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Florida Senate - 2008 CS for SB 1668

By the Committee on Health Regulation; and Senators Jones, Dockery, Diaz de la Portilla, Storms, Lawson, King and Deutch

588-07632-08 20081668c1

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A bill to be entitled

2

An act relating to long-term care facilities; providing a

3

short title; amending s. 400.021, F.S.; revising

4

definitions relating to nursing homes; defining the terms

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"affiliate," "controlling entity," "controlling financial

6

interest," "entity," and "governing body"; amending s.

7

400.0239, F.S.; authorizing the expenditure of funds from

8

the Quality of Long-Term Care Facility Improvement Trust

9

Fund for the development of an electronic Nursing Home

10

Guide; amending s. 400.071, F.S.; revising provisions

11

relating to nursing home license applications; requiring

12

the application to include the facility's affiliates,

13

controlling entities, and entities having a controlling

14

interest in the facility, proof of ability to operate,

15

copies of certain contracts and investigations and fines,

16

and the members of the facility's governing body;

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requiring financial and ownership information to be

18

submitted in a format prescribed by the agency; amending

19

s. 400.102, F.S.; revising grounds for taking action

20

against a nursing home to conform to changes made by the

21

act; amending s. 400.111, F.S.; requiring the disclosure

22

of controlling interests at the time of licensure, license

23

renewal, or change of ownership; amending s. 400.121,

24

F.S.; revising provisions relating to the denial,

25

suspension, or revocation of a license to conform to

26

changes made by the act; amending s. 400.141, F.S.;

27

prohibiting nursing home liability insurance from paying

28

for certain legal costs; requiring the facility to notify

29

the agency if the policy has been exhausted; amending s.

30

400.191, F.S.; requiring that the Agency for Health Care

31

Administration to maintain an electronic Nursing Home

32

Guide; deleting the requirement that the agency provide a

33

printed guide; revising the information that must be

34

provided on the agency's website; creating s. 400.197,

35

F.S.; requiring a nursing home to notify residents and

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post a request for a change of ownership in prominent

37

locations in the nursing home; providing for a hearing as

38

to the fitness of a new owner; providing for

39

investigations of the new owner; providing that a new

40

owner assumes the liabilities of the prior licensee, its

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affiliates, or controlling entities; amending s. 429.02,

42

F.S.; revising definitions for assisted living facilities;

43

defining the terms "affiliate," "controlling entity,"

44

"controlling financial interest," and "entity"; amending

45

s. 429.11, F.S.; revising provisions relating to

46

applications for an assisted living facility license;

47

requiring the application to include members of the

48

facilities governing body, the facility's affiliates,

49

controlling entities, and entities having a controlling

50

interest in the facility, and copies of certain contracts

51

and investigations and fines; requiring financial and

52

ownership information to be submitted in a format

53

prescribed by the agency; amending s. 429.12, F.S.;

54

requiring the assisted living facility to notify residents

55

and post a request for a change of ownership in prominent

56

locations in the facility; providing for a hearing as to

57

the fitness of a new owner upon request; providing for

58

investigations of the new owner; providing that a new

59

owner assumes the liabilities of the prior licensee,

60

affiliates, or controlling entities; amending s. 429.14,

61

F.S.; revising provisions relating to the denial,

62

suspension, or revocation of a license to conform to

63

changes made by the act; amending s. 429.174, F.S.;

64

conforming a cross-reference; amending s. 429.275, F.S.;

65

prohibiting assisted living facility liability insurance

66

from paying for certain legal costs; requiring the

67

facility to notify the agency if the policy has been

68

exhausted; providing effective dates.

69

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1. This act may be cited as the "Long-Term Care

73

Transparency Act."

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     Section 2.  Subsections (2) through (18) of section 400.021,

75

Florida Statutes, are renumbered as subsections (3) through (23),

76

respectively, new subsections (2), (6), (7), (10), and (14) are

77

added to that section, and present subsections (2) through (9) of

78

that sections are amended, to read:

79

     400.021  Definitions.--When used in this part, unless the

80

context otherwise requires, the term:

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     (2) "Affiliate" means an entity having the same or similar

82

owners, officers, board members, directors, limited liability

83

corporation members, operating company, management company, or

84

address as a facility.

85

     (3)(2) "Agency" means the Agency for Health Care

86

Administration, which is the licensing agency under this part.

87

     (4)(3) "Bed reservation policy" means the number of

88

consecutive days and the number of days per year that a resident

89

may leave the nursing home facility for overnight therapeutic

90

visits with family or friends or for hospitalization for an acute

91

condition before the licensee may discharge the resident due to

92

his or her absence from the facility.

93

     (5)(4) "Board" means the Board of Nursing Home

94

Administrators.

95

     (6)(a) "Controlling entity" means an entity that has the

96

ability, acting alone or in concert with others, to directly or

97

indirectly influence, direct, control, or cause the direction of

98

the operation, management, expenditure of money, or policies of

99

a facility.

100

     (b) A controlling entity does not include a lender,

101

financial institution, or secured creditor who does not exercise

102

any influence or control, whether formal or actual, over the

103

operation or management of a facility.

104

     (7) "Controlling financial interest" means having more

105

than a 5 percent financial ownership interest in the facility,

106

an affiliate, or controlling entity.

107

     (8)(5) "Custodial service" means care for a person which

108

entails observation of diet and sleeping habits and maintenance

109

of a watchfulness over the general health, safety, and well-being

110

of the aged or infirm.

111

     (9)(6) "Department" means the Department of Children and

112

Family Services.

113

     (10) "Entity" means an individual, partnership,

114

association, joint venture, company, sole proprietorship,

115

corporation, limited liability corporation, professional limited

116

liability corporation, or any other form of doing business.

117

     (11)(7) "Facility" means an any institution, building,

118

residence, private home, or other place, whether operated for

119

profit or not, including a place operated by a county or

120

municipality, which undertakes through its ownership or

121

management to provide for a period exceeding 24-hour nursing

122

care, personal care, or custodial care for three or more persons

123

not related to the owner or manager by blood or marriage, who by

124

reason of illness, physical infirmity, or advanced age require

125

such services, but does not include any place providing care and

126

treatment primarily for the acutely ill. A facility offering

127

services for fewer than three persons is within the meaning of

128

this definition if it holds itself out to the public to be an

129

establishment that which regularly provides such services.

130

     (12)(8) "Geriatric outpatient clinic" means a site for

131

providing outpatient health care to persons 60 years of age or

132

older, which is staffed by a registered nurse or a physician

133

assistant.

134

     (13)(9) "Geriatric patient" means a any patient who is 60

135

years of age or older.

136

     (14) "Governing body" means the individuals who have

137

responsibility for hiring the administrator and for approving a

138

facility's policies and procedures and ensuring their proper

139

implementation.

140

     Section 3.  Paragraph (h) is added to subsection (2) of

141

section 400.0239, Florida Statutes, to read:

142

     400.0239  Quality of Long-Term Care Facility Improvement

143

Trust Fund.--

144

     (2)  Expenditures from the trust fund shall be allowable for

145

direct support of the following:

146

     (h) The development and expansion of an electronic Nursing

147

Home Guide pursuant to s. 400.191 to aid prospective residents in

148

selecting a nursing facility that will meet their unique needs

149

and standards.

150

     Section 4.  Subsection (1) of section 400.071, Florida

151

Statutes, is amended, present subsections (2) through (5) of that

152

section are renumbered as subsections (3) through (6),

153

respectively, and new subsection (2) is added to that section, to

154

read:

155

     400.071  Application for license.--

156

     (1)  In addition to the requirements of part II of chapter

157

408, the application for a license under this part must shall be

158

under oath and must contain the following:

159

     (a)  The location of the facility for which a license is

160

sought and an indication, as in the original application, that

161

the such location conforms to the local zoning ordinances.

162

     (b)  A signed affidavit disclosing any financial or

163

ownership interest that the applicant, an affiliate, a

164

controlling entity, or an entity having a controlling financial

165

interest as defined in part II of chapter 408 has held in the

166

last 5 years in any entity licensed by this state or any other

167

state to provide health or residential care which has closed

168

voluntarily or involuntarily; has filed for bankruptcy; has had a

169

receiver appointed; has had a license denied, suspended, or

170

revoked; or has had an injunction issued against it which was

171

initiated by a regulatory agency. The affidavit must disclose the

172

reason the any such entity was closed, whether voluntarily or

173

involuntarily.

174

     (c) A signed affidavit disclosing any affiliate of,

175

controlling entity of, and entity having a controlling financial

176

interest in the applicant.

177

     (d) The total number of beds and the total number of

178

Medicare and Medicaid certified beds.

179

     (e)(d) Information relating to the applicant and employees

180

which the agency requires by rule. The applicant must demonstrate

181

that sufficient numbers of qualified staff, by training or

182

experience, will be employed to properly care for the type and

183

number of residents who will reside in the facility.

184

     (f) Proof of financial ability to operate. The applicant

185

must demonstrate an ability to provide staff at required levels

186

and maintain solvency in accordance with this part, applicable

187

provisions of chapter 408, and related rules. Documentation must

188

include, but need not be limited to, the balance sheet and profit

189

and loss statement of the nursing home's 2 previous fiscal years

190

of operation, a statement of projected revenues and expenses for

191

the first 12 months of operation following licensure, a detailed

192

explanation of the assumptions implicit in these projections, the

193

basis for financing the applicant's anticipated cash-flow

194

requirements, and the applicant's access to contingency

195

financing. This information is not required for a routine license

196

renewal.

197

     (g)(e) Copies of any civil verdict or judgment involving

198

the applicant, affiliates, or controlling entities rendered

199

within the 10 years preceding the application, relating to

200

medical negligence, violation of residents' rights, or wrongful

201

death. As a condition of licensure, the licensee agrees to

202

provide to the agency copies of any new verdict or judgment

203

involving the applicant, relating to such matters, within 30 days

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after filing with the clerk of the court. The information must

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required in this paragraph shall be maintained in the facility's

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licensure file and in an agency database that which is available

207

as a public record.

208

     (h) Copies of any contracts with affiliates or controlling

209

entities, including details of goods or services provided and the

210

intended method of payment for those goods and services.

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     (i) Copies of any audits, investigations, or fines related

212

to the receipt or use of federal or state funds by all

213

affiliates, controlling entities, and entities having a

214

controlling financial interest. These include the results of or

215

any ongoing investigations into Medicaid or Medicare fraud or

216

Medicaid or Medicare overpayment, any standing corporate

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integrity agreements, or other remedial action by a public

218

entity.

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     (j) The names and dates of service of the members of the

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applicant's governing body.

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     (2) Information relating to financial and ownership

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information shall be submitted in a format prescribed by the

223

agency.

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     Section 5.  Section 400.102, Florida Statutes, is amended to

225

read:

226

     400.102  Action by agency against licensee; grounds.--In

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addition to the grounds listed in part II of chapter 408, any of

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the following conditions shall be grounds for action by the

229

agency against a licensee:

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     (1)  An intentional or negligent act materially affecting

231

the health or safety of residents of the facility.;

232

     (2)  Misappropriation or conversion of the property of a

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resident of the facility.;

234

     (3)  Failure to follow the criteria and procedures provided

235

under part I of chapter 394 relating to the transportation,

236

voluntary admission, and involuntary examination of a nursing

237

home resident.; or

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     (4)  Fraudulent altering, defacing, or falsifying any

239

medical or nursing home records, or causing or procuring any of

240

these offenses to be committed.

241

     (5) Failure to disclose at the time of licensure, license

242

renewal, or change of ownership all affiliates, controlling

243

entities, entities having a controlling financial interest, or

244

members of the facility's governing body.

245

     Section 6.  Section 400.111, Florida Statutes, is amended to

246

read:

247

     400.111  Disclosure of controlling interest.--In addition to

248

the requirements of part II of chapter 408, the licensee shall at

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the time of licensure, license renewal, or change of ownership

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submit a signed affidavit disclosing any financial or ownership

251

interest that an affiliate, controlling entity, or entity having

252

a controlling financial interest has held within the last 5 years

253

in any entity licensed by the state or any other state to provide

254

health or residential care which entity has closed voluntarily or

255

involuntarily; has filed for bankruptcy; has had a receiver

256

appointed; has had a license denied, suspended, or revoked; or

257

has had an injunction issued against it which was initiated by a

258

regulatory agency. The affidavit must disclose the reason such

259

entity was closed, whether voluntarily or involuntarily. As a

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condition of licensure, license renewal, or change of ownership,

261

the licensee must agree to provide to the agency a signed

262

affidavit disclosing any financial or ownership interest that an

263

affiliate, a controlling entity, or an entity having a

264

controlling financial interest acquires within 30 days after the

265

acquisition.

266

     Section 7.  Subsections (1) and (3) of section 400.121,

267

Florida Statutes, are amended to read:

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     400.121  Denial, suspension, revocation of license;

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administrative fines; procedure; order to increase staffing.--

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     (1) The agency may deny a license an application, revoke or

271

suspend a license, and impose an administrative fine, not to

272

exceed $500 per violation per day for the violation of any

273

provision of this part, part II of chapter 408, or applicable

274

rules, against any applicant or licensee for the following

275

violations by the applicant, licensee, or other controlling

276

interest:

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     (a)  A violation of any provision of this part, part II of

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chapter 408, or applicable rules; or

279

     (b)  An adverse action by a regulatory agency against any

280

other licensed facility that has a common controlling entity or

281

an entity having controlling financial interest in the applicant

282

or with the licensee or applicant against whom the action under

283

this section is being brought. If the adverse action involves

284

solely the management company, the applicant or licensee shall be

285

given 30 days to remedy before final action is taken. If the

286

adverse action is based solely upon actions by the a controlling

287

entity or entity having a controlling financial interest, the

288

applicant or licensee may present factors in mitigation of a any

289

proposed penalty based upon a showing that such penalty is

290

inappropriate under the circumstances.

291

292

All hearings shall be held within the county in which the

293

licensee or applicant operates or applies for a license to

294

operate a facility as defined herein.

295

     (3)  The agency shall revoke or deny a nursing home license

296

if the licensee, a controlling entity, or an entity having a

297

controlling financial interest in the licensee operates a

298

facility in this state that:

299

     (a)  Has had two moratoria issued pursuant to this part or

300

part II of chapter 408 which are imposed by final order for

301

substandard quality of care, as defined by 42 C.F.R. part 483,

302

within any 30-month period;

303

     (b)  Is conditionally licensed for 180 or more continuous

304

days;

305

     (c)  Is cited for two class I deficiencies arising from

306

unrelated circumstances during the same survey or investigation;

307

or

308

     (d)  Is cited for two class I deficiencies arising from

309

separate surveys or investigations within a 30-month period.

310

311

The licensee may present factors in mitigation of revocation, and

312

the agency may make a determination not to revoke a license based

313

upon a showing that revocation is inappropriate under the

314

circumstances.

315

     Section 8.  Subsection (20) of section 400.141, Florida

316

Statutes, are amended to read:

317

     400.141  Administration and management of nursing home

318

facilities.--Every licensed facility shall comply with all

319

applicable standards and rules of the agency and shall:

320

     (20)  Maintain general and professional liability insurance

321

coverage that is in force at all times. The insurance may not be

322

used for the litigation costs or attorney's fees for the defense

323

of a claim against a nursing home pursuant to the common law, s.

324

400.023, or s. 400.0233. The licensee must notify the agency

325

immediately if the policy limits or annual aggregate liability

326

coverage has been exhausted. In lieu of general and professional

327

liability insurance coverage, a state-designated teaching nursing

328

home and its affiliated assisted living facilities created under

329

s. 430.80 may demonstrate proof of financial responsibility as

330

provided in s. 430.80(3)(h).

331

332

Facilities that have been awarded a Gold Seal under the program

333

established in s. 400.235 may develop a plan to provide certified

334

nursing assistant training as prescribed by federal regulations

335

and state rules and may apply to the agency for approval of their

336

program.

337

     Section 9.  Effective December 1, 2008, subsections (2) and

338

(5) of section 400.191, Florida Statutes, are amended to read:

339

     400.191  Availability, distribution, and posting of reports

340

and records.--

341

     (2) The agency shall maintain an electronic publish the

342

Nursing Home Guide annually in a consumer-friendly printed form

343

and quarterly in electronic form, which is updated weekly, to

344

assist consumers and their families in comparing and evaluating

345

nursing home facilities.

346

     (a) The agency shall provide an Internet website that, at a

347

minimum, includes site which shall include at least the following

348

information either directly or indirectly through a link to other

349

another established websites site or sites of the agency's

350

choosing:

351

     1.  A section entitled "Have you considered programs that

352

provide alternatives to nursing home care?" which shall be the

353

first section of the Nursing Home Guide and which shall

354

prominently display information about available alternatives to

355

nursing homes and how to obtain additional information regarding

356

these alternatives. The Nursing Home Guide shall explain that

357

this state offers alternative programs that allow permit

358

qualified elderly persons to stay in their homes instead of being

359

placed in nursing homes and shall encourage interested persons to

360

call the Comprehensive Assessment Review and Evaluation for Long-

361

Term Care Services (CARES) Program to inquire if they qualify.

362

The Nursing Home Guide shall list available home and community-

363

based programs and which shall clearly state the services that

364

are provided and indicate whether nursing home services are

365

included if needed.

366

     2.  A list by name and address of all nursing home

367

facilities in this state, including any prior name by which a

368

facility was known during the previous 24-month period.

369

     3. A list of all affiliates, controlling entities, and

370

entities having a controlling financial interest that are

371

affiliated with or associated with the facility.

372

     4. Any documents related to audits, investigations, or

373

fines related to the receipt or use of federal or state funds by

374

the facility, or any affiliate, controlling entity, or entity

375

having a controlling financial interest, including all related

376

documents submitted under s. 400.071.

377

     5.3. Whether the facility is such nursing home facilities

378

are proprietary or nonproprietary.

379

     6.4. The current owner or owners of the facility's license

380

and the year in which that that entity became the owner of the

381

license.

382

     7.5. The name of the owner or owners of the each facility

383

and whether the facility is affiliated with a company or other

384

organization owning or managing more than one nursing facility in

385

this state.

386

     8.6. The total number of beds in the each facility and the

387

most recently available occupancy levels.

388

     9.7. The number of private and semiprivate rooms in the

389

each facility.

390

     10.8. The religious affiliation, if any, of the each

391

facility.

392

     11.9. The languages spoken by the administrator and staff

393

of the each facility.

394

     12.10. Whether the or not each facility accepts Medicare or

395

Medicaid recipients or insurance, health maintenance

396

organization, Veterans Administration, CHAMPUS program, or

397

workers' compensation coverage.

398

     13.11. Recreational programs, special care units, and other

399

programs available at the each facility.

400

     14.12. Special care units or programs offered at the each

401

facility.

402

     15.13. Whether the facility is a part of a retirement

403

community that offers other services pursuant to part III of this

404

chapter or part I or part III of chapter 429.

405

     16.14. Survey and deficiency information, including all

406

federal and state recertification, licensure, revisit, and

407

complaint survey information, for the each facility for the past

408

30 months. For noncertified nursing homes, state survey and

409

deficiency information, including licensure, revisit, and

410

complaint survey information for the past 30 months shall be

411

provided.

412

     17.15. A summary of the deficiency data for the each

413

facility during over the past 30 months. The summary may include

414

a score, rating, or comparison ranking with respect to other

415

facilities based on the number of citations received by the

416

facility on recertification, licensure, revisit, and complaint

417

surveys; the severity and scope of the citations; and the number

418

of recertification surveys the facility has had during the past

419

30 months. The score, rating, or comparison ranking may be

420

presented in either numeric or symbolic form for the intended

421

consumer audience.

422

     18. The name of the administrator and of all members of the

423

facility's governing body, including their dates of service.

424

     19. A list, by name and address, of all nursing home

425

facilities that have submitted an application for a change of

426

ownership, including the date of the submission and current

427

status of that application.

428

     (b) The agency shall provide the following information in

429

printed form:

430

     1. A section entitled "Have you considered programs that

431

provide alternatives to nursing home care?" which shall be the

432

first section of the Nursing Home guide and which shall

433

prominently display information about available alternatives to

434

nursing homes and how to obtain additional information regarding

435

these alternatives. The Nursing Home guide shall explain that

436

this state offers alternative programs that permit qualified

437

elderly persons to stay in their homes instead of being placed in

438

nursing homes and shall encourage interested persons to call the

439

Comprehensive Assessment Review and Evaluation for Long-Term Care

440

Services (CARES) Program to inquire if they qualify. The Nursing

441

Home guide shall list available home and community-based programs

442

which shall clearly state the services that are provided and

443

indicate whether nursing home services are included if needed.

444

     2. A list by name and address of all nursing home

445

facilities in this state.

446

     3. Whether the nursing home facilities are proprietary or

447

nonproprietary.

448

     4. The current owner or owners of the facility's license

449

and the year that entity became the owner of the license.

450

     5. The total number of beds, and of private and semiprivate

451

rooms, in each facility.

452

     6. The religious affiliation, if any, of each facility.

453

     7. The name of the owner of each facility and whether the

454

facility is affiliated with a company or other organization

455

owning or managing more than one nursing facility in this state.

456

     8. The languages spoken by the administrator and staff of

457

each facility.

458

     9. Whether or not each facility accepts Medicare or

459

Medicaid recipients or insurance, health maintenance

460

organization, Veterans Administration, CHAMPUS program, or

461

workers' compensation coverage.

462

     10. Recreational programs, special care units, and other

463

programs available at each facility.

464

     11. The Internet address for the site where more detailed

465

information can be seen.

466

     12. A statement advising consumers that each facility will

467

have its own policies and procedures related to protecting

468

resident property.

469

     13. A summary of the deficiency data for each facility over

470

the past 30 months. The summary may include a score, rating, or

471

comparison ranking with respect to other facilities based on the

472

number of citations received by the facility on recertification,

473

licensure, revisit, and complaint surveys; the severity and scope

474

of the citations; the number of citations; and the number of

475

recertification surveys the facility has had during the past 30

476

months. The score, rating, or comparison ranking may be presented

477

in either numeric or symbolic form for the intended consumer

478

audience.

479

     (b)(c) The agency shall may provide the following

480

additional information on its an Internet website site or in

481

printed form as the information becomes available:

482

     1.  The licensure status history of each facility.

483

     2.  The rating history of each facility.

484

     3.  The regulatory history of each facility, which may

485

include federal sanctions, state sanctions, federal fines, state

486

fines, and other actions.

487

     4.  Whether the facility currently possesses the Gold Seal

488

designation awarded pursuant to s. 400.235.

489

     5. Known Internet links to the websites Internet sites of

490

the facilities, or their affiliates, controlling entities, and

491

entities having a controlling financial interest.

492

     (5)  Every nursing home facility licensee shall:

493

     (a) Post, in a sufficient number of prominent locations

494

positions in the nursing home so as to be accessible to all

495

residents and to the general public:

496

     1.  A concise summary of the last inspection report

497

pertaining to the nursing home and issued by the agency, with

498

references to the page numbers of the full reports, noting any

499

deficiencies found by the agency and the actions taken by the

500

licensee to rectify the deficiencies and indicating in the

501

summaries where the full reports may be inspected in the nursing

502

home.

503

     2. A copy of all of the pages that list the facility in the

504

most recent version of the Nursing Home Guide.

505

     3. A copy of any conditional license in effect regardless

506

of an administrative or judicial challenge for the purpose of

507

providing public transparency and timely notification.

508

     (b)  Upon request, provide to any person who has completed a

509

written application for admission with an intent to be admitted

510

to, or to a any resident of, a nursing home, or to any relative,

511

spouse, surrogate, or guardian of the person, a copy of the

512

nursing home's last inspection report or a printed copy of the

513

Nursing Home Guide if pertaining to the nursing home and issued

514

by the agency, provided the person requesting the report agrees

515

to pay a reasonable charge to cover copying costs.

516

     Section 10.  Section 400.197, Florida Statutes, is created

517

to read:

518

     400.197 Change of ownership.--

519

     (1) Within 5 days after a licensee submits a request for a

520

change of ownership to the agency, the licensee shall notify all

521

residents of the request in writing and post that information in

522

a sufficient number of prominent locations in the nursing home

523

facility and on the primary Internet website of the nursing home

524

and its controlling entities so that the information is

525

accessible to all residents and the public.

526

     (2) Affected parties, including, but not limited to, a

527

resident, a resident's family member, a resident's legal

528

representative, a resident's guardian, and facility staff may

529

submit information for the agency to consider when evaluating the

530

proposed owner's character, experience, background,

531

qualifications, and fitness for licensure when determining

532

whether to grant a change of ownership.

533

     (3) The agency may propound any reasonable interrogatories

534

in addition to those contained in the request, or conduct further

535

investigations as necessary for the protection of the public and

536

to ascertain the proposed owner's character, experience,

537

background, qualifications, and fitness for licensure.

538

     (4) Upon granting a change of ownership, the new licensee

539

assumes all liabilities of the prior licensee, its affiliates, or

540

controlling entities relating to or arising out of the operation

541

of the facility and services provided at the facility under the

542

prior licensee.

543

     Section 11.  Subsections (3) though (26) of section 429.02,

544

Florida Statutes, are renumbered as subsections (4) through (30),

545

respectively, new subsection (3), (9), (10), and (14) are added

546

to that section, and present subsections (3) through (10) of that

547

section are amended, to read:

548

     429.02  Definitions.--When used in this part, the term:

549

     (3) "Affiliate" means an entity having the same or similar

550

owners, officers, board members, directors, limited liability

551

corporation members, operating company, management company, or

552

address as an assisted living facility.

553

     (4)(3) "Agency" means the Agency for Health Care

554

Administration.

555

     (5)(4) "Aging in place" or "age in place" means the process

556

of providing increased or adjusted services to a person to

557

compensate for the physical or mental decline that may occur with

558

the aging process, in order to maximize the person's dignity and

559

independence and allow permit them to remain in a familiar,

560

noninstitutional, residential environment for as long as

561

possible. Such services may be provided by facility staff,

562

volunteers, family, or friends, or through contractual

563

arrangements with a third party.

564

     (6)(5) "Assisted living facility" means any building or

565

buildings, section or distinct part of a building, private home,

566

boarding home, home for the aged, or other residential facility,

567

whether operated for profit or not, which undertakes through its

568

ownership or management to provide housing, meals, and one or

569

more personal services for a period exceeding 24 hours to one or

570

more adults who are not relatives of the owner or administrator.

571

     (7)(6) "Chemical restraint" means a pharmacologic drug that

572

physically limits, restricts, or deprives an individual of

573

movement or mobility, and is used for discipline or convenience

574

and not required for the treatment of medical symptoms.

575

     (8)(7) "Community living support plan" means a written

576

document prepared by a mental health resident and the resident's

577

mental health case manager in consultation with the administrator

578

of an assisted living facility with a limited mental health

579

license or the administrator's designee. A copy must be provided

580

to the administrator. The plan must include information about the

581

supports, services, and special needs of the resident which

582

enable the resident to live in the assisted living facility and a

583

method by which facility staff can recognize and respond to the

584

signs and symptoms particular to that resident which indicate the

585

need for professional services.

586

     (9)(a) "Controlling entity" means an entity that has the

587

ability, acting alone or in concert with others, to directly or

588

indirectly influence, direct, control, or cause the direction of

589

the operation, management, expenditure of money, or policies of

590

a facility.

591

     (b) A controlling entity does not include a lender,

592

financial institution, or secured creditor who does not exercise

593

any influence or control, whether formal or actual, over the

594

operation or management of a facility.

595

     (10) "Controlling financial interest" means having more

596

than a 5 percent financial ownership interest in the facility,

597

an affiliate, or controlling entity.

598

     (11)(8) "Cooperative agreement" means a written statement

599

of understanding between a mental health care provider and the

600

administrator of the assisted living facility with a limited

601

mental health license in which a mental health resident is

602

living. The agreement must specify directions for accessing

603

emergency and after-hours care for the mental health resident. A

604

single cooperative agreement may service all mental health

605

residents who are clients of the same mental health care

606

provider.

607

     (12)(9) "Department" means the Department of Elderly

608

Affairs.

609

     (13)(10) "Emergency" means a situation, physical condition,

610

or method of operation which presents imminent danger of death or

611

serious physical or mental harm to facility residents.

612

     (14) "Entity" means an individual, partnership,

613

association, joint venture, company, sole proprietorship,

614

corporation, limited liability corporation, professional limited

615

liability corporation, or any other form of doing business.

616

     Section 12.  Subsection (1) of section 429.11, Florida

617

Statutes, is amended, and subsection (8) is added to that

618

section, to read:

619

     429.11  Initial application for license; provisional

620

license.--

621

     (1) Each applicant for licensure must comply with all

622

provisions of part II of chapter 408 and must:

623

     (a) Identify all affiliates other homes or facilities,

624

including the addresses and the license or licenses under which

625

they operate, if applicable, which are currently operated by the

626

applicant or administrator and which provide housing, meals, and

627

personal services to residents.

628

     (b)  Provide the location of the facility for which a

629

license is sought and documentation, signed by the appropriate

630

local government official, which states that the applicant has

631

met local zoning requirements.

632

     (c)  Provide the name, address, date of birth, social

633

security number, education, and experience of the administrator,

634

if different from the applicant.

635

     (d) Provide a signed affidavit disclosing any affiliates,

636

controlling entities, and entities having a controlling financial

637

interest.

638

     (e) Provide copies of any contracts with an affiliate or

639

controlling entity, including details of goods and services

640

provided and the intended payment for those goods and services.

641

     (f) Provide copies of any audits, investigations, or fines

642

related to the receipt or use of federal or state funds by all

643

affiliates, controlling entities, and entities having a

644

controlling financial interest. This includes the results of any

645

ongoing investigations into Medicaid or Medicare fraud or

646

Medicaid or Medicare overpayment, any standing corporate

647

integrity agreements, or other remedial action by any public

648

entity.

649

     (g) Submit all information regarding financial and

650

ownership information in a format prescribed by the agency.

651

     (8) As a condition of licensure, license renewal, or change

652

of ownership, the licensee must agree to provide to the agency a

653

signed affidavit disclosing any financial or ownership interest

654

that an affiliate, a controlling entity, or an entity having a

655

controlling financial interest acquires within 30 days after the

656

acquisition.

657

     Section 13.  Section 429.12, Florida Statutes, is amended to

658

read:

659

     429.12  Sale or transfer of ownership of a facility.--It is

660

the intent of the Legislature to protect the rights of the

661

residents of an assisted living facility when the facility is

662

sold or the ownership thereof is transferred. Therefore, in

663

addition to the requirements of part II of chapter 408, whenever

664

a facility is sold or the ownership thereof is transferred,

665

including leasing:

666

     (1) Within 5 days after submitting a request to the agency

667

for a change of ownership, the licensee shall notify all

668

residents of the request in writing and post that information in

669

a sufficient number of prominent locations in the assisted living

670

facility and on the primary Internet website of the facility so

671

that the information is accessible to all residents and the

672

public. The transferee shall notify the residents, in writing, of

673

the change of ownership within 7 days after receipt of the new

674

license.

675

     (2) Affected parties, including, but not limited to, a

676

resident, a resident's family member, a resident's legal

677

representative, a resident's guardian, and facility staff may

678

submit information for the agency to consider in evaluating the

679

proposed owner's character, experience, background,

680

qualifications, and fitness for the license when determining

681

whether to grant a change of ownership.

682

     (3) The agency may propound any reasonable interrogatories

683

in addition to those contained in the request, or conduct further

684

investigations as necessary for the protection of the public and

685

to ascertain the proposed owner's character, experience,

686

background, qualifications, and fitness for licensure.

687

     (4) Upon granting a change of ownership, the new licensee

688

assumes all liabilities of the prior licensee, its affiliates, or

689

controlling entities relating to or arising out of the operation

690

of the facility and services provided at the facility under the

691

prior licensee.

692

     (5) Within 7 days after receipt of the new license, the

693

transferee shall notify the residents in writing of the change of

694

ownership.

695

     (6)(2) The transferor of a facility, the license of which

696

is denied pending an administrative hearing, shall, as a part of

697

the written change-of-ownership contract, advise the transferee

698

that a plan of correction must be submitted by the transferee and

699

approved by the agency at least 7 days before the change of

700

ownership and that failure to correct the condition that which

701

resulted in the moratorium pursuant to part II of chapter 408 or

702

denial of licensure is grounds for denial of the transferee's

703

license.

704

     Section 14.  Paragraph (m) is added to subsection (1) of

705

section 429.14, Florida Statutes, and subsections (3) and (7) of

706

that section are amended, to read:

707

     429.14  Administrative penalties.--

708

     (1)  In addition to the requirements of part II of chapter

709

408, the agency may deny, revoke, and suspend any license issued

710

under this part and impose an administrative fine in the manner

711

provided in chapter 120 against a licensee of an assisted living

712

facility for a violation of any provision of this part, part II

713

of chapter 408, or applicable rules, or for any of the following

714

actions by a licensee of an assisted living facility, for the

715

actions of any person subject to level 2 background screening

716

under s. 408.809, or for the actions of any facility employee:

717

     (m) Failure to disclose at the time of licensure, license

718

renewal, or change of ownership all affiliates, controlling

719

entities, and entities having a controlling financial interest.

720

     (3)  The agency may deny a license to any applicant or

721

controlling interest as defined in part II of chapter 408 which

722

has or had a 25-percent or greater financial or ownership

723

interest in any other facility licensed under this part, in any

724

affiliate or controlling entity, or in any entity licensed by

725

this state or another state to provide health or residential

726

care, which facility or entity during the 5 years prior to the

727

application for a license closed due to financial inability to

728

operate; had a receiver appointed or a license denied, suspended,

729

or revoked; was subject to a moratorium; or had an injunctive

730

proceeding initiated against it.

731

     (7)  Agency notification of a license suspension or

732

revocation, or denial of a license renewal, or issuance of a

733

conditional license regardless of an administrative or judicial

734

challenge, must shall be posted and visible to the public at the

735

facility.

736

     Section 15.  Section 429.174, Florida Statutes, is amended

737

to read:

738

     429.174  Background screening; exemptions.--The owner or

739

administrator of an assisted living facility must conduct level 1

740

background screening, as set forth in chapter 435, on all

741

employees hired on or after October 1, 1998, who perform personal

742

services as defined in s. 429.02(16). The agency may exempt an

743

individual from employment disqualification as set forth in

744

chapter 435. Such persons shall be considered as having met this

745

requirement if:

746

     (1) Proof of compliance with level 1 screening requirements

747

obtained to meet any professional license requirements in this

748

state is provided and accompanied, under penalty of perjury, by a

749

copy of the person's current professional license and an

750

affidavit of current compliance with the background screening

751

requirements.

752

     (2) The person required to be screened has been

753

continuously employed in the same type of occupation for which

754

the person is seeking employment without a breach in service

755

which exceeds 180 days, and proof of compliance with the level 1

756

screening requirement which is no more than 2 years old is

757

provided. Proof of compliance shall be provided directly from one

758

employer or contractor to another, and not from the person

759

screened. Upon request, a copy of screening results shall be

760

provided by the employer retaining documentation of the screening

761

to the person screened.

762

     (3) The person required to be screened is employed by a

763

corporation or business entity or related corporation or business

764

entity that owns, operates, or manages more than one facility or

765

agency licensed under this chapter, and for whom a level 1

766

screening was conducted by the corporation or business entity as

767

a condition of initial or continued employment.

768

     Section 16.  Subsection (3) of section 429.275, Florida

769

Statutes, is amended to read:

770

     429.275  Business practice; personnel records; liability

771

insurance.--The assisted living facility shall be administered on

772

a sound financial basis that is consistent with good business

773

practices.

774

     (3)  The administrator or owner of a facility shall maintain

775

liability insurance coverage that is in force at all times. The

776

general and professional liability insurance may not be used for

777

the litigation costs or attorney's fees for the defense of a

778

claim against the facility pursuant to common law, s. 429.29, or

779

s. 429.293. The administrator or owner of a facility must notify

780

the agency immediately if the policy limits or annual aggregate

781

liability coverage has been exhausted.

782

     Section 17.  Except as otherwise expressly provided in this

783

act, this act shall take effect July 1, 2008.

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

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