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. 499.01212, F.S.; providing
251an exception to the requirement that a wholesale
252distributor of prescription drugs provide a pedigree paper
253to the person who receives the drug for wholesale
254distribution of prescription drugs contained within a
255medical convenience kit under specified conditions;
256providing that the exception does not apply to any kit
257that contains certain controlled substances; amending s.
258626.9541, F.S.; authorizing an insurer offering a group or
259individual health benefit plan to offer a wellness
260program; authorizing rewards or incentives; providing that
261such rewards or incentives are not insurance benefits;
262providing for verification of a member's inability to
263participate for medical reasons; amending s. 633.081,
264F.S.; limiting Fire Marshal inspections of nursing homes
265to once a year; providing for additional inspections based
266on complaints and violations identified in the course of
267orientation or training activities; amending s. 766.202,
268F.S.; adding persons licensed under part XIV of ch. 468,
269F.S., to the definition of "health care provider";
270amending ss. 394.4787, 400.0239, 408.07, 430.80, and
271651.118, F.S.; conforming terminology and cross-
272references; revising a reference; providing an effective
273date.
274
275Be It Enacted by the Legislature of the State of Florida:
276
277     Section 1.  Present paragraph (e) of subsection (10) and
278paragraph (e) of subsection (14) of section 112.0455, Florida
279Statutes, are amended, and paragraphs (f) through (k) of
280subsection (10) of that section are redesignated as paragraphs
281(e) through (j), respectively, to read:
282     112.0455  Drug-Free Workplace Act.-
283     (10)  EMPLOYER PROTECTION.-
284     (e)  Nothing in this section shall be construed to operate
285retroactively, and nothing in this section shall abrogate the
286right of an employer under state law to conduct drug tests prior
287to January 1, 1990. A drug test conducted by an employer prior
288to January 1, 1990, is not subject to this section.
289     (14)  DISCIPLINE REMEDIES.-
290     (e)  Upon resolving an appeal filed pursuant to paragraph
291(c), and finding a violation of this section, the commission may
292order the following relief:
293     1.  Rescind the disciplinary action, expunge related
294records from the personnel file of the employee or job applicant
295and reinstate the employee.
296     2.  Order compliance with paragraph (10)(f)(g).
297     3.  Award back pay and benefits.
298     4.  Award the prevailing employee or job applicant the
299necessary costs of the appeal, reasonable attorney's fees, and
300expert witness fees.
301     Section 2.  Paragraph (n) of subsection (1) of section
302154.11, Florida Statutes, is amended to read:
303     154.11  Powers of board of trustees.-
304     (1)  The board of trustees of each public health trust
305shall be deemed to exercise a public and essential governmental
306function of both the state and the county and in furtherance
307thereof it shall, subject to limitation by the governing body of
308the county in which such board is located, have all of the
309powers necessary or convenient to carry out the operation and
310governance of designated health care facilities, including, but
311without limiting the generality of, the foregoing:
312     (n)  To appoint originally the staff of physicians to
313practice in any designated facility owned or operated by the
314board and to approve the bylaws and rules to be adopted by the
315medical staff of any designated facility owned and operated by
316the board, such governing regulations to be in accordance with
317the standards of The Joint Commission on the Accreditation of
318Hospitals which provide, among other things, for the method of
319appointing additional staff members and for the removal of staff
320members.
321     Section 3.  Subsection (15) of section 318.21, Florida
322Statutes, is amended to read:
323     318.21  Disposition of civil penalties by county courts.-
324All civil penalties received by a county court pursuant to the
325provisions of this chapter shall be distributed and paid monthly
326as follows:
327     (15)  Of the additional fine assessed under s. 318.18(3)(e)
328for a violation of s. 316.1893, 50 percent of the moneys
329received from the fines shall be remitted to the Department of
330Revenue and deposited into the Brain and Spinal Cord Injury
331Trust Fund of Department of Health and shall be appropriated to
332the Department of Health Agency for Health Care Administration
333as general revenue to provide an enhanced Medicaid payment to
334nursing homes that serve Medicaid recipients with spinal cord
335injuries that are medically complex and who are technologically
336and respiratory dependent with brain and spinal cord injuries.
337The remaining 50 percent of the moneys received from
338enhanced fine imposed under s. 318.18(3)(e) shall be
339the Department of Revenue and deposited into the
340Health Administrative Trust Fund to provide financial support to
341certified trauma centers in the counties where enhanced penalty
342zones are established to ensure the availability and
343accessibility of trauma services. Funds deposited into the
344Administrative Trust Fund under this subsection shall be
345allocated as follows:
346     (a)  Fifty percent shall be allocated equally among all
347Level I, Level II, and pediatric trauma centers in recognition
348of readiness costs for maintaining trauma services.
349     (b)  Fifty percent shall be allocated among Level I, Level
350II, and pediatric trauma centers based on each center's relative
351volume of trauma cases as reported in the Department of Health
352Trauma Registry.
353     Section 4.  Subsection (3) is added to section 381.00315,
354Florida Statutes, to read:
355     381.00315  Public health advisories; public health
356emergencies.-The State Health Officer is responsible for
357declaring public health emergencies and issuing public health
358advisories.
359     (3)  To facilitate effective emergency management, when the
360United States Department of Health and Human Services contracts
361for the manufacture and delivery of licensable products in
362response to a public health emergency and the terms of those
363contracts are made available to the states, the department shall
364accept funds provided by counties, municipalities, and other
365entities designated in the state emergency management plan
366required under s. 252.35(2)(a) for the purpose of participation
367in such contracts. The department shall deposit the funds into
368the Grants and Donations Trust Fund and expend the funds on
369behalf of the donor county, municipality, or other entity for
370the purchase the licensable products made available under the
371contract.
372     Section 5.  Paragraph (e) is added to subsection (2) of
373section 381.0072, Florida Statutes, to read:
374     381.0072  Food service protection.-It shall be the duty of
375the Department of Health to adopt and enforce sanitation rules
376consistent with law to ensure the protection of the public from
377food-borne illness. These rules shall provide the standards and
378requirements for the storage, preparation, serving, or display
379of food in food service establishments as defined in this
380section and which are not permitted or licensed under chapter
381500 or chapter 509.
382     (2)  DUTIES.-
383     (e)  The department shall inspect food service
384establishments in nursing homes licensed under part II of
385chapter 400 twice each year. The department may make additional
386inspections only in response to complaints. The department shall
387coordinate inspections with the Agency for Health Care
388Administration, such that the department's inspection is at
389least 60 days after a recertification visit by the Agency for
390Health Care Administration.
391     Section 6.  Section 383.325, Florida Statutes, is repealed.
392     Section 7.  Subsection (7) of section 394.4787, Florida
393Statutes, is amended to read:
394     394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
395and 394.4789.-As used in this section and ss. 394.4786,
396394.4788, and 394.4789:
397     (7)  "Specialty psychiatric hospital" means a hospital
398licensed by the agency pursuant to s. 395.002(26)(28) and part
399II of chapter 408 as a specialty psychiatric hospital.
400     Section 8.  Subsection (2) of section 394.741, Florida
401Statutes, is amended to read:
402     394.741  Accreditation requirements for providers of
403behavioral health care services.-
404     (2)  Notwithstanding any provision of law to the contrary,
405accreditation shall be accepted by the agency and department in
406lieu of the agency's and department's facility licensure onsite
407review requirements and shall be accepted as a substitute for
408the department's administrative and program monitoring
409requirements, except as required by subsections (3) and (4),
410for:
411     (a)  Any organization from which the department purchases
412behavioral health care services that is accredited by The Joint
413Commission on Accreditation of Healthcare Organizations or the
414Council on Accreditation for Children and Family Services, or
415has those services that are being purchased by the department
416accredited by the Commission on Accreditation of Rehabilitation
417Facilities CARF-the Rehabilitation Accreditation Commission.
418     (b)  Any mental health facility licensed by the agency or
419any substance abuse component licensed by the department that is
420accredited by The Joint Commission on Accreditation of
421Healthcare Organizations, the Commission on Accreditation of
422Rehabilitation Facilities CARF-the Rehabilitation Accreditation
423Commission, or the Council on Accreditation of Children and
424Family Services.
425     (c)  Any network of providers from which the department or
426the agency purchases behavioral health care services accredited
427by The Joint Commission on Accreditation of Healthcare
428Organizations, the Commission on Accreditation of Rehabilitation
429Facilities CARF-the Rehabilitation Accreditation Commission, the
430Council on Accreditation of Children and Family Services, or the
431National Committee for Quality Assurance. A provider
432organization, which is part of an accredited network, is
433afforded the same rights under this part.
434     Section 9.  Present subsections (15) through (32) of
435section 395.002, Florida Statutes, are renumbered as subsections
436(14) through (28), respectively, and present subsections (1),
437(14), (24), (30), and (31), and paragraph (c) of present
438subsection (28) of that section are amended to read:
439     395.002  Definitions.-As used in this chapter:
440     (1)  "Accrediting organizations" means nationally
441recognized or approved accrediting organizations whose standards
442incorporate comparable licensure requirements as determined by
443the agency the Joint Commission on Accreditation of Healthcare
444Organizations, the American Osteopathic Association, the
445Commission on Accreditation of Rehabilitation Facilities, and
446the Accreditation Association for Ambulatory Health Care, Inc.
447     (14)  "Initial denial determination" means a determination
448by a private review agent that the health care services
449furnished or proposed to be furnished to a patient are
450inappropriate, not medically necessary, or not reasonable.
451     (24)  "Private review agent" means any person or entity
452which performs utilization review services for third-party
453payors on a contractual basis for outpatient or inpatient
454services. However, the term shall not include full-time
455employees, personnel, or staff of health insurers, health
456maintenance organizations, or hospitals, or wholly owned
457subsidiaries thereof or affiliates under common ownership, when
458performing utilization review for their respective hospitals,
459health maintenance organizations, or insureds of the same
460insurance group. For this purpose, health insurers, health
461maintenance organizations, and hospitals, or wholly owned
462subsidiaries thereof or affiliates under common ownership,
463include such entities engaged as administrators of self-
464insurance as defined in s. 624.031.
465     (26)(28)  "Specialty hospital" means any facility which
466meets the provisions of subsection (12), and which regularly
467makes available either:
468     (c)  Intensive residential treatment programs for children
469and adolescents as defined in subsection (14) (15).
470     (30)  "Utilization review" means a system for reviewing the
471medical necessity or appropriateness in the allocation of health
472care resources of hospital services given or proposed to be
473given to a patient or group of patients.
474     (31)  "Utilization review plan" means a description of the
475policies and procedures governing utilization review activities
476performed by a private review agent.
477     Section 10.  Paragraph (c) of subsection (1) and paragraph
478(b) of subsection (2) of section 395.003, Florida Statutes, are
479amended to read:
480     395.003  Licensure; denial, suspension, and revocation.-
481     (1)
482     (c)  Until July 1, 2006, additional emergency departments
483located off the premises of licensed hospitals may not be
484authorized by the agency.
485     (2)
486     (b)  The agency shall, at the request of a licensee that is
487a teaching hospital as defined in s. 408.07(45), issue a single
488license to a licensee for facilities that have been previously
489licensed as separate premises, provided such separately licensed
490facilities, taken together, constitute the same premises as
491defined in s. 395.002(22)(23). Such license for the single
492premises shall include all of the beds, services, and programs
493that were previously included on the licenses for the separate
494premises. The granting of a single license under this paragraph
495shall not in any manner reduce the number of beds, services, or
496programs operated by the licensee.
497     Section 11.  Paragraph (e) of subsection (2) and subsection
498(4) of section 395.0193, Florida Statutes, are amended to read:
499     395.0193  Licensed facilities; peer review; disciplinary
500powers; agency or partnership with physicians.-
501     (2)  Each licensed facility, as a condition of licensure,
502shall provide for peer review of physicians who deliver health
503care services at the facility. Each licensed facility shall
504develop written, binding procedures by which such peer review
505shall be conducted. Such procedures shall include:
506     (e)  Recording of agendas and minutes which do not contain
507confidential material, for review by the Division of Medical
508Quality Assurance of the department Health Quality Assurance of
509the agency.
510     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
511actions taken under subsection (3) shall be reported in writing
512to the Division of Medical Quality Assurance of the department
513Health Quality Assurance of the agency within 30 working days
514after its initial occurrence, regardless of the pendency of
515appeals to the governing board of the hospital. The notification
516shall identify the disciplined practitioner, the action taken,
517and the reason for such action. All final disciplinary actions
518taken under subsection (3), if different from those which were
519reported to the department agency within 30 days after the
520initial occurrence, shall be reported within 10 working days to
521the Division of Medical Quality Assurance of the department
522Health Quality Assurance of the agency in writing and shall
523specify the disciplinary action taken and the specific grounds
524therefor. The division shall review each report and determine
525whether it potentially involved conduct by the licensee that is
526subject to disciplinary action, in which case s. 456.073 shall
527apply. The reports are not subject to inspection under s.
528119.07(1) even if the division's investigation results in a
529finding of probable cause.
530     Section 12.  Section 395.1023, Florida Statutes, is amended
531to read:
532     395.1023  Child abuse and neglect cases; duties.-Each
533licensed facility shall adopt a protocol that, at a minimum,
534requires the facility to:
535     (1)  Incorporate a facility policy that every staff member
536has an affirmative duty to report, pursuant to chapter 39, any
537actual or suspected case of child abuse, abandonment, or
538neglect; and
539     (2)  In any case involving suspected child abuse,
540abandonment, or neglect, designate, at the request of the
541Department of Children and Family Services, a staff physician to
542act as a liaison between the hospital and the Department of
543Children and Family Services office which is investigating the
544suspected abuse, abandonment, or neglect, and the child
545protection team, as defined in s. 39.01, when the case is
546referred to such a team.
547
548Each general hospital and appropriate specialty hospital shall
549comply with the provisions of this section and shall notify the
550agency and the Department of Children and Family Services of its
551compliance by sending a copy of its policy to the agency and the
552Department of Children and Family Services as required by rule.
553The failure by a general hospital or appropriate specialty
554hospital to comply shall be punished by a fine not exceeding
555$1,000, to be fixed, imposed, and collected by the agency. Each
556day in violation is considered a separate offense.
557     Section 13.  Subsection (2) and paragraph (d) of subsection
558(3) of section 395.1041, Florida Statutes, are amended to read:
559     395.1041  Access to emergency services and care.-
560     (2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
561shall establish and maintain an inventory of hospitals with
562emergency services. The inventory shall list all services within
563the service capability of the hospital, and such services shall
564appear on the face of the hospital license. Each hospital having
565emergency services shall notify the agency of its service
566capability in the manner and form prescribed by the agency. The
567agency shall use the inventory to assist emergency medical
568services providers and others in locating appropriate emergency
569medical care. The inventory shall also be made available to the
570general public. On or before August 1, 1992, the agency shall
571request that each hospital identify the services which are
572within its service capability. On or before November 1, 1992,
573the agency shall notify each hospital of the service capability
574to be included in the inventory. The hospital has 15 days from
575the date of receipt to respond to the notice. By December 1,
5761992, the agency shall publish a final inventory. Each hospital
577shall reaffirm its service capability when its license is
578renewed and shall notify the agency of the addition of a new
579service or the termination of a service prior to a change in its
580service capability.
581     (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
582FACILITY OR HEALTH CARE PERSONNEL.-
583     (d)1.  Every hospital shall ensure the provision of
584services within the service capability of the hospital, at all
585times, either directly or indirectly through an arrangement with
586another hospital, through an arrangement with one or more
587physicians, or as otherwise made through prior arrangements. A
588hospital may enter into an agreement with another hospital for
589purposes of meeting its service capability requirement, and
590appropriate compensation or other reasonable conditions may be
591negotiated for these backup services.
592     2.  If any arrangement requires the provision of emergency
593medical transportation, such arrangement must be made in
594consultation with the applicable provider and may not require
595the emergency medical service provider to provide transportation
596that is outside the routine service area of that provider or in
597a manner that impairs the ability of the emergency medical
598service provider to timely respond to prehospital emergency
599calls.
600     3.  A hospital shall not be required to ensure service
601capability at all times as required in subparagraph 1. if, prior
602to the receiving of any patient needing such service capability,
603such hospital has demonstrated to the agency that it lacks the
604ability to ensure such capability and it has exhausted all
605reasonable efforts to ensure such capability through backup
606arrangements. In reviewing a hospital's demonstration of lack of
607ability to ensure service capability, the agency shall consider
608factors relevant to the particular case, including the
609following:
610     a.  Number and proximity of hospitals with the same service
611capability.
612     b.  Number, type, credentials, and privileges of
613specialists.
614     c.  Frequency of procedures.
615     d.  Size of hospital.
616     4.  The agency shall publish proposed rules implementing a
617reasonable exemption procedure by November 1, 1992. Subparagraph
6181. shall become effective upon the effective date of said rules
619or January 31, 1993, whichever is earlier. For a period not to
620exceed 1 year from the effective date of subparagraph 1., a
621hospital requesting an exemption shall be deemed to be exempt
622from offering the service until the agency initially acts to
623deny or grant the original request. The agency has 45 days from
624the date of receipt of the request to approve or deny the
625request. After the first year from the effective date of
626subparagraph 1., If the agency fails to initially act within the
627time period, the hospital is deemed to be exempt from offering
628the service until the agency initially acts to deny the request.
629     Section 14.  Section 395.1046, Florida Statutes, is
630repealed.
631     Section 15.  Paragraph (e) of subsection (1) of section
632395.1055, Florida Statutes, is amended to read:
633     395.1055  Rules and enforcement.-
634     (1)  The agency shall adopt rules pursuant to ss.
635120.536(1) and 120.54 to implement the provisions of this part,
636which shall include reasonable and fair minimum standards for
637ensuring that:
638     (e)  Licensed facility beds conform to minimum space,
639equipment, and furnishings standards as specified by the agency,
640the Florida Building Code, and the Florida Fire Prevention Code
641department.
642     Section 16.  Subsection (1) of section 395.10972, Florida
643Statutes, is amended to read:
644     395.10972  Health Care Risk Manager Advisory Council.-The
645Secretary of Health Care Administration may appoint a seven-
646member advisory council to advise the agency on matters
647pertaining to health care risk managers. The members of the
648council shall serve at the pleasure of the secretary. The
649council shall designate a chair. The council shall meet at the
650call of the secretary or at those times as may be required by
651rule of the agency. The members of the advisory council shall
652receive no compensation for their services, but shall be
653reimbursed for travel expenses as provided in s. 112.061. The
654council shall consist of individuals representing the following
655areas:
656     (1)  Two shall be active health care risk managers,
657including one risk manager who is recommended by and a member of
658the Florida Society for of Healthcare Risk Management and
659Patient Safety.
660     Section 17.  Subsection (3) of section 395.2050, Florida
661Statutes, is amended to read:
662     395.2050  Routine inquiry for organ and tissue donation;
663certification for procurement activities; death records review.-
664     (3)  Each organ procurement organization designated by the
665federal Centers for Medicare and Medicaid Services Health Care
666Financing Administration and licensed by the state
667an annual death records review in the organ procurement
668organization's affiliated donor hospitals. The organ procurement
669organization shall enlist the services of every Florida licensed
670tissue bank and eye bank affiliated with or providing service to
671the donor hospital and operating in the same service area to
672participate in the death records review.
673     Section 18.  Subsection (2) of section 395.3036, Florida
674Statutes, is amended to read:
675     395.3036  Confidentiality of records and meetings of
676corporations that lease public hospitals or other public health
677care facilities.-The records of a private corporation that
678leases a public hospital or other public health care facility
679are confidential and exempt from the provisions of s. 119.07(1)
680and s. 24(a), Art. I of the State Constitution, and the meetings
681of the governing board of a private corporation are exempt from
682s. 286.011 and s. 24(b), Art. I of the State Constitution when
683the public lessor complies with the public finance
684accountability provisions of s. 155.40(5) with respect to the
685transfer of any public funds to the private lessee and when the
686private lessee meets at least three of the five following
687criteria:
688     (2)  The public lessor and the private lessee do not
689commingle any of their funds in any account maintained by either
690of them, other than the payment of the rent and administrative
691fees or the transfer of funds pursuant to s. 155.40     (2)
692subsection (2).
693     Section 19.  Section 395.3037, Florida Statutes, is
694repealed.
695     Section 20.  Subsections (1), (4), and (5) of section
696395.3038, Florida Statutes, are amended to read:
697     395.3038  State-listed primary stroke centers and
698comprehensive stroke centers; notification of hospitals.-
699     (1)  The agency shall make available on its website and to
700the department a list of the name and address of each hospital
701that meets the criteria for a primary stroke center and the name
702and address of each hospital that meets the criteria for a
703comprehensive stroke center. The list of primary and
704comprehensive stroke centers shall include only those hospitals
705that attest in an affidavit submitted to the agency that the
706hospital meets the named criteria, or those hospitals that
707attest in an affidavit submitted to the agency that the hospital
708is certified as a primary or a comprehensive stroke center by
709The Joint Commission on Accreditation of Healthcare
710Organizations.
711     (4)  The agency shall adopt by rule criteria for a primary
712stroke center which are substantially similar to the
713certification standards for primary stroke centers of The Joint
714Commission on Accreditation of Healthcare Organizations.
715     (5)  The agency shall adopt by rule criteria for a
716comprehensive stroke center. However, if The Joint Commission on
717Accreditation of Healthcare Organizations establishes criteria
718for a comprehensive stroke center, the agency shall establish
719criteria for a comprehensive stroke center which are
720substantially similar to those criteria established by The Joint
721Commission on Accreditation of Healthcare Organizations.
722     Section 21.  Paragraph (e) of subsection (2) of section
723395.602, Florida Statutes, is amended to read:
724     395.602  Rural hospitals.-
725     (2)  DEFINITIONS.-As used in this part:
726     (e)  "Rural hospital" means an acute care hospital licensed
727under this chapter, having 100 or fewer licensed beds and an
728emergency room, which is:
729     1.  The sole provider within a county with a population
730density of no greater than 100 persons per square mile;
731     2.  An acute care hospital, in a county with a population
732density of no greater than 100 persons per square mile, which is
733at least 30 minutes of travel time, on normally traveled roads
734under normal traffic conditions, from any other acute care
735hospital within the same county;
736     3.  A hospital supported by a tax district or subdistrict
737whose boundaries encompass a population of 100 persons or fewer
738per square mile;
739     4.  A hospital in a constitutional charter county with a
740population of over 1 million persons that has imposed a local
741option health service tax pursuant to law and in an area that
742was directly impacted by a catastrophic event on August 24,
7431992, for which the Governor of Florida declared a state of
744emergency pursuant to chapter 125, and has 120 beds or less that
745serves an agricultural community with an emergency room
746utilization of no less than 20,000 visits and a Medicaid
747inpatient utilization rate greater than 15 percent;
748     4.5.  A hospital with a service area that has a population
749of 100 persons or fewer per square mile. As used in this
750subparagraph, the term "service area" means the fewest number of
751zip codes that account for 75 percent of the hospital's
752discharges for the most recent 5-year period, based on
753information available from the hospital inpatient discharge
754database in the Florida Center for Health Information and Policy
755Analysis at the Agency for Health Care Administration; or
756     5.6.  A hospital designated as a critical access hospital,
757as defined in s. 408.07(15).
758
759Population densities used in this paragraph must be based upon
760the most recently completed United States census. A hospital
761that received funds under s. 409.9116 for a quarter beginning no
762later than July 1, 2002, is deemed to have been and shall
763continue to be a rural hospital from that date through June 30,
7642015, if the hospital continues to have 100 or fewer licensed
765beds and an emergency room, or meets the criteria of
766subparagraph 4. An acute care hospital that has not previously
767been designated as a rural hospital and that meets the criteria
768of this paragraph shall be granted such designation upon
769application, including supporting documentation to the Agency
770for Health Care Administration.
771     Section 22.  Subsection (8) of section 400.021, Florida
772Statutes, is amended to read:
773     400.021  Definitions.-When used in this part, unless the
774context otherwise requires, the term:
775     (8)  "Geriatric outpatient clinic" means a site for
776providing outpatient health care to persons 60 years of age or
777older, which is staffed by a registered nurse or a physician
778assistant, or a licensed practical nurse under the direct
779supervision of a registered nurse, advanced registered nurse
780practitioner, or physician.
781     Section 23.  Paragraph (g) of subsection (2) of section
782400.0239, Florida Statutes, is amended to read:
783     400.0239  Quality of Long-Term Care Facility Improvement
784Trust Fund.-
785     (2)  Expenditures from the trust fund shall be allowable
786for direct support of the following:
787     (g)  Other initiatives authorized by the Centers for
788Medicare and Medicaid Services for the use of federal civil
789monetary penalties, including projects recommended through the
790Medicaid "Up-or-Out" Quality of Care Contract Management Program
791pursuant to s. 400.148.
792     Section 24.  Subsection (15) of section 400.0255, Florida
793Statutes, is amended to read
794     400.0255  Resident transfer or discharge; requirements and
795procedures; hearings.-
796     (15)(a)  The department's Office of Appeals Hearings shall
797conduct hearings under this section. The office shall notify the
798facility of a resident's request for a hearing.
799     (b)  The department shall, by rule, establish procedures to
800be used for fair hearings requested by residents. These
801procedures shall be equivalent to the procedures used for fair
802hearings for other Medicaid cases appearing in s. 409.285 and
803applicable rules, chapter 10-2, part VI, Florida Administrative
804Code. The burden of proof must be clear and convincing evidence.
805A hearing decision must be rendered within 90 days after receipt
806of the request for hearing.
807     (c)  If the hearing decision is favorable to the resident
808who has been transferred or discharged, the resident must be
809readmitted to the facility's first available bed.
810     (d)  The decision of the hearing officer shall be final.
811Any aggrieved party may appeal the decision to the district
812court of appeal in the appellate district where the facility is
813located. Review procedures shall be conducted in accordance with
814the Florida Rules of Appellate Procedure.
815     Section 25.  Subsection (2) of section 400.063, Florida
816Statutes, is amended to read:
817     400.063  Resident protection.-
818     (2)  The agency is authorized to establish for each
819facility, subject to intervention by the agency, a separate bank
820account for the deposit to the credit of the agency of any
821moneys received from the Health Care Trust Fund or any other
822moneys received for the maintenance and care of residents in the
823facility, and the agency is authorized to disburse moneys from
824such account to pay obligations incurred for the purposes of
825this section. The agency is authorized to requisition moneys
826from the Health Care Trust Fund in advance of an actual need for
827cash on the basis of an estimate by the agency of moneys to be
828spent under the authority of this section. Any bank account
829established under this section need not be approved in advance
830of its creation as required by s. 17.58, but shall be secured by
831depository insurance equal to or greater than the balance of
832such account or by the pledge of collateral security in
833conformance with criteria established in s. 18.11. The agency
834shall notify the Chief Financial Officer of any such account so
835established and shall make a quarterly accounting to the Chief
836Financial Officer for all moneys deposited in such account.
837     Section 26.  Subsections (1) and (5) of section 400.071,
838Florida Statutes, are amended to read:
839     400.071  Application for license.-
840     (1)  In addition to the requirements of part II of chapter
841408, the application for a license shall be under oath and must
842contain the following:
843     (a)  The location of the facility for which a license is
844sought and an indication, as in the original application, that
845such location conforms to the local zoning ordinances.
846     (b)  A signed affidavit disclosing any financial or
847ownership interest that a controlling interest as defined in
848part II of chapter 408 has held in the last 5 years in any
849entity licensed by this state or any other state to provide
850health or residential care which has closed voluntarily or
851involuntarily; has filed for bankruptcy; has had a receiver
852appointed; has had a license denied, suspended, or revoked; or
853has had an injunction issued against it which was initiated by a
854regulatory agency. The affidavit must disclose the reason any
855such entity was closed, whether voluntarily or involuntarily.
856     (c)  The total number of beds and the total number of
857Medicare and Medicaid certified beds.
858     (b)(d)  Information relating to the applicant and employees
859which the agency requires by rule. The applicant must
860demonstrate that sufficient numbers of qualified staff, by
861training or experience, will be employed to properly care for
862the type and number of residents who will reside in the
863facility.
864     (c)(e)  Copies of any civil verdict or judgment involving
865the applicant rendered within the 10 years preceding the
866application, relating to medical negligence, violation of
867residents' rights, or wrongful death. As a condition of
868licensure, the licensee agrees to provide to the agency copies
869of any new verdict or judgment involving the applicant, relating
870to such matters, within 30 days after filing with the clerk of
871the court. The information required in this paragraph shall be
872maintained in the facility's licensure file and in an agency
873database which is available as a public record.
874     (5)  As a condition of licensure, each facility must
875establish and submit with its application a plan for quality
876assurance and for conducting risk management.
877     Section 27.  Section 400.0712, Florida Statutes, is amended
878to read:
879     400.0712  Application for inactive license.-
880     (1)  As specified in this section, the agency may issue an
881inactive license to a nursing home facility for all or a portion
882of its beds. Any request by a licensee that a nursing home or
883portion of a nursing home become inactive must be submitted to
884the agency in the approved format. The facility may not initiate
885any suspension of services, notify residents, or initiate
886inactivity before receiving approval from the agency; and a
887licensee that violates this provision may not be issued an
888inactive license.
889     (1)(2)  In addition to the powers granted under part II of
890chapter 408, the agency may issue an inactive license to a
891nursing home that chooses to use an unoccupied contiguous
892portion of the facility for an alternative use to meet the needs
893of elderly persons through the use of less restrictive, less
894institutional services.
895     (a)  An inactive license issued under this subsection may
896be granted for a period not to exceed the current licensure
897expiration date but may be renewed by the agency at the time of
898licensure renewal.
899     (b)  A request to extend the inactive license must be
900submitted to the agency in the approved format and approved by
901the agency in writing.
902     (c)  Nursing homes that receive an inactive license to
903provide alternative services shall not receive preference for
904participation in the Assisted Living for the Elderly Medicaid
905waiver.
906     (2)(3)  The agency shall adopt rules pursuant to ss.
907120.536(1) and 120.54 necessary to implement this section.
908     Section 28.  Section 400.111, Florida Statutes, is amended
909to read:
910     400.111  Disclosure of controlling interest.-In addition to
911the requirements of part II of chapter 408, when requested by
912the agency, the licensee shall submit a signed affidavit
913disclosing any financial or ownership interest that a
914controlling interest has held within the last 5 years in any
915entity licensed by the state or any other state to provide
916health or residential care which entity has closed voluntarily
917or involuntarily; has filed for bankruptcy; has had a receiver
918appointed; has had a license denied, suspended, or revoked; or
919has had an injunction issued against it which was initiated by a
920regulatory agency. The affidavit must disclose the reason such
921entity was closed, whether voluntarily or involuntarily.
922     Section 29.  Subsection (2) of section 400.1183, Florida
923Statutes, is amended to read:
924     400.1183  Resident grievance procedures.-
925     (2)  Each facility shall maintain records of all grievances
926for agency inspection and shall report to the agency at the time
927of relicensure the total number of grievances handled during the
928prior licensure period, a categorization of the cases underlying
929the grievances, and the final disposition of the grievances.
930     Section 30.  Paragraphs (o) through (w) of subsection (1)
931of section 400.141, Florida Statutes, are redesignated as
932paragraphs (n) through (u), respectively, and present paragraphs
933(f), (g), (j), (n), (o), and (r) of that subsection are amended,
934to read:
935     400.141  Administration and management of nursing home
936facilities.-
937     (1)  Every licensed facility shall comply with all
938applicable standards and rules of the agency and shall:
939     (f)  Be allowed and encouraged by the agency to provide
940other needed services under certain conditions. If the facility
941has a standard licensure status, and has had no class I or class
942II deficiencies during the past 2 years or has been awarded a
943Gold Seal under the program established in s. 400.235, it may be
944encouraged by the agency to provide services, including, but not
945limited to, respite and adult day services, which enable
946individuals to move in and out of the facility. A facility is
947not subject to any additional licensure requirements for
948providing these services.
949     1.  Respite care may be offered to persons in need of
950short-term or temporary nursing home services. For each person
951admitted under the respite care program, the facility licensee
952must:
953     a.  Have a written abbreviated plan of care that, at a
954minimum, includes nutritional requirements, medication orders,
955physician orders, nursing assessments, and dietary preferences.
956The nursing or physician assessments may take the place of all
957other assessments required for full-time residents.
958     b.  Have a contract that, at a minimum, specifies the
959services to be provided to the respite resident, including
960charges for services, activities, equipment, emergency medical
961services, and the administration of medications. If multiple
962respite admissions for a single person are anticipated, the
963original contract is valid for 1 year after the date of
964execution.
965     c.  Ensure that each resident is released to his or her
966caregiver or an individual designated in writing by the
967caregiver.
968     2.  A person admitted under the respite care program is:
969     a.  Exempt from requirements in rule related to discharge
970planning.
971     b.  Covered by the resident's rights set forth in s.
972400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
973shall not be considered trust funds subject to the requirements
974of s. 400.022(1)(h) until the resident has been in the facility
975for more than 14 consecutive days.
976     c.  Allowed to use his or her personal medications for the
977respite stay if permitted by facility policy. The facility must
978obtain a physician's orders for the medications. The caregiver
979may provide information regarding the medications as part of the
980nursing assessment, which must agree with the physician's
981orders. Medications shall be released with the resident upon
982discharge in accordance with current orders.
983     3.  A person receiving respite care is entitled to a total
984of 60 days in the facility within a contract year or a calendar
985year if the contract is for less than 12 months. However, each
986single stay may not exceed 14 days. If a stay exceeds 14
987consecutive days, the facility must comply with all assessment
988and care planning requirements applicable to nursing home
989residents.
990     4.  A person receiving respite care must reside in a
991licensed nursing home bed.
992     5.  A prospective respite resident must provide medical
993information from a physician, a physician assistant, or a nurse
994practitioner and other information from the primary caregiver as
995may be required by the facility prior to or at the time of
996admission to receive respite care. The medical information must
997include a physician's order for respite care and proof of a
998physical examination by a licensed physician, physician
999assistant, or nurse practitioner. The physician's order and
1000physical examination may be used to provide intermittent respite
1001care for up to 12 months after the date the order is written.
1002     6.  The facility must assume the duties of the primary
1003caregiver. To ensure continuity of care and services, the
1004resident is entitled to retain his or her personal physician and
1005must have access to medically necessary services such as
1006physical therapy, occupational therapy, or speech therapy, as
1007needed. The facility must arrange for transportation to these
1008services if necessary. Respite care must be provided in
1009accordance with this part and rules adopted by the agency.
1010However, the agency shall, by rule, adopt modified requirements
1011for resident assessment, resident care plans, resident
1012contracts, physician orders, and other provisions, as
1013appropriate, for short-term or temporary nursing home services.
1014     7.  The agency shall allow for shared programming and staff
1015in a facility which meets minimum standards and offers services
1016pursuant to this paragraph, but, if the facility is cited for
1017deficiencies in patient care, may require additional staff and
1018programs appropriate to the needs of service recipients. A
1019person who receives respite care may not be counted as a
1020resident of the facility for purposes of the facility's licensed
1021capacity unless that person receives 24-hour respite care. A
1022person receiving either respite care for 24 hours or longer or
1023adult day services must be included when calculating minimum
1024staffing for the facility. Any costs and revenues generated by a
1025nursing home facility from nonresidential programs or services
1026shall be excluded from the calculations of Medicaid per diems
1027for nursing home institutional care reimbursement.
1028     (g)  If the facility has a standard license or is a Gold
1029Seal facility, exceeds the minimum required hours of licensed
1030nursing and certified nursing assistant direct care per resident
1031per day, and is part of a continuing care facility licensed
1032under chapter 651 or a retirement community that offers other
1033services pursuant to part III of this chapter or part I or part
1034III of chapter 429 on a single campus, be allowed to share
1035programming and staff. At the time of inspection and in the
1036semiannual report required pursuant to paragraph (n) (o), a
1037continuing care facility or retirement community that uses this
1038option must demonstrate through staffing records that minimum
1039staffing requirements for the facility were met. Licensed nurses
1040and certified nursing assistants who work in the nursing home
1041facility may be used to provide services elsewhere on campus if
1042the facility exceeds the minimum number of direct care hours
1043required per resident per day and the total number of residents
1044receiving direct care services from a licensed nurse or a
1045certified nursing assistant does not cause the facility to
1046violate the staffing ratios required under s. 400.23(3)(a).
1047Compliance with the minimum staffing ratios shall be based on
1048total number of residents receiving direct care services,
1049regardless of where they reside on campus. If the facility
1050receives a conditional license, it may not share staff until the
1051conditional license status ends. This paragraph does not
1052restrict the agency's authority under federal or state law to
1053require additional staff if a facility is cited for deficiencies
1054in care which are caused by an insufficient number of certified
1055nursing assistants or licensed nurses. The agency may adopt
1056rules for the documentation necessary to determine compliance
1057with this provision.
1058     (j)  Keep full records of resident admissions and
1059discharges; medical and general health status, including medical
1060records, personal and social history, and identity and address
1061of next of kin or other persons who may have responsibility for
1062the affairs of the residents; and individual resident care plans
1063including, but not limited to, prescribed services, service
1064frequency and duration, and service goals. The records shall be
1065open to inspection by the agency. The facility must maintain
1066clinical records on each resident in accordance with accepted
1067professional standards and practices that are complete,
1068accurately documented, readily accessible, and systematically
1069organized.
1070     (n)  Submit to the agency the information specified in s.
1071400.071(1)(b) for a management company within 30 days after the
1072effective date of the management agreement.
1073     (n)(o)1.  Submit semiannually to the agency, or more
1074frequently if requested by the agency, information regarding
1075facility staff-to-resident ratios, staff turnover, and staff
1076stability, including information regarding certified nursing
1077assistants, licensed nurses, the director of nursing, and the
1078facility administrator. For purposes of this reporting:
1079     a.  Staff-to-resident ratios must be reported in the
1080categories specified in s. 400.23(3)(a) and applicable rules.
1081The ratio must be reported as an average for the most recent
1082calendar quarter.
1083     b.  Staff turnover must be reported for the most recent 12-
1084month period ending on the last workday of the most recent
1085calendar quarter prior to the date the information is submitted.
1086The turnover rate must be computed quarterly, with the annual
1087rate being the cumulative sum of the quarterly rates. The
1088turnover rate is the total number of terminations or separations
1089experienced during the quarter, excluding any employee
1090terminated during a probationary period of 3 months or less,
1091divided by the total number of staff employed at the end of the
1092period for which the rate is computed, and expressed as a
1093percentage.
1094     c.  The formula for determining staff stability is the
1095total number of employees that have been employed for more than
109612 months, divided by the total number of employees employed at
1097the end of the most recent calendar quarter, and expressed as a
1098percentage.
1099     d.  A nursing facility that has failed to comply with state
1100minimum-staffing requirements for 2 consecutive days is
1101prohibited from accepting new admissions until the facility has
1102achieved the minimum-staffing requirements for a period of 6
1103consecutive days. For the purposes of this sub-subparagraph, any
1104person who was a resident of the facility and was absent from
1105the facility for the purpose of receiving medical care at a
1106separate location or was on a leave of absence is not considered
1107a new admission. Failure to impose such an admissions moratorium
1108is subject to a $1,000 fine constitutes a class II deficiency.
1109     e.  A nursing facility which does not have a conditional
1110license may be cited for failure to comply with the standards in
1111s. 400.23(3)(a)1.a. only if it has failed to meet those
1112standards on 2 consecutive days or if it has failed to meet at
1113least 97 percent of those standards on any one day.
1114     f.  A facility which has a conditional license must be in
1115compliance with the standards in s. 400.23(3)(a) at all times.
1116     2.  This paragraph does not limit the agency's ability to
1117impose a deficiency or take other actions if a facility does not
1118have enough staff to meet the residents' needs.
1119     (r)  Report to the agency any filing for bankruptcy
1120protection by the facility or its parent corporation,
1121divestiture or spin-off of its assets, or corporate
1122reorganization within 30 days after the completion of such
1123activity.
1124     Section 31.  Subsection (3) of section 400.142, Florida
1125Statutes, is amended to read:
1126     400.142  Emergency medication kits; orders not to
1127resuscitate.-
1128     (3)  Facility staff may withhold or withdraw
1129cardiopulmonary resuscitation if presented with an order not to
1130resuscitate executed pursuant to s. 401.45. The agency shall
1131adopt rules providing for the implementation of such orders.
1132Facility staff and facilities shall not be subject to criminal
1133prosecution or civil liability, nor be considered to have
1134engaged in negligent or unprofessional conduct, for withholding
1135or withdrawing cardiopulmonary resuscitation pursuant to such an
1136order and rules adopted by the agency. The absence of an order
1137not to resuscitate executed pursuant to s. 401.45 does not
1138preclude a physician from withholding or withdrawing
1139cardiopulmonary resuscitation as otherwise permitted by law.
1140     Section 32.  Subsections (11) through (15) of section
1141400.147, Florida Statutes, are renumbered as subsections (10)
1142through (14), respectively, and present subsection (10) is
1143amended to read:
1144     400.147  Internal risk management and quality assurance
1145program.-
1146     (10)  By the 10th of each month, each facility subject to
1147this section shall report any notice received pursuant to s.
1148400.0233(2) and each initial complaint that was filed with the
1149clerk of the court and served on the facility during the
1150previous month by a resident or a resident's family member,
1151guardian, conservator, or personal legal representative. The
1152report must include the name of the resident, the resident's
1153date of birth and social security number, the Medicaid
1154identification number for Medicaid-eligible persons, the date or
1155dates of the incident leading to the claim or dates of
1156residency, if applicable, and the type of injury or violation of
1157rights alleged to have occurred. Each facility shall also submit
1158a copy of the notices received pursuant to s. 400.0233(2) and
1159complaints filed with the clerk of the court. This report is
1160confidential as provided by law and is not discoverable or
1161admissible in any civil or administrative action, except in such
1162actions brought by the agency to enforce the provisions of this
1163part.
1164     Section 33.  Section 400.148, Florida Statutes, is
1165repealed.
1166     Section 34.  Paragraph (f) of subsection (5) of section
1167400.162, Florida Statutes, is amended to read:
1168     400.162  Property and personal affairs of residents.-
1169     (5)
1170     (f)  At least every 3 months, the licensee shall furnish
1171the resident and the guardian, trustee, or conservator, if any,
1172for the resident a complete and verified statement of all funds
1173and other property to which this subsection applies, detailing
1174the amounts and items received, together with their sources and
1175disposition. For resident property, the licensee shall furnish
1176such a statement annually and within 7 calendar days after a
1177request for a statement. In any event, the licensee shall
1178furnish such statements a statement annually and upon the
1179discharge or transfer of a resident. Any governmental agency or
1180private charitable agency contributing funds or other property
1181on account of a resident also shall be entitled to receive such
1182statements statement annually and upon discharge or transfer and
1183such other report as it may require pursuant to law.
1184     Section 35.  Paragraphs (d) and (e) of subsection (2) of
1185section 400.179, Florida Statutes, are amended to read:
1186     400.179  Liability for Medicaid underpayments and
1187overpayments.-
1188     (2)  Because any transfer of a nursing facility may expose
1189the fact that Medicaid may have underpaid or overpaid the
1190transferor, and because in most instances, any such underpayment
1191or overpayment can only be determined following a formal field
1192audit, the liabilities for any such underpayments or
1193overpayments shall be as follows:
1194     (d)  Where the transfer involves a facility that has been
1195leased by the transferor:
1196     1.  The transferee shall, as a condition to being issued a
1197license by the agency, acquire, maintain, and provide proof to
1198the agency of a bond with a term of 30 months, renewable
1199annually, in an amount not less than the total of 3 months'
1200Medicaid payments to the facility computed on the basis of the
1201preceding 12-month average Medicaid payments to the facility.
1202     2.  A leasehold licensee may meet the requirements of
1203subparagraph 1. by payment of a nonrefundable fee, paid at
1204initial licensure, paid at the time of any subsequent change of
1205ownership, and paid annually thereafter, in the amount of 1
1206percent of the total of 3 months' Medicaid payments to the
1207facility computed on the basis of the preceding 12-month average
1208Medicaid payments to the facility. If a preceding 12-month
1209average is not available, projected Medicaid payments may be
1210used. The fee shall be deposited into the Grants and Donations
1211Trust Fund and shall be accounted for separately as a Medicaid
1212nursing home overpayment account. These fees shall be used at
1213the sole discretion of the agency to repay nursing home Medicaid
1214overpayments. Payment of this fee shall not release the licensee
1215from any liability for any Medicaid overpayments, nor shall
1216payment bar the agency from seeking to recoup overpayments from
1217the licensee and any other liable party. As a condition of
1218exercising this lease bond alternative, licensees paying this
1219fee must maintain an existing lease bond through the end of the
122030-month term period of that bond. The agency is herein granted
1221specific authority to promulgate all rules pertaining to the
1222administration and management of this account, including
1223withdrawals from the account, subject to federal review and
1224approval. This provision shall take effect upon becoming law and
1225shall apply to any leasehold license application. The financial
1226viability of the Medicaid nursing home overpayment account shall
1227be determined by the agency through annual review of the account
1228balance and the amount of total outstanding, unpaid Medicaid
1229overpayments owing from leasehold licensees to the agency as
1230determined by final agency audits. By March 31 of each year, the
1231agency shall assess the cumulative fees collected under this
1232subparagraph, minus any amounts used to repay nursing home
1233Medicaid overpayments and amounts transferred to contribute to
1234the General Revenue Fund pursuant to s. 215.20. If the net
1235cumulative collections, minus amounts utilized to repay nursing
1236home Medicaid overpayments, exceed $25 million, the provisions
1237of this paragraph shall not apply for the subsequent fiscal
1238year.
1239     3.  The leasehold licensee may meet the bond requirement
1240through other arrangements acceptable to the agency. The agency
1241is herein granted specific authority to promulgate rules
1242pertaining to lease bond arrangements.
1243     4.  All existing nursing facility licensees, operating the
1244facility as a leasehold, shall acquire, maintain, and provide
1245proof to the agency of the 30-month bond required in
1246subparagraph 1., above, on and after July 1, 1993, for each
1247license renewal.
1248     5.  It shall be the responsibility of all nursing facility
1249operators, operating the facility as a leasehold, to renew the
125030-month bond and to provide proof of such renewal to the agency
1251annually.
1252     6.  Any failure of the nursing facility operator to
1253acquire, maintain, renew annually, or provide proof to the
1254agency shall be grounds for the agency to deny, revoke, and
1255suspend the facility license to operate such facility and to
1256take any further action, including, but not limited to,
1257enjoining the facility, asserting a moratorium pursuant to part
1258II of chapter 408, or applying for a receiver, deemed necessary
1259to ensure compliance with this section and to safeguard and
1260protect the health, safety, and welfare of the facility's
1261residents. A lease agreement required as a condition of bond
1262financing or refinancing under s. 154.213 by a health facilities
1263authority or required under s. 159.30 by a county or
1264municipality is not a leasehold for purposes of this paragraph
1265and is not subject to the bond requirement of this paragraph.
1266     (e)  For the 2009-2010 fiscal year only, the provisions of
1267paragraph (d) shall not apply. This paragraph expires July 1,
12682010.
1269     Section 36.  Subsection (3) of section 400.19, Florida
1270Statutes, is amended to read:
1271     400.19  Right of entry and inspection.-
1272     (3)  The agency shall every 15 months conduct at least one
1273unannounced inspection to determine compliance by the licensee
1274with statutes, and with rules promulgated under the provisions
1275of those statutes, governing minimum standards of construction,
1276quality and adequacy of care, and rights of residents. The
1277survey shall be conducted every 6 months for the next 2-year
1278period if the facility has been cited for a class I deficiency,
1279has been cited for two or more class II deficiencies arising
1280from separate surveys or investigations within a 60-day period,
1281or has had three or more substantiated complaints within a 6-
1282month period, each resulting in at least one class I or class II
1283deficiency. In addition to any other fees or fines in this part,
1284the agency shall assess a fine for each facility that is subject
1285to the 6-month survey cycle. The fine for the 2-year period
1286shall be $6,000, one-half to be paid at the completion of each
1287survey. The agency may adjust this fine by the change in the
1288Consumer Price Index, based on the 12 months immediately
1289preceding the increase, to cover the cost of the additional
1290surveys. The agency shall verify through subsequent inspection
1291that any deficiency identified during inspection is corrected.
1292However, the agency may verify the correction of a class III or
1293class IV deficiency unrelated to resident rights or resident
1294care without reinspecting the facility if adequate written
1295documentation has been received from the facility, which
1296provides assurance that the deficiency has been corrected. The
1297giving or causing to be given of advance notice of such
1298unannounced inspections by an employee of the agency to any
1299unauthorized person shall constitute cause for suspension of not
1300fewer than 5 working days according to the provisions of chapter
1301110.
1302     Section 37.  Section 400.195, Florida Statutes, is
1303repealed.
1304     Section 38.  Subsection (5) of section 400.23, Florida
1305Statutes, is amended to read:
1306     400.23  Rules; evaluation and deficiencies; licensure
1307status.-
1308     (5)(a)  The agency, in collaboration with the Division of
1309Children's Medical Services Network of the Department of Health,
1310must, no later than December 31, 1993, adopt rules for minimum
1311standards of care for persons under 21 years of age who reside
1312in nursing home facilities. The rules must include a methodology
1313for reviewing a nursing home facility under ss. 408.031-408.045
1314which serves only persons under 21 years of age. A facility may
1315be exempt from these standards for specific persons between 18
1316and 21 years of age, if the person's physician agrees that
1317minimum standards of care based on age are not necessary.
1318     (b)  The agency, in collaboration with the Division of
1319Children's Medical Services Network, shall adopt rules for
1320minimum staffing requirements for nursing home facilities that
1321serve persons under 21 years of age, which shall apply in lieu
1322of the standards contained in subsection (3).
1323     1.  For persons under 21 years of age who require skilled
1324care, the requirements shall include a minimum combined average
1325of licensed nurses, respiratory therapists, respiratory care
1326practitioners, and certified nursing assistants of 3.9 hours of
1327direct care per resident per day for each nursing home facility.
1328     2.  For persons under 21 years of age who are fragile, the
1329requirements shall include a minimum combined average of
1330licensed nurses, respiratory therapists, respiratory care
1331practitioners, and certified nursing assistants of 5 hours of
1332direct care per resident per day for each nursing home facility.
1333     Section 39.  Subsection (1) of section 400.275, Florida
1334Statutes, is amended to read:
1335     400.275  Agency duties.-
1336     (1)  The agency shall ensure that each newly hired nursing
1337home surveyor, as a part of basic training, is assigned full-
1338time to a licensed nursing home for at least 2 days within a 7-
1339day period to observe facility operations outside of the survey
1340process before the surveyor begins survey responsibilities. Such
1341observations may not be the sole basis of a deficiency citation
1342against the facility. The agency may not assign an individual to
1343be a member of a survey team for purposes of a survey,
1344evaluation, or consultation visit at a nursing home facility in
1345which the surveyor was an employee within the preceding 2 5
1346years.
1347     Section 40.  Subsection (2) of section 400.484, Florida
1348Statutes, is amended to read:
1349     400.484  Right of inspection; violations deficiencies;
1350fines.-
1351     (2)  The agency shall impose fines for various classes of
1352violations deficiencies in accordance with the following
1353schedule:
1354     (a)  Class I violations are defined in s. 408.813. A class
1355I deficiency is any act, omission, or practice that results in a
1356patient's death, disablement, or permanent injury, or places a
1357patient at imminent risk of death, disablement, or permanent
1358injury. Upon finding a class I violation deficiency, the agency
1359shall impose an administrative fine in
1360each occurrence and each day that the
1361exists.
1362     (b)  Class II violations are defined in s. 408.813. A class
1363II deficiency is any act, omission, or practice that has a
1364direct adverse effect on the health, safety, or security of a
1365patient. Upon finding a class II violation deficiency, the
1366agency shall impose an administrative fine in the amount of
1367$5,000 for each occurrence and each day that the violation
1368deficiency exists.
1369     (c)  Class III violations are defined in s. 408.813. A
1370class III deficiency is any act, omission, or practice that has
1371an indirect, adverse effect on the health, safety, or security
1372of a patient. Upon finding an uncorrected or repeated class III
1373violation deficiency, the agency shall impose an administrative
1374fine not to exceed $1,000 for each occurrence and each day that
1375the uncorrected or repeated violation deficiency exists.
1376     (d)  Class IV violations are defined in s. 408.813. A class
1377IV deficiency is any act, omission, or practice related to
1378required reports, forms, or documents which does not have the
1379potential of negatively affecting patients. These violations are
1380of a type that the agency determines do not threaten the health,
1381safety, or security of patients. Upon finding an uncorrected or
1382repeated class IV violation deficiency, the agency shall impose
1383an administrative fine not to exceed $500 for each occurrence
1384and each day that the uncorrected or repeated violation
1385deficiency exists.
1386     Section 41.  Paragraph (i) of subsection (1) and subsection
1387(4) of section 400.606, Florida Statutes, are amended to read:
1388     400.606  License; application; renewal; conditional license
1389or permit; certificate of need.-
1390     (1)  In addition to the requirements of part II of chapter
1391408, the initial application and change of ownership application
1392must be accompanied by a plan for the delivery of home,
1393residential, and homelike inpatient hospice services to
1394terminally ill persons and their families. Such plan must
1395contain, but need not be limited to:
1396     (i)  The projected annual operating cost of the hospice.
1397
1398If the applicant is an existing licensed health care provider,
1399the application must be accompanied by a copy of the most recent
1400profit-loss statement and, if applicable, the most recent
1401licensure inspection report.
1402     (4)  A freestanding hospice facility that is primarily
1403engaged in providing inpatient and related services and that is
1404not otherwise licensed as a health care facility shall be
1405required to obtain a certificate of need. However, a
1406freestanding hospice facility with six or fewer beds shall not
1407be required to comply with institutional standards such as, but
1408not limited to, standards requiring sprinkler systems, emergency
1409electrical systems, or special lavatory devices.
1410     Section 42.  Subsection (2) of section 400.607, Florida
1411Statutes, is amended to read:
1412     400.607  Denial, suspension, revocation of license;
1413emergency actions; imposition of administrative fine; grounds.-
1414     (2)  A violation of this part, part II of chapter 408, or
1415applicable rules Any of the following actions by a licensed
1416hospice or any of its employees shall be grounds for
1417administrative action by the agency against a hospice.:
1418     (a)  A violation of the provisions of this part, part II of
1419chapter 408, or applicable rules.
1420     (b)  An intentional or negligent act materially affecting
1421the health or safety of a patient.
1422     Section 43.  Section 400.915, Florida Statutes, is amended
1423to read:
1424     400.915  Construction and renovation; requirements.-The
1425requirements for the construction or renovation of a PPEC center
1426shall comply with:
1427     (1)  The provisions of chapter 553, which pertain to
1428building construction standards, including plumbing, electrical
1429code, glass, manufactured buildings, accessibility for the
1430physically disabled;
1431     (2)  The provisions of s. 633.022 and applicable rules
1432pertaining to physical minimum standards for nonresidential
1433child care physical facilities in rule 10M-12.003, Florida
1434Administrative Code, Child Care Standards; and
1435     (3)  The standards or rules adopted pursuant to this part
1436and part II of chapter 408.
1437     Section 44.  Subsection (1) of section 400.925, Florida
1438Statutes, is amended to read:
1439     400.925  Definitions.-As used in this part, the term:
1440     (1)  "Accrediting organizations" means The Joint Commission
1441on Accreditation of Healthcare Organizations or other national
1442accreditation agencies whose standards for accreditation are
1443comparable to those required by this part for licensure.
1444     Section 45.  Subsections (3) through (6) of section
1445400.931, Florida Statutes, are renumbered as subsections (2)
1446through (5), respectively, and present subsection (2) of that
1447section is amended to read:
1448     400.931  Application for license; fee; provisional license;
1449temporary permit.-
1450     (2)  As an alternative to submitting proof of financial
1451ability to operate as required in s. 408.810(8), the applicant
1452may submit a $50,000 surety bond to the agency.
1453     Section 46.  Subsection (2) of section 400.932, Florida
1454Statutes, is amended to read:
1455     400.932  Administrative penalties.-
1456     (2)  A violation of this part, part II of chapter 408, or
1457applicable rules Any of the following actions by an employee of
1458a home medical equipment provider shall be are grounds for
1459administrative action or penalties by the agency.:
1460     (a)  Violation of this part, part II of chapter 408, or
1461applicable rules.
1462     (b)  An intentional, reckless, or negligent act that
1463materially affects the health or safety of a patient.
1464     Section 47.  Subsection (3) of section 400.967, Florida
1465Statutes, is amended to read:
1466     400.967  Rules and classification of violations
1467deficiencies.-
1468     (3)  The agency shall adopt rules to provide that, when the
1469criteria established under this part and part II of chapter 408
1470are not met, such violations deficiencies shall be classified
1471according to the nature of the violation deficiency. The agency
1472shall indicate the classification on the face of the notice of
1473deficiencies as follows:
1474     (a)  Class I violations deficiencies are defined in s.
1475408.813 those which the agency determines present an imminent
1476danger to the residents or guests of the facility or a
1477substantial probability that death or serious physical harm
1478would result therefrom. The condition or practice constituting a
1479class I violation must be abated or eliminated immediately,
1480unless a fixed period of time, as determined by the agency, is
1481required for correction. A class I violation deficiency is
1482subject to a civil penalty in an amount not less than $5,000 and
1483not exceeding $10,000 for each violation deficiency. A fine may
1484be levied notwithstanding the correction of the violation
1485deficiency.
1486     (b)  Class II violations deficiencies are defined in s.
1487408.813 those which the agency determines have a direct or
1488immediate relationship to the health, safety, or security of the
1489facility residents, other than class I deficiencies. A class II
1490violation deficiency is subject to a civil penalty in an amount
1491not less than $1,000 and not exceeding $5,000 for each violation
1492deficiency. A citation for a class II violation deficiency shall
1493specify the time within which the violation deficiency must be
1494corrected. If a class II violation deficiency is corrected
1495within the time specified, no civil penalty shall be imposed,
1496unless it is a repeated offense.
1497     (c)  Class III violations deficiencies are defined in s.
1498408.813 those which the agency determines to have an indirect or
1499potential relationship to the health, safety, or security of the
1500facility residents, other than class I or class II deficiencies.
1501A class III violation deficiency is subject to a civil penalty
1502of not less than $500 and not exceeding $1,000 for each
1503deficiency. A citation for a class III violation deficiency
1504shall specify the time within which the violation deficiency
1505must be corrected. If a class III violation deficiency is
1506corrected within the time specified, no civil penalty shall be
1507imposed, unless it is a repeated offense.
1508     (d)  Class IV violations are defined in s. 408.813. Upon
1509finding an uncorrected or repeated class IV violation, the
1510agency shall impose an administrative fine not to exceed $500
1511for each occurrence and each day that the uncorrected or
1512repeated violation exists.
1513     Section 48.  Subsections (4) and (7) of section 400.9905,
1514Florida Statutes, are amended to read:
1515     400.9905  Definitions.-
1516     (4)  "Clinic" means an entity at which health care services
1517are provided to individuals and which tenders charges for
1518reimbursement for such services, including a mobile clinic and a
1519portable health service or equipment provider. For purposes of
1520this part, the term does not include and the licensure
1521requirements of this part do not apply to:
1522     (a)  Entities licensed or registered by the state under
1523chapter 395; or entities licensed or registered by the state and
1524providing only health care services within the scope of services
1525authorized under their respective licenses granted under ss.
1526383.30-383.335, chapter 390, chapter 394, chapter 397, this
1527chapter except part X, chapter 429, chapter 463, chapter 465,
1528chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1529chapter 651; end-stage renal disease providers authorized under
153042 C.F.R. part 405, subpart U; or providers certified under 42
1531C.F.R. part 485, subpart B or subpart H; or any entity that
1532provides neonatal or pediatric hospital-based health care
1533services or other health care services by licensed practitioners
1534solely within a hospital licensed under chapter 395.
1535     (b)  Entities that own, directly or indirectly, entities
1536licensed or registered by the state pursuant to chapter 395; or
1537entities that own, directly or indirectly, entities licensed or
1538registered by the state and providing only health care services
1539within the scope of services authorized pursuant to their
1540respective licenses granted under ss. 383.30-383.335, chapter
1541390, chapter 394, chapter 397, this chapter except part X,
1542chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1543part I of chapter 483, chapter 484, chapter 651; end-stage renal
1544disease providers authorized under 42 C.F.R. part 405, subpart
1545U; or providers certified under 42 C.F.R. part 485, subpart B or
1546subpart H; or any entity that provides neonatal or pediatric
1547hospital-based health care services by licensed practitioners
1548solely within a hospital licensed under chapter 395.
1549     (c)  Entities that are owned, directly or indirectly, by an
1550entity licensed or registered by the state pursuant to chapter
1551395; or entities that are owned, directly or indirectly, by an
1552entity licensed or registered by the state and providing only
1553health care services within the scope of services authorized
1554pursuant to their respective licenses granted under ss. 383.30-
1555383.335, chapter 390, chapter 394, chapter 397, this chapter
1556except part X, chapter 429, chapter 463, chapter 465, chapter
1557466, chapter 478, part I of chapter 483, chapter 484, or chapter
1558651; end-stage renal disease providers authorized under 42
1559C.F.R. part 405, subpart U; or providers certified under 42
1560C.F.R. part 485, subpart B or subpart H; or any entity that
1561provides neonatal or pediatric hospital-based health care
1562services by licensed practitioners solely within a hospital
1563under chapter 395.
1564     (d)  Entities that are under common ownership, directly or
1565indirectly, with an entity licensed or registered by the state
1566pursuant to chapter 395; or entities that are under common
1567ownership, directly or indirectly, with an entity licensed or
1568registered by the state and providing only health care services
1569within the scope of services authorized pursuant to their
1570respective licenses granted under ss. 383.30-383.335, chapter
1571390, chapter 394, chapter 397, this chapter except part X,
1572chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1573part I of chapter 483, chapter 484, or chapter 651; end-stage
1574renal disease providers authorized under 42 C.F.R. part 405,
1575subpart U; or providers certified under 42 C.F.R. part 485,
1576subpart B or subpart H; or any entity that provides neonatal or
1577pediatric hospital-based health care services by licensed
1578practitioners solely within a hospital licensed under chapter
1579395.
1580     (e)  An entity that is exempt from federal taxation under
158126 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1582under 26 U.S.C. s. 409 that has a board of trustees not less
1583than two-thirds of which are Florida-licensed health care
1584practitioners and provides only physical therapy services under
1585physician orders, any community college or university clinic,
1586and any entity owned or operated by the federal or state
1587government, including agencies, subdivisions, or municipalities
1588thereof.
1589     (f)  A sole proprietorship, group practice, partnership, or
1590corporation that provides health care services by physicians
1591covered by s. 627.419, that is directly supervised by one or
1592more of such physicians, and that is wholly owned by one or more
1593of those physicians or by a physician and the spouse, parent,
1594child, or sibling of that physician.
1595     (g)  A sole proprietorship, group practice, partnership, or
1596corporation that provides health care services by licensed
1597health care practitioners under chapter 457, chapter 458,
1598chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1599chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1600chapter 490, chapter 491, or part I, part III, part X, part
1601XIII, or part XIV of chapter 468, or s. 464.012, which are
1602wholly owned by one or more licensed health care practitioners,
1603or the licensed health care practitioners set forth in this
1604paragraph and the spouse, parent, child, or sibling of a
1605licensed health care practitioner, so long as one of the owners
1606who is a licensed health care practitioner is supervising the
1607business activities and is legally responsible for the entity's
1608compliance with all federal and state laws. However, a health
1609care practitioner may not supervise services beyond the scope of
1610the practitioner's license, except that, for the purposes of
1611this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1612provides only services authorized pursuant to s. 456.053(3)(b)
1613may be supervised by a licensee specified in s. 456.053(3)(b).
1614     (h)  Clinical facilities affiliated with an accredited
1615medical school at which training is provided for medical
1616students, residents, or fellows.
1617     (i)  Entities that provide only oncology or radiation
1618therapy services by physicians licensed under chapter 458 or
1619chapter 459 or entities that provide oncology or radiation
1620therapy services by physicians licensed under chapter 458 or
1621chapter 459 which are owned by a corporation whose shares are
1622publicly traded on a recognized stock exchange.
1623     (j)  Clinical facilities affiliated with a college of
1624chiropractic accredited by the Council on Chiropractic Education
1625at which training is provided for chiropractic students.
1626     (k)  Entities that provide licensed practitioners to staff
1627emergency departments or to deliver anesthesia services in
1628facilities licensed under chapter 395 and that derive at least
162990 percent of their gross annual revenues from the provision of
1630such services. Entities claiming an exemption from licensure
1631under this paragraph must provide documentation demonstrating
1632compliance.
1633     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1634perinatology clinical facilities that are a publicly traded
1635corporation or that are wholly owned, directly or indirectly, by
1636a publicly traded corporation. As used in this paragraph, a
1637publicly traded corporation is a corporation that issues
1638securities traded on an exchange registered with the United
1639States Securities and Exchange Commission as a national
1640securities exchange.
1641     (m)  Entities that are owned by a corporation that has $250
1642million or more in total annual sales of health care services
1643provided by licensed health care practitioners if one or more of
1644the owners of the entity is a health care practitioner who is
1645licensed in this state, is responsible for supervising the
1646business activities of the entity, and is legally responsible
1647for the entity's compliance with state law for purposes of this
1648section.
1649     (n)  Entities that are owned or controlled, directly or
1650indirectly, by a publicly traded entity with $100 million or
1651more, in the aggregate, in total annual revenues derived from
1652providing health care services by licensed health care
1653practitioners that are employed or contracted by an entity
1654described in this paragraph.
1655     (7)  "Portable health service or equipment provider" means
1656an entity that contracts with or employs persons to provide
1657portable health care services or equipment to multiple locations
1658performing treatment or diagnostic testing of individuals, that
1659bills third-party payors for those services, and that otherwise
1660meets the definition of a clinic in subsection (4).
1661     Section 49.  Paragraph (b) of subsection (1) and paragraph
1662(c) of subsection (4) of section 400.991, Florida Statutes, are
1663amended to read:
1664     400.991  License requirements; background screenings;
1665prohibitions.-
1666     (1)
1667     (b)  Each mobile clinic must obtain a separate health care
1668clinic license and must provide to the agency, at least
1669quarterly, its projected street location to enable the agency to
1670locate and inspect such clinic. A portable health service or
1671equipment provider must obtain a health care clinic license for
1672a single administrative office and is not required to submit
1673quarterly projected street locations.
1674     (4)  In addition to the requirements of part II of chapter
1675408, the applicant must file with the application satisfactory
1676proof that the clinic is in compliance with this part and
1677applicable rules, including:
1678     (c)  Proof of financial ability to operate as required
1679under ss. s. 408.810(8) and 408.8065. As an alternative to
1680submitting proof of financial ability to operate as required
1681under s. 408.810(8), the applicant may file a surety bond of at
1682least $500,000 which guarantees that the clinic will act in full
1683conformity with all legal requirements for operating a clinic,
1684payable to the agency. The agency may adopt rules to specify
1685related requirements for such surety bond.
1686     Section 50.  Paragraph (g) of subsection (1) and paragraph
1687(a) of subsection (7) of section 400.9935, Florida Statutes, are
1688amended to read:
1689     400.9935  Clinic responsibilities.-
1690     (1)  Each clinic shall appoint a medical director or clinic
1691director who shall agree in writing to accept legal
1692responsibility for the following activities on behalf of the
1693clinic. The medical director or the clinic director shall:
1694     (g)  Conduct systematic reviews of clinic billings to
1695ensure that the billings are not fraudulent or unlawful. Upon
1696discovery of an unlawful charge, the medical director or clinic
1697director shall take immediate corrective action. If the clinic
1698performs only the technical component of magnetic resonance
1699imaging, static radiographs, computed tomography, or positron
1700emission tomography, and provides the professional
1701interpretation of such services, in a fixed facility that is
1702accredited by The Joint Commission on Accreditation of
1703Healthcare Organizations or the Accreditation Association for
1704Ambulatory Health Care, and the American College of Radiology;
1705and if, in the preceding quarter, the percentage of scans
1706performed by that clinic which was billed to all personal injury
1707protection insurance carriers was less than 15 percent, the
1708chief financial officer of the clinic may, in a written
1709acknowledgment provided to the agency, assume the responsibility
1710for the conduct of the systematic reviews of clinic billings to
1711ensure that the billings are not fraudulent or unlawful.
1712     (7)(a)  Each clinic engaged in magnetic resonance imaging
1713services must be accredited by The Joint Commission on
1714Accreditation of Healthcare Organizations, the American College
1715of Radiology, or the Accreditation Association for Ambulatory
1716Health Care, within 1 year after licensure. A clinic that is
1717accredited by the American College of Radiology or is within the
1718original 1-year period after licensure and replaces its core
1719magnetic resonance imaging equipment shall be given 1 year after
1720the date on which the equipment is replaced to attain
1721accreditation. However, a clinic may request a single, 6-month
1722extension if it provides evidence to the agency establishing
1723that, for good cause shown, such clinic cannot be accredited
1724within 1 year after licensure, and that such accreditation will
1725be completed within the 6-month extension. After obtaining
1726accreditation as required by this subsection, each such clinic
1727must maintain accreditation as a condition of renewal of its
1728license. A clinic that files a change of ownership application
1729must comply with the original accreditation timeframe
1730requirements of the transferor. The agency shall deny a change
1731of ownership application if the clinic is not in compliance with
1732the accreditation requirements. When a clinic adds, replaces, or
1733modifies magnetic resonance imaging equipment and the
1734accreditation agency requires new accreditation, the clinic must
1735be accredited within 1 year after the date of the addition,
1736replacement, or modification but may request a single, 6-month
1737extension if the clinic provides evidence of good cause to the
1738agency.
1739     Section 51.  Subsection (2) of section 408.034, Florida
1740Statutes, is amended to read:
1741     408.034  Duties and responsibilities of agency; rules.-
1742     (2)  In the exercise of its authority to issue licenses to
1743health care facilities and health service providers, as provided
1744under chapters 393 and 395 and parts II, and IV, and VIII of
1745chapter 400, the agency may not issue a license to any health
1746care facility or health service provider that fails to receive a
1747certificate of need or an exemption for the licensed facility or
1748service.
1749     Section 52.  Paragraph (d) of subsection (1) of section
1750408.036, Florida Statutes, is amended to read:
1751     408.036  Projects subject to review; exemptions.-
1752     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1753health-care-related projects, as described in paragraphs (a)-
1754(g), are subject to review and must file an application for a
1755certificate of need with the agency. The agency is exclusively
1756responsible for determining whether a health-care-related
1757project is subject to review under ss. 408.031-408.045.
1758     (d)  The establishment of a hospice or hospice inpatient
1759facility, except as provided in s. 408.043.
1760     Section 53.  Subsection (2) of section 408.043, Florida
1761Statutes, is amended to read:
1762     408.043  Special provisions.-
1763     (2)  HOSPICES.-When an application is made for a
1764certificate of need to establish or to expand a hospice, the
1765need for such hospice shall be determined on the basis of the
1766need for and availability of hospice services in the community.
1767The formula on which the certificate of need is based shall
1768discourage regional monopolies and promote competition. The
1769inpatient hospice care component of a hospice which is a
1770freestanding facility, or a part of a facility, which is
1771primarily engaged in providing inpatient care and related
1772services and is not licensed as a health care facility shall
1773also be required to obtain a certificate of need. Provision of
1774hospice care by any current provider of health care is a
1775significant change in service and therefore requires a
1776certificate of need for such services.
1777     Section 54.  Paragraph (k) of subsection (3) of section
1778408.05, Florida Statutes, is amended to read:
1779     408.05  Florida Center for Health Information and Policy
1780Analysis.-
1781     (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1782produce comparable and uniform health information and statistics
1783for the development of policy recommendations, the agency shall
1784perform the following functions:
1785     (k)  Develop, in conjunction with the State Consumer Health
1786Information and Policy Advisory Council, and implement a long-
1787range plan for making available health care quality measures and
1788financial data that will allow consumers to compare health care
1789services. The health care quality measures and financial data
1790the agency must make available shall include, but is not limited
1791to, pharmaceuticals, physicians, health care facilities, and
1792health plans and managed care entities. The agency shall submit
1793the initial plan to the Governor, the President of the Senate,
1794and the Speaker of the House of Representatives by January 1,
17952006, and shall update the plan and report on the status of its
1796implementation annually thereafter. The agency shall also make
1797the plan and status report available to the public on its
1798Internet website. As part of the plan, the agency shall identify
1799the process and timeframes for implementation, any barriers to
1800implementation, and recommendations of changes in the law that
1801may be enacted by the Legislature to eliminate the barriers. As
1802preliminary elements of the plan, the agency shall:
1803     1.  Make available patient-safety indicators, inpatient
1804quality indicators, and performance outcome and patient charge
1805data collected from health care facilities pursuant to s.
1806408.061(1)(a) and (2). The terms "patient-safety indicators" and
1807"inpatient quality indicators" shall be as defined by the
1808Centers for Medicare and Medicaid Services, the National Quality
1809Forum, The Joint Commission on Accreditation of Healthcare
1810Organizations, the Agency for Healthcare Research and Quality,
1811the Centers for Disease Control and Prevention, or a similar
1812national entity that establishes standards to measure the
1813performance of health care providers, or by other states. The
1814agency shall determine which conditions, procedures, health care
1815quality measures, and patient charge data to disclose based upon
1816input from the council. When determining which conditions and
1817procedures are to be disclosed, the council and the agency shall
1818consider variation in costs, variation in outcomes, and
1819magnitude of variations and other relevant information. When
1820determining which health care quality measures to disclose, the
1821agency:
1822     a.  Shall consider such factors as volume of cases; average
1823patient charges; average length of stay; complication rates;
1824mortality rates; and infection rates, among others, which shall
1825be adjusted for case mix and severity, if applicable.
1826     b.  May consider such additional measures that are adopted
1827by the Centers for Medicare and Medicaid Studies, National
1828Quality Forum, The Joint Commission on Accreditation of
1829Healthcare Organizations, the Agency for Healthcare Research and
1830Quality, Centers for Disease Control and Prevention, or a
1831similar national entity that establishes standards to measure
1832the performance of health care providers, or by other states.
1833
1834When determining which patient charge data to disclose, the
1835agency shall include such measures as the average of
1836undiscounted charges on frequently performed procedures and
1837preventive diagnostic procedures, the range of procedure charges
1838from highest to lowest, average net revenue per adjusted patient
1839day, average cost per adjusted patient day, and average cost per
1840admission, among others.
1841     2.  Make available performance measures, benefit design,
1842and premium cost data from health plans licensed pursuant to
1843chapter 627 or chapter 641. The agency shall determine which
1844health care quality measures and member and subscriber cost data
1845to disclose, based upon input from the council. When determining
1846which data to disclose, the agency shall consider information
1847that may be required by either individual or group purchasers to
1848assess the value of the product, which may include membership
1849satisfaction, quality of care, current enrollment or membership,
1850coverage areas, accreditation status, premium costs, plan costs,
1851premium increases, range of benefits, copayments and
1852deductibles, accuracy and speed of claims payment, credentials
1853of physicians, number of providers, names of network providers,
1854and hospitals in the network. Health plans shall make available
1855to the agency any such data or information that is not currently
1856reported to the agency or the office.
1857     3.  Determine the method and format for public disclosure
1858of data reported pursuant to this paragraph. The agency shall
1859make its determination based upon input from the State Consumer
1860Health Information and Policy Advisory Council. At a minimum,
1861the data shall be made available on the agency's Internet
1862website in a manner that allows consumers to conduct an
1863interactive search that allows them to view and compare the
1864information for specific providers. The website must include
1865such additional information as is determined necessary to ensure
1866that the website enhances informed decisionmaking among
1867consumers and health care purchasers, which shall include, at a
1868minimum, appropriate guidance on how to use the data and an
1869explanation of why the data may vary from provider to provider.
1870The data specified in subparagraph 1. shall be released no later
1871than January 1, 2006, for the reporting of infection rates, and
1872no later than October 1, 2005, for mortality rates and
1873complication rates. The data specified in subparagraph 2. shall
1874be released no later than October 1, 2006.
1875     4.  Publish on its website undiscounted charges for no
1876fewer than 150 of the most commonly performed adult and
1877pediatric procedures, including outpatient, inpatient,
1878diagnostic, and preventative procedures.
1879     Section 55.  Paragraph (a) of subsection (1) of section
1880408.061, Florida Statutes, is amended to read:
1881     408.061  Data collection; uniform systems of financial
1882reporting; information relating to physician charges;
1883confidential information; immunity.-
1884     (1)  The agency shall require the submission by health care
1885facilities, health care providers, and health insurers of data
1886necessary to carry out the agency's duties. Specifications for
1887data to be collected under this section shall be developed by
1888the agency with the assistance of technical advisory panels
1889including representatives of affected entities, consumers,
1890purchasers, and such other interested parties as may be
1891determined by the agency.
1892     (a)  Data submitted by health care facilities, including
1893the facilities as defined in chapter 395, shall include, but are
1894not limited to: case-mix data, patient admission and discharge
1895data, hospital emergency department data which shall include the
1896number of patients treated in the emergency department of a
1897licensed hospital reported by patient acuity level, data on
1898hospital-acquired infections as specified by rule, data on
1899complications as specified by rule, data on readmissions as
1900specified by rule, with patient and provider-specific
1901identifiers included, actual charge data by diagnostic groups,
1902financial data, accounting data, operating expenses, expenses
1903incurred for rendering services to patients who cannot or do not
1904pay, interest charges, depreciation expenses based on the
1905expected useful life of the property and equipment involved, and
1906demographic data. The agency shall adopt nationally recognized
1907risk adjustment methodologies or software consistent with the
1908standards of the Agency for Healthcare Research and Quality and
1909as selected by the agency for all data submitted as required by
1910this section. Data may be obtained from documents such as, but
1911not limited to: leases, contracts, debt instruments, itemized
1912patient bills, medical record abstracts, and related diagnostic
1913information. Reported data elements shall be reported
1914electronically and in accordance with rule 59E-7.012, Florida
1915Administrative Code. Data submitted shall be certified
1916chief executive officer or an appropriate and duly authorized
1917representative or employee of the licensed facility that the
1918information submitted is true and accurate.
1919     Section 56.  Subsection (43) of section 408.07, Florida
1920Statutes, is amended to read:
1921     408.07  Definitions.-As used in this chapter, with the
1922exception of ss. 408.031-408.045, the term:
1923     (43)  "Rural hospital" means an acute care hospital
1924licensed under chapter 395, having 100 or fewer licensed beds
1925and an emergency room, and which is:
1926     (a)  The sole provider within a county with a population
1927density of no greater than 100 persons per square mile;
1928     (b)  An acute care hospital, in a county with a population
1929density of no greater than 100 persons per square mile, which is
1930at least 30 minutes of travel time, on normally traveled roads
1931under normal traffic conditions, from another acute care
1932hospital within the same county;
1933     (c)  A hospital supported by a tax district or subdistrict
1934whose boundaries encompass a population of 100 persons or fewer
1935per square mile;
1936     (d)  A hospital with a service area that has a population
1937of 100 persons or fewer per square mile. As used in this
1938paragraph, the term "service area" means the fewest number of
1939zip codes that account for 75 percent of the hospital's
1940discharges for the most recent 5-year period, based on
1941information available from the hospital inpatient discharge
1942database in the Florida Center for Health Information and Policy
1943Analysis at the Agency for Health Care Administration; or
1944     (e)  A critical access hospital.
1945
1946Population densities used in this subsection must be based upon
1947the most recently completed United States census. A hospital
1948that received funds under s. 409.9116 for a quarter beginning no
1949later than July 1, 2002, is deemed to have been and shall
1950continue to be a rural hospital from that date through June 30,
19512015, if the hospital continues to have 100 or fewer licensed
1952beds and an emergency room, or meets the criteria of s.
1953395.602(2)(e)4. An acute care hospital that has not previously
1954been designated as a rural hospital and that meets the criteria
1955of this subsection shall be granted such designation upon
1956application, including supporting documentation, to the Agency
1957for Health Care Administration.
1958     Section 57.  Section 408.10, Florida Statutes, is amended
1959to read:
1960     408.10  Consumer complaints.-The agency shall:
1961     (1)  publish and make available to the public a toll-free
1962telephone number for the purpose of handling consumer complaints
1963and shall serve as a liaison between consumer entities and other
1964private entities and governmental entities for the disposition
1965of problems identified by consumers of health care.
1966     (2)  Be empowered to investigate consumer complaints
1967relating to problems with health care facilities' billing
1968practices and issue reports to be made public in any cases where
1969the agency determines the health care facility has engaged in
1970billing practices which are unreasonable and unfair to the
1971consumer.
1972     Section 58.  Subsections (12) through (30) of section
1973408.802, Florida Statutes, are renumbered as subsections (11)
1974through (29), respectively, and present subsection (11) of that
1975section is amended to read:
1976     408.802  Applicability.-The provisions of this part apply
1977to the provision of services that require licensure as defined
1978in this part and to the following entities licensed, registered,
1979or certified by the agency, as described in chapters 112, 383,
1980390, 394, 395, 400, 429, 440, 483, and 765:
1981     (11)  Private review agents, as provided under part I of
1982chapter 395.
1983     Section 59.  Subsection (3) is added to section 408.804,
1984Florida Statutes, to read:
1985     408.804  License required; display.-
1986     (3)  Any person who knowingly alters, defaces, or falsifies
1987a license certificate issued by the agency, or causes or
1988procures any person to commit such an offense, commits a
1989misdemeanor of the second degree, punishable as provided in s.
1990775.082 or s 775.083. Any licensee or provider who displays an
1991altered, defaced, or falsified license certificate is subject to
1992the penalties set forth in s. 408.815 and an administrative fine
1993of $1,000 for each day of illegal display.
1994     Section 60.  Paragraph (d) of subsection (2) of section
1995408.806, Florida Statutes, is amended, present subsections (3)
1996through (8) are renumbered as subsections (4) through (9),
1997respectively, and a new subsection (3) is added to that section,
1998to read:
1999     408.806  License application process.-
2000     (2)
2001     (d)  The agency shall notify the licensee by mail or
2002electronically at least 90 days before the expiration of a
2003license that a renewal license is necessary to continue
2004operation. The licensee's failure to timely file submit a
2005renewal application and license application fee with the agency
2006shall result in a $50 per day late fee charged to the licensee
2007by the agency; however, the aggregate amount of the late fee may
2008not exceed 50 percent of the licensure fee or $500, whichever is
2009less. The agency shall provide a courtesy notice to the licensee
2010by United States mail, electronically, or by any other manner at
2011its address of record or mailing address, if provided, at least
201290 days prior to the expiration of a license informing the
2013licensee of the expiration of the license. If the agency does
2014not provide the courtesy notice or the licensee does not receive
2015the courtesy notice, the licensee continues to be legally
2016obligated to timely file the renewal application and license
2017application fee with the agency and is not excused from the
2018payment of a late fee. If an application is received after the
2019required filing date and exhibits a hand-canceled postmark
2020obtained from a United States post office dated on or before the
2021required filing date, no fine will be levied.
2022     (3)  Payment of the late fee is required to consider any
2023late application complete, and failure to pay the late fee is
2024considered an omission from the application.
2025     Section 61.  Subsections (6) and (9) of section 408.810,
2026Florida Statutes, are amended to read:
2027     408.810  Minimum licensure requirements.-In addition to the
2028licensure requirements specified in this part, authorizing
2029statutes, and applicable rules, each applicant and licensee must
2030comply with the requirements of this section in order to obtain
2031and maintain a license.
2032     (6)(a)  An applicant must provide the agency with proof of
2033the applicant's legal right to occupy the property before a
2034license may be issued. Proof may include, but need not be
2035limited to, copies of warranty deeds, lease or rental
2036agreements, contracts for deeds, quitclaim deeds, or other such
2037documentation.
2038     (b)  In the event the property is encumbered by a mortgage
2039or is leased, an applicant must provide the agency with proof
2040that the mortgagor or landlord has been provided written notice
2041of the applicant's intent as mortgagee or tenant to provide
2042services that require licensure and instruct the mortgagor or
2043landlord to serve the agency by certified mail with copies of
2044any foreclosure or eviction actions initiated by the mortgagor
2045or landlord against the applicant.
2046     (9)  A controlling interest may not withhold from the
2047agency any evidence of financial instability, including, but not
2048limited to, checks returned due to insufficient funds,
2049delinquent accounts, nonpayment of withholding taxes, unpaid
2050utility expenses, nonpayment for essential services, or adverse
2051court action concerning the financial viability of the provider
2052or any other provider licensed under this part that is under the
2053control of the controlling interest. A controlling interest
2054shall notify the agency within 10 days after a court action to
2055initiate bankruptcy, foreclosure, or eviction proceedings
2056concerning the provider, in which the controlling interest is a
2057petitioner or defendant. Any person who violates this subsection
2058commits a misdemeanor of the second degree, punishable as
2059provided in s. 775.082 or s. 775.083. Each day of continuing
2060violation is a separate offense.
2061     Section 62.  Subsection (3) is added to section 408.813,
2062Florida Statutes, to read:
2063     408.813  Administrative fines; violations.-As a penalty for
2064any violation of this part, authorizing statutes, or applicable
2065rules, the agency may impose an administrative fine.
2066     (3)  The agency may impose an administrative fine for a
2067violation that does not qualify as a class I, class II, class
2068III, or class IV violation. Unless otherwise specified by law,
2069the amount of the fine shall not exceed $500 for each violation.
2070Unclassified violations may include:
2071     (a)  Violating any term or condition of a license.
2072     (b)  Violating any provision of this part, authorizing
2073statutes, or applicable rules.
2074     (c)  Exceeding licensed capacity.
2075     (d)  Providing services beyond the scope of the license.
2076     (e)  Violating a moratorium imposed pursuant to s. 408.814.
2077     Section 63.  Subsection (5) is added to section 408.815,
2078Florida Statutes, to read:
2079     408.815  License or application denial; revocation.-
2080     (5)  In order to ensure the health, safety, and welfare of
2081clients when a license has been denied, revoked, or is set to
2082terminate, the agency may extend the license expiration date for
2083a period of up to 30 days for the sole purpose of allowing the
2084safe and orderly discharge of clients. The agency may impose
2085conditions on the extension, including, but not limited to,
2086prohibiting or limiting admissions, expedited discharge
2087planning, required status reports, and mandatory monitoring by
2088the agency or third parties. In imposing these conditions, the
2089agency shall take into consideration the nature and number of
2090clients, the availability and location of acceptable alternative
2091placements, and the ability of the licensee to continue
2092providing care to the clients. The agency may terminate the
2093extension or modify the conditions at any time. This authority
2094is in addition to any other authority granted to the agency
2095under chapter 120, this part, and authorizing statutes but
2096creates no right or entitlement to an extension of a license
2097expiration date.
2098     Section 64.  Paragraph (k) of subsection (4) of section
2099409.221, Florida Statutes, is amended to read:
2100     409.221  Consumer-directed care program.-
2101     (4)  CONSUMER-DIRECTED CARE.-
2102     (k)  Reviews and reports.-The agency and the Departments of
2103Elderly Affairs, Health, and Children and Family Services and
2104the Agency for Persons with Disabilities shall each, on an
2105ongoing basis, review and assess the implementation of the
2106consumer-directed care program. By January 15 of each year, the
2107agency shall submit a written report to the Legislature that
2108includes each department's review of the program and contains
2109recommendations for improvements to the program.
2110     Section 65.  Subsection (1) of section 409.91196, Florida
2111Statutes, is amended to read:
2112     409.91196  Supplemental rebate agreements; public records
2113and public meetings exemption.-
2114     (1)  The rebate amount, percent of rebate, manufacturer's
2115pricing, and supplemental rebate, and other trade secrets as
2116defined in s. 688.002 that the agency has identified for use in
2117negotiations, held by the Agency for Health Care Administration
2118under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2119119.07(1) and s. 24(a), Art. I of the State Constitution.
2120     Section 66.  Paragraph (a) of subsection (39) of section
2121409.912, Florida Statutes, is amended to read:
2122     409.912  Cost-effective purchasing of health care.-The
2123agency shall purchase goods and services for Medicaid recipients
2124in the most cost-effective manner consistent with the delivery
2125of quality medical care. To ensure that medical services are
2126effectively utilized, the agency may, in any case, require a
2127confirmation or second physician's opinion of the correct
2128diagnosis for purposes of authorizing future services under the
2129Medicaid program. This section does not restrict access to
2130emergency services or poststabilization care services as defined
2131in 42 C.F.R. part 438.114. Such confirmation or second opinion
2132shall be rendered in a manner approved by the agency. The agency
2133shall maximize the use of prepaid per capita and prepaid
2134aggregate fixed-sum basis services when appropriate and other
2135alternative service delivery and reimbursement methodologies,
2136including competitive bidding pursuant to s. 287.057, designed
2137to facilitate the cost-effective purchase of a case-managed
2138continuum of care. The agency shall also require providers to
2139minimize the exposure of recipients to the need for acute
2140inpatient, custodial, and other institutional care and the
2141inappropriate or unnecessary use of high-cost services. The
2142agency shall contract with a vendor to monitor and evaluate the
2143clinical practice patterns of providers in order to identify
2144trends that are outside the normal practice patterns of a
2145provider's professional peers or the national guidelines of a
2146provider's professional association. The vendor must be able to
2147provide information and counseling to a provider whose practice
2148patterns are outside the norms, in consultation with the agency,
2149to improve patient care and reduce inappropriate utilization.
2150The agency may mandate prior authorization, drug therapy
2151management, or disease management participation for certain
2152populations of Medicaid beneficiaries, certain drug classes, or
2153particular drugs to prevent fraud, abuse, overuse, and possible
2154dangerous drug interactions. The Pharmaceutical and Therapeutics
2155Committee shall make recommendations to the agency on drugs for
2156which prior authorization is required. The agency shall inform
2157the Pharmaceutical and Therapeutics Committee of its decisions
2158regarding drugs subject to prior authorization. The agency is
2159authorized to limit the entities it contracts with or enrolls as
2160Medicaid providers by developing a provider network through
2161provider credentialing. The agency may competitively bid single-
2162source-provider contracts if procurement of goods or services
2163results in demonstrated cost savings to the state without
2164limiting access to care. The agency may limit its network based
2165on the assessment of beneficiary access to care, provider
2166availability, provider quality standards, time and distance
2167standards for access to care, the cultural competence of the
2168provider network, demographic characteristics of Medicaid
2169beneficiaries, practice and provider-to-beneficiary standards,
2170appointment wait times, beneficiary use of services, provider
2171turnover, provider profiling, provider licensure history,
2172previous program integrity investigations and findings, peer
2173review, provider Medicaid policy and billing compliance records,
2174clinical and medical record audits, and other factors. Providers
2175shall not be entitled to enrollment in the Medicaid provider
2176network. The agency shall determine instances in which allowing
2177Medicaid beneficiaries to purchase durable medical equipment and
2178other goods is less expensive to the Medicaid program than long-
2179term rental of the equipment or goods. The agency may establish
2180rules to facilitate purchases in lieu of long-term rentals in
2181order to protect against fraud and abuse in the Medicaid program
2182as defined in s. 409.913. The agency may seek federal waivers
2183necessary to administer these policies.
2184     (39)(a)  The agency shall implement a Medicaid prescribed-
2185drug spending-control program that includes the following
2186components:
2187     1.  A Medicaid preferred drug list, which shall be a
2188listing of cost-effective therapeutic options recommended by the
2189Medicaid Pharmacy and Therapeutics Committee established
2190pursuant to s. 409.91195 and adopted by the agency for each
2191therapeutic class on the preferred drug list. At the discretion
2192of the committee, and when feasible, the preferred drug list
2193should include at least two products in a therapeutic class. The
2194agency may post the preferred drug list and updates to the
2195preferred drug list on an Internet website without following the
2196rulemaking procedures of chapter 120. Antiretroviral agents are
2197excluded from the preferred drug list. The agency shall also
2198limit the amount of a prescribed drug dispensed to no more than
2199a 34-day supply unless the drug products' smallest marketed
2200package is greater than a 34-day supply, or the drug is
2201determined by the agency to be a maintenance drug in which case
2202a 100-day maximum supply may be authorized. The agency is
2203authorized to seek any federal waivers necessary to implement
2204these cost-control programs and to continue participation in the
2205federal Medicaid rebate program, or alternatively to negotiate
2206state-only manufacturer rebates. The agency may adopt rules to
2207implement this subparagraph. The agency shall continue to
2208provide unlimited contraceptive drugs and items. The agency must
2209establish procedures to ensure that:
2210     a.  There is a response to a request for prior consultation
2211by telephone or other telecommunication device within 24 hours
2212after receipt of a request for prior consultation; and
2213     b.  A 72-hour supply of the drug prescribed is provided in
2214an emergency or when the agency does not provide a response
2215within 24 hours as required by sub-subparagraph a.
2216     2.  Reimbursement to pharmacies for Medicaid prescribed
2217drugs shall be set at the lesser of: the average wholesale price
2218(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2219plus 4.75 percent, the federal upper limit (FUL), the state
2220maximum allowable cost (SMAC), or the usual and customary (UAC)
2221charge billed by the provider.
2222     3.  For a prescribed drug billed as a 340B prescribed
2223medication, the claim must meet the requirements of the Deficit
2224Reduction Act of 2005 and the federal 340B program, contain a
2225national drug code, and be billed at the actual acquisition cost
2226or payment shall be denied.
2227     4.3.  The agency shall develop and implement a process for
2228managing the drug therapies of Medicaid recipients who are using
2229significant numbers of prescribed drugs each month. The
2230management process may include, but is not limited to,
2231comprehensive, physician-directed medical-record reviews, claims
2232analyses, and case evaluations to determine the medical
2233necessity and appropriateness of a patient's treatment plan and
2234drug therapies. The agency may contract with a private
2235organization to provide drug-program-management services. The
2236Medicaid drug benefit management program shall include
2237initiatives to manage drug therapies for HIV/AIDS patients,
2238patients using 20 or more unique prescriptions in a 180-day
2239period, and the top 1,000 patients in annual spending. The
2240agency shall enroll any Medicaid recipient in the drug benefit
2241management program if he or she meets the specifications of this
2242provision and is not enrolled in a Medicaid health maintenance
2243organization.
2244     5.4.  The agency may limit the size of its pharmacy network
2245based on need, competitive bidding, price negotiations,
2246credentialing, or similar criteria. The agency shall give
2247special consideration to rural areas in determining the size and
2248location of pharmacies included in the Medicaid pharmacy
2249network. A pharmacy credentialing process may include criteria
2250such as a pharmacy's full-service status, location, size,
2251patient educational programs, patient consultation, disease
2252management services, and other characteristics. The agency may
2253impose a moratorium on Medicaid pharmacy enrollment when it is
2254determined that it has a sufficient number of Medicaid-
2255participating providers. The agency must allow dispensing
2256practitioners to participate as a part of the Medicaid pharmacy
2257network regardless of the practitioner's proximity to any other
2258entity that is dispensing prescription drugs under the Medicaid
2259program. A dispensing practitioner must meet all credentialing
2260requirements applicable to his or her practice, as determined by
2261the agency.
2262     6.5.  The agency shall develop and implement a program that
2263requires Medicaid practitioners who prescribe drugs to use a
2264counterfeit-proof prescription pad for Medicaid prescriptions.
2265The agency shall require the use of standardized counterfeit-
2266proof prescription pads by Medicaid-participating prescribers or
2267prescribers who write prescriptions for Medicaid recipients. The
2268agency may implement the program in targeted geographic areas or
2269statewide.
2270     7.6.  The agency may enter into arrangements that require
2271manufacturers of generic drugs prescribed to Medicaid recipients
2272to provide rebates of at least 15.1 percent of the average
2273manufacturer price for the manufacturer's generic products.
2274These arrangements shall require that if a generic-drug
2275manufacturer pays federal rebates for Medicaid-reimbursed drugs
2276at a level below 15.1 percent, the manufacturer must provide a
2277supplemental rebate to the state in an amount necessary to
2278achieve a 15.1-percent rebate level.
2279     8.7.  The agency may establish a preferred drug list as
2280described in this subsection, and, pursuant to the establishment
2281of such preferred drug list, it is authorized to negotiate
2282supplemental rebates from manufacturers that are in addition to
2283those required by Title XIX of the Social Security Act and at no
2284less than 14 percent of the average manufacturer price as
2285defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2286the federal or supplemental rebate, or both, equals or exceeds
228729 percent. There is no upper limit on the supplemental rebates
2288the agency may negotiate. The agency may determine that specific
2289products, brand-name or generic, are competitive at lower rebate
2290percentages. Agreement to pay the minimum supplemental rebate
2291percentage will guarantee a manufacturer that the Medicaid
2292Pharmaceutical and Therapeutics Committee will consider a
2293product for inclusion on the preferred drug list. However, a
2294pharmaceutical manufacturer is not guaranteed placement on the
2295preferred drug list by simply paying the minimum supplemental
2296rebate. Agency decisions will be made on the clinical efficacy
2297of a drug and recommendations of the Medicaid Pharmaceutical and
2298Therapeutics Committee, as well as the price of competing
2299products minus federal and state rebates. The agency is
2300authorized to contract with an outside agency or contractor to
2301conduct negotiations for supplemental rebates. For the purposes
2302of this section, the term "supplemental rebates" means cash
2303rebates. Effective July 1, 2004, value-added programs as a
2304substitution for supplemental rebates are prohibited. The agency
2305is authorized to seek any federal waivers to implement this
2306initiative.
2307     9.8.  The Agency for Health Care Administration shall
2308expand home delivery of pharmacy products. To assist Medicaid
2309patients in securing their prescriptions and reduce program
2310costs, the agency shall expand its current mail-order-pharmacy
2311diabetes-supply program to include all generic and brand-name
2312drugs used by Medicaid patients with diabetes. Medicaid
2313recipients in the current program may obtain nondiabetes drugs
2314on a voluntary basis. This initiative is limited to the
2315geographic area covered by the current contract. The agency may
2316seek and implement any federal waivers necessary to implement
2317this subparagraph.
2318     10.9.  The agency shall limit to one dose per month any
2319drug prescribed to treat erectile dysfunction.
2320     11.10.a.  The agency may implement a Medicaid behavioral
2321drug management system. The agency may contract with a vendor
2322that has experience in operating behavioral drug management
2323systems to implement this program. The agency is authorized to
2324seek federal waivers to implement this program.
2325     b.  The agency, in conjunction with the Department of
2326Children and Family Services, may implement the Medicaid
2327behavioral drug management system that is designed to improve
2328the quality of care and behavioral health prescribing practices
2329based on best practice guidelines, improve patient adherence to
2330medication plans, reduce clinical risk, and lower prescribed
2331drug costs and the rate of inappropriate spending on Medicaid
2332behavioral drugs. The program may include the following
2333elements:
2334     (I)  Provide for the development and adoption of best
2335practice guidelines for behavioral health-related drugs such as
2336antipsychotics, antidepressants, and medications for treating
2337bipolar disorders and other behavioral conditions; translate
2338them into practice; review behavioral health prescribers and
2339compare their prescribing patterns to a number of indicators
2340that are based on national standards; and determine deviations
2341from best practice guidelines.
2342     (II)  Implement processes for providing feedback to and
2343educating prescribers using best practice educational materials
2344and peer-to-peer consultation.
2345     (III)  Assess Medicaid beneficiaries who are outliers in
2346their use of behavioral health drugs with regard to the numbers
2347and types of drugs taken, drug dosages, combination drug
2348therapies, and other indicators of improper use of behavioral
2349health drugs.
2350     (IV)  Alert prescribers to patients who fail to refill
2351prescriptions in a timely fashion, are prescribed multiple same-
2352class behavioral health drugs, and may have other potential
2353medication problems.
2354     (V)  Track spending trends for behavioral health drugs and
2355deviation from best practice guidelines.
2356     (VI)  Use educational and technological approaches to
2357promote best practices, educate consumers, and train prescribers
2358in the use of practice guidelines.
2359     (VII)  Disseminate electronic and published materials.
2360     (VIII)  Hold statewide and regional conferences.
2361     (IX)  Implement a disease management program with a model
2362quality-based medication component for severely mentally ill
2363individuals and emotionally disturbed children who are high
2364users of care.
2365     12.11.a.  The agency shall implement a Medicaid
2366prescription drug management system. The agency may contract
2367with a vendor that has experience in operating prescription drug
2368management systems in order to implement this system. Any
2369management system that is implemented in accordance with this
2370subparagraph must rely on cooperation between physicians and
2371pharmacists to determine appropriate practice patterns and
2372clinical guidelines to improve the prescribing, dispensing, and
2373use of drugs in the Medicaid program. The agency may seek
2374federal waivers to implement this program.
2375     b.  The drug management system must be designed to improve
2376the quality of care and prescribing practices based on best
2377practice guidelines, improve patient adherence to medication
2378plans, reduce clinical risk, and lower prescribed drug costs and
2379the rate of inappropriate spending on Medicaid prescription
2380drugs. The program must:
2381     (I)  Provide for the development and adoption of best
2382practice guidelines for the prescribing and use of drugs in the
2383Medicaid program, including translating best practice guidelines
2384into practice; reviewing prescriber patterns and comparing them
2385to indicators that are based on national standards and practice
2386patterns of clinical peers in their community, statewide, and
2387nationally; and determine deviations from best practice
2388guidelines.
2389     (II)  Implement processes for providing feedback to and
2390educating prescribers using best practice educational materials
2391and peer-to-peer consultation.
2392     (III)  Assess Medicaid recipients who are outliers in their
2393use of a single or multiple prescription drugs with regard to
2394the numbers and types of drugs taken, drug dosages, combination
2395drug therapies, and other indicators of improper use of
2396prescription drugs.
2397     (IV)  Alert prescribers to patients who fail to refill
2398prescriptions in a timely fashion, are prescribed multiple drugs
2399that may be redundant or contraindicated, or may have other
2400potential medication problems.
2401     (V)  Track spending trends for prescription drugs and
2402deviation from best practice guidelines.
2403     (VI)  Use educational and technological approaches to
2404promote best practices, educate consumers, and train prescribers
2405in the use of practice guidelines.
2406     (VII)  Disseminate electronic and published materials.
2407     (VIII)  Hold statewide and regional conferences.
2408     (IX)  Implement disease management programs in cooperation
2409with physicians and pharmacists, along with a model quality-
2410based medication component for individuals having chronic
2411medical conditions.
2412     13.12.  The agency is authorized to contract for drug
2413rebate administration, including, but not limited to,
2414calculating rebate amounts, invoicing manufacturers, negotiating
2415disputes with manufacturers, and maintaining a database of
2416rebate collections.
2417     14.13.  The agency may specify the preferred daily dosing
2418form or strength for the purpose of promoting best practices
2419with regard to the prescribing of certain drugs as specified in
2420the General Appropriations Act and ensuring cost-effective
2421prescribing practices.
2422     15.14.  The agency may require prior authorization for
2423Medicaid-covered prescribed drugs. The agency may, but is not
2424required to, prior-authorize the use of a product:
2425     a.  For an indication not approved in labeling;
2426     b.  To comply with certain clinical guidelines; or
2427     c.  If the product has the potential for overuse, misuse,
2428or abuse.
2429
2430The agency may require the prescribing professional to provide
2431information about the rationale and supporting medical evidence
2432for the use of a drug. The agency may post prior authorization
2433criteria and protocol and updates to the list of drugs that are
2434subject to prior authorization on an Internet website without
2435amending its rule or engaging in additional rulemaking.
2436     16.15.  The agency, in conjunction with the Pharmaceutical
2437and Therapeutics Committee, may require age-related prior
2438authorizations for certain prescribed drugs. The agency may
2439preauthorize the use of a drug for a recipient who may not meet
2440the age requirement or may exceed the length of therapy for use
2441of this product as recommended by the manufacturer and approved
2442by the Food and Drug Administration. Prior authorization may
2443require the prescribing professional to provide information
2444about the rationale and supporting medical evidence for the use
2445of a drug.
2446     17.16.  The agency shall implement a step-therapy prior
2447authorization approval process for medications excluded from the
2448preferred drug list. Medications listed on the preferred drug
2449list must be used within the previous 12 months prior to the
2450alternative medications that are not listed. The step-therapy
2451prior authorization may require the prescriber to use the
2452medications of a similar drug class or for a similar medical
2453indication unless contraindicated in the Food and Drug
2454Administration labeling. The trial period between the specified
2455steps may vary according to the medical indication. The step-
2456therapy approval process shall be developed in accordance with
2457the committee as stated in s. 409.91195(7) and (8). A drug
2458product may be approved without meeting the step-therapy prior
2459authorization criteria if the prescribing physician provides the
2460agency with additional written medical or clinical documentation
2461that the product is medically necessary because:
2462     a.  There is not a drug on the preferred drug list to treat
2463the disease or medical condition which is an acceptable clinical
2464alternative;
2465     b.  The alternatives have been ineffective in the treatment
2466of the beneficiary's disease; or
2467     c.  Based on historic evidence and known characteristics of
2468the patient and the drug, the drug is likely to be ineffective,
2469or the number of doses have been ineffective.
2470
2471The agency shall work with the physician to determine the best
2472alternative for the patient. The agency may adopt rules waiving
2473the requirements for written clinical documentation for specific
2474drugs in limited clinical situations.
2475     18.17.  The agency shall implement a return and reuse
2476program for drugs dispensed by pharmacies to institutional
2477recipients, which includes payment of a $5 restocking fee for
2478the implementation and operation of the program. The return and
2479reuse program shall be implemented electronically and in a
2480manner that promotes efficiency. The program must permit a
2481pharmacy to exclude drugs from the program if it is not
2482practical or cost-effective for the drug to be included and must
2483provide for the return to inventory of drugs that cannot be
2484credited or returned in a cost-effective manner. The agency
2485shall determine if the program has reduced the amount of
2486Medicaid prescription drugs which are destroyed on an annual
2487basis and if there are additional ways to ensure more
2488prescription drugs are not destroyed which could safely be
2489reused. The agency's conclusion and recommendations shall be
2490reported to the Legislature by December 1, 2005.
2491     Section 67.  Subsections (3) and (4) of section 429.07,
2492Florida Statutes, are amended, and subsections (6) and (7) are
2493added to that section, to read:
2494     429.07  License required; fee; inspections.-
2495     (3)  In addition to the requirements of s. 408.806, each
2496license granted by the agency must state the type of care for
2497which the license is granted. Licenses shall be issued for one
2498or more of the following categories of care: standard, extended
2499congregate care, limited nursing services, or limited mental
2500health.
2501     (a)  A standard license shall be issued to a facility
2502facilities providing one or more of the personal services
2503identified in s. 429.02. Such licensee facilities may also
2504employ or contract with a person licensed under part I of
2505chapter 464 to administer medications and perform other tasks as
2506specified in s. 429.255.
2507     (b)  An extended congregate care license shall be issued to
2508a licensee facilities providing, directly or through contract,
2509services beyond those authorized in paragraph (a), including
2510acts performed pursuant to part I of chapter 464 by persons
2511licensed thereunder, and supportive services defined by rule to
2512persons who otherwise would be disqualified from continued
2513residence in a facility licensed under this part.
2514     1.  In order for extended congregate care services to be
2515provided in a facility licensed under this part, the agency must
2516first determine that all requirements established in law and
2517rule are met and must specifically designate, on the facility's
2518license, that such services may be provided and whether the
2519designation applies to all or part of a facility. Such
2520designation may be made at the time of initial licensure or
2521relicensure, or upon request in writing by a licensee under this
2522part and part II of chapter 408. Notification of approval or
2523denial of such request shall be made in accordance with part II
2524of chapter 408. An existing licensee facilities qualifying to
2525provide extended congregate care services must have maintained a
2526standard license and may not have been subject to administrative
2527sanctions during the previous 2 years, or since initial
2528licensure if the facility has been licensed for less than 2
2529years, for any of the following reasons:
2530     a.  A class I or class II violation;
2531     b.  Three or more repeat or recurring class III violations
2532of identical or similar resident care standards as specified in
2533rule from which a pattern of noncompliance is found by the
2534agency;
2535     c.  Three or more class III violations that were not
2536corrected in accordance with the corrective action plan approved
2537by the agency;
2538     d.  Violation of resident care standards resulting in a
2539requirement to employ the services of a consultant pharmacist or
2540consultant dietitian;
2541     e.  Denial, suspension, or revocation of a license for
2542another facility under this part in which the applicant for an
2543extended congregate care license has at least 25 percent
2544ownership interest; or
2545     f.  Imposition of a moratorium pursuant to this part or
2546part II of chapter 408 or initiation of injunctive proceedings.
2547     2.  A licensee Facilities that is are licensed to provide
2548extended congregate care services shall maintain a written
2549progress report for on each person who receives such services,
2550and the which report must describe describes the type, amount,
2551duration, scope, and outcome of services that are rendered and
2552the general status of the resident's health. A registered nurse,
2553or appropriate designee, representing the agency shall visit
2554such facilities at least quarterly to monitor residents who are
2555receiving extended congregate care services and to determine if
2556the facility is in compliance with this part, part II of chapter
2557408, and rules that relate to extended congregate care. One of
2558these visits may be in conjunction with the regular survey. The
2559monitoring visits may be provided through contractual
2560arrangements with appropriate community agencies. A registered
2561nurse shall serve as part of the team that inspects such
2562facility. The agency may waive one of the required yearly
2563monitoring visits for a facility that has been licensed for at
2564least 24 months to provide extended congregate care services,
2565if, during the inspection, the registered nurse determines that
2566extended congregate care services are being provided
2567appropriately, and if the facility has no class I or class II
2568violations and no uncorrected class III violations. Before such
2569decision is made, the agency shall consult with the long-term
2570care ombudsman council for the area in which the facility is
2571located to determine if any complaints have been made and
2572substantiated about the quality of services or care. The agency
2573may not waive one of the required yearly monitoring visits if
2574complaints have been made and substantiated.
2575     3.  Licensees Facilities that are licensed to provide
2576extended congregate care services shall:
2577     a.  Demonstrate the capability to meet unanticipated
2578resident service needs.
2579     b.  Offer a physical environment that promotes a homelike
2580setting, provides for resident privacy, promotes resident
2581independence, and allows sufficient congregate space as defined
2582by rule.
2583     c.  Have sufficient staff available, taking into account
2584the physical plant and firesafety features of the building, to
2585assist with the evacuation of residents in an emergency, as
2586necessary.
2587     d.  Adopt and follow policies and procedures that maximize
2588resident independence, dignity, choice, and decisionmaking to
2589permit residents to age in place to the extent possible, so that
2590moves due to changes in functional status are minimized or
2591avoided.
2592     e.  Allow residents or, if applicable, a resident's
2593representative, designee, surrogate, guardian, or attorney in
2594fact to make a variety of personal choices, participate in
2595developing service plans, and share responsibility in
2596decisionmaking.
2597     f.  Implement the concept of managed risk.
2598     g.  Provide, either directly or through contract, the
2599services of a person licensed pursuant to part I of chapter 464.
2600     h.  In addition to the training mandated in s. 429.52,
2601provide specialized training as defined by rule for facility
2602staff.
2603     4.  Licensees Facilities licensed to provide extended
2604congregate care services are exempt from the criteria for
2605continued residency as set forth in rules adopted under s.
2606429.41. Licensees Facilities so licensed shall adopt their own
2607requirements within guidelines for continued residency set forth
2608by rule. However, such licensees facilities may not serve
2609residents who require 24-hour nursing supervision. Licensees
2610Facilities licensed to provide extended congregate care services
2611shall provide each resident with a written copy of facility
2612policies governing admission and retention.
2613     5.  The primary purpose of extended congregate care
2614services is to allow residents, as they become more impaired,
2615the option of remaining in a familiar setting from which they
2616would otherwise be disqualified for continued residency. A
2617facility licensed to provide extended congregate care services
2618may also admit an individual who exceeds the admission criteria
2619for a facility with a standard license, if the individual is
2620determined appropriate for admission to the extended congregate
2621care facility.
2622     6.  Before admission of an individual to a facility
2623licensed to provide extended congregate care services, the
2624individual must undergo a medical examination as provided in s.
2625429.26(4) and the facility must develop a preliminary service
2626plan for the individual.
2627     7.  When a licensee facility can no longer provide or
2628arrange for services in accordance with the resident's service
2629plan and needs and the licensee's facility's policy, the
2630licensee facility shall make arrangements for relocating the
2631person in accordance with s. 429.28(1)(k).
2632     8.  Failure to provide extended congregate care services
2633may result in denial of extended congregate care license
2634renewal.
2635     9.  No later than January 1 of each year, the department,
2636in consultation with the agency, shall prepare and submit to the
2637Governor, the President of the Senate, the Speaker of the House
2638of Representatives, and the chairs of appropriate legislative
2639committees, a report on the status of, and recommendations
2640related to, extended congregate care services. The status report
2641must include, but need not be limited to, the following
2642information:
2643     a.  A description of the facilities licensed to provide
2644such services, including total number of beds licensed under
2645this part.
2646     b.  The number and characteristics of residents receiving
2647such services.
2648     c.  The types of services rendered that could not be
2649provided through a standard license.
2650     d.  An analysis of deficiencies cited during licensure
2651inspections.
2652     e.  The number of residents who required extended
2653congregate care services at admission and the source of
2654admission.
2655     f.  Recommendations for statutory or regulatory changes.
2656     g.  The availability of extended congregate care to state
2657clients residing in facilities licensed under this part and in
2658need of additional services, and recommendations for
2659appropriations to subsidize extended congregate care services
2660for such persons.
2661     h.  Such other information as the department considers
2662appropriate.
2663     (c)  A limited nursing services license shall be issued to
2664a facility that provides services beyond those authorized in
2665paragraph (a) and as specified in this paragraph.
2666     1.  In order for limited nursing services to be provided in
2667a facility licensed under this part, the agency must first
2668determine that all requirements established in law and rule are
2669met and must specifically designate, on the facility's license,
2670that such services may be provided. Such designation may be made
2671at the time of initial licensure or relicensure, or upon request
2672in writing by a licensee under this part and part II of chapter
2673408. Notification of approval or denial of such request shall be
2674made in accordance with part II of chapter 408. Existing
2675facilities qualifying to provide limited nursing services shall
2676have maintained a standard license and may not have been subject
2677to administrative sanctions that affect the health, safety, and
2678welfare of residents for the previous 2 years or since initial
2679licensure if the facility has been licensed for less than 2
2680years.
2681     2.  Facilities that are licensed to provide limited nursing
2682services shall maintain a written progress report on each person
2683who receives such nursing services, which report describes the
2684type, amount, duration, scope, and outcome of services that are
2685rendered and the general status of the resident's health. A
2686registered nurse representing the agency shall visit such
2687facilities at least twice a year to monitor residents who are
2688receiving limited nursing services and to determine if the
2689facility is in compliance with applicable provisions of this
2690part, part II of chapter 408, and related rules. The monitoring
2691visits may be provided through contractual arrangements with
2692appropriate community agencies. A registered nurse shall also
2693serve as part of the team that inspects such facility.
2694     3.  A person who receives limited nursing services under
2695this part must meet the admission criteria established by the
2696agency for assisted living facilities. When a resident no longer
2697meets the admission criteria for a facility licensed under this
2698part, arrangements for relocating the person shall be made in
2699accordance with s. 429.28(1)(k), unless the facility is licensed
2700to provide extended congregate care services.
2701     (4)  In accordance with s. 408.805, an applicant or
2702licensee shall pay a fee for each license application submitted
2703under this part, part II of chapter 408, and applicable rules.
2704The amount of the fee shall be established by rule.
2705     (a)  The biennial license fee required of a facility is
2706$356 $300 per license, with an additional fee of $67.50 $50 per
2707resident based on the total licensed resident capacity of the
2708facility, except that no additional fee will be assessed for
2709beds designated for recipients of optional state supplementation
2710payments provided for in s. 409.212. The total fee may not
2711exceed $18,000 $10,000.
2712     (b)  In addition to the total fee assessed under paragraph
2713(a), the agency shall require facilities that are licensed to
2714provide extended congregate care services under this part to pay
2715an additional fee per licensed facility. The amount of the
2716biennial fee shall be $501 $400 per license, with an additional
2717fee of $10 per resident based on the total licensed resident
2718capacity of the facility.
2719     (c)  In addition to the total fee assessed under paragraph
2720(a), the agency shall require facilities that are licensed to
2721provide limited nursing services under this part to pay an
2722additional fee per licensed facility. The amount of the biennial
2723fee shall be $250 per license, with an additional fee of $10 per
2724resident based on the total licensed resident capacity of the
2725facility.
2726     (6)  In order to determine whether the facility is
2727adequately protecting residents' rights as provided in s.
2728429.28, the biennial survey shall include private informal
2729conversations with a sample of residents and consultation with
2730the ombudsman council in the planning and service area in which
2731the facility is located to discuss residents' experiences within
2732the facility.
2733     (7)  An assisted living facility that has been cited within
2734the previous 24-month period for a class I or class II
2735violation, regardless of the status of any enforcement or
2736disciplinary action, is subject to periodic unannounced
2737monitoring to determine if the facility is in compliance with
2738this part, part II of chapter 408, and applicable rules.
2739Monitoring may occur through a desk review or an onsite
2740assessment. If the class I or class II violation relates to
2741providing or failing to provide nursing care, a registered nurse
2742must participate in at least two onsite monitoring visits within
2743a 12-month period.
2744     Section 68.  Subsection (7) of section 429.11, Florida
2745Statutes, is renumbered as subsection (6), and present
2746subsection (6) of that section is amended to read:
2747     429.11  Initial application for license; provisional
2748license.-
2749     (6)  In addition to the license categories available in s.
2750408.808, a provisional license may be issued to an applicant
2751making initial application for licensure or making application
2752for a change of ownership. A provisional license shall be
2753limited in duration to a specific period of time not to exceed 6
2754months, as determined by the agency.
2755     Section 69.  Section 429.12, Florida Statutes, is amended
2756to read:
2757     429.12  Sale or transfer of ownership of a facility.-It is
2758the intent of the Legislature to protect the rights of the
2759residents of an assisted living facility when the facility is
2760sold or the ownership thereof is transferred. Therefore, in
2761addition to the requirements of part II of chapter 408, whenever
2762a facility is sold or the ownership thereof is transferred,
2763including leasing:.
2764     (1)  The transferee shall notify the residents, in writing,
2765of the change of ownership within 7 days after receipt of the
2766new license.
2767     (2)  The transferor of a facility the license of which is
2768denied pending an administrative hearing shall, as a part of the
2769written change-of-ownership contract, advise the transferee that
2770a plan of correction must be submitted by the transferee and
2771approved by the agency at least 7 days before the change of
2772ownership and that failure to correct the condition which
2773resulted in the moratorium pursuant to part II of chapter 408 or
2774denial of licensure is grounds for denial of the transferee's
2775license.
2776     Section 70.  Paragraphs (b) through (l) of subsection (1)
2777of section 429.14, Florida Statutes, are redesignated as
2778paragraphs (a) through (k), respectively, and present paragraph
2779(a) of subsection (1) and subsections (5) and (6) of that
2780section are amended to read:
2781     429.14  Administrative penalties.-
2782     (1)  In addition to the requirements of part II of chapter
2783408, the agency may deny, revoke, and suspend any license issued
2784under this part and impose an administrative fine in the manner
2785provided in chapter 120 against a licensee of an assisted living
2786facility for a violation of any provision of this part, part II
2787of chapter 408, or applicable rules, or for any of the following
2788actions by a licensee of an assisted living facility, for the
2789actions of any person subject to level 2 background screening
2790under s. 408.809, or for the actions of any facility employee:
2791     (a)  An intentional or negligent act seriously affecting
2792the health, safety, or welfare of a resident of the facility.
2793     (5)  An action taken by the agency to suspend, deny, or
2794revoke a facility's license under this part or part II of
2795chapter 408, in which the agency claims that the facility owner
2796or an employee of the facility has threatened the health,
2797safety, or welfare of a resident of the facility shall be heard
2798by the Division of Administrative Hearings of the Department of
2799Management Services within 120 days after receipt of the
2800facility's request for a hearing, unless that time limitation is
2801waived by both parties. The administrative law judge must render
2802a decision within 30 days after receipt of a proposed
2803recommended order.
2804     (6)  The agency shall provide to the Division of Hotels and
2805Restaurants of the Department of Business and Professional
2806Regulation, on a monthly basis, a list of those assisted living
2807facilities that have had their licenses denied, suspended, or
2808revoked or that are involved in an appellate proceeding pursuant
2809to s. 120.60 related to the denial, suspension, or revocation of
2810a license. This information may be provided electronically or
2811through the agency's Internet website.
2812     Section 71.  Subsections (1), (4), and (5) of section
2813429.17, Florida Statutes, are amended to read:
2814     429.17  Expiration of license; renewal; conditional
2815license.-
2816     (1)  Limited nursing, Extended congregate care, and limited
2817mental health licenses shall expire at the same time as the
2818facility's standard license, regardless of when issued.
2819     (4)  In addition to the license categories available in s.
2820408.808, a conditional license may be issued to an applicant for
2821license renewal if the applicant fails to meet all standards and
2822requirements for licensure. A conditional license issued under
2823this subsection shall be limited in duration to a specific
2824period of time not to exceed 6 months, as determined by the
2825agency, and shall be accompanied by an agency-approved plan of
2826correction.
2827     (5)  When an extended congregate care or limited nursing
2828license is requested during a facility's biennial license
2829period, the fee shall be prorated in order to permit the
2830additional license to expire at the end of the biennial license
2831period. The fee shall be calculated as of the date the
2832additional license application is received by the agency.
2833     Section 72.  Subsection (7) of section 429.19, Florida
2834Statutes, is amended to read:
2835     429.19  Violations; imposition of administrative fines;
2836grounds.-
2837     (7)  In addition to any administrative fines imposed, the
2838agency may assess a survey or monitoring fee, equal to the
2839lesser of one half of the facility's biennial license and bed
2840fee or $500, to cover the cost of conducting initial complaint
2841investigations that result in the finding of a violation that
2842was the subject of the complaint or to monitor the health,
2843safety, or security of residents under s. 429.07     (7) monitoring
2844visits conducted under s. 429.28(3)(c) to verify the correction
2845of the violations.
2846     Section 73.  Subsections (6) through (10) of section
2847429.23, Florida Statutes, are renumbered as subsections (5)
2848through (9), respectively, and present subsection (5) of that
2849section is amended to read:
2850     429.23  Internal risk management and quality assurance
2851program; adverse incidents and reporting requirements.-
2852     (5)  Each facility shall report monthly to the agency any
2853liability claim filed against it. The report must include the
2854name of the resident, the dates of the incident leading to the
2855claim, if applicable, and the type of injury or violation of
2856rights alleged to have occurred. This report is not discoverable
2857in any civil or administrative action, except in such actions
2858brought by the agency to enforce the provisions of this part.
2859     Section 74.  Paragraph (a) of subsection (1) and subsection
2860(2) of section 429.255, Florida Statutes, are amended to read:
2861     429.255  Use of personnel; emergency care.-
2862     (1)(a)  Persons under contract to the facility or, facility
2863staff, or volunteers, who are licensed according to part I of
2864chapter 464, or those persons exempt under s. 464.022(1), and
2865others as defined by rule, may administer medications to
2866residents, take residents' vital signs, manage individual weekly
2867pill organizers for residents who self-administer medication,
2868give prepackaged enemas ordered by a physician, observe
2869residents, document observations on the appropriate resident's
2870record, report observations to the resident's physician, and
2871contract or allow residents or a resident's representative,
2872designee, surrogate, guardian, or attorney in fact to contract
2873with a third party, provided residents meet the criteria for
2874appropriate placement as defined in s. 429.26. Persons under
2875contract to the facility or facility staff who are licensed
2876according to part I of chapter 464 may provide limited nursing
2877services. Nursing assistants certified pursuant to part II of
2878chapter 464 may take residents' vital signs as directed by a
2879licensed nurse or physician. The facility is responsible for
2880maintaining documentation of services provided under this
2881paragraph as required by rule and ensuring that staff are
2882adequately trained to monitor residents receiving these
2883services.
2884     (2)  In facilities licensed to provide extended congregate
2885care, persons under contract to the facility or, facility staff,
2886or volunteers, who are licensed according to part I of chapter
2887464, or those persons exempt under s. 464.022(1), or those
2888persons certified as nursing assistants pursuant to part II of
2889chapter 464, may also perform all duties within the scope of
2890their license or certification, as approved by the facility
2891administrator and pursuant to this part.
2892     Section 75.  Subsection (3) of section 429.28, Florida
2893Statutes, is amended to read:
2894     429.28  Resident bill of rights.-
2895     (3)(a)  The agency shall conduct a survey to determine
2896general compliance with facility standards and compliance with
2897residents' rights as a prerequisite to initial licensure or
2898licensure renewal.
2899     (b)  In order to determine whether the facility is
2900adequately protecting residents' rights, the biennial survey
2901shall include private informal conversations with a sample of
2902residents and consultation with the ombudsman council in the
2903planning and service area in which the facility is located to
2904discuss residents' experiences within the facility.
2905     (c)  During any calendar year in which no survey is
2906conducted, the agency shall conduct at least one monitoring
2907visit of each facility cited in the previous year for a class I
2908or class II violation, or more than three uncorrected class III
2909violations.
2910     (d)  The agency may conduct periodic followup inspections
2911as necessary to monitor the compliance of facilities with a
2912history of any class I, class II, or class III violations that
2913threaten the health, safety, or security of residents.
2914     (e)  The agency may conduct complaint investigations as
2915warranted to investigate any allegations of noncompliance with
2916requirements required under this part or rules adopted under
2917this part.
2918     Section 76.  Subsection (2) of section 429.35, Florida
2919Statutes, is amended to read:
2920     429.35  Maintenance of records; reports.-
2921     (2)  Within 60 days after the date of the biennial
2922inspection visit required under s. 408.811 or within 30 days
2923after the date of any interim visit, the agency shall forward
2924the results of the inspection to the local ombudsman council in
2925whose planning and service area, as defined in part II of
2926chapter 400, the facility is located; to at least one public
2927library or, in the absence of a public library, the county seat
2928in the county in which the inspected assisted living facility is
2929located; and, when appropriate, to the district Adult Services
2930and Mental Health Program Offices. This information may be
2931provided electronically or through the agency's Internet
2932website.
2933     Section 77.  Paragraphs (i) and (j) of subsection (1) of
2934section 429.41, Florida Statutes, are amended to read:
2935     429.41  Rules establishing standards.-
2936     (1)  It is the intent of the Legislature that rules
2937published and enforced pursuant to this section shall include
2938criteria by which a reasonable and consistent quality of
2939resident care and quality of life may be ensured and the results
2940of such resident care may be demonstrated. Such rules shall also
2941ensure a safe and sanitary environment that is residential and
2942noninstitutional in design or nature. It is further intended
2943that reasonable efforts be made to accommodate the needs and
2944preferences of residents to enhance the quality of life in a
2945facility. The agency, in consultation with the department, may
2946adopt rules to administer the requirements of part II of chapter
2947408. In order to provide safe and sanitary facilities and the
2948highest quality of resident care accommodating the needs and
2949preferences of residents, the department, in consultation with
2950the agency, the Department of Children and Family Services, and
2951the Department of Health, shall adopt rules, policies, and
2952procedures to administer this part, which must include
2953reasonable and fair minimum standards in relation to:
2954     (i)  Facilities holding an a limited nursing, extended
2955congregate care, or limited mental health license.
2956     (j)  The establishment of specific criteria to define
2957appropriateness of resident admission and continued residency in
2958a facility holding a standard, limited nursing, extended
2959congregate care, and limited mental health license.
2960     Section 78.  Subsections (1) and (2) of section 429.53,
2961Florida Statutes, are amended to read:
2962     429.53  Consultation by the agency.-
2963     (1)  The area offices of licensure and certification of the
2964agency shall provide consultation to the following upon request:
2965     (a)  A licensee of a facility.
2966     (b)  A person interested in obtaining a license to operate
2967a facility under this part.
2968     (2)  As used in this section, "consultation" includes:
2969     (a)  An explanation of the requirements of this part and
2970rules adopted pursuant thereto;
2971     (b)  An explanation of the license application and renewal
2972procedures;
2973     (c)  The provision of a checklist of general local and
2974state approvals required prior to constructing or developing a
2975facility and a listing of the types of agencies responsible for
2976such approvals;
2977     (d)  An explanation of benefits and financial assistance
2978available to a recipient of supplemental security income
2979residing in a facility;
2980     (c)(e)  Any other information which the agency deems
2981necessary to promote compliance with the requirements of this
2982part; and
2983     (f)  A preconstruction review of a facility to ensure
2984compliance with agency rules and this part.
2985     Section 79.  Subsections (1) and (2) of section 429.54,
2986Florida Statutes, are renumbered as subsections (2) and (3),
2987respectively, and a new subsection (1) is added to that section
2988to read:
2989     429.54  Collection of information; local subsidy.-
2990     (1)  A facility that is licensed under this part must
2991report electronically to the agency semiannually data related to
2992the facility, including, but not limited to, the total number of
2993residents, the number of residents who are receiving limited
2994mental health services, the number of residents who are
2995receiving extended congregate care services, the number of
2996residents who are receiving limited nursing services, and
2997professional staffing employed by or under contract with the
2998licensee to provide resident services. The department, in
2999consultation with the agency, shall adopt rules to administer
3000this subsection.
3001     Section 80.  Subsections (1) and (5) of section 429.71,
3002Florida Statutes, are amended to read:
3003     429.71  Classification of violations deficiencies;
3004administrative fines.-
3005     (1)  In addition to the requirements of part II of chapter
3006408 and in addition to any other liability or penalty provided
3007by law, the agency may impose an administrative fine on a
3008provider according to the following classification:
3009     (a)  Class I violations are defined in s. 408.813 those
3010conditions or practices related to the operation and maintenance
3011of an adult family-care home or to the care of residents which
3012the agency determines present an imminent danger to the
3013residents or guests of the facility or a substantial probability
3014that death or serious physical or emotional harm would result
3015therefrom. The condition or practice that constitutes a class I
3016violation must be abated or eliminated within 24 hours, unless a
3017fixed period, as determined by the agency, is required for
3018correction. A class I violation deficiency is subject to an
3019administrative fine in an amount not less than $500 and not
3020exceeding $1,000 for each violation. A fine may be levied
3021notwithstanding the correction of the deficiency.
3022     (b)  Class II violations are defined in s. 408.813 those
3023conditions or practices related to the operation and maintenance
3024of an adult family-care home or to the care of residents which
3025the agency determines directly threaten the physical or
3026emotional health, safety, or security of the residents, other
3027than class I violations. A class II violation is subject to an
3028administrative fine in an amount not less than $250 and not
3029exceeding $500 for each violation. A citation for a class II
3030violation must specify the time within which the violation is
3031required to be corrected. If a class II violation is corrected
3032within the time specified, no civil penalty shall be imposed,
3033unless it is a repeated offense.
3034     (c)  Class III violations are defined in s. 408.813 those
3035conditions or practices related to the operation and maintenance
3036of an adult family-care home or to the care of residents which
3037the agency determines indirectly or potentially threaten the
3038physical or emotional health, safety, or security of residents,
3039other than class I or class II violations. A class III violation
3040is subject to an administrative fine in an amount not less than
3041$100 and not exceeding $250 for each violation. A citation for a
3042class III violation shall specify the time within which the
3043violation is required to be corrected. If a class III violation
3044is corrected within the time specified, no civil penalty shall
3045be imposed, unless it is a repeated violation offense.
3046     (d)  Class IV violations are defined in s. 408.813 those
3047conditions or occurrences related to the operation and
3048maintenance of an adult family-care home, or related to the
3049required reports, forms, or documents, which do not have the
3050potential of negatively affecting the residents. A provider that
3051does not correct A class IV violation within the time limit
3052specified by the agency is subject to an administrative fine in
3053an amount not less than $50 and not exceeding $100 for each
3054violation. Any class IV violation that is corrected during the
3055time the agency survey is conducted will be identified as an
3056agency finding and not as a violation, unless it is a repeat
3057violation.
3058     (5)  As an alternative to or in conjunction with an
3059administrative action against a provider, the agency may request
3060a plan of corrective action that demonstrates a good faith
3061effort to remedy each violation by a specific date, subject to
3062the approval of the agency.
3063     Section 81.  Paragraphs (b) through (e) of subsection (2)
3064of section 429.911, Florida Statutes, are redesignated as
3065paragraphs (a) through (d), respectively, and present paragraph
3066(a) of that subsection is amended to read:
3067     429.911  Denial, suspension, revocation of license;
3068emergency action; administrative fines; investigations and
3069inspections.-
3070     (2)  Each of the following actions by the owner of an adult
3071day care center or by its operator or employee is a ground for
3072action by the agency against the owner of the center or its
3073operator or employee:
3074     (a)  An intentional or negligent act materially affecting
3075the health or safety of center participants.
3076     Section 82.  Section 429.915, Florida Statutes, is amended
3077to read:
3078     429.915  Conditional license.-In addition to the license
3079categories available in part II of chapter 408, the agency may
3080issue a conditional license to an applicant for license renewal
3081or change of ownership if the applicant fails to meet all
3082standards and requirements for licensure. A conditional license
3083issued under this subsection must be limited to a specific
3084period not exceeding 6 months, as determined by the agency, and
3085must be accompanied by an approved plan of correction.
3086     Section 83.  Paragraphs (b) and (h) of subsection (3) of
3087section 430.80, Florida Statutes, are amended to read:
3088     430.80  Implementation of a teaching nursing home pilot
3089project.-
3090     (3)  To be designated as a teaching nursing home, a nursing
3091home licensee must, at a minimum:
3092     (b)  Participate in a nationally recognized accreditation
3093program and hold a valid accreditation, such as the
3094accreditation awarded by The Joint Commission on Accreditation
3095of Healthcare Organizations;
3096     (h)  Maintain insurance coverage pursuant to s.
3097400.141(1)(q)(s) or proof of financial responsibility in a
3098minimum amount of $750,000. Such proof of financial
3099responsibility may include:
3100     1.  Maintaining an escrow account consisting of cash or
3101assets eligible for deposit in accordance with s. 625.52; or
3102     2.  Obtaining and maintaining pursuant to chapter 675 an
3103unexpired, irrevocable, nontransferable and nonassignable letter
3104of credit issued by any bank or savings association organized
3105and existing under the laws of this state or any bank or savings
3106association organized under the laws of the United States that
3107has its principal place of business in this state or has a
3108branch office which is authorized to receive deposits in this
3109state. The letter of credit shall be used to satisfy the
3110obligation of the facility to the claimant upon presentment of a
3111final judgment indicating liability and awarding damages to be
3112paid by the facility or upon presentment of a settlement
3113agreement signed by all parties to the agreement when such final
3114judgment or settlement is a result of a liability claim against
3115the facility.
3116     Section 84.  Paragraph (a) of subsection (2) of section
3117440.13, Florida Statutes, is amended to read:
3118     440.13  Medical services and supplies; penalty for
3119violations; limitations.-
3120     (2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3121     (a)  Subject to the limitations specified elsewhere in this
3122chapter, the employer shall furnish to the employee such
3123medically necessary remedial treatment, care, and attendance for
3124such period as the nature of the injury or the process of
3125recovery may require, which is in accordance with established
3126practice parameters and protocols of treatment as provided for
3127in this chapter, including medicines, medical supplies, durable
3128medical equipment, orthoses, prostheses, and other medically
3129necessary apparatus. Remedial treatment, care, and attendance,
3130including work-hardening programs or pain-management programs
3131accredited by the Commission on Accreditation of Rehabilitation
3132Facilities or The Joint Commission on the Accreditation of
3133Health Organizations or pain-management programs affiliated with
3134medical schools, shall be considered as covered treatment only
3135when such care is given based on a referral by a physician as
3136defined in this chapter. Medically necessary treatment, care,
3137and attendance does not include chiropractic services in excess
3138of 24 treatments or rendered 12 weeks beyond the date of the
3139initial chiropractic treatment, whichever comes first, unless
3140the carrier authorizes additional treatment or the employee is
3141catastrophically injured.
3142
3143Failure of the carrier to timely comply with this subsection
3144shall be a violation of this chapter and the carrier shall be
3145subject to penalties as provided for in s. 440.525.
3146     Section 85.  Section 483.294, Florida Statutes, is amended
3147to read:
3148     483.294  Inspection of centers.-In accordance with s.
3149408.811, the agency shall biennially, at least once annually,
3150inspect the premises and operations of all centers subject to
3151licensure under this part.
3152     Section 86.  Subsections (32) through (54) of section
3153499.003, Florida Statutes, are renumbered as subsections (33)
3154through (55), respectively, present subsection (42) and
3155paragraph (a) of present subsection (53) are amended, and a new
3156subsection (32) is added to that subsection, to read:
3157     499.003  Definitions of terms used in this part.-As used in
3158this part, the term:
3159     (32)  "Medical convenience kit" means packages or units
3160that contain combination products as defined in 21 C.F.R. s.
31613.2(e)(2).
3162     (43)(42)  "Prescription drug" means a prescription,
3163medicinal, or legend drug, including, but not limited to,
3164finished dosage forms or active ingredients subject to, defined
3165by, or described by s. 503(b) of the Federal Food, Drug, and
3166Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3167(11), subsection (46) (45), or subsection (53) (52).
3168     (54)(53)  "Wholesale distribution" means distribution of
3169prescription drugs to persons other than a consumer or patient,
3170but does not include:
3171     (a)  Any of the following activities, which is not a
3172violation of s. 499.005(21) if such activity is conducted in
3173accordance with s. 499.01(2)(g):
3174     1.  The purchase or other acquisition by a hospital or
3175other health care entity that is a member of a group purchasing
3176organization of a prescription drug for its own use from the
3177group purchasing organization or from other hospitals or health
3178care entities that are members of that organization.
3179     2.  The sale, purchase, or trade of a prescription drug or
3180an offer to sell, purchase, or trade a prescription drug by a
3181charitable organization described in s. 501(c)(3) of the
3182Internal Revenue Code of 1986, as amended and revised, to a
3183nonprofit affiliate of the organization to the extent otherwise
3184permitted by law.
3185     3.  The sale, purchase, or trade of a prescription drug or
3186an offer to sell, purchase, or trade a prescription drug among
3187hospitals or other health care entities that are under common
3188control. For purposes of this subparagraph, "common control"
3189means the power to direct or cause the direction of the
3190management and policies of a person or an organization, whether
3191by ownership of stock, by voting rights, by contract, or
3192otherwise.
3193     4.  The sale, purchase, trade, or other transfer of a
3194prescription drug from or for any federal, state, or local
3195government agency or any entity eligible to purchase
3196prescription drugs at public health services prices pursuant to
3197Pub. L. No. 102-585, s. 602 to a contract provider or its
3198subcontractor for eligible patients of the agency or entity
3199under the following conditions:
3200     a.  The agency or entity must obtain written authorization
3201for the sale, purchase, trade, or other transfer of a
3202prescription drug under this subparagraph from the State Surgeon
3203General or his or her designee.
3204     b.  The contract provider or subcontractor must be
3205authorized by law to administer or dispense prescription drugs.
3206     c.  In the case of a subcontractor, the agency or entity
3207must be a party to and execute the subcontract.
3208     d.  A contract provider or subcontractor must maintain
3209separate and apart from other prescription drug inventory any
3210prescription drugs of the agency or entity in its possession.
3211     d.e.  The contract provider and subcontractor must maintain
3212and produce immediately for inspection all records of movement
3213or transfer of all the prescription drugs belonging to the
3214agency or entity, including, but not limited to, the records of
3215receipt and disposition of prescription drugs. Each contractor
3216and subcontractor dispensing or administering these drugs must
3217maintain and produce records documenting the dispensing or
3218administration. Records that are required to be maintained
3219include, but are not limited to, a perpetual inventory itemizing
3220drugs received and drugs dispensed by prescription number or
3221administered by patient identifier, which must be submitted to
3222the agency or entity quarterly.
3223     e.f.  The contract provider or subcontractor may administer
3224or dispense the prescription drugs only to the eligible patients
3225of the agency or entity or must return the prescription drugs
3226for or to the agency or entity. The contract provider or
3227subcontractor must require proof from each person seeking to
3228fill a prescription or obtain treatment that the person is an
3229eligible patient of the agency or entity and must, at a minimum,
3230maintain a copy of this proof as part of the records of the
3231contractor or subcontractor required under sub-subparagraph d.
3232e.
3233     f.g.  In addition to the departmental inspection authority
3234set forth in s. 499.051, the establishment of the contract
3235provider and subcontractor and all records pertaining to
3236prescription drugs subject to this subparagraph shall be subject
3237to inspection by the agency or entity. All records relating to
3238prescription drugs of a manufacturer under this subparagraph
3239shall be subject to audit by the manufacturer of those drugs,
3240without identifying individual patient information.
3241     Section 87.  Paragraph (i) is added to subsection (3) of
3242section 499.01212, Florida Statutes, to read:
3243     499.01212  Pedigree paper.-
3244     (3)  EXCEPTIONS.-A pedigree paper is not required for:
3245     (i)  The wholesale distribution of prescription drugs
3246contained within a medical convenience kit if:
3247     1.  The medical convenience kit is assembled in an
3248establishment that is registered as a medical device
3249manufacturer with the United States Food and Drug
3250Administration;
3251     2.  The medical convenience kit manufacturer purchased the
3252prescription drug directly from the manufacturer or from a
3253wholesaler that purchased the prescription drug directly from
3254the manufacturer;
3255     3.  The medical convenience kit manufacturer complies with
3256federal law for the distribution of the prescription drugs
3257within the kit; and
3258     4.  The drugs contained in the medical convenience kit are:
3259     a.  Intravenous solutions intended for the replenishment of
3260fluids and electrolytes;
3261     b.  Products intended to maintain the equilibrium of water
3262and minerals in the body;
3263     c.  Products intended for irrigation or reconstitution;
3264     d.  Anesthetics; or
3265     e.  Anticoagulants.
3266
3267This exemption does not apply to a convenience kit containing
3268any controlled substance that appears in a schedule contained in
3269or subject to chapter 893 or the federal Comprehensive Drug
3270Abuse Prevention and Control Act of 1970.
3271     Section 88.  Subsection (3) is added to section 626.9541,
3272Florida Statutes, to read:
3273     626.9541  Unfair methods of competition and unfair or
3274deceptive acts or practices defined; alternative rates of
3275payment; wellness programs.-
3276     (3)  WELLNESS PROGRAMS.-An insurer issuing a group or
3277individual health benefit plan may offer a voluntary wellness or
3278health-improvement program that allows for rewards or
3279incentives, including, but not limited to, merchandise, gift
3280cards, debit cards, premium discounts or rebates, contributions
3281towards a member's health savings account, modifications to
3282copayment, deductible, or coinsurance amounts, or any
3283combination of these incentives, to encourage or reward
3284participation in the program. The health plan member may be
3285required to provide verification, such as a statement from his
3286or her physician, that a medical condition makes it unreasonably
3287difficult or medically inadvisable for the individual to
3288participate in the wellness program. Any reward or incentive
3289established under this subsection is not an insurance benefit
3290and does not violate this section. This subsection does not
3291prohibit an insurer from offering incentives or rewards to
3292members for adherence to wellness or health improvement programs
3293if otherwise allowed by state or federal law. Notwithstanding
3294any provision of this subsection, no insurer, nor its agent, may
3295use any incentive authorized by this subsection for the purpose
3296of redirecting patients from one health care insurance plan to
3297another.
3298     Section 89.  Subsection (1) of section 627.645, Florida
3299Statutes, is amended to read:
3300     627.645  Denial of health insurance claims restricted.-
3301     (1)  No claim for payment under a health insurance policy
3302or self-insured program of health benefits for treatment, care,
3303or services in a licensed hospital which is accredited by The
3304Joint Commission on the Accreditation of Hospitals, the American
3305Osteopathic Association, or the Commission on the Accreditation
3306of Rehabilitative Facilities shall be denied because such
3307hospital lacks major surgical facilities and is primarily of a
3308rehabilitative nature, if such rehabilitation is specifically
3309for treatment of physical disability.
3310     Section 90.  Paragraph (c) of subsection (2) of section
3311627.668, Florida Statutes, is amended to read:
3312     627.668  Optional coverage for mental and nervous disorders
3313required; exception.-
3314     (2)  Under group policies or contracts, inpatient hospital
3315benefits, partial hospitalization benefits, and outpatient
3316benefits consisting of durational limits, dollar amounts,
3317deductibles, and coinsurance factors shall not be less favorable
3318than for physical illness generally, except that:
3319     (c)  Partial hospitalization benefits shall be provided
3320under the direction of a licensed physician. For purposes of
3321this part, the term "partial hospitalization services" is
3322defined as those services offered by a program accredited by The
3323Joint Commission on Accreditation of Hospitals (JCAH) or in
3324compliance with equivalent standards. Alcohol rehabilitation
3325programs accredited by The Joint Commission on Accreditation of
3326Hospitals or approved by the state and licensed drug abuse
3327rehabilitation programs shall also be qualified providers under
3328this section. In any benefit year, if partial hospitalization
3329services or a combination of inpatient and partial
3330hospitalization are utilized, the total benefits paid for all
3331such services shall not exceed the cost of 30 days of inpatient
3332hospitalization for psychiatric services, including physician
3333fees, which prevail in the community in which the partial
3334hospitalization services are rendered. If partial
3335hospitalization services benefits are provided beyond the limits
3336set forth in this paragraph, the durational limits, dollar
3337amounts, and coinsurance factors thereof need not be the same as
3338those applicable to physical illness generally.
3339     Section 91.  Subsection (3) of section 627.669, Florida
3340Statutes, is amended to read:
3341     627.669  Optional coverage required for substance abuse
3342impaired persons; exception.-
3343     (3)  The benefits provided under this section shall be
3344applicable only if treatment is provided by, or under the
3345supervision of, or is prescribed by, a licensed physician or
3346licensed psychologist and if services are provided in a program
3347accredited by The Joint Commission on Accreditation of Hospitals
3348or approved by the state.
3349     Section 92.  Paragraph (a) of subsection (1) of section
3350627.736, Florida Statutes, is amended to read:
3351     627.736  Required personal injury protection benefits;
3352exclusions; priority; claims.-
3353     (1)  REQUIRED BENEFITS.-Every insurance policy complying
3354with the security requirements of s. 627.733 shall provide
3355personal injury protection to the named insured, relatives
3356residing in the same household, persons operating the insured
3357motor vehicle, passengers in such motor vehicle, and other
3358persons struck by such motor vehicle and suffering bodily injury
3359while not an occupant of a self-propelled vehicle, subject to
3360the provisions of subsection (2) and paragraph (4)(e), to a
3361limit of $10,000 for loss sustained by any such person as a
3362result of bodily injury, sickness, disease, or death arising out
3363of the ownership, maintenance, or use of a motor vehicle as
3364follows:
3365     (a)  Medical benefits.-Eighty percent of all reasonable
3366expenses for medically necessary medical, surgical, X-ray,
3367dental, and rehabilitative services, including prosthetic
3368devices, and medically necessary ambulance, hospital, and
3369nursing services. However, the medical benefits shall provide
3370reimbursement only for such services and care that are lawfully
3371provided, supervised, ordered, or prescribed by a physician
3372licensed under chapter 458 or chapter 459, a dentist licensed
3373under chapter 466, or a chiropractic physician licensed under
3374chapter 460 or that are provided by any of the following persons
3375or entities:
3376     1.  A hospital or ambulatory surgical center licensed under
3377chapter 395.
3378     2.  A person or entity licensed under ss. 401.2101-401.45
3379that provides emergency transportation and treatment.
3380     3.  An entity wholly owned by one or more physicians
3381licensed under chapter 458 or chapter 459, chiropractic
3382physicians licensed under chapter 460, or dentists licensed
3383under chapter 466 or by such practitioner or practitioners and
3384the spouse, parent, child, or sibling of that practitioner or
3385those practitioners.
3386     4.  An entity wholly owned, directly or indirectly, by a
3387hospital or hospitals.
3388     5.  A health care clinic licensed under ss. 400.990-400.995
3389that is:
3390     a.  Accredited by The Joint Commission on Accreditation of
3391Healthcare Organizations, the American Osteopathic Association,
3392the Commission on Accreditation of Rehabilitation Facilities, or
3393the Accreditation Association for Ambulatory Health Care, Inc.;
3394or
3395     b.  A health care clinic that:
3396     (I)  Has a medical director licensed under chapter 458,
3397chapter 459, or chapter 460;
3398     (II)  Has been continuously licensed for more than 3 years
3399or is a publicly traded corporation that issues securities
3400traded on an exchange registered with the United States
3401Securities and Exchange Commission as a national securities
3402exchange; and
3403     (III)  Provides at least four of the following medical
3404specialties:
3405     (A)  General medicine.
3406     (B)  Radiography.
3407     (C)  Orthopedic medicine.
3408     (D)  Physical medicine.
3409     (E)  Physical therapy.
3410     (F)  Physical rehabilitation.
3411     (G)  Prescribing or dispensing outpatient prescription
3412medication.
3413     (H)  Laboratory services.
3414
3415The Financial Services Commission shall adopt by rule the form
3416that must be used by an insurer and a health care provider
3417specified in subparagraph 3., subparagraph 4., or subparagraph
34185. to document that the health care provider meets the criteria
3419of this paragraph, which rule must include a requirement for a
3420sworn statement or affidavit.
3421
3422Only insurers writing motor vehicle liability insurance in this
3423state may provide the required benefits of this section, and no
3424such insurer shall require the purchase of any other motor
3425vehicle coverage other than the purchase of property damage
3426liability coverage as required by s. 627.7275 as a condition for
3427providing such required benefits. Insurers may not require that
3428property damage liability insurance in an amount greater than
3429$10,000 be purchased in conjunction with personal injury
3430protection. Such insurers shall make benefits and required
3431property damage liability insurance coverage available through
3432normal marketing channels. Any insurer writing motor vehicle
3433liability insurance in this state who fails to comply with such
3434availability requirement as a general business practice shall be
3435deemed to have violated part IX of chapter 626, and such
3436violation shall constitute an unfair method of competition or an
3437unfair or deceptive act or practice involving the business of
3438insurance; and any such insurer committing such violation shall
3439be subject to the penalties afforded in such part, as well as
3440those which may be afforded elsewhere in the insurance code.
3441     Section 93.  Section 633.081, Florida Statutes, is amended
3442to read:
3443     633.081  Inspection of buildings and equipment; orders;
3444firesafety inspection training requirements; certification;
3445disciplinary action.-The State Fire Marshal and her or his
3446agents shall, at any reasonable hour, when the department has
3447reasonable cause to believe that a violation of this chapter or
3448s. 509.215, or a rule promulgated thereunder, or a minimum
3449firesafety code adopted by a local authority, may exist, inspect
3450any and all buildings and structures which are subject to the
3451requirements of this chapter or s. 509.215 and rules promulgated
3452thereunder. The authority to inspect shall extend to all
3453equipment, vehicles, and chemicals which are located within the
3454premises of any such building or structure. The State Fire
3455Marshal and her or his agents shall inspect nursing homes
3456licensed under part II of chapter 400 only once every calendar
3457year and upon receiving a complaint forming the basis of a
3458reasonable cause to believe that a violation of this chapter or
3459s. 509.215, or a rule promulgated thereunder, or a minimum
3460firesafety code adopted by a local authority may exist and upon
3461identifying such a violation in the course of conducting
3462orientation or training activities within a nursing home.
3463     (1)  Each county, municipality, and special district that
3464has firesafety enforcement responsibilities shall employ or
3465contract with a firesafety inspector. The firesafety inspector
3466must conduct all firesafety inspections that are required by
3467law. The governing body of a county, municipality, or special
3468district that has firesafety enforcement responsibilities may
3469provide a schedule of fees to pay only the costs of inspections
3470conducted pursuant to this subsection and related administrative
3471expenses. Two or more counties, municipalities, or special
3472districts that have firesafety enforcement responsibilities may
3473jointly employ or contract with a firesafety inspector.
3474     (2)  Every firesafety inspection conducted pursuant to
3475state or local firesafety requirements shall be by a person
3476certified as having met the inspection training requirements set
3477by the State Fire Marshal. Such person shall:
3478     (a)  Be a high school graduate or the equivalent as
3479determined by the department;
3480     (b)  Not have been found guilty of, or having pleaded
3481guilty or nolo contendere to, a felony or a crime punishable by
3482imprisonment of 1 year or more under the law of the United
3483States, or of any state thereof, which involves moral turpitude,
3484without regard to whether a judgment of conviction has been
3485entered by the court having jurisdiction of such cases;
3486     (c)  Have her or his fingerprints on file with the
3487department or with an agency designated by the department;
3488     (d)  Have good moral character as determined by the
3489department;
3490     (e)  Be at least 18 years of age;
3491     (f)  Have satisfactorily completed the firesafety inspector
3492certification examination as prescribed by the department; and
3493     (g)1.  Have satisfactorily completed, as determined by the
3494department, a firesafety inspector training program of not less
3495than 200 hours established by the department and administered by
3496agencies and institutions approved by the department for the
3497purpose of providing basic certification training for firesafety
3498inspectors; or
3499     2.  Have received in another state training which is
3500determined by the department to be at least equivalent to that
3501required by the department for approved firesafety inspector
3502education and training programs in this state.
3503     (3)  Each special state firesafety inspection which is
3504required by law and is conducted by or on behalf of an agency of
3505the state must be performed by an individual who has met the
3506provision of subsection (2), except that the duration of the
3507training program shall not exceed 120 hours of specific training
3508for the type of property that such special state firesafety
3509inspectors are assigned to inspect.
3510     (4)  A firefighter certified pursuant to s. 633.35 may
3511conduct firesafety inspections, under the supervision of a
3512certified firesafety inspector, while on duty as a member of a
3513fire department company conducting inservice firesafety
3514inspections without being certified as a firesafety inspector,
3515if such firefighter has satisfactorily completed an inservice
3516fire department company inspector training program of at least
351724 hours' duration as provided by rule of the department.
3518     (5)  Every firesafety inspector or special state firesafety
3519inspector certificate is valid for a period of 3 years from the
3520date of issuance. Renewal of certification shall be subject to
3521the affected person's completing proper application for renewal
3522and meeting all of the requirements for renewal as established
3523under this chapter or by rule promulgated thereunder, which
3524shall include completion of at least 40 hours during the
3525preceding 3-year period of continuing education as required by
3526the rule of the department or, in lieu thereof, successful
3527passage of an examination as established by the department.
3528     (6)  The State Fire Marshal may deny, refuse to renew,
3529suspend, or revoke the certificate of a firesafety inspector or
3530special state firesafety inspector if it finds that any of the
3531following grounds exist:
3532     (a)  Any cause for which issuance of a certificate could
3533have been refused had it then existed and been known to the
3534State Fire Marshal.
3535     (b)  Violation of this chapter or any rule or order of the
3536State Fire Marshal.
3537     (c)  Falsification of records relating to the certificate.
3538     (d)  Having been found guilty of or having pleaded guilty
3539or nolo contendere to a felony, whether or not a judgment of
3540conviction has been entered.
3541     (e)  Failure to meet any of the renewal requirements.
3542     (f)  Having been convicted of a crime in any jurisdiction
3543which directly relates to the practice of fire code inspection,
3544plan review, or administration.
3545     (g)  Making or filing a report or record that the
3546certificateholder knows to be false, or knowingly inducing
3547another to file a false report or record, or knowingly failing
3548to file a report or record required by state or local law, or
3549knowingly impeding or obstructing such filing, or knowingly
3550inducing another person to impede or obstruct such filing.
3551     (h)  Failing to properly enforce applicable fire codes or
3552permit requirements within this state which the
3553certificateholder knows are applicable by committing willful
3554misconduct, gross negligence, gross misconduct, repeated
3555negligence, or negligence resulting in a significant danger to
3556life or property.
3557     (i)  Accepting labor, services, or materials at no charge
3558or at a noncompetitive rate from any person who performs work
3559that is under the enforcement authority of the certificateholder
3560and who is not an immediate family member of the
3561certificateholder. For the purpose of this paragraph, the term
3562"immediate family member" means a spouse, child, parent,
3563sibling, grandparent, aunt, uncle, or first cousin of the person
3564or the person's spouse or any person who resides in the primary
3565residence of the certificateholder.
3566     (7)  The department shall provide by rule for the
3567certification of firesafety inspectors.
3568     Section 94.  Subsection (12) of section 641.495, Florida
3569Statutes, is amended to read:
3570     641.495  Requirements for issuance and maintenance of
3571certificate.-
3572     (12)  The provisions of part I of chapter 395 do not apply
3573to a health maintenance organization that, on or before January
35741, 1991, provides not more than 10 outpatient holding beds for
3575short-term and hospice-type patients in an ambulatory care
3576facility for its members, provided that such health maintenance
3577organization maintains current accreditation by The Joint
3578Commission on Accreditation of Health Care Organizations, the
3579Accreditation Association for Ambulatory Health Care, or the
3580National Committee for Quality Assurance.
3581     Section 95.  Subsection (13) of section 651.118, Florida
3582Statutes, is amended to read:
3583     651.118  Agency for Health Care Administration;
3584certificates of need; sheltered beds; community beds.-
3585     (13)  Residents, as defined in this chapter, are not
3586considered new admissions for the purpose of s.
3587400.141(1)(n)(o)1.d.
3588     Section 96.  Subsection (2) of section 766.1015, Florida
3589Statutes, is amended to read:
3590     766.1015  Civil immunity for members of or consultants to
3591certain boards, committees, or other entities.-
3592     (2)  Such committee, board, group, commission, or other
3593entity must be established in accordance with state law or in
3594accordance with requirements of The Joint Commission on
3595Accreditation of Healthcare Organizations, established and duly
3596constituted by one or more public or licensed private hospitals
3597or behavioral health agencies, or established by a governmental
3598agency. To be protected by this section, the act, decision,
3599omission, or utterance may not be made or done in bad faith or
3600with malicious intent.
3601     Section 97.  Subsection (4) of section 766.202, Florida
3602Statutes, is amended to read:
3603     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3604766.201-766.212, the term:
3605     (4)  "Health care provider" means any hospital, ambulatory
3606surgical center, or mobile surgical facility as defined and
3607licensed under chapter 395; a birth center licensed under
3608chapter 383; any person licensed under chapter 458, chapter 459,
3609chapter 460, chapter 461, chapter 462, chapter 463, part I of
3610chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3611or chapter 486; a clinical lab licensed under chapter 483; a
3612health maintenance organization certificated under part I of
3613chapter 641; a blood bank; a plasma center; an industrial
3614clinic; a renal dialysis facility; or a professional association
3615partnership, corporation, joint venture, or other association
3616for professional activity by health care providers.
3617     Section 98.  This act shall take effect July 1, 2010.


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