November 14, 2019
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       Florida Senate - 2010                              CS for SB 760
       
       
       
       By the Committee on Health Regulation; and Senator Gaetz
       
       
       
       
       588-04383A-10                                          2010760c1
    1                        A bill to be entitled                      
    2         An act relating to health care; repealing s.
    3         112.0455(10)(e), F.S., relating to a prohibition
    4         against applying the Drug-Free Workplace Act
    5         retroactively; amending ss. 154.11, 395.3038, 400.925,
    6         400.9935, 408.05, 440.13, 627.645, 627.668, 627.669,
    7         627.736, 641.495, and 766.1015, F.S.; changing
    8         references to the Joint Commission on the
    9         Accreditation of Healthcare Organizations to the
   10         “Joint Commission”; amending s. 318.21, F.S.;
   11         requiring that a specified percentage of fines
   12         collected from certain civil penalties levied by
   13         county courts for traffic infractions be deposited
   14         into the Brain and Spinal Cord Injury Rehabilitation
   15         Trust Fund within the Department of Health for use for
   16         Medicaid recipients who have spinal cord injuries;
   17         amending s. 381.06014, F.S.; defining the term
   18         “volunteer donor”; requiring that certain blood
   19         establishments disclose specified information on the
   20         Internet; repealing s. 383.325, F.S., relating to
   21         records of licensed birth center facilities; amending
   22         s. 394.741 F.S.; changing references to the Council on
   23         Accreditation for Children and Family Services to the
   24         “Council on Accreditation”; amending s. 394.4787,
   25         F.S.; conforming a cross-reference; amending s.
   26         395.002, F.S.; redefining the term “accrediting
   27         organizations” as it relates to hospital licensure and
   28         regulation; deleting definitions of the terms “initial
   29         denial determination,” “private review agent,”
   30         “utilization review,” and “utilization review plan” as
   31         they relate to hospital licensure and regulation;
   32         amending s. 395.003, F.S.; deleting an obsolete
   33         provision; conforming a cross-reference; amending s.
   34         395.0193, F.S.; requiring the Division of Medical
   35         Quality Assurance within the Department of Health
   36         rather than the Agency for Health Care Administration
   37         to review certain peer review reports and disciplinary
   38         actions; amending s. 395.1023, F.S.; requiring a
   39         licensed facility to adopt a protocol to designate a
   40         physician to act as a liaison between the Department
   41         of Children and Family Services, rather than the
   42         Department of Health, and the licensed facility in
   43         cases involving suspected child abuse; amending s.
   44         395.1041, F.S., relating to emergency services;
   45         deleting obsolete provisions; repealing s. 395.1046,
   46         F.S., relating to the investigation of complaints
   47         regarding hospitals; amending s. 395.1055, F.S.;
   48         requiring the agency to adopt rules that ensure that
   49         licensed facility beds conform to certain standards as
   50         specified by the agency, the Florida Building Code,
   51         and the Florida Fire Prevention Code; amending s.
   52         395.10972, F.S.; changing a reference to the Florida
   53         Society of Healthcare Risk Management to the “Florida
   54         Society for Healthcare Risk Management and Patient
   55         Safety”; amending s. 395.2050, F.S.; providing that
   56         the federal Centers for Medicare and Medicaid
   57         Services, rather than the federal Health Care
   58         Financing Administration, designates organ procurement
   59         organizations; amending s. 395.3036, F.S.; correcting
   60         a cross-reference; repealing s. 395.3037, F.S.;
   61         deleting obsolete definitions; amending s. 395.602,
   62         F.S.; revising the definition of a “rural hospital” as
   63         it relates to hospital licensure and regulation;
   64         amending s. 400.021, F.S.; revising the definition of
   65         a “geriatric outpatient clinic” with regard to
   66         staffing; amending s. 400.0239, F.S.; deleting an
   67         obsolete provision; amending s. 400.0255, F.S.;
   68         correcting an obsolete cross-reference to
   69         administrative rules; amending s. 400.063, F.S.;
   70         removing an obsolete provision; amending s. 400.071,
   71         F.S.; revising the requirements for an application for
   72         a license to operate a nursing home facility; amending
   73         s. 400.0712, F.S.; deleting a provision related to the
   74         issuance of an inactive license to a nursing home;
   75         amending s. 400.111, F.S.; specifying that the
   76         required disclosure of a financial or ownership
   77         interest is contingent upon a request by the agency;
   78         amending s. 400.1183, F.S.; requiring nursing home
   79         facilities to maintain records of grievances for
   80         agency inspection; deleting a requirement that a
   81         facility report the number of grievances handled
   82         during the prior licensure period; amending s.
   83         400.141, F.S.; conforming a cross-reference; deleting
   84         the requirement that a facility submit to the agency
   85         information regarding a management company with which
   86         it has entered into an agreement; specifying a fine
   87         for a nursing facility’s failure to impose an
   88         admissions moratorium if it has failed to comply with
   89         state minimum-staffing requirements; deleting the
   90         requirement for a facility to report to the agency any
   91         filing of bankruptcy protection, divestiture, or
   92         corporate reorganization; amending s. 400.142, F.S.;
   93         removing obsolete provisions requiring the agency to
   94         adopt certain rules; repealing s. 400.147(10), F.S.,
   95         relating to a requirement that a nursing home report
   96         any notice of a filing of a claim for a violation of a
   97         resident’s rights or a claim of negligence; repealing
   98         s. 400.148, F.S., relating to the Medicaid “Up-or-Out”
   99         Quality of Care Contract Management Program; amending
  100         s. 400.19, F.S.; authorizing the agency to verify the
  101         correction of certain violations without reinspection,
  102         even when they are related to resident rights or
  103         resident care, after an unannounced inspection of a
  104         nursing home; repealing s. 400.195, F.S., relating to
  105         reporting requirements; deleting obsolete provisions;
  106         amending s. 400.23, F.S.; changing a reference to the
  107         Division of Children’s Medical Services to the
  108         “Division of Children’s Medical Services Network”;
  109         deleting an obsolete provision; amending s. 400.275,
  110         F.S.; deleting a requirement that the agency ensure
  111         that a newly hired nursing home surveyor is assigned
  112         full time to a licensed nursing home to observe
  113         facility operations; amending ss. 400.484, 400.967,
  114         and 429.71, F.S.; redesignating class I, II, III, and
  115         IV deficiencies as class I, II, III, and IV
  116         “violations”; amending s. 400.606, F.S.; eliminating a
  117         requirement that the plan for the delivery of home,
  118         residential, and homelike inpatient hospice services
  119         for terminally ill patients and their families include
  120         projected annual operating costs; amending s. 400.607,
  121         F.S.; revising the grounds under which the agency may
  122         take administrative action against a hospice; amending
  123         s. 400.915, F.S.; correcting an obsolete cross
  124         reference to administrative rules; amending s.
  125         400.931, F.S.; deleting a provision allowing an
  126         applicant for a license to be a home medical equipment
  127         provider to submit a surety bond to the agency;
  128         amending s. 400.932, F.S.; revising the grounds under
  129         which the agency may take administrative action
  130         against a home medical equipment provider; amending s.
  131         400.933, F.S.; prohibiting a home medical equipment
  132         provider from providing a survey or inspection of an
  133         accrediting organization in lieu of periodic agency
  134         inspection if the provider’s licensure is conditional;
  135         amending s. 400.953, F.S.; deleting a requirement that
  136         the general manager of a home medical equipment
  137         provider annually sign an affidavit regarding the
  138         background screening of personnel; providing
  139         requirements for submission of the affidavit; amending
  140         s. 400.9905, F.S.; specifying that certain licensure
  141         requirements do not apply to certain orthotic,
  142         prosthetic, pediatric cardiology, or perinatology
  143         clinical facilities; redefining the term “portable
  144         service or equipment provider” as it relates to the
  145         Health Care Clinic Act; amending s. 400.991, F.S.;
  146         conforming a provision to changes made by the act;
  147         revising application requirements to show proof of
  148         financial ability to operate a health care clinic;
  149         amending s. 408.034, F.S.; prohibiting the agency from
  150         issuing a license to a health care facility that
  151         applies for a license to operate an intermediate care
  152         facility for developmentally disabled persons under
  153         certain circumstances; amending s. 408.036, F.S.,
  154         relating to certificates of need; conforming a
  155         provision to changes made by the act; amending s.
  156         408.043, F.S.; requiring a freestanding facility or a
  157         part of the facility that is the inpatient hospice
  158         care component of a hospice to obtain a certificate of
  159         need, regardless of whether it is primarily engaged in
  160         providing inpatient care and related services;
  161         amending s. 408.061, F.S.; revising requirements for
  162         the reporting of certified data elements by health
  163         care facilities; amending s. 408.10, F.S.; authorizing
  164         the agency to provide staffing for a toll-free phone
  165         number for the purpose of handling consumer complaints
  166         regarding a health care facility; repealing s.
  167         408.802(11), F.S., relating to the applicability of
  168         the Health Care Licensing Procedures Act to private
  169         review agents; amending s. 408.804, F.S.; providing a
  170         criminal penalty for altering, defacing, or falsifying
  171         a license certificate of certain health care
  172         providers; providing civil penalties for displaying an
  173         altered, defaced, or falsified license certificate;
  174         amending s. 408.806, F.S.; requiring the agency to
  175         provide a courtesy notice to a licensee regarding the
  176         expiration of a licensee’s license; providing that
  177         failure of the agency to provide the courtesy notice
  178         or failure of the licensee to receive the notice does
  179         not excuse the licensee from timely renewing its
  180         license; providing that payment of the late fee is
  181         required for a later application; amending s. 408.810,
  182         F.S.; revising the requirements for obtaining and
  183         maintaining a license for certain health care
  184         providers and those who own a controlling interest in
  185         a health care provider; amending s. 408.813, F.S.;
  186         authorizing the agency to impose administrative fines
  187         for unclassified violations and identifying some of
  188         those violations; amending s. 408.815, F.S.;
  189         authorizing the agency to extend the expiration date
  190         of a license for the purpose of the safe and orderly
  191         discharge of clients; authorizing the agency to impose
  192         conditions on the extension; amending s. 409.906,
  193         F.S.; requiring the agency, in consultation with the
  194         Department of Elderly Affairs, to phase out the adult
  195         day health care waiver program; requiring adult day
  196         health care waiver providers, in consultation with
  197         resource centers for the aged, to assist in the
  198         transition of enrollees from the waiver program;
  199         repealing s. 409.221(4)(k), F.S., relating to the
  200         responsibility of the agency, the Department of
  201         Elderly Affairs, the Department of Health, the
  202         Department of Children and Family Services, and the
  203         Agency for Persons with Disabilities to review and
  204         assess the implementation of the consumer-directed
  205         care program and the agency’s responsibility to submit
  206         a report to the Legislature; repealing s.
  207         409.912(15)(e), (f), and (g), F.S., relating to a
  208         requirement that the Agency for Health Care
  209         Administration submit a report to the Legislature
  210         regarding the operation of the CARES program; amending
  211         s. 429.07, F.S.; deleting the requirement for an
  212         assisted living facility to obtain an additional
  213         license in order to provide limited nursing services;
  214         deleting the requirement for the Agency for Health
  215         Care Administration to conduct quarterly monitoring
  216         visits of facilities that hold a license to provide
  217         extended congregate care services; deleting the
  218         requirement for the Department of Elderly Affairs to
  219         report annually on the status of and recommendations
  220         related to extended congregate care; deleting the
  221         requirement for the Agency for Health Care
  222         Administration to conduct monitoring visits at least
  223         twice a year to facilities providing limited nursing
  224         services; increasing the licensure fees and the
  225         maximum fee required for a standard license;
  226         increasing the licensure fees for the extended
  227         congregate care license; eliminating the license fee
  228         for the limited nursing services license; transferring
  229         from another provision of law the requirement that a
  230         biennial survey of an assisted living facility include
  231         specific actions to determine whether the facility is
  232         adequately protecting residents’ rights; providing
  233         that an assisted living facility that has been cited
  234         for certain violations is subject to monitoring
  235         visits; requiring a registered nurse to participate in
  236         certain monitoring visits; amending s. 429.11, F.S.;
  237         deleting a provision authorizing issuance of a
  238         provisional license to operate as an assisted living
  239         facility; repealing s. 429.12(2), F.S., relating to
  240         the sale or transfer of ownership of an assisted
  241         living facility; amending s. 429.14, F.S.; authorizing
  242         the agency to provide to the Division of Hotels and
  243         Restaurants of the Department of Business and
  244         Professional Regulation, by electronic means or
  245         through the agency’s website, information regarding
  246         the denial, suspension, or revocation of a license;
  247         amending s. 429.17, F.S.; deleting provisions related
  248         to the limited nursing services license; revising the
  249         requirements for a conditional license to operate an
  250         assisted living facility; amending s. 429.19, F.S.;
  251         clarifying that a monitoring fee may be assessed in
  252         addition to an administrative fine; repealing s.
  253         429.23(5), F.S., relating to a requirement that each
  254         assisted living facility submit a report to the agency
  255         regarding liability claims filed against it; amending
  256         s. 429.255, F.S.; eliminating provisions authorizing
  257         the use of volunteers to provide certain health-care
  258         related services in assisted living facilities;
  259         authorizing assisted living facilities to provide
  260         limited nursing services; requiring an assisted living
  261         facility to be responsible for certain recordkeeping
  262         and staff to be trained to monitor residents receiving
  263         certain health-care-related services; repealing s.
  264         429.28(3), F.S., relating to a requirement for a
  265         biennial survey of an assisted living facility, to
  266         conform to changes made by the act; amending s.
  267         429.35, F.S.; authorizing the agency to provide to the
  268         local ombudsman council, electronically or through the
  269         agency’s website, information regarding the results of
  270         an inspection; amending s. 429.41, F.S., relating to
  271         rulemaking; conforming provisions to changes made by
  272         the act; amending s. 429.53, F.S.; requiring the
  273         agency, rather than the agency’s area offices of
  274         licensure and certification, to provide consultation
  275         to certain persons and licensees regarding assisted
  276         living facilities; redefining the term “consultation”
  277         as it relates to assisted living facilities; amending
  278         s. 429.54, F.S.; requiring licensed assisted living
  279         facilities to electronically report certain data
  280         semiannually to the Agency for Health Care
  281         Administration in accordance with rules adopted by the
  282         Department of Elderly Affairs; amending s. 429.65,
  283         F.S.; redefining the term “adult family-care home” as
  284         it relates to the Adult Family-Care Home Act;
  285         repealing s. 429.901(5), F.S.; relating to the
  286         definition of the term “multiple or repeated
  287         violations”; repealing s. 429.911(2)(a), F.S.;
  288         deleting a ground for agency action against an adult
  289         day care center; amending s. 429.915, F.S.; revising
  290         requirements for a conditional license to operate an
  291         adult day care center; amending s. 430.80, F.S.;
  292         conforming a cross-reference; amending s. 483.201,
  293         F.S.; providing for disciplinary action against
  294         clinical laboratories failing to disclose specified
  295         information on the Internet; providing a maximum
  296         annual administrative fine that may be imposed
  297         annually against certain clinical laboratories for
  298         failure to comply with such disclosure requirement;
  299         amending s. 483.294, F.S.; requiring the agency to
  300         biennially, rather than at least annually, inspect the
  301         premises and operations of multiphasic health testing
  302         centers; amending s. 499.003, F.S.; revising the
  303         definition of the term “health care entity” to clarify
  304         that a blood establishment may be a health care entity
  305         and engage in certain activities; amending s. 499.005,
  306         F.S.; clarifying provisions prohibiting the
  307         unauthorized wholesale distribution of a prescription
  308         drug that was purchased by a hospital or other health
  309         care entity, to conform to changes made by the act;
  310         amending s. 499.01, F.S.; exempting certain blood
  311         establishments from the requirements to be permitted
  312         as a prescription drug manufacturer and register
  313         products; requiring that certain blood establishments
  314         obtain a restricted prescription drug distributor
  315         permit under specified conditions; limiting the
  316         prescription drugs that a blood establishment may
  317         distribute under the restricted prescription drug
  318         distributor permit; authorizing the Department of
  319         Health to adopt rules; providing effective dates.
  320  
  321  Be It Enacted by the Legislature of the State of Florida:
  322  
  323         Section 1. Paragraph (e) of subsection (10) of section
  324  112.0455, Florida Statutes, is repealed.
  325         Section 2. Paragraph (n) of subsection (1) of section
  326  154.11, Florida Statutes, is amended to read:
  327         154.11 Powers of board of trustees.—
  328         (1) The board of trustees of each public health trust shall
  329  be deemed to exercise a public and essential governmental
  330  function of both the state and the county and in furtherance
  331  thereof it shall, subject to limitation by the governing body of
  332  the county in which such board is located, have all of the
  333  powers necessary or convenient to carry out the operation and
  334  governance of designated health care facilities, including, but
  335  without limiting the generality of, the foregoing:
  336         (n) To make original appointments of appoint originally the
  337  staff of physicians to practice in any designated facility owned
  338  or operated by the board and to approve the bylaws and rules to
  339  be adopted by the medical staff of any designated facility owned
  340  and operated by the board., Such governing regulations must to
  341  be in accordance with the standards of the Joint Commission and
  342  must on the Accreditation of Hospitals which provide, among
  343  other things, for the method of appointing additional staff
  344  members and for the removal of staff members.
  345         Section 3. Subsection (15) of section 318.21, Florida
  346  Statutes, is amended to read:
  347         318.21 Disposition of civil penalties by county courts.—All
  348  civil penalties received by a county court pursuant to the
  349  provisions of this chapter shall be distributed and paid monthly
  350  as follows:
  351         (15) Of the additional fine assessed under s. 318.18(3)(e)
  352  for a violation of s. 316.1893, 50 percent of the moneys
  353  received from the fines shall be remitted to the Department of
  354  Revenue and deposited into the Brain and Spinal Cord Injury
  355  Trust Fund within the Department of Health and shall be
  356  appropriated to the Department of Health Agency for Health Care
  357  Administration as general revenue to provide an enhanced
  358  Medicaid payment to nursing homes that serve adult Medicaid
  359  recipients with brain and spinal cord injuries that are
  360  medically complex and that are technologically and respiratory
  361  dependent. The remaining 50 percent of the moneys received from
  362  the enhanced fine imposed under s. 318.18(3)(e) shall be
  363  remitted to the Department of Revenue and deposited into the
  364  Department of Health Administrative Trust Fund to provide
  365  financial support to certified trauma centers in the counties
  366  where enhanced penalty zones are established to ensure the
  367  availability and accessibility of trauma services. Funds
  368  deposited into the Administrative Trust Fund under this
  369  subsection shall be allocated as follows:
  370         (a) Fifty percent shall be allocated equally among all
  371  Level I, Level II, and pediatric trauma centers in recognition
  372  of readiness costs for maintaining trauma services.
  373         (b) Fifty percent shall be allocated among Level I, Level
  374  II, and pediatric trauma centers based on each center’s relative
  375  volume of trauma cases as reported in the Department of Health
  376  Trauma Registry.
  377         Section 4. Section 381.06014, Florida Statutes, is amended
  378  to read:
  379         381.06014 Blood establishments.—
  380         (1) As used in this section, the term:
  381         (a) “Blood establishment” means any person, entity, or
  382  organization, operating within the state, which examines an
  383  individual for the purpose of blood donation or which collects,
  384  processes, stores, tests, or distributes blood or blood
  385  components collected from the human body for the purpose of
  386  transfusion, for any other medical purpose, or for the
  387  production of any biological product.
  388         (b) “Volunteer donor” means a person who does not receive
  389  remuneration, other than an incentive, for a blood donation
  390  intended for transfusion, and the product container of the
  391  donation from the person qualifies for labeling with the
  392  statement “volunteer donor” under 21 C.F.R. 606.121.
  393         (2) Any blood establishment operating in the state may not
  394  conduct any activity defined in subsection (1) unless that blood
  395  establishment is operated in a manner consistent with the
  396  provisions of Title 21 parts 211 and 600-640, Code of Federal
  397  Regulations.
  398         (3) Any blood establishment determined to be operating in
  399  the state in a manner not consistent with the provisions of
  400  Title 21 parts 211 and 600-640, Code of Federal Regulations, and
  401  in a manner that constitutes a danger to the health or well
  402  being of donors or recipients as evidenced by the federal Food
  403  and Drug Administration’s inspection reports and the revocation
  404  of the blood establishment’s license or registration shall be in
  405  violation of this chapter and shall immediately cease all
  406  operations in the state.
  407         (4) The operation of a blood establishment in a manner not
  408  consistent with the provisions of Title 21 parts 211 and 600
  409  640, Code of Federal Regulations, and in a manner that
  410  constitutes a danger to the health or well-being of blood donors
  411  or recipients as evidenced by the federal Food and Drug
  412  Administration’s inspection process is declared a nuisance and
  413  inimical to the public health, welfare, and safety. The Agency
  414  for Health Care Administration or any state attorney may bring
  415  an action for an injunction to restrain such operations or
  416  enjoin the future operation of the blood establishment.
  417         (5) A blood establishment that collects blood or blood
  418  components from volunteer donors must disclose on the Internet
  419  information to educate and inform donors and the public about
  420  the blood establishment’s activities. A hospital that collects
  421  blood or blood components from volunteer donors for its own use
  422  or for health care providers that are part of its business
  423  entity is exempt from the disclosure requirements in this
  424  subsection. The information required to be disclosed under this
  425  subsection may be cumulative for all blood establishments within
  426  a business entity. Disciplinary action against the blood
  427  establishment’s clinical laboratory license may be taken as
  428  provided in s. 483.201 for a blood establishment that is
  429  required to disclose but fails to disclose on its website all of
  430  the following information:
  431         (a) A description of the steps involved in collecting,
  432  processing, and distributing volunteer donations, presented in a
  433  manner appropriate for the donating public.
  434         (b) By March 1 of each year, the number of units of blood
  435  components, identified by component, which were:
  436         1. Produced by the blood establishment during the preceding
  437  calendar year;
  438         2. Obtained from other sources during the preceding
  439  calendar year;
  440         3. Distributed during the preceding year to health care
  441  providers located outside this state. However, if the blood
  442  establishment collects donations in a county outside this state,
  443  distributions to health care providers in that county shall be
  444  excluded. Such information shall be aggregated by health care
  445  providers located within the United States and its territories
  446  or outside the United States and its territories; and
  447         4. Distributed to entities that are not health care
  448  providers during the preceding year. Such information shall be
  449  aggregated by purchasers located within the United States and
  450  its territories or outside the United States and its
  451  territories;
  452  
  453  For purposes of this paragraph, the components that must be
  454  reported include whole blood, red blood cells, leukoreduced red
  455  blood cells, fresh frozen plasma or the equivalent, recovered
  456  plasma, platelets, and cryoprecipitated antihemophilic factor.
  457         (c) The blood establishment’s conflict-of-interest policy,
  458  policy concerning related-party transactions, whistleblower
  459  policy, and policy for determining executive compensation. If a
  460  change to any of these documents occurs, the revised document
  461  must be available on the blood establishment’s website by the
  462  following March 1.
  463         (d)1. The most recent 3 years of the Return of Organization
  464  Exempt from Income Tax, Internal Revenue Service Form 990, if
  465  the business entity for the blood establishment is eligible to
  466  file such return. The Form 990 must be available on the blood
  467  establishment’s website within 30 calendar days after filing it
  468  with the Internal Revenue Service; or
  469         2. If the business entity for the blood establishment is
  470  not eligible to file the Form 990 return, a balance sheet,
  471  income statement, statement of changes in cash flow, and the
  472  expression of an opinion thereon by an independent certified
  473  public accountant who audited or reviewed such financial
  474  statements. Such documents must be available on the blood
  475  establishment’s website within 120 days after the end of the
  476  blood establishment’s fiscal year and must remain on the blood
  477  establishment’s website for at least 36 months.
  478         Section 5. Section 383.325, Florida Statutes, is repealed.
  479         Section 6. Subsection (2) of section 394.741, Florida
  480  Statutes, is amended to read:
  481         394.741 Accreditation requirements for providers of
  482  behavioral health care services.—
  483         (2) Notwithstanding any provision of law to the contrary,
  484  accreditation shall be accepted by the agency and department in
  485  lieu of the agency’s and department’s facility licensure onsite
  486  review requirements and shall be accepted as a substitute for
  487  the department’s administrative and program monitoring
  488  requirements, except as required by subsections (3) and (4),
  489  for:
  490         (a) Any organization from which the department purchases
  491  behavioral health care services that is accredited by the Joint
  492  Commission on Accreditation of Healthcare Organizations or the
  493  Council on Accreditation for Children and Family Services, or
  494  has those services that are being purchased by the department
  495  accredited by CARF—the Rehabilitation Accreditation Commission.
  496         (b) Any mental health facility licensed by the agency or
  497  any substance abuse component licensed by the department that is
  498  accredited by the Joint Commission on Accreditation of
  499  Healthcare Organizations, CARF—the Rehabilitation Accreditation
  500  Commission, or the Council on Accreditation of Children and
  501  Family Services.
  502         (c) Any network of providers from which the department or
  503  the agency purchases behavioral health care services accredited
  504  by the Joint Commission on Accreditation of Healthcare
  505  Organizations, CARF—the Rehabilitation Accreditation Commission,
  506  the Council on Accreditation of Children and Family Services, or
  507  the National Committee for Quality Assurance. A provider
  508  organization that, which is part of an accredited network, is
  509  afforded the same rights under this part.
  510         Section 7. Subsection (7) of section 394.4787, Florida
  511  Statutes, is amended to read:
  512         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
  513  394.4789.—As used in this section and ss. 394.4786, 394.4788,
  514  and 394.4789:
  515         (7) “Specialty psychiatric hospital” means a hospital
  516  licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
  517  and part II of chapter 408 as a specialty psychiatric hospital.
  518         Section 8. Section 395.002, Florida Statutes, is amended to
  519  read:
  520         395.002 Definitions.—As used in this chapter the term:
  521         (1) “Accrediting organizations” means nationally recognized
  522  or approved accrediting organizations whose standards
  523  incorporate comparable licensure requirements as determined by
  524  the agency the Joint Commission on Accreditation of Healthcare
  525  Organizations, the American Osteopathic Association, the
  526  Commission on Accreditation of Rehabilitation Facilities, and
  527  the Accreditation Association for Ambulatory Health Care, Inc.
  528         (2) “Agency” means the Agency for Health Care
  529  Administration.
  530         (3) “Ambulatory surgical center” or “mobile surgical
  531  facility” means a facility that has as its the primary purpose
  532  the provision of which is to provide elective surgical care, in
  533  which the patient is admitted to and discharged from the such
  534  facility within the same working day and is not permitted to
  535  stay overnight, and which is not part of a hospital. However, a
  536  facility existing for the primary purpose of performing
  537  terminations of pregnancy, an office maintained by a physician
  538  for the practice of medicine, or an office maintained for the
  539  practice of dentistry shall not be construed to be an ambulatory
  540  surgical center, provided that any facility or office that which
  541  is certified or seeks certification as a Medicare ambulatory
  542  surgical center shall be licensed as an ambulatory surgical
  543  center pursuant to s. 395.003. Any structure or vehicle in which
  544  a physician maintains an office and practices surgery, and which
  545  can appear to the public to be a mobile office because the
  546  structure or vehicle operates at more than one address, shall be
  547  construed to be a mobile surgical facility.
  548         (4) “Biomedical waste” means any solid or liquid waste as
  549  defined in s. 381.0098(2)(a).
  550         (5) “Clinical privileges” means the privileges granted to a
  551  physician or other licensed health care practitioner to render
  552  patient care services in a hospital, but does not include the
  553  privilege of admitting patients.
  554         (6) “Department” means the Department of Health.
  555         (7) “Director” means any member of the official board of
  556  directors as reported in the organization’s annual corporate
  557  report to the Florida Department of State, or, if no such report
  558  is made, any member of the operating board of directors. The
  559  term excludes members of separate, restricted boards that serve
  560  only in an advisory capacity to the operating board.
  561         (8) “Emergency medical condition” means:
  562         (a) A medical condition manifesting itself by acute
  563  symptoms of sufficient severity, which may include severe pain,
  564  such that the absence of immediate medical attention could
  565  reasonably be expected to result in any of the following:
  566         1. Serious jeopardy to patient health, including a pregnant
  567  woman or fetus.
  568         2. Serious impairment to bodily functions.
  569         3. Serious dysfunction of any bodily organ or part.
  570         (b) With respect to a pregnant woman:
  571         1. That there is inadequate time to effect safe transfer to
  572  another hospital prior to delivery;
  573         2. That a transfer may pose a threat to the health and
  574  safety of the patient or fetus; or
  575         3. That there is evidence of the onset and persistence of
  576  uterine contractions or rupture of the membranes.
  577         (9) “Emergency services and care” means medical screening,
  578  examination, and evaluation by a physician, or, to the extent
  579  permitted by applicable law, by other appropriate personnel
  580  under the supervision of a physician, to determine if an
  581  emergency medical condition exists and, if it does, the care,
  582  treatment, or surgery by a physician necessary to relieve or
  583  eliminate the emergency medical condition, within the service
  584  capability of the facility.
  585         (10) “General hospital” means any facility that which meets
  586  the provisions of subsection (12) and which regularly makes its
  587  facilities and services available to the general population.
  588         (11) “Governmental unit” means the state or any county,
  589  municipality, or other political subdivision, or any department,
  590  division, board, or other agency of any of the foregoing.
  591         (12) “Hospital” means any establishment that:
  592         (a) Offers services more intensive than those required for
  593  room, board, personal services, and general nursing care, and
  594  offers facilities and beds for use beyond 24 hours by
  595  individuals requiring diagnosis, treatment, or care for illness,
  596  injury, deformity, infirmity, abnormality, disease, or
  597  pregnancy; and
  598         (b) Regularly makes available at least clinical laboratory
  599  services, diagnostic X-ray services, and treatment facilities
  600  for surgery or obstetrical care, or other definitive medical
  601  treatment of similar extent, except that a critical access
  602  hospital, as defined in s. 408.07, shall not be required to make
  603  available treatment facilities for surgery, obstetrical care, or
  604  similar services as long as it maintains its critical access
  605  hospital designation and shall be required to make such
  606  facilities available only if it ceases to be designated as a
  607  critical access hospital.
  608  
  609  However, the provisions of this chapter does do not apply to any
  610  institution conducted by or for the adherents of any well
  611  recognized church or religious denomination that depends
  612  exclusively upon prayer or spiritual means to heal, care for, or
  613  treat any person. For purposes of local zoning matters, the term
  614  “hospital” includes a medical office building located on the
  615  same premises as a hospital facility, provided the land on which
  616  the medical office building is constructed is zoned for use as a
  617  hospital; provided the premises were zoned for hospital purposes
  618  on January 1, 1992.
  619         (13) “Hospital bed” means a hospital accommodation that
  620  which is ready for immediate occupancy, or is capable of being
  621  made ready for occupancy within 48 hours, excluding provision of
  622  staffing, and which conforms to minimum space, equipment, and
  623  furnishings standards as specified by rule of the agency for the
  624  provision of services specified in this section to a single
  625  patient.
  626         (14) “Initial denial determination” means a determination
  627  by a private review agent that the health care services
  628  furnished or proposed to be furnished to a patient are
  629  inappropriate, not medically necessary, or not reasonable.
  630         (14)(15) “Intensive residential treatment programs for
  631  children and adolescents” means a specialty hospital accredited
  632  by an accrediting organization as defined in subsection (1)
  633  which provides 24-hour care and which has the primary functions
  634  of diagnosis and treatment of patients under the age of 18
  635  having psychiatric disorders in order to restore such patients
  636  to an optimal level of functioning.
  637         (15)(16) “Licensed facility” means a hospital, ambulatory
  638  surgical center, or mobile surgical facility licensed in
  639  accordance with this chapter.
  640         (16)(17) “Lifesafety” means the control and prevention of
  641  fire and other life-threatening conditions on a premises for the
  642  purpose of preserving human life.
  643         (17)(18) “Managing employee” means the administrator or
  644  other similarly titled individual who is responsible for the
  645  daily operation of the facility.
  646         (18)(19) “Medical staff” means physicians licensed under
  647  chapter 458 or chapter 459 with privileges in a licensed
  648  facility, as well as other licensed health care practitioners
  649  with clinical privileges as approved by a licensed facility’s
  650  governing board.
  651         (19)(20) “Medically necessary transfer” means a transfer
  652  made necessary because the patient is in immediate need of
  653  treatment for an emergency medical condition for which the
  654  facility lacks service capability or is at service capacity.
  655         (20)(21) “Mobile surgical facility” is a mobile facility in
  656  which licensed health care professionals provide elective
  657  surgical care under contract with the Department of Corrections
  658  or a private correctional facility operating pursuant to chapter
  659  957 and in which inmate patients are admitted to and discharged
  660  from said facility within the same working day and are not
  661  permitted to stay overnight. However, mobile surgical facilities
  662  may only provide health care services to the inmate patients of
  663  the Department of Corrections, or inmate patients of a private
  664  correctional facility operating pursuant to chapter 957, and not
  665  to the general public.
  666         (21)(22) “Person” means any individual, partnership,
  667  corporation, association, or governmental unit.
  668         (22)(23) “Premises” means those buildings, beds, and
  669  equipment located at the address of the licensed facility and
  670  all other buildings, beds, and equipment for the provision of
  671  hospital, ambulatory surgical, or mobile surgical care located
  672  in such reasonable proximity to the address of the licensed
  673  facility as to appear to the public to be under the dominion and
  674  control of the licensee. For any licensee that is a teaching
  675  hospital as defined in s. 408.07(45), reasonable proximity
  676  includes any buildings, beds, services, programs, and equipment
  677  under the dominion and control of the licensee that are located
  678  at a site with a main address that is within 1 mile of the main
  679  address of the licensed facility; and all such buildings, beds,
  680  and equipment may, at the request of a licensee or applicant, be
  681  included on the facility license as a single premises.
  682         (24) “Private review agent” means any person or entity
  683  which performs utilization review services for third-party
  684  payors on a contractual basis for outpatient or inpatient
  685  services. However, the term shall not include full-time
  686  employees, personnel, or staff of health insurers, health
  687  maintenance organizations, or hospitals, or wholly owned
  688  subsidiaries thereof or affiliates under common ownership, when
  689  performing utilization review for their respective hospitals,
  690  health maintenance organizations, or insureds of the same
  691  insurance group. For this purpose, health insurers, health
  692  maintenance organizations, and hospitals, or wholly owned
  693  subsidiaries thereof or affiliates under common ownership,
  694  include such entities engaged as administrators of self
  695  insurance as defined in s. 624.031.
  696         (23)(25) “Service capability” means all services offered by
  697  the facility where identification of services offered is
  698  evidenced by the appearance of the service in a patient’s
  699  medical record or itemized bill.
  700         (24)(26) “At service capacity” means the temporary
  701  inability of a hospital to provide a service that which is
  702  within the service capability of the hospital, due to maximum
  703  use of the service at the time of the request for the service.
  704         (25)(27) “Specialty bed” means a bed, other than a general
  705  bed, designated on the face of the hospital license for a
  706  dedicated use.
  707         (26)(28) “Specialty hospital” means any facility that which
  708  meets the provisions of subsection (12), and which regularly
  709  makes available either:
  710         (a) The range of medical services offered by general
  711  hospitals, but restricted to a defined age or gender group of
  712  the population;
  713         (b) A restricted range of services appropriate to the
  714  diagnosis, care, and treatment of patients with specific
  715  categories of medical or psychiatric illnesses or disorders; or
  716         (c) Intensive residential treatment programs for children
  717  and adolescents as defined in subsection (15).
  718         (27)(29) “Stabilized” means, with respect to an emergency
  719  medical condition, that no material deterioration of the
  720  condition is likely, within reasonable medical probability, to
  721  result from the transfer of the patient from a hospital.
  722         (30) “Utilization review” means a system for reviewing the
  723  medical necessity or appropriateness in the allocation of health
  724  care resources of hospital services given or proposed to be
  725  given to a patient or group of patients.
  726         (31) “Utilization review plan” means a description of the
  727  policies and procedures governing utilization review activities
  728  performed by a private review agent.
  729         (28)(32) “Validation inspection” means an inspection of the
  730  premises of a licensed facility by the agency to assess whether
  731  a review by an accrediting organization has adequately evaluated
  732  the licensed facility according to minimum state standards.
  733         Section 9. Subsection (1) and paragraph (b) of subsection
  734  (2) of section 395.003, Florida Statutes, are amended to read:
  735         395.003 Licensure; denial, suspension, and revocation.—
  736         (1)(a) The requirements of part II of chapter 408 apply to
  737  the provision of services that require licensure pursuant to ss.
  738  395.001-395.1065 and part II of chapter 408 and to entities
  739  licensed by or applying for such licensure from the Agency for
  740  Health Care Administration pursuant to ss. 395.001-395.1065. A
  741  license issued by the agency is required in order to operate a
  742  hospital, ambulatory surgical center, or mobile surgical
  743  facility in this state.
  744         (b)1. It is unlawful for a person to use or advertise to
  745  the public, in any way or by any medium whatsoever, any facility
  746  as a “hospital,” “ambulatory surgical center,” or “mobile
  747  surgical facility” unless such facility has first secured a
  748  license under the provisions of this part.
  749         2. This part does not apply to veterinary hospitals or to
  750  commercial business establishments using the word “hospital,”
  751  “ambulatory surgical center,” or “mobile surgical facility” as a
  752  part of a trade name if no treatment of human beings is
  753  performed on the premises of such establishments.
  754         (c) Until July 1, 2006, additional emergency departments
  755  located off the premises of licensed hospitals may not be
  756  authorized by the agency.
  757         (2)
  758         (b) The agency shall, at the request of a licensee that is
  759  a teaching hospital as defined in s. 408.07(45), issue a single
  760  license to a licensee for facilities that have been previously
  761  licensed as separate premises, provided such separately licensed
  762  facilities, taken together, constitute the same premises as
  763  defined in s. 395.002(22) s. 395.002(23). Such license for the
  764  single premises shall include all of the beds, services, and
  765  programs that were previously included on the licenses for the
  766  separate premises. The granting of a single license under this
  767  paragraph shall not in any manner reduce the number of beds,
  768  services, or programs operated by the licensee.
  769         Section 10. Paragraph (e) of subsection (2) and subsection
  770  (4) of section 395.0193, Florida Statutes, are amended to read:
  771         395.0193 Licensed facilities; peer review; disciplinary
  772  powers; agency or partnership with physicians.—
  773         (2) Each licensed facility, as a condition of licensure,
  774  shall provide for peer review of physicians who deliver health
  775  care services at the facility. Each licensed facility shall
  776  develop written, binding procedures by which such peer review
  777  shall be conducted. Such procedures shall include:
  778         (e) Recording of agendas and minutes that which do not
  779  contain confidential material, for review by the Division of
  780  Medical Quality Assurance of the department Health Quality
  781  Assurance of the agency.
  782         (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
  783  actions taken under subsection (3) shall be reported in writing
  784  to the Division of Medical Quality Assurance of the department
  785  Health Quality Assurance of the agency within 30 working days
  786  after its initial occurrence, regardless of the pendency of
  787  appeals to the governing board of the hospital. The notification
  788  shall identify the disciplined practitioner, the action taken,
  789  and the reason for such action. All final disciplinary actions
  790  taken under subsection (3), if different from those which were
  791  reported to the department agency within 30 days after the
  792  initial occurrence, shall be reported within 10 working days to
  793  the Division of Medical Quality Assurance of the department
  794  Health Quality Assurance of the agency in writing and shall
  795  specify the disciplinary action taken and the specific grounds
  796  therefor. The division shall review each report and determine
  797  whether it potentially involved conduct by the licensee that is
  798  subject to disciplinary action, in which case s. 456.073 shall
  799  apply. The reports are not subject to inspection under s.
  800  119.07(1) even if the division’s investigation results in a
  801  finding of probable cause.
  802         Section 11. Section 395.1023, Florida Statutes, is amended
  803  to read:
  804         395.1023 Child abuse and neglect cases; duties.—Each
  805  licensed facility shall adopt a protocol that, at a minimum,
  806  requires the facility to:
  807         (1) Incorporate a facility policy that every staff member
  808  has an affirmative duty to report, pursuant to chapter 39, any
  809  actual or suspected case of child abuse, abandonment, or
  810  neglect; and
  811         (2) In any case involving suspected child abuse,
  812  abandonment, or neglect, designate, at the request of the
  813  Department of Children and Family Services department, a staff
  814  physician to act as a liaison between the hospital and the
  815  Department of Children and Family Services office that which is
  816  investigating the suspected abuse, abandonment, or neglect, and
  817  the child protection team, as defined in s. 39.01, when the case
  818  is referred to such a team.
  819  
  820  Each general hospital and appropriate specialty hospital shall
  821  comply with the provisions of this section and shall notify the
  822  agency and the Department of Children and Family Services
  823  department of its compliance by sending a copy of its policy to
  824  the agency and the Department of Children and Family Services
  825  department as required by rule. The failure by a general
  826  hospital or appropriate specialty hospital to comply shall be
  827  punished by a fine not exceeding $1,000, to be fixed, imposed,
  828  and collected by the agency. Each day in violation is considered
  829  a separate offense.
  830         Section 12. Subsection (2) and paragraph (d) of subsection
  831  (3) of section 395.1041, Florida Statutes, are amended to read:
  832         395.1041 Access to emergency services and care.—
  833         (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
  834  shall establish and maintain an inventory of hospitals with
  835  emergency services. The inventory shall list all services within
  836  the service capability of the hospital, and such services shall
  837  appear on the face of the hospital license. Each hospital having
  838  emergency services shall notify the agency of its service
  839  capability in the manner and form prescribed by the agency. The
  840  agency shall use the inventory to assist emergency medical
  841  services providers and others in locating appropriate emergency
  842  medical care. The inventory shall also be made available to the
  843  general public. On or before August 1, 1992, the agency shall
  844  request that each hospital identify the services which are
  845  within its service capability. On or before November 1, 1992,
  846  the agency shall notify each hospital of the service capability
  847  to be included in the inventory. The hospital has 15 days from
  848  the date of receipt to respond to the notice. By December 1,
  849  1992, the agency shall publish a final inventory. Each hospital
  850  shall reaffirm its service capability when its license is
  851  renewed and shall notify the agency of the addition of a new
  852  service or the termination of a service prior to a change in its
  853  service capability.
  854         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
  855  FACILITY OR HEALTH CARE PERSONNEL.—
  856         (d)1. Every hospital shall ensure the provision of services
  857  within the service capability of the hospital, at all times,
  858  either directly or indirectly through an arrangement with
  859  another hospital, through an arrangement with one or more
  860  physicians, or as otherwise made through prior arrangements. A
  861  hospital may enter into an agreement with another hospital for
  862  purposes of meeting its service capability requirement, and
  863  appropriate compensation or other reasonable conditions may be
  864  negotiated for these backup services.
  865         2. If any arrangement requires the provision of emergency
  866  medical transportation, such arrangement must be made in
  867  consultation with the applicable provider and may not require
  868  the emergency medical service provider to provide transportation
  869  that is outside the routine service area of that provider or in
  870  a manner that impairs the ability of the emergency medical
  871  service provider to timely respond to prehospital emergency
  872  calls.
  873         3. A hospital shall not be required to ensure service
  874  capability at all times as required in subparagraph 1. if, prior
  875  to the receiving of any patient needing such service capability,
  876  such hospital has demonstrated to the agency that it lacks the
  877  ability to ensure such capability and it has exhausted all
  878  reasonable efforts to ensure such capability through backup
  879  arrangements. In reviewing a hospital’s demonstration of lack of
  880  ability to ensure service capability, the agency shall consider
  881  factors relevant to the particular case, including the
  882  following:
  883         a. Number and proximity of hospitals with the same service
  884  capability.
  885         b. Number, type, credentials, and privileges of
  886  specialists.
  887         c. Frequency of procedures.
  888         d. Size of hospital.
  889         4. The agency shall publish proposed rules implementing a
  890  reasonable exemption procedure by November 1, 1992. Subparagraph
  891  1. shall become effective upon the effective date of said rules
  892  or January 31, 1993, whichever is earlier. For a period not to
  893  exceed 1 year from the effective date of subparagraph 1., a
  894  hospital requesting an exemption shall be deemed to be exempt
  895  from offering the service until the agency initially acts to
  896  deny or grant the original request. The agency has 45 days from
  897  the date of receipt of the request to approve or deny the
  898  request. After the first year from the effective date of
  899  subparagraph 1., If the agency fails to initially act within the
  900  time period, the hospital is deemed to be exempt from offering
  901  the service until the agency initially acts to deny the request.
  902         Section 13. Section 395.1046, Florida Statutes, is
  903  repealed.
  904         Section 14. Paragraph (e) of subsection (1) of section
  905  395.1055, Florida Statutes, is amended to read:
  906         395.1055 Rules and enforcement.—
  907         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  908  and 120.54 to implement the provisions of this part, which shall
  909  include reasonable and fair minimum standards for ensuring that:
  910         (e) Licensed facility beds conform to minimum space,
  911  equipment, and furnishings standards as specified by the agency,
  912  the Florida Building Code, and the Florida Fire Prevention Code
  913  department.
  914         Section 15. Subsection (1) of section 395.10972, Florida
  915  Statutes, is amended to read:
  916         395.10972 Health Care Risk Manager Advisory Council.—The
  917  Secretary of Health Care Administration may appoint a seven
  918  member advisory council to advise the agency on matters
  919  pertaining to health care risk managers. The members of the
  920  council shall serve at the pleasure of the secretary. The
  921  council shall designate a chair. The council shall meet at the
  922  call of the secretary or at those times as may be required by
  923  rule of the agency. The members of the advisory council shall
  924  receive no compensation for their services, but shall be
  925  reimbursed for travel expenses as provided in s. 112.061. The
  926  council shall consist of individuals representing the following
  927  areas:
  928         (1) Two shall be active health care risk managers,
  929  including one risk manager who is recommended by and a member of
  930  the Florida Society for of Healthcare Risk Management and
  931  Patient Safety.
  932         Section 16. Subsection (3) of section 395.2050, Florida
  933  Statutes, is amended to read:
  934         395.2050 Routine inquiry for organ and tissue donation;
  935  certification for procurement activities; death records review.—
  936         (3) Each organ procurement organization designated by the
  937  federal Centers for Medicare and Medicaid Services Health Care
  938  Financing Administration and licensed by the state shall conduct
  939  an annual death records review in the organ procurement
  940  organization’s affiliated donor hospitals. The organ procurement
  941  organization shall enlist the services of every Florida licensed
  942  tissue bank and eye bank affiliated with or providing service to
  943  the donor hospital and operating in the same service area to
  944  participate in the death records review.
  945         Section 17. Subsection (2) of section 395.3036, Florida
  946  Statutes, is amended to read:
  947         395.3036 Confidentiality of records and meetings of
  948  corporations that lease public hospitals or other public health
  949  care facilities.—The records of a private corporation that
  950  leases a public hospital or other public health care facility
  951  are confidential and exempt from the provisions of s. 119.07(1)
  952  and s. 24(a), Art. I of the State Constitution, and the meetings
  953  of the governing board of a private corporation are exempt from
  954  s. 286.011 and s. 24(b), Art. I of the State Constitution when
  955  the public lessor complies with the public finance
  956  accountability provisions of s. 155.40(5) with respect to the
  957  transfer of any public funds to the private lessee and when the
  958  private lessee meets at least three of the five following
  959  criteria:
  960         (2) The public lessor and the private lessee do not
  961  commingle any of their funds in any account maintained by either
  962  of them, other than the payment of the rent and administrative
  963  fees or the transfer of funds pursuant to subsection (5)(2).
  964         Section 18. Section 395.3037, Florida Statutes, is
  965  repealed.
  966         Section 19. Subsections (1), (4), and (5) of section
  967  395.3038, Florida Statutes, are amended to read:
  968         395.3038 State-listed primary stroke centers and
  969  comprehensive stroke centers; notification of hospitals.—
  970         (1) The agency shall make available on its website and to
  971  the department a list of the name and address of each hospital
  972  that meets the criteria for a primary stroke center and the name
  973  and address of each hospital that meets the criteria for a
  974  comprehensive stroke center. The list of primary and
  975  comprehensive stroke centers shall include only those hospitals
  976  that attest in an affidavit submitted to the agency that the
  977  hospital meets the named criteria, or those hospitals that
  978  attest in an affidavit submitted to the agency that the hospital
  979  is certified as a primary or a comprehensive stroke center by
  980  the Joint Commission on Accreditation of Healthcare
  981  Organizations.
  982         (4) The agency shall adopt by rule criteria for a primary
  983  stroke center which are substantially similar to the
  984  certification standards for primary stroke centers of the Joint
  985  Commission on Accreditation of Healthcare Organizations.
  986         (5) The agency shall adopt by rule criteria for a
  987  comprehensive stroke center. However, if the Joint Commission on
  988  Accreditation of Healthcare Organizations establishes criteria
  989  for a comprehensive stroke center, the agency shall establish
  990  criteria for a comprehensive stroke center which are
  991  substantially similar to those criteria established by the Joint
  992  Commission on Accreditation of Healthcare Organizations.
  993         Section 20. Subsection (2) of section 395.602, Florida
  994  Statutes, is amended to read:
  995         395.602 Rural hospitals.—
  996         (2) DEFINITIONS.—As used in this part:
  997         (a) “Emergency care hospital” means a medical facility that
  998  which provides:
  999         1. Emergency medical treatment; and
 1000         2. Inpatient care to ill or injured persons prior to their
 1001  transportation to another hospital or provides inpatient medical
 1002  care to persons needing care for a period of up to 96 hours. The
 1003  96-hour limitation on inpatient care does not apply to respite,
 1004  skilled nursing, hospice, or other nonacute care patients.
 1005         (b) “Essential access community hospital” means any
 1006  facility that which:
 1007         1. Has at least 100 beds;
 1008         2. Is located more than 35 miles from any other essential
 1009  access community hospital, rural referral center, or urban
 1010  hospital meeting criteria for classification as a regional
 1011  referral center;
 1012         3. Is part of a network that includes rural primary care
 1013  hospitals;
 1014         4. Provides emergency and medical backup services to rural
 1015  primary care hospitals in its rural health network;
 1016         5. Extends staff privileges to rural primary care hospital
 1017  physicians in its network; and
 1018         6. Accepts patients transferred from rural primary care
 1019  hospitals in its network.
 1020         (c) “Inactive rural hospital bed” means a licensed acute
 1021  care hospital bed, as defined in s. 395.002(13), that is
 1022  inactive in that it cannot be occupied by acute care inpatients.
 1023         (d) “Rural area health education center” means an area
 1024  health education center (AHEC), as authorized by Pub. L. No. 94
 1025  484, which provides services in a county with a population
 1026  density of no greater than 100 persons per square mile.
 1027         (e) “Rural hospital” means an acute care hospital licensed
 1028  under this chapter which has, having 100 or fewer licensed beds
 1029  and an emergency room and, which is:
 1030         1. The sole provider within a county with a population
 1031  density of no greater than 100 persons per square mile;
 1032         2. An acute care hospital, in a county with a population
 1033  density of no greater than 100 persons per square mile, which is
 1034  at least 30 minutes of travel time, on normally traveled roads
 1035  under normal traffic conditions, from any other acute care
 1036  hospital within the same county;
 1037         3. A hospital supported by a tax district or subdistrict
 1038  whose boundaries encompass a population of 100 persons or fewer
 1039  per square mile;
 1040         4. A hospital in a constitutional charter county with a
 1041  population of over 1 million persons that has imposed a local
 1042  option health service tax pursuant to law and in an area that
 1043  was directly impacted by a catastrophic event on August 24,
 1044  1992, for which the Governor of Florida declared a state of
 1045  emergency pursuant to chapter 125, and has 120 beds or less that
 1046  serves an agricultural community with an emergency room
 1047  utilization of no less than 20,000 visits and a Medicaid
 1048  inpatient utilization rate greater than 15 percent;
 1049         4.5. A hospital with a service area that has a population
 1050  of 100 persons or fewer per square mile. As used in this
 1051  subparagraph, the term “service area” means the fewest number of
 1052  zip codes that account for 75 percent of the hospital’s
 1053  discharges for the most recent 5-year period, based on
 1054  information available from the hospital inpatient discharge
 1055  database in the Florida Center for Health Information and Policy
 1056  Analysis at the Agency for Health Care Administration; or
 1057         5.6. A hospital designated as a critical access hospital,
 1058  as defined in s. 408.07(15).
 1059  
 1060  Population densities used in this paragraph must be based upon
 1061  the most recently completed United States census. A hospital
 1062  that received funds under s. 409.9116 for a quarter beginning no
 1063  later than July 1, 2002, is deemed to have been and shall
 1064  continue to be a rural hospital from that date through June 30,
 1065  2015, if the hospital continues to have 100 or fewer licensed
 1066  beds and an emergency room, or meets the criteria of
 1067  subparagraph 4. An acute care hospital that has not previously
 1068  been designated as a rural hospital and that meets the criteria
 1069  of this paragraph shall be granted such designation upon
 1070  application, including supporting documentation to the Agency
 1071  for Health Care Administration.
 1072         (f) “Rural primary care hospital” means any facility
 1073  meeting the criteria in paragraph (e) or s. 395.605 which
 1074  provides:
 1075         1. Twenty-four-hour emergency medical care;
 1076         2. Temporary inpatient care for periods of 72 hours or less
 1077  to patients requiring stabilization before discharge or transfer
 1078  to another hospital. The 72-hour limitation does not apply to
 1079  respite, skilled nursing, hospice, or other nonacute care
 1080  patients; and
 1081         3. Has no more than six licensed acute care inpatient beds.
 1082         (g) “Swing-bed” means a bed that which can be used
 1083  interchangeably as either a hospital, skilled nursing facility
 1084  (SNF), or intermediate care facility (ICF) bed pursuant to 42
 1085  C.F.R. parts 405, 435, 440, 442, and 447.
 1086         Section 21. Subsection (8) of section 400.021, Florida
 1087  Statutes, is amended to read:
 1088         400.021 Definitions.—When used in this part, unless the
 1089  context otherwise requires, the term:
 1090         (8) “Geriatric outpatient clinic” means a site for
 1091  providing outpatient health care to persons 60 years of age or
 1092  older, which is staffed by a registered nurse or a physician
 1093  assistant, a licensed practical nurse under the direct
 1094  supervision of a registered nurse, or an advanced registered
 1095  nurse practitioner.
 1096         Section 22. Paragraph (g) of subsection (2) of section
 1097  400.0239, Florida Statutes, is amended to read:
 1098         400.0239 Quality of Long-Term Care Facility Improvement
 1099  Trust Fund.—
 1100         (2) Expenditures from the trust fund shall be allowable for
 1101  direct support of the following:
 1102         (g) Other initiatives authorized by the Centers for
 1103  Medicare and Medicaid Services for the use of federal civil
 1104  monetary penalties, including projects recommended through the
 1105  Medicaid “Up-or-Out” Quality of Care Contract Management Program
 1106  pursuant to s. 400.148.
 1107         Section 23. Subsection (15) of section 400.0255, Florida
 1108  Statutes, is amended to read
 1109         400.0255 Resident transfer or discharge; requirements and
 1110  procedures; hearings.—
 1111         (15)(a) The department’s Office of Appeals Hearings shall
 1112  conduct hearings under this section. The office shall notify the
 1113  facility of a resident’s request for a hearing.
 1114         (b) The department shall, by rule, establish procedures to
 1115  be used for fair hearings requested by residents. These
 1116  procedures shall be equivalent to the procedures used for fair
 1117  hearings for other Medicaid cases appearing in s. 409.285 and
 1118  applicable rules, chapter 10-2, part VI, Florida Administrative
 1119  Code. The burden of proof must be clear and convincing evidence.
 1120  A hearing decision must be rendered within 90 days after receipt
 1121  of the request for hearing.
 1122         (c) If the hearing decision is favorable to the resident
 1123  who has been transferred or discharged, the resident must be
 1124  readmitted to the facility’s first available bed.
 1125         (d) The decision of the hearing officer shall be final. Any
 1126  aggrieved party may appeal the decision to the district court of
 1127  appeal in the appellate district where the facility is located.
 1128  Review procedures shall be conducted in accordance with the
 1129  Florida Rules of Appellate Procedure.
 1130         Section 24. Subsection (2) of section 400.063, Florida
 1131  Statutes, is amended to read:
 1132         400.063 Resident protection.—
 1133         (2) The agency is authorized to establish for each
 1134  facility, subject to intervention by the agency, a separate bank
 1135  account for the deposit to the credit of the agency of any
 1136  moneys received from the Health Care Trust Fund or any other
 1137  moneys received for the maintenance and care of residents in the
 1138  facility, and the agency is authorized to disburse moneys from
 1139  such account to pay obligations incurred for the purposes of
 1140  this section. The agency is authorized to requisition moneys
 1141  from the Health Care Trust Fund in advance of an actual need for
 1142  cash on the basis of an estimate by the agency of moneys to be
 1143  spent under the authority of this section. Any bank account
 1144  established under this section need not be approved in advance
 1145  of its creation as required by s. 17.58, but shall be secured by
 1146  depository insurance equal to or greater than the balance of
 1147  such account or by the pledge of collateral security in
 1148  conformance with criteria established in s. 18.11. The agency
 1149  shall notify the Chief Financial Officer of any such account so
 1150  established and shall make a quarterly accounting to the Chief
 1151  Financial Officer for all moneys deposited in such account.
 1152         Section 25. Subsections (1) and (5) of section 400.071,
 1153  Florida Statutes, are amended to read:
 1154         400.071 Application for license.—
 1155         (1) In addition to the requirements of part II of chapter
 1156  408, the application for a license shall be under oath and must
 1157  contain the following:
 1158         (a) The location of the facility for which a license is
 1159  sought and an indication, as in the original application, that
 1160  such location conforms to the local zoning ordinances.
 1161         (b) A signed affidavit disclosing any financial or
 1162  ownership interest that a controlling interest as defined in
 1163  part II of chapter 408 has held in the last 5 years in any
 1164  entity licensed by this state or any other state to provide
 1165  health or residential care which has closed voluntarily or
 1166  involuntarily; has filed for bankruptcy; has had a receiver
 1167  appointed; has had a license denied, suspended, or revoked; or
 1168  has had an injunction issued against it which was initiated by a
 1169  regulatory agency. The affidavit must disclose the reason any
 1170  such entity was closed, whether voluntarily or involuntarily.
 1171         (c) The total number of beds and the total number of
 1172  Medicare and Medicaid certified beds.
 1173         (b)(d) Information relating to the applicant and employees
 1174  which the agency requires by rule. The applicant must
 1175  demonstrate that sufficient numbers of qualified staff, by
 1176  training or experience, will be employed to properly care for
 1177  the type and number of residents who will reside in the
 1178  facility.
 1179         (c)(e) Copies of any civil verdict or judgment involving
 1180  the applicant rendered within the 10 years preceding the
 1181  application, relating to medical negligence, violation of
 1182  residents’ rights, or wrongful death. As a condition of
 1183  licensure, the licensee agrees to provide to the agency copies
 1184  of any new verdict or judgment involving the applicant, relating
 1185  to such matters, within 30 days after filing with the clerk of
 1186  the court. The information required in this paragraph shall be
 1187  maintained in the facility’s licensure file and in an agency
 1188  database that which is available as a public record.
 1189         (5) As a condition of licensure, each facility must
 1190  establish and submit with its application a plan for quality
 1191  assurance and for conducting risk management.
 1192         Section 26. Section 400.0712, Florida Statutes, is amended
 1193  to read:
 1194         400.0712 Application for inactive license.—
 1195         (1) As specified in this section, the agency may issue an
 1196  inactive license to a nursing home facility for all or a portion
 1197  of its beds. Any request by a licensee that a nursing home or
 1198  portion of a nursing home become inactive must be submitted to
 1199  the agency in the approved format. The facility may not initiate
 1200  any suspension of services, notify residents, or initiate
 1201  inactivity before receiving approval from the agency; and a
 1202  licensee that violates this provision may not be issued an
 1203  inactive license.
 1204         (1)(2)In addition to the authority granted in part II of
 1205  chapter 408, the agency may issue an inactive license to a
 1206  nursing home that chooses to use an unoccupied contiguous
 1207  portion of the facility for an alternative use to meet the needs
 1208  of elderly persons through the use of less restrictive, less
 1209  institutional services.
 1210         (a) An inactive license issued under this subsection may be
 1211  granted for a period not to exceed the current licensure
 1212  expiration date but may be renewed by the agency at the time of
 1213  licensure renewal.
 1214         (b) A request to extend the inactive license must be
 1215  submitted to the agency in the approved format and approved by
 1216  the agency in writing.
 1217         (c) Nursing homes that receive an inactive license to
 1218  provide alternative services shall not receive preference for
 1219  participation in the Assisted Living for the Elderly Medicaid
 1220  waiver.
 1221         (2)(3) The agency shall adopt rules pursuant to ss.
 1222  120.536(1) and 120.54 necessary to administer implement this
 1223  section.
 1224         Section 27. Section 400.111, Florida Statutes, is amended
 1225  to read:
 1226         400.111 Disclosure of controlling interest.—In addition to
 1227  the requirements of part II of chapter 408, when requested by
 1228  the agency, the licensee shall submit a signed affidavit
 1229  disclosing any financial or ownership interest that a
 1230  controlling interest has held within the last 5 years in any
 1231  entity licensed by the state or any other state to provide
 1232  health or residential care if that which entity has closed
 1233  voluntarily or involuntarily; has filed for bankruptcy; has had
 1234  a receiver appointed; has had a license denied, suspended, or
 1235  revoked; or has had an injunction issued against it which was
 1236  initiated by a regulatory agency. The affidavit must disclose
 1237  the reason such entity was closed, whether voluntarily or
 1238  involuntarily.
 1239         Section 28. Section 400.1183, Florida Statutes, is amended
 1240  to read:
 1241         400.1183 Resident grievance procedures.—
 1242         (1) Every nursing home must have a grievance procedure
 1243  available to its residents and their families. The grievance
 1244  procedure must include:
 1245         (a) An explanation of how to pursue redress of a grievance.
 1246         (b) The names, job titles, and telephone numbers of the
 1247  employees responsible for implementing the facility’s grievance
 1248  procedure. The list must include the address and the toll-free
 1249  telephone numbers of the ombudsman and the agency.
 1250         (c) A simple description of the process through which a
 1251  resident may, at any time, contact the toll-free telephone
 1252  hotline of the ombudsman or the agency to report the unresolved
 1253  grievance.
 1254         (d) A procedure for providing assistance to residents who
 1255  cannot prepare a written grievance without help.
 1256         (2) Each facility shall maintain records of all grievances
 1257  for agency inspection and shall report to the agency at the time
 1258  of relicensure the total number of grievances handled during the
 1259  prior licensure period, a categorization of the cases underlying
 1260  the grievances, and the final disposition of the grievances.
 1261         (3) Each facility must respond to the grievance within a
 1262  reasonable time after its submission.
 1263         (4) The agency may investigate any grievance at any time.
 1264         Section 29. Section 400.141, Florida Statutes, is amended
 1265  to read:
 1266         400.141 Administration and management of nursing home
 1267  facilities.—
 1268         (1) Every licensed facility shall comply with all
 1269  applicable standards and rules of the agency and shall:
 1270         (a) Be under the administrative direction and charge of a
 1271  licensed administrator.
 1272         (b) Appoint a medical director licensed pursuant to chapter
 1273  458 or chapter 459. The agency may establish by rule more
 1274  specific criteria for the appointment of a medical director.
 1275         (c) Have available the regular, consultative, and emergency
 1276  services of physicians licensed by the state.
 1277         (d) Provide for resident use of a community pharmacy as
 1278  specified in s. 400.022(1)(q). Any other law to the contrary
 1279  notwithstanding, a registered pharmacist licensed in Florida,
 1280  that is under contract with a facility licensed under this
 1281  chapter or chapter 429, shall repackage a nursing facility
 1282  resident’s bulk prescription medication that which has been
 1283  packaged by another pharmacist licensed in any state in the
 1284  United States into a unit dose system compatible with the system
 1285  used by the nursing facility, if the pharmacist is requested to
 1286  offer such service. In order to be eligible for the repackaging,
 1287  a resident or the resident’s spouse must receive prescription
 1288  medication benefits provided through a former employer as part
 1289  of his or her retirement benefits, a qualified pension plan as
 1290  specified in s. 4972 of the Internal Revenue Code, a federal
 1291  retirement program as specified under 5 C.F.R. s. 831, or a
 1292  long-term care policy as defined in s. 627.9404(1). A pharmacist
 1293  who correctly repackages and relabels the medication and the
 1294  nursing facility that which correctly administers such
 1295  repackaged medication under this paragraph may not be held
 1296  liable in any civil or administrative action arising from the
 1297  repackaging. In order to be eligible for the repackaging, a
 1298  nursing facility resident for whom the medication is to be
 1299  repackaged shall sign an informed consent form provided by the
 1300  facility which includes an explanation of the repackaging
 1301  process and which notifies the resident of the immunities from
 1302  liability provided in this paragraph. A pharmacist who
 1303  repackages and relabels prescription medications, as authorized
 1304  under this paragraph, may charge a reasonable fee for costs
 1305  resulting from the implementation of this provision.
 1306         (e) Provide for the access of the facility residents to
 1307  dental and other health-related services, recreational services,
 1308  rehabilitative services, and social work services appropriate to
 1309  their needs and conditions and not directly furnished by the
 1310  licensee. When a geriatric outpatient nurse clinic is conducted
 1311  in accordance with rules adopted by the agency, outpatients
 1312  attending such clinic shall not be counted as part of the
 1313  general resident population of the nursing home facility, nor
 1314  shall the nursing staff of the geriatric outpatient clinic be
 1315  counted as part of the nursing staff of the facility, until the
 1316  outpatient clinic load exceeds 15 a day.
 1317         (f) Be allowed and encouraged by the agency to provide
 1318  other needed services under certain conditions. If the facility
 1319  has a standard licensure status, and has had no class I or class
 1320  II violations deficiencies during the past 2 years or has been
 1321  awarded a Gold Seal under the program established in s. 400.235,
 1322  it may be encouraged by the agency to provide services,
 1323  including, but not limited to, respite and adult day services
 1324  that, which enable individuals to move in and out of the
 1325  facility. A facility is not subject to any additional licensure
 1326  requirements for providing these services. Respite care may be
 1327  offered to persons in need of short-term or temporary nursing
 1328  home services. Respite care must be provided in accordance with
 1329  this part and rules adopted by the agency. However, the agency
 1330  shall, by rule, adopt modified requirements for resident
 1331  assessment, resident care plans, resident contracts, physician
 1332  orders, and other provisions, as appropriate, for short-term or
 1333  temporary nursing home services. The agency shall allow for
 1334  shared programming and staff in a facility that which meets
 1335  minimum standards and offers services pursuant to this
 1336  paragraph, but, if the facility is cited for deficiencies in
 1337  patient care, may require additional staff and programs
 1338  appropriate to the needs of service recipients. A person who
 1339  receives respite care may not be counted as a resident of the
 1340  facility for purposes of the facility’s licensed capacity unless
 1341  that person receives 24-hour respite care. A person receiving
 1342  either respite care for 24 hours or longer or adult day services
 1343  must be included when calculating minimum staffing for the
 1344  facility. Any costs and revenues generated by a nursing home
 1345  facility from nonresidential programs or services shall be
 1346  excluded from the calculations of Medicaid per diems for nursing
 1347  home institutional care reimbursement.
 1348         (g) If the facility has a standard license or is a Gold
 1349  Seal facility, exceeds the minimum required hours of licensed
 1350  nursing and certified nursing assistant direct care per resident
 1351  per day, and is part of a continuing care facility licensed
 1352  under chapter 651 or a retirement community that offers other
 1353  services pursuant to part III of this chapter or part I or part
 1354  III of chapter 429 on a single campus, be allowed to share
 1355  programming and staff. At the time of inspection and in the
 1356  semiannual report required pursuant to paragraph (o), a
 1357  continuing care facility or retirement community that uses this
 1358  option must demonstrate through staffing records that minimum
 1359  staffing requirements for the facility were met. Licensed nurses
 1360  and certified nursing assistants who work in the nursing home
 1361  facility may be used to provide services elsewhere on campus if
 1362  the facility exceeds the minimum number of direct care hours
 1363  required per resident per day and the total number of residents
 1364  receiving direct care services from a licensed nurse or a
 1365  certified nursing assistant does not cause the facility to
 1366  violate the staffing ratios required under s. 400.23(3)(a).
 1367  Compliance with the minimum staffing ratios shall be based on
 1368  total number of residents receiving direct care services,
 1369  regardless of where they reside on campus. If the facility
 1370  receives a conditional license, it may not share staff until the
 1371  conditional license status ends. This paragraph does not
 1372  restrict the agency’s authority under federal or state law to
 1373  require additional staff if a facility is cited for deficiencies
 1374  in care which are caused by an insufficient number of certified
 1375  nursing assistants or licensed nurses. The agency may adopt
 1376  rules for the documentation necessary to determine compliance
 1377  with this provision.
 1378         (h) Maintain the facility premises and equipment and
 1379  conduct its operations in a safe and sanitary manner.
 1380         (i) If the licensee furnishes food service, provide a
 1381  wholesome and nourishing diet sufficient to meet generally
 1382  accepted standards of proper nutrition for its residents and
 1383  provide such therapeutic diets as may be prescribed by attending
 1384  physicians. In making rules to implement this paragraph, the
 1385  agency shall be guided by standards recommended by nationally
 1386  recognized professional groups and associations with knowledge
 1387  of dietetics.
 1388         (j) Keep full records of resident admissions and
 1389  discharges; medical and general health status, including medical
 1390  records, personal and social history, and identity and address
 1391  of next of kin or other persons who may have responsibility for
 1392  the affairs of the residents; and individual resident care plans
 1393  including, but not limited to, prescribed services, service
 1394  frequency and duration, and service goals. The records shall be
 1395  open to inspection by the agency.
 1396         (k) Keep such fiscal records of its operations and
 1397  conditions as may be necessary to provide information pursuant
 1398  to this part.
 1399         (l) Furnish copies of personnel records for employees
 1400  affiliated with such facility, to any other facility licensed by
 1401  this state requesting this information pursuant to this part.
 1402  Such information contained in the records may include, but is
 1403  not limited to, disciplinary matters and any reason for
 1404  termination. Any facility releasing such records pursuant to
 1405  this part shall be considered to be acting in good faith and may
 1406  not be held liable for information contained in such records,
 1407  absent a showing that the facility maliciously falsified such
 1408  records.
 1409         (m) Publicly display a poster provided by the agency
 1410  containing the names, addresses, and telephone numbers for the
 1411  state’s abuse hotline, the State Long-Term Care Ombudsman, the
 1412  Agency for Health Care Administration consumer hotline, the
 1413  Advocacy Center for Persons with Disabilities, the Florida
 1414  Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
 1415  with a clear description of the assistance to be expected from
 1416  each.
 1417         (n) Submit to the agency the information specified in s.
 1418  400.071(1)(b) for a management company within 30 days after the
 1419  effective date of the management agreement.
 1420         (n)(o)1. Submit semiannually to the agency, or more
 1421  frequently if requested by the agency, information regarding
 1422  facility staff-to-resident ratios, staff turnover, and staff
 1423  stability, including information regarding certified nursing
 1424  assistants, licensed nurses, the director of nursing, and the
 1425  facility administrator. For purposes of this reporting:
 1426         a. Staff-to-resident ratios must be reported in the
 1427  categories specified in s. 400.23(3)(a) and applicable rules.
 1428  The ratio must be reported as an average for the most recent
 1429  calendar quarter.
 1430         b. Staff turnover must be reported for the most recent 12
 1431  month period ending on the last workday of the most recent
 1432  calendar quarter prior to the date the information is submitted.
 1433  The turnover rate must be computed quarterly, with the annual
 1434  rate being the cumulative sum of the quarterly rates. The
 1435  turnover rate is the total number of terminations or separations
 1436  experienced during the quarter, excluding any employee
 1437  terminated during a probationary period of 3 months or less,
 1438  divided by the total number of staff employed at the end of the
 1439  period for which the rate is computed, and expressed as a
 1440  percentage.
 1441         c. The formula for determining staff stability is the total
 1442  number of employees who that have been employed for more than 12
 1443  months, divided by the total number of employees employed at the
 1444  end of the most recent calendar quarter, and expressed as a
 1445  percentage.
 1446         d. A nursing facility that has failed to comply with state
 1447  minimum-staffing requirements for 2 consecutive days is
 1448  prohibited from accepting new admissions until the facility has
 1449  achieved the minimum-staffing requirements for a period of 6
 1450  consecutive days. For the purposes of this sub-subparagraph, any
 1451  person who was a resident of the facility and was absent from
 1452  the facility for the purpose of receiving medical care at a
 1453  separate location or was on a leave of absence is not considered
 1454  a new admission. Failure to impose such an admissions moratorium
 1455  constitutes a class II violation, and the agency shall fine the
 1456  nursing facility $1,000 for such violation deficiency.
 1457         e. A nursing facility that which does not have a
 1458  conditional license may be cited for failure to comply with the
 1459  standards in s. 400.23(3)(a)1.a. only if it has failed to meet
 1460  those standards on 2 consecutive days or if it has failed to
 1461  meet at least 97 percent of those standards on any one day.
 1462         f. A facility that which has a conditional license must be
 1463  in compliance with the standards in s. 400.23(3)(a) at all
 1464  times.
 1465         2. This paragraph does not limit the agency’s ability to
 1466  impose a deficiency or take other actions if a facility does not
 1467  have enough staff to meet the residents’ needs.
 1468         (o)(p) Notify a licensed physician when a resident exhibits
 1469  signs of dementia or cognitive impairment or has a change of
 1470  condition in order to rule out the presence of an underlying
 1471  physiological condition that may be contributing to such
 1472  dementia or impairment. The notification must occur within 30
 1473  days after the acknowledgment of such signs by facility staff.
 1474  If an underlying condition is determined to exist, the facility
 1475  shall arrange, with the appropriate health care provider, the
 1476  necessary care and services to treat the condition.
 1477         (p)(q) If the facility implements a dining and hospitality
 1478  attendant program, ensure that the program is developed and
 1479  implemented under the supervision of the facility director of
 1480  nursing. A licensed nurse, licensed speech or occupational
 1481  therapist, or a registered dietitian must conduct training of
 1482  dining and hospitality attendants. A person employed by a
 1483  facility as a dining and hospitality attendant must perform
 1484  tasks under the direct supervision of a licensed nurse.
 1485         (r) Report to the agency any filing for bankruptcy
 1486  protection by the facility or its parent corporation,
 1487  divestiture or spin-off of its assets, or corporate
 1488  reorganization within 30 days after the completion of such
 1489  activity.
 1490         (q)(s) Maintain general and professional liability
 1491  insurance coverage that is in force at all times. In lieu of
 1492  general and professional liability insurance coverage, a state
 1493  designated teaching nursing home and its affiliated assisted
 1494  living facilities created under s. 430.80 may demonstrate proof
 1495  of financial responsibility as provided in s. 430.80(3)(h).
 1496         (r)(t) Maintain in the medical record for each resident a
 1497  daily chart of certified nursing assistant services provided to
 1498  the resident. The certified nursing assistant who is caring for
 1499  the resident must complete this record by the end of his or her
 1500  shift. This record must indicate assistance with activities of
 1501  daily living, assistance with eating, and assistance with
 1502  drinking, and must record each offering of nutrition and
 1503  hydration for those residents whose plan of care or assessment
 1504  indicates a risk for malnutrition or dehydration.
 1505         (s)(u) Before November 30 of each year, subject to the
 1506  availability of an adequate supply of the necessary vaccine,
 1507  provide for immunizations against influenza viruses to all its
 1508  consenting residents in accordance with the recommendations of
 1509  the United States Centers for Disease Control and Prevention,
 1510  subject to exemptions for medical contraindications and
 1511  religious or personal beliefs. Subject to these exemptions, any
 1512  consenting person who becomes a resident of the facility after
 1513  November 30 but before March 31 of the following year must be
 1514  immunized within 5 working days after becoming a resident.
 1515  Immunization shall not be provided to any resident who provides
 1516  documentation that he or she has been immunized as required by
 1517  this paragraph. This paragraph does not prohibit a resident from
 1518  receiving the immunization from his or her personal physician if
 1519  he or she so chooses. A resident who chooses to receive the
 1520  immunization from his or her personal physician shall provide
 1521  proof of immunization to the facility. The agency may adopt and
 1522  enforce any rules necessary to comply with or administer
 1523  implement this paragraph subsection.
 1524         (t)(v) Assess all residents for eligibility for
 1525  pneumococcal polysaccharide vaccination (PPV) and vaccinate
 1526  residents when indicated within 60 days after the effective date
 1527  of this act in accordance with the recommendations of the United
 1528  States Centers for Disease Control and Prevention, subject to
 1529  exemptions for medical contraindications and religious or
 1530  personal beliefs. Residents admitted after the effective date of
 1531  this act shall be assessed within 5 working days of admission
 1532  and, when indicated, vaccinated within 60 days in accordance
 1533  with the recommendations of the United States Centers for
 1534  Disease Control and Prevention, subject to exemptions for
 1535  medical contraindications and religious or personal beliefs.
 1536  Immunization shall not be provided to any resident who provides
 1537  documentation that he or she has been immunized as required by
 1538  this paragraph. This paragraph does not prohibit a resident from
 1539  receiving the immunization from his or her personal physician if
 1540  he or she so chooses. A resident who chooses to receive the
 1541  immunization from his or her personal physician shall provide
 1542  proof of immunization to the facility. The agency may adopt and
 1543  enforce any rules necessary to comply with or administer
 1544  implement this paragraph.
 1545         (u)(w) Annually encourage and promote to its employees the
 1546  benefits associated with immunizations against influenza viruses
 1547  in accordance with the recommendations of the United States
 1548  Centers for Disease Control and Prevention. The agency may adopt
 1549  and enforce any rules necessary to comply with or administer
 1550  implement this paragraph.
 1551         (2) Facilities that have been awarded a Gold Seal under the
 1552  program established in s. 400.235 may develop a plan to provide
 1553  certified nursing assistant training as prescribed by federal
 1554  regulations and state rules and may apply to the agency for
 1555  approval of their program.
 1556         Section 30. Subsection (3) of section 400.142, Florida
 1557  Statutes, is amended to read:
 1558         400.142 Emergency medication kits; orders not to
 1559  resuscitate.—
 1560         (3) Facility staff may withhold or withdraw cardiopulmonary
 1561  resuscitation if presented with an order not to resuscitate
 1562  executed pursuant to s. 401.45. The agency shall adopt rules
 1563  providing for the implementation of such orders. Facility staff
 1564  and facilities are shall not be subject to criminal prosecution
 1565  or civil liability, nor be considered to have engaged in
 1566  negligent or unprofessional conduct, for withholding or
 1567  withdrawing cardiopulmonary resuscitation pursuant to such an
 1568  order and rules adopted by the agency. The absence of an order
 1569  not to resuscitate executed pursuant to s. 401.45 does not
 1570  preclude a physician from withholding or withdrawing
 1571  cardiopulmonary resuscitation as otherwise permitted by law.
 1572         Section 31. Subsection (10) of section 400.147, Florida
 1573  Statutes, is repealed.
 1574         Section 32. Section 400.148, Florida Statutes, is repealed.
 1575         Section 33. Subsection (3) of section 400.19, Florida
 1576  Statutes, is amended to read:
 1577         400.19 Right of entry and inspection.—
 1578         (3) The agency shall every 15 months conduct at least one
 1579  unannounced inspection to determine compliance by the licensee
 1580  with statutes, and with rules adopted promulgated under the
 1581  provisions of those statutes, governing minimum standards of
 1582  construction, quality and adequacy of care, and rights of
 1583  residents. The survey shall be conducted every 6 months for the
 1584  next 2-year period if the facility has been cited for a class I
 1585  deficiency, has been cited for two or more class II violations
 1586  deficiencies arising from separate surveys or investigations
 1587  within a 60-day period, or has had three or more substantiated
 1588  complaints within a 6-month period, each resulting in at least
 1589  one class I or class II deficiency. In addition to any other
 1590  fees or fines in this part, the agency shall assess a fine for
 1591  each facility that is subject to the 6-month survey cycle. The
 1592  fine for the 2-year period shall be $6,000, one-half to be paid
 1593  at the completion of each survey. The agency may adjust this
 1594  fine by the change in the Consumer Price Index, based on the 12
 1595  months immediately preceding the increase, to cover the cost of
 1596  the additional surveys. The agency shall verify through
 1597  subsequent inspection that any deficiency identified during
 1598  inspection is corrected. However, the agency may verify the
 1599  correction of a class III or class IV violation deficiency
 1600  unrelated to resident rights or resident care without
 1601  reinspecting the facility if adequate written documentation has
 1602  been received from the facility, which provides assurance that
 1603  the deficiency has been corrected. The giving or causing to be
 1604  given of advance notice of such unannounced inspections by an
 1605  employee of the agency to any unauthorized person shall
 1606  constitute cause for suspension of not fewer than 5 working days
 1607  according to the provisions of chapter 110.
 1608         Section 34. Section 400.195, Florida Statutes, is repealed.
 1609         Section 35. Subsection (5) of section 400.23, Florida
 1610  Statutes, is amended to read:
 1611         400.23 Rules; evaluation and deficiencies; licensure
 1612  status.—
 1613         (5) The agency, in collaboration with the Division of
 1614  Children’s Medical Services Network of the Department of Health,
 1615  must, no later than December 31, 1993, adopt rules for minimum
 1616  standards of care for persons under 21 years of age who reside
 1617  in nursing home facilities. The rules must include a methodology
 1618  for reviewing a nursing home facility under ss. 408.031-408.045
 1619  which serves only persons under 21 years of age. A facility may
 1620  be exempt from these standards for specific persons between 18
 1621  and 21 years of age, if the person’s physician agrees that
 1622  minimum standards of care based on age are not necessary.
 1623         Section 36. Subsection (1) of section 400.275, Florida
 1624  Statutes, is amended to read:
 1625         400.275 Agency duties.—
 1626         (1) The agency shall ensure that each newly hired nursing
 1627  home surveyor, as a part of basic training, is assigned full
 1628  time to a licensed nursing home for at least 2 days within a 7
 1629  day period to observe facility operations outside of the survey
 1630  process before the surveyor begins survey responsibilities. Such
 1631  observations may not be the sole basis of a deficiency citation
 1632  against the facility. The agency may not assign an individual to
 1633  be a member of a survey team for purposes of a survey,
 1634  evaluation, or consultation visit at a nursing home facility in
 1635  which the surveyor was an employee within the preceding 5 years.
 1636         Section 37. Section 400.484, Florida Statutes, is amended
 1637  to read:
 1638         400.484 Right of inspection; violations deficiencies;
 1639  fines.—
 1640         (1) In addition to the requirements of s. 408.811, the
 1641  agency may make such inspections and investigations as are
 1642  necessary in order to determine the state of compliance with
 1643  this part, part II of chapter 408, and applicable rules.
 1644         (2) The agency shall impose fines for various classes of
 1645  violations deficiencies in accordance with the following
 1646  schedule:
 1647         (a) A class I violation is defined in s. 408.813. A class I
 1648  deficiency is any act, omission, or practice that results in a
 1649  patient’s death, disablement, or permanent injury, or places a
 1650  patient at imminent risk of death, disablement, or permanent
 1651  injury. Upon finding a class I violation deficiency, the agency
 1652  shall impose an administrative fine in the amount of $15,000 for
 1653  each occurrence and each day that the violation deficiency
 1654  exists.
 1655         (b) A class II violation is defined in s. 408.813. A class
 1656  II deficiency is any act, omission, or practice that has a
 1657  direct adverse effect on the health, safety, or security of a
 1658  patient. Upon finding a class II violation deficiency, the
 1659  agency shall impose an administrative fine in the amount of
 1660  $5,000 for each occurrence and each day that the violation
 1661  deficiency exists.
 1662         (c) A class III violation is defined in s. 408.813. A class
 1663  III deficiency is any act, omission, or practice that has an
 1664  indirect, adverse effect on the health, safety, or security of a
 1665  patient. Upon finding an uncorrected or repeated class III
 1666  violation deficiency, the agency shall impose an administrative
 1667  fine not to exceed $1,000 for each occurrence and each day that
 1668  the uncorrected or repeated violation deficiency exists.
 1669         (d) A class IV violation is defined in s. 408.813. A class
 1670  IV deficiency is any act, omission, or practice related to
 1671  required reports, forms, or documents which does not have the
 1672  potential of negatively affecting patients. These violations are
 1673  of a type that the agency determines do not threaten the health,
 1674  safety, or security of patients. Upon finding an uncorrected or
 1675  repeated class IV violation deficiency, the agency shall impose
 1676  an administrative fine not to exceed $500 for each occurrence
 1677  and each day that the uncorrected or repeated violation
 1678  deficiency exists.
 1679         (3) In addition to any other penalties imposed pursuant to
 1680  this section or part, the agency may assess costs related to an
 1681  investigation that results in a successful prosecution,
 1682  excluding costs associated with an attorney’s time.
 1683         Section 38. Subsections (1) and (4) of section 400.606,
 1684  Florida Statutes, are amended to read:
 1685         400.606 License; application; renewal; conditional license
 1686  or permit; certificate of need.—
 1687         (1) In addition to the requirements of part II of chapter
 1688  408, the initial application and change of ownership application
 1689  must be accompanied by a plan for the delivery of home,
 1690  residential, and homelike inpatient hospice services to
 1691  terminally ill persons and their families. Such plan must
 1692  contain, but need not be limited to:
 1693         (a) The estimated average number of terminally ill persons
 1694  to be served monthly.
 1695         (b) The geographic area in which hospice services will be
 1696  available.
 1697         (c) A listing of services that which are or will be
 1698  provided, either directly by the applicant or through
 1699  contractual arrangements with existing providers.
 1700         (d) Provisions for the implementation of hospice home care
 1701  within 3 months after licensure.
 1702         (e) Provisions for the implementation of hospice homelike
 1703  inpatient care within 12 months after licensure.
 1704         (f) The number and disciplines of professional staff to be
 1705  employed.
 1706         (g) The name and qualifications of any existing or
 1707  potential contractee.
 1708         (h) A plan for attracting and training volunteers.
 1709         (i) The projected annual operating cost of the hospice.
 1710  
 1711  If the applicant is an existing licensed health care provider,
 1712  the application must be accompanied by a copy of the most recent
 1713  profit-loss statement and, if applicable, the most recent
 1714  licensure inspection report.
 1715         (4) A freestanding hospice facility that is primarily
 1716  engaged in providing inpatient and related services and that is
 1717  not otherwise licensed as a health care facility shall be
 1718  required to obtain a certificate of need. However, a
 1719  freestanding hospice facility with six or fewer beds shall not
 1720  be required to comply with institutional standards such as, but
 1721  not limited to, standards requiring sprinkler systems, emergency
 1722  electrical systems, or special lavatory devices.
 1723         Section 39. Subsection (2) of section 400.607, Florida
 1724  Statutes, is amended to read:
 1725         400.607 Denial, suspension, revocation of license;
 1726  emergency actions; imposition of administrative fine; grounds.—
 1727         (2) A violation of the provisions of this part, part II of
 1728  chapter 408, or applicable rules Any of the following actions by
 1729  a licensed hospice or any of its employees shall be grounds for
 1730  administrative action by the agency against a hospice.:
 1731         (a) A violation of the provisions of this part, part II of
 1732  chapter 408, or applicable rules.
 1733         (b) An intentional or negligent act materially affecting
 1734  the health or safety of a patient.
 1735         Section 40. Section 400.915, Florida Statutes, is amended
 1736  to read:
 1737         400.915 Construction and renovation; requirements.—The
 1738  requirements for the construction or renovation of a PPEC center
 1739  shall comply with:
 1740         (1) The provisions of chapter 553, which pertain to
 1741  building construction standards, including plumbing, electrical
 1742  code, glass, manufactured buildings, accessibility for the
 1743  physically disabled;
 1744         (2) The provisions of s. 633.022 and applicable rules
 1745  pertaining to physical minimum standards for nonresidential
 1746  child care physical facilities in rule 10M-12.003, Florida
 1747  Administrative Code, Child Care Standards; and
 1748         (3) The standards or rules adopted pursuant to this part
 1749  and part II of chapter 408.
 1750         Section 41. Subsection (1) of section 400.925, Florida
 1751  Statutes, is amended to read:
 1752         400.925 Definitions.—As used in this part, the term:
 1753         (1) “Accrediting organizations” means the Joint Commission
 1754  on Accreditation of Healthcare Organizations or other national
 1755  accreditation agencies whose standards for accreditation are
 1756  comparable to those required by this part for licensure.
 1757         Section 42. Section 400.931, Florida Statutes, is amended
 1758  to read:
 1759         400.931 Application for license; fee; provisional license;
 1760  temporary permit.—
 1761         (1) In addition to the requirements of part II of chapter
 1762  408, the applicant must file with the application satisfactory
 1763  proof that the home medical equipment provider is in compliance
 1764  with this part and applicable rules, including:
 1765         (a) A report, by category, of the equipment to be provided,
 1766  indicating those offered either directly by the applicant or
 1767  through contractual arrangements with existing providers.
 1768  Categories of equipment include:
 1769         1. Respiratory modalities.
 1770         2. Ambulation aids.
 1771         3. Mobility aids.
 1772         4. Sickroom setup.
 1773         5. Disposables.
 1774         (b) A report, by category, of the services to be provided,
 1775  indicating those offered either directly by the applicant or
 1776  through contractual arrangements with existing providers.
 1777  Categories of services include:
 1778         1. Intake.
 1779         2. Equipment selection.
 1780         3. Delivery.
 1781         4. Setup and installation.
 1782         5. Patient training.
 1783         6. Ongoing service and maintenance.
 1784         7. Retrieval.
 1785         (c) A listing of those with whom the applicant contracts,
 1786  both the providers the applicant uses to provide equipment or
 1787  services to its consumers and the providers for whom the
 1788  applicant provides services or equipment.
 1789         (2) As an alternative to submitting proof of financial
 1790  ability to operate as required in s. 408.810(8), the applicant
 1791  may submit a $50,000 surety bond to the agency.
 1792         (2)(3) As specified in part II of chapter 408, the home
 1793  medical equipment provider must also obtain and maintain
 1794  professional and commercial liability insurance. Proof of
 1795  liability insurance, as defined in s. 624.605, must be submitted
 1796  with the application. The agency shall set the required amounts
 1797  of liability insurance by rule, but the required amount must not
 1798  be less than $250,000 per claim. In the case of contracted
 1799  services, it is required that the contractor must have liability
 1800  insurance not less than $250,000 per claim.
 1801         (3)(4) When a change of the general manager of a home
 1802  medical equipment provider occurs, the licensee must notify the
 1803  agency of the change within 45 days.
 1804         (4)(5) In accordance with s. 408.805, an applicant or a
 1805  licensee shall pay a fee for each license application submitted
 1806  under this part, part II of chapter 408, and applicable rules.
 1807  The amount of the fee shall be established by rule and may not
 1808  exceed $300 per biennium. The agency shall set the fees in an
 1809  amount that is sufficient to cover its costs in carrying out its
 1810  responsibilities under this part. However, state, county, or
 1811  municipal governments applying for licenses under this part are
 1812  exempt from the payment of license fees.
 1813         (5)(6) An applicant for initial licensure, renewal, or
 1814  change of ownership shall also pay an inspection fee not to
 1815  exceed $400, which shall be paid by all applicants except those
 1816  not subject to licensure inspection by the agency as described
 1817  in s. 400.933.
 1818         Section 43. Subsection (2) of section 400.932, Florida
 1819  Statutes, is amended to read:
 1820         400.932 Administrative penalties.—
 1821         (2) A violation of this part, part II of chapter 408, or
 1822  applicable rules Any of the following actions by an employee of
 1823  a home medical equipment provider is are grounds for
 1824  administrative action or penalties by the agency.:
 1825         (a) Violation of this part, part II of chapter 408, or
 1826  applicable rules.
 1827         (b) An intentional, reckless, or negligent act that
 1828  materially affects the health or safety of a patient.
 1829         Section 44. Subsection (2) of section 400.933, Florida
 1830  Statutes, is amended to read:
 1831         400.933 Licensure inspections and investigations.—
 1832         (2) The agency shall accept, in lieu of its own periodic
 1833  inspections for licensure, submission of the following:
 1834         (a) The survey or inspection of an accrediting
 1835  organization, provided the accreditation of the licensed home
 1836  medical equipment provider is not conditional or provisional and
 1837  provided the licensed home medical equipment provider authorizes
 1838  release of, and the agency receives the report of, the
 1839  accrediting organization; or
 1840         (b) A copy of a valid medical oxygen retail establishment
 1841  permit issued by the Department of Health, pursuant to chapter
 1842  499.
 1843         Section 45. Subsection (2) of section 400.953, Florida
 1844  Statutes, is amended to read:
 1845         400.953 Background screening of home medical equipment
 1846  provider personnel.—The agency shall require employment
 1847  screening as provided in chapter 435, using the level 1
 1848  standards for screening set forth in that chapter, for home
 1849  medical equipment provider personnel.
 1850         (2) The general manager of each home medical equipment
 1851  provider must sign an affidavit annually, under penalty of
 1852  perjury, stating that all home medical equipment provider
 1853  personnel hired on or after July 1, 1999, who enter the home of
 1854  a patient in the capacity of their employment have been screened
 1855  and that its remaining personnel have worked for the home
 1856  medical equipment provider continuously since before July 1,
 1857  1999. This attestation must be submitted in accordance with s.
 1858  408.809(6).
 1859         Section 46. Section 400.967, Florida Statutes, is amended
 1860  to read:
 1861         400.967 Rules and classification of violations
 1862  deficiencies.—
 1863         (1) It is the intent of the Legislature that rules adopted
 1864  and enforced under this part and part II of chapter 408 include
 1865  criteria by which a reasonable and consistent quality of
 1866  resident care may be ensured, the results of such resident care
 1867  can be demonstrated, and safe and sanitary facilities can be
 1868  provided.
 1869         (2) Pursuant to the intention of the Legislature, the
 1870  agency, in consultation with the Agency for Persons with
 1871  Disabilities and the Department of Elderly Affairs, shall adopt
 1872  and enforce rules to administer this part and part II of chapter
 1873  408, which shall include reasonable and fair criteria governing:
 1874         (a) The location and construction of the facility;
 1875  including fire and life safety, plumbing, heating, cooling,
 1876  lighting, ventilation, and other housing conditions that will
 1877  ensure the health, safety, and comfort of residents. The agency
 1878  shall establish standards for facilities and equipment to
 1879  increase the extent to which new facilities and a new wing or
 1880  floor added to an existing facility after July 1, 2000, are
 1881  structurally capable of serving as shelters only for residents,
 1882  staff, and families of residents and staff, and equipped to be
 1883  self-supporting during and immediately following disasters. The
 1884  Agency for Health Care Administration shall work with facilities
 1885  licensed under this part and report to the Governor and the
 1886  Legislature by April 1, 2000, its recommendations for cost
 1887  effective renovation standards to be applied to existing
 1888  facilities. In making such rules, the agency shall be guided by
 1889  criteria recommended by nationally recognized, reputable
 1890  professional groups and associations having knowledge concerning
 1891  such subject matters. The agency shall update or revise such
 1892  criteria as the need arises. All facilities must comply with
 1893  those lifesafety code requirements and building code standards
 1894  applicable at the time of approval of their construction plans.
 1895  The agency may require alterations to a building if it
 1896  determines that an existing condition constitutes a distinct
 1897  hazard to life, health, or safety. The agency shall adopt fair
 1898  and reasonable rules setting forth conditions under which
 1899  existing facilities undergoing additions, alterations,
 1900  conversions, renovations, or repairs are required to comply with
 1901  the most recent updated or revised standards.
 1902         (b) The number and qualifications of all personnel,
 1903  including management, medical nursing, and other personnel,
 1904  having responsibility for any part of the care given to
 1905  residents.
 1906         (c) All sanitary conditions within the facility and its
 1907  surroundings, including water supply, sewage disposal, food
 1908  handling, and general hygiene, which will ensure the health and
 1909  comfort of residents.
 1910         (d) The equipment essential to the health and welfare of
 1911  the residents.
 1912         (e) A uniform accounting system.
 1913         (f) The care, treatment, and maintenance of residents and
 1914  measurement of the quality and adequacy thereof.
 1915         (g) The preparation and annual update of a comprehensive
 1916  emergency management plan. The agency shall adopt rules
 1917  establishing minimum criteria for the plan after consultation
 1918  with the Department of Community Affairs. At a minimum, the
 1919  rules must provide for plan components that address emergency
 1920  evacuation transportation; adequate sheltering arrangements;
 1921  postdisaster activities, including emergency power, food, and
 1922  water; postdisaster transportation; supplies; staffing;
 1923  emergency equipment; individual identification of residents and
 1924  transfer of records; and responding to family inquiries. The
 1925  comprehensive emergency management plan is subject to review and
 1926  approval by the local emergency management agency. During its
 1927  review, the local emergency management agency shall ensure that
 1928  the following agencies, at a minimum, are given the opportunity
 1929  to review the plan: the Department of Elderly Affairs, the
 1930  Agency for Persons with Disabilities, the Agency for Health Care
 1931  Administration, and the Department of Community Affairs. Also,
 1932  appropriate volunteer organizations must be given the
 1933  opportunity to review the plan. The local emergency management
 1934  agency shall complete its review within 60 days and either
 1935  approve the plan or advise the facility of necessary revisions.
 1936         (h) The use of restraint and seclusion. Such rules must be
 1937  consistent with recognized best practices; prohibit inherently
 1938  dangerous restraint or seclusion procedures; establish
 1939  limitations on the use and duration of restraint and seclusion;
 1940  establish measures to ensure the safety of clients and staff
 1941  during an incident of restraint or seclusion; establish
 1942  procedures for staff to follow before, during, and after
 1943  incidents of restraint or seclusion, including individualized
 1944  plans for the use of restraints or seclusion in emergency
 1945  situations; establish professional qualifications of and
 1946  training for staff who may order or be engaged in the use of
 1947  restraint or seclusion; establish requirements for facility data
 1948  collection and reporting relating to the use of restraint and
 1949  seclusion; and establish procedures relating to the
 1950  documentation of the use of restraint or seclusion in the
 1951  client’s facility or program record.
 1952         (3) The agency shall adopt rules to provide that, when the
 1953  criteria established under this part and part II of chapter 408
 1954  are not met, such violations deficiencies shall be classified
 1955  according to the nature of the violation deficiency. The agency
 1956  shall indicate the classification on the face of the notice of
 1957  violations deficiencies as follows:
 1958         (a) Class I violations deficiencies are defined in s.
 1959  408.813. those which the agency determines present an imminent
 1960  danger to the residents or guests of the facility or a
 1961  substantial probability that death or serious physical harm
 1962  would result therefrom. The condition or practice constituting a
 1963  class I violation must be abated or eliminated immediately,
 1964  unless a fixed period of time, as determined by the agency, is
 1965  required for correction. A class I violation deficiency is
 1966  subject to a civil penalty in an amount not less than $5,000 and
 1967  not exceeding $10,000 for each violation deficiency. A fine may
 1968  be levied notwithstanding the correction of the violation
 1969  deficiency.
 1970         (b) Class II violations deficiencies are defined in s.
 1971  408.813. those which the agency determines have a direct or
 1972  immediate relationship to the health, safety, or security of the
 1973  facility residents, other than class I deficiencies. A class II
 1974  violation deficiency is subject to a civil penalty in an amount
 1975  not less than $1,000 and not exceeding $5,000 for each
 1976  deficiency. A citation for a class II violation deficiency shall
 1977  specify the time within which the violation deficiency must be
 1978  corrected. If a class II violation deficiency is corrected
 1979  within the time specified, no civil penalty shall be imposed,
 1980  unless it is a repeated offense.
 1981         (c) Class III violations deficiencies are defined in s.
 1982  408.813. those which the agency determines to have an indirect
 1983  or potential relationship to the health, safety, or security of
 1984  the facility residents, other than class I or class II
 1985  deficiencies. A class III violation deficiency is subject to a
 1986  civil penalty of not less than $500 and not exceeding $1,000 for
 1987  each violation deficiency. A citation for a class III violation
 1988  deficiency shall specify the time within which the violation
 1989  deficiency must be corrected. If a class III violation
 1990  deficiency is corrected within the time specified, no civil
 1991  penalty shall be imposed, unless it is a repeated offense.
 1992         (d)Class IV violations are defined in s. 408.813.
 1993         (4) The agency shall approve or disapprove the plans and
 1994  specifications within 60 days after receipt of the final plans
 1995  and specifications. The agency may be granted one 15-day
 1996  extension for the review period, if the secretary of the agency
 1997  so approves. If the agency fails to act within the specified
 1998  time, it is deemed to have approved the plans and
 1999  specifications. When the agency disapproves plans and
 2000  specifications, it must set forth in writing the reasons for
 2001  disapproval. Conferences and consultations may be provided as
 2002  necessary.
 2003         (5) The agency may charge an initial fee of $2,000 for
 2004  review of plans and construction on all projects, no part of
 2005  which is refundable. The agency may also collect a fee, not to
 2006  exceed 1 percent of the estimated construction cost or the
 2007  actual cost of review, whichever is less, for the portion of the
 2008  review that which encompasses initial review through the initial
 2009  revised construction document review. The agency may collect its
 2010  actual costs on all subsequent portions of the review and
 2011  construction inspections. Initial fee payment must accompany the
 2012  initial submission of plans and specifications. Any subsequent
 2013  payment that is due is payable upon receipt of the invoice from
 2014  the agency. Notwithstanding any other provision of law, all
 2015  money received by the agency under this section shall be deemed
 2016  to be trust funds, to be held and applied solely for the
 2017  operations required under this section.
 2018         Section 47. Subsections (4) and (7) of section 400.9905,
 2019  Florida Statutes, are amended to read:
 2020         400.9905 Definitions.—
 2021         (4) “Clinic” means an entity where at which health care
 2022  services are provided to individuals and which tenders charges
 2023  for reimbursement for such services, including a mobile clinic
 2024  and a portable service or equipment provider. For purposes of
 2025  this part, the term does not include and the licensure
 2026  requirements of this part do not apply to:
 2027         (a) Entities licensed or registered by the state under
 2028  chapter 395; or entities licensed or registered by the state and
 2029  providing only health care services within the scope of services
 2030  authorized under their respective licenses granted under ss.
 2031  383.30-383.335, chapter 390, chapter 394, chapter 397, this
 2032  chapter except part X, chapter 429, chapter 463, chapter 465,
 2033  chapter 466, chapter 478, part I of chapter 483, chapter 484, or
 2034  chapter 651; end-stage renal disease providers authorized under
 2035  42 C.F.R. part 405, subpart U; or providers certified under 42
 2036  C.F.R. part 485, subpart B or subpart H; or any entity that
 2037  provides neonatal or pediatric hospital-based health care
 2038  services or other health care services by licensed practitioners
 2039  solely within a hospital licensed under chapter 395.
 2040         (b) Entities that own, directly or indirectly, entities
 2041  licensed or registered by the state pursuant to chapter 395; or
 2042  entities that own, directly or indirectly, entities licensed or
 2043  registered by the state and providing only health care services
 2044  within the scope of services authorized pursuant to their
 2045  respective licenses granted under ss. 383.30-383.335, chapter
 2046  390, chapter 394, chapter 397, this chapter except part X,
 2047  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
 2048  part I of chapter 483, chapter 484, chapter 651; end-stage renal
 2049  disease providers authorized under 42 C.F.R. part 405, subpart
 2050  U; or providers certified under 42 C.F.R. part 485, subpart B or
 2051  subpart H; or any entity that provides neonatal or pediatric
 2052  hospital-based health care services by licensed practitioners
 2053  solely within a hospital licensed under chapter 395.
 2054         (c) Entities that are owned, directly or indirectly, by an
 2055  entity licensed or registered by the state pursuant to chapter
 2056  395; or entities that are owned, directly or indirectly, by an
 2057  entity licensed or registered by the state and providing only
 2058  health care services within the scope of services authorized
 2059  pursuant to their respective licenses granted under ss. 383.30
 2060  383.335, chapter 390, chapter 394, chapter 397, this chapter
 2061  except part X, chapter 429, chapter 463, chapter 465, chapter
 2062  466, chapter 478, part I of chapter 483, chapter 484, or chapter
 2063  651; end-stage renal disease providers authorized under 42
 2064  C.F.R. part 405, subpart U; or providers certified under 42
 2065  C.F.R. part 485, subpart B or subpart H; or any entity that
 2066  provides neonatal or pediatric hospital-based health care
 2067  services by licensed practitioners solely within a hospital
 2068  under chapter 395.
 2069         (d) Entities that are under common ownership, directly or
 2070  indirectly, with an entity licensed or registered by the state
 2071  pursuant to chapter 395; or entities that are under common
 2072  ownership, directly or indirectly, with an entity licensed or
 2073  registered by the state and providing only health care services
 2074  within the scope of services authorized pursuant to their
 2075  respective licenses granted under ss. 383.30-383.335, chapter
 2076  390, chapter 394, chapter 397, this chapter except part X,
 2077  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
 2078  part I of chapter 483, chapter 484, or chapter 651; end-stage
 2079  renal disease providers authorized under 42 C.F.R. part 405,
 2080  subpart U; or providers certified under 42 C.F.R. part 485,
 2081  subpart B or subpart H; or any entity that provides neonatal or
 2082  pediatric hospital-based health care services by licensed
 2083  practitioners solely within a hospital licensed under chapter
 2084  395.
 2085         (e) An entity that is exempt from federal taxation under 26
 2086  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
 2087  under 26 U.S.C. s. 409 that has a board of trustees not less
 2088  than two-thirds of which are Florida-licensed health care
 2089  practitioners and provides only physical therapy services under
 2090  physician orders, any community college or university clinic,
 2091  and any entity owned or operated by the federal or state
 2092  government, including agencies, subdivisions, or municipalities
 2093  thereof.
 2094         (f) A sole proprietorship, group practice, partnership, or
 2095  corporation that provides health care services by physicians
 2096  covered by s. 627.419, that is directly supervised by one or
 2097  more of such physicians, and that is wholly owned by one or more
 2098  of those physicians or by a physician and the spouse, parent,
 2099  child, or sibling of that physician.
 2100         (g) A sole proprietorship, group practice, partnership, or
 2101  corporation that provides health care services by licensed
 2102  health care practitioners under chapter 457, chapter 458,
 2103  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
 2104  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
 2105  chapter 490, chapter 491, or part I, part III, part X, part
 2106  XIII, or part XIV of chapter 468, or s. 464.012, which are
 2107  wholly owned by one or more licensed health care practitioners,
 2108  or the licensed health care practitioners set forth in this
 2109  paragraph and the spouse, parent, child, or sibling of a
 2110  licensed health care practitioner, so long as one of the owners
 2111  who is a licensed health care practitioner is supervising the
 2112  business activities and is legally responsible for the entity’s
 2113  compliance with all federal and state laws. However, a health
 2114  care practitioner may not supervise services beyond the scope of
 2115  the practitioner’s license, except that, for the purposes of
 2116  this part, a clinic owned by a licensee in s. 456.053(3)(b) that
 2117  provides only services authorized pursuant to s. 456.053(3)(b)
 2118  may be supervised by a licensee specified in s. 456.053(3)(b).
 2119         (h) Clinical facilities affiliated with an accredited
 2120  medical school at which training is provided for medical
 2121  students, residents, or fellows.
 2122         (i) Entities that provide only oncology or radiation
 2123  therapy services by physicians licensed under chapter 458 or
 2124  chapter 459 or entities that provide oncology or radiation
 2125  therapy services by physicians licensed under chapter 458 or
 2126  chapter 459 which are owned by a corporation whose shares are
 2127  publicly traded on a recognized stock exchange.
 2128         (j) Clinical facilities affiliated with a college of
 2129  chiropractic accredited by the Council on Chiropractic Education
 2130  at which training is provided for chiropractic students.
 2131         (k) Entities that provide licensed practitioners to staff
 2132  emergency departments or to deliver anesthesia services in
 2133  facilities licensed under chapter 395 and that derive at least
 2134  90 percent of their gross annual revenues from the provision of
 2135  such services. Entities claiming an exemption from licensure
 2136  under this paragraph must provide documentation demonstrating
 2137  compliance.
 2138         (l) Orthotic, or prosthetic, pediatric cardiology, or
 2139  perinatology clinical facilities that are a publicly traded
 2140  corporation or that are wholly owned, directly or indirectly, by
 2141  a publicly traded corporation. As used in this paragraph, a
 2142  publicly traded corporation is a corporation that issues
 2143  securities traded on an exchange registered with the United
 2144  States Securities and Exchange Commission as a national
 2145  securities exchange.
 2146         (7) “Portable service or equipment provider” means an
 2147  entity that contracts with or employs persons to provide
 2148  portable health care services or equipment to multiple locations
 2149  which performing treatment or diagnostic testing of individuals,
 2150  that bills third-party payors for those services, and which that
 2151  otherwise meets the definition of a clinic in subsection (4).
 2152         Section 48. Subsections (1) and (4) of section 400.991,
 2153  Florida Statutes, are amended to read:
 2154         400.991 License requirements; background screenings;
 2155  prohibitions.—
 2156         (1)(a) The requirements of part II of chapter 408 apply to
 2157  the provision of services that require licensure pursuant to
 2158  this part and part II of chapter 408 and to entities licensed by
 2159  or applying for such licensure from the agency pursuant to this
 2160  part. A license issued by the agency is required in order to
 2161  operate a clinic in this state. Each clinic location shall be
 2162  licensed separately regardless of whether the clinic is operated
 2163  under the same business name or management as another clinic.
 2164         (b) Each mobile clinic must obtain a separate health care
 2165  clinic license and must provide to the agency, at least
 2166  quarterly, its projected street location to enable the agency to
 2167  locate and inspect such clinic. A portable service or equipment
 2168  provider must obtain a health care clinic license for a single
 2169  administrative office and is not required to submit quarterly
 2170  projected street locations.
 2171         (4) In addition to the requirements of part II of chapter
 2172  408, the applicant must file with the application satisfactory
 2173  proof that the clinic is in compliance with this part and
 2174  applicable rules, including:
 2175         (a) A listing of services to be provided either directly by
 2176  the applicant or through contractual arrangements with existing
 2177  providers;
 2178         (b) The number and discipline of each professional staff
 2179  member to be employed; and
 2180         (c) Proof of financial ability to operate as required under
 2181  ss. 408.8065 and s. 408.810(8). As an alternative to submitting
 2182  proof of financial ability to operate as required under s.
 2183  408.810(8), the applicant may file a surety bond of at least
 2184  $500,000 which guarantees that the clinic will act in full
 2185  conformity with all legal requirements for operating a clinic,
 2186  payable to the agency. The agency may adopt rules to specify
 2187  related requirements for such surety bond.
 2188         Section 49. Paragraph (g) of subsection (1) and paragraph
 2189  (a) of subsection (7) of section 400.9935, Florida Statutes, are
 2190  amended to read:
 2191         400.9935 Clinic responsibilities.—
 2192         (1) Each clinic shall appoint a medical director or clinic
 2193  director who shall agree in writing to accept legal
 2194  responsibility for the following activities on behalf of the
 2195  clinic. The medical director or the clinic director shall:
 2196         (g) Conduct systematic reviews of clinic billings to ensure
 2197  that the billings are not fraudulent or unlawful. Upon discovery
 2198  of an unlawful charge, the medical director or clinic director
 2199  shall take immediate corrective action. If the clinic performs
 2200  only the technical component of magnetic resonance imaging,
 2201  static radiographs, computed tomography, or positron emission
 2202  tomography, and provides the professional interpretation of such
 2203  services, in a fixed facility that is accredited by the Joint
 2204  Commission on Accreditation of Healthcare Organizations or the
 2205  Accreditation Association for Ambulatory Health Care, and the
 2206  American College of Radiology; and if, in the preceding quarter,
 2207  the percentage of scans performed by that clinic which was
 2208  billed to all personal injury protection insurance carriers was
 2209  less than 15 percent, the chief financial officer of the clinic
 2210  may, in a written acknowledgment provided to the agency, assume
 2211  the responsibility for the conduct of the systematic reviews of
 2212  clinic billings to ensure that the billings are not fraudulent
 2213  or unlawful.
 2214         (7)(a) Each clinic engaged in magnetic resonance imaging
 2215  services must be accredited by the Joint Commission on
 2216  Accreditation of Healthcare Organizations, the American College
 2217  of Radiology, or the Accreditation Association for Ambulatory
 2218  Health Care, within 1 year after licensure. A clinic that is
 2219  accredited by the American College of Radiology or is within the
 2220  original 1-year period after licensure and replaces its core
 2221  magnetic resonance imaging equipment shall be given 1 year after
 2222  the date on which the equipment is replaced to attain
 2223  accreditation. However, a clinic may request a single, 6-month
 2224  extension if it provides evidence to the agency establishing
 2225  that, for good cause shown, such clinic cannot be accredited
 2226  within 1 year after licensure, and that such accreditation will
 2227  be completed within the 6-month extension. After obtaining
 2228  accreditation as required by this subsection, each such clinic
 2229  must maintain accreditation as a condition of renewal of its
 2230  license. A clinic that files a change of ownership application
 2231  must comply with the original accreditation timeframe
 2232  requirements of the transferor. The agency shall deny a change
 2233  of ownership application if the clinic is not in compliance with
 2234  the accreditation requirements. When a clinic adds, replaces, or
 2235  modifies magnetic resonance imaging equipment and the
 2236  accreditation agency requires new accreditation, the clinic must
 2237  be accredited within 1 year after the date of the addition,
 2238  replacement, or modification but may request a single, 6-month
 2239  extension if the clinic provides evidence of good cause to the
 2240  agency.
 2241         Section 50. Subsection (2) of section 408.034, Florida
 2242  Statutes, is amended to read:
 2243         408.034 Duties and responsibilities of agency; rules.—
 2244         (2) In the exercise of its authority to issue licenses to
 2245  health care facilities and health service providers, as provided
 2246  under chapters 393 and 395 and parts II, and IV, and VIII of
 2247  chapter 400, the agency may not issue a license to any health
 2248  care facility or health service provider that fails to receive a
 2249  certificate of need or an exemption for the licensed facility or
 2250  service.
 2251         Section 51. Paragraph (d) of subsection (1) of section
 2252  408.036, Florida Statutes, is amended to read:
 2253         408.036 Projects subject to review; exemptions.—
 2254         (1) APPLICABILITY.—Unless exempt under subsection (3), all
 2255  health-care-related projects, as described in paragraphs (a)
 2256  (g), are subject to review and must file an application for a
 2257  certificate of need with the agency. The agency is exclusively
 2258  responsible for determining whether a health-care-related
 2259  project is subject to review under ss. 408.031-408.045.
 2260         (d) The establishment of a hospice or hospice inpatient
 2261  facility, except as provided in s. 408.043.
 2262         Section 52. Subsection (2) of section 408.043, Florida
 2263  Statutes, is amended to read:
 2264         408.043 Special provisions.—
 2265         (2) HOSPICES.—When an application is made for a certificate
 2266  of need to establish or to expand a hospice, the need for such
 2267  hospice shall be determined on the basis of the need for and
 2268  availability of hospice services in the community. The formula
 2269  on which the certificate of need is based shall discourage
 2270  regional monopolies and promote competition. The inpatient
 2271  hospice care component of a hospice that which is a freestanding
 2272  facility, or a part of a facility, which is primarily engaged in
 2273  providing inpatient care and related services and is not
 2274  licensed as a health care facility shall also be required to
 2275  obtain a certificate of need. Provision of hospice care by any
 2276  current provider of health care is a significant change in
 2277  service and therefore requires a certificate of need for such
 2278  services.
 2279         Section 53. Paragraph (k) of subsection (3) of section
 2280  408.05, Florida Statutes, is amended to read:
 2281         408.05 Florida Center for Health Information and Policy
 2282  Analysis.—
 2283         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
 2284  produce comparable and uniform health information and statistics
 2285  for the development of policy recommendations, the agency shall
 2286  perform the following functions:
 2287         (k) Develop, in conjunction with the State Consumer Health
 2288  Information and Policy Advisory Council, and implement a long
 2289  range plan for making available health care quality measures and
 2290  financial data that will allow consumers to compare health care
 2291  services. The health care quality measures and financial data
 2292  the agency must make available shall include, but is not limited
 2293  to, pharmaceuticals, physicians, health care facilities, and
 2294  health plans and managed care entities. The agency shall submit
 2295  the initial plan to the Governor, the President of the Senate,
 2296  and the Speaker of the House of Representatives by January 1,
 2297  2006, and shall update the plan and report on the status of its
 2298  implementation annually thereafter. The agency shall also make
 2299  the plan and status report available to the public on its
 2300  Internet website. As part of the plan, the agency shall identify
 2301  the process and timeframes for implementation, any barriers to
 2302  implementation, and recommendations of changes in the law that
 2303  may be enacted by the Legislature to eliminate the barriers. As
 2304  preliminary elements of the plan, the agency shall:
 2305         1. Make available patient-safety indicators, inpatient
 2306  quality indicators, and performance outcome and patient charge
 2307  data collected from health care facilities pursuant to s.
 2308  408.061(1)(a) and (2). The terms “patient-safety indicators” and
 2309  “inpatient quality indicators” shall be as defined by the
 2310  Centers for Medicare and Medicaid Services, the National Quality
 2311  Forum, the Joint Commission on Accreditation of Healthcare
 2312  Organizations, the Agency for Healthcare Research and Quality,
 2313  the Centers for Disease Control and Prevention, or a similar
 2314  national entity that establishes standards to measure the
 2315  performance of health care providers, or by other states. The
 2316  agency shall determine which conditions, procedures, health care
 2317  quality measures, and patient charge data to disclose based upon
 2318  input from the council. When determining which conditions and
 2319  procedures are to be disclosed, the council and the agency shall
 2320  consider variation in costs, variation in outcomes, and
 2321  magnitude of variations and other relevant information. When
 2322  determining which health care quality measures to disclose, the
 2323  agency:
 2324         a. Shall consider such factors as volume of cases; average
 2325  patient charges; average length of stay; complication rates;
 2326  mortality rates; and infection rates, among others, which shall
 2327  be adjusted for case mix and severity, if applicable.
 2328         b. May consider such additional measures that are adopted
 2329  by the Centers for Medicare and Medicaid Studies, National
 2330  Quality Forum, the Joint Commission on Accreditation of
 2331  Healthcare Organizations, the Agency for Healthcare Research and
 2332  Quality, Centers for Disease Control and Prevention, or a
 2333  similar national entity that establishes standards to measure
 2334  the performance of health care providers, or by other states.
 2335  
 2336  When determining which patient charge data to disclose, the
 2337  agency shall include such measures as the average of
 2338  undiscounted charges on frequently performed procedures and
 2339  preventive diagnostic procedures, the range of procedure charges
 2340  from highest to lowest, average net revenue per adjusted patient
 2341  day, average cost per adjusted patient day, and average cost per
 2342  admission, among others.
 2343         2. Make available performance measures, benefit design, and
 2344  premium cost data from health plans licensed pursuant to chapter
 2345  627 or chapter 641. The agency shall determine which health care
 2346  quality measures and member and subscriber cost data to
 2347  disclose, based upon input from the council. When determining
 2348  which data to disclose, the agency shall consider information
 2349  that may be required by either individual or group purchasers to
 2350  assess the value of the product, which may include membership
 2351  satisfaction, quality of care, current enrollment or membership,
 2352  coverage areas, accreditation status, premium costs, plan costs,
 2353  premium increases, range of benefits, copayments and
 2354  deductibles, accuracy and speed of claims payment, credentials
 2355  of physicians, number of providers, names of network providers,
 2356  and hospitals in the network. Health plans shall make available
 2357  to the agency any such data or information that is not currently
 2358  reported to the agency or the office.
 2359         3. Determine the method and format for public disclosure of
 2360  data reported pursuant to this paragraph. The agency shall make
 2361  its determination based upon input from the State Consumer
 2362  Health Information and Policy Advisory Council. At a minimum,
 2363  the data shall be made available on the agency’s Internet
 2364  website in a manner that allows consumers to conduct an
 2365  interactive search that allows them to view and compare the
 2366  information for specific providers. The website must include
 2367  such additional information as is determined necessary to ensure
 2368  that the website enhances informed decisionmaking among
 2369  consumers and health care purchasers, which shall include, at a
 2370  minimum, appropriate guidance on how to use the data and an
 2371  explanation of why the data may vary from provider to provider.
 2372  The data specified in subparagraph 1. shall be released no later
 2373  than January 1, 2006, for the reporting of infection rates, and
 2374  no later than October 1, 2005, for mortality rates and
 2375  complication rates. The data specified in subparagraph 2. shall
 2376  be released no later than October 1, 2006.
 2377         4. Publish on its website undiscounted charges for no fewer
 2378  than 150 of the most commonly performed adult and pediatric
 2379  procedures, including outpatient, inpatient, diagnostic, and
 2380  preventative procedures.
 2381         Section 54. Paragraph (a) of subsection (1) of section
 2382  408.061, Florida Statutes, is amended to read:
 2383         408.061 Data collection; uniform systems of financial
 2384  reporting; information relating to physician charges;
 2385  confidential information; immunity.—
 2386         (1) The agency shall require the submission by health care
 2387  facilities, health care providers, and health insurers of data
 2388  necessary to carry out the agency’s duties. Specifications for
 2389  data to be collected under this section shall be developed by
 2390  the agency with the assistance of technical advisory panels
 2391  including representatives of affected entities, consumers,
 2392  purchasers, and such other interested parties as may be
 2393  determined by the agency.
 2394         (a) Data submitted by health care facilities, including the
 2395  facilities as defined in chapter 395, shall include, but are not
 2396  limited to: case-mix data, patient admission and discharge data,
 2397  hospital emergency department data that which shall include the
 2398  number of patients treated in the emergency department of a
 2399  licensed hospital reported by patient acuity level, data on
 2400  hospital-acquired infections as specified by rule, data on
 2401  complications as specified by rule, data on readmissions as
 2402  specified by rule, with patient and provider-specific
 2403  identifiers included, actual charge data by diagnostic groups,
 2404  financial data, accounting data, operating expenses, expenses
 2405  incurred for rendering services to patients who cannot or do not
 2406  pay, interest charges, depreciation expenses based on the
 2407  expected useful life of the property and equipment involved, and
 2408  demographic data. The agency shall adopt nationally recognized
 2409  risk adjustment methodologies or software consistent with the
 2410  standards of the Agency for Healthcare Research and Quality and
 2411  as selected by the agency for all data submitted as required by
 2412  this section. Data may be obtained from documents such as, but
 2413  not limited to: leases, contracts, debt instruments, itemized
 2414  patient bills, medical record abstracts, and related diagnostic
 2415  information. Reported data elements shall be reported
 2416  electronically and in accordance with rule 59E-7.012, Florida
 2417  Administrative Code. Data submitted shall be certified by the
 2418  chief executive officer or an appropriate and duly authorized
 2419  representative or employee of the licensed facility that the
 2420  information submitted is true and accurate.
 2421         Section 55. Subsection (1) of section 408.10, Florida
 2422  Statutes, is amended to read:
 2423         408.10 Consumer complaints.—The agency shall:
 2424         (1) Publish and make available to the public a toll-free
 2425  telephone number for the purpose of handling consumer complaints
 2426  and shall serve as a liaison between consumer entities and other
 2427  private entities and governmental entities for the disposition
 2428  of problems identified by consumers of health care. The agency
 2429  may provide staffing for this toll-free number through agency
 2430  staff or other arrangements.
 2431         Section 56. Subsection (11) of section 408.802, Florida
 2432  Statutes, is repealed.
 2433         Section 57. Effective October 1, 2010, subsection (3) is
 2434  added to section 408.804, Florida Statutes, to read:
 2435         408.804 License required; display.—
 2436         (3)A person who knowingly alters, defaces, or falsifies
 2437  any license certificate issued by the agency, or causes or
 2438  procures another person to commit such an offense, commits a
 2439  misdemeanor of the second degree, punishable as provided in s.
 2440  775.082 or s. 775.083. Any licensee or provider who displays an
 2441  altered, defaced, or falsified license certificate is subject to
 2442  the penalties set forth in s. 408.815 and an administrative fine
 2443  of $1,000 for each day of illegal display.
 2444         Section 58. Paragraph (d) of subsection (2) of section
 2445  408.806, Florida Statutes, is amended to read:
 2446         408.806 License application process.—
 2447         (2)
 2448         (d) The agency shall notify the licensee by mail or
 2449  electronically at least 90 days before the expiration of a
 2450  license that a renewal license is necessary to continue
 2451  operation. The failure of the licensee to timely submit a
 2452  renewal application and license application fee with the agency
 2453  shall result in a $50 per day late fee charged to the licensee
 2454  by the agency; however, the aggregate amount of the late fee may
 2455  not exceed 50 percent of the licensure fee or $500, whichever is
 2456  less. The agency shall provide a courtesy notice to the licensee
 2457  by United States mail, electronically, or by any other manner at
 2458  its address of record at least 90 days before the expiration of
 2459  a license informing the licensee of the expiration of the
 2460  license. Any failure of the agency to provide the courtesy
 2461  notice or any failure of the licensee to receive the courtesy
 2462  notice does not excuse the licensee from the legal obligation to
 2463  timely file the renewal application and license application fee
 2464  with the agency and does not mitigate the late fee. Payment of
 2465  the late fee is required in order for any late application to be
 2466  complete, and failure to pay the late fee is an omission from
 2467  the application. If an application is received after the
 2468  required filing date and exhibits a hand-canceled postmark
 2469  obtained from a United States post office dated on or before the
 2470  required filing date, no fine will be levied.
 2471         Section 59. Subsections (6) and (9) of section 408.810,
 2472  Florida Statutes, are amended to read:
 2473         408.810 Minimum licensure requirements.—In addition to the
 2474  licensure requirements specified in this part, authorizing
 2475  statutes, and applicable rules, each applicant and licensee must
 2476  comply with the requirements of this section in order to obtain
 2477  and maintain a license.
 2478         (6)(a) An applicant must provide the agency with proof of
 2479  the applicant’s legal right to occupy the property before a
 2480  license may be issued. Proof may include, but need not be
 2481  limited to, copies of warranty deeds, lease or rental
 2482  agreements, contracts for deeds, quitclaim deeds, or other such
 2483  documentation.
 2484         (b)If the property is encumbered by a mortgage or is
 2485  leased, an applicant must provide the agency with proof that the
 2486  mortgagor or landlord has received written notice of the
 2487  applicant’s intent, as mortgagee or tenant, to provide services
 2488  that require licensure and with instructions that the agency
 2489  must be served by certified mail with copies of any actions
 2490  initiated by the mortgagor or landlord against the applicant.
 2491         (9) A controlling interest may not withhold from the agency
 2492  any evidence of financial instability, including, but not
 2493  limited to, checks returned due to insufficient funds,
 2494  delinquent accounts, nonpayment of withholding taxes, unpaid
 2495  utility expenses, nonpayment for essential services, or adverse
 2496  court action concerning the financial viability of the provider
 2497  or any other provider licensed under this part which that is
 2498  under the control of the controlling interest. A controlling
 2499  interest shall notify the agency within 10 days after a court
 2500  action, including, but not limited to, the initiation of
 2501  bankruptcy proceedings, foreclosure, or eviction proceedings in
 2502  which the controlling interest is a petitioner or defendant. Any
 2503  person who violates this subsection commits a misdemeanor of the
 2504  second degree, punishable as provided in s. 775.082 or s.
 2505  775.083. Each day of continuing violation is a separate offense.
 2506         Section 60. Paragraph (e) is added to subsection (2) of
 2507  section 408.813, Florida Statutes, to read:
 2508         408.813 Administrative fines; violations.—As a penalty for
 2509  any violation of this part, authorizing statutes, or applicable
 2510  rules, the agency may impose an administrative fine.
 2511         (2) Violations of this part, authorizing statutes, or
 2512  applicable rules shall be classified according to the nature of
 2513  the violation and the gravity of its probable effect on clients.
 2514  The scope of a violation may be cited as an isolated, patterned,
 2515  or widespread deficiency. An isolated deficiency is a deficiency
 2516  affecting one or a very limited number of clients, or involving
 2517  one or a very limited number of staff, or a situation that
 2518  occurred only occasionally or in a very limited number of
 2519  locations. A patterned deficiency is a deficiency in which more
 2520  than a very limited number of clients are affected, or more than
 2521  a very limited number of staff are involved, or the situation
 2522  has occurred in several locations, or the same client or clients
 2523  have been affected by repeated occurrences of the same deficient
 2524  practice but the effect of the deficient practice is not found
 2525  to be pervasive throughout the provider. A widespread deficiency
 2526  is a deficiency in which the problems causing the deficiency are
 2527  pervasive in the provider or represent systemic failure that has
 2528  affected or has the potential to affect a large portion of the
 2529  provider’s clients. This subsection does not affect the
 2530  legislative determination of the amount of a fine imposed under
 2531  authorizing statutes. Violations shall be classified on the
 2532  written notice as follows:
 2533         (e)The agency may impose an administrative fine for
 2534  violations that do not qualify as class I, class II, class III,
 2535  or class IV violations. The amount of the fine may not exceed
 2536  $500 for each violation. Unclassified violations may include:
 2537         1.Violating any term or condition of a license.
 2538         2.Violating any provision of this part, authorizing
 2539  statutes, or applicable rules.
 2540         3.Exceeding licensed capacity without authorization.
 2541         4.Providing services beyond the scope of the license.
 2542         5.Violating a moratorium.
 2543         Section 61. Subsection (5) is added to section 408.815,
 2544  Florida Statutes, to read:
 2545         408.815 License or application denial; revocation.—
 2546         (5)In order to ensure the health, safety, and welfare of
 2547  clients when a license has been denied or revoked or is set to
 2548  terminate, the agency may extend the license expiration date for
 2549  up to 60 days after denial, revocation, or termination for the
 2550  sole purpose of allowing the safe and orderly discharge of
 2551  clients. The agency may impose conditions on the extension,
 2552  including, but not limited to, prohibiting or limiting
 2553  admissions, expediting discharge planning, submitting required
 2554  status reports, and mandatory monitoring by the agency or third
 2555  parties. The agency may terminate the extension or modify the
 2556  conditions at any time at its discretion. Upon the discharge of
 2557  the final client, the extension shall immediately terminate and
 2558  the provider shall cease operation and promptly surrender its
 2559  license certificate to the agency. During the extension, the
 2560  provider must continue to meet all other requirements of this
 2561  part, authorizing statutes, and applicable rules. This authority
 2562  is in addition to any other authority granted to the agency
 2563  under chapter 120, this part, and the authorizing statutes, but
 2564  does not create any right or entitlement to an extension of a
 2565  license expiration date.
 2566         Section 62. Paragraph (d) is added to subsection (13) of
 2567  section 409.906, Florida Statutes, to read:
 2568         409.906 Optional Medicaid services.—Subject to specific
 2569  appropriations, the agency may make payments for services which
 2570  are optional to the state under Title XIX of the Social Security
 2571  Act and are furnished by Medicaid providers to recipients who
 2572  are determined to be eligible on the dates on which the services
 2573  were provided. Any optional service that is provided shall be
 2574  provided only when medically necessary and in accordance with
 2575  state and federal law. Optional services rendered by providers
 2576  in mobile units to Medicaid recipients may be restricted or
 2577  prohibited by the agency. Nothing in this section shall be
 2578  construed to prevent or limit the agency from adjusting fees,
 2579  reimbursement rates, lengths of stay, number of visits, or
 2580  number of services, or making any other adjustments necessary to
 2581  comply with the availability of moneys and any limitations or
 2582  directions provided for in the General Appropriations Act or
 2583  chapter 216. If necessary to safeguard the state’s systems of
 2584  providing services to elderly and disabled persons and subject
 2585  to the notice and review provisions of s. 216.177, the Governor
 2586  may direct the Agency for Health Care Administration to amend
 2587  the Medicaid state plan to delete the optional Medicaid service
 2588  known as “Intermediate Care Facilities for the Developmentally
 2589  Disabled.” Optional services may include:
 2590         (13) HOME AND COMMUNITY-BASED SERVICES.—
 2591         (d)The agency, in consultation with the Department of
 2592  Elderly Affairs, shall phase out the adult day health care
 2593  waiver program and transfer existing waiver enrollees to other
 2594  appropriate home and community-based service programs. Effective
 2595  July 1, 2010, the adult day health care waiver program shall
 2596  cease to enroll new members. Existing enrollees in the adult day
 2597  health care program shall receive counseling regarding available
 2598  options and shall be offered an alternative home and community
 2599  based services program based on eligibility and personal choice.
 2600  Each enrollee in the waiver program shall continue to receive
 2601  home and community-based services without interruption in the
 2602  enrollee’s program of choice. The providers of the adult day
 2603  health care waiver program, in consultation with resource
 2604  centers for the aged, shall assist in the transition of
 2605  enrollees and cease provision of adult day health care waiver
 2606  services by December 31, 2010. The agency may seek federal
 2607  waiver approval to administer this change.
 2608         Section 63. Paragraph (k) of subsection (4) of section
 2609  409.221, Florida Statutes, is repealed.
 2610         Section 64. Paragraphs (e), (f), and (g) of subsection (15)
 2611  of section 409.912, Florida Statutes, are repealed.
 2612         Section 65. Section 429.07, Florida Statutes, is amended to
 2613  read:
 2614         429.07 License required; fee; and inspections.—
 2615         (1) The requirements of part II of chapter 408 apply to the
 2616  provision of services that require licensure pursuant to this
 2617  part and part II of chapter 408 and to entities licensed by or
 2618  applying for such licensure from the agency pursuant to this
 2619  part. A license issued by the agency is required in order to
 2620  operate an assisted living facility in this state.
 2621         (2) Separate licenses shall be required for facilities
 2622  maintained in separate premises, even though operated under the
 2623  same management. A separate license shall not be required for
 2624  separate buildings on the same grounds.
 2625         (3) In addition to the requirements of s. 408.806, each
 2626  license granted by the agency must state the type of care for
 2627  which the license is granted. Licenses shall be issued for one
 2628  or more of the following categories of care: standard, extended
 2629  congregate care, limited nursing services, or limited mental
 2630  health.
 2631         (a) A standard license shall be issued to a facility that
 2632  provides facilities providing one or more of the personal
 2633  services identified in s. 429.02. Such licensee facilities may
 2634  also employ or contract with a person licensed under part I of
 2635  chapter 464 to administer medications and perform other tasks as
 2636  specified in s. 429.255.
 2637         (b) An extended congregate care license shall be issued to
 2638  a licensee that provides facilities providing, directly or
 2639  through contract, services beyond those authorized in paragraph
 2640  (a), including acts performed pursuant to part I of chapter 464
 2641  by persons licensed thereunder, and supportive services defined
 2642  by rule to persons who otherwise would be disqualified from
 2643  continued residence in a facility licensed under this part.
 2644         1. In order for extended congregate care services to be
 2645  provided in a facility licensed under this part, the agency must
 2646  first determine that all requirements established in law and
 2647  rule are met and must specifically designate, on the facility’s
 2648  license, that such services may be provided and whether the
 2649  designation applies to all or part of a facility. Such
 2650  designation may be made at the time of initial licensure or
 2651  relicensure, or upon request in writing by a licensee under this
 2652  part and part II of chapter 408. Notification of approval or
 2653  denial of such request shall be made in accordance with part II
 2654  of chapter 408. An existing licensee facilities qualifying to
 2655  provide extended congregate care services must have maintained a
 2656  standard license and may not have been subject to administrative
 2657  sanctions during the previous 2 years, or since initial
 2658  licensure if the facility has been licensed for less than 2
 2659  years, for any of the following reasons:
 2660         a. A class I or class II violation;
 2661         b. Three or more repeat or recurring class III violations
 2662  of identical or similar resident care standards as specified in
 2663  rule from which a pattern of noncompliance is found by the
 2664  agency;
 2665         c. Three or more class III violations that were not
 2666  corrected in accordance with the corrective action plan approved
 2667  by the agency;
 2668         d. Violation of resident care standards resulting in a
 2669  requirement to employ the services of a consultant pharmacist or
 2670  consultant dietitian;
 2671         e. Denial, suspension, or revocation of a license for
 2672  another facility under this part in which the applicant for an
 2673  extended congregate care license has at least 25 percent
 2674  ownership interest; or
 2675         f. Imposition of a moratorium pursuant to this part or part
 2676  II of chapter 408 or initiation of injunctive proceedings.
 2677         2. A licensee Facilities that is are licensed to provide
 2678  extended congregate care services shall maintain a written
 2679  progress report for on each person who receives such services,
 2680  and the which report must describe describes the type, amount,
 2681  duration, scope, and outcome of services that are rendered and
 2682  the general status of the resident’s health. A registered nurse,
 2683  or appropriate designee, representing the agency shall visit
 2684  such facilities at least quarterly to monitor residents who are
 2685  receiving extended congregate care services and to determine if
 2686  the facility is in compliance with this part, part II of chapter
 2687  408, and rules that relate to extended congregate care. One of
 2688  these visits may be in conjunction with the regular survey. The
 2689  monitoring visits may be provided through contractual
 2690  arrangements with appropriate community agencies. A registered
 2691  nurse shall serve as part of the team that inspects such
 2692  facility. The agency may waive one of the required yearly
 2693  monitoring visits for a facility that has been licensed for at
 2694  least 24 months to provide extended congregate care services,
 2695  if, during the inspection, the registered nurse determines that
 2696  extended congregate care services are being provided
 2697  appropriately, and if the facility has no class I or class II
 2698  violations and no uncorrected class III violations. Before such
 2699  decision is made, the agency shall consult with the long-term
 2700  care ombudsman council for the area in which the facility is
 2701  located to determine if any complaints have been made and
 2702  substantiated about the quality of services or care. The agency
 2703  may not waive one of the required yearly monitoring visits if
 2704  complaints have been made and substantiated.
 2705         3. Licensees Facilities that are licensed to provide
 2706  extended congregate care services shall:
 2707         a. Demonstrate the capability to meet unanticipated
 2708  resident service needs.
 2709         b. Offer a physical environment that promotes a homelike
 2710  setting, provides for resident privacy, promotes resident
 2711  independence, and allows sufficient congregate space as defined
 2712  by rule.
 2713         c. Have sufficient staff available, taking into account the
 2714  physical plant and firesafety features of the building, to
 2715  assist with the evacuation of residents in an emergency, as
 2716  necessary.
 2717         d. Adopt and follow policies and procedures that maximize
 2718  resident independence, dignity, choice, and decisionmaking to
 2719  permit residents to age in place to the extent possible, so that
 2720  moves due to changes in functional status are minimized or
 2721  avoided.
 2722         e. Allow residents or, if applicable, a resident’s
 2723  representative, designee, surrogate, guardian, or attorney in
 2724  fact to make a variety of personal choices, participate in
 2725  developing service plans, and share responsibility in
 2726  decisionmaking.
 2727         f. Implement the concept of managed risk.
 2728         g. Provide, either directly or through contract, the
 2729  services of a person licensed pursuant to part I of chapter 464.
 2730         h. In addition to the training mandated in s. 429.52,
 2731  provide specialized training as defined by rule for facility
 2732  staff.
 2733         4. Licensees Facilities licensed to provide extended
 2734  congregate care services are exempt from the criteria for
 2735  continued residency as set forth in rules adopted under s.
 2736  429.41. Licensees Facilities so licensed shall adopt their own
 2737  requirements within guidelines for continued residency set forth
 2738  by rule. However, such licensees facilities may not serve
 2739  residents who require 24-hour nursing supervision. Licensees
 2740  Facilities licensed to provide extended congregate care services
 2741  shall provide each resident with a written copy of facility
 2742  policies governing admission and retention.
 2743         5. The primary purpose of extended congregate care services
 2744  is to allow residents, as they become more impaired, the option
 2745  of remaining in a familiar setting from which they would
 2746  otherwise be disqualified for continued residency. A licensee
 2747  facility licensed to provide extended congregate care services
 2748  may also admit an individual who exceeds the admission criteria
 2749  for a facility with a standard license, if the individual is
 2750  determined appropriate for admission to the extended congregate
 2751  care facility.
 2752         6. Before admission of an individual to a facility licensed
 2753  to provide extended congregate care services, the individual
 2754  must undergo a medical examination as provided in s. 429.26(4)
 2755  and the facility must develop a preliminary service plan for the
 2756  individual.
 2757         7. When a licensee facility can no longer provide or
 2758  arrange for services in accordance with the resident’s service
 2759  plan and needs and the licensee facility’s policy, the licensee
 2760  facility shall make arrangements for relocating the person in
 2761  accordance with s. 429.28(1)(k).
 2762         8. Failure to provide extended congregate care services may
 2763  result in denial of extended congregate care license renewal.
 2764         9.No later than January 1 of each year, the department, in
 2765  consultation with the agency, shall prepare and submit to the
 2766  Governor, the President of the Senate, the Speaker of the House
 2767  of Representatives, and the chairs of appropriate legislative
 2768  committees, a report on the status of, and recommendations
 2769  related to, extended congregate care services. The status report
 2770  must include, but need not be limited to, the following
 2771  information:
 2772         a.A description of the facilities licensed to provide such
 2773  services, including total number of beds licensed under this
 2774  part.
 2775         b.The number and characteristics of residents receiving
 2776  such services.
 2777         c.The types of services rendered that could not be
 2778  provided through a standard license.
 2779         d.An analysis of deficiencies cited during licensure
 2780  inspections.
 2781         e.The number of residents who required extended congregate
 2782  care services at admission and the source of admission.
 2783         f.Recommendations for statutory or regulatory changes.
 2784         g.The availability of extended congregate care to state
 2785  clients residing in facilities licensed under this part and in
 2786  need of additional services, and recommendations for
 2787  appropriations to subsidize extended congregate care services
 2788  for such persons.
 2789         h.Such other information as the department considers
 2790  appropriate.
 2791         (c)A limited nursing services license shall be issued to a
 2792  facility that provides services beyond those authorized in
 2793  paragraph (a) and as specified in this paragraph.
 2794         1.In order for limited nursing services to be provided in
 2795  a facility licensed under this part, the agency must first
 2796  determine that all requirements established in law and rule are
 2797  met and must specifically designate, on the facility’s license,
 2798  that such services may be provided. Such designation may be made
 2799  at the time of initial licensure or relicensure, or upon request
 2800  in writing by a licensee under this part and part II of chapter
 2801  408. Notification of approval or denial of such request shall be
 2802  made in accordance with part II of chapter 408. Existing
 2803  facilities qualifying to provide limited nursing services shall
 2804  have maintained a standard license and may not have been subject
 2805  to administrative sanctions that affect the health, safety, and
 2806  welfare of residents for the previous 2 years or since initial
 2807  licensure if the facility has been licensed for less than 2
 2808  years.
 2809         2.Facilities that are licensed to provide limited nursing
 2810  services shall maintain a written progress report on each person
 2811  who receives such nursing services, which report describes the
 2812  type, amount, duration, scope, and outcome of services that are
 2813  rendered and the general status of the resident’s health. A
 2814  registered nurse representing the agency shall visit such
 2815  facilities at least twice a year to monitor residents who are
 2816  receiving limited nursing services and to determine if the
 2817  facility is in compliance with applicable provisions of this
 2818  part, part II of chapter 408, and related rules. The monitoring
 2819  visits may be provided through contractual arrangements with
 2820  appropriate community agencies. A registered nurse shall also
 2821  serve as part of the team that inspects such facility.
 2822         3.A person who receives limited nursing services under
 2823  this part must meet the admission criteria established by the
 2824  agency for assisted living facilities. When a resident no longer
 2825  meets the admission criteria for a facility licensed under this
 2826  part, arrangements for relocating the person shall be made in
 2827  accordance with s. 429.28(1)(k), unless the facility is licensed
 2828  to provide extended congregate care services.
 2829         (4) In accordance with s. 408.805, an applicant or licensee
 2830  shall pay a fee for each license application submitted under
 2831  this part, part II of chapter 408, and applicable rules. The
 2832  amount of the fee shall be established by rule.
 2833         (a) The biennial license fee required of a facility is $356
 2834  $300 per license, with an additional fee of $67.50 $50 per
 2835  resident based on the total licensed resident capacity of the
 2836  facility, except that no additional fee will be assessed for
 2837  beds designated for recipients of optional state supplementation
 2838  payments provided for in s. 409.212. The total fee may not
 2839  exceed $18,500 $10,000.
 2840         (b) In addition to the total fee assessed under paragraph
 2841  (a), the agency shall require facilities that are licensed to
 2842  provide extended congregate care services under this part to pay
 2843  an additional fee per licensed facility. The amount of the
 2844  biennial fee shall be $501 $400 per license, with an additional
 2845  fee of $10 per resident based on the total licensed resident
 2846  capacity of the facility.
 2847         (c)In addition to the total fee assessed under paragraph
 2848  (a), the agency shall require facilities that are licensed to
 2849  provide limited nursing services under this part to pay an
 2850  additional fee per licensed facility. The amount of the biennial
 2851  fee shall be $250 per license, with an additional fee of $10 per
 2852  resident based on the total licensed resident capacity of the
 2853  facility.
 2854         (5) Counties or municipalities applying for licenses under
 2855  this part are exempt from the payment of license fees.
 2856         (6) In order to determine whether the licensee is
 2857  adequately protecting residents’ rights as provided in s.
 2858  429.28, the biennial survey must include private, informal
 2859  conversations with a sample of the residents and consultation
 2860  with the ombudsman council in the planning and service area in
 2861  which the facility is located to discuss residents’ experiences
 2862  within the facility.
 2863         (7) An assisted living facility that has been cited within
 2864  the previous 24-month period for a class I violation or a class
 2865  II violation, regardless of the status of any enforcement or
 2866  disciplinary action, is subject to periodic unannounced
 2867  monitoring to determine if the facility is in compliance with
 2868  this part, part II of chapter 408, and applicable rules.
 2869  Monitoring may occur through a desk review or onsite. If a cited
 2870  violation relates to providing or failing to provide nursing
 2871  care, a registered nurse must participate in at least two onsite
 2872  monitoring visits within a 12-month period.
 2873         Section 66. Section 429.11, Florida Statutes, is amended to
 2874  read:
 2875         429.11 Initial application for license; provisional
 2876  license.—
 2877         (1) Each applicant for licensure must comply with all
 2878  provisions of part II of chapter 408 and must:
 2879         (a) Identify all other homes or facilities, including the
 2880  addresses and the license or licenses under which they operate,
 2881  if applicable, which are currently operated by the applicant or
 2882  administrator and which provide housing, meals, and personal
 2883  services to residents.
 2884         (b) Provide the location of the facility for which a
 2885  license is sought and documentation, signed by the appropriate
 2886  local government official, which states that the applicant has
 2887  met local zoning requirements.
 2888         (c) Provide the name, address, date of birth, social
 2889  security number, education, and experience of the administrator,
 2890  if different from the applicant.
 2891         (2) The applicant shall provide proof of liability
 2892  insurance as defined in s. 624.605.
 2893         (3) If the applicant is a community residential home, the
 2894  applicant must provide proof that it has met the requirements
 2895  specified in chapter 419.
 2896         (4) The applicant must furnish proof that the facility has
 2897  received a satisfactory firesafety inspection. The local
 2898  authority having jurisdiction or the State Fire Marshal must
 2899  conduct the inspection within 30 days after written request by
 2900  the applicant.
 2901         (5) The applicant must furnish documentation of a
 2902  satisfactory sanitation inspection of the facility by the county
 2903  health department.
 2904         (6) In addition to the license categories available in s.
 2905  408.808, a provisional license may be issued to an applicant
 2906  making initial application for licensure or making application
 2907  for a change of ownership. A provisional license shall be
 2908  limited in duration to a specific period of time not to exceed 6
 2909  months, as determined by the agency.
 2910         (6)(7) A county or municipality may not issue an
 2911  occupational license that is being obtained for the purpose of
 2912  operating a facility regulated under this part without first
 2913  ascertaining that the applicant has been licensed to operate
 2914  such facility at the specified location or locations by the
 2915  agency. The agency shall furnish to local agencies responsible
 2916  for issuing occupational licenses sufficient instruction for
 2917  making such determinations.
 2918         Section 67. Subsection (2) of section 429.12, Florida
 2919  Statutes, is repealed.
 2920         Section 68. Subsections (5) and (6) of section 429.14,
 2921  Florida Statutes, are amended to read:
 2922         429.14 Administrative penalties.—
 2923         (5) An action taken by the agency to suspend, deny, or
 2924  revoke a facility’s license under this part or part II of
 2925  chapter 408, in which the agency claims that the facility owner
 2926  or an employee of the facility has threatened the health,
 2927  safety, or welfare of a resident of the facility shall be heard
 2928  by the Division of Administrative Hearings of the Department of
 2929  Management Services within 120 days after receipt of the
 2930  facility’s request for a hearing, unless that time limitation is
 2931  waived by both parties. The administrative law judge must render
 2932  a decision within 30 days after receipt of a proposed
 2933  recommended order.
 2934         (6) The agency shall provide to the Division of Hotels and
 2935  Restaurants of the Department of Business and Professional
 2936  Regulation, on a monthly basis, a list of those assisted living
 2937  facilities that have had their licenses denied, suspended, or
 2938  revoked or that are involved in an appellate proceeding pursuant
 2939  to s. 120.60 related to the denial, suspension, or revocation of
 2940  a license. This information may be provided electronically or
 2941  through the agency’s Internet website.
 2942         Section 69. Subsections (1), (4), and (5) of section
 2943  429.17, Florida Statutes, are amended to read:
 2944         429.17 Expiration of license; renewal; conditional
 2945  license.—
 2946         (1) Limited nursing, Extended congregate care, and limited
 2947  mental health licenses shall expire at the same time as the
 2948  facility’s standard license, regardless of when issued.
 2949         (4) In addition to the license categories available in s.
 2950  408.808, a conditional license may be issued to an applicant for
 2951  license renewal if the applicant fails to meet all standards and
 2952  requirements for licensure. A conditional license issued under
 2953  this subsection shall be limited in duration to a specific
 2954  period of time not to exceed 6 months, as determined by the
 2955  agency, and shall be accompanied by an agency-approved plan of
 2956  correction.
 2957         (5) When an extended congregate care or limited nursing
 2958  license is requested during a facility’s biennial license
 2959  period, the fee shall be prorated in order to permit the
 2960  additional license to expire at the end of the biennial license
 2961  period. The fee shall be calculated as of the date the
 2962  additional license application is received by the agency.
 2963         Section 70. Subsection (7) of section 429.19, Florida
 2964  Statutes, is amended to read:
 2965         429.19 Violations; imposition of administrative fines;
 2966  grounds.—
 2967         (7) In addition to any administrative fines imposed, the
 2968  agency may assess a survey or monitoring fee, equal to the
 2969  lesser of one half of the facility’s biennial license and bed
 2970  fee or $500, to cover the cost of conducting initial complaint
 2971  investigations that result in the finding of a violation that
 2972  was the subject of the complaint or monitoring visits conducted
 2973  under s. 429.28(3)(c) to verify the correction of the
 2974  violations, or to monitor the health, safety, or security of
 2975  residents under s. 429.07(7).
 2976         Section 71. Subsection (5) of section 429.23, Florida
 2977  Statutes, is repealed.
 2978         Section 72. Section 429.255, Florida Statutes, is amended
 2979  to read:
 2980         429.255 Use of personnel; emergency care.—
 2981         (1)(a) Persons under contract to the facility or, facility
 2982  staff, or volunteers, who are licensed according to part I of
 2983  chapter 464, or those persons exempt under s. 464.022(1), and
 2984  others as defined by rule, may administer medications to
 2985  residents, take residents’ vital signs, manage individual weekly
 2986  pill organizers for residents who self-administer medication,
 2987  give prepackaged enemas ordered by a physician, observe
 2988  residents, document observations on the appropriate resident’s
 2989  record, report observations to the resident’s physician, and
 2990  contract or allow residents or a resident’s representative,
 2991  designee, surrogate, guardian, or attorney in fact to contract
 2992  with a third party, provided residents meet the criteria for
 2993  appropriate placement as defined in s. 429.26. Persons under
 2994  contract to the facility or facility staff who are licensed
 2995  according to part I of chapter 464 may provide limited nursing
 2996  services. Nursing assistants certified pursuant to part II of
 2997  chapter 464 may take residents’ vital signs as directed by a
 2998  licensed nurse or physician. The licensee is responsible for
 2999  maintaining documentation of services provided under this
 3000  paragraph as required by rule and ensuring that staff are
 3001  adequately trained to monitor residents receiving these
 3002  services.
 3003         (b) All staff in facilities licensed under this part shall
 3004  exercise their professional responsibility to observe residents,
 3005  to document observations on the appropriate resident’s record,
 3006  and to report the observations to the resident’s physician.
 3007  However, the owner or administrator of the facility shall be
 3008  responsible for determining that the resident receiving services
 3009  is appropriate for residence in the facility.
 3010         (c) In an emergency situation, licensed personnel may carry
 3011  out their professional duties pursuant to part I of chapter 464
 3012  until emergency medical personnel assume responsibility for
 3013  care.
 3014         (2) In facilities licensed to provide extended congregate
 3015  care, persons under contract to the facility or, facility staff,
 3016  or volunteers, who are licensed according to part I of chapter
 3017  464, or those persons exempt under s. 464.022(1), or those
 3018  persons certified as nursing assistants pursuant to part II of
 3019  chapter 464, may also perform all duties within the scope of
 3020  their license or certification, as approved by the facility
 3021  administrator and pursuant to this part.
 3022         (3) Facility staff may withhold or withdraw cardiopulmonary
 3023  resuscitation if presented with an order not to resuscitate
 3024  executed pursuant to s. 401.45. The department shall adopt rules
 3025  providing for the implementation of such orders. Facility staff
 3026  and facilities shall not be subject to criminal prosecution or
 3027  civil liability, nor be considered to have engaged in negligent
 3028  or unprofessional conduct, for withholding or withdrawing
 3029  cardiopulmonary resuscitation pursuant to such an order and
 3030  rules adopted by the department. The absence of an order to
 3031  resuscitate executed pursuant to s. 401.45 does not preclude a
 3032  physician from withholding or withdrawing cardiopulmonary
 3033  resuscitation as otherwise permitted by law.
 3034         Section 73. Subsection (3) of section 429.28, Florida
 3035  Statutes, is repealed.
 3036         Section 74. Subsection (2) of section 429.35, Florida
 3037  Statutes, is amended to read:
 3038         429.35 Maintenance of records; reports.—
 3039         (2) Within 60 days after the date of the biennial
 3040  inspection visit required under s. 408.811 or within 30 days
 3041  after the date of any interim visit, the agency shall forward
 3042  the results of the inspection to the local ombudsman council in
 3043  whose planning and service area, as defined in part II of
 3044  chapter 400, the facility is located; to at least one public
 3045  library or, in the absence of a public library, the county seat
 3046  in the county in which the inspected assisted living facility is
 3047  located; and, when appropriate, to the district Adult Services
 3048  and Mental Health Program Offices. This information may be
 3049  provided electronically or through the agency’s Internet site.
 3050         Section 75. Paragraphs (i) and (j) of subsection (1) of
 3051  section 429.41, Florida Statutes, are amended to read:
 3052         429.41 Rules establishing standards.—
 3053         (1) It is the intent of the Legislature that rules
 3054  published and enforced pursuant to this section shall include
 3055  criteria by which a reasonable and consistent quality of
 3056  resident care and quality of life may be ensured and the results
 3057  of such resident care may be demonstrated. Such rules shall also
 3058  ensure a safe and sanitary environment that is residential and
 3059  noninstitutional in design or nature. It is further intended
 3060  that reasonable efforts be made to accommodate the needs and
 3061  preferences of residents to enhance the quality of life in a
 3062  facility. The agency, in consultation with the department, may
 3063  adopt rules to administer the requirements of part II of chapter
 3064  408. In order to provide safe and sanitary facilities and the
 3065  highest quality of resident care accommodating the needs and
 3066  preferences of residents, the department, in consultation with
 3067  the agency, the Department of Children and Family Services, and
 3068  the Department of Health, shall adopt rules, policies, and
 3069  procedures to administer this part, which must include
 3070  reasonable and fair minimum standards in relation to:
 3071         (i) Facilities holding an a limited nursing, extended
 3072  congregate care, or limited mental health license.
 3073         (j) The establishment of specific criteria to define
 3074  appropriateness of resident admission and continued residency in
 3075  a facility holding a standard, limited nursing, extended
 3076  congregate care, and limited mental health license.
 3077         Section 76. Section 429.53, Florida Statutes, is amended to
 3078  read:
 3079         429.53 Consultation by the agency.—
 3080         (1) The area offices of licensure and certification of the
 3081  agency shall provide consultation to the following upon request:
 3082         (a) A licensee of a facility.
 3083         (b) A person interested in obtaining a license to operate a
 3084  facility under this part.
 3085         (2) As used in this section, “consultation” includes:
 3086         (a) An explanation of the requirements of this part and
 3087  rules adopted pursuant thereto;
 3088         (b) An explanation of the license application and renewal
 3089  procedures; and
 3090         (c) The provision of a checklist of general local and state
 3091  approvals required prior to constructing or developing a
 3092  facility and a listing of the types of agencies responsible for
 3093  such approvals;
 3094         (d) An explanation of benefits and financial assistance
 3095  available to a recipient of supplemental security income
 3096  residing in a facility;
 3097         (c)(e) Any other information which the agency deems
 3098  necessary to promote compliance with the requirements of this
 3099  part; and
 3100         (f) A preconstruction review of a facility to ensure
 3101  compliance with agency rules and this part.
 3102         (3) The agency may charge a fee commensurate with the cost
 3103  of providing consultation under this section.
 3104         Section 77. Section 429.54, Florida Statutes, is amended to
 3105  read:
 3106         429.54 Collection of information; local subsidy.—
 3107         (1)Facilities that are licensed under this part must
 3108  report electronically to the agency semiannually, or more
 3109  frequently as determined by rule, data related to the facility,
 3110  including, but not limited to: the total number of residents,
 3111  the number of residents who are receiving limited mental health
 3112  services, the number of residents who are receiving extended
 3113  congregate care services, the number of residents who are
 3114  receiving limited nursing services, funding sources of the
 3115  residents, and professional staffing employed by or under
 3116  contract with the licensee to provide resident services. The
 3117  department, in consultation with the agency, shall adopt rules
 3118  to administer this subsection.
 3119         (2)(1) To enable the department to collect the information
 3120  requested by the Legislature regarding the actual cost of
 3121  providing room, board, and personal care in facilities, the
 3122  department is authorized to conduct field visits and audits of
 3123  facilities as may be necessary. The owners of randomly sampled
 3124  facilities shall submit such reports, audits, and accountings of
 3125  cost as the department may require by rule; provided that such
 3126  reports, audits, and accountings shall be the minimum necessary
 3127  to implement the provisions of this section. Any facility
 3128  selected to participate in the study shall cooperate with the
 3129  department by providing cost of operation information to
 3130  interviewers.
 3131         (3)(2) Local governments or organizations may contribute to
 3132  the cost of care of local facility residents by further
 3133  subsidizing the rate of state-authorized payment to such
 3134  facilities. Implementation of local subsidy shall require
 3135  departmental approval and shall not result in reductions in the
 3136  state supplement.
 3137         Section 78. Subsections (2) and (11) of section 429.65,
 3138  Florida Statutes, are amended to read:
 3139         429.65 Definitions.—As used in this part, the term:
 3140         (2) “Adult family-care home” means a full-time, family-type
 3141  living arrangement, in a private home, under which up to two
 3142  individuals a person who reside in the home and own or rent owns
 3143  or rents the home provide provides room, board, and personal
 3144  care, on a 24-hour basis, for no more than five disabled adults
 3145  or frail elders who are not relatives. The following family-type
 3146  living arrangements are not required to be licensed as an adult
 3147  family-care home:
 3148         (a) An arrangement whereby the person who resides in the
 3149  home and owns or rents the home provides room, board, and
 3150  personal services for not more than two adults who do not
 3151  receive optional state supplementation under s. 409.212. The
 3152  person who provides the housing, meals, and personal care must
 3153  own or rent the home and reside therein.
 3154         (b) An arrangement whereby the person who owns or rents the
 3155  home provides room, board, and personal services only to his or
 3156  her relatives.
 3157         (c) An establishment that is licensed as an assisted living
 3158  facility under this chapter.
 3159         (11) “Provider” means up to two individuals a person who
 3160  are is licensed to operate an adult family-care home.
 3161         Section 79. Section 429.71, Florida Statutes, is amended to
 3162  read:
 3163         429.71 Classification of violations deficiencies;
 3164  administrative fines.—
 3165         (1) In addition to the requirements of part II of chapter
 3166  408 and in addition to any other liability or penalty provided
 3167  by law, the agency may impose an administrative fine on a
 3168  provider according to the following classification:
 3169         (a) Class I violations are defined in s. 408.813. those
 3170  conditions or practices related to the operation and maintenance
 3171  of an adult family-care home or to the care of residents which
 3172  the agency determines present an imminent danger to the
 3173  residents or guests of the facility or a substantial probability
 3174  that death or serious physical or emotional harm would result
 3175  therefrom. The condition or practice that constitutes a class I
 3176  violation must be abated or eliminated within 24 hours, unless a
 3177  fixed period, as determined by the agency, is required for
 3178  correction. A class I violation deficiency is subject to an
 3179  administrative fine in an amount not less than $500 and not
 3180  exceeding $1,000 for each violation. A fine may be levied
 3181  notwithstanding the correction of the violation deficiency.
 3182         (b) Class II violations are defined in s. 408.813. those
 3183  conditions or practices related to the operation and maintenance
 3184  of an adult family-care home or to the care of residents which
 3185  the agency determines directly threaten the physical or
 3186  emotional health, safety, or security of the residents, other
 3187  than class I violations. A class II violation is subject to an
 3188  administrative fine in an amount not less than $250 and not
 3189  exceeding $500 for each violation. A citation for a class II
 3190  violation must specify the time within which the violation is
 3191  required to be corrected. If a class II violation is corrected
 3192  within the time specified, no civil penalty shall be imposed,
 3193  unless it is a repeated offense.
 3194         (c) Class III violations are defined in s. 408.813. those
 3195  conditions or practices related to the operation and maintenance
 3196  of an adult family-care home or to the care of residents which
 3197  the agency determines indirectly or potentially threaten the
 3198  physical or emotional health, safety, or security of residents,
 3199  other than class I or class II violations. A class III violation
 3200  is subject to an administrative fine in an amount not less than
 3201  $100 and not exceeding $250 for each violation. A citation for a
 3202  class III violation shall specify the time within which the
 3203  violation is required to be corrected. If a class III violation
 3204  is corrected within the time specified, no civil penalty shall
 3205  be imposed, unless it is a repeated offense.
 3206         (d) Class IV violations are defined in s. 408.813. those
 3207  conditions or occurrences related to the operation and
 3208  maintenance of an adult family-care home, or related to the
 3209  required reports, forms, or documents, which do not have the
 3210  potential of negatively affecting the residents. A provider that
 3211  does not correct A class IV violation within the time limit
 3212  specified by the agency is subject to an administrative fine in
 3213  an amount not less than $50 and not exceeding $100 for each
 3214  violation. Any class IV violation that is corrected during the
 3215  time the agency survey is conducted will be identified as an
 3216  agency finding and not as a violation.
 3217         (2) The agency may impose an administrative fine for
 3218  violations that which do not qualify as class I, class II, class
 3219  III, or class IV violations. The amount of the fine may shall
 3220  not exceed $250 for each violation or $2,000 in the aggregate.
 3221  Unclassified violations may include:
 3222         (a) Violating any term or condition of a license.
 3223         (b) Violating any provision of this part, part II of
 3224  chapter 408, or applicable rules.
 3225         (c) Failure to follow the criteria and procedures provided
 3226  under part I of chapter 394 relating to the transportation,
 3227  voluntary admission, and involuntary examination of adult
 3228  family-care home residents.
 3229         (d) Exceeding licensed capacity.
 3230         (e) Providing services beyond the scope of the license.
 3231         (f) Violating a moratorium.
 3232         (3) Each day during which a violation occurs constitutes a
 3233  separate offense.
 3234         (4) In determining whether a penalty is to be imposed, and
 3235  in fixing the amount of any penalty to be imposed, the agency
 3236  must consider:
 3237         (a) The gravity of the violation.
 3238         (b) Actions taken by the provider to correct a violation.
 3239         (c) Any previous violation by the provider.
 3240         (d) The financial benefit to the provider of committing or
 3241  continuing the violation.
 3242         (5) As an alternative to or in conjunction with an
 3243  administrative action against a provider, the agency may request
 3244  a plan of corrective action that demonstrates a good faith
 3245  effort to remedy each violation by a specific date, subject to
 3246  the approval of the agency.
 3247         (5)(6) The department shall set forth, by rule, notice
 3248  requirements and procedures for correction of deficiencies.
 3249         Section 80. Subsection (5) of section 429.901, Florida
 3250  Statutes, is repealed.
 3251         Section 81. Paragraph (a) of subsection (2) of section
 3252  429.911, Florida Statutes is repealed.
 3253         Section 82. Section 429.915, Florida Statutes, is amended
 3254  to read:
 3255         429.915 Conditional license.—In addition to the license
 3256  categories available in part II of chapter 408, the agency may
 3257  issue a conditional license to an applicant for license renewal
 3258  or change of ownership if the applicant fails to meet all
 3259  standards and requirements for licensure. A conditional license
 3260  issued under this subsection must be limited to a specific
 3261  period not exceeding 6 months, as determined by the agency, and
 3262  must be accompanied by an approved plan of correction.
 3263         Section 83. Subsection (3) of section 430.80, Florida
 3264  Statutes, is amended to read:
 3265         430.80 Implementation of a teaching nursing home pilot
 3266  project.—
 3267         (3) To be designated as a teaching nursing home, a nursing
 3268  home licensee must, at a minimum:
 3269         (a) Provide a comprehensive program of integrated senior
 3270  services that include institutional services and community-based
 3271  services;
 3272         (b) Participate in a nationally recognized accreditation
 3273  program and hold a valid accreditation, such as the
 3274  accreditation awarded by the Joint Commission on Accreditation
 3275  of Healthcare Organizations;
 3276         (c) Have been in business in this state for a minimum of 10
 3277  consecutive years;
 3278         (d) Demonstrate an active program in multidisciplinary
 3279  education and research that relates to gerontology;
 3280         (e) Have a formalized contractual relationship with at
 3281  least one accredited health profession education program located
 3282  in this state;
 3283         (f) Have a formalized contractual relationship with an
 3284  accredited hospital that is designated by law as a teaching
 3285  hospital; and
 3286         (g) Have senior staff members who hold formal faculty
 3287  appointments at universities, which must include at least one
 3288  accredited health profession education program.
 3289         (h) Maintain insurance coverage pursuant to s.
 3290  400.141(1)(q) s. 400.141(1)(s) or proof of financial
 3291  responsibility in a minimum amount of $750,000. Such proof of
 3292  financial responsibility may include:
 3293         1. Maintaining an escrow account consisting of cash or
 3294  assets eligible for deposit in accordance with s. 625.52; or
 3295         2. Obtaining and maintaining pursuant to chapter 675 an
 3296  unexpired, irrevocable, nontransferable and nonassignable letter
 3297  of credit issued by any bank or savings association organized
 3298  and existing under the laws of this state or any bank or savings
 3299  association organized under the laws of the United States which
 3300  that has its principal place of business in this state or which
 3301  has a branch office that which is authorized to receive deposits
 3302  in this state. The letter of credit shall be used to satisfy the
 3303  obligation of the facility to the claimant upon presentment of a
 3304  final judgment indicating liability and awarding damages to be
 3305  paid by the facility or upon presentment of a settlement
 3306  agreement signed by all parties to the agreement when such final
 3307  judgment or settlement is a result of a liability claim against
 3308  the facility.
 3309         Section 84. Paragraph (a) of subsection (2) of section
 3310  440.13, Florida Statutes, is amended to read:
 3311         440.13 Medical services and supplies; penalty for
 3312  violations; limitations.—
 3313         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
 3314         (a) Subject to the limitations specified elsewhere in this
 3315  chapter, the employer shall furnish to the employee such
 3316  medically necessary remedial treatment, care, and attendance for
 3317  such period as the nature of the injury or the process of
 3318  recovery may require, which is in accordance with established
 3319  practice parameters and protocols of treatment as provided for
 3320  in this chapter, including medicines, medical supplies, durable
 3321  medical equipment, orthoses, prostheses, and other medically
 3322  necessary apparatus. Remedial treatment, care, and attendance,
 3323  including work-hardening programs or pain-management programs
 3324  accredited by the Commission on Accreditation of Rehabilitation
 3325  Facilities or Joint Commission on the Accreditation of Health
 3326  Organizations or pain-management programs affiliated with
 3327  medical schools, shall be considered as covered treatment only
 3328  when such care is given based on a referral by a physician as
 3329  defined in this chapter. Medically necessary treatment, care,
 3330  and attendance does not include chiropractic services in excess
 3331  of 24 treatments or rendered 12 weeks beyond the date of the
 3332  initial chiropractic treatment, whichever comes first, unless
 3333  the carrier authorizes additional treatment or the employee is
 3334  catastrophically injured.
 3335  
 3336  Failure of the carrier to timely comply with this subsection
 3337  shall be a violation of this chapter and the carrier shall be
 3338  subject to penalties as provided for in s. 440.525.
 3339         Section 85. Subsection (11) is added to section 483.201,
 3340  Florida Statutes, to read:
 3341         483.201 Grounds for disciplinary action against clinical
 3342  laboratories.—In addition to the requirements of part II of
 3343  chapter 408, the following acts constitute grounds for which a
 3344  disciplinary action specified in s. 483.221 may be taken against
 3345  a clinical laboratory:
 3346         (11) A blood establishment that collects blood or blood
 3347  components from volunteer donors failing to disclose information
 3348  concerning its activities as required by s. 381.06014. Each day
 3349  of violation constitutes a separate violation and each separate
 3350  violation is subject to a separate fine. If multiple licensed
 3351  establishments operated by a single business entity fail to meet
 3352  such disclosure requirements, the agency may assess fines
 3353  against only one of the business entity’s clinical laboratory
 3354  licenses. The total administrative fine may not exceed $10,000
 3355  for each annual reporting period.
 3356         Section 86. Section 483.294, Florida Statutes, is amended
 3357  to read:
 3358         483.294 Inspection of centers.—In accordance with s.
 3359  408.811, the agency shall biennially, at least once annually,
 3360  inspect the premises and operations of all centers subject to
 3361  licensure under this part.
 3362         Section 87. Subsection (23) of section 499.003, Florida
 3363  Statutes, is amended to read
 3364         499.003 Definitions of terms used in this part.—As used in
 3365  this part, the term:
 3366         (23) “Health care entity” means a closed pharmacy or any
 3367  person, organization, or business entity that provides
 3368  diagnostic, medical, surgical, or dental treatment or care, or
 3369  chronic or rehabilitative care, but does not include any
 3370  wholesale distributor or retail pharmacy licensed under state
 3371  law to deal in prescription drugs. However, a blood
 3372  establishment may be a health care entity and engage in the
 3373  wholesale distribution of prescription drugs under s.
 3374  499.01(2)(g)1.c.
 3375         Section 88. Subsection (21) of section 499.005, Florida
 3376  Statutes, is amended to read:
 3377         499.005 Prohibited acts.—It is unlawful for a person to
 3378  perform or cause the performance of any of the following acts in
 3379  this state:
 3380         (21) The wholesale distribution of any prescription drug
 3381  that was:
 3382         (a) Purchased by a public or private hospital or other
 3383  health care entity, except as authorized in s. 499.01(2)(g)1.c.;
 3384  or
 3385         (b) Donated or supplied at a reduced price to a charitable
 3386  organization.
 3387         Section 89. Paragraphs (a) and (g) of subsection (2) of
 3388  section 499.01, Florida Statutes, are amended to read:
 3389         499.01 Permits.—
 3390         (2) The following permits are established:
 3391         (a) Prescription drug manufacturer permit.—A prescription
 3392  drug manufacturer permit is required for any person that is a
 3393  manufacturer of a prescription drug and that manufactures or
 3394  distributes such prescription drugs in this state.
 3395         1. A person that operates an establishment permitted as a
 3396  prescription drug manufacturer may engage in wholesale
 3397  distribution of prescription drugs manufactured at that
 3398  establishment and must comply with all of the provisions of this
 3399  part, except s. 499.01212, and the rules adopted under this
 3400  part, except s. 499.01212, that apply to a wholesale
 3401  distributor.
 3402         2. A prescription drug manufacturer must comply with all
 3403  appropriate state and federal good manufacturing practices.
 3404         3. A blood establishment as defined in s. 381.06014,
 3405  operating in a manner consistent with the provisions of Title 21
 3406  C.F.R. Parts 211 and 600-640, and manufacturing only the
 3407  prescription drugs described in s. 499.003(53)(d) is not
 3408  required to be permitted as a prescription drug manufacturer
 3409  under this paragraph or register products under s. 499.015.
 3410         (g) Restricted prescription drug distributor permit.—
 3411         1. A restricted prescription drug distributor permit is
 3412  required for:
 3413         a. Any person that engages in the distribution of a
 3414  prescription drug, which distribution is not considered
 3415  “wholesale distribution” under s. 499.003(53)(a).
 3416         b.1.Any A person who engages in the receipt or
 3417  distribution of a prescription drug in this state for the
 3418  purpose of processing its return or its destruction must obtain
 3419  a permit as a restricted prescription drug distributor if such
 3420  person is not the person initiating the return, the prescription
 3421  drug wholesale supplier of the person initiating the return, or
 3422  the manufacturer of the drug.
 3423         c.A blood establishment located in this state which
 3424  collects blood and blood components only from volunteer donors
 3425  as defined in s. 381.06014 or pursuant to an authorized
 3426  practitioner’s order for medical treatment or therapy and
 3427  engages in the wholesale distribution of a prescription drug not
 3428  described in s. 499.003(53)(d) to a health care entity. The
 3429  health care entity receiving a prescription drug distributed
 3430  under this sub-subparagraph must be licensed as a closed
 3431  pharmacy or provide health care services at that establishment.
 3432  The blood establishment must operate in accordance with s.
 3433  381.06014 and may distribute only:
 3434         (I) Prescription drugs indicated for a bleeding or clotting
 3435  disorder or anemia;
 3436         (II) Blood-collection containers approved under s. 505 of
 3437  the federal act;
 3438         (III) Drugs that are blood derivatives, or a recombinant or
 3439  synthetic form of a blood derivative; or
 3440         (IV) Prescription drugs identified in rules adopted by the
 3441  department which are essential to services performed or provided
 3442  by blood establishments and authorized for distribution by blood
 3443  establishments under federal law,
 3444  
 3445  as long as all of the health care services provided by the blood
 3446  establishment are related to its activities as a registered
 3447  blood establishment or the health care services consist of
 3448  collecting, processing, storing, or administering human
 3449  hematopoietic stem cells or progenitor cells or performing
 3450  diagnostic testing of specimens if such specimens are tested
 3451  together with specimens undergoing routine donor testing.
 3452         2. Storage, handling, and recordkeeping of these
 3453  distributions by a person permitted as a restricted prescription
 3454  drug distributor must comply with the requirements for wholesale
 3455  distributors under s. 499.0121, but not those set forth in s.
 3456  499.01212 if the distribution occurs pursuant to sub
 3457  subparagraph 1.a. or sub-subparagraph 1.b.
 3458         3. A person who applies for a permit as a restricted
 3459  prescription drug distributor, or for the renewal of such a
 3460  permit, must provide to the department the information required
 3461  under s. 499.012.
 3462         4. The department may adopt rules regarding the
 3463  distribution of prescription drugs by hospitals, health care
 3464  entities, charitable organizations, or other persons not
 3465  involved in wholesale distribution, and blood establishments,
 3466  which rules are necessary for the protection of the public
 3467  health, safety, and welfare. The department may adopt rules
 3468  related to the transportation, storage, and recordkeeping of
 3469  prescription drugs which are essential to services performed or
 3470  provided by a blood establishment, including requirements for
 3471  the use of prescription drugs in mobile blood-collection
 3472  vehicles.
 3473         Section 90. Subsection (1) of section 627.645, Florida
 3474  Statutes, is amended to read:
 3475         627.645 Denial of health insurance claims restricted.—
 3476         (1) A No claim for payment under a health insurance policy
 3477  or self-insured program of health benefits for treatment, care,
 3478  or services in a licensed hospital that which is accredited by
 3479  the Joint Commission on the Accreditation of Hospitals, the
 3480  American Osteopathic Association, or the Commission on the
 3481  Accreditation of Rehabilitative Facilities may not shall be
 3482  denied because the such hospital lacks major surgical facilities
 3483  and is primarily of a rehabilitative nature, if such
 3484  rehabilitation is specifically for treatment of physical
 3485  disability.
 3486         Section 91. Paragraph (c) of subsection (2) of section
 3487  627.668, Florida Statutes, is amended to read:
 3488         627.668 Optional coverage for mental and nervous disorders
 3489  required; exception.—
 3490         (2) Under group policies or contracts, inpatient hospital
 3491  benefits, partial hospitalization benefits, and outpatient
 3492  benefits consisting of durational limits, dollar amounts,
 3493  deductibles, and coinsurance factors shall not be less favorable
 3494  than for physical illness generally, except that:
 3495         (c) Partial hospitalization benefits shall be provided
 3496  under the direction of a licensed physician. For purposes of
 3497  this part, the term “partial hospitalization services” is
 3498  defined as those services offered by a program accredited by the
 3499  Joint Commission on Accreditation of Hospitals (JCAH) or in
 3500  compliance with equivalent standards. Alcohol rehabilitation
 3501  programs accredited by the Joint Commission on Accreditation of
 3502  Hospitals or approved by the state and licensed drug abuse
 3503  rehabilitation programs shall also be qualified providers under
 3504  this section. In any benefit year, if partial hospitalization
 3505  services or a combination of inpatient and partial
 3506  hospitalization are utilized, the total benefits paid for all
 3507  such services shall not exceed the cost of 30 days of inpatient
 3508  hospitalization for psychiatric services, including physician
 3509  fees, which prevail in the community in which the partial
 3510  hospitalization services are rendered. If partial
 3511  hospitalization services benefits are provided beyond the limits
 3512  set forth in this paragraph, the durational limits, dollar
 3513  amounts, and coinsurance factors thereof need not be the same as
 3514  those applicable to physical illness generally.
 3515         Section 92. Subsection (3) of section 627.669, Florida
 3516  Statutes, is amended to read:
 3517         627.669 Optional coverage required for substance abuse
 3518  impaired persons; exception.—
 3519         (3) The benefits provided under this section shall be
 3520  applicable only if treatment is provided by, or under the
 3521  supervision of, or is prescribed by, a licensed physician or
 3522  licensed psychologist and if services are provided in a program
 3523  accredited by the Joint Commission on Accreditation of Hospitals
 3524  or approved by the state.
 3525         Section 93. Subsection (1) of section 627.736, Florida
 3526  Statutes, is amended to read:
 3527         627.736 Required personal injury protection benefits;
 3528  exclusions; priority; claims.—
 3529         (1) REQUIRED BENEFITS.—Every insurance policy complying
 3530  with the security requirements of s. 627.733 shall provide
 3531  personal injury protection to the named insured, relatives
 3532  residing in the same household, persons operating the insured
 3533  motor vehicle, passengers in such motor vehicle, and other
 3534  persons struck by such motor vehicle and suffering bodily injury
 3535  while not an occupant of a self-propelled vehicle, subject to
 3536  the provisions of subsection (2) and paragraph (4)(e), to a
 3537  limit of $10,000 for loss sustained by any such person as a
 3538  result of bodily injury, sickness, disease, or death arising out
 3539  of the ownership, maintenance, or use of a motor vehicle as
 3540  follows:
 3541         (a) Medical benefits.—Eighty percent of all reasonable
 3542  expenses for medically necessary medical, surgical, X-ray,
 3543  dental, and rehabilitative services, including prosthetic
 3544  devices, and medically necessary ambulance, hospital, and
 3545  nursing services. However, the medical benefits shall provide
 3546  reimbursement only for such services and care that are lawfully
 3547  provided, supervised, ordered, or prescribed by a physician
 3548  licensed under chapter 458 or chapter 459, a dentist licensed
 3549  under chapter 466, or a chiropractic physician licensed under
 3550  chapter 460 or that are provided by any of the following persons
 3551  or entities:
 3552         1. A hospital or ambulatory surgical center licensed under
 3553  chapter 395.
 3554         2. A person or entity licensed under ss. 401.2101-401.45
 3555  which that provides emergency transportation and treatment.
 3556         3. An entity wholly owned by one or more physicians
 3557  licensed under chapter 458 or chapter 459, chiropractic
 3558  physicians licensed under chapter 460, or dentists licensed
 3559  under chapter 466 or by such practitioner or practitioners and
 3560  the spouse, parent, child, or sibling of that practitioner or
 3561  those practitioners.
 3562         4. An entity wholly owned, directly or indirectly, by a
 3563  hospital or hospitals.
 3564         5. A health care clinic licensed under ss. 400.990-400.995
 3565  which that is:
 3566         a. Accredited by the Joint Commission on Accreditation of
 3567  Healthcare Organizations, the American Osteopathic Association,
 3568  the Commission on Accreditation of Rehabilitation Facilities, or
 3569  the Accreditation Association for Ambulatory Health Care, Inc.;
 3570  or
 3571         b. A health care clinic that:
 3572         (I) Has a medical director licensed under chapter 458,
 3573  chapter 459, or chapter 460;
 3574         (II) Has been continuously licensed for more than 3 years
 3575  or is a publicly traded corporation that issues securities
 3576  traded on an exchange registered with the United States
 3577  Securities and Exchange Commission as a national securities
 3578  exchange; and
 3579         (III) Provides at least four of the following medical
 3580  specialties:
 3581         (A) General medicine.
 3582         (B) Radiography.
 3583         (C) Orthopedic medicine.
 3584         (D) Physical medicine.
 3585         (E) Physical therapy.
 3586         (F) Physical rehabilitation.
 3587         (G) Prescribing or dispensing outpatient prescription
 3588  medication.
 3589         (H) Laboratory services.
 3590  
 3591  The Financial Services Commission shall adopt by rule the form
 3592  that must be used by an insurer and a health care provider
 3593  specified in subparagraph 3., subparagraph 4., or subparagraph
 3594  5. to document that the health care provider meets the criteria
 3595  of this paragraph. This, which rule must include a requirement
 3596  for a sworn statement or affidavit.
 3597         (b) Disability benefits.—Sixty percent of any loss of gross
 3598  income and loss of earning capacity per individual from
 3599  inability to work proximately caused by the injury sustained by
 3600  the injured person, plus all expenses reasonably incurred in
 3601  obtaining from others ordinary and necessary services in lieu of
 3602  those that, but for the injury, the injured person would have
 3603  performed without income for the benefit of his or her
 3604  household. All disability benefits payable under this provision
 3605  shall be paid not less than every 2 weeks.
 3606         (c) Death benefits.—Death benefits equal to the lesser of
 3607  $5,000 or the remainder of unused personal injury protection
 3608  benefits per individual. The insurer may pay such benefits to
 3609  the executor or administrator of the deceased, to any of the
 3610  deceased’s relatives by blood or legal adoption or connection by
 3611  marriage, or to any person appearing to the insurer to be
 3612  equitably entitled thereto.
 3613  
 3614  Only insurers writing motor vehicle liability insurance in this
 3615  state may provide the required benefits of this section, and no
 3616  such insurer shall require the purchase of any other motor
 3617  vehicle coverage other than the purchase of property damage
 3618  liability coverage as required by s. 627.7275 as a condition for
 3619  providing such required benefits. Insurers may not require that
 3620  property damage liability insurance in an amount greater than
 3621  $10,000 be purchased in conjunction with personal injury
 3622  protection. Such insurers shall make benefits and required
 3623  property damage liability insurance coverage available through
 3624  normal marketing channels. Any insurer writing motor vehicle
 3625  liability insurance in this state who fails to comply with such
 3626  availability requirement as a general business practice shall be
 3627  deemed to have violated part IX of chapter 626, and such
 3628  violation shall constitute an unfair method of competition or an
 3629  unfair or deceptive act or practice involving the business of
 3630  insurance; and any such insurer committing such violation shall
 3631  be subject to the penalties afforded in such part, as well as
 3632  those which may be afforded elsewhere in the insurance code.
 3633         Section 94. Subsection (12) of section 641.495, Florida
 3634  Statutes, is amended to read:
 3635         641.495 Requirements for issuance and maintenance of
 3636  certificate.—
 3637         (12) The provisions of part I of chapter 395 do not apply
 3638  to a health maintenance organization that, on or before January
 3639  1, 1991, provides not more than 10 outpatient holding beds for
 3640  short-term and hospice-type patients in an ambulatory care
 3641  facility for its members, provided that such health maintenance
 3642  organization maintains current accreditation by the Joint
 3643  Commission on Accreditation of Health Care Organizations, the
 3644  Accreditation Association for Ambulatory Health Care, or the
 3645  National Committee for Quality Assurance.
 3646         Section 95. Subsection (2) of section 766.1015, Florida
 3647  Statutes, is amended to read:
 3648         766.1015 Civil immunity for members of or consultants to
 3649  certain boards, committees, or other entities.—
 3650         (2) Such committee, board, group, commission, or other
 3651  entity must be established in accordance with state law or in
 3652  accordance with requirements of the Joint Commission on
 3653  Accreditation of Healthcare Organizations, established and duly
 3654  constituted by one or more public or licensed private hospitals
 3655  or behavioral health agencies, or established by a governmental
 3656  agency. To be protected by this section, the act, decision,
 3657  omission, or utterance may not be made or done in bad faith or
 3658  with malicious intent.
 3659         Section 96. Except as otherwise expressly provided in this
 3660  act, this act shall take effect July 1, 2010.

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