January 27, 2021
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_h1941__
HB 1941

1
A bill to be entitled
2An act relating to the licensure of health care providers;
3creating pts. I, II, III, and IV of ch. 408, F.S.;
4creating s. 408.801, F.S.; providing a popular name;
5providing legislative findings and purpose; creating s.
6408.802, F.S.; providing applicability; creating s.
7408.803, F.S.; providing definitions; creating s. 408.804,
8F.S.; requiring providers to have and display a license;
9providing limitations; creating s. 408.805, F.S.;
10establishing license fees; providing a method for
11calculating annual adjustment of fees; creating s.
12408.806, F.S.; providing a license application process;
13requiring specified information to be included on the
14application; requiring payment of late fees under certain
15circumstances; requiring inspections; providing an
16exception; authorizing the Agency for Health Care
17Administration to establish procedures and rules for
18electronic transmission of required information; creating
19s. 408.807, F.S.; providing procedures for change of
20ownership; requiring the transferor to notify the agency
21in writing within a specified time period; providing for
22duties and liability of the transferor; providing for
23maintenance of records; creating s. 408.808, F.S.;
24providing license categories and requirements therefor;
25creating s. 408.809, F.S.; requiring background screening
26of specified employees; providing for submission of proof
27of compliance, under certain circumstances; providing
28conditions for granting provisional and standard licenses;
29providing an exception to screening requirements; creating
30s. 408.810, F.S.; providing minimum licensure
31requirements; providing procedures for discontinuance of
32operation and surrender of license; requiring forwarding
33of client records; requiring publication of a notice of
34discontinuance of operation of a provider; providing
35penalties; providing for statewide toll-free telephone
36numbers for reporting complaints and abusive, neglectful,
37and exploitative practices; requiring proof of legal right
38to occupy property, proof of insurance, and proof of
39financial viability, under certain circumstances;
40requiring disclosure of information relating to financial
41instability; providing a penalty; prohibiting the agency
42from licensing a health care provider that does not have a
43certificate of need or an exemption; creating s. 408.811,
44F.S.; providing for inspections and investigations to
45determine compliance; providing that inspection reports
46are public records; requiring retention of records for a
47specified period of time; creating s. 408.812, F.S.;
48prohibiting certain unlicensed activity by a provider;
49requiring unlicensed providers to cease activity;
50providing penalties; requiring reporting of unlicensed
51providers; creating s. 408.813, F.S.; authorizing the
52agency to impose administrative fines; creating s.
53408.814, F.S.; providing conditions for the agency to
54impose a moratorium or emergency suspension on a provider;
55requiring notice; creating s. 408.815, F.S.; providing
56grounds for denial or revocation of a license or change-
57of-ownership application; providing conditions to continue
58operation; exempting renewal applications from provisions
59requiring the agency to approve or deny an application
60within a specified period of time, under certain
61circumstances; creating s. 408.816, F.S.; authorizing the
62agency to institute injunction proceedings, under certain
63circumstances; creating s. 408.817, F.S.; providing basis
64for review of administrative proceedings challenging
65agency licensure enforcement action; creating s. 408.818,
66F.S.; requiring fees and fines related to health care
67licensing to be deposited into the Health Care Trust Fund;
68creating s. 408.819, F.S.; authorizing the agency to adopt
69rules; providing a timeframe for compliance; amending s.
70112.0455, F.S.; providing applicability of licensure
71requirements under pt. II of ch. 408, F.S., to drug-
72testing laboratories; establishing fees for license
73applications; amending ss. 381.0303 and 381.78, F.S.;
74conforming cross references; amending ss. 383.301,
75383.305, and 383.309, F.S.; providing applicability of
76licensure requirements under pt. II of ch. 408, F.S., to
77birth centers; repealing s. 383.304, F.S., relating to
78licensure requirement for birth centers; amending s.
79383.315, F.S.; revising a provision relating to birth
80center consultation agreements; repealing s. 383.332,
81F.S., relating to establishing, managing, or operating a
82birth center without a license and penalties therefor;
83amending s. 383.324, F.S.; conforming provisions relating
84to inspections and investigations of birth centers to
85changes made by the act; repealing s.. 383.325, F.S.,
86relating to inspection reports; amending s. 383.33, F.S.,
87relating to administrative fines, penalties, emergency
88orders , and moratoriums on admissions; conforming
89provisions to changes made by the act; repealing s.
90383.331, F.S., relating to injunctive relief; amending s.
91383.335, F.S., relating to partial exemptions; conforming
92provisions to changes made by the act; amending s. 383.50,
93F.S.; conforming a cross reference; amending s. 390.011,
94F.S.; revising a definition; amending s. 390.012, F.S.,
95relating to rulemaking power of the agency; conforming
96provisions to changes made by the act; repealing s.
97390.013, F.S., relating to effective date of rules
98governing abortion clinics; amending s. 390.014, F.S.;
99providing applicability of licensure requirements under
100pt. II of ch. 408, F.S., to abortion clinics; increasing
101fees for licensing of abortion clinics; repealing s.
102390.015, F.S., relating to application for license to
103operate an abortion clinic; repealing s. 390.016, F.S.,
104relating to expiration and renewal of license; repealing
105s. 390.017, F.S., relating to grounds for suspension or
106revocation of license; amending s. 390.018, F.S.;
107providing applicability of pt. II of ch. 408, F.S., to
108administrative fines; repealing s. 390.019, F.S., relating
109to inspections and investigations of abortion clinics;
110repealing s. 390.021, F.S., relating to injunctive relief;
111amending s. 393.501, F.S.; revising provisions relating to
112rulemaking; amending s. 394.455, F.S.; revising a
113definition; amending s. 394.4787, F.S.; conforming a cross
114reference; amending s. 394.67, F.S.; deleting and revising
115and providing definitions; conforming cross references;
116amending ss. 394.74 and 394.82, F.S.; conforming cross
117references; amending s. 394.875, F.S.; providing purpose
118of short-term residential treatment facilities; providing
119applicability of licensure requirements under pt. II of
120ch. 408, F.S., to crisis stabilization units, short-term
121residential treatment facilities, residential treatment
122facilities, and residential treatment centers for children
123and adolescents; providing an exemption from licensure
124requirements for hospitals licensed under ch. 395, F.S.,
125and certain programs operated therein; repealing s.
126394.876, F.S., relating to license applications; amending
127s. 394.877, F.S.; providing applicability of pt. II of ch.
128408, F.S., to license fees; amending s. 394.878, F.S.,
129relating to issuance and renewal of licenses; conforming
130provisions to changes made by the act; amending s.
131394.879, F.S.; providing for rulemaking authority;
132conforming provisions to changes made by the act; amending
133s. 394.90, F.S.; conforming provisions relating to
134inspections of crisis stabilization units and residential
135treatment facilities to changes made by the act; repealing
136s. 394.902, F.S., relating to denial, suspension, and
137revocation of licenses of certain mental health
138facilities; amending s. 394.907, F.S., relating to access
139to records of community mental health centers; providing
140for the department to determine licensee compliance with
141quality assurance programs; amending s. 395.002, F.S.;
142deleting a definition; conforming cross references;
143amending ss. 395.003, 395.004, and 395.0161, F.S.;
144providing applicability of licensure requirements under
145pt. II of ch. 408, F.S., to hospitals, ambulatory surgical
146centers, and mobile surgical facilities; repealing s.
147395.0055, F.S., relating to background screening;
148repealing s. 395.0162, F.S., relating to inspection
149reports; amending s. 395.0163, F.S.; revising provisions
150relating to deposit of fees; conforming provisions to
151changes made by the act; providing an exception to Florida
152Building Code requirements for a licensed facility under
153specified circumstances; amending s. 395.0191, F.S.;
154requiring the presence of certain registered nurses in the
155operating room of a facility licensed under ch. 395, F.S.,
156during specified procedures; amending s. 395.0193, F.S.;
157requiring that reports concerning disciplinary actions be
158reported to the Department of Health and that final
159disciplinary actions be reported to the Division of Health
160Quality Assurance; conforming a cross reference; amending
161s. 395.0197, F.S.; conforming a cross reference; amending
162ss. 395.0199 and 395.1046, F.S.; providing applicability
163of licensure requirements under pt. II of ch. 408, F.S.,
164to health care utilization review and complaint
165investigation procedures; amending s. 395.1055, F.S.;
166providing applicability of licensure requirements under
167pt. II of ch. 408, F.S., to adoption and enforcement of
168rules; requiring the agency to enforce compliance with
169provisions relating to specified immunizations; amending
170ss. 395.1065, 395.10973, and 395.10974, F.S.; providing
171applicability of licensure requirements under pt. II of
172ch. 408, F.S., to administrative penalties and
173injunctions, rulemaking, and health care risk managers;
174amending ss. 395.602 and 395.701, F.S.; conforming cross
175references; amending s. 400.021, F.S.; deleting
176definitions; amending s. 400.022, F.S.; providing
177applicability of licensure requirements under pt. II of
178ch. 408, F.S., to grounds for action for a violation of
179residents' rights; amending s. 400.051, F.S.; conforming a
180cross reference; amending s. 400.062, F.S.; providing
181applicability of licensure requirements under pt. II of
182ch. 408, F.S., to nursing homes and related health care
183facilities; revising provisions relating to license fees;
184amending s. 400.063, F.S.; conforming a cross reference;
185amending ss. 400.071 and 400.0712, F.S.; providing
186applicability of licensure requirements under pt. II of
187ch. 408, F.S., to license applications; amending s.
188400.102, F.S.; providing applicability of licensure
189requirements under pt. II of ch. 408, F.S., to grounds for
190action by the agency against a licensee; amending s.
191400.111, F.S.; providing applicability of licensure
192requirements under pt. II of ch. 408, F.S.; requiring a
193licensee to disclose certain holdings of a controlling
194interest; amending s. 400.1183, F.S.; revising a provision
195requiring facilities to report resident grievances to the
196agency; amending s. 400.121, F.S., relating to denial,
197suspension, and revocation of licenses and administrative
198fines; conforming provisions to changes made by the act;
199repealing s. 400.125, F.S., relating to injunction
200proceedings; amending s. 400.141, F.S.; revising timeframe
201for submission of information related to staffing
202requirements and number of vacant beds in a facility;
203conforming a cross reference; amending s. 400.162, F.S.;
204providing for payment of a deceased resident's funeral
205services under certain circumstances; amending s. 400.179,
206F.S.; revising provisions relating to liability for
207Medicaid underpayments and overpayments; conforming
208provisions to changes made by the act; amending s. 400.18,
209F.S.; revising provisions relating to the closing of a
210nursing home facility; conforming provisions to changes
211made by the act; amending s. 400.19, F.S.; providing
212applicability of licensure requirements under pt. II of
213ch. 408, F.S., to nursing home facility inspections;
214revising a provision relating to a fine; amending s.
215400.191, F.S.; authorizing the agency to provide
216electronic access to inspection reports; requiring the
217agency to publish the Nursing Home Guide in printed and
218electronic formats and providing information to be
219included therein; revising information to be included on
220the agency Internet site; revising provisions relating to
221availability of nursing home facility records; amending s.
222400.20, F.S.; revising language relating to nursing home
223administrators; amending s. 400.23, F.S.; providing
224applicability of pt. II of ch. 408, F.S., to rulemaking
225for nursing home facilities; providing an alternative to
226nursing home room requirements under the Florida Building
227Code; amending s. 400.241, F.S.; providing applicability
228of licensure requirements under pt. II of ch. 408, F.S.,
229to prohibited acts relating to establishment, operation,
230or advertisement of nursing home facilities; amending s.
231400.402, F.S.; revising and deleting definitions; amending
232s. 400.407, F.S.; providing applicability of licensure
233requirements under pt. II of ch. 408, F.S., to assisted
234living facilities; conforming provisions to changes made
235by the act; providing an exemption; amending s. 400.4075,
236F.S.; providing applicability of licensure requirements
237under pt. II of ch. 408, F.S., to limited mental health
238licenses; amending s. 400.408, F.S., relating to penalties
239imposed on unlicensed assisted living facilities;
240conforming provisions to changes made by the act; amending
241ss. 400.411, 400.412, 400.414, 400.417, and 400.4174,
242F.S.; providing applicability of licensure requirements
243under pt. II of ch. 408, F.S., to assisted living
244facilities; conforming provisions to changes made by the
245act; repealing s. 400.415, F.S., relating to a moratorium
246on admissions and notice thereof; amending s. 400.4176,
247F.S.; conforming provisions to changes made by the act;
248amending s. 400.4178, F.S.; deleting provisions exempting
249specified nursing home facilities from fees for training
250and education programs relating to special care for
251persons with Alzheimer's disease or other related
252disorders; amending ss. 400.418 and 400.419, F.S.;
253providing applicability of pt. II of ch. 408, F.S., to
254provisions relating to disposition and imposition of fees
255and fines collected under pt. III of ch. 400, F.S.;
256conforming provisions to changes made by the act;
257repealing s. 400.421, F.S., relating to injunctive
258proceedings; amending s. 400.422, F.S.; conforming a cross
259reference; amending s. 400.423, F.S.; transferring
260rulemaking authority from the Department of Elderly
261Affairs to the agency; amending s. 400.424, F.S.;
262providing that fines on assisted living facilities for
263failure to comply with certain refund provisions are not
264subject to s. 400.419(3), F.S.; amending ss. 400.4255,
265400.4256, 400.427, and 400.4275, F.S.; conforming
266provisions to changes made by the act; amending s.
267400.426, F.S.; conforming a cross reference; amending ss.
268400.431 and 400.434, F.S.; providing applicability of
269licensure requirements under pt. II of ch. 408, F.S., to
270the closing of and right of entry and inspection of
271assisted living facilities; amending s. 400.435, F.S.;
272revising provisions relating to maintenance of records of
273inspection reports for a specified period of time;
274amending s. 400.441, F.S.; transferring rulemaking
275authority from the Department of Elderly Affairs to the
276agency; deleting provisions requiring submission of
277proposed rules and a report to the Legislature; deleting a
278fee for copies of rules and standards; conforming
279provisions to changes made by the act; amending ss.
280400.442 and 400.444, F.S.; conforming provisions to
281changes made by the act; amending s. 400.447, F.S.;
282providing applicability of licensure requirements under
283pt. II of ch. 408, F.S., to prohibited acts and penalties
284for violation of said requirements; repealing s. 400.451,
285F.S., relating to compliance by existing facilities with
286applicable rules and standards; amending ss. 400.452 and
287400.454, F.S.; conforming provisions to changes made by
288the act; amending ss. 400.464, 400.471, 400.474, and
289400.484, F.S.; providing applicability of licensure
290requirements under pt. II of ch. 408, F.S., to home health
291agencies; amending s. 400.487, F.S.; revising contents of
292home health service agreements; authorizing physician
293assistants and advanced registered nurse practitioners to
294establish treatment orders; amending s. 400.494, F.S.;
295conforming provisions to changes made by the act; amending
296ss. 400.495 and 400.497, F.S.; providing applicability of
297licensure requirements under pt. II of ch. 408, F.S., to
298the toll-free central abuse hotline and rules establishing
299minimum standards for home health aides; amending s.
300400.506, F.S.; providing applicability of licensure
301requirements under pt. II of ch. 408, F.S., to nurse
302registries; requiring a nurse registry to notify patients
303or their families of the availability and costs of visits
304by registered nurses; permitting physician assistants and
305advanced registered nurse practitioners to sign a plan of
306treatment; revising provisions relating to assessment of
307costs related to certain investigations; amending s.
308400.509, F.S.; providing applicability of pt. II of ch.
309408, F.S., to the registration of companion or homemaker
310service providers exempt from licensure; providing a fee
311for registration; conforming provisions to changes made by
312the act; amending s. 400.512, F.S.; conforming provisions
313relating to the screening of home health agency, nurse
314registry, companion, and homemaker personnel to changes
315made by the act; repealing s. 400.515, F.S., relating to
316injunction proceedings; amending s. 400.551, F.S.;
317revising definitions; amending ss. 400.554, 400.555,
318400.5565, 400.557, and 400.5572, F.S.; providing
319applicability of licensure requirements under pt. II of
320ch. 408, F.S., to adult day care centers; amending s.
321400.556, F.S.; authorizing the agency to impose an
322emergency action against an owner, operator, or employee
323of an adult day care facility; revising grounds for action
324by the agency against an owner, operator, or employee of
325an adult day care facility; providing applicability of
326licensure requirements under pt. II of ch. 408, F.S.;
327repealing s. 400.5575, F.S., relating to disposition of
328fees and fines; repealing s. 400.558, F.S., relating to
329injunctive relief; amending ss. 400.559 and 400.56, F.S.;
330providing applicability of licensure requirements under
331pt. II of ch. 408, F.S., to the closing of and right of
332entry and inspection of adult day care centers; amending
333s. 400.562, F.S.; transferring rulemaking authority from
334the Department of Elderly Affairs to the agency; deleting
335a fee for copies of rules and standards; conforming
336provisions to changes made by the act; repealing s.
337400.564, F.S., relating to prohibited acts and penalties
338therefor; amending ss. 400.602, 400.605, 400.606,
339400.6065, and 400.607, F.S.; providing applicability of
340licensure requirements under pt. II of ch. 408, F.S., to
341hospices; conforming provisions to changes made by the
342act; amending s. 400.6095, F.S.; conforming provisions
343relating to rulemaking to changes made by the act;
344amending ss. 400.617, 400.6211, and 400.625, F.S.;
345conforming provisions relating to legislative intent and
346purpose, rulemaking, training and education programs, and
347residency agreements for adult family-care homes to
348changes made by the act; amending ss. 400.619, 400.6194,
349400.6196, and 400.621, F.S.; providing applicability of
350licensure requirements under pt. II of ch. 408, F.S., to
351adult family-care homes; repealing s. 400.622, F.S.,
352relating to injunctive proceedings; amending s. 400.801,
353F.S.; conforming provisions relating to homes for special
354services to changes made by the act; providing a fee;
355amending s. 400.805, F.S.; providing applicability of
356licensure requirements under pt. II of ch. 408, F.S., to
357transitional living facilities; providing a fee; amending
358s. 400.902, F.S.; revising a definition; amending ss.
359400.903, 400.905, 400.907, and 400.908, F.S.; providing
360applicability of licensure requirements under pt. II of
361ch. 408, F.S., to prescribed pediatric extended care
362centers; repealing s. 400.906, F.S., relating to initial
363application for a license; repealing s. 400.910, F.S.,
364relating to expiration or renewal of a license and
365conditional licenses; repealing s. 400.911, F.S., relating
366to injunction proceedings; amending s. 400.912, F.S.;
367conforming provisions relating to the closing of a
368prescribed pediatric extended care center to changes made
369by the act; repealing s. 400.913, F.S., relating to right
370of entry and inspection; amending ss. 400.914 and 400.915,
371F.S.; providing applicability of licensure requirements
372under pt. II of ch. 408, F.S., to rules establishing
373standards for and requirements for construction and
374renovation of prescribed pediatric extended care centers;
375repealing s. 400.916, F.S., relating to penalties for
376prohibited acts; repealing s. 400.917, F.S., relating to
377disposition of moneys from fines and fees; amending s.
378400.925, F.S.; deleting and revising definitions; amending
379ss. 400.93, 400.931, 400.932, 400.933, and 400.935, F.S.;
380providing applicability of licensure requirements under
381pt. II of ch. 408, F.S., to home medical equipment
382providers; repealing s. 400.95, F.S., relating to notice
383of toll-free telephone number for the central abuse
384hotline; amending ss. 400.953 and 400.955, F.S.; revising
385provisions relating to background screening of home
386medical equipment provider personnel; repealing s.
387400.956, F.S., relating to injunction proceedings;
388amending s. 400.960, F.S.; deleting and revising
389definitions; amending s. 400.962, F.S.; providing
390applicability of licensure requirements under pt. II of
391ch. 408, F.S., to intermediate care facilities for persons
392with developmental disabilities; providing a fee;
393repealing s. 400.963, F.S., relating to injunctive
394proceedings; repealing s. 400.965, F.S., relating to
395grounds for actions by the agency against the licensee;
396amending s. 400.967, F.S.; providing applicability of
397licensure requirements under pt. II of ch. 408, F.S., to
398intermediate care facilities for persons with
399developmental disabilities; requiring facilities to adhere
400to the Bill of Rights of Persons Who are Developmentally
401Disabled; amending s. 400.968, F.S.; conforming provisions
402relating to injunctive proceedings and a moratorium on
403admissions to changes made by the act; amending s.
404400.9685, F.S.; conforming language to changes made by the
405act; amending s. 400.969, F.S.; providing applicability of
406pt. II of ch. 408, F.S., to penalties relating to
407intermediate care facilities for persons with
408developmental disabilities; amending s. 400.980, F.S.;
409providing applicability of licensure requirements under
410pt. II of ch. 408, F.S., to health care services pools;
411amending ss. 400.991, 400.9915, 400.9925, 400.993, and
412400.9935, F.S.; providing applicability of licensure
413requirements under pt. II of ch. 408, F.S., to health care
414clinics; providing a fee; repealing s. 400.992, F.S.,
415relating to license renewal, transfer of ownership, and
416provisional licenses; repealing s. 400.994, F.S., relating
417to injunctive proceedings; repealing s. 400.9945, F.S.,
418relating to agency actions; amending s. 400.995, F.S.;
419conforming provisions relating to agency administrative
420penalties to changes made by the act; amending s. 401.265,
421F.S.; requiring license requirements for emergency medical
422technicians and paramedics; amending s. 408.831, F.S.;
423revising provisions relating to agency action to deny,
424suspend, or revoke a license, registration, certificate,
425or application; amending s. 440.102, F.S.; providing
426applicability of licensure requirements under pt. II of
427ch. 408, F.S., to drug testing standards for laboratories;
428amending s. 464.015, F.S.; providing restrictions on the
429use of the title "Certified Registered Nurse Anesthetist";
430amending s. 464.016, F.S.; providing a penalty for misuse
431of the title "Certified Registered Nurse Anesthetist";
432amending ss. 483.035, 483.051, 483.061, 483.091, 483.101,
433483.111, 483.172, 483.201, 483.221, and 483.23, F.S.;
434providing applicability of licensure requirements under
435pt. II of ch. 408, F.S., to clinical laboratories;
436repealing s. 483.131, F.S., relating to the display of a
437license; repealing s. 483.25, F.S., relating to injunctive
438proceedings; amending ss. 483.291, 483.294, 483.30,
439483.302, 483.317, 483.32, and 483.322, F.S.; providing
440applicability of licensure requirements under pt. II of
441ch. 408, F.S., to multiphasic health testing centers;
442repealing s. 483.311, F.S., relating to the display of a
443license; repealing s. 483.328, F.S., relating to
444injunctive relief; amending s. 765.541, F.S.; conforming
445provisions relating to cadaveric organ and tissue
446procurement to changes made by the act; amending s.
447765.542, F.S.; providing applicability of licensure
448requirements under pt. II of ch. 408, F.S., to organ
449procurement organizations and tissue and eye banks;
450amending s. 765.544, F.S.; conforming provisions relating
451to application fees from organizations and tissue and eye
452banks to changes made by the act; amending ss. 402.164,
453409.815, 409.905, 409.907, 468.505, 483.106, 766.118,
454766.316, and 812.014, F.S.; conforming cross references;
455providing for priority of application in case of conflict;
456transferring rules adopted by the Department of Elderly
457Affairs under pts. III, V, VI, and VII of ch. 400, F.S.,
458to the agency; authorizing the agency to issue licenses
459for less than a specified time period and providing
460conditions therefor; providing an effective date.
461
462Be It Enacted by the Legislature of the State of Florida:
463
464     Section 1.  Part I of chapter 408, Florida Statutes,
465consisting of sections 408.031, 408.032, 408.033, 408.034,
466408.035, 408.036, 408.0361, 408.037, 408.038, 408.039, 408.040,
467408.041, 408.042, 408.043, 408.044, 408.045, 408.0455, 408.05,
468408.061, 408.062, 408.063, 408.07, 408.08, 408.09, 408.10,
469408.15, 408.16, 408.18, 408.185, 408.20, 408.301, 408.302,
470408.40, 408.50, 408.70, 408.7056, 408.7057, and 408.7071,
471Florida Statutes, is created and entitled "Health Facility and
472Services Planning."
473     Section 2.  Part II of chapter 408, Florida Statutes,
474consisting of sections 408.801, 408.802, 408.803, 408.804,
475408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
476408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
477408.819, and 408.831, Florida Statutes, is created and entitled
478"Health Care Licensing: General Provisions."
479     Section 3.  Part III of chapter 408, Florida Statutes,
480consisting of sections 408.90, 408.901, 408.902, 408.903,
481408.904, 408.905, 408.906, 408.907, 408.908, and 408.909,
482Florida Statutes, is created and entitled "Health Insurance
483Access."
484     Section 4.  Part IV of chapter 408, Florida Statutes,
485consisting of sections 408.911, 408.913, 408.914, 408.915,
486408.916, 408.917, and 408.918, Florida Statutes, is created and
487entitled "Health and Human Services Eligibility Access System."
488     Section 5.  Sections 408.801, 408.802, 408.803, 408.804,
489408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
490408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
491and 408.819, Florida Statutes, are created to read:
492     408.801  Popular name; purpose.--
493     (1)  This part may be cited as the "Health Care Licensing
494Procedures Act."
495     (2)  The Legislature finds that there is unnecessary
496duplication and variation in the requirements for licensure by
497the Agency for Health Care Administration brought about by the
498historical pattern of legislative action focused exclusively on
499a single type of regulated provider. It is the intent of the
500Legislature to provide a streamlined and consistent set of basic
501licensing requirements for all such providers in order to
502minimize confusion, standardize terminology, and include issues
503that are otherwise not adequately addressed in the Florida
504Statutes pertaining to specific providers.
505     408.802  Applicability.--The provisions of this part apply
506to the provision of services that require licensure as defined
507in this part and to the following entities licensed, registered,
508or certified by the Agency for Health Care Administration, as
509described in chapters 112, 383, 390, 394, 395, 400, 440, 483,
510and 765:
511     (1)  Laboratories authorized to perform testing under the
512Drug-Free Workplace Act, as provided under ss. 112.0455 and
513440.102.
514     (2)  Birth centers, as provided under chapter 383.
515     (3)  Abortion clinics, as provided under chapter 390.
516     (4)  Crisis stabilization units, as provided under parts I
517and IV of chapter 394.
518     (5)  Short-term residential treatment facilities, as
519provided under parts I and IV of chapter 394.
520     (6)  Residential treatment facilities, as provided under
521part IV of chapter 394.
522     (7)  Residential treatment centers for children and
523adolescents, as provided under part IV of chapter 394.
524     (8)  Hospitals, as provided under part I of chapter 395.
525     (9)  Ambulatory surgical centers, as provided under part I
526of chapter 395.
527     (10)  Mobile surgical facilities, as provided under part I
528of chapter 395.
529     (11)  Private review agents, as provided under part I of
530chapter 395.
531     (12)  Health care risk managers, as provided under part I
532of chapter 395.
533     (13)  Nursing homes, as provided under part II of chapter
534400.
535     (14)  Assisted living facilities, as provided under part
536III of chapter 400.
537     (15)  Home health agencies, as provided under part IV of
538chapter 400.
539     (16)  Nurse registries, as provided under part IV of
540chapter 400.
541     (17)  Companion services or homemaker services providers,
542as provided under part IV of chapter 400.
543     (18)  Adult day care centers, as provided under part V of
544chapter 400.
545     (19)  Hospices, as provided under part VI of chapter 400.
546     (20)  Adult family-care homes, as provided under part VII
547of chapter 400.
548     (21)  Homes for special services, as provided under part
549VIII of chapter 400.
550     (22)  Transitional living facilities, as provided under
551part VIII of chapter 400.
552     (23)  Prescribed pediatric extended care centers, as
553provided under part IX of chapter 400.
554     (24)  Home medical equipment providers, as provided under
555part X of chapter 400.
556     (25)  Intermediate care facilities for persons with
557developmental disabilities, as provided under part XI of chapter
558400.
559     (26)  Health care services pools, as provided under part
560XII of chapter 400.
561     (27)  Health care clinics, as provided under part XIII of
562chapter 400.
563     (28)  Clinical laboratories, as provided under part I of
564chapter 483.
565     (29)  Multiphasic health testing centers, as provided under
566part II of chapter 483.
567     (30)  Organ and tissue procurement agencies, as provided
568under chapter 765.
569     408.803  Definitions.--As used in this part, the term:
570     (1)  "Agency" means the Agency for Health Care
571Administration, which is the licensing agency under this part.
572     (2)  "Applicant" means an individual, corporation,
573partnership, firm, association, or governmental entity that
574submits an application to the agency for a license.
575     (3)  "Authorizing statute" means the statute authorizing
576the licensed operation of a provider listed in s. 408.802,
577including chapters 112, 383, 390, 394, 395, 400, 440, 483, and
578765.
579     (4)  "Certification" means certification as a Medicare or
580Medicaid provider of the services that require licensure or
581certification pursuant to the federal Clinical Laboratory
582Improvement Amendment (CLIA).
583     (5)  "Change in ownership" means an event in which the
584licensee changes to a different legal entity or in which 45
585percent or more of the ownership, voting shares, or interest in
586a corporation whose shares are not publicly traded on a
587recognized stock exchange is transferred or assigned, including
588the final transfer or assignment of multiple transfers or
589assignments over a 2-year period that cumulatively total 45
590percent or greater. However, a change solely in the management
591company is not a change of ownership.
592     (6)  "Client" means any person receiving services from a
593provider listed in s. 408.802.
594     (7)  "Controlling interest" means:
595     (a)  The applicant or licensee;
596     (b)  A person or entity that serves as an officer of, is on
597the board of directors of, or has a 5 percent or greater
598ownership interest in the applicant or licensee; or
599     (c)  A person or entity that serves as an officer of, is on
600the board of directors of, or has a 5 percent or greater
601ownership interest in the management company or other entity,
602related or unrelated, with which the applicant or licensee
603contracts to manage the provider.
604
605The term does not include a voluntary board member.
606     (8)  "License" means any permit, registration, certificate,
607or license issued by the agency.
608     (9)  "Licensee" means an individual, corporation,
609partnership, firm, association, or governmental entity that is
610issued a permit, registration, certificate, or license by the
611agency. The licensee is legally responsible for all aspects of
612the provider operation.
613     (10)  "Moratorium" means a prohibition on the acceptance of
614new clients.
615     (11)  "Provider" means any activity, service, agency, or
616facility regulated by the agency and listed in s. 408.802.
617     (12)  "Services that require licensure" means those
618services, including residential services, that require a valid
619license before those services may be provided in accordance with
620authorizing statutes and agency rules.
621     (13)  "Voluntary board member" means a board member of a
622not-for-profit corporation or organization who serves solely in
623a voluntary capacity, does not receive any remuneration for his
624or her services on the board of directors, and has no financial
625interest in the corporation or organization. The agency shall
626recognize a person as a voluntary board member following
627submission of a statement to the agency by the board member and
628the not-for-profit corporation or organization that affirms that
629the board member conforms to this definition. The statement
630affirming the status of the board member must be submitted to
631the agency on a form provided by the agency.
632     408.804  License required; display.--
633     (1)  It is unlawful to provide services that require
634licensure, or operate or maintain a provider that offers or
635provides services that require licensure, without first
636obtaining from the agency a license authorizing the provision of
637such services or the operation or maintenance of such provider.
638     (2)  A license must be displayed in a conspicuous place
639readily visible to clients who enter at the address that appears
640on the license and is valid only in the hands of the licensee to
641whom it is issued and may not be sold, assigned, or otherwise
642transferred, voluntarily or involuntarily. The license is valid
643only for the licensee, provider, and location for which the
644license is issued.
645     408.805  Fees required; adjustments.--Unless otherwise
646limited by authorizing statutes, license fees must be reasonably
647calculated by the agency to cover its costs in carrying out its
648responsibilities under this part, authorizing statutes, and
649applicable rules, including the cost of licensure, inspection,
650and regulation of providers.
651     (1)  Licensure fees shall be adjusted to provide for
652biennial licensure in agency rules.
653     (2)  The agency shall annually adjust licensure fees,
654including fees paid per bed, by not more than the change in the
655Consumer Price Index based on the 12 months immediately
656preceding the increase.
657     (3)  The agency may, by rule, adjust licensure fees to
658cover the cost of administering this part, authorizing statutes,
659and applicable rules.
660     (4)  An inspection fee must be paid as required in
661authorizing statutes.
662     (5)  Fees are nonrefundable.
663     (6)  When a change is reported that requires issuance of a
664license, a fee may be assessed. The fee must be based on the
665actual cost of processing and issuing the license.
666     (7)  A fee may be charged to a licensee requesting a
667duplicate license. The fee may not exceed the actual cost of
668duplication and postage.
669     (8)  Total fees collected may not exceed the cost of
670administering this part, authorizing statutes, and applicable
671rules.
672     408.806  License application process.--
673     (1)  An application for licensure must be made to the
674agency on forms furnished by the agency, submitted under oath,
675and accompanied by the appropriate fee in order to be accepted
676and considered timely. The application must contain information
677required by authorizing statutes and applicable rules and must
678include:
679     (a)  The name, address, and social security number of the
680applicant and each controlling interest if the applicant or
681controlling interest is an individual.
682     (b)  The name, address, and federal employer identification
683number or taxpayer identification number of the applicant and
684each controlling interest if the applicant or controlling
685interest is not an individual.
686     (c)  The name by which the provider is to be known.
687     (d)  The total number of beds or capacity requested, as
688applicable.
689     (e)  The following information regarding the location of
690the provider for which the application is made:
691     1.  A report or letter from the zoning authority indicating
692that the location is zoned appropriately for its use. If the
693provider is a community residential home under chapter 419, the
694zoning requirement must be satisfied by proof of compliance with
695chapter 419. The zoning report or letter is not required for a
696renewal application if the provider location did not change
697since the date on which the most recent license was issued.
698     2.  A satisfactory fire safety report from the local
699authority having jurisdiction or the state fire marshal.
700     (f)  The name of the person or persons under whose
701management or supervision the provider will be operated and the
702name of the administrator, if required.
703     (g)  If the applicant offers continuing care agreements as
704defined in chapter 651, proof shall be furnished that the
705applicant has obtained a certificate of authority as required
706for operation under chapter 651.
707     (h)  Other information, including satisfactory inspection
708results, that the agency finds necessary to determine the
709ability of the applicant to carry out its responsibilities under
710this part, authorizing statutes, and applicable rules.
711     (2)(a)  The applicant for a renewal license must submit an
712application that must be received by the agency at least 60 days
713prior to the expiration of the current license.
714     (b)  The applicant for initial licensure due to a change of
715ownership must submit an application that must be received by
716the agency at least 60 days prior to the date of change of
717ownership.
718     (c)  For any other application or request, the applicant
719must submit an application or request that must be received by
720the agency at least 60 days prior to the requested effective
721date, unless otherwise specified in authorizing statutes or
722rules.
723     (d)  The agency shall notify the licensee by mail or
724electronically at least 90 days prior to the expiration of a
725license that a renewal license is necessary to continue
726operation. The failure to timely file an application and submit
727a license fee shall result in a late fee charged to the licensee
728by the agency in an amount equal to 50 percent of the licensure
729fee but in no event shall the aggregate amount of the fine
730exceed $5,000. If an application is received after the required
731filing date and exhibits a hand-canceled postmark obtained from
732a United States Post Office dated on or before the required
733filing date, no fine will be levied.
734     (3)(a)  Upon receipt of an application for a license, the
735agency shall examine the application and, within 30 days after
736receipt, notify the applicant in writing of any apparent errors
737or omissions and request any additional information required.
738     (b)  Requested information omitted from an application for
739licensure, license renewal, or change of ownership, other than
740an inspection, must be filed with the agency within 21 days
741after the agency's request for omitted information or the
742application shall be deemed incomplete and shall be withdrawn
743from further consideration and the fees shall be forfeited.
744     (c)  Within 60 days after the receipt of a complete
745application, the agency shall approve or deny the application.
746     (4)(a)  Licensees subject to the provisions of this part
747shall be issued biennial licenses unless conditions of the
748license category specify a shorter license period.
749     (b)  Each license issued shall indicate the name of the
750licensee, the type of provider or service that the licensee is
751required or authorized to operate or offer, the date the license
752is effective, the expiration date of the license, the maximum
753capacity of the licensed premises, if applicable, and any other
754information required or deemed necessary by the agency.
755     (5)  In accordance with authorizing statutes and applicable
756rules, proof of compliance with s. 408.810 must be submitted
757with an application for licensure.
758     (6)  The agency may not issue an initial license to a
759health care provider subject to the certificate-of-need
760provisions in part I of this chapter if the licensee has not
761been issued a certificate of need or certificate-of-need
762exemption, when applicable. Failure to apply for the renewal of
763a license prior to the expiration date renders the license null
764and void and the former licensee may not be issued a new license
765unless the licensee reapplies for an initial license and meets
766all current qualifications for licensure, including construction
767standards for facilities, where applicable, and complies with
768certificate-of-need requirements if the applicant is subject to
769the provisions of part I of this chapter.
770     (7)(a)  An applicant must demonstrate compliance with the
771requirements in this part, authorizing statutes, and applicable
772rules during an inspection pursuant to s. 408.811, as required
773by authorizing statutes.
774     (b)  An initial inspection is not required for companion
775services or homemaker services providers, as provided under part
776IV of chapter 400, or for health care services pools, as
777provided under part XII of chapter 400.
778     (c)  If an inspection is required by the authorizing
779statute for a license application other than an initial
780application, the inspection must be unannounced. This paragraph
781does not apply to inspections required pursuant to ss. 383.324,
782395.0161(4), and 483.061(2).
783     (d)  If a provider is not available when an inspection is
784attempted, the application shall be denied.
785     (8)  The agency may establish procedures for the electronic
786submission of required information, including, but not limited
787to:
788     (a)  Licensure applications.
789     (b)  Required signatures.
790     (c)  Payment of fees.
791     (d)  Notarization of applications.
792
793Requirements for electronic submission of any documents required
794by this part or authorizing statutes may be established by rule.
795     408.807  Change of ownership.--Whenever a change of
796ownership occurs:
797     (1)  The transferor shall notify the agency in writing at
798least 60 days before the anticipated date of the change of
799ownership.
800     (2)  The transferee shall make application to the agency
801for a license within the timeframes required in s. 408.806.
802     (3)  The transferor shall be responsible and liable for:
803     (a)  The lawful operation of the provider and the welfare
804of the clients served until the date the transferee is licensed
805by the agency.
806     (b)  Any and all penalties imposed against the transferor
807for violations occurring before the date of change of ownership.
808     (4)  Any restriction on licensure, including a conditional
809license existing at the time of a change of ownership, shall
810remain in effect until removed by the agency.
811     (5)  The transferee shall maintain records of the
812transferor as required in this part, authorizing statutes, and
813applicable rules, including:
814     (a)  All client records.
815     (b)  Inspection reports.
816     (c)  All records required to be maintained pursuant to s.
817409.913, if applicable.
818     408.808  License categories.--
819     (1)  STANDARD LICENSE.--A standard license may be issued to
820an applicant at the time of initial licensure, license renewal,
821or change of ownership. A standard license shall be issued when
822the applicant is in compliance with all statutory requirements
823and agency rules. Unless sooner revoked, a standard license
824expires 2 years after the date of issue.
825     (2)  PROVISIONAL LICENSE.--A provisional license may be
826issued to an applicant pursuant to s. 408.809(3). An applicant
827against whom a proceeding denying or revoking a license is
828pending at the time of license renewal may be issued a
829provisional license effective until final disposition by the
830agency of the proceeding. If judicial relief is sought under
831this section, the court having jurisdiction may issue such
832orders regarding the issuance of a provisional license during
833the pendency of the judicial proceeding.
834     (3)  INACTIVE LICENSE.--An inactive license may be issued
835to a health care provider subject to the certificate-of-need
836provisions in part I of this chapter when the provider is
837currently licensed, does not have a provisional license, and
838will be temporarily unable to provide services but is reasonably
839expected to resume services within 12 months. Such designation
840may be made for a period not to exceed 12 months but may be
841renewed by the agency for up to 6 additional months upon
842demonstration by the licensee of the provider's progress toward
843reopening. A request by a licensee for an inactive license or to
844extend the previously approved inactive period must be submitted
845to the agency and include a written justification for the
846inactive license with the beginning and ending dates of
847inactivity specified, a plan for the transfer of any clients to
848other providers, and the appropriate licensure fees. The agency
849may not accept a request that is submitted after initiating
850closure, after any suspension of service, or after notifying
851clients of closure or suspension of service. Upon agency
852approval, the provider shall notify clients of any necessary
853discharge or transfer as required by authorizing statutes or
854applicable rules. The beginning of the inactive license period
855is the date the provider ceases operations. The end of the
856inactive license period shall become the license expiration
857date. All licensure fees must be current, must be paid in full,
858and may be prorated. Reactivation of an inactive license
859requires the approval of a renewal application, including
860payment of licensure fees and agency inspections indicating
861compliance with all requirements of this part, authorizing
862statutes, and applicable rules.
863     (4)  OTHER LICENSES.--Other types of license categories may
864be issued pursuant to authorizing statutes or applicable rules.
865     408.809  Background screening; prohibited offenses.--
866     (1)  Level 2 background screening pursuant to chapter 435
867must be conducted through the agency on each of the following
868persons, who shall be considered an employee for the purposes of
869conducting screening under chapter 435:
870     (a)  The licensee, if an individual.
871     (b)  The administrator or a similarly titled person who is
872responsible for the day-to-day operation of the provider.
873     (c)  The financial officer or similarly titled individual
874who is responsible for the financial operation of the licensee
875or provider.
876     (d)  Any person who is a controlling interest if the agency
877has reason to believe that such person has been convicted of any
878offense prohibited by s. 435.04. For each controlling interest
879who has been convicted of any such offense, the licensee shall
880submit to the agency a description and explanation of the
881conviction at the time of license application.
882     (2)  Proof of compliance with level 2 screening standards
883submitted within the previous 5 years to meet any provider or
884professional licensure requirements of the agency, the
885Department of Health, the Agency for Persons with Disabilities,
886or the Department of Children and Family Services satisfies the
887requirements of this section, provided that such proof is
888accompanied, under penalty of perjury, by an affidavit of
889compliance with the provisions of chapter 435 using forms
890provided by the agency. Proof of compliance with the background
891screening requirements of the Department of Financial Services
892submitted within the previous 5 years for an applicant for a
893certificate of authority to operate a continuing care retirement
894community under chapter 651 satisfies the Department of Law
895Enforcement and Federal Bureau of Investigation portions of a
896level 2 background check.
897     (3)  A provisional license may be granted to an applicant
898when each individual required by this section to undergo
899background screening has met the standards for the Department of
900Law Enforcement background check but the agency has not yet
901received background screening results from the Federal Bureau of
902Investigation. A standard license may be granted to the licensee
903upon the agency's receipt of a report of the results of the
904Federal Bureau of Investigation background screening for each
905individual required by this section to undergo background
906screening that confirms that all standards have been met or upon
907the granting of an exemption from disqualification by the agency
908as set forth in chapter 435.
909     (4)  When a change of any person required to be screened
910under this section occurs, the licensee must notify the agency
911of the change within the time period specified in the
912authorizing statute or rules and must submit to the agency
913information necessary to conduct level 2 screening or provide
914evidence of compliance with background screening requirements of
915this section. The person may serve in his or her capacity
916pending the agency's receipt of the report from the Federal
917Bureau of Investigation if he or she has met the standards for
918the Department of Law Enforcement background check. However, the
919person may not continue to serve if the report indicates any
920violation of background screening standards unless an exemption
921from disqualification has been granted by the agency as set
922forth in chapter 435.
923     (5)  Background screening is not required to obtain a
924certificate of exemption issued under s. 483.106.
925     408.810  Minimum licensure requirements.--In addition to
926the licensure requirements specified in this part, authorizing
927statutes, and applicable rules, each applicant and licensee must
928comply with the requirements of this section in order to obtain
929and maintain a license.
930     (1)  An applicant for licensure must comply with the
931background screening requirements of s. 408.809.
932     (2)  An applicant for licensure must provide a description
933and explanation of any exclusions, suspensions, or terminations
934of the applicant from the Medicare, Medicaid, or federal
935Clinical Laboratory Improvement Amendment (CLIA) programs.
936     (3)  Unless otherwise specified in this part, authorizing
937statutes, or applicable rules, any information required to be
938reported to the agency must be submitted within 21 calendar days
939after the report period or effective date of the information.
940     (4)  Whenever a licensee discontinues operation of a
941provider:
942     (a)  The licensee must inform the agency not less than 30
943days prior to the discontinuance of operation and inform clients
944of discharge as required by authorizing statutes. Immediately
945upon discontinuance of operation of a provider, the licensee
946shall surrender the license to the agency and the license shall
947be canceled.
948     (b)  Upon closure of a provider, the licensee shall remain
949responsible for retaining and appropriately distributing all
950records within the timeframes prescribed in authorizing statutes
951and applicable rules. In addition, the licensee or, in the event
952of death or dissolution of a licensee, the estate or agent of
953the licensee shall:
954     1.  Make arrangements to forward records for each client to
955one of the following, based upon the client's choice: the client
956or the client's legal representative, the client's attending
957physician, or the health care provider where the client
958currently receives services; or
959     2.  Cause a notice to be published in the newspaper of
960greatest general circulation in the county where the provider
961was located that advises clients of the discontinuance of the
962provider operation. The notice must inform clients that they may
963obtain copies of their records and specify the name, address,
964and telephone number of the person from whom the copies of
965records may be obtained. The notice must appear at least once a
966week for 4 consecutive weeks. Failure to comply with this
967paragraph is a misdemeanor of the second degree, punishable as
968provided in s. 775.082 or s. 775.083.
969     (5)(a)  On or before the first day services are provided to
970a client, a licensee must inform the client and his or her
971immediate family or representative, if appropriate, of the right
972to report:
973     1.  Complaints. The statewide toll-free telephone number
974for reporting complaints to the agency must be provided to
975clients in a manner that is clearly legible and must include the
976words: "To report a complaint regarding the services you
977receive, please call toll-free (phone number)."
978     2.  Abusive, neglectful, or exploitative practices. The
979statewide toll-free telephone number for the central abuse
980hotline must be provided to clients in a manner that is clearly
981legible and must include the words: "To report abuse, neglect,
982or exploitation, please call toll-free (phone number)." The
983agency shall publish a minimum of a 90-day advance notice of a
984change in the toll-free telephone numbers.
985     (b)  Each licensee shall establish appropriate policies and
986procedures for providing such notice to clients.
987     (6)  An applicant must provide the agency with proof of the
988applicant's legal right to occupy the property before a license
989may be issued. Proof may include, but need not be limited to,
990copies of warranty deeds, lease or rental agreements, contracts
991for deeds, quitclaim deeds, or other such documentation.
992     (7)  If proof of insurance is required by the authorizing
993statute, that insurance must be in compliance with chapter 624,
994chapter 626, chapter 627, or chapter 628 and with agency rules.
995     (8)  Upon application for initial licensure or change-of-
996ownership licensure, the applicant shall furnish satisfactory
997proof of the applicant's financial ability to operate in
998accordance with the requirements of this part, authorizing
999statutes, and applicable rules. The agency shall establish
1000standards for this purpose, including information concerning the
1001applicant's controlling interests. The agency shall also
1002establish documentation requirements, to be completed by each
1003applicant, that show anticipated provider revenues and
1004expenditures, the basis for financing the anticipated cash-flow
1005requirements of the provider, and an applicant's access to
1006contingency financing. A current certificate of authority,
1007pursuant to chapter 651, may be provided as proof of financial
1008ability to operate. The agency may require a licensee to provide
1009proof of financial ability to operate at any time if there is
1010evidence of financial instability, including, but not limited
1011to, unpaid expenses necessary for the basic operations of the
1012provider.
1013     (9)  A controlling interest may not withhold from the
1014agency any evidence of financial instability of a licensed
1015provider, including, but not limited to, checks returned due to
1016insufficient funds, delinquent accounts, nonpayment of
1017withholding taxes, unpaid utility expenses, nonpayment for
1018essential services, or adverse court action concerning the
1019financial viability of the provider or any other provider
1020licensed under this part that is under the control of the
1021controlling interest. Any person who violates this subsection
1022commits a misdemeanor of the second degree, punishable as
1023provided in s. 775.082 or s. 775.083. Each day of continuing
1024violation is a separate offense.
1025     (10)  The agency may not issue a license to a health care
1026provider subject to the certificate-of-need provisions in part I
1027of this chapter if the health care provider has not been issued
1028a certificate of need or an exemption. Upon initial licensure of
1029any such provider, the authorization contained in the
1030certificate of need shall be considered fully implemented and
1031merged into the license and shall have no force and effect upon
1032termination of the license for any reason.
1033     408.811  Right of inspection; copies; inspection reports.--
1034     (1)  An authorized officer or employee of the agency may
1035make or cause to be made any inspection or investigation deemed
1036necessary by the agency to determine the state of compliance
1037with this part, authorizing statutes, and applicable rules. The
1038right of inspection extends to any business that the agency has
1039reason to believe is being operated as a provider without a
1040license, but inspection of any business suspected of being
1041operated without the appropriate license may not be made without
1042the permission of the owner or person in charge unless a warrant
1043is first obtained from a circuit court. Any application for a
1044license issued under this part, authorizing statutes, or
1045applicable rules constitutes permission for an appropriate
1046inspection to verify the information submitted on or in
1047connection with the application.
1048     (a)  All inspections shall be unannounced, except as
1049specified in s. 408.806.
1050     (b)  Inspections for relicensure shall be conducted
1051biennially unless otherwise specified by authorizing statutes or
1052applicable rules.
1053     (2)  Inspections conducted in conjunction with
1054certification may be accepted in lieu of a complete licensure
1055inspection.  However, a licensure inspection may also be
1056conducted to review any licensure requirements that are not also
1057requirements for certification.
1058     (3)  The agency shall have access to and the licensee shall
1059provide copies of all provider records required during an
1060inspection at no cost to the agency.
1061     (4)(a)  Each licensee shall maintain as public information,
1062available upon request, records of all inspection reports
1063pertaining to that provider that have been filed by the agency
1064unless those reports are exempt from or contain information that
1065is exempt from s. 119.07(1) or is otherwise made confidential by
1066law. Effective October 1, 2005, copies of such reports shall be
1067retained in the records of the provider for at least 3 years
1068following the date the reports are filed and issued, regardless
1069of a change of ownership.
1070     (b)  A licensee shall, upon the request of any person who
1071has completed a written application with intent to be admitted
1072by such provider, any person who is a client of such provider,
1073or any relative, spouse, or guardian of any such person, furnish
1074to the requester a copy of the last inspection report pertaining
1075to the licensed provider that was issued by the agency or by an
1076accrediting organization if such report is used in lieu of a
1077licensure inspection.
1078     408.812  Unlicensed activity.--
1079     (1)  A person or entity may not offer or advertise services
1080that require licensure as defined by this part, authorizing
1081statutes, or applicable rules to the public without obtaining a
1082valid license from the agency. A licenseholder may not advertise
1083or hold out to the public that he or she holds a license for
1084other than that for which he or she actually holds the license.
1085     (2)  The operation or maintenance of an unlicensed provider
1086or the performance of any services that require licensure
1087without proper licensure is a violation of this part and
1088authorizing statutes. Unlicensed activity constitutes harm that
1089materially affects the health, safety, and welfare of clients.
1090The agency or any state attorney may, in addition to other
1091remedies provided in this part, bring an action for an
1092injunction to restrain such violation or to enjoin the future
1093operation or maintenance of any such provider or the provision
1094of services that require licensure in violation of this part and
1095authorizing statutes until compliance with this part,
1096authorizing statutes, and agency rules has been demonstrated to
1097the satisfaction of the agency.
1098     (3)  Any person or entity that owns, operates, or maintains
1099an unlicensed provider and that, after receiving notification
1100from the agency, fails to cease operation and apply for a
1101license under this part and authorizing statutes commits a
1102felony of the third degree, punishable as provided in s.
1103775.082, s. 775.083, or s. 775.084. Each day of continued
1104operation is a separate offense.
1105     (4)  Any person or entity found who violates subsection (3)
1106a second or subsequent time commits a felony of the second
1107degree, punishable as provided in s. 775.082, s. 775.083, or s.
1108775.084. Each day of continued operation is a separate offense.
1109     (5)  Any person or entity that fails to cease operation
1110after agency notification may be fined $1,000 for each day of
1111noncompliance.
1112     (6)  When a controlling interest or licensee has an
1113interest in more than one provider and fails to license a
1114provider rendering services that require licensure, the agency
1115may revoke all licenses, impose actions under s. 408.814, and
1116impose a fine of $1,000 per day unless otherwise specified by
1117authorizing statutes against each licensee until such time as
1118the appropriate license is obtained for the unlicensed
1119operation.
1120     (7)  In addition to granting injunctive relief pursuant to
1121subsection (2), if the agency determines that a person or entity
1122is operating or maintaining a provider without obtaining a
1123license and determines that a condition exists that poses a
1124threat to the health, safety, or welfare of a client of the
1125provider, the person or entity is subject to the same actions
1126and fines imposed against a licensee as specified in this part,
1127authorizing statutes, and agency rules.
1128     (8)  Any person aware of the operation of an unlicensed
1129provider must report that provider to the agency.
1130     408.813  Administrative fines.--As a penalty for any
1131violation of this part, authorizing statutes, or applicable
1132rules, the agency may impose an administrative fine. Unless the
1133amount of the fine is prescribed by authorizing statutes or
1134applicable rules, the agency may establish criteria by rule for
1135the amount of administrative fines applicable to this part,
1136authorizing statutes, and applicable rules. Each day of
1137violation constitutes a separate violation and is subject to a
1138separate fine. For fines imposed by final order of the agency
1139and not subject to further appeal, the violator shall pay the
1140fine plus interest at the rate specified in s. 55.03 for each
1141day beyond the date set by the agency for payment of the fine.
1142     408.814  Moratoriums; emergency suspensions.--
1143     (1)  The agency may impose an immediate moratorium or
1144emergency suspension as defined in s. 120.60 on any provider if
1145the agency determines that any condition related to the provider
1146or licensee presents a threat to the health, safety, or welfare
1147of a client.
1148     (2)  A provider or licensee, the license of which is denied
1149or revoked, may be subject to immediate imposition of a
1150moratorium or emergency suspension to run concurrently with
1151licensure denial, revocation, or injunction.
1152     (3)  A moratorium or emergency suspension remains in effect
1153after a change of ownership, unless the agency has determined
1154that the conditions that created the moratorium, emergency
1155suspension, or denial of licensure have been corrected.
1156     (4)  When a moratorium or emergency suspension is placed on
1157a provider or licensee, notice of the action shall be posted and
1158visible to the public at the location of the provider until the
1159action is lifted.
1160     408.815  License or application denial; revocation.--
1161     (1)  In addition to the grounds provided in authorizing
1162statutes, grounds that may be used by the agency for denying and
1163revoking a license or change-of-ownership application include
1164any of the following actions by a controlling interest:
1165     (a)  False representation of a material fact in the license
1166application or intentional omission of any material fact from
1167the application.
1168     (b)  An intentional or negligent act materially affecting
1169the health or safety of a client of the provider.
1170     (c)  A violation of this part, authorizing statutes, or
1171applicable rules.
1172     (d)  A demonstrated pattern of deficient performance.
1173     (e)  The applicant, licensee, or controlling interest has
1174been or is currently excluded, suspended, terminated from
1175participation in the state Medicaid program, the Medicaid
1176program of any other state, or the Medicare program.
1177     (2)  If a licensee lawfully continues to operate while a
1178denial or revocation is pending in litigation, the licensee must
1179continue to meet all other requirements of this part,
1180authorizing statutes, and applicable rules and must file
1181subsequent renewal applications for licensure and pay all
1182licensure fees. The provisions of ss. 120.60(1) and
1183408.806(3)(c) shall not apply to renewal applications filed
1184during the time period in which the litigation of the denial or
1185revocation is pending until that litigation is final.
1186     (3)  An action under s. 408.814 or denial of the license of
1187the transferor may be grounds for denial of a change-of-
1188ownership application of the transferee.
1189     408.816  Injunctions.--
1190     (1)  In addition to the other powers provided by this part
1191and authorizing statutes, the agency may institute injunction
1192proceedings in a court of competent jurisdiction to:
1193     (a)  Restrain or prevent the establishment or operation of
1194a provider that does not have a license or is in violation of
1195any provision of this part, authorizing statutes, or applicable
1196rules. The agency may also institute injunction proceedings in a
1197court of competent jurisdiction when a violation of this part,
1198authorizing statutes, or applicable rules constitutes an
1199emergency affecting the immediate health and safety of a client.
1200     (b)  Enforce the provisions of this part, authorizing
1201statutes, or any minimum standard, rule, or order issued or
1202entered into pursuant thereto when the attempt by the agency to
1203correct a violation through administrative sanctions has failed
1204or when the violation materially affects the health, safety, or
1205welfare of clients or involves any operation of an unlicensed
1206provider.
1207     (c)  Terminate the operation of a provider when a violation
1208of any provision of this part, authorizing statutes, or any
1209standard or rule adopted pursuant thereto exists that materially
1210affects the health, safety, or welfare of clients.
1211
1212Such injunctive relief may be temporary or permanent.
1213     (2)  If action is necessary to protect clients of providers
1214from immediate, life-threatening situations, the court may allow
1215a temporary injunction without bond upon proper proof being
1216made. If it appears by competent evidence or a sworn,
1217substantiated affidavit that a temporary injunction should be
1218issued, the court, pending the determination on final hearing,
1219shall enjoin the operation of the provider.
1220     408.817  Administrative proceedings.--Administrative
1221proceedings challenging agency licensure enforcement action
1222shall be reviewed on the basis of the facts and conditions that
1223resulted in the agency action.
1224     408.818  Health Care Trust Fund.--Unless otherwise
1225prescribed by authorizing statutes, all fees and fines collected
1226under this part, authorizing statutes, and applicable rules
1227shall be deposited into the Health Care Trust Fund, created in
1228s. 408.16, and used to pay the costs of the agency in
1229administering the provider program paying the fees or fines.
1230     408.819  Rules.--The agency is authorized to adopt rules as
1231necessary to administer this part. Any licensed provider that is
1232in operation at the time of adoption of any applicable rule
1233under this part or authorizing statutes shall be given a
1234reasonable time under the particular circumstances, not to
1235exceed 6 months after the date of such adoption, within which to
1236comply with such rule, unless otherwise specified by rule.
1237     Section 6.  Subsections (12) and (17) and paragraph (a) of
1238subsection (13) of section 112.0455, Florida Statutes, are
1239amended to read:
1240     112.0455  Drug-Free Workplace Act.--
1241     (12)  DRUG-TESTING STANDARDS; LABORATORIES.--
1242     (a)  The requirements of part II of chapter 408 shall apply
1243to the provision of services that require licensure pursuant to
1244this section and part II of chapter 408 and to entities licensed
1245by or applying for such licensure from the Agency for Health
1246Care Administration pursuant to this section.
1247     (b)(a)  A laboratory may analyze initial or confirmation
1248drug specimens only if:
1249     1.  The laboratory is licensed and approved by the Agency
1250for Health Care Administration using criteria established by the
1251United States Department of Health and Human Services as general
1252guidelines for modeling the state drug testing program and in
1253accordance with part II of chapter 408. Each applicant for
1254licensure and licensee must comply with all requirements of part
1255II of chapter 408 except s. 408.810(5)-(10). the following
1256requirements:
1257     a.  Upon receipt of a completed, signed, and dated
1258application, the agency shall require background screening, in
1259accordance with the level 2 standards for screening set forth in
1260chapter 435, of the managing employee, or other similarly titled
1261individual responsible for the daily operation of the
1262laboratory, and of the financial officer, or other similarly
1263titled individual who is responsible for the financial operation
1264of the laboratory, including billings for services. The
1265applicant must comply with the procedures for level 2 background
1266screening as set forth in chapter 435, as well as the
1267requirements of s. 435.03(3).
1268     b.  The agency may require background screening of any
1269other individual who is an applicant if the agency has probable
1270cause to believe that he or she has been convicted of an offense
1271prohibited under the level 2 standards for screening set forth
1272in chapter 435.
1273     c.  Proof of compliance with the level 2 background
1274screening requirements of chapter 435 which has been submitted
1275within the previous 5 years in compliance with any other health
1276care licensure requirements of this state is acceptable in
1277fulfillment of screening requirements.
1278     d.  A provisional license may be granted to an applicant
1279when each individual required by this section to undergo
1280background screening has met the standards for the Department of
1281Law Enforcement background check, but the agency has not yet
1282received background screening results from the Federal Bureau of
1283Investigation, or a request for a disqualification exemption has
1284been submitted to the agency as set forth in chapter 435, but a
1285response has not yet been issued. A license may be granted to
1286the applicant upon the agency's receipt of a report of the
1287results of the Federal Bureau of Investigation background
1288screening for each individual required by this section to
1289undergo background screening which confirms that all standards
1290have been met, or upon the granting of a disqualification
1291exemption by the agency as set forth in chapter 435. Any other
1292person who is required to undergo level 2 background screening
1293may serve in his or her capacity pending the agency's receipt of
1294the report from the Federal Bureau of Investigation. However,
1295the person may not continue to serve if the report indicates any
1296violation of background screening standards and a
1297disqualification exemption has not been requested of and granted
1298by the agency as set forth in chapter 435.
1299     e.  Each applicant must submit to the agency, with its
1300application, a description and explanation of any exclusions,
1301permanent suspensions, or terminations of the applicant from the
1302Medicare or Medicaid programs. Proof of compliance with the
1303requirements for disclosure of ownership and control interests
1304under the Medicaid or Medicare programs shall be accepted in
1305lieu of this submission.
1306     f.  Each applicant must submit to the agency a description
1307and explanation of any conviction of an offense prohibited under
1308the level 2 standards of chapter 435 by a member of the board of
1309directors of the applicant, its officers, or any individual
1310owning 5 percent or more of the applicant. This requirement does
1311not apply to a director of a not-for-profit corporation or
1312organization if the director serves solely in a voluntary
1313capacity for the corporation or organization, does not regularly
1314take part in the day-to-day operational decisions of the
1315corporation or organization, receives no remuneration for his or
1316her services on the corporation or organization's board of
1317directors, and has no financial interest and has no family
1318members with a financial interest in the corporation or
1319organization, provided that the director and the not-for-profit
1320corporation or organization include in the application a
1321statement affirming that the director's relationship to the
1322corporation satisfies the requirements of this sub-subparagraph.
1323     g.  A license may not be granted to any applicant if the
1324applicant or managing employee has been found guilty of,
1325regardless of adjudication, or has entered a plea of nolo
1326contendere or guilty to, any offense prohibited under the level
13272 standards for screening set forth in chapter 435, unless an
1328exemption from disqualification has been granted by the agency
1329as set forth in chapter 435.
1330     h.  The agency may deny or revoke licensure if the
1331applicant:
1332     (I)  Has falsely represented a material fact in the
1333application required by sub-subparagraph e. or sub-subparagraph
1334f., or has omitted any material fact from the application
1335required by sub-subparagraph e. or sub-subparagraph f.; or
1336     (II)  Has had prior action taken against the applicant
1337under the Medicaid or Medicare program as set forth in sub-
1338subparagraph e.
1339     i.  An application for license renewal must contain the
1340information required under sub-subparagraphs e. and f.
1341     2.  The laboratory has written procedures to ensure chain
1342of custody.
1343     3.  The laboratory follows proper quality control
1344procedures, including, but not limited to:
1345     a.  The use of internal quality controls including the use
1346of samples of known concentrations which are used to check the
1347performance and calibration of testing equipment, and periodic
1348use of blind samples for overall accuracy.
1349     b.  An internal review and certification process for drug
1350test results, conducted by a person qualified to perform that
1351function in the testing laboratory.
1352     c.  Security measures implemented by the testing laboratory
1353to preclude adulteration of specimens and drug test results.
1354     d.  Other necessary and proper actions taken to ensure
1355reliable and accurate drug test results.
1356     (c)(b)  A laboratory shall disclose to the employer a
1357written test result report within 7 working days after receipt
1358of the sample. All laboratory reports of a drug test result
1359shall, at a minimum, state:
1360     1.  The name and address of the laboratory which performed
1361the test and the positive identification of the person tested.
1362     2.  Positive results on confirmation tests only, or
1363negative results, as applicable.
1364     3.  A list of the drugs for which the drug analyses were
1365conducted.
1366     4.  The type of tests conducted for both initial and
1367confirmation tests and the minimum cutoff levels of the tests.
1368     5.  Any correlation between medication reported by the
1369employee or job applicant pursuant to subparagraph (8)(b)2. and
1370a positive confirmed drug test result.
1371
1372No report shall disclose the presence or absence of any drug
1373other than a specific drug and its metabolites listed pursuant
1374to this section.
1375     (d)(c)  The laboratory shall submit to the Agency for
1376Health Care Administration a monthly report with statistical
1377information regarding the testing of employees and job
1378applicants. The reports shall include information on the methods
1379of analyses conducted, the drugs tested for, the number of
1380positive and negative results for both initial and confirmation
1381tests, and any other information deemed appropriate by the
1382Agency for Health Care Administration. No monthly report shall
1383identify specific employees or job applicants.
1384     (e)(d)  Laboratories shall provide technical assistance to
1385the employer, employee, or job applicant for the purpose of
1386interpreting any positive confirmed test results which could
1387have been caused by prescription or nonprescription medication
1388taken by the employee or job applicant.
1389     (13)  RULES.--
1390     (a)  The Agency for Health Care Administration may adopt
1391additional rules to support this law and part II of chapter 408,
1392using criteria established by the United States Department of
1393Health and Human Services as general guidelines for modeling
1394drug-free workplace laboratories the state drug-testing program,
1395concerning, but not limited to:
1396     1.  Standards for drug-testing laboratory licensing and
1397denial, suspension, and revocation of a license.
1398     2.  Urine, hair, blood, and other body specimens and
1399minimum specimen amounts which are appropriate for drug testing,
1400not inconsistent with other provisions established by law.
1401     3.  Methods of analysis and procedures to ensure reliable
1402drug-testing results, including standards for initial tests and
1403confirmation tests, not inconsistent with other provisions
1404established by law.
1405     4.  Minimum cutoff detection levels for drugs or their
1406metabolites for the purposes of determining a positive test
1407result, not inconsistent with other provisions established by
1408law.
1409     5.  Chain-of-custody procedures to ensure proper
1410identification, labeling, and handling of specimens being
1411tested, not inconsistent with other provisions established by
1412law.
1413     6.  Retention, storage, and transportation procedures to
1414ensure reliable results on confirmation tests and retests.
1415     7.  A list of the most common medications by brand name or
1416common name, as applicable, as well as by chemical name, which
1417may alter or affect a drug test.
1418
1419This section shall not be construed to eliminate the bargainable
1420rights as provided in the collective bargaining process where
1421applicable.
1422     (17)  LICENSE FEE.--Fees from licensure of drug-testing
1423laboratories shall be sufficient to carry out the
1424responsibilities of the Agency for Health Care Administration
1425for the regulation of drug-testing laboratories. In accordance
1426with s. 408.805, applicants and licensees shall pay a fee for
1427each license application submitted under this part, part II of
1428chapter 408, and applicable rules. The fee shall be not less
1429than $16,000 or more than $20,000 per biennium and shall be
1430established by rule. The Agency for Health Care Administration
1431shall collect fees for all licenses issued under this part. Each
1432nonrefundable fee shall be due at the time of application and
1433shall be payable to the Agency for Health Care Administration to
1434be deposited in a trust fund administered by the Agency for
1435Health Care Administration and used only for the purposes of
1436this section. The fee schedule is as follows: For licensure as a
1437drug-testing laboratory, an annual fee of not less than $8,000
1438or more than $10,000 per fiscal year; for late filing of an
1439application for renewal, an additional fee of $500 per day shall
1440be charged.
1441     Section 7.  Subsection (7) of section 381.0303, Florida
1442Statutes, is amended to read:
1443     381.0303  Health practitioner recruitment for special needs
1444shelters.--
1445     (7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
1446of emergency management plans to county health departments by
1447home health agencies pursuant to s. 400.497(8)(c) and (d) and by
1448nurse registries pursuant to s. 400.506(11)(16)(e) and by
1449hospice programs pursuant to s. 400.610(1)(b) is conditional
1450upon the receipt of an appropriation by the department to
1451establish medical services disaster coordinator positions in
1452county health departments unless the secretary of the department
1453and a local county commission jointly determine to require such
1454plans to be submitted based on a determination that there is a
1455special need to protect public health in the local area during
1456an emergency.
1457     Section 8.  Paragraph (b) of subsection (4) of section
1458381.78, Florida Statutes, is amended to read:
1459     381.78  Advisory council on brain and spinal cord
1460injuries.--
1461     (4)  The council shall:
1462     (b)  Annually appoint a five-member committee composed of
1463one individual who has a brain injury or has a family member
1464with a brain injury, one individual who has a spinal cord injury
1465or has a family member with a spinal cord injury, and three
1466members who shall be chosen from among these representative
1467groups: physicians, other allied health professionals,
1468administrators of brain and spinal cord injury programs, and
1469representatives from support groups with expertise in areas
1470related to the rehabilitation of individuals who have brain or
1471spinal cord injuries, except that one and only one member of the
1472committee shall be an administrator of a transitional living
1473facility. Membership on the council is not a prerequisite for
1474membership on this committee.
1475     1.  The committee shall perform onsite visits to those
1476transitional living facilities identified by the Agency for
1477Health Care Administration as being in possible violation of the
1478statutes and rules regulating such facilities. The committee
1479members have the same rights of entry and inspection granted
1480under s. 400.805(4)(8) to designated representatives of the
1481agency.
1482     2.  Factual findings of the committee resulting from an
1483onsite investigation of a facility pursuant to subparagraph 1.
1484shall be adopted by the agency in developing its administrative
1485response regarding enforcement of statutes and rules regulating
1486the operation of the facility.
1487     3.  Onsite investigations by the committee shall be funded
1488by the Health Care Trust Fund.
1489     4.  Travel expenses for committee members shall be
1490reimbursed in accordance with s. 112.061.
1491     5.  Members of the committee shall recuse themselves from
1492participating in any investigation that would create a conflict
1493of interest under state law, and the council shall replace the
1494member, either temporarily or permanently.
1495     Section 9.  Section 383.301, Florida Statutes, is amended
1496to read:
1497     383.301  Licensure and regulation of birth centers;
1498legislative intent.--It is the intent of the Legislature to
1499provide for the protection of public health and safety in the
1500establishment, maintenance, and operation of birth centers by
1501providing for licensure of birth centers and for the
1502development, establishment, and enforcement of minimum standards
1503with respect to birth centers. The requirements of part II of
1504chapter 408 shall apply to the provision of services that
1505require licensure pursuant to ss. 383.30-383.335 and part II of
1506chapter 408 and to entities licensed by or applying for such
1507licensure from the Agency for Health Care Administration
1508pursuant to ss. 383.30-383.335.
1509     Section 10.  Section 383.304, Florida Statutes, is
1510repealed.
1511     Section 11.  Section 383.305, Florida Statutes, is amended
1512to read:
1513     383.305  Licensure; issuance, renewal, denial, suspension,
1514revocation; fees; background screening.--
1515     (1)(a)  In accordance with s. 408.805, an applicant or a
1516licensee shall pay a fee for each license application submitted
1517under ss. 383.30-383.335 and part II of chapter 408. The amount
1518of the fee shall be established by rule. Upon receipt of an
1519application for a license and the license fee, the agency shall
1520issue a license if the applicant and facility have received all
1521approvals required by law and meet the requirements established
1522under ss. 383.30-383.335 and by rules promulgated hereunder.
1523     (b)  A provisional license may be issued to any birth
1524center that is in substantial compliance with ss. 383.30-383.335
1525and with the rules of the agency. A provisional license may be
1526granted for a period of no more than 1 year from the effective
1527date of rules adopted by the agency, shall expire automatically
1528at the end of its term, and may not be renewed.
1529     (c)  A license, unless sooner suspended or revoked,
1530automatically expires 1 year from its date of issuance and is
1531renewable upon application for renewal and payment of the fee
1532prescribed, provided the applicant and the birth center meet the
1533requirements established under ss. 383.30-383.335 and by rules
1534promulgated hereunder. A complete application for renewal of a
1535license shall be made 90 days prior to expiration of the license
1536on forms provided by the agency.
1537     (2)  An application for a license, or renewal thereof,
1538shall be made to the agency upon forms provided by it and shall
1539contain such information as the agency reasonably requires,
1540which may include affirmative evidence of ability to comply with
1541applicable laws and rules.
1542     (3)(a)  Each application for a birth center license, or
1543renewal thereof, shall be accompanied by a license fee. Fees
1544shall be established by rule of the agency. Such fees are
1545payable to the agency and shall be deposited in a trust fund
1546administered by the agency, to be used for the sole purpose of
1547carrying out the provisions of ss. 383.30-383.335.
1548     (b)  The fees established pursuant to ss. 383.30-383.335
1549shall be based on actual costs incurred by the agency in the
1550administration of its duties under such sections.
1551     (4)  Each license is valid only for the person or
1552governmental unit to whom or which it is issued; is not subject
1553to sale, assignment, or other transfer, voluntary or
1554involuntary; and is not valid for any premises other than those
1555for which it was originally issued.
1556     (5)  Each license shall be posted in a conspicuous place on
1557the licensed premises.
1558     (6)  Whenever the agency finds that there has been a
1559substantial failure to comply with the requirements established
1560under ss. 383.30-383.335 or in rules adopted under those
1561sections, it is authorized to deny, suspend, or revoke a
1562license.
1563     (2)(7)  Each applicant for licensure and each licensee must
1564comply with the following requirements of part II of chapter 408
1565except s. 408.810(7)-(10).:
1566     (a)  Upon receipt of a completed, signed, and dated
1567application, the agency shall require background screening, in
1568accordance with the level 2 standards for screening set forth in
1569chapter 435, of the managing employee, or other similarly titled
1570individual who is responsible for the daily operation of the
1571center, and of the financial officer, or other similarly titled
1572individual who is responsible for the financial operation of the
1573center, including billings for patient care and services. The
1574applicant must comply with the procedures for level 2 background
1575screening as set forth in chapter 435 as well as the
1576requirements of s. 435.03(3).
1577     (b)  The agency may require background screening of any
1578other individual who is an applicant if the agency has probable
1579cause to believe that he or she has been convicted of a crime or
1580has committed any other offense prohibited under the level 2
1581standards for screening set forth in chapter 435.
1582     (c)  Proof of compliance with the level 2 background
1583screening requirements of chapter 435 which has been submitted
1584within the previous 5 years in compliance with any other health
1585care licensure requirements of this state is acceptable in
1586fulfillment of the requirements of paragraph (a).
1587     (d)  A provisional license may be granted to an applicant
1588when each individual required by this section to undergo
1589background screening has met the standards for the Department of
1590Law Enforcement background check, but the agency has not yet
1591received background screening results from the Federal Bureau of
1592Investigation, or a request for a disqualification exemption has
1593been submitted to the agency as set forth in chapter 435 but a
1594response has not yet been issued. A standard license may be
1595granted to the applicant upon the agency's receipt of a report
1596of the results of the Federal Bureau of Investigation background
1597screening for each individual required by this section to
1598undergo background screening which confirms that all standards
1599have been met, or upon the granting of a disqualification
1600exemption by the agency as set forth in chapter 435. Any other
1601person who is required to undergo level 2 background screening
1602may serve in his or her capacity pending the agency's receipt of
1603the report from the Federal Bureau of Investigation. However,
1604the person may not continue to serve if the report indicates any
1605violation of background screening standards and a
1606disqualification exemption has not been requested of and granted
1607by the agency as set forth in chapter 435.
1608     (e)  Each applicant must submit to the agency, with its
1609application, a description and explanation of any exclusions,
1610permanent suspensions, or terminations of the applicant from the
1611Medicare or Medicaid programs. Proof of compliance with the
1612requirements for disclosure of ownership and control interests
1613under the Medicaid or Medicare programs shall be accepted in
1614lieu of this submission.
1615     (f)  Each applicant must submit to the agency a description
1616and explanation of any conviction of an offense prohibited under
1617the level 2 standards of chapter 435 by a member of the board of
1618directors of the applicant, its officers, or any individual
1619owning 5 percent or more of the applicant. This requirement does
1620not apply to a director of a not-for-profit corporation or
1621organization if the director serves solely in a voluntary
1622capacity for the corporation or organization, does not regularly
1623take part in the day-to-day operational decisions of the
1624corporation or organization, receives no remuneration for his or
1625her services on the corporation or organization's board of
1626directors, and has no financial interest and has no family
1627members with a financial interest in the corporation or
1628organization, provided that the director and the not-for-profit
1629corporation or organization include in the application a
1630statement affirming that the director's relationship to the
1631corporation satisfies the requirements of this paragraph.
1632     (g)  A license may not be granted to an applicant if the
1633applicant or managing employee has been found guilty of,
1634regardless of adjudication, or has entered a plea of nolo
1635contendere or guilty to, any offense prohibited under the level
16362 standards for screening set forth in chapter 435, unless an
1637exemption from disqualification has been granted by the agency
1638as set forth in chapter 435.
1639     (h)  The agency may deny or revoke licensure if the
1640applicant:
1641     1.  Has falsely represented a material fact in the
1642application required by paragraph (e) or paragraph (f), or has
1643omitted any material fact from the application required by
1644paragraph (e) or paragraph (f); or
1645     2.  Has had prior action taken against the applicant under
1646the Medicaid or Medicare program as set forth in paragraph (e).
1647     (i)  An application for license renewal must contain the
1648information required under paragraphs (e) and (f).
1649     Section 12.  Section 383.309, Florida Statutes, is amended
1650to read:
1651     383.309  Minimum standards for birth centers; rules and
1652enforcement.--
1653     (1)  The agency shall adopt and enforce rules to administer
1654ss. 383.30-383.335 and part II of chapter 408, which rules shall
1655include, but are not limited to, reasonable and fair minimum
1656standards for ensuring that:
1657     (a)  Sufficient numbers and qualified types of personnel
1658and occupational disciplines are available at all times to
1659provide necessary and adequate patient care and safety.
1660     (b)  Infection control, housekeeping, sanitary conditions,
1661disaster plan, and medical record procedures that will
1662adequately protect patient care and provide safety are
1663established and implemented.
1664     (c)  Licensed facilities are established, organized, and
1665operated consistent with established programmatic standards.
1666     (2)  Any licensed facility that is in operation at the time
1667of adoption of any applicable rule under ss. 383.30-383.335
1668shall be given a reasonable time under the particular
1669circumstances, not to exceed 1 year after the date of such
1670adoption, within which to comply with such rule.
1671     (2)(3)  The agency may not establish any rule governing the
1672design, construction, erection, alteration, modification,
1673repair, or demolition of birth centers. It is the intent of the
1674Legislature to preempt that function to the Florida Building
1675Commission and the State Fire Marshal through adoption and
1676maintenance of the Florida Building Code and the Florida Fire
1677Prevention Code. However, the agency shall provide technical
1678assistance to the commission and the State Fire Marshal in
1679updating the construction standards of the Florida Building Code
1680and the Florida Fire Prevention Code which govern birth centers.
1681In addition, the agency may enforce the special-occupancy
1682provisions of the Florida Building Code and the Florida Fire
1683Prevention Code which apply to birth centers in conducting any
1684inspection authorized under this chapter.
1685     Section 13.  Subsection (1) of section 383.315, Florida
1686Statutes, is amended to read:
1687     383.315  Agreements with consultants for advice or
1688services; maintenance.--
1689     (1)  A birth center shall maintain in writing a
1690consultation agreement, signed within the current license period
1691year, with each consultant who has agreed to provide advice and
1692services to the birth center as requested.
1693     Section 14.  Section 383.324, Florida Statutes, is amended
1694to read:
1695     383.324  Inspections and investigations; Inspection fees.--
1696     (1)  The agency shall make or cause to be made such
1697inspections and investigations as it deems necessary.
1698     (2)  Each facility licensed under s. 383.305 shall pay to
1699the agency, at the time of inspection, an inspection fee
1700established by rule of the agency.
1701     (3)  The agency shall coordinate all periodic inspections
1702for licensure made by the agency to ensure that the cost to the
1703facility of such inspections and the disruption of services by
1704such inspections is minimized.
1705     Section 15.  Section 383.325, Florida Statutes, is
1706repealed.
1707     Section 16.  Section 383.33, Florida Statutes, is amended
1708to read:
1709     383.33  Administrative fines penalties; emergency orders;
1710moratorium on admissions.--
1711     (1)(a)  In addition to the requirements of part II of
1712chapter 408, the agency may deny, revoke, or suspend a license,
1713or impose an administrative fine not to exceed $500 per
1714violation per day, for the violation of any provision of ss.
1715383.30-383.335, part II of chapter 408, or applicable rules or
1716any rule adopted under ss. 383.30-383.335. Each day of violation
1717constitutes a separate violation and is subject to a separate
1718fine.
1719     (2)(b)  In determining the amount of the fine to be levied
1720for a violation, as provided in subsection (1) paragraph (a),
1721the following factors shall be considered:
1722     (a)1.  The severity of the violation, including the
1723probability that death or serious harm to the health or safety
1724of any person will result or has resulted; the severity of the
1725actual or potential harm; and the extent to which the provisions
1726of ss. 383.30-383.335, part II of chapter 408, or applicable
1727rules were violated.
1728     (b)2.  Actions taken by the licensee to correct the
1729violations or to remedy complaints.
1730     (c)3.  Any previous violations by the licensee.
1731     (c)  All amounts collected pursuant to this section shall
1732be deposited into a trust fund administered by the agency to be
1733used for the sole purpose of carrying out the provisions of ss.
1734383.30-383.335.
1735     (2)  The agency may issue an emergency order immediately
1736suspending or revoking a license when it determines that any
1737condition in the licensed facility presents a clear and present
1738danger to the public health and safety.
1739     (3)  The agency may impose an immediate moratorium on
1740elective admissions to any licensed facility, building or
1741portion thereof, or service when the agency determines that any
1742condition in the facility presents a threat to the public health
1743or safety.
1744     Section 17.  Section 383.331, Florida Statutes, is
1745repealed.
1746     Section 18.  Section 383.332, Florida Statutes, is
1747repealed.
1748     Section 19.  Subsection (1) of section 383.335, Florida
1749Statutes, is amended to read:
1750     383.335  Partial exemptions.--
1751     (1)  Any facility that which was providing obstetrical and
1752gynecological surgical services and was owned and operated by a
1753board-certified obstetrician on June 15, 1984, and that which is
1754otherwise subject to licensure under ss. 383.30-383.335 as a
1755birth center, is exempt from the provisions of ss. 383.30-
1756383.335 and part II of chapter 408 which restrict the provision
1757of surgical services and outlet forceps delivery and the
1758administration of anesthesia at birth centers. The agency shall
1759adopt rules specifically related to the performance of such
1760services and the administration of anesthesia at such
1761facilities.
1762     Section 20.  Subsection (4) of section 383.50, Florida
1763Statutes, is amended to read:
1764     383.50  Treatment of abandoned newborn infant.--
1765     (4)  Each hospital of this state subject to s. 395.1041
1766shall, and any other hospital may, admit and provide all
1767necessary emergency services and care, as defined in s.
1768395.002(9)(10), to any newborn infant left with the hospital in
1769accordance with this section. The hospital or any of its
1770licensed health care professionals shall consider these actions
1771as implied consent for treatment, and a hospital accepting
1772physical custody of a newborn infant has implied consent to
1773perform all necessary emergency services and care. The hospital
1774or any of its licensed health care professionals is immune from
1775criminal or civil liability for acting in good faith in
1776accordance with this section. Nothing in this subsection limits
1777liability for negligence.
1778     Section 21.  Subsection (5) of section 390.011, Florida
1779Statutes, is amended to read:
1780     390.011  Definitions.--As used in this chapter, the term:
1781     (5)  "Hospital" means a facility as defined in s. 395.002
1782and licensed under chapter 395.
1783     Section 22.  Subsection (1) of section 390.012, Florida
1784Statutes, is amended to read:
1785     390.012  Powers of agency; rules; disposal of fetal
1786remains.--
1787     (1)  The agency may shall have the authority to develop and
1788enforce rules pursuant to ss. 390.001-390.018 and part II of
1789chapter 408 for the health, care, and treatment of persons in
1790abortion clinics and for the safe operation of such clinics.
1791These rules shall be comparable to rules which apply to all
1792surgical procedures requiring approximately the same degree of
1793skill and care as the performance of first trimester abortions.
1794The rules shall be reasonably related to the preservation of
1795maternal health of the clients. The rules shall not impose a
1796legally significant burden on a woman's freedom to decide
1797whether to terminate her pregnancy. The rules shall provide for:
1798     (a)  The performance of pregnancy termination procedures
1799only by a licensed physician.
1800     (b)  The making, protection, and preservation of patient
1801records, which shall be treated as medical records under chapter
1802458.
1803     Section 23.  Section 390.013, Florida Statutes, is
1804repealed.
1805     Section 24.  Section 390.014, Florida Statutes, is amended
1806to read:
1807     390.014  Licenses; fees, display, etc.--
1808     (1)  The requirements of part II of chapter 408 shall apply
1809to the provision of services that require licensure pursuant to
1810ss. 390.011-390.018 and part II of chapter 408 and to entities
1811licensed by or applying for such licensure from the Agency for
1812Health Care Administration pursuant to ss. 390.011-390.018.
1813However, each applicant for licensure and each licensee is
1814exempt from s. 408.810(7)-(10). No abortion clinic shall operate
1815in this state without a currently effective license issued by
1816the agency.
1817     (2)  A separate license shall be required for each clinic
1818maintained on separate premises, even though it is operated by
1819the same management as another clinic; but a separate license
1820shall not be required for separate buildings on the same
1821premises.
1822     (3)  In accordance with s. 408.805, an applicant or
1823licensee shall pay a fee for each license application submitted
1824under this part and part II of chapter 408. The amount of the
1825fee shall be established by rule and The annual license fee
1826required for a clinic shall be nonrefundable and shall be
1827reasonably calculated to cover the cost of regulation under this
1828chapter, but may not be less than $70 or $35 nor more than $500
1829per biennium $250.
1830     (4)  Counties and municipalities applying for licenses
1831under this act shall be exempt from the payment of the license
1832fees.
1833     (5)  The license shall be displayed in a conspicuous place
1834inside the clinic.
1835     (6)  A license shall be valid only for the clinic to which
1836it is issued, and it shall not be subject to sale, assignment,
1837or other transfer, voluntary or involuntary. No license shall be
1838valid for any premises other than those for which it was
1839originally issued.
1840     Section 25.  Section 390.015, Florida Statutes, is
1841repealed.
1842     Section 26.  Section 390.016, Florida Statutes, is
1843repealed.
1844     Section 27.  Section 390.017, Florida Statutes, is
1845repealed.
1846     Section 28.  Section 390.018, Florida Statutes, is amended
1847to read:
1848     390.018  Administrative fine penalty in lieu of revocation
1849or suspension.--In addition to the requirements of part II of
1850chapter 408 If the agency finds that one or more grounds exist
1851for the revocation or suspension of a license issued to an
1852abortion clinic, the agency may, in lieu of such suspension or
1853revocation, impose a fine upon the clinic in an amount not to
1854exceed $1,000 for each violation of any provision this part,
1855part II of chapter 408, or applicable rules. The fine shall be
1856paid to the agency within 60 days from the date of entry of the
1857administrative order. If the licensee fails to pay the fine in
1858its entirety to the agency within the period allowed, the
1859license of the licensee shall stand suspended, revoked, or
1860renewal or continuation may be refused, as the case may be, upon
1861expiration of such period and without any further administrative
1862or judicial proceedings.
1863     Section 29.  Section 390.019, Florida Statutes, is
1864repealed.
1865     Section 30.  Section 390.021, Florida Statutes, is
1866repealed.
1867     Section 31.  Subsection (13) of section 394.455, Florida
1868Statutes, is amended to read:
1869     394.455  Definitions.--As used in this part, unless the
1870context clearly requires otherwise, the term:
1871     (13)  "Hospital" means a facility as defined in s. 395.002
1872and licensed under chapter 395.
1873     Section 32.  Subsection (7) of section 394.4787, Florida
1874Statutes, is amended to read:
1875     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
1876and 394.4789.--As used in this section and ss. 394.4786,
1877394.4788, and 394.4789:
1878     (7)  "Specialty psychiatric hospital" means a hospital
1879licensed by the agency pursuant to s. 395.002(28)(29) as a
1880specialty psychiatric hospital.
1881     Section 33.  Subsections (3) through (23) of section
1882394.67, Florida Statutes, are renumbered as subsections (2)
1883through (22), respectively, present subsections (2) and (4) are
1884amended, and a new subsection (23) is added to said section, to
1885read:
1886     394.67  Definitions.--As used in this part, the term:
1887     (2)  "Applicant" means an individual applicant, or any
1888officer, director, agent, managing employee, or affiliated
1889person, or any partner or shareholder having an ownership
1890interest equal to a 5-percent or greater interest in the
1891corporation, partnership, or other business entity.
1892     (3)(4)  "Crisis services" means short-term evaluation,
1893stabilization, and brief intervention services provided to a
1894person who is experiencing an acute mental or emotional crisis,
1895as defined in subsection (17) (18), or an acute substance abuse
1896crisis, as defined in subsection (18) (19), to prevent further
1897deterioration of the person's mental health. Crisis services are
1898provided in settings such as a crisis stabilization unit, an
1899inpatient unit, a short-term residential treatment program, a
1900detoxification facility, or an addictions receiving facility; at
1901the site of the crisis by a mobile crisis response team; or at a
1902hospital on an outpatient basis.
1903     (23)  "Short-term residential treatment facility" means a
1904facility that provides an alternative to inpatient
1905hospitalization and that provides brief, intensive services 24
1906hours a day, 7 days a week for mentally ill individuals who are
1907temporarily in need of a 24-hour-a-day structured therapeutic
1908setting as a less restrictive but longer-term alternative to
1909hospitalization.
1910     Section 34.  Paragraph (a) of subsection (3) of section
1911394.74, Florida Statutes, is amended to read:
1912     394.74  Contracts for provision of local substance abuse
1913and mental health programs.--
1914     (3)  Contracts shall include, but are not limited to:
1915     (a)  A provision that, within the limits of available
1916resources, substance abuse and mental health crisis services, as
1917defined in s. 394.67(3)(4), shall be available to any individual
1918residing or employed within the service area, regardless of
1919ability to pay for such services, current or past health
1920condition, or any other factor;
1921     Section 35.  Subsections (1) and (5) of section 394.82,
1922Florida Statutes, are amended to read:
1923     394.82  Funding of expanded services.--
1924     (1)  Pursuant to the General Appropriations Acts for the
19252001-2002 and 2002-2003 fiscal years, funds appropriated to the
1926Department of Children and Family Services for the purpose of
1927expanding community mental health services must be used to
1928implement programs that emphasize crisis services as defined in
1929s. 394.67(3)(4) and treatment services, rehabilitative services,
1930support services, and case management services, as defined in s.
1931394.67(15)(16). Following the 2002-2003 fiscal year, the
1932Department of Children and Family Services must continue to
1933expand the provision of these community mental health services.
1934     (5)  By January 1, 2004, the crisis services defined in s.
1935394.67(3)(4) shall be implemented, as appropriate, in the
1936state's public community mental health system to serve children
1937and adults who are experiencing an acute mental or emotional
1938crisis, as defined in s. 394.67(17)(18). By January 1, 2006, the
1939mental health services defined in s. 394.67(15)(16) shall be
1940implemented, as appropriate, in the state's public community
1941mental health system to serve adults and older adults who have a
1942severe and persistent mental illness and to serve children who
1943have a serious emotional disturbance or mental illness, as
1944defined in s. 394.492(6).
1945     Section 36.  Section 394.875, Florida Statutes, is amended
1946to read:
1947     394.875  Crisis stabilization units, short-term residential
1948treatment facilities, residential treatment facilities, and
1949residential treatment centers for children and adolescents;
1950authorized services; license required; penalties.--
1951     (1)(a)  The purpose of a crisis stabilization unit is to
1952stabilize and redirect a client to the most appropriate and
1953least restrictive community setting available, consistent with
1954the client's needs. Crisis stabilization units may screen,
1955assess, and admit for stabilization persons who present
1956themselves to the unit and persons who are brought to the unit
1957under s. 394.463. Clients may be provided 24-hour observation,
1958medication prescribed by a physician or psychiatrist, and other
1959appropriate services. Crisis stabilization units shall provide
1960services regardless of the client's ability to pay and shall be
1961limited in size to a maximum of 30 beds.
1962     (b)  The purpose of a short-term residential treatment
1963facility is to provide intensive services in a 24-hour-a-day
1964structured therapeutic setting as a less restrictive but longer-
1965term alternative to hospitalization.
1966     (c)(b)  The purpose of a residential treatment facility is
1967to be a part of a comprehensive treatment program for mentally
1968ill individuals in a community-based residential setting.
1969     (d)(c)  The purpose of a residential treatment center for
1970children and adolescents is to provide mental health assessment
1971and treatment services pursuant to ss. 394.491, 394.495, and
1972394.496 to children and adolescents who meet the target
1973population criteria specified in s. 394.493(1)(a), (b), or (c).
1974     (2)  The requirements of part II of chapter 408 shall apply
1975to the provision of services that require licensure under ss.
1976394.455-394.904 and part II of chapter 408 and to entities
1977licensed by or applying for such licensure from the Agency for
1978Health Care Administration pursuant to ss. 394.455-394.904.
1979However, each applicant for licensure and each licensee is
1980exempt from the provisions of s. 408.810(8)?(10). It is unlawful
1981for any entity to hold itself out as a crisis stabilization
1982unit, a residential treatment facility, or a residential
1983treatment center for children and adolescents, or to act as a
1984crisis stabilization unit, a residential treatment facility, or
1985a residential treatment center for children and adolescents,
1986unless it is licensed by the agency pursuant to this chapter.
1987     (3)  Any person who violates subsection (2) is guilty of a
1988misdemeanor of the first degree, punishable as provided in s.
1989775.082 or s. 775.083.
1990     (4)  The agency may maintain an action in circuit court to
1991enjoin the unlawful operation of a crisis stabilization unit, a
1992residential treatment facility, or a residential treatment
1993center for children and adolescents if the agency first gives
1994the violator 14 days' notice of its intention to maintain such
1995action and if the violator fails to apply for licensure within
1996such 14-day period.
1997     (3)(5)  The following are exempt from licensure as required
1998in ss. 394.455-394.904 Subsection (2) does not apply to:
1999     (a)  Hospitals licensed pursuant to chapter 395 or programs
2000operated within such hospitals. Homes for special services
2001licensed under chapter 400; or
2002     (b)  Nursing homes licensed under chapter 400.
2003     (c)  Comprehensive transitional education programs licensed
2004under s. 393.067.
2005     (4)(6)  The department, in consultation with the agency,
2006may establish multiple license classifications for residential
2007treatment facilities.
2008     (5)(7)  The agency may not issue a license to a crisis
2009stabilization unit unless the unit receives state mental health
2010funds and is affiliated with a designated public receiving
2011facility.
2012     (6)(8)  The agency may issue a license for a crisis
2013stabilization unit or short-term residential treatment facility,
2014certifying the number of authorized beds for such facility as
2015indicated by existing need and available appropriations. The
2016agency may disapprove an application for such a license if it
2017determines that a facility should not be licensed pursuant to
2018the provisions of this chapter. Any facility operating beds in
2019excess of those authorized by the agency shall, upon demand of
2020the agency, reduce the number of beds to the authorized number,
2021forfeit its license, or provide evidence of a license issued
2022pursuant to chapter 395 for the excess beds.
2023     (7)(9)  A children's crisis stabilization unit which does
2024not exceed 20 licensed beds and which provides separate
2025facilities or a distinct part of a facility, separate staffing,
2026and treatment exclusively for minors may be located on the same
2027premises as a crisis stabilization unit serving adults. The
2028department, in consultation with the agency, shall adopt rules
2029governing facility construction, staffing and licensure
2030requirements, and the operation of such units for minors.
2031     (8)(10)  The department, in consultation with the agency,
2032must adopt rules governing a residential treatment center for
2033children and adolescents which specify licensure standards for:
2034admission; length of stay; program and staffing; discharge and
2035discharge planning; treatment planning; seclusion, restraints,
2036and time-out; rights of patients under s. 394.459; use of
2037psychotropic medications; and standards for the operation of
2038such centers.
2039     (9)(11)  Notwithstanding the provisions of subsection (8),
2040crisis stabilization units may not exceed their licensed
2041capacity by more than 10 percent, nor may they exceed their
2042licensed capacity for more than 3 consecutive working days or
2043for more than 7 days in 1 month.
2044     (10)(12)  Notwithstanding the other provisions of this
2045section, any facility licensed under former chapter 396 and
2046chapter 397 for detoxification, residential level I care, and
2047outpatient treatment may elect to license concurrently all of
2048the beds at such facility both for that purpose and as a long-
2049term residential treatment facility pursuant to this section, if
2050all of the following conditions are met:
2051     (a)  The licensure application is received by the
2052department prior to January 1, 1993.
2053     (b)  On January 1, 1993, the facility was licensed under
2054former chapter 396 and chapter 397 as a facility for
2055detoxification, residential level I care, and outpatient
2056treatment of substance abuse.
2057     (c)  The facility restricted its practice to the treatment
2058of law enforcement personnel for a period of at least 12 months
2059beginning after January 1, 1992.
2060     (d)  The number of beds to be licensed under this chapter
2061is equal to or less than the number of beds licensed under
2062former chapter 396 and chapter 397 as of January 1, 1993.
2063     (e)  The licensee agrees in writing to a condition placed
2064upon the license that the facility will limit its treatment
2065exclusively to law enforcement personnel and their immediate
2066families who are seeking admission on a voluntary basis and who
2067are exhibiting symptoms of posttraumatic stress disorder or
2068other mental health problems, including drug or alcohol abuse,
2069which are directly related to law enforcement work and which are
2070amenable to verbal treatment therapies; the licensee agrees to
2071coordinate the provision of appropriate postresidential care for
2072discharged individuals; and the licensee further agrees in
2073writing that a failure to meet any condition specified in this
2074paragraph shall constitute grounds for a revocation of the
2075facility's license as a residential treatment facility.
2076     (f)  The licensee agrees that the facility will meet all
2077licensure requirements for a residential treatment facility,
2078including minimum standards for compliance with lifesafety
2079requirements, except those licensure requirements which are in
2080express conflict with the conditions and other provisions
2081specified in this subsection.
2082     (g)  The licensee agrees that the conditions stated in this
2083subsection must be agreed to in writing by any person acquiring
2084the facility by any means.
2085
2086Any facility licensed under this subsection is not required to
2087provide any services to any persons except those included in the
2088specified conditions of licensure, and is exempt from any
2089requirements related to the 60-day or greater average length of
2090stay imposed on community-based residential treatment facilities
2091otherwise licensed under this chapter.
2092     (13)  Each applicant for licensure must comply with the
2093following requirements:
2094     (a)  Upon receipt of a completed, signed, and dated
2095application, the agency shall require background screening, in
2096accordance with the level 2 standards for screening set forth in
2097chapter 435, of the managing employee and financial officer, or
2098other similarly titled individual who is responsible for the
2099financial operation of the facility, including billings for
2100client care and services. The applicant must comply with the
2101procedures for level 2 background screening as set forth in
2102chapter 435, as well as the requirements of s. 435.03(3).
2103     (b)  The agency may require background screening of any
2104other individual who is an applicant if the agency has probable
2105cause to believe that he or she has been convicted of a crime or
2106has committed any other offense prohibited under the level 2
2107standards for screening set forth in chapter 435.
2108     (c)  Proof of compliance with the level 2 background
2109screening requirements of chapter 435 which has been submitted
2110within the previous 5 years in compliance with any other health
2111care licensure requirements of this state is acceptable in
2112fulfillment of the requirements of paragraph (a).
2113     (d)  A provisional license may be granted to an applicant
2114when each individual required by this section to undergo
2115background screening has met the standards for the Department of
2116Law Enforcement background check, but the agency has not yet
2117received background screening results from the Federal Bureau of
2118Investigation, or a request for a disqualification exemption has
2119been submitted to the agency as set forth in chapter 435, but a
2120response has not yet been issued. A standard license may be
2121granted to the applicant upon the agency's receipt of a report
2122of the results of the Federal Bureau of Investigation background
2123screening for each individual required by this section to
2124undergo background screening which confirms that all standards
2125have been met, or upon the granting of a disqualification
2126exemption by the agency as set forth in chapter 435. Any other
2127person who is required to undergo level 2 background screening
2128may serve in his or her capacity pending the agency's receipt of
2129the report from the Federal Bureau of Investigation. However,
2130the person may not continue to serve if the report indicates any
2131violation of background screening standards and a
2132disqualification exemption has not been requested of and granted
2133by the agency as set forth in chapter 435.
2134     (e)  Each applicant must submit to the agency, with its
2135application, a description and explanation of any exclusions,
2136permanent suspensions, or terminations of the applicant from the
2137Medicare or Medicaid programs. Proof of compliance with the
2138requirements for disclosure of ownership and control interests
2139under the Medicaid or Medicare programs shall be accepted in
2140lieu of this submission.
2141     (f)  Each applicant must submit to the agency a description
2142and explanation of any conviction of an offense prohibited under
2143the level 2 standards of chapter 435 by a member of the board of
2144directors of the applicant, its officers, or any individual
2145owning 5 percent or more of the applicant. This requirement does
2146not apply to a director of a not-for-profit corporation or
2147organization if the director serves solely in a voluntary
2148capacity for the corporation or organization, does not regularly
2149take part in the day-to-day operational decisions of the
2150corporation or organization, receives no remuneration for his or
2151her services on the corporation or organization's board of
2152directors, and has no financial interest and has no family
2153members with a financial interest in the corporation or
2154organization, provided that the director and the not-for-profit
2155corporation or organization include in the application a
2156statement affirming that the director's relationship to the
2157corporation satisfies the requirements of this paragraph.
2158     (g)  A license may not be granted to an applicant if the
2159applicant or managing employee has been found guilty of,
2160regardless of adjudication, or has entered a plea of nolo
2161contendere or guilty to, any offense prohibited under the level
21622 standards for screening set forth in chapter 435, unless an
2163exemption from disqualification has been granted by the agency
2164as set forth in chapter 435.
2165     (h)  The agency may deny or revoke licensure if the
2166applicant:
2167     1.  Has falsely represented a material fact in the
2168application required by paragraph (e) or paragraph (f), or has
2169omitted any material fact from the application required by
2170paragraph (e) or paragraph (f); or
2171     2.  Has had prior action taken against the applicant under
2172the Medicaid or Medicare program as set forth in paragraph (e).
2173     (i)  An application for license renewal must contain the
2174information required under paragraphs (e) and (f).
2175     Section 37.  Section 394.876, Florida Statutes, is
2176repealed.
2177     Section 38.  Section 394.877, Florida Statutes, is amended
2178to read:
2179     394.877  Fees.--
2180     (1)  In accordance with s. 408.805, an applicant or
2181licensee shall pay a fee for each license application submitted
2182under this part, part II of chapter 408, and applicable rules.
2183The amount of the fee shall be established by rule. Each
2184application for licensure or renewal must be accompanied by a
2185fee set by the department, in consultation with the agency, by
2186rule. Such fees shall be reasonably calculated to cover only the
2187cost of regulation under this chapter.
2188     (2)  All fees collected under this section shall be
2189deposited in the Health Care Trust Fund.
2190     Section 39.  Section 394.878, Florida Statutes, is amended
2191to read:
2192     394.878  Issuance and renewal of licenses.--
2193     (1)  Upon review of the application for licensure and
2194receipt of appropriate fees, the agency shall issue an original
2195or renewal license to any applicant that meets the requirements
2196of this chapter.
2197     (2)  A license is valid for a period of 1 year. An
2198applicant for renewal of a license shall apply to the agency no
2199later than 90 days before expiration of the current license.
2200     (3)  A license may not be transferred from one entity to
2201another and is valid only for the premises for which it was
2202originally issued. For the purposes of this subsection,
2203"transfer" includes, but is not limited to, transfer of a
2204majority of the ownership interests in a licensee or transfer of
2205responsibilities under the license to another entity by
2206contractual arrangement.
2207     (4)  Each license shall state the services which the
2208licensee is required or authorized to perform and the maximum
2209residential capacity of the licensed premises.
2210     (1)(5)  The agency may issue a probationary license to an
2211applicant that has completed the application requirements of
2212this chapter but has not, at the time of the application,
2213developed an operational crisis stabilization unit or
2214residential treatment facility. The probationary license shall
2215expire 90 days after issuance and may once be renewed for an
2216additional 90-day period. The agency may cancel a probationary
2217license at any time.
2218     (2)(6)  The agency may issue an interim license to an
2219applicant that has substantially completed all application
2220requirements and has initiated action to fully meet such
2221requirements. The interim license shall expire 90 days after
2222issuance and, in cases of extreme hardship, may once be renewed
2223for an additional 90-day period.
2224     (7)  Any applicant which fails to file an application for
2225license renewal during the 90-day relicensure period shall be
2226considered unlicensed and subject to penalties pursuant to s.
2227394.875.
2228     Section 40.  Subsections (1), (3), and (4) of section
2229394.879, Florida Statutes, are amended to read:
2230     394.879  Rules; enforcement.--
2231     (1)  The agency, in consultation with the department, may
2232adopt rules to implement the requirements of part II of chapter
2233408. The department, in consultation with the agency, shall
2234adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
2235the provisions of this chapter, including, at a minimum, rules
2236providing standards to ensure that:
2237     (a)  Sufficient numbers and types of qualified personnel
2238are on duty and available at all times to provide necessary and
2239adequate client safety and care.
2240     (b)  Adequate space is provided each client of a licensed
2241facility.
2242     (c)  Licensed facilities are limited to an appropriate
2243number of beds.
2244     (d)  Each licensee establishes and implements adequate
2245infection control, housekeeping, sanitation, disaster planning,
2246and medical recordkeeping.
2247     (e)  Licensed facilities are established, organized, and
2248operated in accordance with programmatic standards of the
2249department.
2250     (f)  The operation and purposes of these facilities assure
2251individuals' health, safety, and welfare.
2252     (3)  The department, in consultation with the agency, shall
2253allow any licensed facility in operation at the time of adoption
2254of any rule a reasonable period, not to exceed 1 year, to bring
2255itself into compliance with department rules such rule.
2256     (4)  In accordance with part II of chapter 408, the agency
2257may impose an administrative penalty of no more than $500 per
2258day against any licensee that violates any rule adopted pursuant
2259to this section and may suspend and or revoke the license and or
2260deny the renewal application of such licensee. In imposing such
2261penalty, the agency shall consider the severity of the
2262violation, actions taken by the licensee to correct the
2263violation, and previous violations by the licensee. Fines
2264collected under this subsection shall be deposited in the Mental
2265Health Facility Licensing Trust Fund.
2266     Section 41.  Paragraph (a) of subsection (1) of section
2267394.90, Florida Statutes, is amended to read:
2268     394.90  Inspection; right of entry; records.--
2269     (1)(a)  The department and the agency, in accordance with
2270s. 408.811, may enter and inspect at any time a licensed
2271facility to determine whether the facility is in compliance with
2272this chapter and the applicable rules of the department.
2273     Section 42.  Section 394.902, Florida Statutes, is
2274repealed.
2275     Section 43.  Subsection (7) of section 394.907, Florida
2276Statutes, is amended to read:
2277     394.907  Community mental health centers; quality assurance
2278programs.--
2279     (7)  The department shall have access to all records
2280necessary to determine licensee agency compliance with the
2281provisions of this section. The records of quality assurance
2282programs which relate solely to actions taken in carrying out
2283the provisions of this section, and records obtained by the
2284department to determine licensee agency compliance with this
2285section, are confidential and exempt from s. 119.07(1). Such
2286records are not admissible in any civil or administrative
2287action, except in disciplinary proceedings by the Department of
2288Business and Professional Regulation and the appropriate
2289regulatory board, nor shall such records be available to the
2290public as part of the record of investigation for, and
2291prosecution in disciplinary proceedings made available to the
2292public by the Department of Business and Professional Regulation
2293or the appropriate regulatory board. Meetings or portions of
2294meetings of quality assurance program committees that relate
2295solely to actions taken pursuant to this section are exempt from
2296s. 286.011.
2297     Section 44.  Subsections (5) through (33) of section
2298395.002, Florida Statutes, are renumbered as subsections (4)
2299through (32), respectively, and present subsections (4), (11),
2300and (29) of said section are amended to read:
2301     395.002  Definitions.--As used in this chapter:
2302     (4)  "Applicant" means an individual applicant, or any
2303officer, director, or agent, or any partner or shareholder
2304having an ownership interest equal to a 5-percent or greater
2305interest in the corporation, partnership, or other business
2306entity.
2307     (10)(11)  "General hospital" means any facility which meets
2308the provisions of subsection (12) (13) and which regularly makes
2309its facilities and services available to the general population.
2310     (28)(29)  "Specialty hospital" means any facility which
2311meets the provisions of subsection (12) (13), and which
2312regularly makes available either:
2313     (a)  The range of medical services offered by general
2314hospitals, but restricted to a defined age or gender group of
2315the population;
2316     (b)  A restricted range of services appropriate to the
2317diagnosis, care, and treatment of patients with specific
2318categories of medical or psychiatric illnesses or disorders; or
2319     (c)  Intensive residential treatment programs for children
2320and adolescents as defined in subsection (15) (16).
2321     Section 45.  Section 395.003, Florida Statutes, is amended
2322to read:
2323     395.003  Licensure; issuance, renewal, denial,
2324modification, suspension, and revocation.--
2325     (1)(a)  The requirements of part II of chapter 408 shall
2326apply to the provision of services that require licensure
2327pursuant to ss. 395.001-395.1065 and part II of chapter 408 and
2328to entities licensed by or applying for such licensure from the
2329Agency for Health Care Administration pursuant to ss. 395.001-
2330395.1065. However, each applicant for licensure and each
2331licensee is exempt from s. 408.810(7)-(9). Ambulatory surgical
2332center and mobile surgical facility licensees and applicants for
2333such licensure are also exempt from s. 408.810(10). A person may
2334not establish, conduct, or maintain a hospital, ambulatory
2335surgical center, or mobile surgical facility in this state
2336without first obtaining a license under this part.
2337     (b)1.  It is unlawful for a person to use or advertise to
2338the public, in any way or by any medium whatsoever, any facility
2339as a "hospital," "ambulatory surgical center," or "mobile
2340surgical facility" unless such facility has first secured a
2341license under the provisions of this part.
2342     2.  This part does not apply to veterinary hospitals or to
2343commercial business establishments using the word "hospital,"
2344"ambulatory surgical center," or "mobile surgical facility" as a
2345part of a trade name if no treatment of human beings is
2346performed on the premises of such establishments.
2347     (c)3.  By December 31, 2004, the agency shall submit a
2348report to the President of the Senate and the Speaker of the
2349House of Representatives recommending whether it is in the
2350public interest to allow a hospital to license or operate an
2351emergency department located off the premises of the hospital.
2352If the agency finds it to be in the public interest, the report
2353shall also recommend licensure criteria for such medical
2354facilities, including criteria related to quality of care and,
2355if deemed necessary, the elimination of the possibility of
2356confusion related to the service capabilities of such facility
2357in comparison to the service capabilities of an emergency
2358department located on the premises of the hospital. Until July
23591, 2005, additional emergency departments located off the
2360premises of licensed hospitals may not be authorized by the
2361agency.
2362     (2)(a)  Upon the receipt of an application for a license
2363and the license fee, the agency shall issue a license if the
2364applicant and facility have received all approvals required by
2365law and meet the requirements established under this part and in
2366rules. Such license shall include all beds and services located
2367on the premises of the facility.
2368     (b)  A provisional license may be issued to a new facility
2369or a facility that is in substantial compliance with this part
2370and with the rules of the agency. A provisional license shall be
2371granted for a period of no more than 1 year and shall expire
2372automatically at the end of its term. A provisional license may
2373not be renewed.
2374     (c)  A license, unless sooner suspended or revoked, shall
2375automatically expire 2 years from the date of issuance and shall
2376be renewable biennially upon application for renewal and payment
2377of the fee prescribed by s. 395.004(2), provided the applicant
2378and licensed facility meet the requirements established under
2379this part and in rules. An application for renewal of a license
2380shall be made 90 days prior to expiration of the license, on
2381forms provided by the agency.
2382     (a)(d)  The agency shall, at the request of a licensee,
2383issue a single license to a licensee for facilities located on
2384separate premises. Such a license shall specifically state the
2385location of the facilities, the services, and the licensed beds
2386available on each separate premises. If a licensee requests a
2387single license, the licensee shall designate which facility or
2388office is responsible for receipt of information, payment of
2389fees, service of process, and all other activities necessary for
2390the agency to carry out the provisions of this part.
2391     (b)(e)  The agency shall, at the request of a licensee that
2392is a teaching hospital as defined in s. 408.07(44), issue a
2393single license to a licensee for facilities that have been
2394previously licensed as separate premises, provided such
2395separately licensed facilities, taken together, constitute the
2396same premises as defined in s. 395.002(23)(24). Such license for
2397the single premises shall include all of the beds, services, and
2398programs that were previously included on the licenses for the
2399separate premises. The granting of a single license under this
2400paragraph shall not in any manner reduce the number of beds,
2401services, or programs operated by the licensee.
2402     (c)(f)  Intensive residential treatment programs for
2403children and adolescents which have received accreditation from
2404the Joint Commission on Accreditation of Healthcare
2405Organizations and which meet the minimum standards developed by
2406rule of the agency for such programs shall be licensed by the
2407agency under this part.
2408     (3)(a)  Each license shall be valid only for the person to
2409whom it is issued and shall not be sold, assigned, or otherwise
2410transferred, voluntarily or involuntarily. A license is only
2411valid for the premises for which it was originally issued.
2412     (b)1.  An application for a new license is required if
2413ownership, a majority of the ownership, or controlling interest
2414of a licensed facility is transferred or assigned and when a
2415lessee agrees to undertake or provide services to the extent
2416that legal liability for operation of the facility rests with
2417the lessee. The application for a new license showing such
2418change shall be made at least 60 days prior to the date of the
2419sale, transfer, assignment, or lease.
2420     (3)2.  After a change of ownership has occurred, the
2421transferee shall be liable for any liability to the state,
2422regardless of when identified, resulting from changes to
2423allowable costs affecting provider reimbursement for Medicaid
2424participation or Public Medical Assistance Trust Fund
2425Assessments, and related administrative fines. The transferee,
2426simultaneously with the transfer of ownership, shall pay or make
2427arrangements to pay to the agency or the department any amount
2428owed to the agency or the department; payment assurances may be
2429in the form of an irrevocable credit instrument or payment bond
2430acceptable to the agency or the department provided by or on
2431behalf of the transferor. The issuance of a license to the
2432transferee shall be delayed pending payment or until arrangement
2433for payment acceptable to the agency or the department is made.
2434     (4)  The agency shall issue a license which specifies the
2435service categories and the number of hospital beds in each bed
2436category for which a license is received. Such information shall
2437be listed on the face of the license. All beds which are not
2438covered by any specialty-bed-need methodology shall be specified
2439as general beds. A licensed facility shall not operate a number
2440of hospital beds greater than the number indicated by the agency
2441on the face of the license without approval from the agency
2442under conditions established by rule.
2443     (5)(a)  Adherence to patient rights, standards of care, and
2444examination and placement procedures provided under part I of
2445chapter 394 shall be a condition of licensure for hospitals
2446providing voluntary or involuntary medical or psychiatric
2447observation, evaluation, diagnosis, or treatment.
2448     (b)  Any hospital that provides psychiatric treatment to
2449persons under 18 years of age who have emotional disturbances
2450shall comply with the procedures pertaining to the rights of
2451patients prescribed in part I of chapter 394.
2452     (6)  No specialty hospital shall provide any service or
2453regularly serve any population group beyond those services or
2454groups specified in its license.
2455     (7)  Licenses shall be posted in a conspicuous place on
2456each of the licensed premises.
2457     (7)(8)  In addition to the requirements of part II of
2458chapter 408, whenever the agency finds that there has been a
2459substantial failure to comply with the requirements established
2460under this part or in rules, the agency is authorized to deny,
2461modify, suspend, and or revoke:
2462     (a)  A license;
2463     (b)  That part of a license which is limited to a separate
2464premises, as designated on the license; or
2465     (c)  Licensure approval limited to a facility, building, or
2466portion thereof, or a service, within a given premises.
2467     (8)(9)  A hospital may not be licensed or relicensed if:
2468     (a)  The diagnosis-related groups for 65 percent or more of
2469the discharges from the hospital, in the most recent year for
2470which data is available to the Agency for Health Care
2471Administration pursuant to s. 408.061, are for diagnosis, care,
2472and treatment of patients who have:
2473     1.  Cardiac-related diseases and disorders classified as
2474diagnosis-related groups 103-145, 478-479, 514-518, or 525-527;
2475     2.  Orthopedic-related diseases and disorders classified as
2476diagnosis-related groups 209-256, 471, 491, 496-503, or 519-520;
2477     3.  Cancer-related diseases and disorders classified as
2478diagnosis-related groups 64, 82, 172, 173, 199, 200, 203, 257-
2479260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363,
2480366, 367, 400-414, 473, or 492; or
2481     4.  Any combination of the above discharges.
2482     (b)  The hospital restricts its medical and surgical
2483services to primarily or exclusively cardiac, orthopedic,
2484surgical, or oncology specialties.
2485     (9)(10)  A hospital licensed as of June 1, 2004, shall be
2486exempt from subsection (8) (9) as long as the hospital maintains
2487the same ownership, facility street address, and range of
2488services that were in existence on June 1, 2004. Any transfer of
2489beds, or other agreements that result in the establishment of a
2490hospital or hospital services within the intent of this section,
2491shall be subject to subsection (8) (9). Unless the hospital is
2492otherwise exempt under subsection (8) (9), the agency shall deny
2493or revoke the license of a hospital that violates any of the
2494criteria set forth in that subsection.
2495     (10)(11)  The agency may adopt rules implementing the
2496licensure requirements set forth in subsection (8) (9). Within
249714 days after rendering its decision on a license application or
2498revocation, the agency shall publish its proposed decision in
2499the Florida Administrative Weekly. Within 21 days after
2500publication of the agency's decision, any authorized person may
2501file a request for an administrative hearing. In administrative
2502proceedings challenging the approval, denial, or revocation of a
2503license pursuant to subsection (8) (9), the hearing must be
2504based on the facts and law existing at the time of the agency's
2505proposed agency action. Existing hospitals may initiate or
2506intervene in an administrative hearing to approve, deny, or
2507revoke licensure under subsection (8) (9) based upon a showing
2508that an established program will be substantially affected by
2509the issuance or renewal of a license to a hospital within the
2510same district or service area.
2511     Section 46.  Section 395.004, Florida Statutes, is amended
2512to read:
2513     395.004  Application for license, fees; expenses.--
2514     (1)  In accordance with s. 408.805, an applicant or
2515licensee shall pay a fee for each license application submitted
2516under this part, part II of chapter 408, and applicable rules.
2517The amount of the fee shall be established by rule. An
2518application for a license or renewal thereof shall be made under
2519oath to the agency, upon forms provided by it, and shall contain
2520such information as the agency reasonably requires, which may
2521include affirmative evidence of ability to comply with
2522applicable laws and rules.
2523     (2)  Each application for a general hospital license,
2524specialty hospital license, ambulatory surgical center license,
2525or mobile surgical facility license, or renewal thereof, shall
2526be accompanied by a license fee, in accordance with the
2527following schedule:
2528     (a)  The biennial license, provisional license, and license
2529renewal fee required of a facility licensed under this part
2530shall be reasonably calculated to cover the cost of regulation
2531under this part and shall be established by rule at the rate of
2532not less than $9.50 per hospital bed, nor more than $30 per
2533hospital bed, except that the minimum license fee shall be
2534$1,500 and the total fees collected from all licensed facilities
2535may not exceed the cost of properly carrying out the provisions
2536of this part.
2537     (b)  Such fees shall be paid to the agency and shall be
2538deposited in the Planning and Regulation Trust Fund of the
2539agency, which is hereby created, for the sole purpose of
2540carrying out the provisions of this part.
2541     Section 47.  Section 395.0055, Florida Statutes, is
2542repealed.
2543     Section 48.  Section 395.0161, Florida Statutes, is amended
2544to read:
2545     395.0161  Licensure inspection.--
2546     (1)  In accordance with s. 408.811, the agency shall make
2547or cause to be made such inspections and investigations as it
2548deems necessary, including:
2549     (a)  Inspections directed by the Health Care Financing
2550Administration.
2551     (b)  Validation inspections.
2552     (c)  Lifesafety inspections.
2553     (d)  Licensure complaint investigations, including full
2554licensure investigations with a review of all licensure
2555standards as outlined in the administrative rules. Complaints
2556received by the agency from individuals, organizations, or other
2557sources are subject to review and investigation by the agency.
2558     (e)  Emergency access complaint investigations.
2559     (f)  inspections of mobile surgical facilities at each time
2560a facility establishes a new location, prior to the admission of
2561patients. However, such inspections shall not be required when a
2562mobile surgical facility is moved temporarily to a location
2563where medical treatment will not be provided.
2564     (2)  The agency shall accept, in lieu of its own periodic
2565inspections for licensure, the survey or inspection of an
2566accrediting organization, provided the accreditation of the
2567licensed facility is not provisional and provided the licensed
2568facility authorizes release of, and the agency receives the
2569report of, the accrediting organization. The agency shall
2570develop, and adopt by rule, criteria for accepting survey
2571reports of accrediting organizations in lieu of conducting a
2572state licensure inspection.
2573     (3)  In accordance with s. 408.805, an applicant or
2574licensee shall pay a fee for each license application submitted
2575under this part, part II of chapter 408, and applicable rules.
2576With the exception of state-operated licensed facilities, each
2577facility licensed under this part shall pay to the agency, at
2578the time of inspection, the following fees:
2579     (a)  Inspection for licensure.--A fee shall be paid which
2580is not less than $8 per hospital bed, nor more than $12 per
2581hospital bed, except that the minimum fee shall be $400 per
2582facility.
2583     (b)  Inspection for lifesafety only.--A fee shall be paid
2584which is not less than 75 cents per hospital bed, nor more than
2585$1.50 per hospital bed, except that the minimum fee shall be $40
2586per facility.
2587     (4)  The agency shall coordinate all periodic inspections
2588for licensure made by the agency to ensure that the cost to the
2589facility of such inspections and the disruption of services by
2590such inspections is minimized.
2591     Section 49.  Section 395.0162, Florida Statutes, is
2592repealed.
2593     Section 50.  A licensee that failed to renew its ambulatory
2594surgical center license may meet requirements of the Florida
2595Building Code that were in effect at the time of original
2596licensure for the purposes of an initial application if:
2597     (a)  The license expired between July 1, 2004, and December
259831, 2004.
2599     (b)  The initial license application was filed within 30
2600days after the license expiration.
2601     (c)  The ambulatory surgical center is in compliance with
2602regulatory requirements based upon agency inspection.
2603
2604This section only applies to the initial application for
2605licensure and does not circumvent any requirement to meet
2606current Florida Building Code requirements for renovations or
2607other modifications.
2608     Section 51.  Subsections (2) and (3) of section 395.0163,
2609Florida Statutes, are amended to read:
2610     395.0163  Construction inspections; plan submission and
2611approval; fees.--
2612     (2)(a)  The agency is authorized to charge an initial fee
2613of $2,000 for review of plans and construction on all projects,
2614no part of which is refundable. The agency may also collect a
2615fee, not to exceed 1 percent of the estimated construction cost
2616or the actual cost of review, whichever is less, for the portion
2617of the review which encompasses initial review through the
2618initial revised construction document review. The agency is
2619further authorized to collect its actual costs on all subsequent
2620portions of the review and construction inspections. The initial
2621fee payment shall accompany the initial submission of plans and
2622specifications. Any subsequent payment that is due is payable
2623upon receipt of the invoice from the agency.
2624     (b)  Notwithstanding any other provisions of law to the
2625contrary, all moneys received by the agency pursuant to the
2626provisions of this section shall be deposited in the Planning
2627and Regulation Trust Fund, as created by s. 395.004, to be held
2628and applied solely for the operations required under this
2629section.
2630     (3)  In accordance with s. 408.811, the agency shall
2631inspect a mobile surgical facility at initial licensure and at
2632each time the facility establishes a new location, prior to
2633admission of patients. However, such inspections shall not be
2634required when a mobile surgical facility is moved temporarily to
2635a location where medical treatment will not be provided.
2636     Section 52.  Paragraph (c) of subsection (2) of section
2637395.0191, Florida Statutes, is redesignated as paragraph (d),
2638and a new paragraph (c) is added to said subsection, to read:
2639     395.0191  Staff membership and clinical privileges.--
2640     (2)
2641     (c)  A registered nurse licensed under part I of chapter
2642464 and qualified by training and experience in perioperative
2643nursing as defined in s. 464.027(2)(a) shall be present in the
2644operating room and function as the circulating nurse during all
2645operative, surgical, or invasive procedures.
2646     Section 53.  Subsections (4) and (6) of section 395.0193,
2647Florida Statutes, are amended to read:
2648     395.0193  Licensed facilities; peer review; disciplinary
2649powers; agency or partnership with physicians.--
2650     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
2651actions taken under subsection (3) shall be reported in writing
2652to the Department of Health Division of Health Quality Assurance
2653of the agency within 30 working days after its initial
2654occurrence, regardless of the pendency of appeals to the
2655governing board of the hospital. The notification shall identify
2656the disciplined practitioner, the action taken, and the reason
2657for such action. All final disciplinary actions taken under
2658subsection (3), if different from those which were reported to
2659the department agency within 30 days after the initial
2660occurrence, shall be reported within 10 working days to the
2661Department of Health Division of Health Quality Assurance of the
2662agency in writing and shall specify the disciplinary action
2663taken and the specific grounds therefor. Final disciplinary
2664actions shall be reported monthly to the Division of Health
2665Quality Assurance of the agency. The division shall review each
2666report and determine whether it potentially involved conduct by
2667the licensee that is subject to disciplinary action, in which
2668case s. 456.073 shall apply. The reports are not subject to
2669inspection under s. 119.07(1) even if the division's
2670investigation results in a finding of probable cause.
2671     (6)  For a single incident or series of isolated incidents
2672that are nonwillful violations of the reporting requirements of
2673this section, the agency shall first seek to obtain corrective
2674action by the facility. If correction is not demonstrated within
2675the timeframe established by the agency or if there is a pattern
2676of nonwillful violations of this section, the agency may impose
2677an administrative fine, not to exceed $5,000 for any violation
2678of the reporting requirements of this section. The
2679administrative fine for repeated nonwillful violations shall not
2680exceed $10,000 for any violation. The administrative fine for
2681each intentional and willful violation may not exceed $25,000
2682per violation, per day. The fine for an intentional and willful
2683violation of this section may not exceed $250,000. In
2684determining the amount of fine to be levied, the agency shall be
2685guided by s. 395.1065(1)(2)(b).
2686     Section 54.  Subsection (12) of section 395.0197, Florida
2687Statutes, is amended to read:
2688     395.0197  Internal risk management program.--
2689     (12)  In addition to any penalty imposed pursuant to this
2690section, the agency shall require a written plan of correction
2691from the facility. For a single incident or series of isolated
2692incidents that are nonwillful violations of the reporting
2693requirements of this section, the agency shall first seek to
2694obtain corrective action by the facility. If the correction is
2695not demonstrated within the timeframe established by the agency
2696or if there is a pattern of nonwillful violations of this
2697section, the agency may impose an administrative fine, not to
2698exceed $5,000 for any violation of the reporting requirements of
2699this section. The administrative fine for repeated nonwillful
2700violations shall not exceed $10,000 for any violation. The
2701administrative fine for each intentional and willful violation
2702may not exceed $25,000 per violation, per day. The fine for an
2703intentional and willful violation of this section may not exceed
2704$250,000. In determining the amount of fine to be levied, the
2705agency shall be guided by s. 395.1065(1)(2)(b).
2706     Section 55.  Section 395.0199, Florida Statutes, is amended
2707to read:
2708     395.0199  Private utilization review.--
2709     (1)  The purpose of this section is to:
2710     (a)  Promote the delivery of quality health care in a cost-
2711effective manner.
2712     (b)  Foster greater coordination between providers and
2713health insurers performing utilization review.
2714     (c)  Protect patients and insurance providers by ensuring
2715that private review agents are qualified to perform utilization
2716review activities and to make informed decisions on the
2717appropriateness of medical care.
2718     (d)  This section does not regulate the activities of
2719private review agents, health insurers, health maintenance
2720organizations, or hospitals, except as expressly provided
2721herein, or authorize regulation or intervention as to the
2722correctness of utilization review decisions of insurers or
2723private review agents.
2724     (2)  The requirements of part II of chapter 408 shall apply
2725to the provision of services that require registration or
2726licensure pursuant to this section and part II of chapter 408
2727and to persons registered by or applying for such registration
2728from the Agency for Health Care Administration pursuant to this
2729section. However, each applicant for registration and registrant
2730is exempt from the provisions of ss. 408.806(1)(e)2.,
2731408.810(5)-(10), and 408.811. A private review agent conducting
2732utilization review as to health care services performed or
2733proposed to be performed in this state shall register with the
2734agency in accordance with this section.
2735     (3)  In accordance with s. 408.805, an applicant for
2736registration or registrant shall pay a fee for each registration
2737application submitted under this section, part II of chapter
2738408, and applicable rules. The amount of the fee shall be
2739established by rule Registration shall be made annually with the
2740agency on forms furnished by the agency and shall be accompanied
2741by the appropriate registration fee as set by the agency. The
2742fee and shall be sufficient to pay for the administrative costs
2743of registering the agent, but shall not exceed $250. The agency
2744may also charge reasonable fees, reflecting actual costs, to
2745persons requesting copies of registration.
2746     (4)  Each applicant for registration must comply with the
2747following requirements:
2748     (a)  Upon receipt of a completed, signed, and dated
2749application, the agency shall require background screening, in
2750accordance with the level 2 standards for screening set forth in
2751chapter 435, of the managing employee or other similarly titled
2752individual who is responsible for the operation of the entity.
2753The applicant must comply with the procedures for level 2
2754background screening as set forth in chapter 435, as well as the
2755requirements of s. 435.03(3).
2756     (b)  The agency may require background screening of any
2757other individual who is an applicant, if the agency has probable
2758cause to believe that he or she has been convicted of a crime or
2759has committed any other offense prohibited under the level 2
2760standards for screening set forth in chapter 435.
2761     (c)  Proof of compliance with the level 2 background
2762screening requirements of chapter 435 which has been submitted
2763within the previous 5 years in compliance with any other health
2764care licensure requirements of this state is acceptable in
2765fulfillment of the requirements of paragraph (a).
2766     (d)  A provisional registration may be granted to an
2767applicant when each individual required by this section to
2768undergo background screening has met the standards for the
2769Department of Law Enforcement background check, but the agency
2770has not yet received background screening results from the
2771Federal Bureau of Investigation, or a request for a
2772disqualification exemption has been submitted to the agency as
2773set forth in chapter 435 but a response has not yet been issued.
2774A standard registration may be granted to the applicant upon the
2775agency's receipt of a report of the results of the Federal
2776Bureau of Investigation background screening for each individual
2777required by this section to undergo background screening which
2778confirms that all standards have been met, or upon the granting
2779of a disqualification exemption by the agency as set forth in
2780chapter 435. Any other person who is required to undergo level 2
2781background screening may serve in his or her capacity pending
2782the agency's receipt of the report from the Federal Bureau of
2783Investigation. However, the person may not continue to serve if
2784the report indicates any violation of background screening
2785standards and a disqualification exemption has not been
2786requested of and granted by the agency as set forth in chapter
2787435.
2788     (e)  Each applicant must submit to the agency, with its
2789application, a description and explanation of any exclusions,
2790permanent suspensions, or terminations of the applicant from the
2791Medicare or Medicaid programs. Proof of compliance with the
2792requirements for disclosure of ownership and control interests
2793under the Medicaid or Medicare programs shall be accepted in
2794lieu of this submission.
2795     (f)  Each applicant must submit to the agency a description
2796and explanation of any conviction of an offense prohibited under
2797the level 2 standards of chapter 435 by a member of the board of
2798directors of the applicant, its officers, or any individual
2799owning 5 percent or more of the applicant. This requirement does
2800not apply to a director of a not-for-profit corporation or
2801organization if the director serves solely in a voluntary
2802capacity for the corporation or organization, does not regularly
2803take part in the day-to-day operational decisions of the
2804corporation or organization, receives no remuneration for his or
2805her services on the corporation or organization's board of
2806directors, and has no financial interest and has no family
2807members with a financial interest in the corporation or
2808organization, provided that the director and the not-for-profit
2809corporation or organization include in the application a
2810statement affirming that the director's relationship to the
2811corporation satisfies the requirements of this paragraph.
2812     (g)  A registration may not be granted to an applicant if
2813the applicant or managing employee has been found guilty of,
2814regardless of adjudication, or has entered a plea of nolo
2815contendere or guilty to, any offense prohibited under the level
28162 standards for screening set forth in chapter 435, unless an
2817exemption from disqualification has been granted by the agency
2818as set forth in chapter 435.
2819     (h)  The agency may deny or revoke the registration if any
2820applicant:
2821     1.  Has falsely represented a material fact in the
2822application required by paragraph (e) or paragraph (f), or has
2823omitted any material fact from the application required by
2824paragraph (e) or paragraph (f); or
2825     2.  Has had prior action taken against the applicant under
2826the Medicaid or Medicare program as set forth in paragraph (e).
2827     (i)  An application for registration renewal must contain
2828the information required under paragraphs (e) and (f).
2829     (4)(5)  Registration shall include the following:
2830     (a)  A description of the review policies and procedures to
2831be used in evaluating proposed or delivered hospital care.
2832     (b)  The name, address, and telephone number of the
2833utilization review agent performing utilization review, who
2834shall be at least:
2835     1.  A licensed practical nurse or licensed registered
2836nurse, or other similarly qualified medical records or health
2837care professionals, for performing initial review when
2838information is necessary from the physician or hospital to
2839determine the medical necessity or appropriateness of hospital
2840services; or
2841     2.  A licensed physician, or a licensed physician
2842practicing in the field of psychiatry for review of mental
2843health services, for an initial denial determination prior to a
2844final denial determination by the health insurer and which shall
2845include the written evaluation and findings of the reviewing
2846physician.
2847     (c)  A description of an appeal procedure for patients or
2848health care providers whose services are under review, who may
2849appeal an initial denial determination prior to a final
2850determination by the health insurer with whom the private review
2851agent has contracted. The appeal procedure shall provide for
2852review by a licensed physician, or by a licensed physician
2853practicing in the field of psychiatry for review of mental
2854health services, and shall include the written evaluation and
2855findings of the reviewing physician.
2856     (d)  A designation of the times when the staff of the
2857utilization review agent will be available by toll-free
2858telephone, which shall include at least 40 hours per week during
2859the normal business hours of the agent.
2860     (e)  An acknowledgment and agreement that any private
2861review agent which, as a general business practice, fails to
2862adhere to the policies, procedures, and representations made in
2863its application for registration shall have its registration
2864revoked.
2865     (f)  Disclosure of any incentive payment provision or quota
2866provision which is contained in the agent's contract with a
2867health insurer and is based on reduction or denial of services,
2868reduction of length of stay, or selection of treatment setting.
2869     (g)  Updates of any material changes to review policies or
2870procedures.
2871     (6)  The agency may impose fines or suspend or revoke the
2872registration of any private review agent in violation of this
2873section. Any private review agent failing to register or update
2874registration as required by this section shall be deemed to be
2875within the jurisdiction of the agency and subject to an
2876administrative penalty not to exceed $1,000. The agency may
2877bring actions to enjoin activities of private review agents in
2878violation of this section.
2879     (5)(7)  No insurer shall knowingly contract with or utilize
2880a private review agent which has failed to register as required
2881by this section or which has had a registration revoked by the
2882agency.
2883     (6)(8)  A private review agent which operates under
2884contract with the federal or state government for utilization
2885review of patients eligible for hospital or other services under
2886Title XVIII or Title XIX of the Social Security Act is exempt
2887from the provisions of this section for services provided under
2888such contract. A private review agent which provides utilization
2889review services to the federal or state government and a private
2890insurer shall not be exempt for services provided to
2891nonfederally funded patients. This section shall not apply to
2892persons who perform utilization review services for medically
2893necessary hospital services provided to injured workers pursuant
2894to chapter 440 and shall not apply to self-insurance funds or
2895service companies authorized pursuant to chapter 440 or part VII
2896of chapter 626.
2897     (7)(9)  Facilities licensed under this chapter shall
2898promptly comply with the requests of utilization review agents
2899or insurers which are reasonably necessary to facilitate prompt
2900accomplishment of utilization review activities.
2901     (8)(10)  The agency shall adopt rules to implement the
2902provisions of this section.
2903     Section 56.  Section 395.1046, Florida Statutes, is amended
2904to read:
2905     395.1046  Complaint investigation procedures.--
2906     (1)  In accordance with s. 408.811, the agency shall
2907investigate any complaint against a hospital for any violation
2908of s. 395.1041 that the agency reasonably believes to be legally
2909sufficient. A complaint is legally sufficient if it contains
2910ultimate facts that which show that a violation of this section
2911chapter, or any rule adopted under this chapter by the agency
2912under this section, has occurred. The agency may investigate, or
2913continue to investigate, and may take appropriate final action
2914on a complaint, even though the original complainant withdraws
2915his or her complaint or otherwise indicates his or her desire
2916not to cause it to be investigated to completion. When an
2917investigation of any person or facility is undertaken, the
2918agency shall notify such person in writing of the investigation
2919and inform the person or facility in writing of the substance,
2920the facts which show that a violation has occurred, and the
2921source of any complaint filed against him or her. The agency may
2922conduct an investigation without notification to any person if
2923the act under investigation is a criminal offense. The agency
2924shall have access to all records necessary for the investigation
2925of the complaint.
2926     (2)  The agency or its agent shall expeditiously
2927investigate each complaint against a hospital for a violation of
2928s. 395.1041. When its investigation is complete, the agency
2929shall prepare an investigative report. The report shall contain
2930the investigative findings and the recommendations of the agency
2931concerning the existence of probable cause.
2932     (3)  The complaint and all information obtained by the
2933agency during an investigation conducted pursuant to this
2934section are exempt from the provisions of s. 119.07(1) and s.
293524(a), Art. I of the State Constitution until 10 days after the
2936facility has been determined by the agency to be out of
2937compliance with regulatory requirements probable cause has been
2938found to exist by the agency, or until the person who is the
2939subject of the investigation waives his or her privilege of
2940confidentiality, whichever occurs first. In cases where the
2941agency finds that the complaint is either not legally sufficient
2942or does not demonstrate the facility's noncompliance with
2943regulatory requirements when the agency determines that no
2944probable cause exists, all records pertaining thereto are
2945confidential and exempt from the provisions of s. 119.07(1) and
2946s. 24(a), Art. I of the State Constitution. However, the
2947complaint and a summary of the agency's findings shall be
2948available, although information therein identifying an
2949individual shall not be disclosed.
2950     Section 57.  Subsections (1) and (7) of section 395.1055,
2951Florida Statutes, are amended to read:
2952     395.1055  Rules and enforcement.--
2953     (1)  The agency shall adopt rules pursuant to ss.
2954120.536(1) and 120.54 to implement the provisions of this part
2955and part II of chapter 408, which shall include reasonable and
2956fair minimum standards for ensuring that:
2957     (a)  Sufficient numbers and qualified types of personnel
2958and occupational disciplines are on duty and available at all
2959times to provide necessary and adequate patient care and safety.
2960     (b)  Infection control, housekeeping, sanitary conditions,
2961and medical record procedures that will adequately protect
2962patient care and safety are established and implemented.
2963     (c)  A comprehensive emergency management plan is prepared
2964and updated annually. Such standards must be included in the
2965rules adopted by the agency after consulting with the Department
2966of Community Affairs. At a minimum, the rules must provide for
2967plan components that address emergency evacuation
2968transportation; adequate sheltering arrangements; postdisaster
2969activities, including emergency power, food, and water;
2970postdisaster transportation; supplies; staffing; emergency
2971equipment; individual identification of residents and transfer
2972of records, and responding to family inquiries. The
2973comprehensive emergency management plan is subject to review and
2974approval by the local emergency management agency. During its
2975review, the local emergency management agency shall ensure that
2976the following agencies, at a minimum, are given the opportunity
2977to review the plan: the Department of Elderly Affairs, the
2978Department of Health, the Agency for Health Care Administration,
2979and the Department of Community Affairs. Also, appropriate
2980volunteer organizations must be given the opportunity to review
2981the plan. The local emergency management agency shall complete
2982its review within 60 days and either approve the plan or advise
2983the facility of necessary revisions.
2984     (d)  Licensed facilities are established, organized, and
2985operated consistent with established standards and rules.
2986     (e)  Licensed facility beds conform to minimum space,
2987equipment, and furnishings standards as specified by the
2988department.
2989     (f)  All hospitals submit such data as necessary to conduct
2990certificate-of-need reviews required under part I of chapter 408
2991ss. 408.031-408.045. Such data shall include, but shall not be
2992limited to, patient origin data, hospital utilization data, type
2993of service reporting, and facility staffing data. The agency
2994shall not collect data that identifies or could disclose the
2995identity of individual patients. The agency shall utilize
2996existing uniform statewide data sources when available and shall
2997minimize reporting costs to hospitals.
2998     (g)  Each hospital has a quality improvement program
2999designed according to standards established by their current
3000accrediting organization. This program will enhance quality of
3001care and emphasize quality patient outcomes, corrective action
3002for problems, governing board review, and reporting to the
3003agency of standardized data elements necessary to analyze
3004quality of care outcomes. The agency shall use existing data,
3005when available, and shall not duplicate the efforts of other
3006state agencies in order to obtain such data.
3007     (h)  Licensed facilities make available on their Internet
3008websites, no later than October 1, 2004, and in a hard copy
3009format upon request, a description of and a link to the patient
3010charge and performance outcome data collected from licensed
3011facilities pursuant to s. 408.061.
3012     (7)  The agency shall enforce compliance with the
3013provisions of s. 381.005(2) and rules adopted thereunder with
3014respect to immunizations against the influenza virus and
3015pneumococcal bacteria. Any licensed facility which is in
3016operation at the time of promulgation of any applicable rules
3017under this part shall be given a reasonable time, under the
3018particular circumstances, but not to exceed 1 year from the date
3019of such promulgation, within which to comply with such rules.
3020     Section 58.  Section 395.1065, Florida Statutes, is amended
3021to read:
3022     395.1065  Criminal and Administrative penalties;
3023injunctions; emergency orders; moratorium.--
3024     (1)  Any person establishing, conducting, managing, or
3025operating any facility without a license under this part is
3026guilty of a misdemeanor and, upon conviction, shall be fined not
3027more than $500 for the first offense and not more than $1,000
3028for each subsequent offense, and each day of continuing
3029violation after conviction shall be considered a separate
3030offense.
3031     (1)(2)(a)  The agency may deny, revoke, or suspend a
3032license or impose an administrative fine, not to exceed $1,000
3033per violation, per day, for the violation of any provision of
3034this part, part II of chapter 408, or applicable rules adopted
3035under this part. Each day of violation constitutes a separate
3036violation and is subject to a separate fine.
3037     (b)  In determining the amount of fine to be levied for a
3038violation, as provided in paragraph (a), the following factors
3039shall be considered:
3040     1.  The severity of the violation, including the
3041probability that death or serious harm to the health or safety
3042of any person will result or has resulted, the severity of the
3043actual or potential harm, and the extent to which the provisions
3044of this part were violated.
3045     2.  Actions taken by the licensee to correct the violations
3046or to remedy complaints.
3047     3.  Any previous violations of the licensee.
3048     (c)  All amounts collected pursuant to this section shall
3049be deposited into the Planning and Regulation Trust Fund, as
3050created by s. 395.004.
3051     (c)(d)  The agency may impose an administrative fine for
3052the violation of s. 641.3154 or, if sufficient claims due to a
3053provider from a health maintenance organization do not exist to
3054enable the take-back of an overpayment, as provided under s.
3055641.3155(5), for the violation of s. 641.3155(5). The
3056administrative fine for a violation cited in this paragraph
3057shall be in the amounts specified in s. 641.52(5), and the
3058provisions of paragraph (a) do not apply.
3059     (2)(3)  Notwithstanding the existence or pursuit of any
3060other remedy, the agency may maintain an action in the name of
3061the state for injunction or other process to enforce the
3062provisions of this part, part II of chapter 408, and applicable
3063rules promulgated hereunder.
3064     (4)  The agency may issue an emergency order immediately
3065suspending or revoking a license when it determines that any
3066condition in the licensed facility presents a clear and present
3067danger to public health and safety.
3068     (5)  The agency may impose an immediate moratorium on
3069elective admissions to any licensed facility, building, or
3070portion thereof, or service, when the agency determines that any
3071condition in the facility presents a threat to public health or
3072safety.
3073     (3)(6)  In seeking to impose penalties against a facility
3074as defined in s. 394.455 for a violation of part I of chapter
3075394, the agency is authorized to rely on the investigation and
3076findings by the Department of Health in lieu of conducting its
3077own investigation.
3078     (4)(7)  The agency shall impose a fine of $500 for each
3079instance of the facility's failure to provide the information
3080required by rules adopted pursuant to s. 395.1055(1)(h).
3081     Section 59.  Subsection (1) of section 395.10973, Florida
3082Statutes, is amended to read:
3083     395.10973  Powers and duties of the agency.--It is the
3084function of the agency to:
3085     (1)  Adopt rules pursuant to ss. 120.536(1) and 120.54 to
3086implement the provisions of this part and part II of chapter 408
3087conferring duties upon it.
3088     Section 60.  Section 395.10974, Florida Statutes, is
3089amended to read:
3090     395.10974  Health care risk managers; qualifications,
3091licensure, fees.--
3092     (1)  The requirements of part II of chapter 408 shall apply
3093to the provision of services that require licensure pursuant to
3094ss. 395.10971?395.10976 and part II of chapter 408 and to
3095entities licensed by or applying for such licensure from the
3096Agency for Health Care Administration pursuant to ss. 395.10971?
3097395.10976. Any person desiring to be licensed as a health care
3098risk manager shall submit an application on a form provided by
3099the agency. In order to qualify for licensure, the applicant
3100shall submit evidence satisfactory to the agency that which
3101demonstrates the applicant's competence, by education or
3102experience, in the following areas:
3103     (a)  Applicable standards of health care risk management.
3104     (b)  Applicable federal, state, and local health and safety
3105laws and rules.
3106     (c)  General risk management administration.
3107     (d)  Patient care.
3108     (e)  Medical care.
3109     (f)  Personal and social care.
3110     (g)  Accident prevention.
3111     (h)  Departmental organization and management.
3112     (i)  Community interrelationships.
3113     (j)  Medical terminology.
3114
3115Each applicant for licensure and licensee must comply with all
3116provisions of part II of chapter 408 except ss. 408.806(1)(e)2.,
3117408.810, and 408.811. The agency may require such additional
3118information, from the applicant or any other person, as may be
3119reasonably required to verify the information contained in the
3120application.
3121     (2)  The agency shall not grant or issue a license as a
3122health care risk manager to any individual unless from the
3123application it affirmatively appears that the applicant:
3124     (a)  Is 18 years of age or over;
3125     (b)  Is a high school graduate or equivalent; and
3126     (c)1.  Has fulfilled the requirements of a 1-year program
3127or its equivalent in health care risk management training which
3128may be developed or approved by the agency;
3129     2.  Has completed 2 years of college-level studies which
3130would prepare the applicant for health care risk management, to
3131be further defined by rule; or
3132     3.  Has obtained 1 year of practical experience in health
3133care risk management.
3134     (3)  The agency shall issue a license to practice health
3135care risk management to any applicant who qualifies under this
3136section. In accordance with s. 408.805, an applicant or licensee
3137shall pay a fee for each license application submitted under
3138this part, part II of chapter 408, and applicable rules. The
3139amount of the fee shall be established by rule as follows: and
3140submits an application fee of not more than $75, a background
3141screening fingerprinting fee of not more than $75, and a license
3142fee of not more than $100. The agency shall by rule establish
3143fees and procedures for the issuance and cancellation of
3144licenses.
3145     (4)  The agency shall renew a health care risk manager
3146license upon receipt of a biennial renewal application and fees.
3147The agency shall by rule establish a procedure for the biennial
3148renewal of licenses.
3149     Section 61.  Subsections (6) through (19) of section
3150400.021, Florida Statutes, are renumbered as subsections (5)
3151through (18), respectively, and present subsections (5) and (20)
3152of said section are amended to read:
3153     400.021  Definitions.--When used in this part, unless the
3154context otherwise requires, the term:
3155     (5)  "Controlling interest" means:
3156     (a)  The applicant for licensure or a licensee;
3157     (b)  A person or entity that serves as an officer of, is on
3158the board of directors of, or has a 5 percent or greater
3159ownership interest in the management company or other entity,
3160related or unrelated, which the applicant or licensee may
3161contract with to operate the facility; or
3162     (c)  A person or entity that serves as an officer of, is on
3163the board of directors of, or has a 5 percent or greater
3164ownership interest in the applicant or licensee.
3165
3166The term does not include a voluntary board member.
3167     (20)  "Voluntary board member" means a director of a not-
3168for-profit corporation or organization who serves solely in a
3169voluntary capacity for the corporation or organization, does not
3170receive any remuneration for his or her services on the board of
3171directors, and has no financial interest in the corporation or
3172organization. The agency shall recognize a person as a voluntary
3173board member following submission of a statement to the agency
3174by the director and the not-for-profit corporation or
3175organization which affirms that the director conforms to this
3176definition. The statement affirming the status of the director
3177must be submitted to the agency on a form provided by the
3178agency.
3179     Section 62.  Paragraph (c) of subsection (2) of section
3180395.602, Florida Statutes, is amended to read:
3181     395.602  Rural hospitals.--
3182     (2)  DEFINITIONS.--As used in this part:
3183     (c)  "Inactive rural hospital bed" means a licensed acute
3184care hospital bed, as defined in s. 395.002(13)(14), that is
3185inactive in that it cannot be occupied by acute care inpatients.
3186     Section 63.  Paragraph (c) of subsection (1) of section
3187395.701, Florida Statutes, is amended to read:
3188     395.701  Annual assessments on net operating revenues for
3189inpatient and outpatient services to fund public medical
3190assistance; administrative fines for failure to pay assessments
3191when due; exemption.--
3192     (1)  For the purposes of this section, the term:
3193     (c)  "Hospital" means a health care institution as defined
3194in s. 395.002(12)(13), but does not include any hospital
3195operated by the agency or the Department of Corrections.
3196     Section 64.  Subsection (3) of section 400.022, Florida
3197Statutes, is amended to read:
3198     400.022  Residents' rights.--
3199     (3)  Any violation of the resident's rights set forth in
3200this section shall constitute grounds for action by the agency
3201under the provisions of s. 400.102, s. 400.121, or part II of
3202chapter 408. In order to determine whether the licensee is
3203adequately protecting residents' rights, the licensure annual
3204inspection of the facility shall include private informal
3205conversations with a sample of residents to discuss residents'
3206experiences within the facility with respect to rights specified
3207in this section and general compliance with standards, and
3208consultation with the ombudsman council in the local planning
3209and service area of the Department of Elderly Affairs in which
3210the nursing home is located.
3211     Section 65.  Paragraph (b) of subsection (1) of section
3212400.051, Florida Statutes, is amended to read:
3213     400.051  Homes or institutions exempt from the provisions
3214of this part.--
3215     (1)  The following shall be exempt from the provisions of
3216this part:
3217     (b)  Any hospital, as defined in s. 395.002(11), that is
3218licensed under chapter 395.
3219     Section 66.  Section 400.062, Florida Statutes, is amended
3220to read:
3221     400.062  License required; fee; disposition; display;
3222transfer.--
3223     (1)  The requirements of part II of chapter 408 shall apply
3224to the provision of services that require licensure pursuant to
3225this part and part II of chapter 408 and to entities licensed by
3226or applying for such licensure from the Agency for Health Care
3227Administration pursuant to this part. However, each applicant
3228for licensure and each licensee is exempt from s. 408.810(7). It
3229is unlawful to operate or maintain a facility without first
3230obtaining from the agency a license authorizing such operation.
3231     (2)  Separate licenses shall be required for facilities
3232maintained in separate premises, even though operated under the
3233same management. However, a separate license shall not be
3234required for separate buildings on the same grounds.
3235     (3)  In accordance with s. 408.805, an applicant or
3236licensee shall pay a fee for each license application submitted
3237under this part, part II of chapter 408, and applicable rules.
3238The annual license fee required for each license issued under
3239this part shall be comprised of two parts. Part I of the license
3240fee shall be the basic license fee. The rate per bed for the
3241basic license fee shall be established biennially annually and
3242shall be $100 $50 per bed unless modified by rule. The agency
3243may adjust the per bed licensure fees by the Consumer Price
3244Index based on the 12 months immediately preceding the increase
3245to cover the cost of regulation under this part. Part II of the
3246license fee shall be the resident protection fee, which shall be
3247at the rate of not less than 50 25 cents per bed. The rate per
3248bed shall be the minimum rate per bed, and such rate shall
3249remain in effect until the effective date of a rate per bed
3250adopted by rule by the agency pursuant to this part. At such
3251time as the amount on deposit in the Resident Protection Trust
3252Fund is less than $1 million, the agency may adopt rules to
3253establish a rate which may not exceed $20 $10 per bed. The rate
3254per bed shall revert back to the minimum rate per bed when the
3255amount on deposit in the Resident Protection Trust Fund reaches
3256$1 million, except that any rate established by rule shall
3257remain in effect until such time as the rate has been equally
3258required for each license issued under this part. Any amount in
3259the fund in excess of $2 million shall revert to the Health Care
3260Trust Fund and may not be expended without prior approval of the
3261Legislature. The agency may prorate the biennial annual license
3262fee for those licenses which it issues under this part for less
3263than 2 years 1 year. Funds generated by license fees collected
3264in accordance with this section shall be deposited in the
3265following manner:
3266     (a)  The basic license fee collected shall be deposited in
3267the Health Care Trust Fund, established for the sole purpose of
3268carrying out this part. When the balance of the account
3269established in the Health Care Trust Fund for the deposit of
3270fees collected as authorized under this section exceeds one-
3271third of the annual cost of regulation under this part, the
3272excess shall be used to reduce the licensure fees in the next
3273year.
3274     (b)  The resident protection fee collected shall be
3275deposited in the Resident Protection Trust Fund for the sole
3276purpose of paying, in accordance with the provisions of s.
3277400.063, for the appropriate alternate placement, care, and
3278treatment of a resident removed from a nursing home facility on
3279a temporary, emergency basis or for the maintenance and care of
3280residents in a nursing home facility pending removal and
3281alternate placement.
3282     (4)  Counties or municipalities applying for licenses under
3283this part are exempt from license fees authorized under this
3284section.
3285     (5)  The license shall be displayed in a conspicuous place
3286inside the facility.
3287     (6)  A license shall be valid only in the hands of the
3288individual, firm, partnership, association, or corporation to
3289whom it is issued and shall not be subject to sale, assignment,
3290or other transfer, voluntary or involuntary, nor shall a license
3291be valid for any premises other than those for which originally
3292issued.
3293     Section 67.  Subsection (1) of section 400.063, Florida
3294Statutes, is amended to read:
3295     400.063  Resident Protection Trust Fund.--
3296     (1)  A Resident Protection Trust Fund shall be established
3297for the purpose of collecting and disbursing funds generated
3298from the license fees and administrative fines as provided for
3299in ss. 393.0673(2), 400.062(3)(b), 400.111(1), 400.121(2), and
3300400.23(8). Such funds shall be for the sole purpose of paying
3301for the appropriate alternate placement, care, and treatment of
3302residents who are removed from a facility licensed under this
3303part or a facility specified in s. 393.0678(1) in which the
3304agency determines that existing conditions or practices
3305constitute an immediate danger to the health, safety, or
3306security of the residents. If the agency determines that it is
3307in the best interest of the health, safety, or security of the
3308residents to provide for an orderly removal of the residents
3309from the facility, the agency may utilize such funds to maintain
3310and care for the residents in the facility pending removal and
3311alternative placement. The maintenance and care of the residents
3312shall be under the direction and control of a receiver appointed
3313pursuant to s. 393.0678(1) or s. 400.126(1). However, funds may
3314be expended in an emergency upon a filing of a petition for a
3315receiver, upon the declaration of a state of local emergency
3316pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
3317order of evacuation of a facility by emergency personnel to
3318protect the health and safety of the residents.
3319     Section 68.  Section 400.071, Florida Statutes, is amended
3320to read:
3321     400.071  Application for license.--
3322     (1)  An application for a license as required by s. 400.062
3323shall be made to the agency on forms furnished by it and shall
3324be accompanied by the appropriate license fee.
3325     (1)(2)  The application for a license shall be under oath
3326and shall contain the following:
3327     (a)  The name, address, and social security number of the
3328applicant if an individual; if the applicant is a firm,
3329partnership, or association, its name, address, and employer
3330identification number (EIN), and the name and address of any
3331controlling interest; and the name by which the facility is to
3332be known.
3333     (b)  The name of any person whose name is required on the
3334application under the provisions of paragraph (a) and who owns
3335at least a 10-percent interest in any professional service,
3336firm, association, partnership, or corporation providing goods,
3337leases, or services to the facility for which the application is
3338made, and the name and address of the professional service,
3339firm, association, partnership, or corporation in which such
3340interest is held.
3341     (c)  The location of the facility for which a license is
3342sought and an indication, as in the original application, that
3343such location conforms to the local zoning ordinances.
3344     (d)  The name of the person or persons under whose
3345management or supervision the facility will be conducted and the
3346name of the administrator.
3347     (a)(e)  A signed affidavit disclosing any financial or
3348ownership interest that a controlling interest as defined in
3349part II of chapter 408 person or entity described in paragraph
3350(a) or paragraph (d) has held in the last 5 years in any entity
3351licensed by this state or any other state to provide health or
3352residential care which has closed voluntarily or involuntarily;
3353has filed for bankruptcy; has had a receiver appointed; has had
3354a license denied, suspended, or revoked; or has had an
3355injunction issued against it which was initiated by a regulatory
3356agency. The affidavit must disclose the reason any such entity
3357was closed, whether voluntarily or involuntarily.
3358     (b)(f)  The total number of beds and the total number of
3359Medicare and Medicaid certified beds.
3360     (c)(g)  Information relating to the number, experience, and
3361training of the employees of the facility and of the moral
3362character of the applicant and employees that which the agency
3363requires by rule, including the name and address of any nursing
3364home with which the applicant or employees have been affiliated
3365through ownership or employment within 5 years of the date of
3366the application for a license and the record of any criminal
3367convictions involving the applicant and any criminal convictions
3368involving an employee if known by the applicant after inquiring
3369of the employee. The applicant must demonstrate that sufficient
3370numbers of qualified staff, by training or experience, will be
3371employed to properly care for the type and number of residents
3372who will reside in the facility.
3373     (d)(h)  Copies of any civil verdict or judgment involving
3374the applicant rendered within the 10 years preceding the
3375application, relating to medical negligence, violation of
3376residents' rights, or wrongful death. As a condition of
3377licensure, the licensee agrees to provide to the agency copies
3378of any new verdict or judgment involving the applicant, relating
3379to such matters, within 30 days after filing with the clerk of
3380the court. The information required in this paragraph shall be
3381maintained in the facility's licensure file and in an agency
3382database which is available as a public record.
3383     (3)  The applicant shall submit evidence which establishes
3384the good moral character of the applicant, manager, supervisor,
3385and administrator. No applicant, if the applicant is an
3386individual; no member of a board of directors or officer of an
3387applicant, if the applicant is a firm, partnership, association,
3388or corporation; and no licensed nursing home administrator shall
3389have been convicted, or found guilty, regardless of
3390adjudication, of a crime in any jurisdiction which affects or
3391may potentially affect residents in the facility.
3392     (4)  Each applicant for licensure must comply with the
3393following requirements:
3394     (a)  Upon receipt of a completed, signed, and dated
3395application, the agency shall require background screening of
3396the applicant, in accordance with the level 2 standards for
3397screening set forth in chapter 435. As used in this subsection,
3398the term "applicant" means the facility administrator, or
3399similarly titled individual who is responsible for the day-to-
3400day operation of the licensed facility, and the facility
3401financial officer, or similarly titled individual who is
3402responsible for the financial operation of the licensed
3403facility.
3404     (b)  The agency may require background screening for a
3405member of the board of directors of the licensee or an officer
3406or an individual owning 5 percent or more of the licensee if the
3407agency has probable cause to believe that such individual has
3408been convicted of an offense prohibited under the level 2
3409standards for screening set forth in chapter 435.
3410     (c)  Proof of compliance with the level 2 background
3411screening requirements of chapter 435 which has been submitted
3412within the previous 5 years in compliance with any other health
3413care or assisted living licensure requirements of this state is
3414acceptable in fulfillment of paragraph (a). Proof of compliance
3415with background screening which has been submitted within the
3416previous 5 years to fulfill the requirements of the Financial
3417Services Commission and the Office of Insurance Regulation
3418pursuant to chapter 651 as part of an application for a
3419certificate of authority to operate a continuing care retirement
3420community is acceptable in fulfillment of the Department of Law
3421Enforcement and Federal Bureau of Investigation background
3422check.
3423     (d)  A provisional license may be granted to an applicant
3424when each individual required by this section to undergo
3425background screening has met the standards for the Department of
3426Law Enforcement background check, but the agency has not yet
3427received background screening results from the Federal Bureau of
3428Investigation, or a request for a disqualification exemption has
3429been submitted to the agency as set forth in chapter 435, but a
3430response has not yet been issued. A license may be granted to
3431the applicant upon the agency's receipt of a report of the
3432results of the Federal Bureau of Investigation background
3433screening for each individual required by this section to
3434undergo background screening which confirms that all standards
3435have been met, or upon the granting of a disqualification
3436exemption by the agency as set forth in chapter 435. Any other
3437person who is required to undergo level 2 background screening
3438may serve in his or her capacity pending the agency's receipt of
3439the report from the Federal Bureau of Investigation; however,
3440the person may not continue to serve if the report indicates any
3441violation of background screening standards and a
3442disqualification exemption has not been requested of and granted
3443by the agency as set forth in chapter 435.
3444     (e)  Each applicant must submit to the agency, with its
3445application, a description and explanation of any exclusions,
3446permanent suspensions, or terminations of the applicant from the
3447Medicare or Medicaid programs. Proof of compliance with
3448disclosure of ownership and control interest requirements of the
3449Medicaid or Medicare programs shall be accepted in lieu of this
3450submission.
3451     (f)  Each applicant must submit to the agency a description
3452and explanation of any conviction of an offense prohibited under
3453the level 2 standards of chapter 435 by a member of the board of
3454directors of the applicant, its officers, or any individual
3455owning 5 percent or more of the applicant. This requirement
3456shall not apply to a director of a not-for-profit corporation or
3457organization if the director serves solely in a voluntary
3458capacity for the corporation or organization, does not regularly
3459take part in the day-to-day operational decisions of the
3460corporation or organization, receives no remuneration for his or
3461her services on the corporation or organization's board of
3462directors, and has no financial interest and has no family
3463members with a financial interest in the corporation or
3464organization, provided that the director and the not-for-profit
3465corporation or organization include in the application a
3466statement affirming that the director's relationship to the
3467corporation satisfies the requirements of this paragraph.
3468     (g)  An application for license renewal must contain the
3469information required under paragraphs (e) and (f).
3470     (5)  The applicant shall furnish satisfactory proof of
3471financial ability to operate and conduct the nursing home in
3472accordance with the requirements of this part and all rules
3473adopted under this part, and the agency shall establish
3474standards for this purpose, including information reported under
3475paragraph (2)(e). The agency also shall establish documentation
3476requirements, to be completed by each applicant, that show
3477anticipated facility revenues and expenditures, the basis for
3478financing the anticipated cash-flow requirements of the
3479facility, and an applicant's access to contingency financing.
3480     (6)  If the applicant offers continuing care agreements as
3481defined in chapter 651, proof shall be furnished that such
3482applicant has obtained a certificate of authority as required
3483for operation under that chapter.
3484     (2)(7)  As a condition of licensure, each licensee, except
3485one offering continuing care agreements as defined in chapter
3486651, must agree to accept recipients of Title XIX of the Social
3487Security Act on a temporary, emergency basis. The persons whom
3488the agency may require such licensees to accept are those
3489recipients of Title XIX of the Social Security Act who are
3490residing in a facility in which existing conditions constitute
3491an immediate danger to the health, safety, or security of the
3492residents of the facility.
3493     (3)(8)  The agency may not issue a license to a nursing
3494home that fails to receive a certificate of need under the
3495provisions of ss. 408.031-408.045. It is the intent of the
3496Legislature that, in reviewing a certificate-of-need application
3497to add beds to an existing nursing home facility, preference be
3498given to the application of a licensee who has been awarded a
3499Gold Seal as provided for in s. 400.235, if the applicant
3500otherwise meets the review criteria specified in s. 408.035.
3501     (4)(9)  The agency may develop an abbreviated survey for
3502licensure renewal applicable to a licensee that has continuously
3503operated as a nursing facility since 1991 or earlier, has
3504operated under the same management for at least the preceding 30
3505months, and has had during the preceding 30 months no class I or
3506class II deficiencies.
3507     (5)(10)  As a condition of licensure, each facility must
3508establish and submit with its application a plan for quality
3509assurance and for conducting risk management.
3510     (11)  The applicant must provide the agency with proof of a
3511legal right to occupy the property before a license may be
3512issued. Proof may include, but is not limited to, copies of
3513warranty deeds, lease or rental agreements, contracts for deeds,
3514or quitclaim deeds.
3515     Section 69.  Subsection (4) of section 400.0712, Florida
3516Statutes, is renumbered as subsection (3) and present subsection
3517(3) of said section is amended to read:
3518     400.0712  Application for inactive license.--
3519     (3)  The agency may issue an inactive license to a nursing
3520home that will be temporarily unable to provide services but is
3521reasonably expected to resume services.
3522     (a)  An inactive license issued under this subsection may
3523be issued for a period not to exceed 12 months and may be
3524renewed by the agency for an additional 6 months upon
3525demonstration of progress toward reopening.
3526     (b)  All licensure fees must be current and paid in full,
3527and may be prorated as provided by agency rule, before the
3528inactive license is issued.
3529     (c)  Reactivation of an inactive license requires that the
3530applicant pay all licensure fees and be inspected by the agency
3531to confirm that all of the requirements of this part and
3532applicable rules are met.
3533     Section 70.  Section 400.102, Florida Statutes, is amended
3534to read:
3535     400.102  Action by agency against licensee; grounds.--
3536     (1)  In addition to the grounds listed in part II of
3537chapter 408, any of the following conditions shall be grounds
3538for action by the agency against a licensee:
3539     (1)(a)  An intentional or negligent act materially
3540affecting the health or safety of residents of the facility;
3541     (2)(b)  Misappropriation or conversion of the property of a
3542resident of the facility;
3543     (3)(c)  Failure to follow the criteria and procedures
3544provided under part I of chapter 394 relating to the
3545transportation, voluntary admission, and involuntary examination
3546of a nursing home resident; or
3547     (d)  Violation of provisions of this part or rules adopted
3548under this part;
3549     (4)(e)  Fraudulent altering, defacing, or falsifying any
3550medical or nursing home records, or causing or procuring any of
3551these offenses to be committed.; or
3552     (f)  Any act constituting a ground upon which application
3553for a license may be denied.
3554     (2)  If the agency has reasonable belief that any of such
3555conditions exist, it shall take the following action:
3556     (a)  In the case of an applicant for original licensure,
3557denial action as provided in s. 400.121.
3558     (b)  In the case of an applicant for relicensure or a
3559current licensee, administrative action as provided in s.
3560400.121 or injunctive action as authorized by s. 400.125.
3561     (c)  In the case of a facility operating without a license,
3562injunctive action as authorized in s. 400.125.
3563     Section 71.  Section 400.111, Florida Statutes, is amended
3564to read:
3565     400.111  Disclosure of controlling interest Expiration of
3566license; renewal.--
3567     (1)  A license issued for the operation of a facility,
3568unless sooner suspended or revoked, shall expire on the date set
3569forth by the agency on the face of the license or 1 year from
3570the date of issuance, whichever occurs first. Ninety days prior
3571to the expiration date, an application for renewal shall be
3572submitted to the agency. A license shall be renewed upon the
3573filing of an application on forms furnished by the agency if the
3574applicant has first met the requirements established under this
3575part and all rules adopted under this part. The failure to file
3576an application within the period established in this subsection
3577shall result in a late fee charged to the licensee by the agency
3578in an amount equal to 50 percent of the fee in effect on the
3579last preceding regular renewal date. A late fee shall be levied
3580for each and every day the filing of the license application is
3581delayed, but in no event shall such fine aggregate more than
3582$5,000. If an application is received after the required filing
3583date and exhibits a hand-canceled postmark obtained from a
3584United States Post Office dated on or before the required filing
3585date, no fine will be levied.
3586     (2)  A licensee against whom a revocation or suspension
3587proceeding, or any judicial proceeding instituted by the agency
3588under this part, is pending at the time of license renewal may
3589be issued a temporary license effective until final disposition
3590by the agency of such proceeding. If judicial relief is sought
3591from the aforesaid administrative order, the court having
3592jurisdiction may issue such orders regarding the issuance of a
3593temporary permit during the pendency of the judicial proceeding.
3594     (3)  The agency may not renew a license if the applicant
3595has failed to pay any fines assessed by final order of the
3596agency or final order of the Health Care Financing
3597Administration under requirements for federal certification. The
3598agency may renew the license of an applicant following the
3599assessment of a fine by final order if such fine has been paid
3600into an escrow account pending an appeal of a final order.
3601     (4)  In addition to the requirements of part II of chapter
3602408, the licensee shall submit a signed affidavit disclosing any
3603financial or ownership interest that a controlling interest
3604licensee has held within the last 5 years in any entity licensed
3605by the state or any other state to provide health or residential
3606care which entity has closed voluntarily or involuntarily; has
3607filed for bankruptcy; has had a receiver appointed; has had a
3608license denied, suspended, or revoked; or has had an injunction
3609issued against it which was initiated by a regulatory agency.
3610The affidavit must disclose the reason such entity was closed,
3611whether voluntarily or involuntarily.
3612     Section 72.  Subsections (2) and (5) of section 400.1183,
3613Florida Statutes, are amended to read:
3614     400.1183  Resident grievance procedures.--
3615     (2)  Each facility shall maintain records of all grievances
3616and shall report annually to the agency at the time of
3617relicensure the total number of grievances handled during the
3618prior licensure period, a categorization of the cases underlying
3619the grievances, and the final disposition of the grievances.
3620     (5)  The agency may impose an administrative fine, in
3621accordance with s. 400.121, against a nursing home facility for
3622noncompliance with this section.
3623     Section 73.  Section 400.121, Florida Statutes, is amended
3624to read:
3625     400.121  Denial, suspension, revocation of license;
3626moratorium on admissions; administrative fines; procedure; order
3627to increase staffing.--
3628     (1)  The agency may deny an application, revoke or suspend
3629a license, and or impose an administrative fine, not to exceed
3630$500 per violation per day for the violation of any provision of
3631this part, part II of chapter 408, or applicable rules, against
3632any applicant or licensee for the following violations by the
3633applicant, licensee, or other controlling interest:
3634     (a)  A violation of any provision of this part, part II of
3635chapter 408, or applicable rules s. 400.102(1); or
3636     (b)  A demonstrated pattern of deficient practice;
3637     (c)  Failure to pay any outstanding fines assessed by final
3638order of the agency or final order of the Health Care Financing
3639Administration pursuant to requirements for federal
3640certification. The agency may renew or approve the license of an
3641applicant following the assessment of a fine by final order if
3642such fine has been paid into an escrow account pending an appeal
3643of a final order;
3644     (d)  Exclusion from the Medicare or Medicaid program; or
3645     (b)(e)  An adverse action by a regulatory agency against
3646any other licensed facility that has a common controlling
3647interest with the licensee or applicant against whom the action
3648under this section is being brought. If the adverse action
3649involves solely the management company, the applicant or
3650licensee shall be given 30 days to remedy before final action is
3651taken. If the adverse action is based solely upon actions by a
3652controlling interest, the applicant or licensee may present
3653factors in mitigation of any proposed penalty based upon a
3654showing that such penalty is inappropriate under the
3655circumstances.
3656
3657All hearings shall be held within the county in which the
3658licensee or applicant operates or applies for a license to
3659operate a facility as defined herein.
3660     (2)  Except as provided in s. 400.23(8), a $500 fine shall
3661be imposed for each violation. Each day a violation of this part
3662occurs constitutes a separate violation and is subject to a
3663separate fine, but in no event may any fine aggregate more than
3664$5,000. A fine may be levied pursuant to this section in lieu of
3665and notwithstanding the provisions of s. 400.23. Fines paid
3666shall be deposited in the Resident Protection Trust Fund and
3667expended as provided in s. 400.063.
3668     (3)  The agency shall revoke or deny a nursing home license
3669if the licensee or controlling interest operates a facility in
3670this state that:
3671     (a)  Has had two moratoria imposed by final order for
3672substandard quality of care, as defined by 42 C.F.R. part 483,
3673within any 30-month period;
3674     (b)  Is conditionally licensed for 180 or more continuous
3675days;
3676     (c)  Is cited for two class I deficiencies arising from
3677unrelated circumstances during the same survey or investigation;
3678or
3679     (d)  Is cited for two class I deficiencies arising from
3680separate surveys or investigations within a 30-month period.
3681
3682The licensee may present factors in mitigation of revocation,
3683and the agency may make a determination not to revoke a license
3684based upon a showing that revocation is inappropriate under the
3685circumstances.
3686     (4)  The agency may issue an order immediately suspending
3687or revoking a license when it determines that any condition in
3688the facility presents a danger to the health, safety, or welfare
3689of the residents in the facility.
3690     (5)(a)  The agency may impose an immediate moratorium on
3691admissions to any facility when the agency determines that any
3692condition in the facility presents a threat to the health,
3693safety, or welfare of the residents in the facility.
3694     (4)(b)  Where the agency has placed a moratorium on
3695admissions on any facility two times within a 7-year period, the
3696agency may suspend the nursing home license of the nursing home
3697and the facility's management company, if any. During the
3698suspension, the agency shall take the facility into receivership
3699and shall operate the facility.
3700     (5)(6)  An action taken by the agency to deny, suspend, or
3701revoke a facility's license under this part shall be heard by
3702the Division of Administrative Hearings of the Department of
3703Management Services within 60 days after the assignment of an
3704administrative law judge, unless the time limitation is waived
3705by both parties. The administrative law judge must render a
3706decision within 30 days after receipt of a proposed recommended
3707order.
3708     (6)(7)  The agency is authorized to require a facility to
3709increase staffing beyond the minimum required by law, if the
3710agency has taken administrative action against the facility for
3711care-related deficiencies directly attributable to insufficient
3712staff. Under such circumstances, the facility may request an
3713expedited interim rate increase. The agency shall process the
3714request within 10 days after receipt of all required
3715documentation from the facility. A facility that fails to
3716maintain the required increased staffing is subject to a fine of
3717$500 per day for each day the staffing is below the level
3718required by the agency.
3719     (8)  An administrative proceeding challenging an action
3720taken by the agency pursuant to this section shall be reviewed
3721on the basis of the facts and conditions that resulted in such
3722agency action.
3723     (7)(9)  Notwithstanding any other provision of law to the
3724contrary, agency action in an administrative proceeding under
3725this section may be overcome by the licensee upon a showing by a
3726preponderance of the evidence to the contrary.
3727     (8)(10)  In addition to any other sanction imposed under
3728this part, in any final order that imposes sanctions, the agency
3729may assess costs related to the investigation and prosecution of
3730the case. Payment of agency costs shall be deposited into the
3731Health Care Trust Fund.
3732     Section 74.  Section 400.125, Florida Statutes, is
3733repealed.
3734     Section 75.  Subsections (14), (15), and (16) of section
3735400.141, Florida Statutes, are amended to read:
3736     400.141  Administration and management of nursing home
3737facilities.--Every licensed facility shall comply with all
3738applicable standards and rules of the agency and shall:
3739     (14)  Submit to the agency the information specified in s.
3740400.071(1)(a)(2)(e) for a management company within 30 days
3741after the effective date of the management agreement.
3742     (15)(a)  By the 15th calendar day of the month following
3743the end of each calendar quarter, submit semiannually to the
3744agency, or more frequently if requested by the agency,
3745information regarding facility staff-to-resident ratios, staff
3746turnover, and staff stability, including information regarding
3747certified nursing assistants, licensed nurses, the director of
3748nursing, and the facility administrator. For purposes of this
3749reporting:
3750     1.(a)  Staff-to-resident ratios must be reported in the
3751categories specified in s. 400.23(3)(a) and applicable rules.
3752The ratio must be reported as an average for the most recent
3753calendar quarter.
3754     2.(b)  Staff turnover must be reported for the most recent
375512-month period ending on the last workday of the most recent
3756calendar quarter prior to the date the information is submitted.
3757The turnover rate must be computed quarterly, with the annual
3758rate being the cumulative sum of the quarterly rates. The
3759turnover rate is the total number of terminations or separations
3760experienced during the quarter, excluding any employee
3761terminated during a probationary period of 3 months or less,
3762divided by the total number of staff employed at the end of the
3763period for which the rate is computed, and expressed as a
3764percentage.
3765     3.(c)  The formula for determining staff stability is the
3766total number of employees that have been employed for more than
376712 months, divided by the total number of employees employed at
3768the end of the most recent calendar quarter, and expressed as a
3769percentage.
3770     (b)(d)  A nursing facility that has failed to comply with
3771state minimum-staffing requirements for 2 consecutive days is
3772prohibited from accepting new admissions until the facility has
3773achieved the minimum-staffing requirements for a period of 6
3774consecutive days. For the purposes of this paragraph, any person
3775who was a resident of the facility and was absent from the
3776facility for the purpose of receiving medical care at a separate
3777location or was on a leave of absence is not considered a new
3778admission. Failure to impose such an admissions moratorium
3779constitutes a class II deficiency.
3780     (c)(e)  A nursing facility that which does not have a
3781conditional license may be cited for failure to comply with the
3782standards in s. 400.23(3)(a) only if it has failed to meet those
3783standards on 2 consecutive days or if it has failed to meet at
3784least 97 percent of those standards on any one day.
3785     (d)(f)  A facility that which has a conditional license
3786must be in compliance with the standards in s. 400.23(3)(a) at
3787all times from the effective date of the conditional license
3788until the effective date of a subsequent standard license.
3789
3790Nothing in this subsection section shall limit the agency's
3791ability to impose a deficiency or take other actions if a
3792facility does not have enough staff to meet the residents'
3793needs.
3794     (16)  Report by the 10th calendar day of each month monthly
3795the number of vacant beds in the facility that which are
3796available for resident occupancy on the last day of the month
3797information is reported.
3798
3799Facilities that have been awarded a Gold Seal under the program
3800established in s. 400.235 may develop a plan to provide
3801certified nursing assistant training as prescribed by federal
3802regulations and state rules and may apply to the agency for
3803approval of their program.
3804     Section 76.  Subsection (6) of section 400.162, Florida
3805Statutes, is amended to read:
3806     400.162  Property and personal affairs of residents.--
3807     (6)  In the event of the death of a resident, a licensee
3808shall return all refunds and funds held in trust to the
3809resident's personal representative, if one has been appointed at
3810the time the nursing home disburses such funds, and if not, to
3811the resident's spouse or adult next of kin named in a
3812beneficiary designation form provided by the nursing home to the
3813resident. In the event the resident has not completed the
3814beneficiary designation form or the resident's designated spouse
3815or adult next of kin is deceased or cannot be located and no
3816personal representative has been appointed, the nursing home may
3817release funds to the funeral home that is handling the deceased
3818resident's remains for the funeral home's actual charges for the
3819services performed. In all other situations no spouse or adult
3820next of kin or such person cannot be located, funds due to the
3821resident shall be placed in an interest-bearing account in a
3822bank, savings association, trust company, or credit union
3823located in this state and, if possible, located within the same
3824district in which the facility is located, which funds shall not
3825be represented as part of the assets of the facility on a
3826financial statement, and the licensee shall maintain such
3827account until such time as the trust funds are disbursed
3828pursuant to the provisions of the Florida Probate Code. All
3829other property of a deceased resident being held in trust by the
3830licensee shall be returned to the resident's personal
3831representative, if one has been appointed at the time the
3832nursing home disburses such property, and if not, to the
3833resident's spouse or adult next of kin named in a beneficiary
3834designation form provided by the nursing home to the resident.
3835In the event the resident has no spouse or adult next of kin or
3836such person cannot be located, property being held in trust
3837shall be safeguarded until such time as the property is
3838disbursed pursuant to the provisions of the Florida Probate
3839Code. The trust funds and property of deceased residents shall
3840be kept separate from the funds and the property of the licensee
3841and from the funds and property of the residents of the
3842facility. The nursing home needs to maintain only one account in
3843which the trust funds amounting to less than $100 of deceased
3844residents are placed. However, it shall be the obligation of the
3845nursing home to maintain adequate records to permit compilation
3846of interest due each individual resident's account. Separate
3847accounts shall be maintained with respect to trust funds of
3848deceased residents equal to or in excess of $100. In the event
3849the trust funds of the deceased resident are not disbursed
3850pursuant to the provisions of the Florida Probate Code within 2
3851years of the death of the resident, the trust funds shall be
3852deposited in the Resident Protection Trust Fund and expended as
3853provided for in s. 400.063, notwithstanding the provisions of
3854any other law of this state. Any other property of a deceased
3855resident held in trust by a licensee which is not disbursed in
3856accordance with the provisions of the Florida Probate Code shall
3857escheat to the state as provided by law.
3858     Section 77.  Section 400.179, Florida Statutes, is amended
3859to read:
3860     400.179  Sale or transfer of ownership of a nursing
3861facility; Liability for Medicaid underpayments and
3862overpayments.--
3863     (1)  It is the intent of the Legislature to protect the
3864rights of nursing home residents and the security of public
3865funds when a nursing facility is sold or the ownership is
3866transferred.
3867     (2)  Whenever a nursing facility is sold or the ownership
3868is transferred, including leasing, the transferee shall make
3869application to the agency for a new license at least 90 days
3870prior to the date of transfer of ownership.
3871     (3)  The transferor shall notify the agency in writing at
3872least 90 days prior to the date of transfer of ownership. The
3873transferor shall be responsible and liable for the lawful
3874operation of the nursing facility and the welfare of the
3875residents domiciled in the facility until the date the
3876transferee is licensed by the agency. The transferor shall be
3877liable for any and all penalties imposed against the facility
3878for violations occurring prior to the date of transfer of
3879ownership.
3880     (4)  The transferor shall, prior to transfer of ownership,
3881repay or make arrangements to repay to the agency or the
3882Department of Children and Family Services any amounts owed to
3883the agency or the department. Should the transferor fail to
3884repay or make arrangements to repay the amounts owed to the
3885agency or the department prior to the transfer of ownership, the
3886issuance of a license to the transferee shall be delayed until
3887repayment or until arrangements for repayment are made.
3888     (2)(5)  Because any transfer of a nursing facility may
3889expose the fact that Medicaid may have underpaid or overpaid the
3890transferor, and because in most instances, any such underpayment
3891or overpayment can only be determined following a formal field
3892audit, the liabilities for any such underpayments or
3893overpayments shall be as follows:
3894     (a)  The Medicaid program shall be liable to the transferor
3895for any underpayments owed during the transferor's period of
3896operation of the facility.
3897     (b)  Without regard to whether the transferor had leased or
3898owned the nursing facility, the transferor shall remain liable
3899to the Medicaid program for all Medicaid overpayments received
3900during the transferor's period of operation of the facility,
3901regardless of when determined.
3902     (c)  Where the facility transfer takes any form of a sale
3903of assets, in addition to the transferor's continuing liability
3904for any such overpayments, if the transferor fails to meet these
3905obligations, the transferee shall be liable for all liabilities
3906that can be readily identifiable 90 days in advance of the
3907transfer. Such liability shall continue in succession until the
3908debt is ultimately paid or otherwise resolved. It shall be the
3909burden of the transferee to determine the amount of all such
3910readily identifiable overpayments from the Agency for Health
3911Care Administration, and the agency shall cooperate in every way
3912with the identification of such amounts. Readily identifiable
3913overpayments shall include overpayments that will result from,
3914but not be limited to:
3915     1.  Medicaid rate changes or adjustments;
3916     2.  Any depreciation recapture;
3917     3.  Any recapture of fair rental value system indexing; or
3918     4.  Audits completed by the agency.
3919
3920The transferor shall remain liable for any such Medicaid
3921overpayments that were not readily identifiable 90 days in
3922advance of the nursing facility transfer.
3923     (d)  Where the transfer involves a facility that has been
3924leased by the transferor:
3925     1.  The transferee shall, as a condition to being issued a
3926license by the agency, acquire, maintain, and provide proof to
3927the agency of a bond with a term of 30 months, renewable
3928annually, in an amount not less than the total of 3 months
3929Medicaid payments to the facility computed on the basis of the
3930preceding 12-month average Medicaid payments to the facility.
3931     2.  A leasehold licensee may meet the requirements of
3932subparagraph 1. by payment of a nonrefundable fee, paid at
3933initial licensure, paid at the time of any subsequent change of
3934ownership, and paid annually thereafter at the time of any
3935subsequent annual license renewal, in the amount of 2 percent of
3936the total of 3 months' Medicaid payments to the facility
3937computed on the basis of the preceding 12-month average Medicaid
3938payments to the facility. If a preceding 12-month average is not
3939available, projected Medicaid payments may be used. The fee
3940shall be deposited into the Health Care Trust Fund and shall be
3941accounted for separately as a Medicaid nursing home overpayment
3942account. These fees shall be used at the sole discretion of the
3943agency to repay nursing home Medicaid overpayments. Payment of
3944this fee shall not release the licensee from any liability for
3945any Medicaid overpayments, nor shall payment bar the agency from
3946seeking to recoup overpayments from the licensee and any other
3947liable party. As a condition of exercising this lease bond
3948alternative, licensees paying this fee must maintain an existing
3949lease bond through the end of the 30-month term period of that
3950bond. The agency is herein granted specific authority to
3951promulgate all rules pertaining to the administration and
3952management of this account, including withdrawals from the
3953account, subject to federal review and approval. This provision
3954shall take effect upon becoming law and shall apply to any
3955leasehold license application.
3956     a.  The financial viability of the Medicaid nursing home
3957overpayment account shall be determined by the agency through
3958annual review of the account balance and the amount of total
3959outstanding, unpaid Medicaid overpayments owing from leasehold
3960licensees to the agency as determined by final agency audits.
3961     b.  The agency, in consultation with the Florida Health
3962Care Association and the Florida Association of Homes for the
3963Aging, shall study and make recommendations on the minimum
3964amount to be held in reserve to protect against Medicaid
3965overpayments to leasehold licensees and on the issue of
3966successor liability for Medicaid overpayments upon sale or
3967transfer of ownership of a nursing facility. The agency shall
3968submit the findings and recommendations of the study to the
3969Governor, the President of the Senate, and the Speaker of the
3970House of Representatives by January 1, 2003.
3971     3.  The leasehold licensee may meet the bond requirement
3972through other arrangements acceptable to the agency. The agency
3973is herein granted specific authority to promulgate rules
3974pertaining to lease bond arrangements.
3975     4.  All existing nursing facility licensees, operating the
3976facility as a leasehold, shall acquire, maintain, and provide
3977proof to the agency of the 30-month bond required in
3978subparagraph 1., above, on and after July 1, 1993, for each
3979license renewal.
3980     5.  It shall be the responsibility of all nursing facility
3981operators, operating the facility as a leasehold, to renew the
398230-month bond and to provide proof of such renewal to the agency
3983annually at the time of application for license renewal.
3984     6.  Any failure of the nursing facility operator to
3985acquire, maintain, renew annually, or provide proof to the
3986agency shall be grounds for the agency to deny, cancel, revoke,
3987and or suspend the facility license to operate such facility and
3988to take any further action, including, but not limited to,
3989enjoining the facility, asserting a moratorium pursuant to part
3990II of chapter 408, or applying for a receiver, deemed necessary
3991to ensure compliance with this section and to safeguard and
3992protect the health, safety, and welfare of the facility's
3993residents. A lease agreement required as a condition of bond
3994financing or refinancing under s. 154.213 by a health facilities
3995authority or required under s. 159.30 by a county or
3996municipality is not a leasehold for purposes of this paragraph
3997and is not subject to the bond requirement of this paragraph.
3998     Section 78.  Subsections (1) and (4) of section 400.18,
3999Florida Statutes, are amended to read:
4000     400.18  Closing of nursing facility.--
4001     (1)  In addition to the requirements of part II of chapter
4002408, Whenever a licensee voluntarily discontinues operation, and
4003during the period when it is preparing for such discontinuance,
4004it shall inform the agency not less than 90 days prior to the
4005discontinuance of operation. the licensee also shall inform each
4006the resident or the next of kin, legal representative, or agency
4007acting on behalf of the resident of the fact, and the proposed
4008time, of such discontinuance of operation and give at least 90
4009days' notice so that suitable arrangements may be made for the
4010transfer and care of the resident. In the event any resident has
4011no such person to represent him or her, the licensee shall be
4012responsible for securing a suitable transfer of the resident
4013before the discontinuance of operation. The agency shall be
4014responsible for arranging for the transfer of those residents
4015requiring transfer who are receiving assistance under the
4016Medicaid program.
4017     (4)  Immediately upon discontinuance of operation of a
4018facility, the licensee shall surrender the license therefor to
4019the agency, and the license shall be canceled.
4020     Section 79.  Subsections (1), (2), and (3) of section
4021400.19, Florida Statutes, are amended to read:
4022     400.19  Right of entry and inspection.--
4023     (1)  In accordance with part II of chapter 408, the agency
4024and any duly designated officer or employee thereof or a member
4025of the State Long-Term Care Ombudsman Council or the local long-
4026term care ombudsman council shall have the right to enter upon
4027and into the premises of any facility licensed pursuant to this
4028part, or any distinct nursing home unit of a hospital licensed
4029under chapter 395 or any freestanding facility licensed under
4030chapter 395 that provides extended care or other long-term care
4031services, at any reasonable time in order to determine the state
4032of compliance with the provisions of this part and rules in
4033force pursuant thereto. The right of entry and inspection shall
4034also extend to any premises which the agency has reason to
4035believe is being operated or maintained as a facility without a
4036license, but no such entry or inspection of any premises shall
4037be made without the permission of the owner or person in charge
4038thereof, unless a warrant is first obtained from the circuit
4039court authorizing same. Any application for a facility license
4040or renewal thereof, made pursuant to this part, shall constitute
4041permission for and complete acquiescence in any entry or
4042inspection of the premises for which the license is sought, in
4043order to facilitate verification of the information submitted on
4044or in connection with the application; to discover, investigate,
4045and determine the existence of abuse or neglect; or to elicit,
4046receive, respond to, and resolve complaints. The agency shall,
4047within 60 days after receipt of a complaint made by a resident
4048or resident's representative, complete its investigation and
4049provide to the complainant its findings and resolution.
4050     (2)  The agency shall coordinate nursing home facility
4051licensing activities and responsibilities of any duly designated
4052officer or employee involved in nursing home facility inspection
4053to assure necessary, equitable, and consistent supervision of
4054inspection personnel without unnecessary duplication of
4055inspections, consultation services, or complaint investigations.
4056To facilitate such coordination, all rules promulgated by the
4057agency pursuant to this part shall be distributed to nursing
4058homes licensed under s. 400.062 30 days prior to implementation.
4059This requirement does not apply to emergency rules.
4060     (3)  The agency shall every 15 months conduct at least one
4061unannounced inspection to determine compliance by the licensee
4062with statutes, and with rules promulgated under the provisions
4063of those statutes, governing minimum standards of construction,
4064quality and adequacy of care, and rights of residents. The
4065survey shall be conducted every 6 months for the next 2-year
4066period if the facility has been cited for a class I deficiency,
4067has been cited for two or more class II deficiencies arising
4068from separate surveys or investigations within a 60-day period,
4069or has had three or more substantiated complaints within a 6-
4070month period, each resulting in at least one class I or class II
4071deficiency. In addition to any other fees or fines in this part,
4072the agency shall assess a fine for each facility that is subject
4073to the 6-month survey cycle. The fine for the 2-year period
4074shall be $6,000, one-half to be paid at the completion of each
4075survey. The agency may adjust this fine by the change in the
4076Consumer Price Index, based on the 12 months immediately
4077preceding the increase, to cover the cost of the additional
4078surveys. The agency shall verify through subsequent inspection
4079that any deficiency identified during the annual inspection is
4080corrected. However, the agency may verify the correction of a
4081class III or class IV deficiency unrelated to resident rights or
4082resident care without reinspecting the facility if adequate
4083written documentation has been received from the facility, which
4084provides assurance that the deficiency has been corrected. The
4085giving or causing to be given of advance notice of such
4086unannounced inspections by an employee of the agency to any
4087unauthorized person shall constitute cause for suspension of not
4088fewer than 5 working days according to the provisions of chapter
4089110.
4090     Section 80.  Section 400.191, Florida Statutes, is amended
4091to read:
4092     400.191  Availability, distribution, and posting of reports
4093and records.--
4094     (1)  The agency shall provide information to the public
4095about all of the licensed nursing home facilities operating in
4096the state. The agency shall, within 60 days after an annual
4097inspection visit or within 30 days after any interim visit to a
4098facility, send copies of the inspection reports to the local
4099long-term care ombudsman council, the agency's local office, and
4100a public library or the county seat for the county in which the
4101facility is located. The agency may provide electronic access to
4102inspection reports as a substitute for sending copies.
4103     (2)  The agency shall publish the Nursing Home Guide
4104provide additional information in consumer-friendly printed and
4105electronic formats to assist consumers and their families in
4106comparing and evaluating nursing home facilities.
4107     (a)  The agency shall provide an Internet site which shall
4108include at least the following information either directly or
4109indirectly through a link to another established site or sites
4110of the agency's choosing:
4111     1.  A list by name and address of all nursing home
4112facilities in this state, including any prior name a facility
4113was known by during the previous 12-month period.
4114     2.  Whether such nursing home facilities are proprietary or
4115nonproprietary.
4116     3.  The current owner of the facility's license and the
4117year that that entity became the owner of the license.
4118     4.  The name of the owner or owners of each facility and
4119whether the facility is affiliated with a company or other
4120organization owning or managing more than one nursing facility
4121in this state.
4122     5.  The total number of beds in each facility and the most
4123recently available occupancy levels.
4124     6.  The number of private and semiprivate rooms in each
4125facility.
4126     7.  The religious affiliation, if any, of each facility.
4127     8.  The languages spoken by the administrator and staff of
4128each facility.
4129     9.  Whether or not each facility accepts Medicare or
4130Medicaid recipients or insurance, health maintenance
4131organization, Veterans Administration, CHAMPUS program, or
4132workers' compensation coverage.
4133     10.  Recreational and other programs available at each
4134facility.
4135     11.  Special care units or programs offered at each
4136facility.
4137     12.  Whether the facility is a part of a retirement
4138community that offers other services pursuant to part III, part
4139IV, or part V.
4140     13.  Survey and deficiency information contained on the
4141Online Survey Certification and Reporting (OSCAR) system of the
4142federal Health Care Financing Administration, including all
4143federal and state recertification, licensure annual survey,
4144revisit, and complaint survey information, for each facility for
4145the past 30 45 months. For noncertified nursing homes, state
4146survey and deficiency information, including licensure annual
4147survey, revisit, and complaint survey information for the past
414830 45 months shall be provided.
4149     14.  A summary of the deficiency Online Survey
4150Certification and Reporting (OSCAR) data for each facility over
4151the past 30 45 months. Such summary may include a score, rating,
4152or comparison ranking with respect to other facilities based on
4153the number of citations received by the facility on
4154recertification, licensure of annual, revisit, and complaint
4155surveys; the severity and scope of the citations; and the number
4156of annual recertification surveys the facility has had during
4157the past 30 45 months. The score, rating, or comparison ranking
4158may be presented in either numeric or symbolic form for the
4159intended consumer audience.
4160     (b)  The agency shall provide the following information in
4161printed form:
4162     1.  A list by name and address of all nursing home
4163facilities in this state.
4164     2.  Whether such nursing home facilities are proprietary or
4165nonproprietary.
4166     3.  The current owner or owners of the facility's license
4167and the year that entity became the owner of the license.
4168     4.  The total number of beds, and of private and
4169semiprivate rooms, in each facility.
4170     5.  The religious affiliation, if any, of each facility.
4171     6.  The name of the owner of each facility and whether the
4172facility is affiliated with a company or other organization
4173owning or managing more than one nursing facility in this state.
4174     7.  The languages spoken by the administrator and staff of
4175each facility.
4176     8.  Whether or not each facility accepts Medicare or
4177Medicaid recipients or insurance, health maintenance
4178organization, Veterans Administration, CHAMPUS program, or
4179workers' compensation coverage.
4180     9.  Recreational programs, special care units, and other
4181programs available at each facility.
4182     10.  The Internet address for the site where more detailed
4183information can be seen.
4184     11.  A statement advising consumers that each facility will
4185have its own policies and procedures related to protecting
4186resident property.
4187     12.  A summary of the deficiency Online Survey
4188Certification and Reporting (OSCAR) data for each facility over
4189the past 45 months. Such summary may include a score, rating, or
4190comparison ranking with respect to other facilities based on the
4191number of citations received by the facility on recertification,
4192licensure annual, revisit, and complaint surveys; the severity
4193and scope of the citations; the number of citations; and the
4194number of annual recertification surveys the facility has had
4195during the past 30 45 months. The score, rating, or comparison
4196ranking may be presented in either numeric or symbolic form for
4197the intended consumer audience.
4198     (c)  For purposes of this subsection, references to the
4199Online Survey Certification and Reporting (OSCAR) system shall
4200refer to any future system that the Health Care Financing
4201Administration develops to replace the current OSCAR system.
4202     (c)(d)  The agency may provide the following additional
4203information on an Internet site or in printed form as the
4204information becomes available:
4205     1.  The licensure status history of each facility.
4206     2.  The rating history of each facility.
4207     3.  The regulatory history of each facility, which may
4208include federal sanctions, state sanctions, federal fines, state
4209fines, and other actions.
4210     4.  Whether the facility currently possesses the Gold Seal
4211designation awarded pursuant to s. 400.235.
4212     5.  Internet links to the Internet sites of the facilities
4213or their affiliates.
4214     (3)  Each nursing home facility licensee shall maintain as
4215public information, available upon request, records of all cost
4216and inspection reports pertaining to that facility that have
4217been filed with, or issued by, any governmental agency. Copies
4218of such reports shall be retained in such records for not less
4219than 5 years from the date the reports are filed or issued.
4220     (a)  The agency shall quarterly publish in the Nursing Home
4221Guide a "Nursing Home Guide Watch List" to assist consumers in
4222evaluating the quality of nursing home care in Florida. The
4223watch list must identify each facility that met the criteria for
4224a conditional licensure status to be noticed as specified in
4225this section on any day within the quarter covered by the list
4226and each facility that is was operating under bankruptcy
4227protection on any day within the quarter. The watch list must
4228include, but is not limited to, the facility's name, address,
4229and ownership; the county in which the facility operates; the
4230license expiration date; the number of licensed beds; a
4231description of the deficiency causing the facility to be placed
4232on the list; any corrective action taken; and the cumulative
4233number of days and percentage of days times the facility had a
4234conditional license in the past 30 months has been on a watch
4235list. The watch list must include a brief description regarding
4236how to choose a nursing home, the categories of licensure, the
4237agency's inspection process, an explanation of terms used in the
4238watch list, and the addresses and phone numbers of the agency's
4239managed care and health quality assurance field area offices.
4240     (b)  Upon publication of each quarterly Nursing Home Guide
4241watch list, the agency must post transmit a copy on its website
4242by the 15th calendar day 2 months following the end of the
4243calendar quarter. Each nursing home licensee must retrieve the
4244most recent version of the Nursing Home Guide from of the watch
4245list to each nursing home facility by mail and must make the
4246watch list available on the agency's Internet website.
4247     (4)  Any records of a nursing home facility determined by
4248the agency to be necessary and essential to establish lawful
4249compliance with any rules or standards shall be made available
4250to the agency on the premises of the facility and submitted to
4251the agency. Each facility must submit this information
4252electronically when electronic transmission to the agency is
4253available.
4254     (5)  Every nursing home facility licensee shall:
4255     (a)  Post, in a sufficient number of prominent positions in
4256the nursing home so as to be accessible to all residents and to
4257the general public:
4258     1.  A concise summary of the last inspection report
4259pertaining to the nursing home and issued by the agency, with
4260references to the page numbers of the full reports, noting any
4261deficiencies found by the agency and the actions taken by the
4262licensee to rectify such deficiencies and indicating in such
4263summaries where the full reports may be inspected in the nursing
4264home.
4265     2.  A copy of all pages listing the facility from the most
4266recent version of the Florida Nursing Home Guide Watch List.
4267     (b)  Upon request, provide to any person who has completed
4268a written application with an intent to be admitted to, or to
4269any resident of, such nursing home, or to any relative, spouse,
4270or guardian of such person, a copy of the last inspection report
4271pertaining to the nursing home and issued by the agency,
4272provided the person requesting the report agrees to pay a
4273reasonable charge to cover copying costs.
4274     (6)  The agency may adopt rules as necessary to administer
4275this section.
4276     Section 81.  Section 400.20, Florida Statutes, is amended
4277to read:
4278     400.20  Licensed nursing home administrator required.--A No
4279nursing home may not shall operate except under the supervision
4280of a licensed nursing home administrator, and a no person may
4281not shall be a nursing home administrator unless he or she holds
4282is the holder of a current license as provided in chapter 468.
4283     Section 82.  Subsections (2), (7), and (8) of section
4284400.23, Florida Statutes, are amended to read:
4285     400.23  Rules; evaluation and deficiencies; licensure
4286status.--
4287     (2)  Pursuant to the intention of the Legislature, the
4288agency, in consultation with the Department of Health and the
4289Department of Elderly Affairs, shall adopt and enforce rules to
4290implement this part and part II of chapter 408, which shall
4291include reasonable and fair criteria in relation to:
4292     (a)  The location of the facility and housing conditions
4293that will ensure the health, safety, and comfort of residents,
4294including an adequate call system. In making such rules, the
4295agency shall be guided by criteria recommended by nationally
4296recognized reputable professional groups and associations with
4297knowledge of such subject matters. The agency shall update or
4298revise such criteria as the need arises. The agency may require
4299alterations to a building if it determines that an existing
4300condition constitutes a distinct hazard to life, health, or
4301safety. In performing any inspections of facilities authorized
4302by this part, the agency may enforce the special-occupancy
4303provisions of the Florida Building Code and the Florida Fire
4304Prevention Code which apply to nursing homes. The agency is
4305directed to provide assistance to the Florida Building
4306Commission in updating the construction standards of the code
4307relative to nursing homes. During the care planning process, a
4308resident shall be able to choose the placement of the bed in his
4309or her room, provided the requirements of the Florida Building
4310Code are met through alternate methods or equivalencies and the
4311request does not infringe on the resident's roommate or
4312interfere with the resident's care needs as determined by the
4313care planning team.
4314     (b)  The number and qualifications of all personnel,
4315including management, medical, nursing, and other professional
4316personnel, and nursing assistants, orderlies, and support
4317personnel, having responsibility for any part of the care given
4318residents.
4319     (c)  All sanitary conditions within the facility and its
4320surroundings, including water supply, sewage disposal, food
4321handling, and general hygiene which will ensure the health and
4322comfort of residents.
4323     (d)  The equipment essential to the health and welfare of
4324the residents.
4325     (e)  A uniform accounting system.
4326     (f)  The care, treatment, and maintenance of residents and
4327measurement of the quality and adequacy thereof, based on rules
4328developed under this chapter and the Omnibus Budget
4329Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
43301987), Title IV (Medicare, Medicaid, and Other Health-Related
4331Programs), Subtitle C (Nursing Home Reform), as amended.
4332     (g)  The preparation and annual update of a comprehensive
4333emergency management plan. The agency shall adopt rules
4334establishing minimum criteria for the plan after consultation
4335with the Department of Community Affairs. At a minimum, the
4336rules must provide for plan components that address emergency
4337evacuation transportation; adequate sheltering arrangements;
4338postdisaster activities, including emergency power, food, and
4339water; postdisaster transportation; supplies; staffing;
4340emergency equipment; individual identification of residents and
4341transfer of records; and responding to family inquiries. The
4342comprehensive emergency management plan is subject to review and
4343approval by the local emergency management agency. During its
4344review, the local emergency management agency shall ensure that
4345the following agencies, at a minimum, are given the opportunity
4346to review the plan: the Department of Elderly Affairs, the
4347Department of Health, the Agency for Health Care Administration,
4348and the Department of Community Affairs. Also, appropriate
4349volunteer organizations must be given the opportunity to review
4350the plan. The local emergency management agency shall complete
4351its review within 60 days and either approve the plan or advise
4352the facility of necessary revisions.
4353     (h)  The availability, distribution, and posting of reports
4354and records pursuant to s. 400.191 and the Gold Seal Program
4355pursuant to s. 400.235.
4356     (7)  The agency shall, at least every 15 months, evaluate
4357all nursing home facilities and make a determination as to the
4358degree of compliance by each licensee with the established rules
4359adopted under this part as a basis for assigning a licensure
4360status to that facility. The agency shall base its evaluation on
4361the most recent inspection report, taking into consideration
4362findings from other official reports, surveys, interviews,
4363investigations, and inspections. The agency shall assign a
4364licensure status of standard or conditional to each nursing
4365home.
4366     (a)  A standard licensure status means that a facility has
4367no class I or class II deficiencies and has corrected all class
4368III deficiencies within the time established by the agency.
4369     (b)  A conditional licensure status means that a facility,
4370due to the presence of one or more class I or class II
4371deficiencies, or class III deficiencies not corrected within the
4372time established by the agency, is not in substantial compliance
4373at the time of the survey with criteria established under this
4374part or with rules adopted by the agency. If the facility has no
4375class I, class II, or class III deficiencies at the time of the
4376followup survey, a standard licensure status may be assigned.
4377     (c)  In evaluating the overall quality of care and services
4378and determining whether the facility will receive a conditional
4379or standard license, the agency shall consider the needs and
4380limitations of residents in the facility and the results of
4381interviews and surveys of a representative sampling of
4382residents, families of residents, ombudsman council members in
4383the planning and service area in which the facility is located,
4384guardians of residents, and staff of the nursing home facility.
4385     (d)  The current licensure status of each facility must be
4386indicated in bold print on the face of the license. A list of
4387the deficiencies of the facility shall be posted in a prominent
4388place that is in clear and unobstructed public view at or near
4389the place where residents are being admitted to that facility.
4390Licensees receiving a conditional licensure status for a
4391facility shall prepare, within 10 working days after receiving
4392notice of deficiencies, a plan for correction of all
4393deficiencies and shall submit the plan to the agency for
4394approval.
4395     (e)  Each licensee shall post its license in a prominent
4396place that is in clear and unobstructed public view at or near
4397the place where residents are being admitted to the facility.
4398     (e)(f)  The agency shall adopt rules that:
4399     1.  Establish uniform procedures for the evaluation of
4400facilities.
4401     2.  Provide criteria in the areas referenced in paragraph
4402(c).
4403     3.  Address other areas necessary for carrying out the
4404intent of this section.
4405     (8)  The agency shall adopt rules pursuant to this part and
4406part II of chapter 408 to provide that, when the criteria
4407established under subsection (2) are not met, such deficiencies
4408shall be classified according to the nature and the scope of the
4409deficiency. The scope shall be cited as isolated, patterned, or
4410widespread. An isolated deficiency is a deficiency affecting one
4411or a very limited number of residents, or involving one or a
4412very limited number of staff, or a situation that occurred only
4413occasionally or in a very limited number of locations. A
4414patterned deficiency is a deficiency where more than a very
4415limited number of residents are affected, or more than a very
4416limited number of staff are involved, or the situation has
4417occurred in several locations, or the same resident or residents
4418have been affected by repeated occurrences of the same deficient
4419practice but the effect of the deficient practice is not found
4420to be pervasive throughout the facility. A widespread deficiency
4421is a deficiency in which the problems causing the deficiency are
4422pervasive in the facility or represent systemic failure that has
4423affected or has the potential to affect a large portion of the
4424facility's residents. The agency shall indicate the
4425classification on the face of the notice of deficiencies as
4426follows:
4427     (a)  A class I deficiency is a deficiency that the agency
4428determines presents a situation in which immediate corrective
4429action is necessary because the facility's noncompliance has
4430caused, or is likely to cause, serious injury, harm, impairment,
4431or death to a resident receiving care in a facility. The
4432condition or practice constituting a class I violation shall be
4433abated or eliminated immediately, unless a fixed period of time,
4434as determined by the agency, is required for correction. A class
4435I deficiency is subject to a civil penalty of $10,000 for an
4436isolated deficiency, $12,500 for a patterned deficiency, and
4437$15,000 for a widespread deficiency. The fine amount shall be
4438doubled for each deficiency if the facility was previously cited
4439for one or more class I or class II deficiencies during the last
4440annual inspection or any inspection or complaint investigation
4441since the last annual inspection. A fine must be levied
4442notwithstanding the correction of the deficiency.
4443     (b)  A class II deficiency is a deficiency that the agency
4444determines has compromised the resident's ability to maintain or
4445reach his or her highest practicable physical, mental, and
4446psychosocial well-being, as defined by an accurate and
4447comprehensive resident assessment, plan of care, and provision
4448of services. A class II deficiency is subject to a civil penalty
4449of $2,500 for an isolated deficiency, $5,000 for a patterned
4450deficiency, and $7,500 for a widespread deficiency. The fine
4451amount shall be doubled for each deficiency if the facility was
4452previously cited for one or more class I or class II
4453deficiencies during the last licensure annual inspection or any
4454inspection or complaint investigation since the last licensure
4455annual inspection. A fine shall be levied notwithstanding the
4456correction of the deficiency.
4457     (c)  A class III deficiency is a deficiency that the agency
4458determines will result in no more than minimal physical, mental,
4459or psychosocial discomfort to the resident or has the potential
4460to compromise the resident's ability to maintain or reach his or
4461her highest practical physical, mental, or psychosocial well-
4462being, as defined by an accurate and comprehensive resident
4463assessment, plan of care, and provision of services. A class III
4464deficiency is subject to a civil penalty of $1,000 for an
4465isolated deficiency, $2,000 for a patterned deficiency, and
4466$3,000 for a widespread deficiency. The fine amount shall be
4467doubled for each deficiency if the facility was previously cited
4468for one or more class I or class II deficiencies during the last
4469licensure annual inspection or any inspection or complaint
4470investigation since the last annual inspection. A citation for a
4471class III deficiency must specify the time within which the
4472deficiency is required to be corrected. If a class III
4473deficiency is corrected within the time specified, no civil
4474penalty shall be imposed.
4475     (d)  A class IV deficiency is a deficiency that the agency
4476determines has the potential for causing no more than a minor
4477negative impact on the resident. If the class IV deficiency is
4478isolated, no plan of correction is required.
4479     Section 83.  Subsections (3) and (4) of section 400.241,
4480Florida Statutes, are renumbered as subsections (1) and (2),
4481respectively, and present subsections (1) and (2) of said
4482section are amended to read:
4483     400.241  Prohibited acts; penalties for violations.--
4484     (1)  It is unlawful for any person or public body to
4485establish, conduct, manage, or operate a home as defined in this
4486part without obtaining a valid current license.
4487     (2)  It is unlawful for any person or public body to offer
4488or advertise to the public, in any way by any medium whatever,
4489nursing home care or service or custodial services without
4490obtaining a valid current license. It is unlawful for any holder
4491of a license issued pursuant to the provisions of this part to
4492advertise or hold out to the public that it holds a license for
4493a facility other than that for which it actually holds a
4494license.
4495     Section 84.  Subsections (6) through (27) of section
4496400.402, Florida Statutes, are renumbered as subsections (5)
4497through (26), respectively, and present subsections (5), (12),
4498(14), (17), and (20) are amended to read:
4499     400.402  Definitions.--When used in this part, the term:
4500     (5)  "Applicant" means an individual owner, corporation,
4501partnership, firm, association, or governmental entity that
4502applies for a license.
4503     (11)(12)  "Extended congregate care" means acts beyond
4504those authorized in subsection (16) (17) that may be performed
4505pursuant to part I of chapter 464 by persons licensed thereunder
4506while carrying out their professional duties, and other
4507supportive services which may be specified by rule. The purpose
4508of such services is to enable residents to age in place in a
4509residential environment despite mental or physical limitations
4510that might otherwise disqualify them from residency in a
4511facility licensed under this part.
4512     (13)(14)  "Limited nursing services" means acts that may be
4513performed pursuant to part I of chapter 464 by persons licensed
4514thereunder while carrying out their professional duties but
4515limited to those acts which the agency department specifies by
4516rule. Acts which may be specified by rule as allowable limited
4517nursing services shall be for persons who meet the admission
4518criteria established by the agency department for assisted
4519living facilities and shall not be complex enough to require 24-
4520hour nursing supervision and may include such services as the
4521application and care of routine dressings, and care of casts,
4522braces, and splints.
4523     (16)(17)  "Personal services" means direct physical
4524assistance with or supervision of the activities of daily living
4525and the self-administration of medication and other similar
4526services which the agency department may define by rule.
4527"Personal services" shall not be construed to mean the provision
4528of medical, nursing, dental, or mental health services.
4529     (19)(20)  "Resident" means a person 18 years of age or
4530older, residing in and receiving care from a facility, including
4531a person receiving services pursuant to s. 400.553(2).
4532     Section 85.  Section 400.407, Florida Statutes, is amended
4533to read:
4534     400.407  License required; fee, display.--
4535     (1)  The requirements of part II of chapter 408 shall apply
4536to the provision of services that require licensure pursuant
4537this part and part II of chapter 408 and to entities licensed by
4538or applying for such licensure from the agency pursuant to this
4539part. However, each applicant for licensure and each licensee is
4540exempt from s. 408.810(10). A license issued by the agency is
4541required for an assisted living facility operating in this
4542state.
4543     (2)  Separate licenses shall be required for facilities
4544maintained in separate premises, even though operated under the
4545same management. A separate license shall not be required for
4546separate buildings on the same grounds.
4547     (3)  In addition to the requirements of 408.806, each Any
4548license granted by the agency must state the maximum resident
4549capacity of the facility, the type of care for which the license
4550is granted, the date the license is issued, the expiration date
4551of the license, and any other information deemed necessary by
4552the agency. Licenses shall be issued for one or more of the
4553following categories of care: standard, extended congregate
4554care, limited nursing services, or limited mental health.
4555     (a)  A standard license shall be issued to facilities
4556providing one or more of the personal services identified in s.
4557400.402. Such facilities may also employ or contract with a
4558person licensed under part I of chapter 464 to administer
4559medications and perform other tasks as specified in s. 400.4255.
4560     (b)  An extended congregate care license shall be issued to
4561facilities providing, directly or through contract, services
4562beyond those authorized in paragraph (a), including acts
4563performed pursuant to part I of chapter 464 by persons licensed
4564thereunder, and supportive services defined by rule to persons
4565who otherwise would be disqualified from continued residence in
4566a facility licensed under this part.
4567     1.  In order for extended congregate care services to be
4568provided in a facility licensed under this part, the agency must
4569first determine that all requirements established in law and
4570rule are met and must specifically designate, on the facility's
4571license, that such services may be provided and whether the
4572designation applies to all or part of a facility. Such
4573designation may be made at the time of initial licensure or
4574relicensure, or upon request in writing by a licensee under this
4575part and part II of chapter 408. Notification of approval or
4576denial of such request shall be made in accordance with part II
4577of chapter 408 within 90 days after receipt of such request and
4578all necessary documentation. Existing facilities qualifying to
4579provide extended congregate care services must have maintained a
4580standard license and may not have been subject to administrative
4581sanctions during the previous 2 years, or since initial
4582licensure if the facility has been licensed for less than 2
4583years, for any of the following reasons:
4584     a.  A class I or class II violation;
4585     b.  Three or more repeat or recurring class III violations
4586of identical or similar resident care standards as specified in
4587rule from which a pattern of noncompliance is found by the
4588agency;
4589     c.  Three or more class III violations that were not
4590corrected in accordance with the corrective action plan approved
4591by the agency;
4592     d.  Violation of resident care standards resulting in a
4593requirement to employ the services of a consultant pharmacist or
4594consultant dietitian;
4595     e.  Denial, suspension, or revocation of a license for
4596another facility under this part in which the applicant for an
4597extended congregate care license has at least 25 percent
4598ownership interest; or
4599     f.  Imposition of a moratorium on admissions or initiation
4600of injunctive proceedings.
4601     2.  Facilities that are licensed to provide extended
4602congregate care services shall maintain a written progress
4603report on each person who receives such services, which report
4604describes the type, amount, duration, scope, and outcome of
4605services that are rendered and the general status of the
4606resident's health. A registered nurse, or appropriate designee,
4607representing the agency shall visit such facilities at least
4608quarterly to monitor residents who are receiving extended
4609congregate care services and to determine if the facility is in
4610compliance with this part, part II of chapter 408, and with
4611rules that relate to extended congregate care. One of these
4612visits may be in conjunction with the regular survey. The
4613monitoring visits may be provided through contractual
4614arrangements with appropriate community agencies. A registered
4615nurse shall serve as part of the team that inspects such
4616facility. The agency may waive one of the required yearly
4617monitoring visits for a facility that has been licensed for at
4618least 24 months to provide extended congregate care services,
4619if, during the inspection, the registered nurse determines that
4620extended congregate care services are being provided
4621appropriately, and if the facility has no class I or class II
4622violations and no uncorrected class III violations. Before such
4623decision is made, the agency shall consult with the long-term
4624care ombudsman council for the area in which the facility is
4625located to determine if any complaints have been made and
4626substantiated about the quality of services or care. The agency
4627may not waive one of the required yearly monitoring visits if
4628complaints have been made and substantiated.
4629     3.  Facilities that are licensed to provide extended
4630congregate care services shall:
4631     a.  Demonstrate the capability to meet unanticipated
4632resident service needs.
4633     b.  Offer a physical environment that promotes a homelike
4634setting, provides for resident privacy, promotes resident
4635independence, and allows sufficient congregate space as defined
4636by rule.
4637     c.  Have sufficient staff available, taking into account
4638the physical plant and firesafety features of the building, to
4639assist with the evacuation of residents in an emergency, as
4640necessary.
4641     d.  Adopt and follow policies and procedures that maximize
4642resident independence, dignity, choice, and decisionmaking to
4643permit residents to age in place to the extent possible, so that
4644moves due to changes in functional status are minimized or
4645avoided.
4646     e.  Allow residents or, if applicable, a resident's
4647representative, designee, surrogate, guardian, or attorney in
4648fact to make a variety of personal choices, participate in
4649developing service plans, and share responsibility in
4650decisionmaking.
4651     f.  Implement the concept of managed risk.
4652     g.  Provide, either directly or through contract, the
4653services of a person licensed pursuant to part I of chapter 464.
4654     h.  In addition to the training mandated in s. 400.452,
4655provide specialized training as defined by rule for facility
4656staff.
4657     4.  Facilities licensed to provide extended congregate care
4658services are exempt from the criteria for continued residency as
4659set forth in rules adopted under s. 400.441. Facilities so
4660licensed shall adopt their own requirements within guidelines
4661for continued residency set forth by the department in rule.
4662However, such facilities may not serve residents who require 24-
4663hour nursing supervision. Facilities licensed to provide
4664extended congregate care services shall provide each resident
4665with a written copy of facility policies governing admission and
4666retention.
4667     5.  The primary purpose of extended congregate care
4668services is to allow residents, as they become more impaired,
4669the option of remaining in a familiar setting from which they
4670would otherwise be disqualified for continued residency. A
4671facility licensed to provide extended congregate care services
4672may also admit an individual who exceeds the admission criteria
4673for a facility with a standard license, if the individual is
4674determined appropriate for admission to the extended congregate
4675care facility.
4676     6.  Before admission of an individual to a facility
4677licensed to provide extended congregate care services, the
4678individual must undergo a medical examination as provided in s.
4679400.426(4) and the facility must develop a preliminary service
4680plan for the individual.
4681     7.  When a facility can no longer provide or arrange for
4682services in accordance with the resident's service plan and
4683needs and the facility's policy, the facility shall make
4684arrangements for relocating the person in accordance with s.
4685400.428(1)(k).
4686     8.  Failure to provide extended congregate care services
4687may result in denial of extended congregate care license
4688renewal.
4689     9.  No later than January 1 of each year, the department,
4690in consultation with the agency, shall prepare and submit to the
4691Governor, the President of the Senate, the Speaker of the House
4692of Representatives, and the chairs of appropriate legislative
4693committees, a report on the status of, and recommendations
4694related to, extended congregate care services. The status report
4695must include, but need not be limited to, the following
4696information:
4697     a.  A description of the facilities licensed to provide
4698such services, including total number of beds licensed under
4699this part.
4700     b.  The number and characteristics of residents receiving
4701such services.
4702     c.  The types of services rendered that could not be
4703provided through a standard license.
4704     d.  An analysis of deficiencies cited during licensure
4705inspections.
4706     e.  The number of residents who required extended
4707congregate care services at admission and the source of
4708admission.
4709     f.  Recommendations for statutory or regulatory changes.
4710     g.  The availability of extended congregate care to state
4711clients residing in facilities licensed under this part and in
4712need of additional services, and recommendations for
4713appropriations to subsidize extended congregate care services
4714for such persons.
4715     h.  Such other information as the department considers
4716appropriate.
4717     (c)  A limited nursing services license shall be issued to
4718a facility that provides services beyond those authorized in
4719paragraph (a) and as specified in this paragraph.
4720     1.  In order for limited nursing services to be provided in
4721a facility licensed under this part, the agency must first
4722determine that all requirements established in law and rule are
4723met and must specifically designate, on the facility's license,
4724that such services may be provided. Such designation may be made
4725at the time of initial licensure or relicensure, or upon request
4726in writing by a licensee under this part and part II of chapter
4727408. Notification of approval or denial of such request shall be
4728made in accordance with part II of chapter 408 within 90 days
4729after receipt of such request and all necessary documentation.
4730Existing facilities qualifying to provide limited nursing
4731services shall have maintained a standard license and may not
4732have been subject to administrative sanctions that affect the
4733health, safety, and welfare of residents for the previous 2
4734years or since initial licensure if the facility has been
4735licensed for less than 2 years.
4736     2.  Facilities that are licensed to provide limited nursing
4737services shall maintain a written progress report on each person
4738who receives such nursing services, which report describes the
4739type, amount, duration, scope, and outcome of services that are
4740rendered and the general status of the resident's health. A
4741registered nurse representing the agency shall visit such
4742facilities at least twice a year to monitor residents who are
4743receiving limited nursing services and to determine if the
4744facility is in compliance with applicable provisions of this
4745part, part II of chapter 408, and with related rules. The
4746monitoring visits may be provided through contractual
4747arrangements with appropriate community agencies. A registered
4748nurse shall also serve as part of the team that inspects such
4749facility.
4750     3.  A person who receives limited nursing services under
4751this part must meet the admission criteria established by the
4752agency for assisted living facilities. When a resident no longer
4753meets the admission criteria for a facility licensed under this
4754part, arrangements for relocating the person shall be made in
4755accordance with s. 400.428(1)(k), unless the facility is
4756licensed to provide extended congregate care services.
4757     (4)  In accordance with s. 408.805, an applicant or
4758licensee shall pay a fee for each license application submitted
4759under this part, part II of chapter 408, and applicable rules.
4760The amount of the fee shall be established by rule.
4761     (a)  The biennial license fee required of a facility is
4762$300 per license, with an additional fee of $50 per resident
4763based on the total licensed resident capacity of the facility,
4764except that no additional fee will be assessed for beds
4765designated for recipients of optional state supplementation
4766payments provided for in s. 409.212. The total fee may not
4767exceed $10,000, no part of which shall be returned to the
4768facility. The agency shall adjust the per bed license fee and
4769the total licensure fee annually by not more than the change in
4770the consumer price index based on the 12 months immediately
4771preceding the increase.
4772     (b)  In addition to the total fee assessed under paragraph
4773(a), the agency shall require facilities that are licensed to
4774provide extended congregate care services under this part to pay
4775an additional fee per licensed facility. The amount of the
4776biennial fee shall be $400 per license, with an additional fee
4777of $10 per resident based on the total licensed resident
4778capacity of the facility. No part of this fee shall be returned
4779to the facility. The agency may adjust the per bed license fee
4780and the annual license fee once each year by not more than the
4781average rate of inflation for the 12 months immediately
4782preceding the increase.
4783     (c)  In addition to the total fee assessed under paragraph
4784(a), the agency shall require facilities that are licensed to
4785provide limited nursing services under this part to pay an
4786additional fee per licensed facility. The amount of the biennial
4787fee shall be $250 per license, with an additional fee of $10 per
4788resident based on the total licensed resident capacity of the
4789facility. No part of this fee shall be returned to the facility.
4790The agency may adjust the per bed license fee and the biennial
4791license fee once each year by not more than the average rate of
4792inflation for the 12 months immediately preceding the increase.
4793     (5)  Counties or municipalities applying for licenses under
4794this part are exempt from the payment of license fees.
4795     (6)  The license shall be displayed in a conspicuous place
4796inside the facility.
4797     (7)  A license shall be valid only in the possession of the
4798individual, firm, partnership, association, or corporation to
4799which it is issued and shall not be subject to sale, assignment,
4800or other transfer, voluntary or involuntary; nor shall a license
4801be valid for any premises other than that for which originally
4802issued.
4803     (8)  A fee may be charged to a facility requesting a
4804duplicate license. The fee shall not exceed the actual cost of
4805duplication and postage.
4806     Section 86.  Subsection (1) of section 400.4075, Florida
4807Statutes, is amended to read:
4808     400.4075  Limited mental health license.--An assisted
4809living facility that serves three or more mental health
4810residents must obtain a limited mental health license.
4811     (1)  To obtain a limited mental health license, a facility
4812must hold a standard license as an assisted living facility,
4813must not have any current uncorrected deficiencies or
4814violations, and must ensure that, within 6 months after
4815receiving a limited mental health license, the facility
4816administrator and the staff of the facility who are in direct
4817contact with mental health residents must complete training of
4818no less than 6 hours related to their duties. Such designation
4819may be made at the time of initial licensure or relicensure or
4820upon request in writing by a licensee under this part and part
4821II of chapter 408. Notification of approval or denial of such
4822request shall be made in accordance with this part, part II of
4823chapter 408, and applicable rules. This training will be
4824provided by or approved by the Department of Children and Family
4825Services.
4826     Section 87.  Section 400.408, Florida Statutes, is amended
4827to read:
4828     400.408  Unlicensed facilities; referral of person for
4829residency to unlicensed facility; penalties; verification of
4830licensure status.--
4831     (1)(a)  It is unlawful to own, operate, or maintain an
4832assisted living facility without obtaining a license under this
4833part.
4834     (b)  Except as provided under paragraph (d), any person who
4835owns, operates, or maintains an unlicensed assisted living
4836facility commits a felony of the third degree, punishable as
4837provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
4838continued operation is a separate offense.
4839     (c)  Any person found guilty of violating paragraph (a) a
4840second or subsequent time commits a felony of the second degree,
4841punishable as provided under s. 775.082, s. 775.083, or s.
4842775.084. Each day of continued operation is a separate offense.
4843     (d)  Any person who owns, operates, or maintains an
4844unlicensed assisted living facility due to a change in this part
4845or a modification in department rule within 6 months after the
4846effective date of such change and who, within 10 working days
4847after receiving notification from the agency, fails to cease
4848operation or apply for a license under this part commits a
4849felony of the third degree, punishable as provided in s.
4850775.082, s. 775.083, or s. 775.084. Each day of continued
4851operation is a separate offense.
4852     (e)  Any facility that fails to cease operation after
4853agency notification may be fined for each day of noncompliance
4854pursuant to s. 400.419.
4855     (f)  When a licensee has an interest in more than one
4856assisted living facility, and fails to license any one of these
4857facilities, the agency may revoke the license, impose a
4858moratorium, or impose a fine pursuant to s. 400.419, on any or
4859all of the licensed facilities until such time as the unlicensed
4860facility is licensed or ceases operation.
4861     (g)  If the agency determines that an owner is operating or
4862maintaining an assisted living facility without obtaining a
4863license and determines that a condition exists in the facility
4864that poses a threat to the health, safety, or welfare of a
4865resident of the facility, the owner is subject to the same
4866actions and fines imposed against a licensed facility as
4867specified in ss. 400.414 and 400.419.
4868     (h)  Any person aware of the operation of an unlicensed
4869assisted living facility must report that facility to the
4870agency. The agency shall provide to the department's elder
4871information and referral providers a list, by county, of
4872licensed assisted living facilities, to assist persons who are
4873considering an assisted living facility placement in locating a
4874licensed facility.
4875     (2)(i)  Each field office of the Agency for Health Care
4876Administration shall establish a local coordinating workgroup
4877which includes representatives of local law enforcement
4878agencies, state attorneys, the Medicaid Fraud Control Unit of
4879the Department of Legal Affairs, local fire authorities, the
4880Department of Children and Family Services, the district long-
4881term care ombudsman council, and the district human rights
4882advocacy committee to assist in identifying the operation of
4883unlicensed facilities and to develop and implement a plan to
4884ensure effective enforcement of state laws relating to such
4885facilities. The workgroup shall report its findings, actions,
4886and recommendations semiannually to the Director of Health
4887Facility Regulation of the agency.
4888     (3)(2)  It is unlawful to knowingly refer a person for
4889residency to an unlicensed assisted living facility; to an
4890assisted living facility the license of which is under denial or
4891has been suspended or revoked; or to an assisted living facility
4892that has a moratorium pursuant to part II of chapter 408, on
4893admissions. Any person who violates this subsection commits a
4894noncriminal violation, punishable by a fine not exceeding $500
4895as provided in s. 775.083.
4896     (a)  Any health care practitioner, as defined in s.
4897456.001, who is aware of the operation of an unlicensed facility
4898shall report that facility to the agency. Failure to report a
4899facility that the practitioner knows or has reasonable cause to
4900suspect is unlicensed shall be reported to the practitioner's
4901licensing board.
4902     (b)  Any hospital or community mental health center
4903licensed under chapter 395 or chapter 394 which knowingly
4904discharges a patient or client to an unlicensed facility is
4905subject to sanction by the agency.
4906     (c)  Any employee of the agency or department, or the
4907Department of Children and Family Services, who knowingly refers
4908a person for residency to an unlicensed facility; to a facility
4909the license of which is under denial or has been suspended or
4910revoked; or to a facility that has a moratorium pursuant to part
4911II of chapter 408 on admissions is subject to disciplinary
4912action by the agency or department, or the Department of
4913Children and Family Services.
4914     (d)  The employer of any person who is under contract with
4915the agency or department, or the Department of Children and
4916Family Services, and who knowingly refers a person for residency
4917to an unlicensed facility; to a facility the license of which is
4918under denial or has been suspended or revoked; or to a facility
4919that has a moratorium pursuant to part II of chapter 408 on
4920admissions shall be fined and required to prepare a corrective
4921action plan designed to prevent such referrals.
4922     (e)  The agency shall provide the department and the
4923Department of Children and Family Services with a list of
4924licensed facilities within each county and shall update the list
4925at least quarterly.
4926     (f)  At least annually, the agency shall notify, in
4927appropriate trade publications, physicians licensed under
4928chapter 458 or chapter 459, hospitals licensed under chapter
4929395, nursing home facilities licensed under part II of this
4930chapter, and employees of the agency or the department, or the
4931Department of Children and Family Services, who are responsible
4932for referring persons for residency, that it is unlawful to
4933knowingly refer a person for residency to an unlicensed assisted
4934living facility and shall notify them of the penalty for
4935violating such prohibition. The department and the Department of
4936Children and Family Services shall, in turn, notify service
4937providers under contract to the respective departments who have
4938responsibility for resident referrals to facilities. Further,
4939the notice must direct each noticed facility and individual to
4940contact the appropriate agency office in order to verify the
4941licensure status of any facility prior to referring any person
4942for residency. Each notice must include the name, telephone
4943number, and mailing address of the appropriate office to
4944contact.
4945     Section 88.  Section 400.411, Florida Statutes, is amended
4946to read:
4947     400.411  Initial application for license; provisional
4948license.--
4949     (1)  Each applicant for licensure must comply with all
4950provisions of part II of chapter 408 and must: Application for a
4951license shall be made to the agency on forms furnished by it and
4952shall be accompanied by the appropriate license fee.
4953     (2)  The applicant may be an individual owner, a
4954corporation, a partnership, a firm, an association, or a
4955governmental entity.
4956     (3)  The application must be signed by the applicant under
4957oath and must contain the following:
4958     (a)  The name, address, date of birth, and social security
4959number of the applicant and the name by which the facility is to
4960be known. If the applicant is a firm, partnership, or
4961association, the application shall contain the name, address,
4962date of birth, and social security number of every member
4963thereof. If the applicant is a corporation, the application
4964shall contain the corporation's name and address; the name,
4965address, date of birth, and social security number of each of
4966its directors and officers; and the name and address of each
4967person having at least a 5-percent ownership interest in the
4968corporation.
4969     (b)  The name and address of any professional service,
4970firm, association, partnership, or corporation that is to
4971provide goods, leases, or services to the facility if a 5-
4972percent or greater ownership interest in the service, firm,
4973association, partnership, or corporation is owned by a person
4974whose name must be listed on the application under paragraph
4975(a).
4976     (c)  The name and address of any long-term care facility
4977with which the applicant, administrator, or financial officer
4978has been affiliated through ownership or employment within 5
4979years of the date of this license application; and a signed
4980affidavit disclosing any financial or ownership interest that
4981the applicant, or any person listed in paragraph (a), holds or
4982has held within the last 5 years in any facility licensed under
4983this part, or in any other entity licensed by this state or
4984another state to provide health or residential care, which
4985facility or entity closed or ceased to operate as a result of
4986financial problems, or has had a receiver appointed or a license
4987denied, suspended or revoked, or was subject to a moratorium on
4988admissions, or has had an injunctive proceeding initiated
4989against it.
4990     (d)  A description and explanation of any exclusions,
4991permanent suspensions, or terminations of the applicant from the
4992Medicare or Medicaid programs. Proof of compliance with
4993disclosure of ownership and control interest requirements of the
4994Medicaid or Medicare programs shall be accepted in lieu of this
4995submission.
4996     (e)  The names and addresses of persons of whom the agency
4997may inquire as to the character, reputation, and financial
4998responsibility of the owner and, if different from the
4999applicant, the administrator and financial officer.
5000     (a)(f)  Identify Identification of all other homes or
5001facilities, including the addresses and the license or licenses
5002under which they operate, if applicable, which are currently
5003operated by the applicant or administrator and which provide
5004housing, meals, and personal services to residents.
5005     (b)(g)  Provide the location of the facility for which a
5006license is sought and documentation, signed by the appropriate
5007local government official, which states that the applicant has
5008met local zoning requirements.
5009     (c)(h)  Provide the name, address, date of birth, social
5010security number, education, and experience of the administrator,
5011if different from the applicant.
5012     (4)  The applicant shall furnish satisfactory proof of
5013financial ability to operate and conduct the facility in
5014accordance with the requirements of this part. A certificate of
5015authority, pursuant to chapter 651, may be provided as proof of
5016financial ability.
5017     (5)  If the applicant is a continuing care facility
5018certified under chapter 651, a copy of the facility's
5019certificate of authority must be provided.
5020     (2)(6)  In addition to the requirements of s. 408.810, the
5021applicant shall provide proof of liability insurance as defined
5022in s. 624.605.
5023     (7)  If the applicant is a community residential home, the
5024applicant must provide proof that it has met the requirements
5025specified in chapter 419.
5026     (8)  The applicant must provide the agency with proof of
5027legal right to occupy the property.
5028     (3)(9)  The applicant must furnish proof that the facility
5029has received a satisfactory firesafety inspection. The local
5030authority having jurisdiction or the State Fire Marshal must
5031conduct the inspection within 30 days after written request by
5032the applicant.
5033     (4)(10)  The applicant must furnish documentation of a
5034satisfactory sanitation inspection of the facility by the county
5035health department.
5036     (11)  The applicant must furnish proof of compliance with
5037level 2 background screening as required under s. 400.4174.
5038     (5)(12)  A provisional license may be issued to an
5039applicant making initial application for licensure or making
5040application for a change of ownership. A provisional license
5041shall be limited in duration to a specific period of time not to
5042exceed 6 months, as determined by the agency.
5043     (6)(13)  A county or municipality may not issue an
5044occupational license that is being obtained for the purpose of
5045operating a facility regulated under this part without first
5046ascertaining that the applicant has been licensed to operate
5047such facility at the specified location or locations by the
5048agency. The agency shall furnish to local agencies responsible
5049for issuing occupational licenses sufficient instruction for
5050making such determinations.
5051     Section 89.  Section 400.412, Florida Statutes, is amended
5052to read:
5053     400.412  Sale or transfer of ownership of a facility.--It
5054is the intent of the Legislature to protect the rights of the
5055residents of an assisted living facility when the facility is
5056sold or the ownership thereof is transferred. Therefore, in
5057addition to the requirements of part II of chapter 408, whenever
5058a facility is sold or the ownership thereof is transferred,
5059including leasing:
5060     (1)  The transferee shall make application to the agency
5061for a new license at least 60 days before the date of transfer
5062of ownership. The application must comply with the provisions of
5063s. 400.411.
5064     (2)(a)  The transferor shall notify the agency in writing
5065at least 60 days before the date of transfer of ownership.
5066     (1)(b)  The transferee new owner shall notify the
5067residents, in writing, of the change transfer of ownership
5068within 7 days after of his or her receipt of the new license.
5069     (3)  The transferor shall be responsible and liable for:
5070     (a)  The lawful operation of the facility and the welfare
5071of the residents domiciled in the facility until the date the
5072transferee is licensed by the agency.
5073     (b)  Any and all penalties imposed against the facility for
5074violations occurring before the date of transfer of ownership
5075unless the penalty imposed is a moratorium on admissions or
5076denial of licensure. The moratorium on admissions or denial of
5077licensure remains in effect after the transfer of ownership,
5078unless the agency has approved the transferee's corrective
5079action plan or the conditions which created the moratorium or
5080denial have been corrected, and may be grounds for denial of
5081license to the transferee in accordance with chapter 120.
5082     (c)  Any outstanding liability to the state, unless the
5083transferee has agreed, as a condition of sale or transfer, to
5084accept the outstanding liabilities and to guarantee payment
5085therefor; except that, if the transferee fails to meet these
5086obligations, the transferor shall remain liable for the
5087outstanding liability.
5088     (2)(4)  The transferor of a facility the license of which
5089is denied pending an administrative hearing shall, as a part of
5090the written change of ownership transfer-of-ownership contract,
5091advise the transferee that a plan of correction must be
5092submitted by the transferee and approved by the agency at least
50937 days before the change transfer of ownership and that failure
5094to correct the condition which resulted in the moratorium
5095pursuant to part II of chapter 408 on admissions or denial of
5096licensure is grounds for denial of the transferee's license.
5097     (5)  The transferee must provide the agency with proof of
5098legal right to occupy the property before a license may be
5099issued. Proof may include, but is not limited to, copies of
5100warranty deeds, or copies of lease or rental agreements,
5101contracts for deeds, quitclaim deeds, or other such
5102documentation.
5103     Section 90.  Section 400.414, Florida Statutes, is amended
5104to read:
5105     400.414  Denial, revocation, or suspension of license;
5106moratorium; imposition of administrative fine; grounds.--
5107     (1)  The agency may deny, revoke, and or suspend any
5108license issued under this part and, or impose a moratorium and
5109an administrative fine in the manner provided in chapter 120 on
5110an assisted living facility for a violation of any provision of
5111this part, part II of chapter 408, or applicable rules, or for
5112any of the following actions by an assisted living facility, for
5113the actions of any person subject to level 2 background
5114screening under s. 408.809 400.4174, or for the actions of any
5115facility employee:
5116     (a)  An intentional or negligent act seriously affecting
5117the health, safety, or welfare of a resident of the facility.
5118     (b)  The determination by the agency that the owner lacks
5119the financial ability to provide continuing adequate care to
5120residents.
5121     (c)  Misappropriation or conversion of the property of a
5122resident of the facility.
5123     (d)  Failure to follow the criteria and procedures provided
5124under part I of chapter 394 relating to the transportation,
5125voluntary admission, and involuntary examination of a facility
5126resident.
5127     (e)  A citation of any of the following deficiencies as
5128defined in s. 400.419:
5129     1.  One or more cited class I deficiencies.
5130     2.  Three or more cited class II deficiencies.
5131     3.  Five or more cited class III deficiencies that have
5132been cited on a single survey and have not been corrected within
5133the times specified.
5134     (f)  A determination that a person subject to level 2
5135background screening under s. 408.809 400.4174(1) does not meet
5136the screening standards of s. 435.04 or that the facility is
5137retaining an employee subject to level 1 background screening
5138standards under s. 400.4174(2) who does not meet the screening
5139standards of s. 435.03 and for whom exemptions from
5140disqualification have not been provided by the agency.
5141     (g)  A determination that an employee, volunteer,
5142administrator, or owner, or person who otherwise has access to
5143the residents of a facility does not meet the criteria specified
5144in s. 435.03(2), and the owner or administrator has not taken
5145action to remove the person. Exemptions from disqualification
5146may be granted as set forth in s. 435.07. No administrative
5147action may be taken against the facility if the person is
5148granted an exemption.
5149     (h)  Violation of a moratorium.
5150     (i)  Failure of the license applicant, the licensee during
5151relicensure, or a licensee that holds a provisional license to
5152meet the minimum license requirements of this part, or related
5153rules, at the time of license application or renewal.
5154     (j)  A fraudulent statement or omission of any material
5155fact on an application for a license or any other document
5156required by the agency, including the submission of a license
5157application that conceals the fact that any board member,
5158officer, or person owning 5 percent or more of the facility may
5159not meet the background screening requirements of s. 400.4174,
5160or that the applicant has been excluded, permanently suspended,
5161or terminated from the Medicaid or Medicare programs.
5162     (h)(k)  An intentional or negligent life-threatening act in
5163violation of the uniform firesafety standards for assisted
5164living facilities or other firesafety standards that threatens
5165the health, safety, or welfare of a resident of a facility, as
5166communicated to the agency by the local authority having
5167jurisdiction or the State Fire Marshal.
5168     (l)  Exclusion, permanent suspension, or termination from
5169the Medicare or Medicaid programs.
5170     (i)(m)  Knowingly operating any unlicensed facility or
5171providing without a license any service that must be licensed
5172under this chapter.
5173     (j)(n)  Any act constituting a ground upon which
5174application for a license may be denied.
5175
5176Administrative proceedings challenging agency action under this
5177subsection shall be reviewed on the basis of the facts and
5178conditions that resulted in the agency action.
5179     (2)  Upon notification by the local authority having
5180jurisdiction or by the State Fire Marshal, the agency may deny
5181or revoke the license of an assisted living facility that fails
5182to correct cited fire code violations that affect or threaten
5183the health, safety, or welfare of a resident of a facility.
5184     (3)  The agency may deny a license to any applicant or
5185controlling interest as defined in part II of chapter 408 that
5186to any officer or board member of an applicant who is a firm,
5187corporation, partnership, or association or who owns 5 percent
5188or more of the facility, if the applicant, officer, or board
5189member has or had a 25-percent or greater financial or ownership
5190interest in any other facility licensed under this part, or in
5191any entity licensed by this state or another state to provide
5192health or residential care, which facility or entity during the
51935 years prior to the application for a license closed due to
5194financial inability to operate; had a receiver appointed or a
5195license denied, suspended, or revoked; was subject to a
5196moratorium pursuant to part II of chapter 408 on admissions; had
5197an injunctive proceeding initiated against it; or has an
5198outstanding fine assessed under this chapter.
5199     (4)  The agency shall deny or revoke the license of an
5200assisted living facility that has two or more class I violations
5201that are similar or identical to violations identified by the
5202agency during a survey, inspection, monitoring visit, or
5203complaint investigation occurring within the previous 2 years.
5204     (5)  An action taken by the agency to suspend, deny, or
5205revoke a facility's license under this part, in which the agency
5206claims that the facility owner or an employee of the facility
5207has threatened the health, safety, or welfare of a resident of
5208the facility be heard by the Division of Administrative Hearings
5209of the Department of Management Services within 120 days after
5210receipt of the facility's request for a hearing, unless that
5211time limitation is waived by both parties. The administrative
5212law judge must render a decision within 30 days after receipt of
5213a proposed recommended order.
5214     (6)  The agency shall provide to the Division of Hotels and
5215Restaurants of the Department of Business and Professional
5216Regulation, on a monthly basis, a list of those assisted living
5217facilities that have had their licenses denied, suspended, or
5218revoked or that are involved in an appellate proceeding pursuant
5219to s. 120.60 related to the denial, suspension, or revocation of
5220a license.
5221     (7)  Agency notification of a license suspension or
5222revocation, or denial of a license renewal, shall be posted and
5223visible to the public at the facility.
5224     (8)  The agency may issue a temporary license pending final
5225disposition of a proceeding involving the suspension or
5226revocation of an assisted living facility license.
5227     Section 91.  Section 400.415, Florida Statutes, is
5228repealed.
5229     Section 92.  Section 400.417, Florida Statutes, is amended
5230to read:
5231     400.417  Expiration of license; renewal; conditional
5232license.--
5233     (1)  Biennial licenses, unless sooner suspended or revoked,
5234shall expire 2 years from the date of issuance. Limited nursing,
5235extended congregate care, and limited mental health licenses
5236shall expire at the same time as the facility's standard
5237license, regardless of when issued. The agency shall notify the
5238facility at least 120 days prior to expiration that a renewal
5239license is necessary to continue operation. The notification
5240must be provided electronically or by mail delivery. Ninety days
5241prior to the expiration date, an application for renewal shall
5242be submitted to the agency. Fees must be prorated. The failure
5243to file a timely renewal application shall result in a late fee
5244charged to the facility in an amount equal to 50 percent of the
5245current fee.
5246     (2)  A license shall be renewed in accordance with part II
5247of chapter 408 within 90 days upon the timely filing of an
5248application on forms furnished by the agency and the provision
5249of satisfactory proof of ability to operate and conduct the
5250facility in accordance with the requirements of this part and
5251adopted rules, including proof that the facility has received a
5252satisfactory firesafety inspection, conducted by the local
5253authority having jurisdiction or the State Fire Marshal, within
5254the preceding 12 months and an affidavit of compliance with the
5255background screening requirements of s. 400.4174.
5256     (3)  In addition to the requirements of part II of chapter
5257408, An applicant for renewal of a license who has complied with
5258the provisions of s. 400.411 with respect to proof of financial
5259ability to operate shall not be required to provide further
5260proof unless the facility or any other facility owned or
5261operated in whole or in part by the same person has demonstrated
5262financial instability as provided under s. 400.447(2) or unless
5263the agency suspects that the facility is not financially stable
5264as a result of the annual survey or complaints from the public
5265or a report from the State Long-Term Care Ombudsman Council.
5266each facility must report to the agency any adverse court action
5267concerning the facility's financial viability, within 7 days
5268after its occurrence. The agency shall have access to books,
5269records, and any other financial documents maintained by the
5270facility to the extent necessary to determine the facility's
5271financial stability. A license for the operation of a facility
5272shall not be renewed if the licensee has any outstanding fines
5273assessed pursuant to this part which are in final order status.
5274     (4)  A licensee against whom a revocation or suspension
5275proceeding is pending at the time of license renewal may be
5276issued a conditional license effective until final disposition
5277by the agency. If judicial relief is sought from the final
5278disposition, the court having jurisdiction may issue a
5279conditional license for the duration of the judicial proceeding.
5280     (4)(5)  A conditional license may be issued to an applicant
5281for license renewal if the applicant fails to meet all standards
5282and requirements for licensure. A conditional license issued
5283under this subsection shall be limited in duration to a specific
5284period of time not to exceed 6 months, as determined by the
5285agency, and shall be accompanied by an agency-approved plan of
5286correction.
5287     (5)(6)  When an extended care or limited nursing license is
5288requested during a facility's biennial license period, the fee
5289shall be prorated in order to permit the additional license to
5290expire at the end of the biennial license period. The fee shall
5291be calculated as of the date the additional license application
5292is received by the agency.
5293     (6)(7)  The agency department may by rule establish renewal
5294procedures, identify forms, and specify documentation necessary
5295to administer this section and part II of chapter 408.
5296     Section 93.  Section 400.4174, Florida Statutes, is amended
5297to read:
5298     400.4174  Background screening; exemptions.--
5299     (1)(a)  Level 2 background screening must be conducted on
5300each of the following persons, who shall be considered employees
5301for the purposes of conducting screening under chapter 435:
5302     1.  The facility owner if an individual, the administrator,
5303and the financial officer.
5304     2.  An officer or board member if the facility owner is a
5305firm, corporation, partnership, or association, or any person
5306owning 5 percent or more of the facility if the agency has
5307probable cause to believe that such person has been convicted of
5308any offense prohibited by s. 435.04. For each officer, board
5309member, or person owning 5 percent or more who has been
5310convicted of any such offense, the facility shall submit to the
5311agency a description and explanation of the conviction at the
5312time of license application. This subparagraph does not apply to
5313a board member of a not-for-profit corporation or organization
5314if the board member serves solely in a voluntary capacity, does
5315not regularly take part in the day-to-day operational decisions
5316of the corporation or organization, receives no remuneration for
5317his or her services, and has no financial interest and has no
5318family members with a financial interest in the corporation or
5319organization, provided that the board member and facility submit
5320a statement affirming that the board member's relationship to
5321the facility satisfies the requirements of this subparagraph.
5322     (b)  Proof of compliance with level 2 screening standards
5323which has been submitted within the previous 5 years to meet any
5324facility or professional licensure requirements of the agency or
5325the Department of Health satisfies the requirements of this
5326subsection, provided that such proof is accompanied, under
5327penalty of perjury, by an affidavit of compliance with the
5328provisions of chapter 435. Proof of compliance with the
5329background screening requirements of the Financial Services
5330Commission and the Office of Insurance Regulation for applicants
5331for a certificate of authority to operate a continuing care
5332retirement community under chapter 651, submitted within the
5333last 5 years, satisfies the Department of Law Enforcement and
5334Federal Bureau of Investigation portions of a level 2 background
5335check.
5336     (c)  The agency may grant a provisional license to a
5337facility applying for an initial license when each individual
5338required by this subsection to undergo screening has completed
5339the Department of Law Enforcement background checks, but has not
5340yet received results from the Federal Bureau of Investigation,
5341or when a request for an exemption from disqualification has
5342been submitted to the agency pursuant to s. 435.07, but a
5343response has not been issued.
5344     (2)  The owner or administrator of an assisted living
5345facility must conduct level 1 background screening, as set forth
5346in chapter 435, on all employees hired on or after October 1,
53471998, who perform personal services as defined in s.
5348400.402(16)(17). The agency may exempt an individual from
5349employment disqualification as set forth in chapter 435. Such
5350persons shall be considered as having met this requirement if:
5351     (1)(a)  Proof of compliance with level 1 screening
5352requirements obtained to meet any professional license
5353requirements in this state is provided and accompanied, under
5354penalty of perjury, by a copy of the person's current
5355professional license and an affidavit of current compliance with
5356the background screening requirements.
5357     (2)(b)  The person required to be screened has been
5358continuously employed in the same type of occupation for which
5359the person is seeking employment without a breach in service
5360which exceeds 180 days, and proof of compliance with the level 1
5361screening requirement which is no more than 2 years old is
5362provided. Proof of compliance shall be provided directly from
5363one employer or contractor to another, and not from the person
5364screened. Upon request, a copy of screening results shall be
5365provided by the employer retaining documentation of the
5366screening to the person screened.
5367     (3)(c)  The person required to be screened is employed by a
5368corporation or business entity or related corporation or
5369business entity that owns, operates, or manages more than one
5370facility or agency licensed under this chapter, and for whom a
5371level 1 screening was conducted by the corporation or business
5372entity as a condition of initial or continued employment.
5373     Section 94.  Section 400.4176, Florida Statutes, is amended
5374to read:
5375     400.4176  Notice of change of administrator.--If, during
5376the period for which a license is issued, the owner changes
5377administrators, the owner must notify the agency of the change
5378within 10 days and provide documentation within 90 days that the
5379new administrator has completed the applicable core educational
5380requirements under s. 400.452. Background screening shall be
5381completed on any new administrator as specified in s. 400.4174.
5382     Section 95.  Subsection (8) of section 400.4178, Florida
5383Statutes, is renumbered as subsection (7) and present subsection
5384(7) of said section is amended to read:
5385     400.4178  Special care for persons with Alzheimer's disease
5386or other related disorders.--
5387     (7)  Any facility more than 90 percent of whose residents
5388receive monthly optional supplementation payments is not
5389required to pay for the training and education programs required
5390under this section. A facility that has one or more such
5391residents shall pay a reduced fee that is proportional to the
5392percentage of such residents in the facility. A facility that
5393does not have any residents who receive monthly optional
5394supplementation payments must pay a reasonable fee, as
5395established by the department, for such training and education
5396programs.
5397     Section 96.  Section 400.418, Florida Statutes, is amended
5398to read:
5399     400.418  Disposition of fees and administrative fines.--
5400     (1)  Income from license fees, inspection fees, late fees,
5401and administrative fines collected under this part generated
5402pursuant to ss. 400.407, 400.408, 400.417, 400.419, and 400.431
5403shall be deposited in the Health Care Trust Fund administered by
5404the agency. Such funds shall be directed to and used by the
5405agency for the following purposes:
5406     (1)(a)  Up to 50 percent of the trust funds accrued each
5407fiscal year under this part may be used to offset the expenses
5408of receivership, pursuant to s. 400.422, if the court determines
5409that the income and assets of the facility are insufficient to
5410provide for adequate management and operation.
5411     (2)(b)  An amount of $5,000 of the trust funds accrued each
5412year under this part shall be allocated to pay for inspection-
5413related physical and mental health examinations requested by the
5414agency pursuant to s. 400.426 for residents who are either
5415recipients of supplemental security income or have monthly
5416incomes not in excess of the maximum combined federal and state
5417cash subsidies available to supplemental security income
5418recipients, as provided for in s. 409.212. Such funds shall only
5419be used where the resident is ineligible for Medicaid.
5420     (3)(c)  Any trust funds accrued each year under this part
5421and not used for the purposes specified in subsections (1) and
5422(2) paragraphs (a) and (b) shall be used to offset the costs of
5423the licensure program, including the costs of conducting
5424background investigations, verifying information submitted,
5425defraying the costs of processing the names of applicants, and
5426conducting inspections and monitoring visits pursuant to this
5427part and part II of chapter 408.
5428     (2)  Income from fees generated pursuant to s. 400.441(5)
5429shall be deposited in the Health Care Trust Fund and used to
5430offset the costs of printing and postage.
5431     Section 97.  Section 400.419, Florida Statutes, is amended
5432to read:
5433     400.419  Violations; imposition of administrative fines;
5434grounds.--
5435     (1)  The agency shall impose an administrative fine in the
5436manner provided in chapter 120 for the violation of any
5437provision of this part, part II of chapter 408, and applicable
5438rules for any of the actions or violations as set forth within
5439this section by an assisted living facility, for the actions of
5440any person subject to level 2 background screening under s.
5441400.4174, for the actions of any facility employee, or for an
5442intentional or negligent act seriously affecting the health,
5443safety, or welfare of a resident of the facility.
5444     (2)  Each violation of this part and adopted rules shall be
5445classified according to the nature of the violation and the
5446gravity of its probable effect on facility residents. The agency
5447shall indicate the classification on the written notice of the
5448violation as follows:
5449     (a)  Class "I" violations are those conditions or
5450occurrences related to the operation and maintenance of a
5451facility or to the personal care of residents which the agency
5452determines present an imminent danger to the residents or guests
5453of the facility or a substantial probability that death or
5454serious physical or emotional harm would result therefrom. The
5455condition or practice constituting a class I violation shall be
5456abated or eliminated within 24 hours, unless a fixed period, as
5457determined by the agency, is required for correction. The agency
5458shall impose an administrative fine for a cited class I
5459violation in an amount not less than $5,000 and not exceeding
5460$10,000 for each violation. A fine may be levied notwithstanding
5461the correction of the violation.
5462     (b)  Class "II" violations are those conditions or
5463occurrences related to the operation and maintenance of a
5464facility or to the personal care of residents which the agency
5465determines directly threaten the physical or emotional health,
5466safety, or security of the facility residents, other than class
5467I violations. The agency shall impose an administrative fine for
5468a cited class II violation in an amount not less than $1,000 and
5469not exceeding $5,000 for each violation. A fine shall be levied
5470notwithstanding the correction of the violation.
5471     (c)  Class "III" violations are those conditions or
5472occurrences related to the operation and maintenance of a
5473facility or to the personal care of residents which the agency
5474determines indirectly or potentially threaten the physical or
5475emotional health, safety, or security of facility residents,
5476other than class I or class II violations. The agency shall
5477impose an administrative fine for a cited class III violation in
5478an amount not less than $500 and not exceeding $1,000 for each
5479violation. A citation for a class III violation must specify the
5480time within which the violation is required to be corrected. If
5481a class III violation is corrected within the time specified, no
5482fine may be imposed, unless it is a repeated offense.
5483     (d)  Class "IV" violations are those conditions or
5484occurrences related to the operation and maintenance of a
5485building or to required reports, forms, or documents that do not
5486have the potential of negatively affecting residents. These
5487violations are of a type that the agency determines do not
5488threaten the health, safety, or security of residents of the
5489facility. The agency shall impose an administrative fine for a
5490cited class IV violation in an amount not less than $100 and not
5491exceeding $200 for each violation. A citation for a class IV
5492violation must specify the time within which the violation is
5493required to be corrected. If a class IV violation is corrected
5494within the time specified, no fine shall be imposed. Any class
5495IV violation that is corrected during the time an agency survey
5496is being conducted will be identified as an agency finding and
5497not as a violation.
5498     (3)  For purposes of this section, in determining if a
5499penalty is to be imposed and in fixing the amount of the fine,
5500the agency shall consider the following factors:
5501     (a)  The gravity of the violation, including the
5502probability that death or serious physical or emotional harm to
5503a resident will result or has resulted, the severity of the
5504action or potential harm, and the extent to which the provisions
5505of the applicable laws or rules were violated.
5506     (b)  Actions taken by the owner or administrator to correct
5507violations.
5508     (c)  Any previous violations.
5509     (d)  The financial benefit to the facility of committing or
5510continuing the violation.
5511     (e)  The licensed capacity of the facility.
5512     (4)  Each day of continuing violation after the date fixed
5513for termination of the violation, as ordered by the agency,
5514constitutes an additional, separate, and distinct violation.
5515     (5)  Any action taken to correct a violation shall be
5516documented in writing by the owner or administrator of the
5517facility and verified through followup visits by agency
5518personnel. The agency may impose a fine and, in the case of an
5519owner-operated facility, revoke or deny a facility's license
5520when a facility administrator fraudulently misrepresents action
5521taken to correct a violation.
5522     (6)  For fines that are upheld following administrative or
5523judicial review, the violator shall pay the fine, plus interest
5524at the rate as specified in s. 55.03, for each day beyond the
5525date set by the agency for payment of the fine.
5526     (7)  Any unlicensed facility that continues to operate
5527after agency notification is subject to a $1,000 fine per day.
5528     (8)  Any licensed facility whose owner or administrator
5529concurrently operates an unlicensed facility shall be subject to
5530an administrative fine of $5,000 per day.
5531     (9)  Any facility whose owner fails to apply for a change-
5532of-ownership license in accordance with s. 400.412 and operates
5533the facility under the new ownership is subject to a fine of
5534$5,000.
5535     (6)(10)  In addition to any administrative fines imposed,
5536the agency may assess a survey fee, equal to the lesser of one
5537half of the facility's biennial license and bed fee or $500, to
5538cover the cost of conducting initial complaint investigations
5539that result in the finding of a violation that was the subject
5540of the complaint or monitoring visits conducted under s.
5541400.428(3)(c) to verify the correction of the violations.
5542     (7)(11)  The agency, as an alternative to or in conjunction
5543with an administrative action against a facility for violations
5544of this part and adopted rules, shall make a reasonable attempt
5545to discuss each violation and recommended corrective action with
5546the owner or administrator of the facility, prior to written
5547notification. The agency, instead of fixing a period within
5548which the facility shall enter into compliance with standards,
5549may request a plan of corrective action from the facility which
5550demonstrates a good faith effort to remedy each violation by a
5551specific date, subject to the approval of the agency.
5552     (12)  Administrative fines paid by any facility under this
5553section shall be deposited into the Health Care Trust Fund and
5554expended as provided in s. 400.418.
5555     (8)(13)  The agency shall develop and disseminate an annual
5556list of all facilities sanctioned or fined $5,000 or more for
5557violations of state standards, the number and class of
5558violations involved, the penalties imposed, and the current
5559status of cases. The list shall be disseminated, at no charge,
5560to the Department of Elderly Affairs, the Department of Health,
5561the Department of Children and Family Services, the area
5562agencies on aging, the Florida Statewide Advocacy Council, and
5563the state and local ombudsman councils. The Department of
5564Children and Family Services shall disseminate the list to
5565service providers under contract to the department who are
5566responsible for referring persons to a facility for residency.
5567The agency may charge a fee commensurate with the cost of
5568printing and postage to other interested parties requesting a
5569copy of this list.
5570     Section 98.  Section 400.421, Florida Statutes, is
5571repealed.
5572     Section 99.  Subsection (9) of section 400.422, Florida
5573Statutes, is amended to read:
5574     400.422  Receivership proceedings.--
5575     (9)  The court may direct the agency to allocate funds from
5576the Health Care Trust Fund to the receiver, subject to the
5577provisions of s. 400.418(1).
5578     Section 100.  Subsection (10) of section 400.423, Florida
5579Statutes, is amended to read:
5580     400.423  Internal risk management and quality assurance
5581program; adverse incidents and reporting requirements.--
5582     (10)  The agency Department of Elderly Affairs may adopt
5583rules necessary to administer this section.
5584     Section 101.  Subsections (3) and (8) of section 400.424,
5585Florida Statutes, are amended to read:
5586     400.424  Contracts.--
5587     (3)(a)  The contract shall include a refund policy to be
5588implemented at the time of a resident's transfer, discharge, or
5589death. The refund policy shall provide that the resident or
5590responsible party is entitled to a prorated refund based on the
5591daily rate for any unused portion of payment beyond the
5592termination date after all charges, including the cost of
5593damages to the residential unit resulting from circumstances
5594other than normal use, have been paid to the licensee. For the
5595purpose of this paragraph, the termination date shall be the
5596date the unit is vacated by the resident and cleared of all
5597personal belongings. If the amount of belongings does not
5598preclude renting the unit, the facility may clear the unit and
5599charge the resident or his or her estate for moving and storing
5600the items at a rate equal to the actual cost to the facility,
5601not to exceed 20 percent of the regular rate for the unit,
5602provided that 14 days' advance written notification is given. If
5603the resident's possessions are not claimed within 45 days after
5604notification, the facility may dispose of them. The contract
5605shall also specify any other conditions under which claims will
5606be made against the refund due the resident. Except in the case
5607of death or a discharge due to medical reasons, the refunds
5608shall be computed in accordance with the notice of relocation
5609requirements specified in the contract. However, a resident may
5610not be required to provide the licensee with more than 30 days'
5611notice of termination. If after a contract is terminated, the
5612facility intends to make a claim against a refund due the
5613resident, the facility shall notify the resident or responsible
5614party in writing of the claim and shall provide said party with
5615a reasonable time period of no less than 14 calendar days to
5616respond. The facility shall provide a refund to the resident or
5617responsible party within 45 days after the transfer, discharge,
5618or death of the resident. The agency shall impose a fine upon a
5619facility that fails to comply with the refund provisions of this
5620the paragraph, which fine shall be equal to three times the
5621amount due to the resident and not subject to the provisions of
5622s. 400.419(3). One-half of the fine shall be remitted to the
5623resident or his or her estate, and the other half to the Health
5624Care Trust Fund to be used for the purpose specified in s.
5625400.418.
5626     (b)  If a licensee agrees to reserve a bed for a resident
5627who is admitted to a medical facility, including, but not
5628limited to, a nursing home, health care facility, or psychiatric
5629facility, the resident or his or her responsible party shall
5630notify the licensee of any change in status that would prevent
5631the resident from returning to the facility. Until such notice
5632is received, the agreed-upon daily rate may be charged by the
5633licensee.
5634     (c)  The purpose of any advance payment and a refund policy
5635for such payment, including any advance payment for housing,
5636meals, or personal services, shall be covered in the contract.
5637     (8)  The agency department may by rule clarify terms,
5638establish procedures, clarify refund policies and contract
5639provisions, and specify documentation as necessary to administer
5640this section.
5641     Section 102.  Subsection (3) of section 400.4255, Florida
5642Statutes, is amended to read:
5643     400.4255  Use of personnel; emergency care.--
5644     (3)  Facility staff may withhold or withdraw
5645cardiopulmonary resuscitation if presented with an order not to
5646resuscitate executed pursuant to s. 401.45. The agency
5647department shall adopt rules providing for the implementation of
5648such orders. Facility staff and facilities shall not be subject
5649to criminal prosecution or civil liability, nor be considered to
5650have engaged in negligent or unprofessional conduct, for
5651withholding or withdrawing cardiopulmonary resuscitation
5652pursuant to such an order and applicable rules adopted by the
5653department. The absence of an order to resuscitate executed
5654pursuant to s. 401.45 does not preclude a physician from
5655withholding or withdrawing cardiopulmonary resuscitation as
5656otherwise permitted by law.
5657     Section 103.  Subsection (6) of section 400.4256, Florida
5658Statutes, is amended to read:
5659     400.4256  Assistance with self-administration of
5660medication.--
5661     (6)  The agency department may by rule establish facility
5662procedures and interpret terms as necessary to implement this
5663section.
5664     Section 104.  Subsection (9) of section 400.426, Florida
5665Statutes, is amended to read:
5666     400.426  Appropriateness of placements; examinations of
5667residents.--
5668     (9)  If, at any time after admission to a facility, a
5669resident appears to need care beyond that which the facility is
5670licensed to provide, the agency shall require the resident to be
5671physically examined by a licensed physician or licensed nurse
5672practitioner. This examination shall, to the extent possible, be
5673performed by the resident's preferred physician or nurse
5674practitioner and shall be paid for by the resident with personal
5675funds, except as provided in s. 400.418(2)(1)(b). Following this
5676examination, the examining physician or licensed nurse
5677practitioner shall complete and sign a medical form provided by
5678the agency. The completed medical form shall be submitted to the
5679agency within 30 days after the date the facility owner or
5680administrator is notified by the agency that the physical
5681examination is required. After consultation with the physician
5682or licensed nurse practitioner who performed the examination, a
5683medical review team designated by the agency shall then
5684determine whether the resident is appropriately residing in the
5685facility. The medical review team shall base its decision on a
5686comprehensive review of the resident's physical and functional
5687status, including the resident's preferences, and not on an
5688isolated health-related problem. In the case of a mental health
5689resident, if the resident appears to have needs in addition to
5690those identified in the community living support plan, the
5691agency may require an evaluation by a mental health
5692professional, as determined by the Department of Children and
5693Family Services. A facility may not be required to retain a
5694resident who requires more services or care than the facility is
5695able to provide in accordance with its policies and criteria for
5696admission and continued residency. Members of the medical review
5697team making the final determination may not include the agency
5698personnel who initially questioned the appropriateness of a
5699resident's placement. Such determination is final and binding
5700upon the facility and the resident. Any resident who is
5701determined by the medical review team to be inappropriately
5702residing in a facility shall be given 30 days' written notice to
5703relocate by the owner or administrator, unless the resident's
5704continued residence in the facility presents an imminent danger
5705to the health, safety, or welfare of the resident or a
5706substantial probability exists that death or serious physical
5707harm would result to the resident if allowed to remain in the
5708facility.
5709     Section 105.  Subsection (8) of section 400.427, Florida
5710Statutes, is amended to read:
5711     400.427  Property and personal affairs of residents.--
5712     (8)  The agency department may by rule clarify terms and
5713specify procedures and documentation necessary to administer the
5714provisions of this section relating to the proper management of
5715residents' funds and personal property and the execution of
5716surety bonds.
5717     Section 106.  Subsection (4) of section 400.4275, Florida
5718Statutes, is amended to read:
5719     400.4275  Business practice; personnel records; liability
5720insurance.--The assisted living facility shall be administered
5721on a sound financial basis that is consistent with good business
5722practices.
5723     (4)  The agency department may by rule clarify terms,
5724establish requirements for financial records, accounting
5725procedures, personnel procedures, insurance coverage, and
5726reporting procedures, and specify documentation as necessary to
5727implement the requirements of this section.
5728     Section 107.  Subsections (1), (4), and (5) of section
5729400.431, Florida Statutes, are amended to read:
5730     400.431  Closing of facility; notice; penalty.--
5731     (1)  In addition to the requirements of part II of chapter
5732408, Whenever a facility voluntarily discontinues operation, it
5733shall inform the agency in writing at least 90 days prior to the
5734discontinuance of operation. the facility shall also inform each
5735resident or the next of kin, legal representative, or agency
5736acting on each resident's behalf, of the fact and the proposed
5737time of such discontinuance of operation, following the
5738notification requirements provided in s. 400.428(1)(k). In the
5739event a resident has no person to represent him or her, the
5740facility shall be responsible for referral to an appropriate
5741social service agency for placement.
5742     (4)  Immediately upon discontinuance of the operation of a
5743facility, the owner shall surrender the license therefor to the
5744agency, and the license shall be canceled.
5745     (4)(5)  The agency may levy a fine in an amount no greater
5746than $5,000 upon each person or business entity that owns any
5747interest in a facility that terminates operation without
5748providing notice to the agency and the residents of the facility
5749at least 30 days before operation ceases. This fine shall not be
5750levied against any facility involuntarily closed at the
5751initiation of the agency. The agency shall use the proceeds of
5752the fines to operate the facility until all residents of the
5753facility are relocated and shall deposit any balance of the
5754proceeds into the Health Care Trust Fund established pursuant to
5755s. 400.418.
5756     Section 108.  Section 400.434, Florida Statutes, is amended
5757to read:
5758     400.434  Right of entry and inspection.--Any duly
5759designated officer or employee of the department, the Department
5760of Children and Family Services, the agency, the Medicaid Fraud
5761Control Unit of the Department of Legal Affairs, the state or
5762local fire marshal, or a member of the state or local long-term
5763care ombudsman council, or the agency in accordance with s.
5764408.811 shall have the right to enter unannounced upon and into
5765the premises of any facility licensed pursuant to this part in
5766order to determine the state of compliance with the provisions
5767of this part, part II of chapter 408, and of applicable rules or
5768standards in force pursuant thereto. The right of entry and
5769inspection shall also extend to any premises which the agency
5770has reason to believe is being operated or maintained as a
5771facility without a license; but no such entry or inspection of
5772any premises may be made without the permission of the owner or
5773person in charge thereof, unless a warrant is first obtained
5774from the circuit court authorizing such entry. The warrant
5775requirement shall extend only to a facility which the agency has
5776reason to believe is being operated or maintained as a facility
5777without a license. Any application for a license or renewal
5778thereof made pursuant to this part shall constitute permission
5779for, and complete acquiescence in, any entry or inspection of
5780the premises for which the license is sought, in order to
5781facilitate verification of the information submitted on or in
5782connection with the application; to discover, investigate, and
5783determine the existence of abuse or neglect; or to elicit,
5784receive, respond to, and resolve complaints. Any current valid
5785license shall constitute unconditional permission for, and
5786complete acquiescence in, any entry or inspection of the
5787premises by authorized personnel. The agency shall retain the
5788right of entry and inspection of facilities that have had a
5789license revoked or suspended within the previous 24 months, to
5790ensure that the facility is not operating unlawfully. However,
5791before entering the facility, a statement of probable cause must
5792be filed with the director of the agency, who must approve or
5793disapprove the action within 48 hours. Probable cause shall
5794include, but is not limited to, evidence that the facility holds
5795itself out to the public as a provider of personal care services
5796or the receipt of a complaint by the long-term care ombudsman
5797council about the facility. Data collected by the state or local
5798long-term care ombudsman councils or the state or local advocacy
5799councils may be used by the agency in investigations involving
5800violations of regulatory standards.
5801     Section 109.  Subsections (2) and (3) of section 400.435,
5802Florida Statutes, are renumbered as subsections (1) and (2),
5803respectively, and present subsection (1) of said section is
5804amended to read:
5805     400.435  Inspection Maintenance of records; reports.--
5806     (1)  Every facility shall maintain, as public information
5807available for public inspection under such conditions as the
5808agency shall prescribe, records containing copies of all
5809inspection reports pertaining to the facility that have been
5810issued by the agency to the facility. Copies of inspection
5811reports shall be retained in the records for 5 years from the
5812date the reports are filed or issued.
5813     (1)(2)  Within 60 days after the date of the biennial
5814inspection visit required under s. 408.811 or within 30 days
5815after the date of any interim visit, the agency shall forward
5816the results of the inspection to the local ombudsman council in
5817whose planning and service area, as defined in part II, the
5818facility is located; to at least one public library or, in the
5819absence of a public library, the county seat in the county in
5820which the inspected assisted living facility is located; and,
5821when appropriate, to the district Adult Services and Mental
5822Health Program Offices.
5823     Section 110.  Section 400.441, Florida Statutes, is amended
5824to read:
5825     400.441  Rules establishing standards.--
5826     (1)  It is the intent of the Legislature that rules
5827published and enforced pursuant to this section shall include
5828criteria by which a reasonable and consistent quality of
5829resident care and quality of life may be ensured and the results
5830of such resident care may be demonstrated. Such rules shall also
5831ensure a safe and sanitary environment that is residential and
5832noninstitutional in design or nature. It is further intended
5833that reasonable efforts be made to accommodate the needs and
5834preferences of residents to enhance the quality of life in a
5835facility. In order to provide safe and sanitary facilities and
5836the highest quality of resident care accommodating the needs and
5837preferences of residents, the agency department, in consultation
5838with the department agency, the Department of Children and
5839Family Services, and the Department of Health, shall adopt
5840rules, policies, and procedures to administer this part and part
5841II of chapter 408, which must include reasonable and fair
5842minimum standards in relation to:
5843     (a)  The requirements for and maintenance of facilities,
5844not in conflict with the provisions of chapter 553, relating to
5845plumbing, heating, cooling, lighting, ventilation, living space,
5846and other housing conditions, which will ensure the health,
5847safety, and comfort of residents and protection from fire
5848hazard, including adequate provisions for fire alarm and other
5849fire protection suitable to the size of the structure. Uniform
5850firesafety standards shall be established and enforced by the
5851State Fire Marshal in cooperation with the agency, the
5852department, and the Department of Health.
5853     1.  Evacuation capability determination.--
5854     a.  The provisions of the National Fire Protection
5855Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
5856for determining the ability of the residents, with or without
5857staff assistance, to relocate from or within a licensed facility
5858to a point of safety as provided in the fire codes adopted
5859herein. An evacuation capability evaluation for initial
5860licensure shall be conducted within 6 months after the date of
5861licensure. For existing licensed facilities that are not
5862equipped with an automatic fire sprinkler system, the
5863administrator shall evaluate the evacuation capability of
5864residents at least annually. The evacuation capability
5865evaluation for each facility not equipped with an automatic fire
5866sprinkler system shall be validated, without liability, by the
5867State Fire Marshal, by the local fire marshal, or by the local
5868authority having jurisdiction over firesafety, before the
5869license renewal date. If the State Fire Marshal, local fire
5870marshal, or local authority having jurisdiction over firesafety
5871has reason to believe that the evacuation capability of a
5872facility as reported by the administrator may have changed, it
5873may, with assistance from the facility administrator, reevaluate
5874the evacuation capability through timed exiting drills.
5875Translation of timed fire exiting drills to evacuation
5876capability may be determined:
5877     (I)  Three minutes or less: prompt.
5878     (II)  More than 3 minutes, but not more than 13 minutes:
5879slow.
5880     (III)  More than 13 minutes: impractical.
5881     b.  The Office of the State Fire Marshal shall provide or
5882cause the provision of training and education on the proper
5883application of Chapter 5, NFPA 101A, 1995 edition, to its
5884employees, to staff of the Agency for Health Care Administration
5885who are responsible for regulating facilities under this part,
5886and to local governmental inspectors. The Office of the State
5887Fire Marshal shall provide or cause the provision of this
5888training within its existing budget, but may charge a fee for
5889this training to offset its costs. The initial training must be
5890delivered within 6 months after July 1, 1995, and as needed
5891thereafter.
5892     c.  The Office of the State Fire Marshal, in cooperation
5893with provider associations, shall provide or cause the provision
5894of a training program designed to inform facility operators on
5895how to properly review bid documents relating to the
5896installation of automatic fire sprinklers. The Office of the
5897State Fire Marshal shall provide or cause the provision of this
5898training within its existing budget, but may charge a fee for
5899this training to offset its costs. The initial training must be
5900delivered within 6 months after July 1, 1995, and as needed
5901thereafter.
5902     d.  The administrator of a licensed facility shall sign an
5903affidavit verifying the number of residents occupying the
5904facility at the time of the evacuation capability evaluation.
5905     2.  Firesafety requirements.--
5906     a.  Except for the special applications provided herein,
5907effective January 1, 1996, the provisions of the National Fire
5908Protection Association, Life Safety Code, NFPA 101, 1994
5909edition, Chapter 22 for new facilities and Chapter 23 for
5910existing facilities shall be the uniform fire code applied by
5911the State Fire Marshal for assisted living facilities, pursuant
5912to s. 633.022.
5913     b.  Any new facility, regardless of size, that applies for
5914a license on or after January 1, 1996, must be equipped with an
5915automatic fire sprinkler system. The exceptions as provided in
5916section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein,
5917apply to any new facility housing eight or fewer residents. On
5918July 1, 1995, local governmental entities responsible for the
5919issuance of permits for construction shall inform, without
5920liability, any facility whose permit for construction is
5921obtained prior to January 1, 1996, of this automatic fire
5922sprinkler requirement. As used in this part, the term "a new
5923facility" does not mean an existing facility that has undergone
5924change of ownership.
5925     c.  Notwithstanding any provision of s. 633.022 or of the
5926National Fire Protection Association, NFPA 101A, Chapter 5, 1995
5927edition, to the contrary, any existing facility housing eight or
5928fewer residents is not required to install an automatic fire
5929sprinkler system, nor to comply with any other requirement in
5930Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
5931requirements of NFPA 101, 1988 edition, that applies to this
5932size facility, unless the facility has been classified as
5933impractical to evacuate. Any existing facility housing eight or
5934fewer residents that is classified as impractical to evacuate
5935must install an automatic fire sprinkler system within the
5936timeframes granted in this section.
5937     d.  Any existing facility that is required to install an
5938automatic fire sprinkler system under this paragraph need not
5939meet other firesafety requirements of Chapter 23, NFPA 101, 1994
5940edition, which exceed the provisions of NFPA 101, 1988 edition.
5941The mandate contained in this paragraph which requires certain
5942facilities to install an automatic fire sprinkler system
5943supersedes any other requirement.
5944     e.  This paragraph does not supersede the exceptions
5945granted in NFPA 101, 1988 edition or 1994 edition.
5946     f.  This paragraph does not exempt facilities from other
5947firesafety provisions adopted under s. 633.022 and local
5948building code requirements in effect before July 1, 1995.
5949     g.  A local government may charge fees only in an amount
5950not to exceed the actual expenses incurred by local government
5951relating to the installation and maintenance of an automatic
5952fire sprinkler system in an existing and properly licensed
5953assisted living facility structure as of January 1, 1996.
5954     h.  If a licensed facility undergoes major reconstruction
5955or addition to an existing building on or after January 1, 1996,
5956the entire building must be equipped with an automatic fire
5957sprinkler system. Major reconstruction of a building means
5958repair or restoration that costs in excess of 50 percent of the
5959value of the building as reported on the tax rolls, excluding
5960land, before reconstruction. Multiple reconstruction projects
5961within a 5-year period the total costs of which exceed 50
5962percent of the initial value of the building at the time the
5963first reconstruction project was permitted are to be considered
5964as major reconstruction. Application for a permit for an
5965automatic fire sprinkler system is required upon application for
5966a permit for a reconstruction project that creates costs that go
5967over the 50-percent threshold.
5968     i.  Any facility licensed before January 1, 1996, that is
5969required to install an automatic fire sprinkler system shall
5970ensure that the installation is completed within the following
5971timeframes based upon evacuation capability of the facility as
5972determined under subparagraph 1.:
5973     (I)  Impractical evacuation capability, 24 months.
5974     (II)  Slow evacuation capability, 48 months.
5975     (III)  Prompt evacuation capability, 60 months.
5976
5977The beginning date from which the deadline for the automatic
5978fire sprinkler installation requirement must be calculated is
5979upon receipt of written notice from the local fire official that
5980an automatic fire sprinkler system must be installed. The local
5981fire official shall send a copy of the document indicating the
5982requirement of a fire sprinkler system to the Agency for Health
5983Care Administration.
5984     j.  It is recognized that the installation of an automatic
5985fire sprinkler system may create financial hardship for some
5986facilities. The appropriate local fire official shall, without
5987liability, grant two 1-year extensions to the timeframes for
5988installation established herein, if an automatic fire sprinkler
5989installation cost estimate and proof of denial from two
5990financial institutions for a construction loan to install the
5991automatic fire sprinkler system are submitted. However, for any
5992facility with a class I or class II, or a history of uncorrected
5993class III, firesafety deficiencies, an extension must not be
5994granted. The local fire official shall send a copy of the
5995document granting the time extension to the Agency for Health
5996Care Administration.
5997     k.  A facility owner whose facility is required to be
5998equipped with an automatic fire sprinkler system under Chapter
599923, NFPA 101, 1994 edition, as adopted herein, must disclose to
6000any potential buyer of the facility that an installation of an
6001automatic fire sprinkler requirement exists. The sale of the
6002facility does not alter the timeframe for the installation of
6003the automatic fire sprinkler system.
6004     l.  Existing facilities required to install an automatic
6005fire sprinkler system as a result of construction-type
6006restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
6007herein, or evacuation capability requirements shall be notified
6008by the local fire official in writing of the automatic fire
6009sprinkler requirement, as well as the appropriate date for final
6010compliance as provided in this subparagraph. The local fire
6011official shall send a copy of the document to the Agency for
6012Health Care Administration.
6013     m.  Except in cases of life-threatening fire hazards, if an
6014existing facility experiences a change in the evacuation
6015capability, or if the local authority having jurisdiction
6016identifies a construction-type restriction, such that an
6017automatic fire sprinkler system is required, it shall be
6018afforded time for installation as provided in this subparagraph.
6019
6020Facilities that are fully sprinkled and in compliance with other
6021firesafety standards are not required to conduct more than one
6022of the required fire drills between the hours of 11 p.m. and 7
6023a.m., per year. In lieu of the remaining drills, staff
6024responsible for residents during such hours may be required to
6025participate in a mock drill that includes a review of evacuation
6026procedures. Such standards must be included or referenced in the
6027rules adopted by the State Fire Marshal. Pursuant to s.
6028633.022(1)(b), the State Fire Marshal is the final
6029administrative authority for firesafety standards established
6030and enforced pursuant to this section. All licensed facilities
6031must have an annual fire inspection conducted by the local fire
6032marshal or authority having jurisdiction.
6033     3.  Resident elopement requirements.--Facilities are
6034required to conduct a minimum of two resident elopement
6035prevention and response drills per year. All administrators and
6036direct care staff must participate in the drills which shall
6037include a review of procedures to address resident elopement.
6038Facilities must document the implementation of the drills and
6039ensure that the drills are conducted in a manner consistent with
6040the facility's resident elopement policies and procedures.
6041     (b)  The preparation and annual update of a comprehensive
6042emergency management plan. Such standards must be included in
6043the rules adopted by the agency department after consultation
6044with the Department of Community Affairs. At a minimum, the
6045rules must provide for plan components that address emergency
6046evacuation transportation; adequate sheltering arrangements;
6047postdisaster activities, including provision of emergency power,
6048food, and water; postdisaster transportation; supplies;
6049staffing; emergency equipment; individual identification of
6050residents and transfer of records; communication with families;
6051and responses to family inquiries. The comprehensive emergency
6052management plan is subject to review and approval by the local
6053emergency management agency. During its review, the local
6054emergency management agency shall ensure that the following
6055agencies, at a minimum, are given the opportunity to review the
6056plan: the Department of Elderly Affairs, the Department of
6057Health, the Agency for Health Care Administration, and the
6058Department of Community Affairs. Also, appropriate volunteer
6059organizations must be given the opportunity to review the plan.
6060The local emergency management agency shall complete its review
6061within 60 days and either approve the plan or advise the
6062facility of necessary revisions.
6063     (c)  The number, training, and qualifications of all
6064personnel having responsibility for the care of residents. The
6065rules must require adequate staff to provide for the safety of
6066all residents. Facilities licensed for 17 or more residents are
6067required to maintain an alert staff for 24 hours per day.
6068     (d)  All sanitary conditions within the facility and its
6069surroundings which will ensure the health and comfort of
6070residents. The rules must clearly delineate the responsibilities
6071of the agency's licensure and survey staff, the county health
6072departments, and the local authority having jurisdiction over
6073fire safety and ensure that inspections are not duplicative. The
6074agency may collect fees for food service inspections conducted
6075by the county health departments and transfer such fees to the
6076Department of Health.
6077     (e)  License application and license renewal, transfer of
6078ownership, Proper management of resident funds and personal
6079property, surety bonds, resident contracts, refund policies,
6080financial ability to operate, and facility and staff records.
6081     (f)  Inspections, complaint investigations, moratoriums,
6082classification of deficiencies, levying and enforcement of
6083penalties, and use of income from fees and fines.
6084     (g)  The enforcement of the resident bill of rights
6085specified in s. 400.428.
6086     (h)  The care and maintenance of residents, which must
6087include, but is not limited to:
6088     1.  The supervision of residents;
6089     2.  The provision of personal services;
6090     3.  The provision of, or arrangement for, social and
6091leisure activities;
6092     4.  The arrangement for appointments and transportation to
6093appropriate medical, dental, nursing, or mental health services,
6094as needed by residents;
6095     5.  The management of medication;
6096     6.  The nutritional needs of residents;
6097     7.  Resident records; and
6098     8.  Internal risk management and quality assurance.
6099     (i)  Facilities holding a limited nursing, extended
6100congregate care, or limited mental health license.
6101     (j)  The establishment of specific criteria to define
6102appropriateness of resident admission and continued residency in
6103a facility holding a standard, limited nursing, extended
6104congregate care, and limited mental health license.
6105     (k)  The use of physical or chemical restraints. The use of
6106physical restraints is limited to half-bed rails as prescribed
6107and documented by the resident's physician with the consent of
6108the resident or, if applicable, the resident's representative or
6109designee or the resident's surrogate, guardian, or attorney in
6110fact. The use of chemical restraints is limited to prescribed
6111dosages of medications authorized by the resident's physician
6112and must be consistent with the resident's diagnosis. Residents
6113who are receiving medications that can serve as chemical
6114restraints must be evaluated by their physician at least
6115annually to assess:
6116     1.  The continued need for the medication.
6117     2.  The level of the medication in the resident's blood.
6118     3.  The need for adjustments in the prescription.
6119     (l)  The establishment of specific policies and procedures
6120on resident elopement. Facilities shall conduct a minimum of two
6121resident elopement drills each year. All administrators and
6122direct care staff shall participate in the drills. Facilities
6123shall document the drills.
6124     (2)  In adopting any rules pursuant to this part, the
6125agency department, in conjunction with the department agency,
6126shall make distinct standards for facilities based upon facility
6127size; the types of care provided; the physical and mental
6128capabilities and needs of residents; the type, frequency, and
6129amount of services and care offered; and the staffing
6130characteristics of the facility. Rules developed pursuant to
6131this section shall not restrict the use of shared staffing and
6132shared programming in facilities that are part of retirement
6133communities that provide multiple levels of care and otherwise
6134meet the requirements of law and rule. Except for uniform
6135firesafety standards, the agency department shall adopt by rule
6136separate and distinct standards for facilities with 16 or fewer
6137beds and for facilities with 17 or more beds. The standards for
6138facilities with 16 or fewer beds shall be appropriate for a
6139noninstitutional residential environment, provided that the
6140structure is no more than two stories in height and all persons
6141who cannot exit the facility unassisted in an emergency reside
6142on the first floor. The agency department, in conjunction with
6143the department agency, may make other distinctions among types
6144of facilities as necessary to enforce the provisions of this
6145part. Where appropriate, the agency shall offer alternate
6146solutions for complying with established standards, based on
6147distinctions made by the department and the agency relative to
6148the physical characteristics of facilities and the types of care
6149offered therein.
6150     (3)  The department shall submit a copy of proposed rules
6151to the Speaker of the House of Representatives, the President of
6152the Senate, and appropriate committees of substance for review
6153and comment prior to the promulgation thereof.
6154     (a)  Rules adopted promulgated by the agency department
6155shall encourage the development of homelike facilities which
6156promote the dignity, individuality, personal strengths, and
6157decisionmaking ability of residents.
6158     (4)(b)  The agency, in consultation with the department,
6159may waive rules promulgated pursuant to this part in order to
6160demonstrate and evaluate innovative or cost-effective congregate
6161care alternatives which enable individuals to age in place. Such
6162waivers may be granted only in instances where there is
6163reasonable assurance that the health, safety, or welfare of
6164residents will not be endangered. To apply for a waiver, the
6165licensee shall submit to the agency a written description of the
6166concept to be demonstrated, including goals, objectives, and
6167anticipated benefits; the number and types of residents who will
6168be affected, if applicable; a brief description of how the
6169demonstration will be evaluated; and any other information
6170deemed appropriate by the agency. Any facility granted a waiver
6171shall submit a report of findings to the agency and the
6172department within 12 months. At such time, the agency may renew
6173or revoke the waiver or pursue any regulatory or statutory
6174changes necessary to allow other facilities to adopt the same
6175practices. The agency department may by rule clarify terms and
6176establish waiver application procedures, criteria for reviewing
6177waiver proposals, and procedures for reporting findings, as
6178necessary to implement this subsection.
6179     (5)(4)  The agency may use an abbreviated biennial standard
6180licensure inspection that consists of a review of key quality-
6181of-care standards in lieu of a full inspection in facilities
6182which have a good record of past performance. However, a full
6183inspection shall be conducted in facilities which have had a
6184history of class I or class II violations, uncorrected class III
6185violations, confirmed ombudsman council complaints, or confirmed
6186licensure complaints, within the previous licensure period
6187immediately preceding the inspection or when a potentially
6188serious problem is identified during the abbreviated inspection.
6189The agency, in consultation with the department, shall develop
6190the key quality-of-care standards with input from the State
6191Long-Term Care Ombudsman Council and representatives of provider
6192groups for incorporation into its rules. The department, in
6193consultation with the agency, shall report annually to the
6194Legislature concerning its implementation of this subsection.
6195The report shall include, at a minimum, the key quality-of-care
6196standards which have been developed; the number of facilities
6197identified as being eligible for the abbreviated inspection; the
6198number of facilities which have received the abbreviated
6199inspection and, of those, the number that were converted to full
6200inspection; the number and type of subsequent complaints
6201received by the agency or department on facilities which have
6202had abbreviated inspections; any recommendations for
6203modification to this subsection; any plans by the agency to
6204modify its implementation of this subsection; and any other
6205information which the department believes should be reported.
6206     (5)  A fee shall be charged by the department to any person
6207requesting a copy of this part or rules promulgated under this
6208part. Such fees shall not exceed the actual cost of duplication
6209and postage.
6210     Section 111.  Subsection (4) of section 400.442, Florida
6211Statutes, is amended to read:
6212     400.442  Pharmacy and dietary services.--
6213     (4)  The agency department may by rule establish procedures
6214and specify documentation as necessary to implement this
6215section.
6216     Section 112.  Subsection (3) of section 400.444, Florida
6217Statutes, is amended to read:
6218     400.444  Construction and renovation; requirements.--
6219     (3)  The agency department may adopt rules to establish
6220procedures and specify the documentation necessary to implement
6221this section.
6222     Section 113.  Subsections (4) through (7) of section
6223400.447, Florida Statutes, are renumbered as subsections (1)
6224through (4) and present subsections (1), (2), and (3) of said
6225section are amended to read:
6226     400.447  Prohibited acts; penalties for violation.--
6227     (1)  It is unlawful for any person or public body to offer
6228or advertise to the public, in any way by any medium whatever,
6229personal services as defined in this act, without obtaining a
6230valid current license. It is unlawful for any holder of a
6231license issued pursuant to the provisions of this act to
6232advertise or hold out to the public that it holds a license for
6233a facility other than that for which it actually holds a
6234license.
6235     (2)  It is unlawful for any holder of a license issued
6236pursuant to the provisions of this act to withhold from the
6237agency any evidence of financial instability, including, but not
6238limited to, bad checks, delinquent accounts, nonpayment of
6239withholding taxes, unpaid utility expenses, nonpayment for
6240essential services, or adverse court action concerning the
6241financial viability of the facility or any other facility
6242licensed under part II or part III of this chapter which is
6243owned by the licensee.
6244     (3)  Any person found guilty of violating subsection (1) or
6245subsection (2) commits a misdemeanor of the second degree,
6246punishable as provided in s. 775.083. Each day of continuing
6247violation shall be considered a separate offense.
6248     Section 114.  Section 400.451, Florida Statutes, is
6249repealed.
6250     Section 115.  Subsections (1), (3), and (6) of section
6251400.452, Florida Statutes, as amended by section 3 of chapter
62522003-405, Laws of Florida, are amended to read:
6253     400.452  Staff training and educational programs; core
6254educational requirement.--
6255     (1)  Administrators and other assisted living facility
6256staff must meet minimum training and education requirements
6257established by the Department of Elderly Affairs or agency by
6258rule. This training and education is intended to assist
6259facilities to appropriately respond to the needs of residents,
6260to maintain resident care and facility standards, and to meet
6261licensure requirements.
6262     (3)  Effective January 1, 2004, a new facility
6263administrator must complete the required training and education,
6264including the competency test, within a reasonable time after
6265being employed as an administrator, as determined by the
6266department. Failure to do so is a violation of this part and
6267subjects the violator to an administrative fine as prescribed in
6268s. 400.419. Administrators licensed in accordance with chapter
6269468, part II, are exempt from this requirement. Other licensed
6270professionals may be exempted, as determined by the department
6271by rule.
6272     (6)  Other facility staff shall participate in training
6273relevant to their job duties as specified by rule of the
6274department.
6275     Section 116.  Section 400.454, Florida Statutes, is amended
6276to read:
6277     400.454  Collection of information; local subsidy.--
6278     (1)  To enable the agency department to collect the
6279information requested by the Legislature regarding the actual
6280cost of providing room, board, and personal care in facilities,
6281the agency may department is authorized to conduct field visits
6282and audits of facilities as may be necessary. The owners of
6283randomly sampled facilities shall submit such reports, audits,
6284and accountings of cost as required the department may require
6285by rule; provided that such reports, audits, and accountings
6286shall be the minimum necessary to implement the provisions of
6287this section. Any facility selected to participate in the study
6288shall cooperate with the agency department by providing cost of
6289operation information to interviewers.
6290     (2)  Local governments or organizations may contribute to
6291the cost of care of local facility residents by further
6292subsidizing the rate of state-authorized payment to such
6293facilities. Implementation of local subsidy shall require agency
6294departmental approval and shall not result in reductions in the
6295state supplement.
6296     Section 117.  Subsections (1) and (4) of section 400.464,
6297Florida Statutes, are amended to read:
6298     400.464  Home health agencies to be licensed; expiration of
6299license; exemptions; unlawful acts; penalties.--
6300     (1)  The requirements of part II of chapter 408 shall apply
6301to the provision of services that require licensure pursuant to
6302this part and part II of chapter 408 and entities licensed or
6303registered by or applying for such licensure or registration
6304from the Agency for Health Care Administration pursuant to this
6305part. However, each applicant for licensure and each licensee is
6306exempt from the provisions of ss. 408.806(1)(e)2. and
6307408.810(10). Any home health agency must be licensed by the
6308agency to operate in this state. A license issued to a home
6309health agency, unless sooner suspended or revoked, expires 1
6310year after its date of issuance.
6311     (4)(a)  An organization may not provide, offer, or
6312advertise home health services to the public unless the
6313organization has a valid license or is specifically exempted
6314under this part. An organization that offers or advertises to
6315the public any service for which licensure or registration is
6316required under this part must include in the advertisement the
6317license number or regulation number issued to the organization
6318by the agency. The agency shall assess a fine of not less than
6319$100 to any licensee or registrant who fails to include the
6320license or registration number when submitting the advertisement
6321for publication, broadcast, or printing. The holder of a license
6322issued under this part may not advertise or indicate to the
6323public that it holds a home health agency or nurse registry
6324license other than the one it has been issued.
6325     (b)  A person who violates paragraph (a) is subject to an
6326injunctive proceeding under s. 408.816 400.515. A violation of
6327paragraph (a) or s. 408.813 is a deceptive and unfair trade
6328practice and constitutes a violation of the Florida Deceptive
6329and Unfair Trade Practices Act.
6330     (c)  A person who violates the provisions of paragraph (a)
6331commits a misdemeanor of the second degree, punishable as
6332provided in s. 775.082 or s. 775.083. Any person who commits a
6333second or subsequent violation commits a misdemeanor of the
6334first degree, punishable as provided in s. 775.082 or s.
6335775.083. Each day of continuing violation constitutes a separate
6336offense.
6337     Section 118.  Section 400.471, Florida Statutes, is amended
6338to read:
6339     400.471  Application for license; fee; provisional license;
6340temporary permit.--
6341     (1)  Each applicant for licensure must comply with all
6342provisions of this part and part II of chapter 408. Application
6343for an initial license or for renewal of an existing license
6344must be made under oath to the agency on forms furnished by it
6345and must be accompanied by the appropriate license fee as
6346provided in subsection (8). The agency must take final action on
6347an initial licensure application within 60 days after receipt of
6348all required documentation.
6349     (2)  In addition to the requirements of part II of chapter
6350408, the applicant must file with the application satisfactory
6351proof that the home health agency is in compliance with this
6352part and applicable rules, including:
6353     (a)  A listing of services to be provided, either directly
6354by the applicant or through contractual arrangements with
6355existing providers.;
6356     (b)  The number and discipline of professional staff to be
6357employed.; and
6358     (c)  Proof of financial ability to operate.
6359     (3)  An applicant for initial licensure must demonstrate
6360financial ability to operate by submitting a balance sheet and
6361income and expense statement for the first 2 years of operation
6362which provide evidence of having sufficient assets, credit, and
6363projected revenues to cover liabilities and expenses. The
6364applicant shall have demonstrated financial ability to operate
6365if the applicant's assets, credit, and projected revenues meet
6366or exceed projected liabilities and expenses. All documents
6367required under this subsection must be prepared in accordance
6368with generally accepted accounting principles, and the financial
6369statement must be signed by a certified public accountant.
6370     (4)  Each applicant for licensure must comply with the
6371following requirements:
6372     (a)  Upon receipt of a completed, signed, and dated
6373application, the agency shall require background screening of
6374the applicant, in accordance with the level 2 standards for
6375screening set forth in chapter 435. As used in this subsection,
6376the term "applicant" means the administrator, or a similarly
6377titled person who is responsible for the day-to-day operation of
6378the licensed home health agency, and the financial officer, or
6379similarly titled individual who is responsible for the financial
6380operation of the licensed home health agency.
6381     (b)  The agency may require background screening for a
6382member of the board of directors of the licensee or an officer
6383or an individual owning 5 percent or more of the licensee if the
6384agency reasonably suspects that such individual has been
6385convicted of an offense prohibited under the level 2 standards
6386for screening set forth in chapter 435.
6387     (c)  Proof of compliance with the level 2 background
6388screening requirements of chapter 435 which has been submitted
6389within the previous 5 years in compliance with any other health
6390care or assisted living licensure requirements of this state is
6391acceptable in fulfillment of paragraph (a). Proof of compliance
6392with background screening which has been submitted within the
6393previous 5 years to fulfill the requirements of the Financial
6394Services Commission and the Office of Insurance Regulation
6395pursuant to chapter 651 as part of an application for a
6396certificate of authority to operate a continuing care retirement
6397community is acceptable in fulfillment of the Department of Law
6398Enforcement and Federal Bureau of Investigation background
6399check.
6400     (d)  A provisional license may be granted to an applicant
6401when each individual required by this section to undergo
6402background screening has met the standards for the Department of
6403Law Enforcement background check, but the agency has not yet
6404received background screening results from the Federal Bureau of
6405Investigation. A standard license may be granted to the licensee
6406upon the agency's receipt of a report of the results of the
6407Federal Bureau of Investigation background screening for each
6408individual required by this section to undergo background
6409screening which confirms that all standards have been met, or
6410upon the granting of a disqualification exemption by the agency
6411as set forth in chapter 435. Any other person who is required to
6412undergo level 2 background screening may serve in his or her
6413capacity pending the agency's receipt of the report from the
6414Federal Bureau of Investigation. However, the person may not
6415continue to serve if the report indicates any violation of
6416background screening standards and a disqualification exemption
6417has not been requested of and granted by the agency as set forth
6418in chapter 435.
6419     (e)  Each applicant must submit to the agency, with its
6420application, a description and explanation of any exclusions,
6421permanent suspensions, or terminations of the licensee or
6422potential licensee from the Medicare or Medicaid programs. Proof
6423of compliance with the requirements for disclosure of ownership
6424and control interest under the Medicaid or Medicare programs may
6425be accepted in lieu of this submission.
6426     (f)  Each applicant must submit to the agency a description
6427and explanation of any conviction of an offense prohibited under
6428the level 2 standards of chapter 435 by a member of the board of
6429directors of the applicant, its officers, or any individual
6430owning 5 percent or more of the applicant. This requirement does
6431not apply to a director of a not-for-profit corporation or
6432organization if the director serves solely in a voluntary
6433capacity for the corporation or organization, does not regularly
6434take part in the day-to-day operational decisions of the
6435corporation or organization, receives no remuneration for his or
6436her services on the corporation or organization's board of
6437directors, and has no financial interest and has no family
6438members with a financial interest in the corporation or
6439organization, provided that the director and the not-for-profit
6440corporation or organization include in the application a
6441statement affirming that the director's relationship to the
6442corporation satisfies the requirements of this paragraph.
6443     (g)  A license may not be granted to an applicant if the
6444applicant, administrator, or financial officer has been found
6445guilty of, regardless of adjudication, or has entered a plea of
6446nolo contendere or guilty to, any offense prohibited under the
6447level 2 standards for screening set forth in chapter 435, unless
6448an exemption from disqualification has been granted by the
6449agency as set forth in chapter 435.
6450     (h)  The agency may deny or revoke licensure if the
6451applicant:
6452     1.  Has falsely represented a material fact in the
6453application required by paragraph (e) or paragraph (f), or has
6454omitted any material fact from the application required by
6455paragraph (e) or paragraph (f); or
6456     2.  Has been or is currently excluded, suspended,
6457terminated from, or has involuntarily withdrawn from
6458participation in this state's Medicaid program, or the Medicaid
6459program of any other state, or from participation in the
6460Medicare program or any other governmental or private health
6461care or health insurance program.
6462     (i)  An application for license renewal must contain the
6463information required under paragraphs (e) and (f).
6464     (3)(5)  In addition to the requirements of s. 408.810, the
6465home health agency must also obtain and maintain the following
6466insurance coverages in an amount of not less than $250,000 per
6467claim, and the home health agency must submit proof of coverage
6468with an initial application for licensure and with each annual
6469application for license renewal:
6470     (a)  Malpractice insurance as defined in s. 624.605(1)(k).;
6471     (b)  Liability insurance as defined in s. 624.605(1)(b).
6472     (6)  Ninety days before the expiration date, an application
6473for renewal must be submitted to the agency under oath on forms
6474furnished by it, and a license must be renewed if the applicant
6475has met the requirements established under this part and
6476applicable rules. The home health agency must file with the
6477application satisfactory proof that it is in compliance with
6478this part and applicable rules. If there is evidence of
6479financial instability, the home health agency must submit
6480satisfactory proof of its financial ability to comply with the
6481requirements of this part.
6482     (7)  When transferring the ownership of a home health
6483agency, the transferee must submit an application for a license
6484at least 60 days before the effective date of the transfer. If
6485the home health agency is being leased, a copy of the lease
6486agreement must be filed with the application.
6487     (4)(8)  In accordance with s. 408.805, an applicant or
6488licensee shall pay a fee for each license application submitted
6489under this part, part II of chapter 408, and applicable rules.
6490The amount of the fee shall be established by rule and shall be
6491set at The license fee and annual renewal fee required of a home
6492health agency are nonrefundable. The agency shall set the fees
6493in an amount that is sufficient to cover the agency's its costs
6494in carrying out its responsibilities under this part, but not to
6495exceed $2,000 per biennium $1,000. However, state, county, or
6496municipal governments applying for licenses under this part are
6497exempt from the payment of license fees. All fees collected
6498under this part must be deposited in the Health Care Trust Fund
6499for the administration of this part.
6500     (9)  The license must be displayed in a conspicuous place
6501in the administrative office of the home health agency and is
6502valid only while in the possession of the person to which it is
6503issued. The license may not be sold, assigned, or otherwise
6504transferred, voluntarily or involuntarily, and is valid only for
6505the home health agency and location for which originally issued.
6506     (10)  A home health agency against whom a revocation or
6507suspension proceeding is pending at the time of license renewal
6508may be issued a provisional license effective until final
6509disposition by the agency of such proceedings. If judicial
6510relief is sought from the final disposition, the court that has
6511jurisdiction may issue a temporary permit for the duration of
6512the judicial proceeding.
6513     (5)(11)  The agency may not issue a license designated as
6514certified to a home health agency that fails to satisfy the
6515requirements of a Medicare certification survey from the agency.
6516     (12)  The agency may not issue a license to a home health
6517agency that has any unpaid fines assessed under this part.
6518     Section 119.  Section 400.474, Florida Statutes, is amended
6519to read:
6520     400.474  Denial, suspension, revocation of license;
6521injunction; grounds; penalties.--
6522     (1)  The agency may deny, revoke, and or suspend a license,
6523and or impose an administrative fine in the manner provided in
6524chapter 120, or initiate injunctive proceedings under this part,
6525part II of chapter 408, or applicable rules s. 400.515.
6526     (2)  Any of the following actions by a home health agency
6527or its employee is grounds for disciplinary action by the
6528agency:
6529     (a)  Violation of this part, part II of chapter 408, or of
6530applicable rules.
6531     (b)  An intentional, reckless, or negligent act that
6532materially affects the health or safety of a patient.
6533     (c)  Knowingly providing home health services in an
6534unlicensed assisted living facility or unlicensed adult family-
6535care home, unless the home health agency or employee reports the
6536unlicensed facility or home to the agency within 72 hours after
6537providing the services.
6538     (3)  The agency may impose the following penalties for
6539operating without a license upon an applicant or owner who has
6540in the past operated, or who currently operates, a licensed home
6541health agency.
6542     (a)  If a home health agency that is found to be operating
6543without a license wishes to apply for a license, the home health
6544agency may submit an application only after the agency has
6545verified that the home health agency no longer operates an
6546unlicensed home health agency.
6547     (b)  Any person, partnership, or corporation that violates
6548paragraph (a) and that previously operated a licensed home
6549health agency or concurrently operates both a licensed home
6550health agency and an unlicensed home health agency commits a
6551felony of the third degree punishable as provided in s. 775.082,
6552s. 775.083, or s. 775.084. If an owner has an interest in more
6553than one home health agency and fails to license any one of
6554those home health agencies, the agency must issue a cease and
6555desist order for the activities of the unlicensed home health
6556agency and impose a moratorium on any or all of the licensed
6557related home health agencies until the unlicensed home health
6558agency is licensed.
6559     (3)(c)  If any home health agency is found to be operating
6560without a license meets the criteria in paragraph (a) or
6561paragraph (b) and that home health agency has received any
6562government reimbursement for services provided by an unlicensed
6563home health agency, the agency shall make a fraud referral to
6564the appropriate government reimbursement program.
6565     (4)  The agency may deny, revoke, or suspend the license of
6566a home health agency, or may impose on a home health agency
6567administrative fines not to exceed the aggregate sum of $5,000
6568if:
6569     (a)  The agency is unable to obtain entry to the home
6570health agency to conduct a licensure survey, complaint
6571investigation, surveillance visit, or monitoring visit.
6572     (b)  An applicant or a licensed home health agency has
6573falsely represented a material fact in the application, or has
6574omitted from the application any material fact, including, but
6575not limited to, the fact that the controlling or ownership
6576interest is held by any officer, director, agent, manager,
6577employee, affiliated person, partner, or shareholder who is not
6578eligible to participate.
6579     (c)  An applicant, owner, or person who has a 5 percent or
6580greater interest in a licensed entity:
6581     1.  Has been previously found by any licensing, certifying,
6582or professional standards board or agency to have violated the
6583standards or conditions that relate to home health-related
6584licensure or certification, or to the quality of home health-
6585related services provided; or
6586     2.  Has been or is currently excluded, suspended,
6587terminated from, or has involuntarily withdrawn from,
6588participation in the Medicaid program of this state or any other
6589state, the Medicare program, or any other governmental health
6590care or health insurance program.
6591     Section 120.  Subsection (1) and paragraphs (a) and (b) of
6592subsection (2) of section 400.484, Florida Statutes, are amended
6593to read:
6594     400.484  Right of inspection; deficiencies; fines.--
6595     (1)  In accordance with s. 408.811, Any duly authorized
6596officer or employee of the agency may make such inspections and
6597investigations as are necessary in order to determine the state
6598of compliance with this part and with applicable rules. The
6599right of inspection extends to any business that the agency has
6600reason to believe is being operated as a home health agency
6601without a license, but such inspection of any such business may
6602not be made without the permission of the owner or person in
6603charge unless a warrant is first obtained from a circuit court.
6604Any application for a license issued under this part or for
6605license renewal constitutes permission for an appropriate
6606inspection to verify the information submitted on or in
6607connection with the application.
6608     (2)  The agency shall impose fines for various classes of
6609deficiencies in accordance with the following schedule:
6610     (a)  A class I deficiency is any act, omission, or practice
6611that results in a patient's death, disablement, or permanent
6612injury, or places a patient at imminent risk of death,
6613disablement, or permanent injury. Upon finding a class I
6614deficiency, the agency may impose an administrative fine in the
6615amount of $5,000 for each occurrence and each day that the
6616deficiency exists. In addition, the agency may immediately
6617revoke the license and, or impose a moratorium pursuant to part
6618II of chapter 408 on the admission of new patients, until the
6619factors causing the deficiency have been corrected.
6620     (b)  A class II deficiency is any act, omission, or
6621practice that has a direct adverse effect on the health, safety,
6622or security of a patient. Upon finding a class II deficiency,
6623the agency may impose an administrative fine in the amount of
6624$1,000 for each occurrence and each day that the deficiency
6625exists. In addition, the agency may suspend the license and, or
6626impose a moratorium pursuant to part II of chapter 408 on the
6627admission of new patients, until the deficiency has been
6628corrected.
6629     Section 121.  Subsections (1) and (2) of section 400.487,
6630Florida Statutes, are amended to read:
6631     400.487  Home health service agreements; physician's,
6632physician assistant's, and advanced registered nurse
6633practitioner's treatment orders; patient assessment;
6634establishment and review of plan of care; provision of services;
6635orders not to resuscitate.--
6636     (1)  Services provided by a home health agency must be
6637covered by an agreement between the home health agency and the
6638patient or the patient's legal representative specifying the
6639home health services to be provided, the rates or charges for
6640services paid with private funds, and the sources method of
6641payment, which may include Medicare, Medicaid, private
6642insurance, personal funds, or a combination thereof. A home
6643health agency providing skilled care must make an assessment of
6644the patient's needs within 48 hours after the start of services.
6645     (2)  When required by the provisions of chapter 464; part
6646I, part III, or part V of chapter 468; or chapter 486, the
6647attending physician, physician assistant, or advanced registered
6648nurse practitioner, acting within his or her respective scope of
6649practice, shall for a patient who is to receive skilled care
6650must establish treatment orders for a patient who is to receive
6651skilled care. The treatment orders must be signed by the
6652physician, physician assistant, or advanced registered nurse
6653practitioner before a claim is submitted to a managed care
6654organization and the treatment orders must be signed in the time
6655allowed under the provider agreement. The treatment orders shall
6656within 30 days after the start of care and must be reviewed, as
6657frequently as the patient's illness requires, by the physician,
6658physician assistant, or advanced registered nurse practitioner,
6659in consultation with the home health agency personnel that
6660provide services to the patient.
6661     Section 122.  Section 400.494, Florida Statutes, is amended
6662to read:
6663     400.494  Information about patients confidential.--
6664     (1)  Information about patients received by persons
6665employed by, or providing services to, a home health agency or
6666received by the licensing agency through reports or inspection
6667shall be confidential and exempt from the provisions of s.
6668119.07(1) and shall not be disclosed to any person other than
6669the patient without the written consent of that patient or the
6670patient's guardian.
6671     (2)  This section does not apply to information lawfully
6672requested by the Medicaid Fraud Control Unit of the Office of
6673the Attorney General or requested pursuant to 408.811 Department
6674of Legal Affairs.
6675     Section 123.  Section 400.495, Florida Statutes, is amended
6676to read:
6677     400.495  Notice of toll-free telephone number for central
6678abuse hotline.--In addition to the requirements of 408.810(5),
6679On or before the first day home health services are provided to
6680a patient, any home health agency or nurse registry licensed
6681under this part must inform the patient and his or her immediate
6682family, if appropriate, of the right to report abusive,
6683neglectful, or exploitative practices. The statewide toll-free
6684telephone number for the central abuse hotline must be provided
6685to patients in a manner that is clearly legible and must include
6686the words: "To report abuse, neglect, or exploitation, please
6687call toll-free   (phone number)  ." the Agency for Health Care
6688Administration shall adopt rules that provide for 90 days'
6689advance notice of a change in the toll-free telephone number and
6690that outline due process procedures, as provided under chapter
6691120, for home health agency personnel and nurse registry
6692personnel who are reported to the central abuse hotline. Home
6693health agencies and nurse registries shall establish appropriate
6694policies and procedures for providing such notice to patients.
6695     Section 124.  Section 400.497, Florida Statutes, is amended
6696to read:
6697     400.497  Rules establishing minimum standards.--The agency
6698shall adopt, publish, and enforce rules to implement part II of
6699chapter 408 and this part, including, as applicable, ss. 400.506
6700and 400.509, which must provide reasonable and fair minimum
6701standards relating to:
6702     (1)  The home health aide competency test and home health
6703aide training. The agency shall create the home health aide
6704competency test and establish the curriculum and instructor
6705qualifications for home health aide training. Licensed home
6706health agencies may provide this training and shall furnish
6707documentation of such training to other licensed home health
6708agencies upon request. Successful passage of the competency test
6709by home health aides may be substituted for the training
6710required under this section and any rule adopted pursuant
6711thereto.
6712     (2)  Shared staffing. The agency shall allow shared
6713staffing if the home health agency is part of a retirement
6714community that provides multiple levels of care, is located on
6715one campus, is licensed under this chapter, and otherwise meets
6716the requirements of law and rule.
6717     (3)  The criteria for the frequency of onsite licensure
6718surveys.
6719     (4)  Licensure application and renewal.
6720     (5)  The requirements for onsite and electronic
6721accessibility of supervisory personnel of home health agencies.
6722     (6)  Information to be included in patients' records.
6723     (7)  Geographic service areas.
6724     (8)  Preparation of a comprehensive emergency management
6725plan pursuant to s. 400.492.
6726     (a)  The Agency for Health Care Administration shall adopt
6727rules establishing minimum criteria for the plan and plan
6728updates, with the concurrence of the Department of Health and in
6729consultation with the Department of Community Affairs.
6730     (b)  The rules must address the requirements in s. 400.492.
6731In addition, the rules shall provide for the maintenance of
6732patient-specific medication lists that can accompany patients
6733who are transported from their homes.
6734     (c)  The plan is subject to review and approval by the
6735county health department. During its review, the county health
6736department shall ensure that the following agencies, at a
6737minimum, are given the opportunity to review the plan:
6738     1.  The local emergency management agency.
6739     2.  The Agency for Health Care Administration.
6740     3.  The local chapter of the American Red Cross or other
6741lead sheltering agency.
6742     4.  The district office of the Department of Children and
6743Family Services.
6744
6745The county health department shall complete its review within 60
6746days after receipt of the plan and shall either approve the plan
6747or advise the home health agency of necessary revisions.
6748     (d)  For any home health agency that operates in more than
6749one county, the Department of Health shall review the plan,
6750after consulting with all of the county health departments, the
6751agency, and all the local chapters of the American Red Cross or
6752other lead sheltering agencies in the areas of operation for
6753that particular home health agency. The Department of Health
6754shall complete its review within 90 days after receipt of the
6755plan and shall either approve the plan or advise the home health
6756agency of necessary revisions. The Department of Health shall
6757make every effort to avoid imposing differing requirements based
6758on differences between counties on the home health agency.
6759     (e)  The requirements in this subsection do not apply to:
6760     1.  A facility that is certified under chapter 651 and has
6761a licensed home health agency used exclusively by residents of
6762the facility; or
6763     2.  A retirement community that consists of residential
6764units for independent living and either a licensed nursing home
6765or an assisted living facility, and has a licensed home health
6766agency used exclusively by the residents of the retirement
6767community, provided the comprehensive emergency management plan
6768for the facility or retirement community provides for continuous
6769care of all residents with special needs during an emergency.
6770     Section 125.  Section 400.506, Florida Statutes, is amended
6771to read:
6772     400.506  Licensure of nurse registries; requirements;
6773penalties.--
6774     (1)  A nurse registry is exempt from the licensing
6775requirements of a home health agency but must be licensed as a
6776nurse registry. The requirements of part II of chapter 408 shall
6777apply to the provision of services that require licensure
6778pursuant to ss. 400.506-400.518 and part II of chapter 408 and
6779to entities licensed by or applying for such license from the
6780Agency for Health Care Administration pursuant to ss. 400.506-
6781400.518. Each operational site of the nurse registry must be
6782licensed, unless there is more than one site within a county. If
6783there is more than one site within a county, only one license
6784per county is required. Each operational site must be listed on
6785the license.
6786     (2)  Each applicant for licensure and each licensee must
6787comply with all provisions of part II and chapter 408, except
6788ss. 408.806(1)(e)2., 408.810(6), and 408.810(10). the following
6789requirements:
6790     (a)  Upon receipt of a completed, signed, and dated
6791application, the agency shall require background screening, in
6792accordance with the level 2 standards for screening set forth in
6793chapter 435, of the managing employee, or other similarly titled
6794individual who is responsible for the daily operation of the
6795nurse registry, and of the financial officer, or other similarly
6796titled individual who is responsible for the financial operation
6797of the registry, including billings for patient care and
6798services. The applicant shall comply with the procedures for
6799level 2 background screening as set forth in chapter 435.
6800     (b)  The agency may require background screening of any
6801other individual who is an applicant if the agency has probable
6802cause to believe that he or she has been convicted of a crime or
6803has committed any other offense prohibited under the level 2
6804standards for screening set forth in chapter 435.
6805     (c)  Proof of compliance with the level 2 background
6806screening requirements of chapter 435 which has been submitted
6807within the previous 5 years in compliance with any other health
6808care or assisted living licensure requirements of this state is
6809acceptable in fulfillment of the requirements of paragraph (a).
6810     (d)  A provisional license may be granted to an applicant
6811when each individual required by this section to undergo
6812background screening has met the standards for the Department of
6813Law Enforcement background check but the agency has not yet
6814received background screening results from the Federal Bureau of
6815Investigation. A standard license may be granted to the
6816applicant upon the agency's receipt of a report of the results
6817of the Federal Bureau of Investigation background screening for
6818each individual required by this section to undergo background
6819screening which confirms that all standards have been met, or
6820upon the granting of a disqualification exemption by the agency
6821as set forth in chapter 435. Any other person who is required to
6822undergo level 2 background screening may serve in his or her
6823capacity pending the agency's receipt of the report from the
6824Federal Bureau of Investigation. However, the person may not
6825continue to serve if the report indicates any violation of
6826background screening standards and a disqualification exemption
6827has not been requested of and granted by the agency as set forth
6828in chapter 435.
6829     (e)  Each applicant must submit to the agency, with its
6830application, a description and explanation of any exclusions,
6831permanent suspensions, or terminations of the applicant from the
6832Medicare or Medicaid programs. Proof of compliance with the
6833requirements for disclosure of ownership and control interests
6834under the Medicaid or Medicare programs may be accepted in lieu
6835of this submission.
6836     (f)  Each applicant must submit to the agency a description
6837and explanation of any conviction of an offense prohibited under
6838the level 2 standards of chapter 435 by a member of the board of
6839directors of the applicant, its officers, or any individual
6840owning 5 percent or more of the applicant. This requirement does
6841not apply to a director of a not-for-profit corporation or
6842organization if the director serves solely in a voluntary
6843capacity for the corporation or organization, does not regularly
6844take part in the day-to-day operational decisions of the
6845corporation or organization, receives no remuneration for his or
6846her services on the corporation or organization's board of
6847directors, and has no financial interest and has no family
6848members with a financial interest in the corporation or
6849organization, provided that the director and the not-for-profit
6850corporation or organization include in the application a
6851statement affirming that the director's relationship to the
6852corporation satisfies the requirements of this paragraph.
6853     (g)  A license may not be granted to an applicant if the
6854applicant or managing employee has been found guilty of,
6855regardless of adjudication, or has entered a plea of nolo
6856contendere or guilty to, any offense prohibited under the level
68572 standards for screening set forth in chapter 435, unless an
6858exemption from disqualification has been granted by the agency
6859as set forth in chapter 435.
6860     (h)  The agency may deny or revoke the license if any
6861applicant:
6862     1.  Has falsely represented a material fact in the
6863application required by paragraph (e) or paragraph (f), or has
6864omitted any material fact from the application required by
6865paragraph (e) or paragraph (f); or
6866     2.  Has had prior action taken against the applicant under
6867the Medicaid or Medicare program as set forth in paragraph (e).
6868     (i)  An application for license renewal must contain the
6869information required under paragraphs (e) and (f).
6870     (3)  In accordance with s. 408.805, an applicant or
6871licensee shall pay a fee for each license application submitted
6872under ss. 400.508-400.518, part II of chapter 408, and
6873applicable rules. The amount of the fee shall be established by
6874rule and may not exceed $2,000 per biennium. Application for
6875license must be made to the Agency for Health Care
6876Administration on forms furnished by it and must be accompanied
6877by the appropriate licensure fee, as established by rule and not
6878to exceed the cost of regulation under this part. The licensure
6879fee for nurse registries may not exceed $1,000 and must be
6880deposited in the Health Care Trust Fund.
6881     (4)  The Agency for Health Care Administration may deny,
6882revoke, or suspend a license or impose an administrative fine in
6883the manner provided in chapter 120 against a nurse registry
6884that:
6885     (a)  Fails to comply with this section or applicable rules.
6886     (b)  Commits an intentional, reckless, or negligent act
6887that materially affects the health or safety of a person
6888receiving services.
6889     (5)  A license issued for the operation of a nurse
6890registry, unless sooner suspended or revoked, expires 1 year
6891after its date of issuance. Sixty days before the expiration
6892date, an application for renewal must be submitted to the Agency
6893for Health Care Administration on forms furnished by it. The
6894Agency for Health Care Administration shall renew the license if
6895the applicant has met the requirements of this section and
6896applicable rules. A nurse registry against which a revocation or
6897suspension proceeding is pending at the time of license renewal
6898may be issued a conditional license effective until final
6899disposition by the Agency for Health Care Administration of such
6900proceedings. If judicial relief is sought from the final
6901disposition, the court having jurisdiction may issue a
6902conditional license for the duration of the judicial proceeding.
6903     (6)  The Agency for Health Care Administration may
6904institute injunctive proceedings under s. 400.515.
6905     (4)(7)  A person that offers or advertises to the public
6906that it provides any service for which licensure is required
6907under this section must include in such advertisement the
6908license number issued to it by the Agency for Health Care
6909Administration.
6910     (8)  It is unlawful for a person to offer or advertise to
6911the public services as defined by rule without obtaining a valid
6912license from the Agency for Health Care Administration. It is
6913unlawful for any holder of a license to advertise or hold out to
6914the public that he or she holds a license for other than that
6915for which he or she actually holds a license. A person who
6916violates this subsection is subject to injunctive proceedings
6917under s. 400.515.
6918     (9)  Any duly authorized officer or employee of the Agency
6919for Health Care Administration may make such inspections and
6920investigations as are necessary to respond to complaints or to
6921determine the state of compliance with this section and
6922applicable rules.
6923     (a)  If, in responding to a complaint, an agent or employee
6924of the Agency for Health Care Administration has reason to
6925believe that a crime has been committed, he or she shall notify
6926the appropriate law enforcement agency.
6927     (b)  If, in responding to a complaint, an agent or employee
6928of the Agency for Health Care Administration has reason to
6929believe that abuse, neglect, or exploitation has occurred,
6930according to the definitions in chapter 415, he or she shall
6931file a report under chapter 415.
6932     (5)(10)(a)  A nurse registry may refer for contract in
6933private residences registered nurses and licensed practical
6934nurses registered and licensed under part I of chapter 464,
6935certified nursing assistants certified under part II of chapter
6936464, home health aides who present documented proof of
6937successful completion of the training required by rule of the
6938agency, and companions or homemakers for the purposes of
6939providing those services authorized under s. 400.509(1). Each
6940person referred by a nurse registry must provide current
6941documentation that he or she is free from communicable diseases.
6942     (b)  A certified nursing assistant or home health aide may
6943be referred for a contract to provide care to a patient in his
6944or her home only if that patient is under a physician's care. A
6945certified nursing assistant or home health aide referred for
6946contract in a private residence shall be limited to assisting a
6947patient with bathing, dressing, toileting, grooming, eating,
6948physical transfer, and those normal daily routines the patient
6949could perform for himself or herself were he or she physically
6950capable. A certified nursing assistant or home health aide may
6951not provide medical or other health care services that require
6952specialized training and that may be performed only by licensed
6953health care professionals. The nurse registry shall obtain the
6954name and address of the attending physician and send written
6955notification to the physician within 48 hours after a contract
6956is concluded that a certified nursing assistant or home health
6957aide will be providing care for that patient.
6958     (c)  A nurse registry shall, at the time of contracting for
6959services through the nurse registry, advise the patient, the
6960patient's family, or a person acting on behalf of the patient of
6961the availability of registered nurses to make visits to the
6962patient's home at an additional cost. A registered nurse shall
6963make monthly visits to the patient's home to assess the
6964patient's condition and quality of care being provided by the
6965certified nursing assistant or home health aide. Any condition
6966that which in the professional judgment of the nurse requires
6967further medical attention shall be reported to the attending
6968physician and the nurse registry. The assessment shall become a
6969part of the patient's file with the nurse registry and may be
6970reviewed by the agency during their survey procedure.
6971     (6)(11)  A person who is referred by a nurse registry for
6972contract in private residences and who is not a nurse licensed
6973under part I of chapter 464 may perform only those services or
6974care to clients that the person has been certified to perform or
6975trained to perform as required by law or rules of the Agency for
6976Health Care Administration or the Department of Business and
6977Professional Regulation. Providing services beyond the scope
6978authorized under this subsection constitutes the unauthorized
6979practice of medicine or a violation of the Nurse Practice Act
6980and is punishable as provided under chapter 458, chapter 459, or
6981part I of chapter 464.
6982     (7)(12)  Each nurse registry must require every applicant
6983for contract to complete an application form providing the
6984following information:
6985     (a)  The name, address, date of birth, and social security
6986number of the applicant.
6987     (b)  The educational background and employment history of
6988the applicant.
6989     (c)  The number and date of the applicable license or
6990certification.
6991     (d)  When appropriate, information concerning the renewal
6992of the applicable license, registration, or certification.
6993     (8)(13)  Each nurse registry must comply with the
6994procedures set forth in s. 400.512 for maintaining records of
6995the employment history of all persons referred for contract and
6996is subject to the standards and conditions set forth in that
6997section. However, an initial screening may not be required for
6998persons who have been continuously registered with the nurse
6999registry since September 30, 1990.
7000     (9)(14)  The nurse registry must maintain the application
7001on file, and that file must be open to the inspection of the
7002Agency for Health Care Administration. The nurse registry must
7003maintain on file the name and address of the client to whom the
7004nurse or other nurse registry personnel is sent for contract and
7005the amount of the fee received by the nurse registry. A nurse
7006registry must maintain the file that includes the application
7007and other applicable documentation for 3 years after the date of
7008the last file entry of client-related information.
7009     (10)(15)  Nurse registries shall assist persons who would
7010need assistance and sheltering during evacuations because of
7011physical, mental, or sensory disabilities in registering with
7012the appropriate local emergency management agency pursuant to s.
7013252.355.
7014     (11)(16)  Each nurse registry shall prepare and maintain a
7015comprehensive emergency management plan that is consistent with
7016the criteria in this subsection and with the local special needs
7017plan. The plan shall be updated annually. The plan shall specify
7018how the nurse registry shall facilitate the provision of
7019continuous care by persons referred for contract to persons who
7020are registered pursuant to s. 252.355 during an emergency that
7021interrupts the provision of care or services in private
7022residencies.
7023     (a)  All persons referred for contract who care for persons
7024registered pursuant to s. 252.355 must include in the patient
7025record a description of how care will be continued during a
7026disaster or emergency that interrupts the provision of care in
7027the patient's home. It shall be the responsibility of the person
7028referred for contract to ensure that continuous care is
7029provided.
7030     (b)  Each nurse registry shall maintain a current
7031prioritized list of patients in private residences who are
7032registered pursuant to s. 252.355 and are under the care of
7033persons referred for contract and who need continued services
7034during an emergency. This list shall indicate, for each patient,
7035if the client is to be transported to a special needs shelter
7036and if the patient is receiving skilled nursing services. Nurse
7037registries shall make this list available to county health
7038departments and to local emergency management agencies upon
7039request.
7040     (c)  Each person referred for contract who is caring for a
7041patient who is registered pursuant to s. 252.355 shall provide a
7042list of the patient's medication and equipment needs to the
7043nurse registry. Each person referred for contract shall make
7044this information available to county health departments and to
7045local emergency management agencies upon request.
7046     (d)  Each person referred for contract shall not be
7047required to continue to provide care to patients in emergency
7048situations that are beyond the person's control and that make it
7049impossible to provide services, such as when roads are
7050impassable or when patients do not go to the location specified
7051in their patient records.
7052     (e)  The comprehensive emergency management plan required
7053by this subsection is subject to review and approval by the
7054county health department. During its review, the county health
7055department shall ensure that, at a minimum, the local emergency
7056management agency, the Agency for Health Care Administration,
7057and the local chapter of the American Red Cross or other lead
7058sheltering agency are given the opportunity to review the plan.
7059The county health department shall complete its review within 60
7060days after receipt of the plan and shall either approve the plan
7061or advise the nurse registry of necessary revisions.
7062     (f)  The Agency for Health Care Administration shall adopt
7063rules establishing minimum criteria for the comprehensive
7064emergency management plan and plan updates required by this
7065subsection, with the concurrence of the Department of Health and
7066in consultation with the Department of Community Affairs.
7067     (12)(17)  All persons referred for contract in private
7068residences by a nurse registry must comply with the following
7069requirements for a plan of treatment:
7070     (a)  When, in accordance with the privileges and
7071restrictions imposed upon a nurse under part I of chapter 464,
7072the delivery of care to a patient is under the direction or
7073supervision of a physician or when a physician is responsible
7074for the medical care of the patient, a medical plan of treatment
7075must be established for each patient receiving care or treatment
7076provided by a licensed nurse in the home. The original medical
7077plan of treatment must be timely signed by the physician,
7078physician assistant, or advanced registered nurse practitioner,
7079acting within his or her respective scope of practice, and
7080reviewed by him or her in consultation with the licensed nurse
7081at least every 2 months. Any additional order or change in
7082orders must be obtained from the physician, physician assistant,
7083or advanced registered nurse practitioner and reduced to writing
7084and timely signed by the physician, physician assistant, or
7085advanced registered nurse practitioner. The delivery of care
7086under a medical plan of treatment must be substantiated by the
7087appropriate nursing notes or documentation made by the nurse in
7088compliance with nursing practices established under part I of
7089chapter 464.
7090     (b)  Whenever a medical plan of treatment is established
7091for a patient, the initial medical plan of treatment, any
7092amendment to the plan, additional order or change in orders, and
7093copy of nursing notes must be filed in the office of the nurse
7094registry.
7095     (13)(18)  The nurse registry must comply with the notice
7096requirements of s. 400.495, relating to abuse reporting.
7097     (14)(19)  In addition to any other penalties imposed
7098pursuant to this section or part, the agency may assess costs
7099related to an investigation that results in a successful
7100prosecution., excluding costs associated with an attorney's
7101time. If the agency imposes such an assessment and the
7102assessment is not paid, and if challenged is not the subject of
7103a pending appeal, prior to the renewal of the license, the
7104license shall not be issued until the assessment is paid or
7105arrangements for payment of the assessment are made.
7106     (15)(20)  The Agency for Health Care Administration shall
7107adopt rules to implement this section and part II of chapter
7108408.
7109     Section 126.  Section 400.509, Florida Statutes, is amended
7110to read:
7111     400.509  Registration of particular service providers
7112exempt from licensure; certificate of registration; regulation
7113of registrants.--
7114     (1)  Any organization that provides companion services or
7115homemaker services and does not provide a home health service to
7116a person is exempt from licensure under this part. However, any
7117organization that provides companion services or homemaker
7118services must register with the agency.
7119     (2)  The requirements of part II of chapter 408 shall apply
7120to the provision of services that require registration or
7121licensure pursuant to this section and part II of chapter 408
7122and entities registered by or applying for such registration
7123from the Agency for Health Care Administration pursuant to this
7124section. Each applicant for registration and each registrant
7125must comply with all provisions of part II of chapter 408 except
7126ss. 408.806(1)(e) and 408.810(6)-(10). Registration consists of
7127annually filing with the agency, under oath, on forms provided
7128by it, the following information:
7129     (a)  If the registrant is a firm or partnership, the name,
7130address, date of birth, and social security number of every
7131member.
7132     (b)  If the registrant is a corporation or association, its
7133name and address; the name, address, date of birth, and social
7134security number of each of its directors and officers; and the
7135name and address of each person having at least a 5 percent
7136interest in the corporation or association.
7137     (c)  The name, address, date of birth, and social security
7138number of each person employed by or under contract with the
7139organization.
7140     (3)  In accordance with s. 408.805, applicants and
7141registrants shall pay fees for all registrations issued under
7142this part, part II of chapter 408, and applicable rules. The
7143amount of the fee shall be $50 per biennium. The agency shall
7144charge a registration fee of $25 to be submitted with the
7145information required under subsection (2).
7146     (4)  Each applicant for registration must comply with the
7147following requirements:
7148     (a)  Upon receipt of a completed, signed, and dated
7149application, the agency shall require background screening, in
7150accordance with the level 1 standards for screening set forth in
7151chapter 435, of every individual who will have contact with the
7152client. The agency shall require background screening of the
7153managing employee or other similarly titled individual who is
7154responsible for the operation of the entity, and of the
7155financial officer or other similarly titled individual who is
7156responsible for the financial operation of the entity, including
7157billings for client services in accordance with the level 2
7158standards for background screening as set forth in chapter 435.
7159     (b)  The agency may require background screening of any
7160other individual who is affiliated with the applicant if the
7161agency has a reasonable basis for believing that he or she has
7162been convicted of a crime or has committed any other offense
7163prohibited under the level 2 standards for screening set forth
7164in chapter 435.
7165     (c)  Proof of compliance with the level 2 background
7166screening requirements of chapter 435 which has been submitted
7167within the previous 5 years in compliance with any other health
7168care or assisted living licensure requirements of this state is
7169acceptable in fulfillment of paragraph (a).
7170     (d)  A provisional registration may be granted to an
7171applicant when each individual required by this section to
7172undergo background screening has met the standards for the
7173abuse-registry background check through the agency and the
7174Department of Law Enforcement background check, but the agency
7175has not yet received background screening results from the
7176Federal Bureau of Investigation. A standard registration may be
7177granted to the applicant upon the agency's receipt of a report
7178of the results of the Federal Bureau of Investigation background
7179screening for each individual required by this section to
7180undergo background screening which confirms that all standards
7181have been met, or upon the granting of a disqualification
7182exemption by the agency as set forth in chapter 435. Any other
7183person who is required to undergo level 2 background screening
7184may serve in his or her capacity pending the agency's receipt of
7185the report from the Federal Bureau of Investigation. However,
7186the person may not continue to serve if the report indicates any
7187violation of background screening standards and if a
7188disqualification exemption has not been requested of and granted
7189by the agency as set forth in chapter 435.
7190     (e)  Each applicant must submit to the agency, with its
7191application, a description and explanation of any exclusions,
7192permanent suspensions, or terminations of the applicant from the
7193Medicare or Medicaid programs. Proof of compliance with the
7194requirements for disclosure of ownership and control interests
7195under the Medicaid or Medicare programs may be accepted in lieu
7196of this submission.
7197     (f)  Each applicant must submit to the agency a description
7198and explanation of any conviction of an offense prohibited under
7199the level 2 standards of chapter 435 which was committed by a
7200member of the board of directors of the applicant, its officers,
7201or any individual owning 5 percent or more of the applicant.
7202This requirement does not apply to a director of a not-for-
7203profit corporation or organization who serves solely in a
7204voluntary capacity for the corporation or organization, does not
7205regularly take part in the day-to-day operational decisions of
7206the corporation or organization, receives no remuneration for
7207his or her services on the corporation's or organization's board
7208of directors, and has no financial interest and no family
7209members having a financial interest in the corporation or
7210organization, if the director and the not-for-profit corporation
7211or organization include in the application a statement affirming
7212that the director's relationship to the corporation satisfies
7213the requirements of this paragraph.
7214     (g)  A registration may not be granted to an applicant if
7215the applicant or managing employee has been found guilty of,
7216regardless of adjudication, or has entered a plea of nolo
7217contendere or guilty to, any offense prohibited under the level
72182 standards for screening set forth in chapter 435, unless an
7219exemption from disqualification has been granted by the agency
7220as set forth in chapter 435.
7221     (h)  The agency may deny or revoke the registration of any
7222applicant who:
7223     1.  Has falsely represented a material fact in the
7224application required by paragraph (e) or paragraph (f), or has
7225omitted any material fact from the application required by
7226paragraph (e) or paragraph (f); or
7227     2.  Has had prior action taken against the applicant under
7228the Medicaid or Medicare program as set forth in paragraph (e).
7229     (i)  An application for licensure renewal must contain the
7230information required under paragraphs (e) and (f).
7231     (4)(5)  Each registrant must obtain the employment or
7232contract history of persons who are employed by or under
7233contract with the organization and who will have contact at any
7234time with patients or clients in their homes by:
7235     (a)  Requiring such persons to submit an employment or
7236contractual history to the registrant; and
7237     (b)  Verifying the employment or contractual history,
7238unless through diligent efforts such verification is not
7239possible. The agency shall prescribe by rule the minimum
7240requirements for establishing that diligent efforts have been
7241made.
7242
7243There is no monetary liability on the part of, and no cause of
7244action for damages arises against, a former employer of a
7245prospective employee of or prospective independent contractor
7246with a registrant who reasonably and in good faith communicates
7247his or her honest opinions about the former employee's or
7248contractor's job performance. This subsection does not affect
7249the official immunity of an officer or employee of a public
7250corporation.
7251     (6)  On or before the first day on which services are
7252provided to a patient or client, any registrant under this part
7253must inform the patient or client and his or her immediate
7254family, if appropriate, of the right to report abusive,
7255neglectful, or exploitative practices. The statewide toll-free
7256telephone number for the central abuse hotline must be provided
7257to patients or clients in a manner that is clearly legible and
7258must include the words: "To report abuse, neglect, or
7259exploitation, please call toll-free   (phone number)  ."
7260Registrants must establish appropriate policies and procedures
7261for providing such notice to patients or clients.
7262     (7)  The provisions of s. 400.512 regarding screening apply
7263to any person or business entity registered under this section
7264on or after October 1, 1994.
7265     (8)  Upon verification that all requirements for
7266registration have been met, the Agency for Health Care
7267Administration shall issue a certificate of registration valid
7268for no more than 1 year.
7269     (9)  The Agency for Health Care Administration may deny,
7270suspend, or revoke the registration of a person that:
7271     (a)  Fails to comply with this section or applicable rules.
7272     (b)  Commits an intentional, reckless, or negligent act
7273that materially affects the health or safety of a person
7274receiving services.
7275     (10)  The Agency for Health Care Administration may
7276institute injunctive proceedings under s. 400.515.
7277     (5)(11)  A person that offers or advertises to the public a
7278service for which registration is required must include in its
7279advertisement the registration number issued by the Agency for
7280Health Care Administration.
7281     (12)  It is unlawful for a person to offer or advertise to
7282the public services, as defined by rule, without obtaining a
7283certificate of registration from the Agency for Health Care
7284Administration. It is unlawful for any holder of a certificate
7285of registration to advertise or hold out to the public that he
7286or she holds a certificate of registration for other than that
7287for which he or she actually holds a certificate of
7288registration. Any person who violates this subsection is subject
7289to injunctive proceedings under s. 400.515.
7290     (13)  Any duly authorized officer or employee of the Agency
7291for Health Care Administration has the right to make such
7292inspections and investigations as are necessary in order to
7293respond to complaints or to determine the state of compliance
7294with this section and applicable rules.
7295     (a)  If, in responding to a complaint, an officer or
7296employee of the Agency for Health Care Administration has reason
7297to believe that a crime has been committed, he or she shall
7298notify the appropriate law enforcement agency.
7299     (b)  If, in responding to a complaint, an officer or
7300employee of the Agency for Health Care Administration has reason
7301to believe that abuse, neglect, or exploitation has occurred,
7302according to the definitions in chapter 415, he or she shall
7303file a report under chapter 415.
7304     (6)(14)  In addition to any other penalties imposed
7305pursuant to this section or part, the agency may assess costs
7306related to an investigation that results in a successful
7307prosecution, excluding costs associated with an attorney's time.
7308If the agency imposes such an assessment and the assessment is
7309not paid, and if challenged is not the subject of a pending
7310appeal, prior to the renewal of the registration, the
7311registration shall not be issued until the assessment is paid or
7312arrangements for payment of the assessment are made.
7313     (7)(15)  The Agency for Health Care Administration shall
7314adopt rules to administer this section and part II of chapter
7315408.
7316     Section 127.  Subsections (3) through (7) of section
7317400.512, Florida Statutes, are renumbered as subsections (2)
7318through (6) and present subsections (2) and (7) are amended to
7319read:
7320     400.512  Screening of home health agency personnel; nurse
7321registry personnel; and companions and homemakers.--The agency
7322shall require employment or contractor screening as provided in
7323chapter 435, using the level 1 standards for screening set forth
7324in that chapter, for home health agency personnel; persons
7325referred for employment by nurse registries; and persons
7326employed by companion or homemaker services registered under s.
7327400.509.
7328     (2)  The administrator of each home health agency, the
7329managing employee of each nurse registry, and the managing
7330employee of each companion or homemaker service registered under
7331s. 400.509 must sign an affidavit annually, under penalty of
7332perjury, stating that all personnel hired, contracted with, or
7333registered on or after October 1, 1994, who enter the home of a
7334patient or client in their service capacity have been screened
7335and that its remaining personnel have worked for the home health
7336agency or registrant continuously since before October 1, 1994.
7337     (6)(7)(a)  It is a misdemeanor of the first degree,
7338punishable under s. 775.082 or s. 775.083, for any person
7339willfully, knowingly, or intentionally to:
7340     1.  Fail, by false statement, misrepresentation,
7341impersonation, or other fraudulent means, to disclose in any
7342application for voluntary or paid employment a material fact
7343used in making a determination as to such person's
7344qualifications to be an employee under this section; or
7345     2.  Operate or attempt to operate an entity licensed or
7346registered under this part with persons who do not meet the
7347minimum standards for good moral character as contained in this
7348section; or
7349     2.3.  Use information from the criminal records obtained
7350under this section for any purpose other than screening that
7351person for employment as specified in this section or release
7352such information to any other person for any purpose other than
7353screening for employment under this section.
7354     (b)  It is a felony of the third degree, punishable under
7355s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
7356knowingly, or intentionally to use information from the juvenile
7357records of a person obtained under this section for any purpose
7358other than screening for employment under this section.
7359     Section 128.  Section 400.515, Florida Statutes, is
7360repealed.
7361     Section 129.  Subsections (6) and (7) of section 400.551,
7362Florida Statutes, are amended to read:
7363     400.551  Definitions.--As used in this part, the term:
7364     (6)  "Operator" means the licensee or person having general
7365administrative charge of an adult day care center.
7366     (7)  "Owner" means the licensee owner of an adult day care
7367center.
7368     Section 130.  Section 400.554, Florida Statutes, is amended
7369to read:
7370     400.554  License requirement; fee; exemption; display.--
7371     (1)  The requirements of part II of chapter 408 shall apply
7372to the provision of services that require licensure pursuant
7373this part and part II of chapter 408 and to entities licensed by
7374or applying for such licensure from the Agency for Health Care
7375Administration pursuant this part. However, each applicant for
7376licensure and each licensee is exempt from the provisions of s.
7377408.810(10). It is unlawful to operate an adult day care center
7378without first obtaining from the agency a license authorizing
7379such operation. The agency is responsible for licensing adult
7380day care centers in accordance with this part.
7381     (2)  Separate licenses are required for centers operated on
7382separate premises, even though operated under the same
7383management. Separate licenses are not required for separate
7384buildings on the same premises.
7385     (3)  In accordance with s. 408.805, an applicant or
7386licensee shall pay a fee for each license application submitted
7387under this part and part II of chapter 408. The amount of the
7388fee shall be established by rule and The biennial license fee
7389required of a center shall be determined by the department, but
7390may not exceed $150.
7391     (4)  County-operated or municipally operated centers
7392applying for licensure under this part are exempt from the
7393payment of license fees.
7394     (5)  The license for a center shall be displayed in a
7395conspicuous place inside the center.
7396     (6)  A license is valid only in the possession of the
7397individual, firm, partnership, association, or corporation to
7398which it is issued and is not subject to sale, assignment, or
7399other transfer, voluntary or involuntary; nor is a license valid
7400for any premises other than the premises for which originally
7401issued.
7402     Section 131.  Section 400.555, Florida Statutes, is amended
7403to read:
7404     400.555  Application for license.--
7405     (1)  An application for a license to operate an adult day
7406care center must be made to the agency on forms furnished by the
7407agency and must be accompanied by the appropriate license fee
7408unless the applicant is exempt from payment of the fee as
7409provided in s. 400.554(4).
7410     (2)  In addition to all provisions of part II of chapter
7411408, the applicant for licensure must furnish:
7412     (a)  a description of the physical and mental capabilities
7413and needs of the participants to be served and the availability,
7414frequency, and intensity of basic services and of supportive and
7415optional services to be provided and proof of adequate liability
7416insurance coverage.;
7417     (b)  Satisfactory proof of financial ability to operate and
7418conduct the center in accordance with the requirements of this
7419part, which must include, in the case of an initial application,
7420a 1-year operating plan and proof of a 3-month operating reserve
7421fund; and
7422     (c)  Proof of adequate liability insurance coverage.
7423     (d)  Proof of compliance with level 2 background screening
7424as required under s. 400.5572.
7425     (e)  A description and explanation of any exclusions,
7426permanent suspensions, or terminations of the application from
7427the Medicare or Medicaid programs. Proof of compliance with
7428disclosure of ownership and control interest requirements of the
7429Medicare or Medicaid programs shall be accepted in lieu of this
7430submission.
7431     Section 132.  Section 400.556, Florida Statutes, is amended
7432to read:
7433     400.556  Denial, suspension, revocation of license;
7434emergency action; administrative fines; investigations and
7435inspections.--
7436     (1)  The agency may deny, revoke, or suspend a license
7437under this part, impose an action under s. 408.814, and or may
7438impose an administrative fine against the owner of an adult day
7439care center or its operator or employee in the manner provided
7440in chapter 120 for the violation of any provision of this part,
7441part II of chapter 408, or applicable rules.
7442     (2)  Each of the following actions by the owner of an adult
7443day care center or by its operator or employee is a ground for
7444action by the agency against the owner of the center or its
7445operator or employee:
7446     (a)  An intentional or negligent act materially affecting
7447the health or safety of center participants.
7448     (b)  A violation of this part or of any standard or rule
7449under this part.
7450     (b)(c)  A failure of persons subject to level 2 background
7451screening under s. 408.809 400.4174(1) to meet the screening
7452standards of s. 435.04, or the retention by the center of an
7453employee subject to level 1 background screening standards under
7454s. 400.4174(2) who does not meet the screening standards of s.
7455435.03 and for whom exemptions from disqualification have not
7456been provided by the agency.
7457     (c)(d)  Failure to follow the criteria and procedures
7458provided under part I of chapter 394 relating to the
7459transportation, voluntary admission, and involuntary examination
7460of center participants.
7461     (d)(e)  Multiple or repeated violations of this part or of
7462any standard or rule adopted under this part or part II of
7463chapter 408.
7464     (f)  Exclusion, permanent suspension, or termination of the
7465owner, if an individual, officer, or board member of the adult
7466day care center, if the owner is a firm, corporation,
7467partnership, or association, or any person owning 5 percent or
7468more of the center, from the Medicare or Medicaid program.
7469     (3)  The agency is responsible for all investigations and
7470inspections conducted pursuant to this part.
7471     Section 133.  Section 400.5565, Florida Statutes, is
7472amended to read:
7473     400.5565  Administrative fines; interest.--
7474     (1)(a)  If the agency determines that an adult day care
7475center is not operated in compliance with this part, part II of
7476chapter 408, or applicable with rules adopted under this part,
7477the agency, notwithstanding any other administrative action it
7478takes, shall make a reasonable attempt to discuss with the owner
7479each violation and recommended corrective action prior to
7480providing the owner with written notification. The agency may
7481request the submission of a corrective action plan for the
7482center which demonstrates a good faith effort to remedy each
7483violation by a specific date, subject to the approval of the
7484agency.
7485     (b)  The owner of a center or its operator or employee
7486found in violation of this part, part II of chapter 408, or
7487applicable rules or of rules adopted under this part may be
7488fined by the agency. A fine may not exceed $500 for each
7489violation. In no event, however, may such fines in the aggregate
7490exceed $5,000.
7491     (c)  The failure to correct a violation by the date set by
7492the agency, or the failure to comply with an approved corrective
7493action plan, is a separate violation for each day such failure
7494continues, unless the agency approves an extension to a specific
7495date.
7496     (d)  If the owner of a center or its operator or employee
7497appeals an agency action under this section and the fine is
7498upheld, the violator shall pay the fine, plus interest at the
7499legal rate specified in s. 687.01 for each day that the fine
7500remains unpaid after the date set by the agency for payment of
7501the fine.
7502     (2)  In determining whether to impose a fine and in fixing
7503the amount of any fine, the agency shall consider the following
7504factors:
7505     (a)  The gravity of the violation, including the
7506probability that death or serious physical or emotional harm to
7507a participant will result or has resulted, the severity of the
7508actual or potential harm, and the extent to which the provisions
7509of the applicable statutes or rules were violated.
7510     (b)  Actions taken by the owner or operator to correct
7511violations.
7512     (c)  Any previous violations.
7513     (d)  The financial benefit to the center of committing or
7514continuing the violation.
7515     Section 134.  Section 400.557, Florida Statutes, is amended
7516to read:
7517     400.557  Expiration of license; renewal; Conditional
7518license or permit.--
7519     (1)  A license issued for the operation of an adult day
7520care center, unless sooner suspended or revoked, expires 2 years
7521after the date of issuance. The agency shall notify a licensee
7522at least 120 days before the expiration date that license
7523renewal is required to continue operation. The notification must
7524be provided electronically or by mail delivery. At least 90 days
7525prior to the expiration date, an application for renewal must be
7526submitted to the agency. A license shall be renewed, upon the
7527filing of an application on forms furnished by the agency, if
7528the applicant has first met the requirements of this part and of
7529the rules adopted under this part. The applicant must file with
7530the application satisfactory proof of financial ability to
7531operate the center in accordance with the requirements of this
7532part and in accordance with the needs of the participants to be
7533served and an affidavit of compliance with the background
7534screening requirements of s. 400.5572.
7535     (2)  A licensee against whom a revocation or suspension
7536proceeding is pending at the time for license renewal may be
7537issued a conditional license effective until final disposition
7538by the agency of the proceeding. If judicial relief is sought
7539from the final disposition, the court having jurisdiction may
7540issue a conditional permit effective for the duration of the
7541judicial proceeding.
7542     (3)  The agency may issue a conditional license to an
7543applicant for license renewal or change of ownership if the
7544applicant fails to meet all standards and requirements for
7545licensure. A conditional license issued under this subsection
7546must be limited to a specific period not exceeding 6 months, as
7547determined by the agency, and must be accompanied by an approved
7548plan of correction.
7549     Section 135.  Section 400.5572, Florida Statutes, is
7550amended to read:
7551     400.5572  Background screening.--
7552     (1)(a)  Level 2 background screening must be conducted on
7553each of the following persons, who shall be considered employees
7554for the purposes of conducting screening under chapter 435:
7555     1.  The adult day care center owner if an individual, the
7556operator, and the financial officer.
7557     2.  An officer or board member if the owner of the adult
7558day care center is a firm, corporation, partnership, or
7559association, or any person owning 5 percent or more of the
7560facility, if the agency has probable cause to believe that such
7561person has been convicted of any offense prohibited by s.
7562435.04. For each officer, board member, or person owning 5
7563percent or more who has been convicted of any such offense, the
7564facility shall submit to the agency a description and
7565explanation of the conviction at the time of license
7566application. This subparagraph does not apply to a board member
7567of a not-for-profit corporation or organization if the board
7568member serves solely in a voluntary capacity, does not regularly
7569take part in the day-to-day operational decisions of the
7570corporation or organization, receives no remuneration for his or
7571her services, and has no financial interest and has no family
7572members with a financial interest in the corporation or
7573organization, provided that the board member and facility submit
7574a statement affirming that the board member's relationship to
7575the facility satisfies the requirements of this subparagraph.
7576     (b)  Proof of compliance with level 2 screening standards
7577which has been submitted within the previous 5 years to meet any
7578facility or professional licensure requirements of the agency or
7579the Department of Health satisfies the requirements of this
7580subsection.
7581     (c)  The agency may grant a provisional license to an adult
7582day care center applying for an initial license when each
7583individual required by this subsection to undergo screening has
7584completed the Department of Law Enforcement background check,
7585but has not yet received results from the Federal Bureau of
7586Investigation, or when a request for an exemption from
7587disqualification has been submitted to the agency pursuant to s.
7588435.07, but a response has not been issued.
7589     (2)  The owner or administrator of an adult day care center
7590must conduct level 1 background screening as set forth in
7591chapter 435 on all employees hired on or after October 1, 1998,
7592who provide basic services or supportive and optional services
7593to the participants. Such persons satisfy this requirement if:
7594     (1)(a)  Proof of compliance with level 1 screening
7595requirements obtained to meet any professional license
7596requirements in this state is provided and accompanied, under
7597penalty of perjury, by a copy of the person's current
7598professional license and an affidavit of current compliance with
7599the background screening requirements.
7600     (2)(b)  The person required to be screened has been
7601continuously employed, without a breach in service that exceeds
7602180 days, in the same type of occupation for which the person is
7603seeking employment and provides proof of compliance with the
7604level 1 screening requirement which is no more than 2 years old.
7605Proof of compliance must be provided directly from one employer
7606or contractor to another, and not from the person screened. Upon
7607request, a copy of screening results shall be provided to the
7608person screened by the employer retaining documentation of the
7609screening.
7610     (3)(c)  The person required to be screened is employed by a
7611corporation or business entity or related corporation or
7612business entity that owns, operates, or manages more than one
7613facility or agency licensed under this chapter, and for whom a
7614level 1 screening was conducted by the corporation or business
7615entity as a condition of initial or continued employment.
7616     Section 136.  Section 400.5575, Florida Statutes, is
7617repealed.
7618     Section 137.  Section 400.558, Florida Statutes, is
7619repealed.
7620     Section 138.  Section 400.559, Florida Statutes, is amended
7621to read:
7622     400.559  Discontinuance of operation of adult day care
7623centers Closing or change of owner or operator of center.--
7624     (1)  Before operation of an adult day care center may be
7625voluntarily discontinued, the operator must inform the agency in
7626writing at least 60 days prior to the discontinuance of
7627operation. The operator must also, at such time, inform each
7628participant of the fact and the proposed date of such
7629discontinuance of operation.
7630     (2)  Immediately upon discontinuance of the operation of a
7631center, the owner or operator shall surrender the license for
7632the center to the agency, and the license shall be canceled by
7633the agency.
7634     (3)  If a center has a change of ownership, the new owner
7635shall apply to the agency for a new license at least 60 days
7636before the date of the change of ownership.
7637     (4)  If a center has a change of operator, the new operator
7638shall notify the agency in writing within 30 days after the
7639change of operator.
7640     Section 139.  Section 400.56, Florida Statutes, is amended
7641to read:
7642     400.56  Right of entry and inspection.--In accordance with
7643s. 408.811, Any duly designated officer or employee of the
7644agency or department has the right to enter the premises of any
7645adult day care center licensed pursuant to this part, at any
7646reasonable time, in order to determine the state of compliance
7647with this part, part II of chapter 408, and applicable the rules
7648or standards in force pursuant to this part. The right of entry
7649and inspection also extends to any premises that the agency has
7650reason to believe are being operated as a center without a
7651license, but no entry or inspection of any unlicensed premises
7652may be made without the permission of the owner or operator
7653unless a warrant is first obtained from the circuit court
7654authorizing entry or inspection. Any application for a center
7655license or license renewal made pursuant to this part
7656constitutes permission for, and complete acquiescence in, any
7657entry or inspection of the premises for which the license is
7658sought in order to facilitate verification of the information
7659submitted on or in connection with the application.
7660     Section 140.  Section 400.562, Florida Statutes, is amended
7661to read:
7662     400.562  Rules establishing standards.--
7663     (1)  The agency Department of Elderly Affairs, in
7664conjunction with the Department of Elderly Affairs agency, shall
7665adopt rules to implement the provisions of this part and part II
7666of chapter 408. The rules must include reasonable and fair
7667standards. Any conflict between these standards and those that
7668may be set forth in local, county, or municipal ordinances shall
7669be resolved in favor of those having statewide effect. Such
7670standards must relate to:
7671     (a)  The maintenance of adult day care centers with respect
7672to plumbing, heating, lighting, ventilation, and other building
7673conditions, including adequate meeting space, to ensure the
7674health, safety, and comfort of participants and protection from
7675fire hazard. Such standards may not conflict with chapter 553
7676and must be based upon the size of the structure and the number
7677of participants.
7678     (b)  The number and qualifications of all personnel
7679employed by adult day care centers who have responsibilities for
7680the care of participants.
7681     (c)  All sanitary conditions within adult day care centers
7682and their surroundings, including water supply, sewage disposal,
7683food handling, and general hygiene, and maintenance of sanitary
7684conditions, to ensure the health and comfort of participants.
7685     (d)  Basic services provided by adult day care centers.
7686     (e)  Supportive and optional services provided by adult day
7687care centers.
7688     (f)  Data and information relative to participants and
7689programs of adult day care centers, including, but not limited
7690to, the physical and mental capabilities and needs of the
7691participants, the availability, frequency, and intensity of
7692basic services and of supportive and optional services provided,
7693the frequency of participation, the distances traveled by
7694participants, the hours of operation, the number of referrals to
7695other centers or elsewhere, and the incidence of illness.
7696     (g)  Components of a comprehensive emergency management
7697plan, developed in consultation with the Department of Health,
7698the Department of Elderly Affairs Agency for Health Care
7699Administration, and the Department of Community Affairs.
7700     (2)  Pursuant to s. 119.07, the agency may charge a fee for
7701furnishing a copy of this part, or of the rules adopted under
7702this part, to any person upon request for the copy.
7703     (2)(3)  Pursuant to this part, s. 408.811, and applicable
7704rules adopted by the department, the agency may conduct an
7705abbreviated biennial inspection of key quality-of-care
7706standards, in lieu of a full inspection, of a center that has a
7707record of good performance. However, the agency must conduct a
7708full inspection of a center that has had one or more confirmed
7709complaints within the licensure period immediately preceding the
7710inspection or which has a serious problem identified during the
7711abbreviated inspection. The agency shall by rule develop the key
7712quality-of-care standards, taking into consideration the
7713comments and recommendations of the Department of Elderly
7714Affairs and of provider groups. These standards shall be
7715included in rules adopted by the Department of Elderly Affairs.
7716     Section 141.  Section 400.564, Florida Statutes, is
7717repealed.
7718     Section 142.  Section 400.602, Florida Statutes, is amended
7719to read:
7720     400.602  Licensure required; prohibited acts; exemptions;
7721display, transferability of license.--
7722     (1)(a)  The requirements of part II of chapter 408 shall
7723apply to the provision of services that require licensure
7724pursuant to this part and part II of chapter 408 and to entities
7725licensed by or applying for such licensure from the agency
7726pursuant to this part. It is unlawful to operate or maintain a
7727hospice without first obtaining a license from the agency.
7728     (b)  It is unlawful for Any person or legal entity not
7729licensed as a hospice under this part may not to use the word
7730"hospice" in its name, or to offer or advertise hospice services
7731or hospice-like services in such a way as to mislead a person to
7732believe that the offeror is a hospice licensed under this part.
7733     (2)  Services provided by a hospital, nursing home, or
7734other health care facility, health care provider, or caregiver,
7735or under the Community Care for the Elderly Act, do not
7736constitute a hospice unless the facility, provider, or caregiver
7737establishes a separate and distinct administrative program to
7738provide home, residential, and homelike inpatient hospice
7739services.
7740     (3)(a)  A separately licensed hospice may not use a name
7741which is substantially the same as the name of another hospice
7742licensed under this part.
7743     (b)  A licensed hospice which intends to change its name or
7744address must notify the agency at least 60 days before making
7745the change.
7746     (4)  The license shall be displayed in a conspicuous place
7747inside the hospice program office; shall be valid only in the
7748possession of the person or public agency to which it is issued;
7749shall not be subject to sale, assignment, or other transfer,
7750voluntary or involuntary; and shall not be valid for any hospice
7751other than the hospice for which originally issued.
7752     (4)(5)  Notwithstanding s. 400.601(3), any hospice
7753operating in corporate form exclusively as a hospice,
7754incorporated on or before July 1, 1978, may be transferred to a
7755for-profit or not-for-profit entity, and may transfer the
7756license to that entity.
7757     (5)(6)  Notwithstanding s. 400.601(3), at any time after
7758July 1, 1995, any entity entitled to licensure under subsection
7759(5) may obtain a license for up to two additional hospices in
7760accordance with the other requirements of this part and upon
7761receipt of any certificate of need that may be required under
7762the provisions of part I of chapter 408 ss. 408.031-408.045.
7763     Section 143.  Section 400.605, Florida Statutes, is amended
7764to read:
7765     400.605  Administration; forms; fees; rules; inspections;
7766fines.--
7767     (1)  The agency department, in consultation with the
7768department agency, shall by rule establish minimum standards and
7769procedures for a hospice pursuant to this part and part II of
7770chapter 408. The rules must include:
7771     (a)  License application procedures and requirements.
7772     (a)(b)  The qualifications of professional and ancillary
7773personnel to ensure the provision of appropriate and adequate
7774hospice care.
7775     (b)(c)  Standards and procedures for the administrative
7776management of a hospice.
7777     (c)(d)  Standards for hospice services that ensure the
7778provision of quality patient care.
7779     (d)(e)  Components of a patient plan of care.
7780     (e)(f)  Procedures relating to the implementation of
7781advanced directives and do-not-resuscitate orders.
7782     (f)(g)  Procedures for maintaining and ensuring
7783confidentiality of patient records.
7784     (g)(h)  Standards for hospice care provided in freestanding
7785inpatient facilities that are not otherwise licensed medical
7786facilities and in residential care facilities such as nursing
7787homes, assisted living facilities, adult family care homes, and
7788hospice residential units and facilities.
7789     (h)(i)  Physical plant standards for hospice residential
7790and inpatient facilities and units.
7791     (i)(j)  Components of a comprehensive emergency management
7792plan, developed in consultation with the Department of Health,
7793the Department of Elderly Affairs, and the Department of
7794Community Affairs.
7795     (j)(k)  Standards and procedures relating to the
7796establishment and activities of a quality assurance and
7797utilization review committee.
7798     (k)(l)  Components and procedures relating to the
7799collection of patient demographic data and other information on
7800the provision of hospice care in this state.
7801     (2)  In accordance with s. 408.805, an applicant or
7802licensee shall pay a fee for each license application submitted
7803under this part, part II of chapter 408, and applicable rules.
7804The amount of the fee shall be established by rule and may not
7805exceed $1,200 per biennium. The agency shall:
7806     (a)  Prepare and furnish all forms necessary under the
7807provisions of this part in relation to applications for
7808licensure or licensure renewals.
7809     (b)  Collect from the applicant at the time of filing an
7810application for a license or at the time of renewal of a license
7811a fee which must be reasonably calculated to cover the cost of
7812regulation under this part, but may not exceed $600 per program.
7813All fees collected under this part shall be deposited in the
7814Health Care Trust Fund for the administration of this part.
7815     (c)  Issue hospice licenses to all applicants which meet
7816the provisions of this part and applicable rules.
7817     (3)(d)  In accordance with s. 408.811, the agency shall
7818conduct annual licensure inspections of all licensees, except
7819that licensure inspections may be conducted biennially for
7820hospices having a 3-year record of substantial compliance. The
7821agency shall
7822     (e)  conduct such inspections and investigations as are
7823necessary in order to determine the state of compliance with the
7824provisions of this part, part II of chapter 408, and applicable
7825adopted rules. The right of inspection also extends to any
7826program that the agency has reason to believe is offering or
7827advertising itself as a hospice without a license, but no
7828inspection may be made without the permission of the owner or
7829person in charge thereof unless a warrant is first obtained from
7830a circuit court authorizing such inspection. An application for
7831a license or license renewal made pursuant to this part
7832constitutes permission for an inspection of the hospice for
7833which the license is sought in order to facilitate verification
7834of the information submitted on or in connection with the
7835application.
7836     (4)(f)  In accordance with part II of chapter 408, the
7837agency may impose an administrative fine for any violation of
7838the provisions of this part, part II of chapter 408, or
7839applicable rules.
7840     Section 144.  Section 400.606, Florida Statutes, is amended
7841to read:
7842     400.606  License; application; renewal; conditional license
7843or permit; certificate of need.--
7844     (1)  A license application must be filed on a form provided
7845by the agency and must be accompanied by the appropriate license
7846fee as well as satisfactory proof that the hospice is in
7847compliance with this part and any rules adopted by the
7848department and proof of financial ability to operate and conduct
7849the hospice in accordance with the requirements of this part.
7850The initial application and change of ownership application must
7851be accompanied by a plan for the delivery of home, residential,
7852and homelike inpatient hospice services to terminally ill
7853persons and their families. Such plan must contain, but need not
7854be limited to:
7855     (a)  The estimated average number of terminally ill persons
7856to be served monthly.
7857     (b)  The geographic area in which hospice services will be
7858available.
7859     (c)  A listing of services which are or will be provided,
7860either directly by the applicant or through contractual
7861arrangements with existing providers.
7862     (d)  Provisions for the implementation of hospice home care
7863within 3 months after licensure.
7864     (e)  Provisions for the implementation of hospice homelike
7865inpatient care within 12 months after licensure.
7866     (f)  The number and disciplines of professional staff to be
7867employed.
7868     (g)  The name and qualifications of any existing or
7869potential contractee.
7870     (h)  A plan for attracting and training volunteers.
7871     (i)  The projected annual operating cost of the hospice.
7872     (j)  A statement of financial resources and personnel
7873available to the applicant to deliver hospice care.
7874
7875If the applicant is an existing licensed health care provider,
7876the application must be accompanied by a copy of the most recent
7877profit-loss statement and, if applicable, the most recent
7878licensure inspection report.
7879     (2)  Each applicant must submit to the agency with its
7880application a description and explanation of any exclusions,
7881permanent suspensions, or terminations from the Medicaid or
7882Medicare programs of the owner, if an individual; of any officer
7883or board member of the hospice, if the owner is a firm,
7884corporation, partnership, or association; or of any person
7885owning 5 percent or more of the hospice. Proof of compliance
7886with disclosure of ownership and control interest requirements
7887of the Medicaid or Medicare programs may be accepted in lieu of
7888this submission.
7889     (2)(3)  A license issued for the operation of a hospice,
7890unless sooner suspended or revoked, shall expire automatically 1
7891year from the date of issuance. Sixty days prior to the
7892expiration date, a hospice wishing to renew its license shall
7893submit an application for renewal to the agency on forms
7894furnished by the agency. The agency shall renew the license if
7895the applicant has first met the requirements established under
7896this part and all applicable rules and has provided the
7897information described under this section in addition to the
7898application. However, The application for license renewal shall
7899be accompanied by an update of the plan for delivery of hospice
7900care only if information contained in the plan submitted
7901pursuant to subsection (1) is no longer applicable.
7902     (4)  A hospice against which a revocation or suspension
7903proceeding is pending at the time of license renewal may be
7904issued a conditional license by the agency effective until final
7905disposition of such proceeding. If judicial relief is sought
7906from the final agency action, the court having jurisdiction may
7907issue a conditional permit for the duration of the judicial
7908proceeding.
7909     (3)(5)  The agency shall not issue a license to a hospice
7910that fails to receive a certificate of need under the provisions
7911of part I of chapter 408 ss. 408.031-408.045. A licensed hospice
7912is a health care facility as that term is used in s. 408.039(5)
7913and is entitled to initiate or intervene in an administrative
7914hearing.
7915     (4)(6)  A freestanding hospice facility that is primarily
7916engaged in providing inpatient and related services and that is
7917not otherwise licensed as a health care facility shall be
7918required to obtain a certificate of need. However, a
7919freestanding hospice facility with six or fewer beds shall not
7920be required to comply with institutional standards such as, but
7921not limited to, standards requiring sprinkler systems, emergency
7922electrical systems, or special lavatory devices.
7923     Section 145.  Section 400.6065, Florida Statutes, is
7924amended to read:
7925     400.6065  Background screening.--
7926     (1)  Upon receipt of a completed application under s.
7927400.606, the agency shall require level 2 background screening
7928on each of the following persons, who shall be considered
7929employees for the purposes of conducting screening under chapter
7930435:
7931     (a)  The hospice administrator and financial officer.
7932     (b)  An officer or board member if the hospice is a firm,
7933corporation, partnership, or association, or any person owning 5
7934percent or more of the hospice if the agency has probable cause
7935to believe that such officer, board member, or owner has been
7936convicted of any offense prohibited by s. 435.04. For each
7937officer, board member, or person owning 5 percent or more who
7938has been convicted of any such offense, the hospice shall submit
7939to the agency a description and explanation of the conviction at
7940the time of license application. This paragraph does not apply
7941to a board member of a not-for-profit corporation or
7942organization if the board member serves solely in a voluntary
7943capacity, does not regularly take part in the day-to-day
7944operational decisions of the corporation or organization,
7945receives no remuneration for his or her services, and has no
7946financial interest and has no family members with a financial
7947interest in the corporation or organization, provided that the
7948board member and the corporation or organization submit a
7949statement affirming that the board member's relationship to the
7950corporation or organization satisfies the requirements of this
7951paragraph.
7952     (2)  Proof of compliance with level 2 screening standards
7953which has been submitted within the previous 5 years to meet any
7954facility or professional licensure requirements of the agency or
7955the Department of Health satisfies the requirements of this
7956section.
7957     (3)  The agency may grant a provisional license to a
7958hospice applying for an initial license when each individual
7959required by this section to undergo screening has completed the
7960Department of Law Enforcement background check, but has not yet
7961received results from the Federal Bureau of Investigation.
7962     (1)(4)  The agency shall require employment or contractor
7963screening as provided in chapter 435, using the level 1
7964standards for screening set forth in that chapter, for hospice
7965personnel.
7966     (2)(5)  The agency may grant exemptions from
7967disqualification from employment under this section as provided
7968in s. 435.07.
7969     (6)  The administration of each hospice must sign an
7970affidavit annually, under penalty of perjury, stating that all
7971personnel employed or contracted with on or after October 1,
79721998, who provide hospice services in a facility, or who enter
7973the home of a patient in their service capacity, have been
7974screened.
7975     (3)(7)  Proof of compliance with the screening requirements
7976of chapter 435 shall be accepted in lieu of the requirements of
7977this section if the person has been continuously employed or
7978registered without a breach in service that exceeds 180 days,
7979the proof of compliance is not more than 2 years old, and the
7980person has been screened, at the discretion of the hospice.
7981     (4)(8)(a)  It is a misdemeanor of the first degree,
7982punishable under s. 775.082 or s. 775.083, for any person
7983willfully, knowingly, or intentionally to:
7984     1.  Fail, by false statement, misrepresentation,
7985impersonation, or other fraudulent means, to disclose in any
7986application for voluntary or paid employment a material fact
7987used in making a determination as to such person's
7988qualifications to be employed or contracted with under this
7989section;
7990     2.  Operate or attempt to operate an entity licensed under
7991this part with persons who do not meet the minimum standards for
7992good moral character as contained in this section; or
7993     2.3.  Use information from the criminal records obtained
7994under this section for any purpose other than screening as
7995specified in this section, or release such information to any
7996other person for any purpose other than screening under this
7997section.
7998     (b)  It is a felony of the third degree, punishable under
7999s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
8000knowingly, or intentionally to use information from the juvenile
8001records of a person obtained under this section for any purpose
8002other than screening for employment under this section.
8003     Section 146.  Section 400.607, Florida Statutes, is amended
8004to read:
8005     400.607  Denial, suspension, or revocation of license;
8006emergency actions; imposition of administrative fine; grounds;
8007injunctions.--
8008     (1)  The agency may deny, revoke, and or suspend a license,
8009impose an action under s. 408.814, and or impose an
8010administrative fine, which may not exceed $5,000 per violation,
8011for the violation of any provision of this part, part II of
8012chapter 408, or applicable rules in the manner provided in
8013chapter 120.
8014     (2)  Any of the following actions by a licensed hospice or
8015any of its employees shall be grounds for action by the agency
8016against a hospice:
8017     (a)  A violation of the provisions of this part or
8018applicable rules.
8019     (b)  An intentional or negligent act materially affecting
8020the health or safety of a patient.
8021     (3)  The agency may deny or revoke a license upon a
8022determination that:
8023     (a)  Persons subject to level 2 background screening under
8024s. 400.6065 do not meet the screening standards of s. 435.04,
8025and exemptions from disqualification have not been provided by
8026the agency.
8027     (b)  An officer, board member, or person owning 5 percent
8028or more of the hospice has been excluded, permanently suspended,
8029or terminated from the Medicare or Medicaid programs.
8030     (3)(4)  If, 3 months after the date of obtaining a license,
8031or at any time thereafter, a hospice does not have in operation
8032the home-care component of hospice care, the agency shall
8033immediately revoke the license of such hospice.
8034     (4)(5)  If, 12 months after the date of obtaining a license
8035pursuant to s. 400.606, or at any time thereafter, a hospice
8036does not have in operation the inpatient components of hospice
8037care, the agency shall immediately revoke the license of such
8038hospice.
8039     (6)  The agency may institute a civil action in a court of
8040competent jurisdiction to seek injunctive relief to enforce
8041compliance with this part or any rule adopted pursuant to this
8042part.
8043     (5)(7)  The remedies set forth in this section are
8044independent of and cumulative to other remedies provided by law.
8045     Section 147.  Subsection (8) of section 400.6095, Florida
8046Statutes, is amended to read:
8047     400.6095  Patient admission; assessment; plan of care;
8048discharge; death.--
8049     (8)  The hospice care team may withhold or withdraw
8050cardiopulmonary resuscitation if presented with an order not to
8051resuscitate executed pursuant to s. 401.45. The agency
8052department shall adopt rules providing for the implementation of
8053such orders. Hospice staff shall not be subject to criminal
8054prosecution or civil liability, nor be considered to have
8055engaged in negligent or unprofessional conduct, for withholding
8056or withdrawing cardiopulmonary resuscitation pursuant to such an
8057order and applicable rules adopted by the department. The
8058absence of an order to resuscitate executed pursuant to s.
8059401.45 does not preclude a physician from withholding or
8060withdrawing cardiopulmonary resuscitation as otherwise permitted
8061by law.
8062     Section 148.  Subsection (5) of section 400.617, Florida
8063Statutes, is amended to read:
8064     400.617  Legislative intent; purpose.--
8065     (5)  Rules of the agency department relating to adult
8066family-care homes shall be as minimal and flexible as possible
8067to ensure the protection of residents while minimizing the
8068obstacles that could inhibit the establishment of adult family-
8069care homes.
8070     Section 149.  Section 400.619, Florida Statutes, is amended
8071to read:
8072     400.619  Licensure application and renewal.--
8073     (1)  The requirements of part II of chapter 408 shall apply
8074to the provision of services that require licensure pursuant to
8075this part and part II of chapter 408 and to entities licensed by
8076or applying for such licensure from the Agency for Health Care
8077Administration pursuant to this part. However, each applicant
8078for licensure and each licensee is exempt from s. 408.810(7)-
8079(10). Each person who intends to be an adult family-care home
8080provider must apply for a license from the agency at least 90
8081days before the applicant intends to operate the adult family-
8082care home.
8083     (2)  A person who intends to be an adult family-care home
8084provider must own or rent the adult family-care home that is to
8085be licensed and reside therein.
8086     (3)  In accordance with s. 408.805, an applicant or
8087licensee shall pay a fee for each license application submitted
8088under this part, part II of chapter 408, and applicable rules.
8089The amount of the fee shall be $200 per biennium. The agency
8090shall notify a licensee at least 120 days before the expiration
8091date that license renewal is required to continue operation. The
8092notification must be provided electronically or by mail
8093delivery. Application for a license or annual license renewal
8094must be made on a form provided by the agency, signed under
8095oath, and must be accompanied by a licensing fee of $100 per
8096year.
8097     (4)  Upon receipt of a completed license application or
8098license renewal, and the fee, the agency shall initiate a level
80991 background screening as provided under chapter 435 on the
8100adult family-care home provider, the designated relief person,
8101all adult household members, and all staff members. The
8102applicant or licensee is responsible for paying the fees
8103associated with obtaining the required screening. The agency
8104shall conduct an onsite visit to the home that is to be
8105licensed.
8106     (a)  Proof of compliance with level 1 screening standards
8107which has been submitted within the previous 5 years to meet any
8108facility or professional licensure requirements of the agency or
8109the Department of Health satisfies the requirements of this
8110subsection. Such proof must be accompanied, under penalty of
8111perjury, by a copy of the person's current professional license
8112and an affidavit of current compliance with the background
8113screening requirements.
8114     (b)  The person required to be screened must have been
8115continuously employed in the same type of occupation for which
8116the person is seeking employment without a breach in service
8117that exceeds 180 days, and proof of compliance with the level 1
8118screening requirement which is no more than 2 years old must be
8119provided. Proof of compliance shall be provided directly from
8120one employer or contractor to another, and not from the person
8121screened. Upon request, a copy of screening results shall be
8122provided to the person screened by the employer retaining
8123documentation of the screening.
8124     (5)  The application must be accompanied by a description
8125and explanation of any exclusions, permanent suspensions, or
8126terminations of the applicant from participation in the Medicaid
8127or Medicare programs or any other governmental health care or
8128health insurance program.
8129     (6)  Unless the adult family-care home is a community
8130residential home subject to chapter 419, the applicant must
8131provide documentation, signed by the appropriate governmental
8132official, that the home has met local zoning requirements for
8133the location for which the license is sought.
8134     (5)(7)  Access to a licensed adult family-care home must be
8135provided at reasonable times for the appropriate officials of
8136the department, the Department of Health, the Department of
8137Children and Family Services, the agency, and the State Fire
8138Marshal, who are responsible for the development and maintenance
8139of fire, health, sanitary, and safety standards, to inspect the
8140facility to assure compliance with these standards. In addition,
8141access to a licensed adult family-care home must be provided at
8142reasonable times for the local long-term care ombudsman council.
8143     (8)  A license is effective for 1 year after the date of
8144issuance unless revoked sooner. Each license must state the name
8145of the provider, the address of the home to which the license
8146applies, and the maximum number of residents of the home.
8147Failure to timely file a license renewal application shall
8148result in a late fee equal to 50 percent of the license fee.
8149     (9)  A license is not transferable or applicable to any
8150location or person other than the location and person indicated
8151on the license.
8152     (6)(10)  The licensed maximum capacity of each adult
8153family-care home is based on the service needs of the residents
8154and the capability of the provider to meet the needs of the
8155residents. Any relative who lives in the adult family-care home
8156and who is a disabled adult or frail elder must be included in
8157that limitation.
8158     (7)(11)  Each adult family-care home must designate at
8159least one licensed space for a resident receiving optional state
8160supplementation. The Department of Children and Family Services
8161shall specify by rule the procedures to be followed for
8162referring residents who receive optional state supplementation
8163to adult family-care homes. Those homes licensed as adult foster
8164homes or assisted living facilities prior to January 1, 1994,
8165that convert to adult family-care homes, are exempt from this
8166requirement.
8167     (8)(12)  The agency may issue a conditional license to a
8168provider for the purpose of bringing the adult family-care home
8169into compliance with licensure requirements. A conditional
8170license must be limited to a specific period, not exceeding 6
8171months. The agency department shall, by rule, establish criteria
8172for issuing conditional licenses.
8173     (13)  All moneys collected under this section must be
8174deposited into the Department of Elderly Affairs Administrative
8175Trust Fund.
8176     (9)(14)  The agency department may adopt rules to establish
8177procedures, identify forms, specify documentation, and clarify
8178terms, as necessary, to administer this section and part II of
8179chapter 408.
8180     Section 150.  Section 400.6194, Florida Statutes, is
8181amended to read:
8182     400.6194  Denial, revocation, or suspension of a
8183license.--In addition to the requirements of part II of chapter
8184408 the agency may deny, suspend, and or revoke a license for
8185any of the following reasons:
8186     (1)  Failure of any of the persons required to undergo
8187background screening under s. 400.619 to meet the level 1
8188screening standards of s. 435.03, unless an exemption from
8189disqualification has been provided by the agency.
8190     (2)  An intentional or negligent act materially affecting
8191the health, safety, or welfare of the adult family-care home
8192residents.
8193     (3)  Submission of fraudulent information or omission of
8194any material fact on a license application or any other document
8195required by the agency.
8196     (4)  Failure to pay an administrative fine assessed under
8197this part.
8198     (5)  A violation of this part or adopted rules which
8199results in conditions or practices that directly threaten the
8200physical or emotional health, safety, or welfare of residents.
8201     (3)(6)  Failure to correct cited fire code violations that
8202threaten the health, safety, or welfare of residents.
8203     (7)  Failure to submit a completed initial license
8204application or to complete an application for license renewal
8205within the specified timeframes.
8206     (8)  Exclusion, permanent suspension, or termination of the
8207provider from the Medicare or Medicaid program.
8208     Section 151.  Section 400.6196, Florida Statutes, is
8209amended to read:
8210     400.6196  Classification of deficiencies; administrative
8211fines Violations; penalties.--
8212     (1)  In accordance with part II of chapter 408 and in
8213addition to any other liability or penalty provided by law, the
8214agency may impose an administrative fine a civil penalty on a
8215provider according to the following classification for the
8216violation of any provision of this part, part II of chapter 408,
8217or applicable rules:
8218     (a)  Class I violations are those conditions or practices
8219related to the operation and maintenance of an adult family-care
8220home or to the care of residents which the agency determines
8221present an imminent danger to the residents or guests of the
8222facility or a substantial probability that death or serious
8223physical or emotional harm would result therefrom. The condition
8224or practice that constitutes a class I violation must be abated
8225or eliminated within 24 hours, unless a fixed period, as
8226determined by the agency, is required for correction. A class I
8227deficiency is subject to an administrative fine in an amount not
8228less than $500 and not exceeding $1,000 for each violation. A
8229fine may be levied notwithstanding the correction of the
8230deficiency.
8231     (b)  Class II violations are those conditions or practices
8232related to the operation and maintenance of an adult family-care
8233home or to the care of residents which the agency determines
8234directly threaten the physical or emotional health, safety, or
8235security of the residents, other than class I violations. A
8236class II violation is subject to an administrative fine in an
8237amount not less than $250 and not exceeding $500 for each
8238violation. A citation for a class II violation must specify the
8239time within which the violation is required to be corrected. If
8240a class II violation is corrected within the time specified, no
8241civil penalty shall be imposed, unless it is a repeated offense.
8242     (c)  Class III violations are those conditions or practices
8243related to the operation and maintenance of an adult family-care
8244home or to the care of residents which the agency determines
8245indirectly or potentially threaten the physical or emotional
8246health, safety, or security of residents, other than class I or
8247class II violations. A class III violation is subject to an
8248administrative fine in an amount not less than $100 and not
8249exceeding $250 for each violation. A citation for a class III
8250violation shall specify the time within which the violation is
8251required to be corrected. If a class III violation is corrected
8252within the time specified, no civil penalty shall be imposed,
8253unless it is a repeated offense.
8254     (d)  Class IV violations are those conditions or
8255occurrences related to the operation and maintenance of an adult
8256family-care home, or related to the required reports, forms, or
8257documents, which do not have the potential of negatively
8258affecting the residents. A provider that does not correct a
8259class IV violation within the time limit specified by the agency
8260is subject to an administrative fine in an amount not less than
8261$50 and not exceeding $100 for each violation. Any class IV
8262violation that is corrected during the time the agency survey is
8263conducted will be identified as an agency finding and not as a
8264violation.
8265     (2)  The agency may impose an administrative fine for
8266violations which do not qualify as class I, class II, class III,
8267or class IV violations. The amount of the fine shall not exceed
8268$250 for each violation or $2,000 in the aggregate. Unclassified
8269violations include:
8270     (a)  Violating any term or condition of a license.
8271     (b)  Violating any provision of rule adopted under this
8272part, part II of chapter 408, or applicable rules.
8273     (c)  Failure to follow the criteria and procedures provided
8274under part I of chapter 394 relating to the transportation,
8275voluntary admission, and involuntary examination of adult
8276family-care home residents.
8277     (d)  Exceeding licensed capacity.
8278     (e)  Providing services beyond the scope of the license.
8279     (f)  Violating a moratorium.
8280     (3)  Each day during which a violation occurs constitutes a
8281separate offense.
8282     (3)(4)  In determining whether a penalty is to be imposed,
8283and in fixing the amount of any penalty to be imposed, the
8284agency must consider:
8285     (a)  The gravity of the violation.
8286     (b)  Actions taken by the provider to correct a violation.
8287     (c)  Any previous violation by the provider.
8288     (d)  The financial benefit to the provider of committing or
8289continuing the violation.
8290     (4)(5)  As an alternative to or in conjunction with an
8291administrative action against a provider, the agency may request
8292a plan of corrective action that demonstrates a good faith
8293effort to remedy each violation by a specific date, subject to
8294the approval of the agency.
8295     (5)(6)  The agency department shall set forth, by rule,
8296notice requirements and procedures for correction of
8297deficiencies.
8298     (7)  Civil penalties paid by a provider must be deposited
8299into the Department of Elderly Affairs Administrative Trust Fund
8300and used to offset the expenses of departmental training and
8301education for adult family-care home providers.
8302     (8)  The agency may impose an immediate moratorium on
8303admissions to any adult family-care home if the agency finds
8304that a condition in the home presents a threat to the health,
8305safety, or welfare of its residents. The department may by rule
8306establish facility conditions that constitute grounds for
8307imposing a moratorium and establish procedures for imposing and
8308lifting a moratorium.
8309     Section 152.  Section 400.621, Florida Statutes, is amended
8310to read:
8311     400.621  Rules and standards relating to adult family-care
8312homes.--
8313     (1)  The agency department, in consultation with the
8314Department of Health, the Department of Children and Family
8315Services, and the department agency shall, by rule, establish
8316minimum standards to ensure the health, safety, and well-being
8317of each resident in the adult family-care home pursuant to this
8318part and part II of chapter 408. The rules must address:
8319     (a)  Requirements for the physical site of the facility and
8320facility maintenance.
8321     (b)  Services that must be provided to all residents of an
8322adult family-care home and standards for such services, which
8323must include, but need not be limited to:
8324     1.  Room and board.
8325     2.  Assistance necessary to perform the activities of daily
8326living.
8327     3.  Assistance necessary to administer medication.
8328     4.  Supervision of residents.
8329     5.  Health monitoring.
8330     6.  Social and leisure activities.
8331     (c)  Standards and procedures for license application and
8332annual license renewal, advertising, proper management of each
8333resident's funds and personal property and personal affairs,
8334financial ability to operate, medication management,
8335inspections, complaint investigations, and facility, staff, and
8336resident records.
8337     (d)  Qualifications, training, standards, and
8338responsibilities for providers and staff.
8339     (e)  Compliance with chapter 419, relating to community
8340residential homes.
8341     (f)  Criteria and procedures for determining the
8342appropriateness of a resident's placement and continued
8343residency in an adult family-care home. A resident who requires
834424-hour nursing supervision may not be retained in an adult
8345family-care home unless such resident is an enrolled hospice
8346patient and the resident's continued residency is mutually
8347agreeable to the resident and the provider.
8348     (g)  Procedures for providing notice and assuring the least
8349possible disruption of residents' lives when residents are
8350relocated, an adult family-care home is closed, or the ownership
8351of an adult family-care home is transferred.
8352     (h)  Procedures to protect the residents' rights as
8353provided in s. 400.628.
8354     (i)  Procedures to promote the growth of adult family-care
8355homes as a component of a long-term care system.
8356     (j)  Procedures to promote the goal of aging in place for
8357residents of adult family-care homes.
8358     (2)  The agency department shall by rule provide minimum
8359standards and procedures for emergencies. Pursuant to s.
8360633.022, the State Fire Marshal, in consultation with the
8361department and the agency, shall adopt uniform firesafety
8362standards for adult family-care homes.
8363     (3)  The agency department shall adopt rules providing for
8364the implementation of orders not to resuscitate. The provider
8365may withhold or withdraw cardiopulmonary resuscitation if
8366presented with an order not to resuscitate executed pursuant to
8367s. 401.45. The provider shall not be subject to criminal
8368prosecution or civil liability, nor be considered to have
8369engaged in negligent or unprofessional conduct, for withholding
8370or withdrawing cardiopulmonary resuscitation pursuant to such an
8371order and applicable rules adopted by the department.
8372     (4)  The provider of any adult family-care home that is in
8373operation at the time any rules are adopted or amended under
8374this part may be given a reasonable time, not exceeding 6
8375months, within which to comply with the new or revised rules and
8376standards.
8377     Section 153.  Subsection (3) of section 400.6211, Florida
8378Statutes, is amended to read:
8379     400.6211  Training and education programs.--
8380     (3)  Effective January 1, 2004, providers must complete the
8381training and education program within a reasonable time
8382determined by the agency department. Failure to complete the
8383training and education program within the time set by the agency
8384department is a violation of this part and subjects the provider
8385to revocation of the license.
8386     Section 154.  Section 400.622, Florida Statutes, is
8387repealed.
8388     Section 155.  Subsection (2) of section 400.625, Florida
8389Statutes, is amended to read:
8390     400.625  Residency agreements.--
8391     (2)  Each residency agreement must specify the personal
8392care and accommodations to be provided by the adult family-care
8393home, the rates or charges, a requirement of at least 30 days'
8394notice before a rate increase, and any other provisions required
8395by rule of the agency department.
8396     Section 156.  Section 400.801, Florida Statutes, is amended
8397to read:
8398     400.801  Homes for special services.--
8399     (1)  As used in this section, the term:
8400     (a)  "Agency" means the "Agency for Health Care
8401Administration."
8402     (b)  "Home for special services" means a site where
8403specialized health care services are provided, including
8404personal and custodial care, but not continuous nursing
8405services.
8406     (2)  The requirements of part II of chapter 408 shall apply
8407to the provision of services that require licensure pursuant to
8408this section and part II of chapter 408 and entities licensed by
8409or applying for such licensure from the agency pursuant to this
8410section. However, each applicant for licensure and each licensee
8411is exempt from the provisions of s. 408.810(7)-(10). A person
8412must obtain a license from the agency to operate a home for
8413special services. A license is valid for 1 year.
8414     (3)  In accordance with s. 408.805, an applicant or
8415licensee shall pay a fee for each license application submitted
8416under this part, part II of chapter 408, and applicable rules.
8417The amount of the fee shall be established by rule and shall not
8418be more than $2,000 per biennium. The application for a license
8419under this section must be made on a form provided by the
8420agency. A nonrefundable license fee of not more than $1,000 must
8421be submitted with the license application.
8422     (4)  Each applicant for licensure must comply with the
8423following requirements:
8424     (a)  Upon receipt of a completed, signed, and dated
8425application, the agency shall require background screening, in
8426accordance with the level 2 standards for screening set forth in
8427chapter 435, of the managing employee, or other similarly titled
8428individual who is responsible for the daily operation of the
8429facility, and of the financial officer, or other similarly
8430titled individual who is responsible for the financial operation
8431of the facility, including billings for client care and
8432services, in accordance with the level 2 standards for screening
8433set forth in chapter 435. The applicant must comply with the
8434procedures for level 2 background screening as set forth in
8435chapter 435.
8436     (b)  The agency may require background screening of any
8437other individual who is an applicant if the agency has probable
8438cause to believe that he or she has been convicted of a crime or
8439has committed any other offense prohibited under the level 2
8440standards for screening set forth in chapter 435.
8441     (c)  Proof of compliance with the level 2 background
8442screening requirements of chapter 435 which has been submitted
8443within the previous 5 years in compliance with any other health
8444care or assisted living licensure requirements of this state is
8445acceptable in fulfillment of the requirements of paragraph (a).
8446     (d)  A provisional license may be granted to an applicant
8447when each individual required by this section to undergo
8448background screening has met the standards for the Department of
8449Law Enforcement background check, but the agency has not yet
8450received background screening results from the Federal Bureau of
8451Investigation, or a request for a disqualification exemption has
8452been submitted to the agency as set forth in chapter 435, but a
8453response has not yet been issued. A standard license may be
8454granted to the applicant upon the agency's receipt of a report
8455of the results of the Federal Bureau of Investigation background
8456screening for each individual required by this section to
8457undergo background screening which confirms that all standards
8458have been met, or upon the granting of a disqualification
8459exemption by the agency as set forth in chapter 435. Any other
8460person who is required to undergo level 2 background screening
8461may serve in his or her capacity pending the agency's receipt of
8462the report from the Federal Bureau of Investigation. However,
8463the person may not continue to serve if the report indicates any
8464violation of background screening standards and a
8465disqualification exemption has not been requested of and granted
8466by the agency as set forth in chapter 435.
8467     (e)  Each applicant must submit to the agency, with its
8468application, a description and explanation of any exclusions,
8469permanent suspensions, or terminations of the applicant from the
8470Medicare or Medicaid programs. Proof of compliance with the
8471requirements for disclosure of ownership and control interests
8472under the Medicaid or Medicare programs may be accepted in lieu
8473of this submission.
8474     (f)  Each applicant must submit to the agency a description
8475and explanation of any conviction of an offense prohibited under
8476the level 2 standards of chapter 435 by a member of the board of
8477directors of the applicant, its officers, or any individual
8478owning 5 percent or more of the applicant. This requirement does
8479not apply to a director of a not-for-profit corporation or
8480organization if the director serves solely in a voluntary
8481capacity for the corporation or organization, does not regularly
8482take part in the day-to-day operational decisions of the
8483corporation or organization, receives no remuneration for his or
8484her services on the corporation or organization's board of
8485directors, and has no financial interest and has no family
8486members with a financial interest in the corporation or
8487organization, provided that the director and the not-for-profit
8488corporation or organization include in the application a
8489statement affirming that the director's relationship to the
8490corporation satisfies the requirements of this paragraph.
8491     (g)  A license may not be granted to an applicant if the
8492applicant or managing employee has been found guilty of,
8493regardless of adjudication, or has entered a plea of nolo
8494contendere or guilty to, any offense prohibited under the level
84952 standards for screening set forth in chapter 435, unless an
8496exemption from disqualification has been granted by the agency
8497as set forth in chapter 435.
8498     (h)  The agency may deny or revoke licensure if the
8499applicant:
8500     1.  Has falsely represented a material fact in the
8501application required by paragraph (e) or paragraph (f), or has
8502omitted any material fact from the application required by
8503paragraph (e) or paragraph (f); or
8504     2.  Has had prior action taken against the applicant under
8505the Medicaid or Medicare program as set forth in paragraph (e).
8506     (i)  An application for license renewal must contain the
8507information required under paragraphs (e) and (f).
8508     (5)  Application for license renewal must be submitted 90
8509days before the expiration of the license.
8510     (6)  A change of ownership or control of a home for special
8511services must be reported to the agency in writing at least 60
8512days before the change is scheduled to take effect.
8513     (4)(7)  The agency may shall adopt rules for implementing
8514and enforcing this section and part II of chapter 408.
8515     (8)(a)  It is unlawful for any person to establish,
8516conduct, manage, or operate a home for special services without
8517obtaining a license from the agency.
8518     (b)  It is unlawful for any person to offer or advertise to
8519the public, in any medium whatever, specialized health care
8520services without obtaining a license from the agency.
8521     (c)  It is unlawful for a holder of a license issued under
8522this section to advertise or represent to the public that it
8523holds a license for a type of facility other than the facility
8524for which its license is issued.
8525     (5)(9)(a)  In accordance with part II of chapter 408, a
8526violation of any provision of this section, part II of chapter
8527408, or applicable rules adopted by the agency for implementing
8528this section is punishable by payment of an administrative fine
8529not to exceed $5,000.
8530     (b)  A violation of subsection (8) or rules adopted under
8531that subsection is a misdemeanor of the first degree, punishable
8532as provided in s. 775.082 or s. 775.083. Each day of continuing
8533violation is a separate offense.
8534     Section 157.  Section 400.805, Florida Statutes, is amended
8535to read:
8536     400.805  Transitional living facilities.--
8537     (1)  As used in this section, the term:
8538     (a)  "Agency" means the Agency for Health Care
8539Administration.
8540     (b)  "Department" means the Department of Health.
8541     (c)  "Transitional living facility" means a site where
8542specialized health care services are provided, including, but
8543not limited to, rehabilitative services, community reentry
8544training, aids for independent living, and counseling to spinal-
8545cord-injured persons and head-injured persons. This term does
8546not include a hospital licensed under chapter 395 or any
8547federally operated hospital or facility.
8548     (2)(a)  The requirements of part II of chapter 408 shall
8549apply to the provision of services that require licensure
8550pursuant to this section and part II of chapter 408 and to
8551entities licensed by or applying for such licensure from the
8552agency pursuant to this section. However, each applicant for
8553licensure and each licensee is exempt from the provisions of s.
8554408.810(7)-(10). A person must obtain a license from the agency
8555to operate a transitional living facility. A license issued
8556under this section is valid for 1 year.
8557     (b)  In accordance with this section, an applicant or a
8558licensee shall pay a fee for each license application submitted
8559under this part, part II of chapter 408, and applicable rules.
8560The fee shall consist of a $4,000 license fee and a $78.50 per
8561bed fee per biennium, unless modified by rule. The application
8562for a license must be made on a form provided by the agency. A
8563nonrefundable license fee of $2,000 and a fee of up to $39.25
8564per bed must be submitted with the license application.
8565     (c)  The agency may not issue a license to an applicant
8566until the agency receives notice from the department as provided
8567in paragraph (3)(6)(b).
8568     (3)  Each applicant for licensure must comply with the
8569following requirements:
8570     (a)  Upon receipt of a completed, signed, and dated
8571application, the agency shall require background screening, in
8572accordance with the level 2 standards for screening set forth in
8573chapter 435, of the managing employee, or other similarly titled
8574individual who is responsible for the daily operation of the
8575facility, and of the financial officer, or other similarly
8576titled individual who is responsible for the financial operation
8577of the facility, including billings for client care and
8578services. The applicant must comply with the procedures for
8579level 2 background screening as set forth in chapter 435.
8580     (b)  The agency may require background screening of any
8581other individual who is an applicant if the agency has probable
8582cause to believe that he or she has been convicted of a crime or
8583has committed any other offense prohibited under the level 2
8584standards for screening set forth in chapter 435.
8585     (c)  Proof of compliance with the level 2 background
8586screening requirements of chapter 435 which has been submitted
8587within the previous 5 years in compliance with any other health
8588care or assisted living licensure requirements of this state is
8589acceptable in fulfillment of the requirements of paragraph (a).
8590     (d)  A provisional license may be granted to an applicant
8591when each individual required by this section to undergo
8592background screening has met the standards for the Department of
8593Law Enforcement background check, but the agency has not yet
8594received background screening results from the Federal Bureau of
8595Investigation, or a request for a disqualification exemption has
8596been submitted to the agency as set forth in chapter 435, but a
8597response has not yet been issued. A standard license may be
8598granted to the applicant upon the agency's receipt of a report
8599of the results of the Federal Bureau of Investigation background
8600screening for each individual required by this section to
8601undergo background screening which confirms that all standards
8602have been met, or upon the granting of a disqualification
8603exemption by the agency as set forth in chapter 435. Any other
8604person who is required to undergo level 2 background screening
8605may serve in his or her capacity pending the agency's receipt of
8606the report from the Federal Bureau of Investigation. However,
8607the person may not continue to serve if the report indicates any
8608violation of background screening standards and a
8609disqualification exemption has not been requested of and granted
8610by the agency as set forth in chapter 435.
8611     (e)  Each applicant must submit to the agency, with its
8612application, a description and explanation of any exclusions,
8613permanent suspensions, or terminations of the applicant from the
8614Medicare or Medicaid programs. Proof of compliance with the
8615requirements for disclosure of ownership and control interests
8616under the Medicaid or Medicare programs may be accepted in lieu
8617of this submission.
8618     (f)  Each applicant must submit to the agency a description
8619and explanation of any conviction of an offense prohibited under
8620the level 2 standards of chapter 435 by a member of the board of
8621directors of the applicant, its officers, or any individual
8622owning 5 percent or more of the applicant. This requirement does
8623not apply to a director of a not-for-profit corporation or
8624organization if the director serves solely in a voluntary
8625capacity for the corporation or organization, does not regularly
8626take part in the day-to-day operational decisions of the
8627corporation or organization, receives no remuneration for his or
8628her services on the corporation or organization's board of
8629directors, and has no financial interest and has no family
8630members with a financial interest in the corporation or
8631organization, provided that the director and the not-for-profit
8632corporation or organization include in the application a
8633statement affirming that the director's relationship to the
8634corporation satisfies the requirements of this paragraph.
8635     (g)  A license may not be granted to an applicant if the
8636applicant or managing employee has been found guilty of,
8637regardless of adjudication, or has entered a plea of nolo
8638contendere or guilty to, any offense prohibited under the level
86392 standards for screening set forth in chapter 435, unless an
8640exemption from disqualification has been granted by the agency
8641as set forth in chapter 435.
8642     (h)  The agency may deny or revoke licensure if the
8643applicant:
8644     1.  Has falsely represented a material fact in the
8645application required by paragraph (e) or paragraph (f), or has
8646omitted any material fact from the application required by
8647paragraph (e) or paragraph (f); or
8648     2.  Has had prior action taken against the applicant under
8649the Medicaid or Medicare program as set forth in paragraph (e).
8650     (i)  An application for license renewal must contain the
8651information required under paragraphs (e) and (f).
8652     (4)  An application for renewal of license must be
8653submitted 90 days before the expiration of the license. Upon
8654renewal of licensure, each applicant must submit to the agency,
8655under penalty of perjury, an affidavit as set forth in paragraph
8656(3)(d).
8657     (5)  A change of ownership or control of a transitional
8658living facility must be reported to the agency in writing at
8659least 60 days before the change is scheduled to take effect.
8660     (3)(6)(a)  The agency shall adopt rules in consultation
8661with the department governing the physical plant of transitional
8662living facilities and the fiscal management of transitional
8663living facilities.
8664     (b)  The department shall adopt rules in consultation with
8665the agency governing the services provided to clients of
8666transitional living facilities. The department shall enforce all
8667requirements for providing services to the facility's clients.
8668The department must notify the agency when it determines that an
8669applicant for licensure meets the service requirements adopted
8670by the department.
8671     (c)  The agency and the department shall enforce
8672requirements under this section, as such requirements relate to
8673them respectively, and their respective adopted rules.
8674     (7)(a)  It is unlawful for any person to establish,
8675conduct, manage, or operate a transitional living facility
8676without obtaining a license from the agency.
8677     (b)  It is unlawful for any person to offer or advertise to
8678the public, in any medium whatever, services or care defined in
8679paragraph (1)(c) without obtaining a license from the agency.
8680     (c)  It is unlawful for a holder of a license issued under
8681this section to advertise or represent to the public that it
8682holds a license for a type of facility other than the facility
8683for which its license is issued.
8684     (4)(8)  Any designated officer or employee of the agency,
8685of the state, or of the local fire marshal may enter unannounced
8686upon and into the premises of any facility licensed under this
8687section in order to determine the state of compliance with this
8688section and the rules or standards in force under this section.
8689The right of entry and inspection also extends to any premises
8690that the agency has reason to believe are being operated or
8691maintained as a facility without a license; but such an entry or
8692inspection may not be made without the permission of the owner
8693or person in charge of the facility unless a warrant that
8694authorizes the entry is first obtained from the circuit court.
8695The warrant requirement extends only to a facility that the
8696agency has reason to believe is being operated or maintained as
8697a facility without a license. An application for a license or
8698renewal thereof which is made under this section constitutes
8699permission for, and acquiescence in, any entry or inspection of
8700the premises for which the license is sought, in order to
8701facilitate verification of the information submitted on or in
8702connection with the application; to discover, investigate, and
8703determine the existence of abuse or neglect; or to elicit,
8704receive, respond to, and resolve complaints. A current valid
8705license constitutes unconditional permission for, and
8706acquiescence in, any entry or inspection of the premises by
8707authorized personnel. The agency retains the right of entry and
8708inspection of facilities that have had a license revoked or
8709suspended within the previous 24 months, to ensure that the
8710facility is not operating unlawfully. However, before the
8711facility is entered, a statement of probable cause must be filed
8712with the director of the agency, who must approve or disapprove
8713the action within 48 hours. Probable cause includes, but is not
8714limited to, evidence that the facility holds itself out to the
8715public as a provider of personal assistance services, or the
8716receipt by the advisory council on brain and spinal cord
8717injuries of a complaint about the facility.
8718     (5)(9)  The agency may institute injunctive proceedings in
8719a court of competent jurisdiction for temporary or permanent
8720relief to:
8721     (a)  Enforce this section or any minimum standard, rule, or
8722order issued pursuant thereto if the agency's effort to correct
8723a violation through administrative fines has failed or when the
8724violation materially affects the health, safety, or welfare of
8725residents; or
8726     (b)  Terminate the operation of a facility if a violation
8727of this section or of any standard or rule adopted pursuant
8728thereto exists which materially affects the health, safety, or
8729welfare of residents.
8730
8731The Legislature recognizes that, in some instances, action is
8732necessary to protect residents of facilities from immediately
8733life-threatening situations. If it appears by competent evidence
8734or a sworn, substantiated affidavit that a temporary injunction
8735should issue, the court, pending the determination on final
8736hearing, shall enjoin operation of the facility.
8737     (10)  The agency may impose an immediate moratorium on
8738admissions to a facility when the agency determines that any
8739condition in the facility presents a threat to the health,
8740safety, or welfare of the residents in the facility. If a
8741facility's license is denied, revoked, or suspended, the
8742facility may be subject to the immediate imposition of a
8743moratorium on admissions to run concurrently with licensure
8744denial, revocation, or suspension.
8745     (6)(11)(a)  In accordance with part II of chapter 408, a
8746violation of any provision of this section, part II of chapter
8747408, or applicable rules adopted by the agency or department
8748under this section is punishable by payment of an administrative
8749or a civil penalty fine not to exceed $5,000.
8750     (b)  A violation of subsection (7) or rules adopted under
8751that subsection is a misdemeanor of the first degree, punishable
8752as provided in s. 775.082 or s. 775.083. Each day of a
8753continuing violation is a separate offense.
8754     Section 158.  Subsection (4) of section 400.902, Florida
8755Statutes, is amended to read:
8756     400.902  Definitions.--As used in this part, the term:
8757     (4)  "Owner or operator" means a licensee any individual
8758who has general administrative charge of a PPEC center.
8759     Section 159.  Subsection (3) is added to section 400.903,
8760Florida Statutes, to read:
8761     400.903  PPEC centers to be licensed; exemptions.--
8762     (3)  The requirements of part II of chapter 408 shall apply
8763to the provision of services that require licensure pursuant to
8764this part and part II of chapter 408 and to entities licensed by
8765or applying for such licensure from the agency pursuant to this
8766part. However, each applicant for licensure and each licensee is
8767exempt from the provisions of s. 408.810(10).
8768     Section 160.  Section 400.905, Florida Statutes, is amended
8769to read:
8770     400.905  License required; fee; exemption; display.--
8771     (1)(a)  It is unlawful to operate or maintain a PPEC center
8772without first obtaining from the agency a license authorizing
8773such operation. The agency is responsible for licensing PPEC
8774centers in accordance with the provisions of this part.
8775     (b)  Any person who violates paragraph (a) is guilty of a
8776felony of the third degree, punishable as provided in s.
8777775.082, s. 775.083, or s. 775.084.
8778     (1)(2)  Separate licenses are required for PPEC centers
8779maintained on separate premises, even though they are operated
8780under the same management. Separate licenses are not required
8781for separate buildings on the same grounds.
8782     (2)(3)  In accordance with s. 408.805, an applicant or
8783licensee shall pay a fee for each license application submitted
8784under this part, part II of chapter 408, and applicable rules.
8785The amount of the fee shall be established by rule and shall not
8786be less than $1,000 or more than $3,000 per biennium. The annual
8787license fee required of a PPEC center shall be in an amount
8788determined by the agency to be sufficient to cover the agency's
8789costs in carrying out its responsibilities under this part, but
8790shall not be less than $500 or more than $1,500.
8791     (3)(4)  County-operated or municipally operated PPEC
8792centers applying for licensure under this part are exempt from
8793the payment of license fees.
8794     (5)  The license shall be displayed in a conspicuous place
8795inside the PPEC center.
8796     (6)  A license shall be valid only in the possession of the
8797individual, firm, partnership, association, or corporation to
8798whom it is issued and shall not be subject to sale, assignment,
8799or other transfer, voluntary or involuntary; nor shall a license
8800be valid for any premises other than that for which originally
8801issued.
8802     (7)  Any license granted by the agency shall state the
8803maximum capacity of the facility, the date the license was
8804issued, the expiration date of the license, and any other
8805information deemed necessary by the agency.
8806     Section 161.  Section 400.906, Florida Statutes, is
8807repealed.
8808     Section 162.  Section 400.907, Florida Statutes, is amended
8809to read:
8810     400.907  Denial, suspension, revocation of licensure;
8811administrative fines; grounds.--
8812     (1)  In accordance with part II of chapter 408, the agency
8813may deny, revoke, and or suspend a license and or impose an
8814administrative fine for the violation of any provision of this
8815part, part II of chapter 408, or applicable rules in the manner
8816provided in chapter 120.
8817     (2)  Any of the following actions by a PPEC center or its
8818employee is grounds for action by the agency against a PPEC
8819center or its employee:
8820     (a)  An intentional or negligent act materially affecting
8821the health or safety of children in the PPEC center.
8822     (b)  A violation of the provisions of this part, part II of
8823chapter 408, or applicable rules or of any standards or rules
8824adopted pursuant to this part.
8825     (c)  Multiple and repeated violations of this part or of
8826minimum standards or rules adopted pursuant to this part.
8827     (3)  The agency shall be responsible for all investigations
8828and inspections conducted pursuant to this part.
8829     Section 163.  Section 400.908, Florida Statutes, is amended
8830to read:
8831     400.908  Administrative fines; disposition of fees and
8832fines.--
8833     (1)(a)  If the agency determines that a PPEC center is
8834being operated without a license or is otherwise not in
8835compliance with rules adopted under this part, part II of
8836chapter 408, or applicable rules, the agency, notwithstanding
8837any other administrative action it takes, shall make a
8838reasonable attempt to discuss each violation and recommended
8839corrective action with the owner of the PPEC center prior to
8840written notification thereof. The agency may request that the
8841PPEC center submit a corrective action plan which demonstrates a
8842good faith effort to remedy each violation by a specific date,
8843subject to the approval of the agency.
8844     (b)  In accordance with part II of chapter 408, the agency
8845may fine a PPEC center or employee found in violation of rules
8846adopted pursuant to this part, part II of chapter 408, or
8847applicable rules, in an amount not to exceed $500 for each
8848violation. Such fine may not exceed $5,000 in the aggregate.
8849     (c)  The failure to correct a violation by the date set by
8850the agency, or the failure to comply with an approved corrective
8851action plan, is a separate violation for each day such failure
8852continues, unless the agency approves an extension to a specific
8853date.
8854     (d)  If a PPEC center desires to appeal any agency action
8855under this section and the fine is upheld, the violator shall
8856pay the fine, plus interest at the legal rate specified in s.
8857687.01, for each day beyond the date set by the agency for
8858payment of the fine.
8859     (2)  In determining if a fine is to be imposed and in
8860fixing the amount of any fine, the agency shall consider the
8861following factors:
8862     (a)  The gravity of the violation, including the
8863probability that death or serious physical or emotional harm to
8864a child will result or has resulted, the severity of the actual
8865or potential harm, and the extent to which the provisions of the
8866applicable statutes or rules were violated.
8867     (b)  Actions taken by the owner or operator to correct
8868violations.
8869     (c)  Any previous violations.
8870     (d)  The financial benefit to the PPEC center of committing
8871or continuing the violation.
8872     (3)  Fees and fines received by the agency under this part
8873shall be deposited in the Health Care Trust Fund created in s.
8874408.16.
8875     Section 164.  Section 400.910, Florida Statutes, is
8876repealed.
8877     Section 165.  Section 400.911, Florida Statutes, is
8878repealed.
8879     Section 166.  Section 400.912, Florida Statutes, is amended
8880to read:
8881     400.912  Closing of a PPEC center.--
8882     (1)  Whenever a PPEC center voluntarily discontinues
8883operation, it shall, inform the agency in writing at least 30
8884days before the discontinuance of operation. The PPEC center
8885shall also, at such time, inform each child's legal guardian of
8886the fact and the proposed time of such discontinuance.
8887     (2)  Immediately upon discontinuance of the operation of a
8888PPEC center, the owner or operator shall surrender the license
8889therefor to the agency and the license shall be canceled.
8890     Section 167.  Section 400.913, Florida Statutes, is
8891repealed.
8892     Section 168.  Subsection (1) of section 400.914, Florida
8893Statutes, is amended to read:
8894     400.914  Rules establishing standards.--
8895     (1)  Pursuant to the intention of the Legislature to
8896provide safe and sanitary facilities and healthful programs, the
8897agency in conjunction with the Division of Children's Medical
8898Services Prevention and Intervention of the Department of Health
8899shall adopt and publish rules to implement the provisions of
8900this part and part II of chapter 408, which shall include
8901reasonable and fair standards. Any conflict between these
8902standards and those that may be set forth in local, county, or
8903city ordinances shall be resolved in favor of those having
8904statewide effect. Such standards shall relate to:
8905     (a)  The assurance that PPEC services are family centered
8906and provide individualized medical, developmental, and family
8907training services.
8908     (b)  The maintenance of PPEC centers, not in conflict with
8909the provisions of chapter 553 and based upon the size of the
8910structure and number of children, relating to plumbing, heating,
8911lighting, ventilation, and other building conditions, including
8912adequate space, which will ensure the health, safety, comfort,
8913and protection from fire of the children served.
8914     (c)  The appropriate provisions of the most recent edition
8915of the "Life Safety Code" (NFPA-101) shall be applied.
8916     (d)  The number and qualifications of all personnel who
8917have responsibility for the care of the children served.
8918     (e)  All sanitary conditions within the PPEC center and its
8919surroundings, including water supply, sewage disposal, food
8920handling, and general hygiene, and maintenance thereof, which
8921will ensure the health and comfort of children served.
8922     (f)  Programs and basic services promoting and maintaining
8923the health and development of the children served and meeting
8924the training needs of the children's legal guardians.
8925     (g)  Supportive, contracted, other operational, and
8926transportation services.
8927     (h)  Maintenance of appropriate medical records, data, and
8928information relative to the children and programs. Such records
8929shall be maintained in the facility for inspection by the
8930agency.
8931     Section 169.  Subsection (3) of section 400.915, Florida
8932Statutes, is amended to read:
8933     400.915  Construction and renovation; requirements.--The
8934requirements for the construction or renovation of a PPEC center
8935shall comply with:
8936     (3)  The standards or rules adopted pursuant to this part
8937and part II of chapter 408.
8938     Section 170.  Section 400.916, Florida Statutes, is
8939repealed.
8940     Section 171.  Section 400.917, Florida Statutes, is
8941repealed.
8942     Section 172.  Section 400.925, Florida Statutes, is amended
8943to read:
8944     400.925  Definitions.--As used in this part, the term:
8945     (1)  "Accrediting organizations" means the Joint Commission
8946on Accreditation of Healthcare Organizations or other national
8947accreditation agencies whose standards for accreditation are
8948comparable to those required by this part for licensure.
8949     (2)  "Affiliated person" means any person who directly or
8950indirectly manages, controls, or oversees the operation of a
8951corporation or other business entity that is a licensee,
8952regardless of whether such person is a partner, shareholder,
8953owner, officer, director, agent, or employee of the entity.
8954     (2)(3)  "Agency" means the Agency for Health Care
8955Administration.
8956     (4)  "Applicant" means an individual applicant in the case
8957of a sole proprietorship, or any officer, director, agent,
8958managing employee, general manager, or affiliated person, or any
8959partner or shareholder having an ownership interest equal to 5
8960percent or greater in the corporation, partnership, or other
8961business entity.
8962     (3)(5)  "Consumer" or "patient" means any person who uses
8963home medical equipment in his or her place of residence.
8964     (4)(6)  "Department" means the Department of Children and
8965Family Services.
8966     (5)(7)  "General manager" means the individual who has the
8967general administrative charge of the premises of a licensed home
8968medical equipment provider.
8969     (6)(8)  "Home medical equipment" includes any product as
8970defined by the Federal Drug Administration's Drugs, Devices and
8971Cosmetics Act, any products reimbursed under the Medicare Part B
8972Durable Medical Equipment benefits, or any products reimbursed
8973under the Florida Medicaid durable medical equipment program.
8974Home medical equipment includes oxygen and related respiratory
8975equipment; manual, motorized, or customized wheelchairs and
8976related seating and positioning, but does not include
8977prosthetics or orthotics or any splints, braces, or aids custom
8978fabricated by a licensed health care practitioner; motorized
8979scooters; personal transfer systems; and specialty beds, for use
8980by a person with a medical need.
8981     (7)(9)  "Home medical equipment provider" means any person
8982or entity that sells or rents or offers to sell or rent to or
8983for a consumer:
8984     (a)  Any home medical equipment and services; or
8985     (b)  Home medical equipment that requires any home medical
8986equipment services.
8987     (8)(10)  "Home medical equipment provider personnel" means
8988persons who are employed by or under contract with a home
8989medical equipment provider.
8990     (9)(11)  "Home medical equipment services" means equipment
8991management and consumer instruction, including selection,
8992delivery, setup, and maintenance of equipment, and other related
8993services for the use of home medical equipment in the consumer's
8994regular or temporary place of residence.
8995     (10)(12)  "Licensee" means the person or entity to whom a
8996license to operate as a home medical equipment provider is
8997issued by the agency.
8998     (11)(13)  "Moratorium" has the same meaning as in s.
8999408.803, except that means a mandated temporary cessation or
9000suspension of the sale, rental, or offering of equipment after
9001the imposition of the moratorium. services related to equipment
9002sold or rented prior to the moratorium must be continued without
9003interruption, unless deemed otherwise by the agency.
9004     (12)(14)  "Person" means any individual, firm, partnership,
9005corporation, or association.
9006     (13)(15)  "Premises" means those buildings and equipment
9007which are located at the address of the licensed home medical
9008equipment provider for the provision of home medical equipment
9009services, which are in such reasonable proximity as to appear to
9010the public to be a single provider location, and which comply
9011with zoning ordinances.
9012     (14)(16)  "Residence" means the consumer's home or place of
9013residence, which may include nursing homes, assisted living
9014facilities, transitional living facilities, adult family-care
9015homes, or other congregate residential facilities.
9016     Section 173.  Subsection (3) and paragraphs (b), (d), and
9017(e) of subsection (6) of section 400.93, Florida Statutes, are
9018amended to read:
9019     400.93  Licensure required; exemptions; unlawful acts;
9020penalties.--
9021     (3)  The requirements of part II of chapter 408 shall apply
9022to the provision of services that require licensure pursuant to
9023this part and part II of chapter 408 and to entities licensed by
9024or applying for such licensure from the agency pursuant to this
9025part. However, each applicant for licensure and each licensee is
9026exempt from the provisions of s. 408.810(10). A home medical
9027equipment provider must be licensed by the agency to operate in
9028this state or to provide home medical equipment and services to
9029consumers in this state. A standard license issued to a home
9030medical equipment provider, unless sooner suspended or revoked,
9031expires 2 years after its effective date.
9032     (6)
9033     (b)  A person who violates paragraph (a) is subject to an
9034injunctive proceeding under this part, part II of chapter 408,
9035or applicable rules s. 400.956. A violation of paragraph (a) is
9036a deceptive and unfair trade practice and constitutes a
9037violation of the Florida Deceptive and Unfair Trade Practices
9038Act.
9039     (d)  The following penalties shall be imposed for operating
9040an unlicensed home medical equipment provider:
9041     1.  Any person or entity who operates an unlicensed
9042provider commits a felony of the third degree.
9043     2.  For any person or entity who has received government
9044reimbursement for services provided by an unlicensed provider,
9045the agency shall make a fraud referral to the appropriate
9046government reimbursement program.
9047     3.  For any licensee found to be concurrently operating
9048licensed and unlicensed provider premises, the agency may impose
9049a fine or moratorium, or revoke existing licenses of any or all
9050of the licensee's licensed provider locations until such time as
9051the unlicensed provider premises is licensed.
9052     (e)  A provider found to be operating without a license may
9053apply for licensure, and must cease operations until a license
9054is awarded by the agency.
9055     Section 174.  Section 400.931, Florida Statutes, is amended
9056to read:
9057     400.931  Application for license; fee; provisional license;
9058temporary permit.--
9059     (1)  Application for an initial license or for renewal of
9060an existing license must be made under oath to the agency on
9061forms furnished by it and must be accompanied by the appropriate
9062license fee as provided in subsection (12).
9063     (1)(2)  The applicant must file with the application
9064satisfactory proof that the home medical equipment provider is
9065in compliance with this part and applicable rules, including:
9066     (a)  A report, by category, of the equipment to be
9067provided, indicating those offered either directly by the
9068applicant or through contractual arrangements with existing
9069providers. Categories of equipment include:
9070     1.  Respiratory modalities.
9071     2.  Ambulation aids.
9072     3.  Mobility aids.
9073     4.  Sickroom setup.
9074     5.  Disposables.
9075     (b)  A report, by category, of the services to be provided,
9076indicating those offered either directly by the applicant or
9077through contractual arrangements with existing providers.
9078Categories of services include:
9079     1.  Intake.
9080     2.  Equipment selection.
9081     3.  Delivery.
9082     4.  Setup and installation.
9083     5.  Patient training.
9084     6.  Ongoing service and maintenance.
9085     7.  Retrieval.
9086     (c)  A listing of those with whom the applicant contracts,
9087both the providers the applicant uses to provide equipment or
9088services to its consumers and the providers for whom the
9089applicant provides services or equipment.
9090     (2)(3)  As an alternative to submitting proof of financial
9091ability to operate as required in s. 408.810(8) The applicant
9092for initial licensure must demonstrate financial ability to
9093operate, the applicant may submit which may be accomplished by
9094the submission of a $50,000 surety bond to the agency.
9095     (4)  An applicant for renewal who has demonstrated
9096financial inability to operate must demonstrate financial
9097ability to operate.
9098     (5)  Each applicant for licensure must comply with the
9099following requirements:
9100     (a)  Upon receipt of a completed, signed, and dated
9101application, the agency shall require background screening of
9102the applicant, in accordance with the level 2 standards for
9103screening set forth in chapter 435. As used in this subsection,
9104the term "applicant" means the general manager and the financial
9105officer or similarly titled individual who is responsible for
9106the financial operation of the licensed facility.
9107     (b)  The agency may require background screening for a
9108member of the board of directors of the licensee or an officer
9109or an individual owning 5 percent or more of the licensee if the
9110agency has probable cause to believe that such individual has
9111been convicted of an offense prohibited under the level 2
9112standards for screening set forth in chapter 435.
9113     (c)  Proof of compliance with the level 2 background
9114screening requirements of chapter 435 which has been submitted
9115within the previous 5 years in compliance with any other health
9116care licensure requirements of this state is acceptable in
9117fulfillment of paragraph (a).
9118     (d)  Each applicant must submit to the agency, with its
9119application, a description and explanation of any exclusions,
9120permanent suspensions, or terminations of the applicant from the
9121Medicare or Medicaid programs. Proof of compliance with
9122disclosure of ownership and control interest requirements of the
9123Medicaid or Medicare programs shall be accepted in lieu of this
9124submission.
9125     (e)  Each applicant must submit to the agency a description
9126and explanation of any conviction of an offense prohibited under
9127the level 2 standards of chapter 435 by a member of the board of
9128directors of the applicant, its officers, or any individual
9129owning 5 percent or more of the applicant. This requirement does
9130not apply to a director of a not-for-profit corporation or
9131organization if the director serves solely in a voluntary
9132capacity for the corporation or organization, does not regularly
9133take part in the day-to-day operational decisions of the
9134corporation or organization, receives no remuneration for his or
9135her services on the corporation's or organization's board of
9136directors, and has no financial interest and has no family
9137members with a financial interest in the corporation or
9138organization, provided that the director and the not-for-profit
9139corporation or organization include in the application a
9140statement affirming that the director's relationship to the
9141corporation satisfies the requirements of this provision.
9142     (f)  A license may not be granted to any potential licensee
9143if any applicant, administrator, or financial officer has been
9144found guilty of, regardless of adjudication, or has entered a
9145plea of nolo contendere or guilty to, any offense prohibited
9146under the level 2 standards for screening set forth in chapter
9147435, unless an exemption from disqualification has been granted
9148by the agency as set forth in chapter 435.
9149     (g)  The agency may deny or revoke licensure to any
9150potential licensee if any applicant:
9151     1.  Has falsely represented a material fact in the
9152application required by paragraphs (d) and (e), or has omitted
9153any material fact from the application required by paragraphs
9154(d) and (e); or
9155     2.  Has had prior Medicaid or Medicare action taken against
9156the applicant as set forth in paragraph (d).
9157     (h)  Upon licensure renewal, each applicant must submit to
9158the agency, under penalty of perjury, an affidavit of compliance
9159with the background screening provisions of this section.
9160     (3)(6)  As specified in part II of chapter 408, the home
9161medical equipment provider must also obtain and maintain
9162professional and commercial liability insurance. Proof of
9163liability insurance, as defined in s. 624.605, must be submitted
9164with the application. The agency shall set the required amounts
9165of liability insurance by rule, but the required amount must not
9166be less than $250,000 per claim. In the case of contracted
9167services, it is required that the contractor have liability
9168insurance not less than $250,000 per claim.
9169     (7)  A provisional license shall be issued to an approved
9170applicant for initial licensure for a period of 90 days, during
9171which time a survey must be conducted demonstrating substantial
9172compliance with this section. A provisional license shall also
9173be issued pending the results of an applicant's Federal Bureau
9174of Investigation report of background screening confirming that
9175all standards have been met. If substantial compliance is
9176demonstrated, a standard license shall be issued to expire 2
9177years after the effective date of the provisional license.
9178     (8)  Ninety days before the expiration date, an application
9179for license renewal must be submitted to the agency under oath
9180on forms furnished by the agency, and a license shall be renewed
9181if the applicant has met the requirements established under this
9182part and applicable rules. The home medical equipment provider
9183must file with the application satisfactory proof that it is in
9184compliance with this part and applicable rules. The home medical
9185equipment provider must submit satisfactory proof of its
9186financial ability to comply with the requirements of this part.
9187     (9)  When a change of ownership of a home medical equipment
9188provider occurs, the prospective owner must submit an initial
9189application for a license at least 15 days before the effective
9190date of the change of ownership. An application for change of
9191ownership of a license is required when ownership, a majority of
9192the ownership, or controlling interest of a licensed home
9193medical equipment provider is transferred or assigned and when a
9194licensee agrees to undertake or provide services to the extent
9195that legal liability for operation of the home medical equipment
9196provider rests with the licensee. A provisional license shall be
9197issued to the new owner for a period of 90 days, during which
9198time all required documentation must be submitted and a survey
9199must be conducted demonstrating substantial compliance with this
9200section. If substantial compliance is demonstrated, a standard
9201license shall be issued to expire 2 years after the issuance of
9202the provisional license.
9203     (4)(10)  When a change of the general manager of a home
9204medical equipment provider occurs, the licensee must notify the
9205agency of the change within 45 days. thereof and must provide
9206evidence of compliance with the background screening
9207requirements in subsection (5); except that a general manager
9208who has met the standards for the Department of Law Enforcement
9209background check, but for whom background screening results from
9210the Federal Bureau of Investigation have not yet been received,
9211may be employed pending receipt of the Federal Bureau of
9212Investigation background screening report. An individual may not
9213continue to serve as general manager if the Federal Bureau of
9214Investigation background screening report indicates any
9215violation of background screening standards.
9216     (5)(11)  In accordance with s. 408.805, an applicant or a
9217licensee shall pay a fee for each license application submitted
9218under this part, part II of chapter 408, and applicable rules.
9219The amount of the fee shall be established by rule and shall not
9220exceed $300 per biennium. All licensure fees required of a home
9221medical equipment provider are nonrefundable. The agency shall
9222set the fees in an amount that is sufficient to cover its costs
9223in carrying out its responsibilities under this part. However,
9224state, county, or municipal governments applying for licenses
9225under this part are exempt from the payment of license fees. All
9226fees collected under this part must be deposited in the Health
9227Care Trust Fund for the administration of this part.
9228     (6)(12)  An applicant for initial licensure, renewal, or
9229change of ownership shall also pay a license processing fee not
9230to exceed $300, to be paid by all applicants, and an inspection
9231fee not to exceed $400, which shall to be paid by all applicants
9232except those not subject to licensure inspection by the agency
9233as described in s. 400.933(2).
9234     (13)  When a change is reported which requires issuance of
9235a license, a fee must be assessed. The fee must be based on the
9236actual cost of processing and issuing the license.
9237     (14)  When a duplicate license is issued, a fee must be
9238assessed, not to exceed the actual cost of duplicating and
9239mailing.
9240     (15)  When applications are mailed out upon request, a fee
9241must be assessed, not to exceed the cost of the printing,
9242preparation, and mailing.
9243     (16)  The license must be displayed in a conspicuous place
9244in the administrative office of the home medical equipment
9245provider and is valid only while in the possession of the person
9246or entity to which it is issued. The license may not be sold,
9247assigned, or otherwise transferred, voluntarily or
9248involuntarily, and is valid only for the home medical equipment
9249provider and location for which originally issued.
9250     (17)  A home medical equipment provider against whom a
9251proceeding for revocation or suspension, or for denial of a
9252renewal application, is pending at the time of license renewal
9253may be issued a provisional license effective until final
9254disposition by the agency of such proceedings. If judicial
9255relief is sought from the final disposition, the court that has
9256jurisdiction may issue a temporary permit for the duration of
9257the judicial proceeding.
9258     Section 175.  Section 400.932, Florida Statutes, is amended
9259to read:
9260     400.932  Administrative penalties; injunctions; emergency
9261orders; moratoriums.--
9262     (1)  The agency may deny, revoke, and or suspend a license,
9263and or impose an administrative fine not to exceed $5,000 per
9264violation, per day, or initiate injunctive proceedings under s.
9265408.816 400.956.
9266     (2)  Any of the following actions by an employee of a home
9267medical equipment provider or any of its employees is grounds
9268for administrative action or penalties by the agency:
9269     (a)  Violation of this part or of applicable rules.
9270     (b)  An intentional, reckless, or negligent act that
9271materially affects the health or safety of a patient.
9272     (3)  The agency may deny and or revoke the license of any
9273applicant that:
9274     (a)  Made a false representation or omission of any
9275material fact in making the application, including the
9276submission of an application that conceals the controlling or
9277ownership interest or any officer, director, agent, managing
9278employee, affiliated person, partner, or shareholder who may not
9279be eligible to participate;
9280     (a)(b)  Has been previously found by any professional
9281licensing, certifying, or standards board or agency to have
9282violated the standards or conditions relating to licensure or
9283certification or the quality of services provided. "Professional
9284licensing, certifying, or standards board or agency" shall
9285include, but is not limited to, practitioners, health care
9286facilities, programs, or services, or residential care,
9287treatment programs, or other human services; or
9288     (b)(c)  Has been or is currently excluded, suspended, or
9289terminated from, or has involuntarily withdrawn from,
9290participation in Florida's Medicaid program or any other state's
9291Medicaid program, or participation in the Medicare program or
9292any other governmental or private health care or health
9293insurance program.
9294     (4)  The agency may issue an emergency order immediately
9295suspending or revoking a license when it determines that any
9296condition within the responsibility of the home medical
9297equipment provider presents a clear and present danger to public
9298health and safety.
9299     (5)  The agency may impose an immediate moratorium on any
9300licensed home medical equipment provider when the agency
9301determines that any condition within the responsibility of the
9302home medical equipment provider presents a threat to public
9303health or safety.
9304     Section 176.  Section 400.933, Florida Statutes, is amended
9305to read:
9306     400.933  Licensure inspections; alternatives and
9307investigations.--
9308     (1)  The agency shall make or cause to be made such
9309inspections and investigations as it considers necessary,
9310including:
9311     (a)  Licensure inspections.
9312     (b)  Inspections directed by the federal Health Care
9313Financing Administration.
9314     (c)  Licensure complaint investigations, including full
9315licensure investigations with a review of all licensure
9316standards as outlined in the administrative rules. Complaints
9317received by the agency from individuals, organizations, or other
9318sources are subject to review and investigation by the agency.
9319     (2)  The agency shall accept, in lieu of its own periodic
9320inspections for licensure, submission of the following:
9321     (1)(a)  The survey or inspection of an accrediting
9322organization, provided the accreditation of the licensed home
9323medical equipment provider is not provisional and provided the
9324licensed home medical equipment provider authorizes release of,
9325and the agency receives the report of, the accrediting
9326organization; or
9327     (2)(b)  A copy of a valid medical oxygen retail
9328establishment permit issued by the Department of Health,
9329pursuant to chapter 499.
9330     Section 177.  Section 400.935, Florida Statutes, is amended
9331to read:
9332     400.935  Rules establishing minimum standards.--The agency
9333shall adopt, publish, and enforce rules to implement this part
9334and part II of chapter 408, which must provide reasonable and
9335fair minimum standards relating to:
9336     (1)  The qualifications and minimum training requirements
9337of all home medical equipment provider personnel.
9338     (2)  License application and renewal.
9339     (3)  License and inspection fees.
9340     (2)(4)  Financial ability to operate.
9341     (3)(5)  The administration of the home medical equipment
9342provider.
9343     (4)(6)  Procedures for maintaining patient records.
9344     (5)(7)  Ensuring that the home medical equipment and
9345services provided by a home medical equipment provider are in
9346accordance with the plan of treatment established for each
9347patient, when provided as a part of a plan of treatment.
9348     (6)(8)  Contractual arrangements for the provision of home
9349medical equipment and services by providers not employed by the
9350home medical equipment provider providing for the consumer's
9351needs.
9352     (7)(9)  Physical location and zoning requirements.
9353     (8)(10)  Home medical equipment requiring home medical
9354equipment services.
9355     Section 178.  Section 400.95, Florida Statutes, is
9356repealed.
9357     Section 179.  Subsections (3) through (7) of section
9358400.953, Florida Statutes, are renumbered as subsections (2)
9359through (6), respectively, and present subsection (2) is amended
9360to read:
9361     400.953  Background screening of home medical equipment
9362provider personnel.--The agency shall require employment
9363screening as provided in chapter 435, using the level 1
9364standards for screening set forth in that chapter, for home
9365medical equipment provider personnel.
9366     (2)  The general manager of each home medical equipment
9367provider must sign an affidavit annually, under penalty of
9368perjury, stating that all home medical equipment provider
9369personnel hired on or after July 1, 1999, who enter the home of
9370a patient in the capacity of their employment have been screened
9371and that its remaining personnel have worked for the home
9372medical equipment provider continuously since before July 1,
93731999.
9374     Section 180.  Subsection (4) of section 400.955, Florida
9375Statutes, is amended to read:
9376     400.955  Procedures for screening of home medical equipment
9377provider personnel.--
9378     (4)  The general manager of each home medical equipment
9379provider must sign an affidavit annually, under penalty of
9380perjury, stating that all personnel hired on or after July 1,
93811999, have been screened and that its remaining personnel have
9382worked for the home medical equipment provider continuously
9383since before July 1, 1999.
9384     Section 181.  Section 400.956, Florida Statutes, is
9385repealed.
9386     Section 182.  Section 400.960, Florida Statutes, is amended
9387to read:
9388     400.960  Definitions.--As used in this part, the term:
9389     (1)  "Active treatment" means the provision of services by
9390an interdisciplinary team which are necessary to maximize a  
9391resident's client's individual independence or prevent
9392regression or loss of functional status.
9393     (2)  "Agency" means the Agency for Health Care
9394Administration.
9395     (3)  "Autism" means a pervasive, neurologically based
9396developmental disability of extended duration which causes
9397severe learning, communication, and behavior disorders with age
9398of onset during infancy or childhood. Individuals with autism
9399exhibit impairment in reciprocal social interaction, impairment
9400in verbal and nonverbal communication and imaginative ability,
9401and a markedly restricted repertoire of activities and
9402interests.
9403     (4)  "Cerebral palsy" means a group of disabling symptoms
9404of extended duration which results from damage to the developing
9405brain occurring before, during, or after birth and resulting in
9406the loss or impairment of control over voluntary muscles. The
9407term does not include those symptoms or impairments resulting
9408solely from a stroke.
9409     (5)  "Client" means any person determined by the department
9410to be eligible for developmental services.
9411     (6)  "Client advocate" means a friend or relative of the
9412client, or of the client's immediate family, who advocates for
9413the best interests of the client in any proceedings under this
9414part in which the client or his or her family has the right or
9415duty to participate.
9416     (5)(7)  "Department" means the Department of Children and
9417Family Services.
9418     (6)(8)  "Developmental disability" means a disorder or
9419syndrome that is attributable to retardation, cerebral palsy,
9420autism, spina bifida, or Prader-Willi syndrome and that
9421constitutes a substantial handicap that can reasonably be
9422expected to continue indefinitely.
9423     (7)(9)  "Direct service provider" means a person 18 years
9424of age or older who has direct contact with individuals with
9425developmental disabilities and who is unrelated to the
9426individuals with developmental disabilities.
9427     (8)(10)  "Epilepsy" means a chronic brain disorder of
9428various causes which is characterized by recurrent seizures due
9429to excessive discharge of cerebral neurons. When found
9430concurrently with retardation, autism, or cerebral palsy,
9431epilepsy is considered a secondary disability for which the
9432resident client is eligible to receive services to ameliorate
9433this condition according to the provisions of this part.
9434     (9)(11)  "Guardian advocate" means a person appointed by
9435the circuit court to represent a person with developmental
9436disabilities in any proceedings brought pursuant to s. 393.12,
9437and is distinct from a guardian advocate for mentally ill
9438persons under chapter 394.
9439     (10)(12)  "Intermediate care facility for the
9440developmentally disabled" means a residential facility licensed
9441and certified in accordance with state law, and certified by the
9442Federal Government, pursuant to the Social Security Act, as a
9443provider of Medicaid services to persons who are developmentally
9444disabled.
9445     (11)(13)  "Prader-Willi syndrome" means an inherited
9446condition typified by neonatal hypotonia with failure to thrive,
9447hyperphagia, or an excessive drive to eat which leads to
9448obesity, usually at 18 to 36 months of age, mild to moderate
9449retardation, hypogonadism, short stature, mild facial
9450dysmorphism, and a characteristic neurobehavior.
9451     (12