as provided under part I of
1874chapter 395.
1875     Section 56.  Subsection (3) is added to section 408.804,
1876Florida Statutes, to read:
1877     408.804  License required; display.-
1878     (3)  Any person who knowingly alters, defaces, or falsifies
1879a license certificate issued by the agency, or causes or
1880procures any person to commit such an offense, commits a
1881misdemeanor of the second degree, punishable as provided in s.
1882775.082 or s 775.083. Any licensee or provider who displays an
1883altered, defaced, or falsified license certificate is subject to
1884the penalties set forth in s. 408.815 and an administrative fine
1885of $1,000 for each day of illegal display.
1886     Section 57.  Paragraph (d) of subsection (2) of section
1887408.806, Florida Statutes, is amended, present subsections (3)
1888through (8) are renumbered as subsections (4) through (9),
1889respectively, and a new subsection (3) is added to that section,
1890to read:
1891     408.806  License application process.-
1892     (2)
1893     (d)  The agency shall notify the licensee by mail or
1894electronically at least 90 days before the expiration of a
1895license that a renewal license is necessary to continue
1896operation. The licensee's failure to timely file submit a
1897renewal application and license application fee with the agency
1898shall result in a $50 per day late fee charged to the licensee
1899by the agency; however, the aggregate amount of the late fee may
1900not exceed 50 percent of the licensure fee or $500, whichever is
1901less. The agency shall provide a courtesy notice to the licensee
1902by United States mail, electronically, or by any other manner at
1903its address of record or mailing address, if provided, at least
190490 days prior to the expiration of a license informing the
1905licensee of the expiration of the license. If the agency does
1906not provide the courtesy notice or the licensee does not receive
1907the courtesy notice, the licensee continues to be legally
1908obligated to timely file the renewal application and license
1909application fee with the agency and is not excused from the
1910payment of a late fee. If an application is received after the
1911required filing date and exhibits a hand-canceled postmark
1912obtained from a United States post office dated on or before the
1913required filing date, no fine will be levied.
1914     (3)  Payment of the late fee is required to consider any
1915late application complete, and failure to pay the late fee is
1916considered an omission from the application.
1917     Section 58.  Subsections (6) and (9) of section 408.810,
1918Florida Statutes, are amended to read:
1919     408.810  Minimum licensure requirements.-In addition to the
1920licensure requirements specified in this part, authorizing
1921statutes, and applicable rules, each applicant and licensee must
1922comply with the requirements of this section in order to obtain
1923and maintain a license.
1924     (6)(a)  An applicant must provide the agency with proof of
1925the applicant's legal right to occupy the property before a
1926license may be issued. Proof may include, but need not be
1927limited to, copies of warranty deeds, lease or rental
1928agreements, contracts for deeds, quitclaim deeds, or other such
1929documentation.
1930     (b)  In the event the property is encumbered by a mortgage
1931or is leased, an applicant must provide the agency with proof
1932that the mortgagor or landlord has been provided written notice
1933of the applicant's intent as mortgagee or tenant to provide
1934services that require licensure and instruct the mortgagor or
1935landlord to serve the agency by certified mail with copies of
1936any foreclosure or eviction actions initiated by the mortgagor
1937or landlord against the applicant.
1938     (9)  A controlling interest may not withhold from the
1939agency any evidence of financial instability, including, but not
1940limited to, checks returned due to insufficient funds,
1941delinquent accounts, nonpayment of withholding taxes, unpaid
1942utility expenses, nonpayment for essential services, or adverse
1943court action concerning the financial viability of the provider
1944or any other provider licensed under this part that is under the
1945control of the controlling interest. A controlling interest
1946shall notify the agency within 10 days after a court action to
1947initiate bankruptcy, foreclosure, or eviction proceedings
1948concerning the provider, in which the controlling interest is a
1949petitioner or defendant. Any person who violates this subsection
1950commits a misdemeanor of the second degree, punishable as
1951provided in s. 775.082 or s. 775.083. Each day of continuing
1952violation is a separate offense.
1953     Section 59.  Subsection (3) is added to section 408.813,
1954Florida Statutes, to read:
1955     408.813  Administrative fines; violations.-As a penalty for
1956any violation of this part, authorizing statutes, or applicable
1957rules, the agency may impose an administrative fine.
1958     (3)  The agency may impose an administrative fine for a
1959violation that does not qualify as a class I, class II, class
1960III, or class IV violation. Unless otherwise specified by law,
1961the amount of the fine shall not exceed $500 for each violation.
1962Unclassified violations may include:
1963     (a)  Violating any term or condition of a license.
1964     (b)  Violating any provision of this part, authorizing
1965statutes, or applicable rules.
1966     (c)  Exceeding licensed capacity.
1967     (d)  Providing services beyond the scope of the license.
1968     (e)  Violating a moratorium imposed pursuant to s. 408.814.
1969     Section 60.  Subsection (5) is added to section 408.815,
1970Florida Statutes, to read:
1971     408.815  License or application denial; revocation.-
1972     (5)  In order to ensure the health, safety, and welfare of
1973clients when a license has been denied, revoked, or is set to
1974terminate, the agency may extend the license expiration date for
1975a period of up to 30 days for the sole purpose of allowing the
1976safe and orderly discharge of clients. The agency may impose
1977conditions on the extension, including, but not limited to,
1978prohibiting or limiting admissions, expedited discharge
1979planning, required status reports, and mandatory monitoring by
1980the agency or third parties. In imposing these conditions, the
1981agency shall take into consideration the nature and number of
1982clients, the availability and location of acceptable alternative
1983placements, and the ability of the licensee to continue
1984providing care to the clients. The agency may terminate the
1985extension or modify the conditions at any time. This authority
1986is in addition to any other authority granted to the agency
1987under chapter 120, this part, and authorizing statutes but
1988creates no right or entitlement to an extension of a license
1989expiration date.
1990     Section 61.  Paragraph (k) of subsection (4) of section
1991409.221, Florida Statutes, is amended to read:
1992     409.221  Consumer-directed care program.-
1993     (4)  CONSUMER-DIRECTED CARE.-
1994     (k)  Reviews and reports.-The agency and the Departments of
1995Elderly Affairs, Health, and Children and Family Services and
1996the Agency for Persons with Disabilities shall each, on an
1997ongoing basis, review and assess the implementation of the
1998consumer-directed care program. By January 15 of each year, the
1999agency shall submit a written report to the Legislature that
2000includes each department's review of the program and contains
2001recommendations for improvements to the program.
2002     Section 62.  Subsections (3) and (4) of section 429.07,
2003Florida Statutes, are amended, and subsections (6) and (7) are
2004added to that section, to read:
2005     429.07  License required; fee; inspections.-
2006     (3)  In addition to the requirements of s. 408.806, each
2007license granted by the agency must state the type of care for
2008which the license is granted. Licenses shall be issued for one
2009or more of the following categories of care: standard, extended
2010congregate care, limited nursing services, or limited mental
2011health.
2012     (a)  A standard license shall be issued to a facility
2013facilities providing one or more of the personal services
2014identified in s. 429.02. Such licensee facilities may also
2015employ or contract with a person licensed under part I of
2016chapter 464 to administer medications and perform other tasks as
2017specified in s. 429.255.
2018     (b)  An extended congregate care license shall be issued to
2019a licensee facilities providing, directly or through contract,
2020services beyond those authorized in paragraph (a), including
2021acts performed pursuant to part I of chapter 464 by persons
2022licensed thereunder, and supportive services defined by rule to
2023persons who otherwise would be disqualified from continued
2024residence in a facility licensed under this part.
2025     1.  In order for extended congregate care services to be
2026provided in a facility licensed under this part, the agency must
2027first determine that all requirements established in law and
2028rule are met and must specifically designate, on the facility's
2029license, that such services may be provided and whether the
2030designation applies to all or part of a facility. Such
2031designation may be made at the time of initial licensure or
2032relicensure, or upon request in writing by a licensee under this
2033part and part II of chapter 408. Notification of approval or
2034denial of such request shall be made in accordance with part II
2035of chapter 408. An existing licensee facilities qualifying to
2036provide extended congregate care services must have maintained a
2037standard license and may not have been subject to administrative
2038sanctions during the previous 2 years, or since initial
2039licensure if the facility has been licensed for less than 2
2040years, for any of the following reasons:
2041     a.  A class I or class II violation;
2042     b.  Three or more repeat or recurring class III violations
2043of identical or similar resident care standards as specified in
2044rule from which a pattern of noncompliance is found by the
2045agency;
2046     c.  Three or more class III violations that were not
2047corrected in accordance with the corrective action plan approved
2048by the agency;
2049     d.  Violation of resident care standards resulting in a
2050requirement to employ the services of a consultant pharmacist or
2051consultant dietitian;
2052     e.  Denial, suspension, or revocation of a license for
2053another facility under this part in which the applicant for an
2054extended congregate care license has at least 25 percent
2055ownership interest; or
2056     f.  Imposition of a moratorium pursuant to this part or
2057part II of chapter 408 or initiation of injunctive proceedings.
2058     2.  A licensee Facilities that is are licensed to provide
2059extended congregate care services shall maintain a written
2060progress report for on each person who receives such services,
2061and the which report must describe describes the type, amount,
2062duration, scope, and outcome of services that are rendered and
2063the general status of the resident's health. A registered nurse,
2064or appropriate designee, representing the agency shall visit
2065such facilities at least quarterly to monitor residents who are
2066receiving extended congregate care services and to determine if
2067the facility is in compliance with this part, part II of chapter
2068408, and rules that relate to extended congregate care. One of
2069these visits may be in conjunction with the regular survey. The
2070monitoring visits may be provided through contractual
2071arrangements with appropriate community agencies. A registered
2072nurse shall serve as part of the team that inspects such
2073facility. The agency may waive one of the required yearly
2074monitoring visits for a facility that has been licensed for at
2075least 24 months to provide extended congregate care services,
2076if, during the inspection, the registered nurse determines that
2077extended congregate care services are being provided
2078appropriately, and if the facility has no class I or class II
2079violations and no uncorrected class III violations. Before such
2080decision is made, the agency shall consult with the long-term
2081care ombudsman council for the area in which the facility is
2082located to determine if any complaints have been made and
2083substantiated about the quality of services or care. The agency
2084may not waive one of the required yearly monitoring visits if
2085complaints have been made and substantiated.
2086     3.  Licensees Facilities that are licensed to provide
2087extended congregate care services shall:
2088     a.  Demonstrate the capability to meet unanticipated
2089resident service needs.
2090     b.  Offer a physical environment that promotes a homelike
2091setting, provides for resident privacy, promotes resident
2092independence, and allows sufficient congregate space as defined
2093by rule.
2094     c.  Have sufficient staff available, taking into account
2095the physical plant and firesafety features of the building, to
2096assist with the evacuation of residents in an emergency, as
2097necessary.
2098     d.  Adopt and follow policies and procedures that maximize
2099resident independence, dignity, choice, and decisionmaking to
2100permit residents to age in place to the extent possible, so that
2101moves due to changes in functional status are minimized or
2102avoided.
2103     e.  Allow residents or, if applicable, a resident's
2104representative, designee, surrogate, guardian, or attorney in
2105fact to make a variety of personal choices, participate in
2106developing service plans, and share responsibility in
2107decisionmaking.
2108     f.  Implement the concept of managed risk.
2109     g.  Provide, either directly or through contract, the
2110services of a person licensed pursuant to part I of chapter 464.
2111     h.  In addition to the training mandated in s. 429.52,
2112provide specialized training as defined by rule for facility
2113staff.
2114     4.  Licensees Facilities licensed to provide extended
2115congregate care services are exempt from the criteria for
2116continued residency as set forth in rules adopted under s.
2117429.41. Licensees Facilities so licensed shall adopt their own
2118requirements within guidelines for continued residency set forth
2119by rule. However, such licensees facilities may not serve
2120residents who require 24-hour nursing supervision. Licensees
2121Facilities licensed to provide extended congregate care services
2122shall provide each resident with a written copy of facility
2123policies governing admission and retention.
2124     5.  The primary purpose of extended congregate care
2125services is to allow residents, as they become more impaired,
2126the option of remaining in a familiar setting from which they
2127would otherwise be disqualified for continued residency. A
2128facility licensed to provide extended congregate care services
2129may also admit an individual who exceeds the admission criteria
2130for a facility with a standard license, if the individual is
2131determined appropriate for admission to the extended congregate
2132care facility.
2133     6.  Before admission of an individual to a facility
2134licensed to provide extended congregate care services, the
2135individual must undergo a medical examination as provided in s.
2136429.26(4) and the facility must develop a preliminary service
2137plan for the individual.
2138     7.  When a licensee facility can no longer provide or
2139arrange for services in accordance with the resident's service
2140plan and needs and the licensee's facility's policy, the
2141licensee facility shall make arrangements for relocating the
2142person in accordance with s. 429.28(1)(k).
2143     8.  Failure to provide extended congregate care services
2144may result in denial of extended congregate care license
2145renewal.
2146     9.  No later than January 1 of each year, the department,
2147in consultation with the agency, shall prepare and submit to the
2148Governor, the President of the Senate, the Speaker of the House
2149of Representatives, and the chairs of appropriate legislative
2150committees, a report on the status of, and recommendations
2151related to, extended congregate care services. The status report
2152must include, but need not be limited to, the following
2153information:
2154     a.  A description of the facilities licensed to provide
2155such services, including total number of beds licensed under
2156this part.
2157     b.  The number and characteristics of residents receiving
2158such services.
2159     c.  The types of services rendered that could not be
2160provided through a standard license.
2161     d.  An analysis of deficiencies cited during licensure
2162inspections.
2163     e.  The number of residents who required extended
2164congregate care services at admission and the source of
2165admission.
2166     f.  Recommendations for statutory or regulatory changes.
2167     g.  The availability of extended congregate care to state
2168clients residing in facilities licensed under this part and in
2169need of additional services, and recommendations for
2170appropriations to subsidize extended congregate care services
2171for such persons.
2172     h.  Such other information as the department considers
2173appropriate.
2174     (c)  A limited nursing services license shall be issued to
2175a facility that provides services beyond those authorized in
2176paragraph (a) and as specified in this paragraph.
2177     1.  In order for limited nursing services to be provided in
2178a facility licensed under this part, the agency must first
2179determine that all requirements established in law and rule are
2180met and must specifically designate, on the facility's license,
2181that such services may be provided. Such designation may be made
2182at the time of initial licensure or relicensure, or upon request
2183in writing by a licensee under this part and part II of chapter
2184408. Notification of approval or denial of such request shall be
2185made in accordance with part II of chapter 408. Existing
2186facilities qualifying to provide limited nursing services shall
2187have maintained a standard license and may not have been subject
2188to administrative sanctions that affect the health, safety, and
2189welfare of residents for the previous 2 years or since initial
2190licensure if the facility has been licensed for less than 2
2191years.
2192     2.  Facilities that are licensed to provide limited nursing
2193services shall maintain a written progress report on each person
2194who receives such nursing services, which report describes the
2195type, amount, duration, scope, and outcome of services that are
2196rendered and the general status of the resident's health. A
2197registered nurse representing the agency shall visit such
2198facilities at least twice a year to monitor residents who are
2199receiving limited nursing services and to determine if the
2200facility is in compliance with applicable provisions of this
2201part, part II of chapter 408, and related rules. The monitoring
2202visits may be provided through contractual arrangements with
2203appropriate community agencies. A registered nurse shall also
2204serve as part of the team that inspects such facility.
2205     3.  A person who receives limited nursing services under
2206this part must meet the admission criteria established by the
2207agency for assisted living facilities. When a resident no longer
2208meets the admission criteria for a facility licensed under this
2209part, arrangements for relocating the person shall be made in
2210accordance with s. 429.28(1)(k), unless the facility is licensed
2211to provide extended congregate care services.
2212     (4)  In accordance with s. 408.805, an applicant or
2213licensee shall pay a fee for each license application submitted
2214under this part, part II of chapter 408, and applicable rules.
2215The amount of the fee shall be established by rule.
2216     (a)  The biennial license fee required of a facility is
2217$356 $300 per license, with an additional fee of $67.50 $50 per
2218resident based on the total licensed resident capacity of the
2219facility, except that no additional fee will be assessed for
2220beds designated for recipients of optional state supplementation
2221payments provided for in s. 409.212. The total fee may not
2222exceed $18,000 $10,000.
2223     (b)  In addition to the total fee assessed under paragraph
2224(a), the agency shall require facilities that are licensed to
2225provide extended congregate care services under this part to pay
2226an additional fee per licensed facility. The amount of the
2227biennial fee shall be $501 $400 per license, with an additional
2228fee of $10 per resident based on the total licensed resident
2229capacity of the facility.
2230     (c)  In addition to the total fee assessed under paragraph
2231(a), the agency shall require facilities that are licensed to
2232provide limited nursing services under this part to pay an
2233additional fee per licensed facility. The amount of the biennial
2234fee shall be $250 per license, with an additional fee of $10 per
2235resident based on the total licensed resident capacity of the
2236facility.
2237     (6)  In order to determine whether the facility is
2238adequately protecting residents' rights as provided in s.
2239429.28, the biennial survey shall include private informal
2240conversations with a sample of residents and consultation with
2241the ombudsman council in the planning and service area in which
2242the facility is located to discuss residents' experiences within
2243the facility.
2244     (7)  An assisted living facility that has been cited within
2245the previous 24-month period for a class I or class II
2246violation, regardless of the status of any enforcement or
2247disciplinary action, is subject to periodic unannounced
2248monitoring to determine if the facility is in compliance with
2249this part, part II of chapter 408, and applicable rules.
2250Monitoring may occur through a desk review or an onsite
2251assessment. If the class I or class II violation relates to
2252providing or failing to provide nursing care, a registered nurse
2253must participate in at least two onsite monitoring visits within
2254a 12-month period.
2255     Section 63.  Subsection (7) of section 429.11, Florida
2256Statutes, is renumbered as subsection (6), and present
2257subsection (6) of that section is amended to read:
2258     429.11  Initial application for license; provisional
2259license.-
2260     (6)  In addition to the license categories available in s.
2261408.808, a provisional license may be issued to an applicant
2262making initial application for licensure or making application
2263for a change of ownership. A provisional license shall be
2264limited in duration to a specific period of time not to exceed 6
2265months, as determined by the agency.
2266     Section 64.  Section 429.12, Florida Statutes, is amended
2267to read:
2268     429.12  Sale or transfer of ownership of a facility.-It is
2269the intent of the Legislature to protect the rights of the
2270residents of an assisted living facility when the facility is
2271sold or the ownership thereof is transferred. Therefore, in
2272addition to the requirements of part II of chapter 408, whenever
2273a facility is sold or the ownership thereof is transferred,
2274including leasing:.
2275     (1)  The transferee shall notify the residents, in writing,
2276of the change of ownership within 7 days after receipt of the
2277new license.
2278     (2)  The transferor of a facility the license of which is
2279denied pending an administrative hearing shall, as a part of the
2280written change-of-ownership contract, advise the transferee that
2281a plan of correction must be submitted by the transferee and
2282approved by the agency at least 7 days before the change of
2283ownership and that failure to correct the condition which
2284resulted in the moratorium pursuant to part II of chapter 408 or
2285denial of licensure is grounds for denial of the transferee's
2286license.
2287     Section 65.  Paragraphs (b) through (l) of subsection (1)
2288of section 429.14, Florida Statutes, are redesignated as
2289paragraphs (a) through (k), respectively, and present paragraph
2290(a) of subsection (1) and subsections (5) and (6) of that
2291section are amended to read:
2292     429.14  Administrative penalties.-
2293     (1)  In addition to the requirements of part II of chapter
2294408, the agency may deny, revoke, and suspend any license issued
2295under this part and impose an administrative fine in the manner
2296provided in chapter 120 against a licensee of an assisted living
2297facility for a violation of any provision of this part, part II
2298of chapter 408, or applicable rules, or for any of the following
2299actions by a licensee of an assisted living facility, for the
2300actions of any person subject to level 2 background screening
2301under s. 408.809, or for the actions of any facility employee:
2302     (a)  An intentional or negligent act seriously affecting
2303the health, safety, or welfare of a resident of the facility.
2304     (5)  An action taken by the agency to suspend, deny, or
2305revoke a facility's license under this part or part II of
2306chapter 408, in which the agency claims that the facility owner
2307or an employee of the facility has threatened the health,
2308safety, or welfare of a resident of the facility shall be heard
2309by the Division of Administrative Hearings of the Department of
2310Management Services within 120 days after receipt of the
2311facility's request for a hearing, unless that time limitation is
2312waived by both parties. The administrative law judge must render
2313a decision within 30 days after receipt of a proposed
2314recommended order.
2315     (6)  The agency shall provide to the Division of Hotels and
2316Restaurants of the Department of Business and Professional
2317Regulation, on a monthly basis, a list of those assisted living
2318facilities that have had their licenses denied, suspended, or
2319revoked or that are involved in an appellate proceeding pursuant
2320to s. 120.60 related to the denial, suspension, or revocation of
2321a license. This information may be provided electronically or
2322through the agency's Internet website.
2323     Section 66.  Subsections (1), (4), and (5) of section
2324429.17, Florida Statutes, are amended to read:
2325     429.17  Expiration of license; renewal; conditional
2326license.-
2327     (1)  Limited nursing, Extended congregate care, and limited
2328mental health licenses shall expire at the same time as the
2329facility's standard license, regardless of when issued.
2330     (4)  In addition to the license categories available in s.
2331408.808, a conditional license may be issued to an applicant for
2332license renewal if the applicant fails to meet all standards and
2333requirements for licensure. A conditional license issued under
2334this subsection shall be limited in duration to a specific
2335period of time not to exceed 6 months, as determined by the
2336agency, and shall be accompanied by an agency-approved plan of
2337correction.
2338     (5)  When an extended congregate care or limited nursing
2339license is requested during a facility's biennial license
2340period, the fee shall be prorated in order to permit the
2341additional license to expire at the end of the biennial license
2342period. The fee shall be calculated as of the date the
2343additional license application is received by the agency.
2344     Section 67.  Subsection (7) of section 429.19, Florida
2345Statutes, is amended to read:
2346     429.19  Violations; imposition of administrative fines;
2347grounds.-
2348     (7)  In addition to any administrative fines imposed, the
2349agency may assess a survey or monitoring fee, equal to the
2350lesser of one half of the facility's biennial license and bed
2351fee or $500, to cover the cost of conducting initial complaint
2352investigations that result in the finding of a violation that
2353was the subject of the complaint or to monitor the health,
2354safety, or security of residents under s. 429.07(7) monitoring
2355visits conducted under s. 429.28(3)(c) to verify the correction
2356of the violations.
2357     Section 68.  Subsections (6) through (10) of section
2358429.23, Florida Statutes, are renumbered as subsections (5)
2359through (9), respectively, and present subsection (5) of that
2360section is amended to read:
2361     429.23  Internal risk management and quality assurance
2362program; adverse incidents and reporting requirements.-
2363     (5)  Each facility shall report monthly to the agency any
2364liability claim filed against it. The report must include the
2365name of the resident, the dates of the incident leading to the
2366claim, if applicable, and the type of injury or violation of
2367rights alleged to have occurred. This report is not discoverable
2368in any civil or administrative action, except in such actions
2369brought by the agency to enforce the provisions of this part.
2370     Section 69.  Paragraph (a) of subsection (1) and subsection
2371(2) of section 429.255, Florida Statutes, are amended to read:
2372     429.255  Use of personnel; emergency care.-
2373     (1)(a)  Persons under contract to the facility or, facility
2374staff, or volunteers, who are licensed according to part I of
2375chapter 464, or those persons exempt under s. 464.022(1), and
2376others as defined by rule, may administer medications to
2377residents, take residents' vital signs, manage individual weekly
2378pill organizers for residents who self-administer medication,
2379give prepackaged enemas ordered by a physician, observe
2380residents, document observations on the appropriate resident's
2381record, report observations to the resident's physician, and
2382contract or allow residents or a resident's representative,
2383designee, surrogate, guardian, or attorney in fact to contract
2384with a third party, provided residents meet the criteria for
2385appropriate placement as defined in s. 429.26. Persons under
2386contract to the facility or facility staff who are licensed
2387according to part I of chapter 464 may provide limited nursing
2388services. Nursing assistants certified pursuant to part II of
2389chapter 464 may take residents' vital signs as directed by a
2390licensed nurse or physician. The facility is responsible for
2391maintaining documentation of services provided under this
2392paragraph as required by rule and ensuring that staff are
2393adequately trained to monitor residents receiving these
2394services.
2395     (2)  In facilities licensed to provide extended congregate
2396care, persons under contract to the facility or, facility staff,
2397or volunteers, who are licensed according to part I of chapter
2398464, or those persons exempt under s. 464.022(1), or those
2399persons certified as nursing assistants pursuant to part II of
2400chapter 464, may also perform all duties within the scope of
2401their license or certification, as approved by the facility
2402administrator and pursuant to this part.
2403     Section 70.  Subsection (3) of section 429.28, Florida
2404Statutes, is amended to read:
2405     429.28  Resident bill of rights.-
2406     (3)(a)  The agency shall conduct a survey to determine
2407general compliance with facility standards and compliance with
2408residents' rights as a prerequisite to initial licensure or
2409licensure renewal.
2410     (b)  In order to determine whether the facility is
2411adequately protecting residents' rights, the biennial survey
2412shall include private informal conversations with a sample of
2413residents and consultation with the ombudsman council in the
2414planning and service area in which the facility is located to
2415discuss residents' experiences within the facility.
2416     (c)  During any calendar year in which no survey is
2417conducted, the agency shall conduct at least one monitoring
2418visit of each facility cited in the previous year for a class I
2419or class II violation, or more than three uncorrected class III
2420violations.
2421     (d)  The agency may conduct periodic followup inspections
2422as necessary to monitor the compliance of facilities with a
2423history of any class I, class II, or class III violations that
2424threaten the health, safety, or security of residents.
2425     (e)  The agency may conduct complaint investigations as
2426warranted to investigate any allegations of noncompliance with
2427requirements required under this part or rules adopted under
2428this part.
2429     Section 71.  Subsection (2) of section 429.35, Florida
2430Statutes, is amended to read:
2431     429.35  Maintenance of records; reports.-
2432     (2)  Within 60 days after the date of the biennial
2433inspection visit required under s. 408.811 or within 30 days
2434after the date of any interim visit, the agency shall forward
2435the results of the inspection to the local ombudsman council in
2436whose planning and service area, as defined in part II of
2437chapter 400, the facility is located; to at least one public
2438library or, in the absence of a public library, the county seat
2439in the county in which the inspected assisted living facility is
2440located; and, when appropriate, to the district Adult Services
2441and Mental Health Program Offices. This information may be
2442provided electronically or through the agency's Internet
2443website.
2444     Section 72.  Paragraphs (i) and (j) of subsection (1) of
2445section 429.41, Florida Statutes, are amended to read:
2446     429.41  Rules establishing standards.-
2447     (1)  It is the intent of the Legislature that rules
2448published and enforced pursuant to this section shall include
2449criteria by which a reasonable and consistent quality of
2450resident care and quality of life may be ensured and the results
2451of such resident care may be demonstrated. Such rules shall also
2452ensure a safe and sanitary environment that is residential and
2453noninstitutional in design or nature. It is further intended
2454that reasonable efforts be made to accommodate the needs and
2455preferences of residents to enhance the quality of life in a
2456facility. The agency, in consultation with the department, may
2457adopt rules to administer the requirements of part II of chapter
2458408. In order to provide safe and sanitary facilities and the
2459highest quality of resident care accommodating the needs and
2460preferences of residents, the department, in consultation with
2461the agency, the Department of Children and Family Services, and
2462the Department of Health, shall adopt rules, policies, and
2463procedures to administer this part, which must include
2464reasonable and fair minimum standards in relation to:
2465     (i)  Facilities holding an a limited nursing, extended
2466congregate care, or limited mental health license.
2467     (j)  The establishment of specific criteria to define
2468appropriateness of resident admission and continued residency in
2469a facility holding a standard, limited nursing, extended
2470congregate care, and limited mental health license.
2471     Section 73.  Subsections (1) and (2) of section 429.53,
2472Florida Statutes, are amended to read:
2473     429.53  Consultation by the agency.-
2474     (1)  The area offices of licensure and certification of the
2475agency shall provide consultation to the following upon request:
2476     (a)  A licensee of a facility.
2477     (b)  A person interested in obtaining a license to operate
2478a facility under this part.
2479     (2)  As used in this section, "consultation" includes:
2480     (a)  An explanation of the requirements of this part and
2481rules adopted pursuant thereto;
2482     (b)  An explanation of the license application and renewal
2483procedures;
2484     (c)  The provision of a checklist of general local and
2485state approvals required prior to constructing or developing a
2486facility and a listing of the types of agencies responsible for
2487such approvals;
2488     (d)  An explanation of benefits and financial assistance
2489available to a recipient of supplemental security income
2490residing in a facility;
2491     (c)(e)  Any other information which the agency deems
2492necessary to promote compliance with the requirements of this
2493part; and
2494     (f)  A preconstruction review of a facility to ensure
2495compliance with agency rules and this part.
2496     Section 74.  Subsections (1) and (2) of section 429.54,
2497Florida Statutes, are renumbered as subsections (2) and (3),
2498respectively, and a new subsection (1) is added to that section
2499to read:
2500     429.54  Collection of information; local subsidy.-
2501     (1)  A facility that is licensed under this part must
2502report electronically to the agency semiannually data related to
2503the facility, including, but not limited to, the total number of
2504residents, the number of residents who are receiving limited
2505mental health services, the number of residents who are
2506receiving extended congregate care services, the number of
2507residents who are receiving limited nursing services, and
2508professional staffing employed by or under contract with the
2509licensee to provide resident services. The department, in
2510consultation with the agency, shall adopt rules to administer
2511this subsection.
2512     Section 75.  Subsections (1) and (5) of section 429.71,
2513Florida Statutes, are amended to read:
2514     429.71  Classification of violations deficiencies;
2515administrative fines.-
2516     (1)  In addition to the requirements of part II of chapter
2517408 and in addition to any other liability or penalty provided
2518by law, the agency may impose an administrative fine on a
2519provider according to the following classification:
2520     (a)  Class I violations are defined in s. 408.813 those
2521conditions or practices related to the operation and maintenance
2522of an adult family-care home or to the care of residents which
2523the agency determines present an imminent danger to the
2524residents or guests of the facility or a substantial probability
2525that death or serious physical or emotional harm would result
2526therefrom. The condition or practice that constitutes a class I
2527violation must be abated or eliminated within 24 hours, unless a
2528fixed period, as determined by the agency, is required for
2529correction. A class I violation deficiency is subject to an
2530administrative fine in an amount not less than $500 and not
2531exceeding $1,000 for each violation. A fine may be levied
2532notwithstanding the correction of the deficiency.
2533     (b)  Class II violations are defined in s. 408.813 those
2534conditions or practices related to the operation and maintenance
2535of an adult family-care home or to the care of residents which
2536the agency determines directly threaten the physical or
2537emotional health, safety, or security of the residents, other
2538than class I violations. A class II violation is subject to an
2539administrative fine in an amount not less than $250 and not
2540exceeding $500 for each violation. A citation for a class II
2541violation must specify the time within which the violation is
2542required to be corrected. If a class II violation is corrected
2543within the time specified, no civil penalty shall be imposed,
2544unless it is a repeated offense.
2545     (c)  Class III violations are defined in s. 408.813 those
2546conditions or practices related to the operation and maintenance
2547of an adult family-care home or to the care of residents which
2548the agency determines indirectly or potentially threaten the
2549physical or emotional health, safety, or security of residents,
2550other than class I or class II violations. A class III violation
2551is subject to an administrative fine in an amount not less than
2552$100 and not exceeding $250 for each violation. A citation for a
2553class III violation shall specify the time within which the
2554violation is required to be corrected. If a class III violation
2555is corrected within the time specified, no civil penalty shall
2556be imposed, unless it is a repeated violation offense.
2557     (d)  Class IV violations are defined in s. 408.813 those
2558conditions or occurrences related to the operation and
2559maintenance of an adult family-care home, or related to the
2560required reports, forms, or documents, which do not have the
2561potential of negatively affecting the residents. A provider that
2562does not correct A class IV violation within the time limit
2563specified by the agency is subject to an administrative fine in
2564an amount not less than $50 and not exceeding $100 for each
2565violation. Any class IV violation that is corrected during the
2566time the agency survey is conducted will be identified as an
2567agency finding and not as a violation, unless it is a repeat
2568violation.
2569     (5)  As an alternative to or in conjunction with an
2570administrative action against a provider, the agency may request
2571a plan of corrective action that demonstrates a good faith
2572effort to remedy each violation by a specific date, subject to
2573the approval of the agency.
2574     Section 76.  Paragraphs (b) through (e) of subsection (2)
2575of section 429.911, Florida Statutes, are redesignated as
2576paragraphs (a) through (d), respectively, and present paragraph
2577(a) of that subsection is amended to read:
2578     429.911  Denial, suspension, revocation of license;
2579emergency action; administrative fines; investigations and
2580inspections.-
2581     (2)  Each of the following actions by the owner of an adult
2582day care center or by its operator or employee is a ground for
2583action by the agency against the owner of the center or its
2584operator or employee:
2585     (a)  An intentional or negligent act materially affecting
2586the health or safety of center participants.
2587     Section 77.  Section 429.915, Florida Statutes, is amended
2588to read:
2589     429.915  Conditional license.-In addition to the license
2590categories available in part II of chapter 408, the agency may
2591issue a conditional license to an applicant for license renewal
2592or change of ownership if the applicant fails to meet all
2593standards and requirements for licensure. A conditional license
2594issued under this subsection must be limited to a specific
2595period not exceeding 6 months, as determined by the agency, and
2596must be accompanied by an approved plan of correction.
2597     Section 78.  Paragraphs (b) and (h) of subsection (3) of
2598section 430.80, Florida Statutes, are amended to read:
2599     430.80  Implementation of a teaching nursing home pilot
2600project.-
2601     (3)  To be designated as a teaching nursing home, a nursing
2602home licensee must, at a minimum:
2603     (b)  Participate in a nationally recognized accreditation
2604program and hold a valid accreditation, such as the
2605accreditation awarded by The Joint Commission on Accreditation
2606of Healthcare Organizations;
2607     (h)  Maintain insurance coverage pursuant to s.
2608400.141(1)(q)(s) or proof of financial responsibility in a
2609minimum amount of $750,000. Such proof of financial
2610responsibility may include:
2611     1.  Maintaining an escrow account consisting of cash or
2612assets eligible for deposit in accordance with s. 625.52; or
2613     2.  Obtaining and maintaining pursuant to chapter 675 an
2614unexpired, irrevocable, nontransferable and nonassignable letter
2615of credit issued by any bank or savings association organized
2616and existing under the laws of this state or any bank or savings
2617association organized under the laws of the United States that
2618has its principal place of business in this state or has a
2619branch office which is authorized to receive deposits in this
2620state. The letter of credit shall be used to satisfy the
2621obligation of the facility to the claimant upon presentment of a
2622final judgment indicating liability and awarding damages to be
2623paid by the facility or upon presentment of a settlement
2624agreement signed by all parties to the agreement when such final
2625judgment or settlement is a result of a liability claim against
2626the facility.
2627     Section 79.  Paragraph (a) of subsection (2) of section
2628440.13, Florida Statutes, is amended to read:
2629     440.13  Medical services and supplies; penalty for
2630violations; limitations.-
2631     (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2632     (a)  Subject to the limitations specified elsewhere in this
2633chapter, the employer shall furnish to the employee such
2634medically necessary remedial treatment, care, and attendance for
2635such period as the nature of the injury or the process of
2636recovery may require, which is in accordance with established
2637practice parameters and protocols of treatment as provided for
2638in this chapter, including medicines, medical supplies, durable
2639medical equipment, orthoses, prostheses, and other medically
2640necessary apparatus. Remedial treatment, care, and attendance,
2641including work-hardening programs or pain-management programs
2642accredited by the Commission on Accreditation of Rehabilitation
2643Facilities or The Joint Commission on the Accreditation of
2644Health Organizations or pain-management programs affiliated with
2645medical schools, shall be considered as covered treatment only
2646when such care is given based on a referral by a physician as
2647defined in this chapter. Medically necessary treatment, care,
2648and attendance does not include chiropractic services in excess
2649of 24 treatments or rendered 12 weeks beyond the date of the
2650initial chiropractic treatment, whichever comes first, unless
2651the carrier authorizes additional treatment or the employee is
2652catastrophically injured.
2653
2654Failure of the carrier to timely comply with this subsection
2655shall be a violation of this chapter and the carrier shall be
2656subject to penalties as provided for in s. 440.525.
2657     Section 80.  Section 483.294, Florida Statutes, is amended
2658to read:
2659     483.294  Inspection of centers.-In accordance with s.
2660408.811, the agency shall biennially, at least once annually,
2661inspect the premises and operations of all centers subject to
2662licensure under this part.
2663     Section 81.  Paragraph (a) of subsection (53) of section
2664499.003, Florida Statutes, is amended to read:
2665     499.003  Definitions of terms used in this part.-As used in
2666this part, the term:
2667     (53)  "Wholesale distribution" means distribution of
2668prescription drugs to persons other than a consumer or patient,
2669but does not include:
2670     (a)  Any of the following activities, which is not a
2671violation of s. 499.005(21) if such activity is conducted in
2672accordance with s. 499.01(2)(g):
2673     1.  The purchase or other acquisition by a hospital or
2674other health care entity that is a member of a group purchasing
2675organization of a prescription drug for its own use from the
2676group purchasing organization or from other hospitals or health
2677care entities that are members of that organization.
2678     2.  The sale, purchase, or trade of a prescription drug or
2679an offer to sell, purchase, or trade a prescription drug by a
2680charitable organization described in s. 501(c)(3) of the
2681Internal Revenue Code of 1986, as amended and revised, to a
2682nonprofit affiliate of the organization to the extent otherwise
2683permitted by law.
2684     3.  The sale, purchase, or trade of a prescription drug or
2685an offer to sell, purchase, or trade a prescription drug among
2686hospitals or other health care entities that are under common
2687control. For purposes of this subparagraph, "common control"
2688means the power to direct or cause the direction of the
2689management and policies of a person or an organization, whether
2690by ownership of stock, by voting rights, by contract, or
2691otherwise.
2692     4.  The sale, purchase, trade, or other transfer of a
2693prescription drug from or for any federal, state, or local
2694government agency or any entity eligible to purchase
2695prescription drugs at public health services prices pursuant to
2696Pub. L. No. 102-585, s. 602 to a contract provider or its
2697subcontractor for eligible patients of the agency or entity
2698under the following conditions:
2699     a.  The agency or entity must obtain written authorization
2700for the sale, purchase, trade, or other transfer of a
2701prescription drug under this subparagraph from the State Surgeon
2702General or his or her designee.
2703     b.  The contract provider or subcontractor must be
2704authorized by law to administer or dispense prescription drugs.
2705     c.  In the case of a subcontractor, the agency or entity
2706must be a party to and execute the subcontract.
2707     d.  A contract provider or subcontractor must maintain
2708separate and apart from other prescription drug inventory any
2709prescription drugs of the agency or entity in its possession.
2710     d.e.  The contract provider and subcontractor must maintain
2711and produce immediately for inspection all records of movement
2712or transfer of all the prescription drugs belonging to the
2713agency or entity, including, but not limited to, the records of
2714receipt and disposition of prescription drugs. Each contractor
2715and subcontractor dispensing or administering these drugs must
2716maintain and produce records documenting the dispensing or
2717administration. Records that are required to be maintained
2718include, but are not limited to, a perpetual inventory itemizing
2719drugs received and drugs dispensed by prescription number or
2720administered by patient identifier, which must be submitted to
2721the agency or entity quarterly.
2722     e.f.  The contract provider or subcontractor may administer
2723or dispense the prescription drugs only to the eligible patients
2724of the agency or entity or must return the prescription drugs
2725for or to the agency or entity. The contract provider or
2726subcontractor must require proof from each person seeking to
2727fill a prescription or obtain treatment that the person is an
2728eligible patient of the agency or entity and must, at a minimum,
2729maintain a copy of this proof as part of the records of the
2730contractor or subcontractor required under sub-subparagraph d.
2731e.
2732     f.g.  In addition to the departmental inspection authority
2733set forth in s. 499.051, the establishment of the contract
2734provider and subcontractor and all records pertaining to
2735prescription drugs subject to this subparagraph shall be subject
2736to inspection by the agency or entity. All records relating to
2737prescription drugs of a manufacturer under this subparagraph
2738shall be subject to audit by the manufacturer of those drugs,
2739without identifying individual patient information.
2740     Section 82.  Paragraph (i) is added to subsection (3) of
2741section 499.01212, Florida Statutes, to read:
2742     499.01212  Pedigree paper.-
2743     (3)  EXCEPTIONS.-A pedigree paper is not required for:
2744     (i)  The wholesale distribution of prescription drugs
2745contained within a sealed medical convenience kit if the kit:
2746     1.  Is assembled in an establishment that is registered as
2747a medical device manufacturer with the Food and Drug
2748Administration; and
2749     2.  Does not contain any controlled substance that appears
2750in any schedule contained in or subject to chapter 893 or the
2751federal Comprehensive Drug Abuse Prevention and Control Act of
27521970.
2753     Section 83.  Subsection (1) of section 627.645, Florida
2754Statutes, is amended to read:
2755     627.645  Denial of health insurance claims restricted.-
2756     (1)  No claim for payment under a health insurance policy
2757or self-insured program of health benefits for treatment, care,
2758or services in a licensed hospital which is accredited by The
2759Joint Commission on the Accreditation of Hospitals, the American
2760Osteopathic Association, or the Commission on the Accreditation
2761of Rehabilitative Facilities shall be denied because such
2762hospital lacks major surgical facilities and is primarily of a
2763rehabilitative nature, if such rehabilitation is specifically
2764for treatment of physical disability.
2765     Section 84.  Paragraph (c) of subsection (2) of section
2766627.668, Florida Statutes, is amended to read:
2767     627.668  Optional coverage for mental and nervous disorders
2768required; exception.-
2769     (2)  Under group policies or contracts, inpatient hospital
2770benefits, partial hospitalization benefits, and outpatient
2771benefits consisting of durational limits, dollar amounts,
2772deductibles, and coinsurance factors shall not be less favorable
2773than for physical illness generally, except that:
2774     (c)  Partial hospitalization benefits shall be provided
2775under the direction of a licensed physician. For purposes of
2776this part, the term "partial hospitalization services" is
2777defined as those services offered by a program accredited by The
2778Joint Commission on Accreditation of Hospitals (JCAH) or in
2779compliance with equivalent standards. Alcohol rehabilitation
2780programs accredited by The Joint Commission on Accreditation of
2781Hospitals or approved by the state and licensed drug abuse
2782rehabilitation programs shall also be qualified providers under
2783this section. In any benefit year, if partial hospitalization
2784services or a combination of inpatient and partial
2785hospitalization are utilized, the total benefits paid for all
2786such services shall not exceed the cost of 30 days of inpatient
2787hospitalization for psychiatric services, including physician
2788fees, which prevail in the community in which the partial
2789hospitalization services are rendered. If partial
2790hospitalization services benefits are provided beyond the limits
2791set forth in this paragraph, the durational limits, dollar
2792amounts, and coinsurance factors thereof need not be the same as
2793those applicable to physical illness generally.
2794     Section 85.  Subsection (3) of section 627.669, Florida
2795Statutes, is amended to read:
2796     627.669  Optional coverage required for substance abuse
2797impaired persons; exception.-
2798     (3)  The benefits provided under this section shall be
2799applicable only if treatment is provided by, or under the
2800supervision of, or is prescribed by, a licensed physician or
2801licensed psychologist and if services are provided in a program
2802accredited by The Joint Commission on Accreditation of Hospitals
2803or approved by the state.
2804     Section 86.  Paragraph (a) of subsection (1) of section
2805627.736, Florida Statutes, is amended to read:
2806     627.736  Required personal injury protection benefits;
2807exclusions; priority; claims.-
2808     (1)  REQUIRED BENEFITS.-Every insurance policy complying
2809with the security requirements of s. 627.733 shall provide
2810personal injury protection to the named insured, relatives
2811residing in the same household, persons operating the insured
2812motor vehicle, passengers in such motor vehicle, and other
2813persons struck by such motor vehicle and suffering bodily injury
2814while not an occupant of a self-propelled vehicle, subject to
2815the provisions of subsection (2) and paragraph (4)(e), to a
2816limit of $10,000 for loss sustained by any such person as a
2817result of bodily injury, sickness, disease, or death arising out
2818of the ownership, maintenance, or use of a motor vehicle as
2819follows:
2820     (a)  Medical benefits.-Eighty percent of all reasonable
2821expenses for medically necessary medical, surgical, X-ray,
2822dental, and rehabilitative services, including prosthetic
2823devices, and medically necessary ambulance, hospital, and
2824nursing services. However, the medical benefits shall provide
2825reimbursement only for such services and care that are lawfully
2826provided, supervised, ordered, or prescribed by a physician
2827licensed under chapter 458 or chapter 459, a dentist licensed
2828under chapter 466, or a chiropractic physician licensed under
2829chapter 460 or that are provided by any of the following persons
2830or entities:
2831     1.  A hospital or ambulatory surgical center licensed under
2832chapter 395.
2833     2.  A person or entity licensed under ss. 401.2101-401.45
2834that provides emergency transportation and treatment.
2835     3.  An entity wholly owned by one or more physicians
2836licensed under chapter 458 or chapter 459, chiropractic
2837physicians licensed under chapter 460, or dentists licensed
2838under chapter 466 or by such practitioner or practitioners and
2839the spouse, parent, child, or sibling of that practitioner or
2840those practitioners.
2841     4.  An entity wholly owned, directly or indirectly, by a
2842hospital or hospitals.
2843     5.  A health care clinic licensed under ss. 400.990-400.995
2844that is:
2845     a.  Accredited by The Joint Commission on Accreditation of
2846Healthcare Organizations, the American Osteopathic Association,
2847the Commission on Accreditation of Rehabilitation Facilities, or
2848the Accreditation Association for Ambulatory Health Care, Inc.;
2849or
2850     b.  A health care clinic that:
2851     (I)  Has a medical director licensed under chapter 458,
2852chapter 459, or chapter 460;
2853     (II)  Has been continuously licensed for more than 3 years
2854or is a publicly traded corporation that issues securities
2855traded on an exchange registered with the United States
2856Securities and Exchange Commission as a national securities
2857exchange; and
2858     (III)  Provides at least four of the following medical
2859specialties:
2860     (A)  General medicine.
2861     (B)  Radiography.
2862     (C)  Orthopedic medicine.
2863     (D)  Physical medicine.
2864     (E)  Physical therapy.
2865     (F)  Physical rehabilitation.
2866     (G)  Prescribing or dispensing outpatient prescription
2867medication.
2868     (H)  Laboratory services.
2869
2870The Financial Services Commission shall adopt by rule the form
2871that must be used by an insurer and a health care provider
2872specified in subparagraph 3., subparagraph 4., or subparagraph
28735. to document that the health care provider meets the criteria
2874of this paragraph, which rule must include a requirement for a
2875sworn statement or affidavit.
2876
2877Only insurers writing motor vehicle liability insurance in this
2878state may provide the required benefits of this section, and no
2879such insurer shall require the purchase of any other motor
2880vehicle coverage other than the purchase of property damage
2881liability coverage as required by s. 627.7275 as a condition for
2882providing such required benefits. Insurers may not require that
2883property damage liability insurance in an amount greater than
2884$10,000 be purchased in conjunction with personal injury
2885protection. Such insurers shall make benefits and required
2886property damage liability insurance coverage available through
2887normal marketing channels. Any insurer writing motor vehicle
2888liability insurance in this state who fails to comply with such
2889availability requirement as a general business practice shall be
2890deemed to have violated part IX of chapter 626, and such
2891violation shall constitute an unfair method of competition or an
2892unfair or deceptive act or practice involving the business of
2893insurance; and any such insurer committing such violation shall
2894be subject to the penalties afforded in such part, as well as
2895those which may be afforded elsewhere in the insurance code.
2896     Section 87.  Section 633.081, Florida Statutes, is amended
2897to read:
2898     633.081  Inspection of buildings and equipment; orders;
2899firesafety inspection training requirements; certification;
2900disciplinary action.-The State Fire Marshal and her or his
2901agents shall, at any reasonable hour, when the department has
2902reasonable cause to believe that a violation of this chapter or
2903s. 509.215, or a rule promulgated thereunder, or a minimum
2904firesafety code adopted by a local authority, may exist, inspect
2905any and all buildings and structures which are subject to the
2906requirements of this chapter or s. 509.215 and rules promulgated
2907thereunder. The authority to inspect shall extend to all
2908equipment, vehicles, and chemicals which are located within the
2909premises of any such building or structure. The State Fire
2910Marshal and her or his agents shall inspect nursing homes
2911licensed under part II of chapter 400 only once every calendar
2912year and upon receiving a complaint forming the basis of a
2913reasonable cause to believe that a violation of this chapter or
2914s. 509.215, or a rule promulgated thereunder, or a minimum
2915firesafety code adopted by a local authority may exist and upon
2916identifying such a violation in the course of conducting
2917orientation or training activities within a nursing home.
2918     (1)  Each county, municipality, and special district that
2919has firesafety enforcement responsibilities shall employ or
2920contract with a firesafety inspector. The firesafety inspector
2921must conduct all firesafety inspections that are required by
2922law. The governing body of a county, municipality, or special
2923district that has firesafety enforcement responsibilities may
2924provide a schedule of fees to pay only the costs of inspections
2925conducted pursuant to this subsection and related administrative
2926expenses. Two or more counties, municipalities, or special
2927districts that have firesafety enforcement responsibilities may
2928jointly employ or contract with a firesafety inspector.
2929     (2)  Every firesafety inspection conducted pursuant to
2930state or local firesafety requirements shall be by a person
2931certified as having met the inspection training requirements set
2932by the State Fire Marshal. Such person shall:
2933     (a)  Be a high school graduate or the equivalent as
2934determined by the department;
2935     (b)  Not have been found guilty of, or having pleaded
2936guilty or nolo contendere to, a felony or a crime punishable by
2937imprisonment of 1 year or more under the law of the United
2938States, or of any state thereof, which involves moral turpitude,
2939without regard to whether a judgment of conviction has been
2940entered by the court having jurisdiction of such cases;
2941     (c)  Have her or his fingerprints on file with the
2942department or with an agency designated by the department;
2943     (d)  Have good moral character as determined by the
2944department;
2945     (e)  Be at least 18 years of age;
2946     (f)  Have satisfactorily completed the firesafety inspector
2947certification examination as prescribed by the department; and
2948     (g)1.  Have satisfactorily completed, as determined by the
2949department, a firesafety inspector training program of not less
2950than 200 hours established by the department and administered by
2951agencies and institutions approved by the department for the
2952purpose of providing basic certification training for firesafety
2953inspectors; or
2954     2.  Have received in another state training which is
2955determined by the department to be at least equivalent to that
2956required by the department for approved firesafety inspector
2957education and training programs in this state.
2958     (3)  Each special state firesafety inspection which is
2959required by law and is conducted by or on behalf of an agency of
2960the state must be performed by an individual who has met the
2961provision of subsection (2), except that the duration of the
2962training program shall not exceed 120 hours of specific training
2963for the type of property that such special state firesafety
2964inspectors are assigned to inspect.
2965     (4)  A firefighter certified pursuant to s. 633.35 may
2966conduct firesafety inspections, under the supervision of a
2967certified firesafety inspector, while on duty as a member of a
2968fire department company conducting inservice firesafety
2969inspections without being certified as a firesafety inspector,
2970if such firefighter has satisfactorily completed an inservice
2971fire department company inspector training program of at least
297224 hours' duration as provided by rule of the department.
2973     (5)  Every firesafety inspector or special state firesafety
2974inspector certificate is valid for a period of 3 years from the
2975date of issuance. Renewal of certification shall be subject to
2976the affected person's completing proper application for renewal
2977and meeting all of the requirements for renewal as established
2978under this chapter or by rule promulgated thereunder, which
2979shall include completion of at least 40 hours during the
2980preceding 3-year period of continuing education as required by
2981the rule of the department or, in lieu thereof, successful
2982passage of an examination as established by the department.
2983     (6)  The State Fire Marshal may deny, refuse to renew,
2984suspend, or revoke the certificate of a firesafety inspector or
2985special state firesafety inspector if it finds that any of the
2986following grounds exist:
2987     (a)  Any cause for which issuance of a certificate could
2988have been refused had it then existed and been known to the
2989State Fire Marshal.
2990     (b)  Violation of this chapter or any rule or order of the
2991State Fire Marshal.
2992     (c)  Falsification of records relating to the certificate.
2993     (d)  Having been found guilty of or having pleaded guilty
2994or nolo contendere to a felony, whether or not a judgment of
2995conviction has been entered.
2996     (e)  Failure to meet any of the renewal requirements.
2997     (f)  Having been convicted of a crime in any jurisdiction
2998which directly relates to the practice of fire code inspection,
2999plan review, or administration.
3000     (g)  Making or filing a report or record that the
3001certificateholder knows to be false, or knowingly inducing
3002another to file a false report or record, or knowingly failing
3003to file a report or record required by state or local law, or
3004knowingly impeding or obstructing such filing, or knowingly
3005inducing another person to impede or obstruct such filing.
3006     (h)  Failing to properly enforce applicable fire codes or
3007permit requirements within this state which the
3008certificateholder knows are applicable by committing willful
3009misconduct, gross negligence, gross misconduct, repeated
3010negligence, or negligence resulting in a significant danger to
3011life or property.
3012     (i)  Accepting labor, services, or materials at no charge
3013or at a noncompetitive rate from any person who performs work
3014that is under the enforcement authority of the certificateholder
3015and who is not an immediate family member of the
3016certificateholder. For the purpose of this paragraph, the term
3017"immediate family member" means a spouse, child, parent,
3018sibling, grandparent, aunt, uncle, or first cousin of the person
3019or the person's spouse or any person who resides in the primary
3020residence of the certificateholder.
3021     (7)  The department shall provide by rule for the
3022certification of firesafety inspectors.
3023     Section 88.  Subsection (12) of section 641.495, Florida
3024Statutes, is amended to read:
3025     641.495  Requirements for issuance and maintenance of
3026certificate.-
3027     (12)  The provisions of part I of chapter 395 do not apply
3028to a health maintenance organization that, on or before January
30291, 1991, provides not more than 10 outpatient holding beds for
3030short-term and hospice-type patients in an ambulatory care
3031facility for its members, provided that such health maintenance
3032organization maintains current accreditation by The Joint
3033Commission on Accreditation of Health Care Organizations, the
3034Accreditation Association for Ambulatory Health Care, or the
3035National Committee for Quality Assurance.
3036     Section 89.  Subsection (13) of section 651.118, Florida
3037Statutes, is amended to read:
3038     651.118  Agency for Health Care Administration;
3039certificates of need; sheltered beds; community beds.-
3040     (13)  Residents, as defined in this chapter, are not
3041considered new admissions for the purpose of s.
3042400.141(1)(n)(o)1.d.
3043     Section 90.  Subsection (2) of section 766.1015, Florida
3044Statutes, is amended to read:
3045     766.1015  Civil immunity for members of or consultants to
3046certain boards, committees, or other entities.-
3047     (2)  Such committee, board, group, commission, or other
3048entity must be established in accordance with state law or in
3049accordance with requirements of The Joint Commission on
3050Accreditation of Healthcare Organizations, established and duly
3051constituted by one or more public or licensed private hospitals
3052or behavioral health agencies, or established by a governmental
3053agency. To be protected by this section, the act, decision,
3054omission, or utterance may not be made or done in bad faith or
3055with malicious intent.
3056     Section 91.  Subsection (4) of section 766.202, Florida
3057Statutes, is amended to read:
3058     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3059766.201-766.212, the term:
3060     (4)  "Health care provider" means any hospital, ambulatory
3061surgical center, or mobile surgical facility as defined and
3062licensed under chapter 395; a birth center licensed under
3063chapter 383; any person licensed under chapter 458, chapter 459,
3064chapter 460, chapter 461, chapter 462, chapter 463, part I of
3065chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3066or chapter 486; a clinical lab licensed under chapter 483; a
3067health maintenance organization certificated under part I of
3068chapter 641; a blood bank; a plasma center; an industrial
3069clinic; a renal dialysis facility; or a professional association
3070partnership, corporation, joint venture, or other association
3071for professional activity by health care providers.
3072     Section 92.  This act shall take effect July 1, 2010.


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