January 27, 2021
Print This PagePrint This Page

  *
Session:
Bill #:
Session:
Chamber: View Search Tips
Search Term:
Year: View Search Tips
Search Term:
_h1941c1
HB 1941CS

CHAMBER ACTION




1The Health & Families Council recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to the licensure of health care providers;
7creating pts. I, II, III, and IV of ch. 408, F.S.;
8creating s. 408.801, F.S.; providing a popular name;
9providing legislative findings and purpose; creating s.
10408.802, F.S.; providing applicability; creating s.
11408.803, F.S.; providing definitions; creating s. 408.804,
12F.S.; requiring providers to have and display a license;
13providing limitations; creating s. 408.805, F.S.;
14establishing license fees; providing a method for
15calculating annual adjustment of fees; creating s.
16408.806, F.S.; providing a license application process;
17requiring specified information to be included on the
18application; requiring payment of late fees under certain
19circumstances; requiring inspections; providing an
20exception; authorizing the Agency for Health Care
21Administration to establish procedures and rules for
22electronic transmission of required information; creating
23s. 408.807, F.S.; providing procedures for change of
24ownership; requiring the transferor to notify the agency
25in writing within a specified time period; providing for
26duties and liability of the transferor; providing for
27maintenance of records; creating s. 408.808, F.S.;
28providing license categories and requirements therefor;
29creating s. 408.809, F.S.; requiring background screening
30of specified employees; providing for submission of proof
31of compliance, under certain circumstances; providing
32conditions for granting provisional and standard licenses;
33providing an exception to screening requirements; creating
34s. 408.810, F.S.; providing minimum licensure
35requirements; providing procedures for discontinuance of
36operation and surrender of license; requiring forwarding
37of client records; requiring publication of a notice of
38discontinuance of operation of a provider; providing
39penalties; providing for statewide toll-free telephone
40numbers for reporting complaints and abusive, neglectful,
41and exploitative practices; requiring proof of legal right
42to occupy property, proof of insurance, and proof of
43financial viability, under certain circumstances;
44requiring disclosure of information relating to financial
45instability; providing a penalty; prohibiting the agency
46from licensing a health care provider that does not have a
47certificate of need or an exemption; creating s. 408.811,
48F.S.; providing for inspections and investigations to
49determine compliance; providing that inspection reports
50are public records; requiring retention of records for a
51specified period of time; creating s. 408.812, F.S.;
52prohibiting certain unlicensed activity by a provider;
53requiring unlicensed providers to cease activity;
54providing penalties; requiring reporting of unlicensed
55providers; creating s. 408.813, F.S.; authorizing the
56agency to impose administrative fines; creating s.
57408.814, F.S.; providing conditions for the agency to
58impose a moratorium or emergency suspension on a provider;
59requiring notice; creating s. 408.815, F.S.; providing
60grounds for denial or revocation of a license or change-
61of-ownership application; providing conditions to continue
62operation; exempting renewal applications from provisions
63requiring the agency to approve or deny an application
64within a specified period of time, under certain
65circumstances; creating s. 408.816, F.S.; authorizing the
66agency to institute injunction proceedings, under certain
67circumstances; creating s. 408.817, F.S.; providing basis
68for review of administrative proceedings challenging
69agency licensure enforcement action; creating s. 408.818,
70F.S.; requiring fees and fines related to health care
71licensing to be deposited into the Health Care Trust Fund;
72creating s. 408.819, F.S.; authorizing the agency to adopt
73rules; providing a timeframe for compliance; amending s.
74112.0455, F.S.; providing applicability of licensure
75requirements under pt. II of ch. 408, F.S., to drug-
76testing laboratories; establishing fees for license
77applications; amending ss. 381.0303 and 381.78, F.S.;
78conforming cross references; amending ss. 383.301,
79383.305, and 383.309, F.S.; providing applicability of
80licensure requirements under pt. II of ch. 408, F.S., to
81birth centers; repealing s. 383.304, F.S., relating to
82licensure requirement for birth centers; amending s.
83383.315, F.S.; revising a provision relating to birth
84center consultation agreements; repealing s. 383.332,
85F.S., relating to establishing, managing, or operating a
86birth center without a license and penalties therefor;
87amending s. 383.324, F.S.; conforming provisions relating
88to inspections and investigations of birth centers to
89changes made by the act; repealing s. 383.325, F.S.,
90relating to inspection reports; amending s. 383.33, F.S.,
91relating to administrative fines, penalties, emergency
92orders , and moratoriums on admissions; conforming
93provisions to changes made by the act; repealing s.
94383.331, F.S., relating to injunctive relief; amending s.
95383.335, F.S., relating to partial exemptions; conforming
96provisions to changes made by the act; amending s. 383.50,
97F.S.; conforming a cross reference; amending s. 390.011,
98F.S.; revising a definition; amending s. 390.012, F.S.,
99relating to rulemaking power of the agency; conforming
100provisions to changes made by the act; repealing s.
101390.013, F.S., relating to effective date of rules
102governing abortion clinics; amending s. 390.014, F.S.;
103providing applicability of licensure requirements under
104pt. II of ch. 408, F.S., to abortion clinics; increasing
105fees for licensing of abortion clinics; repealing s.
106390.015, F.S., relating to application for license to
107operate an abortion clinic; repealing s. 390.016, F.S.,
108relating to expiration and renewal of license; repealing
109s. 390.017, F.S., relating to grounds for suspension or
110revocation of license; amending s. 390.018, F.S.;
111providing applicability of pt. II of ch. 408, F.S., to
112administrative fines; repealing s. 390.019, F.S., relating
113to inspections and investigations of abortion clinics;
114repealing s. 390.021, F.S., relating to injunctive relief;
115amending s. 393.501, F.S.; revising provisions relating to
116rulemaking; amending s. 394.455, F.S.; revising a
117definition; amending s. 394.4787, F.S.; conforming a cross
118reference; amending s. 394.67, F.S.; deleting and revising
119and providing definitions; conforming cross references;
120amending ss. 394.74 and 394.82, F.S.; conforming cross
121references; amending s. 394.875, F.S.; providing purpose
122of short-term residential treatment facilities; providing
123applicability of licensure requirements under pt. II of
124ch. 408, F.S., to crisis stabilization units, short-term
125residential treatment facilities, residential treatment
126facilities, and residential treatment centers for children
127and adolescents; providing an exemption from licensure
128requirements for hospitals licensed under ch. 395, F.S.,
129and certain programs operated therein; repealing s.
130394.876, F.S., relating to license applications; amending
131s. 394.877, F.S.; providing applicability of pt. II of ch.
132408, F.S., to license fees; amending s. 394.878, F.S.,
133relating to issuance and renewal of licenses; conforming
134provisions to changes made by the act; amending s.
135394.879, F.S.; providing for rulemaking authority;
136conforming provisions to changes made by the act; amending
137s. 394.90, F.S.; conforming provisions relating to
138inspections of crisis stabilization units and residential
139treatment facilities to changes made by the act; repealing
140s. 394.902, F.S., relating to denial, suspension, and
141revocation of licenses of certain mental health
142facilities; amending s. 394.907, F.S., relating to access
143to records of community mental health centers; providing
144for the department to determine licensee compliance with
145quality assurance programs; amending s. 395.002, F.S.;
146deleting a definition; conforming cross references;
147amending ss. 395.003, 395.004, and 395.0161, F.S.;
148providing applicability of licensure requirements under
149pt. II of ch. 408, F.S., to hospitals, ambulatory surgical
150centers, and mobile surgical facilities; repealing s.
151395.0055, F.S., relating to background screening;
152repealing s. 395.0162, F.S., relating to inspection
153reports; amending s. 395.0163, F.S.; revising provisions
154relating to deposit of fees; conforming provisions to
155changes made by the act; providing an exception to Florida
156Building Code requirements for a licensed facility under
157specified circumstances; amending s. 395.0191, F.S.;
158requiring the presence of certain registered nurses in the
159operating room of a facility licensed under ch. 395, F.S.,
160during specified procedures; amending s. 395.0193, F.S.;
161requiring that reports concerning disciplinary actions be
162reported to the Department of Health and that final
163disciplinary actions be reported to the Division of Health
164Quality Assurance; conforming a cross reference; amending
165s. 395.0197, F.S.; conforming a cross reference; amending
166ss. 395.0199 and 395.1046, F.S.; providing applicability
167of licensure requirements under pt. II of ch. 408, F.S.,
168to health care utilization review and complaint
169investigation procedures; amending s. 395.1055, F.S.;
170providing applicability of licensure requirements under
171pt. II of ch. 408, F.S., to adoption and enforcement of
172rules; requiring the agency to enforce compliance with
173provisions relating to specified immunizations; amending
174ss. 395.1065, 395.10973, and 395.10974, F.S.; providing
175applicability of licensure requirements under pt. II of
176ch. 408, F.S., to administrative penalties and
177injunctions, rulemaking, and health care risk managers;
178amending ss. 395.602 and 395.701, F.S.; conforming cross
179references; amending s. 400.021, F.S.; deleting
180definitions; amending s. 400.022, F.S.; providing
181applicability of licensure requirements under pt. II of
182ch. 408, F.S., to grounds for action for a violation of
183residents' rights; amending s. 400.051, F.S.; conforming a
184cross reference; amending s. 400.062, F.S.; providing
185applicability of licensure requirements under pt. II of
186ch. 408, F.S., to nursing homes and related health care
187facilities; revising provisions relating to license fees;
188amending s. 400.063, F.S.; conforming a cross reference;
189amending ss. 400.071 and 400.0712, F.S.; providing
190applicability of licensure requirements under pt. II of
191ch. 408, F.S., to license applications; amending s.
192400.102, F.S.; providing applicability of licensure
193requirements under pt. II of ch. 408, F.S., to grounds for
194action by the agency against a licensee; amending s.
195400.111, F.S.; providing applicability of licensure
196requirements under pt. II of ch. 408, F.S.; requiring a
197licensee to disclose certain holdings of a controlling
198interest; amending s. 400.1183, F.S.; revising a provision
199requiring facilities to report resident grievances to the
200agency; amending s. 400.121, F.S., relating to denial,
201suspension, and revocation of licenses and administrative
202fines; conforming provisions to changes made by the act;
203repealing s. 400.125, F.S., relating to injunction
204proceedings; amending s. 400.141, F.S.; revising timeframe
205for submission of information related to staffing
206requirements and number of vacant beds in a facility;
207conforming a cross reference; amending s. 400.162, F.S.;
208providing for payment of a deceased resident's funeral
209services under certain circumstances; amending s. 400.179,
210F.S.; revising provisions relating to liability for
211Medicaid underpayments and overpayments; conforming
212provisions to changes made by the act; amending s. 400.18,
213F.S.; revising provisions relating to the closing of a
214nursing home facility; conforming provisions to changes
215made by the act; amending s. 400.19, F.S.; providing
216applicability of licensure requirements under pt. II of
217ch. 408, F.S., to nursing home facility inspections;
218revising a provision relating to a fine; amending s.
219400.191, F.S.; authorizing the agency to provide
220electronic access to inspection reports; requiring the
221agency to publish the Nursing Home Guide in printed and
222electronic formats and providing information to be
223included therein; revising information to be included on
224the agency Internet site; revising provisions relating to
225availability of nursing home facility records; amending s.
226400.20, F.S.; revising language relating to nursing home
227administrators; amending s. 400.23, F.S.; providing
228applicability of pt. II of ch. 408, F.S., to rulemaking
229for nursing home facilities; providing an alternative to
230nursing home room requirements under the Florida Building
231Code, under certain circumstances; requiring nursing home
232facilities to document rooms not in compliance with the
233Florida Building Code and to notify the agency of the
234practice; amending s. 400.241, F.S.; providing
235applicability of licensure requirements under pt. II of
236ch. 408, F.S., to prohibited acts relating to
237establishment, operation, or advertisement of nursing home
238facilities; amending s. 400.402, F.S.; revising and
239deleting definitions; amending s. 400.407, F.S.; providing
240applicability of licensure requirements under pt. II of
241ch. 408, F.S., to assisted living facilities; conforming
242provisions to changes made by the act; providing an
243exemption; amending s. 400.4075, F.S.; providing
244applicability of licensure requirements under pt. II of
245ch. 408, F.S., to limited mental health licenses; amending
246s. 400.408, F.S., relating to penalties imposed on
247unlicensed assisted living facilities; conforming
248provisions to changes made by the act; amending ss.
249400.411, 400.412, 400.414, 400.417, and 400.4174, F.S.;
250providing applicability of licensure requirements under
251pt. II of ch. 408, F.S., to assisted living facilities;
252conforming provisions to changes made by the act;
253repealing s. 400.415, F.S., relating to a moratorium on
254admissions and notice thereof; amending s. 400.4176, F.S.;
255conforming provisions to changes made by the act; amending
256s. 400.4178, F.S.; deleting provisions exempting specified
257nursing home facilities from fees for training and
258education programs relating to special care for persons
259with Alzheimer's disease or other related disorders;
260amending ss. 400.418 and 400.419, F.S.; providing
261applicability of pt. II of ch. 408, F.S., to provisions
262relating to disposition and imposition of fees and fines
263collected under pt. III of ch. 400, F.S.; conforming
264provisions to changes made by the act; repealing s.
265400.421, F.S., relating to injunctive proceedings;
266amending s. 400.422, F.S.; conforming a cross reference;
267amending s. 400.423, F.S.; transferring rulemaking
268authority from the Department of Elderly Affairs to the
269agency; amending s. 400.424, F.S.; providing that fines on
270assisted living facilities for failure to comply with
271certain refund provisions are not subject to s.
272400.419(3), F.S.; amending ss. 400.4255, 400.4256,
273400.427, and 400.4275, F.S.; conforming provisions to
274changes made by the act; amending s. 400.426, F.S.;
275conforming a cross reference; amending ss. 400.431 and
276400.434, F.S.; providing applicability of licensure
277requirements under pt. II of ch. 408, F.S., to the closing
278of and right of entry and inspection of assisted living
279facilities; amending s. 400.435, F.S.; revising provisions
280relating to maintenance of records of inspection reports
281for a specified period of time; amending s. 400.441, F.S.;
282transferring rulemaking authority from the Department of
283Elderly Affairs to the agency; deleting provisions
284requiring submission of proposed rules and a report to the
285Legislature; deleting a fee for copies of rules and
286standards; conforming provisions to changes made by the
287act; amending ss. 400.442 and 400.444, F.S.; conforming
288provisions to changes made by the act; amending s.
289400.447, F.S.; providing applicability of licensure
290requirements under pt. II of ch. 408, F.S., to prohibited
291acts and penalties for violation of said requirements;
292repealing s. 400.451, F.S., relating to compliance by
293existing facilities with applicable rules and standards;
294amending ss. 400.452 and 400.454, F.S.; conforming
295provisions to changes made by the act; amending ss.
296400.464, 400.471, 400.474, and 400.484, F.S.; providing
297applicability of licensure requirements under pt. II of
298ch. 408, F.S., to home health agencies; amending s.
299400.487, F.S.; revising contents of home health service
300agreements; authorizing physician assistants and advanced
301registered nurse practitioners to establish treatment
302orders; amending s. 400.494, F.S.; conforming provisions
303to changes made by the act; amending ss. 400.495 and
304400.497, F.S.; providing applicability of licensure
305requirements under pt. II of ch. 408, F.S., to the toll-
306free central abuse hotline and rules establishing minimum
307standards for home health aides; amending s. 400.506,
308F.S.; providing applicability of licensure requirements
309under pt. II of ch. 408, F.S., to nurse registries;
310requiring a nurse registry to notify patients or their
311families of the availability and costs of visits by
312registered nurses; permitting physician assistants and
313advanced registered nurse practitioners to sign a plan of
314treatment; revising provisions relating to assessment of
315costs related to certain investigations; amending s.
316400.509, F.S.; providing applicability of pt. II of ch.
317408, F.S., to the registration of companion or homemaker
318service providers exempt from licensure; providing a fee
319for registration; conforming provisions to changes made by
320the act; amending s. 400.512, F.S.; conforming provisions
321relating to the screening of home health agency, nurse
322registry, companion, and homemaker personnel to changes
323made by the act; repealing s. 400.515, F.S., relating to
324injunction proceedings; amending s. 400.551, F.S.;
325revising definitions; amending ss. 400.554, 400.555,
326400.5565, 400.557, and 400.5572, F.S.; providing
327applicability of licensure requirements under pt. II of
328ch. 408, F.S., to adult day care centers; amending s.
329400.556, F.S.; authorizing the agency to impose an
330emergency action against an owner, operator, or employee
331of an adult day care facility; revising grounds for action
332by the agency against an owner, operator, or employee of
333an adult day care facility; providing applicability of
334licensure requirements under pt. II of ch. 408, F.S.;
335repealing s. 400.5575, F.S., relating to disposition of
336fees and fines; repealing s. 400.558, F.S., relating to
337injunctive relief; amending ss. 400.559 and 400.56, F.S.;
338providing applicability of licensure requirements under
339pt. II of ch. 408, F.S., to the closing of and right of
340entry and inspection of adult day care centers; amending
341s. 400.562, F.S.; transferring rulemaking authority from
342the Department of Elderly Affairs to the agency; deleting
343a fee for copies of rules and standards; conforming
344provisions to changes made by the act; repealing s.
345400.564, F.S., relating to prohibited acts and penalties
346therefor; amending ss. 400.602, 400.605, 400.606,
347400.6065, and 400.607, F.S.; providing applicability of
348licensure requirements under pt. II of ch. 408, F.S., to
349hospices; conforming provisions to changes made by the
350act; amending s. 400.6095, F.S.; conforming provisions
351relating to rulemaking to changes made by the act;
352amending ss. 400.617, 400.6211, and 400.625, F.S.;
353conforming provisions relating to legislative intent and
354purpose, rulemaking, training and education programs, and
355residency agreements for adult family-care homes to
356changes made by the act; amending ss. 400.619, 400.6194,
357400.6196, and 400.621, F.S.; providing applicability of
358licensure requirements under pt. II of ch. 408, F.S., to
359adult family-care homes; repealing s. 400.622, F.S.,
360relating to injunctive proceedings; amending s. 400.801,
361F.S.; conforming provisions relating to homes for special
362services to changes made by the act; providing a fee;
363amending s. 400.805, F.S.; providing applicability of
364licensure requirements under pt. II of ch. 408, F.S., to
365transitional living facilities; providing a fee; amending
366s. 400.902, F.S.; revising a definition; amending ss.
367400.903, 400.905, 400.907, and 400.908, F.S.; providing
368applicability of licensure requirements under pt. II of
369ch. 408, F.S., to prescribed pediatric extended care
370centers; repealing s. 400.906, F.S., relating to initial
371application for a license; repealing s. 400.910, F.S.,
372relating to expiration or renewal of a license and
373conditional licenses; repealing s. 400.911, F.S., relating
374to injunction proceedings; amending s. 400.912, F.S.;
375conforming provisions relating to the closing of a
376prescribed pediatric extended care center to changes made
377by the act; repealing s. 400.913, F.S., relating to right
378of entry and inspection; amending ss. 400.914 and 400.915,
379F.S.; providing applicability of licensure requirements
380under pt. II of ch. 408, F.S., to rules establishing
381standards for and requirements for construction and
382renovation of prescribed pediatric extended care centers;
383repealing s. 400.916, F.S., relating to penalties for
384prohibited acts; repealing s. 400.917, F.S., relating to
385disposition of moneys from fines and fees; amending s.
386400.925, F.S.; deleting and revising definitions; amending
387ss. 400.93, 400.931, 400.932, 400.933, and 400.935, F.S.;
388providing applicability of licensure requirements under
389pt. II of ch. 408, F.S., to home medical equipment
390providers; repealing s. 400.95, F.S., relating to notice
391of toll-free telephone number for the central abuse
392hotline; amending ss. 400.953 and 400.955, F.S.; revising
393provisions relating to background screening of home
394medical equipment provider personnel; repealing s.
395400.956, F.S., relating to injunction proceedings;
396amending s. 400.960, F.S.; deleting and revising
397definitions; amending s. 400.962, F.S.; providing
398applicability of licensure requirements under pt. II of
399ch. 408, F.S., to intermediate care facilities for persons
400with developmental disabilities; providing a fee;
401repealing s. 400.963, F.S., relating to injunctive
402proceedings; repealing s. 400.965, F.S., relating to
403grounds for actions by the agency against the licensee;
404amending s. 400.967, F.S.; providing applicability of
405licensure requirements under pt. II of ch. 408, F.S., to
406intermediate care facilities for persons with
407developmental disabilities; requiring facilities to adhere
408to the Bill of Rights of Persons Who are Developmentally
409Disabled; amending s. 400.968, F.S.; conforming provisions
410relating to injunctive proceedings and a moratorium on
411admissions to changes made by the act; amending s.
412400.9685, F.S.; conforming language to changes made by the
413act; amending s. 400.969, F.S.; providing applicability of
414pt. II of ch. 408, F.S., to penalties relating to
415intermediate care facilities for persons with
416developmental disabilities; amending s. 400.980, F.S.;
417providing applicability of licensure requirements under
418pt. II of ch. 408, F.S., to health care services pools;
419amending ss. 400.991, 400.9915, 400.9925, 400.993, and
420400.9935, F.S.; providing applicability of licensure
421requirements under pt. II of ch. 408, F.S., to health care
422clinics; providing a fee; repealing s. 400.992, F.S.,
423relating to license renewal, transfer of ownership, and
424provisional licenses; repealing s. 400.994, F.S., relating
425to injunctive proceedings; repealing s. 400.9945, F.S.,
426relating to agency actions; amending s. 400.995, F.S.;
427conforming provisions relating to agency administrative
428penalties to changes made by the act; amending s. 401.265,
429F.S.; requiring license requirements for emergency medical
430technicians and paramedics; amending s. 408.831, F.S.;
431revising provisions relating to agency action to deny,
432suspend, or revoke a license or application; amending s.
433440.102, F.S.; providing applicability of licensure
434requirements under pt. II of ch. 408, F.S., to drug
435testing standards for laboratories; amending s. 464.015,
436F.S.; providing restrictions on the use of the title
437"Certified Registered Nurse Anesthetist"; amending s.
438464.016, F.S.; providing a penalty for misuse of the title
439"Certified Registered Nurse Anesthetist"; amending ss.
440483.035, 483.051, 483.061, 483.091, 483.101, 483.111,
441483.172, 483.201, 483.221, and 483.23, F.S.; providing
442applicability of licensure requirements under pt. II of
443ch. 408, F.S., to clinical laboratories; repealing s.
444483.131, F.S., relating to the display of a license;
445repealing s. 483.25, F.S., relating to injunctive
446proceedings; amending ss. 483.291, 483.294, 483.30,
447483.302, 483.317, 483.32, and 483.322, F.S.; providing
448applicability of licensure requirements under pt. II of
449ch. 408, F.S., to multiphasic health testing centers;
450repealing s. 483.311, F.S., relating to the display of a
451license; repealing s. 483.328, F.S., relating to
452injunctive relief; amending s. 765.541, F.S.; conforming
453provisions relating to cadaveric organ and tissue
454procurement to changes made by the act; amending s.
455765.542, F.S.; providing applicability of licensure
456requirements under pt. II of ch. 408, F.S., to organ
457procurement organizations and tissue and eye banks;
458amending s. 765.544, F.S.; conforming provisions relating
459to application fees from organizations and tissue and eye
460banks to changes made by the act; amending ss. 402.164,
461409.815, 409.905, 409.907, 468.505, 483.106, 766.118,
462766.316, and 812.014, F.S.; conforming cross references;
463providing for priority of application in case of conflict;
464transferring rules adopted by the Department of Elderly
465Affairs under pts. III, V, VI, and VII of ch. 400, F.S.,
466to the agency; authorizing the agency to issue licenses
467for less than a specified time period and providing
468conditions therefor; providing an effective date.
469
470Be It Enacted by the Legislature of the State of Florida:
471
472     Section 1.  Part I of chapter 408, Florida Statutes,
473consisting of sections 408.031, 408.032, 408.033, 408.034,
474408.035, 408.036, 408.0361, 408.037, 408.038, 408.039, 408.040,
475408.041, 408.042, 408.043, 408.044, 408.045, 408.0455, 408.05,
476408.061, 408.062, 408.063, 408.07, 408.08, 408.09, 408.10,
477408.15, 408.16, 408.18, 408.185, 408.20, 408.301, 408.302,
478408.40, 408.50, 408.70, 408.7056, 408.7057, and 408.7071,
479Florida Statutes, is created and entitled "Health Facility and
480Services Planning."
481     Section 2.  Part II of chapter 408, Florida Statutes,
482consisting of sections 408.801, 408.802, 408.803, 408.804,
483408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
484408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
485408.819, and 408.831, Florida Statutes, is created and entitled
486"Health Care Licensing: General Provisions."
487     Section 3.  Part III of chapter 408, Florida Statutes,
488consisting of sections 408.90, 408.901, 408.902, 408.903,
489408.904, 408.905, 408.906, 408.907, 408.908, and 408.909,
490Florida Statutes, is created and entitled "Health Insurance
491Access."
492     Section 4.  Part IV of chapter 408, Florida Statutes,
493consisting of sections 408.911, 408.913, 408.914, 408.915,
494408.916, 408.917, and 408.918, Florida Statutes, is created and
495entitled "Health and Human Services Eligibility Access System."
496     Section 5.  Sections 408.801, 408.802, 408.803, 408.804,
497408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
498408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
499and 408.819, Florida Statutes, are created to read:
500     408.801  Popular name; purpose.--
501     (1)  This part may be cited as the "Health Care Licensing
502Procedures Act."
503     (2)  The Legislature finds that there is unnecessary
504duplication and variation in the requirements for licensure by
505the Agency for Health Care Administration brought about by the
506historical pattern of legislative action focused exclusively on
507a single type of regulated provider. It is the intent of the
508Legislature to provide a streamlined and consistent set of basic
509licensing requirements for all such providers in order to
510minimize confusion, standardize terminology, and include issues
511that are otherwise not adequately addressed in the Florida
512Statutes pertaining to specific providers.
513     408.802  Applicability.--The provisions of this part apply
514to the provision of services that require licensure as defined
515in this part and to the following entities licensed, registered,
516or certified by the Agency for Health Care Administration, as
517described in chapters 112, 383, 390, 394, 395, 400, 440, 483,
518and 765:
519     (1)  Laboratories authorized to perform testing under the
520Drug-Free Workplace Act, as provided under ss. 112.0455 and
521440.102.
522     (2)  Birth centers, as provided under chapter 383.
523     (3)  Abortion clinics, as provided under chapter 390.
524     (4)  Crisis stabilization units, as provided under parts I
525and IV of chapter 394.
526     (5)  Short-term residential treatment facilities, as
527provided under parts I and IV of chapter 394.
528     (6)  Residential treatment facilities, as provided under
529part IV of chapter 394.
530     (7)  Residential treatment centers for children and
531adolescents, as provided under part IV of chapter 394.
532     (8)  Hospitals, as provided under part I of chapter 395.
533     (9)  Ambulatory surgical centers, as provided under part I
534of chapter 395.
535     (10)  Mobile surgical facilities, as provided under part I
536of chapter 395.
537     (11)  Private review agents, as provided under part I of
538chapter 395.
539     (12)  Health care risk managers, as provided under part I
540of chapter 395.
541     (13)  Nursing homes, as provided under part II of chapter
542400.
543     (14)  Assisted living facilities, as provided under part
544III of chapter 400.
545     (15)  Home health agencies, as provided under part IV of
546chapter 400.
547     (16)  Nurse registries, as provided under part IV of
548chapter 400.
549     (17)  Companion services or homemaker services providers,
550as provided under part IV of chapter 400.
551     (18)  Adult day care centers, as provided under part V of
552chapter 400.
553     (19)  Hospices, as provided under part VI of chapter 400.
554     (20)  Adult family-care homes, as provided under part VII
555of chapter 400.
556     (21)  Homes for special services, as provided under part
557VIII of chapter 400.
558     (22)  Transitional living facilities, as provided under
559part VIII of chapter 400.
560     (23)  Prescribed pediatric extended care centers, as
561provided under part IX of chapter 400.
562     (24)  Home medical equipment providers, as provided under
563part X of chapter 400.
564     (25)  Intermediate care facilities for persons with
565developmental disabilities, as provided under part XI of chapter
566400.
567     (26)  Health care services pools, as provided under part
568XII of chapter 400.
569     (27)  Health care clinics, as provided under part XIII of
570chapter 400.
571     (28)  Clinical laboratories, as provided under part I of
572chapter 483.
573     (29)  Multiphasic health testing centers, as provided under
574part II of chapter 483.
575     (30)  Organ and tissue procurement agencies, as provided
576under chapter 765.
577     408.803  Definitions.--As used in this part, the term:
578     (1)  "Agency" means the Agency for Health Care
579Administration, which is the licensing agency under this part.
580     (2)  "Applicant" means an individual, corporation,
581partnership, firm, association, or governmental entity that
582submits an application to the agency for a license.
583     (3)  "Authorizing statute" means the statute authorizing
584the licensed operation of a provider listed in s. 408.802,
585including chapters 112, 383, 390, 394, 395, 400, 440, 483, and
586765.
587     (4)  "Certification" means certification as a Medicare or
588Medicaid provider of the services that require licensure or
589certification pursuant to the federal Clinical Laboratory
590Improvement Amendment (CLIA).
591     (5)  "Change in ownership" means an event in which the
592licensee changes to a different legal entity or in which 45
593percent or more of the ownership, voting shares, or interest in
594a corporation whose shares are not publicly traded on a
595recognized stock exchange is transferred or assigned, including
596the final transfer or assignment of multiple transfers or
597assignments over a 2-year period that cumulatively total 45
598percent or greater. However, a change solely in the management
599company is not a change of ownership.
600     (6)  "Client" means any person receiving services from a
601provider listed in s. 408.802.
602     (7)  "Controlling interest" means:
603     (a)  The applicant or licensee;
604     (b)  A person or entity that serves as an officer of, is on
605the board of directors of, or has a 5 percent or greater
606ownership interest in the applicant or licensee; or
607     (c)  A person or entity that serves as an officer of, is on
608the board of directors of, or has a 5 percent or greater
609ownership interest in the management company or other entity,
610related or unrelated, with which the applicant or licensee
611contracts to manage the provider.
612
613The term does not include a voluntary board member.
614     (8)  "License" means any permit, registration, certificate,
615or license issued by the agency.
616     (9)  "Licensee" means an individual, corporation,
617partnership, firm, association, or governmental entity that is
618issued a permit, registration, certificate, or license by the
619agency. The licensee is legally responsible for all aspects of
620the provider operation.
621     (10)  "Moratorium" means a prohibition on the acceptance of
622new clients.
623     (11)  "Provider" means any activity, service, agency, or
624facility regulated by the agency and listed in s. 408.802.
625     (12)  "Services that require licensure" means those
626services, including residential services, that require a valid
627license before those services may be provided in accordance with
628authorizing statutes and agency rules.
629     (13)  "Voluntary board member" means a board member of a
630not-for-profit corporation or organization who serves solely in
631a voluntary capacity, does not receive any remuneration for his
632or her services on the board of directors, and has no financial
633interest in the corporation or organization. The agency shall
634recognize a person as a voluntary board member following
635submission of a statement to the agency by the board member and
636the not-for-profit corporation or organization that affirms that
637the board member conforms to this definition. The statement
638affirming the status of the board member must be submitted to
639the agency on a form provided by the agency.
640     408.804  License required; display.--
641     (1)  It is unlawful to provide services that require
642licensure, or operate or maintain a provider that offers or
643provides services that require licensure, without first
644obtaining from the agency a license authorizing the provision of
645such services or the operation or maintenance of such provider.
646     (2)  A license must be displayed in a conspicuous place
647readily visible to clients who enter at the address that appears
648on the license and is valid only in the hands of the licensee to
649whom it is issued and may not be sold, assigned, or otherwise
650transferred, voluntarily or involuntarily. The license is valid
651only for the licensee, provider, and location for which the
652license is issued.
653     408.805  Fees required; adjustments.--Unless otherwise
654limited by authorizing statutes, license fees must be reasonably
655calculated by the agency to cover its costs in carrying out its
656responsibilities under this part, authorizing statutes, and
657applicable rules, including the cost of licensure, inspection,
658and regulation of providers.
659     (1)  Licensure fees shall be adjusted to provide for
660biennial licensure in agency rules.
661     (2)  The agency shall annually adjust licensure fees,
662including fees paid per bed, by not more than the change in the
663Consumer Price Index based on the 12 months immediately
664preceding the increase.
665     (3)  The agency may, by rule, adjust licensure fees to
666cover the cost of administering this part, authorizing statutes,
667and applicable rules.
668     (4)  An inspection fee must be paid as required in
669authorizing statutes.
670     (5)  Fees are nonrefundable.
671     (6)  When a change is reported that requires issuance of a
672license, a fee may be assessed. The fee must be based on the
673actual cost of processing and issuing the license.
674     (7)  A fee may be charged to a licensee requesting a
675duplicate license. The fee may not exceed the actual cost of
676duplication and postage.
677     (8)  Total fees collected may not exceed the cost of
678administering this part, authorizing statutes, and applicable
679rules.
680     408.806  License application process.--
681     (1)  An application for licensure must be made to the
682agency on forms furnished by the agency, submitted under oath,
683and accompanied by the appropriate fee in order to be accepted
684and considered timely. The application must contain information
685required by authorizing statutes and applicable rules and must
686include:
687     (a)  The name, address, and social security number of the
688applicant and each controlling interest if the applicant or
689controlling interest is an individual.
690     (b)  The name, address, and federal employer identification
691number or taxpayer identification number of the applicant and
692each controlling interest if the applicant or controlling
693interest is not an individual.
694     (c)  The name by which the provider is to be known.
695     (d)  The total number of beds or capacity requested, as
696applicable.
697     (e)  The following information regarding the location of
698the provider for which the application is made:
699     1.  A report or letter from the zoning authority indicating
700that the location is zoned appropriately for its use. If the
701provider is a community residential home under chapter 419, the
702zoning requirement must be satisfied by proof of compliance with
703chapter 419. The zoning report or letter is not required for a
704renewal application if the provider location did not change
705since the date on which the most recent license was issued.
706     2.  A satisfactory fire safety report from the local
707authority having jurisdiction or the state fire marshal.
708     (f)  The name of the person or persons under whose
709management or supervision the provider will be operated and the
710name of the administrator, if required.
711     (g)  If the applicant offers continuing care agreements as
712defined in chapter 651, proof shall be furnished that the
713applicant has obtained a certificate of authority as required
714for operation under chapter 651.
715     (h)  Other information, including satisfactory inspection
716results, that the agency finds necessary to determine the
717ability of the applicant to carry out its responsibilities under
718this part, authorizing statutes, and applicable rules.
719     (2)(a)  The applicant for a renewal license must submit an
720application that must be received by the agency at least 60 days
721prior to the expiration of the current license.
722     (b)  The applicant for initial licensure due to a change of
723ownership must submit an application that must be received by
724the agency at least 60 days prior to the date of change of
725ownership.
726     (c)  For any other application or request, the applicant
727must submit an application or request that must be received by
728the agency at least 60 days prior to the requested effective
729date, unless otherwise specified in authorizing statutes or
730rules.
731     (d)  The agency shall notify the licensee by mail or
732electronically at least 90 days prior to the expiration of a
733license that a renewal license is necessary to continue
734operation. The failure to timely file an application and submit
735a license fee shall result in a late fee charged to the licensee
736by the agency in an amount equal to 50 percent of the licensure
737fee but in no event shall the aggregate amount of the fine
738exceed $5,000. If an application is received after the required
739filing date and exhibits a hand-canceled postmark obtained from
740a United States Post Office dated on or before the required
741filing date, no fine will be levied.
742     (3)(a)  Upon receipt of an application for a license, the
743agency shall examine the application and, within 30 days after
744receipt, notify the applicant in writing of any apparent errors
745or omissions and request any additional information required.
746     (b)  Requested information omitted from an application for
747licensure, license renewal, or change of ownership, other than
748an inspection, must be filed with the agency within 21 days
749after the agency's request for omitted information or the
750application shall be deemed incomplete and shall be withdrawn
751from further consideration and the fees shall be forfeited.
752     (c)  Within 60 days after the receipt of a complete
753application, the agency shall approve or deny the application.
754     (4)(a)  Licensees subject to the provisions of this part
755shall be issued biennial licenses unless conditions of the
756license category specify a shorter license period.
757     (b)  Each license issued shall indicate the name of the
758licensee, the type of provider or service that the licensee is
759required or authorized to operate or offer, the date the license
760is effective, the expiration date of the license, the maximum
761capacity of the licensed premises, if applicable, and any other
762information required or deemed necessary by the agency.
763     (5)  In accordance with authorizing statutes and applicable
764rules, proof of compliance with s. 408.810 must be submitted
765with an application for licensure.
766     (6)  The agency may not issue an initial license to a
767health care provider subject to the certificate-of-need
768provisions in part I of this chapter if the licensee has not
769been issued a certificate of need or certificate-of-need
770exemption, when applicable. Failure to apply for the renewal of
771a license prior to the expiration date renders the license null
772and void.
773     (7)(a)  An applicant must demonstrate compliance with the
774requirements in this part, authorizing statutes, and applicable
775rules during an inspection pursuant to s. 408.811, as required
776by authorizing statutes.
777     (b)  An initial inspection is not required for companion
778services or homemaker services providers, as provided under part
779IV of chapter 400, or for health care services pools, as
780provided under part XII of chapter 400.
781     (c)  If an inspection is required by the authorizing
782statute for a license application other than an initial
783application, the inspection must be unannounced. This paragraph
784does not apply to inspections required pursuant to ss. 383.324,
785395.0161(4), and 483.061(2).
786     (d)  If a provider is not available when an inspection is
787attempted, the application shall be denied.
788     (8)  The agency may establish procedures for the electronic
789submission of required information, including, but not limited
790to:
791     (a)  Licensure applications.
792     (b)  Required signatures.
793     (c)  Payment of fees.
794     (d)  Notarization of applications.
795
796Requirements for electronic submission of any documents required
797by this part or authorizing statutes may be established by rule.
798     408.807  Change of ownership.--Whenever a change of
799ownership occurs:
800     (1)  The transferor shall notify the agency in writing at
801least 60 days before the anticipated date of the change of
802ownership.
803     (2)  The transferee shall make application to the agency
804for a license within the timeframes required in s. 408.806.
805     (3)  The transferor shall be responsible and liable for:
806     (a)  The lawful operation of the provider and the welfare
807of the clients served until the date the transferee is licensed
808by the agency.
809     (b)  Any and all penalties imposed against the transferor
810for violations occurring before the date of change of ownership.
811     (4)  Any restriction on licensure, including a conditional
812license existing at the time of a change of ownership, shall
813remain in effect until removed by the agency.
814     (5)  The transferee shall maintain records of the
815transferor as required in this part, authorizing statutes, and
816applicable rules, including:
817     (a)  All client records.
818     (b)  Inspection reports.
819     (c)  All records required to be maintained pursuant to s.
820409.913, if applicable.
821     408.808  License categories.--
822     (1)  STANDARD LICENSE.--A standard license may be issued to
823an applicant at the time of initial licensure, license renewal,
824or change of ownership. A standard license shall be issued when
825the applicant is in compliance with all statutory requirements
826and agency rules. Unless sooner revoked, a standard license
827expires 2 years after the date of issue.
828     (2)  PROVISIONAL LICENSE.--A provisional license may be
829issued to an applicant pursuant to s. 408.809(3). An applicant
830against whom a proceeding denying or revoking a license is
831pending at the time of license renewal may be issued a
832provisional license effective until final agency action not
833subject to further appeal.
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 or aggregate limitation of the fine is prescribed by
1134authorizing statutes or applicable rules, the agency may
1135establish criteria by rule for the amount of administrative
1136fines applicable to this part, authorizing statutes, and
1137applicable rules. Each day of violation constitutes a separate
1138violation and is subject to a separate fine. For fines imposed
1139by final order of the agency and not subject to further appeal,
1140the violator shall pay the fine plus interest at the rate
1141specified in s. 55.03 for each day beyond the date set by the
1142agency for payment of the fine.
1143     408.814  Moratoriums; emergency suspensions.--
1144     (1)  The agency may impose an immediate moratorium or
1145emergency suspension as defined in s. 120.60 on any provider if
1146the agency determines that any condition related to the provider
1147or licensee presents a threat to the health, safety, or welfare
1148of a client.
1149     (2)  A provider or licensee, the license of which is denied
1150or revoked, may be subject to immediate imposition of a
1151moratorium or emergency suspension to run concurrently with
1152licensure denial, revocation, or injunction.
1153     (3)  A moratorium or emergency suspension remains in effect
1154after a change of ownership, unless the agency has determined
1155that the conditions that created the moratorium, emergency
1156suspension, or denial of licensure have been corrected.
1157     (4)  When a moratorium or emergency suspension is placed on
1158a provider or licensee, notice of the action shall be posted and
1159visible to the public at the location of the provider until the
1160action is lifted.
1161     408.815  License or application denial; revocation.--
1162     (1)  In addition to the grounds provided in authorizing
1163statutes, grounds that may be used by the agency for denying and
1164revoking a license or change-of-ownership application include
1165any of the following actions by a controlling interest:
1166     (a)  False representation of a material fact in the license
1167application or omission of any material fact from the
1168application.
1169     (b)  An intentional or negligent act materially affecting
1170the health or safety of a client of the provider.
1171     (c)  A violation of this part, authorizing statutes, or
1172applicable rules.
1173     (d)  A demonstrated pattern of deficient performance.
1174     (e)  The applicant, licensee, or controlling interest has
1175been or is currently excluded, suspended, terminated from
1176participation in the state Medicaid program, the Medicaid
1177program of any other state, or the Medicare program.
1178     (2)  If a licensee lawfully continues to operate while a
1179denial or revocation is pending in litigation, the licensee must
1180continue to meet all other requirements of this part,
1181authorizing statutes, and applicable rules and must file
1182subsequent renewal applications for licensure and pay all
1183licensure fees. The provisions of ss. 120.60(1) and
1184408.806(3)(c) shall not apply to renewal applications filed
1185during the time period in which the litigation of the denial or
1186revocation is pending until that litigation is final.
1187     (3)  An action under s. 408.814 or denial of the license of
1188the transferor may be grounds for denial of a change-of-
1189ownership application of the transferee.
1190     408.816  Injunctions.--
1191     (1)  In addition to the other powers provided by this part
1192and authorizing statutes, the agency may institute injunction
1193proceedings in a court of competent jurisdiction to:
1194     (a)  Restrain or prevent the establishment or operation of
1195a provider that does not have a license or is in violation of
1196any provision of this part, authorizing statutes, or applicable
1197rules. The agency may also institute injunction proceedings in a
1198court of competent jurisdiction when a violation of this part,
1199authorizing statutes, or applicable rules constitutes an
1200emergency affecting the immediate health and safety of a client.
1201     (b)  Enforce the provisions of this part, authorizing
1202statutes, or any minimum standard, rule, or order issued or
1203entered into pursuant thereto when the attempt by the agency to
1204correct a violation through administrative sanctions has failed
1205or when the violation materially affects the health, safety, or
1206welfare of clients or involves any operation of an unlicensed
1207provider.
1208     (c)  Terminate the operation of a provider when a violation
1209of any provision of this part, authorizing statutes, or any
1210standard or rule adopted pursuant thereto exists that materially
1211affects the health, safety, or welfare of clients.
1212
1213Such injunctive relief may be temporary or permanent.
1214     (2)  If action is necessary to protect clients of providers
1215from immediate, life-threatening situations, the court may allow
1216a temporary injunction without bond upon proper proof being
1217made. If it appears by competent evidence or a sworn,
1218substantiated affidavit that a temporary injunction should be
1219issued, the court, pending the determination on final hearing,
1220shall enjoin the operation of the provider.
1221     408.817  Administrative proceedings.--Administrative
1222proceedings challenging agency licensure enforcement action
1223shall be reviewed on the basis of the facts and conditions that
1224resulted in the agency action.
1225     408.818  Health Care Trust Fund.--Unless otherwise
1226prescribed by authorizing statutes, all fees and fines collected
1227under this part, authorizing statutes, and applicable rules
1228shall be deposited into the Health Care Trust Fund, created in
1229s. 408.16, and used to pay the costs of the agency in
1230administering the provider program paying the fees or fines.
1231     408.819  Rules.--The agency is authorized to adopt rules as
1232necessary to administer this part. Any licensed provider that is
1233in operation at the time of adoption of any applicable rule
1234under this part or authorizing statutes shall be given a
1235reasonable time under the particular circumstances, not to
1236exceed 6 months after the date of such adoption, within which to
1237comply with such rule, unless otherwise specified by rule.
1238     Section 6.  Subsections (12) and (17) and paragraph (a) of
1239subsection (13) of section 112.0455, Florida Statutes, are
1240amended to read:
1241     112.0455  Drug-Free Workplace Act.--
1242     (12)  DRUG-TESTING STANDARDS; LABORATORIES.--
1243     (a)  The requirements of part II of chapter 408 shall apply
1244to the provision of services that require licensure pursuant to
1245this section and part II of chapter 408 and to entities licensed
1246by or applying for such licensure from the Agency for Health
1247Care Administration pursuant to this section.
1248     (b)(a)  A laboratory may analyze initial or confirmation
1249drug specimens only if:
1250     1.  The laboratory is licensed and approved by the Agency
1251for Health Care Administration using criteria established by the
1252United States Department of Health and Human Services as general
1253guidelines for modeling the state drug testing program and in
1254accordance with part II of chapter 408. Each applicant for
1255licensure and licensee must comply with all requirements of part
1256II of chapter 408 except s. 408.810(5)-(10). the following
1257requirements:
1258     a.  Upon receipt of a completed, signed, and dated
1259application, the agency shall require background screening, in
1260accordance with the level 2 standards for screening set forth in
1261chapter 435, of the managing employee, or other similarly titled
1262individual responsible for the daily operation of the
1263laboratory, and of the financial officer, or other similarly
1264titled individual who is responsible for the financial operation
1265of the laboratory, including billings for services. The
1266applicant must comply with the procedures for level 2 background
1267screening as set forth in chapter 435, as well as the
1268requirements of s. 435.03(3).
1269     b.  The agency may require background screening of any
1270other individual who is an applicant if the agency has probable
1271cause to believe that he or she has been convicted of an offense
1272prohibited under the level 2 standards for screening set forth
1273in chapter 435.
1274     c.  Proof of compliance with the level 2 background
1275screening requirements of chapter 435 which has been submitted
1276within the previous 5 years in compliance with any other health
1277care licensure requirements of this state is acceptable in
1278fulfillment of screening requirements.
1279     d.  A provisional license may be granted to an applicant
1280when each individual required by this section to undergo
1281background screening has met the standards for the Department of
1282Law Enforcement background check, but the agency has not yet
1283received background screening results from the Federal Bureau of
1284Investigation, or a request for a disqualification exemption has
1285been submitted to the agency as set forth in chapter 435, but a
1286response has not yet been issued. A license may be granted to
1287the applicant upon the agency's receipt of a report of the
1288results of the Federal Bureau of Investigation background
1289screening for each individual required by this section to
1290undergo background screening which confirms that all standards
1291have been met, or upon the granting of a disqualification
1292exemption by the agency as set forth in chapter 435. Any other
1293person who is required to undergo level 2 background screening
1294may serve in his or her capacity pending the agency's receipt of
1295the report from the Federal Bureau of Investigation. However,
1296the person may not continue to serve if the report indicates any
1297violation of background screening standards and a
1298disqualification exemption has not been requested of and granted
1299by the agency as set forth in chapter 435.
1300     e.  Each applicant must submit to the agency, with its
1301application, a description and explanation of any exclusions,
1302permanent suspensions, or terminations of the applicant from the
1303Medicare or Medicaid programs. Proof of compliance with the
1304requirements for disclosure of ownership and control interests
1305under the Medicaid or Medicare programs shall be accepted in
1306lieu of this submission.
1307     f.  Each applicant must submit to the agency a description
1308and explanation of any conviction of an offense prohibited under
1309the level 2 standards of chapter 435 by a member of the board of
1310directors of the applicant, its officers, or any individual
1311owning 5 percent or more of the applicant. This requirement does
1312not apply to a director of a not-for-profit corporation or
1313organization if the director serves solely in a voluntary
1314capacity for the corporation or organization, does not regularly
1315take part in the day-to-day operational decisions of the
1316corporation or organization, receives no remuneration for his or
1317her services on the corporation or organization's board of
1318directors, and has no financial interest and has no family
1319members with a financial interest in the corporation or
1320organization, provided that the director and the not-for-profit
1321corporation or organization include in the application a
1322statement affirming that the director's relationship to the
1323corporation satisfies the requirements of this sub-subparagraph.
1324     g.  A license may not be granted to any applicant if the
1325applicant or managing employee has been found guilty of,
1326regardless of adjudication, or has entered a plea of nolo
1327contendere or guilty to, any offense prohibited under the level
13282 standards for screening set forth in chapter 435, unless an
1329exemption from disqualification has been granted by the agency
1330as set forth in chapter 435.
1331     h.  The agency may deny or revoke licensure if the
1332applicant:
1333     (I)  Has falsely represented a material fact in the
1334application required by sub-subparagraph e. or sub-subparagraph
1335f., or has omitted any material fact from the application
1336required by sub-subparagraph e. or sub-subparagraph f.; or
1337     (II)  Has had prior action taken against the applicant
1338under the Medicaid or Medicare program as set forth in sub-
1339subparagraph e.
1340     i.  An application for license renewal must contain the
1341information required under sub-subparagraphs e. and f.
1342     2.  The laboratory has written procedures to ensure chain
1343of custody.
1344     3.  The laboratory follows proper quality control
1345procedures, including, but not limited to:
1346     a.  The use of internal quality controls including the use
1347of samples of known concentrations which are used to check the
1348performance and calibration of testing equipment, and periodic
1349use of blind samples for overall accuracy.
1350     b.  An internal review and certification process for drug
1351test results, conducted by a person qualified to perform that
1352function in the testing laboratory.
1353     c.  Security measures implemented by the testing laboratory
1354to preclude adulteration of specimens and drug test results.
1355     d.  Other necessary and proper actions taken to ensure
1356reliable and accurate drug test results.
1357     (c)(b)  A laboratory shall disclose to the employer a
1358written test result report within 7 working days after receipt
1359of the sample. All laboratory reports of a drug test result
1360shall, at a minimum, state:
1361     1.  The name and address of the laboratory which performed
1362the test and the positive identification of the person tested.
1363     2.  Positive results on confirmation tests only, or
1364negative results, as applicable.
1365     3.  A list of the drugs for which the drug analyses were
1366conducted.
1367     4.  The type of tests conducted for both initial and
1368confirmation tests and the minimum cutoff levels of the tests.
1369     5.  Any correlation between medication reported by the
1370employee or job applicant pursuant to subparagraph (8)(b)2. and
1371a positive confirmed drug test result.
1372
1373No report shall disclose the presence or absence of any drug
1374other than a specific drug and its metabolites listed pursuant
1375to this section.
1376     (d)(c)  The laboratory shall submit to the Agency for
1377Health Care Administration a monthly report with statistical
1378information regarding the testing of employees and job
1379applicants. The reports shall include information on the methods
1380of analyses conducted, the drugs tested for, the number of
1381positive and negative results for both initial and confirmation
1382tests, and any other information deemed appropriate by the
1383Agency for Health Care Administration. No monthly report shall
1384identify specific employees or job applicants.
1385     (e)(d)  Laboratories shall provide technical assistance to
1386the employer, employee, or job applicant for the purpose of
1387interpreting any positive confirmed test results which could
1388have been caused by prescription or nonprescription medication
1389taken by the employee or job applicant.
1390     (13)  RULES.--
1391     (a)  The Agency for Health Care Administration may adopt
1392additional rules to support this law and part II of chapter 408,
1393using criteria established by the United States Department of
1394Health and Human Services as general guidelines for modeling
1395drug-free workplace laboratories the state drug-testing program,
1396concerning, but not limited to:
1397     1.  Standards for drug-testing laboratory licensing and
1398denial, suspension, and revocation of a license.
1399     2.  Urine, hair, blood, and other body specimens and
1400minimum specimen amounts which are appropriate for drug testing,
1401not inconsistent with other provisions established by law.
1402     3.  Methods of analysis and procedures to ensure reliable
1403drug-testing results, including standards for initial tests and
1404confirmation tests, not inconsistent with other provisions
1405established by law.
1406     4.  Minimum cutoff detection levels for drugs or their
1407metabolites for the purposes of determining a positive test
1408result, not inconsistent with other provisions established by
1409law.
1410     5.  Chain-of-custody procedures to ensure proper
1411identification, labeling, and handling of specimens being
1412tested, not inconsistent with other provisions established by
1413law.
1414     6.  Retention, storage, and transportation procedures to
1415ensure reliable results on confirmation tests and retests.
1416     7.  A list of the most common medications by brand name or
1417common name, as applicable, as well as by chemical name, which
1418may alter or affect a drug test.
1419
1420This section shall not be construed to eliminate the bargainable
1421rights as provided in the collective bargaining process where
1422applicable.
1423     (17)  LICENSE FEE.--Fees from licensure of drug-testing
1424laboratories shall be sufficient to carry out the
1425responsibilities of the Agency for Health Care Administration
1426for the regulation of drug-testing laboratories. In accordance
1427with s. 408.805, applicants and licensees shall pay a fee for
1428each license application submitted under this part, part II of
1429chapter 408, and applicable rules. The fee shall be not less
1430than $16,000 or more than $20,000 per biennium and shall be
1431established by rule. The Agency for Health Care Administration
1432shall collect fees for all licenses issued under this part. Each
1433nonrefundable fee shall be due at the time of application and
1434shall be payable to the Agency for Health Care Administration to
1435be deposited in a trust fund administered by the Agency for
1436Health Care Administration and used only for the purposes of
1437this section. The fee schedule is as follows: For licensure as a
1438drug-testing laboratory, an annual fee of not less than $8,000
1439or more than $10,000 per fiscal year; for late filing of an
1440application for renewal, an additional fee of $500 per day shall
1441be charged.
1442     Section 7.  Subsection (7) of section 381.0303, Florida
1443Statutes, is amended to read:
1444     381.0303  Health practitioner recruitment for special needs
1445shelters.--
1446     (7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
1447of emergency management plans to county health departments by
1448home health agencies pursuant to s. 400.497(8)(c) and (d) and by
1449nurse registries pursuant to s. 400.506(11)(16)(e) and by
1450hospice programs pursuant to s. 400.610(1)(b) is conditional
1451upon the receipt of an appropriation by the department to
1452establish medical services disaster coordinator positions in
1453county health departments unless the secretary of the department
1454and a local county commission jointly determine to require such
1455plans to be submitted based on a determination that there is a
1456special need to protect public health in the local area during
1457an emergency.
1458     Section 8.  Paragraph (b) of subsection (4) of section
1459381.78, Florida Statutes, is amended to read:
1460     381.78  Advisory council on brain and spinal cord
1461injuries.--
1462     (4)  The council shall:
1463     (b)  Annually appoint a five-member committee composed of
1464one individual who has a brain injury or has a family member
1465with a brain injury, one individual who has a spinal cord injury
1466or has a family member with a spinal cord injury, and three
1467members who shall be chosen from among these representative
1468groups: physicians, other allied health professionals,
1469administrators of brain and spinal cord injury programs, and
1470representatives from support groups with expertise in areas
1471related to the rehabilitation of individuals who have brain or
1472spinal cord injuries, except that one and only one member of the
1473committee shall be an administrator of a transitional living
1474facility. Membership on the council is not a prerequisite for
1475membership on this committee.
1476     1.  The committee shall perform onsite visits to those
1477transitional living facilities identified by the Agency for
1478Health Care Administration as being in possible violation of the
1479statutes and rules regulating such facilities. The committee
1480members have the same rights of entry and inspection granted
1481under s. 400.805(4)(8) to designated representatives of the
1482agency.
1483     2.  Factual findings of the committee resulting from an
1484onsite investigation of a facility pursuant to subparagraph 1.
1485shall be adopted by the agency in developing its administrative
1486response regarding enforcement of statutes and rules regulating
1487the operation of the facility.
1488     3.  Onsite investigations by the committee shall be funded
1489by the Health Care Trust Fund.
1490     4.  Travel expenses for committee members shall be
1491reimbursed in accordance with s. 112.061.
1492     5.  Members of the committee shall recuse themselves from
1493participating in any investigation that would create a conflict
1494of interest under state law, and the council shall replace the
1495member, either temporarily or permanently.
1496     Section 9.  Section 383.301, Florida Statutes, is amended
1497to read:
1498     383.301  Licensure and regulation of birth centers;
1499legislative intent.--It is the intent of the Legislature to
1500provide for the protection of public health and safety in the
1501establishment, maintenance, and operation of birth centers by
1502providing for licensure of birth centers and for the
1503development, establishment, and enforcement of minimum standards
1504with respect to birth centers. The requirements of part II of
1505chapter 408 shall apply to the provision of services that
1506require licensure pursuant to ss. 383.30-383.335 and part II of
1507chapter 408 and to entities licensed by or applying for such
1508licensure from the Agency for Health Care Administration
1509pursuant to ss. 383.30-383.335.
1510     Section 10.  Section 383.304, Florida Statutes, is
1511repealed.
1512     Section 11.  Section 383.305, Florida Statutes, is amended
1513to read:
1514     383.305  Licensure; issuance, renewal, denial, suspension,
1515revocation; fees; background screening.--
1516     (1)(a)  In accordance with s. 408.805, an applicant or a
1517licensee shall pay a fee for each license application submitted
1518under ss. 383.30-383.335 and part II of chapter 408. The amount
1519of the fee shall be established by rule. Upon receipt of an
1520application for a license and the license fee, the agency shall
1521issue a license if the applicant and facility have received all
1522approvals required by law and meet the requirements established
1523under ss. 383.30-383.335 and by rules promulgated hereunder.
1524     (b)  A provisional license may be issued to any birth
1525center that is in substantial compliance with ss. 383.30-383.335
1526and with the rules of the agency. A provisional license may be
1527granted for a period of no more than 1 year from the effective
1528date of rules adopted by the agency, shall expire automatically
1529at the end of its term, and may not be renewed.
1530     (c)  A license, unless sooner suspended or revoked,
1531automatically expires 1 year from its date of issuance and is
1532renewable upon application for renewal and payment of the fee
1533prescribed, provided the applicant and the birth center meet the
1534requirements established under ss. 383.30-383.335 and by rules
1535promulgated hereunder. A complete application for renewal of a
1536license shall be made 90 days prior to expiration of the license
1537on forms provided by the agency.
1538     (2)  An application for a license, or renewal thereof,
1539shall be made to the agency upon forms provided by it and shall
1540contain such information as the agency reasonably requires,
1541which may include affirmative evidence of ability to comply with
1542applicable laws and rules.
1543     (3)(a)  Each application for a birth center license, or
1544renewal thereof, shall be accompanied by a license fee. Fees
1545shall be established by rule of the agency. Such fees are
1546payable to the agency and shall be deposited in a trust fund
1547administered by the agency, to be used for the sole purpose of
1548carrying out the provisions of ss. 383.30-383.335.
1549     (b)  The fees established pursuant to ss. 383.30-383.335
1550shall be based on actual costs incurred by the agency in the
1551administration of its duties under such sections.
1552     (4)  Each license is valid only for the person or
1553governmental unit to whom or which it is issued; is not subject
1554to sale, assignment, or other transfer, voluntary or
1555involuntary; and is not valid for any premises other than those
1556for which it was originally issued.
1557     (5)  Each license shall be posted in a conspicuous place on
1558the licensed premises.
1559     (6)  Whenever the agency finds that there has been a
1560substantial failure to comply with the requirements established
1561under ss. 383.30-383.335 or in rules adopted under those
1562sections, it is authorized to deny, suspend, or revoke a
1563license.
1564     (2)(7)  Each applicant for licensure and each licensee must
1565comply with the following requirements of part II of chapter 408
1566except s. 408.810(7)-(10).:
1567     (a)  Upon receipt of a completed, signed, and dated
1568application, the agency shall require background screening, in
1569accordance with the level 2 standards for screening set forth in
1570chapter 435, of the managing employee, or other similarly titled
1571individual who is responsible for the daily operation of the
1572center, and of the financial officer, or other similarly titled
1573individual who is responsible for the financial operation of the
1574center, including billings for patient care and services. The
1575applicant must comply with the procedures for level 2 background
1576screening as set forth in chapter 435 as well as the
1577requirements of s. 435.03(3).
1578     (b)  The agency may require background screening of any
1579other individual who is an applicant if the agency has probable
1580cause to believe that he or she has been convicted of a crime or
1581has committed any other offense prohibited under the level 2
1582standards for screening set forth in chapter 435.
1583     (c)  Proof of compliance with the level 2 background
1584screening requirements of chapter 435 which has been submitted
1585within the previous 5 years in compliance with any other health
1586care licensure requirements of this state is acceptable in
1587fulfillment of the requirements of paragraph (a).
1588     (d)  A provisional license may be granted to an applicant
1589when each individual required by this section to undergo
1590background screening has met the standards for the Department of
1591Law Enforcement background check, but the agency has not yet
1592received background screening results from the Federal Bureau of
1593Investigation, or a request for a disqualification exemption has
1594been submitted to the agency as set forth in chapter 435 but a
1595response has not yet been issued. A standard license may be
1596granted to the applicant upon the agency's receipt of a report
1597of the results of the Federal Bureau of Investigation background
1598screening for each individual required by this section to
1599undergo background screening which confirms that all standards
1600have been met, or upon the granting of a disqualification
1601exemption by the agency as set forth in chapter 435. Any other
1602person who is required to undergo level 2 background screening
1603may serve in his or her capacity pending the agency's receipt of
1604the report from the Federal Bureau of Investigation. However,
1605the person may not continue to serve if the report indicates any
1606violation of background screening standards and a
1607disqualification exemption has not been requested of and granted
1608by the agency as set forth in chapter 435.
1609     (e)  Each applicant must submit to the agency, with its
1610application, a description and explanation of any exclusions,
1611permanent suspensions, or terminations of the applicant from the
1612Medicare or Medicaid programs. Proof of compliance with the
1613requirements for disclosure of ownership and control interests
1614under the Medicaid or Medicare programs shall be accepted in
1615lieu of this submission.
1616     (f)  Each applicant must submit to the agency a description
1617and explanation of any conviction of an offense prohibited under
1618the level 2 standards of chapter 435 by a member of the board of
1619directors of the applicant, its officers, or any individual
1620owning 5 percent or more of the applicant. This requirement does
1621not apply to a director of a not-for-profit corporation or
1622organization if the director serves solely in a voluntary
1623capacity for the corporation or organization, does not regularly
1624take part in the day-to-day operational decisions of the
1625corporation or organization, receives no remuneration for his or
1626her services on the corporation or organization's board of
1627directors, and has no financial interest and has no family
1628members with a financial interest in the corporation or
1629organization, provided that the director and the not-for-profit
1630corporation or organization include in the application a
1631statement affirming that the director's relationship to the
1632corporation satisfies the requirements of this paragraph.
1633     (g)  A license may not be granted to an applicant if the
1634applicant or managing employee has been found guilty of,
1635regardless of adjudication, or has entered a plea of nolo
1636contendere or guilty to, any offense prohibited under the level
16372 standards for screening set forth in chapter 435, unless an
1638exemption from disqualification has been granted by the agency
1639as set forth in chapter 435.
1640     (h)  The agency may deny or revoke licensure if the
1641applicant:
1642     1.  Has falsely represented a material fact in the
1643application required by paragraph (e) or paragraph (f), or has
1644omitted any material fact from the application required by
1645paragraph (e) or paragraph (f); or
1646     2.  Has had prior action taken against the applicant under
1647the Medicaid or Medicare program as set forth in paragraph (e).
1648     (i)  An application for license renewal must contain the
1649information required under paragraphs (e) and (f).
1650     Section 12.  Section 383.309, Florida Statutes, is amended
1651to read:
1652     383.309  Minimum standards for birth centers; rules and
1653enforcement.--
1654     (1)  The agency shall adopt and enforce rules to administer
1655ss. 383.30-383.335 and part II of chapter 408, which rules shall
1656include, but are not limited to, reasonable and fair minimum
1657standards for ensuring that:
1658     (a)  Sufficient numbers and qualified types of personnel
1659and occupational disciplines are available at all times to
1660provide necessary and adequate patient care and safety.
1661     (b)  Infection control, housekeeping, sanitary conditions,
1662disaster plan, and medical record procedures that will
1663adequately protect patient care and provide safety are
1664established and implemented.
1665     (c)  Licensed facilities are established, organized, and
1666operated consistent with established programmatic standards.
1667     (2)  Any licensed facility that is in operation at the time
1668of adoption of any applicable rule under ss. 383.30-383.335
1669shall be given a reasonable time under the particular
1670circumstances, not to exceed 1 year after the date of such
1671adoption, within which to comply with such rule.
1672     (2)(3)  The agency may not establish any rule governing the
1673design, construction, erection, alteration, modification,
1674repair, or demolition of birth centers. It is the intent of the
1675Legislature to preempt that function to the Florida Building
1676Commission and the State Fire Marshal through adoption and
1677maintenance of the Florida Building Code and the Florida Fire
1678Prevention Code. However, the agency shall provide technical
1679assistance to the commission and the State Fire Marshal in
1680updating the construction standards of the Florida Building Code
1681and the Florida Fire Prevention Code which govern birth centers.
1682In addition, the agency may enforce the special-occupancy
1683provisions of the Florida Building Code and the Florida Fire
1684Prevention Code which apply to birth centers in conducting any
1685inspection authorized under this chapter.
1686     Section 13.  Subsection (1) of section 383.315, Florida
1687Statutes, is amended to read:
1688     383.315  Agreements with consultants for advice or
1689services; maintenance.--
1690     (1)  A birth center shall maintain in writing a
1691consultation agreement, signed within the current license period
1692year, with each consultant who has agreed to provide advice and
1693services to the birth center as requested.
1694     Section 14.  Section 383.324, Florida Statutes, is amended
1695to read:
1696     383.324  Inspections and investigations; Inspection fees.--
1697     (1)  The agency shall make or cause to be made such
1698inspections and investigations as it deems necessary.
1699     (2)  Each facility licensed under s. 383.305 shall pay to
1700the agency, at the time of inspection, an inspection fee
1701established by rule of the agency.
1702     (3)  The agency shall coordinate all periodic inspections
1703for licensure made by the agency to ensure that the cost to the
1704facility of such inspections and the disruption of services by
1705such inspections is minimized.
1706     Section 15.  Section 383.325, Florida Statutes, is
1707repealed.
1708     Section 16.  Section 383.33, Florida Statutes, is amended
1709to read:
1710     383.33  Administrative fines penalties; emergency orders;
1711moratorium on admissions.--
1712     (1)(a)  In addition to the requirements of part II of
1713chapter 408, the agency may deny, revoke, or suspend a license,
1714or impose an administrative fine not to exceed $500 per
1715violation per day, for the violation of any provision of ss.
1716383.30-383.335, part II of chapter 408, or applicable rules or
1717any rule adopted under ss. 383.30-383.335. Each day of violation
1718constitutes a separate violation and is subject to a separate
1719fine.
1720     (2)(b)  In determining the amount of the fine to be levied
1721for a violation, as provided in subsection (1) paragraph (a),
1722the following factors shall be considered:
1723     (a)1.  The severity of the violation, including the
1724probability that death or serious harm to the health or safety
1725of any person will result or has resulted; the severity of the
1726actual or potential harm; and the extent to which the provisions
1727of ss. 383.30-383.335, part II of chapter 408, or applicable
1728rules were violated.
1729     (b)2.  Actions taken by the licensee to correct the
1730violations or to remedy complaints.
1731     (c)3.  Any previous violations by the licensee.
1732     (c)  All amounts collected pursuant to this section shall
1733be deposited into a trust fund administered by the agency to be
1734used for the sole purpose of carrying out the provisions of ss.
1735383.30-383.335.
1736     (2)  The agency may issue an emergency order immediately
1737suspending or revoking a license when it determines that any
1738condition in the licensed facility presents a clear and present
1739danger to the public health and safety.
1740     (3)  The agency may impose an immediate moratorium on
1741elective admissions to any licensed facility, building or
1742portion thereof, or service when the agency determines that any
1743condition in the facility presents a threat to the public health
1744or safety.
1745     Section 17.  Section 383.331, Florida Statutes, is
1746repealed.
1747     Section 18.  Section 383.332, Florida Statutes, is
1748repealed.
1749     Section 19.  Subsection (1) of section 383.335, Florida
1750Statutes, is amended to read:
1751     383.335  Partial exemptions.--
1752     (1)  Any facility that which was providing obstetrical and
1753gynecological surgical services and was owned and operated by a
1754board-certified obstetrician on June 15, 1984, and that which is
1755otherwise subject to licensure under ss. 383.30-383.335 as a
1756birth center, is exempt from the provisions of ss. 383.30-
1757383.335 and part II of chapter 408 which restrict the provision
1758of surgical services and outlet forceps delivery and the
1759administration of anesthesia at birth centers. The agency shall
1760adopt rules specifically related to the performance of such
1761services and the administration of anesthesia at such
1762facilities.
1763     Section 20.  Subsection (4) of section 383.50, Florida
1764Statutes, is amended to read:
1765     383.50  Treatment of abandoned newborn infant.--
1766     (4)  Each hospital of this state subject to s. 395.1041
1767shall, and any other hospital may, admit and provide all
1768necessary emergency services and care, as defined in s.
1769395.002(9)(10), to any newborn infant left with the hospital in
1770accordance with this section. The hospital or any of its
1771licensed health care professionals shall consider these actions
1772as implied consent for treatment, and a hospital accepting
1773physical custody of a newborn infant has implied consent to
1774perform all necessary emergency services and care. The hospital
1775or any of its licensed health care professionals is immune from
1776criminal or civil liability for acting in good faith in
1777accordance with this section. Nothing in this subsection limits
1778liability for negligence.
1779     Section 21.  Subsection (5) of section 390.011, Florida
1780Statutes, is amended to read:
1781     390.011  Definitions.--As used in this chapter, the term:
1782     (5)  "Hospital" means a facility as defined in s. 395.002
1783and licensed under chapter 395.
1784     Section 22.  Subsection (1) of section 390.012, Florida
1785Statutes, is amended to read:
1786     390.012  Powers of agency; rules; disposal of fetal
1787remains.--
1788     (1)  The agency may shall have the authority to develop and
1789enforce rules pursuant to ss. 390.001-390.018 and part II of
1790chapter 408 for the health, care, and treatment of persons in
1791abortion clinics and for the safe operation of such clinics.
1792These rules shall be comparable to rules which apply to all
1793surgical procedures requiring approximately the same degree of
1794skill and care as the performance of first trimester abortions.
1795The rules shall be reasonably related to the preservation of
1796maternal health of the clients. The rules shall not impose a
1797legally significant burden on a woman's freedom to decide
1798whether to terminate her pregnancy. The rules shall provide for:
1799     (a)  The performance of pregnancy termination procedures
1800only by a licensed physician.
1801     (b)  The making, protection, and preservation of patient
1802records, which shall be treated as medical records under chapter
1803458.
1804     Section 23.  Section 390.013, Florida Statutes, is
1805repealed.
1806     Section 24.  Section 390.014, Florida Statutes, is amended
1807to read:
1808     390.014  Licenses; fees, display, etc.--
1809     (1)  The requirements of part II of chapter 408 shall apply
1810to the provision of services that require licensure pursuant to
1811ss. 390.011-390.018 and part II of chapter 408 and to entities
1812licensed by or applying for such licensure from the Agency for
1813Health Care Administration pursuant to ss. 390.011-390.018.
1814However, each applicant for licensure and each licensee is
1815exempt from s. 408.810(7)-(10). No abortion clinic shall operate
1816in this state without a currently effective license issued by
1817the agency.
1818     (2)  A separate license shall be required for each clinic
1819maintained on separate premises, even though it is operated by
1820the same management as another clinic; but a separate license
1821shall not be required for separate buildings on the same
1822premises.
1823     (3)  In accordance with s. 408.805, an applicant or
1824licensee shall pay a fee for each license application submitted
1825under this part and part II of chapter 408. The amount of the
1826fee shall be established by rule and The annual license fee
1827required for a clinic shall be nonrefundable and shall be
1828reasonably calculated to cover the cost of regulation under this
1829chapter, but may not be less than $70 or $35 nor more than $500
1830per biennium $250.
1831     (4)  Counties and municipalities applying for licenses
1832under this act shall be exempt from the payment of the license
1833fees.
1834     (5)  The license shall be displayed in a conspicuous place
1835inside the clinic.
1836     (6)  A license shall be valid only for the clinic to which
1837it is issued, and it shall not be subject to sale, assignment,
1838or other transfer, voluntary or involuntary. No license shall be
1839valid for any premises other than those for which it was
1840originally issued.
1841     Section 25.  Section 390.015, Florida Statutes, is
1842repealed.
1843     Section 26.  Section 390.016, Florida Statutes, is
1844repealed.
1845     Section 27.  Section 390.017, Florida Statutes, is
1846repealed.
1847     Section 28.  Section 390.018, Florida Statutes, is amended
1848to read:
1849     390.018  Administrative fine penalty in lieu of revocation
1850or suspension.--In addition to the requirements of part II of
1851chapter 408 If the agency finds that one or more grounds exist
1852for the revocation or suspension of a license issued to an
1853abortion clinic, the agency may, in lieu of such suspension or
1854revocation, impose a fine upon the clinic in an amount not to
1855exceed $1,000 for each violation of any provision this part,
1856part II of chapter 408, or applicable rules. The fine shall be
1857paid to the agency within 60 days from the date of entry of the
1858administrative order. If the licensee fails to pay the fine in
1859its entirety to the agency within the period allowed, the
1860license of the licensee shall stand suspended, revoked, or
1861renewal or continuation may be refused, as the case may be, upon
1862expiration of such period and without any further administrative
1863or judicial proceedings.
1864     Section 29.  Section 390.019, Florida Statutes, is
1865repealed.
1866     Section 30.  Section 390.021, Florida Statutes, is
1867repealed.
1868     Section 31.  Subsection (13) of section 394.455, Florida
1869Statutes, is amended to read:
1870     394.455  Definitions.--As used in this part, unless the
1871context clearly requires otherwise, the term:
1872     (13)  "Hospital" means a facility as defined in s. 395.002
1873and licensed under chapter 395.
1874     Section 32.  Subsection (7) of section 394.4787, Florida
1875Statutes, is amended to read:
1876     394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
1877and 394.4789.--As used in this section and ss. 394.4786,
1878394.4788, and 394.4789:
1879     (7)  "Specialty psychiatric hospital" means a hospital
1880licensed by the agency pursuant to s. 395.002(28)(29) as a
1881specialty psychiatric hospital.
1882     Section 33.  Subsections (3) through (23) of section
1883394.67, Florida Statutes, are renumbered as subsections (2)
1884through (22), respectively, present subsections (2) and (4) are
1885amended, and a new subsection (23) is added to said section, to
1886read:
1887     394.67  Definitions.--As used in this part, the term:
1888     (2)  "Applicant" means an individual applicant, or any
1889officer, director, agent, managing employee, or affiliated
1890person, or any partner or shareholder having an ownership
1891interest equal to a 5-percent or greater interest in the
1892corporation, partnership, or other business entity.
1893     (3)(4)  "Crisis services" means short-term evaluation,
1894stabilization, and brief intervention services provided to a
1895person who is experiencing an acute mental or emotional crisis,
1896as defined in subsection (17) (18), or an acute substance abuse
1897crisis, as defined in subsection (18) (19), to prevent further
1898deterioration of the person's mental health. Crisis services are
1899provided in settings such as a crisis stabilization unit, an
1900inpatient unit, a short-term residential treatment program, a
1901detoxification facility, or an addictions receiving facility; at
1902the site of the crisis by a mobile crisis response team; or at a
1903hospital on an outpatient basis.
1904     (23)  "Short-term residential treatment facility" means a
1905facility that provides an alternative to inpatient
1906hospitalization and that provides brief, intensive services 24
1907hours a day, 7 days a week for mentally ill individuals who are
1908temporarily in need of a 24-hour-a-day structured therapeutic
1909setting as a less restrictive but longer-term alternative to
1910hospitalization.
1911     Section 34.  Paragraph (a) of subsection (3) of section
1912394.74, Florida Statutes, is amended to read:
1913     394.74  Contracts for provision of local substance abuse
1914and mental health programs.--
1915     (3)  Contracts shall include, but are not limited to:
1916     (a)  A provision that, within the limits of available
1917resources, substance abuse and mental health crisis services, as
1918defined in s. 394.67(3)(4), shall be available to any individual
1919residing or employed within the service area, regardless of
1920ability to pay for such services, current or past health
1921condition, or any other factor;
1922     Section 35.  Subsections (1) and (5) of section 394.82,
1923Florida Statutes, are amended to read:
1924     394.82  Funding of expanded services.--
1925     (1)  Pursuant to the General Appropriations Acts for the
19262001-2002 and 2002-2003 fiscal years, funds appropriated to the
1927Department of Children and Family Services for the purpose of
1928expanding community mental health services must be used to
1929implement programs that emphasize crisis services as defined in
1930s. 394.67(3)(4) and treatment services, rehabilitative services,
1931support services, and case management services, as defined in s.
1932394.67(15)(16). Following the 2002-2003 fiscal year, the
1933Department of Children and Family Services must continue to
1934expand the provision of these community mental health services.
1935     (5)  By January 1, 2004, the crisis services defined in s.
1936394.67(3)(4) shall be implemented, as appropriate, in the
1937state's public community mental health system to serve children
1938and adults who are experiencing an acute mental or emotional
1939crisis, as defined in s. 394.67(17)(18). By January 1, 2006, the
1940mental health services defined in s. 394.67(15)(16) shall be
1941implemented, as appropriate, in the state's public community
1942mental health system to serve adults and older adults who have a
1943severe and persistent mental illness and to serve children who
1944have a serious emotional disturbance or mental illness, as
1945defined in s. 394.492(6).
1946     Section 36.  Section 394.875, Florida Statutes, is amended
1947to read:
1948     394.875  Crisis stabilization units, short-term residential
1949treatment facilities, residential treatment facilities, and
1950residential treatment centers for children and adolescents;
1951authorized services; license required; penalties.--
1952     (1)(a)  The purpose of a crisis stabilization unit is to
1953stabilize and redirect a client to the most appropriate and
1954least restrictive community setting available, consistent with
1955the client's needs. Crisis stabilization units may screen,
1956assess, and admit for stabilization persons who present
1957themselves to the unit and persons who are brought to the unit
1958under s. 394.463. Clients may be provided 24-hour observation,
1959medication prescribed by a physician or psychiatrist, and other
1960appropriate services. Crisis stabilization units shall provide
1961services regardless of the client's ability to pay and shall be
1962limited in size to a maximum of 30 beds.
1963     (b)  The purpose of a short-term residential treatment
1964facility is to provide intensive services in a 24-hour-a-day
1965structured therapeutic setting as a less restrictive but longer-
1966term alternative to hospitalization.
1967     (c)(b)  The purpose of a residential treatment facility is
1968to be a part of a comprehensive treatment program for mentally
1969ill individuals in a community-based residential setting.
1970     (d)(c)  The purpose of a residential treatment center for
1971children and adolescents is to provide mental health assessment
1972and treatment services pursuant to ss. 394.491, 394.495, and
1973394.496 to children and adolescents who meet the target
1974population criteria specified in s. 394.493(1)(a), (b), or (c).
1975     (2)  The requirements of part II of chapter 408 shall apply
1976to the provision of services that require licensure under ss.
1977394.455-394.904 and part II of chapter 408 and to entities
1978licensed by or applying for such licensure from the Agency for
1979Health Care Administration pursuant to ss. 394.455-394.904.
1980However, each applicant for licensure and each licensee is
1981exempt from the provisions of s. 408.810(8)?(10). It is unlawful
1982for any entity to hold itself out as a crisis stabilization
1983unit, a residential treatment facility, or a residential
1984treatment center for children and adolescents, or to act as a
1985crisis stabilization unit, a residential treatment facility, or
1986a residential treatment center for children and adolescents,
1987unless it is licensed by the agency pursuant to this chapter.
1988     (3)  Any person who violates subsection (2) is guilty of a
1989misdemeanor of the first degree, punishable as provided in s.
1990775.082 or s. 775.083.
1991     (4)  The agency may maintain an action in circuit court to
1992enjoin the unlawful operation of a crisis stabilization unit, a
1993residential treatment facility, or a residential treatment
1994center for children and adolescents if the agency first gives
1995the violator 14 days' notice of its intention to maintain such
1996action and if the violator fails to apply for licensure within
1997such 14-day period.
1998     (3)(5)  The following are exempt from licensure as required
1999in ss. 394.455-394.904 Subsection (2) does not apply to:
2000     (a)  Hospitals licensed pursuant to chapter 395 or programs
2001operated within such hospitals. Homes for special services
2002licensed under chapter 400; or
2003     (b)  Nursing homes licensed under chapter 400.
2004     (c)  Comprehensive transitional education programs licensed
2005under s. 393.067.
2006     (4)(6)  The department, in consultation with the agency,
2007may establish multiple license classifications for residential
2008treatment facilities.
2009     (5)(7)  The agency may not issue a license to a crisis
2010stabilization unit unless the unit receives state mental health
2011funds and is affiliated with a designated public receiving
2012facility.
2013     (6)(8)  The agency may issue a license for a crisis
2014stabilization unit or short-term residential treatment facility,
2015certifying the number of authorized beds for such facility as
2016indicated by existing need and available appropriations. The
2017agency may disapprove an application for such a license if it
2018determines that a facility should not be licensed pursuant to
2019the provisions of this chapter. Any facility operating beds in
2020excess of those authorized by the agency shall, upon demand of
2021the agency, reduce the number of beds to the authorized number,
2022forfeit its license, or provide evidence of a license issued
2023pursuant to chapter 395 for the excess beds.
2024     (7)(9)  A children's crisis stabilization unit which does
2025not exceed 20 licensed beds and which provides separate
2026facilities or a distinct part of a facility, separate staffing,
2027and treatment exclusively for minors may be located on the same
2028premises as a crisis stabilization unit serving adults. The
2029department, in consultation with the agency, shall adopt rules
2030governing facility construction, staffing and licensure
2031requirements, and the operation of such units for minors.
2032     (8)(10)  The department, in consultation with the agency,
2033must adopt rules governing a residential treatment center for
2034children and adolescents which specify licensure standards for:
2035admission; length of stay; program and staffing; discharge and
2036discharge planning; treatment planning; seclusion, restraints,
2037and time-out; rights of patients under s. 394.459; use of
2038psychotropic medications; and standards for the operation of
2039such centers.
2040     (9)(11)  Notwithstanding the provisions of subsection (8),
2041crisis stabilization units may not exceed their licensed
2042capacity by more than 10 percent, nor may they exceed their
2043licensed capacity for more than 3 consecutive working days or
2044for more than 7 days in 1 month.
2045     (10)(12)  Notwithstanding the other provisions of this
2046section, any facility licensed under former chapter 396 and
2047chapter 397 for detoxification, residential level I care, and
2048outpatient treatment may elect to license concurrently all of
2049the beds at such facility both for that purpose and as a long-
2050term residential treatment facility pursuant to this section, if
2051all of the following conditions are met:
2052     (a)  The licensure application is received by the
2053department prior to January 1, 1993.
2054     (b)  On January 1, 1993, the facility was licensed under
2055former chapter 396 and chapter 397 as a facility for
2056detoxification, residential level I care, and outpatient
2057treatment of substance abuse.
2058     (c)  The facility restricted its practice to the treatment
2059of law enforcement personnel for a period of at least 12 months
2060beginning after January 1, 1992.
2061     (d)  The number of beds to be licensed under this chapter
2062is equal to or less than the number of beds licensed under
2063former chapter 396 and chapter 397 as of January 1, 1993.
2064     (e)  The licensee agrees in writing to a condition placed
2065upon the license that the facility will limit its treatment
2066exclusively to law enforcement personnel and their immediate
2067families who are seeking admission on a voluntary basis and who
2068are exhibiting symptoms of posttraumatic stress disorder or
2069other mental health problems, including drug or alcohol abuse,
2070which are directly related to law enforcement work and which are
2071amenable to verbal treatment therapies; the licensee agrees to
2072coordinate the provision of appropriate postresidential care for
2073discharged individuals; and the licensee further agrees in
2074writing that a failure to meet any condition specified in this
2075paragraph shall constitute grounds for a revocation of the
2076facility's license as a residential treatment facility.
2077     (f)  The licensee agrees that the facility will meet all
2078licensure requirements for a residential treatment facility,
2079including minimum standards for compliance with lifesafety
2080requirements, except those licensure requirements which are in
2081express conflict with the conditions and other provisions
2082specified in this subsection.
2083     (g)  The licensee agrees that the conditions stated in this
2084subsection must be agreed to in writing by any person acquiring
2085the facility by any means.
2086
2087Any facility licensed under this subsection is not required to
2088provide any services to any persons except those included in the
2089specified conditions of licensure, and is exempt from any
2090requirements related to the 60-day or greater average length of
2091stay imposed on community-based residential treatment facilities
2092otherwise licensed under this chapter.
2093     (13)  Each applicant for licensure must comply with the
2094following requirements:
2095     (a)  Upon receipt of a completed, signed, and dated
2096application, the agency shall require background screening, in
2097accordance with the level 2 standards for screening set forth in
2098chapter 435, of the managing employee and financial officer, or
2099other similarly titled individual who is responsible for the
2100financial operation of the facility, including billings for
2101client care and services. The applicant must comply with the
2102procedures for level 2 background screening as set forth in
2103chapter 435, as well as the requirements of s. 435.03(3).
2104     (b)  The agency may require background screening of any
2105other individual who is an applicant if the agency has probable
2106cause to believe that he or she has been convicted of a crime or
2107has committed any other offense prohibited under the level 2
2108standards for screening set forth in chapter 435.
2109     (c)  Proof of compliance with the level 2 background
2110screening requirements of chapter 435 which has been submitted
2111within the previous 5 years in compliance with any other health
2112care licensure requirements of this state is acceptable in
2113fulfillment of the requirements of paragraph (a).
2114     (d)  A provisional license may be granted to an applicant
2115when each individual required by this section to undergo
2116background screening has met the standards for the Department of
2117Law Enforcement background check, but the agency has not yet
2118received background screening results from the Federal Bureau of
2119Investigation, or a request for a disqualification exemption has
2120been submitted to the agency as set forth in chapter 435, but a
2121response has not yet been issued. A standard license may be
2122granted to the applicant upon the agency's receipt of a report
2123of the results of the Federal Bureau of Investigation background
2124screening for each individual required by this section to
2125undergo background screening which confirms that all standards
2126have been met, or upon the granting of a disqualification
2127exemption by the agency as set forth in chapter 435. Any other
2128person who is required to undergo level 2 background screening
2129may serve in his or her capacity pending the agency's receipt of
2130the report from the Federal Bureau of Investigation. However,
2131the person may not continue to serve if the report indicates any
2132violation of background screening standards and a
2133disqualification exemption has not been requested of and granted
2134by the agency as set forth in chapter 435.
2135     (e)  Each applicant must submit to the agency, with its
2136application, a description and explanation of any exclusions,
2137permanent suspensions, or terminations of the applicant from the
2138Medicare or Medicaid programs. Proof of compliance with the
2139requirements for disclosure of ownership and control interests
2140under the Medicaid or Medicare programs shall be accepted in
2141lieu of this submission.
2142     (f)  Each applicant must submit to the agency a description
2143and explanation of any conviction of an offense prohibited under
2144the level 2 standards of chapter 435 by a member of the board of
2145directors of the applicant, its officers, or any individual
2146owning 5 percent or more of the applicant. This requirement does
2147not apply to a director of a not-for-profit corporation or
2148organization if the director serves solely in a voluntary
2149capacity for the corporation or organization, does not regularly
2150take part in the day-to-day operational decisions of the
2151corporation or organization, receives no remuneration for his or
2152her services on the corporation or organization's board of
2153directors, and has no financial interest and has no family
2154members with a financial interest in the corporation or
2155organization, provided that the director and the not-for-profit
2156corporation or organization include in the application a
2157statement affirming that the director's relationship to the
2158corporation satisfies the requirements of this paragraph.
2159     (g)  A license may not be granted to an applicant if the
2160applicant or managing employee has been found guilty of,
2161regardless of adjudication, or has entered a plea of nolo
2162contendere or guilty to, any offense prohibited under the level
21632 standards for screening set forth in chapter 435, unless an
2164exemption from disqualification has been granted by the agency
2165as set forth in chapter 435.
2166     (h)  The agency may deny or revoke licensure if the
2167applicant:
2168     1.  Has falsely represented a material fact in the
2169application required by paragraph (e) or paragraph (f), or has
2170omitted any material fact from the application required by
2171paragraph (e) or paragraph (f); or
2172     2.  Has had prior action taken against the applicant under
2173the Medicaid or Medicare program as set forth in paragraph (e).
2174     (i)  An application for license renewal must contain the
2175information required under paragraphs (e) and (f).
2176     Section 37.  Section 394.876, Florida Statutes, is
2177repealed.
2178     Section 38.  Section 394.877, Florida Statutes, is amended
2179to read:
2180     394.877  Fees.--
2181     (1)  In accordance with s. 408.805, an applicant or
2182licensee shall pay a fee for each license application submitted
2183under this part, part II of chapter 408, and applicable rules.
2184The amount of the fee shall be established by rule. Each
2185application for licensure or renewal must be accompanied by a
2186fee set by the department, in consultation with the agency, by
2187rule. Such fees shall be reasonably calculated to cover only the
2188cost of regulation under this chapter.
2189     (2)  All fees collected under this section shall be
2190deposited in the Health Care Trust Fund.
2191     Section 39.  Section 394.878, Florida Statutes, is amended
2192to read:
2193     394.878  Issuance and renewal of licenses.--
2194     (1)  Upon review of the application for licensure and
2195receipt of appropriate fees, the agency shall issue an original
2196or renewal license to any applicant that meets the requirements
2197of this chapter.
2198     (2)  A license is valid for a period of 1 year. An
2199applicant for renewal of a license shall apply to the agency no
2200later than 90 days before expiration of the current license.
2201     (3)  A license may not be transferred from one entity to
2202another and is valid only for the premises for which it was
2203originally issued. For the purposes of this subsection,
2204"transfer" includes, but is not limited to, transfer of a
2205majority of the ownership interests in a licensee or transfer of
2206responsibilities under the license to another entity by
2207contractual arrangement.
2208     (4)  Each license shall state the services which the
2209licensee is required or authorized to perform and the maximum
2210residential capacity of the licensed premises.
2211     (1)(5)  The agency may issue a probationary license to an
2212applicant that has completed the application requirements of
2213this chapter but has not, at the time of the application,
2214developed an operational crisis stabilization unit or
2215residential treatment facility. The probationary license shall
2216expire 90 days after issuance and may once be renewed for an
2217additional 90-day period. The agency may cancel a probationary
2218license at any time.
2219     (2)(6)  The agency may issue an interim license to an
2220applicant that has substantially completed all application
2221requirements and has initiated action to fully meet such
2222requirements. The interim license shall expire 90 days after
2223issuance and, in cases of extreme hardship, may once be renewed
2224for an additional 90-day period.
2225     (7)  Any applicant which fails to file an application for
2226license renewal during the 90-day relicensure period shall be
2227considered unlicensed and subject to penalties pursuant to s.
2228394.875.
2229     Section 40.  Subsections (1), (3), and (4) of section
2230394.879, Florida Statutes, are amended to read:
2231     394.879  Rules; enforcement.--
2232     (1)  The agency, in consultation with the department, may
2233adopt rules to implement the requirements of part II of chapter
2234408. The department, in consultation with the agency, shall
2235adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
2236the provisions of this chapter, including, at a minimum, rules
2237providing standards to ensure that:
2238     (a)  Sufficient numbers and types of qualified personnel
2239are on duty and available at all times to provide necessary and
2240adequate client safety and care.
2241     (b)  Adequate space is provided each client of a licensed
2242facility.
2243     (c)  Licensed facilities are limited to an appropriate
2244number of beds.
2245     (d)  Each licensee establishes and implements adequate
2246infection control, housekeeping, sanitation, disaster planning,
2247and medical recordkeeping.
2248     (e)  Licensed facilities are established, organized, and
2249operated in accordance with programmatic standards of the
2250department.
2251     (f)  The operation and purposes of these facilities assure
2252individuals' health, safety, and welfare.
2253     (3)  The department, in consultation with the agency, shall
2254allow any licensed facility in operation at the time of adoption
2255of any rule a reasonable period, not to exceed 1 year, to bring
2256itself into compliance with department rules such rule.
2257     (4)  In accordance with part II of chapter 408, the agency
2258may impose an administrative penalty of no more than $500 per
2259day against any licensee that violates any rule adopted pursuant
2260to this section and may suspend and or revoke the license and or
2261deny the renewal application of such licensee. In imposing such
2262penalty, the agency shall consider the severity of the
2263violation, actions taken by the licensee to correct the
2264violation, and previous violations by the licensee. Fines
2265collected under this subsection shall be deposited in the Mental
2266Health Facility Licensing Trust Fund.
2267     Section 41.  Paragraph (a) of subsection (1) of section
2268394.90, Florida Statutes, is amended to read:
2269     394.90  Inspection; right of entry; records.--
2270     (1)(a)  The department and the agency, in accordance with
2271s. 408.811, may enter and inspect at any time a licensed
2272facility to determine whether the facility is in compliance with
2273this chapter and the applicable rules of the department.
2274     Section 42.  Section 394.902, Florida Statutes, is
2275repealed.
2276     Section 43.  Subsection (7) of section 394.907, Florida
2277Statutes, is amended to read:
2278     394.907  Community mental health centers; quality assurance
2279programs.--
2280     (7)  The department shall have access to all records
2281necessary to determine licensee agency compliance with the
2282provisions of this section. The records of quality assurance
2283programs which relate solely to actions taken in carrying out
2284the provisions of this section, and records obtained by the
2285department to determine licensee agency compliance with this
2286section, are confidential and exempt from s. 119.07(1). Such
2287records are not admissible in any civil or administrative
2288action, except in disciplinary proceedings by the Department of
2289Business and Professional Regulation and the appropriate
2290regulatory board, nor shall such records be available to the
2291public as part of the record of investigation for, and
2292prosecution in disciplinary proceedings made available to the
2293public by the Department of Business and Professional Regulation
2294or the appropriate regulatory board. Meetings or portions of
2295meetings of quality assurance program committees that relate
2296solely to actions taken pursuant to this section are exempt from
2297s. 286.011.
2298     Section 44.  Subsections (5) through (33) of section
2299395.002, Florida Statutes, are renumbered as subsections (4)
2300through (32), respectively, and present subsections (4), (11),
2301and (29) of said section are amended to read:
2302     395.002  Definitions.--As used in this chapter:
2303     (4)  "Applicant" means an individual applicant, or any
2304officer, director, or agent, or any partner or shareholder
2305having an ownership interest equal to a 5-percent or greater
2306interest in the corporation, partnership, or other business
2307entity.
2308     (10)(11)  "General hospital" means any facility which meets
2309the provisions of subsection (12) (13) and which regularly makes
2310its facilities and services available to the general population.
2311     (28)(29)  "Specialty hospital" means any facility which
2312meets the provisions of subsection (12) (13), and which
2313regularly makes available either:
2314     (a)  The range of medical services offered by general
2315hospitals, but restricted to a defined age or gender group of
2316the population;
2317     (b)  A restricted range of services appropriate to the
2318diagnosis, care, and treatment of patients with specific
2319categories of medical or psychiatric illnesses or disorders; or
2320     (c)  Intensive residential treatment programs for children
2321and adolescents as defined in subsection (15) (16).
2322     Section 45.  Section 395.003, Florida Statutes, is amended
2323to read:
2324     395.003  Licensure; issuance, renewal, denial,
2325modification, suspension, and revocation.--
2326     (1)(a)  The requirements of part II of chapter 408 shall
2327apply to the provision of services that require licensure
2328pursuant to ss. 395.001-395.1065 and part II of chapter 408 and
2329to entities licensed by or applying for such licensure from the
2330Agency for Health Care Administration pursuant to ss. 395.001-
2331395.1065. However, each applicant for licensure and each
2332licensee is exempt from s. 408.810(7)-(9). Ambulatory surgical
2333center and mobile surgical facility licensees and applicants for
2334such licensure are also exempt from s. 408.810(10). A person may
2335not establish, conduct, or maintain a hospital, ambulatory
2336surgical center, or mobile surgical facility in this state
2337without first obtaining a license under this part.
2338     (b)1.  It is unlawful for a person to use or advertise to
2339the public, in any way or by any medium whatsoever, any facility
2340as a "hospital," "ambulatory surgical center," or "mobile
2341surgical facility" unless such facility has first secured a
2342license under the provisions of this part.
2343     2.  This part does not apply to veterinary hospitals or to
2344commercial business establishments using the word "hospital,"
2345"ambulatory surgical center," or "mobile surgical facility" as a
2346part of a trade name if no treatment of human beings is
2347performed on the premises of such establishments.
2348     (c)3.  By December 31, 2004, the agency shall submit a
2349report to the President of the Senate and the Speaker of the
2350House of Representatives recommending whether it is in the
2351public interest to allow a hospital to license or operate an
2352emergency department located off the premises of the hospital.
2353If the agency finds it to be in the public interest, the report
2354shall also recommend licensure criteria for such medical
2355facilities, including criteria related to quality of care and,
2356if deemed necessary, the elimination of the possibility of
2357confusion related to the service capabilities of such facility
2358in comparison to the service capabilities of an emergency
2359department located on the premises of the hospital. Until July
23601, 2005, additional emergency departments located off the
2361premises of licensed hospitals may not be authorized by the
2362agency.
2363     (2)(a)  Upon the receipt of an application for a license
2364and the license fee, the agency shall issue a license if the
2365applicant and facility have received all approvals required by
2366law and meet the requirements established under this part and in
2367rules. Such license shall include all beds and services located
2368on the premises of the facility.
2369     (b)  A provisional license may be issued to a new facility
2370or a facility that is in substantial compliance with this part
2371and with the rules of the agency. A provisional license shall be
2372granted for a period of no more than 1 year and shall expire
2373automatically at the end of its term. A provisional license may
2374not be renewed.
2375     (c)  A license, unless sooner suspended or revoked, shall
2376automatically expire 2 years from the date of issuance and shall
2377be renewable biennially upon application for renewal and payment
2378of the fee prescribed by s. 395.004(2), provided the applicant
2379and licensed facility meet the requirements established under
2380this part and in rules. An application for renewal of a license
2381shall be made 90 days prior to expiration of the license, on
2382forms provided by the agency.
2383     (a)(d)  The agency shall, at the request of a licensee,
2384issue a single license to a licensee for facilities located on
2385separate premises. Such a license shall specifically state the
2386location of the facilities, the services, and the licensed beds
2387available on each separate premises. If a licensee requests a
2388single license, the licensee shall designate which facility or
2389office is responsible for receipt of information, payment of
2390fees, service of process, and all other activities necessary for
2391the agency to carry out the provisions of this part.
2392     (b)(e)  The agency shall, at the request of a licensee that
2393is a teaching hospital as defined in s. 408.07(44), issue a
2394single license to a licensee for facilities that have been
2395previously licensed as separate premises, provided such
2396separately licensed facilities, taken together, constitute the
2397same premises as defined in s. 395.002(23)(24). Such license for
2398the single premises shall include all of the beds, services, and
2399programs that were previously included on the licenses for the
2400separate premises. The granting of a single license under this
2401paragraph shall not in any manner reduce the number of beds,
2402services, or programs operated by the licensee.
2403     (c)(f)  Intensive residential treatment programs for
2404children and adolescents which have received accreditation from
2405the Joint Commission on Accreditation of Healthcare
2406Organizations and which meet the minimum standards developed by
2407rule of the agency for such programs shall be licensed by the
2408agency under this part.
2409     (3)(a)  Each license shall be valid only for the person to
2410whom it is issued and shall not be sold, assigned, or otherwise
2411transferred, voluntarily or involuntarily. A license is only
2412valid for the premises for which it was originally issued.
2413     (b)1.  An application for a new license is required if
2414ownership, a majority of the ownership, or controlling interest
2415of a licensed facility is transferred or assigned and when a
2416lessee agrees to undertake or provide services to the extent
2417that legal liability for operation of the facility rests with
2418the lessee. The application for a new license showing such
2419change shall be made at least 60 days prior to the date of the
2420sale, transfer, assignment, or lease.
2421     (3)2.  After a change of ownership has occurred, the
2422transferee shall be liable for any liability to the state,
2423regardless of when identified, resulting from changes to
2424allowable costs affecting provider reimbursement for Medicaid
2425participation or Public Medical Assistance Trust Fund
2426Assessments, and related administrative fines. The transferee,
2427simultaneously with the transfer of ownership, shall pay or make
2428arrangements to pay to the agency or the department any amount
2429owed to the agency or the department; payment assurances may be
2430in the form of an irrevocable credit instrument or payment bond
2431acceptable to the agency or the department provided by or on
2432behalf of the transferor. The issuance of a license to the
2433transferee shall be delayed pending payment or until arrangement
2434for payment acceptable to the agency or the department is made.
2435     (4)  The agency shall issue a license which specifies the
2436service categories and the number of hospital beds in each bed
2437category for which a license is received. Such information shall
2438be listed on the face of the license. All beds which are not
2439covered by any specialty-bed-need methodology shall be specified
2440as general beds. A licensed facility shall not operate a number
2441of hospital beds greater than the number indicated by the agency
2442on the face of the license without approval from the agency
2443under conditions established by rule.
2444     (5)(a)  Adherence to patient rights, standards of care, and
2445examination and placement procedures provided under part I of
2446chapter 394 shall be a condition of licensure for hospitals
2447providing voluntary or involuntary medical or psychiatric
2448observation, evaluation, diagnosis, or treatment.
2449     (b)  Any hospital that provides psychiatric treatment to
2450persons under 18 years of age who have emotional disturbances
2451shall comply with the procedures pertaining to the rights of
2452patients prescribed in part I of chapter 394.
2453     (6)  No specialty hospital shall provide any service or
2454regularly serve any population group beyond those services or
2455groups specified in its license.
2456     (7)  Licenses shall be posted in a conspicuous place on
2457each of the licensed premises.
2458     (7)(8)  In addition to the requirements of part II of
2459chapter 408, whenever the agency finds that there has been a
2460substantial failure to comply with the requirements established
2461under this part or in rules, the agency is authorized to deny,
2462modify, suspend, and or revoke:
2463     (a)  A license;
2464     (b)  That part of a license which is limited to a separate
2465premises, as designated on the license; or
2466     (c)  Licensure approval limited to a facility, building, or
2467portion thereof, or a service, within a given premises.
2468     (8)(9)  A hospital may not be licensed or relicensed if:
2469     (a)  The diagnosis-related groups for 65 percent or more of
2470the discharges from the hospital, in the most recent year for
2471which data is available to the Agency for Health Care
2472Administration pursuant to s. 408.061, are for diagnosis, care,
2473and treatment of patients who have:
2474     1.  Cardiac-related diseases and disorders classified as
2475diagnosis-related groups 103-145, 478-479, 514-518, or 525-527;
2476     2.  Orthopedic-related diseases and disorders classified as
2477diagnosis-related groups 209-256, 471, 491, 496-503, or 519-520;
2478     3.  Cancer-related diseases and disorders classified as
2479diagnosis-related groups 64, 82, 172, 173, 199, 200, 203, 257-
2480260, 274, 275, 303, 306, 307, 318, 319, 338, 344, 346, 347, 363,
2481366, 367, 400-414, 473, or 492; or
2482     4.  Any combination of the above discharges.
2483     (b)  The hospital restricts its medical and surgical
2484services to primarily or exclusively cardiac, orthopedic,
2485surgical, or oncology specialties.
2486     (9)(10)  A hospital licensed as of June 1, 2004, shall be
2487exempt from subsection (8) (9) as long as the hospital maintains
2488the same ownership, facility street address, and range of
2489services that were in existence on June 1, 2004. Any transfer of
2490beds, or other agreements that result in the establishment of a
2491hospital or hospital services within the intent of this section,
2492shall be subject to subsection (8) (9). Unless the hospital is
2493otherwise exempt under subsection (8) (9), the agency shall deny
2494or revoke the license of a hospital that violates any of the
2495criteria set forth in that subsection.
2496     (10)(11)  The agency may adopt rules implementing the
2497licensure requirements set forth in subsection (8) (9). Within
249814 days after rendering its decision on a license application or
2499revocation, the agency shall publish its proposed decision in
2500the Florida Administrative Weekly. Within 21 days after
2501publication of the agency's decision, any authorized person may
2502file a request for an administrative hearing. In administrative
2503proceedings challenging the approval, denial, or revocation of a
2504license pursuant to subsection (8) (9), the hearing must be
2505based on the facts and law existing at the time of the agency's
2506proposed agency action. Existing hospitals may initiate or
2507intervene in an administrative hearing to approve, deny, or
2508revoke licensure under subsection (8) (9) based upon a showing
2509that an established program will be substantially affected by
2510the issuance or renewal of a license to a hospital within the
2511same district or service area.
2512     Section 46.  Section 395.004, Florida Statutes, is amended
2513to read:
2514     395.004  Application for license, fees; expenses.--
2515     (1)  In accordance with s. 408.805, an applicant or
2516licensee shall pay a fee for each license application submitted
2517under this part, part II of chapter 408, and applicable rules.
2518The amount of the fee shall be established by rule. An
2519application for a license or renewal thereof shall be made under
2520oath to the agency, upon forms provided by it, and shall contain
2521such information as the agency reasonably requires, which may
2522include affirmative evidence of ability to comply with
2523applicable laws and rules.
2524     (2)  Each application for a general hospital license,
2525specialty hospital license, ambulatory surgical center license,
2526or mobile surgical facility license, or renewal thereof, shall
2527be accompanied by a license fee, in accordance with the
2528following schedule:
2529     (a)  The biennial license, provisional license, and license
2530renewal fee required of a facility licensed under this part
2531shall be reasonably calculated to cover the cost of regulation
2532under this part and shall be established by rule at the rate of
2533not less than $9.50 per hospital bed, nor more than $30 per
2534hospital bed, except that the minimum license fee shall be
2535$1,500 and the total fees collected from all licensed facilities
2536may not exceed the cost of properly carrying out the provisions
2537of this part.
2538     (b)  Such fees shall be paid to the agency and shall be
2539deposited in the Planning and Regulation Trust Fund of the
2540agency, which is hereby created, for the sole purpose of
2541carrying out the provisions of this part.
2542     Section 47.  Section 395.0055, Florida Statutes, is
2543repealed.
2544     Section 48.  Section 395.0161, Florida Statutes, is amended
2545to read:
2546     395.0161  Licensure inspection.--
2547     (1)  In accordance with s. 408.811, the agency shall make
2548or cause to be made such inspections and investigations as it
2549deems necessary, including:
2550     (a)  Inspections directed by the Health Care Financing
2551Administration.
2552     (b)  Validation inspections.
2553     (c)  Lifesafety inspections.
2554     (d)  Licensure complaint investigations, including full
2555licensure investigations with a review of all licensure
2556standards as outlined in the administrative rules. Complaints
2557received by the agency from individuals, organizations, or other
2558sources are subject to review and investigation by the agency.
2559     (e)  Emergency access complaint investigations.
2560     (f)  inspections of mobile surgical facilities at each time
2561a facility establishes a new location, prior to the admission of
2562patients. However, such inspections shall not be required when a
2563mobile surgical facility is moved temporarily to a location
2564where medical treatment will not be provided.
2565     (2)  The agency shall accept, in lieu of its own periodic
2566inspections for licensure, the survey or inspection of an
2567accrediting organization, provided the accreditation of the
2568licensed facility is not provisional and provided the licensed
2569facility authorizes release of, and the agency receives the
2570report of, the accrediting organization. The agency shall
2571develop, and adopt by rule, criteria for accepting survey
2572reports of accrediting organizations in lieu of conducting a
2573state licensure inspection.
2574     (3)  In accordance with s. 408.805, an applicant or
2575licensee shall pay a fee for each license application submitted
2576under this part, part II of chapter 408, and applicable rules.
2577With the exception of state-operated licensed facilities, each
2578facility licensed under this part shall pay to the agency, at
2579the time of inspection, the following fees:
2580     (a)  Inspection for licensure.--A fee shall be paid which
2581is not less than $8 per hospital bed, nor more than $12 per
2582hospital bed, except that the minimum fee shall be $400 per
2583facility.
2584     (b)  Inspection for lifesafety only.--A fee shall be paid
2585which is not less than 75 cents per hospital bed, nor more than
2586$1.50 per hospital bed, except that the minimum fee shall be $40
2587per facility.
2588     (4)  The agency shall coordinate all periodic inspections
2589for licensure made by the agency to ensure that the cost to the
2590facility of such inspections and the disruption of services by
2591such inspections is minimized.
2592     Section 49.  Section 395.0162, Florida Statutes, is
2593repealed.
2594     Section 50.  A licensee that failed to renew its ambulatory
2595surgical center license may meet requirements of the Florida
2596Building Code that were in effect at the time of original
2597licensure for the purposes of an initial application if:
2598     (a)  The license expired between July 1, 2004, and December
259931, 2004.
2600     (b)  The initial license application was filed within 30
2601days after the license expiration.
2602     (c)  The ambulatory surgical center is in compliance with
2603regulatory requirements based upon agency inspection.
2604
2605This section only applies to the initial application for
2606licensure and does not circumvent any requirement to meet
2607current Florida Building Code requirements for renovations or
2608other modifications.
2609     Section 51.  Subsections (2) and (3) of section 395.0163,
2610Florida Statutes, are amended to read:
2611     395.0163  Construction inspections; plan submission and
2612approval; fees.--
2613     (2)(a)  The agency is authorized to charge an initial fee
2614of $2,000 for review of plans and construction on all projects,
2615no part of which is refundable. The agency may also collect a
2616fee, not to exceed 1 percent of the estimated construction cost
2617or the actual cost of review, whichever is less, for the portion
2618of the review which encompasses initial review through the
2619initial revised construction document review. The agency is
2620further authorized to collect its actual costs on all subsequent
2621portions of the review and construction inspections. The initial
2622fee payment shall accompany the initial submission of plans and
2623specifications. Any subsequent payment that is due is payable
2624upon receipt of the invoice from the agency.
2625     (b)  Notwithstanding any other provisions of law to the
2626contrary, all moneys received by the agency pursuant to the
2627provisions of this section shall be deposited in the Planning
2628and Regulation Trust Fund, as created by s. 395.004, to be held
2629and applied solely for the operations required under this
2630section.
2631     (3)  In accordance with s. 408.811, the agency shall
2632inspect a mobile surgical facility at initial licensure and at
2633each time the facility establishes a new location, prior to
2634admission of patients. However, such inspections shall not be
2635required when a mobile surgical facility is moved temporarily to
2636a location where medical treatment will not be provided.
2637     Section 52.  Paragraph (c) of subsection (2) of section
2638395.0191, Florida Statutes, is redesignated as paragraph (d),
2639and a new paragraph (c) is added to said subsection, to read:
2640     395.0191  Staff membership and clinical privileges.--
2641     (2)
2642     (c)  A registered nurse licensed under part I of chapter
2643464 and qualified by training and experience in perioperative
2644nursing as defined in s. 464.027(2)(a) shall be present in the
2645operating room and function as the circulating nurse during all
2646operative, surgical, or invasive procedures.
2647     Section 53.  Subsections (4) and (6) of section 395.0193,
2648Florida Statutes, are amended to read:
2649     395.0193  Licensed facilities; peer review; disciplinary
2650powers; agency or partnership with physicians.--
2651     (4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
2652actions taken under subsection (3) shall be reported in writing
2653to the Department of Health Division of Health Quality Assurance
2654of the agency within 30 working days after its initial
2655occurrence, regardless of the pendency of appeals to the
2656governing board of the hospital. The notification shall identify
2657the disciplined practitioner, the action taken, and the reason
2658for such action. All final disciplinary actions taken under
2659subsection (3), if different from those which were reported to
2660the department agency within 30 days after the initial
2661occurrence, shall be reported within 10 working days to the
2662Department of Health Division of Health Quality Assurance of the
2663agency in writing and shall specify the disciplinary action
2664taken and the specific grounds therefor. Final disciplinary
2665actions shall be reported monthly to the Division of Health
2666Quality Assurance of the agency. The division shall review each
2667report and determine whether it potentially involved conduct by
2668the licensee that is subject to disciplinary action, in which
2669case s. 456.073 shall apply. The reports are not subject to
2670inspection under s. 119.07(1) even if the division's
2671investigation results in a finding of probable cause.
2672     (6)  For a single incident or series of isolated incidents
2673that are nonwillful violations of the reporting requirements of
2674this section, the agency shall first seek to obtain corrective
2675action by the facility. If correction is not demonstrated within
2676the timeframe established by the agency or if there is a pattern
2677of nonwillful violations of this section, the agency may impose
2678an administrative fine, not to exceed $5,000 for any violation
2679of the reporting requirements of this section. The
2680administrative fine for repeated nonwillful violations shall not
2681exceed $10,000 for any violation. The administrative fine for
2682each intentional and willful violation may not exceed $25,000
2683per violation, per day. The fine for an intentional and willful
2684violation of this section may not exceed $250,000. In
2685determining the amount of fine to be levied, the agency shall be
2686guided by s. 395.1065(1)(2)(b).
2687     Section 54.  Subsection (12) of section 395.0197, Florida
2688Statutes, is amended to read:
2689     395.0197  Internal risk management program.--
2690     (12)  In addition to any penalty imposed pursuant to this
2691section, the agency shall require a written plan of correction
2692from the facility. For a single incident or series of isolated
2693incidents that are nonwillful violations of the reporting
2694requirements of this section, the agency shall first seek to
2695obtain corrective action by the facility. If the correction is
2696not demonstrated within the timeframe established by the agency
2697or if there is a pattern of nonwillful violations of this
2698section, the agency may impose an administrative fine, not to
2699exceed $5,000 for any violation of the reporting requirements of
2700this section. The administrative fine for repeated nonwillful
2701violations shall not exceed $10,000 for any violation. The
2702administrative fine for each intentional and willful violation
2703may not exceed $25,000 per violation, per day. The fine for an
2704intentional and willful violation of this section may not exceed
2705$250,000. In determining the amount of fine to be levied, the
2706agency shall be guided by s. 395.1065(1)(2)(b).
2707     Section 55.  Section 395.0199, Florida Statutes, is amended
2708to read:
2709     395.0199  Private utilization review.--
2710     (1)  The purpose of this section is to:
2711     (a)  Promote the delivery of quality health care in a cost-
2712effective manner.
2713     (b)  Foster greater coordination between providers and
2714health insurers performing utilization review.
2715     (c)  Protect patients and insurance providers by ensuring
2716that private review agents are qualified to perform utilization
2717review activities and to make informed decisions on the
2718appropriateness of medical care.
2719     (d)  This section does not regulate the activities of
2720private review agents, health insurers, health maintenance
2721organizations, or hospitals, except as expressly provided
2722herein, or authorize regulation or intervention as to the
2723correctness of utilization review decisions of insurers or
2724private review agents.
2725     (2)  The requirements of part II of chapter 408 shall apply
2726to the provision of services that require registration or
2727licensure pursuant to this section and part II of chapter 408
2728and to persons registered by or applying for such registration
2729from the Agency for Health Care Administration pursuant to this
2730section. However, each applicant for registration and registrant
2731is exempt from the provisions of ss. 408.806(1)(e)2.,
2732408.810(5)-(10), and 408.811. A private review agent conducting
2733utilization review as to health care services performed or
2734proposed to be performed in this state shall register with the
2735agency in accordance with this section.
2736     (3)  In accordance with s. 408.805, an applicant for
2737registration or registrant shall pay a fee for each registration
2738application submitted under this section, part II of chapter
2739408, and applicable rules. The amount of the fee shall be
2740established by rule Registration shall be made annually with the
2741agency on forms furnished by the agency and shall be accompanied
2742by the appropriate registration fee as set by the agency. The
2743fee and shall be sufficient to pay for the administrative costs
2744of registering the agent, but shall not exceed $250. The agency
2745may also charge reasonable fees, reflecting actual costs, to
2746persons requesting copies of registration.
2747     (4)  Each applicant for registration must comply with the
2748following requirements:
2749     (a)  Upon receipt of a completed, signed, and dated
2750application, the agency shall require background screening, in
2751accordance with the level 2 standards for screening set forth in
2752chapter 435, of the managing employee or other similarly titled
2753individual who is responsible for the operation of the entity.
2754The applicant must comply with the procedures for level 2
2755background screening as set forth in chapter 435, as well as the
2756requirements of s. 435.03(3).
2757     (b)  The agency may require background screening of any
2758other individual who is an applicant, if the agency has probable
2759cause to believe that he or she has been convicted of a crime or
2760has committed any other offense prohibited under the level 2
2761standards for screening set forth in chapter 435.
2762     (c)  Proof of compliance with the level 2 background
2763screening requirements of chapter 435 which has been submitted
2764within the previous 5 years in compliance with any other health
2765care licensure requirements of this state is acceptable in
2766fulfillment of the requirements of paragraph (a).
2767     (d)  A provisional registration may be granted to an
2768applicant when each individual required by this section to
2769undergo background screening has met the standards for the
2770Department of Law Enforcement background check, but the agency
2771has not yet received background screening results from the
2772Federal Bureau of Investigation, or a request for a
2773disqualification exemption has been submitted to the agency as
2774set forth in chapter 435 but a response has not yet been issued.
2775A standard registration may be granted to the applicant upon the
2776agency's receipt of a report of the results of the Federal
2777Bureau of Investigation background screening for each individual
2778required by this section to undergo background screening which
2779confirms that all standards have been met, or upon the granting
2780of a disqualification exemption by the agency as set forth in
2781chapter 435. Any other person who is required to undergo level 2
2782background screening may serve in his or her capacity pending
2783the agency's receipt of the report from the Federal Bureau of
2784Investigation. However, the person may not continue to serve if
2785the report indicates any violation of background screening
2786standards and a disqualification exemption has not been
2787requested of and granted by the agency as set forth in chapter
2788435.
2789     (e)  Each applicant must submit to the agency, with its
2790application, a description and explanation of any exclusions,
2791permanent suspensions, or terminations of the applicant from the
2792Medicare or Medicaid programs. Proof of compliance with the
2793requirements for disclosure of ownership and control interests
2794under the Medicaid or Medicare programs shall be accepted in
2795lieu of this submission.
2796     (f)  Each applicant must submit to the agency a description
2797and explanation of any conviction of an offense prohibited under
2798the level 2 standards of chapter 435 by a member of the board of
2799directors of the applicant, its officers, or any individual
2800owning 5 percent or more of the applicant. This requirement does
2801not apply to a director of a not-for-profit corporation or
2802organization if the director serves solely in a voluntary
2803capacity for the corporation or organization, does not regularly
2804take part in the day-to-day operational decisions of the
2805corporation or organization, receives no remuneration for his or
2806her services on the corporation or organization's board of
2807directors, and has no financial interest and has no family
2808members with a financial interest in the corporation or
2809organization, provided that the director and the not-for-profit
2810corporation or organization include in the application a
2811statement affirming that the director's relationship to the
2812corporation satisfies the requirements of this paragraph.
2813     (g)  A registration may not be granted to an applicant if
2814the applicant or managing employee has been found guilty of,
2815regardless of adjudication, or has entered a plea of nolo
2816contendere or guilty to, any offense prohibited under the level
28172 standards for screening set forth in chapter 435, unless an
2818exemption from disqualification has been granted by the agency
2819as set forth in chapter 435.
2820     (h)  The agency may deny or revoke the registration if any
2821applicant:
2822     1.  Has falsely represented a material fact in the
2823application required by paragraph (e) or paragraph (f), or has
2824omitted any material fact from the application required by
2825paragraph (e) or paragraph (f); or
2826     2.  Has had prior action taken against the applicant under
2827the Medicaid or Medicare program as set forth in paragraph (e).
2828     (i)  An application for registration renewal must contain
2829the information required under paragraphs (e) and (f).
2830     (4)(5)  Registration shall include the following:
2831     (a)  A description of the review policies and procedures to
2832be used in evaluating proposed or delivered hospital care.
2833     (b)  The name, address, and telephone number of the
2834utilization review agent performing utilization review, who
2835shall be at least:
2836     1.  A licensed practical nurse or licensed registered
2837nurse, or other similarly qualified medical records or health
2838care professionals, for performing initial review when
2839information is necessary from the physician or hospital to
2840determine the medical necessity or appropriateness of hospital
2841services; or
2842     2.  A licensed physician, or a licensed physician
2843practicing in the field of psychiatry for review of mental
2844health services, for an initial denial determination prior to a
2845final denial determination by the health insurer and which shall
2846include the written evaluation and findings of the reviewing
2847physician.
2848     (c)  A description of an appeal procedure for patients or
2849health care providers whose services are under review, who may
2850appeal an initial denial determination prior to a final
2851determination by the health insurer with whom the private review
2852agent has contracted. The appeal procedure shall provide for
2853review by a licensed physician, or by a licensed physician
2854practicing in the field of psychiatry for review of mental
2855health services, and shall include the written evaluation and
2856findings of the reviewing physician.
2857     (d)  A designation of the times when the staff of the
2858utilization review agent will be available by toll-free
2859telephone, which shall include at least 40 hours per week during
2860the normal business hours of the agent.
2861     (e)  An acknowledgment and agreement that any private
2862review agent which, as a general business practice, fails to
2863adhere to the policies, procedures, and representations made in
2864its application for registration shall have its registration
2865revoked.
2866     (f)  Disclosure of any incentive payment provision or quota
2867provision which is contained in the agent's contract with a
2868health insurer and is based on reduction or denial of services,
2869reduction of length of stay, or selection of treatment setting.
2870     (g)  Updates of any material changes to review policies or
2871procedures.
2872     (6)  The agency may impose fines or suspend or revoke the
2873registration of any private review agent in violation of this
2874section. Any private review agent failing to register or update
2875registration as required by this section shall be deemed to be
2876within the jurisdiction of the agency and subject to an
2877administrative penalty not to exceed $1,000. The agency may
2878bring actions to enjoin activities of private review agents in
2879violation of this section.
2880     (5)(7)  No insurer shall knowingly contract with or utilize
2881a private review agent which has failed to register as required
2882by this section or which has had a registration revoked by the
2883agency.
2884     (6)(8)  A private review agent which operates under
2885contract with the federal or state government for utilization
2886review of patients eligible for hospital or other services under
2887Title XVIII or Title XIX of the Social Security Act is exempt
2888from the provisions of this section for services provided under
2889such contract. A private review agent which provides utilization
2890review services to the federal or state government and a private
2891insurer shall not be exempt for services provided to
2892nonfederally funded patients. This section shall not apply to
2893persons who perform utilization review services for medically
2894necessary hospital services provided to injured workers pursuant
2895to chapter 440 and shall not apply to self-insurance funds or
2896service companies authorized pursuant to chapter 440 or part VII
2897of chapter 626.
2898     (7)(9)  Facilities licensed under this chapter shall
2899promptly comply with the requests of utilization review agents
2900or insurers which are reasonably necessary to facilitate prompt
2901accomplishment of utilization review activities.
2902     (8)(10)  The agency shall adopt rules to implement the
2903provisions of this section.
2904     Section 56.  Section 395.1046, Florida Statutes, is amended
2905to read:
2906     395.1046  Complaint investigation procedures.--
2907     (1)  In accordance with s. 408.811, the agency shall
2908investigate any complaint against a hospital for any violation
2909of s. 395.1041 that the agency reasonably believes to be legally
2910sufficient. A complaint is legally sufficient if it contains
2911ultimate facts that which show that a violation of this section
2912chapter, or any rule adopted under this chapter by the agency
2913under this section, has occurred. The agency may investigate, or
2914continue to investigate, and may take appropriate final action
2915on a complaint, even though the original complainant withdraws
2916his or her complaint or otherwise indicates his or her desire
2917not to cause it to be investigated to completion. When an
2918investigation of any person or facility is undertaken, the
2919agency shall notify such person in writing of the investigation
2920and inform the person or facility in writing of the substance,
2921the facts which show that a violation has occurred, and the
2922source of any complaint filed against him or her. The agency may
2923conduct an investigation without notification to any person if
2924the act under investigation is a criminal offense. The agency
2925shall have access to all records necessary for the investigation
2926of the complaint.
2927     (2)  The agency or its agent shall expeditiously
2928investigate each complaint against a hospital for a violation of
2929s. 395.1041. When its investigation is complete, the agency
2930shall prepare an investigative report. The report shall contain
2931the investigative findings and the recommendations of the agency
2932concerning the existence of probable cause.
2933     (3)  The complaint and all information obtained by the
2934agency during an investigation conducted pursuant to this
2935section are exempt from the provisions of s. 119.07(1) and s.
293624(a), Art. I of the State Constitution until 10 days after the
2937facility has been determined by the agency to be out of
2938compliance with regulatory requirements probable cause has been
2939found to exist by the agency, or until the person who is the
2940subject of the investigation waives his or her privilege of
2941confidentiality, whichever occurs first. In cases where the
2942agency finds that the complaint is either not legally sufficient
2943or does not demonstrate the facility's noncompliance with
2944regulatory requirements when the agency determines that no
2945probable cause exists, all records pertaining thereto are
2946confidential and exempt from the provisions of s. 119.07(1) and
2947s. 24(a), Art. I of the State Constitution. However, the
2948complaint and a summary of the agency's findings shall be
2949available, although information therein identifying an
2950individual shall not be disclosed.
2951     Section 57.  Subsections (1) and (7) of section 395.1055,
2952Florida Statutes, are amended to read:
2953     395.1055  Rules and enforcement.--
2954     (1)  The agency shall adopt rules pursuant to ss.
2955120.536(1) and 120.54 to implement the provisions of this part
2956and part II of chapter 408, which shall include reasonable and
2957fair minimum standards for ensuring that:
2958     (a)  Sufficient numbers and qualified types of personnel
2959and occupational disciplines are on duty and available at all
2960times to provide necessary and adequate patient care and safety.
2961     (b)  Infection control, housekeeping, sanitary conditions,
2962and medical record procedures that will adequately protect
2963patient care and safety are established and implemented.
2964     (c)  A comprehensive emergency management plan is prepared
2965and updated annually. Such standards must be included in the
2966rules adopted by the agency after consulting with the Department
2967of Community Affairs. At a minimum, the rules must provide for
2968plan components that address emergency evacuation
2969transportation; adequate sheltering arrangements; postdisaster
2970activities, including emergency power, food, and water;
2971postdisaster transportation; supplies; staffing; emergency
2972equipment; individual identification of residents and transfer
2973of records, and responding to family inquiries. The
2974comprehensive emergency management plan is subject to review and
2975approval by the local emergency management agency. During its
2976review, the local emergency management agency shall ensure that
2977the following agencies, at a minimum, are given the opportunity
2978to review the plan: the Department of Elderly Affairs, the
2979Department of Health, the Agency for Health Care Administration,
2980and the Department of Community Affairs. Also, appropriate
2981volunteer organizations must be given the opportunity to review
2982the plan. The local emergency management agency shall complete
2983its review within 60 days and either approve the plan or advise
2984the facility of necessary revisions.
2985     (d)  Licensed facilities are established, organized, and
2986operated consistent with established standards and rules.
2987     (e)  Licensed facility beds conform to minimum space,
2988equipment, and furnishings standards as specified by the
2989department.
2990     (f)  All hospitals submit such data as necessary to conduct
2991certificate-of-need reviews required under part I of chapter 408
2992ss. 408.031-408.045. Such data shall include, but shall not be
2993limited to, patient origin data, hospital utilization data, type
2994of service reporting, and facility staffing data. The agency
2995shall not collect data that identifies or could disclose the
2996identity of individual patients. The agency shall utilize
2997existing uniform statewide data sources when available and shall
2998minimize reporting costs to hospitals.
2999     (g)  Each hospital has a quality improvement program
3000designed according to standards established by their current
3001accrediting organization. This program will enhance quality of
3002care and emphasize quality patient outcomes, corrective action
3003for problems, governing board review, and reporting to the
3004agency of standardized data elements necessary to analyze
3005quality of care outcomes. The agency shall use existing data,
3006when available, and shall not duplicate the efforts of other
3007state agencies in order to obtain such data.
3008     (h)  Licensed facilities make available on their Internet
3009websites, no later than October 1, 2004, and in a hard copy
3010format upon request, a description of and a link to the patient
3011charge and performance outcome data collected from licensed
3012facilities pursuant to s. 408.061.
3013     (7)  The agency shall enforce compliance with the
3014provisions of s. 381.005(2) and rules adopted thereunder with
3015respect to immunizations against the influenza virus and
3016pneumococcal bacteria. Any licensed facility which is in
3017operation at the time of promulgation of any applicable rules
3018under this part shall be given a reasonable time, under the
3019particular circumstances, but not to exceed 1 year from the date
3020of such promulgation, within which to comply with such rules.
3021     Section 58.  Section 395.1065, Florida Statutes, is amended
3022to read:
3023     395.1065  Criminal and Administrative penalties;
3024injunctions; emergency orders; moratorium.--
3025     (1)  Any person establishing, conducting, managing, or
3026operating any facility without a license under this part is
3027guilty of a misdemeanor and, upon conviction, shall be fined not
3028more than $500 for the first offense and not more than $1,000
3029for each subsequent offense, and each day of continuing
3030violation after conviction shall be considered a separate
3031offense.
3032     (1)(2)(a)  The agency may deny, revoke, or suspend a
3033license or impose an administrative fine, not to exceed $1,000
3034per violation, per day, for the violation of any provision of
3035this part, part II of chapter 408, or applicable rules adopted
3036under this part. Each day of violation constitutes a separate
3037violation and is subject to a separate fine.
3038     (b)  In determining the amount of fine to be levied for a
3039violation, as provided in paragraph (a), the following factors
3040shall be considered:
3041     1.  The severity of the violation, including the
3042probability that death or serious harm to the health or safety
3043of any person will result or has resulted, the severity of the
3044actual or potential harm, and the extent to which the provisions
3045of this part were violated.
3046     2.  Actions taken by the licensee to correct the violations
3047or to remedy complaints.
3048     3.  Any previous violations of the licensee.
3049     (c)  All amounts collected pursuant to this section shall
3050be deposited into the Planning and Regulation Trust Fund, as
3051created by s. 395.004.
3052     (c)(d)  The agency may impose an administrative fine for
3053the violation of s. 641.3154 or, if sufficient claims due to a
3054provider from a health maintenance organization do not exist to
3055enable the take-back of an overpayment, as provided under s.
3056641.3155(5), for the violation of s. 641.3155(5). The
3057administrative fine for a violation cited in this paragraph
3058shall be in the amounts specified in s. 641.52(5), and the
3059provisions of paragraph (a) do not apply.
3060     (2)(3)  Notwithstanding the existence or pursuit of any
3061other remedy, the agency may maintain an action in the name of
3062the state for injunction or other process to enforce the
3063provisions of this part, part II of chapter 408, and applicable
3064rules promulgated hereunder.
3065     (4)  The agency may issue an emergency order immediately
3066suspending or revoking a license when it determines that any
3067condition in the licensed facility presents a clear and present
3068danger to public health and safety.
3069     (5)  The agency may impose an immediate moratorium on
3070elective admissions to any licensed facility, building, or
3071portion thereof, or service, when the agency determines that any
3072condition in the facility presents a threat to public health or
3073safety.
3074     (3)(6)  In seeking to impose penalties against a facility
3075as defined in s. 394.455 for a violation of part I of chapter
3076394, the agency is authorized to rely on the investigation and
3077findings by the Department of Health in lieu of conducting its
3078own investigation.
3079     (4)(7)  The agency shall impose a fine of $500 for each
3080instance of the facility's failure to provide the information
3081required by rules adopted pursuant to s. 395.1055(1)(h).
3082     Section 59.  Subsection (1) of section 395.10973, Florida
3083Statutes, is amended to read:
3084     395.10973  Powers and duties of the agency.--It is the
3085function of the agency to:
3086     (1)  Adopt rules pursuant to ss. 120.536(1) and 120.54 to
3087implement the provisions of this part and part II of chapter 408
3088conferring duties upon it.
3089     Section 60.  Section 395.10974, Florida Statutes, is
3090amended to read:
3091     395.10974  Health care risk managers; qualifications,
3092licensure, fees.--
3093     (1)  The requirements of part II of chapter 408 shall apply
3094to the provision of services that require licensure pursuant to
3095ss. 395.10971?395.10976 and part II of chapter 408 and to
3096entities licensed by or applying for such licensure from the
3097Agency for Health Care Administration pursuant to ss. 395.10971?
3098395.10976. Any person desiring to be licensed as a health care
3099risk manager shall submit an application on a form provided by
3100the agency. In order to qualify for licensure, the applicant
3101shall submit evidence satisfactory to the agency that which
3102demonstrates the applicant's competence, by education or
3103experience, in the following areas:
3104     (a)  Applicable standards of health care risk management.
3105     (b)  Applicable federal, state, and local health and safety
3106laws and rules.
3107     (c)  General risk management administration.
3108     (d)  Patient care.
3109     (e)  Medical care.
3110     (f)  Personal and social care.
3111     (g)  Accident prevention.
3112     (h)  Departmental organization and management.
3113     (i)  Community interrelationships.
3114     (j)  Medical terminology.
3115
3116Each applicant for licensure and licensee must comply with all
3117provisions of part II of chapter 408 except ss. 408.806(1)(e)2.,
3118408.810, and 408.811. The agency may require such additional
3119information, from the applicant or any other person, as may be
3120reasonably required to verify the information contained in the
3121application.
3122     (2)  The agency shall not grant or issue a license as a
3123health care risk manager to any individual unless from the
3124application it affirmatively appears that the applicant:
3125     (a)  Is 18 years of age or over;
3126     (b)  Is a high school graduate or equivalent; and
3127     (c)1.  Has fulfilled the requirements of a 1-year program
3128or its equivalent in health care risk management training which
3129may be developed or approved by the agency;
3130     2.  Has completed 2 years of college-level studies which
3131would prepare the applicant for health care risk management, to
3132be further defined by rule; or
3133     3.  Has obtained 1 year of practical experience in health
3134care risk management.
3135     (3)  The agency shall issue a license to practice health
3136care risk management to any applicant who qualifies under this
3137section. In accordance with s. 408.805, an applicant or licensee
3138shall pay a fee for each license application submitted under
3139this part, part II of chapter 408, and applicable rules. The
3140amount of the fee shall be established by rule as follows: and
3141submits an application fee of not more than $75, a background
3142screening fingerprinting fee of not more than $75, and a license
3143fee of not more than $100. The agency shall by rule establish
3144fees and procedures for the issuance and cancellation of
3145licenses.
3146     (4)  The agency shall renew a health care risk manager
3147license upon receipt of a biennial renewal application and fees.
3148The agency shall by rule establish a procedure for the biennial
3149renewal of licenses.
3150     Section 61.  Subsections (6) through (19) of section
3151400.021, Florida Statutes, are renumbered as subsections (5)
3152through (18), respectively, and present subsections (5) and (20)
3153of said section are amended to read:
3154     400.021  Definitions.--When used in this part, unless the
3155context otherwise requires, the term:
3156     (5)  "Controlling interest" means:
3157     (a)  The applicant for licensure or a licensee;
3158     (b)  A person or entity that serves as an officer of, is on
3159the board of directors of, or has a 5 percent or greater
3160ownership interest in the management company or other entity,
3161related or unrelated, which the applicant or licensee may
3162contract with to operate the facility; or
3163     (c)  A person or entity that serves as an officer of, is on
3164the board of directors of, or has a 5 percent or greater
3165ownership interest in the applicant or licensee.
3166
3167The term does not include a voluntary board member.
3168     (20)  "Voluntary board member" means a director of a not-
3169for-profit corporation or organization who serves solely in a
3170voluntary capacity for the corporation or organization, does not
3171receive any remuneration for his or her services on the board of
3172directors, and has no financial interest in the corporation or
3173organization. The agency shall recognize a person as a voluntary
3174board member following submission of a statement to the agency
3175by the director and the not-for-profit corporation or
3176organization which affirms that the director conforms to this
3177definition. The statement affirming the status of the director
3178must be submitted to the agency on a form provided by the
3179agency.
3180     Section 62.  Paragraph (c) of subsection (2) of section
3181395.602, Florida Statutes, is amended to read:
3182     395.602  Rural hospitals.--
3183     (2)  DEFINITIONS.--As used in this part:
3184     (c)  "Inactive rural hospital bed" means a licensed acute
3185care hospital bed, as defined in s. 395.002(13)(14), that is
3186inactive in that it cannot be occupied by acute care inpatients.
3187     Section 63.  Paragraph (c) of subsection (1) of section
3188395.701, Florida Statutes, is amended to read:
3189     395.701  Annual assessments on net operating revenues for
3190inpatient and outpatient services to fund public medical
3191assistance; administrative fines for failure to pay assessments
3192when due; exemption.--
3193     (1)  For the purposes of this section, the term:
3194     (c)  "Hospital" means a health care institution as defined
3195in s. 395.002(12)(13), but does not include any hospital
3196operated by the agency or the Department of Corrections.
3197     Section 64.  Subsection (3) of section 400.022, Florida
3198Statutes, is amended to read:
3199     400.022  Residents' rights.--
3200     (3)  Any violation of the resident's rights set forth in
3201this section shall constitute grounds for action by the agency
3202under the provisions of s. 400.102, s. 400.121, or part II of
3203chapter 408. In order to determine whether the licensee is
3204adequately protecting residents' rights, the licensure annual
3205inspection of the facility shall include private informal
3206conversations with a sample of residents to discuss residents'
3207experiences within the facility with respect to rights specified
3208in this section and general compliance with standards, and
3209consultation with the ombudsman council in the local planning
3210and service area of the Department of Elderly Affairs in which
3211the nursing home is located.
3212     Section 65.  Paragraph (b) of subsection (1) of section
3213400.051, Florida Statutes, is amended to read:
3214     400.051  Homes or institutions exempt from the provisions
3215of this part.--
3216     (1)  The following shall be exempt from the provisions of
3217this part:
3218     (b)  Any hospital, as defined in s. 395.002(11), that is
3219licensed under chapter 395.
3220     Section 66.  Section 400.062, Florida Statutes, is amended
3221to read:
3222     400.062  License required; fee; disposition; display;
3223transfer.--
3224     (1)  The requirements of part II of chapter 408 shall apply
3225to the provision of services that require licensure pursuant to
3226this part and part II of chapter 408 and to entities licensed by
3227or applying for such licensure from the Agency for Health Care
3228Administration pursuant to this part. However, each applicant
3229for licensure and each licensee is exempt from s. 408.810(7). It
3230is unlawful to operate or maintain a facility without first
3231obtaining from the agency a license authorizing such operation.
3232     (2)  Separate licenses shall be required for facilities
3233maintained in separate premises, even though operated under the
3234same management. However, a separate license shall not be
3235required for separate buildings on the same grounds.
3236     (3)  In accordance with s. 408.805, an applicant or
3237licensee shall pay a fee for each license application submitted
3238under this part, part II of chapter 408, and applicable rules.
3239The annual license fee required for each license issued under
3240this part shall be comprised of two parts. Part I of the license
3241fee shall be the basic license fee. The rate per bed for the
3242basic license fee shall be established biennially annually and
3243shall be $100 $50 per bed unless modified by rule. The agency
3244may adjust the per bed licensure fees by the Consumer Price
3245Index based on the 12 months immediately preceding the increase
3246to cover the cost of regulation under this part. Part II of the
3247license fee shall be the resident protection fee, which shall be
3248at the rate of not less than 50 25 cents per bed. The rate per
3249bed shall be the minimum rate per bed, and such rate shall
3250remain in effect until the effective date of a rate per bed
3251adopted by rule by the agency pursuant to this part. At such
3252time as the amount on deposit in the Resident Protection Trust
3253Fund is less than $1 million, the agency may adopt rules to
3254establish a rate which may not exceed $20 $10 per bed. The rate
3255per bed shall revert back to the minimum rate per bed when the
3256amount on deposit in the Resident Protection Trust Fund reaches
3257$1 million, except that any rate established by rule shall
3258remain in effect until such time as the rate has been equally
3259required for each license issued under this part. Any amount in
3260the fund in excess of $2 million shall revert to the Health Care
3261Trust Fund and may not be expended without prior approval of the
3262Legislature. The agency may prorate the biennial annual license
3263fee for those licenses which it issues under this part for less
3264than 2 years 1 year. Funds generated by license fees collected
3265in accordance with this section shall be deposited in the
3266following manner:
3267     (a)  The basic license fee collected shall be deposited in
3268the Health Care Trust Fund, established for the sole purpose of
3269carrying out this part. When the balance of the account
3270established in the Health Care Trust Fund for the deposit of
3271fees collected as authorized under this section exceeds one-
3272third of the annual cost of regulation under this part, the
3273excess shall be used to reduce the licensure fees in the next
3274year.
3275     (b)  The resident protection fee collected shall be
3276deposited in the Resident Protection Trust Fund for the sole
3277purpose of paying, in accordance with the provisions of s.
3278400.063, for the appropriate alternate placement, care, and
3279treatment of a resident removed from a nursing home facility on
3280a temporary, emergency basis or for the maintenance and care of
3281residents in a nursing home facility pending removal and
3282alternate placement.
3283     (4)  Counties or municipalities applying for licenses under
3284this part are exempt from license fees authorized under this
3285section.
3286     (5)  The license shall be displayed in a conspicuous place
3287inside the facility.
3288     (6)  A license shall be valid only in the hands of the
3289individual, firm, partnership, association, or corporation to
3290whom it is issued and shall not be subject to sale, assignment,
3291or other transfer, voluntary or involuntary, nor shall a license
3292be valid for any premises other than those for which originally
3293issued.
3294     Section 67.  Subsection (1) of section 400.063, Florida
3295Statutes, is amended to read:
3296     400.063  Resident Protection Trust Fund.--
3297     (1)  A Resident Protection Trust Fund shall be established
3298for the purpose of collecting and disbursing funds generated
3299from the license fees and administrative fines as provided for
3300in ss. 393.0673(2), 400.062(3)(b), 400.111(1), 400.121(2), and
3301400.23(8). Such funds shall be for the sole purpose of paying
3302for the appropriate alternate placement, care, and treatment of
3303residents who are removed from a facility licensed under this
3304part or a facility specified in s. 393.0678(1) in which the
3305agency determines that existing conditions or practices
3306constitute an immediate danger to the health, safety, or
3307security of the residents. If the agency determines that it is
3308in the best interest of the health, safety, or security of the
3309residents to provide for an orderly removal of the residents
3310from the facility, the agency may utilize such funds to maintain
3311and care for the residents in the facility pending removal and
3312alternative placement. The maintenance and care of the residents
3313shall be under the direction and control of a receiver appointed
3314pursuant to s. 393.0678(1) or s. 400.126(1). However, funds may
3315be expended in an emergency upon a filing of a petition for a
3316receiver, upon the declaration of a state of local emergency
3317pursuant to s. 252.38(3)(a)5., or upon a duly authorized local
3318order of evacuation of a facility by emergency personnel to
3319protect the health and safety of the residents.
3320     Section 68.  Section 400.071, Florida Statutes, is amended
3321to read:
3322     400.071  Application for license.--
3323     (1)  An application for a license as required by s. 400.062
3324shall be made to the agency on forms furnished by it and shall
3325be accompanied by the appropriate license fee.
3326     (1)(2)  The application for a license shall be under oath
3327and shall contain the following:
3328     (a)  The name, address, and social security number of the
3329applicant if an individual; if the applicant is a firm,
3330partnership, or association, its name, address, and employer
3331identification number (EIN), and the name and address of any
3332controlling interest; and the name by which the facility is to
3333be known.
3334     (b)  The name of any person whose name is required on the
3335application under the provisions of paragraph (a) and who owns
3336at least a 10-percent interest in any professional service,
3337firm, association, partnership, or corporation providing goods,
3338leases, or services to the facility for which the application is
3339made, and the name and address of the professional service,
3340firm, association, partnership, or corporation in which such
3341interest is held.
3342     (c)  The location of the facility for which a license is
3343sought and an indication, as in the original application, that
3344such location conforms to the local zoning ordinances.
3345     (d)  The name of the person or persons under whose
3346management or supervision the facility will be conducted and the
3347name of the administrator.
3348     (a)(e)  A signed affidavit disclosing any financial or
3349ownership interest that a controlling interest as defined in
3350part II of chapter 408 person or entity described in paragraph
3351(a) or paragraph (d) has held in the last 5 years in any entity
3352licensed by this state or any other state to provide health or
3353residential care which has closed voluntarily or involuntarily;
3354has filed for bankruptcy; has had a receiver appointed; has had
3355a license denied, suspended, or revoked; or has had an
3356injunction issued against it which was initiated by a regulatory
3357agency. The affidavit must disclose the reason any such entity
3358was closed, whether voluntarily or involuntarily.
3359     (b)(f)  The total number of beds and the total number of
3360Medicare and Medicaid certified beds.
3361     (c)(g)  Information relating to the number, experience, and
3362training of the employees of the facility and of the moral
3363character of the applicant and employees that which the agency
3364requires by rule, including the name and address of any nursing
3365home with which the applicant or employees have been affiliated
3366through ownership or employment within 5 years of the date of
3367the application for a license and the record of any criminal
3368convictions involving the applicant and any criminal convictions
3369involving an employee if known by the applicant after inquiring
3370of the employee. The applicant must demonstrate that sufficient
3371numbers of qualified staff, by training or experience, will be
3372employed to properly care for the type and number of residents
3373who will reside in the facility.
3374     (d)(h)  Copies of any civil verdict or judgment involving
3375the applicant rendered within the 10 years preceding the
3376application, relating to medical negligence, violation of
3377residents' rights, or wrongful death. As a condition of
3378licensure, the licensee agrees to provide to the agency copies
3379of any new verdict or judgment involving the applicant, relating
3380to such matters, within 30 days after filing with the clerk of
3381the court. The information required in this paragraph shall be
3382maintained in the facility's licensure file and in an agency
3383database which is available as a public record.
3384     (3)  The applicant shall submit evidence which establishes
3385the good moral character of the applicant, manager, supervisor,
3386and administrator. No applicant, if the applicant is an
3387individual; no member of a board of directors or officer of an
3388applicant, if the applicant is a firm, partnership, association,
3389or corporation; and no licensed nursing home administrator shall
3390have been convicted, or found guilty, regardless of
3391adjudication, of a crime in any jurisdiction which affects or
3392may potentially affect residents in the facility.
3393     (4)  Each applicant for licensure must comply with the
3394following requirements:
3395     (a)  Upon receipt of a completed, signed, and dated
3396application, the agency shall require background screening of
3397the applicant, in accordance with the level 2 standards for
3398screening set forth in chapter 435. As used in this subsection,
3399the term "applicant" means the facility administrator, or
3400similarly titled individual who is responsible for the day-to-
3401day operation of the licensed facility, and the facility
3402financial officer, or similarly titled individual who is
3403responsible for the financial operation of the licensed
3404facility.
3405     (b)  The agency may require background screening for a
3406member of the board of directors of the licensee or an officer
3407or an individual owning 5 percent or more of the licensee if the
3408agency has probable cause to believe that such individual has
3409been convicted of an offense prohibited under the level 2
3410standards for screening set forth in chapter 435.
3411     (c)  Proof of compliance with the level 2 background
3412screening requirements of chapter 435 which has been submitted
3413within the previous 5 years in compliance with any other health
3414care or assisted living licensure requirements of this state is
3415acceptable in fulfillment of paragraph (a). Proof of compliance
3416with background screening which has been submitted within the
3417previous 5 years to fulfill the requirements of the Financial
3418Services Commission and the Office of Insurance Regulation
3419pursuant to chapter 651 as part of an application for a
3420certificate of authority to operate a continuing care retirement
3421community is acceptable in fulfillment of the Department of Law
3422Enforcement and Federal Bureau of Investigation background
3423check.
3424     (d)  A provisional license may be granted to an applicant
3425when each individual required by this section to undergo
3426background screening has met the standards for the Department of
3427Law Enforcement background check, but the agency has not yet
3428received background screening results from the Federal Bureau of
3429Investigation, or a request for a disqualification exemption has
3430been submitted to the agency as set forth in chapter 435, but a
3431response has not yet been issued. A license may be granted to
3432the applicant upon the agency's receipt of a report of the
3433results of the Federal Bureau of Investigation background
3434screening for each individual required by this section to
3435undergo background screening which confirms that all standards
3436have been met, or upon the granting of a disqualification
3437exemption by the agency as set forth in chapter 435. Any other
3438person who is required to undergo level 2 background screening
3439may serve in his or her capacity pending the agency's receipt of
3440the report from the Federal Bureau of Investigation; however,
3441the person may not continue to serve if the report indicates any
3442violation of background screening standards and a
3443disqualification exemption has not been requested of and granted
3444by the agency as set forth in chapter 435.
3445     (e)  Each applicant must submit to the agency, with its
3446application, a description and explanation of any exclusions,
3447permanent suspensions, or terminations of the applicant from the
3448Medicare or Medicaid programs. Proof of compliance with
3449disclosure of ownership and control interest requirements of the
3450Medicaid or Medicare programs shall be accepted in lieu of this
3451submission.
3452     (f)  Each applicant must submit to the agency a description
3453and explanation of any conviction of an offense prohibited under
3454the level 2 standards of chapter 435 by a member of the board of
3455directors of the applicant, its officers, or any individual
3456owning 5 percent or more of the applicant. This requirement
3457shall not apply to a director of a not-for-profit corporation or
3458organization if the director serves solely in a voluntary
3459capacity for the corporation or organization, does not regularly
3460take part in the day-to-day operational decisions of the
3461corporation or organization, receives no remuneration for his or
3462her services on the corporation or organization's board of
3463directors, and has no financial interest and has no family
3464members with a financial interest in the corporation or
3465organization, provided that the director and the not-for-profit
3466corporation or organization include in the application a
3467statement affirming that the director's relationship to the
3468corporation satisfies the requirements of this paragraph.
3469     (g)  An application for license renewal must contain the
3470information required under paragraphs (e) and (f).
3471     (5)  The applicant shall furnish satisfactory proof of
3472financial ability to operate and conduct the nursing home in
3473accordance with the requirements of this part and all rules
3474adopted under this part, and the agency shall establish
3475standards for this purpose, including information reported under
3476paragraph (2)(e). The agency also shall establish documentation
3477requirements, to be completed by each applicant, that show
3478anticipated facility revenues and expenditures, the basis for
3479financing the anticipated cash-flow requirements of the
3480facility, and an applicant's access to contingency financing.
3481     (6)  If the applicant offers continuing care agreements as
3482defined in chapter 651, proof shall be furnished that such
3483applicant has obtained a certificate of authority as required
3484for operation under that chapter.
3485     (2)(7)  As a condition of licensure, each licensee, except
3486one offering continuing care agreements as defined in chapter
3487651, must agree to accept recipients of Title XIX of the Social
3488Security Act on a temporary, emergency basis. The persons whom
3489the agency may require such licensees to accept are those
3490recipients of Title XIX of the Social Security Act who are
3491residing in a facility in which existing conditions constitute
3492an immediate danger to the health, safety, or security of the
3493residents of the facility.
3494     (3)(8)  The agency may not issue a license to a nursing
3495home that fails to receive a certificate of need under the
3496provisions of ss. 408.031-408.045. It is the intent of the
3497Legislature that, in reviewing a certificate-of-need application
3498to add beds to an existing nursing home facility, preference be
3499given to the application of a licensee who has been awarded a
3500Gold Seal as provided for in s. 400.235, if the applicant
3501otherwise meets the review criteria specified in s. 408.035.
3502     (4)(9)  The agency may develop an abbreviated survey for
3503licensure renewal applicable to a licensee that has continuously
3504operated as a nursing facility since 1991 or earlier, has
3505operated under the same management for at least the preceding 30
3506months, and has had during the preceding 30 months no class I or
3507class II deficiencies.
3508     (5)(10)  As a condition of licensure, each facility must
3509establish and submit with its application a plan for quality
3510assurance and for conducting risk management.
3511     (11)  The applicant must provide the agency with proof of a
3512legal right to occupy the property before a license may be
3513issued. Proof may include, but is not limited to, copies of
3514warranty deeds, lease or rental agreements, contracts for deeds,
3515or quitclaim deeds.
3516     Section 69.  Subsection (4) of section 400.0712, Florida
3517Statutes, is renumbered as subsection (3) and present subsection
3518(3) of said section is amended to read:
3519     400.0712  Application for inactive license.--
3520     (3)  The agency may issue an inactive license to a nursing
3521home that will be temporarily unable to provide services but is
3522reasonably expected to resume services.
3523     (a)  An inactive license issued under this subsection may
3524be issued for a period not to exceed 12 months and may be
3525renewed by the agency for an additional 6 months upon
3526demonstration of progress toward reopening.
3527     (b)  All licensure fees must be current and paid in full,
3528and may be prorated as provided by agency rule, before the
3529inactive license is issued.
3530     (c)  Reactivation of an inactive license requires that the
3531applicant pay all licensure fees and be inspected by the agency
3532to confirm that all of the requirements of this part and
3533applicable rules are met.
3534     Section 70.  Section 400.102, Florida Statutes, is amended
3535to read:
3536     400.102  Action by agency against licensee; grounds.--
3537     (1)  In addition to the grounds listed in part II of
3538chapter 408, any of the following conditions shall be grounds
3539for action by the agency against a licensee:
3540     (1)(a)  An intentional or negligent act materially
3541affecting the health or safety of residents of the facility;
3542     (2)(b)  Misappropriation or conversion of the property of a
3543resident of the facility;
3544     (3)(c)  Failure to follow the criteria and procedures
3545provided under part I of chapter 394 relating to the
3546transportation, voluntary admission, and involuntary examination
3547of a nursing home resident; or
3548     (d)  Violation of provisions of this part or rules adopted
3549under this part;
3550     (4)(e)  Fraudulent altering, defacing, or falsifying any
3551medical or nursing home records, or causing or procuring any of
3552these offenses to be committed.; or
3553     (f)  Any act constituting a ground upon which application
3554for a license may be denied.
3555     (2)  If the agency has reasonable belief that any of such
3556conditions exist, it shall take the following action:
3557     (a)  In the case of an applicant for original licensure,
3558denial action as provided in s. 400.121.
3559     (b)  In the case of an applicant for relicensure or a
3560current licensee, administrative action as provided in s.
3561400.121 or injunctive action as authorized by s. 400.125.
3562     (c)  In the case of a facility operating without a license,
3563injunctive action as authorized in s. 400.125.
3564     Section 71.  Section 400.111, Florida Statutes, is amended
3565to read:
3566     400.111  Disclosure of controlling interest Expiration of
3567license; renewal.--
3568     (1)  A license issued for the operation of a facility,
3569unless sooner suspended or revoked, shall expire on the date set
3570forth by the agency on the face of the license or 1 year from
3571the date of issuance, whichever occurs first. Ninety days prior
3572to the expiration date, an application for renewal shall be
3573submitted to the agency. A license shall be renewed upon the
3574filing of an application on forms furnished by the agency if the
3575applicant has first met the requirements established under this
3576part and all rules adopted under this part. The failure to file
3577an application within the period established in this subsection
3578shall result in a late fee charged to the licensee by the agency
3579in an amount equal to 50 percent of the fee in effect on the
3580last preceding regular renewal date. A late fee shall be levied
3581for each and every day the filing of the license application is
3582delayed, but in no event shall such fine aggregate more than
3583$5,000. If an application is received after the required filing
3584date and exhibits a hand-canceled postmark obtained from a
3585United States Post Office dated on or before the required filing
3586date, no fine will be levied.
3587     (2)  A licensee against whom a revocation or suspension
3588proceeding, or any judicial proceeding instituted by the agency
3589under this part, is pending at the time of license renewal may
3590be issued a temporary license effective until final disposition
3591by the agency of such proceeding. If judicial relief is sought
3592from the aforesaid administrative order, the court having
3593jurisdiction may issue such orders regarding the issuance of a
3594temporary permit during the pendency of the judicial proceeding.
3595     (3)  The agency may not renew a license if the applicant
3596has failed to pay any fines assessed by final order of the
3597agency or final order of the Health Care Financing
3598Administration under requirements for federal certification. The
3599agency may renew the license of an applicant following the
3600assessment of a fine by final order if such fine has been paid
3601into an escrow account pending an appeal of a final order.
3602     (4)  In addition to the requirements of part II of chapter
3603408, the licensee shall submit a signed affidavit disclosing any
3604financial or ownership interest that a controlling interest
3605licensee has held within the last 5 years in any entity licensed
3606by the state or any other state to provide health or residential
3607care which entity has closed voluntarily or involuntarily; has
3608filed for bankruptcy; has had a receiver appointed; has had a
3609license denied, suspended, or revoked; or has had an injunction
3610issued against it which was initiated by a regulatory agency.
3611The affidavit must disclose the reason such entity was closed,
3612whether voluntarily or involuntarily.
3613     Section 72.  Subsections (2) and (5) of section 400.1183,
3614Florida Statutes, are amended to read:
3615     400.1183  Resident grievance procedures.--
3616     (2)  Each facility shall maintain records of all grievances
3617and shall report annually to the agency at the time of
3618relicensure the total number of grievances handled during the
3619prior licensure period, a categorization of the cases underlying
3620the grievances, and the final disposition of the grievances.
3621     (5)  The agency may impose an administrative fine, in
3622accordance with s. 400.121, against a nursing home facility for
3623noncompliance with this section.
3624     Section 73.  Section 400.121, Florida Statutes, is amended
3625to read:
3626     400.121  Denial, suspension, revocation of license;
3627moratorium on admissions; administrative fines; procedure; order
3628to increase staffing.--
3629     (1)  The agency may deny an application, revoke or suspend
3630a license, and or impose an administrative fine, not to exceed
3631$500 per violation per day for the violation of any provision of
3632this part, part II of chapter 408, or applicable rules, against
3633any applicant or licensee for the following violations by the
3634applicant, licensee, or other controlling interest:
3635     (a)  A violation of any provision of this part, part II of
3636chapter 408, or applicable rules s. 400.102(1); or
3637     (b)  A demonstrated pattern of deficient practice;
3638     (c)  Failure to pay any outstanding fines assessed by final
3639order of the agency or final order of the Health Care Financing
3640Administration pursuant to requirements for federal
3641certification. The agency may renew or approve the license of an
3642applicant following the assessment of a fine by final order if
3643such fine has been paid into an escrow account pending an appeal
3644of a final order;
3645     (d)  Exclusion from the Medicare or Medicaid program; or
3646     (b)(e)  An adverse action by a regulatory agency against
3647any other licensed facility that has a common controlling
3648interest with the licensee or applicant against whom the action
3649under this section is being brought. If the adverse action
3650involves solely the management company, the applicant or
3651licensee shall be given 30 days to remedy before final action is
3652taken. If the adverse action is based solely upon actions by a
3653controlling interest, the applicant or licensee may present
3654factors in mitigation of any proposed penalty based upon a
3655showing that such penalty is inappropriate under the
3656circumstances.
3657
3658All hearings shall be held within the county in which the
3659licensee or applicant operates or applies for a license to
3660operate a facility as defined herein.
3661     (2)  Except as provided in s. 400.23(8), a $500 fine shall
3662be imposed for each violation. Each day a violation of this part
3663occurs constitutes a separate violation and is subject to a
3664separate fine, but in no event may any fine aggregate more than
3665$5,000. A fine may be levied pursuant to this section in lieu of
3666and notwithstanding the provisions of s. 400.23. Fines paid
3667shall be deposited in the Resident Protection Trust Fund and
3668expended as provided in s. 400.063.
3669     (3)  The agency shall revoke or deny a nursing home license
3670if the licensee or controlling interest operates a facility in
3671this state that:
3672     (a)  Has had two moratoria imposed by final order for
3673substandard quality of care, as defined by 42 C.F.R. part 483,
3674within any 30-month period;
3675     (b)  Is conditionally licensed for 180 or more continuous
3676days;
3677     (c)  Is cited for two class I deficiencies arising from
3678unrelated circumstances during the same survey or investigation;
3679or
3680     (d)  Is cited for two class I deficiencies arising from
3681separate surveys or investigations within a 30-month period.
3682
3683The licensee may present factors in mitigation of revocation,
3684and the agency may make a determination not to revoke a license
3685based upon a showing that revocation is inappropriate under the
3686circumstances.
3687     (4)  The agency may issue an order immediately suspending
3688or revoking a license when it determines that any condition in
3689the facility presents a danger to the health, safety, or welfare
3690of the residents in the facility.
3691     (5)(a)  The agency may impose an immediate moratorium on
3692admissions to any facility when the agency determines that any
3693condition in the facility presents a threat to the health,
3694safety, or welfare of the residents in the facility.
3695     (4)(b)  Where the agency has placed a moratorium on
3696admissions on any facility two times within a 7-year period, the
3697agency may suspend the nursing home license of the nursing home
3698and the facility's management company, if any. During the
3699suspension, the agency shall take the facility into receivership
3700and shall operate the facility.
3701     (5)(6)  An action taken by the agency to deny, suspend, or
3702revoke a facility's license under this part shall be heard by
3703the Division of Administrative Hearings of the Department of
3704Management Services within 60 days after the assignment of an
3705administrative law judge, unless the time limitation is waived
3706by both parties. The administrative law judge must render a
3707decision within 30 days after receipt of a proposed recommended
3708order.
3709     (6)(7)  The agency is authorized to require a facility to
3710increase staffing beyond the minimum required by law, if the
3711agency has taken administrative action against the facility for
3712care-related deficiencies directly attributable to insufficient
3713staff. Under such circumstances, the facility may request an
3714expedited interim rate increase. The agency shall process the
3715request within 10 days after receipt of all required
3716documentation from the facility. A facility that fails to
3717maintain the required increased staffing is subject to a fine of
3718$500 per day for each day the staffing is below the level
3719required by the agency.
3720     (8)  An administrative proceeding challenging an action
3721taken by the agency pursuant to this section shall be reviewed
3722on the basis of the facts and conditions that resulted in such
3723agency action.
3724     (7)(9)  Notwithstanding any other provision of law to the
3725contrary, agency action in an administrative proceeding under
3726this section may be overcome by the licensee upon a showing by a
3727preponderance of the evidence to the contrary.
3728     (8)(10)  In addition to any other sanction imposed under
3729this part, in any final order that imposes sanctions, the agency
3730may assess costs related to the investigation and prosecution of
3731the case. Payment of agency costs shall be deposited into the
3732Health Care Trust Fund.
3733     Section 74.  Section 400.125, Florida Statutes, is
3734repealed.
3735     Section 75.  Subsections (14), (15), and (16) of section
3736400.141, Florida Statutes, are amended to read:
3737     400.141  Administration and management of nursing home
3738facilities.--Every licensed facility shall comply with all
3739applicable standards and rules of the agency and shall:
3740     (14)  Submit to the agency the information specified in s.
3741400.071(1)(a)(2)(e) for a management company within 30 days
3742after the effective date of the management agreement.
3743     (15)(a)  By the 15th calendar day of the month following
3744the end of each calendar quarter, submit semiannually to the
3745agency, or more frequently if requested by the agency,
3746information regarding facility staff-to-resident ratios, staff
3747turnover, and staff stability, including information regarding
3748certified nursing assistants, licensed nurses, the director of
3749nursing, and the facility administrator. For purposes of this
3750reporting:
3751     1.(a)  Staff-to-resident ratios must be reported in the
3752categories specified in s. 400.23(3)(a) and applicable rules.
3753The ratio must be reported as an average for the most recent
3754calendar quarter.
3755     2.(b)  Staff turnover must be reported for the most recent
375612-month period ending on the last workday of the most recent
3757calendar quarter prior to the date the information is submitted.
3758The turnover rate must be computed quarterly, with the annual
3759rate being the cumulative sum of the quarterly rates. The
3760turnover rate is the total number of terminations or separations
3761experienced during the quarter, excluding any employee
3762terminated during a probationary period of 3 months or less,
3763divided by the total number of staff employed at the end of the
3764period for which the rate is computed, and expressed as a
3765percentage.
3766     3.(c)  The formula for determining staff stability is the
3767total number of employees that have been employed for more than
376812 months, divided by the total number of employees employed at
3769the end of the most recent calendar quarter, and expressed as a
3770percentage.
3771     (b)(d)  A nursing facility that has failed to comply with
3772state minimum-staffing requirements for 2 consecutive days is
3773prohibited from accepting new admissions until the facility has
3774achieved the minimum-staffing requirements for a period of 6
3775consecutive days. For the purposes of this paragraph, any person
3776who was a resident of the facility and was absent from the
3777facility for the purpose of receiving medical care at a separate
3778location or was on a leave of absence is not considered a new
3779admission. Failure to impose such an admissions moratorium
3780constitutes a class II deficiency.
3781     (c)(e)  A nursing facility that which does not have a
3782conditional license may be cited for failure to comply with the
3783standards in s. 400.23(3)(a) only if it has failed to meet those
3784standards on 2 consecutive days or if it has failed to meet at
3785least 97 percent of those standards on any one day.
3786     (d)(f)  A facility that which has a conditional license
3787must be in compliance with the standards in s. 400.23(3)(a) at
3788all times from the effective date of the conditional license
3789until the effective date of a subsequent standard license.
3790
3791Nothing in this subsection section shall limit the agency's
3792ability to impose a deficiency or take other actions if a
3793facility does not have enough staff to meet the residents'
3794needs.
3795     (16)  Report by the 10th calendar day of each month monthly
3796the number of vacant beds in the facility that which are
3797available for resident occupancy on the last day of the prior
3798month information is reported.
3799
3800Facilities that have been awarded a Gold Seal under the program
3801established in s. 400.235 may develop a plan to provide
3802certified nursing assistant training as prescribed by federal
3803regulations and state rules and may apply to the agency for
3804approval of their program.
3805     Section 76.  Subsection (6) of section 400.162, Florida
3806Statutes, is amended to read:
3807     400.162  Property and personal affairs of residents.--
3808     (6)  In the event of the death of a resident, a licensee
3809shall return all refunds and funds held in trust to the
3810resident's personal representative, if one has been appointed at
3811the time the nursing home disburses such funds, and if not, to
3812the resident's spouse or adult next of kin named in a
3813beneficiary designation form provided by the nursing home to the
3814resident. In the event the resident has not completed the
3815beneficiary designation form or the resident's designated spouse
3816or adult next of kin is deceased or cannot be located and no
3817personal representative has been appointed, the nursing home may
3818release funds to the funeral home that is handling the deceased
3819resident's remains for the funeral home's actual charges for the
3820services performed. In all other situations no spouse or adult
3821next of kin or such person cannot be located, funds due to the
3822resident shall be placed in an interest-bearing account in a
3823bank, savings association, trust company, or credit union
3824located in this state and, if possible, located within the same
3825district in which the facility is located, which funds shall not
3826be represented as part of the assets of the facility on a
3827financial statement, and the licensee shall maintain such
3828account until such time as the trust funds are disbursed
3829pursuant to the provisions of the Florida Probate Code. All
3830other property of a deceased resident being held in trust by the
3831licensee shall be returned to the resident's personal
3832representative, if one has been appointed at the time the
3833nursing home disburses such property, and if not, to the
3834resident's spouse or adult next of kin named in a beneficiary
3835designation form provided by the nursing home to the resident.
3836In the event the resident has no spouse or adult next of kin or
3837such person cannot be located, property being held in trust
3838shall be safeguarded until such time as the property is
3839disbursed pursuant to the provisions of the Florida Probate
3840Code. The trust funds and property of deceased residents shall
3841be kept separate from the funds and the property of the licensee
3842and from the funds and property of the residents of the
3843facility. The nursing home needs to maintain only one account in
3844which the trust funds amounting to less than $100 of deceased
3845residents are placed. However, it shall be the obligation of the
3846nursing home to maintain adequate records to permit compilation
3847of interest due each individual resident's account. Separate
3848accounts shall be maintained with respect to trust funds of
3849deceased residents equal to or in excess of $100. In the event
3850the trust funds of the deceased resident are not disbursed
3851pursuant to the provisions of the Florida Probate Code within 2
3852years of the death of the resident, the trust funds shall be
3853deposited in the Resident Protection Trust Fund and expended as
3854provided for in s. 400.063, notwithstanding the provisions of
3855any other law of this state. Any other property of a deceased
3856resident held in trust by a licensee which is not disbursed in
3857accordance with the provisions of the Florida Probate Code shall
3858escheat to the state as provided by law.
3859     Section 77.  Section 400.179, Florida Statutes, is amended
3860to read:
3861     400.179  Sale or transfer of ownership of a nursing
3862facility; Liability for Medicaid underpayments and
3863overpayments.--
3864     (1)  It is the intent of the Legislature to protect the
3865rights of nursing home residents and the security of public
3866funds when a nursing facility is sold or the ownership is
3867transferred.
3868     (2)  Whenever a nursing facility is sold or the ownership
3869is transferred, including leasing, the transferee shall make
3870application to the agency for a new license at least 90 days
3871prior to the date of transfer of ownership.
3872     (3)  The transferor shall notify the agency in writing at
3873least 90 days prior to the date of transfer of ownership. The
3874transferor shall be responsible and liable for the lawful
3875operation of the nursing facility and the welfare of the
3876residents domiciled in the facility until the date the
3877transferee is licensed by the agency. The transferor shall be
3878liable for any and all penalties imposed against the facility
3879for violations occurring prior to the date of transfer of
3880ownership.
3881     (4)  The transferor shall, prior to transfer of ownership,
3882repay or make arrangements to repay to the agency or the
3883Department of Children and Family Services any amounts owed to
3884the agency or the department. Should the transferor fail to
3885repay or make arrangements to repay the amounts owed to the
3886agency or the department prior to the transfer of ownership, the
3887issuance of a license to the transferee shall be delayed until
3888repayment or until arrangements for repayment are made.
3889     (2)(5)  Because any transfer of a nursing facility may
3890expose the fact that Medicaid may have underpaid or overpaid the
3891transferor, and because in most instances, any such underpayment
3892or overpayment can only be determined following a formal field
3893audit, the liabilities for any such underpayments or
3894overpayments shall be as follows:
3895     (a)  The Medicaid program shall be liable to the transferor
3896for any underpayments owed during the transferor's period of
3897operation of the facility.
3898     (b)  Without regard to whether the transferor had leased or
3899owned the nursing facility, the transferor shall remain liable
3900to the Medicaid program for all Medicaid overpayments received
3901during the transferor's period of operation of the facility,
3902regardless of when determined.
3903     (c)  Where the facility transfer takes any form of a sale
3904of assets, in addition to the transferor's continuing liability
3905for any such overpayments, if the transferor fails to meet these
3906obligations, the transferee shall be liable for all liabilities
3907that can be readily identifiable 90 days in advance of the
3908transfer. Such liability shall continue in succession until the
3909debt is ultimately paid or otherwise resolved. It shall be the
3910burden of the transferee to determine the amount of all such
3911readily identifiable overpayments from the Agency for Health
3912Care Administration, and the agency shall cooperate in every way
3913with the identification of such amounts. Readily identifiable
3914overpayments shall include overpayments that will result from,
3915but not be limited to:
3916     1.  Medicaid rate changes or adjustments;
3917     2.  Any depreciation recapture;
3918     3.  Any recapture of fair rental value system indexing; or
3919     4.  Audits completed by the agency.
3920
3921The transferor shall remain liable for any such Medicaid
3922overpayments that were not readily identifiable 90 days in
3923advance of the nursing facility transfer.
3924     (d)  Where the transfer involves a facility that has been
3925leased by the transferor:
3926     1.  The transferee shall, as a condition to being issued a
3927license by the agency, acquire, maintain, and provide proof to
3928the agency of a bond with a term of 30 months, renewable
3929annually, in an amount not less than the total of 3 months
3930Medicaid payments to the facility computed on the basis of the
3931preceding 12-month average Medicaid payments to the facility.
3932     2.  A leasehold licensee may meet the requirements of
3933subparagraph 1. by payment of a nonrefundable fee, paid at
3934initial licensure, paid at the time of any subsequent change of
3935ownership, and paid annually thereafter at the time of any
3936subsequent annual license renewal, in the amount of 2 percent of
3937the total of 3 months' Medicaid payments to the facility
3938computed on the basis of the preceding 12-month average Medicaid
3939payments to the facility. If a preceding 12-month average is not
3940available, projected Medicaid payments may be used. The fee
3941shall be deposited into the Health Care Trust Fund and shall be
3942accounted for separately as a Medicaid nursing home overpayment
3943account. These fees shall be used at the sole discretion of the
3944agency to repay nursing home Medicaid overpayments. Payment of
3945this fee shall not release the licensee from any liability for
3946any Medicaid overpayments, nor shall payment bar the agency from
3947seeking to recoup overpayments from the licensee and any other
3948liable party. As a condition of exercising this lease bond
3949alternative, licensees paying this fee must maintain an existing
3950lease bond through the end of the 30-month term period of that
3951bond. The agency is herein granted specific authority to
3952promulgate all rules pertaining to the administration and
3953management of this account, including withdrawals from the
3954account, subject to federal review and approval. This provision
3955shall take effect upon becoming law and shall apply to any
3956leasehold license application.
3957     a.  The financial viability of the Medicaid nursing home
3958overpayment account shall be determined by the agency through
3959annual review of the account balance and the amount of total
3960outstanding, unpaid Medicaid overpayments owing from leasehold
3961licensees to the agency as determined by final agency audits.
3962     b.  The agency, in consultation with the Florida Health
3963Care Association and the Florida Association of Homes for the
3964Aging, shall study and make recommendations on the minimum
3965amount to be held in reserve to protect against Medicaid
3966overpayments to leasehold licensees and on the issue of
3967successor liability for Medicaid overpayments upon sale or
3968transfer of ownership of a nursing facility. The agency shall
3969submit the findings and recommendations of the study to the
3970Governor, the President of the Senate, and the Speaker of the
3971House of Representatives by January 1, 2003.
3972     3.  The leasehold licensee may meet the bond requirement
3973through other arrangements acceptable to the agency. The agency
3974is herein granted specific authority to promulgate rules
3975pertaining to lease bond arrangements.
3976     4.  All existing nursing facility licensees, operating the
3977facility as a leasehold, shall acquire, maintain, and provide
3978proof to the agency of the 30-month bond required in
3979subparagraph 1., above, on and after July 1, 1993, for each
3980license renewal.
3981     5.  It shall be the responsibility of all nursing facility
3982operators, operating the facility as a leasehold, to renew the
398330-month bond and to provide proof of such renewal to the agency
3984annually at the time of application for license renewal.
3985     6.  Any failure of the nursing facility operator to
3986acquire, maintain, renew annually, or provide proof to the
3987agency shall be grounds for the agency to deny, cancel, revoke,
3988and or suspend the facility license to operate such facility and
3989to take any further action, including, but not limited to,
3990enjoining the facility, asserting a moratorium pursuant to part
3991II of chapter 408, or applying for a receiver, deemed necessary
3992to ensure compliance with this section and to safeguard and
3993protect the health, safety, and welfare of the facility's
3994residents. A lease agreement required as a condition of bond
3995financing or refinancing under s. 154.213 by a health facilities
3996authority or required under s. 159.30 by a county or
3997municipality is not a leasehold for purposes of this paragraph
3998and is not subject to the bond requirement of this paragraph.
3999     Section 78.  Subsections (1) and (4) of section 400.18,
4000Florida Statutes, are amended to read:
4001     400.18  Closing of nursing facility.--
4002     (1)  In addition to the requirements of part II of chapter
4003408, Whenever a licensee voluntarily discontinues operation, and
4004during the period when it is preparing for such discontinuance,
4005it shall inform the agency not less than 90 days prior to the
4006discontinuance of operation. the licensee also shall inform each
4007the resident or the next of kin, legal representative, or agency
4008acting on behalf of the resident of the fact, and the proposed
4009time, of such discontinuance of operation and give at least 90
4010days' notice so that suitable arrangements may be made for the
4011transfer and care of the resident. In the event any resident has
4012no such person to represent him or her, the licensee shall be
4013responsible for securing a suitable transfer of the resident
4014before the discontinuance of operation. The agency shall be
4015responsible for arranging for the transfer of those residents
4016requiring transfer who are receiving assistance under the
4017Medicaid program.
4018     (4)  Immediately upon discontinuance of operation of a
4019facility, the licensee shall surrender the license therefor to
4020the agency, and the license shall be canceled.
4021     Section 79.  Subsections (1), (2), and (3) of section
4022400.19, Florida Statutes, are amended to read:
4023     400.19  Right of entry and inspection.--
4024     (1)  In accordance with part II of chapter 408, the agency
4025and any duly designated officer or employee thereof or a member
4026of the State Long-Term Care Ombudsman Council or the local long-
4027term care ombudsman council shall have the right to enter upon
4028and into the premises of any facility licensed pursuant to this
4029part, or any distinct nursing home unit of a hospital licensed
4030under chapter 395 or any freestanding facility licensed under
4031chapter 395 that provides extended care or other long-term care
4032services, at any reasonable time in order to determine the state
4033of compliance with the provisions of this part and rules in
4034force pursuant thereto. The right of entry and inspection shall
4035also extend to any premises which the agency has reason to
4036believe is being operated or maintained as a facility without a
4037license, but no such entry or inspection of any premises shall
4038be made without the permission of the owner or person in charge
4039thereof, unless a warrant is first obtained from the circuit
4040court authorizing same. Any application for a facility license
4041or renewal thereof, made pursuant to this part, shall constitute
4042permission for and complete acquiescence in any entry or
4043inspection of the premises for which the license is sought, in
4044order to facilitate verification of the information submitted on
4045or in connection with the application; to discover, investigate,
4046and determine the existence of abuse or neglect; or to elicit,
4047receive, respond to, and resolve complaints. The agency shall,
4048within 60 days after receipt of a complaint made by a resident
4049or resident's representative, complete its investigation and
4050provide to the complainant its findings and resolution.
4051     (2)  The agency shall coordinate nursing home facility
4052licensing activities and responsibilities of any duly designated
4053officer or employee involved in nursing home facility inspection
4054to assure necessary, equitable, and consistent supervision of
4055inspection personnel without unnecessary duplication of
4056inspections, consultation services, or complaint investigations.
4057To facilitate such coordination, all rules promulgated by the
4058agency pursuant to this part shall be distributed to nursing
4059homes licensed under s. 400.062 30 days prior to implementation.
4060This requirement does not apply to emergency rules.
4061     (3)  The agency shall every 15 months conduct at least one
4062unannounced inspection to determine compliance by the licensee
4063with statutes, and with rules promulgated under the provisions
4064of those statutes, governing minimum standards of construction,
4065quality and adequacy of care, and rights of residents. The
4066survey shall be conducted every 6 months for the next 2-year
4067period if the facility has been cited for a class I deficiency,
4068has been cited for two or more class II deficiencies arising
4069from separate surveys or investigations within a 60-day period,
4070or has had three or more substantiated complaints within a 6-
4071month period, each resulting in at least one class I or class II
4072deficiency. In addition to any other fees or fines in this part,
4073the agency shall assess a fine for each facility that is subject
4074to the 6-month survey cycle. The fine for the 2-year period
4075shall be $6,000, one-half to be paid at the completion of each
4076survey. The agency may adjust this fine by the change in the
4077Consumer Price Index, based on the 12 months immediately
4078preceding the increase, to cover the cost of the additional
4079surveys. The agency shall verify through subsequent inspection
4080that any deficiency identified during the annual inspection is
4081corrected. However, the agency may verify the correction of a
4082class III or class IV deficiency unrelated to resident rights or
4083resident care without reinspecting the facility if adequate
4084written documentation has been received from the facility, which
4085provides assurance that the deficiency has been corrected. The
4086giving or causing to be given of advance notice of such
4087unannounced inspections by an employee of the agency to any
4088unauthorized person shall constitute cause for suspension of not
4089fewer than 5 working days according to the provisions of chapter
4090110.
4091     Section 80.  Section 400.191, Florida Statutes, is amended
4092to read:
4093     400.191  Availability, distribution, and posting of reports
4094and records.--
4095     (1)  The agency shall provide information to the public
4096about all of the licensed nursing home facilities operating in
4097the state. The agency shall, within 60 days after an annual
4098inspection visit or within 30 days after any interim visit to a
4099facility, send copies of the inspection reports to the local
4100long-term care ombudsman council, the agency's local office, and
4101a public library or the county seat for the county in which the
4102facility is located. The agency may provide electronic access to
4103inspection reports as a substitute for sending copies.
4104     (2)  The agency shall publish the Nursing Home Guide
4105provide additional information in consumer-friendly printed and
4106electronic formats to assist consumers and their families in
4107comparing and evaluating nursing home facilities.
4108     (a)  The agency shall provide an Internet site which shall
4109include at least the following information either directly or
4110indirectly through a link to another established site or sites
4111of the agency's choosing:
4112     1.  A list by name and address of all nursing home
4113facilities in this state, including any prior name a facility
4114was known by during the previous 12-month period.
4115     2.  Whether such nursing home facilities are proprietary or
4116nonproprietary.
4117     3.  The current owner of the facility's license and the
4118year that that entity became the owner of the license.
4119     4.  The name of the owner or owners of each facility and
4120whether the facility is affiliated with a company or other
4121organization owning or managing more than one nursing facility
4122in this state.
4123     5.  The total number of beds in each facility and the most
4124recently available occupancy levels.
4125     6.  The number of private and semiprivate rooms in each
4126facility.
4127     7.  The religious affiliation, if any, of each facility.
4128     8.  The languages spoken by the administrator and staff of
4129each facility.
4130     9.  Whether or not each facility accepts Medicare or
4131Medicaid recipients or insurance, health maintenance
4132organization, Veterans Administration, CHAMPUS program, or
4133workers' compensation coverage.
4134     10.  Recreational and other programs available at each
4135facility.
4136     11.  Special care units or programs offered at each
4137facility.
4138     12.  Whether the facility is a part of a retirement
4139community that offers other services pursuant to part III, part
4140IV, or part V.
4141     13.  Survey and deficiency information contained on the
4142Online Survey Certification and Reporting (OSCAR) system of the
4143federal Health Care Financing Administration, including all
4144federal and state recertification, licensure annual survey,
4145revisit, and complaint survey information, for each facility for
4146the past 30 45 months. For noncertified nursing homes, state
4147survey and deficiency information, including licensure annual
4148survey, revisit, and complaint survey information for the past
414930 45 months shall be provided.
4150     14.  A summary of the deficiency Online Survey
4151Certification and Reporting (OSCAR) data for each facility over
4152the past 30 45 months. Such summary may include a score, rating,
4153or comparison ranking with respect to other facilities based on
4154the number of citations received by the facility on
4155recertification, licensure of annual, revisit, and complaint
4156surveys; the severity and scope of the citations; and the number
4157of annual recertification surveys the facility has had during
4158the past 30 45 months. The score, rating, or comparison ranking
4159may be presented in either numeric or symbolic form for the
4160intended consumer audience.
4161     (b)  The agency shall provide the following information in
4162printed form:
4163     1.  A list by name and address of all nursing home
4164facilities in this state.
4165     2.  Whether such nursing home facilities are proprietary or
4166nonproprietary.
4167     3.  The current owner or owners of the facility's license
4168and the year that entity became the owner of the license.
4169     4.  The total number of beds, and of private and
4170semiprivate rooms, in each facility.
4171     5.  The religious affiliation, if any, of each facility.
4172     6.  The name of the owner of each facility and whether the
4173facility is affiliated with a company or other organization
4174owning or managing more than one nursing facility in this state.
4175     7.  The languages spoken by the administrator and staff of
4176each facility.
4177     8.  Whether or not each facility accepts Medicare or
4178Medicaid recipients or insurance, health maintenance
4179organization, Veterans Administration, CHAMPUS program, or
4180workers' compensation coverage.
4181     9.  Recreational programs, special care units, and other
4182programs available at each facility.
4183     10.  The Internet address for the site where more detailed
4184information can be seen.
4185     11.  A statement advising consumers that each facility will
4186have its own policies and procedures related to protecting
4187resident property.
4188     12.  A summary of the deficiency Online Survey
4189Certification and Reporting (OSCAR) data for each facility over
4190the past 45 months. Such summary may include a score, rating, or
4191comparison ranking with respect to other facilities based on the
4192number of citations received by the facility on recertification,
4193licensure annual, revisit, and complaint surveys; the severity
4194and scope of the citations; the number of citations; and the
4195number of annual recertification surveys the facility has had
4196during the past 30 45 months. The score, rating, or comparison
4197ranking may be presented in either numeric or symbolic form for
4198the intended consumer audience.
4199     (c)  For purposes of this subsection, references to the
4200Online Survey Certification and Reporting (OSCAR) system shall
4201refer to any future system that the Health Care Financing
4202Administration develops to replace the current OSCAR system.
4203     (c)(d)  The agency may provide the following additional
4204information on an Internet site or in printed form as the
4205information becomes available:
4206     1.  The licensure status history of each facility.
4207     2.  The rating history of each facility.
4208     3.  The regulatory history of each facility, which may
4209include federal sanctions, state sanctions, federal fines, state
4210fines, and other actions.
4211     4.  Whether the facility currently possesses the Gold Seal
4212designation awarded pursuant to s. 400.235.
4213     5.  Internet links to the Internet sites of the facilities
4214or their affiliates.
4215     (3)  Each nursing home facility licensee shall maintain as
4216public information, available upon request, records of all cost
4217and inspection reports pertaining to that facility that have
4218been filed with, or issued by, any governmental agency. Copies
4219of such reports shall be retained in such records for not less
4220than 5 years from the date the reports are filed or issued.
4221     (a)  The agency shall quarterly publish in the Nursing Home
4222Guide a "Nursing Home Guide Watch List" to assist consumers in
4223evaluating the quality of nursing home care in Florida. The
4224watch list must identify each facility that met the criteria for
4225a conditional licensure status to be noticed as specified in
4226this section on any day within the quarter covered by the list
4227and each facility that is was operating under bankruptcy
4228protection on any day within the quarter. The watch list must
4229include, but is not limited to, the facility's name, address,
4230and ownership; the county in which the facility operates; the
4231license expiration date; the number of licensed beds; a
4232description of the deficiency causing the facility to be placed
4233on the list; any corrective action taken; and the cumulative
4234number of days and percentage of days times the facility had a
4235conditional license in the past 30 months has been on a watch
4236list. The watch list must include a brief description regarding
4237how to choose a nursing home, the categories of licensure, the
4238agency's inspection process, an explanation of terms used in the
4239watch list, and the addresses and phone numbers of the agency's
4240managed care and health quality assurance field area offices.
4241     (b)  Upon publication of each quarterly Nursing Home Guide
4242watch list, the agency must post transmit a copy on its website
4243by the 15th calendar day 2 months following the end of the
4244calendar quarter. Each nursing home licensee must retrieve the
4245most recent version of the Nursing Home Guide from of the watch
4246list to each nursing home facility by mail and must make the
4247watch list available on the agency's Internet website.
4248     (4)  Any records of a nursing home facility determined by
4249the agency to be necessary and essential to establish lawful
4250compliance with any rules or standards shall be made available
4251to the agency on the premises of the facility and submitted to
4252the agency. Each facility must submit this information
4253electronically when electronic transmission to the agency is
4254available.
4255     (5)  Every nursing home facility licensee shall:
4256     (a)  Post, in a sufficient number of prominent positions in
4257the nursing home so as to be accessible to all residents and to
4258the general public:
4259     1.  A concise summary of the last inspection report
4260pertaining to the nursing home and issued by the agency, with
4261references to the page numbers of the full reports, noting any
4262deficiencies found by the agency and the actions taken by the
4263licensee to rectify such deficiencies and indicating in such
4264summaries where the full reports may be inspected in the nursing
4265home.
4266     2.  A copy of all pages listing the facility from the most
4267recent version of the Florida Nursing Home Guide Watch List.
4268     (b)  Upon request, provide to any person who has completed
4269a written application with an intent to be admitted to, or to
4270any resident of, such nursing home, or to any relative, spouse,
4271or guardian of such person, a copy of the last inspection report
4272pertaining to the nursing home and issued by the agency,
4273provided the person requesting the report agrees to pay a
4274reasonable charge to cover copying costs.
4275     (6)  The agency may adopt rules as necessary to administer
4276this section.
4277     Section 81.  Section 400.20, Florida Statutes, is amended
4278to read:
4279     400.20  Licensed nursing home administrator required.--A No
4280nursing home may not shall operate except under the supervision
4281of a licensed nursing home administrator, and a no person may
4282not shall be a nursing home administrator unless he or she holds
4283is the holder of a current license as provided in chapter 468.
4284     Section 82.  Subsections (2), (7), and (8) of section
4285400.23, Florida Statutes, are amended to read:
4286     400.23  Rules; evaluation and deficiencies; licensure
4287status.--
4288     (2)  Pursuant to the intention of the Legislature, the
4289agency, in consultation with the Department of Health and the
4290Department of Elderly Affairs, shall adopt and enforce rules to
4291implement this part and part II of chapter 408, which shall
4292include reasonable and fair criteria in relation to:
4293     (a)  The location of the facility and housing conditions
4294that will ensure the health, safety, and comfort of residents,
4295including an adequate call system. In making such rules, the
4296agency shall be guided by criteria recommended by nationally
4297recognized reputable professional groups and associations with
4298knowledge of such subject matters. The agency shall update or
4299revise such criteria as the need arises. The agency may require
4300alterations to a building if it determines that an existing
4301condition constitutes a distinct hazard to life, health, or
4302safety. In performing any inspections of facilities authorized
4303by this part, the agency may enforce the special-occupancy
4304provisions of the Florida Building Code and the Florida Fire
4305Prevention Code which apply to nursing homes. The agency is
4306directed to provide assistance to the Florida Building
4307Commission in updating the construction standards of the code
4308relative to nursing homes. A resident or the representative of
4309the resident shall be able to request a change in the placement
4310of the bed in his or her room, provided that at admission the
4311resident or the representative of the resident is presented with
4312a room that meets requirements of the Florida Building Code. The
4313location of a bed may be changed if the requested placement does
4314not infringe on the resident's roommate or interfere with the
4315resident's care or safety as determined by the care planning
4316team in accordance with facility policies and procedures. In
4317addition, the bed placement may not be used as a restraint. Each
4318facility shall maintain a log of resident rooms with beds that
4319are not in strict compliance with the Florida Building Code in
4320order for such log to be used by surveyors and nurse monitors
4321during inspections and visits. Any resident or representative of
4322a resident who requests that a bed be moved shall sign a
4323statement indicating that he or she understands the room will
4324not be in compliance with the Florida Building Code, but he or
4325she would prefer to exercise his or her right to self-
4326determination. The statement must be retained as part of the
4327resident's care plan. Any facility that offers this option shall
4328submit to the agency a letter signed by the nursing home
4329administrator of record notifying the agency of this practice
4330and include a copy of the facility's policies and procedures.
4331     (b)  The number and qualifications of all personnel,
4332including management, medical, nursing, and other professional
4333personnel, and nursing assistants, orderlies, and support
4334personnel, having responsibility for any part of the care given
4335residents.
4336     (c)  All sanitary conditions within the facility and its
4337surroundings, including water supply, sewage disposal, food
4338handling, and general hygiene which will ensure the health and
4339comfort of residents.
4340     (d)  The equipment essential to the health and welfare of
4341the residents.
4342     (e)  A uniform accounting system.
4343     (f)  The care, treatment, and maintenance of residents and
4344measurement of the quality and adequacy thereof, based on rules
4345developed under this chapter and the Omnibus Budget
4346Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
43471987), Title IV (Medicare, Medicaid, and Other Health-Related
4348Programs), Subtitle C (Nursing Home Reform), as amended.
4349     (g)  The preparation and annual update of a comprehensive
4350emergency management plan. The agency shall adopt rules
4351establishing minimum criteria for the plan after consultation
4352with the Department of Community Affairs. At a minimum, the
4353rules must provide for plan components that address emergency
4354evacuation transportation; adequate sheltering arrangements;
4355postdisaster activities, including emergency power, food, and
4356water; postdisaster transportation; supplies; staffing;
4357emergency equipment; individual identification of residents and
4358transfer of records; and responding to family inquiries. The
4359comprehensive emergency management plan is subject to review and
4360approval by the local emergency management agency. During its
4361review, the local emergency management agency shall ensure that
4362the following agencies, at a minimum, are given the opportunity
4363to review the plan: the Department of Elderly Affairs, the
4364Department of Health, the Agency for Health Care Administration,
4365and the Department of Community Affairs. Also, appropriate
4366volunteer organizations must be given the opportunity to review
4367the plan. The local emergency management agency shall complete
4368its review within 60 days and either approve the plan or advise
4369the facility of necessary revisions.
4370     (h)  The availability, distribution, and posting of reports
4371and records pursuant to s. 400.191 and the Gold Seal Program
4372pursuant to s. 400.235.
4373     (7)  The agency shall, at least every 15 months, evaluate
4374all nursing home facilities and make a determination as to the
4375degree of compliance by each licensee with the established rules
4376adopted under this part as a basis for assigning a licensure
4377status to that facility. The agency shall base its evaluation on
4378the most recent inspection report, taking into consideration
4379findings from other official reports, surveys, interviews,
4380investigations, and inspections. The agency shall assign a
4381licensure status of standard or conditional to each nursing
4382home.
4383     (a)  A standard licensure status means that a facility has
4384no class I or class II deficiencies and has corrected all class
4385III deficiencies within the time established by the agency.
4386     (b)  A conditional licensure status means that a facility,
4387due to the presence of one or more class I or class II
4388deficiencies, or class III deficiencies not corrected within the
4389time established by the agency, is not in substantial compliance
4390at the time of the survey with criteria established under this
4391part or with rules adopted by the agency. If the facility has no
4392class I, class II, or class III deficiencies at the time of the
4393followup survey, a standard licensure status may be assigned.
4394     (c)  In evaluating the overall quality of care and services
4395and determining whether the facility will receive a conditional
4396or standard license, the agency shall consider the needs and
4397limitations of residents in the facility and the results of
4398interviews and surveys of a representative sampling of
4399residents, families of residents, ombudsman council members in
4400the planning and service area in which the facility is located,
4401guardians of residents, and staff of the nursing home facility.
4402     (d)  The current licensure status of each facility must be
4403indicated in bold print on the face of the license. A list of
4404the deficiencies of the facility shall be posted in a prominent
4405place that is in clear and unobstructed public view at or near
4406the place where residents are being admitted to that facility.
4407Licensees receiving a conditional licensure status for a
4408facility shall prepare, within 10 working days after receiving
4409notice of deficiencies, a plan for correction of all
4410deficiencies and shall submit the plan to the agency for
4411approval.
4412     (e)  Each licensee shall post its license in a prominent
4413place that is in clear and unobstructed public view at or near
4414the place where residents are being admitted to the facility.
4415     (e)(f)  The agency shall adopt rules that:
4416     1.  Establish uniform procedures for the evaluation of
4417facilities.
4418     2.  Provide criteria in the areas referenced in paragraph
4419(c).
4420     3.  Address other areas necessary for carrying out the
4421intent of this section.
4422     (8)  The agency shall adopt rules pursuant to this part and
4423part II of chapter 408 to provide that, when the criteria
4424established under subsection (2) are not met, such deficiencies
4425shall be classified according to the nature and the scope of the
4426deficiency. The scope shall be cited as isolated, patterned, or
4427widespread. An isolated deficiency is a deficiency affecting one
4428or a very limited number of residents, or involving one or a
4429very limited number of staff, or a situation that occurred only
4430occasionally or in a very limited number of locations. A
4431patterned deficiency is a deficiency where more than a very
4432limited number of residents are affected, or more than a very
4433limited number of staff are involved, or the situation has
4434occurred in several locations, or the same resident or residents
4435have been affected by repeated occurrences of the same deficient
4436practice but the effect of the deficient practice is not found
4437to be pervasive throughout the facility. A widespread deficiency
4438is a deficiency in which the problems causing the deficiency are
4439pervasive in the facility or represent systemic failure that has
4440affected or has the potential to affect a large portion of the
4441facility's residents. The agency shall indicate the
4442classification on the face of the notice of deficiencies as
4443follows:
4444     (a)  A class I deficiency is a deficiency that the agency
4445determines presents a situation in which immediate corrective
4446action is necessary because the facility's noncompliance has
4447caused, or is likely to cause, serious injury, harm, impairment,
4448or death to a resident receiving care in a facility. The
4449condition or practice constituting a class I violation shall be
4450abated or eliminated immediately, unless a fixed period of time,
4451as determined by the agency, is required for correction. A class
4452I deficiency is subject to a civil penalty of $10,000 for an
4453isolated deficiency, $12,500 for a patterned deficiency, and
4454$15,000 for a widespread deficiency. The fine amount shall be
4455doubled for each deficiency if the facility was previously cited
4456for one or more class I or class II deficiencies during the last
4457annual inspection or any inspection or complaint investigation
4458since the last annual inspection. A fine must be levied
4459notwithstanding the correction of the deficiency.
4460     (b)  A class II deficiency is a deficiency that the agency
4461determines has compromised the resident's ability to maintain or
4462reach his or her highest practicable physical, mental, and
4463psychosocial well-being, as defined by an accurate and
4464comprehensive resident assessment, plan of care, and provision
4465of services. A class II deficiency is subject to a civil penalty
4466of $2,500 for an isolated deficiency, $5,000 for a patterned
4467deficiency, and $7,500 for a widespread deficiency. The fine
4468amount shall be doubled for each deficiency if the facility was
4469previously cited for one or more class I or class II
4470deficiencies during the last licensure annual inspection or any
4471inspection or complaint investigation since the last licensure
4472annual inspection. A fine shall be levied notwithstanding the
4473correction of the deficiency.
4474     (c)  A class III deficiency is a deficiency that the agency
4475determines will result in no more than minimal physical, mental,
4476or psychosocial discomfort to the resident or has the potential
4477to compromise the resident's ability to maintain or reach his or
4478her highest practical physical, mental, or psychosocial well-
4479being, as defined by an accurate and comprehensive resident
4480assessment, plan of care, and provision of services. A class III
4481deficiency is subject to a civil penalty of $1,000 for an
4482isolated deficiency, $2,000 for a patterned deficiency, and
4483$3,000 for a widespread deficiency. The fine amount shall be
4484doubled for each deficiency if the facility was previously cited
4485for one or more class I or class II deficiencies during the last
4486licensure annual inspection or any inspection or complaint
4487investigation since the last annual inspection. A citation for a
4488class III deficiency must specify the time within which the
4489deficiency is required to be corrected. If a class III
4490deficiency is corrected within the time specified, no civil
4491penalty shall be imposed.
4492     (d)  A class IV deficiency is a deficiency that the agency
4493determines has the potential for causing no more than a minor
4494negative impact on the resident. If the class IV deficiency is
4495isolated, no plan of correction is required.
4496     Section 83.  Subsections (3) and (4) of section 400.241,
4497Florida Statutes, are renumbered as subsections (1) and (2),
4498respectively, and present subsections (1) and (2) of said
4499section are amended to read:
4500     400.241  Prohibited acts; penalties for violations.--
4501     (1)  It is unlawful for any person or public body to
4502establish, conduct, manage, or operate a home as defined in this
4503part without obtaining a valid current license.
4504     (2)  It is unlawful for any person or public body to offer
4505or advertise to the public, in any way by any medium whatever,
4506nursing home care or service or custodial services without
4507obtaining a valid current license. It is unlawful for any holder
4508of a license issued pursuant to the provisions of this part to
4509advertise or hold out to the public that it holds a license for
4510a facility other than that for which it actually holds a
4511license.
4512     Section 84.  Subsections (6) through (27) of section
4513400.402, Florida Statutes, are renumbered as subsections (5)
4514through (26), respectively, and present subsections (5), (12),
4515(14), (17), and (20) are amended to read:
4516     400.402  Definitions.--When used in this part, the term:
4517     (5)  "Applicant" means an individual owner, corporation,
4518partnership, firm, association, or governmental entity that
4519applies for a license.
4520     (11)(12)  "Extended congregate care" means acts beyond
4521those authorized in subsection (16) (17) that may be performed
4522pursuant to part I of chapter 464 by persons licensed thereunder
4523while carrying out their professional duties, and other
4524supportive services which may be specified by rule. The purpose
4525of such services is to enable residents to age in place in a
4526residential environment despite mental or physical limitations
4527that might otherwise disqualify them from residency in a
4528facility licensed under this part.
4529     (13)(14)  "Limited nursing services" means acts that may be
4530performed pursuant to part I of chapter 464 by persons licensed
4531thereunder while carrying out their professional duties but
4532limited to those acts which the agency department specifies by
4533rule. Acts which may be specified by rule as allowable limited
4534nursing services shall be for persons who meet the admission
4535criteria established by the agency department for assisted
4536living facilities and shall not be complex enough to require 24-
4537hour nursing supervision and may include such services as the
4538application and care of routine dressings, and care of casts,
4539braces, and splints.
4540     (16)(17)  "Personal services" means direct physical
4541assistance with or supervision of the activities of daily living
4542and the self-administration of medication and other similar
4543services which the agency department may define by rule.
4544"Personal services" shall not be construed to mean the provision
4545of medical, nursing, dental, or mental health services.
4546     (19)(20)  "Resident" means a person 18 years of age or
4547older, residing in and receiving care from a facility, including
4548a person receiving services pursuant to s. 400.553(2).
4549     Section 85.  Section 400.407, Florida Statutes, is amended
4550to read:
4551     400.407  License required; fee, display.--
4552     (1)  The requirements of part II of chapter 408 shall apply
4553to the provision of services that require licensure pursuant
4554this part and part II of chapter 408 and to entities licensed by
4555or applying for such licensure from the agency pursuant to this
4556part. However, each applicant for licensure and each licensee is
4557exempt from s. 408.810(10). A license issued by the agency is
4558required for an assisted living facility operating in this
4559state.
4560     (2)  Separate licenses shall be required for facilities
4561maintained in separate premises, even though operated under the
4562same management. A separate license shall not be required for
4563separate buildings on the same grounds.
4564     (3)  In addition to the requirements of 408.806, each Any
4565license granted by the agency must state the maximum resident
4566capacity of the facility, the type of care for which the license
4567is granted, the date the license is issued, the expiration date
4568of the license, and any other information deemed necessary by
4569the agency. Licenses shall be issued for one or more of the
4570following categories of care: standard, extended congregate
4571care, limited nursing services, or limited mental health.
4572     (a)  A standard license shall be issued to facilities
4573providing one or more of the personal services identified in s.
4574400.402. Such facilities may also employ or contract with a
4575person licensed under part I of chapter 464 to administer
4576medications and perform other tasks as specified in s. 400.4255.
4577     (b)  An extended congregate care license shall be issued to
4578facilities providing, directly or through contract, services
4579beyond those authorized in paragraph (a), including acts
4580performed pursuant to part I of chapter 464 by persons licensed
4581thereunder, and supportive services defined by rule to persons
4582who otherwise would be disqualified from continued residence in
4583a facility licensed under this part.
4584     1.  In order for extended congregate care services to be
4585provided in a facility licensed under this part, the agency must
4586first determine that all requirements established in law and
4587rule are met and must specifically designate, on the facility's
4588license, that such services may be provided and whether the
4589designation applies to all or part of a facility. Such
4590designation may be made at the time of initial licensure or
4591relicensure, or upon request in writing by a licensee under this
4592part and part II of chapter 408. Notification of approval or
4593denial of such request shall be made in accordance with part II
4594of chapter 408 within 90 days after receipt of such request and
4595all necessary documentation. Existing facilities qualifying to
4596provide extended congregate care services must have maintained a
4597standard license and may not have been subject to administrative
4598sanctions during the previous 2 years, or since initial
4599licensure if the facility has been licensed for less than 2
4600years, for any of the following reasons:
4601     a.  A class I or class II violation;
4602     b.  Three or more repeat or recurring class III violations
4603of identical or similar resident care standards as specified in
4604rule from which a pattern of noncompliance is found by the
4605agency;
4606     c.  Three or more class III violations that were not
4607corrected in accordance with the corrective action plan approved
4608by the agency;
4609     d.  Violation of resident care standards resulting in a
4610requirement to employ the services of a consultant pharmacist or
4611consultant dietitian;
4612     e.  Denial, suspension, or revocation of a license for
4613another facility under this part in which the applicant for an
4614extended congregate care license has at least 25 percent
4615ownership interest; or
4616     f.  Imposition of a moratorium on admissions or initiation
4617of injunctive proceedings.
4618     2.  Facilities that are licensed to provide extended
4619congregate care services shall maintain a written progress
4620report on each person who receives such services, which report
4621describes the type, amount, duration, scope, and outcome of
4622services that are rendered and the general status of the
4623resident's health. A registered nurse, or appropriate designee,
4624representing the agency shall visit such facilities at least
4625quarterly to monitor residents who are receiving extended
4626congregate care services and to determine if the facility is in
4627compliance with this part, part II of chapter 408, and with
4628rules that relate to extended congregate care. One of these
4629visits may be in conjunction with the regular survey. The
4630monitoring visits may be provided through contractual
4631arrangements with appropriate community agencies. A registered
4632nurse shall serve as part of the team that inspects such
4633facility. The agency may waive one of the required yearly
4634monitoring visits for a facility that has been licensed for at
4635least 24 months to provide extended congregate care services,
4636if, during the inspection, the registered nurse determines that
4637extended congregate care services are being provided
4638appropriately, and if the facility has no class I or class II
4639violations and no uncorrected class III violations. Before such
4640decision is made, the agency shall consult with the long-term
4641care ombudsman council for the area in which the facility is
4642located to determine if any complaints have been made and
4643substantiated about the quality of services or care. The agency
4644may not waive one of the required yearly monitoring visits if
4645complaints have been made and substantiated.
4646     3.  Facilities that are licensed to provide extended
4647congregate care services shall:
4648     a.  Demonstrate the capability to meet unanticipated
4649resident service needs.
4650     b.  Offer a physical environment that promotes a homelike
4651setting, provides for resident privacy, promotes resident
4652independence, and allows sufficient congregate space as defined
4653by rule.
4654     c.  Have sufficient staff available, taking into account
4655the physical plant and firesafety features of the building, to
4656assist with the evacuation of residents in an emergency, as
4657necessary.
4658     d.  Adopt and follow policies and procedures that maximize
4659resident independence, dignity, choice, and decisionmaking to
4660permit residents to age in place to the extent possible, so that
4661moves due to changes in functional status are minimized or
4662avoided.
4663     e.  Allow residents or, if applicable, a resident's
4664representative, designee, surrogate, guardian, or attorney in
4665fact to make a variety of personal choices, participate in
4666developing service plans, and share responsibility in
4667decisionmaking.
4668     f.  Implement the concept of managed risk.
4669     g.  Provide, either directly or through contract, the
4670services of a person licensed pursuant to part I of chapter 464.
4671     h.  In addition to the training mandated in s. 400.452,
4672provide specialized training as defined by rule for facility
4673staff.
4674     4.  Facilities licensed to provide extended congregate care
4675services are exempt from the criteria for continued residency as
4676set forth in rules adopted under s. 400.441. Facilities so
4677licensed shall adopt their own requirements within guidelines
4678for continued residency set forth by the department in rule.
4679However, such facilities may not serve residents who require 24-
4680hour nursing supervision. Facilities licensed to provide
4681extended congregate care services shall provide each resident
4682with a written copy of facility policies governing admission and
4683retention.
4684     5.  The primary purpose of extended congregate care
4685services is to allow residents, as they become more impaired,
4686the option of remaining in a familiar setting from which they
4687would otherwise be disqualified for continued residency. A
4688facility licensed to provide extended congregate care services
4689may also admit an individual who exceeds the admission criteria
4690for a facility with a standard license, if the individual is
4691determined appropriate for admission to the extended congregate
4692care facility.
4693     6.  Before admission of an individual to a facility
4694licensed to provide extended congregate care services, the
4695individual must undergo a medical examination as provided in s.
4696400.426(4) and the facility must develop a preliminary service
4697plan for the individual.
4698     7.  When a facility can no longer provide or arrange for
4699services in accordance with the resident's service plan and
4700needs and the facility's policy, the facility shall make
4701arrangements for relocating the person in accordance with s.
4702400.428(1)(k).
4703     8.  Failure to provide extended congregate care services
4704may result in denial of extended congregate care license
4705renewal.
4706     9.  No later than January 1 of each year, the department,
4707in consultation with the agency, shall prepare and submit to the
4708Governor, the President of the Senate, the Speaker of the House
4709of Representatives, and the chairs of appropriate legislative
4710committees, a report on the status of, and recommendations
4711related to, extended congregate care services. The status report
4712must include, but need not be limited to, the following
4713information:
4714     a.  A description of the facilities licensed to provide
4715such services, including total number of beds licensed under
4716this part.
4717     b.  The number and characteristics of residents receiving
4718such services.
4719     c.  The types of services rendered that could not be
4720provided through a standard license.
4721     d.  An analysis of deficiencies cited during licensure
4722inspections.
4723     e.  The number of residents who required extended
4724congregate care services at admission and the source of
4725admission.
4726     f.  Recommendations for statutory or regulatory changes.
4727     g.  The availability of extended congregate care to state
4728clients residing in facilities licensed under this part and in
4729need of additional services, and recommendations for
4730appropriations to subsidize extended congregate care services
4731for such persons.
4732     h.  Such other information as the department considers
4733appropriate.
4734     (c)  A limited nursing services license shall be issued to
4735a facility that provides services beyond those authorized in
4736paragraph (a) and as specified in this paragraph.
4737     1.  In order for limited nursing services to be provided in
4738a facility licensed under this part, the agency must first
4739determine that all requirements established in law and rule are
4740met and must specifically designate, on the facility's license,
4741that such services may be provided. Such designation may be made
4742at the time of initial licensure or relicensure, or upon request
4743in writing by a licensee under this part and part II of chapter
4744408. Notification of approval or denial of such request shall be
4745made in accordance with part II of chapter 408 within 90 days
4746after receipt of such request and all necessary documentation.
4747Existing facilities qualifying to provide limited nursing
4748services shall have maintained a standard license and may not
4749have been subject to administrative sanctions that affect the
4750health, safety, and welfare of residents for the previous 2
4751years or since initial licensure if the facility has been
4752licensed for less than 2 years.
4753     2.  Facilities that are licensed to provide limited nursing
4754services shall maintain a written progress report on each person
4755who receives such nursing services, which report describes the
4756type, amount, duration, scope, and outcome of services that are
4757rendered and the general status of the resident's health. A
4758registered nurse representing the agency shall visit such
4759facilities at least twice a year to monitor residents who are
4760receiving limited nursing services and to determine if the
4761facility is in compliance with applicable provisions of this
4762part, part II of chapter 408, and with related rules. The
4763monitoring visits may be provided through contractual
4764arrangements with appropriate community agencies. A registered
4765nurse shall also serve as part of the team that inspects such
4766facility.
4767     3.  A person who receives limited nursing services under
4768this part must meet the admission criteria established by the
4769agency for assisted living facilities. When a resident no longer
4770meets the admission criteria for a facility licensed under this
4771part, arrangements for relocating the person shall be made in
4772accordance with s. 400.428(1)(k), unless the facility is
4773licensed to provide extended congregate care services.
4774     (4)  In accordance with s. 408.805, an applicant or
4775licensee shall pay a fee for each license application submitted
4776under this part, part II of chapter 408, and applicable rules.
4777The amount of the fee shall be established by rule.
4778     (a)  The biennial license fee required of a facility is
4779$300 per license, with an additional fee of $50 per resident
4780based on the total licensed resident capacity of the facility,
4781except that no additional fee will be assessed for beds
4782designated for recipients of optional state supplementation
4783payments provided for in s. 409.212. The total fee may not
4784exceed $10,000, no part of which shall be returned to the
4785facility. The agency shall adjust the per bed license fee and
4786the total licensure fee annually by not more than the change in
4787the consumer price index based on the 12 months immediately
4788preceding the increase.
4789     (b)  In addition to the total fee assessed under paragraph
4790(a), the agency shall require facilities that are licensed to
4791provide extended congregate care services under this part to pay
4792an additional fee per licensed facility. The amount of the
4793biennial fee shall be $400 per license, with an additional fee
4794of $10 per resident based on the total licensed resident
4795capacity of the facility. No part of this fee shall be returned
4796to the facility. The agency may adjust the per bed license fee
4797and the annual license fee once each year by not more than the
4798average rate of inflation for the 12 months immediately
4799preceding the increase.
4800     (c)  In addition to the total fee assessed under paragraph
4801(a), the agency shall require facilities that are licensed to
4802provide limited nursing services under this part to pay an
4803additional fee per licensed facility. The amount of the biennial
4804fee shall be $250 per license, with an additional fee of $10 per
4805resident based on the total licensed resident capacity of the
4806facility. No part of this fee shall be returned to the facility.
4807The agency may adjust the per bed license fee and the biennial
4808license fee once each year by not more than the average rate of
4809inflation for the 12 months immediately preceding the increase.
4810     (5)  Counties or municipalities applying for licenses under
4811this part are exempt from the payment of license fees.
4812     (6)  The license shall be displayed in a conspicuous place
4813inside the facility.
4814     (7)  A license shall be valid only in the possession of the
4815individual, firm, partnership, association, or corporation to
4816which it is issued and shall not be subject to sale, assignment,
4817or other transfer, voluntary or involuntary; nor shall a license
4818be valid for any premises other than that for which originally
4819issued.
4820     (8)  A fee may be charged to a facility requesting a
4821duplicate license. The fee shall not exceed the actual cost of
4822duplication and postage.
4823     Section 86.  Subsection (1) of section 400.4075, Florida
4824Statutes, is amended to read:
4825     400.4075  Limited mental health license.--An assisted
4826living facility that serves three or more mental health
4827residents must obtain a limited mental health license.
4828     (1)  To obtain a limited mental health license, a facility
4829must hold a standard license as an assisted living facility,
4830must not have any current uncorrected deficiencies or
4831violations, and must ensure that, within 6 months after
4832receiving a limited mental health license, the facility
4833administrator and the staff of the facility who are in direct
4834contact with mental health residents must complete training of
4835no less than 6 hours related to their duties. Such designation
4836may be made at the time of initial licensure or relicensure or
4837upon request in writing by a licensee under this part and part
4838II of chapter 408. Notification of approval or denial of such
4839request shall be made in accordance with this part, part II of
4840chapter 408, and applicable rules. This training will be
4841provided by or approved by the Department of Children and Family
4842Services.
4843     Section 87.  Section 400.408, Florida Statutes, is amended
4844to read:
4845     400.408  Unlicensed facilities; referral of person for
4846residency to unlicensed facility; penalties; verification of
4847licensure status.--
4848     (1)(a)  It is unlawful to own, operate, or maintain an
4849assisted living facility without obtaining a license under this
4850part.
4851     (b)  Except as provided under paragraph (d), any person who
4852owns, operates, or maintains an unlicensed assisted living
4853facility commits a felony of the third degree, punishable as
4854provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
4855continued operation is a separate offense.
4856     (c)  Any person found guilty of violating paragraph (a) a
4857second or subsequent time commits a felony of the second degree,
4858punishable as provided under s. 775.082, s. 775.083, or s.
4859775.084. Each day of continued operation is a separate offense.
4860     (d)  Any person who owns, operates, or maintains an
4861unlicensed assisted living facility due to a change in this part
4862or a modification in department rule within 6 months after the
4863effective date of such change and who, within 10 working days
4864after receiving notification from the agency, fails to cease
4865operation or apply for a license under this part commits a
4866felony of the third degree, punishable as provided in s.
4867775.082, s. 775.083, or s. 775.084. Each day of continued
4868operation is a separate offense.
4869     (e)  Any facility that fails to cease operation after
4870agency notification may be fined for each day of noncompliance
4871pursuant to s. 400.419.
4872     (f)  When a licensee has an interest in more than one
4873assisted living facility, and fails to license any one of these
4874facilities, the agency may revoke the license, impose a
4875moratorium, or impose a fine pursuant to s. 400.419, on any or
4876all of the licensed facilities until such time as the unlicensed
4877facility is licensed or ceases operation.
4878     (g)  If the agency determines that an owner is operating or
4879maintaining an assisted living facility without obtaining a
4880license and determines that a condition exists in the facility
4881that poses a threat to the health, safety, or welfare of a
4882resident of the facility, the owner is subject to the same
4883actions and fines imposed against a licensed facility as
4884specified in ss. 400.414 and 400.419.
4885     (h)  Any person aware of the operation of an unlicensed
4886assisted living facility must report that facility to the
4887agency. The agency shall provide to the department's elder
4888information and referral providers a list, by county, of
4889licensed assisted living facilities, to assist persons who are
4890considering an assisted living facility placement in locating a
4891licensed facility.
4892     (2)(i)  Each field office of the Agency for Health Care
4893Administration shall establish a local coordinating workgroup
4894which includes representatives of local law enforcement
4895agencies, state attorneys, the Medicaid Fraud Control Unit of
4896the Department of Legal Affairs, local fire authorities, the
4897Department of Children and Family Services, the district long-
4898term care ombudsman council, and the district human rights
4899advocacy committee to assist in identifying the operation of
4900unlicensed facilities and to develop and implement a plan to
4901ensure effective enforcement of state laws relating to such
4902facilities. The workgroup shall report its findings, actions,
4903and recommendations semiannually to the Director of Health
4904Facility Regulation of the agency.
4905     (3)(2)  It is unlawful to knowingly refer a person for
4906residency to an unlicensed assisted living facility; to an
4907assisted living facility the license of which is under denial or
4908has been suspended or revoked; or to an assisted living facility
4909that has a moratorium pursuant to part II of chapter 408, on
4910admissions. Any person who violates this subsection commits a
4911noncriminal violation, punishable by a fine not exceeding $500
4912as provided in s. 775.083.
4913     (a)  Any health care practitioner, as defined in s.
4914456.001, who is aware of the operation of an unlicensed facility
4915shall report that facility to the agency. Failure to report a
4916facility that the practitioner knows or has reasonable cause to
4917suspect is unlicensed shall be reported to the practitioner's
4918licensing board.
4919     (b)  Any hospital or community mental health center
4920licensed under chapter 395 or chapter 394 which knowingly
4921discharges a patient or client to an unlicensed facility is
4922subject to sanction by the agency.
4923     (c)  Any employee of the agency or department, or the
4924Department of Children and Family Services, who knowingly refers
4925a person for residency to an unlicensed facility; to a facility
4926the license of which is under denial or has been suspended or
4927revoked; or to a facility that has a moratorium pursuant to part
4928II of chapter 408 on admissions is subject to disciplinary
4929action by the agency or department, or the Department of
4930Children and Family Services.
4931     (d)  The employer of any person who is under contract with
4932the agency or department, or the Department of Children and
4933Family Services, and who knowingly refers a person for residency
4934to an unlicensed facility; to a facility the license of which is
4935under denial or has been suspended or revoked; or to a facility
4936that has a moratorium pursuant to part II of chapter 408 on
4937admissions shall be fined and required to prepare a corrective
4938action plan designed to prevent such referrals.
4939     (e)  The agency shall provide the department and the
4940Department of Children and Family Services with a list of
4941licensed facilities within each county and shall update the list
4942at least quarterly.
4943     (f)  At least annually, the agency shall notify, in
4944appropriate trade publications, physicians licensed under
4945chapter 458 or chapter 459, hospitals licensed under chapter
4946395, nursing home facilities licensed under part II of this
4947chapter, and employees of the agency or the department, or the
4948Department of Children and Family Services, who are responsible
4949for referring persons for residency, that it is unlawful to
4950knowingly refer a person for residency to an unlicensed assisted
4951living facility and shall notify them of the penalty for
4952violating such prohibition. The department and the Department of
4953Children and Family Services shall, in turn, notify service
4954providers under contract to the respective departments who have
4955responsibility for resident referrals to facilities. Further,
4956the notice must direct each noticed facility and individual to
4957contact the appropriate agency office in order to verify the
4958licensure status of any facility prior to referring any person
4959for residency. Each notice must include the name, telephone
4960number, and mailing address of the appropriate office to
4961contact.
4962     Section 88.  Section 400.411, Florida Statutes, is amended
4963to read:
4964     400.411  Initial application for license; provisional
4965license.--
4966     (1)  Each applicant for licensure must comply with all
4967provisions of part II of chapter 408 and must: Application for a
4968license shall be made to the agency on forms furnished by it and
4969shall be accompanied by the appropriate license fee.
4970     (2)  The applicant may be an individual owner, a
4971corporation, a partnership, a firm, an association, or a
4972governmental entity.
4973     (3)  The application must be signed by the applicant under
4974oath and must contain the following:
4975     (a)  The name, address, date of birth, and social security
4976number of the applicant and the name by which the facility is to
4977be known. If the applicant is a firm, partnership, or
4978association, the application shall contain the name, address,
4979date of birth, and social security number of every member
4980thereof. If the applicant is a corporation, the application
4981shall contain the corporation's name and address; the name,
4982address, date of birth, and social security number of each of
4983its directors and officers; and the name and address of each
4984person having at least a 5-percent ownership interest in the
4985corporation.
4986     (b)  The name and address of any professional service,
4987firm, association, partnership, or corporation that is to
4988provide goods, leases, or services to the facility if a 5-
4989percent or greater ownership interest in the service, firm,
4990association, partnership, or corporation is owned by a person
4991whose name must be listed on the application under paragraph
4992(a).
4993     (c)  The name and address of any long-term care facility
4994with which the applicant, administrator, or financial officer
4995has been affiliated through ownership or employment within 5
4996years of the date of this license application; and a signed
4997affidavit disclosing any financial or ownership interest that
4998the applicant, or any person listed in paragraph (a), holds or
4999has held within the last 5 years in any facility licensed under
5000this part, or in any other entity licensed by this state or
5001another state to provide health or residential care, which
5002facility or entity closed or ceased to operate as a result of
5003financial problems, or has had a receiver appointed or a license
5004denied, suspended or revoked, or was subject to a moratorium on
5005admissions, or has had an injunctive proceeding initiated
5006against it.
5007     (d)  A description and explanation of any exclusions,
5008permanent suspensions, or terminations of the applicant from the
5009Medicare or Medicaid programs. Proof of compliance with
5010disclosure of ownership and control interest requirements of the
5011Medicaid or Medicare programs shall be accepted in lieu of this
5012submission.
5013     (e)  The names and addresses of persons of whom the agency
5014may inquire as to the character, reputation, and financial
5015responsibility of the owner and, if different from the
5016applicant, the administrator and financial officer.
5017     (a)(f)  Identify Identification of all other homes or
5018facilities, including the addresses and the license or licenses
5019under which they operate, if applicable, which are currently
5020operated by the applicant or administrator and which provide
5021housing, meals, and personal services to residents.
5022     (b)(g)  Provide the location of the facility for which a
5023license is sought and documentation, signed by the appropriate
5024local government official, which states that the applicant has
5025met local zoning requirements.
5026     (c)(h)  Provide the name, address, date of birth, social
5027security number, education, and experience of the administrator,
5028if different from the applicant.
5029     (4)  The applicant shall furnish satisfactory proof of
5030financial ability to operate and conduct the facility in
5031accordance with the requirements of this part. A certificate of
5032authority, pursuant to chapter 651, may be provided as proof of
5033financial ability.
5034     (5)  If the applicant is a continuing care facility
5035certified under chapter 651, a copy of the facility's
5036certificate of authority must be provided.
5037     (2)(6)  In addition to the requirements of s. 408.810, the
5038applicant shall provide proof of liability insurance as defined
5039in s. 624.605.
5040     (7)  If the applicant is a community residential home, the
5041applicant must provide proof that it has met the requirements
5042specified in chapter 419.
5043     (8)  The applicant must provide the agency with proof of
5044legal right to occupy the property.
5045     (3)(9)  The applicant must furnish proof that the facility
5046has received a satisfactory firesafety inspection. The local
5047authority having jurisdiction or the State Fire Marshal must
5048conduct the inspection within 30 days after written request by
5049the applicant.
5050     (4)(10)  The applicant must furnish documentation of a
5051satisfactory sanitation inspection of the facility by the county
5052health department.
5053     (11)  The applicant must furnish proof of compliance with
5054level 2 background screening as required under s. 400.4174.
5055     (5)(12)  A provisional license may be issued to an
5056applicant making initial application for licensure or making
5057application for a change of ownership. A provisional license
5058shall be limited in duration to a specific period of time not to
5059exceed 6 months, as determined by the agency.
5060     (6)(13)  A county or municipality may not issue an
5061occupational license that is being obtained for the purpose of
5062operating a facility regulated under this part without first
5063ascertaining that the applicant has been licensed to operate
5064such facility at the specified location or locations by the
5065agency. The agency shall furnish to local agencies responsible
5066for issuing occupational licenses sufficient instruction for
5067making such determinations.
5068     Section 89.  Section 400.412, Florida Statutes, is amended
5069to read:
5070     400.412  Sale or transfer of ownership of a facility.--It
5071is the intent of the Legislature to protect the rights of the
5072residents of an assisted living facility when the facility is
5073sold or the ownership thereof is transferred. Therefore, in
5074addition to the requirements of part II of chapter 408, whenever
5075a facility is sold or the ownership thereof is transferred,
5076including leasing:
5077     (1)  The transferee shall make application to the agency
5078for a new license at least 60 days before the date of transfer
5079of ownership. The application must comply with the provisions of
5080s. 400.411.
5081     (2)(a)  The transferor shall notify the agency in writing
5082at least 60 days before the date of transfer of ownership.
5083     (1)(b)  The transferee new owner shall notify the
5084residents, in writing, of the change transfer of ownership
5085within 7 days after of his or her receipt of the new license.
5086     (3)  The transferor shall be responsible and liable for:
5087     (a)  The lawful operation of the facility and the welfare
5088of the residents domiciled in the facility until the date the
5089transferee is licensed by the agency.
5090     (b)  Any and all penalties imposed against the facility for
5091violations occurring before the date of transfer of ownership
5092unless the penalty imposed is a moratorium on admissions or
5093denial of licensure. The moratorium on admissions or denial of
5094licensure remains in effect after the transfer of ownership,
5095unless the agency has approved the transferee's corrective
5096action plan or the conditions which created the moratorium or
5097denial have been corrected, and may be grounds for denial of
5098license to the transferee in accordance with chapter 120.
5099     (c)  Any outstanding liability to the state, unless the
5100transferee has agreed, as a condition of sale or transfer, to
5101accept the outstanding liabilities and to guarantee payment
5102therefor; except that, if the transferee fails to meet these
5103obligations, the transferor shall remain liable for the
5104outstanding liability.
5105     (2)(4)  The transferor of a facility the license of which
5106is denied pending an administrative hearing shall, as a part of
5107the written change of ownership transfer-of-ownership contract,
5108advise the transferee that a plan of correction must be
5109submitted by the transferee and approved by the agency at least
51107 days before the change transfer of ownership and that failure
5111to correct the condition which resulted in the moratorium
5112pursuant to part II of chapter 408 on admissions or denial of
5113licensure is grounds for denial of the transferee's license.
5114     (5)  The transferee must provide the agency with proof of
5115legal right to occupy the property before a license may be
5116issued. Proof may include, but is not limited to, copies of
5117warranty deeds, or copies of lease or rental agreements,
5118contracts for deeds, quitclaim deeds, or other such
5119documentation.
5120     Section 90.  Section 400.414, Florida Statutes, is amended
5121to read:
5122     400.414  Denial, revocation, or suspension of license;
5123moratorium; imposition of administrative fine; grounds.--
5124     (1)  The agency may deny, revoke, and or suspend any
5125license issued under this part and, or impose a moratorium and
5126an administrative fine in the manner provided in chapter 120 on
5127an assisted living facility for a violation of any provision of
5128this part, part II of chapter 408, or applicable rules, or for
5129any of the following actions by an assisted living facility, for
5130the actions of any person subject to level 2 background
5131screening under s. 408.809 400.4174, or for the actions of any
5132facility employee:
5133     (a)  An intentional or negligent act seriously affecting
5134the health, safety, or welfare of a resident of the facility.
5135     (b)  The determination by the agency that the owner lacks
5136the financial ability to provide continuing adequate care to
5137residents.
5138     (c)  Misappropriation or conversion of the property of a
5139resident of the facility.
5140     (d)  Failure to follow the criteria and procedures provided
5141under part I of chapter 394 relating to the transportation,
5142voluntary admission, and involuntary examination of a facility
5143resident.
5144     (e)  A citation of any of the following deficiencies as
5145defined in s. 400.419:
5146     1.  One or more cited class I deficiencies.
5147     2.  Three or more cited class II deficiencies.
5148     3.  Five or more cited class III deficiencies that have
5149been cited on a single survey and have not been corrected within
5150the times specified.
5151     (f)  A determination that a person subject to level 2
5152background screening under s. 408.809 400.4174(1) does not meet
5153the screening standards of s. 435.04 or that the facility is
5154retaining an employee subject to level 1 background screening
5155standards under s. 400.4174(2) who does not meet the screening
5156standards of s. 435.03 and for whom exemptions from
5157disqualification have not been provided by the agency.
5158     (g)  A determination that an employee, volunteer,
5159administrator, or owner, or person who otherwise has access to
5160the residents of a facility does not meet the criteria specified
5161in s. 435.03(2), and the owner or administrator has not taken
5162action to remove the person. Exemptions from disqualification
5163may be granted as set forth in s. 435.07. No administrative
5164action may be taken against the facility if the person is
5165granted an exemption.
5166     (h)  Violation of a moratorium.
5167     (i)  Failure of the license applicant, the licensee during
5168relicensure, or a licensee that holds a provisional license to
5169meet the minimum license requirements of this part, or related
5170rules, at the time of license application or renewal.
5171     (j)  A fraudulent statement or omission of any material
5172fact on an application for a license or any other document
5173required by the agency, including the submission of a license
5174application that conceals the fact that any board member,
5175officer, or person owning 5 percent or more of the facility may
5176not meet the background screening requirements of s. 400.4174,
5177or that the applicant has been excluded, permanently suspended,
5178or terminated from the Medicaid or Medicare programs.
5179     (h)(k)  An intentional or negligent life-threatening act in
5180violation of the uniform firesafety standards for assisted
5181living facilities or other firesafety standards that threatens
5182the health, safety, or welfare of a resident of a facility, as
5183communicated to the agency by the local authority having
5184jurisdiction or the State Fire Marshal.
5185     (l)  Exclusion, permanent suspension, or termination from
5186the Medicare or Medicaid programs.
5187     (i)(m)  Knowingly operating any unlicensed facility or
5188providing without a license any service that must be licensed
5189under this chapter.
5190     (j)(n)  Any act constituting a ground upon which
5191application for a license may be denied.
5192
5193Administrative proceedings challenging agency action under this
5194subsection shall be reviewed on the basis of the facts and
5195conditions that resulted in the agency action.
5196     (2)  Upon notification by the local authority having
5197jurisdiction or by the State Fire Marshal, the agency may deny
5198or revoke the license of an assisted living facility that fails
5199to correct cited fire code violations that affect or threaten
5200the health, safety, or welfare of a resident of a facility.
5201     (3)  The agency may deny a license to any applicant or
5202controlling interest as defined in part II of chapter 408 that
5203to any officer or board member of an applicant who is a firm,
5204corporation, partnership, or association or who owns 5 percent
5205or more of the facility, if the applicant, officer, or board
5206member has or had a 25-percent or greater financial or ownership
5207interest in any other facility licensed under this part, or in
5208any entity licensed by this state or another state to provide
5209health or residential care, which facility or entity during the
52105 years prior to the application for a license closed due to
5211financial inability to operate; had a receiver appointed or a
5212license denied, suspended, or revoked; was subject to a
5213moratorium pursuant to part II of chapter 408 on admissions; had
5214an injunctive proceeding initiated against it; or has an
5215outstanding fine assessed under this chapter.
5216     (4)  The agency shall deny or revoke the license of an
5217assisted living facility that has two or more class I violations
5218that are similar or identical to violations identified by the
5219agency during a survey, inspection, monitoring visit, or
5220complaint investigation occurring within the previous 2 years.
5221     (5)  An action taken by the agency to suspend, deny, or
5222revoke a facility's license under this part, in which the agency
5223claims that the facility owner or an employee of the facility
5224has threatened the health, safety, or welfare of a resident of
5225the facility be heard by the Division of Administrative Hearings
5226of the Department of Management Services within 120 days after
5227receipt of the facility's request for a hearing, unless that
5228time limitation is waived by both parties. The administrative
5229law judge must render a decision within 30 days after receipt of
5230a proposed recommended order.
5231     (6)  The agency shall provide to the Division of Hotels and
5232Restaurants of the Department of Business and Professional
5233Regulation, on a monthly basis, a list of those assisted living
5234facilities that have had their licenses denied, suspended, or
5235revoked or that are involved in an appellate proceeding pursuant
5236to s. 120.60 related to the denial, suspension, or revocation of
5237a license.
5238     (7)  Agency notification of a license suspension or
5239revocation, or denial of a license renewal, shall be posted and
5240visible to the public at the facility.
5241     (8)  The agency may issue a temporary license pending final
5242disposition of a proceeding involving the suspension or
5243revocation of an assisted living facility license.
5244     Section 91.  Section 400.415, Florida Statutes, is
5245repealed.
5246     Section 92.  Section 400.417, Florida Statutes, is amended
5247to read:
5248     400.417  Expiration of license; renewal; conditional
5249license.--
5250     (1)  Biennial licenses, unless sooner suspended or revoked,
5251shall expire 2 years from the date of issuance. Limited nursing,
5252extended congregate care, and limited mental health licenses
5253shall expire at the same time as the facility's standard
5254license, regardless of when issued. The agency shall notify the
5255facility at least 120 days prior to expiration that a renewal
5256license is necessary to continue operation. The notification
5257must be provided electronically or by mail delivery. Ninety days
5258prior to the expiration date, an application for renewal shall
5259be submitted to the agency. Fees must be prorated. The failure
5260to file a timely renewal application shall result in a late fee
5261charged to the facility in an amount equal to 50 percent of the
5262current fee.
5263     (2)  A license shall be renewed in accordance with part II
5264of chapter 408 within 90 days upon the timely filing of an
5265application on forms furnished by the agency and the provision
5266of satisfactory proof of ability to operate and conduct the
5267facility in accordance with the requirements of this part and
5268adopted rules, including proof that the facility has received a
5269satisfactory firesafety inspection, conducted by the local
5270authority having jurisdiction or the State Fire Marshal, within
5271the preceding 12 months and an affidavit of compliance with the
5272background screening requirements of s. 400.4174.
5273     (3)  In addition to the requirements of part II of chapter
5274408, An applicant for renewal of a license who has complied with
5275the provisions of s. 400.411 with respect to proof of financial
5276ability to operate shall not be required to provide further
5277proof unless the facility or any other facility owned or
5278operated in whole or in part by the same person has demonstrated
5279financial instability as provided under s. 400.447(2) or unless
5280the agency suspects that the facility is not financially stable
5281as a result of the annual survey or complaints from the public
5282or a report from the State Long-Term Care Ombudsman Council.
5283each facility must report to the agency any adverse court action
5284concerning the facility's financial viability, within 7 days
5285after its occurrence. The agency shall have access to books,
5286records, and any other financial documents maintained by the
5287facility to the extent necessary to determine the facility's
5288financial stability. A license for the operation of a facility
5289shall not be renewed if the licensee has any outstanding fines
5290assessed pursuant to this part which are in final order status.
5291     (4)  A licensee against whom a revocation or suspension
5292proceeding is pending at the time of license renewal may be
5293issued a conditional license effective until final disposition
5294by the agency. If judicial relief is sought from the final
5295disposition, the court having jurisdiction may issue a
5296conditional license for the duration of the judicial proceeding.
5297     (4)(5)  A conditional license may be issued to an applicant
5298for license renewal if the applicant fails to meet all standards
5299and requirements for licensure. A conditional license issued
5300under this subsection shall be limited in duration to a specific
5301period of time not to exceed 6 months, as determined by the
5302agency, and shall be accompanied by an agency-approved plan of
5303correction.
5304     (5)(6)  When an extended care or limited nursing license is
5305requested during a facility's biennial license period, the fee
5306shall be prorated in order to permit the additional license to
5307expire at the end of the biennial license period. The fee shall
5308be calculated as of the date the additional license application
5309is received by the agency.
5310     (6)(7)  The agency department may by rule establish renewal
5311procedures, identify forms, and specify documentation necessary
5312to administer this section and part II of chapter 408.
5313     Section 93.  Section 400.4174, Florida Statutes, is amended
5314to read:
5315     400.4174  Background screening; exemptions.--
5316     (1)(a)  Level 2 background screening must be conducted on
5317each of the following persons, who shall be considered employees
5318for the purposes of conducting screening under chapter 435:
5319     1.  The facility owner if an individual, the administrator,
5320and the financial officer.
5321     2.  An officer or board member if the facility owner is a
5322firm, corporation, partnership, or association, or any person
5323owning 5 percent or more of the facility if the agency has
5324probable cause to believe that such person has been convicted of
5325any offense prohibited by s. 435.04. For each officer, board
5326member, or person owning 5 percent or more who has been
5327convicted of any such offense, the facility shall submit to the
5328agency a description and explanation of the conviction at the
5329time of license application. This subparagraph does not apply to
5330a board member of a not-for-profit corporation or organization
5331if the board member serves solely in a voluntary capacity, does
5332not regularly take part in the day-to-day operational decisions
5333of the corporation or organization, receives no remuneration for
5334his or her services, and has no financial interest and has no
5335family members with a financial interest in the corporation or
5336organization, provided that the board member and facility submit
5337a statement affirming that the board member's relationship to
5338the facility satisfies the requirements of this subparagraph.
5339     (b)  Proof of compliance with level 2 screening standards
5340which has been submitted within the previous 5 years to meet any
5341facility or professional licensure requirements of the agency or
5342the Department of Health satisfies the requirements of this
5343subsection, provided that such proof is accompanied, under
5344penalty of perjury, by an affidavit of compliance with the
5345provisions of chapter 435. Proof of compliance with the
5346background screening requirements of the Financial Services
5347Commission and the Office of Insurance Regulation for applicants
5348for a certificate of authority to operate a continuing care
5349retirement community under chapter 651, submitted within the
5350last 5 years, satisfies the Department of Law Enforcement and
5351Federal Bureau of Investigation portions of a level 2 background
5352check.
5353     (c)  The agency may grant a provisional license to a
5354facility applying for an initial license when each individual
5355required by this subsection to undergo screening has completed
5356the Department of Law Enforcement background checks, but has not
5357yet received results from the Federal Bureau of Investigation,
5358or when a request for an exemption from disqualification has
5359been submitted to the agency pursuant to s. 435.07, but a
5360response has not been issued.
5361     (2)  The owner or administrator of an assisted living
5362facility must conduct level 1 background screening, as set forth
5363in chapter 435, on all employees hired on or after October 1,
53641998, who perform personal services as defined in s.
5365400.402(16)(17). The agency may exempt an individual from
5366employment disqualification as set forth in chapter 435. Such
5367persons shall be considered as having met this requirement if:
5368     (1)(a)  Proof of compliance with level 1 screening
5369requirements obtained to meet any professional license
5370requirements in this state is provided and accompanied, under
5371penalty of perjury, by a copy of the person's current
5372professional license and an affidavit of current compliance with
5373the background screening requirements.
5374     (2)(b)  The person required to be screened has been
5375continuously employed in the same type of occupation for which
5376the person is seeking employment without a breach in service
5377which exceeds 180 days, and proof of compliance with the level 1
5378screening requirement which is no more than 2 years old is
5379provided. Proof of compliance shall be provided directly from
5380one employer or contractor to another, and not from the person
5381screened. Upon request, a copy of screening results shall be
5382provided by the employer retaining documentation of the
5383screening to the person screened.
5384     (3)(c)  The person required to be screened is employed by a
5385corporation or business entity or related corporation or
5386business entity that owns, operates, or manages more than one
5387facility or agency licensed under this chapter, and for whom a
5388level 1 screening was conducted by the corporation or business
5389entity as a condition of initial or continued employment.
5390     Section 94.  Section 400.4176, Florida Statutes, is amended
5391to read:
5392     400.4176  Notice of change of administrator.--If, during
5393the period for which a license is issued, the owner changes
5394administrators, the owner must notify the agency of the change
5395within 10 days and provide documentation within 90 days that the
5396new administrator has completed the applicable core educational
5397requirements under s. 400.452. Background screening shall be
5398completed on any new administrator as specified in s. 400.4174.
5399     Section 95.  Subsection (8) of section 400.4178, Florida
5400Statutes, is renumbered as subsection (7) and present subsection
5401(7) of said section is amended to read:
5402     400.4178  Special care for persons with Alzheimer's disease
5403or other related disorders.--
5404     (7)  Any facility more than 90 percent of whose residents
5405receive monthly optional supplementation payments is not
5406required to pay for the training and education programs required
5407under this section. A facility that has one or more such
5408residents shall pay a reduced fee that is proportional to the
5409percentage of such residents in the facility. A facility that
5410does not have any residents who receive monthly optional
5411supplementation payments must pay a reasonable fee, as
5412established by the department, for such training and education
5413programs.
5414     Section 96.  Section 400.418, Florida Statutes, is amended
5415to read:
5416     400.418  Disposition of fees and administrative fines.--
5417     (1)  Income from license fees, inspection fees, late fees,
5418and administrative fines collected under this part generated
5419pursuant to ss. 400.407, 400.408, 400.417, 400.419, and 400.431
5420shall be deposited in the Health Care Trust Fund administered by
5421the agency. Such funds shall be directed to and used by the
5422agency for the following purposes:
5423     (1)(a)  Up to 50 percent of the trust funds accrued each
5424fiscal year under this part may be used to offset the expenses
5425of receivership, pursuant to s. 400.422, if the court determines
5426that the income and assets of the facility are insufficient to
5427provide for adequate management and operation.
5428     (2)(b)  An amount of $5,000 of the trust funds accrued each
5429year under this part shall be allocated to pay for inspection-
5430related physical and mental health examinations requested by the
5431agency pursuant to s. 400.426 for residents who are either
5432recipients of supplemental security income or have monthly
5433incomes not in excess of the maximum combined federal and state
5434cash subsidies available to supplemental security income
5435recipients, as provided for in s. 409.212. Such funds shall only
5436be used where the resident is ineligible for Medicaid.
5437     (3)(c)  Any trust funds accrued each year under this part
5438and not used for the purposes specified in subsections (1) and
5439(2) paragraphs (a) and (b) shall be used to offset the costs of
5440the licensure program, including the costs of conducting
5441background investigations, verifying information submitted,
5442defraying the costs of processing the names of applicants, and
5443conducting inspections and monitoring visits pursuant to this
5444part and part II of chapter 408.
5445     (2)  Income from fees generated pursuant to s. 400.441(5)
5446shall be deposited in the Health Care Trust Fund and used to
5447offset the costs of printing and postage.
5448     Section 97.  Section 400.419, Florida Statutes, is amended
5449to read:
5450     400.419  Violations; imposition of administrative fines;
5451grounds.--
5452     (1)  The agency shall impose an administrative fine in the
5453manner provided in chapter 120 for the violation of any
5454provision of this part, part II of chapter 408, and applicable
5455rules for any of the actions or violations as set forth within
5456this section by an assisted living facility, for the actions of
5457any person subject to level 2 background screening under s.
5458400.4174, for the actions of any facility employee, or for an
5459intentional or negligent act seriously affecting the health,
5460safety, or welfare of a resident of the facility.
5461     (2)  Each violation of this part and adopted rules shall be
5462classified according to the nature of the violation and the
5463gravity of its probable effect on facility residents. The agency
5464shall indicate the classification on the written notice of the
5465violation as follows:
5466     (a)  Class "I" violations are those conditions or
5467occurrences related to the operation and maintenance of a
5468facility or to the personal care of residents which the agency
5469determines present an imminent danger to the residents or guests
5470of the facility or a substantial probability that death or
5471serious physical or emotional harm would result therefrom. The
5472condition or practice constituting a class I violation shall be
5473abated or eliminated within 24 hours, unless a fixed period, as
5474determined by the agency, is required for correction. The agency
5475shall impose an administrative fine for a cited class I
5476violation in an amount not less than $5,000 and not exceeding
5477$10,000 for each violation. A fine may be levied notwithstanding
5478the correction of the violation.
5479     (b)  Class "II" violations are those conditions or
5480occurrences related to the operation and maintenance of a
5481facility or to the personal care of residents which the agency
5482determines directly threaten the physical or emotional health,
5483safety, or security of the facility residents, other than class
5484I violations. The agency shall impose an administrative fine for
5485a cited class II violation in an amount not less than $1,000 and
5486not exceeding $5,000 for each violation. A fine shall be levied
5487notwithstanding the correction of the violation.
5488     (c)  Class "III" violations are those conditions or
5489occurrences related to the operation and maintenance of a
5490facility or to the personal care of residents which the agency
5491determines indirectly or potentially threaten the physical or
5492emotional health, safety, or security of facility residents,
5493other than class I or class II violations. The agency shall
5494impose an administrative fine for a cited class III violation in
5495an amount not less than $500 and not exceeding $1,000 for each
5496violation. A citation for a class III violation must specify the
5497time within which the violation is required to be corrected. If
5498a class III violation is corrected within the time specified, no
5499fine may be imposed, unless it is a repeated offense.
5500     (d)  Class "IV" violations are those conditions or
5501occurrences related to the operation and maintenance of a
5502building or to required reports, forms, or documents that do not
5503have the potential of negatively affecting residents. These
5504violations are of a type that the agency determines do not
5505threaten the health, safety, or security of residents of the
5506facility. The agency shall impose an administrative fine for a
5507cited class IV violation in an amount not less than $100 and not
5508exceeding $200 for each violation. A citation for a class IV
5509violation must specify the time within which the violation is
5510required to be corrected. If a class IV violation is corrected
5511within the time specified, no fine shall be imposed. Any class
5512IV violation that is corrected during the time an agency survey
5513is being conducted will be identified as an agency finding and
5514not as a violation.
5515     (3)  For purposes of this section, in determining if a
5516penalty is to be imposed and in fixing the amount of the fine,
5517the agency shall consider the following factors:
5518     (a)  The gravity of the violation, including the
5519probability that death or serious physical or emotional harm to
5520a resident will result or has resulted, the severity of the
5521action or potential harm, and the extent to which the provisions
5522of the applicable laws or rules were violated.
5523     (b)  Actions taken by the owner or administrator to correct
5524violations.
5525     (c)  Any previous violations.
5526     (d)  The financial benefit to the facility of committing or
5527continuing the violation.
5528     (e)  The licensed capacity of the facility.
5529     (4)  Each day of continuing violation after the date fixed
5530for termination of the violation, as ordered by the agency,
5531constitutes an additional, separate, and distinct violation.
5532     (5)  Any action taken to correct a violation shall be
5533documented in writing by the owner or administrator of the
5534facility and verified through followup visits by agency
5535personnel. The agency may impose a fine and, in the case of an
5536owner-operated facility, revoke or deny a facility's license
5537when a facility administrator fraudulently misrepresents action
5538taken to correct a violation.
5539     (6)  For fines that are upheld following administrative or
5540judicial review, the violator shall pay the fine, plus interest
5541at the rate as specified in s. 55.03, for each day beyond the
5542date set by the agency for payment of the fine.
5543     (7)  Any unlicensed facility that continues to operate
5544after agency notification is subject to a $1,000 fine per day.
5545     (8)  Any licensed facility whose owner or administrator
5546concurrently operates an unlicensed facility shall be subject to
5547an administrative fine of $5,000 per day.
5548     (9)  Any facility whose owner fails to apply for a change-
5549of-ownership license in accordance with s. 400.412 and operates
5550the facility under the new ownership is subject to a fine of
5551$5,000.
5552     (6)(10)  In addition to any administrative fines imposed,
5553the agency may assess a survey fee, equal to the lesser of one
5554half of the facility's biennial license and bed fee or $500, to
5555cover the cost of conducting initial complaint investigations
5556that result in the finding of a violation that was the subject
5557of the complaint or monitoring visits conducted under s.
5558400.428(3)(c) to verify the correction of the violations.
5559     (7)(11)  The agency, as an alternative to or in conjunction
5560with an administrative action against a facility for violations
5561of this part and adopted rules, shall make a reasonable attempt
5562to discuss each violation and recommended corrective action with
5563the owner or administrator of the facility, prior to written
5564notification. The agency, instead of fixing a period within
5565which the facility shall enter into compliance with standards,
5566may request a plan of corrective action from the facility which
5567demonstrates a good faith effort to remedy each violation by a
5568specific date, subject to the approval of the agency.
5569     (12)  Administrative fines paid by any facility under this
5570section shall be deposited into the Health Care Trust Fund and
5571expended as provided in s. 400.418.
5572     (8)(13)  The agency shall develop and disseminate an annual
5573list of all facilities sanctioned or fined $5,000 or more for
5574violations of state standards, the number and class of
5575violations involved, the penalties imposed, and the current
5576status of cases. The list shall be disseminated, at no charge,
5577to the Department of Elderly Affairs, the Department of Health,
5578the Department of Children and Family Services, the area
5579agencies on aging, the Florida Statewide Advocacy Council, and
5580the state and local ombudsman councils. The Department of
5581Children and Family Services shall disseminate the list to
5582service providers under contract to the department who are
5583responsible for referring persons to a facility for residency.
5584The agency may charge a fee commensurate with the cost of
5585printing and postage to other interested parties requesting a
5586copy of this list.
5587     Section 98.  Section 400.421, Florida Statutes, is
5588repealed.
5589     Section 99.  Subsection (9) of section 400.422, Florida
5590Statutes, is amended to read:
5591     400.422  Receivership proceedings.--
5592     (9)  The court may direct the agency to allocate funds from
5593the Health Care Trust Fund to the receiver, subject to the
5594provisions of s. 400.418(1).
5595     Section 100.  Subsection (10) of section 400.423, Florida
5596Statutes, is amended to read:
5597     400.423  Internal risk management and quality assurance
5598program; adverse incidents and reporting requirements.--
5599     (10)  The agency Department of Elderly Affairs may adopt
5600rules necessary to administer this section.
5601     Section 101.  Subsections (3) and (8) of section 400.424,
5602Florida Statutes, are amended to read:
5603     400.424  Contracts.--
5604     (3)(a)  The contract shall include a refund policy to be
5605implemented at the time of a resident's transfer, discharge, or
5606death. The refund policy shall provide that the resident or
5607responsible party is entitled to a prorated refund based on the
5608daily rate for any unused portion of payment beyond the
5609termination date after all charges, including the cost of
5610damages to the residential unit resulting from circumstances
5611other than normal use, have been paid to the licensee. For the
5612purpose of this paragraph, the termination date shall be the
5613date the unit is vacated by the resident and cleared of all
5614personal belongings. If the amount of belongings does not
5615preclude renting the unit, the facility may clear the unit and
5616charge the resident or his or her estate for moving and storing
5617the items at a rate equal to the actual cost to the facility,
5618not to exceed 20 percent of the regular rate for the unit,
5619provided that 14 days' advance written notification is given. If
5620the resident's possessions are not claimed within 45 days after
5621notification, the facility may dispose of them. The contract
5622shall also specify any other conditions under which claims will
5623be made against the refund due the resident. Except in the case
5624of death or a discharge due to medical reasons, the refunds
5625shall be computed in accordance with the notice of relocation
5626requirements specified in the contract. However, a resident may
5627not be required to provide the licensee with more than 30 days'
5628notice of termination. If after a contract is terminated, the
5629facility intends to make a claim against a refund due the
5630resident, the facility shall notify the resident or responsible
5631party in writing of the claim and shall provide said party with
5632a reasonable time period of no less than 14 calendar days to
5633respond. The facility shall provide a refund to the resident or
5634responsible party within 45 days after the transfer, discharge,
5635or death of the resident. The agency shall impose a fine upon a
5636facility that fails to comply with the refund provisions of this
5637the paragraph, which fine shall be equal to three times the
5638amount due to the resident and not subject to the provisions of
5639s. 400.419(3). One-half of the fine shall be remitted to the
5640resident or his or her estate, and the other half to the Health
5641Care Trust Fund to be used for the purpose specified in s.
5642400.418.
5643     (b)  If a licensee agrees to reserve a bed for a resident
5644who is admitted to a medical facility, including, but not
5645limited to, a nursing home, health care facility, or psychiatric
5646facility, the resident or his or her responsible party shall
5647notify the licensee of any change in status that would prevent
5648the resident from returning to the facility. Until such notice
5649is received, the agreed-upon daily rate may be charged by the
5650licensee.
5651     (c)  The purpose of any advance payment and a refund policy
5652for such payment, including any advance payment for housing,
5653meals, or personal services, shall be covered in the contract.
5654     (8)  The agency department may by rule clarify terms,
5655establish procedures, clarify refund policies and contract
5656provisions, and specify documentation as necessary to administer
5657this section.
5658     Section 102.  Subsection (3) of section 400.4255, Florida
5659Statutes, is amended to read:
5660     400.4255  Use of personnel; emergency care.--
5661     (3)  Facility staff may withhold or withdraw
5662cardiopulmonary resuscitation if presented with an order not to
5663resuscitate executed pursuant to s. 401.45. The agency
5664department shall adopt rules providing for the implementation of
5665such orders. Facility staff and facilities shall not be subject
5666to criminal prosecution or civil liability, nor be considered to
5667have engaged in negligent or unprofessional conduct, for
5668withholding or withdrawing cardiopulmonary resuscitation
5669pursuant to such an order and applicable rules adopted by the
5670department. The absence of an order to resuscitate executed
5671pursuant to s. 401.45 does not preclude a physician from
5672withholding or withdrawing cardiopulmonary resuscitation as
5673otherwise permitted by law.
5674     Section 103.  Subsection (6) of section 400.4256, Florida
5675Statutes, is amended to read:
5676     400.4256  Assistance with self-administration of
5677medication.--
5678     (6)  The agency department may by rule establish facility
5679procedures and interpret terms as necessary to implement this
5680section.
5681     Section 104.  Subsection (9) of section 400.426, Florida
5682Statutes, is amended to read:
5683     400.426  Appropriateness of placements; examinations of
5684residents.--
5685     (9)  If, at any time after admission to a facility, a
5686resident appears to need care beyond that which the facility is
5687licensed to provide, the agency shall require the resident to be
5688physically examined by a licensed physician or licensed nurse
5689practitioner. This examination shall, to the extent possible, be
5690performed by the resident's preferred physician or nurse
5691practitioner and shall be paid for by the resident with personal
5692funds, except as provided in s. 400.418(2)(1)(b). Following this
5693examination, the examining physician or licensed nurse
5694practitioner shall complete and sign a medical form provided by
5695the agency. The completed medical form shall be submitted to the
5696agency within 30 days after the date the facility owner or
5697administrator is notified by the agency that the physical
5698examination is required. After consultation with the physician
5699or licensed nurse practitioner who performed the examination, a
5700medical review team designated by the agency shall then
5701determine whether the resident is appropriately residing in the
5702facility. The medical review team shall base its decision on a
5703comprehensive review of the resident's physical and functional
5704status, including the resident's preferences, and not on an
5705isolated health-related problem. In the case of a mental health
5706resident, if the resident appears to have needs in addition to
5707those identified in the community living support plan, the
5708agency may require an evaluation by a mental health
5709professional, as determined by the Department of Children and
5710Family Services. A facility may not be required to retain a
5711resident who requires more services or care than the facility is
5712able to provide in accordance with its policies and criteria for
5713admission and continued residency. Members of the medical review
5714team making the final determination may not include the agency
5715personnel who initially questioned the appropriateness of a
5716resident's placement. Such determination is final and binding
5717upon the facility and the resident. Any resident who is
5718determined by the medical review team to be inappropriately
5719residing in a facility shall be given 30 days' written notice to
5720relocate by the owner or administrator, unless the resident's
5721continued residence in the facility presents an imminent danger
5722to the health, safety, or welfare of the resident or a
5723substantial probability exists that death or serious physical
5724harm would result to the resident if allowed to remain in the
5725facility.
5726     Section 105.  Subsection (8) of section 400.427, Florida
5727Statutes, is amended to read:
5728     400.427  Property and personal affairs of residents.--
5729     (8)  The agency department may by rule clarify terms and
5730specify procedures and documentation necessary to administer the
5731provisions of this section relating to the proper management of
5732residents' funds and personal property and the execution of
5733surety bonds.
5734     Section 106.  Subsection (4) of section 400.4275, Florida
5735Statutes, is amended to read:
5736     400.4275  Business practice; personnel records; liability
5737insurance.--The assisted living facility shall be administered
5738on a sound financial basis that is consistent with good business
5739practices.
5740     (4)  The agency department may by rule clarify terms,
5741establish requirements for financial records, accounting
5742procedures, personnel procedures, insurance coverage, and
5743reporting procedures, and specify documentation as necessary to
5744implement the requirements of this section.
5745     Section 107.  Subsections (1), (4), and (5) of section
5746400.431, Florida Statutes, are amended to read:
5747     400.431  Closing of facility; notice; penalty.--
5748     (1)  In addition to the requirements of part II of chapter
5749408, Whenever a facility voluntarily discontinues operation, it
5750shall inform the agency in writing at least 90 days prior to the
5751discontinuance of operation. the facility shall also inform each
5752resident or the next of kin, legal representative, or agency
5753acting on each resident's behalf, of the fact and the proposed
5754time of such discontinuance of operation, following the
5755notification requirements provided in s. 400.428(1)(k). In the
5756event a resident has no person to represent him or her, the
5757facility shall be responsible for referral to an appropriate
5758social service agency for placement.
5759     (4)  Immediately upon discontinuance of the operation of a
5760facility, the owner shall surrender the license therefor to the
5761agency, and the license shall be canceled.
5762     (4)(5)  The agency may levy a fine in an amount no greater
5763than $5,000 upon each person or business entity that owns any
5764interest in a facility that terminates operation without
5765providing notice to the agency and the residents of the facility
5766at least 30 days before operation ceases. This fine shall not be
5767levied against any facility involuntarily closed at the
5768initiation of the agency. The agency shall use the proceeds of
5769the fines to operate the facility until all residents of the
5770facility are relocated and shall deposit any balance of the
5771proceeds into the Health Care Trust Fund established pursuant to
5772s. 400.418.
5773     Section 108.  Section 400.434, Florida Statutes, is amended
5774to read:
5775     400.434  Right of entry and inspection.--Any duly
5776designated officer or employee of the department, the Department
5777of Children and Family Services, the agency, the Medicaid Fraud
5778Control Unit of the Department of Legal Affairs, the state or
5779local fire marshal, or a member of the state or local long-term
5780care ombudsman council, or the agency in accordance with s.
5781408.811 shall have the right to enter unannounced upon and into
5782the premises of any facility licensed pursuant to this part in
5783order to determine the state of compliance with the provisions
5784of this part, part II of chapter 408, and of applicable rules or
5785standards in force pursuant thereto. The right of entry and
5786inspection shall also extend to any premises which the agency
5787has reason to believe is being operated or maintained as a
5788facility without a license; but no such entry or inspection of
5789any premises may be made without the permission of the owner or
5790person in charge thereof, unless a warrant is first obtained
5791from the circuit court authorizing such entry. The warrant
5792requirement shall extend only to a facility which the agency has
5793reason to believe is being operated or maintained as a facility
5794without a license. Any application for a license or renewal
5795thereof made pursuant to this part shall constitute permission
5796for, and complete acquiescence in, any entry or inspection of
5797the premises for which the license is sought, in order to
5798facilitate verification of the information submitted on or in
5799connection with the application; to discover, investigate, and
5800determine the existence of abuse or neglect; or to elicit,
5801receive, respond to, and resolve complaints. Any current valid
5802license shall constitute unconditional permission for, and
5803complete acquiescence in, any entry or inspection of the
5804premises by authorized personnel. The agency shall retain the
5805right of entry and inspection of facilities that have had a
5806license revoked or suspended within the previous 24 months, to
5807ensure that the facility is not operating unlawfully. However,
5808before entering the facility, a statement of probable cause must
5809be filed with the director of the agency, who must approve or
5810disapprove the action within 48 hours. Probable cause shall
5811include, but is not limited to, evidence that the facility holds
5812itself out to the public as a provider of personal care services
5813or the receipt of a complaint by the long-term care ombudsman
5814council about the facility. Data collected by the state or local
5815long-term care ombudsman councils or the state or local advocacy
5816councils may be used by the agency in investigations involving
5817violations of regulatory standards.
5818     Section 109.  Subsections (2) and (3) of section 400.435,
5819Florida Statutes, are renumbered as subsections (1) and (2),
5820respectively, and present subsection (1) of said section is
5821amended to read:
5822     400.435  Inspection Maintenance of records; reports.--
5823     (1)  Every facility shall maintain, as public information
5824available for public inspection under such conditions as the
5825agency shall prescribe, records containing copies of all
5826inspection reports pertaining to the facility that have been
5827issued by the agency to the facility. Copies of inspection
5828reports shall be retained in the records for 5 years from the
5829date the reports are filed or issued.
5830     (1)(2)  Within 60 days after the date of the biennial
5831inspection visit required under s. 408.811 or within 30 days
5832after the date of any interim visit, the agency shall forward
5833the results of the inspection to the local ombudsman council in
5834whose planning and service area, as defined in part II, the
5835facility is located; to at least one public library or, in the
5836absence of a public library, the county seat in the county in
5837which the inspected assisted living facility is located; and,
5838when appropriate, to the district Adult Services and Mental
5839Health Program Offices.
5840     Section 110.  Section 400.441, Florida Statutes, is amended
5841to read:
5842     400.441  Rules establishing standards.--
5843     (1)  It is the intent of the Legislature that rules
5844published and enforced pursuant to this section shall include
5845criteria by which a reasonable and consistent quality of
5846resident care and quality of life may be ensured and the results
5847of such resident care may be demonstrated. Such rules shall also
5848ensure a safe and sanitary environment that is residential and
5849noninstitutional in design or nature. It is further intended
5850that reasonable efforts be made to accommodate the needs and
5851preferences of residents to enhance the quality of life in a
5852facility. In order to provide safe and sanitary facilities and
5853the highest quality of resident care accommodating the needs and
5854preferences of residents, the agency department, in consultation
5855with the department agency, the Department of Children and
5856Family Services, and the Department of Health, shall adopt
5857rules, policies, and procedures to administer this part and part
5858II of chapter 408, which must include reasonable and fair
5859minimum standards in relation to:
5860     (a)  The requirements for and maintenance of facilities,
5861not in conflict with the provisions of chapter 553, relating to
5862plumbing, heating, cooling, lighting, ventilation, living space,
5863and other housing conditions, which will ensure the health,
5864safety, and comfort of residents and protection from fire
5865hazard, including adequate provisions for fire alarm and other
5866fire protection suitable to the size of the structure. Uniform
5867firesafety standards shall be established and enforced by the
5868State Fire Marshal in cooperation with the agency, the
5869department, and the Department of Health.
5870     1.  Evacuation capability determination.--
5871     a.  The provisions of the National Fire Protection
5872Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
5873for determining the ability of the residents, with or without
5874staff assistance, to relocate from or within a licensed facility
5875to a point of safety as provided in the fire codes adopted
5876herein. An evacuation capability evaluation for initial
5877licensure shall be conducted within 6 months after the date of
5878licensure. For existing licensed facilities that are not
5879equipped with an automatic fire sprinkler system, the
5880administrator shall evaluate the evacuation capability of
5881residents at least annually. The evacuation capability
5882evaluation for each facility not equipped with an automatic fire
5883sprinkler system shall be validated, without liability, by the
5884State Fire Marshal, by the local fire marshal, or by the local
5885authority having jurisdiction over firesafety, before the
5886license renewal date. If the State Fire Marshal, local fire
5887marshal, or local authority having jurisdiction over firesafety
5888has reason to believe that the evacuation capability of a
5889facility as reported by the administrator may have changed, it
5890may, with assistance from the facility administrator, reevaluate
5891the evacuation capability through timed exiting drills.
5892Translation of timed fire exiting drills to evacuation
5893capability may be determined:
5894     (I)  Three minutes or less: prompt.
5895     (II)  More than 3 minutes, but not more than 13 minutes:
5896slow.
5897     (III)  More than 13 minutes: impractical.
5898     b.  The Office of the State Fire Marshal shall provide or
5899cause the provision of training and education on the proper
5900application of Chapter 5, NFPA 101A, 1995 edition, to its
5901employees, to staff of the Agency for Health Care Administration
5902who are responsible for regulating facilities under this part,
5903and to local governmental inspectors. The Office of the State
5904Fire Marshal shall provide or cause the provision of this
5905training within its existing budget, but may charge a fee for
5906this training to offset its costs. The initial training must be
5907delivered within 6 months after July 1, 1995, and as needed
5908thereafter.
5909     c.  The Office of the State Fire Marshal, in cooperation
5910with provider associations, shall provide or cause the provision
5911of a training program designed to inform facility operators on
5912how to properly review bid documents relating to the
5913installation of automatic fire sprinklers. The Office of the
5914State Fire Marshal shall provide or cause the provision of this
5915training within its existing budget, but may charge a fee for
5916this training to offset its costs. The initial training must be
5917delivered within 6 months after July 1, 1995, and as needed
5918thereafter.
5919     d.  The administrator of a licensed facility shall sign an
5920affidavit verifying the number of residents occupying the
5921facility at the time of the evacuation capability evaluation.
5922     2.  Firesafety requirements.--
5923     a.  Except for the special applications provided herein,
5924effective January 1, 1996, the provisions of the National Fire
5925Protection Association, Life Safety Code, NFPA 101, 1994
5926edition, Chapter 22 for new facilities and Chapter 23 for
5927existing facilities shall be the uniform fire code applied by
5928the State Fire Marshal for assisted living facilities, pursuant
5929to s. 633.022.
5930     b.  Any new facility, regardless of size, that applies for
5931a license on or after January 1, 1996, must be equipped with an
5932automatic fire sprinkler system. The exceptions as provided in
5933section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein,
5934apply to any new facility housing eight or fewer residents. On
5935July 1, 1995, local governmental entities responsible for the
5936issuance of permits for construction shall inform, without
5937liability, any facility whose permit for construction is
5938obtained prior to January 1, 1996, of this automatic fire
5939sprinkler requirement. As used in this part, the term "a new
5940facility" does not mean an existing facility that has undergone
5941change of ownership.
5942     c.  Notwithstanding any provision of s. 633.022 or of the
5943National Fire Protection Association, NFPA 101A, Chapter 5, 1995
5944edition, to the contrary, any existing facility housing eight or
5945fewer residents is not required to install an automatic fire
5946sprinkler system, nor to comply with any other requirement in
5947Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
5948requirements of NFPA 101, 1988 edition, that applies to this
5949size facility, unless the facility has been classified as
5950impractical to evacuate. Any existing facility housing eight or
5951fewer residents that is classified as impractical to evacuate
5952must install an automatic fire sprinkler system within the
5953timeframes granted in this section.
5954     d.  Any existing facility that is required to install an
5955automatic fire sprinkler system under this paragraph need not
5956meet other firesafety requirements of Chapter 23, NFPA 101, 1994
5957edition, which exceed the provisions of NFPA 101, 1988 edition.
5958The mandate contained in this paragraph which requires certain
5959facilities to install an automatic fire sprinkler system
5960supersedes any other requirement.
5961     e.  This paragraph does not supersede the exceptions
5962granted in NFPA 101, 1988 edition or 1994 edition.
5963     f.  This paragraph does not exempt facilities from other
5964firesafety provisions adopted under s. 633.022 and local
5965building code requirements in effect before July 1, 1995.
5966     g.  A local government may charge fees only in an amount
5967not to exceed the actual expenses incurred by local government
5968relating to the installation and maintenance of an automatic
5969fire sprinkler system in an existing and properly licensed
5970assisted living facility structure as of January 1, 1996.
5971     h.  If a licensed facility undergoes major reconstruction
5972or addition to an existing building on or after January 1, 1996,
5973the entire building must be equipped with an automatic fire
5974sprinkler system. Major reconstruction of a building means
5975repair or restoration that costs in excess of 50 percent of the
5976value of the building as reported on the tax rolls, excluding
5977land, before reconstruction. Multiple reconstruction projects
5978within a 5-year period the total costs of which exceed 50
5979percent of the initial value of the building at the time the
5980first reconstruction project was permitted are to be considered
5981as major reconstruction. Application for a permit for an
5982automatic fire sprinkler system is required upon application for
5983a permit for a reconstruction project that creates costs that go
5984over the 50-percent threshold.
5985     i.  Any facility licensed before January 1, 1996, that is
5986required to install an automatic fire sprinkler system shall
5987ensure that the installation is completed within the following
5988timeframes based upon evacuation capability of the facility as
5989determined under subparagraph 1.:
5990     (I)  Impractical evacuation capability, 24 months.
5991     (II)  Slow evacuation capability, 48 months.
5992     (III)  Prompt evacuation capability, 60 months.
5993
5994The beginning date from which the deadline for the automatic
5995fire sprinkler installation requirement must be calculated is
5996upon receipt of written notice from the local fire official that
5997an automatic fire sprinkler system must be installed. The local
5998fire official shall send a copy of the document indicating the
5999requirement of a fire sprinkler system to the Agency for Health
6000Care Administration.
6001     j.  It is recognized that the installation of an automatic
6002fire sprinkler system may create financial hardship for some
6003facilities. The appropriate local fire official shall, without
6004liability, grant two 1-year extensions to the timeframes for
6005installation established herein, if an automatic fire sprinkler
6006installation cost estimate and proof of denial from two
6007financial institutions for a construction loan to install the
6008automatic fire sprinkler system are submitted. However, for any
6009facility with a class I or class II, or a history of uncorrected
6010class III, firesafety deficiencies, an extension must not be
6011granted. The local fire official shall send a copy of the
6012document granting the time extension to the Agency for Health
6013Care Administration.
6014     k.  A facility owner whose facility is required to be
6015equipped with an automatic fire sprinkler system under Chapter
601623, NFPA 101, 1994 edition, as adopted herein, must disclose to
6017any potential buyer of the facility that an installation of an
6018automatic fire sprinkler requirement exists. The sale of the
6019facility does not alter the timeframe for the installation of
6020the automatic fire sprinkler system.
6021     l.  Existing facilities required to install an automatic
6022fire sprinkler system as a result of construction-type
6023restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
6024herein, or evacuation capability requirements shall be notified
6025by the local fire official in writing of the automatic fire
6026sprinkler requirement, as well as the appropriate date for final
6027compliance as provided in this subparagraph. The local fire
6028official shall send a copy of the document to the Agency for
6029Health Care Administration.
6030     m.  Except in cases of life-threatening fire hazards, if an
6031existing facility experiences a change in the evacuation
6032capability, or if the local authority having jurisdiction
6033identifies a construction-type restriction, such that an
6034automatic fire sprinkler system is required, it shall be
6035afforded time for installation as provided in this subparagraph.
6036
6037Facilities that are fully sprinkled and in compliance with other
6038firesafety standards are not required to conduct more than one
6039of the required fire drills between the hours of 11 p.m. and 7
6040a.m., per year. In lieu of the remaining drills, staff
6041responsible for residents during such hours may be required to
6042participate in a mock drill that includes a review of evacuation
6043procedures. Such standards must be included or referenced in the
6044rules adopted by the State Fire Marshal. Pursuant to s.
6045633.022(1)(b), the State Fire Marshal is the final
6046administrative authority for firesafety standards established
6047and enforced pursuant to this section. All licensed facilities
6048must have an annual fire inspection conducted by the local fire
6049marshal or authority having jurisdiction.
6050     3.  Resident elopement requirements.--Facilities are
6051required to conduct a minimum of two resident elopement
6052prevention and response drills per year. All administrators and
6053direct care staff must participate in the drills which shall
6054include a review of procedures to address resident elopement.
6055Facilities must document the implementation of the drills and
6056ensure that the drills are conducted in a manner consistent with
6057the facility's resident elopement policies and procedures.
6058     (b)  The preparation and annual update of a comprehensive
6059emergency management plan. Such standards must be included in
6060the rules adopted by the agency department after consultation
6061with the Department of Community Affairs. At a minimum, the
6062rules must provide for plan components that address emergency
6063evacuation transportation; adequate sheltering arrangements;
6064postdisaster activities, including provision of emergency power,
6065food, and water; postdisaster transportation; supplies;
6066staffing; emergency equipment; individual identification of
6067residents and transfer of records; communication with families;
6068and responses to family inquiries. The comprehensive emergency
6069management plan is subject to review and approval by the local
6070emergency management agency. During its review, the local
6071emergency management agency shall ensure that the following
6072agencies, at a minimum, are given the opportunity to review the
6073plan: the Department of Elderly Affairs, the Department of
6074Health, the Agency for Health Care Administration, and the
6075Department of Community Affairs. Also, appropriate volunteer
6076organizations must be given the opportunity to review the plan.
6077The local emergency management agency shall complete its review
6078within 60 days and either approve the plan or advise the
6079facility of necessary revisions.
6080     (c)  The number, training, and qualifications of all
6081personnel having responsibility for the care of residents. The
6082rules must require adequate staff to provide for the safety of
6083all residents. Facilities licensed for 17 or more residents are
6084required to maintain an alert staff for 24 hours per day.
6085     (d)  All sanitary conditions within the facility and its
6086surroundings which will ensure the health and comfort of
6087residents. The rules must clearly delineate the responsibilities
6088of the agency's licensure and survey staff, the county health
6089departments, and the local authority having jurisdiction over
6090fire safety and ensure that inspections are not duplicative. The
6091agency may collect fees for food service inspections conducted
6092by the county health departments and transfer such fees to the
6093Department of Health.
6094     (e)  License application and license renewal, transfer of
6095ownership, Proper management of resident funds and personal
6096property, surety bonds, resident contracts, refund policies,
6097financial ability to operate, and facility and staff records.
6098     (f)  Inspections, complaint investigations, moratoriums,
6099classification of deficiencies, levying and enforcement of
6100penalties, and use of income from fees and fines.
6101     (g)  The enforcement of the resident bill of rights
6102specified in s. 400.428.
6103     (h)  The care and maintenance of residents, which must
6104include, but is not limited to:
6105     1.  The supervision of residents;
6106     2.  The provision of personal services;
6107     3.  The provision of, or arrangement for, social and
6108leisure activities;
6109     4.  The arrangement for appointments and transportation to
6110appropriate medical, dental, nursing, or mental health services,
6111as needed by residents;
6112     5.  The management of medication;
6113     6.  The nutritional needs of residents;
6114     7.  Resident records; and
6115     8.  Internal risk management and quality assurance.
6116     (i)  Facilities holding a limited nursing, extended
6117congregate care, or limited mental health license.
6118     (j)  The establishment of specific criteria to define
6119appropriateness of resident admission and continued residency in
6120a facility holding a standard, limited nursing, extended
6121congregate care, and limited mental health license.
6122     (k)  The use of physical or chemical restraints. The use of
6123physical restraints is limited to half-bed rails as prescribed
6124and documented by the resident's physician with the consent of
6125the resident or, if applicable, the resident's representative or
6126designee or the resident's surrogate, guardian, or attorney in
6127fact. The use of chemical restraints is limited to prescribed
6128dosages of medications authorized by the resident's physician
6129and must be consistent with the resident's diagnosis. Residents
6130who are receiving medications that can serve as chemical
6131restraints must be evaluated by their physician at least
6132annually to assess:
6133     1.  The continued need for the medication.
6134     2.  The level of the medication in the resident's blood.
6135     3.  The need for adjustments in the prescription.
6136     (l)  The establishment of specific policies and procedures
6137on resident elopement. Facilities shall conduct a minimum of two
6138resident elopement drills each year. All administrators and
6139direct care staff shall participate in the drills. Facilities
6140shall document the drills.
6141     (2)  In adopting any rules pursuant to this part, the
6142agency department, in conjunction with the department agency,
6143shall make distinct standards for facilities based upon facility
6144size; the types of care provided; the physical and mental
6145capabilities and needs of residents; the type, frequency, and
6146amount of services and care offered; and the staffing
6147characteristics of the facility. Rules developed pursuant to
6148this section shall not restrict the use of shared staffing and
6149shared programming in facilities that are part of retirement
6150communities that provide multiple levels of care and otherwise
6151meet the requirements of law and rule. Except for uniform
6152firesafety standards, the agency department shall adopt by rule
6153separate and distinct standards for facilities with 16 or fewer
6154beds and for facilities with 17 or more beds. The standards for
6155facilities with 16 or fewer beds shall be appropriate for a
6156noninstitutional residential environment, provided that the
6157structure is no more than two stories in height and all persons
6158who cannot exit the facility unassisted in an emergency reside
6159on the first floor. The agency department, in conjunction with
6160the department agency, may make other distinctions among types
6161of facilities as necessary to enforce the provisions of this
6162part. Where appropriate, the agency shall offer alternate
6163solutions for complying with established standards, based on
6164distinctions made by the department and the agency relative to
6165the physical characteristics of facilities and the types of care
6166offered therein.
6167     (3)  The department shall submit a copy of proposed rules
6168to the Speaker of the House of Representatives, the President of
6169the Senate, and appropriate committees of substance for review
6170and comment prior to the promulgation thereof.
6171     (a)  Rules adopted promulgated by the agency department
6172shall encourage the development of homelike facilities which
6173promote the dignity, individuality, personal strengths, and
6174decisionmaking ability of residents.
6175     (4)(b)  The agency, in consultation with the department,
6176may waive rules promulgated pursuant to this part in order to
6177demonstrate and evaluate innovative or cost-effective congregate
6178care alternatives which enable individuals to age in place. Such
6179waivers may be granted only in instances where there is
6180reasonable assurance that the health, safety, or welfare of
6181residents will not be endangered. To apply for a waiver, the
6182licensee shall submit to the agency a written description of the
6183concept to be demonstrated, including goals, objectives, and
6184anticipated benefits; the number and types of residents who will
6185be affected, if applicable; a brief description of how the
6186demonstration will be evaluated; and any other information
6187deemed appropriate by the agency. Any facility granted a waiver
6188shall submit a report of findings to the agency and the
6189department within 12 months. At such time, the agency may renew
6190or revoke the waiver or pursue any regulatory or statutory
6191changes necessary to allow other facilities to adopt the same
6192practices. The agency department may by rule clarify terms and
6193establish waiver application procedures, criteria for reviewing
6194waiver proposals, and procedures for reporting findings, as
6195necessary to implement this subsection.
6196     (5)(4)  The agency may use an abbreviated biennial standard
6197licensure inspection that consists of a review of key quality-
6198of-care standards in lieu of a full inspection in facilities
6199which have a good record of past performance. However, a full
6200inspection shall be conducted in facilities which have had a
6201history of class I or class II violations, uncorrected class III
6202violations, confirmed ombudsman council complaints, or confirmed
6203licensure complaints, within the previous licensure period
6204immediately preceding the inspection or when a potentially
6205serious problem is identified during the abbreviated inspection.
6206The agency, in consultation with the department, shall develop
6207the key quality-of-care standards with input from the State
6208Long-Term Care Ombudsman Council and representatives of provider
6209groups for incorporation into its rules. The department, in
6210consultation with the agency, shall report annually to the
6211Legislature concerning its implementation of this subsection.
6212The report shall include, at a minimum, the key quality-of-care
6213standards which have been developed; the number of facilities
6214identified as being eligible for the abbreviated inspection; the
6215number of facilities which have received the abbreviated
6216inspection and, of those, the number that were converted to full
6217inspection; the number and type of subsequent complaints
6218received by the agency or department on facilities which have
6219had abbreviated inspections; any recommendations for
6220modification to this subsection; any plans by the agency to
6221modify its implementation of this subsection; and any other
6222information which the department believes should be reported.
6223     (5)  A fee shall be charged by the department to any person
6224requesting a copy of this part or rules promulgated under this
6225part. Such fees shall not exceed the actual cost of duplication
6226and postage.
6227     Section 111.  Subsection (4) of section 400.442, Florida
6228Statutes, is amended to read:
6229     400.442  Pharmacy and dietary services.--
6230     (4)  The agency department may by rule establish procedures
6231and specify documentation as necessary to implement this
6232section.
6233     Section 112.  Subsection (3) of section 400.444, Florida
6234Statutes, is amended to read:
6235     400.444  Construction and renovation; requirements.--
6236     (3)  The agency department may adopt rules to establish
6237procedures and specify the documentation necessary to implement
6238this section.
6239     Section 113.  Subsections (4) through (7) of section
6240400.447, Florida Statutes, are renumbered as subsections (1)
6241through (4) and present subsections (1), (2), and (3) of said
6242section are amended to read:
6243     400.447  Prohibited acts; penalties for violation.--
6244     (1)  It is unlawful for any person or public body to offer
6245or advertise to the public, in any way by any medium whatever,
6246personal services as defined in this act, without obtaining a
6247valid current license. It is unlawful for any holder of a
6248license issued pursuant to the provisions of this act to
6249advertise or hold out to the public that it holds a license for
6250a facility other than that for which it actually holds a
6251license.
6252     (2)  It is unlawful for any holder of a license issued
6253pursuant to the provisions of this act to withhold from the
6254agency any evidence of financial instability, including, but not
6255limited to, bad checks, delinquent accounts, nonpayment of
6256withholding taxes, unpaid utility expenses, nonpayment for
6257essential services, or adverse court action concerning the
6258financial viability of the facility or any other facility
6259licensed under part II or part III of this chapter which is
6260owned by the licensee.
6261     (3)  Any person found guilty of violating subsection (1) or
6262subsection (2) commits a misdemeanor of the second degree,
6263punishable as provided in s. 775.083. Each day of continuing
6264violation shall be considered a separate offense.
6265     Section 114.  Section 400.451, Florida Statutes, is
6266repealed.
6267     Section 115.  Subsections (1), (3), and (6) of section
6268400.452, Florida Statutes, as amended by section 3 of chapter
62692003-405, Laws of Florida, are amended to read:
6270     400.452  Staff training and educational programs; core
6271educational requirement.--
6272     (1)  Administrators and other assisted living facility
6273staff must meet minimum training and education requirements
6274established by the Department of Elderly Affairs or agency by
6275rule. This training and education is intended to assist
6276facilities to appropriately respond to the needs of residents,
6277to maintain resident care and facility standards, and to meet
6278licensure requirements.
6279     (3)  Effective January 1, 2004, a new facility
6280administrator must complete the required training and education,
6281including the competency test, within a reasonable time after
6282being employed as an administrator, as determined by the
6283department. Failure to do so is a violation of this part and
6284subjects the violator to an administrative fine as prescribed in
6285s. 400.419. Administrators licensed in accordance with chapter
6286468, part II, are exempt from this requirement. Other licensed
6287professionals may be exempted, as determined by the department
6288by rule.
6289     (6)  Other facility staff shall participate in training
6290relevant to their job duties as specified by rule of the
6291department.
6292     Section 116.  Section 400.454, Florida Statutes, is amended
6293to read:
6294     400.454  Collection of information; local subsidy.--
6295     (1)  To enable the agency department to collect the
6296information requested by the Legislature regarding the actual
6297cost of providing room, board, and personal care in facilities,
6298the agency may department is authorized to conduct field visits
6299and audits of facilities as may be necessary. The owners of
6300randomly sampled facilities shall submit such reports, audits,
6301and accountings of cost as required the department may require
6302by rule; provided that such reports, audits, and accountings
6303shall be the minimum necessary to implement the provisions of
6304this section. Any facility selected to participate in the study
6305shall cooperate with the agency department by providing cost of
6306operation information to interviewers.
6307     (2)  Local governments or organizations may contribute to
6308the cost of care of local facility residents by further
6309subsidizing the rate of state-authorized payment to such
6310facilities. Implementation of local subsidy shall require agency
6311departmental approval and shall not result in reductions in the
6312state supplement.
6313     Section 117.  Subsections (1) and (4) of section 400.464,
6314Florida Statutes, are amended to read:
6315     400.464  Home health agencies to be licensed; expiration of
6316license; exemptions; unlawful acts; penalties.--
6317     (1)  The requirements of part II of chapter 408 shall apply
6318to the provision of services that require licensure pursuant to
6319this part and part II of chapter 408 and entities licensed or
6320registered by or applying for such licensure or registration
6321from the Agency for Health Care Administration pursuant to this
6322part. However, each applicant for licensure and each licensee is
6323exempt from the provisions of ss. 408.806(1)(e)2. and
6324408.810(10). Any home health agency must be licensed by the
6325agency to operate in this state. A license issued to a home
6326health agency, unless sooner suspended or revoked, expires 1
6327year after its date of issuance.
6328     (4)(a)  An organization may not provide, offer, or
6329advertise home health services to the public unless the
6330organization has a valid license or is specifically exempted
6331under this part. An organization that offers or advertises to
6332the public any service for which licensure or registration is
6333required under this part must include in the advertisement the
6334license number or regulation number issued to the organization
6335by the agency. The agency shall assess a fine of not less than
6336$100 to any licensee or registrant who fails to include the
6337license or registration number when submitting the advertisement
6338for publication, broadcast, or printing. The holder of a license
6339issued under this part may not advertise or indicate to the
6340public that it holds a home health agency or nurse registry
6341license other than the one it has been issued.
6342     (b)  A person who violates paragraph (a) is subject to an
6343injunctive proceeding under s. 408.816 400.515. A violation of
6344paragraph (a) or s. 408.813 is a deceptive and unfair trade
6345practice and constitutes a violation of the Florida Deceptive
6346and Unfair Trade Practices Act.
6347     (c)  A person who violates the provisions of paragraph (a)
6348commits a misdemeanor of the second degree, punishable as
6349provided in s. 775.082 or s. 775.083. Any person who commits a
6350second or subsequent violation commits a misdemeanor of the
6351first degree, punishable as provided in s. 775.082 or s.
6352775.083. Each day of continuing violation constitutes a separate
6353offense.
6354     Section 118.  Section 400.471, Florida Statutes, is amended
6355to read:
6356     400.471  Application for license; fee; provisional license;
6357temporary permit.--
6358     (1)  Each applicant for licensure must comply with all
6359provisions of this part and part II of chapter 408. Application
6360for an initial license or for renewal of an existing license
6361must be made under oath to the agency on forms furnished by it
6362and must be accompanied by the appropriate license fee as
6363provided in subsection (8). The agency must take final action on
6364an initial licensure application within 60 days after receipt of
6365all required documentation.
6366     (2)  In addition to the requirements of part II of chapter
6367408, the applicant must file with the application satisfactory
6368proof that the home health agency is in compliance with this
6369part and applicable rules, including:
6370     (a)  A listing of services to be provided, either directly
6371by the applicant or through contractual arrangements with
6372existing providers.;
6373     (b)  The number and discipline of professional staff to be
6374employed.; and
6375     (c)  Proof of financial ability to operate.
6376     (3)  An applicant for initial licensure must demonstrate
6377financial ability to operate by submitting a balance sheet and
6378income and expense statement for the first 2 years of operation
6379which provide evidence of having sufficient assets, credit, and
6380projected revenues to cover liabilities and expenses. The
6381applicant shall have demonstrated financial ability to operate
6382if the applicant's assets, credit, and projected revenues meet
6383or exceed projected liabilities and expenses. All documents
6384required under this subsection must be prepared in accordance
6385with generally accepted accounting principles, and the financial
6386statement must be signed by a certified public accountant.
6387     (4)  Each applicant for licensure must comply with the
6388following requirements:
6389     (a)  Upon receipt of a completed, signed, and dated
6390application, the agency shall require background screening of
6391the applicant, in accordance with the level 2 standards for
6392screening set forth in chapter 435. As used in this subsection,
6393the term "applicant" means the administrator, or a similarly
6394titled person who is responsible for the day-to-day operation of
6395the licensed home health agency, and the financial officer, or
6396similarly titled individual who is responsible for the financial
6397operation of the licensed home health agency.
6398     (b)  The agency may require background screening for a
6399member of the board of directors of the licensee or an officer
6400or an individual owning 5 percent or more of the licensee if the
6401agency reasonably suspects that such individual has been
6402convicted of an offense prohibited under the level 2 standards
6403for screening set forth in chapter 435.
6404     (c)  Proof of compliance with the level 2 background
6405screening requirements of chapter 435 which has been submitted
6406within the previous 5 years in compliance with any other health
6407care or assisted living licensure requirements of this state is
6408acceptable in fulfillment of paragraph (a). Proof of compliance
6409with background screening which has been submitted within the
6410previous 5 years to fulfill the requirements of the Financial
6411Services Commission and the Office of Insurance Regulation
6412pursuant to chapter 651 as part of an application for a
6413certificate of authority to operate a continuing care retirement
6414community is acceptable in fulfillment of the Department of Law
6415Enforcement and Federal Bureau of Investigation background
6416check.
6417     (d)  A provisional license may be granted to an applicant
6418when each individual required by this section to undergo
6419background screening has met the standards for the Department of
6420Law Enforcement background check, but the agency has not yet
6421received background screening results from the Federal Bureau of
6422Investigation. A standard license may be granted to the licensee
6423upon the agency's receipt of a report of the results of the
6424Federal Bureau of Investigation background screening for each
6425individual required by this section to undergo background
6426screening which confirms that all standards have been met, or
6427upon the granting of a disqualification exemption by the agency
6428as set forth in chapter 435. Any other person who is required to
6429undergo level 2 background screening may serve in his or her
6430capacity pending the agency's receipt of the report from the
6431Federal Bureau of Investigation. However, the person may not
6432continue to serve if the report indicates any violation of
6433background screening standards and a disqualification exemption
6434has not been requested of and granted by the agency as set forth
6435in chapter 435.
6436     (e)  Each applicant must submit to the agency, with its
6437application, a description and explanation of any exclusions,
6438permanent suspensions, or terminations of the licensee or
6439potential licensee from the Medicare or Medicaid programs. Proof
6440of compliance with the requirements for disclosure of ownership
6441and control interest under the Medicaid or Medicare programs may
6442be accepted in lieu of this submission.
6443     (f)  Each applicant must submit to the agency a description
6444and explanation of any conviction of an offense prohibited under
6445the level 2 standards of chapter 435 by a member of the board of
6446directors of the applicant, its officers, or any individual
6447owning 5 percent or more of the applicant. This requirement does
6448not apply to a director of a not-for-profit corporation or
6449organization if the director serves solely in a voluntary
6450capacity for the corporation or organization, does not regularly
6451take part in the day-to-day operational decisions of the
6452corporation or organization, receives no remuneration for his or
6453her services on the corporation or organization's board of
6454directors, and has no financial interest and has no family
6455members with a financial interest in the corporation or
6456organization, provided that the director and the not-for-profit
6457corporation or organization include in the application a
6458statement affirming that the director's relationship to the
6459corporation satisfies the requirements of this paragraph.
6460     (g)  A license may not be granted to an applicant if the
6461applicant, administrator, or financial officer has been found
6462guilty of, regardless of adjudication, or has entered a plea of
6463nolo contendere or guilty to, any offense prohibited under the
6464level 2 standards for screening set forth in chapter 435, unless
6465an exemption from disqualification has been granted by the
6466agency as set forth in chapter 435.
6467     (h)  The agency may deny or revoke licensure if the
6468applicant:
6469     1.  Has falsely represented a material fact in the
6470application required by paragraph (e) or paragraph (f), or has
6471omitted any material fact from the application required by
6472paragraph (e) or paragraph (f); or
6473     2.  Has been or is currently excluded, suspended,
6474terminated from, or has involuntarily withdrawn from
6475participation in this state's Medicaid program, or the Medicaid
6476program of any other state, or from participation in the
6477Medicare program or any other governmental or private health
6478care or health insurance program.
6479     (i)  An application for license renewal must contain the
6480information required under paragraphs (e) and (f).
6481     (3)(5)  In addition to the requirements of s. 408.810, the
6482home health agency must also obtain and maintain the following
6483insurance coverages in an amount of not less than $250,000 per
6484claim, and the home health agency must submit proof of coverage
6485with an initial application for licensure and with each annual
6486application for license renewal:
6487     (a)  Malpractice insurance as defined in s. 624.605(1)(k).;
6488     (b)  Liability insurance as defined in s. 624.605(1)(b).
6489     (6)  Ninety days before the expiration date, an application
6490for renewal must be submitted to the agency under oath on forms
6491furnished by it, and a license must be renewed if the applicant
6492has met the requirements established under this part and
6493applicable rules. The home health agency must file with the
6494application satisfactory proof that it is in compliance with
6495this part and applicable rules. If there is evidence of
6496financial instability, the home health agency must submit
6497satisfactory proof of its financial ability to comply with the
6498requirements of this part.
6499     (7)  When transferring the ownership of a home health
6500agency, the transferee must submit an application for a license
6501at least 60 days before the effective date of the transfer. If
6502the home health agency is being leased, a copy of the lease
6503agreement must be filed with the application.
6504     (4)(8)  In accordance with s. 408.805, an applicant or
6505licensee shall pay a fee for each license application submitted
6506under this part, part II of chapter 408, and applicable rules.
6507The amount of the fee shall be established by rule and shall be
6508set at The license fee and annual renewal fee required of a home
6509health agency are nonrefundable. The agency shall set the fees
6510in an amount that is sufficient to cover the agency's its costs
6511in carrying out its responsibilities under this part, but not to
6512exceed $2,000 per biennium $1,000. However, state, county, or
6513municipal governments applying for licenses under this part are
6514exempt from the payment of license fees. All fees collected
6515under this part must be deposited in the Health Care Trust Fund
6516for the administration of this part.
6517     (9)  The license must be displayed in a conspicuous place
6518in the administrative office of the home health agency and is
6519valid only while in the possession of the person to which it is
6520issued. The license may not be sold, assigned, or otherwise
6521transferred, voluntarily or involuntarily, and is valid only for
6522the home health agency and location for which originally issued.
6523     (10)  A home health agency against whom a revocation or
6524suspension proceeding is pending at the time of license renewal
6525may be issued a provisional license effective until final
6526disposition by the agency of such proceedings. If judicial
6527relief is sought from the final disposition, the court that has
6528jurisdiction may issue a temporary permit for the duration of
6529the judicial proceeding.
6530     (5)(11)  The agency may not issue a license designated as
6531certified to a home health agency that fails to satisfy the
6532requirements of a Medicare certification survey from the agency.
6533     (12)  The agency may not issue a license to a home health
6534agency that has any unpaid fines assessed under this part.
6535     Section 119.  Section 400.474, Florida Statutes, is amended
6536to read:
6537     400.474  Denial, suspension, revocation of license;
6538injunction; grounds; penalties.--
6539     (1)  The agency may deny, revoke, and or suspend a license,
6540and or impose an administrative fine in the manner provided in
6541chapter 120, or initiate injunctive proceedings under this part,
6542part II of chapter 408, or applicable rules s. 400.515.
6543     (2)  Any of the following actions by a home health agency
6544or its employee is grounds for disciplinary action by the
6545agency:
6546     (a)  Violation of this part, part II of chapter 408, or of
6547applicable rules.
6548     (b)  An intentional, reckless, or negligent act that
6549materially affects the health or safety of a patient.
6550     (c)  Knowingly providing home health services in an
6551unlicensed assisted living facility or unlicensed adult family-
6552care home, unless the home health agency or employee reports the
6553unlicensed facility or home to the agency within 72 hours after
6554providing the services.
6555     (3)  The agency may impose the following penalties for
6556operating without a license upon an applicant or owner who has
6557in the past operated, or who currently operates, a licensed home
6558health agency.
6559     (a)  If a home health agency that is found to be operating
6560without a license wishes to apply for a license, the home health
6561agency may submit an application only after the agency has
6562verified that the home health agency no longer operates an
6563unlicensed home health agency.
6564     (b)  Any person, partnership, or corporation that violates
6565paragraph (a) and that previously operated a licensed home
6566health agency or concurrently operates both a licensed home
6567health agency and an unlicensed home health agency commits a
6568felony of the third degree punishable as provided in s. 775.082,
6569s. 775.083, or s. 775.084. If an owner has an interest in more
6570than one home health agency and fails to license any one of
6571those home health agencies, the agency must issue a cease and
6572desist order for the activities of the unlicensed home health
6573agency and impose a moratorium on any or all of the licensed
6574related home health agencies until the unlicensed home health
6575agency is licensed.
6576     (3)(c)  If any home health agency is found to be operating
6577without a license meets the criteria in paragraph (a) or
6578paragraph (b) and that home health agency has received any
6579government reimbursement for services provided by an unlicensed
6580home health agency, the agency shall make a fraud referral to
6581the appropriate government reimbursement program.
6582     (4)  The agency may deny, revoke, or suspend the license of
6583a home health agency, or may impose on a home health agency
6584administrative fines not to exceed the aggregate sum of $5,000
6585if:
6586     (a)  The agency is unable to obtain entry to the home
6587health agency to conduct a licensure survey, complaint
6588investigation, surveillance visit, or monitoring visit.
6589     (b)  An applicant or a licensed home health agency has
6590falsely represented a material fact in the application, or has
6591omitted from the application any material fact, including, but
6592not limited to, the fact that the controlling or ownership
6593interest is held by any officer, director, agent, manager,
6594employee, affiliated person, partner, or shareholder who is not
6595eligible to participate.
6596     (c)  An applicant, owner, or person who has a 5 percent or
6597greater interest in a licensed entity:
6598     1.  Has been previously found by any licensing, certifying,
6599or professional standards board or agency to have violated the
6600standards or conditions that relate to home health-related
6601licensure or certification, or to the quality of home health-
6602related services provided; or
6603     2.  Has been or is currently excluded, suspended,
6604terminated from, or has involuntarily withdrawn from,
6605participation in the Medicaid program of this state or any other
6606state, the Medicare program, or any other governmental health
6607care or health insurance program.
6608     Section 120.  Subsection (1) and paragraphs (a) and (b) of
6609subsection (2) of section 400.484, Florida Statutes, are amended
6610to read:
6611     400.484  Right of inspection; deficiencies; fines.--
6612     (1)  In accordance with s. 408.811, Any duly authorized
6613officer or employee of the agency may make such inspections and
6614investigations as are necessary in order to determine the state
6615of compliance with this part and with applicable rules. The
6616right of inspection extends to any business that the agency has
6617reason to believe is being operated as a home health agency
6618without a license, but such inspection of any such business may
6619not be made without the permission of the owner or person in
6620charge unless a warrant is first obtained from a circuit court.
6621Any application for a license issued under this part or for
6622license renewal constitutes permission for an appropriate
6623inspection to verify the information submitted on or in
6624connection with the application.
6625     (2)  The agency shall impose fines for various classes of
6626deficiencies in accordance with the following schedule:
6627     (a)  A class I deficiency is any act, omission, or practice
6628that results in a patient's death, disablement, or permanent
6629injury, or places a patient at imminent risk of death,
6630disablement, or permanent injury. Upon finding a class I
6631deficiency, the agency may impose an administrative fine in the
6632amount of $5,000 for each occurrence and each day that the
6633deficiency exists. In addition, the agency may immediately
6634revoke the license and, or impose a moratorium pursuant to part
6635II of chapter 408 on the admission of new patients, until the
6636factors causing the deficiency have been corrected.
6637     (b)  A class II deficiency is any act, omission, or
6638practice that has a direct adverse effect on the health, safety,
6639or security of a patient. Upon finding a class II deficiency,
6640the agency may impose an administrative fine in the amount of
6641$1,000 for each occurrence and each day that the deficiency
6642exists. In addition, the agency may suspend the license and, or
6643impose a moratorium pursuant to part II of chapter 408 on the
6644admission of new patients, until the deficiency has been
6645corrected.
6646     Section 121.  Subsections (1) and (2) of section 400.487,
6647Florida Statutes, are amended to read:
6648     400.487  Home health service agreements; physician's,
6649physician assistant's, and advanced registered nurse
6650practitioner's treatment orders; patient assessment;
6651establishment and review of plan of care; provision of services;
6652orders not to resuscitate.--
6653     (1)  Services provided by a home health agency must be
6654covered by an agreement between the home health agency and the
6655patient or the patient's legal representative specifying the
6656home health services to be provided, the rates or charges for
6657services paid with private funds, and the sources method of
6658payment, which may include Medicare, Medicaid, private
6659insurance, personal funds, or a combination thereof. A home
6660health agency providing skilled care must make an assessment of
6661the patient's needs within 48 hours after the start of services.
6662     (2)  When required by the provisions of chapter 464; part
6663I, part III, or part V of chapter 468; or chapter 486, the
6664attending physician, physician assistant, or advanced registered
6665nurse practitioner, acting within his or her respective scope of
6666practice, shall for a patient who is to receive skilled care
6667must establish treatment orders for a patient who is to receive
6668skilled care. The treatment orders must be signed by the
6669physician, physician assistant, or advanced registered nurse
6670practitioner before a claim is submitted to a managed care
6671organization and the treatment orders must be signed in the time
6672allowed under the provider agreement. The treatment orders shall
6673within 30 days after the start of care and must be reviewed, as
6674frequently as the patient's illness requires, by the physician,
6675physician assistant, or advanced registered nurse practitioner,
6676in consultation with the home health agency personnel that
6677provide services to the patient.
6678     Section 122.  Section 400.494, Florida Statutes, is amended
6679to read:
6680     400.494  Information about patients confidential.--
6681     (1)  Information about patients received by persons
6682employed by, or providing services to, a home health agency or
6683received by the licensing agency through reports or inspection
6684shall be confidential and exempt from the provisions of s.
6685119.07(1) and shall not be disclosed to any person other than
6686the patient without the written consent of that patient or the
6687patient's guardian.
6688     (2)  This section does not apply to information lawfully
6689requested by the Medicaid Fraud Control Unit of the Office of
6690the Attorney General or requested pursuant to 408.811 Department
6691of Legal Affairs.
6692     Section 123.  Section 400.495, Florida Statutes, is amended
6693to read:
6694     400.495  Notice of toll-free telephone number for central
6695abuse hotline.--In addition to the requirements of 408.810(5),
6696On or before the first day home health services are provided to
6697a patient, any home health agency or nurse registry licensed
6698under this part must inform the patient and his or her immediate
6699family, if appropriate, of the right to report abusive,
6700neglectful, or exploitative practices. The statewide toll-free
6701telephone number for the central abuse hotline must be provided
6702to patients in a manner that is clearly legible and must include
6703the words: "To report abuse, neglect, or exploitation, please
6704call toll-free   (phone number)  ." the Agency for Health Care
6705Administration shall adopt rules that provide for 90 days'
6706advance notice of a change in the toll-free telephone number and
6707that outline due process procedures, as provided under chapter
6708120, for home health agency personnel and nurse registry
6709personnel who are reported to the central abuse hotline. Home
6710health agencies and nurse registries shall establish appropriate
6711policies and procedures for providing such notice to patients.
6712     Section 124.  Section 400.497, Florida Statutes, is amended
6713to read:
6714     400.497  Rules establishing minimum standards.--The agency
6715shall adopt, publish, and enforce rules to implement part II of
6716chapter 408 and this part, including, as applicable, ss. 400.506
6717and 400.509, which must provide reasonable and fair minimum
6718standards relating to:
6719     (1)  The home health aide competency test and home health
6720aide training. The agency shall create the home health aide
6721competency test and establish the curriculum and instructor
6722qualifications for home health aide training. Licensed home
6723health agencies may provide this training and shall furnish
6724documentation of such training to other licensed home health
6725agencies upon request. Successful passage of the competency test
6726by home health aides may be substituted for the training
6727required under this section and any rule adopted pursuant
6728thereto.
6729     (2)  Shared staffing. The agency shall allow shared
6730staffing if the home health agency is part of a retirement
6731community that provides multiple levels of care, is located on
6732one campus, is licensed under this chapter, and otherwise meets
6733the requirements of law and rule.
6734     (3)  The criteria for the frequency of onsite licensure
6735surveys.
6736     (4)  Licensure application and renewal.
6737     (5)  The requirements for onsite and electronic
6738accessibility of supervisory personnel of home health agencies.
6739     (6)  Information to be included in patients' records.
6740     (7)  Geographic service areas.
6741     (8)  Preparation of a comprehensive emergency management
6742plan pursuant to s. 400.492.
6743     (a)  The Agency for Health Care Administration shall adopt
6744rules establishing minimum criteria for the plan and plan
6745updates, with the concurrence of the Department of Health and in
6746consultation with the Department of Community Affairs.
6747     (b)  The rules must address the requirements in s. 400.492.
6748In addition, the rules shall provide for the maintenance of
6749patient-specific medication lists that can accompany patients
6750who are transported from their homes.
6751     (c)  The plan is subject to review and approval by the
6752county health department. During its review, the county health
6753department shall ensure that the following agencies, at a
6754minimum, are given the opportunity to review the plan:
6755     1.  The local emergency management agency.
6756     2.  The Agency for Health Care Administration.
6757     3.  The local chapter of the American Red Cross or other
6758lead sheltering agency.
6759     4.  The district office of the Department of Children and
6760Family Services.
6761
6762The county health department shall complete its review within 60
6763days after receipt of the plan and shall either approve the plan
6764or advise the home health agency of necessary revisions.
6765     (d)  For any home health agency that operates in more than
6766one county, the Department of Health shall review the plan,
6767after consulting with all of the county health departments, the
6768agency, and all the local chapters of the American Red Cross or
6769other lead sheltering agencies in the areas of operation for
6770that particular home health agency. The Department of Health
6771shall complete its review within 90 days after receipt of the
6772plan and shall either approve the plan or advise the home health
6773agency of necessary revisions. The Department of Health shall
6774make every effort to avoid imposing differing requirements based
6775on differences between counties on the home health agency.
6776     (e)  The requirements in this subsection do not apply to:
6777     1.  A facility that is certified under chapter 651 and has
6778a licensed home health agency used exclusively by residents of
6779the facility; or
6780     2.  A retirement community that consists of residential
6781units for independent living and either a licensed nursing home
6782or an assisted living facility, and has a licensed home health
6783agency used exclusively by the residents of the retirement
6784community, provided the comprehensive emergency management plan
6785for the facility or retirement community provides for continuous
6786care of all residents with special needs during an emergency.
6787     Section 125.  Section 400.506, Florida Statutes, is amended
6788to read:
6789     400.506  Licensure of nurse registries; requirements;
6790penalties.--
6791     (1)  A nurse registry is exempt from the licensing
6792requirements of a home health agency but must be licensed as a
6793nurse registry. The requirements of part II of chapter 408 shall
6794apply to the provision of services that require licensure
6795pursuant to ss. 400.506-400.518 and part II of chapter 408 and
6796to entities licensed by or applying for such license from the
6797Agency for Health Care Administration pursuant to ss. 400.506-
6798400.518. Each operational site of the nurse registry must be
6799licensed, unless there is more than one site within a county. If
6800there is more than one site within a county, only one license
6801per county is required. Each operational site must be listed on
6802the license.
6803     (2)  Each applicant for licensure and each licensee must
6804comply with all provisions of part II and chapter 408, except
6805ss. 408.806(1)(e)2., 408.810(6), and 408.810(10). the following
6806requirements:
6807     (a)  Upon receipt of a completed, signed, and dated
6808application, the agency shall require background screening, in
6809accordance with the level 2 standards for screening set forth in
6810chapter 435, of the managing employee, or other similarly titled
6811individual who is responsible for the daily operation of the
6812nurse registry, and of the financial officer, or other similarly
6813titled individual who is responsible for the financial operation
6814of the registry, including billings for patient care and
6815services. The applicant shall comply with the procedures for
6816level 2 background screening as set forth in chapter 435.
6817     (b)  The agency may require background screening of any
6818other individual who is an applicant if the agency has probable
6819cause to believe that he or she has been convicted of a crime or
6820has committed any other offense prohibited under the level 2
6821standards for screening set forth in chapter 435.
6822     (c)  Proof of compliance with the level 2 background
6823screening requirements of chapter 435 which has been submitted
6824within the previous 5 years in compliance with any other health
6825care or assisted living licensure requirements of this state is
6826acceptable in fulfillment of the requirements of paragraph (a).
6827     (d)  A provisional license may be granted to an applicant
6828when each individual required by this section to undergo
6829background screening has met the standards for the Department of
6830Law Enforcement background check but the agency has not yet
6831received background screening results from the Federal Bureau of
6832Investigation. A standard license may be granted to the
6833applicant upon the agency's receipt of a report of the results
6834of the Federal Bureau of Investigation background screening for
6835each individual required by this section to undergo background
6836screening which confirms that all standards have been met, or
6837upon the granting of a disqualification exemption by the agency
6838as set forth in chapter 435. Any other person who is required to
6839undergo level 2 background screening may serve in his or her
6840capacity pending the agency's receipt of the report from the
6841Federal Bureau of Investigation. However, the person may not
6842continue to serve if the report indicates any violation of
6843background screening standards and a disqualification exemption
6844has not been requested of and granted by the agency as set forth
6845in chapter 435.
6846     (e)  Each applicant must submit to the agency, with its
6847application, a description and explanation of any exclusions,
6848permanent suspensions, or terminations of the applicant from the
6849Medicare or Medicaid programs. Proof of compliance with the
6850requirements for disclosure of ownership and control interests
6851under the Medicaid or Medicare programs may be accepted in lieu
6852of this submission.
6853     (f)  Each applicant must submit to the agency a description
6854and explanation of any conviction of an offense prohibited under
6855the level 2 standards of chapter 435 by a member of the board of
6856directors of the applicant, its officers, or any individual
6857owning 5 percent or more of the applicant. This requirement does
6858not apply to a director of a not-for-profit corporation or
6859organization if the director serves solely in a voluntary
6860capacity for the corporation or organization, does not regularly
6861take part in the day-to-day operational decisions of the
6862corporation or organization, receives no remuneration for his or
6863her services on the corporation or organization's board of
6864directors, and has no financial interest and has no family
6865members with a financial interest in the corporation or
6866organization, provided that the director and the not-for-profit
6867corporation or organization include in the application a
6868statement affirming that the director's relationship to the
6869corporation satisfies the requirements of this paragraph.
6870     (g)  A license may not be granted to an applicant if the
6871applicant or managing employee has been found guilty of,
6872regardless of adjudication, or has entered a plea of nolo
6873contendere or guilty to, any offense prohibited under the level
68742 standards for screening set forth in chapter 435, unless an
6875exemption from disqualification has been granted by the agency
6876as set forth in chapter 435.
6877     (h)  The agency may deny or revoke the license if any
6878applicant:
6879     1.  Has falsely represented a material fact in the
6880application required by paragraph (e) or paragraph (f), or has
6881omitted any material fact from the application required by
6882paragraph (e) or paragraph (f); or
6883     2.  Has had prior action taken against the applicant under
6884the Medicaid or Medicare program as set forth in paragraph (e).
6885     (i)  An application for license renewal must contain the
6886information required under paragraphs (e) and (f).
6887     (3)  In accordance with s. 408.805, an applicant or
6888licensee shall pay a fee for each license application submitted
6889under ss. 400.508-400.518, part II of chapter 408, and
6890applicable rules. The amount of the fee shall be established by
6891rule and may not exceed $2,000 per biennium. Application for
6892license must be made to the Agency for Health Care
6893Administration on forms furnished by it and must be accompanied
6894by the appropriate licensure fee, as established by rule and not
6895to exceed the cost of regulation under this part. The licensure
6896fee for nurse registries may not exceed $1,000 and must be
6897deposited in the Health Care Trust Fund.
6898     (4)  The Agency for Health Care Administration may deny,
6899revoke, or suspend a license or impose an administrative fine in
6900the manner provided in chapter 120 against a nurse registry
6901that:
6902     (a)  Fails to comply with this section or applicable rules.
6903     (b)  Commits an intentional, reckless, or negligent act
6904that materially affects the health or safety of a person
6905receiving services.
6906     (5)  A license issued for the operation of a nurse
6907registry, unless sooner suspended or revoked, expires 1 year
6908after its date of issuance. Sixty days before the expiration
6909date, an application for renewal must be submitted to the Agency
6910for Health Care Administration on forms furnished by it. The
6911Agency for Health Care Administration shall renew the license if
6912the applicant has met the requirements of this section and
6913applicable rules. A nurse registry against which a revocation or
6914suspension proceeding is pending at the time of license renewal
6915may be issued a conditional license effective until final
6916disposition by the Agency for Health Care Administration of such
6917proceedings. If judicial relief is sought from the final
6918disposition, the court having jurisdiction may issue a
6919conditional license for the duration of the judicial proceeding.
6920     (6)  The Agency for Health Care Administration may
6921institute injunctive proceedings under s. 400.515.
6922     (4)(7)  A person that offers or advertises to the public
6923that it provides any service for which licensure is required
6924under this section must include in such advertisement the
6925license number issued to it by the Agency for Health Care
6926Administration.
6927     (8)  It is unlawful for a person to offer or advertise to
6928the public services as defined by rule without obtaining a valid
6929license from the Agency for Health Care Administration. It is
6930unlawful for any holder of a license to advertise or hold out to
6931the public that he or she holds a license for other than that
6932for which he or she actually holds a license. A person who
6933violates this subsection is subject to injunctive proceedings
6934under s. 400.515.
6935     (9)  Any duly authorized officer or employee of the Agency
6936for Health Care Administration may make such inspections and
6937investigations as are necessary to respond to complaints or to
6938determine the state of compliance with this section and
6939applicable rules.
6940     (a)  If, in responding to a complaint, an agent or employee
6941of the Agency for Health Care Administration has reason to
6942believe that a crime has been committed, he or she shall notify
6943the appropriate law enforcement agency.
6944     (b)  If, in responding to a complaint, an agent or employee
6945of the Agency for Health Care Administration has reason to
6946believe that abuse, neglect, or exploitation has occurred,
6947according to the definitions in chapter 415, he or she shall
6948file a report under chapter 415.
6949     (5)(10)(a)  A nurse registry may refer for contract in
6950private residences registered nurses and licensed practical
6951nurses registered and licensed under part I of chapter 464,
6952certified nursing assistants certified under part II of chapter
6953464, home health aides who present documented proof of
6954successful completion of the training required by rule of the
6955agency, and companions or homemakers for the purposes of
6956providing those services authorized under s. 400.509(1). Each
6957person referred by a nurse registry must provide current
6958documentation that he or she is free from communicable diseases.
6959     (b)  A certified nursing assistant or home health aide may
6960be referred for a contract to provide care to a patient in his
6961or her home only if that patient is under a physician's care. A
6962certified nursing assistant or home health aide referred for
6963contract in a private residence shall be limited to assisting a
6964patient with bathing, dressing, toileting, grooming, eating,
6965physical transfer, and those normal daily routines the patient
6966could perform for himself or herself were he or she physically
6967capable. A certified nursing assistant or home health aide may
6968not provide medical or other health care services that require
6969specialized training and that may be performed only by licensed
6970health care professionals. The nurse registry shall obtain the
6971name and address of the attending physician and send written
6972notification to the physician within 48 hours after a contract
6973is concluded that a certified nursing assistant or home health
6974aide will be providing care for that patient.
6975     (c)  A nurse registry shall, at the time of contracting for
6976services through the nurse registry, advise the patient, the
6977patient's family, or a person acting on behalf of the patient of
6978the availability of registered nurses to make visits to the
6979patient's home at an additional cost. A registered nurse shall
6980make monthly visits to the patient's home to assess the
6981patient's condition and quality of care being provided by the
6982certified nursing assistant or home health aide. Any condition
6983that which in the professional judgment of the nurse requires
6984further medical attention shall be reported to the attending
6985physician and the nurse registry. The assessment shall become a
6986part of the patient's file with the nurse registry and may be
6987reviewed by the agency during their survey procedure.
6988     (6)(11)  A person who is referred by a nurse registry for
6989contract in private residences and who is not a nurse licensed
6990under part I of chapter 464 may perform only those services or
6991care to clients that the person has been certified to perform or
6992trained to perform as required by law or rules of the Agency for
6993Health Care Administration or the Department of Business and
6994Professional Regulation. Providing services beyond the scope
6995authorized under this subsection constitutes the unauthorized
6996practice of medicine or a violation of the Nurse Practice Act
6997and is punishable as provided under chapter 458, chapter 459, or
6998part I of chapter 464.
6999     (7)(12)  Each nurse registry must require every applicant
7000for contract to complete an application form providing the
7001following information:
7002     (a)  The name, address, date of birth, and social security
7003number of the applicant.
7004     (b)  The educational background and employment history of
7005the applicant.
7006     (c)  The number and date of the applicable license or
7007certification.
7008     (d)  When appropriate, information concerning the renewal
7009of the applicable license, registration, or certification.
7010     (8)(13)  Each nurse registry must comply with the
7011procedures set forth in s. 400.512 for maintaining records of
7012the employment history of all persons referred for contract and
7013is subject to the standards and conditions set forth in that
7014section. However, an initial screening may not be required for
7015persons who have been continuously registered with the nurse
7016registry since September 30, 1990.
7017     (9)(14)  The nurse registry must maintain the application
7018on file, and that file must be open to the inspection of the
7019Agency for Health Care Administration. The nurse registry must
7020maintain on file the name and address of the client to whom the
7021nurse or other nurse registry personnel is sent for contract and
7022the amount of the fee received by the nurse registry. A nurse
7023registry must maintain the file that includes the application
7024and other applicable documentation for 3 years after the date of
7025the last file entry of client-related information.
7026     (10)(15)  Nurse registries shall assist persons who would
7027need assistance and sheltering during evacuations because of
7028physical, mental, or sensory disabilities in registering with
7029the appropriate local emergency management agency pursuant to s.
7030252.355.
7031     (11)(16)  Each nurse registry shall prepare and maintain a
7032comprehensive emergency management plan that is consistent with
7033the criteria in this subsection and with the local special needs
7034plan. The plan shall be updated annually. The plan shall specify
7035how the nurse registry shall facilitate the provision of
7036continuous care by persons referred for contract to persons who
7037are registered pursuant to s. 252.355 during an emergency that
7038interrupts the provision of care or services in private
7039residencies.
7040     (a)  All persons referred for contract who care for persons
7041registered pursuant to s. 252.355 must include in the patient
7042record a description of how care will be continued during a
7043disaster or emergency that interrupts the provision of care in
7044the patient's home. It shall be the responsibility of the person
7045referred for contract to ensure that continuous care is
7046provided.
7047     (b)  Each nurse registry shall maintain a current
7048prioritized list of patients in private residences who are
7049registered pursuant to s. 252.355 and are under the care of
7050persons referred for contract and who need continued services
7051during an emergency. This list shall indicate, for each patient,
7052if the client is to be transported to a special needs shelter
7053and if the patient is receiving skilled nursing services. Nurse
7054registries shall make this list available to county health
7055departments and to local emergency management agencies upon
7056request.
7057     (c)  Each person referred for contract who is caring for a
7058patient who is registered pursuant to s. 252.355 shall provide a
7059list of the patient's medication and equipment needs to the
7060nurse registry. Each person referred for contract shall make
7061this information available to county health departments and to
7062local emergency management agencies upon request.
7063     (d)  Each person referred for contract shall not be
7064required to continue to provide care to patients in emergency
7065situations that are beyond the person's control and that make it
7066impossible to provide services, such as when roads are
7067impassable or when patients do not go to the location specified
7068in their patient records.
7069     (e)  The comprehensive emergency management plan required
7070by this subsection is subject to review and approval by the
7071county health department. During its review, the county health
7072department shall ensure that, at a minimum, the local emergency
7073management agency, the Agency for Health Care Administration,
7074and the local chapter of the American Red Cross or other lead
7075sheltering agency are given the opportunity to review the plan.
7076The county health department shall complete its review within 60
7077days after receipt of the plan and shall either approve the plan
7078or advise the nurse registry of necessary revisions.
7079     (f)  The Agency for Health Care Administration shall adopt
7080rules establishing minimum criteria for the comprehensive
7081emergency management plan and plan updates required by this
7082subsection, with the concurrence of the Department of Health and
7083in consultation with the Department of Community Affairs.
7084     (12)(17)  All persons referred for contract in private
7085residences by a nurse registry must comply with the following
7086requirements for a plan of treatment:
7087     (a)  When, in accordance with the privileges and
7088restrictions imposed upon a nurse under part I of chapter 464,
7089the delivery of care to a patient is under the direction or
7090supervision of a physician or when a physician is responsible
7091for the medical care of the patient, a medical plan of treatment
7092must be established for each patient receiving care or treatment
7093provided by a licensed nurse in the home. The original medical
7094plan of treatment must be timely signed by the physician,
7095physician assistant, or advanced registered nurse practitioner,
7096acting within his or her respective scope of practice, and
7097reviewed by him or her in consultation with the licensed nurse
7098at least every 2 months. Any additional order or change in
7099orders must be obtained from the physician, physician assistant,
7100or advanced registered nurse practitioner and reduced to writing
7101and timely signed by the physician, physician assistant, or
7102advanced registered nurse practitioner. The delivery of care
7103under a medical plan of treatment must be substantiated by the
7104appropriate nursing notes or documentation made by the nurse in
7105compliance with nursing practices established under part I of
7106chapter 464.
7107     (b)  Whenever a medical plan of treatment is established
7108for a patient, the initial medical plan of treatment, any
7109amendment to the plan, additional order or change in orders, and
7110copy of nursing notes must be filed in the office of the nurse
7111registry.
7112     (13)(18)  The nurse registry must comply with the notice
7113requirements of s. 400.495, relating to abuse reporting.
7114     (14)(19)  In addition to any other penalties imposed
7115pursuant to this section or part, the agency may assess costs
7116related to an investigation that results in a successful
7117prosecution., excluding costs associated with an attorney's
7118time. If the agency imposes such an assessment and the
7119assessment is not paid, and if challenged is not the subject of
7120a pending appeal, prior to the renewal of the license, the
7121license shall not be issued until the assessment is paid or
7122arrangements for payment of the assessment are made.
7123     (15)(20)  The Agency for Health Care Administration shall
7124adopt rules to implement this section and part II of chapter
7125408.
7126     Section 126.  Section 400.509, Florida Statutes, is amended
7127to read:
7128     400.509  Registration of particular service providers
7129exempt from licensure; certificate of registration; regulation
7130of registrants.--
7131     (1)  Any organization that provides companion services or
7132homemaker services and does not provide a home health service to
7133a person is exempt from licensure under this part. However, any
7134organization that provides companion services or homemaker
7135services must register with the agency.
7136     (2)  The requirements of part II of chapter 408 shall apply
7137to the provision of services that require registration or
7138licensure pursuant to this section and part II of chapter 408
7139and entities registered by or applying for such registration
7140from the Agency for Health Care Administration pursuant to this
7141section. Each applicant for registration and each registrant
7142must comply with all provisions of part II of chapter 408 except
7143ss. 408.806(1)(e) and 408.810(6)-(10). Registration consists of
7144annually filing with the agency, under oath, on forms provided
7145by it, the following information:
7146     (a)  If the registrant is a firm or partnership, the name,
7147address, date of birth, and social security number of every
7148member.
7149     (b)  If the registrant is a corporation or association, its
7150name and address; the name, address, date of birth, and social
7151security number of each of its directors and officers; and the
7152name and address of each person having at least a 5 percent
7153interest in the corporation or association.
7154     (c)  The name, address, date of birth, and social security
7155number of each person employed by or under contract with the
7156organization.
7157     (3)  In accordance with s. 408.805, applicants and
7158registrants shall pay fees for all registrations issued under
7159this part, part II of chapter 408, and applicable rules. The
7160amount of the fee shall be $50 per biennium. The agency shall
7161charge a registration fee of $25 to be submitted with the
7162information required under subsection (2).
7163     (4)  Each applicant for registration must comply with the
7164following requirements:
7165     (a)  Upon receipt of a completed, signed, and dated
7166application, the agency shall require background screening, in
7167accordance with the level 1 standards for screening set forth in
7168chapter 435, of every individual who will have contact with the
7169client. The agency shall require background screening of the
7170managing employee or other similarly titled individual who is
7171responsible for the operation of the entity, and of the
7172financial officer or other similarly titled individual who is
7173responsible for the financial operation of the entity, including
7174billings for client services in accordance with the level 2
7175standards for background screening as set forth in chapter 435.
7176     (b)  The agency may require background screening of any
7177other individual who is affiliated with the applicant if the
7178agency has a reasonable basis for believing that he or she has
7179been convicted of a crime or has committed any other offense
7180prohibited under the level 2 standards for screening set forth
7181in chapter 435.
7182     (c)  Proof of compliance with the level 2 background
7183screening requirements of chapter 435 which has been submitted
7184within the previous 5 years in compliance with any other health
7185care or assisted living licensure requirements of this state is
7186acceptable in fulfillment of paragraph (a).
7187     (d)  A provisional registration may be granted to an
7188applicant when each individual required by this section to
7189undergo background screening has met the standards for the
7190abuse-registry background check through the agency and the
7191Department of Law Enforcement background check, but the agency
7192has not yet received background screening results from the
7193Federal Bureau of Investigation. A standard registration may be
7194granted to the applicant upon the agency's receipt of a report
7195of the results of the Federal Bureau of Investigation background
7196screening for each individual required by this section to
7197undergo background screening which confirms that all standards
7198have been met, or upon the granting of a disqualification
7199exemption by the agency as set forth in chapter 435. Any other
7200person who is required to undergo level 2 background screening
7201may serve in his or her capacity pending the agency's receipt of
7202the report from the Federal Bureau of Investigation. However,
7203the person may not continue to serve if the report indicates any
7204violation of background screening standards and if a
7205disqualification exemption has not been requested of and granted
7206by the agency as set forth in chapter 435.
7207     (e)  Each applicant must submit to the agency, with its
7208application, a description and explanation of any exclusions,
7209permanent suspensions, or terminations of the applicant from the
7210Medicare or Medicaid programs. Proof of compliance with the
7211requirements for disclosure of ownership and control interests
7212under the Medicaid or Medicare programs may be accepted in lieu
7213of this submission.
7214     (f)  Each applicant must submit to the agency a description
7215and explanation of any conviction of an offense prohibited under
7216the level 2 standards of chapter 435 which was committed by a
7217member of the board of directors of the applicant, its officers,
7218or any individual owning 5 percent or more of the applicant.
7219This requirement does not apply to a director of a not-for-
7220profit corporation or organization who serves solely in a
7221voluntary capacity for the corporation or organization, does not
7222regularly take part in the day-to-day operational decisions of
7223the corporation or organization, receives no remuneration for
7224his or her services on the corporation's or organization's board
7225of directors, and has no financial interest and no family
7226members having a financial interest in the corporation or
7227organization, if the director and the not-for-profit corporation
7228or organization include in the application a statement affirming
7229that the director's relationship to the corporation satisfies
7230the requirements of this paragraph.
7231     (g)  A registration may not be granted to an applicant if
7232the applicant or managing employee has been found guilty of,
7233regardless of adjudication, or has entered a plea of nolo
7234contendere or guilty to, any offense prohibited under the level
72352 standards for screening set forth in chapter 435, unless an
7236exemption from disqualification has been granted by the agency
7237as set forth in chapter 435.
7238     (h)  The agency may deny or revoke the registration of any
7239applicant who:
7240     1.  Has falsely represented a material fact in the
7241application required by paragraph (e) or paragraph (f), or has
7242omitted any material fact from the application required by
7243paragraph (e) or paragraph (f); or
7244     2.  Has had prior action taken against the applicant under
7245the Medicaid or Medicare program as set forth in paragraph (e).
7246     (i)  An application for licensure renewal must contain the
7247information required under paragraphs (e) and (f).
7248     (4)(5)  Each registrant must obtain the employment or
7249contract history of persons who are employed by or under
7250contract with the organization and who will have contact at any
7251time with patients or clients in their homes by:
7252     (a)  Requiring such persons to submit an employment or
7253contractual history to the registrant; and
7254     (b)  Verifying the employment or contractual history,
7255unless through diligent efforts such verification is not
7256possible. The agency shall prescribe by rule the minimum
7257requirements for establishing that diligent efforts have been
7258made.
7259
7260There is no monetary liability on the part of, and no cause of
7261action for damages arises against, a former employer of a
7262prospective employee of or prospective independent contractor
7263with a registrant who reasonably and in good faith communicates
7264his or her honest opinions about the former employee's or
7265contractor's job performance. This subsection does not affect
7266the official immunity of an officer or employee of a public
7267corporation.
7268     (6)  On or before the first day on which services are
7269provided to a patient or client, any registrant under this part
7270must inform the patient or client and his or her immediate
7271family, if appropriate, of the right to report abusive,
7272neglectful, or exploitative practices. The statewide toll-free
7273telephone number for the central abuse hotline must be provided
7274to patients or clients in a manner that is clearly legible and
7275must include the words: "To report abuse, neglect, or
7276exploitation, please call toll-free   (phone number)  ."
7277Registrants must establish appropriate policies and procedures
7278for providing such notice to patients or clients.
7279     (7)  The provisions of s. 400.512 regarding screening apply
7280to any person or business entity registered under this section
7281on or after October 1, 1994.
7282     (8)  Upon verification that all requirements for
7283registration have been met, the Agency for Health Care
7284Administration shall issue a certificate of registration valid
7285for no more than 1 year.
7286     (9)  The Agency for Health Care Administration may deny,
7287suspend, or revoke the registration of a person that:
7288     (a)  Fails to comply with this section or applicable rules.
7289     (b)  Commits an intentional, reckless, or negligent act
7290that materially affects the health or safety of a person
7291receiving services.
7292     (10)  The Agency for Health Care Administration may
7293institute injunctive proceedings under s. 400.515.
7294     (5)(11)  A person that offers or advertises to the public a
7295service for which registration is required must include in its
7296advertisement the registration number issued by the Agency for
7297Health Care Administration.
7298     (12)  It is unlawful for a person to offer or advertise to
7299the public services, as defined by rule, without obtaining a
7300certificate of registration from the Agency for Health Care
7301Administration. It is unlawful for any holder of a certificate
7302of registration to advertise or hold out to the public that he
7303or she holds a certificate of registration for other than that
7304for which he or she actually holds a certificate of
7305registration. Any person who violates this subsection is subject
7306to injunctive proceedings under s. 400.515.
7307     (13)  Any duly authorized officer or employee of the Agency
7308for Health Care Administration has the right to make such
7309inspections and investigations as are necessary in order to
7310respond to complaints or to determine the state of compliance
7311with this section and applicable rules.
7312     (a)  If, in responding to a complaint, an officer or
7313employee of the Agency for Health Care Administration has reason
7314to believe that a crime has been committed, he or she shall
7315notify the appropriate law enforcement agency.
7316     (b)  If, in responding to a complaint, an officer or
7317employee of the Agency for Health Care Administration has reason
7318to believe that abuse, neglect, or exploitation has occurred,
7319according to the definitions in chapter 415, he or she shall
7320file a report under chapter 415.
7321     (6)(14)  In addition to any other penalties imposed
7322pursuant to this section or part, the agency may assess costs
7323related to an investigation that results in a successful
7324prosecution, excluding costs associated with an attorney's time.
7325If the agency imposes such an assessment and the assessment is
7326not paid, and if challenged is not the subject of a pending
7327appeal, prior to the renewal of the registration, the
7328registration shall not be issued until the assessment is paid or
7329arrangements for payment of the assessment are made.
7330     (7)(15)  The Agency for Health Care Administration shall
7331adopt rules to administer this section and part II of chapter
7332408.
7333     Section 127.  Subsections (3) through (7) of section
7334400.512, Florida Statutes, are renumbered as subsections (2)
7335through (6) and present subsections (2) and (7) are amended to
7336read:
7337     400.512  Screening of home health agency personnel; nurse
7338registry personnel; and companions and homemakers.--The agency
7339shall require employment or contractor screening as provided in
7340chapter 435, using the level 1 standards for screening set forth
7341in that chapter, for home health agency personnel; persons
7342referred for employment by nurse registries; and persons
7343employed by companion or homemaker services registered under s.
7344400.509.
7345     (2)  The administrator of each home health agency, the
7346managing employee of each nurse registry, and the managing
7347employee of each companion or homemaker service registered under
7348s. 400.509 must sign an affidavit annually, under penalty of
7349perjury, stating that all personnel hired, contracted with, or
7350registered on or after October 1, 1994, who enter the home of a
7351patient or client in their service capacity have been screened
7352and that its remaining personnel have worked for the home health
7353agency or registrant continuously since before October 1, 1994.
7354     (6)(7)(a)  It is a misdemeanor of the first degree,
7355punishable under s. 775.082 or s. 775.083, for any person
7356willfully, knowingly, or intentionally to:
7357     1.  Fail, by false statement, misrepresentation,
7358impersonation, or other fraudulent means, to disclose in any
7359application for voluntary or paid employment a material fact
7360used in making a determination as to such person's
7361qualifications to be an employee under this section; or
7362     2.  Operate or attempt to operate an entity licensed or
7363registered under this part with persons who do not meet the
7364minimum standards for good moral character as contained in this
7365section; or
7366     2.3.  Use information from the criminal records obtained
7367under this section for any purpose other than screening that
7368person for employment as specified in this section or release
7369such information to any other person for any purpose other than
7370screening for employment under this section.
7371     (b)  It is a felony of the third degree, punishable under
7372s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
7373knowingly, or intentionally to use information from the juvenile
7374records of a person obtained under this section for any purpose
7375other than screening for employment under this section.
7376     Section 128.  Section 400.515, Florida Statutes, is
7377repealed.
7378     Section 129.  Subsections (6) and (7) of section 400.551,
7379Florida Statutes, are amended to read:
7380     400.551  Definitions.--As used in this part, the term:
7381     (6)  "Operator" means the licensee or person having general
7382administrative charge of an adult day care center.
7383     (7)  "Owner" means the licensee owner of an adult day care
7384center.
7385     Section 130.  Section 400.554, Florida Statutes, is amended
7386to read:
7387     400.554  License requirement; fee; exemption; display.--
7388     (1)  The requirements of part II of chapter 408 shall apply
7389to the provision of services that require licensure pursuant
7390this part and part II of chapter 408 and to entities licensed by
7391or applying for such licensure from the Agency for Health Care
7392Administration pursuant this part. However, each applicant for
7393licensure and each licensee is exempt from the provisions of s.
7394408.810(10). It is unlawful to operate an adult day care center
7395without first obtaining from the agency a license authorizing
7396such operation. The agency is responsible for licensing adult
7397day care centers in accordance with this part.
7398     (2)  Separate licenses are required for centers operated on
7399separate premises, even though operated under the same
7400management. Separate licenses are not required for separate
7401buildings on the same premises.
7402     (3)  In accordance with s. 408.805, an applicant or
7403licensee shall pay a fee for each license application submitted
7404under this part and part II of chapter 408. The amount of the
7405fee shall be established by rule and The biennial license fee
7406required of a center shall be determined by the department, but
7407may not exceed $150.
7408     (4)  County-operated or municipally operated centers
7409applying for licensure under this part are exempt from the
7410payment of license fees.
7411     (5)  The license for a center shall be displayed in a
7412conspicuous place inside the center.
7413     (6)  A license is valid only in the possession of the
7414individual, firm, partnership, association, or corporation to
7415which it is issued and is not subject to sale, assignment, or
7416other transfer, voluntary or involuntary; nor is a license valid
7417for any premises other than the premises for which originally
7418issued.
7419     Section 131.  Section 400.555, Florida Statutes, is amended
7420to read:
7421     400.555  Application for license.--
7422     (1)  An application for a license to operate an adult day
7423care center must be made to the agency on forms furnished by the
7424agency and must be accompanied by the appropriate license fee
7425unless the applicant is exempt from payment of the fee as
7426provided in s. 400.554(4).
7427     (2)  In addition to all provisions of part II of chapter
7428408, the applicant for licensure must furnish:
7429     (a)  a description of the physical and mental capabilities
7430and needs of the participants to be served and the availability,
7431frequency, and intensity of basic services and of supportive and
7432optional services to be provided and proof of adequate liability
7433insurance coverage.;
7434     (b)  Satisfactory proof of financial ability to operate and
7435conduct the center in accordance with the requirements of this
7436part, which must include, in the case of an initial application,
7437a 1-year operating plan and proof of a 3-month operating reserve
7438fund; and
7439     (c)  Proof of adequate liability insurance coverage.
7440     (d)  Proof of compliance with level 2 background screening
7441as required under s. 400.5572.
7442     (e)  A description and explanation of any exclusions,
7443permanent suspensions, or terminations of the application from
7444the Medicare or Medicaid programs. Proof of compliance with
7445disclosure of ownership and control interest requirements of the
7446Medicare or Medicaid programs shall be accepted in lieu of this
7447submission.
7448     Section 132.  Section 400.556, Florida Statutes, is amended
7449to read:
7450     400.556  Denial, suspension, revocation of license;
7451emergency action; administrative fines; investigations and
7452inspections.--
7453     (1)  The agency may deny, revoke, or suspend a license
7454under this part, impose an action under s. 408.814, and or may
7455impose an administrative fine against the owner of an adult day
7456care center or its operator or employee in the manner provided
7457in chapter 120 for the violation of any provision of this part,
7458part II of chapter 408, or applicable rules.
7459     (2)  Each of the following actions by the owner of an adult
7460day care center or by its operator or employee is a ground for
7461action by the agency against the owner of the center or its
7462operator or employee:
7463     (a)  An intentional or negligent act materially affecting
7464the health or safety of center participants.
7465     (b)  A violation of this part or of any standard or rule
7466under this part.
7467     (b)(c)  A failure of persons subject to level 2 background
7468screening under s. 408.809 400.4174(1) to meet the screening
7469standards of s. 435.04, or the retention by the center of an
7470employee subject to level 1 background screening standards under
7471s. 400.4174(2) who does not meet the screening standards of s.
7472435.03 and for whom exemptions from disqualification have not
7473been provided by the agency.
7474     (c)(d)  Failure to follow the criteria and procedures
7475provided under part I of chapter 394 relating to the
7476transportation, voluntary admission, and involuntary examination
7477of center participants.
7478     (d)(e)  Multiple or repeated violations of this part or of
7479any standard or rule adopted under this part or part II of
7480chapter 408.
7481     (f)  Exclusion, permanent suspension, or termination of the
7482owner, if an individual, officer, or board member of the adult
7483day care center, if the owner is a firm, corporation,
7484partnership, or association, or any person owning 5 percent or
7485more of the center, from the Medicare or Medicaid program.
7486     (3)  The agency is responsible for all investigations and
7487inspections conducted pursuant to this part.
7488     Section 133.  Section 400.5565, Florida Statutes, is
7489amended to read:
7490     400.5565  Administrative fines; interest.--
7491     (1)(a)  If the agency determines that an adult day care
7492center is not operated in compliance with this part, part II of
7493chapter 408, or applicable with rules adopted under this part,
7494the agency, notwithstanding any other administrative action it
7495takes, shall make a reasonable attempt to discuss with the owner
7496each violation and recommended corrective action prior to
7497providing the owner with written notification. The agency may
7498request the submission of a corrective action plan for the
7499center which demonstrates a good faith effort to remedy each
7500violation by a specific date, subject to the approval of the
7501agency.
7502     (b)  The owner of a center or its operator or employee
7503found in violation of this part, part II of chapter 408, or
7504applicable rules or of rules adopted under this part may be
7505fined by the agency. A fine may not exceed $500 for each
7506violation. In no event, however, may such fines in the aggregate
7507exceed $5,000.
7508     (c)  The failure to correct a violation by the date set by
7509the agency, or the failure to comply with an approved corrective
7510action plan, is a separate violation for each day such failure
7511continues, unless the agency approves an extension to a specific
7512date.
7513     (d)  If the owner of a center or its operator or employee
7514appeals an agency action under this section and the fine is
7515upheld, the violator shall pay the fine, plus interest at the
7516legal rate specified in s. 687.01 for each day that the fine
7517remains unpaid after the date set by the agency for payment of
7518the fine.
7519     (2)  In determining whether to impose a fine and in fixing
7520the amount of any fine, the agency shall consider the following
7521factors:
7522     (a)  The gravity of the violation, including the
7523probability that death or serious physical or emotional harm to
7524a participant will result or has resulted, the severity of the
7525actual or potential harm, and the extent to which the provisions
7526of the applicable statutes or rules were violated.
7527     (b)  Actions taken by the owner or operator to correct
7528violations.
7529     (c)  Any previous violations.
7530     (d)  The financial benefit to the center of committing or
7531continuing the violation.
7532     Section 134.  Section 400.557, Florida Statutes, is amended
7533to read:
7534     400.557  Expiration of license; renewal; Conditional
7535license or permit.--
7536     (1)  A license issued for the operation of an adult day
7537care center, unless sooner suspended or revoked, expires 2 years
7538after the date of issuance. The agency shall notify a licensee
7539at least 120 days before the expiration date that license
7540renewal is required to continue operation. The notification must
7541be provided electronically or by mail delivery. At least 90 days
7542prior to the expiration date, an application for renewal must be
7543submitted to the agency. A license shall be renewed, upon the
7544filing of an application on forms furnished by the agency, if
7545the applicant has first met the requirements of this part and of
7546the rules adopted under this part. The applicant must file with
7547the application satisfactory proof of financial ability to
7548operate the center in accordance with the requirements of this
7549part and in accordance with the needs of the participants to be
7550served and an affidavit of compliance with the background
7551screening requirements of s. 400.5572.
7552     (2)  A licensee against whom a revocation or suspension
7553proceeding is pending at the time for license renewal may be
7554issued a conditional license effective until final disposition
7555by the agency of the proceeding. If judicial relief is sought
7556from the final disposition, the court having jurisdiction may
7557issue a conditional permit effective for the duration of the
7558judicial proceeding.
7559     (3)  The agency may issue a conditional license to an
7560applicant for license renewal or change of ownership if the
7561applicant fails to meet all standards and requirements for
7562licensure. A conditional license issued under this subsection
7563must be limited to a specific period not exceeding 6 months, as
7564determined by the agency, and must be accompanied by an approved
7565plan of correction.
7566     Section 135.  Section 400.5572, Florida Statutes, is
7567amended to read:
7568     400.5572  Background screening.--
7569     (1)(a)  Level 2 background screening must be conducted on
7570each of the following persons, who shall be considered employees
7571for the purposes of conducting screening under chapter 435:
7572     1.  The adult day care center owner if an individual, the
7573operator, and the financial officer.
7574     2.  An officer or board member if the owner of the adult
7575day care center is a firm, corporation, partnership, or
7576association, or any person owning 5 percent or more of the
7577facility, if the agency has probable cause to believe that such
7578person has been convicted of any offense prohibited by s.
7579435.04. For each officer, board member, or person owning 5
7580percent or more who has been convicted of any such offense, the
7581facility shall submit to the agency a description and
7582explanation of the conviction at the time of license
7583application. This subparagraph does not apply to a board member
7584of a not-for-profit corporation or organization if the board
7585member serves solely in a voluntary capacity, does not regularly
7586take part in the day-to-day operational decisions of the
7587corporation or organization, receives no remuneration for his or
7588her services, and has no financial interest and has no family
7589members with a financial interest in the corporation or
7590organization, provided that the board member and facility submit
7591a statement affirming that the board member's relationship to
7592the facility satisfies the requirements of this subparagraph.
7593     (b)  Proof of compliance with level 2 screening standards
7594which has been submitted within the previous 5 years to meet any
7595facility or professional licensure requirements of the agency or
7596the Department of Health satisfies the requirements of this
7597subsection.
7598     (c)  The agency may grant a provisional license to an adult
7599day care center applying for an initial license when each
7600individual required by this subsection to undergo screening has
7601completed the Department of Law Enforcement background check,
7602but has not yet received results from the Federal Bureau of
7603Investigation, or when a request for an exemption from
7604disqualification has been submitted to the agency pursuant to s.
7605435.07, but a response has not been issued.
7606     (2)  The owner or administrator of an adult day care center
7607must conduct level 1 background screening as set forth in
7608chapter 435 on all employees hired on or after October 1, 1998,
7609who provide basic services or supportive and optional services
7610to the participants. Such persons satisfy this requirement if:
7611     (1)(a)  Proof of compliance with level 1 screening
7612requirements obtained to meet any professional license
7613requirements in this state is provided and accompanied, under
7614penalty of perjury, by a copy of the person's current
7615professional license and an affidavit of current compliance with
7616the background screening requirements.
7617     (2)(b)  The person required to be screened has been
7618continuously employed, without a breach in service that exceeds
7619180 days, in the same type of occupation for which the person is
7620seeking employment and provides proof of compliance with the
7621level 1 screening requirement which is no more than 2 years old.
7622Proof of compliance must be provided directly from one employer
7623or contractor to another, and not from the person screened. Upon
7624request, a copy of screening results shall be provided to the
7625person screened by the employer retaining documentation of the
7626screening.
7627     (3)(c)  The person required to be screened is employed by a
7628corporation or business entity or related corporation or
7629business entity that owns, operates, or manages more than one
7630facility or agency licensed under this chapter, and for whom a
7631level 1 screening was conducted by the corporation or business
7632entity as a condition of initial or continued employment.
7633     Section 136.  Section 400.5575, Florida Statutes, is
7634repealed.
7635     Section 137.  Section 400.558, Florida Statutes, is
7636repealed.
7637     Section 138.  Section 400.559, Florida Statutes, is amended
7638to read:
7639     400.559  Discontinuance of operation of adult day care
7640centers Closing or change of owner or operator of center.--
7641     (1)  Before operation of an adult day care center may be
7642voluntarily discontinued, the operator must inform the agency in
7643writing at least 60 days prior to the discontinuance of
7644operation. The operator must also, at such time, inform each
7645participant of the fact and the proposed date of such
7646discontinuance of operation.
7647     (2)  Immediately upon discontinuance of the operation of a
7648center, the owner or operator shall surrender the license for
7649the center to the agency, and the license shall be canceled by
7650the agency.
7651     (3)  If a center has a change of ownership, the new owner
7652shall apply to the agency for a new license at least 60 days
7653before the date of the change of ownership.
7654     (4)  If a center has a change of operator, the new operator
7655shall notify the agency in writing within 30 days after the
7656change of operator.
7657     Section 139.  Section 400.56, Florida Statutes, is amended
7658to read:
7659     400.56  Right of entry and inspection.--In accordance with
7660s. 408.811, Any duly designated officer or employee of the
7661agency or department has the right to enter the premises of any
7662adult day care center licensed pursuant to this part, at any
7663reasonable time, in order to determine the state of compliance
7664with this part, part II of chapter 408, and applicable the rules
7665or standards in force pursuant to this part. The right of entry
7666and inspection also extends to any premises that the agency has
7667reason to believe are being operated as a center without a
7668license, but no entry or inspection of any unlicensed premises
7669may be made without the permission of the owner or operator
7670unless a warrant is first obtained from the circuit court
7671authorizing entry or inspection. Any application for a center
7672license or license renewal made pursuant to this part
7673constitutes permission for, and complete acquiescence in, any
7674entry or inspection of the premises for which the license is
7675sought in order to facilitate verification of the information
7676submitted on or in connection with the application.
7677     Section 140.  Section 400.562, Florida Statutes, is amended
7678to read:
7679     400.562  Rules establishing standards.--
7680     (1)  The agency Department of Elderly Affairs, in
7681conjunction with the Department of Elderly Affairs agency, shall
7682adopt rules to implement the provisions of this part and part II
7683of chapter 408. The rules must include reasonable and fair
7684standards. Any conflict between these standards and those that
7685may be set forth in local, county, or municipal ordinances shall
7686be resolved in favor of those having statewide effect. Such
7687standards must relate to:
7688     (a)  The maintenance of adult day care centers with respect
7689to plumbing, heating, lighting, ventilation, and other building
7690conditions, including adequate meeting space, to ensure the
7691health, safety, and comfort of participants and protection from
7692fire hazard. Such standards may not conflict with chapter 553
7693and must be based upon the size of the structure and the number
7694of participants.
7695     (b)  The number and qualifications of all personnel
7696employed by adult day care centers who have responsibilities for
7697the care of participants.
7698     (c)  All sanitary conditions within adult day care centers
7699and their surroundings, including water supply, sewage disposal,
7700food handling, and general hygiene, and maintenance of sanitary
7701conditions, to ensure the health and comfort of participants.
7702     (d)  Basic services provided by adult day care centers.
7703     (e)  Supportive and optional services provided by adult day
7704care centers.
7705     (f)  Data and information relative to participants and
7706programs of adult day care centers, including, but not limited
7707to, the physical and mental capabilities and needs of the
7708participants, the availability, frequency, and intensity of
7709basic services and of supportive and optional services provided,
7710the frequency of participation, the distances traveled by
7711participants, the hours of operation, the number of referrals to
7712other centers or elsewhere, and the incidence of illness.
7713     (g)  Components of a comprehensive emergency management
7714plan, developed in consultation with the Department of Health,
7715the Department of Elderly Affairs Agency for Health Care
7716Administration, and the Department of Community Affairs.
7717     (2)  Pursuant to s. 119.07, the agency may charge a fee for
7718furnishing a copy of this part, or of the rules adopted under
7719this part, to any person upon request for the copy.
7720     (2)(3)  Pursuant to this part, s. 408.811, and applicable
7721rules adopted by the department, the agency may conduct an
7722abbreviated biennial inspection of key quality-of-care
7723standards, in lieu of a full inspection, of a center that has a
7724record of good performance. However, the agency must conduct a
7725full inspection of a center that has had one or more confirmed
7726complaints within the licensure period immediately preceding the
7727inspection or which has a serious problem identified during the
7728abbreviated inspection. The agency shall by rule develop the key
7729quality-of-care standards, taking into consideration the
7730comments and recommendations of the Department of Elderly
7731Affairs and of provider groups. These standards shall be
7732included in rules adopted by the Department of Elderly Affairs.
7733     Section 141.  Section 400.564, Florida Statutes, is
7734repealed.
7735     Section 142.  Section 400.602, Florida Statutes, is amended
7736to read:
7737     400.602  Licensure required; prohibited acts; exemptions;
7738display, transferability of license.--
7739     (1)(a)  The requirements of part II of chapter 408 shall
7740apply to the provision of services that require licensure
7741pursuant to this part and part II of chapter 408 and to entities
7742licensed by or applying for such licensure from the agency
7743pursuant to this part. It is unlawful to operate or maintain a
7744hospice without first obtaining a license from the agency.
7745     (b)  It is unlawful for Any person or legal entity not
7746licensed as a hospice under this part may not to use the word
7747"hospice" in its name, or to offer or advertise hospice services
7748or hospice-like services in such a way as to mislead a person to
7749believe that the offeror is a hospice licensed under this part.
7750     (2)  Services provided by a hospital, nursing home, or
7751other health care facility, health care provider, or caregiver,
7752or under the Community Care for the Elderly Act, do not
7753constitute a hospice unless the facility, provider, or caregiver
7754establishes a separate and distinct administrative program to
7755provide home, residential, and homelike inpatient hospice
7756services.
7757     (3)(a)  A separately licensed hospice may not use a name
7758which is substantially the same as the name of another hospice
7759licensed under this part.
7760     (b)  A licensed hospice which intends to change its name or
7761address must notify the agency at least 60 days before making
7762the change.
7763     (4)  The license shall be displayed in a conspicuous place
7764inside the hospice program office; shall be valid only in the
7765possession of the person or public agency to which it is issued;
7766shall not be subject to sale, assignment, or other transfer,
7767voluntary or involuntary; and shall not be valid for any hospice
7768other than the hospice for which originally issued.
7769     (4)(5)  Notwithstanding s. 400.601(3), any hospice
7770operating in corporate form exclusively as a hospice,
7771incorporated on or before July 1, 1978, may be transferred to a
7772for-profit or not-for-profit entity, and may transfer the
7773license to that entity.
7774     (5)(6)  Notwithstanding s. 400.601(3), at any time after
7775July 1, 1995, any entity entitled to licensure under subsection
7776(5) may obtain a license for up to two additional hospices in
7777accordance with the other requirements of this part and upon
7778receipt of any certificate of need that may be required under
7779the provisions of part I of chapter 408 ss. 408.031-408.045.
7780     Section 143.  Section 400.605, Florida Statutes, is amended
7781to read:
7782     400.605  Administration; forms; fees; rules; inspections;
7783fines.--
7784     (1)  The agency department, in consultation with the
7785department agency, shall by rule establish minimum standards and
7786procedures for a hospice pursuant to this part and part II of
7787chapter 408. The rules must include:
7788     (a)  License application procedures and requirements.
7789     (a)(b)  The qualifications of professional and ancillary
7790personnel to ensure the provision of appropriate and adequate
7791hospice care.
7792     (b)(c)  Standards and procedures for the administrative
7793management of a hospice.
7794     (c)(d)  Standards for hospice services that ensure the
7795provision of quality patient care.
7796     (d)(e)  Components of a patient plan of care.
7797     (e)(f)  Procedures relating to the implementation of
7798advanced directives and do-not-resuscitate orders.
7799     (f)(g)  Procedures for maintaining and ensuring
7800confidentiality of patient records.
7801     (g)(h)  Standards for hospice care provided in freestanding
7802inpatient facilities that are not otherwise licensed medical
7803facilities and in residential care facilities such as nursing
7804homes, assisted living facilities, adult family care homes, and
7805hospice residential units and facilities.
7806     (h)(i)  Physical plant standards for hospice residential
7807and inpatient facilities and units.
7808     (i)(j)  Components of a comprehensive emergency management
7809plan, developed in consultation with the Department of Health,
7810the Department of Elderly Affairs, and the Department of
7811Community Affairs.
7812     (j)(k)  Standards and procedures relating to the
7813establishment and activities of a quality assurance and
7814utilization review committee.
7815     (k)(l)  Components and procedures relating to the
7816collection of patient demographic data and other information on
7817the provision of hospice care in this state.
7818     (2)  In accordance with s. 408.805, an applicant or
7819licensee shall pay a fee for each license application submitted
7820under this part, part II of chapter 408, and applicable rules.
7821The amount of the fee shall be established by rule and may not
7822exceed $1,200 per biennium. The agency shall:
7823     (a)  Prepare and furnish all forms necessary under the
7824provisions of this part in relation to applications for
7825licensure or licensure renewals.
7826     (b)  Collect from the applicant at the time of filing an
7827application for a license or at the time of renewal of a license
7828a fee which must be reasonably calculated to cover the cost of
7829regulation under this part, but may not exceed $600 per program.
7830All fees collected under this part shall be deposited in the
7831Health Care Trust Fund for the administration of this part.
7832     (c)  Issue hospice licenses to all applicants which meet
7833the provisions of this part and applicable rules.
7834     (3)(d)  In accordance with s. 408.811, the agency shall
7835conduct annual licensure inspections of all licensees, except
7836that licensure inspections may be conducted biennially for
7837hospices having a 3-year record of substantial compliance. The
7838agency shall
7839     (e)  conduct such inspections and investigations as are
7840necessary in order to determine the state of compliance with the
7841provisions of this part, part II of chapter 408, and applicable
7842adopted rules. The right of inspection also extends to any
7843program that the agency has reason to believe is offering or
7844advertising itself as a hospice without a license, but no
7845inspection may be made without the permission of the owner or
7846person in charge thereof unless a warrant is first obtained from
7847a circuit court authorizing such inspection. An application for
7848a license or license renewal made pursuant to this part
7849constitutes permission for an inspection of the hospice for
7850which the license is sought in order to facilitate verification
7851of the information submitted on or in connection with the
7852application.
7853     (4)(f)  In accordance with part II of chapter 408, the
7854agency may impose an administrative fine for any violation of
7855the provisions of this part, part II of chapter 408, or
7856applicable rules.
7857     Section 144.  Section 400.606, Florida Statutes, is amended
7858to read:
7859     400.606  License; application; renewal; conditional license
7860or permit; certificate of need.--
7861     (1)  A license application must be filed on a form provided
7862by the agency and must be accompanied by the appropriate license
7863fee as well as satisfactory proof that the hospice is in
7864compliance with this part and any rules adopted by the
7865department and proof of financial ability to operate and conduct
7866the hospice in accordance with the requirements of this part.
7867The initial application and change of ownership application must
7868be accompanied by a plan for the delivery of home, residential,
7869and homelike inpatient hospice services to terminally ill
7870persons and their families. Such plan must contain, but need not
7871be limited to:
7872     (a)  The estimated average number of terminally ill persons
7873to be served monthly.
7874     (b)  The geographic area in which hospice services will be
7875available.
7876     (c)  A listing of services which are or will be provided,
7877either directly by the applicant or through contractual
7878arrangements with existing providers.
7879     (d)  Provisions for the implementation of hospice home care
7880within 3 months after licensure.
7881     (e)  Provisions for the implementation of hospice homelike
7882inpatient care within 12 months after licensure.
7883     (f)  The number and disciplines of professional staff to be
7884employed.
7885     (g)  The name and qualifications of any existing or
7886potential contractee.
7887     (h)  A plan for attracting and training volunteers.
7888     (i)  The projected annual operating cost of the hospice.
7889     (j)  A statement of financial resources and personnel
7890available to the applicant to deliver hospice care.
7891
7892If the applicant is an existing licensed health care provider,
7893the application must be accompanied by a copy of the most recent
7894profit-loss statement and, if applicable, the most recent
7895licensure inspection report.
7896     (2)  Each applicant must submit to the agency with its
7897application a description and explanation of any exclusions,
7898permanent suspensions, or terminations from the Medicaid or
7899Medicare programs of the owner, if an individual; of any officer
7900or board member of the hospice, if the owner is a firm,
7901corporation, partnership, or association; or of any person
7902owning 5 percent or more of the hospice. Proof of compliance
7903with disclosure of ownership and control interest requirements
7904of the Medicaid or Medicare programs may be accepted in lieu of
7905this submission.
7906     (2)(3)  A license issued for the operation of a hospice,
7907unless sooner suspended or revoked, shall expire automatically 1
7908year from the date of issuance. Sixty days prior to the
7909expiration date, a hospice wishing to renew its license shall
7910submit an application for renewal to the agency on forms
7911furnished by the agency. The agency shall renew the license if
7912the applicant has first met the requirements established under
7913this part and all applicable rules and has provided the
7914information described under this section in addition to the
7915application. However, The application for license renewal shall
7916be accompanied by an update of the plan for delivery of hospice
7917care only if information contained in the plan submitted
7918pursuant to subsection (1) is no longer applicable.
7919     (4)  A hospice against which a revocation or suspension
7920proceeding is pending at the time of license renewal may be
7921issued a conditional license by the agency effective until final
7922disposition of such proceeding. If judicial relief is sought
7923from the final agency action, the court having jurisdiction may
7924issue a conditional permit for the duration of the judicial
7925proceeding.
7926     (3)(5)  The agency shall not issue a license to a hospice
7927that fails to receive a certificate of need under the provisions
7928of part I of chapter 408 ss. 408.031-408.045. A licensed hospice
7929is a health care facility as that term is used in s. 408.039(5)
7930and is entitled to initiate or intervene in an administrative
7931hearing.
7932     (4)(6)  A freestanding hospice facility that is primarily
7933engaged in providing inpatient and related services and that is
7934not otherwise licensed as a health care facility shall be
7935required to obtain a certificate of need. However, a
7936freestanding hospice facility with six or fewer beds shall not
7937be required to comply with institutional standards such as, but
7938not limited to, standards requiring sprinkler systems, emergency
7939electrical systems, or special lavatory devices.
7940     Section 145.  Section 400.6065, Florida Statutes, is
7941amended to read:
7942     400.6065  Background screening.--
7943     (1)  Upon receipt of a completed application under s.
7944400.606, the agency shall require level 2 background screening
7945on each of the following persons, who shall be considered
7946employees for the purposes of conducting screening under chapter
7947435:
7948     (a)  The hospice administrator and financial officer.
7949     (b)  An officer or board member if the hospice is a firm,
7950corporation, partnership, or association, or any person owning 5
7951percent or more of the hospice if the agency has probable cause
7952to believe that such officer, board member, or owner has been
7953convicted of any offense prohibited by s. 435.04. For each
7954officer, board member, or person owning 5 percent or more who
7955has been convicted of any such offense, the hospice shall submit
7956to the agency a description and explanation of the conviction at
7957the time of license application. This paragraph does not apply
7958to a board member of a not-for-profit corporation or
7959organization if the board member serves solely in a voluntary
7960capacity, does not regularly take part in the day-to-day
7961operational decisions of the corporation or organization,
7962receives no remuneration for his or her services, and has no
7963financial interest and has no family members with a financial
7964interest in the corporation or organization, provided that the
7965board member and the corporation or organization submit a
7966statement affirming that the board member's relationship to the
7967corporation or organization satisfies the requirements of this
7968paragraph.
7969     (2)  Proof of compliance with level 2 screening standards
7970which has been submitted within the previous 5 years to meet any
7971facility or professional licensure requirements of the agency or
7972the Department of Health satisfies the requirements of this
7973section.
7974     (3)  The agency may grant a provisional license to a
7975hospice applying for an initial license when each individual
7976required by this section to undergo screening has completed the
7977Department of Law Enforcement background check, but has not yet
7978received results from the Federal Bureau of Investigation.
7979     (1)(4)  The agency shall require employment or contractor
7980screening as provided in chapter 435, using the level 1
7981standards for screening set forth in that chapter, for hospice
7982personnel.
7983     (2)(5)  The agency may grant exemptions from
7984disqualification from employment under this section as provided
7985in s. 435.07.
7986     (6)  The administration of each hospice must sign an
7987affidavit annually, under penalty of perjury, stating that all
7988personnel employed or contracted with on or after October 1,
79891998, who provide hospice services in a facility, or who enter
7990the home of a patient in their service capacity, have been
7991screened.
7992     (3)(7)  Proof of compliance with the screening requirements
7993of chapter 435 shall be accepted in lieu of the requirements of
7994this section if the person has been continuously employed or
7995registered without a breach in service that exceeds 180 days,
7996the proof of compliance is not more than 2 years old, and the
7997person has been screened, at the discretion of the hospice.
7998     (4)(8)(a)  It is a misdemeanor of the first degree,
7999punishable under s. 775.082 or s. 775.083, for any person
8000willfully, knowingly, or intentionally to:
8001     1.  Fail, by false statement, misrepresentation,
8002impersonation, or other fraudulent means, to disclose in any
8003application for voluntary or paid employment a material fact
8004used in making a determination as to such person's
8005qualifications to be employed or contracted with under this
8006section;
8007     2.  Operate or attempt to operate an entity licensed under
8008this part with persons who do not meet the minimum standards for
8009good moral character as contained in this section; or
8010     2.3.  Use information from the criminal records obtained
8011under this section for any purpose other than screening as
8012specified in this section, or release such information to any
8013other person for any purpose other than screening under this
8014section.
8015     (b)  It is a felony of the third degree, punishable under
8016s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
8017knowingly, or intentionally to use information from the juvenile
8018records of a person obtained under this section for any purpose
8019other than screening for employment under this section.
8020     Section 146.  Section 400.607, Florida Statutes, is amended
8021to read:
8022     400.607  Denial, suspension, or revocation of license;
8023emergency actions; imposition of administrative fine; grounds;
8024injunctions.--
8025     (1)  The agency may deny, revoke, and or suspend a license,
8026impose an action under s. 408.814, and or impose an
8027administrative fine, which may not exceed $5,000 per violation,
8028for the violation of any provision of this part, part II of
8029chapter 408, or applicable rules in the manner provided in
8030chapter 120.
8031     (2)  Any of the following actions by a licensed hospice or
8032any of its employees shall be grounds for action by the agency
8033against a hospice:
8034     (a)  A violation of the provisions of this part or
8035applicable rules.
8036     (b)  An intentional or negligent act materially affecting
8037the health or safety of a patient.
8038     (3)  The agency may deny or revoke a license upon a
8039determination that:
8040     (a)  Persons subject to level 2 background screening under
8041s. 400.6065 do not meet the screening standards of s. 435.04,
8042and exemptions from disqualification have not been provided by
8043the agency.
8044     (b)  An officer, board member, or person owning 5 percent
8045or more of the hospice has been excluded, permanently suspended,
8046or terminated from the Medicare or Medicaid programs.
8047     (3)(4)  If, 3 months after the date of obtaining a license,
8048or at any time thereafter, a hospice does not have in operation
8049the home-care component of hospice care, the agency shall
8050immediately revoke the license of such hospice.
8051     (4)(5)  If, 12 months after the date of obtaining a license
8052pursuant to s. 400.606, or at any time thereafter, a hospice
8053does not have in operation the inpatient components of hospice
8054care, the agency shall immediately revoke the license of such
8055hospice.
8056     (6)  The agency may institute a civil action in a court of
8057competent jurisdiction to seek injunctive relief to enforce
8058compliance with this part or any rule adopted pursuant to this
8059part.
8060     (5)(7)  The remedies set forth in this section are
8061independent of and cumulative to other remedies provided by law.
8062     Section 147.  Subsection (8) of section 400.6095, Florida
8063Statutes, is amended to read:
8064     400.6095  Patient admission; assessment; plan of care;
8065discharge; death.--
8066     (8)  The hospice care team may withhold or withdraw
8067cardiopulmonary resuscitation if presented with an order not to
8068resuscitate executed pursuant to s. 401.45. The agency
8069department shall adopt rules providing for the implementation of
8070such orders. Hospice staff shall not be subject to criminal
8071prosecution or civil liability, nor be considered to have
8072engaged in negligent or unprofessional conduct, for withholding
8073or withdrawing cardiopulmonary resuscitation pursuant to such an
8074order and applicable rules adopted by the department. The
8075absence of an order to resuscitate executed pursuant to s.
8076401.45 does not preclude a physician from withholding or
8077withdrawing cardiopulmonary resuscitation as otherwise permitted
8078by law.
8079     Section 148.  Subsection (5) of section 400.617, Florida
8080Statutes, is amended to read:
8081     400.617  Legislative intent; purpose.--
8082     (5)  Rules of the agency department relating to adult
8083family-care homes shall be as minimal and flexible as possible
8084to ensure the protection of residents while minimizing the
8085obstacles that could inhibit the establishment of adult family-
8086care homes.
8087     Section 149.  Section 400.619, Florida Statutes, is amended
8088to read:
8089     400.619  Licensure application and renewal.--
8090     (1)  The requirements of part II of chapter 408 shall apply
8091to the provision of services that require licensure pursuant to
8092this part and part II of chapter 408 and to entities licensed by
8093or applying for such licensure from the Agency for Health Care
8094Administration pursuant to this part. However, each applicant
8095for licensure and each licensee is exempt from s. 408.810(7)-
8096(10). Each person who intends to be an adult family-care home
8097provider must apply for a license from the agency at least 90
8098days before the applicant intends to operate the adult family-
8099care home.
8100     (2)  A person who intends to be an adult family-care home
8101provider must own or rent the adult family-care home that is to
8102be licensed and reside therein.
8103     (3)  In accordance with s. 408.805, an applicant or
8104licensee shall pay a fee for each license application submitted
8105under this part, part II of chapter 408, and applicable rules.
8106The amount of the fee shall be $200 per biennium. The agency
8107shall notify a licensee at least 120 days before the expiration
8108date that license renewal is required to continue operation. The
8109notification must be provided electronically or by mail
8110delivery. Application for a license or annual license renewal
8111must be made on a form provided by the agency, signed under
8112oath, and must be accompanied by a licensing fee of $100 per
8113year.
8114     (4)  Upon receipt of a completed license application or
8115license renewal, and the fee, the agency shall initiate a level
81161 background screening as provided under chapter 435 on the
8117adult family-care home provider, the designated relief person,
8118all adult household members, and all staff members. The
8119applicant or licensee is responsible for paying the fees
8120associated with obtaining the required screening. The agency
8121shall conduct an onsite visit to the home that is to be
8122licensed.
8123     (a)  Proof of compliance with level 1 screening standards
8124which has been submitted within the previous 5 years to meet any
8125facility or professional licensure requirements of the agency or
8126the Department of Health satisfies the requirements of this
8127subsection. Such proof must be accompanied, under penalty of
8128perjury, by a copy of the person's current professional license
8129and an affidavit of current compliance with the background
8130screening requirements.
8131     (b)  The person required to be screened must have been
8132continuously employed in the same type of occupation for which
8133the person is seeking employment without a breach in service
8134that exceeds 180 days, and proof of compliance with the level 1
8135screening requirement which is no more than 2 years old must be
8136provided. Proof of compliance shall be provided directly from
8137one employer or contractor to another, and not from the person
8138screened. Upon request, a copy of screening results shall be
8139provided to the person screened by the employer retaining
8140documentation of the screening.
8141     (5)  The application must be accompanied by a description
8142and explanation of any exclusions, permanent suspensions, or
8143terminations of the applicant from participation in the Medicaid
8144or Medicare programs or any other governmental health care or
8145health insurance program.
8146     (6)  Unless the adult family-care home is a community
8147residential home subject to chapter 419, the applicant must
8148provide documentation, signed by the appropriate governmental
8149official, that the home has met local zoning requirements for
8150the location for which the license is sought.
8151     (5)(7)  Access to a licensed adult family-care home must be
8152provided at reasonable times for the appropriate officials of
8153the department, the Department of Health, the Department of
8154Children and Family Services, the agency, and the State Fire
8155Marshal, who are responsible for the development and maintenance
8156of fire, health, sanitary, and safety standards, to inspect the
8157facility to assure compliance with these standards. In addition,
8158access to a licensed adult family-care home must be provided at
8159reasonable times for the local long-term care ombudsman council.
8160     (8)  A license is effective for 1 year after the date of
8161issuance unless revoked sooner. Each license must state the name
8162of the provider, the address of the home to which the license
8163applies, and the maximum number of residents of the home.
8164Failure to timely file a license renewal application shall
8165result in a late fee equal to 50 percent of the license fee.
8166     (9)  A license is not transferable or applicable to any
8167location or person other than the location and person indicated
8168on the license.
8169     (6)(10)  The licensed maximum capacity of each adult
8170family-care home is based on the service needs of the residents
8171and the capability of the provider to meet the needs of the
8172residents. Any relative who lives in the adult family-care home
8173and who is a disabled adult or frail elder must be included in
8174that limitation.
8175     (7)(11)  Each adult family-care home must designate at
8176least one licensed space for a resident receiving optional state
8177supplementation. The Department of Children and Family Services
8178shall specify by rule the procedures to be followed for
8179referring residents who receive optional state supplementation
8180to adult family-care homes. Those homes licensed as adult foster
8181homes or assisted living facilities prior to January 1, 1994,
8182that convert to adult family-care homes, are exempt from this
8183requirement.
8184     (8)(12)  The agency may issue a conditional license to a
8185provider for the purpose of bringing the adult family-care home
8186into compliance with licensure requirements. A conditional
8187license must be limited to a specific period, not exceeding 6
8188months. The agency department shall, by rule, establish criteria
8189for issuing conditional licenses.
8190     (13)  All moneys collected under this section must be
8191deposited into the Department of Elderly Affairs Administrative
8192Trust Fund.
8193     (9)(14)  The agency department may adopt rules to establish
8194procedures, identify forms, specify documentation, and clarify
8195terms, as necessary, to administer this section and part II of
8196chapter 408.
8197     Section 150.  Section 400.6194, Florida Statutes, is
8198amended to read:
8199     400.6194  Denial, revocation, or suspension of a
8200license.--In addition to the requirements of part II of chapter
8201408 the agency may deny, suspend, and or revoke a license for
8202any of the following reasons:
8203     (1)  Failure of any of the persons required to undergo
8204background screening under s. 400.619 to meet the level 1
8205screening standards of s. 435.03, unless an exemption from
8206disqualification has been provided by the agency.
8207     (2)  An intentional or negligent act materially affecting
8208the health, safety, or welfare of the adult family-care home
8209residents.
8210     (3)  Submission of fraudulent information or omission of
8211any material fact on a license application or any other document
8212required by the agency.
8213     (4)  Failure to pay an administrative fine assessed under
8214this part.
8215     (5)  A violation of this part or adopted rules which
8216results in conditions or practices that directly threaten the
8217physical or emotional health, safety, or welfare of residents.
8218     (3)(6)  Failure to correct cited fire code violations that
8219threaten the health, safety, or welfare of residents.
8220     (7)  Failure to submit a completed initial license
8221application or to complete an application for license renewal
8222within the specified timeframes.
8223     (8)  Exclusion, permanent suspension, or termination of the
8224provider from the Medicare or Medicaid program.
8225     Section 151.  Section 400.6196, Florida Statutes, is
8226amended to read:
8227     400.6196  Classification of deficiencies; administrative
8228fines Violations; penalties.--
8229     (1)  In accordance with part II of chapter 408 and in
8230addition to any other liability or penalty provided by law, the
8231agency may impose an administrative fine a civil penalty on a
8232provider according to the following classification for the
8233violation of any provision of this part, part II of chapter 408,
8234or applicable rules:
8235     (a)  Class I violations are those conditions or practices
8236related to the operation and maintenance of an adult family-care
8237home or to the care of residents which the agency determines
8238present an imminent danger to the residents or guests of the
8239facility or a substantial probability that death or serious
8240physical or emotional harm would result therefrom. The condition
8241or practice that constitutes a class I violation must be abated
8242or eliminated within 24 hours, unless a fixed period, as
8243determined by the agency, is required for correction. A class I
8244deficiency is subject to an administrative fine in an amount not
8245less than $500 and not exceeding $1,000 for each violation. A
8246fine may be levied notwithstanding the correction of the
8247deficiency.
8248     (b)  Class II violations are those conditions or practices
8249related to the operation and maintenance of an adult family-care
8250home or to the care of residents which the agency determines
8251directly threaten the physical or emotional health, safety, or
8252security of the residents, other than class I violations. A
8253class II violation is subject to an administrative fine in an
8254amount not less than $250 and not exceeding $500 for each
8255violation. A citation for a class II violation must specify the
8256time within which the violation is required to be corrected. If
8257a class II violation is corrected within the time specified, no
8258civil penalty shall be imposed, unless it is a repeated offense.
8259     (c)  Class III violations are those conditions or practices
8260related to the operation and maintenance of an adult family-care
8261home or to the care of residents which the agency determines
8262indirectly or potentially threaten the physical or emotional
8263health, safety, or security of residents, other than class I or
8264class II violations. A class III violation is subject to an
8265administrative fine in an amount not less than $100 and not
8266exceeding $250 for each violation. A citation for a class III
8267violation shall specify the time within which the violation is
8268required to be corrected. If a class III violation is corrected
8269within the time specified, no civil penalty shall be imposed,
8270unless it is a repeated offense.
8271     (d)  Class IV violations are those conditions or
8272occurrences related to the operation and maintenance of an adult
8273family-care home, or related to the required reports, forms, or
8274documents, which do not have the potential of negatively
8275affecting the residents. A provider that does not correct a
8276class IV violation within the time limit specified by the agency
8277is subject to an administrative fine in an amount not less than
8278$50 and not exceeding $100 for each violation. Any class IV
8279violation that is corrected during the time the agency survey is
8280conducted will be identified as an agency finding and not as a
8281violation.
8282     (2)  The agency may impose an administrative fine for
8283violations which do not qualify as class I, class II, class III,
8284or class IV violations. The amount of the fine shall not exceed
8285$250 for each violation or $2,000 in the aggregate. Unclassified
8286violations include:
8287     (a)  Violating any term or condition of a license.
8288     (b)  Violating any provision of rule adopted under this
8289part, part II of chapter 408, or applicable rules.
8290     (c)  Failure to follow the criteria and procedures provided
8291under part I of chapter 394 relating to the transportation,
8292voluntary admission, and involuntary examination of adult
8293family-care home residents.
8294     (d)  Exceeding licensed capacity.
8295     (e)  Providing services beyond the scope of the license.
8296     (f)  Violating a moratorium.
8297     (3)  Each day during which a violation occurs constitutes a
8298separate offense.
8299     (3)(4)  In determining whether a penalty is to be imposed,
8300and in fixing the amount of any penalty to be imposed, the
8301agency must consider:
8302     (a)  The gravity of the violation.
8303     (b)  Actions taken by the provider to correct a violation.
8304     (c)  Any previous violation by the provider.
8305     (d)  The financial benefit to the provider of committing or
8306continuing the violation.
8307     (4)(5)  As an alternative to or in conjunction with an
8308administrative action against a provider, the agency may request
8309a plan of corrective action that demonstrates a good faith
8310effort to remedy each violation by a specific date, subject to
8311the approval of the agency.
8312     (5)(6)  The agency department shall set forth, by rule,
8313notice requirements and procedures for correction of
8314deficiencies.
8315     (7)  Civil penalties paid by a provider must be deposited
8316into the Department of Elderly Affairs Administrative Trust Fund
8317and used to offset the expenses of departmental training and
8318education for adult family-care home providers.
8319     (8)  The agency may impose an immediate moratorium on
8320admissions to any adult family-care home if the agency finds
8321that a condition in the home presents a threat to the health,
8322safety, or welfare of its residents. The department may by rule
8323establish facility conditions that constitute grounds for
8324imposing a moratorium and establish procedures for imposing and
8325lifting a moratorium.
8326     Section 152.  Section 400.621, Florida Statutes, is amended
8327to read:
8328     400.621  Rules and standards relating to adult family-care
8329homes.--
8330     (1)  The agency department, in consultation with the
8331Department of Health, the Department of Children and Family
8332Services, and the department agency shall, by rule, establish
8333minimum standards to ensure the health, safety, and well-being
8334of each resident in the adult family-care home pursuant to this
8335part and part II of chapter 408. The rules must address:
8336     (a)  Requirements for the physical site of the facility and
8337facility maintenance.
8338     (b)  Services that must be provided to all residents of an
8339adult family-care home and standards for such services, which
8340must include, but need not be limited to:
8341     1.  Room and board.
8342     2.  Assistance necessary to perform the activities of daily
8343living.
8344     3.  Assistance necessary to administer medication.
8345     4.  Supervision of residents.
8346     5.  Health monitoring.
8347     6.  Social and leisure activities.
8348     (c)  Standards and procedures for license application and
8349annual license renewal, advertising, proper management of each
8350resident's funds and personal property and personal affairs,
8351financial ability to operate, medication management,
8352inspections, complaint investigations, and facility, staff, and
8353resident records.
8354     (d)  Qualifications, training, standards, and
8355responsibilities for providers and staff.
8356     (e)  Compliance with chapter 419, relating to community
8357residential homes.
8358     (f)  Criteria and procedures for determining the
8359appropriateness of a resident's placement and continued
8360residency in an adult family-care home. A resident who requires
836124-hour nursing supervision may not be retained in an adult
8362family-care home unless such resident is an enrolled hospice
8363patient and the resident's continued residency is mutually
8364agreeable to the resident and the provider.
8365     (g)  Procedures for providing notice and assuring the least
8366possible disruption of residents' lives when residents are
8367relocated, an adult family-care home is closed, or the ownership
8368of an adult family-care home is transferred.
8369     (h)  Procedures to protect the residents' rights as
8370provided in s. 400.628.
8371     (i)  Procedures to promote the growth of adult family-care
8372homes as a component of a long-term care system.
8373     (j)  Procedures to promote the goal of aging in place for
8374residents of adult family-care homes.
8375     (2)  The agency department shall by rule provide minimum
8376standards and procedures for emergencies. Pursuant to s.
8377633.022, the State Fire Marshal, in consultation with the
8378department and the agency, shall adopt uniform firesafety
8379standards for adult family-care homes.
8380     (3)  The agency department shall adopt rules providing for
8381the implementation of orders not to resuscitate. The provider
8382may withhold or withdraw cardiopulmonary resuscitation if
8383presented with an order not to resuscitate executed pursuant to
8384s. 401.45. The provider shall not be subject to criminal
8385prosecution or civil liability, nor be considered to have
8386engaged in negligent or unprofessional conduct, for withholding
8387or withdrawing cardiopulmonary resuscitation pursuant to such an
8388order and applicable rules adopted by the department.
8389     (4)  The provider of any adult family-care home that is in
8390operation at the time any rules are adopted or amended under
8391this part may be given a reasonable time, not exceeding 6
8392months, within which to comply with the new or revised rules and
8393standards.
8394     Section 153.  Subsection (3) of section 400.6211, Florida
8395Statutes, is amended to read:
8396     400.6211  Training and education programs.--
8397     (3)  Effective January 1, 2004, providers must complete the
8398training and education program within a reasonable time
8399determined by the agency department. Failure to complete the
8400training and education program within the time set by the agency
8401department is a violation of this part and subjects the provider
8402to revocation of the license.
8403     Section 154.  Section 400.622, Florida Statutes, is
8404repealed.
8405     Section 155.  Subsection (2) of section 400.625, Florida
8406Statutes, is amended to read:
8407     400.625  Residency agreements.--
8408     (2)  Each residency agreement must specify the personal
8409care and accommodations to be provided by the adult family-care
8410home, the rates or charges, a requirement of at least 30 days'
8411notice before a rate increase, and any other provisions required
8412by rule of the agency department.
8413     Section 156.  Section 400.801, Florida Statutes, is amended
8414to read:
8415     400.801  Homes for special services.--
8416     (1)  As used in this section, the term:
8417     (a)  "Agency" means the "Agency for Health Care
8418Administration."
8419     (b)  "Home for special services" means a site where
8420specialized health care services are provided, including
8421personal and custodial care, but not continuous nursing
8422services.
8423     (2)  The requirements of part II of chapter 408 shall apply
8424to the provision of services that require licensure pursuant to
8425this section and part II of chapter 408 and entities licensed by
8426or applying for such licensure from the agency pursuant to this
8427section. However, each applicant for licensure and each licensee
8428is exempt from the provisions of s. 408.810(7)-(10). A person
8429must obtain a license from the agency to operate a home for
8430special services. A license is valid for 1 year.
8431     (3)  In accordance with s. 408.805, an applicant or
8432licensee shall pay a fee for each license application submitted
8433under this part, part II of chapter 408, and applicable rules.
8434The amount of the fee shall be established by rule and shall not
8435be more than $2,000 per biennium. The application for a license
8436under this section must be made on a form provided by the
8437agency. A nonrefundable license fee of not more than $1,000 must
8438be submitted with the license application.
8439     (4)  Each applicant for licensure must comply with the
8440following requirements:
8441     (a)  Upon receipt of a completed, signed, and dated
8442application, the agency shall require background screening, in
8443accordance with the level 2 standards for screening set forth in
8444chapter 435, of the managing employee, or other similarly titled
8445individual who is responsible for the daily operation of the
8446facility, and of the financial officer, or other similarly
8447titled individual who is responsible for the financial operation
8448of the facility, including billings for client care and
8449services, in accordance with the level 2 standards for screening
8450set forth in chapter 435. The applicant must comply with the
8451procedures for level 2 background screening as set forth in
8452chapter 435.
8453     (b)  The agency may require background screening of any
8454other individual who is an applicant if the agency has probable
8455cause to believe that he or she has been convicted of a crime or
8456has committed any other offense prohibited under the level 2
8457standards for screening set forth in chapter 435.
8458     (c)  Proof of compliance with the level 2 background
8459screening requirements of chapter 435 which has been submitted
8460within the previous 5 years in compliance with any other health
8461care or assisted living licensure requirements of this state is
8462acceptable in fulfillment of the requirements of paragraph (a).
8463     (d)  A provisional license may be granted to an applicant
8464when each individual required by this section to undergo
8465background screening has met the standards for the Department of
8466Law Enforcement background check, but the agency has not yet
8467received background screening results from the Federal Bureau of
8468Investigation, or a request for a disqualification exemption has
8469been submitted to the agency as set forth in chapter 435, but a
8470response has not yet been issued. A standard license may be
8471granted to the applicant upon the agency's receipt of a report
8472of the results of the Federal Bureau of Investigation background
8473screening for each individual required by this section to
8474undergo background screening which confirms that all standards
8475have been met, or upon the granting of a disqualification
8476exemption by the agency as set forth in chapter 435. Any other
8477person who is required to undergo level 2 background screening
8478may serve in his or her capacity pending the agency's receipt of
8479the report from the Federal Bureau of Investigation. However,
8480the person may not continue to serve if the report indicates any
8481violation of background screening standards and a
8482disqualification exemption has not been requested of and granted
8483by the agency as set forth in chapter 435.
8484     (e)  Each applicant must submit to the agency, with its
8485application, a description and explanation of any exclusions,
8486permanent suspensions, or terminations of the applicant from the
8487Medicare or Medicaid programs. Proof of compliance with the
8488requirements for disclosure of ownership and control interests
8489under the Medicaid or Medicare programs may be accepted in lieu
8490of this submission.
8491     (f)  Each applicant must submit to the agency a description
8492and explanation of any conviction of an offense prohibited under
8493the level 2 standards of chapter 435 by a member of the board of
8494directors of the applicant, its officers, or any individual
8495owning 5 percent or more of the applicant. This requirement does
8496not apply to a director of a not-for-profit corporation or
8497organization if the director serves solely in a voluntary
8498capacity for the corporation or organization, does not regularly
8499take part in the day-to-day operational decisions of the
8500corporation or organization, receives no remuneration for his or
8501her services on the corporation or organization's board of
8502directors, and has no financial interest and has no family
8503members with a financial interest in the corporation or
8504organization, provided that the director and the not-for-profit
8505corporation or organization include in the application a
8506statement affirming that the director's relationship to the
8507corporation satisfies the requirements of this paragraph.
8508     (g)  A license may not be granted to an applicant if the
8509applicant or managing employee has been found guilty of,
8510regardless of adjudication, or has entered a plea of nolo
8511contendere or guilty to, any offense prohibited under the level
85122 standards for screening set forth in chapter 435, unless an
8513exemption from disqualification has been granted by the agency
8514as set forth in chapter 435.
8515     (h)  The agency may deny or revoke licensure if the
8516applicant:
8517     1.  Has falsely represented a material fact in the
8518application required by paragraph (e) or paragraph (f), or has
8519omitted any material fact from the application required by
8520paragraph (e) or paragraph (f); or
8521     2.  Has had prior action taken against the applicant under
8522the Medicaid or Medicare program as set forth in paragraph (e).
8523     (i)  An application for license renewal must contain the
8524information required under paragraphs (e) and (f).
8525     (5)  Application for license renewal must be submitted 90
8526days before the expiration of the license.
8527     (6)  A change of ownership or control of a home for special
8528services must be reported to the agency in writing at least 60
8529days before the change is scheduled to take effect.
8530     (4)(7)  The agency may shall adopt rules for implementing
8531and enforcing this section and part II of chapter 408.
8532     (8)(a)  It is unlawful for any person to establish,
8533conduct, manage, or operate a home for special services without
8534obtaining a license from the agency.
8535     (b)  It is unlawful for any person to offer or advertise to
8536the public, in any medium whatever, specialized health care
8537services without obtaining a license from the agency.
8538     (c)  It is unlawful for a holder of a license issued under
8539this section to advertise or represent to the public that it
8540holds a license for a type of facility other than the facility
8541for which its license is issued.
8542     (5)(9)(a)  In accordance with part II of chapter 408, a
8543violation of any provision of this section, part II of chapter
8544408, or applicable rules adopted by the agency for implementing
8545this section is punishable by payment of an administrative fine
8546not to exceed $5,000.
8547     (b)  A violation of subsection (8) or rules adopted under
8548that subsection is a misdemeanor of the first degree, punishable
8549as provided in s. 775.082 or s. 775.083. Each day of continuing
8550violation is a separate offense.
8551     Section 157.  Section 400.805, Florida Statutes, is amended
8552to read:
8553     400.805  Transitional living facilities.--
8554     (1)  As used in this section, the term:
8555     (a)  "Agency" means the Agency for Health Care
8556Administration.
8557     (b)  "Department" means the Department of Health.
8558     (c)  "Transitional living facility" means a site where
8559specialized health care services are provided, including, but
8560not limited to, rehabilitative services, community reentry
8561training, aids for independent living, and counseling to spinal-
8562cord-injured persons and head-injured persons. This term does
8563not include a hospital licensed under chapter 395 or any
8564federally operated hospital or facility.
8565     (2)(a)  The requirements of part II of chapter 408 shall
8566apply to the provision of services that require licensure
8567pursuant to this section and part II of chapter 408 and to
8568entities licensed by or applying for such licensure from the
8569agency pursuant to this section. However, each applicant for
8570licensure and each licensee is exempt from the provisions of s.
8571408.810(7)-(10). A person must obtain a license from the agency
8572to operate a transitional living facility. A license issued
8573under this section is valid for 1 year.
8574     (b)  In accordance with this section, an applicant or a
8575licensee shall pay a fee for each license application submitted
8576under this part, part II of chapter 408, and applicable rules.
8577The fee shall consist of a $4,000 license fee and a $78.50 per
8578bed fee per biennium, unless modified by rule. The application
8579for a license must be made on a form provided by the agency. A
8580nonrefundable license fee of $2,000 and a fee of up to $39.25
8581per bed must be submitted with the license application.
8582     (c)  The agency may not issue a license to an applicant
8583until the agency receives notice from the department as provided
8584in paragraph (3)(6)(b).
8585     (3)  Each applicant for licensure must comply with the
8586following requirements:
8587     (a)  Upon receipt of a completed, signed, and dated
8588application, the agency shall require background screening, in
8589accordance with the level 2 standards for screening set forth in
8590chapter 435, of the managing employee, or other similarly titled
8591individual who is responsible for the daily operation of the
8592facility, and of the financial officer, or other similarly
8593titled individual who is responsible for the financial operation
8594of the facility, including billings for client care and
8595services. The applicant must comply with the procedures for
8596level 2 background screening as set forth in chapter 435.
8597     (b)  The agency may require background screening of any
8598other individual who is an applicant if the agency has probable
8599cause to believe that he or she has been convicted of a crime or
8600has committed any other offense prohibited under the level 2
8601standards for screening set forth in chapter 435.
8602     (c)  Proof of compliance with the level 2 background
8603screening requirements of chapter 435 which has been submitted
8604within the previous 5 years in compliance with any other health
8605care or assisted living licensure requirements of this state is
8606acceptable in fulfillment of the requirements of paragraph (a).
8607     (d)  A provisional license may be granted to an applicant
8608when each individual required by this section to undergo
8609background screening has met the standards for the Department of
8610Law Enforcement background check, but the agency has not yet
8611received background screening results from the Federal Bureau of
8612Investigation, or a request for a disqualification exemption has
8613been submitted to the agency as set forth in chapter 435, but a
8614response has not yet been issued. A standard license may be
8615granted to the applicant upon the agency's receipt of a report
8616of the results of the Federal Bureau of Investigation background
8617screening for each individual required by this section to
8618undergo background screening which confirms that all standards
8619have been met, or upon the granting of a disqualification
8620exemption by the agency as set forth in chapter 435. Any other
8621person who is required to undergo level 2 background screening
8622may serve in his or her capacity pending the agency's receipt of
8623the report from the Federal Bureau of Investigation. However,
8624the person may not continue to serve if the report indicates any
8625violation of background screening standards and a
8626disqualification exemption has not been requested of and granted
8627by the agency as set forth in chapter 435.
8628     (e)  Each applicant must submit to the agency, with its
8629application, a description and explanation of any exclusions,
8630permanent suspensions, or terminations of the applicant from the
8631Medicare or Medicaid programs. Proof of compliance with the
8632requirements for disclosure of ownership and control interests
8633under the Medicaid or Medicare programs may be accepted in lieu
8634of this submission.
8635     (f)  Each applicant must submit to the agency a description
8636and explanation of any conviction of an offense prohibited under
8637the level 2 standards of chapter 435 by a member of the board of
8638directors of the applicant, its officers, or any individual
8639owning 5 percent or more of the applicant. This requirement does
8640not apply to a director of a not-for-profit corporation or
8641organization if the director serves solely in a voluntary
8642capacity for the corporation or organization, does not regularly
8643take part in the day-to-day operational decisions of the
8644corporation or organization, receives no remuneration for his or
8645her services on the corporation or organization's board of
8646directors, and has no financial interest and has no family
8647members with a financial interest in the corporation or
8648organization, provided that the director and the not-for-profit
8649corporation or organization include in the application a
8650statement affirming that the director's relationship to the
8651corporation satisfies the requirements of this paragraph.
8652     (g)  A license may not be granted to an applicant if the
8653applicant or managing employee has been found guilty of,
8654regardless of adjudication, or has entered a plea of nolo
8655contendere or guilty to, any offense prohibited under the level
86562 standards for screening set forth in chapter 435, unless an
8657exemption from disqualification has been granted by the agency
8658as set forth in chapter 435.
8659     (h)  The agency may deny or revoke licensure if the
8660applicant:
8661     1.  Has falsely represented a material fact in the
8662application required by paragraph (e) or paragraph (f), or has
8663omitted any material fact from the application required by
8664paragraph (e) or paragraph (f); or
8665     2.  Has had prior action taken against the applicant under
8666the Medicaid or Medicare program as set forth in paragraph (e).
8667     (i)  An application for license renewal must contain the
8668information required under paragraphs (e) and (f).
8669     (4)  An application for renewal of license must be
8670submitted 90 days before the expiration of the license. Upon
8671renewal of licensure, each applicant must submit to the agency,
8672under penalty of perjury, an affidavit as set forth in paragraph
8673(3)(d).
8674     (5)  A change of ownership or control of a transitional
8675living facility must be reported to the agency in writing at
8676least 60 days before the change is scheduled to take effect.
8677     (3)(6)(a)  The agency shall adopt rules in consultation
8678with the department governing the physical plant of transitional
8679living facilities and the fiscal management of transitional
8680living facilities.
8681     (b)  The department shall adopt rules in consultation with
8682the agency governing the services provided to clients of
8683transitional living facilities. The department shall enforce all
8684requirements for providing services to the facility's clients.
8685The department must notify the agency when it determines that an
8686applicant for licensure meets the service requirements adopted
8687by the department.
8688     (c)  The agency and the department shall enforce
8689requirements under this section, as such requirements relate to
8690them respectively, and their respective adopted rules.
8691     (7)(a)  It is unlawful for any person to establish,
8692conduct, manage, or operate a transitional living facility
8693without obtaining a license from the agency.
8694     (b)  It is unlawful for any person to offer or advertise to
8695the public, in any medium whatever, services or care defined in
8696paragraph (1)(c) without obtaining a license from the agency.
8697     (c)  It is unlawful for a holder of a license issued under
8698this section to advertise or represent to the public that it
8699holds a license for a type of facility other than the facility
8700for which its license is issued.
8701     (4)(8)  Any designated officer or employee of the agency,
8702of the state, or of the local fire marshal may enter unannounced
8703upon and into the premises of any facility licensed under this
8704section in order to determine the state of compliance with this
8705section and the rules or standards in force under this section.
8706The right of entry and inspection also extends to any premises
8707that the agency has reason to believe are being operated or
8708maintained as a facility without a license; but such an entry or
8709inspection may not be made without the permission of the owner
8710or person in charge of the facility unless a warrant that
8711authorizes the entry is first obtained from the circuit court.
8712The warrant requirement extends only to a facility that the
8713agency has reason to believe is being operated or maintained as
8714a facility without a license. An application for a license or
8715renewal thereof which is made under this section constitutes
8716permission for, and acquiescence in, any entry or inspection of
8717the premises for which the license is sought, in order to
8718facilitate verification of the information submitted on or in
8719connection with the application; to discover, investigate, and
8720determine the existence of abuse or neglect; or to elicit,
8721receive, respond to, and resolve complaints. A current valid
8722license constitutes unconditional permission for, and
8723acquiescence in, any entry or inspection of the premises by
8724authorized personnel. The agency retains the right of entry and
8725inspection of facilities that have had a license revoked or
8726suspended within the previous 24 months, to ensure that the
8727facility is not operating unlawfully. However, before the
8728facility is entered, a statement of probable cause must be filed
8729with the director of the agency, who must approve or disapprove
8730the action within 48 hours. Probable cause includes, but is not
8731limited to, evidence that the facility holds itself out to the
8732public as a provider of personal assistance services, or the
8733receipt by the advisory council on brain and spinal cord
8734injuries of a complaint about the facility.
8735     (5)(9)  The agency may institute injunctive proceedings in
8736a court of competent jurisdiction for temporary or permanent
8737relief to:
8738     (a)  Enforce this section or any minimum standard, rule, or
8739order issued pursuant thereto if the agency's effort to correct
8740a violation through administrative fines has failed or when the
8741violation materially affects the health, safety, or welfare of
8742residents; or
8743     (b)  Terminate the operation of a facility if a violation
8744of this section or of any standard or rule adopted pursuant
8745thereto exists which materially affects the health, safety, or
8746welfare of residents.
8747
8748The Legislature recognizes that, in some instances, action is
8749necessary to protect residents of facilities from immediately
8750life-threatening situations. If it appears by competent evidence
8751or a sworn, substantiated affidavit that a temporary injunction
8752should issue, the court, pending the determination on final
8753hearing, shall enjoin operation of the facility.
8754     (10)  The agency may impose an immediate moratorium on
8755admissions to a facility when the agency determines that any
8756condition in the facility presents a threat to the health,
8757safety, or welfare of the residents in the facility. If a
8758facility's license is denied, revoked, or suspended, the
8759facility may be subject to the immediate imposition of a
8760moratorium on admissions to run concurrently with licensure
8761denial, revocation, or suspension.
8762     (6)(11)(a)  In accordance with part II of chapter 408, a
8763violation of any provision of this section, part II of chapter
8764408, or applicable rules adopted by the agency or department
8765under this section is punishable by payment of an administrative
8766or a civil penalty fine not to exceed $5,000.
8767     (b)  A violation of subsection (7) or rules adopted under
8768that subsection is a misdemeanor of the first degree, punishable
8769as provided in s. 775.082 or s. 775.083. Each day of a
8770continuing violation is a separate offense.
8771     Section 158.  Subsection (4) of section 400.902, Florida
8772Statutes, is amended to read:
8773     400.902  Definitions.--As used in this part, the term:
8774     (4)  "Owner or operator" means a licensee any individual
8775who has general administrative charge of a PPEC center.
8776     Section 159.  Subsection (3) is added to section 400.903,
8777Florida Statutes, to read:
8778     400.903  PPEC centers to be licensed; exemptions.--
8779     (3)  The requirements of part II of chapter 408 shall apply
8780to the provision of services that require licensure pursuant to
8781this part and part II of chapter 408 and to entities licensed by
8782or applying for such licensure from the agency pursuant to this
8783part. However, each applicant for licensure and each licensee is
8784exempt from the provisions of s. 408.810(10).
8785     Section 160.  Section 400.905, Florida Statutes, is amended
8786to read:
8787     400.905  License required; fee; exemption; display.--
8788     (1)(a)  It is unlawful to operate or maintain a PPEC center
8789without first obtaining from the agency a license authorizing
8790such operation. The agency is responsible for licensing PPEC
8791centers in accordance with the provisions of this part.
8792     (b)  Any person who violates paragraph (a) is guilty of a
8793felony of the third degree, punishable as provided in s.
8794775.082, s. 775.083, or s. 775.084.
8795     (1)(2)  Separate licenses are required for PPEC centers
8796maintained on separate premises, even though they are operated
8797under the same management. Separate licenses are not required
8798for separate buildings on the same grounds.
8799     (2)(3)  In accordance with s. 408.805, an applicant or
8800licensee shall pay a fee for each license application submitted
8801under this part, part II of chapter 408, and applicable rules.
8802The amount of the fee shall be established by rule and shall not
8803be less than $1,000 or more than $3,000 per biennium. The annual
8804license fee required of a PPEC center shall be in an amount
8805determined by the agency to be sufficient to cover the agency's
8806costs in carrying out its responsibilities under this part, but
8807shall not be less than $500 or more than $1,500.
8808     (3)(4)  County-operated or municipally operated PPEC
8809centers applying for licensure under this part are exempt from
8810the payment of license fees.
8811     (5)  The license shall be displayed in a conspicuous place
8812inside the PPEC center.
8813     (6)  A license shall be valid only in the possession of the
8814individual, firm, partnership, association, or corporation to
8815whom it is issued and shall not be subject to sale, assignment,
8816or other transfer, voluntary or involuntary; nor shall a license
8817be valid for any premises other than that for which originally
8818issued.
8819     (7)  Any license granted by the agency shall state the
8820maximum capacity of the facility, the date the license was
8821issued, the expiration date of the license, and any other
8822information deemed necessary by the agency.
8823     Section 161.  Section 400.906, Florida Statutes, is
8824repealed.
8825     Section 162.  Section 400.907, Florida Statutes, is amended
8826to read:
8827     400.907  Denial, suspension, revocation of licensure;
8828administrative fines; grounds.--
8829     (1)  In accordance with part II of chapter 408, the agency
8830may deny, revoke, and or suspend a license and or impose an
8831administrative fine for the violation of any provision of this
8832part, part II of chapter 408, or applicable rules in the manner
8833provided in chapter 120.
8834     (2)  Any of the following actions by a PPEC center or its
8835employee is grounds for action by the agency against a PPEC
8836center or its employee:
8837     (a)  An intentional or negligent act materially affecting
8838the health or safety of children in the PPEC center.
8839     (b)  A violation of the provisions of this part, part II of
8840chapter 408, or applicable rules or of any standards or rules
8841adopted pursuant to this part.
8842     (c)  Multiple and repeated violations of this part or of
8843minimum standards or rules adopted pursuant to this part.
8844     (3)  The agency shall be responsible for all investigations
8845and inspections conducted pursuant to this part.
8846     Section 163.  Section 400.908, Florida Statutes, is amended
8847to read:
8848     400.908  Administrative fines; disposition of fees and
8849fines.--
8850     (1)(a)  If the agency determines that a PPEC center is
8851being operated without a license or is otherwise not in
8852compliance with rules adopted under this part, part II of
8853chapter 408, or applicable rules, the agency, notwithstanding
8854any other administrative action it takes, shall make a
8855reasonable attempt to discuss each violation and recommended
8856corrective action with the owner of the PPEC center prior to
8857written notification thereof. The agency may request that the
8858PPEC center submit a corrective action plan which demonstrates a
8859good faith effort to remedy each violation by a specific date,
8860subject to the approval of the agency.
8861     (b)  In accordance with part II of chapter 408, the agency
8862may fine a PPEC center or employee found in violation of rules
8863adopted pursuant to this part, part II of chapter 408, or
8864applicable rules, in an amount not to exceed $500 for each
8865violation. Such fine may not exceed $5,000 in the aggregate.
8866     (c)  The failure to correct a violation by the date set by
8867the agency, or the failure to comply with an approved corrective
8868action plan, is a separate violation for each day such failure
8869continues, unless the agency approves an extension to a specific
8870date.
8871     (d)  If a PPEC center desires to appeal any agency action
8872under this section and the fine is upheld, the violator shall
8873pay the fine, plus interest at the legal rate specified in s.
8874687.01, for each day beyond the date set by the agency for
8875payment of the fine.
8876     (2)  In determining if a fine is to be imposed and in
8877fixing the amount of any fine, the agency shall consider the
8878following factors:
8879     (a)  The gravity of the violation, including the
8880probability that death or serious physical or emotional harm to
8881a child will result or has resulted, the severity of the actual
8882or potential harm, and the extent to which the provisions of the
8883applicable statutes or rules were violated.
8884     (b)  Actions taken by the owner or operator to correct
8885violations.
8886     (c)  Any previous violations.
8887     (d)  The financial benefit to the PPEC center of committing
8888or continuing the violation.
8889     (3)  Fees and fines received by the agency under this part
8890shall be deposited in the Health Care Trust Fund created in s.
8891408.16.
8892     Section 164.  Section 400.910, Florida Statutes, is
8893repealed.
8894     Section 165.  Section 400.911, Florida Statutes, is
8895repealed.
8896     Section 166.  Section 400.912, Florida Statutes, is amended
8897to read:
8898     400.912  Closing of a PPEC center.--
8899     (1)  Whenever a PPEC center voluntarily discontinues
8900operation, it shall, inform the agency in writing at least 30
8901days before the discontinuance of operation. The PPEC center
8902shall also, at such time, inform each child's legal guardian of
8903the fact and the proposed time of such discontinuance.
8904     (2)  Immediately upon discontinuance of the operation of a
8905PPEC center, the owner or operator shall surrender the license
8906therefor to the agency and the license shall be canceled.
8907     Section 167.  Section 400.913, Florida Statutes, is
8908repealed.
8909     Section 168.  Subsection (1) of section 400.914, Florida
8910Statutes, is amended to read:
8911     400.914  Rules establishing standards.--
8912     (1)  Pursuant to the intention of the Legislature to
8913provide safe and sanitary facilities and healthful programs, the
8914agency in conjunction with the Division of Children's Medical
8915Services Prevention and Intervention of the Department of Health
8916shall adopt and publish rules to implement the provisions of
8917this part and part II of chapter 408, which shall include
8918reasonable and fair standards. Any conflict between these
8919standards and those that may be set forth in local, county, or
8920city ordinances shall be resolved in favor of those having
8921statewide effect. Such standards shall relate to:
8922     (a)  The assurance that PPEC services are family centered
8923and provide individualized medical, developmental, and family
8924training services.
8925     (b)  The maintenance of PPEC centers, not in conflict with
8926the provisions of chapter 553 and based upon the size of the
8927structure and number of children, relating to plumbing, heating,
8928lighting, ventilation, and other building conditions, including
8929adequate space, which will ensure the health, safety, comfort,
8930and protection from fire of the children served.
8931     (c)  The appropriate provisions of the most recent edition
8932of the "Life Safety Code" (NFPA-101) shall be applied.
8933     (d)  The number and qualifications of all personnel who
8934have responsibility for the care of the children served.
8935     (e)  All sanitary conditions within the PPEC center and its
8936surroundings, including water supply, sewage disposal, food
8937handling, and general hygiene, and maintenance thereof, which
8938will ensure the health and comfort of children served.
8939     (f)  Programs and basic services promoting and maintaining
8940the health and development of the children served and meeting
8941the training needs of the children's legal guardians.
8942     (g)  Supportive, contracted, other operational, and
8943transportation services.
8944     (h)  Maintenance of appropriate medical records, data, and
8945information relative to the children and programs. Such records
8946shall be maintained in the facility for inspection by the
8947agency.
8948     Section 169.  Subsection (3) of section 400.915, Florida
8949Statutes, is amended to read:
8950     400.915  Construction and renovation; requirements.--The
8951requirements for the construction or renovation of a PPEC center
8952shall comply with:
8953     (3)  The standards or rules adopted pursuant to this part
8954and part II of chapter 408.
8955     Section 170.  Section 400.916, Florida Statutes, is
8956repealed.
8957     Section 171.  Section 400.917, Florida Statutes, is
8958repealed.
8959     Section 172.  Section 400.925, Florida Statutes, is amended
8960to read:
8961     400.925  Definitions.--As used in this part, the term:
8962     (1)  "Accrediting organizations" means the Joint Commission
8963on Accreditation of Healthcare Organizations or other national
8964accreditation agencies whose standards for accreditation are
8965comparable to those required by this part for licensure.
8966     (2)  "Affiliated person" means any person who directly or
8967indirectly manages, controls, or oversees the operation of a
8968corporation or other business entity that is a licensee,
8969regardless of whether such person is a partner, shareholder,
8970owner, officer, director, agent, or employee of the entity.
8971     (2)(3)  "Agency" means the Agency for Health Care
8972Administration.
8973     (4)  "Applicant" means an individual applicant in the case
8974of a sole proprietorship, or any officer, director, agent,
8975managing employee, general manager, or affiliated person, or any
8976partner or shareholder having an ownership interest equal to 5
8977percent or greater in the corporation, partnership, or other
8978business entity.
8979     (3)(5)  "Consumer" or "patient" means any person who uses
8980home medical equipment in his or her place of residence.
8981     (4)(6)  "Department" means the Department of Children and
8982Family Services.
8983     (5)(7)  "General manager" means the individual who has the
8984general administrative charge of the premises of a licensed home
8985medical equipment provider.
8986     (6)(8)  "Home medical equipment" includes any product as
8987defined by the Federal Drug Administration's Drugs, Devices and
8988Cosmetics Act, any products reimbursed under the Medicare Part B
8989Durable Medical Equipment benefits, or any products reimbursed
8990under the Florida Medicaid durable medical equipment program.
8991Home medical equipment includes oxygen and related respiratory
8992equipment; manual, motorized, or customized wheelchairs and
8993related seating and positioning, but does not include
8994prosthetics or orthotics or any splints, braces, or aids custom
8995fabricated by a licensed health care practitioner; motorized
8996scooters; personal transfer systems; and specialty beds, for use
8997by a person with a medical need.
8998     (7)(9)  "Home medical equipment provider" means any person
8999or entity that sells or rents or offers to sell or rent to or
9000for a consumer:
9001     (a)  Any home medical equipment and services; or
9002     (b)  Home medical equipment that requires any home medical
9003equipment services.
9004     (8)(10)  "Home medical equipment provider personnel" means
9005persons who are employed by or under contract with a home
9006medical equipment provider.
9007     (9)(11)  "Home medical equipment services" means equipment
9008management and consumer instruction, including selection,
9009delivery, setup, and maintenance of equipment, and other related
9010services for the use of home medical equipment in the consumer's
9011regular or temporary place of residence.
9012     (10)(12)  "Licensee" means the person or entity to whom a
9013license to operate as a home medical equipment provider is
9014issued by the agency.
9015     (11)(13)  "Moratorium" has the same meaning as in s.
9016408.803, except that means a mandated temporary cessation or
9017suspension of the sale, rental, or offering of equipment after
9018the imposition of the moratorium. services related to equipment
9019sold or rented prior to the moratorium must be continued without
9020interruption, unless deemed otherwise by the agency.
9021     (12)(14)  "Person" means any individual, firm, partnership,
9022corporation, or association.
9023     (13)(15)  "Premises" means those buildings and equipment
9024which are located at the address of the licensed home medical
9025equipment provider for the provision of home medical equipment
9026services, which are in such reasonable proximity as to appear to
9027the public to be a single provider location, and which comply
9028with zoning ordinances.
9029     (14)(16)  "Residence" means the consumer's home or place of
9030residence, which may include nursing homes, assisted living
9031facilities, transitional living facilities, adult family-care
9032homes, or other congregate residential facilities.
9033     Section 173.  Subsection (3) and paragraphs (b), (d), and
9034(e) of subsection (6) of section 400.93, Florida Statutes, are
9035amended to read:
9036     400.93  Licensure required; exemptions; unlawful acts;
9037penalties.--
9038     (3)  The requirements of part II of chapter 408 shall apply
9039to the provision of services that require licensure pursuant to
9040this part and part II of chapter 408 and to entities licensed by
9041or applying for such licensure from the agency pursuant to this
9042part. However, each applicant for licensure and each licensee is
9043exempt from the provisions of s. 408.810(10). A home medical
9044equipment provider must be licensed by the agency to operate in
9045this state or to provide home medical equipment and services to
9046consumers in this state. A standard license issued to a home
9047medical equipment provider, unless sooner suspended or revoked,
9048expires 2 years after its effective date.
9049     (6)
9050     (b)  A person who violates paragraph (a) is subject to an
9051injunctive proceeding under this part, part II of chapter 408,
9052or applicable rules s. 400.956. A violation of paragraph (a) is
9053a deceptive and unfair trade practice and constitutes a
9054violation of the Florida Deceptive and Unfair Trade Practices
9055Act.
9056     (d)  The following penalties shall be imposed for operating
9057an unlicensed home medical equipment provider:
9058     1.  Any person or entity who operates an unlicensed
9059provider commits a felony of the third degree.
9060     2.  For any person or entity who has received government
9061reimbursement for services provided by an unlicensed provider,
9062the agency shall make a fraud referral to the appropriate
9063government reimbursement program.
9064     3.  For any licensee found to be concurrently operating
9065licensed and unlicensed provider premises, the agency may impose
9066a fine or moratorium, or revoke existing licenses of any or all
9067of the licensee's licensed provider locations until such time as
9068the unlicensed provider premises is licensed.
9069     (e)  A provider found to be operating without a license may
9070apply for licensure, and must cease operations until a license
9071is awarded by the agency.
9072     Section 174.  Section 400.931, Florida Statutes, is amended
9073to read:
9074     400.931  Application for license; fee; provisional license;
9075temporary permit.--
9076     (1)  Application for an initial license or for renewal of
9077an existing license must be made under oath to the agency on
9078forms furnished by it and must be accompanied by the appropriate
9079license fee as provided in subsection (12).
9080     (1)(2)  The applicant must file with the application
9081satisfactory proof that the home medical equipment provider is
9082in compliance with this part and applicable rules, including:
9083     (a)  A report, by category, of the equipment to be
9084provided, indicating those offered either directly by the
9085applicant or through contractual arrangements with existing
9086providers. Categories of equipment include:
9087     1.  Respiratory modalities.
9088     2.  Ambulation aids.
9089     3.  Mobility aids.
9090     4.  Sickroom setup.
9091     5.  Disposables.
9092     (b)  A report, by category, of the services to be provided,
9093indicating those offered either directly by the applicant or
9094through contractual arrangements with existing providers.
9095Categories of services include:
9096     1.  Intake.
9097     2.  Equipment selection.
9098     3.  Delivery.
9099     4.  Setup and installation.
9100     5.  Patient training.
9101     6.  Ongoing service and maintenance.
9102     7.  Retrieval.
9103     (c)  A listing of those with whom the applicant contracts,
9104both the providers the applicant uses to provide equipment or
9105services to its consumers and the providers for whom the
9106applicant provides services or equipment.
9107     (2)(3)  As an alternative to submitting proof of financial
9108ability to operate as required in s. 408.810(8) The applicant
9109for initial licensure must demonstrate financial ability to
9110operate, the applicant may submit which may be accomplished by
9111the submission of a $50,000 surety bond to the agency.
9112     (4)  An applicant for renewal who has demonstrated
9113financial inability to operate must demonstrate financial
9114ability to operate.
9115     (5)  Each applicant for licensure must comply with the
9116following requirements:
9117     (a)  Upon receipt of a completed, signed, and dated
9118application, the agency shall require background screening of
9119the applicant, in accordance with the level 2 standards for
9120screening set forth in chapter 435. As used in this subsection,
9121the term "applicant" means the general manager and the financial
9122officer or similarly titled individual who is responsible for
9123the financial operation of the licensed facility.
9124     (b)  The agency may require background screening for a
9125member of the board of directors of the licensee or an officer
9126or an individual owning 5 percent or more of the licensee if the
9127agency has probable cause to believe that such individual has
9128been convicted of an offense prohibited under the level 2
9129standards for screening set forth in chapter 435.
9130     (c)  Proof of compliance with the level 2 background
9131screening requirements of chapter 435 which has been submitted
9132within the previous 5 years in compliance with any other health
9133care licensure requirements of this state is acceptable in
9134fulfillment of paragraph (a).
9135     (d)  Each applicant must submit to the agency, with its
9136application, a description and explanation of any exclusions,
9137permanent suspensions, or terminations of the applicant from the
9138Medicare or Medicaid programs. Proof of compliance with
9139disclosure of ownership and control interest requirements of the
9140Medicaid or Medicare programs shall be accepted in lieu of this
9141submission.
9142     (e)  Each applicant must submit to the agency a description
9143and explanation of any conviction of an offense prohibited under
9144the level 2 standards of chapter 435 by a member of the board of
9145directors of the applicant, its officers, or any individual
9146owning 5 percent or more of the applicant. This requirement does
9147not apply to a director of a not-for-profit corporation or
9148organization if the director serves solely in a voluntary
9149capacity for the corporation or organization, does not regularly
9150take part in the day-to-day operational decisions of the
9151corporation or organization, receives no remuneration for his or
9152her services on the corporation's or organization's board of
9153directors, and has no financial interest and has no family
9154members with a financial interest in the corporation or
9155organization, provided that the director and the not-for-profit
9156corporation or organization include in the application a
9157statement affirming that the director's relationship to the
9158corporation satisfies the requirements of this provision.
9159     (f)  A license may not be granted to any potential licensee
9160if any applicant, administrator, or financial officer has been
9161found guilty of, regardless of adjudication, or has entered a
9162plea of nolo contendere or guilty to, any offense prohibited
9163under the level 2 standards for screening set forth in chapter
9164435, unless an exemption from disqualification has been granted
9165by the agency as set forth in chapter 435.
9166     (g)  The agency may deny or revoke licensure to any
9167potential licensee if any applicant:
9168     1.  Has falsely represented a material fact in the
9169application required by paragraphs (d) and (e), or has omitted
9170any material fact from the application required by paragraphs
9171(d) and (e); or
9172     2.  Has had prior Medicaid or Medicare action taken against
9173the applicant as set forth in paragraph (d).
9174     (h)  Upon licensure renewal, each applicant must submit to
9175the agency, under penalty of perjury, an affidavit of compliance
9176with the background screening provisions of this section.
9177     (3)(6)  As specified in part II of chapter 408, the home
9178medical equipment provider must also obtain and maintain
9179professional and commercial liability insurance. Proof of
9180liability insurance, as defined in s. 624.605, must be submitted
9181with the application. The agency shall set the required amounts
9182of liability insurance by rule, but the required amount must not
9183be less than $250,000 per claim. In the case of contracted
9184services, it is required that the contractor have liability
9185insurance not less than $250,000 per claim.
9186     (7)  A provisional license shall be issued to an approved
9187applicant for initial licensure for a period of 90 days, during
9188which time a survey must be conducted demonstrating substantial
9189compliance with this section. A provisional license shall also
9190be issued pending the results of an applicant's Federal Bureau
9191of Investigation report of background screening confirming that
9192all standards have been met. If substantial compliance is
9193demonstrated, a standard license shall be issued to expire 2
9194years after the effective date of the provisional license.
9195     (8)  Ninety days before the expiration date, an application
9196for license renewal must be submitted to the agency under oath
9197on forms furnished by the agency, and a license shall be renewed
9198if the applicant has met the requirements established under this
9199part and applicable rules. The home medical equipment provider
9200must file with the application satisfactory proof that it is in
9201compliance with this part and applicable rules. The home medical
9202equipment provider must submit satisfactory proof of its
9203financial ability to comply with the requirements of this part.
9204     (9)  When a change of ownership of a home medical equipment
9205provider occurs, the prospective owner must submit an initial
9206application for a license at least 15 days before the effective
9207date of the change of ownership. An application for change of
9208ownership of a license is required when ownership, a majority of
9209the ownership, or controlling interest of a licensed home
9210medical equipment provider is transferred or assigned and when a
9211licensee agrees to undertake or provide services to the extent
9212that legal liability for operation of the home medical equipment
9213provider rests with the licensee. A provisional license shall be
9214issued to the new owner for a period of 90 days, during which
9215time all required documentation must be submitted and a survey
9216must be conducted demonstrating substantial compliance with this
9217section. If substantial compliance is demonstrated, a standard
9218license shall be issued to expire 2 years after the issuance of
9219the provisional license.
9220     (4)(10)  When a change of the general manager of a home
9221medical equipment provider occurs, the licensee must notify the
9222agency of the change within 45 days. thereof and must provide
9223evidence of compliance with the background screening
9224requirements in subsection (5); except that a general manager
9225who has met the standards for the Department of Law Enforcement
9226background check, but for whom background screening results from
9227the Federal Bureau of Investigation have not yet been received,
9228may be employed pending receipt of the Federal Bureau of
9229Investigation background screening report. An individual may not
9230continue to serve as general manager if the Federal Bureau of
9231Investigation background screening report indicates any
9232violation of background screening standards.
9233     (5)(11)  In accordance with s. 408.805, an applicant or a
9234licensee shall pay a fee for each license application submitted
9235under this part, part II of chapter 408, and applicable rules.
9236The amount of the fee shall be established by rule and shall not
9237exceed $300 per biennium. All licensure fees required of a home
9238medical equipment provider are nonrefundable. The agency shall
9239set the fees in an amount that is sufficient to cover its costs
9240in carrying out its responsibilities under this part. However,
9241state, county, or municipal governments applying for licenses
9242under this part are exempt from the payment of license fees. All
9243fees collected under this part must be deposited in the Health
9244Care Trust Fund for the administration of this part.
9245     (6)(12)  An applicant for initial licensure, renewal, or
9246change of ownership shall also pay a license processing fee not
9247to exceed $300, to be paid by all applicants, and an inspection
9248fee not to exceed $400, which shall to be paid by all applicants
9249except those not subject to licensure inspection by the agency
9250as described in s. 400.933(2).
9251     (13)  When a change is reported which requires issuance of
9252a license, a fee must be assessed. The fee must be based on the
9253actual cost of processing and issuing the license.
9254     (14)  When a duplicate license is issued, a fee must be
9255assessed, not to exceed the actual cost of duplicating and
9256mailing.
9257     (15)  When applications are mailed out upon request, a fee
9258must be assessed, not to exceed the cost of the printing,
9259preparation, and mailing.
9260     (16)  The license must be displayed in a conspicuous place
9261in the administrative office of the home medical equipment
9262provider and is valid only while in the possession of the person
9263or entity to which it is issued. The license may not be sold,
9264assigned, or otherwise transferred, voluntarily or
9265involuntarily, and is valid only for the home medical equipment
9266provider and location for which originally issued.
9267     (17)  A home medical equipment provider against whom a
9268proceeding for revocation or suspension, or for denial of a
9269renewal application, is pending at the time of license renewal
9270may be issued a provisional license effective until final
9271disposition by the agency of such proceedings. If judicial
9272relief is sought from the final disposition, the court that has
9273jurisdiction may issue a temporary permit for the duration of
9274the judicial proceeding.
9275     Section 175.  Section 400.932, Florida Statutes, is amended
9276to read:
9277     400.932  Administrative penalties; injunctions; emergency
9278orders; moratoriums.--
9279     (1)  The agency may deny, revoke, and or suspend a license,
9280and or impose an administrative fine not to exceed $5,000 per
9281violation, per day, or initiate injunctive proceedings under s.
9282408.816 400.956.
9283     (2)  Any of the following actions by an employee of a home
9284medical equipment provider or any of its employees is grounds
9285for administrative action or penalties by the agency:
9286     (a)  Violation of this part or of applicable rules.
9287     (b)  An intentional, reckless, or negligent act that
9288materially affects the health or safety of a patient.
9289     (3)  The agency may deny and or revoke the license of any
9290applicant that:
9291     (a)  Made a false representation or omission of any
9292material fact in making the application, including the
9293submission of an application that conceals the controlling or
9294ownership interest or any officer, director, agent, managing
9295employee, affiliated person, partner, or shareholder who may not
9296be eligible to participate;
9297     (a)(b)  Has been previously found by any professional
9298licensing, certifying, or standards board or agency to have
9299violated the standards or conditions relating to licensure or
9300certification or the quality of services provided. "Professional
9301licensing, certifying, or standards board or agency" shall
9302include, but is not limited to, practitioners, health care
9303facilities, programs, or services, or residential care,
9304treatment programs, or other human services; or
9305     (b)(c)  Has been or is currently excluded, suspended, or
9306terminated from, or has involuntarily withdrawn from,
9307participation in Florida's Medicaid program or any other state's
9308Medicaid program, or participation in the Medicare program or
9309any other governmental or private health care or health
9310insurance program.
9311     (4)  The agency may issue an emergency order immediately
9312suspending or revoking a license when it determines that any
9313condition within the responsibility of the home medical
9314equipment provider presents a clear and present danger to public
9315health and safety.
9316     (5)  The agency may impose an immediate moratorium on any
9317licensed home medical equipment provider when the agency
9318determines that any condition within the responsibility of the
9319home medical equipment provider presents a threat to public
9320health or safety.
9321     Section 176.  Section 400.933, Florida Statutes, is amended
9322to read:
9323     400.933  Licensure inspections; alternatives and
9324investigations.--
9325     (1)  The agency shall make or cause to be made such
9326inspections and investigations as it considers necessary,
9327including:
9328     (a)  Licensure inspections.
9329     (b)  Inspections directed by the federal Health Care
9330Financing Administration.
9331     (c)  Licensure complaint investigations, including full
9332licensure investigations with a review of all licensure
9333standards as outlined in the administrative rules. Complaints
9334received by the agency from individuals, organizations, or other
9335sources are subject to review and investigation by the agency.
9336     (2)  The agency shall accept, in lieu of its own periodic
9337inspections for licensure, submission of the following:
9338     (1)(a)  The survey or inspection of an accrediting
9339organization, provided the accreditation of the licensed home
9340medical equipment provider is not provisional and provided the
9341licensed home medical equipment provider authorizes release of,
9342and the agency receives the report of, the accrediting
9343organization; or
9344     (2)(b)  A copy of a valid medical oxygen retail
9345establishment permit issued by the Department of Health,
9346pursuant to chapter 499.
9347     Section 177.  Section 400.935, Florida Statutes, is amended
9348to read:
9349     400.935  Rules establishing minimum standards.--The agency
9350shall adopt, publish, and enforce rules to implement this part
9351and part II of chapter 408, which must provide reasonable and
9352fair minimum standards relating to:
9353     (1)  The qualifications and minimum training requirements
9354of all home medical equipment provider personnel.
9355     (2)  License application and renewal.
9356     (3)  License and inspection fees.
9357     (2)(4)  Financial ability to operate.
9358     (3)(5)  The administration of the home medical equipment
9359provider.
9360     (4)(6)  Procedures for maintaining patient records.
9361     (5)(7)  Ensuring that the home medical equipment and
9362services provided by a home medical equipment provider are in
9363accordance with the plan of treatment established for each
9364patient, when provided as a part of a plan of treatment.
9365     (6)(8)  Contractual arrangements for the provision of home
9366medical equipment and services by providers not employed by the
9367home medical equipment provider providing for the consumer's
9368needs.
9369     (7)(9)  Physical location and zoning requirements.
9370     (8)(10)  Home medical equipment requiring home medical
9371equipment services.
9372     Section 178.  Section 400.95, Florida Statutes, is
9373repealed.
9374     Section 179.  Subsections (3) through (7) of section
9375400.953, Florida Statutes, are renumbered as subsections (2)
9376through (6), respectively, and present subsection (2) is amended
9377to read:
9378     400.953  Background screening of home medical equipment
9379provider personnel.--The agency shall require employment
9380screening as provided in chapter 435, using the level 1
9381standards for screening set forth in that chapter, for home
9382medical equipment provider personnel.
9383     (2)  The general manager of each home medical equipment
9384provider must sign an affidavit annually, under penalty of
9385perjury, stating that all home medical equipment provider
9386personnel hired on or after July 1, 1999, who enter the home of
9387a patient in the capacity of their employment have been screened
9388and that its remaining personnel have worked for the home
9389medical equipment provider continuously since before July 1,
93901999.
9391     Section 180.  Subsection (4) of section 400.955, Florida
9392Statutes, is amended to read:
9393     400.955  Procedures for screening of home medical equipment
9394provider personnel.--
9395     (4)  The general manager of each home medical equipment
9396provider must sign an affidavit annually, under penalty of
9397perjury, stating that all personnel hired on or after July 1,
93981999, have been screened and that its remaining personnel have
9399worked for the home medical equipment provider continuously
9400since before July 1, 1999.
9401     Section 181.  Section 400.956, Florida Statutes, is
9402repealed.
9403     Section 182.  Section 400.960, Florida Statutes, is amended
9404to read:
9405     400.960  Definitions.--As used in this part, the term:
9406     (1)  "Active treatment" means the provision of services by
9407an interdisciplinary team which are necessary to maximize a  
9408resident's client's individual independence or prevent
9409regression or loss of functional status.
9410     (2)  "Agency" means the Agency for Health Care
9411Administration.
9412     (3)  "Autism" means a pervasive, neurologically based
9413developmental disability of extended duration which causes
9414severe learning, communication, and behavior disorders with age
9415of onset during infancy or childhood. Individuals with autism
9416exhibit impairment in reciprocal social interaction, impairment
9417in verbal and nonverbal communication and imaginative ability,
9418and a markedly restricted repertoire of activities and
9419interests.
9420     (4)  "Cerebral palsy" means a group of disabling symptoms
9421of extended duration which results from damage to the developing
9422brain occurring before, during, or after birth and resulting in
9423the loss or impairment of control over voluntary muscles. The
9424term does not include those symptoms or impairments resulting
9425solely from a stroke.
9426     (5)  "Client" means any person determined by the department
9427to be eligible for developmental services.
9428     (6)  "Client advocate" means a friend or relative of the
9429client, or of the client's immediate family, who advocates for
9430the best interests of the client in any proceedings under this
9431part in which the client or his or her family has the right or
9432duty to participate.
9433     (5)(7)  "Department" means the Department of Children and
9434Family Services.
9435     (6)(8)  "Developmental disability" means a disorder or
9436syndrome that is attributable to retardation, cerebral palsy,
9437autism, spina bifida, or Prader-Willi syndrome and that
9438constitutes a substantial handicap that can reasonably be
9439expected to continue indefinitely.
9440     (7)(9)  "Direct service provider" means a person 18 years
9441of age or older who has direct contact with individuals with
9442developmental disabilities and who is unrelated to the
9443individuals with developmental disabilities.
9444     (8)(10)  "Epilepsy" means a chronic brain disorder of
9445various causes which is characterized by recurrent seizures due
9446to excessive discharge of cerebral neurons. When found
9447concurrently with retardation, autism, or cerebral palsy,
9448epilepsy is considered a secondary disability for which the
9449resident client is eligible to receive services to ameliorate
9450this condition according to the provisions of this part.