January 22, 2021
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       Florida Senate - 2010                                    SB 1816
       
       
       
       By the Committee on Health Regulation
       
       
       
       
       588-02055B-10                                         20101816__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 429.07, F.S.; deleting the requirement for
    4         an assisted living facility to obtain an additional
    5         license in order to provide limited nursing services;
    6         deleting the requirement for the Agency for Health
    7         Care Administration to conduct quarterly monitoring
    8         visits of facilities that hold a license to provide
    9         extended congregate care services; deleting the
   10         requirement for the Department of Elderly Affairs to
   11         report annually on the status of and recommendations
   12         related to extended congregate care; deleting the
   13         requirement for the Agency for Health Care
   14         Administration to conduct monitoring visits at least
   15         twice a year to facilities providing limited nursing
   16         services; increasing the licensure fees and the
   17         maximum fee required for the standard license;
   18         increasing the licensure fees for the extended
   19         congregate care license; eliminating the license fee
   20         for the limited nursing services license; transferring
   21         from another provision of law the requirement that a
   22         biennial survey of an assisted living facility include
   23         specific actions to determine whether the facility is
   24         adequately protecting residents’ rights; providing
   25         that an assisted living facility that has a class I
   26         violation or a class II violation is subject to
   27         monitoring visits; requiring a registered nurse to
   28         participate in certain monitoring visits; amending s.
   29         429.17, F.S.; deleting provisions related to the
   30         limited nursing services license; amending s. 429.19,
   31         F.S.; clarifying that a monitoring fee may be assessed
   32         in addition to an administrative fine; amending s.
   33         429.255, F.S.; eliminating provisions authorizing the
   34         use of volunteers to provide certain health-care
   35         related services in assisted living facilities;
   36         authorizing assisted living facilities to provide
   37         limited nursing services; requiring an assisted living
   38         facility to be responsible for certain recordkeeping
   39         and staff to be trained to monitor residents receiving
   40         certain health-care-related services; repealing s.
   41         429.28(3), F.S., relating to a requirement for a
   42         biennial survey of an assisted living facility, to
   43         conform to changes made by the act; amending s.
   44         429.41, F.S., relating to rulemaking; conforming
   45         provisions to changes made by the act; amending s.
   46         429.54, F.S.; requiring licensed assisted living
   47         facilities to electronically report certain data
   48         semiannually to the Agency for Health Care
   49         Administration in accordance with rules adopted by the
   50         Department of Elderly Affairs; providing an effective
   51         date.
   52  
   53  Be It Enacted by the Legislature of the State of Florida:
   54  
   55         Section 1. Subsections (3) and (4) of section 429.07,
   56  Florida Statutes, are amended, and subsections (6) and (7) are
   57  added to that section, to read:
   58         429.07 License required; fee; inspections.—
   59         (3) In addition to the requirements of s. 408.806, each
   60  license granted by the agency must state the type of care for
   61  which the license is granted. Licenses shall be issued for one
   62  or more of the following categories of care: standard, extended
   63  congregate care, limited nursing services, or limited mental
   64  health.
   65         (a) A standard license shall be issued to a facility
   66  facilities providing one or more of the personal services
   67  identified in s. 429.02. Such licensee facilities may also
   68  employ or contract with a person licensed under part I of
   69  chapter 464 to administer medications and perform other tasks as
   70  specified in s. 429.255.
   71         (b) An extended congregate care license shall be issued to
   72  a licensee facilities providing, directly or through contract,
   73  services beyond those authorized in paragraph (a), including
   74  acts performed pursuant to part I of chapter 464 by persons
   75  licensed thereunder, and supportive services defined by rule to
   76  persons who otherwise would be disqualified from continued
   77  residence in a facility licensed under this part.
   78         1. In order for extended congregate care services to be
   79  provided in a facility licensed under this part, the agency must
   80  first determine that all requirements established in law and
   81  rule are met and must specifically designate, on the facility’s
   82  license, that such services may be provided and whether the
   83  designation applies to all or part of a facility. Such
   84  designation may be made at the time of initial licensure or
   85  relicensure, or upon request in writing by a licensee under this
   86  part and part II of chapter 408. Notification of approval or
   87  denial of such request shall be made in accordance with part II
   88  of chapter 408. An existing licensee facilities qualifying to
   89  provide extended congregate care services must have maintained a
   90  standard license and may not have been subject to administrative
   91  sanctions during the previous 2 years, or since initial
   92  licensure if the facility has been licensed for less than 2
   93  years, for any of the following reasons:
   94         a. A class I or class II violation;
   95         b. Three or more repeat or recurring class III violations
   96  of identical or similar resident care standards as specified in
   97  rule from which a pattern of noncompliance is found by the
   98  agency;
   99         c. Three or more class III violations that were not
  100  corrected in accordance with the corrective action plan approved
  101  by the agency;
  102         d. Violation of resident care standards resulting in a
  103  requirement to employ the services of a consultant pharmacist or
  104  consultant dietitian;
  105         e. Denial, suspension, or revocation of a license for
  106  another facility under this part in which the applicant for an
  107  extended congregate care license has at least 25 percent
  108  ownership interest; or
  109         f. Imposition of a moratorium pursuant to this part or part
  110  II of chapter 408 or initiation of injunctive proceedings.
  111         2. A licensee Facilities that is are licensed to provide
  112  extended congregate care services shall maintain a written
  113  progress report for on each person who receives such services,
  114  and the which report must describe describes the type, amount,
  115  duration, scope, and outcome of services that are rendered and
  116  the general status of the resident’s health. A registered nurse,
  117  or appropriate designee, representing the agency shall visit
  118  such facilities at least quarterly to monitor residents who are
  119  receiving extended congregate care services and to determine if
  120  the facility is in compliance with this part, part II of chapter
  121  408, and rules that relate to extended congregate care. One of
  122  these visits may be in conjunction with the regular survey. The
  123  monitoring visits may be provided through contractual
  124  arrangements with appropriate community agencies. A registered
  125  nurse shall serve as part of the team that inspects such
  126  facility. The agency may waive one of the required yearly
  127  monitoring visits for a facility that has been licensed for at
  128  least 24 months to provide extended congregate care services,
  129  if, during the inspection, the registered nurse determines that
  130  extended congregate care services are being provided
  131  appropriately, and if the facility has no class I or class II
  132  violations and no uncorrected class III violations. Before such
  133  decision is made, the agency shall consult with the long-term
  134  care ombudsman council for the area in which the facility is
  135  located to determine if any complaints have been made and
  136  substantiated about the quality of services or care. The agency
  137  may not waive one of the required yearly monitoring visits if
  138  complaints have been made and substantiated.
  139         3. Licensees Facilities that are licensed to provide
  140  extended congregate care services shall:
  141         a. Demonstrate the capability to meet unanticipated
  142  resident service needs.
  143         b. Offer a physical environment that promotes a homelike
  144  setting, provides for resident privacy, promotes resident
  145  independence, and allows sufficient congregate space as defined
  146  by rule.
  147         c. Have sufficient staff available, taking into account the
  148  physical plant and firesafety features of the building, to
  149  assist with the evacuation of residents in an emergency, as
  150  necessary.
  151         d. Adopt and follow policies and procedures that maximize
  152  resident independence, dignity, choice, and decisionmaking to
  153  permit residents to age in place to the extent possible, so that
  154  moves due to changes in functional status are minimized or
  155  avoided.
  156         e. Allow residents or, if applicable, a resident’s
  157  representative, designee, surrogate, guardian, or attorney in
  158  fact to make a variety of personal choices, participate in
  159  developing service plans, and share responsibility in
  160  decisionmaking.
  161         f. Implement the concept of managed risk.
  162         g. Provide, either directly or through contract, the
  163  services of a person licensed pursuant to part I of chapter 464.
  164         h. In addition to the training mandated in s. 429.52,
  165  provide specialized training as defined by rule for facility
  166  staff.
  167         4. Licensees Facilities licensed to provide extended
  168  congregate care services are exempt from the criteria for
  169  continued residency as set forth in rules adopted under s.
  170  429.41. Licensees Facilities so licensed shall adopt their own
  171  requirements within guidelines for continued residency set forth
  172  by rule. However, such licensees facilities may not serve
  173  residents who require 24-hour nursing supervision. Licensees
  174  Facilities licensed to provide extended congregate care services
  175  shall provide each resident with a written copy of facility
  176  policies governing admission and retention.
  177         5. The primary purpose of extended congregate care services
  178  is to allow residents, as they become more impaired, the option
  179  of remaining in a familiar setting from which they would
  180  otherwise be disqualified for continued residency. A licensee
  181  facility licensed to provide extended congregate care services
  182  may also admit an individual who exceeds the admission criteria
  183  for a facility with a standard license, if the individual is
  184  determined appropriate for admission to the extended congregate
  185  care facility.
  186         6. Before admission of an individual to a facility licensed
  187  to provide extended congregate care services, the individual
  188  must undergo a medical examination as provided in s. 429.26(4)
  189  and the facility must develop a preliminary service plan for the
  190  individual.
  191         7. When a licensee facility can no longer provide or
  192  arrange for services in accordance with the resident’s service
  193  plan and needs and the licensee’s facility’s policy, the
  194  licensee facility shall make arrangements for relocating the
  195  person in accordance with s. 429.28(1)(k).
  196         8. Failure to provide extended congregate care services may
  197  result in denial of extended congregate care license renewal.
  198         9.No later than January 1 of each year, the department, in
  199  consultation with the agency, shall prepare and submit to the
  200  Governor, the President of the Senate, the Speaker of the House
  201  of Representatives, and the chairs of appropriate legislative
  202  committees, a report on the status of, and recommendations
  203  related to, extended congregate care services. The status report
  204  must include, but need not be limited to, the following
  205  information:
  206         a.A description of the facilities licensed to provide such
  207  services, including total number of beds licensed under this
  208  part.
  209         b.The number and characteristics of residents receiving
  210  such services.
  211         c.The types of services rendered that could not be
  212  provided through a standard license.
  213         d.An analysis of deficiencies cited during licensure
  214  inspections.
  215         e.The number of residents who required extended congregate
  216  care services at admission and the source of admission.
  217         f.Recommendations for statutory or regulatory changes.
  218         g.The availability of extended congregate care to state
  219  clients residing in facilities licensed under this part and in
  220  need of additional services, and recommendations for
  221  appropriations to subsidize extended congregate care services
  222  for such persons.
  223         h.Such other information as the department considers
  224  appropriate.
  225         (c)A limited nursing services license shall be issued to a
  226  facility that provides services beyond those authorized in
  227  paragraph (a) and as specified in this paragraph.
  228         1.In order for limited nursing services to be provided in
  229  a facility licensed under this part, the agency must first
  230  determine that all requirements established in law and rule are
  231  met and must specifically designate, on the facility’s license,
  232  that such services may be provided. Such designation may be made
  233  at the time of initial licensure or relicensure, or upon request
  234  in writing by a licensee under this part and part II of chapter
  235  408. Notification of approval or denial of such request shall be
  236  made in accordance with part II of chapter 408. Existing
  237  facilities qualifying to provide limited nursing services shall
  238  have maintained a standard license and may not have been subject
  239  to administrative sanctions that affect the health, safety, and
  240  welfare of residents for the previous 2 years or since initial
  241  licensure if the facility has been licensed for less than 2
  242  years.
  243         2.Facilities that are licensed to provide limited nursing
  244  services shall maintain a written progress report on each person
  245  who receives such nursing services, which report describes the
  246  type, amount, duration, scope, and outcome of services that are
  247  rendered and the general status of the resident’s health. A
  248  registered nurse representing the agency shall visit such
  249  facilities at least twice a year to monitor residents who are
  250  receiving limited nursing services and to determine if the
  251  facility is in compliance with applicable provisions of this
  252  part, part II of chapter 408, and related rules. The monitoring
  253  visits may be provided through contractual arrangements with
  254  appropriate community agencies. A registered nurse shall also
  255  serve as part of the team that inspects such facility.
  256         3.A person who receives limited nursing services under
  257  this part must meet the admission criteria established by the
  258  agency for assisted living facilities. When a resident no longer
  259  meets the admission criteria for a facility licensed under this
  260  part, arrangements for relocating the person shall be made in
  261  accordance with s. 429.28(1)(k), unless the facility is licensed
  262  to provide extended congregate care services.
  263         (4) In accordance with s. 408.805, an applicant or licensee
  264  shall pay a fee for each license application submitted under
  265  this part, part II of chapter 408, and applicable rules. The
  266  amount of the fee shall be established by rule.
  267         (a) The biennial license fee required of a facility is $356
  268  $300 per license, with an additional fee of $67.50 $50 per
  269  resident based on the total licensed resident capacity of the
  270  facility, except that no additional fee will be assessed for
  271  beds designated for recipients of optional state supplementation
  272  payments provided for in s. 409.212. The total fee may not
  273  exceed $18,500 $10,000.
  274         (b) In addition to the total fee assessed under paragraph
  275  (a), the agency shall require facilities that are licensed to
  276  provide extended congregate care services under this part to pay
  277  an additional fee per licensed facility. The amount of the
  278  biennial fee shall be $501 $400 per license, with an additional
  279  fee of $10 per resident based on the total licensed resident
  280  capacity of the facility.
  281         (c)In addition to the total fee assessed under paragraph
  282  (a), the agency shall require facilities that are licensed to
  283  provide limited nursing services under this part to pay an
  284  additional fee per licensed facility. The amount of the biennial
  285  fee shall be $250 per license, with an additional fee of $10 per
  286  resident based on the total licensed resident capacity of the
  287  facility.
  288         (6)In order to determine whether the licensee is
  289  adequately protecting residents’ rights as provided in s.
  290  429.28, the biennial survey shall include private informal
  291  conversations with a sample of residents and consultation with
  292  the ombudsman council in the planning and service area in which
  293  the facility is located to discuss residents’ experiences within
  294  the facility.
  295         (7)An assisted living facility that has been cited within
  296  the previous 24-month period for a class I violation or a class
  297  II violation, regardless of the status of any enforcement or
  298  disciplinary action, is subject to periodic unannounced
  299  monitoring to determine if the facility is in compliance with
  300  this part, part II of chapter 408, and applicable rules.
  301  Monitoring may occur through a desk review or onsite. If a cited
  302  violation relates to providing or failing to provide nursing
  303  care, a registered nurse must participate in at least two onsite
  304  monitoring visits within a 12-month period.
  305         Section 2. Subsections (1) and (5) of section 429.17,
  306  Florida Statutes, are amended to read:
  307         429.17 Expiration of license; renewal; conditional
  308  license.—
  309         (1) Limited nursing, Extended congregate care, and limited
  310  mental health licenses shall expire at the same time as the
  311  facility’s standard license, regardless of when issued.
  312         (5) When an extended congregate care or limited nursing
  313  license is requested during a facility’s biennial license
  314  period, the fee shall be prorated in order to permit the
  315  additional license to expire at the end of the biennial license
  316  period. The fee shall be calculated as of the date the
  317  additional license application is received by the agency.
  318         Section 3. Subsection (7) of section 429.19, Florida
  319  Statutes, is amended to read:
  320         429.19 Violations; imposition of administrative fines;
  321  grounds.—
  322         (7) In addition to any administrative fines imposed, the
  323  agency may assess a survey or monitoring fee, equal to the
  324  lesser of one half of the facility’s biennial license and bed
  325  fee or $500, to cover the cost of conducting initial complaint
  326  investigations that result in the finding of a violation that
  327  was the subject of the complaint or monitoring visits conducted
  328  under s. 429.28(3)(c) to verify the correction of the
  329  violations, or to monitor the health, safety, or security of
  330  residents under s. 429.07(7).
  331         Section 4. Section 429.255, Florida Statutes, is amended to
  332  read:
  333         429.255 Use of personnel; emergency care.—
  334         (1)(a) Persons under contract to the facility or, facility
  335  staff, or volunteers, who are licensed according to part I of
  336  chapter 464, or those persons exempt under s. 464.022(1), and
  337  others as defined by rule, may administer medications to
  338  residents, take residents’ vital signs, manage individual weekly
  339  pill organizers for residents who self-administer medication,
  340  give prepackaged enemas ordered by a physician, observe
  341  residents, document observations on the appropriate resident’s
  342  record, report observations to the resident’s physician, and
  343  contract or allow residents or a resident’s representative,
  344  designee, surrogate, guardian, or attorney in fact to contract
  345  with a third party, provided residents meet the criteria for
  346  appropriate placement as defined in s. 429.26. Persons under
  347  contract to the facility or facility staff who are licensed
  348  according to part I of chapter 464 may provide limited nursing
  349  services. Nursing assistants certified pursuant to part II of
  350  chapter 464 may take residents’ vital signs as directed by a
  351  licensed nurse or physician. The licensee is responsible for
  352  maintaining documentation of services provided under this
  353  paragraph as required by rule and ensuring that staff are
  354  adequately trained to monitor residents receiving these
  355  services.
  356         (b) All staff in facilities licensed under this part shall
  357  exercise their professional responsibility to observe residents,
  358  to document observations on the appropriate resident’s record,
  359  and to report the observations to the resident’s physician.
  360  However, the owner or administrator of the facility shall be
  361  responsible for determining that the resident receiving services
  362  is appropriate for residence in the facility.
  363         (c) In an emergency situation, licensed personnel may carry
  364  out their professional duties pursuant to part I of chapter 464
  365  until emergency medical personnel assume responsibility for
  366  care.
  367         (2) In facilities licensed to provide extended congregate
  368  care, persons under contract to the facility or, facility staff,
  369  or volunteers, who are licensed according to part I of chapter
  370  464, or those persons exempt under s. 464.022(1), or those
  371  persons certified as nursing assistants pursuant to part II of
  372  chapter 464, may also perform all duties within the scope of
  373  their license or certification, as approved by the facility
  374  administrator and pursuant to this part.
  375         (3) Facility staff may withhold or withdraw cardiopulmonary
  376  resuscitation if presented with an order not to resuscitate
  377  executed pursuant to s. 401.45. The department shall adopt rules
  378  providing for the implementation of such orders. Facility staff
  379  and facilities shall not be subject to criminal prosecution or
  380  civil liability, nor be considered to have engaged in negligent
  381  or unprofessional conduct, for withholding or withdrawing
  382  cardiopulmonary resuscitation pursuant to such an order and
  383  rules adopted by the department. The absence of an order to
  384  resuscitate executed pursuant to s. 401.45 does not preclude a
  385  physician from withholding or withdrawing cardiopulmonary
  386  resuscitation as otherwise permitted by law.
  387         Section 5. Subsection (3) of section 429.28, Florida
  388  Statutes, is repealed.
  389         Section 6. Paragraphs (i) and (j) of subsection (1) of
  390  section 429.41, Florida Statutes, are amended to read:
  391         429.41 Rules establishing standards.—
  392         (1) It is the intent of the Legislature that rules
  393  published and enforced pursuant to this section shall include
  394  criteria by which a reasonable and consistent quality of
  395  resident care and quality of life may be ensured and the results
  396  of such resident care may be demonstrated. Such rules shall also
  397  ensure a safe and sanitary environment that is residential and
  398  noninstitutional in design or nature. It is further intended
  399  that reasonable efforts be made to accommodate the needs and
  400  preferences of residents to enhance the quality of life in a
  401  facility. The agency, in consultation with the department, may
  402  adopt rules to administer the requirements of part II of chapter
  403  408. In order to provide safe and sanitary facilities and the
  404  highest quality of resident care accommodating the needs and
  405  preferences of residents, the department, in consultation with
  406  the agency, the Department of Children and Family Services, and
  407  the Department of Health, shall adopt rules, policies, and
  408  procedures to administer this part, which must include
  409  reasonable and fair minimum standards in relation to:
  410         (i) Facilities holding an a limited nursing, extended
  411  congregate care, or limited mental health license.
  412         (j) The establishment of specific criteria to define
  413  appropriateness of resident admission and continued residency in
  414  a facility holding a standard, limited nursing, extended
  415  congregate care, and limited mental health license.
  416         Section 7. Section 429.54, Florida Statutes, is amended to
  417  read:
  418         429.54 Collection of information; local subsidy.—
  419         (1)Facilities that are licensed under this part must
  420  report electronically to the agency semiannually, or more
  421  frequently as determined by rule, data related to the facility,
  422  including, but not limited to: the total number of residents,
  423  the number of residents who are receiving limited mental health
  424  services, the number of residents who are receiving extended
  425  congregate care services, the number of residents who are
  426  receiving limited nursing services, funding sources of the
  427  residents, and professional staffing employed by or under
  428  contract with the licensee to provide resident services. The
  429  department, in consultation with the agency, shall adopt rules
  430  to administer this subsection.
  431         (2)(1) To enable the department to collect the information
  432  requested by the Legislature regarding the actual cost of
  433  providing room, board, and personal care in facilities, the
  434  department is authorized to conduct field visits and audits of
  435  facilities as may be necessary. The owners of randomly sampled
  436  facilities shall submit such reports, audits, and accountings of
  437  cost as the department may require by rule; provided that such
  438  reports, audits, and accountings shall be the minimum necessary
  439  to implement the provisions of this section. Any facility
  440  selected to participate in the study shall cooperate with the
  441  department by providing cost of operation information to
  442  interviewers.
  443         (3)(2) Local governments or organizations may contribute to
  444  the cost of care of local facility residents by further
  445  subsidizing the rate of state-authorized payment to such
  446  facilities. Implementation of local subsidy shall require
  447  departmental approval and shall not result in reductions in the
  448  state supplement.
  449         Section 8. This act shall take effect July 1, 2010.

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