CS/CS/CS/HB 1143

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.
8381.00315, F.S.; directing the Department of Health to
9accept funds from counties, municipalities, and certain
10other entities for the purchase of certain products made
11available under a contract of the United States Department
12of Health and Human Services for the manufacture and
13delivery of such products in response to a public health
14emergency; amending s. 381.0072, F.S.; limiting Department
15of Health food service inspections in nursing homes;
16requiring the department to coordinate inspections with
17the Agency for Health Care Administration; repealing s.
18383.325, F.S., relating to confidentiality of inspection
19reports of licensed birth center facilities; amending s.
20395.002, F.S.; revising and deleting definitions
21applicable to regulation of hospitals and other licensed
22facilities; conforming a cross-reference; amending s.
23395.003, F.S.; deleting an obsolete provision; conforming
24a cross-reference; amending s. 395.0193, F.S.; requiring a
25licensed facility to report certain peer review
26information and final disciplinary actions to the Division
27of Medical Quality Assurance of the Department of Health
28rather than the Division of Health Quality Assurance of
29the Agency for Health Care Administration; amending s.
30395.1023, F.S.; providing for the Department of Children
31and Family Services rather than the Department of Health
32to perform certain functions with respect to child
33protection cases; requiring certain hospitals to notify
34the Department of Children and Family Services of
35compliance; amending s. 395.1041, F.S., relating to
36hospital emergency services and care; deleting obsolete
37provisions; repealing s. 395.1046, F.S., relating to
38complaint investigation procedures; amending s. 395.1055,
39F.S.; requiring licensed facility beds to conform to
40standards specified by the Agency for Health Care
41Administration, the Florida Building Code, and the Florida
42Fire Prevention Code; amending s. 395.10972, F.S.;
43revising a reference to the Florida Society of Healthcare
44Risk Management to conform to the current designation;
45amending s. 395.2050, F.S.; revising a reference to the
46federal Health Care Financing Administration to conform to
47the current designation; amending s. 395.3036, F.S.;
48correcting a reference; repealing s. 395.3037, F.S.,
49relating to redundant definitions; amending ss. 154.11,
50394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
51627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
52F.S.; revising references to the Joint Commission on
53Accreditation of Healthcare Organizations, the Commission
54on Accreditation of Rehabilitation Facilities, and the
55Council on Accreditation to conform to their current
56designations; amending s. 395.602, F.S.; revising the
57definition of the term "rural hospital" to delete an
58obsolete provision; amending s. 400.021, F.S.; revising
59the definition of the term "geriatric outpatient clinic";
60amending s. 400.063, F.S.; deleting an obsolete provision;
61amending ss. 400.071 and 400.0712, F.S.; revising
62applicability of general licensure requirements under pt.
63II of ch. 408, F.S., to applications for nursing home
64licensure; revising provisions governing inactive
65licenses; amending s. 400.111, F.S.; providing for
66disclosure of controlling interest of a nursing home
67facility upon request by the Agency for Health Care
68Administration; amending s. 400.1183, F.S.; revising
69grievance record maintenance and reporting requirements
70for nursing homes; amending s. 400.141, F.S.; providing
71criteria for the provision of respite services by nursing
72homes; requiring a written plan of care; requiring a
73contract for services; requiring resident release to
74caregivers to be designated in writing; providing an
75exemption to the application of discharge planning rules;
76providing for residents' rights; providing for use of
77personal medications; providing terms of respite stay;
78providing for communication of patient information;
79requiring a physician order for care and proof of a
80physical examination; providing for services for respite
81patients and duties of facilities with respect to such
82patients; conforming a cross-reference; requiring
83facilities to maintain clinical records that meet
84specified standards; providing a fine relating to an
85admissions moratorium; deleting requirement for facilities
86to submit certain information related to management
87companies to the agency; deleting a requirement for
88facilities to notify the agency of certain bankruptcy
89filings to conform to changes made by the act; amending s.
90400.142, F.S.; deleting language relating to agency
91adoption of rules; amending 400.147, F.S.; revising
92reporting requirements for licensed nursing home
93facilities relating to adverse incidents; repealing s.
94400.148, F.S., relating to the Medicaid "Up-or-Out"
95Quality of Care Contract Management Program; amending s.
96400.162, F.S., requiring nursing homes to provide a
97resident property statement annually and upon request;
98amending s. 400.179, F.S.; revising requirements for
99nursing home lease bond alternative fees; deleting an
100obsolete provision; amending s. 400.19, F.S.; revising
101inspection requirements; repealing s. 400.195, F.S.,
102relating to agency reporting requirements; amending s.
103400.23, F.S.; deleting an obsolete provision; correcting a
104reference; directing the agency to adopt rules for minimum
105staffing standards in nursing homes that serve persons
106under 21 years of age; providing minimum staffing
107standards; amending s. 400.275, F.S.; revising agency
108duties with regard to training nursing home surveyor
109teams; revising requirements for team members; amending s.
110400.484, F.S.; revising the schedule of home health agency
111inspection violations; amending s. 400.606, F.S.; revising
112the content requirements of the plan accompanying an
113initial or change-of-ownership application for licensure
114of a hospice; revising requirements relating to
115certificates of need for certain hospice facilities;
116amending s. 400.607, F.S.; revising grounds for agency
117action against a hospice; amending s. 400.931, F.S.;
118deleting a requirement that an applicant for a home
119medical equipment provider license submit a surety bond to
120the agency; amending s. 400.932, F.S.; revising grounds
121for the imposition of administrative penalties for certain
122violations by an employee of a home medical equipment
123provider; amending s. 400.967, F.S.; revising the schedule
124of inspection violations for intermediate care facilities
125for the developmentally disabled; providing a penalty for
126certain violations; amending s. 400.9905, F.S.; providing
127that pt. X of ch, 400, F.S., the Health Care Clinic Act,
128does not apply to an entity owned by a corporation with a
129specified amount of annual sales of health care services
130under certain circumstances or to an entity owned or
131controlled by a publicly traded entity with a specified
132amount of annual revenues; amending s. 400.991, F.S.;
133conforming terminology; revising application requirements
134relating to documentation of financial ability to operate
135a mobile clinic; amending s. 408.034, F.S.; revising
136agency authority relating to licensing of intermediate
137care facilities for the developmentally disabled; amending
138s. 408.036, F.S.; deleting an exemption from certain
139certificate-of-need review requirements for a hospice or a
140hospice inpatient facility; amending s. 408.043, F.S.;
141revising requirements for certain freestanding inpatient
142hospice care facilities to obtain a certificate of need;
143amending s. 408.061, F.S.; revising health care facility
144data reporting requirements; amending s. 408.10, F.S.;
145removing agency authority to investigate certain consumer
146complaints; amending s. 408.802, F.S.; removing
147applicability of pt. II of ch. 408, F.S., relating to
148general licensure requirements, to private review agents;
149amending s. 408.804, F.S.; providing penalties for
150altering, defacing, or falsifying a license certificate
151issued by the agency or displaying such an altered,
152defaced, or falsified certificate; amending s. 408.806,
153F.S.; revising agency responsibilities for notification of
154licensees of impending expiration of a license; requiring
155payment of a late fee for a license application to be
156considered complete under certain circumstances; amending
157s. 408.810, F.S.; revising provisions relating to
158information required for licensure; requiring proof of
159submission of notice to a mortgagor or landlord regarding
160provision of services requiring licensure; requiring
161disclosure of information by a controlling interest of
162certain court actions relating to financial instability
163within a specified time period; amending s. 408.813, F.S.;
164authorizing the agency to impose fines for unclassified
165violations of pt. II of ch. 408, F.S.; amending s.
166408.815, F.S.; authorizing the agency to extend a license
167expiration date under certain circumstances; amending s.
168409.221, F.S.; deleting a reporting requirement relating
169to the consumer-directed care program; amending s.
170409.91196, F.S.; conforming a cross-reference; amending s.
171409.912, F.S.; revising procedures for implementation of a
172Medicaid prescribed-drug spending-control program;
173amending s. 429.07, F.S.; deleting the requirement for an
174assisted living facility to obtain an additional license
175in order to provide limited nursing services; deleting the
176requirement for the agency to conduct quarterly monitoring
177visits of facilities that hold a license to provide
178extended congregate care services; deleting the
179requirement for the department to report annually on the
180status of and recommendations related to extended
181congregate care; deleting the requirement for the agency
182to conduct monitoring visits at least twice a year to
183facilities providing limited nursing services; increasing
184the licensure fees and the maximum fee required for the
185standard license; increasing the licensure fees for the
186extended congregate care license; eliminating the license
187fee for the limited nursing services license; transferring
188from another provision of law the requirement that a
189biennial survey of an assisted living facility include
190specific actions to determine whether the facility is
191adequately protecting residents' rights; providing that an
192assisted living facility that has a class I or class II
193violation is subject to monitoring visits; requiring a
194registered nurse to participate in certain monitoring
195visits; amending s. 429.11, F.S.; revising licensure
196application requirements for assisted living facilities to
197eliminate provisional licenses; amending s. 429.12, F.S.;
198revising notification requirements for the sale or
199transfer of ownership of an assisted living facility;
200amending s. 429.14, F.S.; removing a ground for the
201imposition of an administrative penalty; clarifying
202language relating to a facility's request for a hearing
203under certain circumstances; authorizing the agency to
204provide certain information relating to the licensure
205status of assisted living facilities electronically or
206through the agency's Internet website; amending s. 429.17,
207F.S.; deleting provisions relating to the limited nursing
208services license; revising agency responsibilities
209regarding the issuance of conditional licenses; amending
210s. 429.19, F.S.; clarifying that a monitoring fee may be
211assessed in addition to an administrative fine; amending
212s. 429.23, F.S.; deleting reporting requirements for
213assisted living facilities relating to liability claims;
214amending s. 429.255, F.S.; eliminating provisions
215authorizing the use of volunteers to provide certain
216health-care-related services in assisted living
217facilities; authorizing assisted living facilities to
218provide limited nursing services; requiring an assisted
219living facility to be responsible for certain
220recordkeeping and staff to be trained to monitor residents
221receiving certain health-care-related services; amending
222s. 429.28, F.S.; deleting a requirement for a biennial
223survey of an assisted living facility, to conform to
224changes made by the act; amending s. 429.35, F.S.;
225authorizing the agency to provide certain information
226relating to the inspections of assisted living facilities
227electronically or through the agency's Internet website;
228amending s. 429.41, F.S., relating to rulemaking;
229conforming provisions to changes made by the act; amending
230s. 429.53, F.S.; revising provisions relating to
231consultation by the agency; revising a definition;
232amending s. 429.54, F.S.; requiring licensed assisted
233living facilities to electronically report certain data
234semiannually to the agency in accordance with rules
235adopted by the department; amending s. 429.71, F.S.;
236revising schedule of inspection violations for adult
237family-care homes; amending s. 429.911, F.S.; deleting a
238ground for agency action against an adult day care center;
239amending s. 429.915, F.S.; revising agency
240responsibilities regarding the issuance of conditional
241licenses; amending s. 483.294, F.S.; revising frequency of
242agency inspections of multiphasic health testing centers;
243amending s. 499.003, F.S.; removing a requirement that
244certain prescription drug purchasers maintain a separate
245inventory of certain prescription drugs; amending s.
246499.01212, F.S.; exempting prescription drugs contained in
247sealed medical convenience kits from the pedigree paper
248requirements under specified circumstances; amending s.
249633.081, F.S.; limiting Fire Marshal inspections of
250nursing homes to once a year; providing for additional
251inspections based on complaints and violations identified
252in the course of orientation or training activities;
253amending s. 766.202, F.S.; adding persons licensed under
254pt. XIV of ch. 468, F.S., to the definition of "health
255care provider"; amending ss. 394.4787, 400.0239, 408.07,
256430.80, and 651.118, F.S.; conforming terminology and
257cross-references; revising a reference; providing an
258effective date.
260Be It Enacted by the Legislature of the State of Florida:
262     Section 1.  Present paragraph (e) of subsection (10) and
263paragraph (e) of subsection (14) of section 112.0455, Florida
264Statutes, are amended, and paragraphs (f) through (k) of
265subsection (10) of that section are redesignated as paragraphs
266(e) through (j), respectively, to read:
267     112.0455  Drug-Free Workplace Act.-
269     (e)  Nothing in this section shall be construed to operate
270retroactively, and nothing in this section shall abrogate the
271right of an employer under state law to conduct drug tests prior
272to January 1, 1990. A drug test conducted by an employer prior
273to January 1, 1990, is not subject to this section.
275     (e)  Upon resolving an appeal filed pursuant to paragraph
276(c), and finding a violation of this section, the commission may
277order the following relief:
278     1.  Rescind the disciplinary action, expunge related
279records from the personnel file of the employee or job applicant
280and reinstate the employee.
281     2.  Order compliance with paragraph (10)(f)(g).
282     3.  Award back pay and benefits.
283     4.  Award the prevailing employee or job applicant the
284necessary costs of the appeal, reasonable attorney's fees, and
285expert witness fees.
286     Section 2.  Paragraph (n) of subsection (1) of section
287154.11, Florida Statutes, is amended to read:
288     154.11  Powers of board of trustees.-
289     (1)  The board of trustees of each public health trust
290shall be deemed to exercise a public and essential governmental
291function of both the state and the county and in furtherance
292thereof it shall, subject to limitation by the governing body of
293the county in which such board is located, have all of the
294powers necessary or convenient to carry out the operation and
295governance of designated health care facilities, including, but
296without limiting the generality of, the foregoing:
297     (n)  To appoint originally the staff of physicians to
298practice in any designated facility owned or operated by the
299board and to approve the bylaws and rules to be adopted by the
300medical staff of any designated facility owned and operated by
301the board, such governing regulations to be in accordance with
302the standards of The Joint Commission on the Accreditation of
303Hospitals which provide, among other things, for the method of
304appointing additional staff members and for the removal of staff
306     Section 3.  Subsection (15) of section 318.21, Florida
307Statutes, is amended to read:
308     318.21  Disposition of civil penalties by county courts.-
309All civil penalties received by a county court pursuant to the
310provisions of this chapter shall be distributed and paid monthly
311as follows:
312     (15)  Of the additional fine assessed under s. 318.18(3)(e)
313for a violation of s. 316.1893, 50 percent of the moneys
314received from the fines shall be remitted to the Department of
315Revenue and deposited into the Brain and Spinal Cord Injury
316Trust Fund of Department of Health and shall be appropriated to
317the Department of Health Agency for Health Care Administration
318as general revenue to provide an enhanced Medicaid payment to
319nursing homes that serve Medicaid recipients with spinal cord
320injuries that are medically complex and who are technologically
321and respiratory dependent with brain and spinal cord injuries.
322The remaining 50 percent of the moneys received from the
323enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
324the Department of Revenue and deposited into the Department of
325Health Administrative Trust Fund to provide financial support to
326certified trauma centers in the counties where enhanced penalty
327zones are established to ensure the availability and
328accessibility of trauma services. Funds deposited into the
329Administrative Trust Fund under this subsection shall be
330allocated as follows:
331     (a)  Fifty percent shall be allocated equally among all
332Level I, Level II, and pediatric trauma centers in recognition
333of readiness costs for maintaining trauma services.
334     (b)  Fifty percent shall be allocated among Level I, Level
335II, and pediatric trauma centers based on each center's relative
336volume of trauma cases as reported in the Department of Health
337Trauma Registry.
338     Section 4.  Subsection (3) is added to section 381.00315,
339Florida Statutes, to read:
340     381.00315  Public health advisories; public health
341emergencies.-The State Health Officer is responsible for
342declaring public health emergencies and issuing public health
344     (3)  To facilitate effective emergency management, when the
345United States Department of Health and Human Services contracts
346for the manufacture and delivery of licensable products in
347response to a public health emergency and the terms of those
348contracts are made available to the states, the department shall
349accept funds provided by counties, municipalities, and other
350entities designated in the state emergency management plan
351required under s. 252.35(2)(a) for the purpose of participation
352in such contracts. The department shall deposit the funds into
353the Grants and Donations Trust Fund and expend the funds on
354behalf of the donor county, municipality, or other entity for
355the purchase the licensable products made available under the
357     Section 5.  Paragraph (e) is added to subsection (2) of
358section 381.0072, Florida Statutes, to read:
359     381.0072  Food service protection.-It shall be the duty of
360the Department of Health to adopt and enforce sanitation rules
361consistent with law to ensure the protection of the public from
362food-borne illness. These rules shall provide the standards and
363requirements for the storage, preparation, serving, or display
364of food in food service establishments as defined in this
365section and which are not permitted or licensed under chapter
366500 or chapter 509.
367     (2)  DUTIES.-
368     (e)  The department shall inspect food service
369establishments in nursing homes licensed under part II of
370chapter 400 twice each year. The department may make additional
371inspections only in response to complaints. The department shall
372coordinate inspections with the Agency for Health Care
373Administration, such that the department's inspection is at
374least 60 days after a recertification visit by the Agency for
375Health Care Administration.
376     Section 6.  Section 383.325, Florida Statutes, is repealed.
377     Section 7.  Subsection (7) of section 394.4787, Florida
378Statutes, is amended to read:
379     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
380and 394.4789.-As used in this section and ss. 394.4786,
381394.4788, and 394.4789:
382     (7)  "Specialty psychiatric hospital" means a hospital
383licensed by the agency pursuant to s. 395.002(26)(28) and part
384II of chapter 408 as a specialty psychiatric hospital.
385     Section 8.  Subsection (2) of section 394.741, Florida
386Statutes, is amended to read:
387     394.741  Accreditation requirements for providers of
388behavioral health care services.-
389     (2)  Notwithstanding any provision of law to the contrary,
390accreditation shall be accepted by the agency and department in
391lieu of the agency's and department's facility licensure onsite
392review requirements and shall be accepted as a substitute for
393the department's administrative and program monitoring
394requirements, except as required by subsections (3) and (4),
396     (a)  Any organization from which the department purchases
397behavioral health care services that is accredited by The Joint
398Commission on Accreditation of Healthcare Organizations or the
399Council on Accreditation for Children and Family Services, or
400has those services that are being purchased by the department
401accredited by the Commission on Accreditation of Rehabilitation
402Facilities CARF-the Rehabilitation Accreditation Commission.
403     (b)  Any mental health facility licensed by the agency or
404any substance abuse component licensed by the department that is
405accredited by The Joint Commission on Accreditation of
406Healthcare Organizations, the Commission on Accreditation of
407Rehabilitation Facilities CARF-the Rehabilitation Accreditation
408Commission, or the Council on Accreditation of Children and
409Family Services.
410     (c)  Any network of providers from which the department or
411the agency purchases behavioral health care services accredited
412by The Joint Commission on Accreditation of Healthcare
413Organizations, the Commission on Accreditation of Rehabilitation
414Facilities CARF-the Rehabilitation Accreditation Commission, the
415Council on Accreditation of Children and Family Services, or the
416National Committee for Quality Assurance. A provider
417organization, which is part of an accredited network, is
418afforded the same rights under this part.
419     Section 9.  Present subsections (15) through (32) of
420section 395.002, Florida Statutes, are renumbered as subsections
421(14) through (28), respectively, and present subsections (1),
422(14), (24), (30), and (31), and paragraph (c) of present
423subsection (28) of that section are amended to read:
424     395.002  Definitions.-As used in this chapter:
425     (1)  "Accrediting organizations" means nationally
426recognized or approved accrediting organizations whose standards
427incorporate comparable licensure requirements as determined by
428the agency the Joint Commission on Accreditation of Healthcare
429Organizations, the American Osteopathic Association, the
430Commission on Accreditation of Rehabilitation Facilities, and
431the Accreditation Association for Ambulatory Health Care, Inc.
432     (14)  "Initial denial determination" means a determination
433by a private review agent that the health care services
434furnished or proposed to be furnished to a patient are
435inappropriate, not medically necessary, or not reasonable.
436     (24)  "Private review agent" means any person or entity
437which performs utilization review services for third-party
438payors on a contractual basis for outpatient or inpatient
439services. However, the term shall not include full-time
440employees, personnel, or staff of health insurers, health
441maintenance organizations, or hospitals, or wholly owned
442subsidiaries thereof or affiliates under common ownership, when
443performing utilization review for their respective hospitals,
444health maintenance organizations, or insureds of the same
445insurance group. For this purpose, health insurers, health
446maintenance organizations, and hospitals, or wholly owned
447subsidiaries thereof or affiliates under common ownership,
448include such entities engaged as administrators of self-
449insurance as defined in s. 624.031.
450     (26)(28)  "Specialty hospital" means any facility which
451meets the provisions of subsection (12), and which regularly
452makes available either:
453     (c)  Intensive residential treatment programs for children
454and adolescents as defined in subsection (14) (15).
455     (30)  "Utilization review" means a system for reviewing the
456medical necessity or appropriateness in the allocation of health
457care resources of hospital services given or proposed to be
458given to a patient or group of patients.
459     (31)  "Utilization review plan" means a description of the
460policies and procedures governing utilization review activities
461performed by a private review agent.
462     Section 10.  Paragraph (c) of subsection (1) and paragraph
463(b) of subsection (2) of section 395.003, Florida Statutes, are
464amended to read:
465     395.003  Licensure; denial, suspension, and revocation.-
466     (1)
467     (c)  Until July 1, 2006, additional emergency departments
468located off the premises of licensed hospitals may not be
469authorized by the agency.
470     (2)
471     (b)  The agency shall, at the request of a licensee that is
472a teaching hospital as defined in s. 408.07(45), issue a single
473license to a licensee for facilities that have been previously
474licensed as separate premises, provided such separately licensed
475facilities, taken together, constitute the same premises as
476defined in s. 395.002(22)(23). Such license for the single
477premises shall include all of the beds, services, and programs
478that were previously included on the licenses for the separate
479premises. The granting of a single license under this paragraph
480shall not in any manner reduce the number of beds, services, or
481programs operated by the licensee.
482     Section 11.  Paragraph (e) of subsection (2) and subsection
483(4) of section 395.0193, Florida Statutes, are amended to read:
484     395.0193  Licensed facilities; peer review; disciplinary
485powers; agency or partnership with physicians.-
486     (2)  Each licensed facility, as a condition of licensure,
487shall provide for peer review of physicians who deliver health
488care services at the facility. Each licensed facility shall
489develop written, binding procedures by which such peer review
490shall be conducted. Such procedures shall include:
491     (e)  Recording of agendas and minutes which do not contain
492confidential material, for review by the Division of Medical
493Quality Assurance of the department Health Quality Assurance of
494the agency.
495     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
496actions taken under subsection (3) shall be reported in writing
497to the Division of Medical Quality Assurance of the department
498Health Quality Assurance of the agency within 30 working days
499after its initial occurrence, regardless of the pendency of
500appeals to the governing board of the hospital. The notification
501shall identify the disciplined practitioner, the action taken,
502and the reason for such action. All final disciplinary actions
503taken under subsection (3), if different from those which were
504reported to the department agency within 30 days after the
505initial occurrence, shall be reported within 10 working days to
506the Division of Medical Quality Assurance of the department
507Health Quality Assurance of the agency in writing and shall
508specify the disciplinary action taken and the specific grounds
509therefor. The division shall review each report and determine
510whether it potentially involved conduct by the licensee that is
511subject to disciplinary action, in which case s. 456.073 shall
512apply. The reports are not subject to inspection under s.
513119.07(1) even if the division's investigation results in a
514finding of probable cause.
515     Section 12.  Section 395.1023, Florida Statutes, is amended
516to read:
517     395.1023  Child abuse and neglect cases; duties.-Each
518licensed facility shall adopt a protocol that, at a minimum,
519requires the facility to:
520     (1)  Incorporate a facility policy that every staff member
521has an affirmative duty to report, pursuant to chapter 39, any
522actual or suspected case of child abuse, abandonment, or
523neglect; and
524     (2)  In any case involving suspected child abuse,
525abandonment, or neglect, designate, at the request of the
526Department of Children and Family Services, a staff physician to
527act as a liaison between the hospital and the Department of
528Children and Family Services office which is investigating the
529suspected abuse, abandonment, or neglect, and the child
530protection team, as defined in s. 39.01, when the case is
531referred to such a team.
533Each general hospital and appropriate specialty hospital shall
534comply with the provisions of this section and shall notify the
535agency and the Department of Children and Family Services of its
536compliance by sending a copy of its policy to the agency and the
537Department of Children and Family Services as required by rule.
538The failure by a general hospital or appropriate specialty
539hospital to comply shall be punished by a fine not exceeding
540$1,000, to be fixed, imposed, and collected by the agency. Each
541day in violation is considered a separate offense.
542     Section 13.  Subsection (2) and paragraph (d) of subsection
543(3) of section 395.1041, Florida Statutes, are amended to read:
544     395.1041  Access to emergency services and care.-
546shall establish and maintain an inventory of hospitals with
547emergency services. The inventory shall list all services within
548the service capability of the hospital, and such services shall
549appear on the face of the hospital license. Each hospital having
550emergency services shall notify the agency of its service
551capability in the manner and form prescribed by the agency. The
552agency shall use the inventory to assist emergency medical
553services providers and others in locating appropriate emergency
554medical care. The inventory shall also be made available to the
555general public. On or before August 1, 1992, the agency shall
556request that each hospital identify the services which are
557within its service capability. On or before November 1, 1992,
558the agency shall notify each hospital of the service capability
559to be included in the inventory. The hospital has 15 days from
560the date of receipt to respond to the notice. By December 1,
5611992, the agency shall publish a final inventory. Each hospital
562shall reaffirm its service capability when its license is
563renewed and shall notify the agency of the addition of a new
564service or the termination of a service prior to a change in its
565service capability.
568     (d)1.  Every hospital shall ensure the provision of
569services within the service capability of the hospital, at all
570times, either directly or indirectly through an arrangement with
571another hospital, through an arrangement with one or more
572physicians, or as otherwise made through prior arrangements. A
573hospital may enter into an agreement with another hospital for
574purposes of meeting its service capability requirement, and
575appropriate compensation or other reasonable conditions may be
576negotiated for these backup services.
577     2.  If any arrangement requires the provision of emergency
578medical transportation, such arrangement must be made in
579consultation with the applicable provider and may not require
580the emergency medical service provider to provide transportation
581that is outside the routine service area of that provider or in
582a manner that impairs the ability of the emergency medical
583service provider to timely respond to prehospital emergency
585     3.  A hospital shall not be required to ensure service
586capability at all times as required in subparagraph 1. if, prior
587to the receiving of any patient needing such service capability,
588such hospital has demonstrated to the agency that it lacks the
589ability to ensure such capability and it has exhausted all
590reasonable efforts to ensure such capability through backup
591arrangements. In reviewing a hospital's demonstration of lack of
592ability to ensure service capability, the agency shall consider
593factors relevant to the particular case, including the
595     a.  Number and proximity of hospitals with the same service
597     b.  Number, type, credentials, and privileges of
599     c.  Frequency of procedures.
600     d.  Size of hospital.
601     4.  The agency shall publish proposed rules implementing a
602reasonable exemption procedure by November 1, 1992. Subparagraph
6031. shall become effective upon the effective date of said rules
604or January 31, 1993, whichever is earlier. For a period not to
605exceed 1 year from the effective date of subparagraph 1., a
606hospital requesting an exemption shall be deemed to be exempt
607from offering the service until the agency initially acts to
608deny or grant the original request. The agency has 45 days from
609the date of receipt of the request to approve or deny the
610request. After the first year from the effective date of
611subparagraph 1., If the agency fails to initially act within the
612time period, the hospital is deemed to be exempt from offering
613the service until the agency initially acts to deny the request.
614     Section 14.  Section 395.1046, Florida Statutes, is
616     Section 15.  Paragraph (e) of subsection (1) of section
617395.1055, Florida Statutes, is amended to read:
618     395.1055  Rules and enforcement.-
619     (1)  The agency shall adopt rules pursuant to ss.
620120.536(1) and 120.54 to implement the provisions of this part,
621which shall include reasonable and fair minimum standards for
622ensuring that:
623     (e)  Licensed facility beds conform to minimum space,
624equipment, and furnishings standards as specified by the agency,
625the Florida Building Code, and the Florida Fire Prevention Code
627     Section 16.  Subsection (1) of section 395.10972, Florida
628Statutes, is amended to read:
629     395.10972  Health Care Risk Manager Advisory Council.-The
630Secretary of Health Care Administration may appoint a seven-
631member advisory council to advise the agency on matters
632pertaining to health care risk managers. The members of the
633council shall serve at the pleasure of the secretary. The
634council shall designate a chair. The council shall meet at the
635call of the secretary or at those times as may be required by
636rule of the agency. The members of the advisory council shall
637receive no compensation for their services, but shall be
638reimbursed for travel expenses as provided in s. 112.061. The
639council shall consist of individuals representing the following
641     (1)  Two shall be active health care risk managers,
642including one risk manager who is recommended by and a member of
643the Florida Society for of Healthcare Risk Management and
644Patient Safety.
645     Section 17.  Subsection (3) of section 395.2050, Florida
646Statutes, is amended to read:
647     395.2050  Routine inquiry for organ and tissue donation;
648certification for procurement activities; death records review.-
649     (3)  Each organ procurement organization designated by the
650federal Centers for Medicare and Medicaid Services Health Care
651Financing Administration and licensed by the state shall conduct
652an annual death records review in the organ procurement
653organization's affiliated donor hospitals. The organ procurement
654organization shall enlist the services of every Florida licensed
655tissue bank and eye bank affiliated with or providing service to
656the donor hospital and operating in the same service area to
657participate in the death records review.
658     Section 18.  Subsection (2) of section 395.3036, Florida
659Statutes, is amended to read:
660     395.3036  Confidentiality of records and meetings of
661corporations that lease public hospitals or other public health
662care facilities.-The records of a private corporation that
663leases a public hospital or other public health care facility
664are confidential and exempt from the provisions of s. 119.07(1)
665and s. 24(a), Art. I of the State Constitution, and the meetings
666of the governing board of a private corporation are exempt from
667s. 286.011 and s. 24(b), Art. I of the State Constitution when
668the public lessor complies with the public finance
669accountability provisions of s. 155.40(5) with respect to the
670transfer of any public funds to the private lessee and when the
671private lessee meets at least three of the five following
673     (2)  The public lessor and the private lessee do not
674commingle any of their funds in any account maintained by either
675of them, other than the payment of the rent and administrative
676fees or the transfer of funds pursuant to s. 155.40(2)
677subsection (2).
678     Section 19.  Section 395.3037, Florida Statutes, is
680     Section 20.  Subsections (1), (4), and (5) of section
681395.3038, Florida Statutes, are amended to read:
682     395.3038  State-listed primary stroke centers and
683comprehensive stroke centers; notification of hospitals.-
684     (1)  The agency shall make available on its website and to
685the department a list of the name and address of each hospital
686that meets the criteria for a primary stroke center and the name
687and address of each hospital that meets the criteria for a
688comprehensive stroke center. The list of primary and
689comprehensive stroke centers shall include only those hospitals
690that attest in an affidavit submitted to the agency that the
691hospital meets the named criteria, or those hospitals that
692attest in an affidavit submitted to the agency that the hospital
693is certified as a primary or a comprehensive stroke center by
694The Joint Commission on Accreditation of Healthcare
696     (4)  The agency shall adopt by rule criteria for a primary
697stroke center which are substantially similar to the
698certification standards for primary stroke centers of The Joint
699Commission on Accreditation of Healthcare Organizations.
700     (5)  The agency shall adopt by rule criteria for a
701comprehensive stroke center. However, if The Joint Commission on
702Accreditation of Healthcare Organizations establishes criteria
703for a comprehensive stroke center, the agency shall establish
704criteria for a comprehensive stroke center which are
705substantially similar to those criteria established by The Joint
706Commission on Accreditation of Healthcare Organizations.
707     Section 21.  Paragraph (e) of subsection (2) of section
708395.602, Florida Statutes, is amended to read:
709     395.602  Rural hospitals.-
710     (2)  DEFINITIONS.-As used in this part:
711     (e)  "Rural hospital" means an acute care hospital licensed
712under this chapter, having 100 or fewer licensed beds and an
713emergency room, which is:
714     1.  The sole provider within a county with a population
715density of no greater than 100 persons per square mile;
716     2.  An acute care hospital, in a county with a population
717density of no greater than 100 persons per square mile, which is
718at least 30 minutes of travel time, on normally traveled roads
719under normal traffic conditions, from any other acute care
720hospital within the same county;
721     3.  A hospital supported by a tax district or subdistrict
722whose boundaries encompass a population of 100 persons or fewer
723per square mile;
724     4.  A hospital in a constitutional charter county with a
725population of over 1 million persons that has imposed a local
726option health service tax pursuant to law and in an area that
727was directly impacted by a catastrophic event on August 24,
7281992, for which the Governor of Florida declared a state of
729emergency pursuant to chapter 125, and has 120 beds or less that
730serves an agricultural community with an emergency room
731utilization of no less than 20,000 visits and a Medicaid
732inpatient utilization rate greater than 15 percent;
733     4.5.  A hospital with a service area that has a population
734of 100 persons or fewer per square mile. As used in this
735subparagraph, the term "service area" means the fewest number of
736zip codes that account for 75 percent of the hospital's
737discharges for the most recent 5-year period, based on
738information available from the hospital inpatient discharge
739database in the Florida Center for Health Information and Policy
740Analysis at the Agency for Health Care Administration; or
741     5.6.  A hospital designated as a critical access hospital,
742as defined in s. 408.07(15).
744Population densities used in this paragraph must be based upon
745the most recently completed United States census. A hospital
746that received funds under s. 409.9116 for a quarter beginning no
747later than July 1, 2002, is deemed to have been and shall
748continue to be a rural hospital from that date through June 30,
7492015, if the hospital continues to have 100 or fewer licensed
750beds and an emergency room, or meets the criteria of
751subparagraph 4. An acute care hospital that has not previously
752been designated as a rural hospital and that meets the criteria
753of this paragraph shall be granted such designation upon
754application, including supporting documentation to the Agency
755for Health Care Administration.
756     Section 22.  Subsection (8) of section 400.021, Florida
757Statutes, is amended to read:
758     400.021  Definitions.-When used in this part, unless the
759context otherwise requires, the term:
760     (8)  "Geriatric outpatient clinic" means a site for
761providing outpatient health care to persons 60 years of age or
762older, which is staffed by a registered nurse or a physician
763assistant, or a licensed practical nurse under the direct
764supervision of a registered nurse, advanced registered nurse
765practitioner, or physician.
766     Section 23.  Paragraph (g) of subsection (2) of section
767400.0239, Florida Statutes, is amended to read:
768     400.0239  Quality of Long-Term Care Facility Improvement
769Trust Fund.-
770     (2)  Expenditures from the trust fund shall be allowable
771for direct support of the following:
772     (g)  Other initiatives authorized by the Centers for
773Medicare and Medicaid Services for the use of federal civil
774monetary penalties, including projects recommended through the
775Medicaid "Up-or-Out" Quality of Care Contract Management Program
776pursuant to s. 400.148.
777     Section 24.  Subsection (2) of section 400.063, Florida
778Statutes, is amended to read:
779     400.063  Resident protection.-
780     (2)  The agency is authorized to establish for each
781facility, subject to intervention by the agency, a separate bank
782account for the deposit to the credit of the agency of any
783moneys received from the Health Care Trust Fund or any other
784moneys received for the maintenance and care of residents in the
785facility, and the agency is authorized to disburse moneys from
786such account to pay obligations incurred for the purposes of
787this section. The agency is authorized to requisition moneys
788from the Health Care Trust Fund in advance of an actual need for
789cash on the basis of an estimate by the agency of moneys to be
790spent under the authority of this section. Any bank account
791established under this section need not be approved in advance
792of its creation as required by s. 17.58, but shall be secured by
793depository insurance equal to or greater than the balance of
794such account or by the pledge of collateral security in
795conformance with criteria established in s. 18.11. The agency
796shall notify the Chief Financial Officer of any such account so
797established and shall make a quarterly accounting to the Chief
798Financial Officer for all moneys deposited in such account.
799     Section 25.  Subsections (1) and (5) of section 400.071,
800Florida Statutes, are amended to read:
801     400.071  Application for license.-
802     (1)  In addition to the requirements of part II of chapter
803408, the application for a license shall be under oath and must
804contain the following:
805     (a)  The location of the facility for which a license is
806sought and an indication, as in the original application, that
807such location conforms to the local zoning ordinances.
808     (b)  A signed affidavit disclosing any financial or
809ownership interest that a controlling interest as defined in
810part II of chapter 408 has held in the last 5 years in any
811entity licensed by this state or any other state to provide
812health or residential care which has closed voluntarily or
813involuntarily; has filed for bankruptcy; has had a receiver
814appointed; has had a license denied, suspended, or revoked; or
815has had an injunction issued against it which was initiated by a
816regulatory agency. The affidavit must disclose the reason any
817such entity was closed, whether voluntarily or involuntarily.
818     (c)  The total number of beds and the total number of
819Medicare and Medicaid certified beds.
820     (b)(d)  Information relating to the applicant and employees
821which the agency requires by rule. The applicant must
822demonstrate that sufficient numbers of qualified staff, by
823training or experience, will be employed to properly care for
824the type and number of residents who will reside in the
826     (c)(e)  Copies of any civil verdict or judgment involving
827the applicant rendered within the 10 years preceding the
828application, relating to medical negligence, violation of
829residents' rights, or wrongful death. As a condition of
830licensure, the licensee agrees to provide to the agency copies
831of any new verdict or judgment involving the applicant, relating
832to such matters, within 30 days after filing with the clerk of
833the court. The information required in this paragraph shall be
834maintained in the facility's licensure file and in an agency
835database which is available as a public record.
836     (5)  As a condition of licensure, each facility must
837establish and submit with its application a plan for quality
838assurance and for conducting risk management.
839     Section 26.  Section 400.0712, Florida Statutes, is amended
840to read:
841     400.0712  Application for inactive license.-
842     (1)  As specified in this section, the agency may issue an
843inactive license to a nursing home facility for all or a portion
844of its beds. Any request by a licensee that a nursing home or
845portion of a nursing home become inactive must be submitted to
846the agency in the approved format. The facility may not initiate
847any suspension of services, notify residents, or initiate
848inactivity before receiving approval from the agency; and a
849licensee that violates this provision may not be issued an
850inactive license.
851     (1)(2)  In addition to the powers granted under part II of
852chapter 408, the agency may issue an inactive license to a
853nursing home that chooses to use an unoccupied contiguous
854portion of the facility for an alternative use to meet the needs
855of elderly persons through the use of less restrictive, less
856institutional services.
857     (a)  An inactive license issued under this subsection may
858be granted for a period not to exceed the current licensure
859expiration date but may be renewed by the agency at the time of
860licensure renewal.
861     (b)  A request to extend the inactive license must be
862submitted to the agency in the approved format and approved by
863the agency in writing.
864     (c)  Nursing homes that receive an inactive license to
865provide alternative services shall not receive preference for
866participation in the Assisted Living for the Elderly Medicaid
868     (2)(3)  The agency shall adopt rules pursuant to ss.
869120.536(1) and 120.54 necessary to implement this section.
870     Section 27.  Section 400.111, Florida Statutes, is amended
871to read:
872     400.111  Disclosure of controlling interest.-In addition to
873the requirements of part II of chapter 408, when requested by
874the agency, the licensee shall submit a signed affidavit
875disclosing any financial or ownership interest that a
876controlling interest has held within the last 5 years in any
877entity licensed by the state or any other state to provide
878health or residential care which entity has closed voluntarily
879or involuntarily; has filed for bankruptcy; has had a receiver
880appointed; has had a license denied, suspended, or revoked; or
881has had an injunction issued against it which was initiated by a
882regulatory agency. The affidavit must disclose the reason such
883entity was closed, whether voluntarily or involuntarily.
884     Section 28.  Subsection (2) of section 400.1183, Florida
885Statutes, is amended to read:
886     400.1183  Resident grievance procedures.-
887     (2)  Each facility shall maintain records of all grievances
888for agency inspection and shall report to the agency at the time
889of relicensure the total number of grievances handled during the
890prior licensure period, a categorization of the cases underlying
891the grievances, and the final disposition of the grievances.
892     Section 29.  Paragraphs (o) through (w) of subsection (1)
893of section 400.141, Florida Statutes, are redesignated as
894paragraphs (n) through (u), respectively, and present paragraphs
895(f), (g), (j), (n), (o), and (r) of that subsection are amended,
896to read:
897     400.141  Administration and management of nursing home
899     (1)  Every licensed facility shall comply with all
900applicable standards and rules of the agency and shall:
901     (f)  Be allowed and encouraged by the agency to provide
902other needed services under certain conditions. If the facility
903has a standard licensure status, and has had no class I or class
904II deficiencies during the past 2 years or has been awarded a
905Gold Seal under the program established in s. 400.235, it may be
906encouraged by the agency to provide services, including, but not
907limited to, respite and adult day services, which enable
908individuals to move in and out of the facility. A facility is
909not subject to any additional licensure requirements for
910providing these services.
911     1.  Respite care may be offered to persons in need of
912short-term or temporary nursing home services. For each person
913admitted under the respite care program, the facility licensee
915     a.  Have a written abbreviated plan of care that, at a
916minimum, includes nutritional requirements, medication orders,
917physician orders, nursing assessments, and dietary preferences.
918The nursing or physician assessments may take the place of all
919other assessments required for full-time residents.
920     b.  Have a contract that, at a minimum, specifies the
921services to be provided to the respite resident, including
922charges for services, activities, equipment, emergency medical
923services, and the administration of medications. If multiple
924respite admissions for a single person are anticipated, the
925original contract is valid for 1 year after the date of
927     c.  Ensure that each resident is released to his or her
928caregiver or an individual designated in writing by the
930     2.  A person admitted under the respite care program is:
931     a.  Exempt from requirements in rule related to discharge
933     b.  Covered by the resident's rights set forth in s.
934400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
935shall not be considered trust funds subject to the requirements
936of s. 400.022(1)(h) until the resident has been in the facility
937for more than 14 consecutive days.
938     c.  Allowed to use his or her personal medications for the
939respite stay if permitted by facility policy. The facility must
940obtain a physician's orders for the medications. The caregiver
941may provide information regarding the medications as part of the
942nursing assessment, which must agree with the physician's
943orders. Medications shall be released with the resident upon
944discharge in accordance with current orders.
945     3.  A person receiving respite care is entitled to a total
946of 60 days in the facility within a contract year or a calendar
947year if the contract is for less than 12 months. However, each
948single stay may not exceed 14 days. If a stay exceeds 14
949consecutive days, the facility must comply with all assessment
950and care planning requirements applicable to nursing home
952     4.  A person receiving respite care must reside in a
953licensed nursing home bed.
954     5.  A prospective respite resident must provide medical
955information from a physician, a physician assistant, or a nurse
956practitioner and other information from the primary caregiver as
957may be required by the facility prior to or at the time of
958admission to receive respite care. The medical information must
959include a physician's order for respite care and proof of a
960physical examination by a licensed physician, physician
961assistant, or nurse practitioner. The physician's order and
962physical examination may be used to provide intermittent respite
963care for up to 12 months after the date the order is written.
964     6.  The facility must assume the duties of the primary
965caregiver. To ensure continuity of care and services, the
966resident is entitled to retain his or her personal physician and
967must have access to medically necessary services such as
968physical therapy, occupational therapy, or speech therapy, as
969needed. The facility must arrange for transportation to these
970services if necessary. Respite care must be provided in
971accordance with this part and rules adopted by the agency.
972However, the agency shall, by rule, adopt modified requirements
973for resident assessment, resident care plans, resident
974contracts, physician orders, and other provisions, as
975appropriate, for short-term or temporary nursing home services.
976     7.  The agency shall allow for shared programming and staff
977in a facility which meets minimum standards and offers services
978pursuant to this paragraph, but, if the facility is cited for
979deficiencies in patient care, may require additional staff and
980programs appropriate to the needs of service recipients. A
981person who receives respite care may not be counted as a
982resident of the facility for purposes of the facility's licensed
983capacity unless that person receives 24-hour respite care. A
984person receiving either respite care for 24 hours or longer or
985adult day services must be included when calculating minimum
986staffing for the facility. Any costs and revenues generated by a
987nursing home facility from nonresidential programs or services
988shall be excluded from the calculations of Medicaid per diems
989for nursing home institutional care reimbursement.
990     (g)  If the facility has a standard license or is a Gold
991Seal facility, exceeds the minimum required hours of licensed
992nursing and certified nursing assistant direct care per resident
993per day, and is part of a continuing care facility licensed
994under chapter 651 or a retirement community that offers other
995services pursuant to part III of this chapter or part I or part
996III of chapter 429 on a single campus, be allowed to share
997programming and staff. At the time of inspection and in the
998semiannual report required pursuant to paragraph (n) (o), a
999continuing care facility or retirement community that uses this
1000option must demonstrate through staffing records that minimum
1001staffing requirements for the facility were met. Licensed nurses
1002and certified nursing assistants who work in the nursing home
1003facility may be used to provide services elsewhere on campus if
1004the facility exceeds the minimum number of direct care hours
1005required per resident per day and the total number of residents
1006receiving direct care services from a licensed nurse or a
1007certified nursing assistant does not cause the facility to
1008violate the staffing ratios required under s. 400.23(3)(a).
1009Compliance with the minimum staffing ratios shall be based on
1010total number of residents receiving direct care services,
1011regardless of where they reside on campus. If the facility
1012receives a conditional license, it may not share staff until the
1013conditional license status ends. This paragraph does not
1014restrict the agency's authority under federal or state law to
1015require additional staff if a facility is cited for deficiencies
1016in care which are caused by an insufficient number of certified
1017nursing assistants or licensed nurses. The agency may adopt
1018rules for the documentation necessary to determine compliance
1019with this provision.
1020     (j)  Keep full records of resident admissions and
1021discharges; medical and general health status, including medical
1022records, personal and social history, and identity and address
1023of next of kin or other persons who may have responsibility for
1024the affairs of the residents; and individual resident care plans
1025including, but not limited to, prescribed services, service
1026frequency and duration, and service goals. The records shall be
1027open to inspection by the agency. The facility must maintain
1028clinical records on each resident in accordance with accepted
1029professional standards and practices that are complete,
1030accurately documented, readily accessible, and systematically
1032     (n)  Submit to the agency the information specified in s.
1033400.071(1)(b) for a management company within 30 days after the
1034effective date of the management agreement.
1035     (n)(o)1.  Submit semiannually to the agency, or more
1036frequently if requested by the agency, information regarding
1037facility staff-to-resident ratios, staff turnover, and staff
1038stability, including information regarding certified nursing
1039assistants, licensed nurses, the director of nursing, and the
1040facility administrator. For purposes of this reporting:
1041     a.  Staff-to-resident ratios must be reported in the
1042categories specified in s. 400.23(3)(a) and applicable rules.
1043The ratio must be reported as an average for the most recent
1044calendar quarter.
1045     b.  Staff turnover must be reported for the most recent 12-
1046month period ending on the last workday of the most recent
1047calendar quarter prior to the date the information is submitted.
1048The turnover rate must be computed quarterly, with the annual
1049rate being the cumulative sum of the quarterly rates. The
1050turnover rate is the total number of terminations or separations
1051experienced during the quarter, excluding any employee
1052terminated during a probationary period of 3 months or less,
1053divided by the total number of staff employed at the end of the
1054period for which the rate is computed, and expressed as a
1056     c.  The formula for determining staff stability is the
1057total number of employees that have been employed for more than
105812 months, divided by the total number of employees employed at
1059the end of the most recent calendar quarter, and expressed as a
1061     d.  A nursing facility that has failed to comply with state
1062minimum-staffing requirements for 2 consecutive days is
1063prohibited from accepting new admissions until the facility has
1064achieved the minimum-staffing requirements for a period of 6
1065consecutive days. For the purposes of this sub-subparagraph, any
1066person who was a resident of the facility and was absent from
1067the facility for the purpose of receiving medical care at a
1068separate location or was on a leave of absence is not considered
1069a new admission. Failure to impose such an admissions moratorium
1070is subject to a $1,000 fine constitutes a class II deficiency.
1071     e.  A nursing facility which does not have a conditional
1072license may be cited for failure to comply with the standards in
1073s. 400.23(3)(a)1.a. only if it has failed to meet those
1074standards on 2 consecutive days or if it has failed to meet at
1075least 97 percent of those standards on any one day.
1076     f.  A facility which has a conditional license must be in
1077compliance with the standards in s. 400.23(3)(a) at all times.
1078     2.  This paragraph does not limit the agency's ability to
1079impose a deficiency or take other actions if a facility does not
1080have enough staff to meet the residents' needs.
1081     (r)  Report to the agency any filing for bankruptcy
1082protection by the facility or its parent corporation,
1083divestiture or spin-off of its assets, or corporate
1084reorganization within 30 days after the completion of such
1086     Section 30.  Subsection (3) of section 400.142, Florida
1087Statutes, is amended to read:
1088     400.142  Emergency medication kits; orders not to
1090     (3)  Facility staff may withhold or withdraw
1091cardiopulmonary resuscitation if presented with an order not to
1092resuscitate executed pursuant to s. 401.45. The agency shall
1093adopt rules providing for the implementation of such orders.
1094Facility staff and facilities shall not be subject to criminal
1095prosecution or civil liability, nor be considered to have
1096engaged in negligent or unprofessional conduct, for withholding
1097or withdrawing cardiopulmonary resuscitation pursuant to such an
1098order and rules adopted by the agency. The absence of an order
1099not to resuscitate executed pursuant to s. 401.45 does not
1100preclude a physician from withholding or withdrawing
1101cardiopulmonary resuscitation as otherwise permitted by law.
1102     Section 31.  Subsections (11) through (15) of section
1103400.147, Florida Statutes, are renumbered as subsections (10)
1104through (14), respectively, and present subsection (10) is
1105amended to read:
1106     400.147  Internal risk management and quality assurance
1108     (10)  By the 10th of each month, each facility subject to
1109this section shall report any notice received pursuant to s.
1110400.0233(2) and each initial complaint that was filed with the
1111clerk of the court and served on the facility during the
1112previous month by a resident or a resident's family member,
1113guardian, conservator, or personal legal representative. The
1114report must include the name of the resident, the resident's
1115date of birth and social security number, the Medicaid
1116identification number for Medicaid-eligible persons, the date or
1117dates of the incident leading to the claim or dates of
1118residency, if applicable, and the type of injury or violation of
1119rights alleged to have occurred. Each facility shall also submit
1120a copy of the notices received pursuant to s. 400.0233(2) and
1121complaints filed with the clerk of the court. This report is
1122confidential as provided by law and is not discoverable or
1123admissible in any civil or administrative action, except in such
1124actions brought by the agency to enforce the provisions of this
1126     Section 32.  Section 400.148, Florida Statutes, is
1128     Section 33.  Paragraph (f) of subsection (5) of section
1129400.162, Florida Statutes, is amended to read:
1130     400.162  Property and personal affairs of residents.-
1131     (5)
1132     (f)  At least every 3 months, the licensee shall furnish
1133the resident and the guardian, trustee, or conservator, if any,
1134for the resident a complete and verified statement of all funds
1135and other property to which this subsection applies, detailing
1136the amounts and items received, together with their sources and
1137disposition. For resident property, the licensee shall furnish
1138such a statement annually and within 7 calendar days after a
1139request for a statement. In any event, the licensee shall
1140furnish such statements a statement annually and upon the
1141discharge or transfer of a resident. Any governmental agency or
1142private charitable agency contributing funds or other property
1143on account of a resident also shall be entitled to receive such
1144statements statement annually and upon discharge or transfer and
1145such other report as it may require pursuant to law.
1146     Section 34.  Paragraphs (d) and (e) of subsection (2) of
1147section 400.179, Florida Statutes, are amended to read:
1148     400.179  Liability for Medicaid underpayments and
1150     (2)  Because any transfer of a nursing facility may expose
1151the fact that Medicaid may have underpaid or overpaid the
1152transferor, and because in most instances, any such underpayment
1153or overpayment can only be determined following a formal field
1154audit, the liabilities for any such underpayments or
1155overpayments shall be as follows:
1156     (d)  Where the transfer involves a facility that has been
1157leased by the transferor:
1158     1.  The transferee shall, as a condition to being issued a
1159license by the agency, acquire, maintain, and provide proof to
1160the agency of a bond with a term of 30 months, renewable
1161annually, in an amount not less than the total of 3 months'
1162Medicaid payments to the facility computed on the basis of the
1163preceding 12-month average Medicaid payments to the facility.
1164     2.  A leasehold licensee may meet the requirements of
1165subparagraph 1. by payment of a nonrefundable fee, paid at
1166initial licensure, paid at the time of any subsequent change of
1167ownership, and paid annually thereafter, in the amount of 1
1168percent of the total of 3 months' Medicaid payments to the
1169facility computed on the basis of the preceding 12-month average
1170Medicaid payments to the facility. If a preceding 12-month
1171average is not available, projected Medicaid payments may be
1172used. The fee shall be deposited into the Grants and Donations
1173Trust Fund and shall be accounted for separately as a Medicaid
1174nursing home overpayment account. These fees shall be used at
1175the sole discretion of the agency to repay nursing home Medicaid
1176overpayments. Payment of this fee shall not release the licensee
1177from any liability for any Medicaid overpayments, nor shall
1178payment bar the agency from seeking to recoup overpayments from
1179the licensee and any other liable party. As a condition of
1180exercising this lease bond alternative, licensees paying this
1181fee must maintain an existing lease bond through the end of the
118230-month term period of that bond. The agency is herein granted
1183specific authority to promulgate all rules pertaining to the
1184administration and management of this account, including
1185withdrawals from the account, subject to federal review and
1186approval. This provision shall take effect upon becoming law and
1187shall apply to any leasehold license application. The financial
1188viability of the Medicaid nursing home overpayment account shall
1189be determined by the agency through annual review of the account
1190balance and the amount of total outstanding, unpaid Medicaid
1191overpayments owing from leasehold licensees to the agency as
1192determined by final agency audits. By March 31 of each year, the
1193agency shall assess the cumulative fees collected under this
1194subparagraph, minus any amounts used to repay nursing home
1195Medicaid overpayments and amounts transferred to contribute to
1196the General Revenue Fund pursuant to s. 215.20. If the net
1197cumulative collections, minus amounts utilized to repay nursing
1198home Medicaid overpayments, exceed $25 million, the provisions
1199of this paragraph shall not apply for the subsequent fiscal
1201     3.  The leasehold licensee may meet the bond requirement
1202through other arrangements acceptable to the agency. The agency
1203is herein granted specific authority to promulgate rules
1204pertaining to lease bond arrangements.
1205     4.  All existing nursing facility licensees, operating the
1206facility as a leasehold, shall acquire, maintain, and provide
1207proof to the agency of the 30-month bond required in
1208subparagraph 1., above, on and after July 1, 1993, for each
1209license renewal.
1210     5.  It shall be the responsibility of all nursing facility
1211operators, operating the facility as a leasehold, to renew the
121230-month bond and to provide proof of such renewal to the agency
1214     6.  Any failure of the nursing facility operator to
1215acquire, maintain, renew annually, or provide proof to the
1216agency shall be grounds for the agency to deny, revoke, and
1217suspend the facility license to operate such facility and to
1218take any further action, including, but not limited to,
1219enjoining the facility, asserting a moratorium pursuant to part
1220II of chapter 408, or applying for a receiver, deemed necessary
1221to ensure compliance with this section and to safeguard and
1222protect the health, safety, and welfare of the facility's
1223residents. A lease agreement required as a condition of bond
1224financing or refinancing under s. 154.213 by a health facilities
1225authority or required under s. 159.30 by a county or
1226municipality is not a leasehold for purposes of this paragraph
1227and is not subject to the bond requirement of this paragraph.
1228     (e)  For the 2009-2010 fiscal year only, the provisions of
1229paragraph (d) shall not apply. This paragraph expires July 1,
1231     Section 35.  Subsection (3) of section 400.19, Florida
1232Statutes, is amended to read:
1233     400.19  Right of entry and inspection.-
1234     (3)  The agency shall every 15 months conduct at least one
1235unannounced inspection to determine compliance by the licensee
1236with statutes, and with rules promulgated under the provisions
1237of those statutes, governing minimum standards of construction,
1238quality and adequacy of care, and rights of residents. The
1239survey shall be conducted every 6 months for the next 2-year
1240period if the facility has been cited for a class I deficiency,
1241has been cited for two or more class II deficiencies arising
1242from separate surveys or investigations within a 60-day period,
1243or has had three or more substantiated complaints within a 6-
1244month period, each resulting in at least one class I or class II
1245deficiency. In addition to any other fees or fines in this part,
1246the agency shall assess a fine for each facility that is subject
1247to the 6-month survey cycle. The fine for the 2-year period
1248shall be $6,000, one-half to be paid at the completion of each
1249survey. The agency may adjust this fine by the change in the
1250Consumer Price Index, based on the 12 months immediately
1251preceding the increase, to cover the cost of the additional
1252surveys. The agency shall verify through subsequent inspection
1253that any deficiency identified during inspection is corrected.
1254However, the agency may verify the correction of a class III or
1255class IV deficiency unrelated to resident rights or resident
1256care without reinspecting the facility if adequate written
1257documentation has been received from the facility, which
1258provides assurance that the deficiency has been corrected. The
1259giving or causing to be given of advance notice of such
1260unannounced inspections by an employee of the agency to any
1261unauthorized person shall constitute cause for suspension of not
1262fewer than 5 working days according to the provisions of chapter
1264     Section 36.  Section 400.195, Florida Statutes, is
1266     Section 37.  Subsection (5) of section 400.23, Florida
1267Statutes, is amended to read:
1268     400.23  Rules; evaluation and deficiencies; licensure
1270     (5)(a)  The agency, in collaboration with the Division of
1271Children's Medical Services Network of the Department of Health,
1272must, no later than December 31, 1993, adopt rules for minimum
1273standards of care for persons under 21 years of age who reside
1274in nursing home facilities. The rules must include a methodology
1275for reviewing a nursing home facility under ss. 408.031-408.045
1276which serves only persons under 21 years of age. A facility may
1277be exempt from these standards for specific persons between 18
1278and 21 years of age, if the person's physician agrees that
1279minimum standards of care based on age are not necessary.
1280     (b)  The agency, in collaboration with the Division of
1281Children's Medical Services Network, shall adopt rules for
1282minimum staffing requirements for nursing home facilities that
1283serve persons under 21 years of age, which shall apply in lieu
1284of the standards contained in subsection (3).
1285     1.  For persons under 21 years of age who require skilled
1286care, the requirements shall include a minimum combined average
1287of licensed nurses, respiratory therapists, and certified
1288nursing assistants of 3.9 hours of direct care per resident per
1289day for each nursing home facility.
1290     2.  For persons under 21 years of age who are fragile, the
1291requirements shall include a minimum combined average of
1292licensed nurses, respiratory therapists, respiratory care
1293practitioners, and certified nursing assistants of 5 hours of
1294direct care per resident per day for each nursing home facility.
1295     Section 38.  Subsection (1) of section 400.275, Florida
1296Statutes, is amended to read:
1297     400.275  Agency duties.-
1298     (1)  The agency shall ensure that each newly hired nursing
1299home surveyor, as a part of basic training, is assigned full-
1300time to a licensed nursing home for at least 2 days within a 7-
1301day period to observe facility operations outside of the survey
1302process before the surveyor begins survey responsibilities. Such
1303observations may not be the sole basis of a deficiency citation
1304against the facility. The agency may not assign an individual to
1305be a member of a survey team for purposes of a survey,
1306evaluation, or consultation visit at a nursing home facility in
1307which the surveyor was an employee within the preceding 2 5
1309     Section 39.  Subsection (2) of section 400.484, Florida
1310Statutes, is amended to read:
1311     400.484  Right of inspection; violations deficiencies;
1313     (2)  The agency shall impose fines for various classes of
1314violations deficiencies in accordance with the following
1316     (a)  Class I violations are defined in s. 408.813. A class
1317I deficiency is any act, omission, or practice that results in a
1318patient's death, disablement, or permanent injury, or places a
1319patient at imminent risk of death, disablement, or permanent
1320injury. Upon finding a class I violation deficiency, the agency
1321shall impose an administrative fine in the amount of $15,000 for
1322each occurrence and each day that the violation deficiency
1324     (b)  Class II violations are defined in s. 408.813. A class
1325II deficiency is any act, omission, or practice that has a
1326direct adverse effect on the health, safety, or security of a
1327patient. Upon finding a class II violation deficiency, the
1328agency shall impose an administrative fine in the amount of
1329$5,000 for each occurrence and each day that the violation
1330deficiency exists.
1331     (c)  Class III violations are defined in s. 408.813. A
1332class III deficiency is any act, omission, or practice that has
1333an indirect, adverse effect on the health, safety, or security
1334of a patient. Upon finding an uncorrected or repeated class III
1335violation deficiency, the agency shall impose an administrative
1336fine not to exceed $1,000 for each occurrence and each day that
1337the uncorrected or repeated violation deficiency exists.
1338     (d)  Class IV violations are defined in s. 408.813. A class
1339IV deficiency is any act, omission, or practice related to
1340required reports, forms, or documents which does not have the
1341potential of negatively affecting patients. These violations are
1342of a type that the agency determines do not threaten the health,
1343safety, or security of patients. Upon finding an uncorrected or
1344repeated class IV violation deficiency, the agency shall impose
1345an administrative fine not to exceed $500 for each occurrence
1346and each day that the uncorrected or repeated violation
1347deficiency exists.
1348     Section 40.  Paragraph (i) of subsection (1) and subsection
1349(4) of section 400.606, Florida Statutes, are amended to read:
1350     400.606  License; application; renewal; conditional license
1351or permit; certificate of need.-
1352     (1)  In addition to the requirements of part II of chapter
1353408, the initial application and change of ownership application
1354must be accompanied by a plan for the delivery of home,
1355residential, and homelike inpatient hospice services to
1356terminally ill persons and their families. Such plan must
1357contain, but need not be limited to:
1358     (i)  The projected annual operating cost of the hospice.
1360If the applicant is an existing licensed health care provider,
1361the application must be accompanied by a copy of the most recent
1362profit-loss statement and, if applicable, the most recent
1363licensure inspection report.
1364     (4)  A freestanding hospice facility that is primarily
1365engaged in providing inpatient and related services and that is
1366not otherwise licensed as a health care facility shall be
1367required to obtain a certificate of need. However, a
1368freestanding hospice facility with six or fewer beds shall not
1369be required to comply with institutional standards such as, but
1370not limited to, standards requiring sprinkler systems, emergency
1371electrical systems, or special lavatory devices.
1372     Section 41.  Subsection (2) of section 400.607, Florida
1373Statutes, is amended to read:
1374     400.607  Denial, suspension, revocation of license;
1375emergency actions; imposition of administrative fine; grounds.-
1376     (2)  A violation of this part, part II of chapter 408, or
1377applicable rules Any of the following actions by a licensed
1378hospice or any of its employees shall be grounds for
1379administrative action by the agency against a hospice.:
1380     (a)  A violation of the provisions of this part, part II of
1381chapter 408, or applicable rules.
1382     (b)  An intentional or negligent act materially affecting
1383the health or safety of a patient.
1384     Section 42.  Subsection (1) of section 400.925, Florida
1385Statutes, is amended to read:
1386     400.925  Definitions.-As used in this part, the term:
1387     (1)  "Accrediting organizations" means The Joint Commission
1388on Accreditation of Healthcare Organizations or other national
1389accreditation agencies whose standards for accreditation are
1390comparable to those required by this part for licensure.
1391     Section 43.  Subsections (3) through (6) of section
1392400.931, Florida Statutes, are renumbered as subsections (2)
1393through (5), respectively, and present subsection (2) of that
1394section is amended to read:
1395     400.931  Application for license; fee; provisional license;
1396temporary permit.-
1397     (2)  As an alternative to submitting proof of financial
1398ability to operate as required in s. 408.810(8), the applicant
1399may submit a $50,000 surety bond to the agency.
1400     Section 44.  Subsection (2) of section 400.932, Florida
1401Statutes, is amended to read:
1402     400.932  Administrative penalties.-
1403     (2)  A violation of this part, part II of chapter 408, or
1404applicable rules Any of the following actions by an employee of
1405a home medical equipment provider shall be are grounds for
1406administrative action or penalties by the agency.:
1407     (a)  Violation of this part, part II of chapter 408, or
1408applicable rules.
1409     (b)  An intentional, reckless, or negligent act that
1410materially affects the health or safety of a patient.
1411     Section 45.  Subsection (3) of section 400.967, Florida
1412Statutes, is amended to read:
1413     400.967  Rules and classification of violations
1415     (3)  The agency shall adopt rules to provide that, when the
1416criteria established under this part and part II of chapter 408
1417are not met, such violations deficiencies shall be classified
1418according to the nature of the violation deficiency. The agency
1419shall indicate the classification on the face of the notice of
1420deficiencies as follows:
1421     (a)  Class I violations deficiencies are defined in s.
1422408.813 those which the agency determines present an imminent
1423danger to the residents or guests of the facility or a
1424substantial probability that death or serious physical harm
1425would result therefrom. The condition or practice constituting a
1426class I violation must be abated or eliminated immediately,
1427unless a fixed period of time, as determined by the agency, is
1428required for correction. A class I violation deficiency is
1429subject to a civil penalty in an amount not less than $5,000 and
1430not exceeding $10,000 for each violation deficiency. A fine may
1431be levied notwithstanding the correction of the violation
1433     (b)  Class II violations deficiencies are defined in s.
1434408.813 those which the agency determines have a direct or
1435immediate relationship to the health, safety, or security of the
1436facility residents, other than class I deficiencies. A class II
1437violation deficiency is subject to a civil penalty in an amount
1438not less than $1,000 and not exceeding $5,000 for each violation
1439deficiency. A citation for a class II violation deficiency shall
1440specify the time within which the violation deficiency must be
1441corrected. If a class II violation deficiency is corrected
1442within the time specified, no civil penalty shall be imposed,
1443unless it is a repeated offense.
1444     (c)  Class III violations deficiencies are defined in s.
1445408.813 those which the agency determines to have an indirect or
1446potential relationship to the health, safety, or security of the
1447facility residents, other than class I or class II deficiencies.
1448A class III violation deficiency is subject to a civil penalty
1449of not less than $500 and not exceeding $1,000 for each
1450deficiency. A citation for a class III violation deficiency
1451shall specify the time within which the violation deficiency
1452must be corrected. If a class III violation deficiency is
1453corrected within the time specified, no civil penalty shall be
1454imposed, unless it is a repeated offense.
1455     (d)  Class IV violations are defined in s. 408.813. Upon
1456finding an uncorrected or repeated class IV violation, the
1457agency shall impose an administrative fine not to exceed $500
1458for each occurrence and each day that the uncorrected or
1459repeated violation exists.
1460     Section 46.  Subsections (4) and (7) of section 400.9905,
1461Florida Statutes, are amended to read:
1462     400.9905  Definitions.-
1463     (4)  "Clinic" means an entity at which health care services
1464are provided to individuals and which tenders charges for
1465reimbursement for such services, including a mobile clinic and a
1466portable health service or equipment provider. For purposes of
1467this part, the term does not include and the licensure
1468requirements of this part do not apply to:
1469     (a)  Entities licensed or registered by the state under
1470chapter 395; or entities licensed or registered by the state and
1471providing only health care services within the scope of services
1472authorized under their respective licenses granted under ss.
1473383.30-383.335, chapter 390, chapter 394, chapter 397, this
1474chapter except part X, chapter 429, chapter 463, chapter 465,
1475chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1476chapter 651; end-stage renal disease providers authorized under
147742 C.F.R. part 405, subpart U; or providers certified under 42
1478C.F.R. part 485, subpart B or subpart H; or any entity that
1479provides neonatal or pediatric hospital-based health care
1480services or other health care services by licensed practitioners
1481solely within a hospital licensed under chapter 395.
1482     (b)  Entities that own, directly or indirectly, entities
1483licensed or registered by the state pursuant to chapter 395; or
1484entities that own, directly or indirectly, entities licensed or
1485registered by the state and providing only health care services
1486within the scope of services authorized pursuant to their
1487respective licenses granted under ss. 383.30-383.335, chapter
1488390, chapter 394, chapter 397, this chapter except part X,
1489chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1490part I of chapter 483, chapter 484, chapter 651; end-stage renal
1491disease providers authorized under 42 C.F.R. part 405, subpart
1492U; or providers certified under 42 C.F.R. part 485, subpart B or
1493subpart H; or any entity that provides neonatal or pediatric
1494hospital-based health care services by licensed practitioners
1495solely within a hospital licensed under chapter 395.
1496     (c)  Entities that are owned, directly or indirectly, by an
1497entity licensed or registered by the state pursuant to chapter
1498395; or entities that are owned, directly or indirectly, by an
1499entity licensed or registered by the state and providing only
1500health care services within the scope of services authorized
1501pursuant to their respective licenses granted under ss. 383.30-
1502383.335, chapter 390, chapter 394, chapter 397, this chapter
1503except part X, chapter 429, chapter 463, chapter 465, chapter
1504466, chapter 478, part I of chapter 483, chapter 484, or chapter
1505651; end-stage renal disease providers authorized under 42
1506C.F.R. part 405, subpart U; or providers certified under 42
1507C.F.R. part 485, subpart B or subpart H; or any entity that
1508provides neonatal or pediatric hospital-based health care
1509services by licensed practitioners solely within a hospital
1510under chapter 395.
1511     (d)  Entities that are under common ownership, directly or
1512indirectly, with an entity licensed or registered by the state
1513pursuant to chapter 395; or entities that are under common
1514ownership, directly or indirectly, with an entity licensed or
1515registered by the state and providing only health care services
1516within the scope of services authorized pursuant to their
1517respective licenses granted under ss. 383.30-383.335, chapter
1518390, chapter 394, chapter 397, this chapter except part X,
1519chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1520part I of chapter 483, chapter 484, or chapter 651; end-stage
1521renal disease providers authorized under 42 C.F.R. part 405,
1522subpart U; or providers certified under 42 C.F.R. part 485,
1523subpart B or subpart H; or any entity that provides neonatal or
1524pediatric hospital-based health care services by licensed
1525practitioners solely within a hospital licensed under chapter
1527     (e)  An entity that is exempt from federal taxation under
152826 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1529under 26 U.S.C. s. 409 that has a board of trustees not less
1530than two-thirds of which are Florida-licensed health care
1531practitioners and provides only physical therapy services under
1532physician orders, any community college or university clinic,
1533and any entity owned or operated by the federal or state
1534government, including agencies, subdivisions, or municipalities
1536     (f)  A sole proprietorship, group practice, partnership, or
1537corporation that provides health care services by physicians
1538covered by s. 627.419, that is directly supervised by one or
1539more of such physicians, and that is wholly owned by one or more
1540of those physicians or by a physician and the spouse, parent,
1541child, or sibling of that physician.
1542     (g)  A sole proprietorship, group practice, partnership, or
1543corporation that provides health care services by licensed
1544health care practitioners under chapter 457, chapter 458,
1545chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1546chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1547chapter 490, chapter 491, or part I, part III, part X, part
1548XIII, or part XIV of chapter 468, or s. 464.012, which are
1549wholly owned by one or more licensed health care practitioners,
1550or the licensed health care practitioners set forth in this
1551paragraph and the spouse, parent, child, or sibling of a
1552licensed health care practitioner, so long as one of the owners
1553who is a licensed health care practitioner is supervising the
1554business activities and is legally responsible for the entity's
1555compliance with all federal and state laws. However, a health
1556care practitioner may not supervise services beyond the scope of
1557the practitioner's license, except that, for the purposes of
1558this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1559provides only services authorized pursuant to s. 456.053(3)(b)
1560may be supervised by a licensee specified in s. 456.053(3)(b).
1561     (h)  Clinical facilities affiliated with an accredited
1562medical school at which training is provided for medical
1563students, residents, or fellows.
1564     (i)  Entities that provide only oncology or radiation
1565therapy services by physicians licensed under chapter 458 or
1566chapter 459 or entities that provide oncology or radiation
1567therapy services by physicians licensed under chapter 458 or
1568chapter 459 which are owned by a corporation whose shares are
1569publicly traded on a recognized stock exchange.
1570     (j)  Clinical facilities affiliated with a college of
1571chiropractic accredited by the Council on Chiropractic Education
1572at which training is provided for chiropractic students.
1573     (k)  Entities that provide licensed practitioners to staff
1574emergency departments or to deliver anesthesia services in
1575facilities licensed under chapter 395 and that derive at least
157690 percent of their gross annual revenues from the provision of
1577such services. Entities claiming an exemption from licensure
1578under this paragraph must provide documentation demonstrating
1580     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1581perinatology clinical facilities that are a publicly traded
1582corporation or that are wholly owned, directly or indirectly, by
1583a publicly traded corporation. As used in this paragraph, a
1584publicly traded corporation is a corporation that issues
1585securities traded on an exchange registered with the United
1586States Securities and Exchange Commission as a national
1587securities exchange.
1588     (m)  Entities that are owned by a corporation that has $250
1589million or more in total annual sales of health care services
1590provided by licensed health care practitioners if one or more of
1591the owners of the entity is a health care practitioner who is
1592licensed in this state, is responsible for supervising the
1593business activities of the entity, and is legally responsible
1594for the entity's compliance with state law for purposes of this
1596     (n)  Entities that are owned or controlled, directly or
1597indirectly, by a publicly traded entity with $100 million or
1598more, in the aggregate, in total annual revenues derived from
1599providing health care services by licensed health care
1600practitioners that are employed or contracted by an entity
1601described in this paragraph.
1602     (7)  "Portable health service or equipment provider" means
1603an entity that contracts with or employs persons to provide
1604portable health care services or equipment to multiple locations
1605performing treatment or diagnostic testing of individuals, that
1606bills third-party payors for those services, and that otherwise
1607meets the definition of a clinic in subsection (4).
1608     Section 47.  Paragraph (b) of subsection (1) and paragraph
1609(c) of subsection (4) of section 400.991, Florida Statutes, are
1610amended to read:
1611     400.991  License requirements; background screenings;
1613     (1)
1614     (b)  Each mobile clinic must obtain a separate health care
1615clinic license and must provide to the agency, at least
1616quarterly, its projected street location to enable the agency to
1617locate and inspect such clinic. A portable health service or
1618equipment provider must obtain a health care clinic license for
1619a single administrative office and is not required to submit
1620quarterly projected street locations.
1621     (4)  In addition to the requirements of part II of chapter
1622408, the applicant must file with the application satisfactory
1623proof that the clinic is in compliance with this part and
1624applicable rules, including:
1625     (c)  Proof of financial ability to operate as required
1626under ss. s. 408.810(8) and 408.8065. As an alternative to
1627submitting proof of financial ability to operate as required
1628under s. 408.810(8), the applicant may file a surety bond of at
1629least $500,000 which guarantees that the clinic will act in full
1630conformity with all legal requirements for operating a clinic,
1631payable to the agency. The agency may adopt rules to specify
1632related requirements for such surety bond.
1633     Section 48.  Paragraph (g) of subsection (1) and paragraph
1634(a) of subsection (7) of section 400.9935, Florida Statutes, are
1635amended to read:
1636     400.9935  Clinic responsibilities.-
1637     (1)  Each clinic shall appoint a medical director or clinic
1638director who shall agree in writing to accept legal
1639responsibility for the following activities on behalf of the
1640clinic. The medical director or the clinic director shall:
1641     (g)  Conduct systematic reviews of clinic billings to
1642ensure that the billings are not fraudulent or unlawful. Upon
1643discovery of an unlawful charge, the medical director or clinic
1644director shall take immediate corrective action. If the clinic
1645performs only the technical component of magnetic resonance
1646imaging, static radiographs, computed tomography, or positron
1647emission tomography, and provides the professional
1648interpretation of such services, in a fixed facility that is
1649accredited by The Joint Commission on Accreditation of
1650Healthcare Organizations or the Accreditation Association for
1651Ambulatory Health Care, and the American College of Radiology;
1652and if, in the preceding quarter, the percentage of scans
1653performed by that clinic which was billed to all personal injury
1654protection insurance carriers was less than 15 percent, the
1655chief financial officer of the clinic may, in a written
1656acknowledgment provided to the agency, assume the responsibility
1657for the conduct of the systematic reviews of clinic billings to
1658ensure that the billings are not fraudulent or unlawful.
1659     (7)(a)  Each clinic engaged in magnetic resonance imaging
1660services must be accredited by The Joint Commission on
1661Accreditation of Healthcare Organizations, the American College
1662of Radiology, or the Accreditation Association for Ambulatory
1663Health Care, within 1 year after licensure. A clinic that is
1664accredited by the American College of Radiology or is within the
1665original 1-year period after licensure and replaces its core
1666magnetic resonance imaging equipment shall be given 1 year after
1667the date on which the equipment is replaced to attain
1668accreditation. However, a clinic may request a single, 6-month
1669extension if it provides evidence to the agency establishing
1670that, for good cause shown, such clinic cannot be accredited
1671within 1 year after licensure, and that such accreditation will
1672be completed within the 6-month extension. After obtaining
1673accreditation as required by this subsection, each such clinic
1674must maintain accreditation as a condition of renewal of its
1675license. A clinic that files a change of ownership application
1676must comply with the original accreditation timeframe
1677requirements of the transferor. The agency shall deny a change
1678of ownership application if the clinic is not in compliance with
1679the accreditation requirements. When a clinic adds, replaces, or
1680modifies magnetic resonance imaging equipment and the
1681accreditation agency requires new accreditation, the clinic must
1682be accredited within 1 year after the date of the addition,
1683replacement, or modification but may request a single, 6-month
1684extension if the clinic provides evidence of good cause to the
1686     Section 49.  Subsection (2) of section 408.034, Florida
1687Statutes, is amended to read:
1688     408.034  Duties and responsibilities of agency; rules.-
1689     (2)  In the exercise of its authority to issue licenses to
1690health care facilities and health service providers, as provided
1691under chapters 393 and 395 and parts II, and IV, and VIII of
1692chapter 400, the agency may not issue a license to any health
1693care facility or health service provider that fails to receive a
1694certificate of need or an exemption for the licensed facility or
1696     Section 50.  Paragraph (d) of subsection (1) of section
1697408.036, Florida Statutes, is amended to read:
1698     408.036  Projects subject to review; exemptions.-
1699     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1700health-care-related projects, as described in paragraphs (a)-
1701(g), are subject to review and must file an application for a
1702certificate of need with the agency. The agency is exclusively
1703responsible for determining whether a health-care-related
1704project is subject to review under ss. 408.031-408.045.
1705     (d)  The establishment of a hospice or hospice inpatient
1706facility, except as provided in s. 408.043.
1707     Section 51.  Subsection (2) of section 408.043, Florida
1708Statutes, is amended to read:
1709     408.043  Special provisions.-
1710     (2)  HOSPICES.-When an application is made for a
1711certificate of need to establish or to expand a hospice, the
1712need for such hospice shall be determined on the basis of the
1713need for and availability of hospice services in the community.
1714The formula on which the certificate of need is based shall
1715discourage regional monopolies and promote competition. The
1716inpatient hospice care component of a hospice which is a
1717freestanding facility, or a part of a facility, which is
1718primarily engaged in providing inpatient care and related
1719services and is not licensed as a health care facility shall
1720also be required to obtain a certificate of need. Provision of
1721hospice care by any current provider of health care is a
1722significant change in service and therefore requires a
1723certificate of need for such services.
1724     Section 52.  Paragraph (k) of subsection (3) of section
1725408.05, Florida Statutes, is amended to read:
1726     408.05  Florida Center for Health Information and Policy
1729produce comparable and uniform health information and statistics
1730for the development of policy recommendations, the agency shall
1731perform the following functions:
1732     (k)  Develop, in conjunction with the State Consumer Health
1733Information and Policy Advisory Council, and implement a long-
1734range plan for making available health care quality measures and
1735financial data that will allow consumers to compare health care
1736services. The health care quality measures and financial data
1737the agency must make available shall include, but is not limited
1738to, pharmaceuticals, physicians, health care facilities, and
1739health plans and managed care entities. The agency shall submit
1740the initial plan to the Governor, the President of the Senate,
1741and the Speaker of the House of Representatives by January 1,
17422006, and shall update the plan and report on the status of its
1743implementation annually thereafter. The agency shall also make
1744the plan and status report available to the public on its
1745Internet website. As part of the plan, the agency shall identify
1746the process and timeframes for implementation, any barriers to
1747implementation, and recommendations of changes in the law that
1748may be enacted by the Legislature to eliminate the barriers. As
1749preliminary elements of the plan, the agency shall:
1750     1.  Make available patient-safety indicators, inpatient
1751quality indicators, and performance outcome and patient charge
1752data collected from health care facilities pursuant to s.
1753408.061(1)(a) and (2). The terms "patient-safety indicators" and
1754"inpatient quality indicators" shall be as defined by the
1755Centers for Medicare and Medicaid Services, the National Quality
1756Forum, The Joint Commission on Accreditation of Healthcare
1757Organizations, the Agency for Healthcare Research and Quality,
1758the Centers for Disease Control and Prevention, or a similar
1759national entity that establishes standards to measure the
1760performance of health care providers, or by other states. The
1761agency shall determine which conditions, procedures, health care
1762quality measures, and patient charge data to disclose based upon
1763input from the council. When determining which conditions and
1764procedures are to be disclosed, the council and the agency shall
1765consider variation in costs, variation in outcomes, and
1766magnitude of variations and other relevant information. When
1767determining which health care quality measures to disclose, the
1769     a.  Shall consider such factors as volume of cases; average
1770patient charges; average length of stay; complication rates;
1771mortality rates; and infection rates, among others, which shall
1772be adjusted for case mix and severity, if applicable.
1773     b.  May consider such additional measures that are adopted
1774by the Centers for Medicare and Medicaid Studies, National
1775Quality Forum, The Joint Commission on Accreditation of
1776Healthcare Organizations, the Agency for Healthcare Research and
1777Quality, Centers for Disease Control and Prevention, or a
1778similar national entity that establishes standards to measure
1779the performance of health care providers, or by other states.
1781When determining which patient charge data to disclose, the
1782agency shall include such measures as the average of
1783undiscounted charges on frequently performed procedures and
1784preventive diagnostic procedures, the range of procedure charges
1785from highest to lowest, average net revenue per adjusted patient
1786day, average cost per adjusted patient day, and average cost per
1787admission, among others.
1788     2.  Make available performance measures, benefit design,
1789and premium cost data from health plans licensed pursuant to
1790chapter 627 or chapter 641. The agency shall determine which
1791health care quality measures and member and subscriber cost data
1792to disclose, based upon input from the council. When determining
1793which data to disclose, the agency shall consider information
1794that may be required by either individual or group purchasers to
1795assess the value of the product, which may include membership
1796satisfaction, quality of care, current enrollment or membership,
1797coverage areas, accreditation status, premium costs, plan costs,
1798premium increases, range of benefits, copayments and
1799deductibles, accuracy and speed of claims payment, credentials
1800of physicians, number of providers, names of network providers,
1801and hospitals in the network. Health plans shall make available
1802to the agency any such data or information that is not currently
1803reported to the agency or the office.
1804     3.  Determine the method and format for public disclosure
1805of data reported pursuant to this paragraph. The agency shall
1806make its determination based upon input from the State Consumer
1807Health Information and Policy Advisory Council. At a minimum,
1808the data shall be made available on the agency's Internet
1809website in a manner that allows consumers to conduct an
1810interactive search that allows them to view and compare the
1811information for specific providers. The website must include
1812such additional information as is determined necessary to ensure
1813that the website enhances informed decisionmaking among
1814consumers and health care purchasers, which shall include, at a
1815minimum, appropriate guidance on how to use the data and an
1816explanation of why the data may vary from provider to provider.
1817The data specified in subparagraph 1. shall be released no later
1818than January 1, 2006, for the reporting of infection rates, and
1819no later than October 1, 2005, for mortality rates and
1820complication rates. The data specified in subparagraph 2. shall
1821be released no later than October 1, 2006.
1822     4.  Publish on its website undiscounted charges for no
1823fewer than 150 of the most commonly performed adult and
1824pediatric procedures, including outpatient, inpatient,
1825diagnostic, and preventative procedures.
1826     Section 53.  Paragraph (a) of subsection (1) of section
1827408.061, Florida Statutes, is amended to read:
1828     408.061  Data collection; uniform systems of financial
1829reporting; information relating to physician charges;
1830confidential information; immunity.-
1831     (1)  The agency shall require the submission by health care
1832facilities, health care providers, and health insurers of data
1833necessary to carry out the agency's duties. Specifications for
1834data to be collected under this section shall be developed by
1835the agency with the assistance of technical advisory panels
1836including representatives of affected entities, consumers,
1837purchasers, and such other interested parties as may be
1838determined by the agency.
1839     (a)  Data submitted by health care facilities, including
1840the facilities as defined in chapter 395, shall include, but are
1841not limited to: case-mix data, patient admission and discharge
1842data, hospital emergency department data which shall include the
1843number of patients treated in the emergency department of a
1844licensed hospital reported by patient acuity level, data on
1845hospital-acquired infections as specified by rule, data on
1846complications as specified by rule, data on readmissions as
1847specified by rule, with patient and provider-specific
1848identifiers included, actual charge data by diagnostic groups,
1849financial data, accounting data, operating expenses, expenses
1850incurred for rendering services to patients who cannot or do not
1851pay, interest charges, depreciation expenses based on the
1852expected useful life of the property and equipment involved, and
1853demographic data. The agency shall adopt nationally recognized
1854risk adjustment methodologies or software consistent with the
1855standards of the Agency for Healthcare Research and Quality and
1856as selected by the agency for all data submitted as required by
1857this section. Data may be obtained from documents such as, but
1858not limited to: leases, contracts, debt instruments, itemized
1859patient bills, medical record abstracts, and related diagnostic
1860information. Reported data elements shall be reported
1861electronically and in accordance with rule 59E-7.012, Florida
1862Administrative Code. Data submitted shall be certified by the
1863chief executive officer or an appropriate and duly authorized
1864representative or employee of the licensed facility that the
1865information submitted is true and accurate.
1866     Section 54.  Subsection (43) of section 408.07, Florida
1867Statutes, is amended to read:
1868     408.07  Definitions.-As used in this chapter, with the
1869exception of ss. 408.031-408.045, the term:
1870     (43)  "Rural hospital" means an acute care hospital
1871licensed under chapter 395, having 100 or fewer licensed beds
1872and an emergency room, and which is:
1873     (a)  The sole provider within a county with a population
1874density of no greater than 100 persons per square mile;
1875     (b)  An acute care hospital, in a county with a population
1876density of no greater than 100 persons per square mile, which is
1877at least 30 minutes of travel time, on normally traveled roads
1878under normal traffic conditions, from another acute care
1879hospital within the same county;
1880     (c)  A hospital supported by a tax district or subdistrict
1881whose boundaries encompass a population of 100 persons or fewer
1882per square mile;
1883     (d)  A hospital with a service area that has a population
1884of 100 persons or fewer per square mile. As used in this
1885paragraph, the term "service area" means the fewest number of
1886zip codes that account for 75 percent of the hospital's
1887discharges for the most recent 5-year period, based on
1888information available from the hospital inpatient discharge
1889database in the Florida Center for Health Information and Policy
1890Analysis at the Agency for Health Care Administration; or
1891     (e)  A critical access hospital.
1893Population densities used in this subsection must be based upon
1894the most recently completed United States census. A hospital
1895that received funds under s. 409.9116 for a quarter beginning no
1896later than July 1, 2002, is deemed to have been and shall
1897continue to be a rural hospital from that date through June 30,
18982015, if the hospital continues to have 100 or fewer licensed
1899beds and an emergency room, or meets the criteria of s.
1900395.602(2)(e)4. An acute care hospital that has not previously
1901been designated as a rural hospital and that meets the criteria
1902of this subsection shall be granted such designation upon
1903application, including supporting documentation, to the Agency
1904for Health Care Administration.
1905     Section 55.  Section 408.10, Florida Statutes, is amended
1906to read:
1907     408.10  Consumer complaints.-The agency shall:
1908     (1)  publish and make available to the public a toll-free
1909telephone number for the purpose of handling consumer complaints
1910and shall serve as a liaison between consumer entities and other
1911private entities and governmental entities for the disposition
1912of problems identified by consumers of health care.
1913     (2)  Be empowered to investigate consumer complaints
1914relating to problems with health care facilities' billing
1915practices and issue reports to be made public in any cases where
1916the agency determines the health care facility has engaged in
1917billing practices which are unreasonable and unfair to the
1919     Section 56.  Subsections (12) through (30) of section
1920408.802, Florida Statutes, are renumbered as subsections (11)
1921through (29), respectively, and present subsection (11) of that
1922section is amended to read:
1923     408.802  Applicability.-The provisions of this part apply
1924to the provision of services that require licensure as defined
1925in this part and to the following entities licensed, registered,
1926or certified by the agency, as described in chapters 112, 383,
1927390, 394, 395, 400, 429, 440, 483, and 765:
1928     (11)  Private review agents, as provided under part I of
1929chapter 395.
1930     Section 57.  Subsection (3) is added to section 408.804,
1931Florida Statutes, to read:
1932     408.804  License required; display.-
1933     (3)  Any person who knowingly alters, defaces, or falsifies
1934a license certificate issued by the agency, or causes or
1935procures any person to commit such an offense, commits a
1936misdemeanor of the second degree, punishable as provided in s.
1937775.082 or s 775.083. Any licensee or provider who displays an
1938altered, defaced, or falsified license certificate is subject to
1939the penalties set forth in s. 408.815 and an administrative fine
1940of $1,000 for each day of illegal display.
1941     Section 58.  Paragraph (d) of subsection (2) of section
1942408.806, Florida Statutes, is amended, present subsections (3)
1943through (8) are renumbered as subsections (4) through (9),
1944respectively, and a new subsection (3) is added to that section,
1945to read:
1946     408.806  License application process.-
1947     (2)
1948     (d)  The agency shall notify the licensee by mail or
1949electronically at least 90 days before the expiration of a
1950license that a renewal license is necessary to continue
1951operation. The licensee's failure to timely file submit a
1952renewal application and license application fee with the agency
1953shall result in a $50 per day late fee charged to the licensee
1954by the agency; however, the aggregate amount of the late fee may
1955not exceed 50 percent of the licensure fee or $500, whichever is
1956less. The agency shall provide a courtesy notice to the licensee
1957by United States mail, electronically, or by any other manner at
1958its address of record or mailing address, if provided, at least
195990 days prior to the expiration of a license informing the
1960licensee of the expiration of the license. If the agency does
1961not provide the courtesy notice or the licensee does not receive
1962the courtesy notice, the licensee continues to be legally
1963obligated to timely file the renewal application and license
1964application fee with the agency and is not excused from the
1965payment of a late fee. If an application is received after the
1966required filing date and exhibits a hand-canceled postmark
1967obtained from a United States post office dated on or before the
1968required filing date, no fine will be levied.
1969     (3)  Payment of the late fee is required to consider any
1970late application complete, and failure to pay the late fee is
1971considered an omission from the application.
1972     Section 59.  Subsections (6) and (9) of section 408.810,
1973Florida Statutes, are amended to read:
1974     408.810  Minimum licensure requirements.-In addition to the
1975licensure requirements specified in this part, authorizing
1976statutes, and applicable rules, each applicant and licensee must
1977comply with the requirements of this section in order to obtain
1978and maintain a license.
1979     (6)(a)  An applicant must provide the agency with proof of
1980the applicant's legal right to occupy the property before a
1981license may be issued. Proof may include, but need not be
1982limited to, copies of warranty deeds, lease or rental
1983agreements, contracts for deeds, quitclaim deeds, or other such
1985     (b)  In the event the property is encumbered by a mortgage
1986or is leased, an applicant must provide the agency with proof
1987that the mortgagor or landlord has been provided written notice
1988of the applicant's intent as mortgagee or tenant to provide
1989services that require licensure and instruct the mortgagor or
1990landlord to serve the agency by certified mail with copies of
1991any foreclosure or eviction actions initiated by the mortgagor
1992or landlord against the applicant.
1993     (9)  A controlling interest may not withhold from the
1994agency any evidence of financial instability, including, but not
1995limited to, checks returned due to insufficient funds,
1996delinquent accounts, nonpayment of withholding taxes, unpaid
1997utility expenses, nonpayment for essential services, or adverse
1998court action concerning the financial viability of the provider
1999or any other provider licensed under this part that is under the
2000control of the controlling interest. A controlling interest
2001shall notify the agency within 10 days after a court action to
2002initiate bankruptcy, foreclosure, or eviction proceedings
2003concerning the provider, in which the controlling interest is a
2004petitioner or defendant. Any person who violates this subsection
2005commits a misdemeanor of the second degree, punishable as
2006provided in s. 775.082 or s. 775.083. Each day of continuing
2007violation is a separate offense.
2008     Section 60.  Subsection (3) is added to section 408.813,
2009Florida Statutes, to read:
2010     408.813  Administrative fines; violations.-As a penalty for
2011any violation of this part, authorizing statutes, or applicable
2012rules, the agency may impose an administrative fine.
2013     (3)  The agency may impose an administrative fine for a
2014violation that does not qualify as a class I, class II, class
2015III, or class IV violation. Unless otherwise specified by law,
2016the amount of the fine shall not exceed $500 for each violation.
2017Unclassified violations may include:
2018     (a)  Violating any term or condition of a license.
2019     (b)  Violating any provision of this part, authorizing
2020statutes, or applicable rules.
2021     (c)  Exceeding licensed capacity.
2022     (d)  Providing services beyond the scope of the license.
2023     (e)  Violating a moratorium imposed pursuant to s. 408.814.
2024     Section 61.  Subsection (5) is added to section 408.815,
2025Florida Statutes, to read:
2026     408.815  License or application denial; revocation.-
2027     (5)  In order to ensure the health, safety, and welfare of
2028clients when a license has been denied, revoked, or is set to
2029terminate, the agency may extend the license expiration date for
2030a period of up to 30 days for the sole purpose of allowing the
2031safe and orderly discharge of clients. The agency may impose
2032conditions on the extension, including, but not limited to,
2033prohibiting or limiting admissions, expedited discharge
2034planning, required status reports, and mandatory monitoring by
2035the agency or third parties. In imposing these conditions, the
2036agency shall take into consideration the nature and number of
2037clients, the availability and location of acceptable alternative
2038placements, and the ability of the licensee to continue
2039providing care to the clients. The agency may terminate the
2040extension or modify the conditions at any time. This authority
2041is in addition to any other authority granted to the agency
2042under chapter 120, this part, and authorizing statutes but
2043creates no right or entitlement to an extension of a license
2044expiration date.
2045     Section 62.  Paragraph (k) of subsection (4) of section
2046409.221, Florida Statutes, is amended to read:
2047     409.221  Consumer-directed care program.-
2049     (k)  Reviews and reports.-The agency and the Departments of
2050Elderly Affairs, Health, and Children and Family Services and
2051the Agency for Persons with Disabilities shall each, on an
2052ongoing basis, review and assess the implementation of the
2053consumer-directed care program. By January 15 of each year, the
2054agency shall submit a written report to the Legislature that
2055includes each department's review of the program and contains
2056recommendations for improvements to the program.
2057     Section 63.  Subsection (1) of section 409.91196, Florida
2058Statutes, is amended to read:
2059     409.91196  Supplemental rebate agreements; public records
2060and public meetings exemption.-
2061     (1)  The rebate amount, percent of rebate, manufacturer's
2062pricing, and supplemental rebate, and other trade secrets as
2063defined in s. 688.002 that the agency has identified for use in
2064negotiations, held by the Agency for Health Care Administration
2065under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2066119.07(1) and s. 24(a), Art. I of the State Constitution.
2067     Section 64.  Paragraph (a) of subsection (39) of section
2068409.912, Florida Statutes, is amended to read:
2069     409.912  Cost-effective purchasing of health care.-The
2070agency shall purchase goods and services for Medicaid recipients
2071in the most cost-effective manner consistent with the delivery
2072of quality medical care. To ensure that medical services are
2073effectively utilized, the agency may, in any case, require a
2074confirmation or second physician's opinion of the correct
2075diagnosis for purposes of authorizing future services under the
2076Medicaid program. This section does not restrict access to
2077emergency services or poststabilization care services as defined
2078in 42 C.F.R. part 438.114. Such confirmation or second opinion
2079shall be rendered in a manner approved by the agency. The agency
2080shall maximize the use of prepaid per capita and prepaid
2081aggregate fixed-sum basis services when appropriate and other
2082alternative service delivery and reimbursement methodologies,
2083including competitive bidding pursuant to s. 287.057, designed
2084to facilitate the cost-effective purchase of a case-managed
2085continuum of care. The agency shall also require providers to
2086minimize the exposure of recipients to the need for acute
2087inpatient, custodial, and other institutional care and the
2088inappropriate or unnecessary use of high-cost services. The
2089agency shall contract with a vendor to monitor and evaluate the
2090clinical practice patterns of providers in order to identify
2091trends that are outside the normal practice patterns of a
2092provider's professional peers or the national guidelines of a
2093provider's professional association. The vendor must be able to
2094provide information and counseling to a provider whose practice
2095patterns are outside the norms, in consultation with the agency,
2096to improve patient care and reduce inappropriate utilization.
2097The agency may mandate prior authorization, drug therapy
2098management, or disease management participation for certain
2099populations of Medicaid beneficiaries, certain drug classes, or
2100particular drugs to prevent fraud, abuse, overuse, and possible
2101dangerous drug interactions. The Pharmaceutical and Therapeutics
2102Committee shall make recommendations to the agency on drugs for
2103which prior authorization is required. The agency shall inform
2104the Pharmaceutical and Therapeutics Committee of its decisions
2105regarding drugs subject to prior authorization. The agency is
2106authorized to limit the entities it contracts with or enrolls as
2107Medicaid providers by developing a provider network through
2108provider credentialing. The agency may competitively bid single-
2109source-provider contracts if procurement of goods or services
2110results in demonstrated cost savings to the state without
2111limiting access to care. The agency may limit its network based
2112on the assessment of beneficiary access to care, provider
2113availability, provider quality standards, time and distance
2114standards for access to care, the cultural competence of the
2115provider network, demographic characteristics of Medicaid
2116beneficiaries, practice and provider-to-beneficiary standards,
2117appointment wait times, beneficiary use of services, provider
2118turnover, provider profiling, provider licensure history,
2119previous program integrity investigations and findings, peer
2120review, provider Medicaid policy and billing compliance records,
2121clinical and medical record audits, and other factors. Providers
2122shall not be entitled to enrollment in the Medicaid provider
2123network. The agency shall determine instances in which allowing
2124Medicaid beneficiaries to purchase durable medical equipment and
2125other goods is less expensive to the Medicaid program than long-
2126term rental of the equipment or goods. The agency may establish
2127rules to facilitate purchases in lieu of long-term rentals in
2128order to protect against fraud and abuse in the Medicaid program
2129as defined in s. 409.913. The agency may seek federal waivers
2130necessary to administer these policies.
2131     (39)(a)  The agency shall implement a Medicaid prescribed-
2132drug spending-control program that includes the following
2134     1.  A Medicaid preferred drug list, which shall be a
2135listing of cost-effective therapeutic options recommended by the
2136Medicaid Pharmacy and Therapeutics Committee established
2137pursuant to s. 409.91195 and adopted by the agency for each
2138therapeutic class on the preferred drug list. At the discretion
2139of the committee, and when feasible, the preferred drug list
2140should include at least two products in a therapeutic class. The
2141agency may post the preferred drug list and updates to the
2142preferred drug list on an Internet website without following the
2143rulemaking procedures of chapter 120. Antiretroviral agents are
2144excluded from the preferred drug list. The agency shall also
2145limit the amount of a prescribed drug dispensed to no more than
2146a 34-day supply unless the drug products' smallest marketed
2147package is greater than a 34-day supply, or the drug is
2148determined by the agency to be a maintenance drug in which case
2149a 100-day maximum supply may be authorized. The agency is
2150authorized to seek any federal waivers necessary to implement
2151these cost-control programs and to continue participation in the
2152federal Medicaid rebate program, or alternatively to negotiate
2153state-only manufacturer rebates. The agency may adopt rules to
2154implement this subparagraph. The agency shall continue to
2155provide unlimited contraceptive drugs and items. The agency must
2156establish procedures to ensure that:
2157     a.  There is a response to a request for prior consultation
2158by telephone or other telecommunication device within 24 hours
2159after receipt of a request for prior consultation; and
2160     b.  A 72-hour supply of the drug prescribed is provided in
2161an emergency or when the agency does not provide a response
2162within 24 hours as required by sub-subparagraph a.
2163     2.  Reimbursement to pharmacies for Medicaid prescribed
2164drugs shall be set at the lesser of: the average wholesale price
2165(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2166plus 4.75 percent, the federal upper limit (FUL), the state
2167maximum allowable cost (SMAC), or the usual and customary (UAC)
2168charge billed by the provider.
2169     3.  For a prescribed drug billed as a 340B prescribed
2170medication, the claim must meet the requirements of the Deficit
2171Reduction Act of 2005 and the federal 340B program, contain a
2172national drug code, and be billed at the actual acquisition cost
2173or payment shall be denied.
2174     4.3.  The agency shall develop and implement a process for
2175managing the drug therapies of Medicaid recipients who are using
2176significant numbers of prescribed drugs each month. The
2177management process may include, but is not limited to,
2178comprehensive, physician-directed medical-record reviews, claims
2179analyses, and case evaluations to determine the medical
2180necessity and appropriateness of a patient's treatment plan and
2181drug therapies. The agency may contract with a private
2182organization to provide drug-program-management services. The
2183Medicaid drug benefit management program shall include
2184initiatives to manage drug therapies for HIV/AIDS patients,
2185patients using 20 or more unique prescriptions in a 180-day
2186period, and the top 1,000 patients in annual spending. The
2187agency shall enroll any Medicaid recipient in the drug benefit
2188management program if he or she meets the specifications of this
2189provision and is not enrolled in a Medicaid health maintenance
2191     5.4.  The agency may limit the size of its pharmacy network
2192based on need, competitive bidding, price negotiations,
2193credentialing, or similar criteria. The agency shall give
2194special consideration to rural areas in determining the size and
2195location of pharmacies included in the Medicaid pharmacy
2196network. A pharmacy credentialing process may include criteria
2197such as a pharmacy's full-service status, location, size,
2198patient educational programs, patient consultation, disease
2199management services, and other characteristics. The agency may
2200impose a moratorium on Medicaid pharmacy enrollment when it is
2201determined that it has a sufficient number of Medicaid-
2202participating providers. The agency must allow dispensing
2203practitioners to participate as a part of the Medicaid pharmacy
2204network regardless of the practitioner's proximity to any other
2205entity that is dispensing prescription drugs under the Medicaid
2206program. A dispensing practitioner must meet all credentialing
2207requirements applicable to his or her practice, as determined by
2208the agency.
2209     6.5.  The agency shall develop and implement a program that
2210requires Medicaid practitioners who prescribe drugs to use a
2211counterfeit-proof prescription pad for Medicaid prescriptions.
2212The agency shall require the use of standardized counterfeit-
2213proof prescription pads by Medicaid-participating prescribers or
2214prescribers who write prescriptions for Medicaid recipients. The
2215agency may implement the program in targeted geographic areas or
2217     7.6.  The agency may enter into arrangements that require
2218manufacturers of generic drugs prescribed to Medicaid recipients
2219to provide rebates of at least 15.1 percent of the average
2220manufacturer price for the manufacturer's generic products.
2221These arrangements shall require that if a generic-drug
2222manufacturer pays federal rebates for Medicaid-reimbursed drugs
2223at a level below 15.1 percent, the manufacturer must provide a
2224supplemental rebate to the state in an amount necessary to
2225achieve a 15.1-percent rebate level.
2226     8.7.  The agency may establish a preferred drug list as
2227described in this subsection, and, pursuant to the establishment
2228of such preferred drug list, it is authorized to negotiate
2229supplemental rebates from manufacturers that are in addition to
2230those required by Title XIX of the Social Security Act and at no
2231less than 14 percent of the average manufacturer price as
2232defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2233the federal or supplemental rebate, or both, equals or exceeds
223429 percent. There is no upper limit on the supplemental rebates
2235the agency may negotiate. The agency may determine that specific
2236products, brand-name or generic, are competitive at lower rebate
2237percentages. Agreement to pay the minimum supplemental rebate
2238percentage will guarantee a manufacturer that the Medicaid
2239Pharmaceutical and Therapeutics Committee will consider a
2240product for inclusion on the preferred drug list. However, a
2241pharmaceutical manufacturer is not guaranteed placement on the
2242preferred drug list by simply paying the minimum supplemental
2243rebate. Agency decisions will be made on the clinical efficacy
2244of a drug and recommendations of the Medicaid Pharmaceutical and
2245Therapeutics Committee, as well as the price of competing
2246products minus federal and state rebates. The agency is
2247authorized to contract with an outside agency or contractor to
2248conduct negotiations for supplemental rebates. For the purposes
2249of this section, the term "supplemental rebates" means cash
2250rebates. Effective July 1, 2004, value-added programs as a
2251substitution for supplemental rebates are prohibited. The agency
2252is authorized to seek any federal waivers to implement this
2254     9.8.  The Agency for Health Care Administration shall
2255expand home delivery of pharmacy products. To assist Medicaid
2256patients in securing their prescriptions and reduce program
2257costs, the agency shall expand its current mail-order-pharmacy
2258diabetes-supply program to include all generic and brand-name
2259drugs used by Medicaid patients with diabetes. Medicaid
2260recipients in the current program may obtain nondiabetes drugs
2261on a voluntary basis. This initiative is limited to the
2262geographic area covered by the current contract. The agency may
2263seek and implement any federal waivers necessary to implement
2264this subparagraph.
2265     10.9.  The agency shall limit to one dose per month any
2266drug prescribed to treat erectile dysfunction.
2267     11.10.a.  The agency may implement a Medicaid behavioral
2268drug management system. The agency may contract with a vendor
2269that has experience in operating behavioral drug management
2270systems to implement this program. The agency is authorized to
2271seek federal waivers to implement this program.
2272     b.  The agency, in conjunction with the Department of
2273Children and Family Services, may implement the Medicaid
2274behavioral drug management system that is designed to improve
2275the quality of care and behavioral health prescribing practices
2276based on best practice guidelines, improve patient adherence to
2277medication plans, reduce clinical risk, and lower prescribed
2278drug costs and the rate of inappropriate spending on Medicaid
2279behavioral drugs. The program may include the following
2281     (I)  Provide for the development and adoption of best
2282practice guidelines for behavioral health-related drugs such as
2283antipsychotics, antidepressants, and medications for treating
2284bipolar disorders and other behavioral conditions; translate
2285them into practice; review behavioral health prescribers and
2286compare their prescribing patterns to a number of indicators
2287that are based on national standards; and determine deviations
2288from best practice guidelines.
2289     (II)  Implement processes for providing feedback to and
2290educating prescribers using best practice educational materials
2291and peer-to-peer consultation.
2292     (III)  Assess Medicaid beneficiaries who are outliers in
2293their use of behavioral health drugs with regard to the numbers
2294and types of drugs taken, drug dosages, combination drug
2295therapies, and other indicators of improper use of behavioral
2296health drugs.
2297     (IV)  Alert prescribers to patients who fail to refill
2298prescriptions in a timely fashion, are prescribed multiple same-
2299class behavioral health drugs, and may have other potential
2300medication problems.
2301     (V)  Track spending trends for behavioral health drugs and
2302deviation from best practice guidelines.
2303     (VI)  Use educational and technological approaches to
2304promote best practices, educate consumers, and train prescribers
2305in the use of practice guidelines.
2306     (VII)  Disseminate electronic and published materials.
2307     (VIII)  Hold statewide and regional conferences.
2308     (IX)  Implement a disease management program with a model
2309quality-based medication component for severely mentally ill
2310individuals and emotionally disturbed children who are high
2311users of care.
2312     12.11.a.  The agency shall implement a Medicaid
2313prescription drug management system. The agency may contract
2314with a vendor that has experience in operating prescription drug
2315management systems in order to implement this system. Any
2316management system that is implemented in accordance with this
2317subparagraph must rely on cooperation between physicians and
2318pharmacists to determine appropriate practice patterns and
2319clinical guidelines to improve the prescribing, dispensing, and
2320use of drugs in the Medicaid program. The agency may seek
2321federal waivers to implement this program.
2322     b.  The drug management system must be designed to improve
2323the quality of care and prescribing practices based on best
2324practice guidelines, improve patient adherence to medication
2325plans, reduce clinical risk, and lower prescribed drug costs and
2326the rate of inappropriate spending on Medicaid prescription
2327drugs. The program must:
2328     (I)  Provide for the development and adoption of best
2329practice guidelines for the prescribing and use of drugs in the
2330Medicaid program, including translating best practice guidelines
2331into practice; reviewing prescriber patterns and comparing them
2332to indicators that are based on national standards and practice
2333patterns of clinical peers in their community, statewide, and
2334nationally; and determine deviations from best practice
2336     (II)  Implement processes for providing feedback to and
2337educating prescribers using best practice educational materials
2338and peer-to-peer consultation.
2339     (III)  Assess Medicaid recipients who are outliers in their
2340use of a single or multiple prescription drugs with regard to
2341the numbers and types of drugs taken, drug dosages, combination
2342drug therapies, and other indicators of improper use of
2343prescription drugs.
2344     (IV)  Alert prescribers to patients who fail to refill
2345prescriptions in a timely fashion, are prescribed multiple drugs
2346that may be redundant or contraindicated, or may have other
2347potential medication problems.
2348     (V)  Track spending trends for prescription drugs and
2349deviation from best practice guidelines.
2350     (VI)  Use educational and technological approaches to
2351promote best practices, educate consumers, and train prescribers
2352in the use of practice guidelines.
2353     (VII)  Disseminate electronic and published materials.
2354     (VIII)  Hold statewide and regional conferences.
2355     (IX)  Implement disease management programs in cooperation
2356with physicians and pharmacists, along with a model quality-
2357based medication component for individuals having chronic
2358medical conditions.
2359     13.12.  The agency is authorized to contract for drug
2360rebate administration, including, but not limited to,
2361calculating rebate amounts, invoicing manufacturers, negotiating
2362disputes with manufacturers, and maintaining a database of
2363rebate collections.
2364     14.13.  The agency may specify the preferred daily dosing
2365form or strength for the purpose of promoting best practices
2366with regard to the prescribing of certain drugs as specified in
2367the General Appropriations Act and ensuring cost-effective
2368prescribing practices.
2369     15.14.  The agency may require prior authorization for
2370Medicaid-covered prescribed drugs. The agency may, but is not
2371required to, prior-authorize the use of a product:
2372     a.  For an indication not approved in labeling;
2373     b.  To comply with certain clinical guidelines; or
2374     c.  If the product has the potential for overuse, misuse,
2375or abuse.
2377The agency may require the prescribing professional to provide
2378information about the rationale and supporting medical evidence
2379for the use of a drug. The agency may post prior authorization
2380criteria and protocol and updates to the list of drugs that are
2381subject to prior authorization on an Internet website without
2382amending its rule or engaging in additional rulemaking.
2383     16.15.  The agency, in conjunction with the Pharmaceutical
2384and Therapeutics Committee, may require age-related prior
2385authorizations for certain prescribed drugs. The agency may
2386preauthorize the use of a drug for a recipient who may not meet
2387the age requirement or may exceed the length of therapy for use
2388of this product as recommended by the manufacturer and approved
2389by the Food and Drug Administration. Prior authorization may
2390require the prescribing professional to provide information
2391about the rationale and supporting medical evidence for the use
2392of a drug.
2393     17.16.  The agency shall implement a step-therapy prior
2394authorization approval process for medications excluded from the
2395preferred drug list. Medications listed on the preferred drug
2396list must be used within the previous 12 months prior to the
2397alternative medications that are not listed. The step-therapy
2398prior authorization may require the prescriber to use the
2399medications of a similar drug class or for a similar medical
2400indication unless contraindicated in the Food and Drug
2401Administration labeling. The trial period between the specified
2402steps may vary according to the medical indication. The step-
2403therapy approval process shall be developed in accordance with
2404the committee as stated in s. 409.91195(7) and (8). A drug
2405product may be approved without meeting the step-therapy prior
2406authorization criteria if the prescribing physician provides the
2407agency with additional written medical or clinical documentation
2408that the product is medically necessary because:
2409     a.  There is not a drug on the preferred drug list to treat
2410the disease or medical condition which is an acceptable clinical
2412     b.  The alternatives have been ineffective in the treatment
2413of the beneficiary's disease; or
2414     c.  Based on historic evidence and known characteristics of
2415the patient and the drug, the drug is likely to be ineffective,
2416or the number of doses have been ineffective.
2418The agency shall work with the physician to determine the best
2419alternative for the patient. The agency may adopt rules waiving
2420the requirements for written clinical documentation for specific
2421drugs in limited clinical situations.
2422     18.17.  The agency shall implement a return and reuse
2423program for drugs dispensed by pharmacies to institutional
2424recipients, which includes payment of a $5 restocking fee for
2425the implementation and operation of the program. The return and
2426reuse program shall be implemented electronically and in a
2427manner that promotes efficiency. The program must permit a
2428pharmacy to exclude drugs from the program if it is not
2429practical or cost-effective for the drug to be included and must
2430provide for the return to inventory of drugs that cannot be
2431credited or returned in a cost-effective manner. The agency
2432shall determine if the program has reduced the amount of
2433Medicaid prescription drugs which are destroyed on an annual
2434basis and if there are additional ways to ensure more
2435prescription drugs are not destroyed which could safely be
2436reused. The agency's conclusion and recommendations shall be
2437reported to the Legislature by December 1, 2005.
2438     Section 65.  Subsections (3) and (4) of section 429.07,
2439Florida Statutes, are amended, and subsections (6) and (7) are
2440added to that section, to read:
2441     429.07  License required; fee; inspections.-
2442     (3)  In addition to the requirements of s. 408.806, each
2443license granted by the agency must state the type of care for
2444which the license is granted. Licenses shall be issued for one
2445or more of the following categories of care: standard, extended
2446congregate care, limited nursing services, or limited mental
2448     (a)  A standard license shall be issued to a facility
2449facilities providing one or more of the personal services
2450identified in s. 429.02. Such licensee facilities may also
2451employ or contract with a person licensed under part I of
2452chapter 464 to administer medications and perform other tasks as
2453specified in s. 429.255.
2454     (b)  An extended congregate care license shall be issued to
2455a licensee facilities providing, directly or through contract,
2456services beyond those authorized in paragraph (a), including
2457acts performed pursuant to part I of chapter 464 by persons
2458licensed thereunder, and supportive services defined by rule to
2459persons who otherwise would be disqualified from continued
2460residence in a facility licensed under this part.
2461     1.  In order for extended congregate care services to be
2462provided in a facility licensed under this part, the agency must
2463first determine that all requirements established in law and
2464rule are met and must specifically designate, on the facility's
2465license, that such services may be provided and whether the
2466designation applies to all or part of a facility. Such
2467designation may be made at the time of initial licensure or
2468relicensure, or upon request in writing by a licensee under this
2469part and part II of chapter 408. Notification of approval or
2470denial of such request shall be made in accordance with part II
2471of chapter 408. An existing licensee facilities qualifying to
2472provide extended congregate care services must have maintained a
2473standard license and may not have been subject to administrative
2474sanctions during the previous 2 years, or since initial
2475licensure if the facility has been licensed for less than 2
2476years, for any of the following reasons:
2477     a.  A class I or class II violation;
2478     b.  Three or more repeat or recurring class III violations
2479of identical or similar resident care standards as specified in
2480rule from which a pattern of noncompliance is found by the
2482     c.  Three or more class III violations that were not
2483corrected in accordance with the corrective action plan approved
2484by the agency;
2485     d.  Violation of resident care standards resulting in a
2486requirement to employ the services of a consultant pharmacist or
2487consultant dietitian;
2488     e.  Denial, suspension, or revocation of a license for
2489another facility under this part in which the applicant for an
2490extended congregate care license has at least 25 percent
2491ownership interest; or
2492     f.  Imposition of a moratorium pursuant to this part or
2493part II of chapter 408 or initiation of injunctive proceedings.
2494     2.  A licensee Facilities that is are licensed to provide
2495extended congregate care services shall maintain a written
2496progress report for on each person who receives such services,
2497and the which report must describe describes the type, amount,
2498duration, scope, and outcome of services that are rendered and
2499the general status of the resident's health. A registered nurse,
2500or appropriate designee, representing the agency shall visit
2501such facilities at least quarterly to monitor residents who are
2502receiving extended congregate care services and to determine if
2503the facility is in compliance with this part, part II of chapter
2504408, and rules that relate to extended congregate care. One of
2505these visits may be in conjunction with the regular survey. The
2506monitoring visits may be provided through contractual
2507arrangements with appropriate community agencies. A registered
2508nurse shall serve as part of the team that inspects such
2509facility. The agency may waive one of the required yearly
2510monitoring visits for a facility that has been licensed for at
2511least 24 months to provide extended congregate care services,
2512if, during the inspection, the registered nurse determines that
2513extended congregate care services are being provided
2514appropriately, and if the facility has no class I or class II
2515violations and no uncorrected class III violations. Before such
2516decision is made, the agency shall consult with the long-term
2517care ombudsman council for the area in which the facility is
2518located to determine if any complaints have been made and
2519substantiated about the quality of services or care. The agency
2520may not waive one of the required yearly monitoring visits if
2521complaints have been made and substantiated.
2522     3.  Licensees Facilities that are licensed to provide
2523extended congregate care services shall:
2524     a.  Demonstrate the capability to meet unanticipated
2525resident service needs.
2526     b.  Offer a physical environment that promotes a homelike
2527setting, provides for resident privacy, promotes resident
2528independence, and allows sufficient congregate space as defined
2529by rule.
2530     c.  Have sufficient staff available, taking into account
2531the physical plant and firesafety features of the building, to
2532assist with the evacuation of residents in an emergency, as
2534     d.  Adopt and follow policies and procedures that maximize
2535resident independence, dignity, choice, and decisionmaking to
2536permit residents to age in place to the extent possible, so that
2537moves due to changes in functional status are minimized or
2539     e.  Allow residents or, if applicable, a resident's
2540representative, designee, surrogate, guardian, or attorney in
2541fact to make a variety of personal choices, participate in
2542developing service plans, and share responsibility in
2544     f.  Implement the concept of managed risk.
2545     g.  Provide, either directly or through contract, the
2546services of a person licensed pursuant to part I of chapter 464.
2547     h.  In addition to the training mandated in s. 429.52,
2548provide specialized training as defined by rule for facility
2550     4.  Licensees Facilities licensed to provide extended
2551congregate care services are exempt from the criteria for
2552continued residency as set forth in rules adopted under s.
2553429.41. Licensees Facilities so licensed shall adopt their own
2554requirements within guidelines for continued residency set forth
2555by rule. However, such licensees facilities may not serve
2556residents who require 24-hour nursing supervision. Licensees
2557Facilities licensed to provide extended congregate care services
2558shall provide each resident with a written copy of facility
2559policies governing admission and retention.
2560     5.  The primary purpose of extended congregate care
2561services is to allow residents, as they become more impaired,
2562the option of remaining in a familiar setting from which they
2563would otherwise be disqualified for continued residency. A
2564facility licensed to provide extended congregate care services
2565may also admit an individual who exceeds the admission criteria
2566for a facility with a standard license, if the individual is
2567determined appropriate for admission to the extended congregate
2568care facility.
2569     6.  Before admission of an individual to a facility
2570licensed to provide extended congregate care services, the
2571individual must undergo a medical examination as provided in s.
2572429.26(4) and the facility must develop a preliminary service
2573plan for the individual.
2574     7.  When a licensee facility can no longer provide or
2575arrange for services in accordance with the resident's service
2576plan and needs and the licensee's facility's policy, the
2577licensee facility shall make arrangements for relocating the
2578person in accordance with s. 429.28(1)(k).
2579     8.  Failure to provide extended congregate care services
2580may result in denial of extended congregate care license
2582     9.  No later than January 1 of each year, the department,
2583in consultation with the agency, shall prepare and submit to the
2584Governor, the President of the Senate, the Speaker of the House
2585of Representatives, and the chairs of appropriate legislative
2586committees, a report on the status of, and recommendations
2587related to, extended congregate care services. The status report
2588must include, but need not be limited to, the following
2590     a.  A description of the facilities licensed to provide
2591such services, including total number of beds licensed under
2592this part.
2593     b.  The number and characteristics of residents receiving
2594such services.
2595     c.  The types of services rendered that could not be
2596provided through a standard license.
2597     d.  An analysis of deficiencies cited during licensure
2599     e.  The number of residents who required extended
2600congregate care services at admission and the source of
2602     f.  Recommendations for statutory or regulatory changes.
2603     g.  The availability of extended congregate care to state
2604clients residing in facilities licensed under this part and in
2605need of additional services, and recommendations for
2606appropriations to subsidize extended congregate care services
2607for such persons.
2608     h.  Such other information as the department considers
2610     (c)  A limited nursing services license shall be issued to
2611a facility that provides services beyond those authorized in
2612paragraph (a) and as specified in this paragraph.
2613     1.  In order for limited nursing services to be provided in
2614a facility licensed under this part, the agency must first
2615determine that all requirements established in law and rule are
2616met and must specifically designate, on the facility's license,
2617that such services may be provided. Such designation may be made
2618at the time of initial licensure or relicensure, or upon request
2619in writing by a licensee under this part and part II of chapter
2620408. Notification of approval or denial of such request shall be
2621made in accordance with part II of chapter 408. Existing
2622facilities qualifying to provide limited nursing services shall
2623have maintained a standard license and may not have been subject
2624to administrative sanctions that affect the health, safety, and
2625welfare of residents for the previous 2 years or since initial
2626licensure if the facility has been licensed for less than 2
2628     2.  Facilities that are licensed to provide limited nursing
2629services shall maintain a written progress report on each person
2630who receives such nursing services, which report describes the
2631type, amount, duration, scope, and outcome of services that are
2632rendered and the general status of the resident's health. A
2633registered nurse representing the agency shall visit such
2634facilities at least twice a year to monitor residents who are
2635receiving limited nursing services and to determine if the
2636facility is in compliance with applicable provisions of this
2637part, part II of chapter 408, and related rules. The monitoring
2638visits may be provided through contractual arrangements with
2639appropriate community agencies. A registered nurse shall also
2640serve as part of the team that inspects such facility.
2641     3.  A person who receives limited nursing services under
2642this part must meet the admission criteria established by the
2643agency for assisted living facilities. When a resident no longer
2644meets the admission criteria for a facility licensed under this
2645part, arrangements for relocating the person shall be made in
2646accordance with s. 429.28(1)(k), unless the facility is licensed
2647to provide extended congregate care services.
2648     (4)  In accordance with s. 408.805, an applicant or
2649licensee shall pay a fee for each license application submitted
2650under this part, part II of chapter 408, and applicable rules.
2651The amount of the fee shall be established by rule.
2652     (a)  The biennial license fee required of a facility is
2653$356 $300 per license, with an additional fee of $67.50 $50 per
2654resident based on the total licensed resident capacity of the
2655facility, except that no additional fee will be assessed for
2656beds designated for recipients of optional state supplementation
2657payments provided for in s. 409.212. The total fee may not
2658exceed $18,000 $10,000.
2659     (b)  In addition to the total fee assessed under paragraph
2660(a), the agency shall require facilities that are licensed to
2661provide extended congregate care services under this part to pay
2662an additional fee per licensed facility. The amount of the
2663biennial fee shall be $501 $400 per license, with an additional
2664fee of $10 per resident based on the total licensed resident
2665capacity of the facility.
2666     (c)  In addition to the total fee assessed under paragraph
2667(a), the agency shall require facilities that are licensed to
2668provide limited nursing services under this part to pay an
2669additional fee per licensed facility. The amount of the biennial
2670fee shall be $250 per license, with an additional fee of $10 per
2671resident based on the total licensed resident capacity of the
2673     (6)  In order to determine whether the facility is
2674adequately protecting residents' rights as provided in s.
2675429.28, the biennial survey shall include private informal
2676conversations with a sample of residents and consultation with
2677the ombudsman council in the planning and service area in which
2678the facility is located to discuss residents' experiences within
2679the facility.
2680     (7)  An assisted living facility that has been cited within
2681the previous 24-month period for a class I or class II
2682violation, regardless of the status of any enforcement or
2683disciplinary action, is subject to periodic unannounced
2684monitoring to determine if the facility is in compliance with
2685this part, part II of chapter 408, and applicable rules.
2686Monitoring may occur through a desk review or an onsite
2687assessment. If the class I or class II violation relates to
2688providing or failing to provide nursing care, a registered nurse
2689must participate in at least two onsite monitoring visits within
2690a 12-month period.
2691     Section 66.  Subsection (7) of section 429.11, Florida
2692Statutes, is renumbered as subsection (6), and present
2693subsection (6) of that section is amended to read:
2694     429.11  Initial application for license; provisional
2696     (6)  In addition to the license categories available in s.
2697408.808, a provisional license may be issued to an applicant
2698making initial application for licensure or making application
2699for a change of ownership. A provisional license shall be
2700limited in duration to a specific period of time not to exceed 6
2701months, as determined by the agency.
2702     Section 67.  Section 429.12, Florida Statutes, is amended
2703to read:
2704     429.12  Sale or transfer of ownership of a facility.-It is
2705the intent of the Legislature to protect the rights of the
2706residents of an assisted living facility when the facility is
2707sold or the ownership thereof is transferred. Therefore, in
2708addition to the requirements of part II of chapter 408, whenever
2709a facility is sold or the ownership thereof is transferred,
2710including leasing:.
2711     (1)  The transferee shall notify the residents, in writing,
2712of the change of ownership within 7 days after receipt of the
2713new license.
2714     (2)  The transferor of a facility the license of which is
2715denied pending an administrative hearing shall, as a part of the
2716written change-of-ownership contract, advise the transferee that
2717a plan of correction must be submitted by the transferee and
2718approved by the agency at least 7 days before the change of
2719ownership and that failure to correct the condition which
2720resulted in the moratorium pursuant to part II of chapter 408 or
2721denial of licensure is grounds for denial of the transferee's
2723     Section 68.  Paragraphs (b) through (l) of subsection (1)
2724of section 429.14, Florida Statutes, are redesignated as
2725paragraphs (a) through (k), respectively, and present paragraph
2726(a) of subsection (1) and subsections (5) and (6) of that
2727section are amended to read:
2728     429.14  Administrative penalties.-
2729     (1)  In addition to the requirements of part II of chapter
2730408, the agency may deny, revoke, and suspend any license issued
2731under this part and impose an administrative fine in the manner
2732provided in chapter 120 against a licensee of an assisted living
2733facility for a violation of any provision of this part, part II
2734of chapter 408, or applicable rules, or for any of the following
2735actions by a licensee of an assisted living facility, for the
2736actions of any person subject to level 2 background screening
2737under s. 408.809, or for the actions of any facility employee:
2738     (a)  An intentional or negligent act seriously affecting
2739the health, safety, or welfare of a resident of the facility.
2740     (5)  An action taken by the agency to suspend, deny, or
2741revoke a facility's license under this part or part II of
2742chapter 408, in which the agency claims that the facility owner
2743or an employee of the facility has threatened the health,
2744safety, or welfare of a resident of the facility shall be heard
2745by the Division of Administrative Hearings of the Department of
2746Management Services within 120 days after receipt of the
2747facility's request for a hearing, unless that time limitation is
2748waived by both parties. The administrative law judge must render
2749a decision within 30 days after receipt of a proposed
2750recommended order.
2751     (6)  The agency shall provide to the Division of Hotels and
2752Restaurants of the Department of Business and Professional
2753Regulation, on a monthly basis, a list of those assisted living
2754facilities that have had their licenses denied, suspended, or
2755revoked or that are involved in an appellate proceeding pursuant
2756to s. 120.60 related to the denial, suspension, or revocation of
2757a license. This information may be provided electronically or
2758through the agency's Internet website.
2759     Section 69.  Subsections (1), (4), and (5) of section
2760429.17, Florida Statutes, are amended to read:
2761     429.17  Expiration of license; renewal; conditional
2763     (1)  Limited nursing, Extended congregate care, and limited
2764mental health licenses shall expire at the same time as the
2765facility's standard license, regardless of when issued.
2766     (4)  In addition to the license categories available in s.
2767408.808, a conditional license may be issued to an applicant for
2768license renewal if the applicant fails to meet all standards and
2769requirements for licensure. A conditional license issued under
2770this subsection shall be limited in duration to a specific
2771period of time not to exceed 6 months, as determined by the
2772agency, and shall be accompanied by an agency-approved plan of
2774     (5)  When an extended congregate care or limited nursing
2775license is requested during a facility's biennial license
2776period, the fee shall be prorated in order to permit the
2777additional license to expire at the end of the biennial license
2778period. The fee shall be calculated as of the date the
2779additional license application is received by the agency.
2780     Section 70.  Subsection (7) of section 429.19, Florida
2781Statutes, is amended to read:
2782     429.19  Violations; imposition of administrative fines;
2784     (7)  In addition to any administrative fines imposed, the
2785agency may assess a survey or monitoring fee, equal to the
2786lesser of one half of the facility's biennial license and bed
2787fee or $500, to cover the cost of conducting initial complaint
2788investigations that result in the finding of a violation that
2789was the subject of the complaint or to monitor the health,
2790safety, or security of residents under s. 429.07(7) monitoring
2791visits conducted under s. 429.28(3)(c) to verify the correction
2792of the violations.
2793     Section 71.  Subsections (6) through (10) of section
2794429.23, Florida Statutes, are renumbered as subsections (5)
2795through (9), respectively, and present subsection (5) of that
2796section is amended to read:
2797     429.23  Internal risk management and quality assurance
2798program; adverse incidents and reporting requirements.-
2799     (5)  Each facility shall report monthly to the agency any
2800liability claim filed against it. The report must include the
2801name of the resident, the dates of the incident leading to the
2802claim, if applicable, and the type of injury or violation of
2803rights alleged to have occurred. This report is not discoverable
2804in any civil or administrative action, except in such actions
2805brought by the agency to enforce the provisions of this part.
2806     Section 72.  Paragraph (a) of subsection (1) and subsection
2807(2) of section 429.255, Florida Statutes, are amended to read:
2808     429.255  Use of personnel; emergency care.-
2809     (1)(a)  Persons under contract to the facility or, facility
2810staff, or volunteers, who are licensed according to part I of
2811chapter 464, or those persons exempt under s. 464.022(1), and
2812others as defined by rule, may administer medications to
2813residents, take residents' vital signs, manage individual weekly
2814pill organizers for residents who self-administer medication,
2815give prepackaged enemas ordered by a physician, observe
2816residents, document observations on the appropriate resident's
2817record, report observations to the resident's physician, and
2818contract or allow residents or a resident's representative,
2819designee, surrogate, guardian, or attorney in fact to contract
2820with a third party, provided residents meet the criteria for
2821appropriate placement as defined in s. 429.26. Persons under
2822contract to the facility or facility staff who are licensed
2823according to part I of chapter 464 may provide limited nursing
2824services. Nursing assistants certified pursuant to part II of
2825chapter 464 may take residents' vital signs as directed by a
2826licensed nurse or physician. The facility is responsible for
2827maintaining documentation of services provided under this
2828paragraph as required by rule and ensuring that staff are
2829adequately trained to monitor residents receiving these
2831     (2)  In facilities licensed to provide extended congregate
2832care, persons under contract to the facility or, facility staff,
2833or volunteers, who are licensed according to part I of chapter
2834464, or those persons exempt under s. 464.022(1), or those
2835persons certified as nursing assistants pursuant to part II of
2836chapter 464, may also perform all duties within the scope of
2837their license or certification, as approved by the facility
2838administrator and pursuant to this part.
2839     Section 73.  Subsection (3) of section 429.28, Florida
2840Statutes, is amended to read:
2841     429.28  Resident bill of rights.-
2842     (3)(a)  The agency shall conduct a survey to determine
2843general compliance with facility standards and compliance with
2844residents' rights as a prerequisite to initial licensure or
2845licensure renewal.
2846     (b)  In order to determine whether the facility is
2847adequately protecting residents' rights, the biennial survey
2848shall include private informal conversations with a sample of
2849residents and consultation with the ombudsman council in the
2850planning and service area in which the facility is located to
2851discuss residents' experiences within the facility.
2852     (c)  During any calendar year in which no survey is
2853conducted, the agency shall conduct at least one monitoring
2854visit of each facility cited in the previous year for a class I
2855or class II violation, or more than three uncorrected class III
2857     (d)  The agency may conduct periodic followup inspections
2858as necessary to monitor the compliance of facilities with a
2859history of any class I, class II, or class III violations that
2860threaten the health, safety, or security of residents.
2861     (e)  The agency may conduct complaint investigations as
2862warranted to investigate any allegations of noncompliance with
2863requirements required under this part or rules adopted under
2864this part.
2865     Section 74.  Subsection (2) of section 429.35, Florida
2866Statutes, is amended to read:
2867     429.35  Maintenance of records; reports.-
2868     (2)  Within 60 days after the date of the biennial
2869inspection visit required under s. 408.811 or within 30 days
2870after the date of any interim visit, the agency shall forward
2871the results of the inspection to the local ombudsman council in
2872whose planning and service area, as defined in part II of
2873chapter 400, the facility is located; to at least one public
2874library or, in the absence of a public library, the county seat
2875in the county in which the inspected assisted living facility is
2876located; and, when appropriate, to the district Adult Services
2877and Mental Health Program Offices. This information may be
2878provided electronically or through the agency's Internet
2880     Section 75.  Paragraphs (i) and (j) of subsection (1) of
2881section 429.41, Florida Statutes, are amended to read:
2882     429.41  Rules establishing standards.-
2883     (1)  It is the intent of the Legislature that rules
2884published and enforced pursuant to this section shall include
2885criteria by which a reasonable and consistent quality of
2886resident care and quality of life may be ensured and the results
2887of such resident care may be demonstrated. Such rules shall also
2888ensure a safe and sanitary environment that is residential and
2889noninstitutional in design or nature. It is further intended
2890that reasonable efforts be made to accommodate the needs and
2891preferences of residents to enhance the quality of life in a
2892facility. The agency, in consultation with the department, may
2893adopt rules to administer the requirements of part II of chapter
2894408. In order to provide safe and sanitary facilities and the
2895highest quality of resident care accommodating the needs and
2896preferences of residents, the department, in consultation with
2897the agency, the Department of Children and Family Services, and
2898the Department of Health, shall adopt rules, policies, and
2899procedures to administer this part, which must include
2900reasonable and fair minimum standards in relation to:
2901     (i)  Facilities holding an a limited nursing, extended
2902congregate care, or limited mental health license.
2903     (j)  The establishment of specific criteria to define
2904appropriateness of resident admission and continued residency in
2905a facility holding a standard, limited nursing, extended
2906congregate care, and limited mental health license.
2907     Section 76.  Subsections (1) and (2) of section 429.53,
2908Florida Statutes, are amended to read:
2909     429.53  Consultation by the agency.-
2910     (1)  The area offices of licensure and certification of the
2911agency shall provide consultation to the following upon request:
2912     (a)  A licensee of a facility.
2913     (b)  A person interested in obtaining a license to operate
2914a facility under this part.
2915     (2)  As used in this section, "consultation" includes:
2916     (a)  An explanation of the requirements of this part and
2917rules adopted pursuant thereto;
2918     (b)  An explanation of the license application and renewal
2920     (c)  The provision of a checklist of general local and
2921state approvals required prior to constructing or developing a
2922facility and a listing of the types of agencies responsible for
2923such approvals;
2924     (d)  An explanation of benefits and financial assistance
2925available to a recipient of supplemental security income
2926residing in a facility;
2927     (c)(e)  Any other information which the agency deems
2928necessary to promote compliance with the requirements of this
2929part; and
2930     (f)  A preconstruction review of a facility to ensure
2931compliance with agency rules and this part.
2932     Section 77.  Subsections (1) and (2) of section 429.54,
2933Florida Statutes, are renumbered as subsections (2) and (3),
2934respectively, and a new subsection (1) is added to that section
2935to read:
2936     429.54  Collection of information; local subsidy.-
2937     (1)  A facility that is licensed under this part must
2938report electronically to the agency semiannually data related to
2939the facility, including, but not limited to, the total number of
2940residents, the number of residents who are receiving limited
2941mental health services, the number of residents who are
2942receiving extended congregate care services, the number of
2943residents who are receiving limited nursing services, and
2944professional staffing employed by or under contract with the
2945licensee to provide resident services. The department, in
2946consultation with the agency, shall adopt rules to administer
2947this subsection.
2948     Section 78.  Subsections (1) and (5) of section 429.71,
2949Florida Statutes, are amended to read:
2950     429.71  Classification of violations deficiencies;
2951administrative fines.-
2952     (1)  In addition to the requirements of part II of chapter
2953408 and in addition to any other liability or penalty provided
2954by law, the agency may impose an administrative fine on a
2955provider according to the following classification:
2956     (a)  Class I violations are defined in s. 408.813 those
2957conditions or practices related to the operation and maintenance
2958of an adult family-care home or to the care of residents which
2959the agency determines present an imminent danger to the
2960residents or guests of the facility or a substantial probability
2961that death or serious physical or emotional harm would result
2962therefrom. The condition or practice that constitutes a class I
2963violation must be abated or eliminated within 24 hours, unless a
2964fixed period, as determined by the agency, is required for
2965correction. A class I violation deficiency is subject to an
2966administrative fine in an amount not less than $500 and not
2967exceeding $1,000 for each violation. A fine may be levied
2968notwithstanding the correction of the deficiency.
2969     (b)  Class II violations are defined in s. 408.813 those
2970conditions or practices related to the operation and maintenance
2971of an adult family-care home or to the care of residents which
2972the agency determines directly threaten the physical or
2973emotional health, safety, or security of the residents, other
2974than class I violations. A class II violation is subject to an
2975administrative fine in an amount not less than $250 and not
2976exceeding $500 for each violation. A citation for a class II
2977violation must specify the time within which the violation is
2978required to be corrected. If a class II violation is corrected
2979within the time specified, no civil penalty shall be imposed,
2980unless it is a repeated offense.
2981     (c)  Class III violations are defined in s. 408.813 those
2982conditions or practices related to the operation and maintenance
2983of an adult family-care home or to the care of residents which
2984the agency determines indirectly or potentially threaten the
2985physical or emotional health, safety, or security of residents,
2986other than class I or class II violations. A class III violation
2987is subject to an administrative fine in an amount not less than
2988$100 and not exceeding $250 for each violation. A citation for a
2989class III violation shall specify the time within which the
2990violation is required to be corrected. If a class III violation
2991is corrected within the time specified, no civil penalty shall
2992be imposed, unless it is a repeated violation offense.
2993     (d)  Class IV violations are defined in s. 408.813 those
2994conditions or occurrences related to the operation and
2995maintenance of an adult family-care home, or related to the
2996required reports, forms, or documents, which do not have the
2997potential of negatively affecting the residents. A provider that
2998does not correct A class IV violation within the time limit
2999specified by the agency is subject to an administrative fine in
3000an amount not less than $50 and not exceeding $100 for each
3001violation. Any class IV violation that is corrected during the
3002time the agency survey is conducted will be identified as an
3003agency finding and not as a violation, unless it is a repeat
3005     (5)  As an alternative to or in conjunction with an
3006administrative action against a provider, the agency may request
3007a plan of corrective action that demonstrates a good faith
3008effort to remedy each violation by a specific date, subject to
3009the approval of the agency.
3010     Section 79.  Paragraphs (b) through (e) of subsection (2)
3011of section 429.911, Florida Statutes, are redesignated as
3012paragraphs (a) through (d), respectively, and present paragraph
3013(a) of that subsection is amended to read:
3014     429.911  Denial, suspension, revocation of license;
3015emergency action; administrative fines; investigations and
3017     (2)  Each of the following actions by the owner of an adult
3018day care center or by its operator or employee is a ground for
3019action by the agency against the owner of the center or its
3020operator or employee:
3021     (a)  An intentional or negligent act materially affecting
3022the health or safety of center participants.
3023     Section 80.  Section 429.915, Florida Statutes, is amended
3024to read:
3025     429.915  Conditional license.-In addition to the license
3026categories available in part II of chapter 408, the agency may
3027issue a conditional license to an applicant for license renewal
3028or change of ownership if the applicant fails to meet all
3029standards and requirements for licensure. A conditional license
3030issued under this subsection must be limited to a specific
3031period not exceeding 6 months, as determined by the agency, and
3032must be accompanied by an approved plan of correction.
3033     Section 81.  Paragraphs (b) and (h) of subsection (3) of
3034section 430.80, Florida Statutes, are amended to read:
3035     430.80  Implementation of a teaching nursing home pilot
3037     (3)  To be designated as a teaching nursing home, a nursing
3038home licensee must, at a minimum:
3039     (b)  Participate in a nationally recognized accreditation
3040program and hold a valid accreditation, such as the
3041accreditation awarded by The Joint Commission on Accreditation
3042of Healthcare Organizations;
3043     (h)  Maintain insurance coverage pursuant to s.
3044400.141(1)(q)(s) or proof of financial responsibility in a
3045minimum amount of $750,000. Such proof of financial
3046responsibility may include:
3047     1.  Maintaining an escrow account consisting of cash or
3048assets eligible for deposit in accordance with s. 625.52; or
3049     2.  Obtaining and maintaining pursuant to chapter 675 an
3050unexpired, irrevocable, nontransferable and nonassignable letter
3051of credit issued by any bank or savings association organized
3052and existing under the laws of this state or any bank or savings
3053association organized under the laws of the United States that
3054has its principal place of business in this state or has a
3055branch office which is authorized to receive deposits in this
3056state. The letter of credit shall be used to satisfy the
3057obligation of the facility to the claimant upon presentment of a
3058final judgment indicating liability and awarding damages to be
3059paid by the facility or upon presentment of a settlement
3060agreement signed by all parties to the agreement when such final
3061judgment or settlement is a result of a liability claim against
3062the facility.
3063     Section 82.  Paragraph (a) of subsection (2) of section
3064440.13, Florida Statutes, is amended to read:
3065     440.13  Medical services and supplies; penalty for
3066violations; limitations.-
3068     (a)  Subject to the limitations specified elsewhere in this
3069chapter, the employer shall furnish to the employee such
3070medically necessary remedial treatment, care, and attendance for
3071such period as the nature of the injury or the process of
3072recovery may require, which is in accordance with established
3073practice parameters and protocols of treatment as provided for
3074in this chapter, including medicines, medical supplies, durable
3075medical equipment, orthoses, prostheses, and other medically
3076necessary apparatus. Remedial treatment, care, and attendance,
3077including work-hardening programs or pain-management programs
3078accredited by the Commission on Accreditation of Rehabilitation
3079Facilities or The Joint Commission on the Accreditation of
3080Health Organizations or pain-management programs affiliated with
3081medical schools, shall be considered as covered treatment only
3082when such care is given based on a referral by a physician as
3083defined in this chapter. Medically necessary treatment, care,
3084and attendance does not include chiropractic services in excess
3085of 24 treatments or rendered 12 weeks beyond the date of the
3086initial chiropractic treatment, whichever comes first, unless
3087the carrier authorizes additional treatment or the employee is
3088catastrophically injured.
3090Failure of the carrier to timely comply with this subsection
3091shall be a violation of this chapter and the carrier shall be
3092subject to penalties as provided for in s. 440.525.
3093     Section 83.  Section 483.294, Florida Statutes, is amended
3094to read:
3095     483.294  Inspection of centers.-In accordance with s.
3096408.811, the agency shall biennially, at least once annually,
3097inspect the premises and operations of all centers subject to
3098licensure under this part.
3099     Section 84.  Paragraph (a) of subsection (53) of section
3100499.003, Florida Statutes, is amended to read:
3101     499.003  Definitions of terms used in this part.-As used in
3102this part, the term:
3103     (53)  "Wholesale distribution" means distribution of
3104prescription drugs to persons other than a consumer or patient,
3105but does not include:
3106     (a)  Any of the following activities, which is not a
3107violation of s. 499.005(21) if such activity is conducted in
3108accordance with s. 499.01(2)(g):
3109     1.  The purchase or other acquisition by a hospital or
3110other health care entity that is a member of a group purchasing
3111organization of a prescription drug for its own use from the
3112group purchasing organization or from other hospitals or health
3113care entities that are members of that organization.
3114     2.  The sale, purchase, or trade of a prescription drug or
3115an offer to sell, purchase, or trade a prescription drug by a
3116charitable organization described in s. 501(c)(3) of the
3117Internal Revenue Code of 1986, as amended and revised, to a
3118nonprofit affiliate of the organization to the extent otherwise
3119permitted by law.
3120     3.  The sale, purchase, or trade of a prescription drug or
3121an offer to sell, purchase, or trade a prescription drug among
3122hospitals or other health care entities that are under common
3123control. For purposes of this subparagraph, "common control"
3124means the power to direct or cause the direction of the
3125management and policies of a person or an organization, whether
3126by ownership of stock, by voting rights, by contract, or
3128     4.  The sale, purchase, trade, or other transfer of a
3129prescription drug from or for any federal, state, or local
3130government agency or any entity eligible to purchase
3131prescription drugs at public health services prices pursuant to
3132Pub. L. No. 102-585, s. 602 to a contract provider or its
3133subcontractor for eligible patients of the agency or entity
3134under the following conditions:
3135     a.  The agency or entity must obtain written authorization
3136for the sale, purchase, trade, or other transfer of a
3137prescription drug under this subparagraph from the State Surgeon
3138General or his or her designee.
3139     b.  The contract provider or subcontractor must be
3140authorized by law to administer or dispense prescription drugs.
3141     c.  In the case of a subcontractor, the agency or entity
3142must be a party to and execute the subcontract.
3143     d.  A contract provider or subcontractor must maintain
3144separate and apart from other prescription drug inventory any
3145prescription drugs of the agency or entity in its possession.
3146     d.e.  The contract provider and subcontractor must maintain
3147and produce immediately for inspection all records of movement
3148or transfer of all the prescription drugs belonging to the
3149agency or entity, including, but not limited to, the records of
3150receipt and disposition of prescription drugs. Each contractor
3151and subcontractor dispensing or administering these drugs must
3152maintain and produce records documenting the dispensing or
3153administration. Records that are required to be maintained
3154include, but are not limited to, a perpetual inventory itemizing
3155drugs received and drugs dispensed by prescription number or
3156administered by patient identifier, which must be submitted to
3157the agency or entity quarterly.
3158     e.f.  The contract provider or subcontractor may administer
3159or dispense the prescription drugs only to the eligible patients
3160of the agency or entity or must return the prescription drugs
3161for or to the agency or entity. The contract provider or
3162subcontractor must require proof from each person seeking to
3163fill a prescription or obtain treatment that the person is an
3164eligible patient of the agency or entity and must, at a minimum,
3165maintain a copy of this proof as part of the records of the
3166contractor or subcontractor required under sub-subparagraph d.
3168     f.g.  In addition to the departmental inspection authority
3169set forth in s. 499.051, the establishment of the contract
3170provider and subcontractor and all records pertaining to
3171prescription drugs subject to this subparagraph shall be subject
3172to inspection by the agency or entity. All records relating to
3173prescription drugs of a manufacturer under this subparagraph
3174shall be subject to audit by the manufacturer of those drugs,
3175without identifying individual patient information.
3176     Section 85.  Paragraph (i) is added to subsection (3) of
3177section 499.01212, Florida Statutes, to read:
3178     499.01212  Pedigree paper.-
3179     (3)  EXCEPTIONS.-A pedigree paper is not required for:
3180     (i)  The wholesale distribution of prescription drugs
3181contained within a sealed medical convenience kit if the kit:
3182     1.  Is assembled in an establishment that is registered as
3183a medical device manufacturer with the Food and Drug
3184Administration; and
3185     2.  Does not contain any controlled substance that appears
3186in any schedule contained in or subject to chapter 893 or the
3187federal Comprehensive Drug Abuse Prevention and Control Act of
3189     Section 86.  Subsection (1) of section 627.645, Florida
3190Statutes, is amended to read:
3191     627.645  Denial of health insurance claims restricted.-
3192     (1)  No claim for payment under a health insurance policy
3193or self-insured program of health benefits for treatment, care,
3194or services in a licensed hospital which is accredited by The
3195Joint Commission on the Accreditation of Hospitals, the American
3196Osteopathic Association, or the Commission on the Accreditation
3197of Rehabilitative Facilities shall be denied because such
3198hospital lacks major surgical facilities and is primarily of a
3199rehabilitative nature, if such rehabilitation is specifically
3200for treatment of physical disability.
3201     Section 87.  Paragraph (c) of subsection (2) of section
3202627.668, Florida Statutes, is amended to read:
3203     627.668  Optional coverage for mental and nervous disorders
3204required; exception.-
3205     (2)  Under group policies or contracts, inpatient hospital
3206benefits, partial hospitalization benefits, and outpatient
3207benefits consisting of durational limits, dollar amounts,
3208deductibles, and coinsurance factors shall not be less favorable
3209than for physical illness generally, except that:
3210     (c)  Partial hospitalization benefits shall be provided
3211under the direction of a licensed physician. For purposes of
3212this part, the term "partial hospitalization services" is
3213defined as those services offered by a program accredited by The
3214Joint Commission on Accreditation of Hospitals (JCAH) or in
3215compliance with equivalent standards. Alcohol rehabilitation
3216programs accredited by The Joint Commission on Accreditation of
3217Hospitals or approved by the state and licensed drug abuse
3218rehabilitation programs shall also be qualified providers under
3219this section. In any benefit year, if partial hospitalization
3220services or a combination of inpatient and partial
3221hospitalization are utilized, the total benefits paid for all
3222such services shall not exceed the cost of 30 days of inpatient
3223hospitalization for psychiatric services, including physician
3224fees, which prevail in the community in which the partial
3225hospitalization services are rendered. If partial
3226hospitalization services benefits are provided beyond the limits
3227set forth in this paragraph, the durational limits, dollar
3228amounts, and coinsurance factors thereof need not be the same as
3229those applicable to physical illness generally.
3230     Section 88.  Subsection (3) of section 627.669, Florida
3231Statutes, is amended to read:
3232     627.669  Optional coverage required for substance abuse
3233impaired persons; exception.-
3234     (3)  The benefits provided under this section shall be
3235applicable only if treatment is provided by, or under the
3236supervision of, or is prescribed by, a licensed physician or
3237licensed psychologist and if services are provided in a program
3238accredited by The Joint Commission on Accreditation of Hospitals
3239or approved by the state.
3240     Section 89.  Paragraph (a) of subsection (1) of section
3241627.736, Florida Statutes, is amended to read:
3242     627.736  Required personal injury protection benefits;
3243exclusions; priority; claims.-
3244     (1)  REQUIRED BENEFITS.-Every insurance policy complying
3245with the security requirements of s. 627.733 shall provide
3246personal injury protection to the named insured, relatives
3247residing in the same household, persons operating the insured
3248motor vehicle, passengers in such motor vehicle, and other
3249persons struck by such motor vehicle and suffering bodily injury
3250while not an occupant of a self-propelled vehicle, subject to
3251the provisions of subsection (2) and paragraph (4)(e), to a
3252limit of $10,000 for loss sustained by any such person as a
3253result of bodily injury, sickness, disease, or death arising out
3254of the ownership, maintenance, or use of a motor vehicle as
3256     (a)  Medical benefits.-Eighty percent of all reasonable
3257expenses for medically necessary medical, surgical, X-ray,
3258dental, and rehabilitative services, including prosthetic
3259devices, and medically necessary ambulance, hospital, and
3260nursing services. However, the medical benefits shall provide
3261reimbursement only for such services and care that are lawfully
3262provided, supervised, ordered, or prescribed by a physician
3263licensed under chapter 458 or chapter 459, a dentist licensed
3264under chapter 466, or a chiropractic physician licensed under
3265chapter 460 or that are provided by any of the following persons
3266or entities:
3267     1.  A hospital or ambulatory surgical center licensed under
3268chapter 395.
3269     2.  A person or entity licensed under ss. 401.2101-401.45
3270that provides emergency transportation and treatment.
3271     3.  An entity wholly owned by one or more physicians
3272licensed under chapter 458 or chapter 459, chiropractic
3273physicians licensed under chapter 460, or dentists licensed
3274under chapter 466 or by such practitioner or practitioners and
3275the spouse, parent, child, or sibling of that practitioner or
3276those practitioners.
3277     4.  An entity wholly owned, directly or indirectly, by a
3278hospital or hospitals.
3279     5.  A health care clinic licensed under ss. 400.990-400.995
3280that is:
3281     a.  Accredited by The Joint Commission on Accreditation of
3282Healthcare Organizations, the American Osteopathic Association,
3283the Commission on Accreditation of Rehabilitation Facilities, or
3284the Accreditation Association for Ambulatory Health Care, Inc.;
3286     b.  A health care clinic that:
3287     (I)  Has a medical director licensed under chapter 458,
3288chapter 459, or chapter 460;
3289     (II)  Has been continuously licensed for more than 3 years
3290or is a publicly traded corporation that issues securities
3291traded on an exchange registered with the United States
3292Securities and Exchange Commission as a national securities
3293exchange; and
3294     (III)  Provides at least four of the following medical
3296     (A)  General medicine.
3297     (B)  Radiography.
3298     (C)  Orthopedic medicine.
3299     (D)  Physical medicine.
3300     (E)  Physical therapy.
3301     (F)  Physical rehabilitation.
3302     (G)  Prescribing or dispensing outpatient prescription
3304     (H)  Laboratory services.
3306The Financial Services Commission shall adopt by rule the form
3307that must be used by an insurer and a health care provider
3308specified in subparagraph 3., subparagraph 4., or subparagraph
33095. to document that the health care provider meets the criteria
3310of this paragraph, which rule must include a requirement for a
3311sworn statement or affidavit.
3313Only insurers writing motor vehicle liability insurance in this
3314state may provide the required benefits of this section, and no
3315such insurer shall require the purchase of any other motor
3316vehicle coverage other than the purchase of property damage
3317liability coverage as required by s. 627.7275 as a condition for
3318providing such required benefits. Insurers may not require that
3319property damage liability insurance in an amount greater than
3320$10,000 be purchased in conjunction with personal injury
3321protection. Such insurers shall make benefits and required
3322property damage liability insurance coverage available through
3323normal marketing channels. Any insurer writing motor vehicle
3324liability insurance in this state who fails to comply with such
3325availability requirement as a general business practice shall be
3326deemed to have violated part IX of chapter 626, and such
3327violation shall constitute an unfair method of competition or an
3328unfair or deceptive act or practice involving the business of
3329insurance; and any such insurer committing such violation shall
3330be subject to the penalties afforded in such part, as well as
3331those which may be afforded elsewhere in the insurance code.
3332     Section 90.  Section 633.081, Florida Statutes, is amended
3333to read:
3334     633.081  Inspection of buildings and equipment; orders;
3335firesafety inspection training requirements; certification;
3336disciplinary action.-The State Fire Marshal and her or his
3337agents shall, at any reasonable hour, when the department has
3338reasonable cause to believe that a violation of this chapter or
3339s. 509.215, or a rule promulgated thereunder, or a minimum
3340firesafety code adopted by a local authority, may exist, inspect
3341any and all buildings and structures which are subject to the
3342requirements of this chapter or s. 509.215 and rules promulgated
3343thereunder. The authority to inspect shall extend to all
3344equipment, vehicles, and chemicals which are located within the
3345premises of any such building or structure. The State Fire
3346Marshal and her or his agents shall inspect nursing homes
3347licensed under part II of chapter 400 only once every calendar
3348year and upon receiving a complaint forming the basis of a
3349reasonable cause to believe that a violation of this chapter or
3350s. 509.215, or a rule promulgated thereunder, or a minimum
3351firesafety code adopted by a local authority may exist and upon
3352identifying such a violation in the course of conducting
3353orientation or training activities within a nursing home.
3354     (1)  Each county, municipality, and special district that
3355has firesafety enforcement responsibilities shall employ or
3356contract with a firesafety inspector. The firesafety inspector
3357must conduct all firesafety inspections that are required by
3358law. The governing body of a county, municipality, or special
3359district that has firesafety enforcement responsibilities may
3360provide a schedule of fees to pay only the costs of inspections
3361conducted pursuant to this subsection and related administrative
3362expenses. Two or more counties, municipalities, or special
3363districts that have firesafety enforcement responsibilities may
3364jointly employ or contract with a firesafety inspector.
3365     (2)  Every firesafety inspection conducted pursuant to
3366state or local firesafety requirements shall be by a person
3367certified as having met the inspection training requirements set
3368by the State Fire Marshal. Such person shall:
3369     (a)  Be a high school graduate or the equivalent as
3370determined by the department;
3371     (b)  Not have been found guilty of, or having pleaded
3372guilty or nolo contendere to, a felony or a crime punishable by
3373imprisonment of 1 year or more under the law of the United
3374States, or of any state thereof, which involves moral turpitude,
3375without regard to whether a judgment of conviction has been
3376entered by the court having jurisdiction of such cases;
3377     (c)  Have her or his fingerprints on file with the
3378department or with an agency designated by the department;
3379     (d)  Have good moral character as determined by the
3381     (e)  Be at least 18 years of age;
3382     (f)  Have satisfactorily completed the firesafety inspector
3383certification examination as prescribed by the department; and
3384     (g)1.  Have satisfactorily completed, as determined by the
3385department, a firesafety inspector training program of not less
3386than 200 hours established by the department and administered by
3387agencies and institutions approved by the department for the
3388purpose of providing basic certification training for firesafety
3389inspectors; or
3390     2.  Have received in another state training which is
3391determined by the department to be at least equivalent to that
3392required by the department for approved firesafety inspector
3393education and training programs in this state.
3394     (3)  Each special state firesafety inspection which is
3395required by law and is conducted by or on behalf of an agency of
3396the state must be performed by an individual who has met the
3397provision of subsection (2), except that the duration of the
3398training program shall not exceed 120 hours of specific training
3399for the type of property that such special state firesafety
3400inspectors are assigned to inspect.
3401     (4)  A firefighter certified pursuant to s. 633.35 may
3402conduct firesafety inspections, under the supervision of a
3403certified firesafety inspector, while on duty as a member of a
3404fire department company conducting inservice firesafety
3405inspections without being certified as a firesafety inspector,
3406if such firefighter has satisfactorily completed an inservice
3407fire department company inspector training program of at least
340824 hours' duration as provided by rule of the department.
3409     (5)  Every firesafety inspector or special state firesafety
3410inspector certificate is valid for a period of 3 years from the
3411date of issuance. Renewal of certification shall be subject to
3412the affected person's completing proper application for renewal
3413and meeting all of the requirements for renewal as established
3414under this chapter or by rule promulgated thereunder, which
3415shall include completion of at least 40 hours during the
3416preceding 3-year period of continuing education as required by
3417the rule of the department or, in lieu thereof, successful
3418passage of an examination as established by the department.
3419     (6)  The State Fire Marshal may deny, refuse to renew,
3420suspend, or revoke the certificate of a firesafety inspector or
3421special state firesafety inspector if it finds that any of the
3422following grounds exist:
3423     (a)  Any cause for which issuance of a certificate could
3424have been refused had it then existed and been known to the
3425State Fire Marshal.
3426     (b)  Violation of this chapter or any rule or order of the
3427State Fire Marshal.
3428     (c)  Falsification of records relating to the certificate.
3429     (d)  Having been found guilty of or having pleaded guilty
3430or nolo contendere to a felony, whether or not a judgment of
3431conviction has been entered.
3432     (e)  Failure to meet any of the renewal requirements.
3433     (f)  Having been convicted of a crime in any jurisdiction
3434which directly relates to the practice of fire code inspection,
3435plan review, or administration.
3436     (g)  Making or filing a report or record that the
3437certificateholder knows to be false, or knowingly inducing
3438another to file a false report or record, or knowingly failing
3439to file a report or record required by state or local law, or
3440knowingly impeding or obstructing such filing, or knowingly
3441inducing another person to impede or obstruct such filing.
3442     (h)  Failing to properly enforce applicable fire codes or
3443permit requirements within this state which the
3444certificateholder knows are applicable by committing willful
3445misconduct, gross negligence, gross misconduct, repeated
3446negligence, or negligence resulting in a significant danger to
3447life or property.
3448     (i)  Accepting labor, services, or materials at no charge
3449or at a noncompetitive rate from any person who performs work
3450that is under the enforcement authority of the certificateholder
3451and who is not an immediate family member of the
3452certificateholder. For the purpose of this paragraph, the term
3453"immediate family member" means a spouse, child, parent,
3454sibling, grandparent, aunt, uncle, or first cousin of the person
3455or the person's spouse or any person who resides in the primary
3456residence of the certificateholder.
3457     (7)  The department shall provide by rule for the
3458certification of firesafety inspectors.
3459     Section 91.  Subsection (12) of section 641.495, Florida
3460Statutes, is amended to read:
3461     641.495  Requirements for issuance and maintenance of
3463     (12)  The provisions of part I of chapter 395 do not apply
3464to a health maintenance organization that, on or before January
34651, 1991, provides not more than 10 outpatient holding beds for
3466short-term and hospice-type patients in an ambulatory care
3467facility for its members, provided that such health maintenance
3468organization maintains current accreditation by The Joint
3469Commission on Accreditation of Health Care Organizations, the
3470Accreditation Association for Ambulatory Health Care, or the
3471National Committee for Quality Assurance.
3472     Section 92.  Subsection (13) of section 651.118, Florida
3473Statutes, is amended to read:
3474     651.118  Agency for Health Care Administration;
3475certificates of need; sheltered beds; community beds.-
3476     (13)  Residents, as defined in this chapter, are not
3477considered new admissions for the purpose of s.
3479     Section 93.  Subsection (2) of section 766.1015, Florida
3480Statutes, is amended to read:
3481     766.1015  Civil immunity for members of or consultants to
3482certain boards, committees, or other entities.-
3483     (2)  Such committee, board, group, commission, or other
3484entity must be established in accordance with state law or in
3485accordance with requirements of The Joint Commission on
3486Accreditation of Healthcare Organizations, established and duly
3487constituted by one or more public or licensed private hospitals
3488or behavioral health agencies, or established by a governmental
3489agency. To be protected by this section, the act, decision,
3490omission, or utterance may not be made or done in bad faith or
3491with malicious intent.
3492     Section 94.  Subsection (4) of section 766.202, Florida
3493Statutes, is amended to read:
3494     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3495766.201-766.212, the term:
3496     (4)  "Health care provider" means any hospital, ambulatory
3497surgical center, or mobile surgical facility as defined and
3498licensed under chapter 395; a birth center licensed under
3499chapter 383; any person licensed under chapter 458, chapter 459,
3500chapter 460, chapter 461, chapter 462, chapter 463, part I of
3501chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3502or chapter 486; a clinical lab licensed under chapter 483; a
3503health maintenance organization certificated under part I of
3504chapter 641; a blood bank; a plasma center; an industrial
3505clinic; a renal dialysis facility; or a professional association
3506partnership, corporation, joint venture, or other association
3507for professional activity by health care providers.
3508     Section 95.  This act shall take effect July 1, 2010.

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

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