November 30, 2020
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CS/CS/CS/HB 1143

1
A bill to be entitled
2An act relating to health care; amending s. 112.0455,
3F.S., relating to the Drug-Free Workplace Act; deleting an
4obsolete provision; amending s. 318.21, F.S.; revising
5distribution of funds from civil penalties imposed for
6traffic infractions by county courts; amending s.
7381.00315, F.S.; directing the Department of Health to
8accept funds from counties, municipalities, and certain
9other entities for the purchase of certain products made
10available under a contract of the United States Department
11of Health and Human Services for the manufacture and
12delivery of such products in response to a public health
13emergency; amending s. 381.0072, F.S.; limiting Department
14of Health food service inspections in nursing homes;
15requiring the department to coordinate inspections with
16the Agency for Health Care Administration; repealing s.
17383.325, F.S., relating to confidentiality of inspection
18reports of licensed birth center facilities; amending s.
19395.002, F.S.; revising and deleting definitions
20applicable to regulation of hospitals and other licensed
21facilities; conforming a cross-reference; amending s.
22395.003, F.S.; deleting an obsolete provision; conforming
23a cross-reference; amending s. 395.0193, F.S.; requiring a
24licensed facility to report certain peer review
25information and final disciplinary actions to the Division
26of Medical Quality Assurance of the Department of Health
27rather than the Division of Health Quality Assurance of
28the Agency for Health Care Administration; amending s.
29395.1023, F.S.; providing for the Department of Children
30and Family Services rather than the Department of Health
31to perform certain functions with respect to child
32protection cases; requiring certain hospitals to notify
33the Department of Children and Family Services of
34compliance; amending s. 395.1041, F.S., relating to
35hospital emergency services and care; deleting obsolete
36provisions; repealing s. 395.1046, F.S., relating to
37complaint investigation procedures; amending s. 395.1055,
38F.S.; requiring licensed facility beds to conform to
39standards specified by the Agency for Health Care
40Administration, the Florida Building Code, and the Florida
41Fire Prevention Code; amending s. 395.10972, F.S.;
42revising a reference to the Florida Society of Healthcare
43Risk Management to conform to the current designation;
44amending s. 395.2050, F.S.; revising a reference to the
45federal Health Care Financing Administration to conform to
46the current designation; amending s. 395.3036, F.S.;
47correcting a reference; repealing s. 395.3037, F.S.,
48relating to redundant definitions; amending ss. 154.11,
49394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
50627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
51F.S.; revising references to the Joint Commission on
52Accreditation of Healthcare Organizations, the Commission
53on Accreditation of Rehabilitation Facilities, and the
54Council on Accreditation to conform to their current
55designations; amending s. 395.602, F.S.; revising the
56definition of the term "rural hospital" to delete an
57obsolete provision; amending s. 400.021, F.S.; revising
58the definition of the term "geriatric outpatient clinic";
59amending s. 400.0255, F.S.; correcting an obsolete cross-
60reference to administrative rules; amending s. 400.063,
61F.S.; deleting an obsolete provision; amending ss. 400.071
62and 400.0712, F.S.; revising applicability of general
63licensure requirements under part II of ch. 408, F.S., to
64applications for nursing home licensure; revising
65provisions governing inactive licenses; amending s.
66400.111, F.S.; providing for disclosure of controlling
67interest of a nursing home facility upon request by the
68Agency for Health Care Administration; amending s.
69400.1183, F.S.; revising grievance record maintenance and
70reporting requirements for nursing homes; amending s.
71400.141, F.S.; providing criteria for the provision of
72respite services by nursing homes; requiring a written
73plan of care; requiring a contract for services; requiring
74resident release to caregivers to be designated in
75writing; providing an exemption to the application of
76discharge planning rules; providing for residents' rights;
77providing for use of personal medications; providing terms
78of respite stay; providing for communication of patient
79information; requiring a physician order for care and
80proof of a physical examination; providing for services
81for respite patients and duties of facilities with respect
82to such patients; 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. 400.915, F.S.;
118correcting an obsolete cross-reference to administrative
119rules; amending s. 400.931, F.S.; deleting a requirement
120that an applicant for a home medical equipment provider
121license submit a surety bond to the agency; amending s.
122400.932, F.S.; revising grounds for the imposition of
123administrative penalties for certain violations by an
124employee of a home medical equipment provider; amending s.
125400.967, F.S.; revising the schedule of inspection
126violations for intermediate care facilities for the
127developmentally disabled; providing a penalty for certain
128violations; amending s. 400.9905, F.S.; providing that
129part X of ch, 400, F.S., the Health Care Clinic Act, does
130not apply to an entity owned by a corporation with a
131specified amount of annual sales of health care services
132under certain circumstances or to an entity owned or
133controlled by a publicly traded entity with a specified
134amount of annual revenues; amending s. 400.991, F.S.;
135conforming terminology; revising application requirements
136relating to documentation of financial ability to operate
137a mobile clinic; amending s. 408.034, F.S.; revising
138agency authority relating to licensing of intermediate
139care facilities for the developmentally disabled; amending
140s. 408.036, F.S.; deleting an exemption from certain
141certificate-of-need review requirements for a hospice or a
142hospice inpatient facility; amending s. 408.043, F.S.;
143revising requirements for certain freestanding inpatient
144hospice care facilities to obtain a certificate of need;
145amending s. 408.061, F.S.; revising health care facility
146data reporting requirements; amending s. 408.10, F.S.;
147removing agency authority to investigate certain consumer
148complaints; amending s. 408.802, F.S.; removing
149applicability of part II of ch. 408, F.S., relating to
150general licensure requirements, to private review agents;
151amending s. 408.804, F.S.; providing penalties for
152altering, defacing, or falsifying a license certificate
153issued by the agency or displaying such an altered,
154defaced, or falsified certificate; amending s. 408.806,
155F.S.; revising agency responsibilities for notification of
156licensees of impending expiration of a license; requiring
157payment of a late fee for a license application to be
158considered complete under certain circumstances; amending
159s. 408.810, F.S.; revising provisions relating to
160information required for licensure; requiring proof of
161submission of notice to a mortgagor or landlord regarding
162provision of services requiring licensure; requiring
163disclosure of information by a controlling interest of
164certain court actions relating to financial instability
165within a specified time period; amending s. 408.813, F.S.;
166authorizing the agency to impose fines for unclassified
167violations of part II of ch. 408, F.S.; amending s.
168408.815, F.S.; authorizing the agency to extend a license
169expiration date under certain circumstances; amending s.
170409.221, F.S.; deleting a reporting requirement relating
171to the consumer-directed care program; amending s.
172409.91196, F.S.; conforming a cross-reference; amending s.
173409.912, F.S.; revising procedures for implementation of a
174Medicaid prescribed-drug spending-control program;
175amending s. 429.07, F.S.; deleting the requirement for an
176assisted living facility to obtain an additional license
177in order to provide limited nursing services; deleting the
178requirement for the agency to conduct quarterly monitoring
179visits of facilities that hold a license to provide
180extended congregate care services; deleting the
181requirement for the department to report annually on the
182status of and recommendations related to extended
183congregate care; deleting the requirement for the agency
184to conduct monitoring visits at least twice a year to
185facilities providing limited nursing services; increasing
186the licensure fees and the maximum fee required for the
187standard license; increasing the licensure fees for the
188extended congregate care license; eliminating the license
189fee for the limited nursing services license; transferring
190from another provision of law the requirement that a
191biennial survey of an assisted living facility include
192specific actions to determine whether the facility is
193adequately protecting residents' rights; providing that an
194assisted living facility that has a class I or class II
195violation is subject to monitoring visits; requiring a
196registered nurse to participate in certain monitoring
197visits; amending s. 429.11, F.S.; revising licensure
198application requirements for assisted living facilities to
199eliminate provisional licenses; amending s. 429.12, F.S.;
200revising notification requirements for the sale or
201transfer of ownership of an assisted living facility;
202amending s. 429.14, F.S.; removing a ground for the
203imposition of an administrative penalty; clarifying
204provisions relating to a facility's request for a hearing
205under certain circumstances; authorizing the agency to
206provide certain information relating to the licensure
207status of assisted living facilities electronically or
208through the agency's Internet website; amending s. 429.17,
209F.S.; deleting provisions relating to the limited nursing
210services license; revising agency responsibilities
211regarding the issuance of conditional licenses; amending
212s. 429.19, F.S.; clarifying that a monitoring fee may be
213assessed in addition to an administrative fine; amending
214s. 429.23, F.S.; deleting reporting requirements for
215assisted living facilities relating to liability claims;
216amending s. 429.255, F.S.; eliminating provisions
217authorizing the use of volunteers to provide certain
218health-care-related services in assisted living
219facilities; authorizing assisted living facilities to
220provide limited nursing services; requiring an assisted
221living facility to be responsible for certain
222recordkeeping and staff to be trained to monitor residents
223receiving certain health-care-related services; amending
224s. 429.28, F.S.; deleting a requirement for a biennial
225survey of an assisted living facility, to conform to
226changes made by the act; amending s. 429.35, F.S.;
227authorizing the agency to provide certain information
228relating to the inspections of assisted living facilities
229electronically or through the agency's Internet website;
230amending s. 429.41, F.S., relating to rulemaking;
231conforming provisions to changes made by the act; amending
232s. 429.53, F.S.; revising provisions relating to
233consultation by the agency; revising a definition;
234amending s. 429.54, F.S.; requiring licensed assisted
235living facilities to electronically report certain data
236semiannually to the agency in accordance with rules
237adopted by the department; amending s. 429.71, F.S.;
238revising schedule of inspection violations for adult
239family-care homes; amending s. 429.911, F.S.; deleting a
240ground for agency action against an adult day care center;
241amending s. 429.915, F.S.; revising agency
242responsibilities regarding the issuance of conditional
243licenses; amending s. 483.294, F.S.; revising frequency of
244agency inspections of multiphasic health testing centers;
245amending s. 499.003, F.S.; defining the term "medical
246convenience kit" for purposes of pt. I of ch. 499, F.S.;
247providing an exception to applicability of the term;
248removing a requirement that certain prescription drug
249purchasers maintain a separate inventory of certain
250prescription drugs; amending s. 633.081, F.S.; limiting
251Fire Marshal inspections of nursing homes to once a year;
252providing for additional inspections based on complaints
253and violations identified in the course of orientation or
254training activities; amending s. 766.202, F.S.; adding
255persons licensed under part XIV of ch. 468, F.S., to the
256definition of "health care provider"; amending ss.
257394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
258conforming terminology and cross-references; revising a
259reference; providing an effective date.
260
261Be It Enacted by the Legislature of the State of Florida:
262
263     Section 1.  Present paragraph (e) of subsection (10) and
264paragraph (e) of subsection (14) of section 112.0455, Florida
265Statutes, are amended, and paragraphs (f) through (k) of
266subsection (10) of that section are redesignated as paragraphs
267(e) through (j), respectively, to read:
268     112.0455  Drug-Free Workplace Act.-
269     (10)  EMPLOYER PROTECTION.-
270     (e)  Nothing in this section shall be construed to operate
271retroactively, and nothing in this section shall abrogate the
272right of an employer under state law to conduct drug tests prior
273to January 1, 1990. A drug test conducted by an employer prior
274to January 1, 1990, is not subject to this section.
275     (14)  DISCIPLINE REMEDIES.-
276     (e)  Upon resolving an appeal filed pursuant to paragraph
277(c), and finding a violation of this section, the commission may
278order the following relief:
279     1.  Rescind the disciplinary action, expunge related
280records from the personnel file of the employee or job applicant
281and reinstate the employee.
282     2.  Order compliance with paragraph (10)(f)(g).
283     3.  Award back pay and benefits.
284     4.  Award the prevailing employee or job applicant the
285necessary costs of the appeal, reasonable attorney's fees, and
286expert witness fees.
287     Section 2.  Paragraph (n) of subsection (1) of section
288154.11, Florida Statutes, is amended to read:
289     154.11  Powers of board of trustees.-
290     (1)  The board of trustees of each public health trust
291shall be deemed to exercise a public and essential governmental
292function of both the state and the county and in furtherance
293thereof it shall, subject to limitation by the governing body of
294the county in which such board is located, have all of the
295powers necessary or convenient to carry out the operation and
296governance of designated health care facilities, including, but
297without limiting the generality of, the foregoing:
298     (n)  To appoint originally the staff of physicians to
299practice in any designated facility owned or operated by the
300board and to approve the bylaws and rules to be adopted by the
301medical staff of any designated facility owned and operated by
302the board, such governing regulations to be in accordance with
303the standards of The Joint Commission on the Accreditation of
304Hospitals which provide, among other things, for the method of
305appointing additional staff members and for the removal of staff
306members.
307     Section 3.  Subsection (15) of section 318.21, Florida
308Statutes, is amended to read:
309     318.21  Disposition of civil penalties by county courts.-
310All civil penalties received by a county court pursuant to the
311provisions of this chapter shall be distributed and paid monthly
312as follows:
313     (15)  Of the additional fine assessed under s. 318.18(3)(e)
314for a violation of s. 316.1893, 50 percent of the moneys
315received from the fines shall be remitted to the Department of
316Revenue and deposited into the Brain and Spinal Cord Injury
317Trust Fund of Department of Health and shall be appropriated to
318the Department of Health Agency for Health Care Administration
319as general revenue to provide an enhanced Medicaid payment to
320nursing homes that serve Medicaid recipients with spinal cord
321injuries that are medically complex and who are technologically
322and respiratory dependent with brain and spinal cord injuries.
323The remaining 50 percent of the moneys received from the
324enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
325the Department of Revenue and deposited into the Department of
326Health Administrative Trust Fund to provide financial support to
327certified trauma centers in the counties where enhanced penalty
328zones are established to ensure the availability and
329accessibility of trauma services. Funds deposited into the
330Administrative Trust Fund under this subsection shall be
331allocated as follows:
332     (a)  Fifty percent shall be allocated equally among all
333Level I, Level II, and pediatric trauma centers in recognition
334of readiness costs for maintaining trauma services.
335     (b)  Fifty percent shall be allocated among Level I, Level
336II, and pediatric trauma centers based on each center's relative
337volume of trauma cases as reported in the Department of Health
338Trauma Registry.
339     Section 4.  Subsection (3) is added to section 381.00315,
340Florida Statutes, to read:
341     381.00315  Public health advisories; public health
342emergencies.-The State Health Officer is responsible for
343declaring public health emergencies and issuing public health
344advisories.
345     (3)  To facilitate effective emergency management, when the
346United States Department of Health and Human Services contracts
347for the manufacture and delivery of licensable products in
348response to a public health emergency and the terms of those
349contracts are made available to the states, the department shall
350accept funds provided by counties, municipalities, and other
351entities designated in the state emergency management plan
352required under s. 252.35(2)(a) for the purpose of participation
353in such contracts. The department shall deposit the funds into
354the Grants and Donations Trust Fund and expend the funds on
355behalf of the donor county, municipality, or other entity for
356the purchase the licensable products made available under the
357contract.
358     Section 5.  Paragraph (e) is added to subsection (2) of
359section 381.0072, Florida Statutes, to read:
360     381.0072  Food service protection.-It shall be the duty of
361the Department of Health to adopt and enforce sanitation rules
362consistent with law to ensure the protection of the public from
363food-borne illness. These rules shall provide the standards and
364requirements for the storage, preparation, serving, or display
365of food in food service establishments as defined in this
366section and which are not permitted or licensed under chapter
367500 or chapter 509.
368     (2)  DUTIES.-
369     (e)  The department shall inspect food service
370establishments in nursing homes licensed under part II of
371chapter 400 twice each year. The department may make additional
372inspections only in response to complaints. The department shall
373coordinate inspections with the Agency for Health Care
374Administration, such that the department's inspection is at
375least 60 days after a recertification visit by the Agency for
376Health Care Administration.
377     Section 6.  Section 383.325, Florida Statutes, is repealed.
378     Section 7.  Subsection (7) of section 394.4787, Florida
379Statutes, is amended to read:
380     394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
381and 394.4789.-As used in this section and ss. 394.4786,
382394.4788, and 394.4789:
383     (7)  "Specialty psychiatric hospital" means a hospital
384licensed by the agency pursuant to s. 395.002(26)(28) and part
385II of chapter 408 as a specialty psychiatric hospital.
386     Section 8.  Subsection (2) of section 394.741, Florida
387Statutes, is amended to read:
388     394.741  Accreditation requirements for providers of
389behavioral health care services.-
390     (2)  Notwithstanding any provision of law to the contrary,
391accreditation shall be accepted by the agency and department in
392lieu of the agency's and department's facility licensure onsite
393review requirements and shall be accepted as a substitute for
394the department's administrative and program monitoring
395requirements, except as required by subsections (3) and (4),
396for:
397     (a)  Any organization from which the department purchases
398behavioral health care services that is accredited by The Joint
399Commission on Accreditation of Healthcare Organizations or the
400Council on Accreditation for Children and Family Services, or
401has those services that are being purchased by the department
402accredited by the Commission on Accreditation of Rehabilitation
403Facilities CARF-the Rehabilitation Accreditation Commission.
404     (b)  Any mental health facility licensed by the agency or
405any substance abuse component licensed by the department that is
406accredited by The Joint Commission on Accreditation of
407Healthcare Organizations, the Commission on Accreditation of
408Rehabilitation Facilities CARF-the Rehabilitation Accreditation
409Commission, or the Council on Accreditation of Children and
410Family Services.
411     (c)  Any network of providers from which the department or
412the agency purchases behavioral health care services accredited
413by The Joint Commission on Accreditation of Healthcare
414Organizations, the Commission on Accreditation of Rehabilitation
415Facilities CARF-the Rehabilitation Accreditation Commission, the
416Council on Accreditation of Children and Family Services, or the
417National Committee for Quality Assurance. A provider
418organization, which is part of an accredited network, is
419afforded the same rights under this part.
420     Section 9.  Present subsections (15) through (32) of
421section 395.002, Florida Statutes, are renumbered as subsections
422(14) through (28), respectively, and present subsections (1),
423(14), (24), (30), and (31), and paragraph (c) of present
424subsection (28) of that section are amended to read:
425     395.002  Definitions.-As used in this chapter:
426     (1)  "Accrediting organizations" means nationally
427recognized or approved accrediting organizations whose standards
428incorporate comparable licensure requirements as determined by
429the agency the Joint Commission on Accreditation of Healthcare
430Organizations, the American Osteopathic Association, the
431Commission on Accreditation of Rehabilitation Facilities, and
432the Accreditation Association for Ambulatory Health Care, Inc.
433     (14)  "Initial denial determination" means a determination
434by a private review agent that the health care services
435furnished or proposed to be furnished to a patient are
436inappropriate, not medically necessary, or not reasonable.
437     (24)  "Private review agent" means any person or entity
438which performs utilization review services for third-party
439payors on a contractual basis for outpatient or inpatient
440services. However, the term shall not include full-time
441employees, personnel, or staff of health insurers, health
442maintenance organizations, or hospitals, or wholly owned
443subsidiaries thereof or affiliates under common ownership, when
444performing utilization review for their respective hospitals,
445health maintenance organizations, or insureds of the same
446insurance group. For this purpose, health insurers, health
447maintenance organizations, and hospitals, or wholly owned
448subsidiaries thereof or affiliates under common ownership,
449include such entities engaged as administrators of self-
450insurance as defined in s. 624.031.
451     (26)(28)  "Specialty hospital" means any facility which
452meets the provisions of subsection (12), and which regularly
453makes available either:
454     (c)  Intensive residential treatment programs for children
455and adolescents as defined in subsection (14) (15).
456     (30)  "Utilization review" means a system for reviewing the
457medical necessity or appropriateness in the allocation of health
458care resources of hospital services given or proposed to be
459given to a patient or group of patients.
460     (31)  "Utilization review plan" means a description of the
461policies and procedures governing utilization review activities
462performed by a private review agent.
463     Section 10.  Paragraph (c) of subsection (1) and paragraph
464(b) of subsection (2) of section 395.003, Florida Statutes, are
465amended to read:
466     395.003  Licensure; denial, suspension, and revocation.-
467     (1)
468     (c)  Until July 1, 2006, additional emergency departments
469located off the premises of licensed hospitals may not be
470authorized by the agency.
471     (2)
472     (b)  The agency shall, at the request of a licensee that is
473a teaching hospital as defined in s. 408.07(45), issue a single
474license to a licensee for facilities that have been previously
475licensed as separate premises, provided such separately licensed
476facilities, taken together, constitute the same premises as
477defined in s. 395.002(22)(23). Such license for the single
478premises shall include all of the beds, services, and programs
479that were previously included on the licenses for the separate
480premises. The granting of a single license under this paragraph
481shall not in any manner reduce the number of beds, services, or
482programs operated by the licensee.
483     Section 11.  Paragraph (e) of subsection (2) and subsection
484(4) of section 395.0193, Florida Statutes, are amended to read:
485     395.0193  Licensed facilities; peer review; disciplinary
486powers; agency or partnership with physicians.-
487     (2)  Each licensed facility, as a condition of licensure,
488shall provide for peer review of physicians who deliver health
489care services at the facility. Each licensed facility shall
490develop written, binding procedures by which such peer review
491shall be conducted. Such procedures shall include:
492     (e)  Recording of agendas and minutes which do not contain
493confidential material, for review by the Division of Medical
494Quality Assurance of the department Health Quality Assurance of
495the agency.
496     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
497actions taken under subsection (3) shall be reported in writing
498to the Division of Medical Quality Assurance of the department
499Health Quality Assurance of the agency within 30 working days
500after its initial occurrence, regardless of the pendency of
501appeals to the governing board of the hospital. The notification
502shall identify the disciplined practitioner, the action taken,
503and the reason for such action. All final disciplinary actions
504taken under subsection (3), if different from those which were
505reported to the department agency within 30 days after the
506initial occurrence, shall be reported within 10 working days to
507the Division of Medical Quality Assurance of the department
508Health Quality Assurance of the agency in writing and shall
509specify the disciplinary action taken and the specific grounds
510therefor. The division shall review each report and determine
511whether it potentially involved conduct by the licensee that is
512subject to disciplinary action, in which case s. 456.073 shall
513apply. The reports are not subject to inspection under s.
514119.07(1) even if the division's investigation results in a
515finding of probable cause.
516     Section 12.  Section 395.1023, Florida Statutes, is amended
517to read:
518     395.1023  Child abuse and neglect cases; duties.-Each
519licensed facility shall adopt a protocol that, at a minimum,
520requires the facility to:
521     (1)  Incorporate a facility policy that every staff member
522has an affirmative duty to report, pursuant to chapter 39, any
523actual or suspected case of child abuse, abandonment, or
524neglect; and
525     (2)  In any case involving suspected child abuse,
526abandonment, or neglect, designate, at the request of the
527Department of Children and Family Services, a staff physician to
528act as a liaison between the hospital and the Department of
529Children and Family Services office which is investigating the
530suspected abuse, abandonment, or neglect, and the child
531protection team, as defined in s. 39.01, when the case is
532referred to such a team.
533
534Each general hospital and appropriate specialty hospital shall
535comply with the provisions of this section and shall notify the
536agency and the Department of Children and Family Services of its
537compliance by sending a copy of its policy to the agency and the
538Department of Children and Family Services as required by rule.
539The failure by a general hospital or appropriate specialty
540hospital to comply shall be punished by a fine not exceeding
541$1,000, to be fixed, imposed, and collected by the agency. Each
542day in violation is considered a separate offense.
543     Section 13.  Subsection (2) and paragraph (d) of subsection
544(3) of section 395.1041, Florida Statutes, are amended to read:
545     395.1041  Access to emergency services and care.-
546     (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
547shall establish and maintain an inventory of hospitals with
548emergency services. The inventory shall list all services within
549the service capability of the hospital, and such services shall
550appear on the face of the hospital license. Each hospital having
551emergency services shall notify the agency of its service
552capability in the manner and form prescribed by the agency. The
553agency shall use the inventory to assist emergency medical
554services providers and others in locating appropriate emergency
555medical care. The inventory shall also be made available to the
556general public. On or before August 1, 1992, the agency shall
557request that each hospital identify the services which are
558within its service capability. On or before November 1, 1992,
559the agency shall notify each hospital of the service capability
560to be included in the inventory. The hospital has 15 days from
561the date of receipt to respond to the notice. By December 1,
5621992, the agency shall publish a final inventory. Each hospital
563shall reaffirm its service capability when its license is
564renewed and shall notify the agency of the addition of a new
565service or the termination of a service prior to a change in its
566service capability.
567     (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
568FACILITY OR HEALTH CARE PERSONNEL.-
569     (d)1.  Every hospital shall ensure the provision of
570services within the service capability of the hospital, at all
571times, either directly or indirectly through an arrangement with
572another hospital, through an arrangement with one or more
573physicians, or as otherwise made through prior arrangements. A
574hospital may enter into an agreement with another hospital for
575purposes of meeting its service capability requirement, and
576appropriate compensation or other reasonable conditions may be
577negotiated for these backup services.
578     2.  If any arrangement requires the provision of emergency
579medical transportation, such arrangement must be made in
580consultation with the applicable provider and may not require
581the emergency medical service provider to provide transportation
582that is outside the routine service area of that provider or in
583a manner that impairs the ability of the emergency medical
584service provider to timely respond to prehospital emergency
585calls.
586     3.  A hospital shall not be required to ensure service
587capability at all times as required in subparagraph 1. if, prior
588to the receiving of any patient needing such service capability,
589such hospital has demonstrated to the agency that it lacks the
590ability to ensure such capability and it has exhausted all
591reasonable efforts to ensure such capability through backup
592arrangements. In reviewing a hospital's demonstration of lack of
593ability to ensure service capability, the agency shall consider
594factors relevant to the particular case, including the
595following:
596     a.  Number and proximity of hospitals with the same service
597capability.
598     b.  Number, type, credentials, and privileges of
599specialists.
600     c.  Frequency of procedures.
601     d.  Size of hospital.
602     4.  The agency shall publish proposed rules implementing a
603reasonable exemption procedure by November 1, 1992. Subparagraph
6041. shall become effective upon the effective date of said rules
605or January 31, 1993, whichever is earlier. For a period not to
606exceed 1 year from the effective date of subparagraph 1., a
607hospital requesting an exemption shall be deemed to be exempt
608from offering the service until the agency initially acts to
609deny or grant the original request. The agency has 45 days from
610the date of receipt of the request to approve or deny the
611request. After the first year from the effective date of
612subparagraph 1., If the agency fails to initially act within the
613time period, the hospital is deemed to be exempt from offering
614the service until the agency initially acts to deny the request.
615     Section 14.  Section 395.1046, Florida Statutes, is
616repealed.
617     Section 15.  Paragraph (e) of subsection (1) of section
618395.1055, Florida Statutes, is amended to read:
619     395.1055  Rules and enforcement.-
620     (1)  The agency shall adopt rules pursuant to ss.
621120.536(1) and 120.54 to implement the provisions of this part,
622which shall include reasonable and fair minimum standards for
623ensuring that:
624     (e)  Licensed facility beds conform to minimum space,
625equipment, and furnishings standards as specified by the agency,
626the Florida Building Code, and the Florida Fire Prevention Code
627department.
628     Section 16.  Subsection (1) of section 395.10972, Florida
629Statutes, is amended to read:
630     395.10972  Health Care Risk Manager Advisory Council.-The
631Secretary of Health Care Administration may appoint a seven-
632member advisory council to advise the agency on matters
633pertaining to health care risk managers. The members of the
634council shall serve at the pleasure of the secretary. The
635council shall designate a chair. The council shall meet at the
636call of the secretary or at those times as may be required by
637rule of the agency. The members of the advisory council shall
638receive no compensation for their services, but shall be
639reimbursed for travel expenses as provided in s. 112.061. The
640council shall consist of individuals representing the following
641areas:
642     (1)  Two shall be active health care risk managers,
643including one risk manager who is recommended by and a member of
644the Florida Society for of Healthcare Risk Management and
645Patient Safety.
646     Section 17.  Subsection (3) of section 395.2050, Florida
647Statutes, is amended to read:
648     395.2050  Routine inquiry for organ and tissue donation;
649certification for procurement activities; death records review.-
650     (3)  Each organ procurement organization designated by the
651federal Centers for Medicare and Medicaid Services Health Care
652Financing Administration and licensed by the state shall conduct
653an annual death records review in the organ procurement
654organization's affiliated donor hospitals. The organ procurement
655organization shall enlist the services of every Florida licensed
656tissue bank and eye bank affiliated with or providing service to
657the donor hospital and operating in the same service area to
658participate in the death records review.
659     Section 18.  Subsection (2) of section 395.3036, Florida
660Statutes, is amended to read:
661     395.3036  Confidentiality of records and meetings of
662corporations that lease public hospitals or other public health
663care facilities.-The records of a private corporation that
664leases a public hospital or other public health care facility
665are confidential and exempt from the provisions of s. 119.07(1)
666and s. 24(a), Art. I of the State Constitution, and the meetings
667of the governing board of a private corporation are exempt from
668s. 286.011 and s. 24(b), Art. I of the State Constitution when
669the public lessor complies with the public finance
670accountability provisions of s. 155.40(5) with respect to the
671transfer of any public funds to the private lessee and when the
672private lessee meets at least three of the five following
673criteria:
674     (2)  The public lessor and the private lessee do not
675commingle any of their funds in any account maintained by either
676of them, other than the payment of the rent and administrative
677fees or the transfer of funds pursuant to s. 155.40     (2)
678subsection (2).
679     Section 19.  Section 395.3037, Florida Statutes, is
680repealed.
681     Section 20.  Subsections (1), (4), and (5) of section
682395.3038, Florida Statutes, are amended to read:
683     395.3038  State-listed primary stroke centers and
684comprehensive stroke centers; notification of hospitals.-
685     (1)  The agency shall make available on its website and to
686the department a list of the name and address of each hospital
687that meets the criteria for a primary stroke center and the name
688and address of each hospital that meets the criteria for a
689comprehensive stroke center. The list of primary and
690comprehensive stroke centers shall include only those hospitals
691that attest in an affidavit submitted to the agency that the
692hospital meets the named criteria, or those hospitals that
693attest in an affidavit submitted to the agency that the hospital
694is certified as a primary or a comprehensive stroke center by
695The Joint Commission on Accreditation of Healthcare
696Organizations.
697     (4)  The agency shall adopt by rule criteria for a primary
698stroke center which are substantially similar to the
699certification standards for primary stroke centers of The Joint
700Commission on Accreditation of Healthcare Organizations.
701     (5)  The agency shall adopt by rule criteria for a
702comprehensive stroke center. However, if The Joint Commission on
703Accreditation of Healthcare Organizations establishes criteria
704for a comprehensive stroke center, the agency shall establish
705criteria for a comprehensive stroke center which are
706substantially similar to those criteria established by The Joint
707Commission on Accreditation of Healthcare Organizations.
708     Section 21.  Paragraph (e) of subsection (2) of section
709395.602, Florida Statutes, is amended to read:
710     395.602  Rural hospitals.-
711     (2)  DEFINITIONS.-As used in this part:
712     (e)  "Rural hospital" means an acute care hospital licensed
713under this chapter, having 100 or fewer licensed beds and an
714emergency room, which is:
715     1.  The sole provider within a county with a population
716density of no greater than 100 persons per square mile;
717     2.  An acute care hospital, in a county with a population
718density of no greater than 100 persons per square mile, which is
719at least 30 minutes of travel time, on normally traveled roads
720under normal traffic conditions, from any other acute care
721hospital within the same county;
722     3.  A hospital supported by a tax district or subdistrict
723whose boundaries encompass a population of 100 persons or fewer
724per square mile;
725     4.  A hospital in a constitutional charter county with a
726population of over 1 million persons that has imposed a local
727option health service tax pursuant to law and in an area that
728was directly impacted by a catastrophic event on August 24,
7291992, for which the Governor of Florida declared a state of
730emergency pursuant to chapter 125, and has 120 beds or less that
731serves an agricultural community with an emergency room
732utilization of no less than 20,000 visits and a Medicaid
733inpatient utilization rate greater than 15 percent;
734     4.5.  A hospital with a service area that has a population
735of 100 persons or fewer per square mile. As used in this
736subparagraph, the term "service area" means the fewest number of
737zip codes that account for 75 percent of the hospital's
738discharges for the most recent 5-year period, based on
739information available from the hospital inpatient discharge
740database in the Florida Center for Health Information and Policy
741Analysis at the Agency for Health Care Administration; or
742     5.6.  A hospital designated as a critical access hospital,
743as defined in s. 408.07(15).
744
745Population densities used in this paragraph must be based upon
746the most recently completed United States census. A hospital
747that received funds under s. 409.9116 for a quarter beginning no
748later than July 1, 2002, is deemed to have been and shall
749continue to be a rural hospital from that date through June 30,
7502015, if the hospital continues to have 100 or fewer licensed
751beds and an emergency room, or meets the criteria of
752subparagraph 4. An acute care hospital that has not previously
753been designated as a rural hospital and that meets the criteria
754of this paragraph shall be granted such designation upon
755application, including supporting documentation to the Agency
756for Health Care Administration.
757     Section 22.  Subsection (8) of section 400.021, Florida
758Statutes, is amended to read:
759     400.021  Definitions.-When used in this part, unless the
760context otherwise requires, the term:
761     (8)  "Geriatric outpatient clinic" means a site for
762providing outpatient health care to persons 60 years of age or
763older, which is staffed by a registered nurse or a physician
764assistant, or a licensed practical nurse under the direct
765supervision of a registered nurse, advanced registered nurse
766practitioner, or physician.
767     Section 23.  Paragraph (g) of subsection (2) of section
768400.0239, Florida Statutes, is amended to read:
769     400.0239  Quality of Long-Term Care Facility Improvement
770Trust Fund.-
771     (2)  Expenditures from the trust fund shall be allowable
772for direct support of the following:
773     (g)  Other initiatives authorized by the Centers for
774Medicare and Medicaid Services for the use of federal civil
775monetary penalties, including projects recommended through the
776Medicaid "Up-or-Out" Quality of Care Contract Management Program
777pursuant to s. 400.148.
778     Section 24.  Subsection (15) of section 400.0255, Florida
779Statutes, is amended to read
780     400.0255  Resident transfer or discharge; requirements and
781procedures; hearings.-
782     (15)(a)  The department's Office of Appeals Hearings shall
783conduct hearings under this section. The office shall notify the
784facility of a resident's request for a hearing.
785     (b)  The department shall, by rule, establish procedures to
786be used for fair hearings requested by residents. These
787procedures shall be equivalent to the procedures used for fair
788hearings for other Medicaid cases appearing in s. 409.285 and
789applicable rules, chapter 10-2, part VI, Florida Administrative
790Code. The burden of proof must be clear and convincing evidence.
791A hearing decision must be rendered within 90 days after receipt
792of the request for hearing.
793     (c)  If the hearing decision is favorable to the resident
794who has been transferred or discharged, the resident must be
795readmitted to the facility's first available bed.
796     (d)  The decision of the hearing officer shall be final.
797Any aggrieved party may appeal the decision to the district
798court of appeal in the appellate district where the facility is
799located. Review procedures shall be conducted in accordance with
800the Florida Rules of Appellate Procedure.
801     Section 25.  Subsection (2) of section 400.063, Florida
802Statutes, is amended to read:
803     400.063  Resident protection.-
804     (2)  The agency is authorized to establish for each
805facility, subject to intervention by the agency, a separate bank
806account for the deposit to the credit of the agency of any
807moneys received from the Health Care Trust Fund or any other
808moneys received for the maintenance and care of residents in the
809facility, and the agency is authorized to disburse moneys from
810such account to pay obligations incurred for the purposes of
811this section. The agency is authorized to requisition moneys
812from the Health Care Trust Fund in advance of an actual need for
813cash on the basis of an estimate by the agency of moneys to be
814spent under the authority of this section. Any bank account
815established under this section need not be approved in advance
816of its creation as required by s. 17.58, but shall be secured by
817depository insurance equal to or greater than the balance of
818such account or by the pledge of collateral security in
819conformance with criteria established in s. 18.11. The agency
820shall notify the Chief Financial Officer of any such account so
821established and shall make a quarterly accounting to the Chief
822Financial Officer for all moneys deposited in such account.
823     Section 26.  Subsections (1) and (5) of section 400.071,
824Florida Statutes, are amended to read:
825     400.071  Application for license.-
826     (1)  In addition to the requirements of part II of chapter
827408, the application for a license shall be under oath and must
828contain the following:
829     (a)  The location of the facility for which a license is
830sought and an indication, as in the original application, that
831such location conforms to the local zoning ordinances.
832     (b)  A signed affidavit disclosing any financial or
833ownership interest that a controlling interest as defined in
834part II of chapter 408 has held in the last 5 years in any
835entity licensed by this state or any other state to provide
836health or residential care which has closed voluntarily or
837involuntarily; has filed for bankruptcy; has had a receiver
838appointed; has had a license denied, suspended, or revoked; or
839has had an injunction issued against it which was initiated by a
840regulatory agency. The affidavit must disclose the reason any
841such entity was closed, whether voluntarily or involuntarily.
842     (c)  The total number of beds and the total number of
843Medicare and Medicaid certified beds.
844     (b)(d)  Information relating to the applicant and employees
845which the agency requires by rule. The applicant must
846demonstrate that sufficient numbers of qualified staff, by
847training or experience, will be employed to properly care for
848the type and number of residents who will reside in the
849facility.
850     (c)(e)  Copies of any civil verdict or judgment involving
851the applicant rendered within the 10 years preceding the
852application, relating to medical negligence, violation of
853residents' rights, or wrongful death. As a condition of
854licensure, the licensee agrees to provide to the agency copies
855of any new verdict or judgment involving the applicant, relating
856to such matters, within 30 days after filing with the clerk of
857the court. The information required in this paragraph shall be
858maintained in the facility's licensure file and in an agency
859database which is available as a public record.
860     (5)  As a condition of licensure, each facility must
861establish and submit with its application a plan for quality
862assurance and for conducting risk management.
863     Section 27.  Section 400.0712, Florida Statutes, is amended
864to read:
865     400.0712  Application for inactive license.-
866     (1)  As specified in this section, the agency may issue an
867inactive license to a nursing home facility for all or a portion
868of its beds. Any request by a licensee that a nursing home or
869portion of a nursing home become inactive must be submitted to
870the agency in the approved format. The facility may not initiate
871any suspension of services, notify residents, or initiate
872inactivity before receiving approval from the agency; and a
873licensee that violates this provision may not be issued an
874inactive license.
875     (1)(2)  In addition to the powers granted under part II of
876chapter 408, the agency may issue an inactive license to a
877nursing home that chooses to use an unoccupied contiguous
878portion of the facility for an alternative use to meet the needs
879of elderly persons through the use of less restrictive, less
880institutional services.
881     (a)  An inactive license issued under this subsection may
882be granted for a period not to exceed the current licensure
883expiration date but may be renewed by the agency at the time of
884licensure renewal.
885     (b)  A request to extend the inactive license must be
886submitted to the agency in the approved format and approved by
887the agency in writing.
888     (c)  Nursing homes that receive an inactive license to
889provide alternative services shall not receive preference for
890participation in the Assisted Living for the Elderly Medicaid
891waiver.
892     (2)(3)  The agency shall adopt rules pursuant to ss.
893120.536(1) and 120.54 necessary to implement this section.
894     Section 28.  Section 400.111, Florida Statutes, is amended
895to read:
896     400.111  Disclosure of controlling interest.-In addition to
897the requirements of part II of chapter 408, when requested by
898the agency, the licensee shall submit a signed affidavit
899disclosing any financial or ownership interest that a
900controlling interest has held within the last 5 years in any
901entity licensed by the state or any other state to provide
902health or residential care which entity has closed voluntarily
903or involuntarily; has filed for bankruptcy; has had a receiver
904appointed; has had a license denied, suspended, or revoked; or
905has had an injunction issued against it which was initiated by a
906regulatory agency. The affidavit must disclose the reason such
907entity was closed, whether voluntarily or involuntarily.
908     Section 29.  Subsection (2) of section 400.1183, Florida
909Statutes, is amended to read:
910     400.1183  Resident grievance procedures.-
911     (2)  Each facility shall maintain records of all grievances
912for agency inspection and shall report to the agency at the time
913of relicensure the total number of grievances handled during the
914prior licensure period, a categorization of the cases underlying
915the grievances, and the final disposition of the grievances.
916     Section 30.  Paragraphs (o) through (w) of subsection (1)
917of section 400.141, Florida Statutes, are redesignated as
918paragraphs (n) through (u), respectively, and present paragraphs
919(f), (g), (j), (n), (o), and (r) of that subsection are amended,
920to read:
921     400.141  Administration and management of nursing home
922facilities.-
923     (1)  Every licensed facility shall comply with all
924applicable standards and rules of the agency and shall:
925     (f)  Be allowed and encouraged by the agency to provide
926other needed services under certain conditions. If the facility
927has a standard licensure status, and has had no class I or class
928II deficiencies during the past 2 years or has been awarded a
929Gold Seal under the program established in s. 400.235, it may be
930encouraged by the agency to provide services, including, but not
931limited to, respite and adult day services, which enable
932individuals to move in and out of the facility. A facility is
933not subject to any additional licensure requirements for
934providing these services.
935     1.  Respite care may be offered to persons in need of
936short-term or temporary nursing home services. For each person
937admitted under the respite care program, the facility licensee
938must:
939     a.  Have a written abbreviated plan of care that, at a
940minimum, includes nutritional requirements, medication orders,
941physician orders, nursing assessments, and dietary preferences.
942The nursing or physician assessments may take the place of all
943other assessments required for full-time residents.
944     b.  Have a contract that, at a minimum, specifies the
945services to be provided to the respite resident, including
946charges for services, activities, equipment, emergency medical
947services, and the administration of medications. If multiple
948respite admissions for a single person are anticipated, the
949original contract is valid for 1 year after the date of
950execution.
951     c.  Ensure that each resident is released to his or her
952caregiver or an individual designated in writing by the
953caregiver.
954     2.  A person admitted under the respite care program is:
955     a.  Exempt from requirements in rule related to discharge
956planning.
957     b.  Covered by the resident's rights set forth in s.
958400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
959shall not be considered trust funds subject to the requirements
960of s. 400.022(1)(h) until the resident has been in the facility
961for more than 14 consecutive days.
962     c.  Allowed to use his or her personal medications for the
963respite stay if permitted by facility policy. The facility must
964obtain a physician's orders for the medications. The caregiver
965may provide information regarding the medications as part of the
966nursing assessment, which must agree with the physician's
967orders. Medications shall be released with the resident upon
968discharge in accordance with current orders.
969     3.  A person receiving respite care is entitled to a total
970of 60 days in the facility within a contract year or a calendar
971year if the contract is for less than 12 months. However, each
972single stay may not exceed 14 days. If a stay exceeds 14
973consecutive days, the facility must comply with all assessment
974and care planning requirements applicable to nursing home
975residents.
976     4.  A person receiving respite care must reside in a
977licensed nursing home bed.
978     5.  A prospective respite resident must provide medical
979information from a physician, a physician assistant, or a nurse
980practitioner and other information from the primary caregiver as
981may be required by the facility prior to or at the time of
982admission to receive respite care. The medical information must
983include a physician's order for respite care and proof of a
984physical examination by a licensed physician, physician
985assistant, or nurse practitioner. The physician's order and
986physical examination may be used to provide intermittent respite
987care for up to 12 months after the date the order is written.
988     6.  The facility must assume the duties of the primary
989caregiver. To ensure continuity of care and services, the
990resident is entitled to retain his or her personal physician and
991must have access to medically necessary services such as
992physical therapy, occupational therapy, or speech therapy, as
993needed. The facility must arrange for transportation to these
994services if necessary. Respite care must be provided in
995accordance with this part and rules adopted by the agency.
996However, the agency shall, by rule, adopt modified requirements
997for resident assessment, resident care plans, resident
998contracts, physician orders, and other provisions, as
999appropriate, for short-term or temporary nursing home services.
1000     7.  The agency shall allow for shared programming and staff
1001in a facility which meets minimum standards and offers services
1002pursuant to this paragraph, but, if the facility is cited for
1003deficiencies in patient care, may require additional staff and
1004programs appropriate to the needs of service recipients. A
1005person who receives respite care may not be counted as a
1006resident of the facility for purposes of the facility's licensed
1007capacity unless that person receives 24-hour respite care. A
1008person receiving either respite care for 24 hours or longer or
1009adult day services must be included when calculating minimum
1010staffing for the facility. Any costs and revenues generated by a
1011nursing home facility from nonresidential programs or services
1012shall be excluded from the calculations of Medicaid per diems
1013for nursing home institutional care reimbursement.
1014     (g)  If the facility has a standard license or is a Gold
1015Seal facility, exceeds the minimum required hours of licensed
1016nursing and certified nursing assistant direct care per resident
1017per day, and is part of a continuing care facility licensed
1018under chapter 651 or a retirement community that offers other
1019services pursuant to part III of this chapter or part I or part
1020III of chapter 429 on a single campus, be allowed to share
1021programming and staff. At the time of inspection and in the
1022semiannual report required pursuant to paragraph (n) (o), a
1023continuing care facility or retirement community that uses this
1024option must demonstrate through staffing records that minimum
1025staffing requirements for the facility were met. Licensed nurses
1026and certified nursing assistants who work in the nursing home
1027facility may be used to provide services elsewhere on campus if
1028the facility exceeds the minimum number of direct care hours
1029required per resident per day and the total number of residents
1030receiving direct care services from a licensed nurse or a
1031certified nursing assistant does not cause the facility to
1032violate the staffing ratios required under s. 400.23(3)(a).
1033Compliance with the minimum staffing ratios shall be based on
1034total number of residents receiving direct care services,
1035regardless of where they reside on campus. If the facility
1036receives a conditional license, it may not share staff until the
1037conditional license status ends. This paragraph does not
1038restrict the agency's authority under federal or state law to
1039require additional staff if a facility is cited for deficiencies
1040in care which are caused by an insufficient number of certified
1041nursing assistants or licensed nurses. The agency may adopt
1042rules for the documentation necessary to determine compliance
1043with this provision.
1044     (j)  Keep full records of resident admissions and
1045discharges; medical and general health status, including medical
1046records, personal and social history, and identity and address
1047of next of kin or other persons who may have responsibility for
1048the affairs of the residents; and individual resident care plans
1049including, but not limited to, prescribed services, service
1050frequency and duration, and service goals. The records shall be
1051open to inspection by the agency. The facility must maintain
1052clinical records on each resident in accordance with accepted
1053professional standards and practices that are complete,
1054accurately documented, readily accessible, and systematically
1055organized.
1056     (n)  Submit to the agency the information specified in s.
1057400.071(1)(b) for a management company within 30 days after the
1058effective date of the management agreement.
1059     (n)(o)1.  Submit semiannually to the agency, or more
1060frequently if requested by the agency, information regarding
1061facility staff-to-resident ratios, staff turnover, and staff
1062stability, including information regarding certified nursing
1063assistants, licensed nurses, the director of nursing, and the
1064facility administrator. For purposes of this reporting:
1065     a.  Staff-to-resident ratios must be reported in the
1066categories specified in s. 400.23(3)(a) and applicable rules.
1067The ratio must be reported as an average for the most recent
1068calendar quarter.
1069     b.  Staff turnover must be reported for the most recent 12-
1070month period ending on the last workday of the most recent
1071calendar quarter prior to the date the information is submitted.
1072The turnover rate must be computed quarterly, with the annual
1073rate being the cumulative sum of the quarterly rates. The
1074turnover rate is the total number of terminations or separations
1075experienced during the quarter, excluding any employee
1076terminated during a probationary period of 3 months or less,
1077divided by the total number of staff employed at the end of the
1078period for which the rate is computed, and expressed as a
1079percentage.
1080     c.  The formula for determining staff stability is the
1081total number of employees that have been employed for more than
108212 months, divided by the total number of employees employed at
1083the end of the most recent calendar quarter, and expressed as a
1084percentage.
1085     d.  A nursing facility that has failed to comply with state
1086minimum-staffing requirements for 2 consecutive days is
1087prohibited from accepting new admissions until the facility has
1088achieved the minimum-staffing requirements for a period of 6
1089consecutive days. For the purposes of this sub-subparagraph, any
1090person who was a resident of the facility and was absent from
1091the facility for the purpose of receiving medical care at a
1092separate location or was on a leave of absence is not considered
1093a new admission. Failure to impose such an admissions moratorium
1094is subject to a $1,000 fine constitutes a class II deficiency.
1095     e.  A nursing facility which does not have a conditional
1096license may be cited for failure to comply with the standards in
1097s. 400.23(3)(a)1.a. only if it has failed to meet those
1098standards on 2 consecutive days or if it has failed to meet at
1099least 97 percent of those standards on any one day.
1100     f.  A facility which has a conditional license must be in
1101compliance with the standards in s. 400.23(3)(a) at all times.
1102     2.  This paragraph does not limit the agency's ability to
1103impose a deficiency or take other actions if a facility does not
1104have enough staff to meet the residents' needs.
1105     (r)  Report to the agency any filing for bankruptcy
1106protection by the facility or its parent corporation,
1107divestiture or spin-off of its assets, or corporate
1108reorganization within 30 days after the completion of such
1109activity.
1110     Section 31.  Subsection (3) of section 400.142, Florida
1111Statutes, is amended to read:
1112     400.142  Emergency medication kits; orders not to
1113resuscitate.-
1114     (3)  Facility staff may withhold or withdraw
1115cardiopulmonary resuscitation if presented with an order not to
1116resuscitate executed pursuant to s. 401.45. The agency shall
1117adopt rules providing for the implementation of such orders.
1118Facility staff and facilities shall not be subject to criminal
1119prosecution or civil liability, nor be considered to have
1120engaged in negligent or unprofessional conduct, for withholding
1121or withdrawing cardiopulmonary resuscitation pursuant to such an
1122order and rules adopted by the agency. The absence of an order
1123not to resuscitate executed pursuant to s. 401.45 does not
1124preclude a physician from withholding or withdrawing
1125cardiopulmonary resuscitation as otherwise permitted by law.
1126     Section 32.  Subsections (11) through (15) of section
1127400.147, Florida Statutes, are renumbered as subsections (10)
1128through (14), respectively, and present subsection (10) is
1129amended to read:
1130     400.147  Internal risk management and quality assurance
1131program.-
1132     (10)  By the 10th of each month, each facility subject to
1133this section shall report any notice received pursuant to s.
1134400.0233(2) and each initial complaint that was filed with the
1135clerk of the court and served on the facility during the
1136previous month by a resident or a resident's family member,
1137guardian, conservator, or personal legal representative. The
1138report must include the name of the resident, the resident's
1139date of birth and social security number, the Medicaid
1140identification number for Medicaid-eligible persons, the date or
1141dates of the incident leading to the claim or dates of
1142residency, if applicable, and the type of injury or violation of
1143rights alleged to have occurred. Each facility shall also submit
1144a copy of the notices received pursuant to s. 400.0233(2) and
1145complaints filed with the clerk of the court. This report is
1146confidential as provided by law and is not discoverable or
1147admissible in any civil or administrative action, except in such
1148actions brought by the agency to enforce the provisions of this
1149part.
1150     Section 33.  Section 400.148, Florida Statutes, is
1151repealed.
1152     Section 34.  Paragraph (f) of subsection (5) of section
1153400.162, Florida Statutes, is amended to read:
1154     400.162  Property and personal affairs of residents.-
1155     (5)
1156     (f)  At least every 3 months, the licensee shall furnish
1157the resident and the guardian, trustee, or conservator, if any,
1158for the resident a complete and verified statement of all funds
1159and other property to which this subsection applies, detailing
1160the amounts and items received, together with their sources and
1161disposition. For resident property, the licensee shall furnish
1162such a statement annually and within 7 calendar days after a
1163request for a statement. In any event, the licensee shall
1164furnish such statements a statement annually and upon the
1165discharge or transfer of a resident. Any governmental agency or
1166private charitable agency contributing funds or other property
1167on account of a resident also shall be entitled to receive such
1168statements statement annually and upon discharge or transfer and
1169such other report as it may require pursuant to law.
1170     Section 35.  Paragraphs (d) and (e) of subsection (2) of
1171section 400.179, Florida Statutes, are amended to read:
1172     400.179  Liability for Medicaid underpayments and
1173overpayments.-
1174     (2)  Because any transfer of a nursing facility may expose
1175the fact that Medicaid may have underpaid or overpaid the
1176transferor, and because in most instances, any such underpayment
1177or overpayment can only be determined following a formal field
1178audit, the liabilities for any such underpayments or
1179overpayments shall be as follows:
1180     (d)  Where the transfer involves a facility that has been
1181leased by the transferor:
1182     1.  The transferee shall, as a condition to being issued a
1183license by the agency, acquire, maintain, and provide proof to
1184the agency of a bond with a term of 30 months, renewable
1185annually, in an amount not less than the total of 3 months'
1186Medicaid payments to the facility computed on the basis of the
1187preceding 12-month average Medicaid payments to the facility.
1188     2.  A leasehold licensee may meet the requirements of
1189subparagraph 1. by payment of a nonrefundable fee, paid at
1190initial licensure, paid at the time of any subsequent change of
1191ownership, and paid annually thereafter, in the amount of 1
1192percent of the total of 3 months' Medicaid payments to the
1193facility computed on the basis of the preceding 12-month average
1194Medicaid payments to the facility. If a preceding 12-month
1195average is not available, projected Medicaid payments may be
1196used. The fee shall be deposited into the Grants and Donations
1197Trust Fund and shall be accounted for separately as a Medicaid
1198nursing home overpayment account. These fees shall be used at
1199the sole discretion of the agency to repay nursing home Medicaid
1200overpayments. Payment of this fee shall not release the licensee
1201from any liability for any Medicaid overpayments, nor shall
1202payment bar the agency from seeking to recoup overpayments from
1203the licensee and any other liable party. As a condition of
1204exercising this lease bond alternative, licensees paying this
1205fee must maintain an existing lease bond through the end of the
120630-month term period of that bond. The agency is herein granted
1207specific authority to promulgate all rules pertaining to the
1208administration and management of this account, including
1209withdrawals from the account, subject to federal review and
1210approval. This provision shall take effect upon becoming law and
1211shall apply to any leasehold license application. The financial
1212viability of the Medicaid nursing home overpayment account shall
1213be determined by the agency through annual review of the account
1214balance and the amount of total outstanding, unpaid Medicaid
1215overpayments owing from leasehold licensees to the agency as
1216determined by final agency audits. By March 31 of each year, the
1217agency shall assess the cumulative fees collected under this
1218subparagraph, minus any amounts used to repay nursing home
1219Medicaid overpayments and amounts transferred to contribute to
1220the General Revenue Fund pursuant to s. 215.20. If the net
1221cumulative collections, minus amounts utilized to repay nursing
1222home Medicaid overpayments, exceed $25 million, the provisions
1223of this paragraph shall not apply for the subsequent fiscal
1224year.
1225     3.  The leasehold licensee may meet the bond requirement
1226through other arrangements acceptable to the agency. The agency
1227is herein granted specific authority to promulgate rules
1228pertaining to lease bond arrangements.
1229     4.  All existing nursing facility licensees, operating the
1230facility as a leasehold, shall acquire, maintain, and provide
1231proof to the agency of the 30-month bond required in
1232subparagraph 1., above, on and after July 1, 1993, for each
1233license renewal.
1234     5.  It shall be the responsibility of all nursing facility
1235operators, operating the facility as a leasehold, to renew the
123630-month bond and to provide proof of such renewal to the agency
1237annually.
1238     6.  Any failure of the nursing facility operator to
1239acquire, maintain, renew annually, or provide proof to the
1240agency shall be grounds for the agency to deny, revoke, and
1241suspend the facility license to operate such facility and to
1242take any further action, including, but not limited to,
1243enjoining the facility, asserting a moratorium pursuant to part
1244II of chapter 408, or applying for a receiver, deemed necessary
1245to ensure compliance with this section and to safeguard and
1246protect the health, safety, and welfare of the facility's
1247residents. A lease agreement required as a condition of bond
1248financing or refinancing under s. 154.213 by a health facilities
1249authority or required under s. 159.30 by a county or
1250municipality is not a leasehold for purposes of this paragraph
1251and is not subject to the bond requirement of this paragraph.
1252     (e)  For the 2009-2010 fiscal year only, the provisions of
1253paragraph (d) shall not apply. This paragraph expires July 1,
12542010.
1255     Section 36.  Subsection (3) of section 400.19, Florida
1256Statutes, is amended to read:
1257     400.19  Right of entry and inspection.-
1258     (3)  The agency shall every 15 months conduct at least one
1259unannounced inspection to determine compliance by the licensee
1260with statutes, and with rules promulgated under the provisions
1261of those statutes, governing minimum standards of construction,
1262quality and adequacy of care, and rights of residents. The
1263survey shall be conducted every 6 months for the next 2-year
1264period if the facility has been cited for a class I deficiency,
1265has been cited for two or more class II deficiencies arising
1266from separate surveys or investigations within a 60-day period,
1267or has had three or more substantiated complaints within a 6-
1268month period, each resulting in at least one class I or class II
1269deficiency. In addition to any other fees or fines in this part,
1270the agency shall assess a fine for each facility that is subject
1271to the 6-month survey cycle. The fine for the 2-year period
1272shall be $6,000, one-half to be paid at the completion of each
1273survey. The agency may adjust this fine by the change in the
1274Consumer Price Index, based on the 12 months immediately
1275preceding the increase, to cover the cost of the additional
1276surveys. The agency shall verify through subsequent inspection
1277that any deficiency identified during inspection is corrected.
1278However, the agency may verify the correction of a class III or
1279class IV deficiency unrelated to resident rights or resident
1280care without reinspecting the facility if adequate written
1281documentation has been received from the facility, which
1282provides assurance that the deficiency has been corrected. The
1283giving or causing to be given of advance notice of such
1284unannounced inspections by an employee of the agency to any
1285unauthorized person shall constitute cause for suspension of not
1286fewer than 5 working days according to the provisions of chapter
1287110.
1288     Section 37.  Section 400.195, Florida Statutes, is
1289repealed.
1290     Section 38.  Subsection (5) of section 400.23, Florida
1291Statutes, is amended to read:
1292     400.23  Rules; evaluation and deficiencies; licensure
1293status.-
1294     (5)(a)  The agency, in collaboration with the Division of
1295Children's Medical Services Network of the Department of Health,
1296must, no later than December 31, 1993, adopt rules for minimum
1297standards of care for persons under 21 years of age who reside
1298in nursing home facilities. The rules must include a methodology
1299for reviewing a nursing home facility under ss. 408.031-408.045
1300which serves only persons under 21 years of age. A facility may
1301be exempt from these standards for specific persons between 18
1302and 21 years of age, if the person's physician agrees that
1303minimum standards of care based on age are not necessary.
1304     (b)  The agency, in collaboration with the Division of
1305Children's Medical Services Network, shall adopt rules for
1306minimum staffing requirements for nursing home facilities that
1307serve persons under 21 years of age, which shall apply in lieu
1308of the standards contained in subsection (3).
1309     1.  For persons under 21 years of age who require skilled
1310care, the requirements shall include a minimum combined average
1311of licensed nurses, respiratory therapists, respiratory care
1312practitioners, and certified nursing assistants of 3.9 hours of
1313direct care per resident per day for each nursing home facility.
1314     2.  For persons under 21 years of age who are fragile, the
1315requirements shall include a minimum combined average of
1316licensed nurses, respiratory therapists, respiratory care
1317practitioners, and certified nursing assistants of 5 hours of
1318direct care per resident per day for each nursing home facility.
1319     Section 39.  Subsection (1) of section 400.275, Florida
1320Statutes, is amended to read:
1321     400.275  Agency duties.-
1322     (1)  The agency shall ensure that each newly hired nursing
1323home surveyor, as a part of basic training, is assigned full-
1324time to a licensed nursing home for at least 2 days within a 7-
1325day period to observe facility operations outside of the survey
1326process before the surveyor begins survey responsibilities. Such
1327observations may not be the sole basis of a deficiency citation
1328against the facility. The agency may not assign an individual to
1329be a member of a survey team for purposes of a survey,
1330evaluation, or consultation visit at a nursing home facility in
1331which the surveyor was an employee within the preceding 2 5
1332years.
1333     Section 40.  Subsection (2) of section 400.484, Florida
1334Statutes, is amended to read:
1335     400.484  Right of inspection; violations deficiencies;
1336fines.-
1337     (2)  The agency shall impose fines for various classes of
1338violations deficiencies in accordance with the following
1339schedule:
1340     (a)  Class I violations are defined in s. 408.813. A class
1341I deficiency is any act, omission, or practice that results in a
1342patient's death, disablement, or permanent injury, or places a
1343patient at imminent risk of death, disablement, or permanent
1344injury. Upon finding a class I violation deficiency, the agency
1345shall impose an administrative fine in the amount of $15,000 for
1346each occurrence and each day that the violation deficiency
1347exists.
1348     (b)  Class II violations are defined in s. 408.813. A class
1349II deficiency is any act, omission, or practice that has a
1350direct adverse effect on the health, safety, or security of a
1351patient. Upon finding a class II violation deficiency, the
1352agency shall impose an administrative fine in the amount of
1353$5,000 for each occurrence and each day that the violation
1354deficiency exists.
1355     (c)  Class III violations are defined in s. 408.813. A
1356class III deficiency is any act, omission, or practice that has
1357an indirect, adverse effect on the health, safety, or security
1358of a patient. Upon finding an uncorrected or repeated class III
1359violation deficiency, the agency shall impose an administrative
1360fine not to exceed $1,000 for each occurrence and each day that
1361the uncorrected or repeated violation deficiency exists.
1362     (d)  Class IV violations are defined in s. 408.813. A class
1363IV deficiency is any act, omission, or practice related to
1364required reports, forms, or documents which does not have the
1365potential of negatively affecting patients. These violations are
1366of a type that the agency determines do not threaten the health,
1367safety, or security of patients. Upon finding an uncorrected or
1368repeated class IV violation deficiency, the agency shall impose
1369an administrative fine not to exceed $500 for each occurrence
1370and each day that the uncorrected or repeated violation
1371deficiency exists.
1372     Section 41.  Paragraph (i) of subsection (1) and subsection
1373(4) of section 400.606, Florida Statutes, are amended to read:
1374     400.606  License; application; renewal; conditional license
1375or permit; certificate of need.-
1376     (1)  In addition to the requirements of part II of chapter
1377408, the initial application and change of ownership application
1378must be accompanied by a plan for the delivery of home,
1379residential, and homelike inpatient hospice services to
1380terminally ill persons and their families. Such plan must
1381contain, but need not be limited to:
1382     (i)  The projected annual operating cost of the hospice.
1383
1384If the applicant is an existing licensed health care provider,
1385the application must be accompanied by a copy of the most recent
1386profit-loss statement and, if applicable, the most recent
1387licensure inspection report.
1388     (4)  A freestanding hospice facility that is primarily
1389engaged in providing inpatient and related services and that is
1390not otherwise licensed as a health care facility shall be
1391required to obtain a certificate of need. However, a
1392freestanding hospice facility with six or fewer beds shall not
1393be required to comply with institutional standards such as, but
1394not limited to, standards requiring sprinkler systems, emergency
1395electrical systems, or special lavatory devices.
1396     Section 42.  Subsection (2) of section 400.607, Florida
1397Statutes, is amended to read:
1398     400.607  Denial, suspension, revocation of license;
1399emergency actions; imposition of administrative fine; grounds.-
1400     (2)  A violation of this part, part II of chapter 408, or
1401applicable rules Any of the following actions by a licensed
1402hospice or any of its employees shall be grounds for
1403administrative action by the agency against a hospice.:
1404     (a)  A violation of the provisions of this part, part II of
1405chapter 408, or applicable rules.
1406     (b)  An intentional or negligent act materially affecting
1407the health or safety of a patient.
1408     Section 43.  Section 400.915, Florida Statutes, is amended
1409to read:
1410     400.915  Construction and renovation; requirements.-The
1411requirements for the construction or renovation of a PPEC center
1412shall comply with:
1413     (1)  The provisions of chapter 553, which pertain to
1414building construction standards, including plumbing, electrical
1415code, glass, manufactured buildings, accessibility for the
1416physically disabled;
1417     (2)  The provisions of s. 633.022 and applicable rules
1418pertaining to physical minimum standards for nonresidential
1419child care physical facilities in rule 10M-12.003, Florida
1420Administrative Code, Child Care Standards; and
1421     (3)  The standards or rules adopted pursuant to this part
1422and part II of chapter 408.
1423     Section 44.  Subsection (1) of section 400.925, Florida
1424Statutes, is amended to read:
1425     400.925  Definitions.-As used in this part, the term:
1426     (1)  "Accrediting organizations" means The Joint Commission
1427on Accreditation of Healthcare Organizations or other national
1428accreditation agencies whose standards for accreditation are
1429comparable to those required by this part for licensure.
1430     Section 45.  Subsections (3) through (6) of section
1431400.931, Florida Statutes, are renumbered as subsections (2)
1432through (5), respectively, and present subsection (2) of that
1433section is amended to read:
1434     400.931  Application for license; fee; provisional license;
1435temporary permit.-
1436     (2)  As an alternative to submitting proof of financial
1437ability to operate as required in s. 408.810(8), the applicant
1438may submit a $50,000 surety bond to the agency.
1439     Section 46.  Subsection (2) of section 400.932, Florida
1440Statutes, is amended to read:
1441     400.932  Administrative penalties.-
1442     (2)  A violation of this part, part II of chapter 408, or
1443applicable rules Any of the following actions by an employee of
1444a home medical equipment provider shall be are grounds for
1445administrative action or penalties by the agency.:
1446     (a)  Violation of this part, part II of chapter 408, or
1447applicable rules.
1448     (b)  An intentional, reckless, or negligent act that
1449materially affects the health or safety of a patient.
1450     Section 47.  Subsection (3) of section 400.967, Florida
1451Statutes, is amended to read:
1452     400.967  Rules and classification of violations
1453deficiencies.-
1454     (3)  The agency shall adopt rules to provide that, when the
1455criteria established under this part and part II of chapter 408
1456are not met, such violations deficiencies shall be classified
1457according to the nature of the violation deficiency. The agency
1458shall indicate the classification on the face of the notice of
1459deficiencies as follows:
1460     (a)  Class I violations deficiencies are defined in s.
1461408.813 those which the agency determines present an imminent
1462danger to the residents or guests of the facility or a
1463substantial probability that death or serious physical harm
1464would result therefrom. The condition or practice constituting a
1465class I violation must be abated or eliminated immediately,
1466unless a fixed period of time, as determined by the agency, is
1467required for correction. A class I violation deficiency is
1468subject to a civil penalty in an amount not less than $5,000 and
1469not exceeding $10,000 for each violation deficiency. A fine may
1470be levied notwithstanding the correction of the violation
1471deficiency.
1472     (b)  Class II violations deficiencies are defined in s.
1473408.813 those which the agency determines have a direct or
1474immediate relationship to the health, safety, or security of the
1475facility residents, other than class I deficiencies. A class II
1476violation deficiency is subject to a civil penalty in an amount
1477not less than $1,000 and not exceeding $5,000 for each violation
1478deficiency. A citation for a class II violation deficiency shall
1479specify the time within which the violation deficiency must be
1480corrected. If a class II violation deficiency is corrected
1481within the time specified, no civil penalty shall be imposed,
1482unless it is a repeated offense.
1483     (c)  Class III violations deficiencies are defined in s.
1484408.813 those which the agency determines to have an indirect or
1485potential relationship to the health, safety, or security of the
1486facility residents, other than class I or class II deficiencies.
1487A class III violation deficiency is subject to a civil penalty
1488of not less than $500 and not exceeding $1,000 for each
1489deficiency. A citation for a class III violation deficiency
1490shall specify the time within which the violation deficiency
1491must be corrected. If a class III violation deficiency is
1492corrected within the time specified, no civil penalty shall be
1493imposed, unless it is a repeated offense.
1494     (d)  Class IV violations are defined in s. 408.813. Upon
1495finding an uncorrected or repeated class IV violation, the
1496agency shall impose an administrative fine not to exceed $500
1497for each occurrence and each day that the uncorrected or
1498repeated violation exists.
1499     Section 48.  Subsections (4) and (7) of section 400.9905,
1500Florida Statutes, are amended to read:
1501     400.9905  Definitions.-
1502     (4)  "Clinic" means an entity at which health care services
1503are provided to individuals and which tenders charges for
1504reimbursement for such services, including a mobile clinic and a
1505portable health service or equipment provider. For purposes of
1506this part, the term does not include and the licensure
1507requirements of this part do not apply to:
1508     (a)  Entities licensed or registered by the state under
1509chapter 395; or entities licensed or registered by the state and
1510providing only health care services within the scope of services
1511authorized under their respective licenses granted under ss.
1512383.30-383.335, chapter 390, chapter 394, chapter 397, this
1513chapter except part X, chapter 429, chapter 463, chapter 465,
1514chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1515chapter 651; end-stage renal disease providers authorized under
151642 C.F.R. part 405, subpart U; or providers certified under 42
1517C.F.R. part 485, subpart B or subpart H; or any entity that
1518provides neonatal or pediatric hospital-based health care
1519services or other health care services by licensed practitioners
1520solely within a hospital licensed under chapter 395.
1521     (b)  Entities that own, directly or indirectly, entities
1522licensed or registered by the state pursuant to chapter 395; or
1523entities that own, directly or indirectly, entities licensed or
1524registered by the state and providing only health care services
1525within the scope of services authorized pursuant to their
1526respective licenses granted under ss. 383.30-383.335, chapter
1527390, chapter 394, chapter 397, this chapter except part X,
1528chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1529part I of chapter 483, chapter 484, chapter 651; end-stage renal
1530disease providers authorized under 42 C.F.R. part 405, subpart
1531U; or providers certified under 42 C.F.R. part 485, subpart B or
1532subpart H; or any entity that provides neonatal or pediatric
1533hospital-based health care services by licensed practitioners
1534solely within a hospital licensed under chapter 395.
1535     (c)  Entities that are owned, directly or indirectly, by an
1536entity licensed or registered by the state pursuant to chapter
1537395; or entities that are owned, directly or indirectly, by an
1538entity licensed or registered by the state and providing only
1539health care services within the scope of services authorized
1540pursuant to their respective licenses granted under ss. 383.30-
1541383.335, chapter 390, chapter 394, chapter 397, this chapter
1542except part X, chapter 429, chapter 463, chapter 465, chapter
1543466, chapter 478, part I of chapter 483, chapter 484, or chapter
1544651; end-stage renal disease providers authorized under 42
1545C.F.R. part 405, subpart U; or providers certified under 42
1546C.F.R. part 485, subpart B or subpart H; or any entity that
1547provides neonatal or pediatric hospital-based health care
1548services by licensed practitioners solely within a hospital
1549under chapter 395.
1550     (d)  Entities that are under common ownership, directly or
1551indirectly, with an entity licensed or registered by the state
1552pursuant to chapter 395; or entities that are under common
1553ownership, directly or indirectly, with an entity licensed or
1554registered by the state and providing only health care services
1555within the scope of services authorized pursuant to their
1556respective licenses granted under ss. 383.30-383.335, chapter
1557390, chapter 394, chapter 397, this chapter except part X,
1558chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1559part I of chapter 483, chapter 484, or chapter 651; end-stage
1560renal disease providers authorized under 42 C.F.R. part 405,
1561subpart U; or providers certified under 42 C.F.R. part 485,
1562subpart B or subpart H; or any entity that provides neonatal or
1563pediatric hospital-based health care services by licensed
1564practitioners solely within a hospital licensed under chapter
1565395.
1566     (e)  An entity that is exempt from federal taxation under
156726 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1568under 26 U.S.C. s. 409 that has a board of trustees not less
1569than two-thirds of which are Florida-licensed health care
1570practitioners and provides only physical therapy services under
1571physician orders, any community college or university clinic,
1572and any entity owned or operated by the federal or state
1573government, including agencies, subdivisions, or municipalities
1574thereof.
1575     (f)  A sole proprietorship, group practice, partnership, or
1576corporation that provides health care services by physicians
1577covered by s. 627.419, that is directly supervised by one or
1578more of such physicians, and that is wholly owned by one or more
1579of those physicians or by a physician and the spouse, parent,
1580child, or sibling of that physician.
1581     (g)  A sole proprietorship, group practice, partnership, or
1582corporation that provides health care services by licensed
1583health care practitioners under chapter 457, chapter 458,
1584chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1585chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1586chapter 490, chapter 491, or part I, part III, part X, part
1587XIII, or part XIV of chapter 468, or s. 464.012, which are
1588wholly owned by one or more licensed health care practitioners,
1589or the licensed health care practitioners set forth in this
1590paragraph and the spouse, parent, child, or sibling of a
1591licensed health care practitioner, so long as one of the owners
1592who is a licensed health care practitioner is supervising the
1593business activities and is legally responsible for the entity's
1594compliance with all federal and state laws. However, a health
1595care practitioner may not supervise services beyond the scope of
1596the practitioner's license, except that, for the purposes of
1597this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1598provides only services authorized pursuant to s. 456.053(3)(b)
1599may be supervised by a licensee specified in s. 456.053(3)(b).
1600     (h)  Clinical facilities affiliated with an accredited
1601medical school at which training is provided for medical
1602students, residents, or fellows.
1603     (i)  Entities that provide only oncology or radiation
1604therapy services by physicians licensed under chapter 458 or
1605chapter 459 or entities that provide oncology or radiation
1606therapy services by physicians licensed under chapter 458 or
1607chapter 459 which are owned by a corporation whose shares are
1608publicly traded on a recognized stock exchange.
1609     (j)  Clinical facilities affiliated with a college of
1610chiropractic accredited by the Council on Chiropractic Education
1611at which training is provided for chiropractic students.
1612     (k)  Entities that provide licensed practitioners to staff
1613emergency departments or to deliver anesthesia services in
1614facilities licensed under chapter 395 and that derive at least
161590 percent of their gross annual revenues from the provision of
1616such services. Entities claiming an exemption from licensure
1617under this paragraph must provide documentation demonstrating
1618compliance.
1619     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1620perinatology clinical facilities that are a publicly traded
1621corporation or that are wholly owned, directly or indirectly, by
1622a publicly traded corporation. As used in this paragraph, a
1623publicly traded corporation is a corporation that issues
1624securities traded on an exchange registered with the United
1625States Securities and Exchange Commission as a national
1626securities exchange.
1627     (m)  Entities that are owned by a corporation that has $250
1628million or more in total annual sales of health care services
1629provided by licensed health care practitioners if one or more of
1630the owners of the entity is a health care practitioner who is
1631licensed in this state, is responsible for supervising the
1632business activities of the entity, and is legally responsible
1633for the entity's compliance with state law for purposes of this
1634section.
1635     (n)  Entities that are owned or controlled, directly or
1636indirectly, by a publicly traded entity with $100 million or
1637more, in the aggregate, in total annual revenues derived from
1638providing health care services by licensed health care
1639practitioners that are employed or contracted by an entity
1640described in this paragraph.
1641     (7)  "Portable health service or equipment provider" means
1642an entity that contracts with or employs persons to provide
1643portable health care services or equipment to multiple locations
1644performing treatment or diagnostic testing of individuals, that
1645bills third-party payors for those services, and that otherwise
1646meets the definition of a clinic in subsection (4).
1647     Section 49.  Paragraph (b) of subsection (1) and paragraph
1648(c) of subsection (4) of section 400.991, Florida Statutes, are
1649amended to read:
1650     400.991  License requirements; background screenings;
1651prohibitions.-
1652     (1)
1653     (b)  Each mobile clinic must obtain a separate health care
1654clinic license and must provide to the agency, at least
1655quarterly, its projected street location to enable the agency to
1656locate and inspect such clinic. A portable health service or
1657equipment provider must obtain a health care clinic license for
1658a single administrative office and is not required to submit
1659quarterly projected street locations.
1660     (4)  In addition to the requirements of part II of chapter
1661408, the applicant must file with the application satisfactory
1662proof that the clinic is in compliance with this part and
1663applicable rules, including:
1664     (c)  Proof of financial ability to operate as required
1665under ss. s. 408.810(8) and 408.8065. As an alternative to
1666submitting proof of financial ability to operate as required
1667under s. 408.810(8), the applicant may file a surety bond of at
1668least $500,000 which guarantees that the clinic will act in full
1669conformity with all legal requirements for operating a clinic,
1670payable to the agency. The agency may adopt rules to specify
1671related requirements for such surety bond.
1672     Section 50.  Paragraph (g) of subsection (1) and paragraph
1673(a) of subsection (7) of section 400.9935, Florida Statutes, are
1674amended to read:
1675     400.9935  Clinic responsibilities.-
1676     (1)  Each clinic shall appoint a medical director or clinic
1677director who shall agree in writing to accept legal
1678responsibility for the following activities on behalf of the
1679clinic. The medical director or the clinic director shall:
1680     (g)  Conduct systematic reviews of clinic billings to
1681ensure that the billings are not fraudulent or unlawful. Upon
1682discovery of an unlawful charge, the medical director or clinic
1683director shall take immediate corrective action. If the clinic
1684performs only the technical component of magnetic resonance
1685imaging, static radiographs, computed tomography, or positron
1686emission tomography, and provides the professional
1687interpretation of such services, in a fixed facility that is
1688accredited by The Joint Commission on Accreditation of
1689Healthcare Organizations or the Accreditation Association for
1690Ambulatory Health Care, and the American College of Radiology;
1691and if, in the preceding quarter, the percentage of scans
1692performed by that clinic which was billed to all personal injury
1693protection insurance carriers was less than 15 percent, the
1694chief financial officer of the clinic may, in a written
1695acknowledgment provided to the agency, assume the responsibility
1696for the conduct of the systematic reviews of clinic billings to
1697ensure that the billings are not fraudulent or unlawful.
1698     (7)(a)  Each clinic engaged in magnetic resonance imaging
1699services must be accredited by The Joint Commission on
1700Accreditation of Healthcare Organizations, the American College
1701of Radiology, or the Accreditation Association for Ambulatory
1702Health Care, within 1 year after licensure. A clinic that is
1703accredited by the American College of Radiology or is within the
1704original 1-year period after licensure and replaces its core
1705magnetic resonance imaging equipment shall be given 1 year after
1706the date on which the equipment is replaced to attain
1707accreditation. However, a clinic may request a single, 6-month
1708extension if it provides evidence to the agency establishing
1709that, for good cause shown, such clinic cannot be accredited
1710within 1 year after licensure, and that such accreditation will
1711be completed within the 6-month extension. After obtaining
1712accreditation as required by this subsection, each such clinic
1713must maintain accreditation as a condition of renewal of its
1714license. A clinic that files a change of ownership application
1715must comply with the original accreditation timeframe
1716requirements of the transferor. The agency shall deny a change
1717of ownership application if the clinic is not in compliance with
1718the accreditation requirements. When a clinic adds, replaces, or
1719modifies magnetic resonance imaging equipment and the
1720accreditation agency requires new accreditation, the clinic must
1721be accredited within 1 year after the date of the addition,
1722replacement, or modification but may request a single, 6-month
1723extension if the clinic provides evidence of good cause to the
1724agency.
1725     Section 51.  Subsection (2) of section 408.034, Florida
1726Statutes, is amended to read:
1727     408.034  Duties and responsibilities of agency; rules.-
1728     (2)  In the exercise of its authority to issue licenses to
1729health care facilities and health service providers, as provided
1730under chapters 393 and 395 and parts II, and IV, and VIII of
1731chapter 400, the agency may not issue a license to any health
1732care facility or health service provider that fails to receive a
1733certificate of need or an exemption for the licensed facility or
1734service.
1735     Section 52.  Paragraph (d) of subsection (1) of section
1736408.036, Florida Statutes, is amended to read:
1737     408.036  Projects subject to review; exemptions.-
1738     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1739health-care-related projects, as described in paragraphs (a)-
1740(g), are subject to review and must file an application for a
1741certificate of need with the agency. The agency is exclusively
1742responsible for determining whether a health-care-related
1743project is subject to review under ss. 408.031-408.045.
1744     (d)  The establishment of a hospice or hospice inpatient
1745facility, except as provided in s. 408.043.
1746     Section 53.  Subsection (2) of section 408.043, Florida
1747Statutes, is amended to read:
1748     408.043  Special provisions.-
1749     (2)  HOSPICES.-When an application is made for a
1750certificate of need to establish or to expand a hospice, the
1751need for such hospice shall be determined on the basis of the
1752need for and availability of hospice services in the community.
1753The formula on which the certificate of need is based shall
1754discourage regional monopolies and promote competition. The
1755inpatient hospice care component of a hospice which is a
1756freestanding facility, or a part of a facility, which is
1757primarily engaged in providing inpatient care and related
1758services and is not licensed as a health care facility shall
1759also be required to obtain a certificate of need. Provision of
1760hospice care by any current provider of health care is a
1761significant change in service and therefore requires a
1762certificate of need for such services.
1763     Section 54.  Paragraph (k) of subsection (3) of section
1764408.05, Florida Statutes, is amended to read:
1765     408.05  Florida Center for Health Information and Policy
1766Analysis.-
1767     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1768produce comparable and uniform health information and statistics
1769for the development of policy recommendations, the agency shall
1770perform the following functions:
1771     (k)  Develop, in conjunction with the State Consumer Health
1772Information and Policy Advisory Council, and implement a long-
1773range plan for making available health care quality measures and
1774financial data that will allow consumers to compare health care
1775services. The health care quality measures and financial data
1776the agency must make available shall include, but is not limited
1777to, pharmaceuticals, physicians, health care facilities, and
1778health plans and managed care entities. The agency shall submit
1779the initial plan to the Governor, the President of the Senate,
1780and the Speaker of the House of Representatives by January 1,
17812006, and shall update the plan and report on the status of its
1782implementation annually thereafter. The agency shall also make
1783the plan and status report available to the public on its
1784Internet website. As part of the plan, the agency shall identify
1785the process and timeframes for implementation, any barriers to
1786implementation, and recommendations of changes in the law that
1787may be enacted by the Legislature to eliminate the barriers. As
1788preliminary elements of the plan, the agency shall:
1789     1.  Make available patient-safety indicators, inpatient
1790quality indicators, and performance outcome and patient charge
1791data collected from health care facilities pursuant to s.
1792408.061(1)(a) and (2). The terms "patient-safety indicators" and
1793"inpatient quality indicators" shall be as defined by the
1794Centers for Medicare and Medicaid Services, the National Quality
1795Forum, The Joint Commission on Accreditation of Healthcare
1796Organizations, the Agency for Healthcare Research and Quality,
1797the Centers for Disease Control and Prevention, or a similar
1798national entity that establishes standards to measure the
1799performance of health care providers, or by other states. The
1800agency shall determine which conditions, procedures, health care
1801quality measures, and patient charge data to disclose based upon
1802input from the council. When determining which conditions and
1803procedures are to be disclosed, the council and the agency shall
1804consider variation in costs, variation in outcomes, and
1805magnitude of variations and other relevant information. When
1806determining which health care quality measures to disclose, the
1807agency:
1808     a.  Shall consider such factors as volume of cases; average
1809patient charges; average length of stay; complication rates;
1810mortality rates; and infection rates, among others, which shall
1811be adjusted for case mix and severity, if applicable.
1812     b.  May consider such additional measures that are adopted
1813by the Centers for Medicare and Medicaid Studies, National
1814Quality Forum, The Joint Commission on Accreditation of
1815Healthcare Organizations, the Agency for Healthcare Research and
1816Quality, Centers for Disease Control and Prevention, or a
1817similar national entity that establishes standards to measure
1818the performance of health care providers, or by other states.
1819
1820When determining which patient charge data to disclose, the
1821agency shall include such measures as the average of
1822undiscounted charges on frequently performed procedures and
1823preventive diagnostic procedures, the range of procedure charges
1824from highest to lowest, average net revenue per adjusted patient
1825day, average cost per adjusted patient day, and average cost per
1826admission, among others.
1827     2.  Make available performance measures, benefit design,
1828and premium cost data from health plans licensed pursuant to
1829chapter 627 or chapter 641. The agency shall determine which
1830health care quality measures and member and subscriber cost data
1831to disclose, based upon input from the council. When determining
1832which data to disclose, the agency shall consider information
1833that may be required by either individual or group purchasers to
1834assess the value of the product, which may include membership
1835satisfaction, quality of care, current enrollment or membership,
1836coverage areas, accreditation status, premium costs, plan costs,
1837premium increases, range of benefits, copayments and
1838deductibles, accuracy and speed of claims payment, credentials
1839of physicians, number of providers, names of network providers,
1840and hospitals in the network. Health plans shall make available
1841to the agency any such data or information that is not currently
1842reported to the agency or the office.
1843     3.  Determine the method and format for public disclosure
1844of data reported pursuant to this paragraph. The agency shall
1845make its determination based upon input from the State Consumer
1846Health Information and Policy Advisory Council. At a minimum,
1847the data shall be made available on the agency's Internet
1848website in a manner that allows consumers to conduct an
1849interactive search that allows them to view and compare the
1850information for specific providers. The website must include
1851such additional information as is determined necessary to ensure
1852that the website enhances informed decisionmaking among
1853consumers and health care purchasers, which shall include, at a
1854minimum, appropriate guidance on how to use the data and an
1855explanation of why the data may vary from provider to provider.
1856The data specified in subparagraph 1. shall be released no later
1857than January 1, 2006, for the reporting of infection rates, and
1858no later than October 1, 2005, for mortality rates and
1859complication rates. The data specified in subparagraph 2. shall
1860be released no later than October 1, 2006.
1861     4.  Publish on its website undiscounted charges for no
1862fewer than 150 of the most commonly performed adult and
1863pediatric procedures, including outpatient, inpatient,
1864diagnostic, and preventative procedures.
1865     Section 55.  Paragraph (a) of subsection (1) of section
1866408.061, Florida Statutes, is amended to read:
1867     408.061  Data collection; uniform systems of financial
1868reporting; information relating to physician charges;
1869confidential information; immunity.-
1870     (1)  The agency shall require the submission by health care
1871facilities, health care providers, and health insurers of data
1872necessary to carry out the agency's duties. Specifications for
1873data to be collected under this section shall be developed by
1874the agency with the assistance of technical advisory panels
1875including representatives of affected entities, consumers,
1876purchasers, and such other interested parties as may be
1877determined by the agency.
1878     (a)  Data submitted by health care facilities, including
1879the facilities as defined in chapter 395, shall include, but are
1880not limited to: case-mix data, patient admission and discharge
1881data, hospital emergency department data which shall include the
1882number of patients treated in the emergency department of a
1883licensed hospital reported by patient acuity level, data on
1884hospital-acquired infections as specified by rule, data on
1885complications as specified by rule, data on readmissions as
1886specified by rule, with patient and provider-specific
1887identifiers included, actual charge data by diagnostic groups,
1888financial data, accounting data, operating expenses, expenses
1889incurred for rendering services to patients who cannot or do not
1890pay, interest charges, depreciation expenses based on the
1891expected useful life of the property and equipment involved, and
1892demographic data. The agency shall adopt nationally recognized
1893risk adjustment methodologies or software consistent with the
1894standards of the Agency for Healthcare Research and Quality and
1895as selected by the agency for all data submitted as required by
1896this section. Data may be obtained from documents such as, but
1897not limited to: leases, contracts, debt instruments, itemized
1898patient bills, medical record abstracts, and related diagnostic
1899information. Reported data elements shall be reported
1900electronically and in accordance with rule 59E-7.012, Florida
1901Administrative Code. Data submitted shall be certified by the
1902chief executive officer or an appropriate and duly authorized
1903representative or employee of the licensed facility that the
1904information submitted is true and accurate.
1905     Section 56.  Subsection (43) of section 408.07, Florida
1906Statutes, is amended to read:
1907     408.07  Definitions.-As used in this chapter, with the
1908exception of ss. 408.031-408.045, the term:
1909     (43)  "Rural hospital" means an acute care hospital
1910licensed under chapter 395, having 100 or fewer licensed beds
1911and an emergency room, and which is:
1912     (a)  The sole provider within a county with a population
1913density of no greater than 100 persons per square mile;
1914     (b)  An acute care hospital, in a county with a population
1915density of no greater than 100 persons per square mile, which is
1916at least 30 minutes of travel time, on normally traveled roads
1917under normal traffic conditions, from another acute care
1918hospital within the same county;
1919     (c)  A hospital supported by a tax district or subdistrict
1920whose boundaries encompass a population of 100 persons or fewer
1921per square mile;
1922     (d)  A hospital with a service area that has a population
1923of 100 persons or fewer per square mile. As used in this
1924paragraph, the term "service area" means the fewest number of
1925zip codes that account for 75 percent of the hospital's
1926discharges for the most recent 5-year period, based on
1927information available from the hospital inpatient discharge
1928database in the Florida Center for Health Information and Policy
1929Analysis at the Agency for Health Care Administration; or
1930     (e)  A critical access hospital.
1931
1932Population densities used in this subsection must be based upon
1933the most recently completed United States census. A hospital
1934that received funds under s. 409.9116 for a quarter beginning no
1935later than July 1, 2002, is deemed to have been and shall
1936continue to be a rural hospital from that date through June 30,
19372015, if the hospital continues to have 100 or fewer licensed
1938beds and an emergency room, or meets the criteria of s.
1939395.602(2)(e)4. An acute care hospital that has not previously
1940been designated as a rural hospital and that meets the criteria
1941of this subsection shall be granted such designation upon
1942application, including supporting documentation, to the Agency
1943for Health Care Administration.
1944     Section 57.  Section 408.10, Florida Statutes, is amended
1945to read:
1946     408.10  Consumer complaints.-The agency shall:
1947     (1)  publish and make available to the public a toll-free
1948telephone number for the purpose of handling consumer complaints
1949and shall serve as a liaison between consumer entities and other
1950private entities and governmental entities for the disposition
1951of problems identified by consumers of health care.
1952     (2)  Be empowered to investigate consumer complaints
1953relating to problems with health care facilities' billing
1954practices and issue reports to be made public in any cases where
1955the agency determines the health care facility has engaged in
1956billing practices which are unreasonable and unfair to the
1957consumer.
1958     Section 58.  Subsections (12) through (30) of section
1959408.802, Florida Statutes, are renumbered as subsections (11)
1960through (29), respectively, and present subsection (11) of that
1961section is amended to read:
1962     408.802  Applicability.-The provisions of this part apply
1963to the provision of services that require licensure as defined
1964in this part and to the following entities licensed, registered,
1965or certified by the agency, as described in chapters 112, 383,
1966390, 394, 395, 400, 429, 440, 483, and 765:
1967     (11)  Private review agents, as provided under part I of
1968chapter 395.
1969     Section 59.  Subsection (3) is added to section 408.804,
1970Florida Statutes, to read:
1971     408.804  License required; display.-
1972     (3)  Any person who knowingly alters, defaces, or falsifies
1973a license certificate issued by the agency, or causes or
1974procures any person to commit such an offense, commits a
1975misdemeanor of the second degree, punishable as provided in s.
1976775.082 or s 775.083. Any licensee or provider who displays an
1977altered, defaced, or falsified license certificate is subject to
1978the penalties set forth in s. 408.815 and an administrative fine
1979of $1,000 for each day of illegal display.
1980     Section 60.  Paragraph (d) of subsection (2) of section
1981408.806, Florida Statutes, is amended, present subsections (3)
1982through (8) are renumbered as subsections (4) through (9),
1983respectively, and a new subsection (3) is added to that section,
1984to read:
1985     408.806  License application process.-
1986     (2)
1987     (d)  The agency shall notify the licensee by mail or
1988electronically at least 90 days before the expiration of a
1989license that a renewal license is necessary to continue
1990operation. The licensee's failure to timely file submit a
1991renewal application and license application fee with the agency
1992shall result in a $50 per day late fee charged to the licensee
1993by the agency; however, the aggregate amount of the late fee may
1994not exceed 50 percent of the licensure fee or $500, whichever is
1995less. The agency shall provide a courtesy notice to the licensee
1996by United States mail, electronically, or by any other manner at
1997its address of record or mailing address, if provided, at least
199890 days prior to the expiration of a license informing the
1999licensee of the expiration of the license. If the agency does
2000not provide the courtesy notice or the licensee does not receive
2001the courtesy notice, the licensee continues to be legally
2002obligated to timely file the renewal application and license
2003application fee with the agency and is not excused from the
2004payment of a late fee. If an application is received after the
2005required filing date and exhibits a hand-canceled postmark
2006obtained from a United States post office dated on or before the
2007required filing date, no fine will be levied.
2008     (3)  Payment of the late fee is required to consider any
2009late application complete, and failure to pay the late fee is
2010considered an omission from the application.
2011     Section 61.  Subsections (6) and (9) of section 408.810,
2012Florida Statutes, are amended to read:
2013     408.810  Minimum licensure requirements.-In addition to the
2014licensure requirements specified in this part, authorizing
2015statutes, and applicable rules, each applicant and licensee must
2016comply with the requirements of this section in order to obtain
2017and maintain a license.
2018     (6)(a)  An applicant must provide the agency with proof of
2019the applicant's legal right to occupy the property before a
2020license may be issued. Proof may include, but need not be
2021limited to, copies of warranty deeds, lease or rental
2022agreements, contracts for deeds, quitclaim deeds, or other such
2023documentation.
2024     (b)  In the event the property is encumbered by a mortgage
2025or is leased, an applicant must provide the agency with proof
2026that the mortgagor or landlord has been provided written notice
2027of the applicant's intent as mortgagee or tenant to provide
2028services that require licensure and instruct the mortgagor or
2029landlord to serve the agency by certified mail with copies of
2030any foreclosure or eviction actions initiated by the mortgagor
2031or landlord against the applicant.
2032     (9)  A controlling interest may not withhold from the
2033agency any evidence of financial instability, including, but not
2034limited to, checks returned due to insufficient funds,
2035delinquent accounts, nonpayment of withholding taxes, unpaid
2036utility expenses, nonpayment for essential services, or adverse
2037court action concerning the financial viability of the provider
2038or any other provider licensed under this part that is under the
2039control of the controlling interest. A controlling interest
2040shall notify the agency within 10 days after a court action to
2041initiate bankruptcy, foreclosure, or eviction proceedings
2042concerning the provider, in which the controlling interest is a
2043petitioner or defendant. Any person who violates this subsection
2044commits a misdemeanor of the second degree, punishable as
2045provided in s. 775.082 or s. 775.083. Each day of continuing
2046violation is a separate offense.
2047     Section 62.  Subsection (3) is added to section 408.813,
2048Florida Statutes, to read:
2049     408.813  Administrative fines; violations.-As a penalty for
2050any violation of this part, authorizing statutes, or applicable
2051rules, the agency may impose an administrative fine.
2052     (3)  The agency may impose an administrative fine for a
2053violation that does not qualify as a class I, class II, class
2054III, or class IV violation. Unless otherwise specified by law,
2055the amount of the fine shall not exceed $500 for each violation.
2056Unclassified violations may include:
2057     (a)  Violating any term or condition of a license.
2058     (b)  Violating any provision of this part, authorizing
2059statutes, or applicable rules.
2060     (c)  Exceeding licensed capacity.
2061     (d)  Providing services beyond the scope of the license.
2062     (e)  Violating a moratorium imposed pursuant to s. 408.814.
2063     Section 63.  Subsection (5) is added to section 408.815,
2064Florida Statutes, to read:
2065     408.815  License or application denial; revocation.-
2066     (5)  In order to ensure the health, safety, and welfare of
2067clients when a license has been denied, revoked, or is set to
2068terminate, the agency may extend the license expiration date for
2069a period of up to 30 days for the sole purpose of allowing the
2070safe and orderly discharge of clients. The agency may impose
2071conditions on the extension, including, but not limited to,
2072prohibiting or limiting admissions, expedited discharge
2073planning, required status reports, and mandatory monitoring by
2074the agency or third parties. In imposing these conditions, the
2075agency shall take into consideration the nature and number of
2076clients, the availability and location of acceptable alternative
2077placements, and the ability of the licensee to continue
2078providing care to the clients. The agency may terminate the
2079extension or modify the conditions at any time. This authority
2080is in addition to any other authority granted to the agency
2081under chapter 120, this part, and authorizing statutes but
2082creates no right or entitlement to an extension of a license
2083expiration date.
2084     Section 64.  Paragraph (k) of subsection (4) of section
2085409.221, Florida Statutes, is amended to read:
2086     409.221  Consumer-directed care program.-
2087     (4)  CONSUMER-DIRECTED CARE.-
2088     (k)  Reviews and reports.-The agency and the Departments of
2089Elderly Affairs, Health, and Children and Family Services and
2090the Agency for Persons with Disabilities shall each, on an
2091ongoing basis, review and assess the implementation of the
2092consumer-directed care program. By January 15 of each year, the
2093agency shall submit a written report to the Legislature that
2094includes each department's review of the program and contains
2095recommendations for improvements to the program.
2096     Section 65.  Subsection (1) of section 409.91196, Florida
2097Statutes, is amended to read:
2098     409.91196  Supplemental rebate agreements; public records
2099and public meetings exemption.-
2100     (1)  The rebate amount, percent of rebate, manufacturer's
2101pricing, and supplemental rebate, and other trade secrets as
2102defined in s. 688.002 that the agency has identified for use in
2103negotiations, held by the Agency for Health Care Administration
2104under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2105119.07(1) and s. 24(a), Art. I of the State Constitution.
2106     Section 66.  Paragraph (a) of subsection (39) of section
2107409.912, Florida Statutes, is amended to read:
2108     409.912  Cost-effective purchasing of health care.-The
2109agency shall purchase goods and services for Medicaid recipients
2110in the most cost-effective manner consistent with the delivery
2111of quality medical care. To ensure that medical services are
2112effectively utilized, the agency may, in any case, require a
2113confirmation or second physician's opinion of the correct
2114diagnosis for purposes of authorizing future services under the
2115Medicaid program. This section does not restrict access to
2116emergency services or poststabilization care services as defined
2117in 42 C.F.R. part 438.114. Such confirmation or second opinion
2118shall be rendered in a manner approved by the agency. The agency
2119shall maximize the use of prepaid per capita and prepaid
2120aggregate fixed-sum basis services when appropriate and other
2121alternative service delivery and reimbursement methodologies,
2122including competitive bidding pursuant to s. 287.057, designed
2123to facilitate the cost-effective purchase of a case-managed
2124continuum of care. The agency shall also require providers to
2125minimize the exposure of recipients to the need for acute
2126inpatient, custodial, and other institutional care and the
2127inappropriate or unnecessary use of high-cost services. The
2128agency shall contract with a vendor to monitor and evaluate the
2129clinical practice patterns of providers in order to identify
2130trends that are outside the normal practice patterns of a
2131provider's professional peers or the national guidelines of a
2132provider's professional association. The vendor must be able to
2133provide information and counseling to a provider whose practice
2134patterns are outside the norms, in consultation with the agency,
2135to improve patient care and reduce inappropriate utilization.
2136The agency may mandate prior authorization, drug therapy
2137management, or disease management participation for certain
2138populations of Medicaid beneficiaries, certain drug classes, or
2139particular drugs to prevent fraud, abuse, overuse, and possible
2140dangerous drug interactions. The Pharmaceutical and Therapeutics
2141Committee shall make recommendations to the agency on drugs for
2142which prior authorization is required. The agency shall inform
2143the Pharmaceutical and Therapeutics Committee of its decisions
2144regarding drugs subject to prior authorization. The agency is
2145authorized to limit the entities it contracts with or enrolls as
2146Medicaid providers by developing a provider network through
2147provider credentialing. The agency may competitively bid single-
2148source-provider contracts if procurement of goods or services
2149results in demonstrated cost savings to the state without
2150limiting access to care. The agency may limit its network based
2151on the assessment of beneficiary access to care, provider
2152availability, provider quality standards, time and distance
2153standards for access to care, the cultural competence of the
2154provider network, demographic characteristics of Medicaid
2155beneficiaries, practice and provider-to-beneficiary standards,
2156appointment wait times, beneficiary use of services, provider
2157turnover, provider profiling, provider licensure history,
2158previous program integrity investigations and findings, peer
2159review, provider Medicaid policy and billing compliance records,
2160clinical and medical record audits, and other factors. Providers
2161shall not be entitled to enrollment in the Medicaid provider
2162network. The agency shall determine instances in which allowing
2163Medicaid beneficiaries to purchase durable medical equipment and
2164other goods is less expensive to the Medicaid program than long-
2165term rental of the equipment or goods. The agency may establish
2166rules to facilitate purchases in lieu of long-term rentals in
2167order to protect against fraud and abuse in the Medicaid program
2168as defined in s. 409.913. The agency may seek federal waivers
2169necessary to administer these policies.
2170     (39)(a)  The agency shall implement a Medicaid prescribed-
2171drug spending-control program that includes the following
2172components:
2173     1.  A Medicaid preferred drug list, which shall be a
2174listing of cost-effective therapeutic options recommended by the
2175Medicaid Pharmacy and Therapeutics Committee established
2176pursuant to s. 409.91195 and adopted by the agency for each
2177therapeutic class on the preferred drug list. At the discretion
2178of the committee, and when feasible, the preferred drug list
2179should include at least two products in a therapeutic class. The
2180agency may post the preferred drug list and updates to the
2181preferred drug list on an Internet website without following the
2182rulemaking procedures of chapter 120. Antiretroviral agents are
2183excluded from the preferred drug list. The agency shall also
2184limit the amount of a prescribed drug dispensed to no more than
2185a 34-day supply unless the drug products' smallest marketed
2186package is greater than a 34-day supply, or the drug is
2187determined by the agency to be a maintenance drug in which case
2188a 100-day maximum supply may be authorized. The agency is
2189authorized to seek any federal waivers necessary to implement
2190these cost-control programs and to continue participation in the
2191federal Medicaid rebate program, or alternatively to negotiate
2192state-only manufacturer rebates. The agency may adopt rules to
2193implement this subparagraph. The agency shall continue to
2194provide unlimited contraceptive drugs and items. The agency must
2195establish procedures to ensure that:
2196     a.  There is a response to a request for prior consultation
2197by telephone or other telecommunication device within 24 hours
2198after receipt of a request for prior consultation; and
2199     b.  A 72-hour supply of the drug prescribed is provided in
2200an emergency or when the agency does not provide a response
2201within 24 hours as required by sub-subparagraph a.
2202     2.  Reimbursement to pharmacies for Medicaid prescribed
2203drugs shall be set at the lesser of: the average wholesale price
2204(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2205plus 4.75 percent, the federal upper limit (FUL), the state
2206maximum allowable cost (SMAC), or the usual and customary (UAC)
2207charge billed by the provider.
2208     3.  For a prescribed drug billed as a 340B prescribed
2209medication, the claim must meet the requirements of the Deficit
2210Reduction Act of 2005 and the federal 340B program, contain a
2211national drug code, and be billed at the actual acquisition cost
2212or payment shall be denied.
2213     4.3.  The agency shall develop and implement a process for
2214managing the drug therapies of Medicaid recipients who are using
2215significant numbers of prescribed drugs each month. The
2216management process may include, but is not limited to,
2217comprehensive, physician-directed medical-record reviews, claims
2218analyses, and case evaluations to determine the medical
2219necessity and appropriateness of a patient's treatment plan and
2220drug therapies. The agency may contract with a private
2221organization to provide drug-program-management services. The
2222Medicaid drug benefit management program shall include
2223initiatives to manage drug therapies for HIV/AIDS patients,
2224patients using 20 or more unique prescriptions in a 180-day
2225period, and the top 1,000 patients in annual spending. The
2226agency shall enroll any Medicaid recipient in the drug benefit
2227management program if he or she meets the specifications of this
2228provision and is not enrolled in a Medicaid health maintenance
2229organization.
2230     5.4.  The agency may limit the size of its pharmacy network
2231based on need, competitive bidding, price negotiations,
2232credentialing, or similar criteria. The agency shall give
2233special consideration to rural areas in determining the size and
2234location of pharmacies included in the Medicaid pharmacy
2235network. A pharmacy credentialing process may include criteria
2236such as a pharmacy's full-service status, location, size,
2237patient educational programs, patient consultation, disease
2238management services, and other characteristics. The agency may
2239impose a moratorium on Medicaid pharmacy enrollment when it is
2240determined that it has a sufficient number of Medicaid-
2241participating providers. The agency must allow dispensing
2242practitioners to participate as a part of the Medicaid pharmacy
2243network regardless of the practitioner's proximity to any other
2244entity that is dispensing prescription drugs under the Medicaid
2245program. A dispensing practitioner must meet all credentialing
2246requirements applicable to his or her practice, as determined by
2247the agency.
2248     6.5.  The agency shall develop and implement a program that
2249requires Medicaid practitioners who prescribe drugs to use a
2250counterfeit-proof prescription pad for Medicaid prescriptions.
2251The agency shall require the use of standardized counterfeit-
2252proof prescription pads by Medicaid-participating prescribers or
2253prescribers who write prescriptions for Medicaid recipients. The
2254agency may implement the program in targeted geographic areas or
2255statewide.
2256     7.6.  The agency may enter into arrangements that require
2257manufacturers of generic drugs prescribed to Medicaid recipients
2258to provide rebates of at least 15.1 percent of the average
2259manufacturer price for the manufacturer's generic products.
2260These arrangements shall require that if a generic-drug
2261manufacturer pays federal rebates for Medicaid-reimbursed drugs
2262at a level below 15.1 percent, the manufacturer must provide a
2263supplemental rebate to the state in an amount necessary to
2264achieve a 15.1-percent rebate level.
2265     8.7.  The agency may establish a preferred drug list as
2266described in this subsection, and, pursuant to the establishment
2267of such preferred drug list, it is authorized to negotiate
2268supplemental rebates from manufacturers that are in addition to
2269those required by Title XIX of the Social Security Act and at no
2270less than 14 percent of the average manufacturer price as
2271defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2272the federal or supplemental rebate, or both, equals or exceeds
227329 percent. There is no upper limit on the supplemental rebates
2274the agency may negotiate. The agency may determine that specific
2275products, brand-name or generic, are competitive at lower rebate
2276percentages. Agreement to pay the minimum supplemental rebate
2277percentage will guarantee a manufacturer that the Medicaid
2278Pharmaceutical and Therapeutics Committee will consider a
2279product for inclusion on the preferred drug list. However, a
2280pharmaceutical manufacturer is not guaranteed placement on the
2281preferred drug list by simply paying the minimum supplemental
2282rebate. Agency decisions will be made on the clinical efficacy
2283of a drug and recommendations of the Medicaid Pharmaceutical and
2284Therapeutics Committee, as well as the price of competing
2285products minus federal and state rebates. The agency is
2286authorized to contract with an outside agency or contractor to
2287conduct negotiations for supplemental rebates. For the purposes
2288of this section, the term "supplemental rebates" means cash
2289rebates. Effective July 1, 2004, value-added programs as a
2290substitution for supplemental rebates are prohibited. The agency
2291is authorized to seek any federal waivers to implement this
2292initiative.
2293     9.8.  The Agency for Health Care Administration shall
2294expand home delivery of pharmacy products. To assist Medicaid
2295patients in securing their prescriptions and reduce program
2296costs, the agency shall expand its current mail-order-pharmacy
2297diabetes-supply program to include all generic and brand-name
2298drugs used by Medicaid patients with diabetes. Medicaid
2299recipients in the current program may obtain nondiabetes drugs
2300on a voluntary basis. This initiative is limited to the
2301geographic area covered by the current contract. The agency may
2302seek and implement any federal waivers necessary to implement
2303this subparagraph.
2304     10.9.  The agency shall limit to one dose per month any
2305drug prescribed to treat erectile dysfunction.
2306     11.10.a.  The agency may implement a Medicaid behavioral
2307drug management system. The agency may contract with a vendor
2308that has experience in operating behavioral drug management
2309systems to implement this program. The agency is authorized to
2310seek federal waivers to implement this program.
2311     b.  The agency, in conjunction with the Department of
2312Children and Family Services, may implement the Medicaid
2313behavioral drug management system that is designed to improve
2314the quality of care and behavioral health prescribing practices
2315based on best practice guidelines, improve patient adherence to
2316medication plans, reduce clinical risk, and lower prescribed
2317drug costs and the rate of inappropriate spending on Medicaid
2318behavioral drugs. The program may include the following
2319elements:
2320     (I)  Provide for the development and adoption of best
2321practice guidelines for behavioral health-related drugs such as
2322antipsychotics, antidepressants, and medications for treating
2323bipolar disorders and other behavioral conditions; translate
2324them into practice; review behavioral health prescribers and
2325compare their prescribing patterns to a number of indicators
2326that are based on national standards; and determine deviations
2327from best practice guidelines.
2328     (II)  Implement processes for providing feedback to and
2329educating prescribers using best practice educational materials
2330and peer-to-peer consultation.
2331     (III)  Assess Medicaid beneficiaries who are outliers in
2332their use of behavioral health drugs with regard to the numbers
2333and types of drugs taken, drug dosages, combination drug
2334therapies, and other indicators of improper use of behavioral
2335health drugs.
2336     (IV)  Alert prescribers to patients who fail to refill
2337prescriptions in a timely fashion, are prescribed multiple same-
2338class behavioral health drugs, and may have other potential
2339medication problems.
2340     (V)  Track spending trends for behavioral health drugs and
2341deviation from best practice guidelines.
2342     (VI)  Use educational and technological approaches to
2343promote best practices, educate consumers, and train prescribers
2344in the use of practice guidelines.
2345     (VII)  Disseminate electronic and published materials.
2346     (VIII)  Hold statewide and regional conferences.
2347     (IX)  Implement a disease management program with a model
2348quality-based medication component for severely mentally ill
2349individuals and emotionally disturbed children who are high
2350users of care.
2351     12.11.a.  The agency shall implement a Medicaid
2352prescription drug management system. The agency may contract
2353with a vendor that has experience in operating prescription drug
2354management systems in order to implement this system. Any
2355management system that is implemented in accordance with this
2356subparagraph must rely on cooperation between physicians and
2357pharmacists to determine appropriate practice patterns and
2358clinical guidelines to improve the prescribing, dispensing, and
2359use of drugs in the Medicaid program. The agency may seek
2360federal waivers to implement this program.
2361     b.  The drug management system must be designed to improve
2362the quality of care and prescribing practices based on best
2363practice guidelines, improve patient adherence to medication
2364plans, reduce clinical risk, and lower prescribed drug costs and
2365the rate of inappropriate spending on Medicaid prescription
2366drugs. The program must:
2367     (I)  Provide for the development and adoption of best
2368practice guidelines for the prescribing and use of drugs in the
2369Medicaid program, including translating best practice guidelines
2370into practice; reviewing prescriber patterns and comparing them
2371to indicators that are based on national standards and practice
2372patterns of clinical peers in their community, statewide, and
2373nationally; and determine deviations from best practice
2374guidelines.
2375     (II)  Implement processes for providing feedback to and
2376educating prescribers using best practice educational materials
2377and peer-to-peer consultation.
2378     (III)  Assess Medicaid recipients who are outliers in their
2379use of a single or multiple prescription drugs with regard to
2380the numbers and types of drugs taken, drug dosages, combination
2381drug therapies, and other indicators of improper use of
2382prescription drugs.
2383     (IV)  Alert prescribers to patients who fail to refill
2384prescriptions in a timely fashion, are prescribed multiple drugs
2385that may be redundant or contraindicated, or may have other
2386potential medication problems.
2387     (V)  Track spending trends for prescription drugs and
2388deviation from best practice guidelines.
2389     (VI)  Use educational and technological approaches to
2390promote best practices, educate consumers, and train prescribers
2391in the use of practice guidelines.
2392     (VII)  Disseminate electronic and published materials.
2393     (VIII)  Hold statewide and regional conferences.
2394     (IX)  Implement disease management programs in cooperation
2395with physicians and pharmacists, along with a model quality-
2396based medication component for individuals having chronic
2397medical conditions.
2398     13.12.  The agency is authorized to contract for drug
2399rebate administration, including, but not limited to,
2400calculating rebate amounts, invoicing manufacturers, negotiating
2401disputes with manufacturers, and maintaining a database of
2402rebate collections.
2403     14.13.  The agency may specify the preferred daily dosing
2404form or strength for the purpose of promoting best practices
2405with regard to the prescribing of certain drugs as specified in
2406the General Appropriations Act and ensuring cost-effective
2407prescribing practices.
2408     15.14.  The agency may require prior authorization for
2409Medicaid-covered prescribed drugs. The agency may, but is not
2410required to, prior-authorize the use of a product:
2411     a.  For an indication not approved in labeling;
2412     b.  To comply with certain clinical guidelines; or
2413     c.  If the product has the potential for overuse, misuse,
2414or abuse.
2415
2416The agency may require the prescribing professional to provide
2417information about the rationale and supporting medical evidence
2418for the use of a drug. The agency may post prior authorization
2419criteria and protocol and updates to the list of drugs that are
2420subject to prior authorization on an Internet website without
2421amending its rule or engaging in additional rulemaking.
2422     16.15.  The agency, in conjunction with the Pharmaceutical
2423and Therapeutics Committee, may require age-related prior
2424authorizations for certain prescribed drugs. The agency may
2425preauthorize the use of a drug for a recipient who may not meet
2426the age requirement or may exceed the length of therapy for use
2427of this product as recommended by the manufacturer and approved
2428by the Food and Drug Administration. Prior authorization may
2429require the prescribing professional to provide information
2430about the rationale and supporting medical evidence for the use
2431of a drug.
2432     17.16.  The agency shall implement a step-therapy prior
2433authorization approval process for medications excluded from the
2434preferred drug list. Medications listed on the preferred drug
2435list must be used within the previous 12 months prior to the
2436alternative medications that are not listed. The step-therapy
2437prior authorization may require the prescriber to use the
2438medications of a similar drug class or for a similar medical
2439indication unless contraindicated in the Food and Drug
2440Administration labeling. The trial period between the specified
2441steps may vary according to the medical indication. The step-
2442therapy approval process shall be developed in accordance with
2443the committee as stated in s. 409.91195(7) and (8). A drug
2444product may be approved without meeting the step-therapy prior
2445authorization criteria if the prescribing physician provides the
2446agency with additional written medical or clinical documentation
2447that the product is medically necessary because:
2448     a.  There is not a drug on the preferred drug list to treat
2449the disease or medical condition which is an acceptable clinical
2450alternative;
2451     b.  The alternatives have been ineffective in the treatment
2452of the beneficiary's disease; or
2453     c.  Based on historic evidence and known characteristics of
2454the patient and the drug, the drug is likely to be ineffective,
2455or the number of doses have been ineffective.
2456
2457The agency shall work with the physician to determine the best
2458alternative for the patient. The agency may adopt rules waiving
2459the requirements for written clinical documentation for specific
2460drugs in limited clinical situations.
2461     18.17.  The agency shall implement a return and reuse
2462program for drugs dispensed by pharmacies to institutional
2463recipients, which includes payment of a $5 restocking fee for
2464the implementation and operation of the program. The return and
2465reuse program shall be implemented electronically and in a
2466manner that promotes efficiency. The program must permit a
2467pharmacy to exclude drugs from the program if it is not
2468practical or cost-effective for the drug to be included and must
2469provide for the return to inventory of drugs that cannot be
2470credited or returned in a cost-effective manner. The agency
2471shall determine if the program has reduced the amount of
2472Medicaid prescription drugs which are destroyed on an annual
2473basis and if there are additional ways to ensure more
2474prescription drugs are not destroyed which could safely be
2475reused. The agency's conclusion and recommendations shall be
2476reported to the Legislature by December 1, 2005.
2477     Section 67.  Subsections (3) and (4) of section 429.07,
2478Florida Statutes, are amended, and subsections (6) and (7) are
2479added to that section, to read:
2480     429.07  License required; fee; inspections.-
2481     (3)  In addition to the requirements of s. 408.806, each
2482license granted by the agency must state the type of care for
2483which the license is granted. Licenses shall be issued for one
2484or more of the following categories of care: standard, extended
2485congregate care, limited nursing services, or limited mental
2486health.
2487     (a)  A standard license shall be issued to a facility
2488facilities providing one or more of the personal services
2489identified in s. 429.02. Such licensee facilities may also
2490employ or contract with a person licensed under part I of
2491chapter 464 to administer medications and perform other tasks as
2492specified in s. 429.255.
2493     (b)  An extended congregate care license shall be issued to
2494a licensee facilities providing, directly or through contract,
2495services beyond those authorized in paragraph (a), including
2496acts performed pursuant to part I of chapter 464 by persons
2497licensed thereunder, and supportive services defined by rule to
2498persons who otherwise would be disqualified from continued
2499residence in a facility licensed under this part.
2500     1.  In order for extended congregate care services to be
2501provided in a facility licensed under this part, the agency must
2502first determine that all requirements established in law and
2503rule are met and must specifically designate, on the facility's
2504license, that such services may be provided and whether the
2505designation applies to all or part of a facility. Such
2506designation may be made at the time of initial licensure or
2507relicensure, or upon request in writing by a licensee under this
2508part and part II of chapter 408. Notification of approval or
2509denial of such request shall be made in accordance with part II
2510of chapter 408. An existing licensee facilities qualifying to
2511provide extended congregate care services must have maintained a
2512standard license and may not have been subject to administrative
2513sanctions during the previous 2 years, or since initial
2514licensure if the facility has been licensed for less than 2
2515years, for any of the following reasons:
2516     a.  A class I or class II violation;
2517     b.  Three or more repeat or recurring class III violations
2518of identical or similar resident care standards as specified in
2519rule from which a pattern of noncompliance is found by the
2520agency;
2521     c.  Three or more class III violations that were not
2522corrected in accordance with the corrective action plan approved
2523by the agency;
2524     d.  Violation of resident care standards resulting in a
2525requirement to employ the services of a consultant pharmacist or
2526consultant dietitian;
2527     e.  Denial, suspension, or revocation of a license for
2528another facility under this part in which the applicant for an
2529extended congregate care license has at least 25 percent
2530ownership interest; or
2531     f.  Imposition of a moratorium pursuant to this part or
2532part II of chapter 408 or initiation of injunctive proceedings.
2533     2.  A licensee Facilities that is are licensed to provide
2534extended congregate care services shall maintain a written
2535progress report for on each person who receives such services,
2536and the which report must describe describes the type, amount,
2537duration, scope, and outcome of services that are rendered and
2538the general status of the resident's health. A registered nurse,
2539or appropriate designee, representing the agency shall visit
2540such facilities at least quarterly to monitor residents who are
2541receiving extended congregate care services and to determine if
2542the facility is in compliance with this part, part II of chapter
2543408, and rules that relate to extended congregate care. One of
2544these visits may be in conjunction with the regular survey. The
2545monitoring visits may be provided through contractual
2546arrangements with appropriate community agencies. A registered
2547nurse shall serve as part of the team that inspects such
2548facility. The agency may waive one of the required yearly
2549monitoring visits for a facility that has been licensed for at
2550least 24 months to provide extended congregate care services,
2551if, during the inspection, the registered nurse determines that
2552extended congregate care services are being provided
2553appropriately, and if the facility has no class I or class II
2554violations and no uncorrected class III violations. Before such
2555decision is made, the agency shall consult with the long-term
2556care ombudsman council for the area in which the facility is
2557located to determine if any complaints have been made and
2558substantiated about the quality of services or care. The agency
2559may not waive one of the required yearly monitoring visits if
2560complaints have been made and substantiated.
2561     3.  Licensees Facilities that are licensed to provide
2562extended congregate care services shall:
2563     a.  Demonstrate the capability to meet unanticipated
2564resident service needs.
2565     b.  Offer a physical environment that promotes a homelike
2566setting, provides for resident privacy, promotes resident
2567independence, and allows sufficient congregate space as defined
2568by rule.
2569     c.  Have sufficient staff available, taking into account
2570the physical plant and firesafety features of the building, to
2571assist with the evacuation of residents in an emergency, as
2572necessary.
2573     d.  Adopt and follow policies and procedures that maximize
2574resident independence, dignity, choice, and decisionmaking to
2575permit residents to age in place to the extent possible, so that
2576moves due to changes in functional status are minimized or
2577avoided.
2578     e.  Allow residents or, if applicable, a resident's
2579representative, designee, surrogate, guardian, or attorney in
2580fact to make a variety of personal choices, participate in
2581developing service plans, and share responsibility in
2582decisionmaking.
2583     f.  Implement the concept of managed risk.
2584     g.  Provide, either directly or through contract, the
2585services of a person licensed pursuant to part I of chapter 464.
2586     h.  In addition to the training mandated in s. 429.52,
2587provide specialized training as defined by rule for facility
2588staff.
2589     4.  Licensees Facilities licensed to provide extended
2590congregate care services are exempt from the criteria for
2591continued residency as set forth in rules adopted under s.
2592429.41. Licensees Facilities so licensed shall adopt their own
2593requirements within guidelines for continued residency set forth
2594by rule. However, such licensees facilities may not serve
2595residents who require 24-hour nursing supervision. Licensees
2596Facilities licensed to provide extended congregate care services
2597shall provide each resident with a written copy of facility
2598policies governing admission and retention.
2599     5.  The primary purpose of extended congregate care
2600services is to allow residents, as they become more impaired,
2601the option of remaining in a familiar setting from which they
2602would otherwise be disqualified for continued residency. A
2603facility licensed to provide extended congregate care services
2604may also admit an individual who exceeds the admission criteria
2605for a facility with a standard license, if the individual is
2606determined appropriate for admission to the extended congregate
2607care facility.
2608     6.  Before admission of an individual to a facility
2609licensed to provide extended congregate care services, the
2610individual must undergo a medical examination as provided in s.
2611429.26(4) and the facility must develop a preliminary service
2612plan for the individual.
2613     7.  When a licensee facility can no longer provide or
2614arrange for services in accordance with the resident's service
2615plan and needs and the licensee's facility's policy, the
2616licensee facility shall make arrangements for relocating the
2617person in accordance with s. 429.28(1)(k).
2618     8.  Failure to provide extended congregate care services
2619may result in denial of extended congregate care license
2620renewal.
2621     9.  No later than January 1 of each year, the department,
2622in consultation with the agency, shall prepare and submit to the
2623Governor, the President of the Senate, the Speaker of the House
2624of Representatives, and the chairs of appropriate legislative
2625committees, a report on the status of, and recommendations
2626related to, extended congregate care services. The status report
2627must include, but need not be limited to, the following
2628information:
2629     a.  A description of the facilities licensed to provide
2630such services, including total number of beds licensed under
2631this part.
2632     b.  The number and characteristics of residents receiving
2633such services.
2634     c.  The types of services rendered that could not be
2635provided through a standard license.
2636     d.  An analysis of deficiencies cited during licensure
2637inspections.
2638     e.  The number of residents who required extended
2639congregate care services at admission and the source of
2640admission.
2641     f.  Recommendations for statutory or regulatory changes.
2642     g.  The availability of extended congregate care to state
2643clients residing in facilities licensed under this part and in
2644need of additional services, and recommendations for
2645appropriations to subsidize extended congregate care services
2646for such persons.
2647     h.  Such other information as the department considers
2648appropriate.
2649     (c)  A limited nursing services license shall be issued to
2650a facility that provides services beyond those authorized in
2651paragraph (a) and as specified in this paragraph.
2652     1.  In order for limited nursing services to be provided in
2653a facility licensed under this part, the agency must first
2654determine that all requirements established in law and rule are
2655met and must specifically designate, on the facility's license,
2656that such services may be provided. Such designation may be made
2657at the time of initial licensure or relicensure, or upon request
2658in writing by a licensee under this part and part II of chapter
2659408. Notification of approval or denial of such request shall be
2660made in accordance with part II of chapter 408. Existing
2661facilities qualifying to provide limited nursing services shall
2662have maintained a standard license and may not have been subject
2663to administrative sanctions that affect the health, safety, and
2664welfare of residents for the previous 2 years or since initial
2665licensure if the facility has been licensed for less than 2
2666years.
2667     2.  Facilities that are licensed to provide limited nursing
2668services shall maintain a written progress report on each person
2669who receives such nursing services, which report describes the
2670type, amount, duration, scope, and outcome of services that are
2671rendered and the general status of the resident's health. A
2672registered nurse representing the agency shall visit such
2673facilities at least twice a year to monitor residents who are
2674receiving limited nursing services and to determine if the
2675facility is in compliance with applicable provisions of this
2676part, part II of chapter 408, and related rules. The monitoring
2677visits may be provided through contractual arrangements with
2678appropriate community agencies. A registered nurse shall also
2679serve as part of the team that inspects such facility.
2680     3.  A person who receives limited nursing services under
2681this part must meet the admission criteria established by the
2682agency for assisted living facilities. When a resident no longer
2683meets the admission criteria for a facility licensed under this
2684part, arrangements for relocating the person shall be made in
2685accordance with s. 429.28(1)(k), unless the facility is licensed
2686to provide extended congregate care services.
2687     (4)  In accordance with s. 408.805, an applicant or
2688licensee shall pay a fee for each license application submitted
2689under this part, part II of chapter 408, and applicable rules.
2690The amount of the fee shall be established by rule.
2691     (a)  The biennial license fee required of a facility is
2692$356 $300 per license, with an additional fee of $67.50 $50 per
2693resident based on the total licensed resident capacity of the
2694facility, except that no additional fee will be assessed for
2695beds designated for recipients of optional state supplementation
2696payments provided for in s. 409.212. The total fee may not
2697exceed $18,000 $10,000.
2698     (b)  In addition to the total fee assessed under paragraph
2699(a), the agency shall require facilities that are licensed to
2700provide extended congregate care services under this part to pay
2701an additional fee per licensed facility. The amount of the
2702biennial fee shall be $501 $400 per license, with an additional
2703fee of $10 per resident based on the total licensed resident
2704capacity of the facility.
2705     (c)  In addition to the total fee assessed under paragraph
2706(a), the agency shall require facilities that are licensed to
2707provide limited nursing services under this part to pay an
2708additional fee per licensed facility. The amount of the biennial
2709fee shall be $250 per license, with an additional fee of $10 per
2710resident based on the total licensed resident capacity of the
2711facility.
2712     (6)  In order to determine whether the facility is
2713adequately protecting residents' rights as provided in s.
2714429.28, the biennial survey shall include private informal
2715conversations with a sample of residents and consultation with
2716the ombudsman council in the planning and service area in which
2717the facility is located to discuss residents' experiences within
2718the facility.
2719     (7)  An assisted living facility that has been cited within
2720the previous 24-month period for a class I or class II
2721violation, regardless of the status of any enforcement or
2722disciplinary action, is subject to periodic unannounced
2723monitoring to determine if the facility is in compliance with
2724this part, part II of chapter 408, and applicable rules.
2725Monitoring may occur through a desk review or an onsite
2726assessment. If the class I or class II violation relates to
2727providing or failing to provide nursing care, a registered nurse
2728must participate in at least two onsite monitoring visits within
2729a 12-month period.
2730     Section 68.  Subsection (7) of section 429.11, Florida
2731Statutes, is renumbered as subsection (6), and present
2732subsection (6) of that section is amended to read:
2733     429.11  Initial application for license; provisional
2734license.-
2735     (6)  In addition to the license categories available in s.
2736408.808, a provisional license may be issued to an applicant
2737making initial application for licensure or making application
2738for a change of ownership. A provisional license shall be
2739limited in duration to a specific period of time not to exceed 6
2740months, as determined by the agency.
2741     Section 69.  Section 429.12, Florida Statutes, is amended
2742to read:
2743     429.12  Sale or transfer of ownership of a facility.-It is
2744the intent of the Legislature to protect the rights of the
2745residents of an assisted living facility when the facility is
2746sold or the ownership thereof is transferred. Therefore, in
2747addition to the requirements of part II of chapter 408, whenever
2748a facility is sold or the ownership thereof is transferred,
2749including leasing:.
2750     (1)  The transferee shall notify the residents, in writing,
2751of the change of ownership within 7 days after receipt of the
2752new license.
2753     (2)  The transferor of a facility the license of which is
2754denied pending an administrative hearing shall, as a part of the
2755written change-of-ownership contract, advise the transferee that
2756a plan of correction must be submitted by the transferee and
2757approved by the agency at least 7 days before the change of
2758ownership and that failure to correct the condition which
2759resulted in the moratorium pursuant to part II of chapter 408 or
2760denial of licensure is grounds for denial of the transferee's
2761license.
2762     Section 70.  Paragraphs (b) through (l) of subsection (1)
2763of section 429.14, Florida Statutes, are redesignated as
2764paragraphs (a) through (k), respectively, and present paragraph
2765(a) of subsection (1) and subsections (5) and (6) of that
2766section are amended to read:
2767     429.14  Administrative penalties.-
2768     (1)  In addition to the requirements of part II of chapter
2769408, the agency may deny, revoke, and suspend any license issued
2770under this part and impose an administrative fine in the manner
2771provided in chapter 120 against a licensee of an assisted living
2772facility for a violation of any provision of this part, part II
2773of chapter 408, or applicable rules, or for any of the following
2774actions by a licensee of an assisted living facility, for the
2775actions of any person subject to level 2 background screening
2776under s. 408.809, or for the actions of any facility employee:
2777     (a)  An intentional or negligent act seriously affecting
2778the health, safety, or welfare of a resident of the facility.
2779     (5)  An action taken by the agency to suspend, deny, or
2780revoke a facility's license under this part or part II of
2781chapter 408, in which the agency claims that the facility owner
2782or an employee of the facility has threatened the health,
2783safety, or welfare of a resident of the facility shall be heard
2784by the Division of Administrative Hearings of the Department of
2785Management Services within 120 days after receipt of the
2786facility's request for a hearing, unless that time limitation is
2787waived by both parties. The administrative law judge must render
2788a decision within 30 days after receipt of a proposed
2789recommended order.
2790     (6)  The agency shall provide to the Division of Hotels and
2791Restaurants of the Department of Business and Professional
2792Regulation, on a monthly basis, a list of those assisted living
2793facilities that have had their licenses denied, suspended, or
2794revoked or that are involved in an appellate proceeding pursuant
2795to s. 120.60 related to the denial, suspension, or revocation of
2796a license. This information may be provided electronically or
2797through the agency's Internet website.
2798     Section 71.  Subsections (1), (4), and (5) of section
2799429.17, Florida Statutes, are amended to read:
2800     429.17  Expiration of license; renewal; conditional
2801license.-
2802     (1)  Limited nursing, Extended congregate care, and limited
2803mental health licenses shall expire at the same time as the
2804facility's standard license, regardless of when issued.
2805     (4)  In addition to the license categories available in s.
2806408.808, a conditional license may be issued to an applicant for
2807license renewal if the applicant fails to meet all standards and
2808requirements for licensure. A conditional license issued under
2809this subsection shall be limited in duration to a specific
2810period of time not to exceed 6 months, as determined by the
2811agency, and shall be accompanied by an agency-approved plan of
2812correction.
2813     (5)  When an extended congregate care or limited nursing
2814license is requested during a facility's biennial license
2815period, the fee shall be prorated in order to permit the
2816additional license to expire at the end of the biennial license
2817period. The fee shall be calculated as of the date the
2818additional license application is received by the agency.
2819     Section 72.  Subsection (7) of section 429.19, Florida
2820Statutes, is amended to read:
2821     429.19  Violations; imposition of administrative fines;
2822grounds.-
2823     (7)  In addition to any administrative fines imposed, the
2824agency may assess a survey or monitoring fee, equal to the
2825lesser of one half of the facility's biennial license and bed
2826fee or $500, to cover the cost of conducting initial complaint
2827investigations that result in the finding of a violation that
2828was the subject of the complaint or to monitor the health,
2829safety, or security of residents under s. 429.07     (7) monitoring
2830visits conducted under s. 429.28(3)(c) to verify the correction
2831of the violations.
2832     Section 73.  Subsections (6) through (10) of section
2833429.23, Florida Statutes, are renumbered as subsections (5)
2834through (9), respectively, and present subsection (5) of that
2835section is amended to read:
2836     429.23  Internal risk management and quality assurance
2837program; adverse incidents and reporting requirements.-
2838     (5)  Each facility shall report monthly to the agency any
2839liability claim filed against it. The report must include the
2840name of the resident, the dates of the incident leading to the
2841claim, if applicable, and the type of injury or violation of
2842rights alleged to have occurred. This report is not discoverable
2843in any civil or administrative action, except in such actions
2844brought by the agency to enforce the provisions of this part.
2845     Section 74.  Paragraph (a) of subsection (1) and subsection
2846(2) of section 429.255, Florida Statutes, are amended to read:
2847     429.255  Use of personnel; emergency care.-
2848     (1)(a)  Persons under contract to the facility or, facility
2849staff, or volunteers, who are licensed according to part I of
2850chapter 464, or those persons exempt under s. 464.022(1), and
2851others as defined by rule, may administer medications to
2852residents, take residents' vital signs, manage individual weekly
2853pill organizers for residents who self-administer medication,
2854give prepackaged enemas ordered by a physician, observe
2855residents, document observations on the appropriate resident's
2856record, report observations to the resident's physician, and
2857contract or allow residents or a resident's representative,
2858designee, surrogate, guardian, or attorney in fact to contract
2859with a third party, provided residents meet the criteria for
2860appropriate placement as defined in s. 429.26. Persons under
2861contract to the facility or facility staff who are licensed
2862according to part I of chapter 464 may provide limited nursing
2863services. Nursing assistants certified pursuant to part II of
2864chapter 464 may take residents' vital signs as directed by a
2865licensed nurse or physician. The facility is responsible for
2866maintaining documentation of services provided under this
2867paragraph as required by rule and ensuring that staff are
2868adequately trained to monitor residents receiving these
2869services.
2870     (2)  In facilities licensed to provide extended congregate
2871care, persons under contract to the facility or, facility staff,
2872or volunteers, who are licensed according to part I of chapter
2873464, or those persons exempt under s. 464.022(1), or those
2874persons certified as nursing assistants pursuant to part II of
2875chapter 464, may also perform all duties within the scope of
2876their license or certification, as approved by the facility
2877administrator and pursuant to this part.
2878     Section 75.  Subsection (3) of section 429.28, Florida
2879Statutes, is amended to read:
2880     429.28  Resident bill of rights.-
2881     (3)(a)  The agency shall conduct a survey to determine
2882general compliance with facility standards and compliance with
2883residents' rights as a prerequisite to initial licensure or
2884licensure renewal.
2885     (b)  In order to determine whether the facility is
2886adequately protecting residents' rights, the biennial survey
2887shall include private informal conversations with a sample of
2888residents and consultation with the ombudsman council in the
2889planning and service area in which the facility is located to
2890discuss residents' experiences within the facility.
2891     (c)  During any calendar year in which no survey is
2892conducted, the agency shall conduct at least one monitoring
2893visit of each facility cited in the previous year for a class I
2894or class II violation, or more than three uncorrected class III
2895violations.
2896     (d)  The agency may conduct periodic followup inspections
2897as necessary to monitor the compliance of facilities with a
2898history of any class I, class II, or class III violations that
2899threaten the health, safety, or security of residents.
2900     (e)  The agency may conduct complaint investigations as
2901warranted to investigate any allegations of noncompliance with
2902requirements required under this part or rules adopted under
2903this part.
2904     Section 76.  Subsection (2) of section 429.35, Florida
2905Statutes, is amended to read:
2906     429.35  Maintenance of records; reports.-
2907     (2)  Within 60 days after the date of the biennial
2908inspection visit required under s. 408.811 or within 30 days
2909after the date of any interim visit, the agency shall forward
2910the results of the inspection to the local ombudsman council in
2911whose planning and service area, as defined in part II of
2912chapter 400, the facility is located; to at least one public
2913library or, in the absence of a public library, the county seat
2914in the county in which the inspected assisted living facility is
2915located; and, when appropriate, to the district Adult Services
2916and Mental Health Program Offices. This information may be
2917provided electronically or through the agency's Internet
2918website.
2919     Section 77.  Paragraphs (i) and (j) of subsection (1) of
2920section 429.41, Florida Statutes, are amended to read:
2921     429.41  Rules establishing standards.-
2922     (1)  It is the intent of the Legislature that rules
2923published and enforced pursuant to this section shall include
2924criteria by which a reasonable and consistent quality of
2925resident care and quality of life may be ensured and the results
2926of such resident care may be demonstrated. Such rules shall also
2927ensure a safe and sanitary environment that is residential and
2928noninstitutional in design or nature. It is further intended
2929that reasonable efforts be made to accommodate the needs and
2930preferences of residents to enhance the quality of life in a
2931facility. The agency, in consultation with the department, may
2932adopt rules to administer the requirements of part II of chapter
2933408. In order to provide safe and sanitary facilities and the
2934highest quality of resident care accommodating the needs and
2935preferences of residents, the department, in consultation with
2936the agency, the Department of Children and Family Services, and
2937the Department of Health, shall adopt rules, policies, and
2938procedures to administer this part, which must include
2939reasonable and fair minimum standards in relation to:
2940     (i)  Facilities holding an a limited nursing, extended
2941congregate care, or limited mental health license.
2942     (j)  The establishment of specific criteria to define
2943appropriateness of resident admission and continued residency in
2944a facility holding a standard, limited nursing, extended
2945congregate care, and limited mental health license.
2946     Section 78.  Subsections (1) and (2) of section 429.53,
2947Florida Statutes, are amended to read:
2948     429.53  Consultation by the agency.-
2949     (1)  The area offices of licensure and certification of the
2950agency shall provide consultation to the following upon request:
2951     (a)  A licensee of a facility.
2952     (b)  A person interested in obtaining a license to operate
2953a facility under this part.
2954     (2)  As used in this section, "consultation" includes:
2955     (a)  An explanation of the requirements of this part and
2956rules adopted pursuant thereto;
2957     (b)  An explanation of the license application and renewal
2958procedures;
2959     (c)  The provision of a checklist of general local and
2960state approvals required prior to constructing or developing a
2961facility and a listing of the types of agencies responsible for
2962such approvals;
2963     (d)  An explanation of benefits and financial assistance
2964available to a recipient of supplemental security income
2965residing in a facility;
2966     (c)(e)  Any other information which the agency deems
2967necessary to promote compliance with the requirements of this
2968part; and
2969     (f)  A preconstruction review of a facility to ensure
2970compliance with agency rules and this part.
2971     Section 79.  Subsections (1) and (2) of section 429.54,
2972Florida Statutes, are renumbered as subsections (2) and (3),
2973respectively, and a new subsection (1) is added to that section
2974to read:
2975     429.54  Collection of information; local subsidy.-
2976     (1)  A facility that is licensed under this part must
2977report electronically to the agency semiannually data related to
2978the facility, including, but not limited to, the total number of
2979residents, the number of residents who are receiving limited
2980mental health services, the number of residents who are
2981receiving extended congregate care services, the number of
2982residents who are receiving limited nursing services, and
2983professional staffing employed by or under contract with the
2984licensee to provide resident services. The department, in
2985consultation with the agency, shall adopt rules to administer
2986this subsection.
2987     Section 80.  Subsections (1) and (5) of section 429.71,
2988Florida Statutes, are amended to read:
2989     429.71  Classification of violations deficiencies;
2990administrative fines.-
2991     (1)  In addition to the requirements of part II of chapter
2992408 and in addition to any other liability or penalty provided
2993by law, the agency may impose an administrative fine on a
2994provider according to the following classification:
2995     (a)  Class I violations are defined in s. 408.813 those
2996conditions or practices related to the operation and maintenance
2997of an adult family-care home or to the care of residents which
2998the agency determines present an imminent danger to the
2999residents or guests of the facility or a substantial probability
3000that death or serious physical or emotional harm would result
3001therefrom. The condition or practice that constitutes a class I
3002violation must be abated or eliminated within 24 hours, unless a
3003fixed period, as determined by the agency, is required for
3004correction. A class I violation deficiency is subject to an
3005administrative fine in an amount not less than $500 and not
3006exceeding $1,000 for each violation. A fine may be levied
3007notwithstanding the correction of the deficiency.
3008     (b)  Class II violations are defined in s. 408.813 those
3009conditions or practices related to the operation and maintenance
3010of an adult family-care home or to the care of residents which
3011the agency determines directly threaten the physical or
3012emotional health, safety, or security of the residents, other
3013than class I violations. A class II violation is subject to an
3014administrative fine in an amount not less than $250 and not
3015exceeding $500 for each violation. A citation for a class II
3016violation must specify the time within which the violation is
3017required to be corrected. If a class II violation is corrected
3018within the time specified, no civil penalty shall be imposed,
3019unless it is a repeated offense.
3020     (c)  Class III violations are defined in s. 408.813 those
3021conditions or practices related to the operation and maintenance
3022of an adult family-care home or to the care of residents which
3023the agency determines indirectly or potentially threaten the
3024physical or emotional health, safety, or security of residents,
3025other than class I or class II violations. A class III violation
3026is subject to an administrative fine in an amount not less than
3027$100 and not exceeding $250 for each violation. A citation for a
3028class III violation shall specify the time within which the
3029violation is required to be corrected. If a class III violation
3030is corrected within the time specified, no civil penalty shall
3031be imposed, unless it is a repeated violation offense.
3032     (d)  Class IV violations are defined in s. 408.813 those
3033conditions or occurrences related to the operation and
3034maintenance of an adult family-care home, or related to the
3035required reports, forms, or documents, which do not have the
3036potential of negatively affecting the residents. A provider that
3037does not correct A class IV violation within the time limit
3038specified by the agency is subject to an administrative fine in
3039an amount not less than $50 and not exceeding $100 for each
3040violation. Any class IV violation that is corrected during the
3041time the agency survey is conducted will be identified as an
3042agency finding and not as a violation, unless it is a repeat
3043violation.
3044     (5)  As an alternative to or in conjunction with an
3045administrative action against a provider, the agency may request
3046a plan of corrective action that demonstrates a good faith
3047effort to remedy each violation by a specific date, subject to
3048the approval of the agency.
3049     Section 81.  Paragraphs (b) through (e) of subsection (2)
3050of section 429.911, Florida Statutes, are redesignated as
3051paragraphs (a) through (d), respectively, and present paragraph
3052(a) of that subsection is amended to read:
3053     429.911  Denial, suspension, revocation of license;
3054emergency action; administrative fines; investigations and
3055inspections.-
3056     (2)  Each of the following actions by the owner of an adult
3057day care center or by its operator or employee is a ground for
3058action by the agency against the owner of the center or its
3059operator or employee:
3060     (a)  An intentional or negligent act materially affecting
3061the health or safety of center participants.
3062     Section 82.  Section 429.915, Florida Statutes, is amended
3063to read:
3064     429.915  Conditional license.-In addition to the license
3065categories available in part II of chapter 408, the agency may
3066issue a conditional license to an applicant for license renewal
3067or change of ownership if the applicant fails to meet all
3068standards and requirements for licensure. A conditional license
3069issued under this subsection must be limited to a specific
3070period not exceeding 6 months, as determined by the agency, and
3071must be accompanied by an approved plan of correction.
3072     Section 83.  Paragraphs (b) and (h) of subsection (3) of
3073section 430.80, Florida Statutes, are amended to read:
3074     430.80  Implementation of a teaching nursing home pilot
3075project.-
3076     (3)  To be designated as a teaching nursing home, a nursing
3077home licensee must, at a minimum:
3078     (b)  Participate in a nationally recognized accreditation
3079program and hold a valid accreditation, such as the
3080accreditation awarded by The Joint Commission on Accreditation
3081of Healthcare Organizations;
3082     (h)  Maintain insurance coverage pursuant to s.
3083400.141(1)(q)(s) or proof of financial responsibility in a
3084minimum amount of $750,000. Such proof of financial
3085responsibility may include:
3086     1.  Maintaining an escrow account consisting of cash or
3087assets eligible for deposit in accordance with s. 625.52; or
3088     2.  Obtaining and maintaining pursuant to chapter 675 an
3089unexpired, irrevocable, nontransferable and nonassignable letter
3090of credit issued by any bank or savings association organized
3091and existing under the laws of this state or any bank or savings
3092association organized under the laws of the United States that
3093has its principal place of business in this state or has a
3094branch office which is authorized to receive deposits in this
3095state. The letter of credit shall be used to satisfy the
3096obligation of the facility to the claimant upon presentment of a
3097final judgment indicating liability and awarding damages to be
3098paid by the facility or upon presentment of a settlement
3099agreement signed by all parties to the agreement when such final
3100judgment or settlement is a result of a liability claim against
3101the facility.
3102     Section 84.  Paragraph (a) of subsection (2) of section
3103440.13, Florida Statutes, is amended to read:
3104     440.13  Medical services and supplies; penalty for
3105violations; limitations.-
3106     (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3107     (a)  Subject to the limitations specified elsewhere in this
3108chapter, the employer shall furnish to the employee such
3109medically necessary remedial treatment, care, and attendance for
3110such period as the nature of the injury or the process of
3111recovery may require, which is in accordance with established
3112practice parameters and protocols of treatment as provided for
3113in this chapter, including medicines, medical supplies, durable
3114medical equipment, orthoses, prostheses, and other medically
3115necessary apparatus. Remedial treatment, care, and attendance,
3116including work-hardening programs or pain-management programs
3117accredited by the Commission on Accreditation of Rehabilitation
3118Facilities or The Joint Commission on the Accreditation of
3119Health Organizations or pain-management programs affiliated with
3120medical schools, shall be considered as covered treatment only
3121when such care is given based on a referral by a physician as
3122defined in this chapter. Medically necessary treatment, care,
3123and attendance does not include chiropractic services in excess
3124of 24 treatments or rendered 12 weeks beyond the date of the
3125initial chiropractic treatment, whichever comes first, unless
3126the carrier authorizes additional treatment or the employee is
3127catastrophically injured.
3128
3129Failure of the carrier to timely comply with this subsection
3130shall be a violation of this chapter and the carrier shall be
3131subject to penalties as provided for in s. 440.525.
3132     Section 85.  Section 483.294, Florida Statutes, is amended
3133to read:
3134     483.294  Inspection of centers.-In accordance with s.
3135408.811, the agency shall biennially, at least once annually,
3136inspect the premises and operations of all centers subject to
3137licensure under this part.
3138     Section 86.  Subsections (32) through (54) of section
3139499.003, Florida Statutes, are renumbered as subsections (33)
3140through (55), respectively, present subsection (42) and
3141paragraph (a) of present subsection (53) are amended, and a new
3142subsection (32) is added to that subsection, to read:
3143     499.003  Definitions of terms used in this part.-As used in
3144this part, the term:
3145     (32)  "Medical convenience kit" means packages or units
3146that contain combination products as defined in 21 C.F.R. s.
31473.2(e)(2).
3148     (43)(42)  "Prescription drug" means a prescription,
3149medicinal, or legend drug, including, but not limited to,
3150finished dosage forms or active ingredients subject to, defined
3151by, or described by s. 503(b) of the Federal Food, Drug, and
3152Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3153(11), subsection (46) (45), or subsection (53) (52).
3154     (54)(53)  "Wholesale distribution" means distribution of
3155prescription drugs to persons other than a consumer or patient,
3156but does not include:
3157     (a)  Any of the following activities, which is not a
3158violation of s. 499.005(21) if such activity is conducted in
3159accordance with s. 499.01(2)(g):
3160     1.  The purchase or other acquisition by a hospital or
3161other health care entity that is a member of a group purchasing
3162organization of a prescription drug for its own use from the
3163group purchasing organization or from other hospitals or health
3164care entities that are members of that organization.
3165     2.  The sale, purchase, or trade of a prescription drug or
3166an offer to sell, purchase, or trade a prescription drug by a
3167charitable organization described in s. 501(c)(3) of the
3168Internal Revenue Code of 1986, as amended and revised, to a
3169nonprofit affiliate of the organization to the extent otherwise
3170permitted by law.
3171     3.  The sale, purchase, or trade of a prescription drug or
3172an offer to sell, purchase, or trade a prescription drug among
3173hospitals or other health care entities that are under common
3174control. For purposes of this subparagraph, "common control"
3175means the power to direct or cause the direction of the
3176management and policies of a person or an organization, whether
3177by ownership of stock, by voting rights, by contract, or
3178otherwise.
3179     4.  The sale, purchase, trade, or other transfer of a
3180prescription drug from or for any federal, state, or local
3181government agency or any entity eligible to purchase
3182prescription drugs at public health services prices pursuant to
3183Pub. L. No. 102-585, s. 602 to a contract provider or its
3184subcontractor for eligible patients of the agency or entity
3185under the following conditions:
3186     a.  The agency or entity must obtain written authorization
3187for the sale, purchase, trade, or other transfer of a
3188prescription drug under this subparagraph from the State Surgeon
3189General or his or her designee.
3190     b.  The contract provider or subcontractor must be
3191authorized by law to administer or dispense prescription drugs.
3192     c.  In the case of a subcontractor, the agency or entity
3193must be a party to and execute the subcontract.
3194     d.  A contract provider or subcontractor must maintain
3195separate and apart from other prescription drug inventory any
3196prescription drugs of the agency or entity in its possession.
3197     d.e.  The contract provider and subcontractor must maintain
3198and produce immediately for inspection all records of movement
3199or transfer of all the prescription drugs belonging to the
3200agency or entity, including, but not limited to, the records of
3201receipt and disposition of prescription drugs. Each contractor
3202and subcontractor dispensing or administering these drugs must
3203maintain and produce records documenting the dispensing or
3204administration. Records that are required to be maintained
3205include, but are not limited to, a perpetual inventory itemizing
3206drugs received and drugs dispensed by prescription number or
3207administered by patient identifier, which must be submitted to
3208the agency or entity quarterly.
3209     e.f.  The contract provider or subcontractor may administer
3210or dispense the prescription drugs only to the eligible patients
3211of the agency or entity or must return the prescription drugs
3212for or to the agency or entity. The contract provider or
3213subcontractor must require proof from each person seeking to
3214fill a prescription or obtain treatment that the person is an
3215eligible patient of the agency or entity and must, at a minimum,
3216maintain a copy of this proof as part of the records of the
3217contractor or subcontractor required under sub-subparagraph d.
3218e.
3219     f.g.  In addition to the departmental inspection authority
3220set forth in s. 499.051, the establishment of the contract
3221provider and subcontractor and all records pertaining to
3222prescription drugs subject to this subparagraph shall be subject
3223to inspection by the agency or entity. All records relating to
3224prescription drugs of a manufacturer under this subparagraph
3225shall be subject to audit by the manufacturer of those drugs,
3226without identifying individual patient information.
3227     Section 87.  Paragraph (i) is added to subsection (3) of
3228section 499.01212, Florida Statutes, to read:
3229     499.01212  Pedigree paper.-
3230     (3)  EXCEPTIONS.-A pedigree paper is not required for:
3231     (i)  The wholesale distribution of prescription drugs
3232contained within a medical convenience kit if:
3233     1.  The medical convenience kit is assembled in an
3234establishment that is registered as a medical device
3235manufacturer with the United States Food and Drug
3236Administration;
3237     2.  The medical convenience kit manufacturer purchased the
3238prescription drug directly from the manufacturer or from a
3239wholesaler that purchased the prescription drug directly from
3240the manufacturer;
3241     3.  The medical convenience kit manufacturer complies with
3242federal law for the distribution of the prescription drugs
3243within the kit; and
3244     4.  The drugs contained in the medical convenience kit are:
3245     a.  Intravenous solutions intended for the replenishment of
3246fluids and electrolytes;
3247     b.  Products intended to maintain the equilibrium of water
3248and minerals in the body;
3249     c.  Products intended for irrigation or reconstitution;
3250     d.  Anesthetics; or
3251     e.  Anticoagulants.
3252
3253This exemption does not apply to a convenience kit containing
3254any controlled substance that appears in a schedule contained in
3255or subject to chapter 893 or the federal Comprehensive Drug
3256Abuse Prevention and Control Act of 1970.
3257     Section 88.  Subsection (1) of section 627.645, Florida
3258Statutes, is amended to read:
3259     627.645  Denial of health insurance claims restricted.-
3260     (1)  No claim for payment under a health insurance policy
3261or self-insured program of health benefits for treatment, care,
3262or services in a licensed hospital which is accredited by The
3263Joint Commission on the Accreditation of Hospitals, the American
3264Osteopathic Association, or the Commission on the Accreditation
3265of Rehabilitative Facilities shall be denied because such
3266hospital lacks major surgical facilities and is primarily of a
3267rehabilitative nature, if such rehabilitation is specifically
3268for treatment of physical disability.
3269     Section 89.  Paragraph (c) of subsection (2) of section
3270627.668, Florida Statutes, is amended to read:
3271     627.668  Optional coverage for mental and nervous disorders
3272required; exception.-
3273     (2)  Under group policies or contracts, inpatient hospital
3274benefits, partial hospitalization benefits, and outpatient
3275benefits consisting of durational limits, dollar amounts,
3276deductibles, and coinsurance factors shall not be less favorable
3277than for physical illness generally, except that:
3278     (c)  Partial hospitalization benefits shall be provided
3279under the direction of a licensed physician. For purposes of
3280this part, the term "partial hospitalization services" is
3281defined as those services offered by a program accredited by The
3282Joint Commission on Accreditation of Hospitals (JCAH) or in
3283compliance with equivalent standards. Alcohol rehabilitation
3284programs accredited by The Joint Commission on Accreditation of
3285Hospitals or approved by the state and licensed drug abuse
3286rehabilitation programs shall also be qualified providers under
3287this section. In any benefit year, if partial hospitalization
3288services or a combination of inpatient and partial
3289hospitalization are utilized, the total benefits paid for all
3290such services shall not exceed the cost of 30 days of inpatient
3291hospitalization for psychiatric services, including physician
3292fees, which prevail in the community in which the partial
3293hospitalization services are rendered. If partial
3294hospitalization services benefits are provided beyond the limits
3295set forth in this paragraph, the durational limits, dollar
3296amounts, and coinsurance factors thereof need not be the same as
3297those applicable to physical illness generally.
3298     Section 90.  Subsection (3) of section 627.669, Florida
3299Statutes, is amended to read:
3300     627.669  Optional coverage required for substance abuse
3301impaired persons; exception.-
3302     (3)  The benefits provided under this section shall be
3303applicable only if treatment is provided by, or under the
3304supervision of, or is prescribed by, a licensed physician or
3305licensed psychologist and if services are provided in a program
3306accredited by The Joint Commission on Accreditation of Hospitals
3307or approved by the state.
3308     Section 91.  Paragraph (a) of subsection (1) of section
3309627.736, Florida Statutes, is amended to read:
3310     627.736  Required personal injury protection benefits;
3311exclusions; priority; claims.-
3312     (1)  REQUIRED BENEFITS.-Every insurance policy complying
3313with the security requirements of s. 627.733 shall provide
3314personal injury protection to the named insured, relatives
3315residing in the same household, persons operating the insured
3316motor vehicle, passengers in such motor vehicle, and other
3317persons struck by such motor vehicle and suffering bodily injury
3318while not an occupant of a self-propelled vehicle, subject to
3319the provisions of subsection (2) and paragraph (4)(e), to a
3320limit of $10,000 for loss sustained by any such person as a
3321result of bodily injury, sickness, disease, or death arising out
3322of the ownership, maintenance, or use of a motor vehicle as
3323follows:
3324     (a)  Medical benefits.-Eighty percent of all reasonable
3325expenses for medically necessary medical, surgical, X-ray,
3326dental, and rehabilitative services, including prosthetic
3327devices, and medically necessary ambulance, hospital, and
3328nursing services. However, the medical benefits shall provide
3329reimbursement only for such services and care that are lawfully
3330provided, supervised, ordered, or prescribed by a physician
3331licensed under chapter 458 or chapter 459, a dentist licensed
3332under chapter 466, or a chiropractic physician licensed under
3333chapter 460 or that are provided by any of the following persons
3334or entities:
3335     1.  A hospital or ambulatory surgical center licensed under
3336chapter 395.
3337     2.  A person or entity licensed under ss. 401.2101-401.45
3338that provides emergency transportation and treatment.
3339     3.  An entity wholly owned by one or more physicians
3340licensed under chapter 458 or chapter 459, chiropractic
3341physicians licensed under chapter 460, or dentists licensed
3342under chapter 466 or by such practitioner or practitioners and
3343the spouse, parent, child, or sibling of that practitioner or
3344those practitioners.
3345     4.  An entity wholly owned, directly or indirectly, by a
3346hospital or hospitals.
3347     5.  A health care clinic licensed under ss. 400.990-400.995
3348that is:
3349     a.  Accredited by The Joint Commission on Accreditation of
3350Healthcare Organizations, the American Osteopathic Association,
3351the Commission on Accreditation of Rehabilitation Facilities, or
3352the Accreditation Association for Ambulatory Health Care, Inc.;
3353or
3354     b.  A health care clinic that:
3355     (I)  Has a medical director licensed under chapter 458,
3356chapter 459, or chapter 460;
3357     (II)  Has been continuously licensed for more than 3 years
3358or is a publicly traded corporation that issues securities
3359traded on an exchange registered with the United States
3360Securities and Exchange Commission as a national securities
3361exchange; and
3362     (III)  Provides at least four of the following medical
3363specialties:
3364     (A)  General medicine.
3365     (B)  Radiography.
3366     (C)  Orthopedic medicine.
3367     (D)  Physical medicine.
3368     (E)  Physical therapy.
3369     (F)  Physical rehabilitation.
3370     (G)  Prescribing or dispensing outpatient prescription
3371medication.
3372     (H)  Laboratory services.
3373
3374The Financial Services Commission shall adopt by rule the form
3375that must be used by an insurer and a health care provider
3376specified in subparagraph 3., subparagraph 4., or subparagraph
33775. to document that the health care provider meets the criteria
3378of this paragraph, which rule must include a requirement for a
3379sworn statement or affidavit.
3380
3381Only insurers writing motor vehicle liability insurance in this
3382state may provide the required benefits of this section, and no
3383such insurer shall require the purchase of any other motor
3384vehicle coverage other than the purchase of property damage
3385liability coverage as required by s. 627.7275 as a condition for
3386providing such required benefits. Insurers may not require that
3387property damage liability insurance in an amount greater than
3388$10,000 be purchased in conjunction with personal injury
3389protection. Such insurers shall make benefits and required
3390property damage liability insurance coverage available through
3391normal marketing channels. Any insurer writing motor vehicle
3392liability insurance in this state who fails to comply with such
3393availability requirement as a general business practice shall be
3394deemed to have violated part IX of chapter 626, and such
3395violation shall constitute an unfair method of competition or an
3396unfair or deceptive act or practice involving the business of
3397insurance; and any such insurer committing such violation shall
3398be subject to the penalties afforded in such part, as well as
3399those which may be afforded elsewhere in the insurance code.
3400     Section 92.  Section 633.081, Florida Statutes, is amended
3401to read:
3402     633.081  Inspection of buildings and equipment; orders;
3403firesafety inspection training requirements; certification;
3404disciplinary action.-The State Fire Marshal and her or his
3405agents shall, at any reasonable hour, when the department has
3406reasonable cause to believe that a violation of this chapter or
3407s. 509.215, or a rule promulgated thereunder, or a minimum
3408firesafety code adopted by a local authority, may exist, inspect
3409any and all buildings and structures which are subject to the
3410requirements of this chapter or s. 509.215 and rules promulgated
3411thereunder. The authority to inspect shall extend to all
3412equipment, vehicles, and chemicals which are located within the
3413premises of any such building or structure. The State Fire
3414Marshal and her or his agents shall inspect nursing homes
3415licensed under part II of chapter 400 only once every calendar
3416year and upon receiving a complaint forming the basis of a
3417reasonable cause to believe that a violation of this chapter or
3418s. 509.215, or a rule promulgated thereunder, or a minimum
3419firesafety code adopted by a local authority may exist and upon
3420identifying such a violation in the course of conducting
3421orientation or training activities within a nursing home.
3422     (1)  Each county, municipality, and special district that
3423has firesafety enforcement responsibilities shall employ or
3424contract with a firesafety inspector. The firesafety inspector
3425must conduct all firesafety inspections that are required by
3426law. The governing body of a county, municipality, or special
3427district that has firesafety enforcement responsibilities may
3428provide a schedule of fees to pay only the costs of inspections
3429conducted pursuant to this subsection and related administrative
3430expenses. Two or more counties, municipalities, or special
3431districts that have firesafety enforcement responsibilities may
3432jointly employ or contract with a firesafety inspector.
3433     (2)  Every firesafety inspection conducted pursuant to
3434state or local firesafety requirements shall be by a person
3435certified as having met the inspection training requirements set
3436by the State Fire Marshal. Such person shall:
3437     (a)  Be a high school graduate or the equivalent as
3438determined by the department;
3439     (b)  Not have been found guilty of, or having pleaded
3440guilty or nolo contendere to, a felony or a crime punishable by
3441imprisonment of 1 year or more under the law of the United
3442States, or of any state thereof, which involves moral turpitude,
3443without regard to whether a judgment of conviction has been
3444entered by the court having jurisdiction of such cases;
3445     (c)  Have her or his fingerprints on file with the
3446department or with an agency designated by the department;
3447     (d)  Have good moral character as determined by the
3448department;
3449     (e)  Be at least 18 years of age;
3450     (f)  Have satisfactorily completed the firesafety inspector
3451certification examination as prescribed by the department; and
3452     (g)1.  Have satisfactorily completed, as determined by the
3453department, a firesafety inspector training program of not less
3454than 200 hours established by the department and administered by
3455agencies and institutions approved by the department for the
3456purpose of providing basic certification training for firesafety
3457inspectors; or
3458     2.  Have received in another state training which is
3459determined by the department to be at least equivalent to that
3460required by the department for approved firesafety inspector
3461education and training programs in this state.
3462     (3)  Each special state firesafety inspection which is
3463required by law and is conducted by or on behalf of an agency of
3464the state must be performed by an individual who has met the
3465provision of subsection (2), except that the duration of the
3466training program shall not exceed 120 hours of specific training
3467for the type of property that such special state firesafety
3468inspectors are assigned to inspect.
3469     (4)  A firefighter certified pursuant to s. 633.35 may
3470conduct firesafety inspections, under the supervision of a
3471certified firesafety inspector, while on duty as a member of a
3472fire department company conducting inservice firesafety
3473inspections without being certified as a firesafety inspector,
3474if such firefighter has satisfactorily completed an inservice
3475fire department company inspector training program of at least
347624 hours' duration as provided by rule of the department.
3477     (5)  Every firesafety inspector or special state firesafety
3478inspector certificate is valid for a period of 3 years from the
3479date of issuance. Renewal of certification shall be subject to
3480the affected person's completing proper application for renewal
3481and meeting all of the requirements for renewal as established
3482under this chapter or by rule promulgated thereunder, which
3483shall include completion of at least 40 hours during the
3484preceding 3-year period of continuing education as required by
3485the rule of the department or, in lieu thereof, successful
3486passage of an examination as established by the department.
3487     (6)  The State Fire Marshal may deny, refuse to renew,
3488suspend, or revoke the certificate of a firesafety inspector or
3489special state firesafety inspector if it finds that any of the
3490following grounds exist:
3491     (a)  Any cause for which issuance of a certificate could
3492have been refused had it then existed and been known to the
3493State Fire Marshal.
3494     (b)  Violation of this chapter or any rule or order of the
3495State Fire Marshal.
3496     (c)  Falsification of records relating to the certificate.
3497     (d)  Having been found guilty of or having pleaded guilty
3498or nolo contendere to a felony, whether or not a judgment of
3499conviction has been entered.
3500     (e)  Failure to meet any of the renewal requirements.
3501     (f)  Having been convicted of a crime in any jurisdiction
3502which directly relates to the practice of fire code inspection,
3503plan review, or administration.
3504     (g)  Making or filing a report or record that the
3505certificateholder knows to be false, or knowingly inducing
3506another to file a false report or record, or knowingly failing
3507to file a report or record required by state or local law, or
3508knowingly impeding or obstructing such filing, or knowingly
3509inducing another person to impede or obstruct such filing.
3510     (h)  Failing to properly enforce applicable fire codes or
3511permit requirements within this state which the
3512certificateholder knows are applicable by committing willful
3513misconduct, gross negligence, gross misconduct, repeated
3514negligence, or negligence resulting in a significant danger to
3515life or property.
3516     (i)  Accepting labor, services, or materials at no charge
3517or at a noncompetitive rate from any person who performs work
3518that is under the enforcement authority of the certificateholder
3519and who is not an immediate family member of the
3520certificateholder. For the purpose of this paragraph, the term
3521"immediate family member" means a spouse, child, parent,
3522sibling, grandparent, aunt, uncle, or first cousin of the person
3523or the person's spouse or any person who resides in the primary
3524residence of the certificateholder.
3525     (7)  The department shall provide by rule for the
3526certification of firesafety inspectors.
3527     Section 93.  Subsection (12) of section 641.495, Florida
3528Statutes, is amended to read:
3529     641.495  Requirements for issuance and maintenance of
3530certificate.-
3531     (12)  The provisions of part I of chapter 395 do not apply
3532to a health maintenance organization that, on or before January
35331, 1991, provides not more than 10 outpatient holding beds for
3534short-term and hospice-type patients in an ambulatory care
3535facility for its members, provided that such health maintenance
3536organization maintains current accreditation by The Joint
3537Commission on Accreditation of Health Care Organizations, the
3538Accreditation Association for Ambulatory Health Care, or the
3539National Committee for Quality Assurance.
3540     Section 94.  Subsection (13) of section 651.118, Florida
3541Statutes, is amended to read:
3542     651.118  Agency for Health Care Administration;
3543certificates of need; sheltered beds; community beds.-
3544     (13)  Residents, as defined in this chapter, are not
3545considered new admissions for the purpose of s.
3546400.141(1)(n)(o)1.d.
3547     Section 95.  Subsection (2) of section 766.1015, Florida
3548Statutes, is amended to read:
3549     766.1015  Civil immunity for members of or consultants to
3550certain boards, committees, or other entities.-
3551     (2)  Such committee, board, group, commission, or other
3552entity must be established in accordance with state law or in
3553accordance with requirements of The Joint Commission on
3554Accreditation of Healthcare Organizations, established and duly
3555constituted by one or more public or licensed private hospitals
3556or behavioral health agencies, or established by a governmental
3557agency. To be protected by this section, the act, decision,
3558omission, or utterance may not be made or done in bad faith or
3559with malicious intent.
3560     Section 96.  Subsection (4) of section 766.202, Florida
3561Statutes, is amended to read:
3562     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3563766.201-766.212, the term:
3564     (4)  "Health care provider" means any hospital, ambulatory
3565surgical center, or mobile surgical facility as defined and
3566licensed under chapter 395; a birth center licensed under
3567chapter 383; any person licensed under chapter 458, chapter 459,
3568chapter 460, chapter 461, chapter 462, chapter 463, part I of
3569chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3570or chapter 486; a clinical lab licensed under chapter 483; a
3571health maintenance organization certificated under part I of
3572chapter 641; a blood bank; a plasma center; an industrial
3573clinic; a renal dialysis facility; or a professional association
3574partnership, corporation, joint venture, or other association
3575for professional activity by health care providers.
3576     Section 97.  This act shall take effect July 1, 2010.


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