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

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.
19390.0111, F.S.; requiring that an ultrasound be performed
20on any woman obtaining an abortion; specifying who must
21perform an ultrasound; requiring that the ultrasound be
22reviewed with the patient prior to the woman giving
23informed consent; specifying who must review the
24ultrasound with the patient; requiring that the woman
25certify in writing that she declined to review the
26ultrasound and did so of her own free will and without
27undue influence; providing an exemption from the
28requirement to view the ultrasound for women who are the
29victims of rape, incest, domestic violence, or human
30trafficking or for women who have a serious medical
31condition necessitating the abortion; revising
32requirements for written materials; amending s. 390.012,
33F.S.; requiring ultrasounds for all patients; requiring
34that live ultrasound images be reviewed and explained to
35the patient; requiring that all other provisions in s.
36390.0111, F.S., be complied with if the patient declines
37to view her live ultrasound images; amending s. 395.002,
38F.S.; revising and deleting definitions applicable to
39regulation of hospitals and other licensed facilities;
40conforming a cross-reference; amending s. 395.003, F.S.;
41deleting an obsolete provision; conforming a cross-
42reference; amending s. 395.0193, F.S.; requiring a
43licensed facility to report certain peer review
44information and final disciplinary actions to the Division
45of Medical Quality Assurance of the Department of Health
46rather than the Division of Health Quality Assurance of
47the Agency for Health Care Administration; amending s.
48395.1023, F.S.; providing for the Department of Children
49and Family Services rather than the Department of Health
50to perform certain functions with respect to child
51protection cases; requiring certain hospitals to notify
52the Department of Children and Family Services of
53compliance; amending s. 395.1041, F.S., relating to
54hospital emergency services and care; deleting obsolete
55provisions; repealing s. 395.1046, F.S., relating to
56complaint investigation procedures; amending s. 395.1055,
57F.S.; requiring licensed facility beds to conform to
58standards specified by the Agency for Health Care
59Administration, the Florida Building Code, and the Florida
60Fire Prevention Code; amending s. 395.10972, F.S.;
61revising a reference to the Florida Society of Healthcare
62Risk Management to conform to the current designation;
63amending s. 395.2050, F.S.; revising a reference to the
64federal Health Care Financing Administration to conform to
65the current designation; amending s. 395.3036, F.S.;
66correcting a reference; repealing s. 395.3037, F.S.,
67relating to redundant definitions; amending ss. 154.11,
68394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
69627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
70F.S.; revising references to the Joint Commission on
71Accreditation of Healthcare Organizations, the Commission
72on Accreditation of Rehabilitation Facilities, and the
73Council on Accreditation to conform to their current
74designations; amending s. 395.602, F.S.; revising the
75definition of the term "rural hospital" to delete an
76obsolete provision; amending s. 400.021, F.S.; revising
77the definition of the term "geriatric outpatient clinic";
78amending s. 400.0255, F.S.; correcting an obsolete cross-
79reference to administrative rules; amending s. 400.063,
80F.S.; deleting an obsolete provision; amending ss. 400.071
81and 400.0712, F.S.; revising applicability of general
82licensure requirements under part II of ch. 408, F.S., to
83applications for nursing home licensure; revising
84provisions governing inactive licenses; amending s.
85400.111, F.S.; providing for disclosure of controlling
86interest of a nursing home facility upon request by the
87Agency for Health Care Administration; amending s.
88400.1183, F.S.; revising grievance record maintenance and
89reporting requirements for nursing homes; amending s.
90400.141, F.S.; providing criteria for the provision of
91respite services by nursing homes; requiring a written
92plan of care; requiring a contract for services; requiring
93resident release to caregivers to be designated in
94writing; providing an exemption to the application of
95discharge planning rules; providing for residents' rights;
96providing for use of personal medications; providing terms
97of respite stay; providing for communication of patient
98information; requiring a physician order for care and
99proof of a physical examination; providing for services
100for respite patients and duties of facilities with respect
101to such patients; conforming a cross-reference; requiring
102facilities to maintain clinical records that meet
103specified standards; providing a fine relating to an
104admissions moratorium; deleting requirement for facilities
105to submit certain information related to management
106companies to the agency; deleting a requirement for
107facilities to notify the agency of certain bankruptcy
108filings to conform to changes made by the act; amending s.
109400.142, F.S.; deleting language relating to agency
110adoption of rules; amending 400.147, F.S.; revising
111reporting requirements for licensed nursing home
112facilities relating to adverse incidents; repealing s.
113400.148, F.S., relating to the Medicaid "Up-or-Out"
114Quality of Care Contract Management Program; amending s.
115400.162, F.S., requiring nursing homes to provide a
116resident property statement annually and upon request;
117amending s. 400.179, F.S.; revising requirements for
118nursing home lease bond alternative fees; deleting an
119obsolete provision; amending s. 400.19, F.S.; revising
120inspection requirements; repealing s. 400.195, F.S.,
121relating to agency reporting requirements; amending s.
122400.23, F.S.; deleting an obsolete provision; correcting a
123reference; directing the agency to adopt rules for minimum
124staffing standards in nursing homes that serve persons
125under 21 years of age; providing minimum staffing
126standards; amending s. 400.275, F.S.; revising agency
127duties with regard to training nursing home surveyor
128teams; revising requirements for team members; amending s.
129400.484, F.S.; revising the schedule of home health agency
130inspection violations; amending s. 400.606, F.S.; revising
131the content requirements of the plan accompanying an
132initial or change-of-ownership application for licensure
133of a hospice; revising requirements relating to
134certificates of need for certain hospice facilities;
135amending s. 400.607, F.S.; revising grounds for agency
136action against a hospice; amending s. 400.915, F.S.;
137correcting an obsolete cross-reference to administrative
138rules; amending s. 400.931, F.S.; deleting a requirement
139that an applicant for a home medical equipment provider
140license submit a surety bond to the agency; amending s.
141400.932, F.S.; revising grounds for the imposition of
142administrative penalties for certain violations by an
143employee of a home medical equipment provider; amending s.
144400.967, F.S.; revising the schedule of inspection
145violations for intermediate care facilities for the
146developmentally disabled; providing a penalty for certain
147violations; amending s. 400.9905, F.S.; providing that
148part X of ch, 400, F.S., the Health Care Clinic Act, does
149not apply to an entity owned by a corporation with a
150specified amount of annual sales of health care services
151under certain circumstances or to an entity owned or
152controlled by a publicly traded entity with a specified
153amount of annual revenues; amending s. 400.991, F.S.;
154conforming terminology; revising application requirements
155relating to documentation of financial ability to operate
156a mobile clinic; amending s. 408.034, F.S.; revising
157agency authority relating to licensing of intermediate
158care facilities for the developmentally disabled; amending
159s. 408.036, F.S.; deleting an exemption from certain
160certificate-of-need review requirements for a hospice or a
161hospice inpatient facility; amending s. 408.043, F.S.;
162revising requirements for certain freestanding inpatient
163hospice care facilities to obtain a certificate of need;
164amending s. 408.061, F.S.; revising health care facility
165data reporting requirements; amending s. 408.10, F.S.;
166removing agency authority to investigate certain consumer
167complaints; amending s. 408.802, F.S.; removing
168applicability of part II of ch. 408, F.S., relating to
169general licensure requirements, to private review agents;
170amending s. 408.804, F.S.; providing penalties for
171altering, defacing, or falsifying a license certificate
172issued by the agency or displaying such an altered,
173defaced, or falsified certificate; amending s. 408.806,
174F.S.; revising agency responsibilities for notification of
175licensees of impending expiration of a license; requiring
176payment of a late fee for a license application to be
177considered complete under certain circumstances; amending
178s. 408.810, F.S.; revising provisions relating to
179information required for licensure; requiring proof of
180submission of notice to a mortgagor or landlord regarding
181provision of services requiring licensure; requiring
182disclosure of information by a controlling interest of
183certain court actions relating to financial instability
184within a specified time period; amending s. 408.813, F.S.;
185authorizing the agency to impose fines for unclassified
186violations of part II of ch. 408, F.S.; amending s.
187408.815, F.S.; authorizing the agency to extend a license
188expiration date under certain circumstances; amending s.
189409.221, F.S.; deleting a reporting requirement relating
190to the consumer-directed care program; amending s.
191409.91196, F.S.; conforming a cross-reference; amending s.
192409.912, F.S.; revising procedures for implementation of a
193Medicaid prescribed-drug spending-control program;
194amending s. 429.07, F.S.; deleting the requirement for an
195assisted living facility to obtain an additional license
196in order to provide limited nursing services; deleting the
197requirement for the agency to conduct quarterly monitoring
198visits of facilities that hold a license to provide
199extended congregate care services; deleting the
200requirement for the department to report annually on the
201status of and recommendations related to extended
202congregate care; deleting the requirement for the agency
203to conduct monitoring visits at least twice a year to
204facilities providing limited nursing services; increasing
205the licensure fees and the maximum fee required for the
206standard license; increasing the licensure fees for the
207extended congregate care license; eliminating the license
208fee for the limited nursing services license; transferring
209from another provision of law the requirement that a
210biennial survey of an assisted living facility include
211specific actions to determine whether the facility is
212adequately protecting residents' rights; providing that an
213assisted living facility that has a class I or class II
214violation is subject to monitoring visits; requiring a
215registered nurse to participate in certain monitoring
216visits; amending s. 429.11, F.S.; revising licensure
217application requirements for assisted living facilities to
218eliminate provisional licenses; amending s. 429.12, F.S.;
219revising notification requirements for the sale or
220transfer of ownership of an assisted living facility;
221amending s. 429.14, F.S.; removing a ground for the
222imposition of an administrative penalty; clarifying
223provisions relating to a facility's request for a hearing
224under certain circumstances; authorizing the agency to
225provide certain information relating to the licensure
226status of assisted living facilities electronically or
227through the agency's Internet website; amending s. 429.17,
228F.S.; deleting provisions relating to the limited nursing
229services license; revising agency responsibilities
230regarding the issuance of conditional licenses; amending
231s. 429.19, F.S.; clarifying that a monitoring fee may be
232assessed in addition to an administrative fine; amending
233s. 429.23, F.S.; deleting reporting requirements for
234assisted living facilities relating to liability claims;
235amending s. 429.255, F.S.; eliminating provisions
236authorizing the use of volunteers to provide certain
237health-care-related services in assisted living
238facilities; authorizing assisted living facilities to
239provide limited nursing services; requiring an assisted
240living facility to be responsible for certain
241recordkeeping and staff to be trained to monitor residents
242receiving certain health-care-related services; amending
243s. 429.28, F.S.; deleting a requirement for a biennial
244survey of an assisted living facility, to conform to
245changes made by the act; amending s. 429.35, F.S.;
246authorizing the agency to provide certain information
247relating to the inspections of assisted living facilities
248electronically or through the agency's Internet website;
249amending s. 429.41, F.S., relating to rulemaking;
250conforming provisions to changes made by the act; amending
251s. 429.53, F.S.; revising provisions relating to
252consultation by the agency; revising a definition;
253amending s. 429.54, F.S.; requiring licensed assisted
254living facilities to electronically report certain data
255semiannually to the agency in accordance with rules
256adopted by the department; amending s. 429.71, F.S.;
257revising schedule of inspection violations for adult
258family-care homes; amending s. 429.911, F.S.; deleting a
259ground for agency action against an adult day care center;
260amending s. 429.915, F.S.; revising agency
261responsibilities regarding the issuance of conditional
262licenses; amending s. 483.294, F.S.; revising frequency of
263agency inspections of multiphasic health testing centers;
264amending s. 499.003, F.S.; defining the term "medical
265convenience kit" for purposes of pt. I of ch. 499, F.S.;
266providing an exception to applicability of the term;
267amending s. 499.0121, F.S.; providing an exception to the
268requirement that a wholesale distributor of prescription
269drugs provide a pedigree paper to the person who receives
270the drug for wholesale distribution of prescription drugs
271contained within a medical convenience kit under specified
272conditions; providing that the exception does not apply to
273any kit that contains certain controlled substances;
274amending s. 626.9541, F.S.; authorizing an insurer
275offering a group or individual health benefit plan to
276offer a wellness program; authorizing rewards or
277incentives; providing that such rewards or incentives are
278not insurance benefits; providing for verification of a
279member's inability to participate for medical reasons;
280amending s. 633.081, F.S.; limiting Fire Marshal
281inspections of nursing homes to once a year; providing for
282additional inspections based on complaints and violations
283identified in the course of orientation or training
284activities; amending s. 766.202, F.S.; adding persons
285licensed under part XIV of ch. 468, F.S., to the
286definition of "health care provider"; amending ss.
287394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
288conforming terminology and cross-references; revising a
289reference; providing a statement of public policy
290protecting persons from government compulsion relating to
291purchasing health insurance coverage; preserving the right
292to collect certain debts incurred for health insurance or
293health services; authorizing the Attorney General to
294implement or advocate such public policy in federal or
295state court or administrative forums on behalf of certain
296persons; creating s. 627.64995, F.S.; prohibiting the use
297of state or federal funds to provide coverage for
298abortions in an exchange created pursuant to federal law;
299specifying conditions under which a health insurance
300policy or group health insurance policy is deemed to be
301purchased with state or federal funds; providing
302exceptions; creating s. 641.31099, F.S.; prohibiting the
303use of state or federal funds to provide coverage for
304abortions in an exchange created pursuant to federal law;
305specifying conditions under which a health maintenance
306contract is deemed to provide coverage purchased with
307state or federal funds; providing exceptions; providing an
308effective date.
310Be It Enacted by the Legislature of the State of Florida:
312     Section 1.  Present paragraph (e) of subsection (10) and
313paragraph (e) of subsection (14) of section 112.0455, Florida
314Statutes, are amended, and paragraphs (f) through (k) of
315subsection (10) of that section are redesignated as paragraphs
316(e) through (j), respectively, to read:
317     112.0455  Drug-Free Workplace Act.-
319     (e)  Nothing in this section shall be construed to operate
320retroactively, and nothing in this section shall abrogate the
321right of an employer under state law to conduct drug tests prior
322to January 1, 1990. A drug test conducted by an employer prior
323to January 1, 1990, is not subject to this section.
325     (e)  Upon resolving an appeal filed pursuant to paragraph
326(c), and finding a violation of this section, the commission may
327order the following relief:
328     1.  Rescind the disciplinary action, expunge related
329records from the personnel file of the employee or job applicant
330and reinstate the employee.
331     2.  Order compliance with paragraph (10)(f)(g).
332     3.  Award back pay and benefits.
333     4.  Award the prevailing employee or job applicant the
334necessary costs of the appeal, reasonable attorney's fees, and
335expert witness fees.
336     Section 2.  Paragraph (n) of subsection (1) of section
337154.11, Florida Statutes, is amended to read:
338     154.11  Powers of board of trustees.-
339     (1)  The board of trustees of each public health trust
340shall be deemed to exercise a public and essential governmental
341function of both the state and the county and in furtherance
342thereof it shall, subject to limitation by the governing body of
343the county in which such board is located, have all of the
344powers necessary or convenient to carry out the operation and
345governance of designated health care facilities, including, but
346without limiting the generality of, the foregoing:
347     (n)  To appoint originally the staff of physicians to
348practice in any designated facility owned or operated by the
349board and to approve the bylaws and rules to be adopted by the
350medical staff of any designated facility owned and operated by
351the board, such governing regulations to be in accordance with
352the standards of The Joint Commission on the Accreditation of
353Hospitals which provide, among other things, for the method of
354appointing additional staff members and for the removal of staff
356     Section 3.  Subsection (15) of section 318.21, Florida
357Statutes, is amended to read:
358     318.21  Disposition of civil penalties by county courts.-
359All civil penalties received by a county court pursuant to the
360provisions of this chapter shall be distributed and paid monthly
361as follows:
362     (15)  Of the additional fine assessed under s. 318.18(3)(e)
363for a violation of s. 316.1893, 50 percent of the moneys
364received from the fines shall be remitted to the Department of
365Revenue and deposited into the Brain and Spinal Cord Injury
366Trust Fund of Department of Health and shall be appropriated to
367the Department of Health Agency for Health Care Administration
368as general revenue to provide an enhanced Medicaid payment to
369nursing homes that serve Medicaid recipients with spinal cord
370injuries that are medically complex and who are technologically
371and respiratory dependent with brain and spinal cord injuries.
372The remaining 50 percent of the moneys received from the
373enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
374the Department of Revenue and deposited into the Department of
375Health Administrative Trust Fund to provide financial support to
376certified trauma centers in the counties where enhanced penalty
377zones are established to ensure the availability and
378accessibility of trauma services. Funds deposited into the
379Administrative Trust Fund under this subsection shall be
380allocated as follows:
381     (a)  Fifty percent shall be allocated equally among all
382Level I, Level II, and pediatric trauma centers in recognition
383of readiness costs for maintaining trauma services.
384     (b)  Fifty percent shall be allocated among Level I, Level
385II, and pediatric trauma centers based on each center's relative
386volume of trauma cases as reported in the Department of Health
387Trauma Registry.
388     Section 4.  Subsection (3) is added to section 381.00315,
389Florida Statutes, to read:
390     381.00315  Public health advisories; public health
391emergencies.-The State Health Officer is responsible for
392declaring public health emergencies and issuing public health
394     (3)  To facilitate effective emergency management, when the
395United States Department of Health and Human Services contracts
396for the manufacture and delivery of licensable products in
397response to a public health emergency and the terms of those
398contracts are made available to the states, the department shall
399accept funds provided by counties, municipalities, and other
400entities designated in the state emergency management plan
401required under s. 252.35(2)(a) for the purpose of participation
402in such contracts. The department shall deposit the funds into
403the Grants and Donations Trust Fund and expend the funds on
404behalf of the donor county, municipality, or other entity for
405the purchase the licensable products made available under the
407     Section 5.  Paragraph (e) is added to subsection (2) of
408section 381.0072, Florida Statutes, to read:
409     381.0072  Food service protection.-It shall be the duty of
410the Department of Health to adopt and enforce sanitation rules
411consistent with law to ensure the protection of the public from
412food-borne illness. These rules shall provide the standards and
413requirements for the storage, preparation, serving, or display
414of food in food service establishments as defined in this
415section and which are not permitted or licensed under chapter
416500 or chapter 509.
417     (2)  DUTIES.-
418     (e)  The department shall inspect food service
419establishments in nursing homes licensed under part II of
420chapter 400 twice each year. The department may make additional
421inspections only in response to complaints. The department shall
422coordinate inspections with the Agency for Health Care
423Administration, such that the department's inspection is at
424least 60 days after a recertification visit by the Agency for
425Health Care Administration.
426     Section 6.  Section 383.325, Florida Statutes, is repealed.
427     Section 7.  Subsection (7) of section 394.4787, Florida
428Statutes, is amended to read:
429     394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
430and 394.4789.-As used in this section and ss. 394.4786,
431394.4788, and 394.4789:
432     (7)  "Specialty psychiatric hospital" means a hospital
433licensed by the agency pursuant to s. 395.002(26)(28) and part
434II of chapter 408 as a specialty psychiatric hospital.
435     Section 8.  Subsection (2) of section 394.741, Florida
436Statutes, is amended to read:
437     394.741  Accreditation requirements for providers of
438behavioral health care services.-
439     (2)  Notwithstanding any provision of law to the contrary,
440accreditation shall be accepted by the agency and department in
441lieu of the agency's and department's facility licensure onsite
442review requirements and shall be accepted as a substitute for
443the department's administrative and program monitoring
444requirements, except as required by subsections (3) and (4),
446     (a)  Any organization from which the department purchases
447behavioral health care services that is accredited by The Joint
448Commission on Accreditation of Healthcare Organizations or the
449Council on Accreditation for Children and Family Services, or
450has those services that are being purchased by the department
451accredited by the Commission on Accreditation of Rehabilitation
452Facilities CARF-the Rehabilitation Accreditation Commission.
453     (b)  Any mental health facility licensed by the agency or
454any substance abuse component licensed by the department that is
455accredited by The Joint Commission on Accreditation of
456Healthcare Organizations, the Commission on Accreditation of
457Rehabilitation Facilities CARF-the Rehabilitation Accreditation
458Commission, or the Council on Accreditation of Children and
459Family Services.
460     (c)  Any network of providers from which the department or
461the agency purchases behavioral health care services accredited
462by The Joint Commission on Accreditation of Healthcare
463Organizations, the Commission on Accreditation of Rehabilitation
464Facilities CARF-the Rehabilitation Accreditation Commission, the
465Council on Accreditation of Children and Family Services, or the
466National Committee for Quality Assurance. A provider
467organization, which is part of an accredited network, is
468afforded the same rights under this part.
469     Section 9.  Subsection (3) of section 390.0111, Florida
470Statutes, is amended to read:
471     390.0111  Termination of pregnancies.-
472     (3)  CONSENTS REQUIRED.-A termination of pregnancy may not
473be performed or induced except with the voluntary and informed
474written consent of the pregnant woman or, in the case of a
475mental incompetent, the voluntary and informed written consent
476of her court-appointed guardian.
477     (a)  Except in the case of a medical emergency, consent to
478a termination of pregnancy is voluntary and informed only if:
479     1.  The physician who is to perform the procedure, or the
480referring physician, has, at a minimum, orally, in person,
481informed the woman of:
482     a.  The nature and risks of undergoing or not undergoing
483the proposed procedure that a reasonable patient would consider
484material to making a knowing and willful decision of whether to
485terminate a pregnancy.
486     b.  The probable gestational age of the fetus, verified by
487an ultrasound, at the time the termination of pregnancy is to be
489     (I)  The ultrasound must be performed by the physician who
490is to perform the abortion or by a person having documented
491evidence that he or she has completed a course in the operation
492of ultrasound equipment, as prescribed by rule by the Department
493of Health, and who is working in conjunction with the physician.
494     (II)  The person performing the ultrasound must allow the
495woman to view the live ultrasound images, and a physician or a
496registered nurse, licensed practical nurse, advanced registered
497nurse practitioner, or physician assistant working in
498conjunction with the physician must contemporaneously review and
499explain the live ultrasound images to the woman prior to the
500woman giving informed consent to having an abortion procedure
501performed. However, this sub-sub-subparagraph does not apply if,
502at the time the woman schedules or arrives for her appointment
503to obtain an abortion, a copy of a restraining order, police
504report, medical record, or other court order or documentation is
505presented that evidences that the woman is obtaining the
506abortion because the woman is a victim of rape, incest, domestic
507violence, or human trafficking or that the woman has been
508diagnosed as having a condition that, on the basis of a
509physician's good faith clinical judgment, would create a serious
510risk of substantial and irreversible impairment of a major
511bodily function if the woman delayed terminating her pregnancy.
512     (III)  The woman has a right to decline to view the
513ultrasound images after she is informed of her right and offered
514an opportunity to view them. If the woman declines to view the
515ultrasound images, the woman shall complete a form, as
516determined by department rule, acknowledging that she was
517offered an opportunity to view her ultrasound but that she
518rejected that opportunity. The form must also indicate that the
519woman's decision not to view the ultrasound was not based on any
520undue influence from any third party to discourage her from
521viewing the images and that she declined to view the images of
522her own free will.
523     c.  The medical risks to the woman and fetus of carrying
524the pregnancy to term.
525     2.  Printed materials prepared and provided by the
526department have been provided to the pregnant woman, if she
527chooses to view these materials, including:
528     a.  A description of the fetus, including a description of
529the various stages of development.
530     b.  A list of entities agencies that offer alternatives to
531terminating the pregnancy.
532     c.  Detailed information on the availability of medical
533assistance benefits for prenatal care, childbirth, and neonatal
535     3.  The woman acknowledges in writing, before the
536termination of pregnancy, that the information required to be
537provided under this subsection has been provided.
539Nothing in this paragraph is intended to prohibit a physician
540from providing any additional information which the physician
541deems material to the woman's informed decision to terminate her
543     (b)  In the event a medical emergency exists and a
544physician cannot comply with the requirements for informed
545consent, a physician may terminate a pregnancy if he or she has
546obtained at least one corroborative medical opinion attesting to
547the medical necessity for emergency medical procedures and to
548the fact that to a reasonable degree of medical certainty the
549continuation of the pregnancy would threaten the life of the
550pregnant woman. In the event no second physician is available
551for a corroborating opinion, the physician may proceed but shall
552document reasons for the medical necessity in the patient's
553medical records.
554     (c)  Violation of this subsection by a physician
555constitutes grounds for disciplinary action under s. 458.331 or
556s. 459.015. Substantial compliance or reasonable belief that
557complying with the requirements of informed consent would
558threaten the life or health of the patient is a defense to any
559action brought under this paragraph.
560     Section 10.  Paragraph (d) of subsection (3) of section
561390.012, Florida Statutes, is amended to read:
562     390.012  Powers of agency; rules; disposal of fetal
564     (3)  For clinics that perform or claim to perform abortions
565after the first trimester of pregnancy, the agency shall adopt
566rules pursuant to ss. 120.536(1) and 120.54 to implement the
567provisions of this chapter, including the following:
568     (d)  Rules relating to the medical screening and evaluation
569of each abortion clinic patient. At a minimum, these rules shall
571     1.  A medical history including reported allergies to
572medications, antiseptic solutions, or latex; past surgeries; and
573an obstetric and gynecological history.
574     2.  A physical examination, including a bimanual
575examination estimating uterine size and palpation of the adnexa.
576     3.  The appropriate laboratory tests, including:
577     a.  For an abortion in which an ultrasound examination is
578not performed before the abortion procedure, Urine or blood
579tests for pregnancy performed before the abortion procedure.
580     b.  A test for anemia.
581     c.  Rh typing, unless reliable written documentation of
582blood type is available.
583     d.  Other tests as indicated from the physical examination.
584     4.  An ultrasound evaluation for all patients who elect to
585have an abortion after the first trimester. The rules shall
586require that if a person who is not a physician performs an
587ultrasound examination, that person shall have documented
588evidence that he or she has completed a course in the operation
589of ultrasound equipment as prescribed in rule. The physician,
590registered nurse, licensed practical nurse, advanced registered
591nurse practitioner, or physician assistant shall review and
592explain, at the request of the patient, the live ultrasound
593images evaluation results, including an estimate of the probable
594gestational age of the fetus, with the patient before the
595abortion procedure is performed, unless the patient declines
596pursuant to s. 390.0111. If the patient declines to view the
597live ultrasound images, the applicable rules established by the
598department shall require that s. 390.0111 be complied with in
599all other respects.
600     5.  That the physician is responsible for estimating the
601gestational age of the fetus based on the ultrasound examination
602and obstetric standards in keeping with established standards of
603care regarding the estimation of fetal age as defined in rule
604and shall write the estimate in the patient's medical history.
605The physician shall keep original prints of each ultrasound
606examination of a patient in the patient's medical history file.
607     Section 11.  Present subsections (15) through (32) of
608section 395.002, Florida Statutes, are renumbered as subsections
609(14) through (28), respectively, and present subsections (1),
610(14), (24), (30), and (31), and paragraph (c) of present
611subsection (28) of that section are amended to read:
612     395.002  Definitions.-As used in this chapter:
613     (1)  "Accrediting organizations" means nationally
614recognized or approved accrediting organizations whose standards
615incorporate comparable licensure requirements as determined by
616the agency the Joint Commission on Accreditation of Healthcare
617Organizations, the American Osteopathic Association, the
618Commission on Accreditation of Rehabilitation Facilities, and
619the Accreditation Association for Ambulatory Health Care, Inc.
620     (14)  "Initial denial determination" means a determination
621by a private review agent that the health care services
622furnished or proposed to be furnished to a patient are
623inappropriate, not medically necessary, or not reasonable.
624     (24)  "Private review agent" means any person or entity
625which performs utilization review services for third-party
626payors on a contractual basis for outpatient or inpatient
627services. However, the term shall not include full-time
628employees, personnel, or staff of health insurers, health
629maintenance organizations, or hospitals, or wholly owned
630subsidiaries thereof or affiliates under common ownership, when
631performing utilization review for their respective hospitals,
632health maintenance organizations, or insureds of the same
633insurance group. For this purpose, health insurers, health
634maintenance organizations, and hospitals, or wholly owned
635subsidiaries thereof or affiliates under common ownership,
636include such entities engaged as administrators of self-
637insurance as defined in s. 624.031.
638     (26)(28)  "Specialty hospital" means any facility which
639meets the provisions of subsection (12), and which regularly
640makes available either:
641     (c)  Intensive residential treatment programs for children
642and adolescents as defined in subsection (14) (15).
643     (30)  "Utilization review" means a system for reviewing the
644medical necessity or appropriateness in the allocation of health
645care resources of hospital services given or proposed to be
646given to a patient or group of patients.
647     (31)  "Utilization review plan" means a description of the
648policies and procedures governing utilization review activities
649performed by a private review agent.
650     Section 12.  Paragraph (c) of subsection (1) and paragraph
651(b) of subsection (2) of section 395.003, Florida Statutes, are
652amended to read:
653     395.003  Licensure; denial, suspension, and revocation.-
654     (1)
655     (c)  Until July 1, 2006, additional emergency departments
656located off the premises of licensed hospitals may not be
657authorized by the agency.
658     (2)
659     (b)  The agency shall, at the request of a licensee that is
660a teaching hospital as defined in s. 408.07(45), issue a single
661license to a licensee for facilities that have been previously
662licensed as separate premises, provided such separately licensed
663facilities, taken together, constitute the same premises as
664defined in s. 395.002(22)(23). Such license for the single
665premises shall include all of the beds, services, and programs
666that were previously included on the licenses for the separate
667premises. The granting of a single license under this paragraph
668shall not in any manner reduce the number of beds, services, or
669programs operated by the licensee.
670     Section 13.  Paragraph (e) of subsection (2) and subsection
671(4) of section 395.0193, Florida Statutes, are amended to read:
672     395.0193  Licensed facilities; peer review; disciplinary
673powers; agency or partnership with physicians.-
674     (2)  Each licensed facility, as a condition of licensure,
675shall provide for peer review of physicians who deliver health
676care services at the facility. Each licensed facility shall
677develop written, binding procedures by which such peer review
678shall be conducted. Such procedures shall include:
679     (e)  Recording of agendas and minutes which do not contain
680confidential material, for review by the Division of Medical
681Quality Assurance of the department Health Quality Assurance of
682the agency.
683     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
684actions taken under subsection (3) shall be reported in writing
685to the Division of Medical Quality Assurance of the department
686Health Quality Assurance of the agency within 30 working days
687after its initial occurrence, regardless of the pendency of
688appeals to the governing board of the hospital. The notification
689shall identify the disciplined practitioner, the action taken,
690and the reason for such action. All final disciplinary actions
691taken under subsection (3), if different from those which were
692reported to the department agency within 30 days after the
693initial occurrence, shall be reported within 10 working days to
694the Division of Medical Quality Assurance of the department
695Health Quality Assurance of the agency in writing and shall
696specify the disciplinary action taken and the specific grounds
697therefor. The division shall review each report and determine
698whether it potentially involved conduct by the licensee that is
699subject to disciplinary action, in which case s. 456.073 shall
700apply. The reports are not subject to inspection under s.
701119.07(1) even if the division's investigation results in a
702finding of probable cause.
703     Section 14.  Section 395.1023, Florida Statutes, is amended
704to read:
705     395.1023  Child abuse and neglect cases; duties.-Each
706licensed facility shall adopt a protocol that, at a minimum,
707requires the facility to:
708     (1)  Incorporate a facility policy that every staff member
709has an affirmative duty to report, pursuant to chapter 39, any
710actual or suspected case of child abuse, abandonment, or
711neglect; and
712     (2)  In any case involving suspected child abuse,
713abandonment, or neglect, designate, at the request of the
714Department of Children and Family Services, a staff physician to
715act as a liaison between the hospital and the Department of
716Children and Family Services office which is investigating the
717suspected abuse, abandonment, or neglect, and the child
718protection team, as defined in s. 39.01, when the case is
719referred to such a team.
721Each general hospital and appropriate specialty hospital shall
722comply with the provisions of this section and shall notify the
723agency and the Department of Children and Family Services of its
724compliance by sending a copy of its policy to the agency and the
725Department of Children and Family Services as required by rule.
726The failure by a general hospital or appropriate specialty
727hospital to comply shall be punished by a fine not exceeding
728$1,000, to be fixed, imposed, and collected by the agency. Each
729day in violation is considered a separate offense.
730     Section 15.  Subsection (2) and paragraph (d) of subsection
731(3) of section 395.1041, Florida Statutes, are amended to read:
732     395.1041  Access to emergency services and care.-
734shall establish and maintain an inventory of hospitals with
735emergency services. The inventory shall list all services within
736the service capability of the hospital, and such services shall
737appear on the face of the hospital license. Each hospital having
738emergency services shall notify the agency of its service
739capability in the manner and form prescribed by the agency. The
740agency shall use the inventory to assist emergency medical
741services providers and others in locating appropriate emergency
742medical care. The inventory shall also be made available to the
743general public. On or before August 1, 1992, the agency shall
744request that each hospital identify the services which are
745within its service capability. On or before November 1, 1992,
746the agency shall notify each hospital of the service capability
747to be included in the inventory. The hospital has 15 days from
748the date of receipt to respond to the notice. By December 1,
7491992, the agency shall publish a final inventory. Each hospital
750shall reaffirm its service capability when its license is
751renewed and shall notify the agency of the addition of a new
752service or the termination of a service prior to a change in its
753service capability.
756     (d)1.  Every hospital shall ensure the provision of
757services within the service capability of the hospital, at all
758times, either directly or indirectly through an arrangement with
759another hospital, through an arrangement with one or more
760physicians, or as otherwise made through prior arrangements. A
761hospital may enter into an agreement with another hospital for
762purposes of meeting its service capability requirement, and
763appropriate compensation or other reasonable conditions may be
764negotiated for these backup services.
765     2.  If any arrangement requires the provision of emergency
766medical transportation, such arrangement must be made in
767consultation with the applicable provider and may not require
768the emergency medical service provider to provide transportation
769that is outside the routine service area of that provider or in
770a manner that impairs the ability of the emergency medical
771service provider to timely respond to prehospital emergency
773     3.  A hospital shall not be required to ensure service
774capability at all times as required in subparagraph 1. if, prior
775to the receiving of any patient needing such service capability,
776such hospital has demonstrated to the agency that it lacks the
777ability to ensure such capability and it has exhausted all
778reasonable efforts to ensure such capability through backup
779arrangements. In reviewing a hospital's demonstration of lack of
780ability to ensure service capability, the agency shall consider
781factors relevant to the particular case, including the
783     a.  Number and proximity of hospitals with the same service
785     b.  Number, type, credentials, and privileges of
787     c.  Frequency of procedures.
788     d.  Size of hospital.
789     4.  The agency shall publish proposed rules implementing a
790reasonable exemption procedure by November 1, 1992. Subparagraph
7911. shall become effective upon the effective date of said rules
792or January 31, 1993, whichever is earlier. For a period not to
793exceed 1 year from the effective date of subparagraph 1., a
794hospital requesting an exemption shall be deemed to be exempt
795from offering the service until the agency initially acts to
796deny or grant the original request. The agency has 45 days from
797the date of receipt of the request to approve or deny the
798request. After the first year from the effective date of
799subparagraph 1., If the agency fails to initially act within the
800time period, the hospital is deemed to be exempt from offering
801the service until the agency initially acts to deny the request.
802     Section 16.  Section 395.1046, Florida Statutes, is
804     Section 17.  Paragraph (e) of subsection (1) of section
805395.1055, Florida Statutes, is amended to read:
806     395.1055  Rules and enforcement.-
807     (1)  The agency shall adopt rules pursuant to ss.
808120.536(1) and 120.54 to implement the provisions of this part,
809which shall include reasonable and fair minimum standards for
810ensuring that:
811     (e)  Licensed facility beds conform to minimum space,
812equipment, and furnishings standards as specified by the agency,
813the Florida Building Code, and the Florida Fire Prevention Code
815     Section 18.  Subsection (1) of section 395.10972, Florida
816Statutes, is amended to read:
817     395.10972  Health Care Risk Manager Advisory Council.-The
818Secretary of Health Care Administration may appoint a seven-
819member advisory council to advise the agency on matters
820pertaining to health care risk managers. The members of the
821council shall serve at the pleasure of the secretary. The
822council shall designate a chair. The council shall meet at the
823call of the secretary or at those times as may be required by
824rule of the agency. The members of the advisory council shall
825receive no compensation for their services, but shall be
826reimbursed for travel expenses as provided in s. 112.061. The
827council shall consist of individuals representing the following
829     (1)  Two shall be active health care risk managers,
830including one risk manager who is recommended by and a member of
831the Florida Society for of Healthcare Risk Management and
832Patient Safety.
833     Section 19.  Subsection (3) of section 395.2050, Florida
834Statutes, is amended to read:
835     395.2050  Routine inquiry for organ and tissue donation;
836certification for procurement activities; death records review.-
837     (3)  Each organ procurement organization designated by the
838federal Centers for Medicare and Medicaid Services Health Care
839Financing Administration and licensed by the state shall conduct
840an annual death records review in the organ procurement
841organization's affiliated donor hospitals. The organ procurement
842organization shall enlist the services of every Florida licensed
843tissue bank and eye bank affiliated with or providing service to
844the donor hospital and operating in the same service area to
845participate in the death records review.
846     Section 20.  Subsection (2) of section 395.3036, Florida
847Statutes, is amended to read:
848     395.3036  Confidentiality of records and meetings of
849corporations that lease public hospitals or other public health
850care facilities.-The records of a private corporation that
851leases a public hospital or other public health care facility
852are confidential and exempt from the provisions of s. 119.07(1)
853and s. 24(a), Art. I of the State Constitution, and the meetings
854of the governing board of a private corporation are exempt from
855s. 286.011 and s. 24(b), Art. I of the State Constitution when
856the public lessor complies with the public finance
857accountability provisions of s. 155.40(5) with respect to the
858transfer of any public funds to the private lessee and when the
859private lessee meets at least three of the five following
861     (2)  The public lessor and the private lessee do not
862commingle any of their funds in any account maintained by either
863of them, other than the payment of the rent and administrative
864fees or the transfer of funds pursuant to s. 155.40     (2)
865subsection (2).
866     Section 21.  Section 395.3037, Florida Statutes, is
868     Section 22.  Subsections (1), (4), and (5) of section
869395.3038, Florida Statutes, are amended to read:
870     395.3038  State-listed primary stroke centers and
871comprehensive stroke centers; notification of hospitals.-
872     (1)  The agency shall make available on its website and to
873the department a list of the name and address of each hospital
874that meets the criteria for a primary stroke center and the name
875and address of each hospital that meets the criteria for a
876comprehensive stroke center. The list of primary and
877comprehensive stroke centers shall include only those hospitals
878that attest in an affidavit submitted to the agency that the
879hospital meets the named criteria, or those hospitals that
880attest in an affidavit submitted to the agency that the hospital
881is certified as a primary or a comprehensive stroke center by
882The Joint Commission on Accreditation of Healthcare
884     (4)  The agency shall adopt by rule criteria for a primary
885stroke center which are substantially similar to the
886certification standards for primary stroke centers of The Joint
887Commission on Accreditation of Healthcare Organizations.
888     (5)  The agency shall adopt by rule criteria for a
889comprehensive stroke center. However, if The Joint Commission on
890Accreditation of Healthcare Organizations establishes criteria
891for a comprehensive stroke center, the agency shall establish
892criteria for a comprehensive stroke center which are
893substantially similar to those criteria established by The Joint
894Commission on Accreditation of Healthcare Organizations.
895     Section 23.  Paragraph (e) of subsection (2) of section
896395.602, Florida Statutes, is amended to read:
897     395.602  Rural hospitals.-
898     (2)  DEFINITIONS.-As used in this part:
899     (e)  "Rural hospital" means an acute care hospital licensed
900under this chapter, having 100 or fewer licensed beds and an
901emergency room, which is:
902     1.  The sole provider within a county with a population
903density of no greater than 100 persons per square mile;
904     2.  An acute care hospital, in a county with a population
905density of no greater than 100 persons per square mile, which is
906at least 30 minutes of travel time, on normally traveled roads
907under normal traffic conditions, from any other acute care
908hospital within the same county;
909     3.  A hospital supported by a tax district or subdistrict
910whose boundaries encompass a population of 100 persons or fewer
911per square mile;
912     4.  A hospital in a constitutional charter county with a
913population of over 1 million persons that has imposed a local
914option health service tax pursuant to law and in an area that
915was directly impacted by a catastrophic event on August 24,
9161992, for which the Governor of Florida declared a state of
917emergency pursuant to chapter 125, and has 120 beds or less that
918serves an agricultural community with an emergency room
919utilization of no less than 20,000 visits and a Medicaid
920inpatient utilization rate greater than 15 percent;
921     4.5.  A hospital with a service area that has a population
922of 100 persons or fewer per square mile. As used in this
923subparagraph, the term "service area" means the fewest number of
924zip codes that account for 75 percent of the hospital's
925discharges for the most recent 5-year period, based on
926information available from the hospital inpatient discharge
927database in the Florida Center for Health Information and Policy
928Analysis at the Agency for Health Care Administration; or
929     5.6.  A hospital designated as a critical access hospital,
930as defined in s. 408.07(15).
932Population densities used in this paragraph must be based upon
933the most recently completed United States census. A hospital
934that received funds under s. 409.9116 for a quarter beginning no
935later than July 1, 2002, is deemed to have been and shall
936continue to be a rural hospital from that date through June 30,
9372015, if the hospital continues to have 100 or fewer licensed
938beds and an emergency room, or meets the criteria of
939subparagraph 4. An acute care hospital that has not previously
940been designated as a rural hospital and that meets the criteria
941of this paragraph shall be granted such designation upon
942application, including supporting documentation to the Agency
943for Health Care Administration.
944     Section 24.  Subsection (8) of section 400.021, Florida
945Statutes, is amended to read:
946     400.021  Definitions.-When used in this part, unless the
947context otherwise requires, the term:
948     (8)  "Geriatric outpatient clinic" means a site for
949providing outpatient health care to persons 60 years of age or
950older, which is staffed by a registered nurse or a physician
951assistant, or a licensed practical nurse under the direct
952supervision of a registered nurse, advanced registered nurse
953practitioner, or physician.
954     Section 25.  Paragraph (g) of subsection (2) of section
955400.0239, Florida Statutes, is amended to read:
956     400.0239  Quality of Long-Term Care Facility Improvement
957Trust Fund.-
958     (2)  Expenditures from the trust fund shall be allowable
959for direct support of the following:
960     (g)  Other initiatives authorized by the Centers for
961Medicare and Medicaid Services for the use of federal civil
962monetary penalties, including projects recommended through the
963Medicaid "Up-or-Out" Quality of Care Contract Management Program
964pursuant to s. 400.148.
965     Section 26.  Subsection (15) of section 400.0255, Florida
966Statutes, is amended to read
967     400.0255  Resident transfer or discharge; requirements and
968procedures; hearings.-
969     (15)(a)  The department's Office of Appeals Hearings shall
970conduct hearings under this section. The office shall notify the
971facility of a resident's request for a hearing.
972     (b)  The department shall, by rule, establish procedures to
973be used for fair hearings requested by residents. These
974procedures shall be equivalent to the procedures used for fair
975hearings for other Medicaid cases appearing in s. 409.285 and
976applicable rules, chapter 10-2, part VI, Florida Administrative
977Code. The burden of proof must be clear and convincing evidence.
978A hearing decision must be rendered within 90 days after receipt
979of the request for hearing.
980     (c)  If the hearing decision is favorable to the resident
981who has been transferred or discharged, the resident must be
982readmitted to the facility's first available bed.
983     (d)  The decision of the hearing officer shall be final.
984Any aggrieved party may appeal the decision to the district
985court of appeal in the appellate district where the facility is
986located. Review procedures shall be conducted in accordance with
987the Florida Rules of Appellate Procedure.
988     Section 27.  Subsection (2) of section 400.063, Florida
989Statutes, is amended to read:
990     400.063  Resident protection.-
991     (2)  The agency is authorized to establish for each
992facility, subject to intervention by the agency, a separate bank
993account for the deposit to the credit of the agency of any
994moneys received from the Health Care Trust Fund or any other
995moneys received for the maintenance and care of residents in the
996facility, and the agency is authorized to disburse moneys from
997such account to pay obligations incurred for the purposes of
998this section. The agency is authorized to requisition moneys
999from the Health Care Trust Fund in advance of an actual need for
1000cash on the basis of an estimate by the agency of moneys to be
1001spent under the authority of this section. Any bank account
1002established under this section need not be approved in advance
1003of its creation as required by s. 17.58, but shall be secured by
1004depository insurance equal to or greater than the balance of
1005such account or by the pledge of collateral security in
1006conformance with criteria established in s. 18.11. The agency
1007shall notify the Chief Financial Officer of any such account so
1008established and shall make a quarterly accounting to the Chief
1009Financial Officer for all moneys deposited in such account.
1010     Section 28.  Subsections (1) and (5) of section 400.071,
1011Florida Statutes, are amended to read:
1012     400.071  Application for license.-
1013     (1)  In addition to the requirements of part II of chapter
1014408, the application for a license shall be under oath and must
1015contain the following:
1016     (a)  The location of the facility for which a license is
1017sought and an indication, as in the original application, that
1018such location conforms to the local zoning ordinances.
1019     (b)  A signed affidavit disclosing any financial or
1020ownership interest that a controlling interest as defined in
1021part II of chapter 408 has held in the last 5 years in any
1022entity licensed by this state or any other state to provide
1023health or residential care which has closed voluntarily or
1024involuntarily; has filed for bankruptcy; has had a receiver
1025appointed; has had a license denied, suspended, or revoked; or
1026has had an injunction issued against it which was initiated by a
1027regulatory agency. The affidavit must disclose the reason any
1028such entity was closed, whether voluntarily or involuntarily.
1029     (c)  The total number of beds and the total number of
1030Medicare and Medicaid certified beds.
1031     (b)(d)  Information relating to the applicant and employees
1032which the agency requires by rule. The applicant must
1033demonstrate that sufficient numbers of qualified staff, by
1034training or experience, will be employed to properly care for
1035the type and number of residents who will reside in the
1037     (c)(e)  Copies of any civil verdict or judgment involving
1038the applicant rendered within the 10 years preceding the
1039application, relating to medical negligence, violation of
1040residents' rights, or wrongful death. As a condition of
1041licensure, the licensee agrees to provide to the agency copies
1042of any new verdict or judgment involving the applicant, relating
1043to such matters, within 30 days after filing with the clerk of
1044the court. The information required in this paragraph shall be
1045maintained in the facility's licensure file and in an agency
1046database which is available as a public record.
1047     (5)  As a condition of licensure, each facility must
1048establish and submit with its application a plan for quality
1049assurance and for conducting risk management.
1050     Section 29.  Section 400.0712, Florida Statutes, is amended
1051to read:
1052     400.0712  Application for inactive license.-
1053     (1)  As specified in this section, the agency may issue an
1054inactive license to a nursing home facility for all or a portion
1055of its beds. Any request by a licensee that a nursing home or
1056portion of a nursing home become inactive must be submitted to
1057the agency in the approved format. The facility may not initiate
1058any suspension of services, notify residents, or initiate
1059inactivity before receiving approval from the agency; and a
1060licensee that violates this provision may not be issued an
1061inactive license.
1062     (1)(2)  In addition to the powers granted under part II of
1063chapter 408, the agency may issue an inactive license to a
1064nursing home that chooses to use an unoccupied contiguous
1065portion of the facility for an alternative use to meet the needs
1066of elderly persons through the use of less restrictive, less
1067institutional services.
1068     (a)  An inactive license issued under this subsection may
1069be granted for a period not to exceed the current licensure
1070expiration date but may be renewed by the agency at the time of
1071licensure renewal.
1072     (b)  A request to extend the inactive license must be
1073submitted to the agency in the approved format and approved by
1074the agency in writing.
1075     (c)  Nursing homes that receive an inactive license to
1076provide alternative services shall not receive preference for
1077participation in the Assisted Living for the Elderly Medicaid
1079     (2)(3)  The agency shall adopt rules pursuant to ss.
1080120.536(1) and 120.54 necessary to implement this section.
1081     Section 30.  Section 400.111, Florida Statutes, is amended
1082to read:
1083     400.111  Disclosure of controlling interest.-In addition to
1084the requirements of part II of chapter 408, when requested by
1085the agency, the licensee shall submit a signed affidavit
1086disclosing any financial or ownership interest that a
1087controlling interest has held within the last 5 years in any
1088entity licensed by the state or any other state to provide
1089health or residential care which entity has closed voluntarily
1090or involuntarily; has filed for bankruptcy; has had a receiver
1091appointed; has had a license denied, suspended, or revoked; or
1092has had an injunction issued against it which was initiated by a
1093regulatory agency. The affidavit must disclose the reason such
1094entity was closed, whether voluntarily or involuntarily.
1095     Section 31.  Subsection (2) of section 400.1183, Florida
1096Statutes, is amended to read:
1097     400.1183  Resident grievance procedures.-
1098     (2)  Each facility shall maintain records of all grievances
1099for agency inspection and shall report to the agency at the time
1100of relicensure the total number of grievances handled during the
1101prior licensure period, a categorization of the cases underlying
1102the grievances, and the final disposition of the grievances.
1103     Section 32.  Paragraphs (o) through (w) of subsection (1)
1104of section 400.141, Florida Statutes, are redesignated as
1105paragraphs (n) through (u), respectively, and present paragraphs
1106(f), (g), (j), (n), (o), and (r) of that subsection are amended,
1107to read:
1108     400.141  Administration and management of nursing home
1110     (1)  Every licensed facility shall comply with all
1111applicable standards and rules of the agency and shall:
1112     (f)  Be allowed and encouraged by the agency to provide
1113other needed services under certain conditions. If the facility
1114has a standard licensure status, and has had no class I or class
1115II deficiencies during the past 2 years or has been awarded a
1116Gold Seal under the program established in s. 400.235, it may be
1117encouraged by the agency to provide services, including, but not
1118limited to, respite and adult day services, which enable
1119individuals to move in and out of the facility. A facility is
1120not subject to any additional licensure requirements for
1121providing these services.
1122     1.  Respite care may be offered to persons in need of
1123short-term or temporary nursing home services. For each person
1124admitted under the respite care program, the facility licensee
1126     a.  Have a written abbreviated plan of care that, at a
1127minimum, includes nutritional requirements, medication orders,
1128physician orders, nursing assessments, and dietary preferences.
1129The nursing or physician assessments may take the place of all
1130other assessments required for full-time residents.
1131     b.  Have a contract that, at a minimum, specifies the
1132services to be provided to the respite resident, including
1133charges for services, activities, equipment, emergency medical
1134services, and the administration of medications. If multiple
1135respite admissions for a single person are anticipated, the
1136original contract is valid for 1 year after the date of
1138     c.  Ensure that each resident is released to his or her
1139caregiver or an individual designated in writing by the
1141     2.  A person admitted under the respite care program is:
1142     a.  Exempt from requirements in rule related to discharge
1144     b.  Covered by the resident's rights set forth in s.
1145400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
1146shall not be considered trust funds subject to the requirements
1147of s. 400.022(1)(h) until the resident has been in the facility
1148for more than 14 consecutive days.
1149     c.  Allowed to use his or her personal medications for the
1150respite stay if permitted by facility policy. The facility must
1151obtain a physician's orders for the medications. The caregiver
1152may provide information regarding the medications as part of the
1153nursing assessment, which must agree with the physician's
1154orders. Medications shall be released with the resident upon
1155discharge in accordance with current orders.
1156     3.  A person receiving respite care is entitled to a total
1157of 60 days in the facility within a contract year or a calendar
1158year if the contract is for less than 12 months. However, each
1159single stay may not exceed 14 days. If a stay exceeds 14
1160consecutive days, the facility must comply with all assessment
1161and care planning requirements applicable to nursing home
1163     4.  A person receiving respite care must reside in a
1164licensed nursing home bed.
1165     5.  A prospective respite resident must provide medical
1166information from a physician, a physician assistant, or a nurse
1167practitioner and other information from the primary caregiver as
1168may be required by the facility prior to or at the time of
1169admission to receive respite care. The medical information must
1170include a physician's order for respite care and proof of a
1171physical examination by a licensed physician, physician
1172assistant, or nurse practitioner. The physician's order and
1173physical examination may be used to provide intermittent respite
1174care for up to 12 months after the date the order is written.
1175     6.  The facility must assume the duties of the primary
1176caregiver. To ensure continuity of care and services, the
1177resident is entitled to retain his or her personal physician and
1178must have access to medically necessary services such as
1179physical therapy, occupational therapy, or speech therapy, as
1180needed. The facility must arrange for transportation to these
1181services if necessary. Respite care must be provided in
1182accordance with this part and rules adopted by the agency.
1183However, the agency shall, by rule, adopt modified requirements
1184for resident assessment, resident care plans, resident
1185contracts, physician orders, and other provisions, as
1186appropriate, for short-term or temporary nursing home services.
1187     7.  The agency shall allow for shared programming and staff
1188in a facility which meets minimum standards and offers services
1189pursuant to this paragraph, but, if the facility is cited for
1190deficiencies in patient care, may require additional staff and
1191programs appropriate to the needs of service recipients. A
1192person who receives respite care may not be counted as a
1193resident of the facility for purposes of the facility's licensed
1194capacity unless that person receives 24-hour respite care. A
1195person receiving either respite care for 24 hours or longer or
1196adult day services must be included when calculating minimum
1197staffing for the facility. Any costs and revenues generated by a
1198nursing home facility from nonresidential programs or services
1199shall be excluded from the calculations of Medicaid per diems
1200for nursing home institutional care reimbursement.
1201     (g)  If the facility has a standard license or is a Gold
1202Seal facility, exceeds the minimum required hours of licensed
1203nursing and certified nursing assistant direct care per resident
1204per day, and is part of a continuing care facility licensed
1205under chapter 651 or a retirement community that offers other
1206services pursuant to part III of this chapter or part I or part
1207III of chapter 429 on a single campus, be allowed to share
1208programming and staff. At the time of inspection and in the
1209semiannual report required pursuant to paragraph (n) (o), a
1210continuing care facility or retirement community that uses this
1211option must demonstrate through staffing records that minimum
1212staffing requirements for the facility were met. Licensed nurses
1213and certified nursing assistants who work in the nursing home
1214facility may be used to provide services elsewhere on campus if
1215the facility exceeds the minimum number of direct care hours
1216required per resident per day and the total number of residents
1217receiving direct care services from a licensed nurse or a
1218certified nursing assistant does not cause the facility to
1219violate the staffing ratios required under s. 400.23(3)(a).
1220Compliance with the minimum staffing ratios shall be based on
1221total number of residents receiving direct care services,
1222regardless of where they reside on campus. If the facility
1223receives a conditional license, it may not share staff until the
1224conditional license status ends. This paragraph does not
1225restrict the agency's authority under federal or state law to
1226require additional staff if a facility is cited for deficiencies
1227in care which are caused by an insufficient number of certified
1228nursing assistants or licensed nurses. The agency may adopt
1229rules for the documentation necessary to determine compliance
1230with this provision.
1231     (j)  Keep full records of resident admissions and
1232discharges; medical and general health status, including medical
1233records, personal and social history, and identity and address
1234of next of kin or other persons who may have responsibility for
1235the affairs of the residents; and individual resident care plans
1236including, but not limited to, prescribed services, service
1237frequency and duration, and service goals. The records shall be
1238open to inspection by the agency. The facility must maintain
1239clinical records on each resident in accordance with accepted
1240professional standards and practices that are complete,
1241accurately documented, readily accessible, and systematically
1243     (n)  Submit to the agency the information specified in s.
1244400.071(1)(b) for a management company within 30 days after the
1245effective date of the management agreement.
1246     (n)(o)1.  Submit semiannually to the agency, or more
1247frequently if requested by the agency, information regarding
1248facility staff-to-resident ratios, staff turnover, and staff
1249stability, including information regarding certified nursing
1250assistants, licensed nurses, the director of nursing, and the
1251facility administrator. For purposes of this reporting:
1252     a.  Staff-to-resident ratios must be reported in the
1253categories specified in s. 400.23(3)(a) and applicable rules.
1254The ratio must be reported as an average for the most recent
1255calendar quarter.
1256     b.  Staff turnover must be reported for the most recent 12-
1257month period ending on the last workday of the most recent
1258calendar quarter prior to the date the information is submitted.
1259The turnover rate must be computed quarterly, with the annual
1260rate being the cumulative sum of the quarterly rates. The
1261turnover rate is the total number of terminations or separations
1262experienced during the quarter, excluding any employee
1263terminated during a probationary period of 3 months or less,
1264divided by the total number of staff employed at the end of the
1265period for which the rate is computed, and expressed as a
1267     c.  The formula for determining staff stability is the
1268total number of employees that have been employed for more than
126912 months, divided by the total number of employees employed at
1270the end of the most recent calendar quarter, and expressed as a
1272     d.  A nursing facility that has failed to comply with state
1273minimum-staffing requirements for 2 consecutive days is
1274prohibited from accepting new admissions until the facility has
1275achieved the minimum-staffing requirements for a period of 6
1276consecutive days. For the purposes of this sub-subparagraph, any
1277person who was a resident of the facility and was absent from
1278the facility for the purpose of receiving medical care at a
1279separate location or was on a leave of absence is not considered
1280a new admission. Failure to impose such an admissions moratorium
1281is subject to a $1,000 fine constitutes a class II deficiency.
1282     e.  A nursing facility which does not have a conditional
1283license may be cited for failure to comply with the standards in
1284s. 400.23(3)(a)1.a. only if it has failed to meet those
1285standards on 2 consecutive days or if it has failed to meet at
1286least 97 percent of those standards on any one day.
1287     f.  A facility which has a conditional license must be in
1288compliance with the standards in s. 400.23(3)(a) at all times.
1289     2.  This paragraph does not limit the agency's ability to
1290impose a deficiency or take other actions if a facility does not
1291have enough staff to meet the residents' needs.
1292     (r)  Report to the agency any filing for bankruptcy
1293protection by the facility or its parent corporation,
1294divestiture or spin-off of its assets, or corporate
1295reorganization within 30 days after the completion of such
1297     Section 33.  Subsection (3) of section 400.142, Florida
1298Statutes, is amended to read:
1299     400.142  Emergency medication kits; orders not to
1301     (3)  Facility staff may withhold or withdraw
1302cardiopulmonary resuscitation if presented with an order not to
1303resuscitate executed pursuant to s. 401.45. The agency shall
1304adopt rules providing for the implementation of such orders.
1305Facility staff and facilities shall not be subject to criminal
1306prosecution or civil liability, nor be considered to have
1307engaged in negligent or unprofessional conduct, for withholding
1308or withdrawing cardiopulmonary resuscitation pursuant to such an
1309order and rules adopted by the agency. The absence of an order
1310not to resuscitate executed pursuant to s. 401.45 does not
1311preclude a physician from withholding or withdrawing
1312cardiopulmonary resuscitation as otherwise permitted by law.
1313     Section 34.  Subsections (11) through (15) of section
1314400.147, Florida Statutes, are renumbered as subsections (10)
1315through (14), respectively, and present subsection (10) is
1316amended to read:
1317     400.147  Internal risk management and quality assurance
1319     (10)  By the 10th of each month, each facility subject to
1320this section shall report any notice received pursuant to s.
1321400.0233(2) and each initial complaint that was filed with the
1322clerk of the court and served on the facility during the
1323previous month by a resident or a resident's family member,
1324guardian, conservator, or personal legal representative. The
1325report must include the name of the resident, the resident's
1326date of birth and social security number, the Medicaid
1327identification number for Medicaid-eligible persons, the date or
1328dates of the incident leading to the claim or dates of
1329residency, if applicable, and the type of injury or violation of
1330rights alleged to have occurred. Each facility shall also submit
1331a copy of the notices received pursuant to s. 400.0233(2) and
1332complaints filed with the clerk of the court. This report is
1333confidential as provided by law and is not discoverable or
1334admissible in any civil or administrative action, except in such
1335actions brought by the agency to enforce the provisions of this
1337     Section 35.  Section 400.148, Florida Statutes, is
1339     Section 36.  Paragraph (f) of subsection (5) of section
1340400.162, Florida Statutes, is amended to read:
1341     400.162  Property and personal affairs of residents.-
1342     (5)
1343     (f)  At least every 3 months, the licensee shall furnish
1344the resident and the guardian, trustee, or conservator, if any,
1345for the resident a complete and verified statement of all funds
1346and other property to which this subsection applies, detailing
1347the amounts and items received, together with their sources and
1348disposition. For resident property, the licensee shall furnish
1349such a statement annually and within 7 calendar days after a
1350request for a statement. In any event, the licensee shall
1351furnish such statements a statement annually and upon the
1352discharge or transfer of a resident. Any governmental agency or
1353private charitable agency contributing funds or other property
1354on account of a resident also shall be entitled to receive such
1355statements statement annually and upon discharge or transfer and
1356such other report as it may require pursuant to law.
1357     Section 37.  Paragraphs (d) and (e) of subsection (2) of
1358section 400.179, Florida Statutes, are amended to read:
1359     400.179  Liability for Medicaid underpayments and
1361     (2)  Because any transfer of a nursing facility may expose
1362the fact that Medicaid may have underpaid or overpaid the
1363transferor, and because in most instances, any such underpayment
1364or overpayment can only be determined following a formal field
1365audit, the liabilities for any such underpayments or
1366overpayments shall be as follows:
1367     (d)  Where the transfer involves a facility that has been
1368leased by the transferor:
1369     1.  The transferee shall, as a condition to being issued a
1370license by the agency, acquire, maintain, and provide proof to
1371the agency of a bond with a term of 30 months, renewable
1372annually, in an amount not less than the total of 3 months'
1373Medicaid payments to the facility computed on the basis of the
1374preceding 12-month average Medicaid payments to the facility.
1375     2.  A leasehold licensee may meet the requirements of
1376subparagraph 1. by payment of a nonrefundable fee, paid at
1377initial licensure, paid at the time of any subsequent change of
1378ownership, and paid annually thereafter, in the amount of 1
1379percent of the total of 3 months' Medicaid payments to the
1380facility computed on the basis of the preceding 12-month average
1381Medicaid payments to the facility. If a preceding 12-month
1382average is not available, projected Medicaid payments may be
1383used. The fee shall be deposited into the Grants and Donations
1384Trust Fund and shall be accounted for separately as a Medicaid
1385nursing home overpayment account. These fees shall be used at
1386the sole discretion of the agency to repay nursing home Medicaid
1387overpayments. Payment of this fee shall not release the licensee
1388from any liability for any Medicaid overpayments, nor shall
1389payment bar the agency from seeking to recoup overpayments from
1390the licensee and any other liable party. As a condition of
1391exercising this lease bond alternative, licensees paying this
1392fee must maintain an existing lease bond through the end of the
139330-month term period of that bond. The agency is herein granted
1394specific authority to promulgate all rules pertaining to the
1395administration and management of this account, including
1396withdrawals from the account, subject to federal review and
1397approval. This provision shall take effect upon becoming law and
1398shall apply to any leasehold license application. The financial
1399viability of the Medicaid nursing home overpayment account shall
1400be determined by the agency through annual review of the account
1401balance and the amount of total outstanding, unpaid Medicaid
1402overpayments owing from leasehold licensees to the agency as
1403determined by final agency audits. By March 31 of each year, the
1404agency shall assess the cumulative fees collected under this
1405subparagraph, minus any amounts used to repay nursing home
1406Medicaid overpayments and amounts transferred to contribute to
1407the General Revenue Fund pursuant to s. 215.20. If the net
1408cumulative collections, minus amounts utilized to repay nursing
1409home Medicaid overpayments, exceed $25 million, the provisions
1410of this paragraph shall not apply for the subsequent fiscal
1412     3.  The leasehold licensee may meet the bond requirement
1413through other arrangements acceptable to the agency. The agency
1414is herein granted specific authority to promulgate rules
1415pertaining to lease bond arrangements.
1416     4.  All existing nursing facility licensees, operating the
1417facility as a leasehold, shall acquire, maintain, and provide
1418proof to the agency of the 30-month bond required in
1419subparagraph 1., above, on and after July 1, 1993, for each
1420license renewal.
1421     5.  It shall be the responsibility of all nursing facility
1422operators, operating the facility as a leasehold, to renew the
142330-month bond and to provide proof of such renewal to the agency
1425     6.  Any failure of the nursing facility operator to
1426acquire, maintain, renew annually, or provide proof to the
1427agency shall be grounds for the agency to deny, revoke, and
1428suspend the facility license to operate such facility and to
1429take any further action, including, but not limited to,
1430enjoining the facility, asserting a moratorium pursuant to part
1431II of chapter 408, or applying for a receiver, deemed necessary
1432to ensure compliance with this section and to safeguard and
1433protect the health, safety, and welfare of the facility's
1434residents. A lease agreement required as a condition of bond
1435financing or refinancing under s. 154.213 by a health facilities
1436authority or required under s. 159.30 by a county or
1437municipality is not a leasehold for purposes of this paragraph
1438and is not subject to the bond requirement of this paragraph.
1439     (e)  For the 2009-2010 fiscal year only, the provisions of
1440paragraph (d) shall not apply. This paragraph expires July 1,
1442     Section 38.  Subsection (3) of section 400.19, Florida
1443Statutes, is amended to read:
1444     400.19  Right of entry and inspection.-
1445     (3)  The agency shall every 15 months conduct at least one
1446unannounced inspection to determine compliance by the licensee
1447with statutes, and with rules promulgated under the provisions
1448of those statutes, governing minimum standards of construction,
1449quality and adequacy of care, and rights of residents. The
1450survey shall be conducted every 6 months for the next 2-year
1451period if the facility has been cited for a class I deficiency,
1452has been cited for two or more class II deficiencies arising
1453from separate surveys or investigations within a 60-day period,
1454or has had three or more substantiated complaints within a 6-
1455month period, each resulting in at least one class I or class II
1456deficiency. In addition to any other fees or fines in this part,
1457the agency shall assess a fine for each facility that is subject
1458to the 6-month survey cycle. The fine for the 2-year period
1459shall be $6,000, one-half to be paid at the completion of each
1460survey. The agency may adjust this fine by the change in the
1461Consumer Price Index, based on the 12 months immediately
1462preceding the increase, to cover the cost of the additional
1463surveys. The agency shall verify through subsequent inspection
1464that any deficiency identified during inspection is corrected.
1465However, the agency may verify the correction of a class III or
1466class IV deficiency unrelated to resident rights or resident
1467care without reinspecting the facility if adequate written
1468documentation has been received from the facility, which
1469provides assurance that the deficiency has been corrected. The
1470giving or causing to be given of advance notice of such
1471unannounced inspections by an employee of the agency to any
1472unauthorized person shall constitute cause for suspension of not
1473fewer than 5 working days according to the provisions of chapter
1475     Section 39.  Section 400.195, Florida Statutes, is
1477     Section 40.  Subsection (5) of section 400.23, Florida
1478Statutes, is amended to read:
1479     400.23  Rules; evaluation and deficiencies; licensure
1481     (5)(a)  The agency, in collaboration with the Division of
1482Children's Medical Services Network of the Department of Health,
1483must, no later than December 31, 1993, adopt rules for minimum
1484standards of care for persons under 21 years of age who reside
1485in nursing home facilities. The rules must include a methodology
1486for reviewing a nursing home facility under ss. 408.031-408.045
1487which serves only persons under 21 years of age. A facility may
1488be exempt from these standards for specific persons between 18
1489and 21 years of age, if the person's physician agrees that
1490minimum standards of care based on age are not necessary.
1491     (b)  The agency, in collaboration with the Division of
1492Children's Medical Services Network, shall adopt rules for
1493minimum staffing requirements for nursing home facilities that
1494serve persons under 21 years of age, which shall apply in lieu
1495of the standards contained in subsection (3).
1496     1.  For persons under 21 years of age who require skilled
1497care, the requirements shall include a minimum combined average
1498of licensed nurses, respiratory therapists, respiratory care
1499practitioners, and certified nursing assistants of 3.9 hours of
1500direct care per resident per day for each nursing home facility.
1501     2.  For persons under 21 years of age who are fragile, the
1502requirements shall include a minimum combined average of
1503licensed nurses, respiratory therapists, respiratory care
1504practitioners, and certified nursing assistants of 5 hours of
1505direct care per resident per day for each nursing home facility.
1506     Section 41.  Subsection (1) of section 400.275, Florida
1507Statutes, is amended to read:
1508     400.275  Agency duties.-
1509     (1)  The agency shall ensure that each newly hired nursing
1510home surveyor, as a part of basic training, is assigned full-
1511time to a licensed nursing home for at least 2 days within a 7-
1512day period to observe facility operations outside of the survey
1513process before the surveyor begins survey responsibilities. Such
1514observations may not be the sole basis of a deficiency citation
1515against the facility. The agency may not assign an individual to
1516be a member of a survey team for purposes of a survey,
1517evaluation, or consultation visit at a nursing home facility in
1518which the surveyor was an employee within the preceding 2 5
1520     Section 42.  Subsection (2) of section 400.484, Florida
1521Statutes, is amended to read:
1522     400.484  Right of inspection; violations deficiencies;
1524     (2)  The agency shall impose fines for various classes of
1525violations deficiencies in accordance with the following
1527     (a)  Class I violations are defined in s. 408.813. A class
1528I deficiency is any act, omission, or practice that results in a
1529patient's death, disablement, or permanent injury, or places a
1530patient at imminent risk of death, disablement, or permanent
1531injury. Upon finding a class I violation deficiency, the agency
1532shall impose an administrative fine in the amount of $15,000 for
1533each occurrence and each day that the violation deficiency
1535     (b)  Class II violations are defined in s. 408.813. A class
1536II deficiency is any act, omission, or practice that has a
1537direct adverse effect on the health, safety, or security of a
1538patient. Upon finding a class II violation deficiency, the
1539agency shall impose an administrative fine in the amount of
1540$5,000 for each occurrence and each day that the violation
1541deficiency exists.
1542     (c)  Class III violations are defined in s. 408.813. A
1543class III deficiency is any act, omission, or practice that has
1544an indirect, adverse effect on the health, safety, or security
1545of a patient. Upon finding an uncorrected or repeated class III
1546violation deficiency, the agency shall impose an administrative
1547fine not to exceed $1,000 for each occurrence and each day that
1548the uncorrected or repeated violation deficiency exists.
1549     (d)  Class IV violations are defined in s. 408.813. A class
1550IV deficiency is any act, omission, or practice related to
1551required reports, forms, or documents which does not have the
1552potential of negatively affecting patients. These violations are
1553of a type that the agency determines do not threaten the health,
1554safety, or security of patients. Upon finding an uncorrected or
1555repeated class IV violation deficiency, the agency shall impose
1556an administrative fine not to exceed $500 for each occurrence
1557and each day that the uncorrected or repeated violation
1558deficiency exists.
1559     Section 43.  Paragraph (i) of subsection (1) and subsection
1560(4) of section 400.606, Florida Statutes, are amended to read:
1561     400.606  License; application; renewal; conditional license
1562or permit; certificate of need.-
1563     (1)  In addition to the requirements of part II of chapter
1564408, the initial application and change of ownership application
1565must be accompanied by a plan for the delivery of home,
1566residential, and homelike inpatient hospice services to
1567terminally ill persons and their families. Such plan must
1568contain, but need not be limited to:
1569     (i)  The projected annual operating cost of the hospice.
1571If the applicant is an existing licensed health care provider,
1572the application must be accompanied by a copy of the most recent
1573profit-loss statement and, if applicable, the most recent
1574licensure inspection report.
1575     (4)  A freestanding hospice facility that is primarily
1576engaged in providing inpatient and related services and that is
1577not otherwise licensed as a health care facility shall be
1578required to obtain a certificate of need. However, a
1579freestanding hospice facility with six or fewer beds shall not
1580be required to comply with institutional standards such as, but
1581not limited to, standards requiring sprinkler systems, emergency
1582electrical systems, or special lavatory devices.
1583     Section 44.  Subsection (2) of section 400.607, Florida
1584Statutes, is amended to read:
1585     400.607  Denial, suspension, revocation of license;
1586emergency actions; imposition of administrative fine; grounds.-
1587     (2)  A violation of this part, part II of chapter 408, or
1588applicable rules Any of the following actions by a licensed
1589hospice or any of its employees shall be grounds for
1590administrative action by the agency against a hospice.:
1591     (a)  A violation of the provisions of this part, part II of
1592chapter 408, or applicable rules.
1593     (b)  An intentional or negligent act materially affecting
1594the health or safety of a patient.
1595     Section 45.  Section 400.915, Florida Statutes, is amended
1596to read:
1597     400.915  Construction and renovation; requirements.-The
1598requirements for the construction or renovation of a PPEC center
1599shall comply with:
1600     (1)  The provisions of chapter 553, which pertain to
1601building construction standards, including plumbing, electrical
1602code, glass, manufactured buildings, accessibility for the
1603physically disabled;
1604     (2)  The provisions of s. 633.022 and applicable rules
1605pertaining to physical minimum standards for nonresidential
1606child care physical facilities in rule 10M-12.003, Florida
1607Administrative Code, Child Care Standards; and
1608     (3)  The standards or rules adopted pursuant to this part
1609and part II of chapter 408.
1610     Section 46.  Subsection (1) of section 400.925, Florida
1611Statutes, is amended to read:
1612     400.925  Definitions.-As used in this part, the term:
1613     (1)  "Accrediting organizations" means The Joint Commission
1614on Accreditation of Healthcare Organizations or other national
1615accreditation agencies whose standards for accreditation are
1616comparable to those required by this part for licensure.
1617     Section 47.  Subsections (3) through (6) of section
1618400.931, Florida Statutes, are renumbered as subsections (2)
1619through (5), respectively, and present subsection (2) of that
1620section is amended to read:
1621     400.931  Application for license; fee; provisional license;
1622temporary permit.-
1623     (2)  As an alternative to submitting proof of financial
1624ability to operate as required in s. 408.810(8), the applicant
1625may submit a $50,000 surety bond to the agency.
1626     Section 48.  Subsection (2) of section 400.932, Florida
1627Statutes, is amended to read:
1628     400.932  Administrative penalties.-
1629     (2)  A violation of this part, part II of chapter 408, or
1630applicable rules Any of the following actions by an employee of
1631a home medical equipment provider shall be are grounds for
1632administrative action or penalties by the agency.:
1633     (a)  Violation of this part, part II of chapter 408, or
1634applicable rules.
1635     (b)  An intentional, reckless, or negligent act that
1636materially affects the health or safety of a patient.
1637     Section 49.  Subsection (3) of section 400.967, Florida
1638Statutes, is amended to read:
1639     400.967  Rules and classification of violations
1641     (3)  The agency shall adopt rules to provide that, when the
1642criteria established under this part and part II of chapter 408
1643are not met, such violations deficiencies shall be classified
1644according to the nature of the violation deficiency. The agency
1645shall indicate the classification on the face of the notice of
1646deficiencies as follows:
1647     (a)  Class I violations deficiencies are defined in s.
1648408.813 those which the agency determines present an imminent
1649danger to the residents or guests of the facility or a
1650substantial probability that death or serious physical harm
1651would result therefrom. The condition or practice constituting a
1652class I violation must be abated or eliminated immediately,
1653unless a fixed period of time, as determined by the agency, is
1654required for correction. A class I violation deficiency is
1655subject to a civil penalty in an amount not less than $5,000 and
1656not exceeding $10,000 for each violation deficiency. A fine may
1657be levied notwithstanding the correction of the violation
1659     (b)  Class II violations deficiencies are defined in s.
1660408.813 those which the agency determines have a direct or
1661immediate relationship to the health, safety, or security of the
1662facility residents, other than class I deficiencies. A class II
1663violation deficiency is subject to a civil penalty in an amount
1664not less than $1,000 and not exceeding $5,000 for each violation
1665deficiency. A citation for a class II violation deficiency shall
1666specify the time within which the violation deficiency must be
1667corrected. If a class II violation deficiency is corrected
1668within the time specified, no civil penalty shall be imposed,
1669unless it is a repeated offense.
1670     (c)  Class III violations deficiencies are defined in s.
1671408.813 those which the agency determines to have an indirect or
1672potential relationship to the health, safety, or security of the
1673facility residents, other than class I or class II deficiencies.
1674A class III violation deficiency is subject to a civil penalty
1675of not less than $500 and not exceeding $1,000 for each
1676deficiency. A citation for a class III violation deficiency
1677shall specify the time within which the violation deficiency
1678must be corrected. If a class III violation deficiency is
1679corrected within the time specified, no civil penalty shall be
1680imposed, unless it is a repeated offense.
1681     (d)  Class IV violations are defined in s. 408.813. Upon
1682finding an uncorrected or repeated class IV violation, the
1683agency shall impose an administrative fine not to exceed $500
1684for each occurrence and each day that the uncorrected or
1685repeated violation exists.
1686     Section 50.  Subsections (4) and (7) of section 400.9905,
1687Florida Statutes, are amended to read:
1688     400.9905  Definitions.-
1689     (4)  "Clinic" means an entity at which health care services
1690are provided to individuals and which tenders charges for
1691reimbursement for such services, including a mobile clinic and a
1692portable health service or equipment provider. For purposes of
1693this part, the term does not include and the licensure
1694requirements of this part do not apply to:
1695     (a)  Entities licensed or registered by the state under
1696chapter 395; or entities licensed or registered by the state and
1697providing only health care services within the scope of services
1698authorized under their respective licenses granted under ss.
1699383.30-383.335, chapter 390, chapter 394, chapter 397, this
1700chapter except part X, chapter 429, chapter 463, chapter 465,
1701chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1702chapter 651; end-stage renal disease providers authorized under
170342 C.F.R. part 405, subpart U; or providers certified under 42
1704C.F.R. part 485, subpart B or subpart H; or any entity that
1705provides neonatal or pediatric hospital-based health care
1706services or other health care services by licensed practitioners
1707solely within a hospital licensed under chapter 395.
1708     (b)  Entities that own, directly or indirectly, entities
1709licensed or registered by the state pursuant to chapter 395; or
1710entities that own, directly or indirectly, entities licensed or
1711registered by the state and providing only health care services
1712within the scope of services authorized pursuant to their
1713respective licenses granted under ss. 383.30-383.335, chapter
1714390, chapter 394, chapter 397, this chapter except part X,
1715chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1716part I of chapter 483, chapter 484, chapter 651; end-stage renal
1717disease providers authorized under 42 C.F.R. part 405, subpart
1718U; or providers certified under 42 C.F.R. part 485, subpart B or
1719subpart H; or any entity that provides neonatal or pediatric
1720hospital-based health care services by licensed practitioners
1721solely within a hospital licensed under chapter 395.
1722     (c)  Entities that are owned, directly or indirectly, by an
1723entity licensed or registered by the state pursuant to chapter
1724395; or entities that are owned, directly or indirectly, by an
1725entity licensed or registered by the state and providing only
1726health care services within the scope of services authorized
1727pursuant to their respective licenses granted under ss. 383.30-
1728383.335, chapter 390, chapter 394, chapter 397, this chapter
1729except part X, chapter 429, chapter 463, chapter 465, chapter
1730466, chapter 478, part I of chapter 483, chapter 484, or chapter
1731651; end-stage renal disease providers authorized under 42
1732C.F.R. part 405, subpart U; or providers certified under 42
1733C.F.R. part 485, subpart B or subpart H; or any entity that
1734provides neonatal or pediatric hospital-based health care
1735services by licensed practitioners solely within a hospital
1736under chapter 395.
1737     (d)  Entities that are under common ownership, directly or
1738indirectly, with an entity licensed or registered by the state
1739pursuant to chapter 395; or entities that are under common
1740ownership, directly or indirectly, with an entity licensed or
1741registered by the state and providing only health care services
1742within the scope of services authorized pursuant to their
1743respective licenses granted under ss. 383.30-383.335, chapter
1744390, chapter 394, chapter 397, this chapter except part X,
1745chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1746part I of chapter 483, chapter 484, or chapter 651; end-stage
1747renal disease providers authorized under 42 C.F.R. part 405,
1748subpart U; or providers certified under 42 C.F.R. part 485,
1749subpart B or subpart H; or any entity that provides neonatal or
1750pediatric hospital-based health care services by licensed
1751practitioners solely within a hospital licensed under chapter
1753     (e)  An entity that is exempt from federal taxation under
175426 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1755under 26 U.S.C. s. 409 that has a board of trustees not less
1756than two-thirds of which are Florida-licensed health care
1757practitioners and provides only physical therapy services under
1758physician orders, any community college or university clinic,
1759and any entity owned or operated by the federal or state
1760government, including agencies, subdivisions, or municipalities
1762     (f)  A sole proprietorship, group practice, partnership, or
1763corporation that provides health care services by physicians
1764covered by s. 627.419, that is directly supervised by one or
1765more of such physicians, and that is wholly owned by one or more
1766of those physicians or by a physician and the spouse, parent,
1767child, or sibling of that physician.
1768     (g)  A sole proprietorship, group practice, partnership, or
1769corporation that provides health care services by licensed
1770health care practitioners under chapter 457, chapter 458,
1771chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1772chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1773chapter 490, chapter 491, or part I, part III, part X, part
1774XIII, or part XIV of chapter 468, or s. 464.012, which are
1775wholly owned by one or more licensed health care practitioners,
1776or the licensed health care practitioners set forth in this
1777paragraph and the spouse, parent, child, or sibling of a
1778licensed health care practitioner, so long as one of the owners
1779who is a licensed health care practitioner is supervising the
1780business activities and is legally responsible for the entity's
1781compliance with all federal and state laws. However, a health
1782care practitioner may not supervise services beyond the scope of
1783the practitioner's license, except that, for the purposes of
1784this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1785provides only services authorized pursuant to s. 456.053(3)(b)
1786may be supervised by a licensee specified in s. 456.053(3)(b).
1787     (h)  Clinical facilities affiliated with an accredited
1788medical school at which training is provided for medical
1789students, residents, or fellows.
1790     (i)  Entities that provide only oncology or radiation
1791therapy services by physicians licensed under chapter 458 or
1792chapter 459 or entities that provide oncology or radiation
1793therapy services by physicians licensed under chapter 458 or
1794chapter 459 which are owned by a corporation whose shares are
1795publicly traded on a recognized stock exchange.
1796     (j)  Clinical facilities affiliated with a college of
1797chiropractic accredited by the Council on Chiropractic Education
1798at which training is provided for chiropractic students.
1799     (k)  Entities that provide licensed practitioners to staff
1800emergency departments or to deliver anesthesia services in
1801facilities licensed under chapter 395 and that derive at least
180290 percent of their gross annual revenues from the provision of
1803such services. Entities claiming an exemption from licensure
1804under this paragraph must provide documentation demonstrating
1806     (l)  Orthotic, or prosthetic, pediatric cardiology, or
1807perinatology clinical facilities that are a publicly traded
1808corporation or that are wholly owned, directly or indirectly, by
1809a publicly traded corporation. As used in this paragraph, a
1810publicly traded corporation is a corporation that issues
1811securities traded on an exchange registered with the United
1812States Securities and Exchange Commission as a national
1813securities exchange.
1814     (m)  Entities that are owned by a corporation that has $250
1815million or more in total annual sales of health care services
1816provided by licensed health care practitioners if one or more of
1817the owners of the entity is a health care practitioner who is
1818licensed in this state, is responsible for supervising the
1819business activities of the entity, and is legally responsible
1820for the entity's compliance with state law for purposes of this
1822     (n)  Entities that are owned or controlled, directly or
1823indirectly, by a publicly traded entity with $100 million or
1824more, in the aggregate, in total annual revenues derived from
1825providing health care services by licensed health care
1826practitioners that are employed or contracted by an entity
1827described in this paragraph.
1828     (7)  "Portable health service or equipment provider" means
1829an entity that contracts with or employs persons to provide
1830portable health care services or equipment to multiple locations
1831performing treatment or diagnostic testing of individuals, that
1832bills third-party payors for those services, and that otherwise
1833meets the definition of a clinic in subsection (4).
1834     Section 51.  Paragraph (b) of subsection (1) and paragraph
1835(c) of subsection (4) of section 400.991, Florida Statutes, are
1836amended to read:
1837     400.991  License requirements; background screenings;
1839     (1)
1840     (b)  Each mobile clinic must obtain a separate health care
1841clinic license and must provide to the agency, at least
1842quarterly, its projected street location to enable the agency to
1843locate and inspect such clinic. A portable health service or
1844equipment provider must obtain a health care clinic license for
1845a single administrative office and is not required to submit
1846quarterly projected street locations.
1847     (4)  In addition to the requirements of part II of chapter
1848408, the applicant must file with the application satisfactory
1849proof that the clinic is in compliance with this part and
1850applicable rules, including:
1851     (c)  Proof of financial ability to operate as required
1852under ss. s. 408.810(8) and 408.8065. As an alternative to
1853submitting proof of financial ability to operate as required
1854under s. 408.810(8), the applicant may file a surety bond of at
1855least $500,000 which guarantees that the clinic will act in full
1856conformity with all legal requirements for operating a clinic,
1857payable to the agency. The agency may adopt rules to specify
1858related requirements for such surety bond.
1859     Section 52.  Paragraph (g) of subsection (1) and paragraph
1860(a) of subsection (7) of section 400.9935, Florida Statutes, are
1861amended to read:
1862     400.9935  Clinic responsibilities.-
1863     (1)  Each clinic shall appoint a medical director or clinic
1864director who shall agree in writing to accept legal
1865responsibility for the following activities on behalf of the
1866clinic. The medical director or the clinic director shall:
1867     (g)  Conduct systematic reviews of clinic billings to
1868ensure that the billings are not fraudulent or unlawful. Upon
1869discovery of an unlawful charge, the medical director or clinic
1870director shall take immediate corrective action. If the clinic
1871performs only the technical component of magnetic resonance
1872imaging, static radiographs, computed tomography, or positron
1873emission tomography, and provides the professional
1874interpretation of such services, in a fixed facility that is
1875accredited by The Joint Commission on Accreditation of
1876Healthcare Organizations or the Accreditation Association for
1877Ambulatory Health Care, and the American College of Radiology;
1878and if, in the preceding quarter, the percentage of scans
1879performed by that clinic which was billed to all personal injury
1880protection insurance carriers was less than 15 percent, the
1881chief financial officer of the clinic may, in a written
1882acknowledgment provided to the agency, assume the responsibility
1883for the conduct of the systematic reviews of clinic billings to
1884ensure that the billings are not fraudulent or unlawful.
1885     (7)(a)  Each clinic engaged in magnetic resonance imaging
1886services must be accredited by The Joint Commission on
1887Accreditation of Healthcare Organizations, the American College
1888of Radiology, or the Accreditation Association for Ambulatory
1889Health Care, within 1 year after licensure. A clinic that is
1890accredited by the American College of Radiology or is within the
1891original 1-year period after licensure and replaces its core
1892magnetic resonance imaging equipment shall be given 1 year after
1893the date on which the equipment is replaced to attain
1894accreditation. However, a clinic may request a single, 6-month
1895extension if it provides evidence to the agency establishing
1896that, for good cause shown, such clinic cannot be accredited
1897within 1 year after licensure, and that such accreditation will
1898be completed within the 6-month extension. After obtaining
1899accreditation as required by this subsection, each such clinic
1900must maintain accreditation as a condition of renewal of its
1901license. A clinic that files a change of ownership application
1902must comply with the original accreditation timeframe
1903requirements of the transferor. The agency shall deny a change
1904of ownership application if the clinic is not in compliance with
1905the accreditation requirements. When a clinic adds, replaces, or
1906modifies magnetic resonance imaging equipment and the
1907accreditation agency requires new accreditation, the clinic must
1908be accredited within 1 year after the date of the addition,
1909replacement, or modification but may request a single, 6-month
1910extension if the clinic provides evidence of good cause to the
1912     Section 53.  Subsection (2) of section 408.034, Florida
1913Statutes, is amended to read:
1914     408.034  Duties and responsibilities of agency; rules.-
1915     (2)  In the exercise of its authority to issue licenses to
1916health care facilities and health service providers, as provided
1917under chapters 393 and 395 and parts II, and IV, and VIII of
1918chapter 400, the agency may not issue a license to any health
1919care facility or health service provider that fails to receive a
1920certificate of need or an exemption for the licensed facility or
1922     Section 54.  Paragraph (d) of subsection (1) of section
1923408.036, Florida Statutes, is amended to read:
1924     408.036  Projects subject to review; exemptions.-
1925     (1)  APPLICABILITY.-Unless exempt under subsection (3), all
1926health-care-related projects, as described in paragraphs (a)-
1927(g), are subject to review and must file an application for a
1928certificate of need with the agency. The agency is exclusively
1929responsible for determining whether a health-care-related
1930project is subject to review under ss. 408.031-408.045.
1931     (d)  The establishment of a hospice or hospice inpatient
1932facility, except as provided in s. 408.043.
1933     Section 55.  Subsection (2) of section 408.043, Florida
1934Statutes, is amended to read:
1935     408.043  Special provisions.-
1936     (2)  HOSPICES.-When an application is made for a
1937certificate of need to establish or to expand a hospice, the
1938need for such hospice shall be determined on the basis of the
1939need for and availability of hospice services in the community.
1940The formula on which the certificate of need is based shall
1941discourage regional monopolies and promote competition. The
1942inpatient hospice care component of a hospice which is a
1943freestanding facility, or a part of a facility, which is
1944primarily engaged in providing inpatient care and related
1945services and is not licensed as a health care facility shall
1946also be required to obtain a certificate of need. Provision of
1947hospice care by any current provider of health care is a
1948significant change in service and therefore requires a
1949certificate of need for such services.
1950     Section 56.  Paragraph (k) of subsection (3) of section
1951408.05, Florida Statutes, is amended to read:
1952     408.05  Florida Center for Health Information and Policy
1955produce comparable and uniform health information and statistics
1956for the development of policy recommendations, the agency shall
1957perform the following functions:
1958     (k)  Develop, in conjunction with the State Consumer Health
1959Information and Policy Advisory Council, and implement a long-
1960range plan for making available health care quality measures and
1961financial data that will allow consumers to compare health care
1962services. The health care quality measures and financial data
1963the agency must make available shall include, but is not limited
1964to, pharmaceuticals, physicians, health care facilities, and
1965health plans and managed care entities. The agency shall submit
1966the initial plan to the Governor, the President of the Senate,
1967and the Speaker of the House of Representatives by January 1,
19682006, and shall update the plan and report on the status of its
1969implementation annually thereafter. The agency shall also make
1970the plan and status report available to the public on its
1971Internet website. As part of the plan, the agency shall identify
1972the process and timeframes for implementation, any barriers to
1973implementation, and recommendations of changes in the law that
1974may be enacted by the Legislature to eliminate the barriers. As
1975preliminary elements of the plan, the agency shall:
1976     1.  Make available patient-safety indicators, inpatient
1977quality indicators, and performance outcome and patient charge
1978data collected from health care facilities pursuant to s.
1979408.061(1)(a) and (2). The terms "patient-safety indicators" and
1980"inpatient quality indicators" shall be as defined by the
1981Centers for Medicare and Medicaid Services, the National Quality
1982Forum, The Joint Commission on Accreditation of Healthcare
1983Organizations, the Agency for Healthcare Research and Quality,
1984the Centers for Disease Control and Prevention, or a similar
1985national entity that establishes standards to measure the
1986performance of health care providers, or by other states. The
1987agency shall determine which conditions, procedures, health care
1988quality measures, and patient charge data to disclose based upon
1989input from the council. When determining which conditions and
1990procedures are to be disclosed, the council and the agency shall
1991consider variation in costs, variation in outcomes, and
1992magnitude of variations and other relevant information. When
1993determining which health care quality measures to disclose, the
1995     a.  Shall consider such factors as volume of cases; average
1996patient charges; average length of stay; complication rates;
1997mortality rates; and infection rates, among others, which shall
1998be adjusted for case mix and severity, if applicable.
1999     b.  May consider such additional measures that are adopted
2000by the Centers for Medicare and Medicaid Studies, National
2001Quality Forum, The Joint Commission on Accreditation of
2002Healthcare Organizations, the Agency for Healthcare Research and
2003Quality, Centers for Disease Control and Prevention, or a
2004similar national entity that establishes standards to measure
2005the performance of health care providers, or by other states.
2007When determining which patient charge data to disclose, the
2008agency shall include such measures as the average of
2009undiscounted charges on frequently performed procedures and
2010preventive diagnostic procedures, the range of procedure charges
2011from highest to lowest, average net revenue per adjusted patient
2012day, average cost per adjusted patient day, and average cost per
2013admission, among others.
2014     2.  Make available performance measures, benefit design,
2015and premium cost data from health plans licensed pursuant to
2016chapter 627 or chapter 641. The agency shall determine which
2017health care quality measures and member and subscriber cost data
2018to disclose, based upon input from the council. When determining
2019which data to disclose, the agency shall consider information
2020that may be required by either individual or group purchasers to
2021assess the value of the product, which may include membership
2022satisfaction, quality of care, current enrollment or membership,
2023coverage areas, accreditation status, premium costs, plan costs,
2024premium increases, range of benefits, copayments and
2025deductibles, accuracy and speed of claims payment, credentials
2026of physicians, number of providers, names of network providers,
2027and hospitals in the network. Health plans shall make available
2028to the agency any such data or information that is not currently
2029reported to the agency or the office.
2030     3.  Determine the method and format for public disclosure
2031of data reported pursuant to this paragraph. The agency shall
2032make its determination based upon input from the State Consumer
2033Health Information and Policy Advisory Council. At a minimum,
2034the data shall be made available on the agency's Internet
2035website in a manner that allows consumers to conduct an
2036interactive search that allows them to view and compare the
2037information for specific providers. The website must include
2038such additional information as is determined necessary to ensure
2039that the website enhances informed decisionmaking among
2040consumers and health care purchasers, which shall include, at a
2041minimum, appropriate guidance on how to use the data and an
2042explanation of why the data may vary from provider to provider.
2043The data specified in subparagraph 1. shall be released no later
2044than January 1, 2006, for the reporting of infection rates, and
2045no later than October 1, 2005, for mortality rates and
2046complication rates. The data specified in subparagraph 2. shall
2047be released no later than October 1, 2006.
2048     4.  Publish on its website undiscounted charges for no
2049fewer than 150 of the most commonly performed adult and
2050pediatric procedures, including outpatient, inpatient,
2051diagnostic, and preventative procedures.
2052     Section 57.  Paragraph (a) of subsection (1) of section
2053408.061, Florida Statutes, is amended to read:
2054     408.061  Data collection; uniform systems of financial
2055reporting; information relating to physician charges;
2056confidential information; immunity.-
2057     (1)  The agency shall require the submission by health care
2058facilities, health care providers, and health insurers of data
2059necessary to carry out the agency's duties. Specifications for
2060data to be collected under this section shall be developed by
2061the agency with the assistance of technical advisory panels
2062including representatives of affected entities, consumers,
2063purchasers, and such other interested parties as may be
2064determined by the agency.
2065     (a)  Data submitted by health care facilities, including
2066the facilities as defined in chapter 395, shall include, but are
2067not limited to: case-mix data, patient admission and discharge
2068data, hospital emergency department data which shall include the
2069number of patients treated in the emergency department of a
2070licensed hospital reported by patient acuity level, data on
2071hospital-acquired infections as specified by rule, data on
2072complications as specified by rule, data on readmissions as
2073specified by rule, with patient and provider-specific
2074identifiers included, actual charge data by diagnostic groups,
2075financial data, accounting data, operating expenses, expenses
2076incurred for rendering services to patients who cannot or do not
2077pay, interest charges, depreciation expenses based on the
2078expected useful life of the property and equipment involved, and
2079demographic data. The agency shall adopt nationally recognized
2080risk adjustment methodologies or software consistent with the
2081standards of the Agency for Healthcare Research and Quality and
2082as selected by the agency for all data submitted as required by
2083this section. Data may be obtained from documents such as, but
2084not limited to: leases, contracts, debt instruments, itemized
2085patient bills, medical record abstracts, and related diagnostic
2086information. Reported data elements shall be reported
2087electronically and in accordance with rule 59E-7.012, Florida
2088Administrative Code. Data submitted shall be certified by the
2089chief executive officer or an appropriate and duly authorized
2090representative or employee of the licensed facility that the
2091information submitted is true and accurate.
2092     Section 58.  Subsection (43) of section 408.07, Florida
2093Statutes, is amended to read:
2094     408.07  Definitions.-As used in this chapter, with the
2095exception of ss. 408.031-408.045, the term:
2096     (43)  "Rural hospital" means an acute care hospital
2097licensed under chapter 395, having 100 or fewer licensed beds
2098and an emergency room, and which is:
2099     (a)  The sole provider within a county with a population
2100density of no greater than 100 persons per square mile;
2101     (b)  An acute care hospital, in a county with a population
2102density of no greater than 100 persons per square mile, which is
2103at least 30 minutes of travel time, on normally traveled roads
2104under normal traffic conditions, from another acute care
2105hospital within the same county;
2106     (c)  A hospital supported by a tax district or subdistrict
2107whose boundaries encompass a population of 100 persons or fewer
2108per square mile;
2109     (d)  A hospital with a service area that has a population
2110of 100 persons or fewer per square mile. As used in this
2111paragraph, the term "service area" means the fewest number of
2112zip codes that account for 75 percent of the hospital's
2113discharges for the most recent 5-year period, based on
2114information available from the hospital inpatient discharge
2115database in the Florida Center for Health Information and Policy
2116Analysis at the Agency for Health Care Administration; or
2117     (e)  A critical access hospital.
2119Population densities used in this subsection must be based upon
2120the most recently completed United States census. A hospital
2121that received funds under s. 409.9116 for a quarter beginning no
2122later than July 1, 2002, is deemed to have been and shall
2123continue to be a rural hospital from that date through June 30,
21242015, if the hospital continues to have 100 or fewer licensed
2125beds and an emergency room, or meets the criteria of s.
2126395.602(2)(e)4. An acute care hospital that has not previously
2127been designated as a rural hospital and that meets the criteria
2128of this subsection shall be granted such designation upon
2129application, including supporting documentation, to the Agency
2130for Health Care Administration.
2131     Section 59.  Section 408.10, Florida Statutes, is amended
2132to read:
2133     408.10  Consumer complaints.-The agency shall:
2134     (1)  publish and make available to the public a toll-free
2135telephone number for the purpose of handling consumer complaints
2136and shall serve as a liaison between consumer entities and other
2137private entities and governmental entities for the disposition
2138of problems identified by consumers of health care.
2139     (2)  Be empowered to investigate consumer complaints
2140relating to problems with health care facilities' billing
2141practices and issue reports to be made public in any cases where
2142the agency determines the health care facility has engaged in
2143billing practices which are unreasonable and unfair to the
2145     Section 60.  Subsections (12) through (30) of section
2146408.802, Florida Statutes, are renumbered as subsections (11)
2147through (29), respectively, and present subsection (11) of that
2148section is amended to read:
2149     408.802  Applicability.-The provisions of this part apply
2150to the provision of services that require licensure as defined
2151in this part and to the following entities licensed, registered,
2152or certified by the agency, as described in chapters 112, 383,
2153390, 394, 395, 400, 429, 440, 483, and 765:
2154     (11)  Private review agents, as provided under part I of
2155chapter 395.
2156     Section 61.  Subsection (3) is added to section 408.804,
2157Florida Statutes, to read:
2158     408.804  License required; display.-
2159     (3)  Any person who knowingly alters, defaces, or falsifies
2160a license certificate issued by the agency, or causes or
2161procures any person to commit such an offense, commits a
2162misdemeanor of the second degree, punishable as provided in s.
2163775.082 or s 775.083. Any licensee or provider who displays an
2164altered, defaced, or falsified license certificate is subject to
2165the penalties set forth in s. 408.815 and an administrative fine
2166of $1,000 for each day of illegal display.
2167     Section 62.  Paragraph (d) of subsection (2) of section
2168408.806, Florida Statutes, is amended, present subsections (3)
2169through (8) are renumbered as subsections (4) through (9),
2170respectively, and a new subsection (3) is added to that section,
2171to read:
2172     408.806  License application process.-
2173     (2)
2174     (d)  The agency shall notify the licensee by mail or
2175electronically at least 90 days before the expiration of a
2176license that a renewal license is necessary to continue
2177operation. The licensee's failure to timely file submit a
2178renewal application and license application fee with the agency
2179shall result in a $50 per day late fee charged to the licensee
2180by the agency; however, the aggregate amount of the late fee may
2181not exceed 50 percent of the licensure fee or $500, whichever is
2182less. The agency shall provide a courtesy notice to the licensee
2183by United States mail, electronically, or by any other manner at
2184its address of record or mailing address, if provided, at least
218590 days prior to the expiration of a license informing the
2186licensee of the expiration of the license. If the agency does
2187not provide the courtesy notice or the licensee does not receive
2188the courtesy notice, the licensee continues to be legally
2189obligated to timely file the renewal application and license
2190application fee with the agency and is not excused from the
2191payment of a late fee. If an application is received after the
2192required filing date and exhibits a hand-canceled postmark
2193obtained from a United States post office dated on or before the
2194required filing date, no fine will be levied.
2195     (3)  Payment of the late fee is required to consider any
2196late application complete, and failure to pay the late fee is
2197considered an omission from the application.
2198     Section 63.  Subsections (6) and (9) of section 408.810,
2199Florida Statutes, are amended to read:
2200     408.810  Minimum licensure requirements.-In addition to the
2201licensure requirements specified in this part, authorizing
2202statutes, and applicable rules, each applicant and licensee must
2203comply with the requirements of this section in order to obtain
2204and maintain a license.
2205     (6)(a)  An applicant must provide the agency with proof of
2206the applicant's legal right to occupy the property before a
2207license may be issued. Proof may include, but need not be
2208limited to, copies of warranty deeds, lease or rental
2209agreements, contracts for deeds, quitclaim deeds, or other such
2211     (b)  In the event the property is encumbered by a mortgage
2212or is leased, an applicant must provide the agency with proof
2213that the mortgagor or landlord has been provided written notice
2214of the applicant's intent as mortgagee or tenant to provide
2215services that require licensure and instruct the mortgagor or
2216landlord to serve the agency by certified mail with copies of
2217any foreclosure or eviction actions initiated by the mortgagor
2218or landlord against the applicant.
2219     (9)  A controlling interest may not withhold from the
2220agency any evidence of financial instability, including, but not
2221limited to, checks returned due to insufficient funds,
2222delinquent accounts, nonpayment of withholding taxes, unpaid
2223utility expenses, nonpayment for essential services, or adverse
2224court action concerning the financial viability of the provider
2225or any other provider licensed under this part that is under the
2226control of the controlling interest. A controlling interest
2227shall notify the agency within 10 days after a court action to
2228initiate bankruptcy, foreclosure, or eviction proceedings
2229concerning the provider, in which the controlling interest is a
2230petitioner or defendant. Any person who violates this subsection
2231commits a misdemeanor of the second degree, punishable as
2232provided in s. 775.082 or s. 775.083. Each day of continuing
2233violation is a separate offense.
2234     Section 64.  Subsection (3) is added to section 408.813,
2235Florida Statutes, to read:
2236     408.813  Administrative fines; violations.-As a penalty for
2237any violation of this part, authorizing statutes, or applicable
2238rules, the agency may impose an administrative fine.
2239     (3)  The agency may impose an administrative fine for a
2240violation that does not qualify as a class I, class II, class
2241III, or class IV violation. Unless otherwise specified by law,
2242the amount of the fine shall not exceed $500 for each violation.
2243Unclassified violations may include:
2244     (a)  Violating any term or condition of a license.
2245     (b)  Violating any provision of this part, authorizing
2246statutes, or applicable rules.
2247     (c)  Exceeding licensed capacity.
2248     (d)  Providing services beyond the scope of the license.
2249     (e)  Violating a moratorium imposed pursuant to s. 408.814.
2250     Section 65.  Subsection (5) is added to section 408.815,
2251Florida Statutes, to read:
2252     408.815  License or application denial; revocation.-
2253     (5)  In order to ensure the health, safety, and welfare of
2254clients when a license has been denied, revoked, or is set to
2255terminate, the agency may extend the license expiration date for
2256a period of up to 30 days for the sole purpose of allowing the
2257safe and orderly discharge of clients. The agency may impose
2258conditions on the extension, including, but not limited to,
2259prohibiting or limiting admissions, expedited discharge
2260planning, required status reports, and mandatory monitoring by
2261the agency or third parties. In imposing these conditions, the
2262agency shall take into consideration the nature and number of
2263clients, the availability and location of acceptable alternative
2264placements, and the ability of the licensee to continue
2265providing care to the clients. The agency may terminate the
2266extension or modify the conditions at any time. This authority
2267is in addition to any other authority granted to the agency
2268under chapter 120, this part, and authorizing statutes but
2269creates no right or entitlement to an extension of a license
2270expiration date.
2271     Section 66.  Paragraph (k) of subsection (4) of section
2272409.221, Florida Statutes, is amended to read:
2273     409.221  Consumer-directed care program.-
2275     (k)  Reviews and reports.-The agency and the Departments of
2276Elderly Affairs, Health, and Children and Family Services and
2277the Agency for Persons with Disabilities shall each, on an
2278ongoing basis, review and assess the implementation of the
2279consumer-directed care program. By January 15 of each year, the
2280agency shall submit a written report to the Legislature that
2281includes each department's review of the program and contains
2282recommendations for improvements to the program.
2283     Section 67.  Subsection (1) of section 409.91196, Florida
2284Statutes, is amended to read:
2285     409.91196  Supplemental rebate agreements; public records
2286and public meetings exemption.-
2287     (1)  The rebate amount, percent of rebate, manufacturer's
2288pricing, and supplemental rebate, and other trade secrets as
2289defined in s. 688.002 that the agency has identified for use in
2290negotiations, held by the Agency for Health Care Administration
2291under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2292119.07(1) and s. 24(a), Art. I of the State Constitution.
2293     Section 68.  Paragraph (a) of subsection (39) of section
2294409.912, Florida Statutes, is amended to read:
2295     409.912  Cost-effective purchasing of health care.-The
2296agency shall purchase goods and services for Medicaid recipients
2297in the most cost-effective manner consistent with the delivery
2298of quality medical care. To ensure that medical services are
2299effectively utilized, the agency may, in any case, require a
2300confirmation or second physician's opinion of the correct
2301diagnosis for purposes of authorizing future services under the
2302Medicaid program. This section does not restrict access to
2303emergency services or poststabilization care services as defined
2304in 42 C.F.R. part 438.114. Such confirmation or second opinion
2305shall be rendered in a manner approved by the agency. The agency
2306shall maximize the use of prepaid per capita and prepaid
2307aggregate fixed-sum basis services when appropriate and other
2308alternative service delivery and reimbursement methodologies,
2309including competitive bidding pursuant to s. 287.057, designed
2310to facilitate the cost-effective purchase of a case-managed
2311continuum of care. The agency shall also require providers to
2312minimize the exposure of recipients to the need for acute
2313inpatient, custodial, and other institutional care and the
2314inappropriate or unnecessary use of high-cost services. The
2315agency shall contract with a vendor to monitor and evaluate the
2316clinical practice patterns of providers in order to identify
2317trends that are outside the normal practice patterns of a
2318provider's professional peers or the national guidelines of a
2319provider's professional association. The vendor must be able to
2320provide information and counseling to a provider whose practice
2321patterns are outside the norms, in consultation with the agency,
2322to improve patient care and reduce inappropriate utilization.
2323The agency may mandate prior authorization, drug therapy
2324management, or disease management participation for certain
2325populations of Medicaid beneficiaries, certain drug classes, or
2326particular drugs to prevent fraud, abuse, overuse, and possible
2327dangerous drug interactions. The Pharmaceutical and Therapeutics
2328Committee shall make recommendations to the agency on drugs for
2329which prior authorization is required. The agency shall inform
2330the Pharmaceutical and Therapeutics Committee of its decisions
2331regarding drugs subject to prior authorization. The agency is
2332authorized to limit the entities it contracts with or enrolls as
2333Medicaid providers by developing a provider network through
2334provider credentialing. The agency may competitively bid single-
2335source-provider contracts if procurement of goods or services
2336results in demonstrated cost savings to the state without
2337limiting access to care. The agency may limit its network based
2338on the assessment of beneficiary access to care, provider
2339availability, provider quality standards, time and distance
2340standards for access to care, the cultural competence of the
2341provider network, demographic characteristics of Medicaid
2342beneficiaries, practice and provider-to-beneficiary standards,
2343appointment wait times, beneficiary use of services, provider
2344turnover, provider profiling, provider licensure history,
2345previous program integrity investigations and findings, peer
2346review, provider Medicaid policy and billing compliance records,
2347clinical and medical record audits, and other factors. Providers
2348shall not be entitled to enrollment in the Medicaid provider
2349network. The agency shall determine instances in which allowing
2350Medicaid beneficiaries to purchase durable medical equipment and
2351other goods is less expensive to the Medicaid program than long-
2352term rental of the equipment or goods. The agency may establish
2353rules to facilitate purchases in lieu of long-term rentals in
2354order to protect against fraud and abuse in the Medicaid program
2355as defined in s. 409.913. The agency may seek federal waivers
2356necessary to administer these policies.
2357     (39)(a)  The agency shall implement a Medicaid prescribed-
2358drug spending-control program that includes the following
2360     1.  A Medicaid preferred drug list, which shall be a
2361listing of cost-effective therapeutic options recommended by the
2362Medicaid Pharmacy and Therapeutics Committee established
2363pursuant to s. 409.91195 and adopted by the agency for each
2364therapeutic class on the preferred drug list. At the discretion
2365of the committee, and when feasible, the preferred drug list
2366should include at least two products in a therapeutic class. The
2367agency may post the preferred drug list and updates to the
2368preferred drug list on an Internet website without following the
2369rulemaking procedures of chapter 120. Antiretroviral agents are
2370excluded from the preferred drug list. The agency shall also
2371limit the amount of a prescribed drug dispensed to no more than
2372a 34-day supply unless the drug products' smallest marketed
2373package is greater than a 34-day supply, or the drug is
2374determined by the agency to be a maintenance drug in which case
2375a 100-day maximum supply may be authorized. The agency is
2376authorized to seek any federal waivers necessary to implement
2377these cost-control programs and to continue participation in the
2378federal Medicaid rebate program, or alternatively to negotiate
2379state-only manufacturer rebates. The agency may adopt rules to
2380implement this subparagraph. The agency shall continue to
2381provide unlimited contraceptive drugs and items. The agency must
2382establish procedures to ensure that:
2383     a.  There is a response to a request for prior consultation
2384by telephone or other telecommunication device within 24 hours
2385after receipt of a request for prior consultation; and
2386     b.  A 72-hour supply of the drug prescribed is provided in
2387an emergency or when the agency does not provide a response
2388within 24 hours as required by sub-subparagraph a.
2389     2.  Reimbursement to pharmacies for Medicaid prescribed
2390drugs shall be set at the lesser of: the average wholesale price
2391(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2392plus 4.75 percent, the federal upper limit (FUL), the state
2393maximum allowable cost (SMAC), or the usual and customary (UAC)
2394charge billed by the provider.
2395     3.  For a prescribed drug billed as a 340B prescribed
2396medication, the claim must meet the requirements of the Deficit
2397Reduction Act of 2005 and the federal 340B program, contain a
2398national drug code, and be billed at the actual acquisition cost
2399or payment shall be denied.
2400     4.3.  The agency shall develop and implement a process for
2401managing the drug therapies of Medicaid recipients who are using
2402significant numbers of prescribed drugs each month. The
2403management process may include, but is not limited to,
2404comprehensive, physician-directed medical-record reviews, claims
2405analyses, and case evaluations to determine the medical
2406necessity and appropriateness of a patient's treatment plan and
2407drug therapies. The agency may contract with a private
2408organization to provide drug-program-management services. The
2409Medicaid drug benefit management program shall include
2410initiatives to manage drug therapies for HIV/AIDS patients,
2411patients using 20 or more unique prescriptions in a 180-day
2412period, and the top 1,000 patients in annual spending. The
2413agency shall enroll any Medicaid recipient in the drug benefit
2414management program if he or she meets the specifications of this
2415provision and is not enrolled in a Medicaid health maintenance
2417     5.4.  The agency may limit the size of its pharmacy network
2418based on need, competitive bidding, price negotiations,
2419credentialing, or similar criteria. The agency shall give
2420special consideration to rural areas in determining the size and
2421location of pharmacies included in the Medicaid pharmacy
2422network. A pharmacy credentialing process may include criteria
2423such as a pharmacy's full-service status, location, size,
2424patient educational programs, patient consultation, disease
2425management services, and other characteristics. The agency may
2426impose a moratorium on Medicaid pharmacy enrollment when it is
2427determined that it has a sufficient number of Medicaid-
2428participating providers. The agency must allow dispensing
2429practitioners to participate as a part of the Medicaid pharmacy
2430network regardless of the practitioner's proximity to any other
2431entity that is dispensing prescription drugs under the Medicaid
2432program. A dispensing practitioner must meet all credentialing
2433requirements applicable to his or her practice, as determined by
2434the agency.
2435     6.5.  The agency shall develop and implement a program that
2436requires Medicaid practitioners who prescribe drugs to use a
2437counterfeit-proof prescription pad for Medicaid prescriptions.
2438The agency shall require the use of standardized counterfeit-
2439proof prescription pads by Medicaid-participating prescribers or
2440prescribers who write prescriptions for Medicaid recipients. The
2441agency may implement the program in targeted geographic areas or
2443     7.6.  The agency may enter into arrangements that require
2444manufacturers of generic drugs prescribed to Medicaid recipients
2445to provide rebates of at least 15.1 percent of the average
2446manufacturer price for the manufacturer's generic products.
2447These arrangements shall require that if a generic-drug
2448manufacturer pays federal rebates for Medicaid-reimbursed drugs
2449at a level below 15.1 percent, the manufacturer must provide a
2450supplemental rebate to the state in an amount necessary to
2451achieve a 15.1-percent rebate level.
2452     8.7.  The agency may establish a preferred drug list as
2453described in this subsection, and, pursuant to the establishment
2454of such preferred drug list, it is authorized to negotiate
2455supplemental rebates from manufacturers that are in addition to
2456those required by Title XIX of the Social Security Act and at no
2457less than 14 percent of the average manufacturer price as
2458defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2459the federal or supplemental rebate, or both, equals or exceeds
246029 percent. There is no upper limit on the supplemental rebates
2461the agency may negotiate. The agency may determine that specific
2462products, brand-name or generic, are competitive at lower rebate
2463percentages. Agreement to pay the minimum supplemental rebate
2464percentage will guarantee a manufacturer that the Medicaid
2465Pharmaceutical and Therapeutics Committee will consider a
2466product for inclusion on the preferred drug list. However, a
2467pharmaceutical manufacturer is not guaranteed placement on the
2468preferred drug list by simply paying the minimum supplemental
2469rebate. Agency decisions will be made on the clinical efficacy
2470of a drug and recommendations of the Medicaid Pharmaceutical and
2471Therapeutics Committee, as well as the price of competing
2472products minus federal and state rebates. The agency is
2473authorized to contract with an outside agency or contractor to
2474conduct negotiations for supplemental rebates. For the purposes
2475of this section, the term "supplemental rebates" means cash
2476rebates. Effective July 1, 2004, value-added programs as a
2477substitution for supplemental rebates are prohibited. The agency
2478is authorized to seek any federal waivers to implement this
2480     9.8.  The Agency for Health Care Administration shall
2481expand home delivery of pharmacy products. To assist Medicaid
2482patients in securing their prescriptions and reduce program
2483costs, the agency shall expand its current mail-order-pharmacy
2484diabetes-supply program to include all generic and brand-name
2485drugs used by Medicaid patients with diabetes. Medicaid
2486recipients in the current program may obtain nondiabetes drugs
2487on a voluntary basis. This initiative is limited to the
2488geographic area covered by the current contract. The agency may
2489seek and implement any federal waivers necessary to implement
2490this subparagraph.
2491     10.9.  The agency shall limit to one dose per month any
2492drug prescribed to treat erectile dysfunction.
2493     11.10.a.  The agency may implement a Medicaid behavioral
2494drug management system. The agency may contract with a vendor
2495that has experience in operating behavioral drug management
2496systems to implement this program. The agency is authorized to
2497seek federal waivers to implement this program.
2498     b.  The agency, in conjunction with the Department of
2499Children and Family Services, may implement the Medicaid
2500behavioral drug management system that is designed to improve
2501the quality of care and behavioral health prescribing practices
2502based on best practice guidelines, improve patient adherence to
2503medication plans, reduce clinical risk, and lower prescribed
2504drug costs and the rate of inappropriate spending on Medicaid
2505behavioral drugs. The program may include the following
2507     (I)  Provide for the development and adoption of best
2508practice guidelines for behavioral health-related drugs such as
2509antipsychotics, antidepressants, and medications for treating
2510bipolar disorders and other behavioral conditions; translate
2511them into practice; review behavioral health prescribers and
2512compare their prescribing patterns to a number of indicators
2513that are based on national standards; and determine deviations
2514from best practice guidelines.
2515     (II)  Implement processes for providing feedback to and
2516educating prescribers using best practice educational materials
2517and peer-to-peer consultation.
2518     (III)  Assess Medicaid beneficiaries who are outliers in
2519their use of behavioral health drugs with regard to the numbers
2520and types of drugs taken, drug dosages, combination drug
2521therapies, and other indicators of improper use of behavioral
2522health drugs.
2523     (IV)  Alert prescribers to patients who fail to refill
2524prescriptions in a timely fashion, are prescribed multiple same-
2525class behavioral health drugs, and may have other potential
2526medication problems.
2527     (V)  Track spending trends for behavioral health drugs and
2528deviation from best practice guidelines.
2529     (VI)  Use educational and technological approaches to
2530promote best practices, educate consumers, and train prescribers
2531in the use of practice guidelines.
2532     (VII)  Disseminate electronic and published materials.
2533     (VIII)  Hold statewide and regional conferences.
2534     (IX)  Implement a disease management program with a model
2535quality-based medication component for severely mentally ill
2536individuals and emotionally disturbed children who are high
2537users of care.
2538     12.11.a.  The agency shall implement a Medicaid
2539prescription drug management system. The agency may contract
2540with a vendor that has experience in operating prescription drug
2541management systems in order to implement this system. Any
2542management system that is implemented in accordance with this
2543subparagraph must rely on cooperation between physicians and
2544pharmacists to determine appropriate practice patterns and
2545clinical guidelines to improve the prescribing, dispensing, and
2546use of drugs in the Medicaid program. The agency may seek
2547federal waivers to implement this program.
2548     b.  The drug management system must be designed to improve
2549the quality of care and prescribing practices based on best
2550practice guidelines, improve patient adherence to medication
2551plans, reduce clinical risk, and lower prescribed drug costs and
2552the rate of inappropriate spending on Medicaid prescription
2553drugs. The program must:
2554     (I)  Provide for the development and adoption of best
2555practice guidelines for the prescribing and use of drugs in the
2556Medicaid program, including translating best practice guidelines
2557into practice; reviewing prescriber patterns and comparing them
2558to indicators that are based on national standards and practice
2559patterns of clinical peers in their community, statewide, and
2560nationally; and determine deviations from best practice
2562     (II)  Implement processes for providing feedback to and
2563educating prescribers using best practice educational materials
2564and peer-to-peer consultation.
2565     (III)  Assess Medicaid recipients who are outliers in their
2566use of a single or multiple prescription drugs with regard to
2567the numbers and types of drugs taken, drug dosages, combination
2568drug therapies, and other indicators of improper use of
2569prescription drugs.
2570     (IV)  Alert prescribers to patients who fail to refill
2571prescriptions in a timely fashion, are prescribed multiple drugs
2572that may be redundant or contraindicated, or may have other
2573potential medication problems.
2574     (V)  Track spending trends for prescription drugs and
2575deviation from best practice guidelines.
2576     (VI)  Use educational and technological approaches to
2577promote best practices, educate consumers, and train prescribers
2578in the use of practice guidelines.
2579     (VII)  Disseminate electronic and published materials.
2580     (VIII)  Hold statewide and regional conferences.
2581     (IX)  Implement disease management programs in cooperation
2582with physicians and pharmacists, along with a model quality-
2583based medication component for individuals having chronic
2584medical conditions.
2585     13.12.  The agency is authorized to contract for drug
2586rebate administration, including, but not limited to,
2587calculating rebate amounts, invoicing manufacturers, negotiating
2588disputes with manufacturers, and maintaining a database of
2589rebate collections.
2590     14.13.  The agency may specify the preferred daily dosing
2591form or strength for the purpose of promoting best practices
2592with regard to the prescribing of certain drugs as specified in
2593the General Appropriations Act and ensuring cost-effective
2594prescribing practices.
2595     15.14.  The agency may require prior authorization for
2596Medicaid-covered prescribed drugs. The agency may, but is not
2597required to, prior-authorize the use of a product:
2598     a.  For an indication not approved in labeling;
2599     b.  To comply with certain clinical guidelines; or
2600     c.  If the product has the potential for overuse, misuse,
2601or abuse.
2603The agency may require the prescribing professional to provide
2604information about the rationale and supporting medical evidence
2605for the use of a drug. The agency may post prior authorization
2606criteria and protocol and updates to the list of drugs that are
2607subject to prior authorization on an Internet website without
2608amending its rule or engaging in additional rulemaking.
2609     16.15.  The agency, in conjunction with the Pharmaceutical
2610and Therapeutics Committee, may require age-related prior
2611authorizations for certain prescribed drugs. The agency may
2612preauthorize the use of a drug for a recipient who may not meet
2613the age requirement or may exceed the length of therapy for use
2614of this product as recommended by the manufacturer and approved
2615by the Food and Drug Administration. Prior authorization may
2616require the prescribing professional to provide information
2617about the rationale and supporting medical evidence for the use
2618of a drug.
2619     17.16.  The agency shall implement a step-therapy prior
2620authorization approval process for medications excluded from the
2621preferred drug list. Medications listed on the preferred drug
2622list must be used within the previous 12 months prior to the
2623alternative medications that are not listed. The step-therapy
2624prior authorization may require the prescriber to use the
2625medications of a similar drug class or for a similar medical
2626indication unless contraindicated in the Food and Drug
2627Administration labeling. The trial period between the specified
2628steps may vary according to the medical indication. The step-
2629therapy approval process shall be developed in accordance with
2630the committee as stated in s. 409.91195(7) and (8). A drug
2631product may be approved without meeting the step-therapy prior
2632authorization criteria if the prescribing physician provides the
2633agency with additional written medical or clinical documentation
2634that the product is medically necessary because:
2635     a.  There is not a drug on the preferred drug list to treat
2636the disease or medical condition which is an acceptable clinical
2638     b.  The alternatives have been ineffective in the treatment
2639of the beneficiary's disease; or
2640     c.  Based on historic evidence and known characteristics of
2641the patient and the drug, the drug is likely to be ineffective,
2642or the number of doses have been ineffective.
2644The agency shall work with the physician to determine the best
2645alternative for the patient. The agency may adopt rules waiving
2646the requirements for written clinical documentation for specific
2647drugs in limited clinical situations.
2648     18.17.  The agency shall implement a return and reuse
2649program for drugs dispensed by pharmacies to institutional
2650recipients, which includes payment of a $5 restocking fee for
2651the implementation and operation of the program. The return and
2652reuse program shall be implemented electronically and in a
2653manner that promotes efficiency. The program must permit a
2654pharmacy to exclude drugs from the program if it is not
2655practical or cost-effective for the drug to be included and must
2656provide for the return to inventory of drugs that cannot be
2657credited or returned in a cost-effective manner. The agency
2658shall determine if the program has reduced the amount of
2659Medicaid prescription drugs which are destroyed on an annual
2660basis and if there are additional ways to ensure more
2661prescription drugs are not destroyed which could safely be
2662reused. The agency's conclusion and recommendations shall be
2663reported to the Legislature by December 1, 2005.
2664     Section 69.  Subsections (3) and (4) of section 429.07,
2665Florida Statutes, are amended, and subsections (6) and (7) are
2666added to that section, to read:
2667     429.07  License required; fee; inspections.-
2668     (3)  In addition to the requirements of s. 408.806, each
2669license granted by the agency must state the type of care for
2670which the license is granted. Licenses shall be issued for one
2671or more of the following categories of care: standard, extended
2672congregate care, limited nursing services, or limited mental
2674     (a)  A standard license shall be issued to a facility
2675facilities providing one or more of the personal services
2676identified in s. 429.02. Such licensee facilities may also
2677employ or contract with a person licensed under part I of
2678chapter 464 to administer medications and perform other tasks as
2679specified in s. 429.255.
2680     (b)  An extended congregate care license shall be issued to
2681a licensee facilities providing, directly or through contract,
2682services beyond those authorized in paragraph (a), including
2683acts performed pursuant to part I of chapter 464 by persons
2684licensed thereunder, and supportive services defined by rule to
2685persons who otherwise would be disqualified from continued
2686residence in a facility licensed under this part.
2687     1.  In order for extended congregate care services to be
2688provided in a facility licensed under this part, the agency must
2689first determine that all requirements established in law and
2690rule are met and must specifically designate, on the facility's
2691license, that such services may be provided and whether the
2692designation applies to all or part of a facility. Such
2693designation may be made at the time of initial licensure or
2694relicensure, or upon request in writing by a licensee under this
2695part and part II of chapter 408. Notification of approval or
2696denial of such request shall be made in accordance with part II
2697of chapter 408. An existing licensee facilities qualifying to
2698provide extended congregate care services must have maintained a
2699standard license and may not have been subject to administrative
2700sanctions during the previous 2 years, or since initial
2701licensure if the facility has been licensed for less than 2
2702years, for any of the following reasons:
2703     a.  A class I or class II violation;
2704     b.  Three or more repeat or recurring class III violations
2705of identical or similar resident care standards as specified in
2706rule from which a pattern of noncompliance is found by the
2708     c.  Three or more class III violations that were not
2709corrected in accordance with the corrective action plan approved
2710by the agency;
2711     d.  Violation of resident care standards resulting in a
2712requirement to employ the services of a consultant pharmacist or
2713consultant dietitian;
2714     e.  Denial, suspension, or revocation of a license for
2715another facility under this part in which the applicant for an
2716extended congregate care license has at least 25 percent
2717ownership interest; or
2718     f.  Imposition of a moratorium pursuant to this part or
2719part II of chapter 408 or initiation of injunctive proceedings.
2720     2.  A licensee Facilities that is are licensed to provide
2721extended congregate care services shall maintain a written
2722progress report for on each person who receives such services,
2723and the which report must describe describes the type, amount,
2724duration, scope, and outcome of services that are rendered and
2725the general status of the resident's health. A registered nurse,
2726or appropriate designee, representing the agency shall visit
2727such facilities at least quarterly to monitor residents who are
2728receiving extended congregate care services and to determine if
2729the facility is in compliance with this part, part II of chapter
2730408, and rules that relate to extended congregate care. One of
2731these visits may be in conjunction with the regular survey. The
2732monitoring visits may be provided through contractual
2733arrangements with appropriate community agencies. A registered
2734nurse shall serve as part of the team that inspects such
2735facility. The agency may waive one of the required yearly
2736monitoring visits for a facility that has been licensed for at
2737least 24 months to provide extended congregate care services,
2738if, during the inspection, the registered nurse determines that
2739extended congregate care services are being provided
2740appropriately, and if the facility has no class I or class II
2741violations and no uncorrected class III violations. Before such
2742decision is made, the agency shall consult with the long-term
2743care ombudsman council for the area in which the facility is
2744located to determine if any complaints have been made and
2745substantiated about the quality of services or care. The agency
2746may not waive one of the required yearly monitoring visits if
2747complaints have been made and substantiated.
2748     3.  Licensees Facilities that are licensed to provide
2749extended congregate care services shall:
2750     a.  Demonstrate the capability to meet unanticipated
2751resident service needs.
2752     b.  Offer a physical environment that promotes a homelike
2753setting, provides for resident privacy, promotes resident
2754independence, and allows sufficient congregate space as defined
2755by rule.
2756     c.  Have sufficient staff available, taking into account
2757the physical plant and firesafety features of the building, to
2758assist with the evacuation of residents in an emergency, as
2760     d.  Adopt and follow policies and procedures that maximize
2761resident independence, dignity, choice, and decisionmaking to
2762permit residents to age in place to the extent possible, so that
2763moves due to changes in functional status are minimized or
2765     e.  Allow residents or, if applicable, a resident's
2766representative, designee, surrogate, guardian, or attorney in
2767fact to make a variety of personal choices, participate in
2768developing service plans, and share responsibility in
2770     f.  Implement the concept of managed risk.
2771     g.  Provide, either directly or through contract, the
2772services of a person licensed pursuant to part I of chapter 464.
2773     h.  In addition to the training mandated in s. 429.52,
2774provide specialized training as defined by rule for facility
2776     4.  Licensees Facilities licensed to provide extended
2777congregate care services are exempt from the criteria for
2778continued residency as set forth in rules adopted under s.
2779429.41. Licensees Facilities so licensed shall adopt their own
2780requirements within guidelines for continued residency set forth
2781by rule. However, such licensees facilities may not serve
2782residents who require 24-hour nursing supervision. Licensees
2783Facilities licensed to provide extended congregate care services
2784shall provide each resident with a written copy of facility
2785policies governing admission and retention.
2786     5.  The primary purpose of extended congregate care
2787services is to allow residents, as they become more impaired,
2788the option of remaining in a familiar setting from which they
2789would otherwise be disqualified for continued residency. A
2790facility licensed to provide extended congregate care services
2791may also admit an individual who exceeds the admission criteria
2792for a facility with a standard license, if the individual is
2793determined appropriate for admission to the extended congregate
2794care facility.
2795     6.  Before admission of an individual to a facility
2796licensed to provide extended congregate care services, the
2797individual must undergo a medical examination as provided in s.
2798429.26(4) and the facility must develop a preliminary service
2799plan for the individual.
2800     7.  When a licensee facility can no longer provide or
2801arrange for services in accordance with the resident's service
2802plan and needs and the licensee's facility's policy, the
2803licensee facility shall make arrangements for relocating the
2804person in accordance with s. 429.28(1)(k).
2805     8.  Failure to provide extended congregate care services
2806may result in denial of extended congregate care license
2808     9.  No later than January 1 of each year, the department,
2809in consultation with the agency, shall prepare and submit to the
2810Governor, the President of the Senate, the Speaker of the House
2811of Representatives, and the chairs of appropriate legislative
2812committees, a report on the status of, and recommendations
2813related to, extended congregate care services. The status report
2814must include, but need not be limited to, the following
2816     a.  A description of the facilities licensed to provide
2817such services, including total number of beds licensed under
2818this part.
2819     b.  The number and characteristics of residents receiving
2820such services.
2821     c.  The types of services rendered that could not be
2822provided through a standard license.
2823     d.  An analysis of deficiencies cited during licensure
2825     e.  The number of residents who required extended
2826congregate care services at admission and the source of
2828     f.  Recommendations for statutory or regulatory changes.
2829     g.  The availability of extended congregate care to state
2830clients residing in facilities licensed under this part and in
2831need of additional services, and recommendations for
2832appropriations to subsidize extended congregate care services
2833for such persons.
2834     h.  Such other information as the department considers
2836     (c)  A limited nursing services license shall be issued to
2837a facility that provides services beyond those authorized in
2838paragraph (a) and as specified in this paragraph.
2839     1.  In order for limited nursing services to be provided in
2840a facility licensed under this part, the agency must first
2841determine that all requirements established in law and rule are
2842met and must specifically designate, on the facility's license,
2843that such services may be provided. Such designation may be made
2844at the time of initial licensure or relicensure, or upon request
2845in writing by a licensee under this part and part II of chapter
2846408. Notification of approval or denial of such request shall be
2847made in accordance with part II of chapter 408. Existing
2848facilities qualifying to provide limited nursing services shall
2849have maintained a standard license and may not have been subject
2850to administrative sanctions that affect the health, safety, and
2851welfare of residents for the previous 2 years or since initial
2852licensure if the facility has been licensed for less than 2
2854     2.  Facilities that are licensed to provide limited nursing
2855services shall maintain a written progress report on each person
2856who receives such nursing services, which report describes the
2857type, amount, duration, scope, and outcome of services that are
2858rendered and the general status of the resident's health. A
2859registered nurse representing the agency shall visit such
2860facilities at least twice a year to monitor residents who are
2861receiving limited nursing services and to determine if the
2862facility is in compliance with applicable provisions of this
2863part, part II of chapter 408, and related rules. The monitoring
2864visits may be provided through contractual arrangements with
2865appropriate community agencies. A registered nurse shall also
2866serve as part of the team that inspects such facility.
2867     3.  A person who receives limited nursing services under
2868this part must meet the admission criteria established by the
2869agency for assisted living facilities. When a resident no longer
2870meets the admission criteria for a facility licensed under this
2871part, arrangements for relocating the person shall be made in
2872accordance with s. 429.28(1)(k), unless the facility is licensed
2873to provide extended congregate care services.
2874     (4)  In accordance with s. 408.805, an applicant or
2875licensee shall pay a fee for each license application submitted
2876under this part, part II of chapter 408, and applicable rules.
2877The amount of the fee shall be established by rule.
2878     (a)  The biennial license fee required of a facility is
2879$356 $300 per license, with an additional fee of $67.50 $50 per
2880resident based on the total licensed resident capacity of the
2881facility, except that no additional fee will be assessed for
2882beds designated for recipients of optional state supplementation
2883payments provided for in s. 409.212. The total fee may not
2884exceed $18,000 $10,000.
2885     (b)  In addition to the total fee assessed under paragraph
2886(a), the agency shall require facilities that are licensed to
2887provide extended congregate care services under this part to pay
2888an additional fee per licensed facility. The amount of the
2889biennial fee shall be $501 $400 per license, with an additional
2890fee of $10 per resident based on the total licensed resident
2891capacity of the facility.
2892     (c)  In addition to the total fee assessed under paragraph
2893(a), the agency shall require facilities that are licensed to
2894provide limited nursing services under this part to pay an
2895additional fee per licensed facility. The amount of the biennial
2896fee shall be $250 per license, with an additional fee of $10 per
2897resident based on the total licensed resident capacity of the
2899     (6)  In order to determine whether the facility is
2900adequately protecting residents' rights as provided in s.
2901429.28, the biennial survey shall include private informal
2902conversations with a sample of residents and consultation with
2903the ombudsman council in the planning and service area in which
2904the facility is located to discuss residents' experiences within
2905the facility.
2906     (7)  An assisted living facility that has been cited within
2907the previous 24-month period for a class I or class II
2908violation, regardless of the status of any enforcement or
2909disciplinary action, is subject to periodic unannounced
2910monitoring to determine if the facility is in compliance with
2911this part, part II of chapter 408, and applicable rules.
2912Monitoring may occur through a desk review or an onsite
2913assessment. If the class I or class II violation relates to
2914providing or failing to provide nursing care, a registered nurse
2915must participate in at least two onsite monitoring visits within
2916a 12-month period.
2917     Section 70.  Subsection (7) of section 429.11, Florida
2918Statutes, is renumbered as subsection (6), and present
2919subsection (6) of that section is amended to read:
2920     429.11  Initial application for license; provisional
2922     (6)  In addition to the license categories available in s.
2923408.808, a provisional license may be issued to an applicant
2924making initial application for licensure or making application
2925for a change of ownership. A provisional license shall be
2926limited in duration to a specific period of time not to exceed 6
2927months, as determined by the agency.
2928     Section 71.  Section 429.12, Florida Statutes, is amended
2929to read:
2930     429.12  Sale or transfer of ownership of a facility.-It is
2931the intent of the Legislature to protect the rights of the
2932residents of an assisted living facility when the facility is
2933sold or the ownership thereof is transferred. Therefore, in
2934addition to the requirements of part II of chapter 408, whenever
2935a facility is sold or the ownership thereof is transferred,
2936including leasing:.
2937     (1)  The transferee shall notify the residents, in writing,
2938of the change of ownership within 7 days after receipt of the
2939new license.
2940     (2)  The transferor of a facility the license of which is
2941denied pending an administrative hearing shall, as a part of the
2942written change-of-ownership contract, advise the transferee that
2943a plan of correction must be submitted by the transferee and
2944approved by the agency at least 7 days before the change of
2945ownership and that failure to correct the condition which
2946resulted in the moratorium pursuant to part II of chapter 408 or
2947denial of licensure is grounds for denial of the transferee's
2949     Section 72.  Paragraphs (b) through (l) of subsection (1)
2950of section 429.14, Florida Statutes, are redesignated as
2951paragraphs (a) through (k), respectively, and present paragraph
2952(a) of subsection (1) and subsections (5) and (6) of that
2953section are amended to read:
2954     429.14  Administrative penalties.-
2955     (1)  In addition to the requirements of part II of chapter
2956408, the agency may deny, revoke, and suspend any license issued
2957under this part and impose an administrative fine in the manner
2958provided in chapter 120 against a licensee of an assisted living
2959facility for a violation of any provision of this part, part II
2960of chapter 408, or applicable rules, or for any of the following
2961actions by a licensee of an assisted living facility, for the
2962actions of any person subject to level 2 background screening
2963under s. 408.809, or for the actions of any facility employee:
2964     (a)  An intentional or negligent act seriously affecting
2965the health, safety, or welfare of a resident of the facility.
2966     (5)  An action taken by the agency to suspend, deny, or
2967revoke a facility's license under this part or part II of
2968chapter 408, in which the agency claims that the facility owner
2969or an employee of the facility has threatened the health,
2970safety, or welfare of a resident of the facility shall be heard
2971by the Division of Administrative Hearings of the Department of
2972Management Services within 120 days after receipt of the
2973facility's request for a hearing, unless that time limitation is
2974waived by both parties. The administrative law judge must render
2975a decision within 30 days after receipt of a proposed
2976recommended order.
2977     (6)  The agency shall provide to the Division of Hotels and
2978Restaurants of the Department of Business and Professional
2979Regulation, on a monthly basis, a list of those assisted living
2980facilities that have had their licenses denied, suspended, or
2981revoked or that are involved in an appellate proceeding pursuant
2982to s. 120.60 related to the denial, suspension, or revocation of
2983a license. This information may be provided electronically or
2984through the agency's Internet website.
2985     Section 73.  Subsections (1), (4), and (5) of section
2986429.17, Florida Statutes, are amended to read:
2987     429.17  Expiration of license; renewal; conditional
2989     (1)  Limited nursing, Extended congregate care, and limited
2990mental health licenses shall expire at the same time as the
2991facility's standard license, regardless of when issued.
2992     (4)  In addition to the license categories available in s.
2993408.808, a conditional license may be issued to an applicant for
2994license renewal if the applicant fails to meet all standards and
2995requirements for licensure. A conditional license issued under
2996this subsection shall be limited in duration to a specific
2997period of time not to exceed 6 months, as determined by the
2998agency, and shall be accompanied by an agency-approved plan of
3000     (5)  When an extended congregate care or limited nursing
3001license is requested during a facility's biennial license
3002period, the fee shall be prorated in order to permit the
3003additional license to expire at the end of the biennial license
3004period. The fee shall be calculated as of the date the
3005additional license application is received by the agency.
3006     Section 74.  Subsection (7) of section 429.19, Florida
3007Statutes, is amended to read:
3008     429.19  Violations; imposition of administrative fines;
3010     (7)  In addition to any administrative fines imposed, the
3011agency may assess a survey or monitoring fee, equal to the
3012lesser of one half of the facility's biennial license and bed
3013fee or $500, to cover the cost of conducting initial complaint
3014investigations that result in the finding of a violation that
3015was the subject of the complaint or to monitor the health,
3016safety, or security of residents under s. 429.07     (7) monitoring
3017visits conducted under s. 429.28(3)(c) to verify the correction
3018of the violations.
3019     Section 75.  Subsections (6) through (10) of section
3020429.23, Florida Statutes, are renumbered as subsections (5)
3021through (9), respectively, and present subsection (5) of that
3022section is amended to read:
3023     429.23  Internal risk management and quality assurance
3024program; adverse incidents and reporting requirements.-
3025     (5)  Each facility shall report monthly to the agency any
3026liability claim filed against it. The report must include the
3027name of the resident, the dates of the incident leading to the
3028claim, if applicable, and the type of injury or violation of
3029rights alleged to have occurred. This report is not discoverable
3030in any civil or administrative action, except in such actions
3031brought by the agency to enforce the provisions of this part.
3032     Section 76.  Paragraph (a) of subsection (1) and subsection
3033(2) of section 429.255, Florida Statutes, are amended to read:
3034     429.255  Use of personnel; emergency care.-
3035     (1)(a)  Persons under contract to the facility or, facility
3036staff, or volunteers, who are licensed according to part I of
3037chapter 464, or those persons exempt under s. 464.022(1), and
3038others as defined by rule, may administer medications to
3039residents, take residents' vital signs, manage individual weekly
3040pill organizers for residents who self-administer medication,
3041give prepackaged enemas ordered by a physician, observe
3042residents, document observations on the appropriate resident's
3043record, report observations to the resident's physician, and
3044contract or allow residents or a resident's representative,
3045designee, surrogate, guardian, or attorney in fact to contract
3046with a third party, provided residents meet the criteria for
3047appropriate placement as defined in s. 429.26. Persons under
3048contract to the facility or facility staff who are licensed
3049according to part I of chapter 464 may provide limited nursing
3050services. Nursing assistants certified pursuant to part II of
3051chapter 464 may take residents' vital signs as directed by a
3052licensed nurse or physician. The facility is responsible for
3053maintaining documentation of services provided under this
3054paragraph as required by rule and ensuring that staff are
3055adequately trained to monitor residents receiving these
3057     (2)  In facilities licensed to provide extended congregate
3058care, persons under contract to the facility or, facility staff,
3059or volunteers, who are licensed according to part I of chapter
3060464, or those persons exempt under s. 464.022(1), or those
3061persons certified as nursing assistants pursuant to part II of
3062chapter 464, may also perform all duties within the scope of
3063their license or certification, as approved by the facility
3064administrator and pursuant to this part.
3065     Section 77.  Subsection (3) of section 429.28, Florida
3066Statutes, is amended to read:
3067     429.28  Resident bill of rights.-
3068     (3)(a)  The agency shall conduct a survey to determine
3069general compliance with facility standards and compliance with
3070residents' rights as a prerequisite to initial licensure or
3071licensure renewal.
3072     (b)  In order to determine whether the facility is
3073adequately protecting residents' rights, the biennial survey
3074shall include private informal conversations with a sample of
3075residents and consultation with the ombudsman council in the
3076planning and service area in which the facility is located to
3077discuss residents' experiences within the facility.
3078     (c)  During any calendar year in which no survey is
3079conducted, the agency shall conduct at least one monitoring
3080visit of each facility cited in the previous year for a class I
3081or class II violation, or more than three uncorrected class III
3083     (d)  The agency may conduct periodic followup inspections
3084as necessary to monitor the compliance of facilities with a
3085history of any class I, class II, or class III violations that
3086threaten the health, safety, or security of residents.
3087     (e)  The agency may conduct complaint investigations as
3088warranted to investigate any allegations of noncompliance with
3089requirements required under this part or rules adopted under
3090this part.
3091     Section 78.  Subsection (2) of section 429.35, Florida
3092Statutes, is amended to read:
3093     429.35  Maintenance of records; reports.-
3094     (2)  Within 60 days after the date of the biennial
3095inspection visit required under s. 408.811 or within 30 days
3096after the date of any interim visit, the agency shall forward
3097the results of the inspection to the local ombudsman council in
3098whose planning and service area, as defined in part II of
3099chapter 400, the facility is located; to at least one public
3100library or, in the absence of a public library, the county seat
3101in the county in which the inspected assisted living facility is
3102located; and, when appropriate, to the district Adult Services
3103and Mental Health Program Offices. This information may be
3104provided electronically or through the agency's Internet
3106     Section 79.  Paragraphs (i) and (j) of subsection (1) of
3107section 429.41, Florida Statutes, are amended to read:
3108     429.41  Rules establishing standards.-
3109     (1)  It is the intent of the Legislature that rules
3110published and enforced pursuant to this section shall include
3111criteria by which a reasonable and consistent quality of
3112resident care and quality of life may be ensured and the results
3113of such resident care may be demonstrated. Such rules shall also
3114ensure a safe and sanitary environment that is residential and
3115noninstitutional in design or nature. It is further intended
3116that reasonable efforts be made to accommodate the needs and
3117preferences of residents to enhance the quality of life in a
3118facility. The agency, in consultation with the department, may
3119adopt rules to administer the requirements of part II of chapter
3120408. In order to provide safe and sanitary facilities and the
3121highest quality of resident care accommodating the needs and
3122preferences of residents, the department, in consultation with
3123the agency, the Department of Children and Family Services, and
3124the Department of Health, shall adopt rules, policies, and
3125procedures to administer this part, which must include
3126reasonable and fair minimum standards in relation to:
3127     (i)  Facilities holding an a limited nursing, extended
3128congregate care, or limited mental health license.
3129     (j)  The establishment of specific criteria to define
3130appropriateness of resident admission and continued residency in
3131a facility holding a standard, limited nursing, extended
3132congregate care, and limited mental health license.
3133     Section 80.  Subsections (1) and (2) of section 429.53,
3134Florida Statutes, are amended to read:
3135     429.53  Consultation by the agency.-
3136     (1)  The area offices of licensure and certification of the
3137agency shall provide consultation to the following upon request:
3138     (a)  A licensee of a facility.
3139     (b)  A person interested in obtaining a license to operate
3140a facility under this part.
3141     (2)  As used in this section, "consultation" includes:
3142     (a)  An explanation of the requirements of this part and
3143rules adopted pursuant thereto;
3144     (b)  An explanation of the license application and renewal
3146     (c)  The provision of a checklist of general local and
3147state approvals required prior to constructing or developing a
3148facility and a listing of the types of agencies responsible for
3149such approvals;
3150     (d)  An explanation of benefits and financial assistance
3151available to a recipient of supplemental security income
3152residing in a facility;
3153     (c)(e)  Any other information which the agency deems
3154necessary to promote compliance with the requirements of this
3155part; and
3156     (f)  A preconstruction review of a facility to ensure
3157compliance with agency rules and this part.
3158     Section 81.  Subsections (1) and (2) of section 429.54,
3159Florida Statutes, are renumbered as subsections (2) and (3),
3160respectively, and a new subsection (1) is added to that section
3161to read:
3162     429.54  Collection of information; local subsidy.-
3163     (1)  A facility that is licensed under this part must
3164report electronically to the agency semiannually data related to
3165the facility, including, but not limited to, the total number of
3166residents, the number of residents who are receiving limited
3167mental health services, the number of residents who are
3168receiving extended congregate care services, the number of
3169residents who are receiving limited nursing services, and
3170professional staffing employed by or under contract with the
3171licensee to provide resident services. The department, in
3172consultation with the agency, shall adopt rules to administer
3173this subsection.
3174     Section 82.  Subsections (1) and (5) of section 429.71,
3175Florida Statutes, are amended to read:
3176     429.71  Classification of violations deficiencies;
3177administrative fines.-
3178     (1)  In addition to the requirements of part II of chapter
3179408 and in addition to any other liability or penalty provided
3180by law, the agency may impose an administrative fine on a
3181provider according to the following classification:
3182     (a)  Class I violations are defined in s. 408.813 those
3183conditions or practices related to the operation and maintenance
3184of an adult family-care home or to the care of residents which
3185the agency determines present an imminent danger to the
3186residents or guests of the facility or a substantial probability
3187that death or serious physical or emotional harm would result
3188therefrom. The condition or practice that constitutes a class I
3189violation must be abated or eliminated within 24 hours, unless a
3190fixed period, as determined by the agency, is required for
3191correction. A class I violation deficiency is subject to an
3192administrative fine in an amount not less than $500 and not
3193exceeding $1,000 for each violation. A fine may be levied
3194notwithstanding the correction of the deficiency.
3195     (b)  Class II violations are defined in s. 408.813 those
3196conditions or practices related to the operation and maintenance
3197of an adult family-care home or to the care of residents which
3198the agency determines directly threaten the physical or
3199emotional health, safety, or security of the residents, other
3200than class I violations. A class II violation is subject to an
3201administrative fine in an amount not less than $250 and not
3202exceeding $500 for each violation. A citation for a class II
3203violation must specify the time within which the violation is
3204required to be corrected. If a class II violation is corrected
3205within the time specified, no civil penalty shall be imposed,
3206unless it is a repeated offense.
3207     (c)  Class III violations are defined in s. 408.813 those
3208conditions or practices related to the operation and maintenance
3209of an adult family-care home or to the care of residents which
3210the agency determines indirectly or potentially threaten the
3211physical or emotional health, safety, or security of residents,
3212other than class I or class II violations. A class III violation
3213is subject to an administrative fine in an amount not less than
3214$100 and not exceeding $250 for each violation. A citation for a
3215class III violation shall specify the time within which the
3216violation is required to be corrected. If a class III violation
3217is corrected within the time specified, no civil penalty shall
3218be imposed, unless it is a repeated violation offense.
3219     (d)  Class IV violations are defined in s. 408.813 those
3220conditions or occurrences related to the operation and
3221maintenance of an adult family-care home, or related to the
3222required reports, forms, or documents, which do not have the
3223potential of negatively affecting the residents. A provider that
3224does not correct A class IV violation within the time limit
3225specified by the agency is subject to an administrative fine in
3226an amount not less than $50 and not exceeding $100 for each
3227violation. Any class IV violation that is corrected during the
3228time the agency survey is conducted will be identified as an
3229agency finding and not as a violation, unless it is a repeat
3231     (5)  As an alternative to or in conjunction with an
3232administrative action against a provider, the agency may request
3233a plan of corrective action that demonstrates a good faith
3234effort to remedy each violation by a specific date, subject to
3235the approval of the agency.
3236     Section 83.  Paragraphs (b) through (e) of subsection (2)
3237of section 429.911, Florida Statutes, are redesignated as
3238paragraphs (a) through (d), respectively, and present paragraph
3239(a) of that subsection is amended to read:
3240     429.911  Denial, suspension, revocation of license;
3241emergency action; administrative fines; investigations and
3243     (2)  Each of the following actions by the owner of an adult
3244day care center or by its operator or employee is a ground for
3245action by the agency against the owner of the center or its
3246operator or employee:
3247     (a)  An intentional or negligent act materially affecting
3248the health or safety of center participants.
3249     Section 84.  Section 429.915, Florida Statutes, is amended
3250to read:
3251     429.915  Conditional license.-In addition to the license
3252categories available in part II of chapter 408, the agency may
3253issue a conditional license to an applicant for license renewal
3254or change of ownership if the applicant fails to meet all
3255standards and requirements for licensure. A conditional license
3256issued under this subsection must be limited to a specific
3257period not exceeding 6 months, as determined by the agency, and
3258must be accompanied by an approved plan of correction.
3259     Section 85.  Paragraphs (b) and (h) of subsection (3) of
3260section 430.80, Florida Statutes, are amended to read:
3261     430.80  Implementation of a teaching nursing home pilot
3263     (3)  To be designated as a teaching nursing home, a nursing
3264home licensee must, at a minimum:
3265     (b)  Participate in a nationally recognized accreditation
3266program and hold a valid accreditation, such as the
3267accreditation awarded by The Joint Commission on Accreditation
3268of Healthcare Organizations;
3269     (h)  Maintain insurance coverage pursuant to s.
3270400.141(1)(q)(s) or proof of financial responsibility in a
3271minimum amount of $750,000. Such proof of financial
3272responsibility may include:
3273     1.  Maintaining an escrow account consisting of cash or
3274assets eligible for deposit in accordance with s. 625.52; or
3275     2.  Obtaining and maintaining pursuant to chapter 675 an
3276unexpired, irrevocable, nontransferable and nonassignable letter
3277of credit issued by any bank or savings association organized
3278and existing under the laws of this state or any bank or savings
3279association organized under the laws of the United States that
3280has its principal place of business in this state or has a
3281branch office which is authorized to receive deposits in this
3282state. The letter of credit shall be used to satisfy the
3283obligation of the facility to the claimant upon presentment of a
3284final judgment indicating liability and awarding damages to be
3285paid by the facility or upon presentment of a settlement
3286agreement signed by all parties to the agreement when such final
3287judgment or settlement is a result of a liability claim against
3288the facility.
3289     Section 86.  Paragraph (a) of subsection (2) of section
3290440.13, Florida Statutes, is amended to read:
3291     440.13  Medical services and supplies; penalty for
3292violations; limitations.-
3294     (a)  Subject to the limitations specified elsewhere in this
3295chapter, the employer shall furnish to the employee such
3296medically necessary remedial treatment, care, and attendance for
3297such period as the nature of the injury or the process of
3298recovery may require, which is in accordance with established
3299practice parameters and protocols of treatment as provided for
3300in this chapter, including medicines, medical supplies, durable
3301medical equipment, orthoses, prostheses, and other medically
3302necessary apparatus. Remedial treatment, care, and attendance,
3303including work-hardening programs or pain-management programs
3304accredited by the Commission on Accreditation of Rehabilitation
3305Facilities or The Joint Commission on the Accreditation of
3306Health Organizations or pain-management programs affiliated with
3307medical schools, shall be considered as covered treatment only
3308when such care is given based on a referral by a physician as
3309defined in this chapter. Medically necessary treatment, care,
3310and attendance does not include chiropractic services in excess
3311of 24 treatments or rendered 12 weeks beyond the date of the
3312initial chiropractic treatment, whichever comes first, unless
3313the carrier authorizes additional treatment or the employee is
3314catastrophically injured.
3316Failure of the carrier to timely comply with this subsection
3317shall be a violation of this chapter and the carrier shall be
3318subject to penalties as provided for in s. 440.525.
3319     Section 87.  Section 483.294, Florida Statutes, is amended
3320to read:
3321     483.294  Inspection of centers.-In accordance with s.
3322408.811, the agency shall biennially, at least once annually,
3323inspect the premises and operations of all centers subject to
3324licensure under this part.
3325     Section 88. Subsections (32) through (54) of section
3326499.003, Florida Statutes, are renumbered as subsections (33)
3327through (55) respectively, present subsection (42) is amended,
3328and a new subsection (32) is added to that subsection, to read:
3329     499.003  Definitions of terms used in this part.-As used in
3330this part, the term:
3331     (32)  "Medical convenience kit" means packages or units
3332that contain combination products as defined in 21 C.F.R. s.
3334     (43)(42)  "Prescription drug" means a prescription,
3335medicinal, or legend drug, including, but not limited to,
3336finished dosage forms or active ingredients subject to, defined
3337by, or described by s. 503(b) of the Federal Food, Drug, and
3338Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3339(11), subsection (46) (45), or subsection (53) (52).
3340     Section 89.  Paragraph (i) is added to subsection (3) of
3341section 499.01212, Florida Statutes, to read:
3342     499.01212  Pedigree paper.-
3343     (3)  EXCEPTIONS.-A pedigree paper is not required for:
3344     (i)  The wholesale distribution of prescription drugs
3345contained within a medical convenience kit if:
3346     1.  The medical convenience kit is assembled in an
3347establishment that is registered as a medical device
3348manufacturer with the United States Food and Drug
3350     2.  The medical convenience kit manufacturer purchased the
3351prescription drug directly from the manufacturer or from a
3352wholesaler that purchased the prescription drug directly from
3353the manufacturer;
3354     3.  The medical convenience kit manufacturer complies with
3355federal law for the distribution of the prescription drugs
3356within the kit; and
3357     4.  The drugs contained in the medical convenience kit are:
3358     a.  Intravenous solutions intended for the replenishment of
3359fluids and electrolytes;
3360     b.  Products intended to maintain the equilibrium of water
3361and minerals in the body;
3362     c.  Products intended for irrigation or reconstitution;
3363     d.  Anesthetics; or
3364     e.  Anticoagulants.
3366This exemption does not apply to a convenience kit containing
3367any controlled substance that appears in a schedule contained in
3368or subject to chapter 893 or the federal Comprehensive Drug
3369Abuse Prevention and Control Act of 1970.
3370     Section 90.  Subsection (3) is added to section 626.9541,
3371Florida Statutes, to read:
3372     626.9541  Unfair methods of competition and unfair or
3373deceptive acts or practices defined; alternative rates of
3374payment; wellness programs.-
3375     (3)  WELLNESS PROGRAMS.-An insurer issuing a group or
3376individual health benefit plan may offer a voluntary wellness or
3377health-improvement program that allows for rewards or
3378incentives, including, but not limited to, merchandise, gift
3379cards, debit cards, premium discounts or rebates, contributions
3380towards a member's health savings account, modifications to
3381copayment, deductible, or coinsurance amounts, or any
3382combination of these incentives, to encourage or reward
3383participation in the program. The health plan member may be
3384required to provide verification, such as a statement from his
3385or her physician, that a medical condition makes it unreasonably
3386difficult or medically inadvisable for the individual to
3387participate in the wellness program. Any reward or incentive
3388established under this subsection is not an insurance benefit
3389and does not violate this section. This subsection does not
3390prohibit an insurer from offering incentives or rewards to
3391members for adherence to wellness or health improvement programs
3392if otherwise allowed by state or federal law. Notwithstanding
3393any provision of this subsection, no insurer, nor its agent, may
3394use any incentive authorized by this subsection for the purpose
3395of redirecting patients from one health care insurance plan to
3397     Section 91.  Subsection (1) of section 627.645, Florida
3398Statutes, is amended to read:
3399     627.645  Denial of health insurance claims restricted.-
3400     (1)  No claim for payment under a health insurance policy
3401or self-insured program of health benefits for treatment, care,
3402or services in a licensed hospital which is accredited by The
3403Joint Commission on the Accreditation of Hospitals, the American
3404Osteopathic Association, or the Commission on the Accreditation
3405of Rehabilitative Facilities shall be denied because such
3406hospital lacks major surgical facilities and is primarily of a
3407rehabilitative nature, if such rehabilitation is specifically
3408for treatment of physical disability.
3409     Section 92.  Paragraph (c) of subsection (2) of section
3410627.668, Florida Statutes, is amended to read:
3411     627.668  Optional coverage for mental and nervous disorders
3412required; exception.-
3413     (2)  Under group policies or contracts, inpatient hospital
3414benefits, partial hospitalization benefits, and outpatient
3415benefits consisting of durational limits, dollar amounts,
3416deductibles, and coinsurance factors shall not be less favorable
3417than for physical illness generally, except that:
3418     (c)  Partial hospitalization benefits shall be provided
3419under the direction of a licensed physician. For purposes of
3420this part, the term "partial hospitalization services" is
3421defined as those services offered by a program accredited by The
3422Joint Commission on Accreditation of Hospitals (JCAH) or in
3423compliance with equivalent standards. Alcohol rehabilitation
3424programs accredited by The Joint Commission on Accreditation of
3425Hospitals or approved by the state and licensed drug abuse
3426rehabilitation programs shall also be qualified providers under
3427this section. In any benefit year, if partial hospitalization
3428services or a combination of inpatient and partial
3429hospitalization are utilized, the total benefits paid for all
3430such services shall not exceed the cost of 30 days of inpatient
3431hospitalization for psychiatric services, including physician
3432fees, which prevail in the community in which the partial
3433hospitalization services are rendered. If partial
3434hospitalization services benefits are provided beyond the limits
3435set forth in this paragraph, the durational limits, dollar
3436amounts, and coinsurance factors thereof need not be the same as
3437those applicable to physical illness generally.
3438     Section 93.  Subsection (3) of section 627.669, Florida
3439Statutes, is amended to read:
3440     627.669  Optional coverage required for substance abuse
3441impaired persons; exception.-
3442     (3)  The benefits provided under this section shall be
3443applicable only if treatment is provided by, or under the
3444supervision of, or is prescribed by, a licensed physician or
3445licensed psychologist and if services are provided in a program
3446accredited by The Joint Commission on Accreditation of Hospitals
3447or approved by the state.
3448     Section 94.  Paragraph (a) of subsection (1) of section
3449627.736, Florida Statutes, is amended to read:
3450     627.736  Required personal injury protection benefits;
3451exclusions; priority; claims.-
3452     (1)  REQUIRED BENEFITS.-Every insurance policy complying
3453with the security requirements of s. 627.733 shall provide
3454personal injury protection to the named insured, relatives
3455residing in the same household, persons operating the insured
3456motor vehicle, passengers in such motor vehicle, and other
3457persons struck by such motor vehicle and suffering bodily injury
3458while not an occupant of a self-propelled vehicle, subject to
3459the provisions of subsection (2) and paragraph (4)(e), to a
3460limit of $10,000 for loss sustained by any such person as a
3461result of bodily injury, sickness, disease, or death arising out
3462of the ownership, maintenance, or use of a motor vehicle as
3464     (a)  Medical benefits.-Eighty percent of all reasonable
3465expenses for medically necessary medical, surgical, X-ray,
3466dental, and rehabilitative services, including prosthetic
3467devices, and medically necessary ambulance, hospital, and
3468nursing services. However, the medical benefits shall provide
3469reimbursement only for such services and care that are lawfully
3470provided, supervised, ordered, or prescribed by a physician
3471licensed under chapter 458 or chapter 459, a dentist licensed
3472under chapter 466, or a chiropractic physician licensed under
3473chapter 460 or that are provided by any of the following persons
3474or entities:
3475     1.  A hospital or ambulatory surgical center licensed under
3476chapter 395.
3477     2.  A person or entity licensed under ss. 401.2101-401.45
3478that provides emergency transportation and treatment.
3479     3.  An entity wholly owned by one or more physicians
3480licensed under chapter 458 or chapter 459, chiropractic
3481physicians licensed under chapter 460, or dentists licensed
3482under chapter 466 or by such practitioner or practitioners and
3483the spouse, parent, child, or sibling of that practitioner or
3484those practitioners.
3485     4.  An entity wholly owned, directly or indirectly, by a
3486hospital or hospitals.
3487     5.  A health care clinic licensed under ss. 400.990-400.995
3488that is:
3489     a.  Accredited by The Joint Commission on Accreditation of
3490Healthcare Organizations, the American Osteopathic Association,
3491the Commission on Accreditation of Rehabilitation Facilities, or
3492the Accreditation Association for Ambulatory Health Care, Inc.;
3494     b.  A health care clinic that:
3495     (I)  Has a medical director licensed under chapter 458,
3496chapter 459, or chapter 460;
3497     (II)  Has been continuously licensed for more than 3 years
3498or is a publicly traded corporation that issues securities
3499traded on an exchange registered with the United States
3500Securities and Exchange Commission as a national securities
3501exchange; and
3502     (III)  Provides at least four of the following medical
3504     (A)  General medicine.
3505     (B)  Radiography.
3506     (C)  Orthopedic medicine.
3507     (D)  Physical medicine.
3508     (E)  Physical therapy.
3509     (F)  Physical rehabilitation.
3510     (G)  Prescribing or dispensing outpatient prescription
3512     (H)  Laboratory services.
3514The Financial Services Commission shall adopt by rule the form
3515that must be used by an insurer and a health care provider
3516specified in subparagraph 3., subparagraph 4., or subparagraph
35175. to document that the health care provider meets the criteria
3518of this paragraph, which rule must include a requirement for a
3519sworn statement or affidavit.
3521Only insurers writing motor vehicle liability insurance in this
3522state may provide the required benefits of this section, and no
3523such insurer shall require the purchase of any other motor
3524vehicle coverage other than the purchase of property damage
3525liability coverage as required by s. 627.7275 as a condition for
3526providing such required benefits. Insurers may not require that
3527property damage liability insurance in an amount greater than
3528$10,000 be purchased in conjunction with personal injury
3529protection. Such insurers shall make benefits and required
3530property damage liability insurance coverage available through
3531normal marketing channels. Any insurer writing motor vehicle
3532liability insurance in this state who fails to comply with such
3533availability requirement as a general business practice shall be
3534deemed to have violated part IX of chapter 626, and such
3535violation shall constitute an unfair method of competition or an
3536unfair or deceptive act or practice involving the business of
3537insurance; and any such insurer committing such violation shall
3538be subject to the penalties afforded in such part, as well as
3539those which may be afforded elsewhere in the insurance code.
3540     Section 95.  Section 633.081, Florida Statutes, is amended
3541to read:
3542     633.081  Inspection of buildings and equipment; orders;
3543firesafety inspection training requirements; certification;
3544disciplinary action.-The State Fire Marshal and her or his
3545agents shall, at any reasonable hour, when the department has
3546reasonable cause to believe that a violation of this chapter or
3547s. 509.215, or a rule promulgated thereunder, or a minimum
3548firesafety code adopted by a local authority, may exist, inspect
3549any and all buildings and structures which are subject to the
3550requirements of this chapter or s. 509.215 and rules promulgated
3551thereunder. The authority to inspect shall extend to all
3552equipment, vehicles, and chemicals which are located within the
3553premises of any such building or structure. The State Fire
3554Marshal and her or his agents shall inspect nursing homes
3555licensed under part II of chapter 400 only once every calendar
3556year and upon receiving a complaint forming the basis of a
3557reasonable cause to believe that a violation of this chapter or
3558s. 509.215, or a rule promulgated thereunder, or a minimum
3559firesafety code adopted by a local authority may exist and upon
3560identifying such a violation in the course of conducting
3561orientation or training activities within a nursing home.
3562     (1)  Each county, municipality, and special district that
3563has firesafety enforcement responsibilities shall employ or
3564contract with a firesafety inspector. The firesafety inspector
3565must conduct all firesafety inspections that are required by
3566law. The governing body of a county, municipality, or special
3567district that has firesafety enforcement responsibilities may
3568provide a schedule of fees to pay only the costs of inspections
3569conducted pursuant to this subsection and related administrative
3570expenses. Two or more counties, municipalities, or special
3571districts that have firesafety enforcement responsibilities may
3572jointly employ or contract with a firesafety inspector.
3573     (2)  Every firesafety inspection conducted pursuant to
3574state or local firesafety requirements shall be by a person
3575certified as having met the inspection training requirements set
3576by the State Fire Marshal. Such person shall:
3577     (a)  Be a high school graduate or the equivalent as
3578determined by the department;
3579     (b)  Not have been found guilty of, or having pleaded
3580guilty or nolo contendere to, a felony or a crime punishable by
3581imprisonment of 1 year or more under the law of the United
3582States, or of any state thereof, which involves moral turpitude,
3583without regard to whether a judgment of conviction has been
3584entered by the court having jurisdiction of such cases;
3585     (c)  Have her or his fingerprints on file with the
3586department or with an agency designated by the department;
3587     (d)  Have good moral character as determined by the
3589     (e)  Be at least 18 years of age;
3590     (f)  Have satisfactorily completed the firesafety inspector
3591certification examination as prescribed by the department; and
3592     (g)1.  Have satisfactorily completed, as determined by the
3593department, a firesafety inspector training program of not less
3594than 200 hours established by the department and administered by
3595agencies and institutions approved by the department for the
3596purpose of providing basic certification training for firesafety
3597inspectors; or
3598     2.  Have received in another state training which is
3599determined by the department to be at least equivalent to that
3600required by the department for approved firesafety inspector
3601education and training programs in this state.
3602     (3)  Each special state firesafety inspection which is
3603required by law and is conducted by or on behalf of an agency of
3604the state must be performed by an individual who has met the
3605provision of subsection (2), except that the duration of the
3606training program shall not exceed 120 hours of specific training
3607for the type of property that such special state firesafety
3608inspectors are assigned to inspect.
3609     (4)  A firefighter certified pursuant to s. 633.35 may
3610conduct firesafety inspections, under the supervision of a
3611certified firesafety inspector, while on duty as a member of a
3612fire department company conducting inservice firesafety
3613inspections without being certified as a firesafety inspector,
3614if such firefighter has satisfactorily completed an inservice
3615fire department company inspector training program of at least
361624 hours' duration as provided by rule of the department.
3617     (5)  Every firesafety inspector or special state firesafety
3618inspector certificate is valid for a period of 3 years from the
3619date of issuance. Renewal of certification shall be subject to
3620the affected person's completing proper application for renewal
3621and meeting all of the requirements for renewal as established
3622under this chapter or by rule promulgated thereunder, which
3623shall include completion of at least 40 hours during the
3624preceding 3-year period of continuing education as required by
3625the rule of the department or, in lieu thereof, successful
3626passage of an examination as established by the department.
3627     (6)  The State Fire Marshal may deny, refuse to renew,
3628suspend, or revoke the certificate of a firesafety inspector or
3629special state firesafety inspector if it finds that any of the
3630following grounds exist:
3631     (a)  Any cause for which issuance of a certificate could
3632have been refused had it then existed and been known to the
3633State Fire Marshal.
3634     (b)  Violation of this chapter or any rule or order of the
3635State Fire Marshal.
3636     (c)  Falsification of records relating to the certificate.
3637     (d)  Having been found guilty of or having pleaded guilty
3638or nolo contendere to a felony, whether or not a judgment of
3639conviction has been entered.
3640     (e)  Failure to meet any of the renewal requirements.
3641     (f)  Having been convicted of a crime in any jurisdiction
3642which directly relates to the practice of fire code inspection,
3643plan review, or administration.
3644     (g)  Making or filing a report or record that the
3645certificateholder knows to be false, or knowingly inducing
3646another to file a false report or record, or knowingly failing
3647to file a report or record required by state or local law, or
3648knowingly impeding or obstructing such filing, or knowingly
3649inducing another person to impede or obstruct such filing.
3650     (h)  Failing to properly enforce applicable fire codes or
3651permit requirements within this state which the
3652certificateholder knows are applicable by committing willful
3653misconduct, gross negligence, gross misconduct, repeated
3654negligence, or negligence resulting in a significant danger to
3655life or property.
3656     (i)  Accepting labor, services, or materials at no charge
3657or at a noncompetitive rate from any person who performs work
3658that is under the enforcement authority of the certificateholder
3659and who is not an immediate family member of the
3660certificateholder. For the purpose of this paragraph, the term
3661"immediate family member" means a spouse, child, parent,
3662sibling, grandparent, aunt, uncle, or first cousin of the person
3663or the person's spouse or any person who resides in the primary
3664residence of the certificateholder.
3665     (7)  The department shall provide by rule for the
3666certification of firesafety inspectors.
3667     Section 96.  Subsection (12) of section 641.495, Florida
3668Statutes, is amended to read:
3669     641.495  Requirements for issuance and maintenance of
3671     (12)  The provisions of part I of chapter 395 do not apply
3672to a health maintenance organization that, on or before January
36731, 1991, provides not more than 10 outpatient holding beds for
3674short-term and hospice-type patients in an ambulatory care
3675facility for its members, provided that such health maintenance
3676organization maintains current accreditation by The Joint
3677Commission on Accreditation of Health Care Organizations, the
3678Accreditation Association for Ambulatory Health Care, or the
3679National Committee for Quality Assurance.
3680     Section 97.  Subsection (13) of section 651.118, Florida
3681Statutes, is amended to read:
3682     651.118  Agency for Health Care Administration;
3683certificates of need; sheltered beds; community beds.-
3684     (13)  Residents, as defined in this chapter, are not
3685considered new admissions for the purpose of s.
3687     Section 98.  Subsection (2) of section 766.1015, Florida
3688Statutes, is amended to read:
3689     766.1015  Civil immunity for members of or consultants to
3690certain boards, committees, or other entities.-
3691     (2)  Such committee, board, group, commission, or other
3692entity must be established in accordance with state law or in
3693accordance with requirements of The Joint Commission on
3694Accreditation of Healthcare Organizations, established and duly
3695constituted by one or more public or licensed private hospitals
3696or behavioral health agencies, or established by a governmental
3697agency. To be protected by this section, the act, decision,
3698omission, or utterance may not be made or done in bad faith or
3699with malicious intent.
3700     Section 99.  Subsection (4) of section 766.202, Florida
3701Statutes, is amended to read:
3702     766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3703766.201-766.212, the term:
3704     (4)  "Health care provider" means any hospital, ambulatory
3705surgical center, or mobile surgical facility as defined and
3706licensed under chapter 395; a birth center licensed under
3707chapter 383; any person licensed under chapter 458, chapter 459,
3708chapter 460, chapter 461, chapter 462, chapter 463, part I of
3709chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3710or chapter 486; a clinical lab licensed under chapter 483; a
3711health maintenance organization certificated under part I of
3712chapter 641; a blood bank; a plasma center; an industrial
3713clinic; a renal dialysis facility; or a professional association
3714partnership, corporation, joint venture, or other association
3715for professional activity by health care providers.
3716     Section 100.  (1)  It is hereby declared the public policy
3717of this state that a federal, state, or local government may not
3718compel a person to purchase health insurance or health services,
3719except as a condition of:
3720     (a)  Public employment;
3721     (b)  Voluntary participation in a state or local benefit;
3722     (c)  Operating a dangerous instrumentality;
3723     (d)  Undertaking an occupation having a risk of
3724occupational injury or illness; or
3725     (e)  An order of child support.
3727A federal, state, or local government may also compel a person
3728to purchase health services in the case of an actual emergency
3729declared by the Governor when the public health is immediately
3731     (2)  This section does not prohibit collection of debts
3732lawfully incurred for health insurance or health services.
3733     (3)  The Attorney General may implement or otherwise
3734advocate the public policy described in this section in any
3735state or federal court or administrative forum on behalf of one
3736or more persons within the state whose constitutional rights may
3737be subject to infringement by an Act of Congress with respect to
3738health insurance coverage, or subject to the implementation of a
3739federal legislative program relating to or impacting the rights
3740or interests of persons with respect to health insurance
3742     Section 101.  Section 627.64995, Florida Statutes, is
3743created to read:
3744     627.64995  Restrictions on use of funds for state
3746     (1)  A health insurance policy or group health insurance
3747policy purchased in whole or in part with state or federal funds
3748through an exchange created pursuant to the federal Patient
3749Protection and Affordable Care Act may not provide coverage for
3750an abortion as defined in s. 390.011(1). A policy is deemed to
3751be purchased with state or federal funds if it is a policy
3752toward which any tax credit or cost-sharing credit is applied.
3753     (2)  This section does not prohibit coverage for an
3754abortion that is performed to save the life or physical health
3755of the mother or if the pregnancy resulted from an act of rape
3756or incest.
3757     (3)  This section may not be construed to prevent a health
3758insurance plan or group health insurance plan from providing any
3759private person or entity with separate coverage for abortions,
3760provided such coverage is not purchased, in whole or in part,
3761with state or federal funds.
3762     (4)  For purposes of this section, the term "state" means
3763the State of Florida or any of its political subdivisions.
3764     Section 102.  Section 641.31099, Florida Statutes, is
3765created to read:
3766     641.31099  Restrictions on the use of funds for state
3768     (1)  A health maintenance contract under which coverage is
3769purchased in whole or in part with state or federal funds
3770through an exchange created pursuant to the federal Patient
3771Protection and Affordable Care Act may not provide coverage for
3772an abortion as defined in s. 390.011(1). Coverage under a health
3773maintenance contract is deemed to be purchased with state or
3774federal funds if the coverage is provided under a contract
3775toward which any tax credit or cost-sharing credit is applied.
3776     (2)  This section does not prohibit coverage for an
3777abortion that is performed to save the life or physical health
3778of the mother or if the pregnancy resulted from an act of rape
3779or incest.
3780     (3)  This section may not be construed to prevent a health
3781maintenance contract from providing any private person or entity
3782with separate coverage for abortions, provided such coverage is
3783not purchased, in whole or in part, with state or federal funds.
3784     (4)  For purposes of this section, the term "state" means
3785the State of Florida or any of its political subdivisions.
3786     Section 103.  This act shall take effect July 1, 2010.

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