July 18, 2019
Print This PagePrint This Page

  *
Session:
Bill #:
Session:
Chamber: View Search Tips
Search Term:
Year: View Search Tips
Search Term:
       Florida Senate - 2010                                    SB 2138
       
       
       
       By Senator Gardiner
       
       
       
       
       9-01107-10                                            20102138__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 1.01,
    3         F.S.; defining the term “Joint Commission”; repealing
    4         s. 112.0455(10)(e), F.S., relating to a prohibition
    5         against applying the Drug-Free Workplace Act
    6         retroactively; amending s. 154.11, F.S.; renaming the
    7         Joint Commission on the Accreditation of Hospitals as
    8         the “Joint Commission”; amending s. 318.21, F.S.;
    9         requiring that certain fines received by the county
   10         court for traffic infractions be remitted to the
   11         Department of Revenue for deposit into the Brain and
   12         Spinal Cord Injury Rehabilitation Trust Fund within
   13         the Department of Health for use for Medicaid
   14         recipients who have spinal cord injuries; repealing s.
   15         383.325, F.S., relating to the requirement of a
   16         licensed facility under s. 383.305, F.S., to maintain
   17         inspection reports; amending s. 394.4787, F.S.;
   18         conforming a cross-reference; amending s. 394.741,
   19         F.S.; renaming the Joint Commission on the
   20         Accreditation of Healthcare Organizations as the
   21         “Joint Commission”; renaming the Council on
   22         Accreditation for Children and Family Services as the
   23         “Council on Accreditation”; amending s. 395.002, F.S.;
   24         redefining the term “accrediting organizations” as it
   25         relates to hospital licensure and regulation; deleting
   26         the definitions for the terms “initial denial
   27         determination,” “private review agent,” and
   28         “utilization review plan” as they relate to hospital
   29         licensure and regulation; amending s. 395.003, F.S.;
   30         deleting a provision that prohibits the Agency for
   31         Health Care Administration from authorizing emergency
   32         departments that are located off the premises of a
   33         licensed hospital; amending s. 395.0193, F.S.;
   34         requiring the Division of Medical Quality Assurance
   35         within the Department of Health to conduct the reviews
   36         of the recordings of agendas and minutes of licensed
   37         facilities; requiring the Division of Medical Quality
   38         Assurance within the Department of Health to report
   39         disciplinary actions rather than the Division of
   40         Health Quality Assurance within the Agency for Health
   41         Care Administration; amending s. 395.1023, F.S.;
   42         requiring a licensed facility to adopt a protocol to
   43         designate a physician in cases involving suspected
   44         child abuse at the request of the Department of
   45         Children and Family Services rather than the
   46         Department of Health; amending s. 395.1041, F.S.;
   47         deleting provisions that require the Agency for Health
   48         Care Administration to request a hospital to identify
   49         its services, notify each hospital of the service
   50         capability to be included in the inventory, and
   51         publish a final inventory; deleting obsolete
   52         provisions; repealing s. 395.1046, F.S., relating to
   53         the investigation of complaints regarding hospitals;
   54         amending s. 395.1055, F.S.; requiring the agency to
   55         adopt rules that ensure that licensed facility beds
   56         conform to certain standards as specified by the
   57         agency, the Florida Building Code, and the Florida
   58         Fire Prevention Code; amending s. 395.10972, F.S.;
   59         renaming the Florida Society of Healthcare Risk
   60         Management as the “Florida Society for Healthcare Risk
   61         Management and Patient Safety”; amending s. 395.2050,
   62         F.S.; providing for an organ procurement organization
   63         to be designated by the federal Centers for Medicare
   64         and Medicaid Services rather than the federal Health
   65         Care Financing Administration; amending s. 395.3036,
   66         F.S.; correcting a cross-reference; repealing s.
   67         395.3037, F.S.; deleting definitions relating to
   68         obsolete provisions governing primary and
   69         comprehensive stroke centers; amending s. 395.3038,
   70         F.S.; renaming the Joint Commission on the
   71         Accreditation of Healthcare Organizations as the
   72         “Joint Commission”; amending s. 395.602, F.S.;
   73         redefining the term “rural hospital” as it relates to
   74         hospital licensure and regulation; amending s.
   75         400.021, F.S.; redefining the term “geriatric
   76         outpatient clinic” as it relates to nursing homes;
   77         amending ss. 400.0239 and 400.063, F.S., relating to
   78         trust funds; deleting obsolete provisions; amending s.
   79         400.071, F.S.; revising the requirements for an
   80         application for a license to operate a nursing home
   81         facility; amending s. 400.0712, F.S.; deleting the
   82         agency’s authority to issue an inactive license to a
   83         nursing home facility; amending s. 400.111, F.S.;
   84         requiring the agency to request a licensee to submit
   85         an affidavit disclosing financial or ownership
   86         interest that a controlling interest has held in
   87         certain entities; amending s. 400.1183, F.S.;
   88         requiring nursing home facilities to maintain records
   89         of grievances for agency inspection; deleting a
   90         requirement that a facility report the number of
   91         grievances handled during the prior licensure period;
   92         amending s. 400.141, F.S.; conforming a cross
   93         reference; deleting the requirement that a facility
   94         submit to the agency information regarding a
   95         management company with which it has entered into an
   96         agreement; specifying a fine for a nursing facility’s
   97         failure to impose an admissions moratorium for not
   98         complying with state minimum-staffing requirements;
   99         deleting the requirement for a facility to report to
  100         the agency any filing of bankruptcy protection,
  101         divestiture, or corporate reorganization; amending s.
  102         400.142, F.S.; deleting a provision that requires the
  103         agency to adopt rules regarding orders not to
  104         resuscitate; repealing s. 400.147(10), F.S., relating
  105         to a requirement that a nursing home facility report
  106         any notice of a filing of a claim for a violation of a
  107         resident’s rights or a claim of negligence; repealing
  108         s. 400.148, F.S., relating to the Medicaid “Up-or-Out”
  109         Quality of Care Contract Management Program; amending
  110         s. 400.19, F.S.; authorizing the agency to verify the
  111         correction of certain deficiencies after an
  112         unannounced inspection of a nursing home facility;
  113         repealing s. 400.195, F.S., relating to agency
  114         reporting requirements; amending s. 400.23, F.S.;
  115         renaming the Children’s Medical Services of the
  116         Department of Health as the “Children’s Medical
  117         Services Network”; deleting an obsolete provision;
  118         amending s. 400.275, F.S.; deleting a requirement that
  119         the agency ensure that a newly hired nursing home
  120         surveyor is assigned full time to a licensed nursing
  121         home to observe facility operations; amending s.
  122         400.462, F.S.; revising definitions with regard to the
  123         Home Health Services Act; defining the terms “primary
  124         home health agency” and “temporary” with regard to the
  125         Home Health Services Act; amending s. 400.476, F.S.;
  126         providing requirements for an alternative
  127         administrator of a home health agency; revising the
  128         duties of the administrator; revising the requirements
  129         for a director of nursing for a specified number of
  130         home health agencies; prohibiting a home health agency
  131         from using an individual as a home health aide unless
  132         the person has completed training and an evaluation
  133         program; requiring a home health aide to meet certain
  134         standards in order to be competent in performing
  135         certain tasks; requiring a home health agency and
  136         staff to comply with accepted professional standards;
  137         providing certain requirements for a written contract
  138         between certain personnel and the agency; requiring a
  139         home health agency to provide certain services through
  140         its employees; authorizing a home health agency to
  141         provide additional services with another organization;
  142         providing responsibilities of a home health agency
  143         when it provides home health aide services through
  144         another organization; requiring the home health agency
  145         to coordinate personnel that provide home health
  146         services; requiring personnel to communicate with the
  147         home health agency; amending s. 400.484, F.S.;
  148         redefining class I, II, III, and IV deficiencies as
  149         class I, II, III, and IV violations; amending s.
  150         400.487, F.S.; requiring a home health agency to
  151         provide a copy of the agreement between the agency and
  152         a patient which specifies the home health services to
  153         be provided; providing the rights that are protected
  154         by the home health agency; requiring the home health
  155         agency to furnish nursing services by or under the
  156         supervision of a registered nurse; requiring the home
  157         health agency to provide therapy services through a
  158         qualified therapist or therapy assistant; providing
  159         the duties and qualifications of a therapist and
  160         therapy assistant; requiring supervision by a physical
  161         therapist or occupational therapist of a physical
  162         therapist assistant or occupational therapist
  163         assistant; providing duties of a physical therapist
  164         assistant or occupational therapist assistant;
  165         providing for speech therapy services to be provided
  166         by a qualified speech pathologist or audiologist;
  167         providing for a plan of care; providing that only the
  168         staff of a home health agency may administer drugs and
  169         treatments as ordered by certain health professionals;
  170         providing requirements for verbal orders; providing
  171         duties of a registered nurse, licensed practical
  172         nurse, home health aide, and certified nursing
  173         assistant who work for a home health agency; amending
  174         s. 400.606, F.S.; revising the requirements for the
  175         plan for the delivery of home, residential, and
  176         homelike inpatient hospice services for terminally ill
  177         patients and their families; amending s. 400.607,
  178         F.S.; revising the grounds under which the agency may
  179         take administrative action against a hospice; amending
  180         s. 400.925, F.S.; renaming the Joint Commission on the
  181         Accreditation of Healthcare Organizations as the
  182         “Joint Commission” within the definition of the term
  183         “accrediting organizations” as it relates to home
  184         medical equipment providers; amending s. 400.931,
  185         F.S.; deleting the requirement that an applicant for a
  186         license to be a home medical equipment provider submit
  187         a surety bond to the agency; amending s. 400.932,
  188         F.S.; revising the grounds under which the agency may
  189         take administrative action against a home medical
  190         equipment provider; amending s. 400.933, F.S.;
  191         prohibiting a home medical equipment provider from
  192         submitting a survey or inspection of an accrediting
  193         organization if the home medical equipment provider’s
  194         licensure is conditional or provisional; amending s.
  195         400.953, F.S.; deleting the requirement of a general
  196         manager of a home medical equipment provider to
  197         annually sign an affidavit regarding the background
  198         screening of personnel; providing requirements for
  199         submission of the affidavit; amending s. 400.967,
  200         F.S.; redefining class I, II, III, and IV deficiencies
  201         as class I, II, III, and IV violations as they relate
  202         to intermediate care facilities for developmentally
  203         disabled persons; amending s. 400.969, F.S.; revising
  204         the grounds for an administrative or civil penalty;
  205         amending s. 400.9905, F.S.; redefining the term
  206         “portable service or equipment provider” as it relates
  207         to the Health Care Clinic Act; amending s. 400.991,
  208         F.S.; conforming a provision to changes made by the
  209         act; revising application requirements to show proof
  210         of financial ability to operate a health care clinic;
  211         amending s. 400.9935, F.S.; renaming the Joint
  212         Commission on the Accreditation of Healthcare
  213         Organizations as the “Joint Commission” for purposes
  214         of the Health Care Clinic Act; amending s. 408.034,
  215         F.S.; prohibiting the agency from issuing a license to
  216         a health care facility that applies for a license to
  217         operate an intermediate care facility for
  218         developmentally disabled persons under certain
  219         conditions; amending s. 408.036, F.S., relating to
  220         certificates of need; conforming a provision to
  221         changes made by the act; amending s. 408.043, F.S.;
  222         requiring a freestanding facility or a part of the
  223         facility that is the inpatient hospice care component
  224         of a hospice to obtain a certificate of need; amending
  225         s. 408.05, F.S.; renaming the Joint Commission on the
  226         Accreditation of Healthcare Organizations as the
  227         “Joint Commission”; amending s. 408.061, F.S.;
  228         revising requirements for the reporting of certified
  229         data elements by health care facilities; amending s.
  230         408.10, F.S.; authorizing the agency to provide
  231         staffing for a toll-free phone number for the purpose
  232         of handling consumer complaints regarding a health
  233         care facility; repealing s. 408.802(11), F.S.,
  234         relating to the applicability of the Health Care
  235         Licensing Procedures Act to private review agents;
  236         amending s. 408.804, F.S.; providing a criminal
  237         penalty for altering, defacing, or falsifying a
  238         license certificate of certain health care providers;
  239         providing civil penalties for displaying an altered,
  240         defaced, or falsified license certificate; amending s.
  241         408.806, F.S.; requiring the agency to provide a
  242         courtesy notice to a licensee regarding the expiration
  243         of a licensee’s license; providing that failure of the
  244         agency to provide the courtesy notice or failure of
  245         the licensee to receive the notice is not an excuse
  246         for the licensee to timely renew its license;
  247         providing that payment of the late fee is required for
  248         a later application; amending s. 408.810, F.S.;
  249         revising the requirements for obtaining and
  250         maintaining a license for certain health care
  251         providers and those who own a controlling interest in
  252         a health care provider; amending s. 408.811, F.S.;
  253         providing that a licensee’s inspection report is not
  254         subject to administrative challenge; amending s.
  255         408.813, F.S.; authorizing the agency to impose
  256         administrative fines for unclassified violations;
  257         amending s. 408.815, F.S.; authorizing the agency to
  258         extend the expiration date of a license for the
  259         purpose of the safe and orderly discharge of clients;
  260         authorizing the agency to impose conditions on the
  261         extension; amending s. 409.906, F.S.; requiring the
  262         agency, in consultation with the Department of Elderly
  263         Affairs, to phase out the adult day health care waiver
  264         program; requiring adult day health care waiver
  265         providers, in consultation with resource centers for
  266         the aged to assist in the transition of enrollees from
  267         the waiver program; repealing s. 409.221(4)(k), F.S.,
  268         relating to the responsibility of the agency, the
  269         Department of Elderly Affairs, the Department of
  270         Health, the Department of Children and Family
  271         Services, and the Agency for Persons with Disabilities
  272         to review and assess the implementation of the
  273         consumer-directed care program and the agency’s
  274         responsibility to submit a report to the Legislature;
  275         repealing s. 409.912(15)(e), (f), and (g), F.S.,
  276         relating to a requirement for the Agency for Health
  277         Care Administration to submit a report to the
  278         Legislature regarding the operations of the CARE
  279         program; amending s. 429.11, F.S.; deleting provisions
  280         relating to a provisional license to operate as an
  281         assisted living facility; repealing s. 429.12(2),
  282         F.S., relating to the sale or transfer of ownership of
  283         an assisted living facility; amending s. 429.14, F.S.;
  284         authorizing the agency to provide electronically or
  285         through the agency’s Internet site information
  286         regarding the denial, suspension, or revocation of a
  287         license to the Division of Hotels and Restaurants of
  288         the Department of Business and Professional
  289         Regulation; amending s. 429.17, F.S.; revising the
  290         requirements for a conditional license to operate an
  291         assisted living facility; repealing s. 429.23(5),
  292         F.S., relating to each assisted living facility’s
  293         requirement to submit a report to the agency regarding
  294         liability claims filed against it; amending s. 429.35,
  295         F.S.; authorizing the agency to provide electronically
  296         or through the agency’s Internet website information
  297         regarding the results of an inspection to the local
  298         ombudsman council; amending s. 429.53, F.S.; requiring
  299         the agency, rather than the agency’s area offices of
  300         licensure and certification, to provide consultation
  301         to certain persons and licensees regarding assisted
  302         living facilities; redefining the term “consultation”
  303         as it relates to assisted living facilities; amending
  304         s. 429.65, F.S.; redefining the term “adult family
  305         care home” as it relates to the Adult Family-Care Home
  306         Act; amending s. 429.71, F.S.; redefining class I, II,
  307         III, and IV deficiencies as class I, II, III, and IV
  308         violations as they relate to adult family-care homes;
  309         repealing s. 429.911, F.S., relating to the denial,
  310         suspension, or revocation of a license to operate an
  311         adult day care center; amending s. 429.915, F.S.;
  312         revising requirements for a conditional license to
  313         operate an adult day care center; amending s. 430.80,
  314         F.S.; conforming a cross-reference; renaming the Joint
  315         Commission on the Accreditation of Healthcare
  316         Organizations to the Joint Commission; amending s.
  317         440.13, F.S.; renaming the Joint Commission on the
  318         Accreditation of Healthcare Organizations as the
  319         “Joint Commission”; amending s. 483.294, F.S.;
  320         requiring the agency to biennially inspect the
  321         premises and operations of multiphasic health testing
  322         centers; amending ss. 627.645, 627.668, and 627.669,
  323         F.S.; renaming the Joint Commission on the
  324         Accreditation of Hospitals to the Joint Commission;
  325         amending ss. 627.736 and 641.495 F.S.; renaming the
  326         Joint Commission on the Accreditation of Healthcare
  327         Organizations as the “Joint Commission”; amending s.
  328         651.118, F.S.; conforming a cross-reference; amending
  329         s. 766.1015, F.S.; renaming the Joint Commission on
  330         the Accreditation of Healthcare Organizations as the
  331         “Joint Commission”; providing effective dates.
  332  
  333  Be It Enacted by the Legislature of the State of Florida:
  334  
  335         Section 1. Subsection (16) is added to section 1.01,
  336  Florida Statutes, to read:
  337         1.01 Definitions.—In construing these statutes and each and
  338  every word, phrase, or part hereof, where the context will
  339  permit:
  340         (16) The term “Joint Commission” means the independent,
  341  not-for-profit organization that evaluates and accredits
  342  hospitals and health care organizations and programs in the
  343  United States. The Joint Commission was formerly known as the
  344  Joint Commission on Accreditation of Hospitals (JCAH) and the
  345  Joint Commission on Accreditation of Healthcare Organizations
  346  (JCAHO).
  347         Section 2. Paragraph (e) of subsection (10) of section
  348  112.0455, Florida Statutes, is repealed.
  349         Section 3. Paragraph (n) of subsection (1) of section
  350  154.11, Florida Statutes, is amended to read:
  351         154.11 Powers of board of trustees.—
  352         (1) The board of trustees of each public health trust shall
  353  be deemed to exercise a public and essential governmental
  354  function of both the state and the county and in furtherance
  355  thereof it shall, subject to limitation by the governing body of
  356  the county in which such board is located, have all of the
  357  powers necessary or convenient to carry out the operation and
  358  governance of designated health care facilities, including, but
  359  without limiting the generality of, the foregoing:
  360         (n) To appoint originally the staff of physicians to
  361  practice in any designated facility owned or operated by the
  362  board and to approve the bylaws and rules to be adopted by the
  363  medical staff of any designated facility owned and operated by
  364  the board, such governing regulations to be in accordance with
  365  the standards of the Joint Commission on the Accreditation of
  366  Hospitals which provide, among other things, for the method of
  367  appointing additional staff members and for the removal of staff
  368  members.
  369         Section 4. Subsection (15) of section 318.21, Florida
  370  Statutes, is amended to read:
  371         318.21 Disposition of civil penalties by county courts.—All
  372  civil penalties received by a county court pursuant to the
  373  provisions of this chapter shall be distributed and paid monthly
  374  as follows:
  375         (15) Of the additional fine assessed under s. 318.18(3)(e)
  376  for a violation of s. 316.1893, 50 percent of the moneys
  377  received from the fines shall be remitted to the Department of
  378  Revenue and deposited into Brain and Spinal Cord Injury
  379  Rehabilitation Trust Fund within Department of Health and shall
  380  be appropriated to the Department of Health Agency for Health
  381  Care Administration as general revenue to provide an enhanced
  382  Medicaid payment to nursing homes that serve Medicaid recipients
  383  with brain and spinal cord injuries that are medically complex,
  384  technologically dependent, and respiratory dependent. The
  385  remaining 50 percent of the moneys received from the enhanced
  386  fine imposed under s. 318.18(3)(e) shall be remitted to the
  387  Department of Revenue and deposited into the Department of
  388  Health Administrative Trust Fund to provide financial support to
  389  certified trauma centers in the counties where enhanced penalty
  390  zones are established to ensure the availability and
  391  accessibility of trauma services. Funds deposited into the
  392  Administrative Trust Fund under this subsection shall be
  393  allocated as follows:
  394         (a) Fifty percent shall be allocated equally among all
  395  Level I, Level II, and pediatric trauma centers in recognition
  396  of readiness costs for maintaining trauma services.
  397         (b) Fifty percent shall be allocated among Level I, Level
  398  II, and pediatric trauma centers based on each center’s relative
  399  volume of trauma cases as reported in the Department of Health
  400  Trauma Registry.
  401         Section 5. Section 383.325, Florida Statutes, is repealed.
  402         Section 6. Subsection (7) of section 394.4787, Florida
  403  Statutes, is amended to read:
  404         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
  405  394.4789.—As used in this section and ss. 394.4786, 394.4788,
  406  and 394.4789:
  407         (7) “Specialty psychiatric hospital” means a hospital
  408  licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
  409  and part II of chapter 408 as a specialty psychiatric hospital.
  410         Section 7. Subsection (2) of section 394.741, Florida
  411  Statutes, is amended to read:
  412         394.741 Accreditation requirements for providers of
  413  behavioral health care services.—
  414         (2) Notwithstanding any provision of law to the contrary,
  415  accreditation shall be accepted by the agency and department in
  416  lieu of the agency’s and department’s facility licensure onsite
  417  review requirements and shall be accepted as a substitute for
  418  the department’s administrative and program monitoring
  419  requirements, except as required by subsections (3) and (4),
  420  for:
  421         (a) Any organization from which the department purchases
  422  behavioral health care services that is accredited by the Joint
  423  Commission on Accreditation of Healthcare Organizations or the
  424  Council on Accreditation for Children and Family Services, or
  425  has those services that are being purchased by the department
  426  accredited by CARF—the Rehabilitation Accreditation Commission.
  427         (b) Any mental health facility licensed by the agency or
  428  any substance abuse component licensed by the department that is
  429  accredited by the Joint Commission on Accreditation of
  430  Healthcare Organizations, CARF—the Rehabilitation Accreditation
  431  Commission, or the Council on Accreditation of Children and
  432  Family Services.
  433         (c) Any network of providers from which the department or
  434  the agency purchases behavioral health care services accredited
  435  by the Joint Commission on Accreditation of Healthcare
  436  Organizations, CARF—the Rehabilitation Accreditation Commission,
  437  the Council on Accreditation of Children and Family Services, or
  438  the National Committee for Quality Assurance. A provider
  439  organization, which is part of an accredited network, is
  440  afforded the same rights under this part.
  441         Section 8. Section 395.002, Florida Statutes, is amended to
  442  read:
  443         395.002 Definitions.—As used in this chapter, the term:
  444         (1) “Accrediting organizations” means nationally recognized
  445  or approved accrediting organizations whose standards
  446  incorporate comparable licensure requirements as determined by
  447  the agency. the Joint Commission on Accreditation of Healthcare
  448  Organizations, the American Osteopathic Association, the
  449  Commission on Accreditation of Rehabilitation Facilities, and
  450  the Accreditation Association for Ambulatory Health Care, Inc.
  451         (2) “Agency” means the Agency for Health Care
  452  Administration.
  453         (3) “Ambulatory surgical center” or “mobile surgical
  454  facility” means a facility the primary purpose of which is to
  455  provide elective surgical care, in which the patient is admitted
  456  to and discharged from such facility within the same working day
  457  and is not permitted to stay overnight, and which is not part of
  458  a hospital. However, a facility existing for the primary purpose
  459  of performing terminations of pregnancy, an office maintained by
  460  a physician for the practice of medicine, or an office
  461  maintained for the practice of dentistry shall not be construed
  462  to be an ambulatory surgical center, provided that any facility
  463  or office which is certified or seeks certification as a
  464  Medicare ambulatory surgical center shall be licensed as an
  465  ambulatory surgical center pursuant to s. 395.003. Any structure
  466  or vehicle in which a physician maintains an office and
  467  practices surgery, and which can appear to the public to be a
  468  mobile office because the structure or vehicle operates at more
  469  than one address, shall be construed to be a mobile surgical
  470  facility.
  471         (4) “Biomedical waste” means any solid or liquid waste as
  472  defined in s. 381.0098(2)(a).
  473         (5) “Clinical privileges” means the privileges granted to a
  474  physician or other licensed health care practitioner to render
  475  patient care services in a hospital, but does not include the
  476  privilege of admitting patients.
  477         (6) “Department” means the Department of Health.
  478         (7) “Director” means any member of the official board of
  479  directors as reported in the organization’s annual corporate
  480  report to the Florida Department of State, or, if no such report
  481  is made, any member of the operating board of directors. The
  482  term excludes members of separate, restricted boards that serve
  483  only in an advisory capacity to the operating board.
  484         (8) “Emergency medical condition” means:
  485         (a) A medical condition manifesting itself by acute
  486  symptoms of sufficient severity, which may include severe pain,
  487  such that the absence of immediate medical attention could
  488  reasonably be expected to result in any of the following:
  489         1. Serious jeopardy to patient health, including a pregnant
  490  woman or fetus.
  491         2. Serious impairment to bodily functions.
  492         3. Serious dysfunction of any bodily organ or part.
  493         (b) With respect to a pregnant woman:
  494         1. That there is inadequate time to effect safe transfer to
  495  another hospital prior to delivery;
  496         2. That a transfer may pose a threat to the health and
  497  safety of the patient or fetus; or
  498         3. That there is evidence of the onset and persistence of
  499  uterine contractions or rupture of the membranes.
  500         (9) “Emergency services and care” means medical screening,
  501  examination, and evaluation by a physician, or, to the extent
  502  permitted by applicable law, by other appropriate personnel
  503  under the supervision of a physician, to determine if an
  504  emergency medical condition exists and, if it does, the care,
  505  treatment, or surgery by a physician necessary to relieve or
  506  eliminate the emergency medical condition, within the service
  507  capability of the facility.
  508         (10) “General hospital” means any facility which meets the
  509  provisions of subsection (12) and which regularly makes its
  510  facilities and services available to the general population.
  511         (11) “Governmental unit” means the state or any county,
  512  municipality, or other political subdivision, or any department,
  513  division, board, or other agency of any of the foregoing.
  514         (12) “Hospital” means any establishment that:
  515         (a) Offers services more intensive than those required for
  516  room, board, personal services, and general nursing care, and
  517  offers facilities and beds for use beyond 24 hours by
  518  individuals requiring diagnosis, treatment, or care for illness,
  519  injury, deformity, infirmity, abnormality, disease, or
  520  pregnancy; and
  521         (b) Regularly makes available at least clinical laboratory
  522  services, diagnostic X-ray services, and treatment facilities
  523  for surgery or obstetrical care, or other definitive medical
  524  treatment of similar extent, except that a critical access
  525  hospital, as defined in s. 408.07, shall not be required to make
  526  available treatment facilities for surgery, obstetrical care, or
  527  similar services as long as it maintains its critical access
  528  hospital designation and shall be required to make such
  529  facilities available only if it ceases to be designated as a
  530  critical access hospital.
  531  
  532  However, the provisions of this chapter do not apply to any
  533  institution conducted by or for the adherents of any well
  534  recognized church or religious denomination that depends
  535  exclusively upon prayer or spiritual means to heal, care for, or
  536  treat any person. For purposes of local zoning matters, the term
  537  “hospital” includes a medical office building located on the
  538  same premises as a hospital facility, provided the land on which
  539  the medical office building is constructed is zoned for use as a
  540  hospital; provided the premises were zoned for hospital purposes
  541  on January 1, 1992.
  542         (13) “Hospital bed” means a hospital accommodation which is
  543  ready for immediate occupancy, or is capable of being made ready
  544  for occupancy within 48 hours, excluding provision of staffing,
  545  and which conforms to minimum space, equipment, and furnishings
  546  standards as specified by rule of the agency for the provision
  547  of services specified in this section to a single patient.
  548         (14)“Initial denial determination” means a determination
  549  by a private review agent that the health care services
  550  furnished or proposed to be furnished to a patient are
  551  inappropriate, not medically necessary, or not reasonable.
  552         (14)(15) “Intensive residential treatment programs for
  553  children and adolescents” means a specialty hospital accredited
  554  by an accrediting organization as defined in subsection (1)
  555  which provides 24-hour care and which has the primary functions
  556  of diagnosis and treatment of patients under the age of 18
  557  having psychiatric disorders in order to restore such patients
  558  to an optimal level of functioning.
  559         (15)(16) “Licensed facility” means a hospital, ambulatory
  560  surgical center, or mobile surgical facility licensed in
  561  accordance with this chapter.
  562         (16)(17) “Lifesafety” means the control and prevention of
  563  fire and other life-threatening conditions on a premises for the
  564  purpose of preserving human life.
  565         (17)(18) “Managing employee” means the administrator or
  566  other similarly titled individual who is responsible for the
  567  daily operation of the facility.
  568         (18)(19) “Medical staff” means physicians licensed under
  569  chapter 458 or chapter 459 with privileges in a licensed
  570  facility, as well as other licensed health care practitioners
  571  with clinical privileges as approved by a licensed facility’s
  572  governing board.
  573         (19)(20) “Medically necessary transfer” means a transfer
  574  made necessary because the patient is in immediate need of
  575  treatment for an emergency medical condition for which the
  576  facility lacks service capability or is at service capacity.
  577         (20)(21) “Mobile surgical facility” is a mobile facility in
  578  which licensed health care professionals provide elective
  579  surgical care under contract with the Department of Corrections
  580  or a private correctional facility operating pursuant to chapter
  581  957 and in which inmate patients are admitted to and discharged
  582  from said facility within the same working day and are not
  583  permitted to stay overnight. However, mobile surgical facilities
  584  may only provide health care services to the inmate patients of
  585  the Department of Corrections, or inmate patients of a private
  586  correctional facility operating pursuant to chapter 957, and not
  587  to the general public.
  588         (21)(22) “Person” means any individual, partnership,
  589  corporation, association, or governmental unit.
  590         (22)(23) “Premises” means those buildings, beds, and
  591  equipment located at the address of the licensed facility and
  592  all other buildings, beds, and equipment for the provision of
  593  hospital, ambulatory surgical, or mobile surgical care located
  594  in such reasonable proximity to the address of the licensed
  595  facility as to appear to the public to be under the dominion and
  596  control of the licensee. For any licensee that is a teaching
  597  hospital as defined in s. 408.07(45), reasonable proximity
  598  includes any buildings, beds, services, programs, and equipment
  599  under the dominion and control of the licensee that are located
  600  at a site with a main address that is within 1 mile of the main
  601  address of the licensed facility; and all such buildings, beds,
  602  and equipment may, at the request of a licensee or applicant, be
  603  included on the facility license as a single premises.
  604         (24)“Private review agent” means any person or entity
  605  which performs utilization review services for third-party
  606  payors on a contractual basis for outpatient or inpatient
  607  services. However, the term shall not include full-time
  608  employees, personnel, or staff of health insurers, health
  609  maintenance organizations, or hospitals, or wholly owned
  610  subsidiaries thereof or affiliates under common ownership, when
  611  performing utilization review for their respective hospitals,
  612  health maintenance organizations, or insureds of the same
  613  insurance group. For this purpose, health insurers, health
  614  maintenance organizations, and hospitals, or wholly owned
  615  subsidiaries thereof or affiliates under common ownership,
  616  include such entities engaged as administrators of self
  617  insurance as defined in s. 624.031.
  618         (23)(25) “Service capability” means all services offered by
  619  the facility where identification of services offered is
  620  evidenced by the appearance of the service in a patient’s
  621  medical record or itemized bill.
  622         (24)(26) “At service capacity” means the temporary
  623  inability of a hospital to provide a service which is within the
  624  service capability of the hospital, due to maximum use of the
  625  service at the time of the request for the service.
  626         (25)(27) “Specialty bed” means a bed, other than a general
  627  bed, designated on the face of the hospital license for a
  628  dedicated use.
  629         (26)(28) “Specialty hospital” means any facility which
  630  meets the provisions of subsection (12), and which regularly
  631  makes available either:
  632         (a) The range of medical services offered by general
  633  hospitals, but restricted to a defined age or gender group of
  634  the population;
  635         (b) A restricted range of services appropriate to the
  636  diagnosis, care, and treatment of patients with specific
  637  categories of medical or psychiatric illnesses or disorders; or
  638         (c) Intensive residential treatment programs for children
  639  and adolescents as defined in subsection (14) (15).
  640         (27)(29) “Stabilized” means, with respect to an emergency
  641  medical condition, that no material deterioration of the
  642  condition is likely, within reasonable medical probability, to
  643  result from the transfer of the patient from a hospital.
  644         (30)“Utilization review” means a system for reviewing the
  645  medical necessity or appropriateness in the allocation of health
  646  care resources of hospital services given or proposed to be
  647  given to a patient or group of patients.
  648         (31)“Utilization review plan” means a description of the
  649  policies and procedures governing utilization review activities
  650  performed by a private review agent.
  651         (28)(32) “Validation inspection” means an inspection of the
  652  premises of a licensed facility by the agency to assess whether
  653  a review by an accrediting organization has adequately evaluated
  654  the licensed facility according to minimum state standards.
  655         Section 9. Subsection (1) of section 395.003, Florida
  656  Statutes, is amended to read:
  657         395.003 Licensure; denial, suspension, and revocation.—
  658         (1)(a) The requirements of part II of chapter 408 apply to
  659  the provision of services that require licensure pursuant to ss.
  660  395.001-395.1065 and part II of chapter 408 and to entities
  661  licensed by or applying for such licensure from the Agency for
  662  Health Care Administration pursuant to ss. 395.001-395.1065. A
  663  license issued by the agency is required in order to operate a
  664  hospital, ambulatory surgical center, or mobile surgical
  665  facility in this state.
  666         (b)1. It is unlawful for a person to use or advertise to
  667  the public, in any way or by any medium whatsoever, any facility
  668  as a “hospital,” “ambulatory surgical center,” or “mobile
  669  surgical facility” unless such facility has first secured a
  670  license under the provisions of this part.
  671         2. This part does not apply to veterinary hospitals or to
  672  commercial business establishments using the word “hospital,”
  673  “ambulatory surgical center,” or “mobile surgical facility” as a
  674  part of a trade name if no treatment of human beings is
  675  performed on the premises of such establishments.
  676         (c)Until July 1, 2006, additional emergency departments
  677  located off the premises of licensed hospitals may not be
  678  authorized by the agency.
  679         Section 10. Paragraph (e) of subsection (2) and subsection
  680  (4) of section 395.0193, Florida Statutes, are amended to read:
  681         395.0193 Licensed facilities; peer review; disciplinary
  682  powers; agency or partnership with physicians.—
  683         (2) Each licensed facility, as a condition of licensure,
  684  shall provide for peer review of physicians who deliver health
  685  care services at the facility. Each licensed facility shall
  686  develop written, binding procedures by which such peer review
  687  shall be conducted. Such procedures shall include:
  688         (e) Recording of agendas and minutes which do not contain
  689  confidential material, for review by the Division of Medical
  690  Quality Assurance of the department Health Quality Assurance of
  691  the agency.
  692         (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
  693  actions taken under subsection (3) shall be reported in writing
  694  to the Division of Medical Quality Assurance of the department
  695  Health Quality Assurance of the agency within 30 working days
  696  after its initial occurrence, regardless of the pendency of
  697  appeals to the governing board of the hospital. The notification
  698  shall identify the disciplined practitioner, the action taken,
  699  and the reason for such action. All final disciplinary actions
  700  taken under subsection (3), if different from those which were
  701  reported to the department agency within 30 days after the
  702  initial occurrence, shall be reported within 10 working days to
  703  the Division of Medical Quality Assurance of the department
  704  Health Quality Assurance of the agency in writing and shall
  705  specify the disciplinary action taken and the specific grounds
  706  therefor. The division shall review each report and determine
  707  whether it potentially involved conduct by the licensee that is
  708  subject to disciplinary action, in which case s. 456.073 shall
  709  apply. The reports are not subject to inspection under s.
  710  119.07(1) even if the division’s investigation results in a
  711  finding of probable cause.
  712         Section 11. Section 395.1023, Florida Statutes, is amended
  713  to read:
  714         395.1023 Child abuse and neglect cases; duties.—Each
  715  licensed facility shall adopt a protocol that, at a minimum,
  716  requires the facility to:
  717         (1) Incorporate a facility policy that every staff member
  718  has an affirmative duty to report, pursuant to chapter 39, any
  719  actual or suspected case of child abuse, abandonment, or
  720  neglect; and
  721         (2) In any case involving suspected child abuse,
  722  abandonment, or neglect, designate, at the request of the
  723  Department of Children and Family Services, a staff physician to
  724  act as a liaison between the hospital and the Department of
  725  Children and Family Services office which is investigating the
  726  suspected abuse, abandonment, or neglect, and the child
  727  protection team, as defined in s. 39.01, when the case is
  728  referred to such a team.
  729  
  730  Each general hospital and appropriate specialty hospital shall
  731  comply with the provisions of this section and shall notify the
  732  agency and the Department of Children and Family Services of its
  733  compliance by sending a copy of its policy to the agency and the
  734  Department of Children and Family Services as required by rule.
  735  The failure by a general hospital or appropriate specialty
  736  hospital to comply shall be punished by a fine not exceeding
  737  $1,000, to be fixed, imposed, and collected by the agency. Each
  738  day in violation is considered a separate offense.
  739         Section 12. Subsection (2) and paragraph (d) of subsection
  740  (3) of section 395.1041, Florida Statutes, are amended to read:
  741         395.1041 Access to emergency services and care.—
  742         (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
  743  shall establish and maintain an inventory of hospitals with
  744  emergency services. The inventory shall list all services within
  745  the service capability of the hospital, and such services shall
  746  appear on the face of the hospital license. Each hospital having
  747  emergency services shall notify the agency of its service
  748  capability in the manner and form prescribed by the agency. The
  749  agency shall use the inventory to assist emergency medical
  750  services providers and others in locating appropriate emergency
  751  medical care. The inventory shall also be made available to the
  752  general public. On or before August 1, 1992, the agency shall
  753  request that each hospital identify the services which are
  754  within its service capability. On or before November 1, 1992,
  755  the agency shall notify each hospital of the service capability
  756  to be included in the inventory. The hospital has 15 days from
  757  the date of receipt to respond to the notice. By December 1,
  758  1992, the agency shall publish a final inventory. Each hospital
  759  shall reaffirm its service capability when its license is
  760  renewed and shall notify the agency of the addition of a new
  761  service or the termination of a service prior to a change in its
  762  service capability.
  763         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
  764  FACILITY OR HEALTH CARE PERSONNEL.—
  765         (d)1. Every hospital shall ensure the provision of services
  766  within the service capability of the hospital, at all times,
  767  either directly or indirectly through an arrangement with
  768  another hospital, through an arrangement with one or more
  769  physicians, or as otherwise made through prior arrangements. A
  770  hospital may enter into an agreement with another hospital for
  771  purposes of meeting its service capability requirement, and
  772  appropriate compensation or other reasonable conditions may be
  773  negotiated for these backup services.
  774         2. If any arrangement requires the provision of emergency
  775  medical transportation, such arrangement must be made in
  776  consultation with the applicable provider and may not require
  777  the emergency medical service provider to provide transportation
  778  that is outside the routine service area of that provider or in
  779  a manner that impairs the ability of the emergency medical
  780  service provider to timely respond to prehospital emergency
  781  calls.
  782         3. A hospital shall not be required to ensure service
  783  capability at all times as required in subparagraph 1. if, prior
  784  to the receiving of any patient needing such service capability,
  785  such hospital has demonstrated to the agency that it lacks the
  786  ability to ensure such capability and it has exhausted all
  787  reasonable efforts to ensure such capability through backup
  788  arrangements. In reviewing a hospital’s demonstration of lack of
  789  ability to ensure service capability, the agency shall consider
  790  factors relevant to the particular case, including the
  791  following:
  792         a. Number and proximity of hospitals with the same service
  793  capability.
  794         b. Number, type, credentials, and privileges of
  795  specialists.
  796         c. Frequency of procedures.
  797         d. Size of hospital.
  798         4. The agency shall publish proposed rules implementing a
  799  reasonable exemption procedure by November 1, 1992. Subparagraph
  800  1. shall become effective upon the effective date of said rules
  801  or January 31, 1993, whichever is earlier. For a period not to
  802  exceed 1 year from the effective date of subparagraph 1., a
  803  hospital requesting an exemption shall be deemed to be exempt
  804  from offering the service until the agency initially acts to
  805  deny or grant the original request. The agency has 45 days from
  806  the date of receipt of the request to approve or deny the
  807  request. After the first year from the effective date of
  808  subparagraph 1., If the agency fails to initially act within the
  809  time period, the hospital is deemed to be exempt from offering
  810  the service until the agency initially acts to deny the request.
  811         Section 13. Section 395.1046, Florida Statutes, is
  812  repealed.
  813         Section 14. Paragraph (e) of subsection (1) of section
  814  395.1055, Florida Statutes, is amended to read:
  815         395.1055 Rules and enforcement.—
  816         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  817  and 120.54 to implement the provisions of this part, which shall
  818  include reasonable and fair minimum standards for ensuring that:
  819         (e) Licensed facility beds conform to minimum space,
  820  equipment, and furnishings standards as specified by the agency,
  821  the Florida Building Code, and the Florida Fire Prevention Code
  822  department.
  823         Section 15. Subsection (1) of section 395.10972, Florida
  824  Statutes, is amended to read:
  825         395.10972 Health Care Risk Manager Advisory Council.—The
  826  Secretary of Health Care Administration may appoint a seven
  827  member advisory council to advise the agency on matters
  828  pertaining to health care risk managers. The members of the
  829  council shall serve at the pleasure of the secretary. The
  830  council shall designate a chair. The council shall meet at the
  831  call of the secretary or at those times as may be required by
  832  rule of the agency. The members of the advisory council shall
  833  receive no compensation for their services, but shall be
  834  reimbursed for travel expenses as provided in s. 112.061. The
  835  council shall consist of individuals representing the following
  836  areas:
  837         (1) Two shall be active health care risk managers,
  838  including one risk manager who is recommended by and a member of
  839  the Florida Society for of Healthcare Risk Management and
  840  Patient Safety.
  841         Section 16. Subsection (3) of section 395.2050, Florida
  842  Statutes, is amended to read:
  843         395.2050 Routine inquiry for organ and tissue donation;
  844  certification for procurement activities; death records review.—
  845         (3) Each organ procurement organization designated by the
  846  federal Centers for Medicare and Medicaid Services Health Care
  847  Financing Administration and licensed by the state shall conduct
  848  an annual death records review in the organ procurement
  849  organization’s affiliated donor hospitals. The organ procurement
  850  organization shall enlist the services of every Florida licensed
  851  tissue bank and eye bank affiliated with or providing service to
  852  the donor hospital and operating in the same service area to
  853  participate in the death records review.
  854         Section 17. Subsection (2) of section 395.3036, Florida
  855  Statutes, is amended to read:
  856         395.3036 Confidentiality of records and meetings of
  857  corporations that lease public hospitals or other public health
  858  care facilities.—The records of a private corporation that
  859  leases a public hospital or other public health care facility
  860  are confidential and exempt from the provisions of s. 119.07(1)
  861  and s. 24(a), Art. I of the State Constitution, and the meetings
  862  of the governing board of a private corporation are exempt from
  863  s. 286.011 and s. 24(b), Art. I of the State Constitution when
  864  the public lessor complies with the public finance
  865  accountability provisions of s. 155.40(5) with respect to the
  866  transfer of any public funds to the private lessee and when the
  867  private lessee meets at least three of the five following
  868  criteria:
  869         (2) The public lessor and the private lessee do not
  870  commingle any of their funds in any account maintained by either
  871  of them, other than the payment of the rent and administrative
  872  fees or the transfer of funds pursuant to subsection (5) (2).
  873         Section 18. Section 395.3037, Florida Statutes, is
  874  repealed.
  875         Section 19. Subsections (1), (4), and (5) of section
  876  395.3038, Florida Statutes, are amended to read:
  877         395.3038 State-listed primary stroke centers and
  878  comprehensive stroke centers; notification of hospitals.—
  879         (1) The agency shall make available on its website and to
  880  the department a list of the name and address of each hospital
  881  that meets the criteria for a primary stroke center and the name
  882  and address of each hospital that meets the criteria for a
  883  comprehensive stroke center. The list of primary and
  884  comprehensive stroke centers shall include only those hospitals
  885  that attest in an affidavit submitted to the agency that the
  886  hospital meets the named criteria, or those hospitals that
  887  attest in an affidavit submitted to the agency that the hospital
  888  is certified as a primary or a comprehensive stroke center by
  889  the Joint Commission on Accreditation of Healthcare
  890  Organizations.
  891         (4) The agency shall adopt by rule criteria for a primary
  892  stroke center which are substantially similar to the
  893  certification standards for primary stroke centers of the Joint
  894  Commission on Accreditation of Healthcare Organizations.
  895         (5) The agency shall adopt by rule criteria for a
  896  comprehensive stroke center. However, if the Joint Commission on
  897  Accreditation of Healthcare Organizations establishes criteria
  898  for a comprehensive stroke center, the agency shall establish
  899  criteria for a comprehensive stroke center which are
  900  substantially similar to those criteria established by the Joint
  901  Commission on Accreditation of Healthcare Organizations.
  902         Section 20. Subsection (2) of section 395.602, Florida
  903  Statutes, is amended to read:
  904         395.602 Rural hospitals.—
  905         (2) DEFINITIONS.—As used in this part:
  906         (e) “Rural hospital” means an acute care hospital licensed
  907  under this chapter, having 100 or fewer licensed beds and an
  908  emergency room, which is:
  909         1. The sole provider within a county with a population
  910  density of no greater than 100 persons per square mile;
  911         2. An acute care hospital, in a county with a population
  912  density of no greater than 100 persons per square mile, which is
  913  at least 30 minutes of travel time, on normally traveled roads
  914  under normal traffic conditions, from any other acute care
  915  hospital within the same county;
  916         3. A hospital supported by a tax district or subdistrict
  917  whose boundaries encompass a population of 100 persons or fewer
  918  per square mile;
  919         4.A hospital in a constitutional charter county with a
  920  population of over 1 million persons that has imposed a local
  921  option health service tax pursuant to law and in an area that
  922  was directly impacted by a catastrophic event on August 24,
  923  1992, for which the Governor of Florida declared a state of
  924  emergency pursuant to chapter 125, and has 120 beds or less that
  925  serves an agricultural community with an emergency room
  926  utilization of no less than 20,000 visits and a Medicaid
  927  inpatient utilization rate greater than 15 percent;
  928         4.5. A hospital with a service area that has a population
  929  of 100 persons or fewer per square mile. As used in this
  930  subparagraph, the term “service area” means the fewest number of
  931  zip codes that account for 75 percent of the hospital’s
  932  discharges for the most recent 5-year period, based on
  933  information available from the hospital inpatient discharge
  934  database in the Florida Center for Health Information and Policy
  935  Analysis at the Agency for Health Care Administration; or
  936         5.6. A hospital designated as a critical access hospital,
  937  as defined in s. 408.07(15).
  938  
  939  Population densities used in this paragraph must be based upon
  940  the most recently completed United States census. A hospital
  941  that received funds under s. 409.9116 for a quarter beginning no
  942  later than July 1, 2002, is deemed to have been and shall
  943  continue to be a rural hospital from that date through June 30,
  944  2015, if the hospital continues to have 100 or fewer licensed
  945  beds and an emergency room, or meets the criteria of
  946  subparagraph 4. An acute care hospital that has not previously
  947  been designated as a rural hospital and that meets the criteria
  948  of this paragraph shall be granted such designation upon
  949  application, including supporting documentation to the Agency
  950  for Health Care Administration.
  951         Section 21. Subsection (8) of section 400.021, Florida
  952  Statutes, is amended to read:
  953         400.021 Definitions.—When used in this part, unless the
  954  context otherwise requires, the term:
  955         (8) “Geriatric outpatient clinic” means a site for
  956  providing outpatient health care to persons 60 years of age or
  957  older, which is staffed by a registered nurse, or a physician
  958  assistant, a licensed practical nurse under the direct
  959  supervision of a registered nurse, or an advanced registered
  960  nurse practitioner.
  961         Section 22. Paragraph (g) of subsection (2) of section
  962  400.0239, Florida Statutes, is amended to read:
  963         400.0239 Quality of Long-Term Care Facility Improvement
  964  Trust Fund.—
  965         (2) Expenditures from the trust fund shall be allowable for
  966  direct support of the following:
  967         (g) Other initiatives authorized by the Centers for
  968  Medicare and Medicaid Services for the use of federal civil
  969  monetary penalties, including projects recommended through the
  970  Medicaid “Up-or-Out” Quality of Care Contract Management Program
  971  pursuant to s. 400.148.
  972         Section 23. Subsection (2) of section 400.063, Florida
  973  Statutes, is amended to read:
  974         400.063 Resident protection.—
  975         (2) The agency is authorized to establish for each
  976  facility, subject to intervention by the agency, a separate bank
  977  account for the deposit to the credit of the agency of any
  978  moneys received from the Health Care Trust Fund or any other
  979  moneys received for the maintenance and care of residents in the
  980  facility, and the agency is authorized to disburse moneys from
  981  such account to pay obligations incurred for the purposes of
  982  this section. The agency is authorized to requisition moneys
  983  from the Health Care Trust Fund in advance of an actual need for
  984  cash on the basis of an estimate by the agency of moneys to be
  985  spent under the authority of this section. Any bank account
  986  established under this section need not be approved in advance
  987  of its creation as required by s. 17.58, but shall be secured by
  988  depository insurance equal to or greater than the balance of
  989  such account or by the pledge of collateral security in
  990  conformance with criteria established in s. 18.11. The agency
  991  shall notify the Chief Financial Officer of any such account so
  992  established and shall make a quarterly accounting to the Chief
  993  Financial Officer for all moneys deposited in such account.
  994         Section 24. Subsections (1) and (5) of section 400.071,
  995  Florida Statutes, are amended to read:
  996         400.071 Application for license.—
  997         (1) In addition to the requirements of part II of chapter
  998  408, the application for a license shall be under oath and must
  999  contain the following:
 1000         (a) The location of the facility for which a license is
 1001  sought and an indication, as in the original application, that
 1002  such location conforms to the local zoning ordinances.
 1003         (b)A signed affidavit disclosing any financial or
 1004  ownership interest that a controlling interest as defined in
 1005  part II of chapter 408 has held in the last 5 years in any
 1006  entity licensed by this state or any other state to provide
 1007  health or residential care which has closed voluntarily or
 1008  involuntarily; has filed for bankruptcy; has had a receiver
 1009  appointed; has had a license denied, suspended, or revoked; or
 1010  has had an injunction issued against it which was initiated by a
 1011  regulatory agency. The affidavit must disclose the reason any
 1012  such entity was closed, whether voluntarily or involuntarily.
 1013         (c)The total number of beds and the total number of
 1014  Medicare and Medicaid certified beds.
 1015         (b)(d) Information relating to the applicant and employees
 1016  which the agency requires by rule. The applicant must
 1017  demonstrate that sufficient numbers of qualified staff, by
 1018  training or experience, will be employed to properly care for
 1019  the type and number of residents who will reside in the
 1020  facility.
 1021         (c)(e) Copies of any civil verdict or judgment involving
 1022  the applicant rendered within the 10 years preceding the
 1023  application, relating to medical negligence, violation of
 1024  residents’ rights, or wrongful death. As a condition of
 1025  licensure, the licensee agrees to provide to the agency copies
 1026  of any new verdict or judgment involving the applicant, relating
 1027  to such matters, within 30 days after filing with the clerk of
 1028  the court. The information required in this paragraph shall be
 1029  maintained in the facility’s licensure file and in an agency
 1030  database which is available as a public record.
 1031         (5) As a condition of licensure, each facility must
 1032  establish and submit with its application a plan for quality
 1033  assurance and for conducting risk management.
 1034         Section 25. Section 400.0712, Florida Statutes, is amended
 1035  to read:
 1036         400.0712 Application for inactive license.—
 1037         (1)As specified in this section, the agency may issue an
 1038  inactive license to a nursing home facility for all or a portion
 1039  of its beds. Any request by a licensee that a nursing home or
 1040  portion of a nursing home become inactive must be submitted to
 1041  the agency in the approved format. The facility may not initiate
 1042  any suspension of services, notify residents, or initiate
 1043  inactivity before receiving approval from the agency; and a
 1044  licensee that violates this provision may not be issued an
 1045  inactive license.
 1046         (1)(2)In addition to the authority granted in part II of
 1047  chapter 408, the agency may issue an inactive license to a
 1048  nursing home that chooses to use an unoccupied contiguous
 1049  portion of the facility for an alternative use to meet the needs
 1050  of elderly persons through the use of less restrictive, less
 1051  institutional services.
 1052         (a) An inactive license issued under this subsection may be
 1053  granted for a period not to exceed the current licensure
 1054  expiration date but may be renewed by the agency at the time of
 1055  licensure renewal.
 1056         (b) A request to extend the inactive license must be
 1057  submitted to the agency in the approved format and approved by
 1058  the agency in writing.
 1059         (c) Nursing homes that receive an inactive license to
 1060  provide alternative services shall not receive preference for
 1061  participation in the Assisted Living for the Elderly Medicaid
 1062  waiver.
 1063         (2)(3) The agency shall adopt rules pursuant to ss.
 1064  120.536(1) and 120.54 necessary to administer implement this
 1065  section.
 1066         Section 26. Section 400.111, Florida Statutes, is amended
 1067  to read:
 1068         400.111 Disclosure of controlling interest.—In addition to
 1069  the requirements of part II of chapter 408, when requested by
 1070  the agency, the licensee shall submit a signed affidavit
 1071  disclosing any financial or ownership interest that a
 1072  controlling interest has held within the last 5 years in any
 1073  entity licensed by the state or any other state to provide
 1074  health or residential care which entity has closed voluntarily
 1075  or involuntarily; has filed for bankruptcy; has had a receiver
 1076  appointed; has had a license denied, suspended, or revoked; or
 1077  has had an injunction issued against it which was initiated by a
 1078  regulatory agency. The affidavit must disclose the reason such
 1079  entity was closed, whether voluntarily or involuntarily.
 1080         Section 27. Section 400.1183, Florida Statutes, is amended
 1081  to read:
 1082         400.1183 Resident grievance procedures.—
 1083         (1) Every nursing home must have a grievance procedure
 1084  available to its residents and their families. The grievance
 1085  procedure must include:
 1086         (a) An explanation of how to pursue redress of a grievance.
 1087         (b) The names, job titles, and telephone numbers of the
 1088  employees responsible for implementing the facility’s grievance
 1089  procedure. The list must include the address and the toll-free
 1090  telephone numbers of the ombudsman and the agency.
 1091         (c) A simple description of the process through which a
 1092  resident may, at any time, contact the toll-free telephone
 1093  hotline of the ombudsman or the agency to report the unresolved
 1094  grievance.
 1095         (d) A procedure for providing assistance to residents who
 1096  cannot prepare a written grievance without help.
 1097         (2) Each facility shall maintain records of all grievances
 1098  for agency inspection and shall report to the agency at the time
 1099  of relicensure the total number of grievances handled during the
 1100  prior licensure period, a categorization of the cases underlying
 1101  the grievances, and the final disposition of the grievances.
 1102         (3) Each facility must respond to the grievance within a
 1103  reasonable time after its submission.
 1104         (4) The agency may investigate any grievance at any time.
 1105         Section 28. Subsection (1) of section 400.141, Florida
 1106  Statutes, is amended to read:
 1107         400.141 Administration and management of nursing home
 1108  facilities.—
 1109         (1) Every licensed facility shall comply with all
 1110  applicable standards and rules of the agency and shall:
 1111         (a) Be under the administrative direction and charge of a
 1112  licensed administrator.
 1113         (b) Appoint a medical director licensed pursuant to chapter
 1114  458 or chapter 459. The agency may establish by rule more
 1115  specific criteria for the appointment of a medical director.
 1116         (c) Have available the regular, consultative, and emergency
 1117  services of physicians licensed by the state.
 1118         (d) Provide for resident use of a community pharmacy as
 1119  specified in s. 400.022(1)(q). Any other law to the contrary
 1120  notwithstanding, a registered pharmacist licensed in Florida,
 1121  that is under contract with a facility licensed under this
 1122  chapter or chapter 429, shall repackage a nursing facility
 1123  resident’s bulk prescription medication which has been packaged
 1124  by another pharmacist licensed in any state in the United States
 1125  into a unit dose system compatible with the system used by the
 1126  nursing facility, if the pharmacist is requested to offer such
 1127  service. In order to be eligible for the repackaging, a resident
 1128  or the resident’s spouse must receive prescription medication
 1129  benefits provided through a former employer as part of his or
 1130  her retirement benefits, a qualified pension plan as specified
 1131  in s. 4972 of the Internal Revenue Code, a federal retirement
 1132  program as specified under 5 C.F.R. s. 831, or a long-term care
 1133  policy as defined in s. 627.9404(1). A pharmacist who correctly
 1134  repackages and relabels the medication and the nursing facility
 1135  which correctly administers such repackaged medication under
 1136  this paragraph may not be held liable in any civil or
 1137  administrative action arising from the repackaging. In order to
 1138  be eligible for the repackaging, a nursing facility resident for
 1139  whom the medication is to be repackaged shall sign an informed
 1140  consent form provided by the facility which includes an
 1141  explanation of the repackaging process and which notifies the
 1142  resident of the immunities from liability provided in this
 1143  paragraph. A pharmacist who repackages and relabels prescription
 1144  medications, as authorized under this paragraph, may charge a
 1145  reasonable fee for costs resulting from the implementation of
 1146  this provision.
 1147         (e) Provide for the access of the facility residents to
 1148  dental and other health-related services, recreational services,
 1149  rehabilitative services, and social work services appropriate to
 1150  their needs and conditions and not directly furnished by the
 1151  licensee. When a geriatric outpatient nurse clinic is conducted
 1152  in accordance with rules adopted by the agency, outpatients
 1153  attending such clinic shall not be counted as part of the
 1154  general resident population of the nursing home facility, nor
 1155  shall the nursing staff of the geriatric outpatient clinic be
 1156  counted as part of the nursing staff of the facility, until the
 1157  outpatient clinic load exceeds 15 a day.
 1158         (f) Be allowed and encouraged by the agency to provide
 1159  other needed services under certain conditions. If the facility
 1160  has a standard licensure status, and has had no class I or class
 1161  II deficiencies during the past 2 years or has been awarded a
 1162  Gold Seal under the program established in s. 400.235, it may be
 1163  encouraged by the agency to provide services, including, but not
 1164  limited to, respite and adult day services, which enable
 1165  individuals to move in and out of the facility. A facility is
 1166  not subject to any additional licensure requirements for
 1167  providing these services. Respite care may be offered to persons
 1168  in need of short-term or temporary nursing home services.
 1169  Respite care must be provided in accordance with this part and
 1170  rules adopted by the agency. However, the agency shall, by rule,
 1171  adopt modified requirements for resident assessment, resident
 1172  care plans, resident contracts, physician orders, and other
 1173  provisions, as appropriate, for short-term or temporary nursing
 1174  home services. The agency shall allow for shared programming and
 1175  staff in a facility which meets minimum standards and offers
 1176  services pursuant to this paragraph, but, if the facility is
 1177  cited for deficiencies in patient care, may require additional
 1178  staff and programs appropriate to the needs of service
 1179  recipients. A person who receives respite care may not be
 1180  counted as a resident of the facility for purposes of the
 1181  facility’s licensed capacity unless that person receives 24-hour
 1182  respite care. A person receiving either respite care for 24
 1183  hours or longer or adult day services must be included when
 1184  calculating minimum staffing for the facility. Any costs and
 1185  revenues generated by a nursing home facility from
 1186  nonresidential programs or services shall be excluded from the
 1187  calculations of Medicaid per diems for nursing home
 1188  institutional care reimbursement.
 1189         (g) If the facility has a standard license or is a Gold
 1190  Seal facility, exceeds the minimum required hours of licensed
 1191  nursing and certified nursing assistant direct care per resident
 1192  per day, and is part of a continuing care facility licensed
 1193  under chapter 651 or a retirement community that offers other
 1194  services pursuant to part III of this chapter or part I or part
 1195  III of chapter 429 on a single campus, be allowed to share
 1196  programming and staff. At the time of inspection and in the
 1197  semiannual report required pursuant to paragraph (n) (o), a
 1198  continuing care facility or retirement community that uses this
 1199  option must demonstrate through staffing records that minimum
 1200  staffing requirements for the facility were met. Licensed nurses
 1201  and certified nursing assistants who work in the nursing home
 1202  facility may be used to provide services elsewhere on campus if
 1203  the facility exceeds the minimum number of direct care hours
 1204  required per resident per day and the total number of residents
 1205  receiving direct care services from a licensed nurse or a
 1206  certified nursing assistant does not cause the facility to
 1207  violate the staffing ratios required under s. 400.23(3)(a).
 1208  Compliance with the minimum staffing ratios shall be based on
 1209  total number of residents receiving direct care services,
 1210  regardless of where they reside on campus. If the facility
 1211  receives a conditional license, it may not share staff until the
 1212  conditional license status ends. This paragraph does not
 1213  restrict the agency’s authority under federal or state law to
 1214  require additional staff if a facility is cited for deficiencies
 1215  in care which are caused by an insufficient number of certified
 1216  nursing assistants or licensed nurses. The agency may adopt
 1217  rules for the documentation necessary to determine compliance
 1218  with this provision.
 1219         (h) Maintain the facility premises and equipment and
 1220  conduct its operations in a safe and sanitary manner.
 1221         (i) If the licensee furnishes food service, provide a
 1222  wholesome and nourishing diet sufficient to meet generally
 1223  accepted standards of proper nutrition for its residents and
 1224  provide such therapeutic diets as may be prescribed by attending
 1225  physicians. In making rules to implement this paragraph, the
 1226  agency shall be guided by standards recommended by nationally
 1227  recognized professional groups and associations with knowledge
 1228  of dietetics.
 1229         (j) Keep full records of resident admissions and
 1230  discharges; medical and general health status, including medical
 1231  records, personal and social history, and identity and address
 1232  of next of kin or other persons who may have responsibility for
 1233  the affairs of the residents; and individual resident care plans
 1234  including, but not limited to, prescribed services, service
 1235  frequency and duration, and service goals. The records shall be
 1236  open to inspection by the agency.
 1237         (k) Keep such fiscal records of its operations and
 1238  conditions as may be necessary to provide information pursuant
 1239  to this part.
 1240         (l) Furnish copies of personnel records for employees
 1241  affiliated with such facility, to any other facility licensed by
 1242  this state requesting this information pursuant to this part.
 1243  Such information contained in the records may include, but is
 1244  not limited to, disciplinary matters and any reason for
 1245  termination. Any facility releasing such records pursuant to
 1246  this part shall be considered to be acting in good faith and may
 1247  not be held liable for information contained in such records,
 1248  absent a showing that the facility maliciously falsified such
 1249  records.
 1250         (m) Publicly display a poster provided by the agency
 1251  containing the names, addresses, and telephone numbers for the
 1252  state’s abuse hotline, the State Long-Term Care Ombudsman, the
 1253  Agency for Health Care Administration consumer hotline, the
 1254  Advocacy Center for Persons with Disabilities, the Florida
 1255  Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
 1256  with a clear description of the assistance to be expected from
 1257  each.
 1258         (n)Submit to the agency the information specified in s.
 1259  400.071(1)(b) for a management company within 30 days after the
 1260  effective date of the management agreement.
 1261         (n)(o)1. Submit semiannually to the agency, or more
 1262  frequently if requested by the agency, information regarding
 1263  facility staff-to-resident ratios, staff turnover, and staff
 1264  stability, including information regarding certified nursing
 1265  assistants, licensed nurses, the director of nursing, and the
 1266  facility administrator. For purposes of this reporting:
 1267         a. Staff-to-resident ratios must be reported in the
 1268  categories specified in s. 400.23(3)(a) and applicable rules.
 1269  The ratio must be reported as an average for the most recent
 1270  calendar quarter.
 1271         b. Staff turnover must be reported for the most recent 12
 1272  month period ending on the last workday of the most recent
 1273  calendar quarter prior to the date the information is submitted.
 1274  The turnover rate must be computed quarterly, with the annual
 1275  rate being the cumulative sum of the quarterly rates. The
 1276  turnover rate is the total number of terminations or separations
 1277  experienced during the quarter, excluding any employee
 1278  terminated during a probationary period of 3 months or less,
 1279  divided by the total number of staff employed at the end of the
 1280  period for which the rate is computed, and expressed as a
 1281  percentage.
 1282         c. The formula for determining staff stability is the total
 1283  number of employees that have been employed for more than 12
 1284  months, divided by the total number of employees employed at the
 1285  end of the most recent calendar quarter, and expressed as a
 1286  percentage.
 1287         d. A nursing facility that has failed to comply with state
 1288  minimum-staffing requirements for 2 consecutive days is
 1289  prohibited from accepting new admissions until the facility has
 1290  achieved the minimum-staffing requirements for a period of 6
 1291  consecutive days. For the purposes of this sub-subparagraph, any
 1292  person who was a resident of the facility and was absent from
 1293  the facility for the purpose of receiving medical care at a
 1294  separate location or was on a leave of absence is not considered
 1295  a new admission. The agency shall fine the nursing facility
 1296  $1,000 if it fails Failure to impose such an admissions
 1297  moratorium constitutes a class II deficiency.
 1298         e. A nursing facility which does not have a conditional
 1299  license may be cited for failure to comply with the standards in
 1300  s. 400.23(3)(a)1.a. only if it has failed to meet those
 1301  standards on 2 consecutive days or if it has failed to meet at
 1302  least 97 percent of those standards on any one day.
 1303         f. A facility which has a conditional license must be in
 1304  compliance with the standards in s. 400.23(3)(a) at all times.
 1305         2. This paragraph does not limit the agency’s ability to
 1306  impose a deficiency or take other actions if a facility does not
 1307  have enough staff to meet the residents’ needs.
 1308         (o)(p) Notify a licensed physician when a resident exhibits
 1309  signs of dementia or cognitive impairment or has a change of
 1310  condition in order to rule out the presence of an underlying
 1311  physiological condition that may be contributing to such
 1312  dementia or impairment. The notification must occur within 30
 1313  days after the acknowledgment of such signs by facility staff.
 1314  If an underlying condition is determined to exist, the facility
 1315  shall arrange, with the appropriate health care provider, the
 1316  necessary care and services to treat the condition.
 1317         (p)(q) If the facility implements a dining and hospitality
 1318  attendant program, ensure that the program is developed and
 1319  implemented under the supervision of the facility director of
 1320  nursing. A licensed nurse, licensed speech or occupational
 1321  therapist, or a registered dietitian must conduct training of
 1322  dining and hospitality attendants. A person employed by a
 1323  facility as a dining and hospitality attendant must perform
 1324  tasks under the direct supervision of a licensed nurse.
 1325         (r)Report to the agency any filing for bankruptcy
 1326  protection by the facility or its parent corporation,
 1327  divestiture or spin-off of its assets, or corporate
 1328  reorganization within 30 days after the completion of such
 1329  activity.
 1330         (q)(s) Maintain general and professional liability
 1331  insurance coverage that is in force at all times. In lieu of
 1332  general and professional liability insurance coverage, a state
 1333  designated teaching nursing home and its affiliated assisted
 1334  living facilities created under s. 430.80 may demonstrate proof
 1335  of financial responsibility as provided in s. 430.80(3)(h).
 1336         (r)(t) Maintain in the medical record for each resident a
 1337  daily chart of certified nursing assistant services provided to
 1338  the resident. The certified nursing assistant who is caring for
 1339  the resident must complete this record by the end of his or her
 1340  shift. This record must indicate assistance with activities of
 1341  daily living, assistance with eating, and assistance with
 1342  drinking, and must record each offering of nutrition and
 1343  hydration for those residents whose plan of care or assessment
 1344  indicates a risk for malnutrition or dehydration.
 1345         (s)(u) Before November 30 of each year, subject to the
 1346  availability of an adequate supply of the necessary vaccine,
 1347  provide for immunizations against influenza viruses to all its
 1348  consenting residents in accordance with the recommendations of
 1349  the United States Centers for Disease Control and Prevention,
 1350  subject to exemptions for medical contraindications and
 1351  religious or personal beliefs. Subject to these exemptions, any
 1352  consenting person who becomes a resident of the facility after
 1353  November 30 but before March 31 of the following year must be
 1354  immunized within 5 working days after becoming a resident.
 1355  Immunization shall not be provided to any resident who provides
 1356  documentation that he or she has been immunized as required by
 1357  this paragraph. This paragraph does not prohibit a resident from
 1358  receiving the immunization from his or her personal physician if
 1359  he or she so chooses. A resident who chooses to receive the
 1360  immunization from his or her personal physician shall provide
 1361  proof of immunization to the facility. The agency may adopt and
 1362  enforce any rules necessary to comply with or administer
 1363  implement this paragraph subsection.
 1364         (t)(v) Assess all residents for eligibility for
 1365  pneumococcal polysaccharide vaccination (PPV) and vaccinate
 1366  residents when indicated within 60 days after the effective date
 1367  of this act in accordance with the recommendations of the United
 1368  States Centers for Disease Control and Prevention, subject to
 1369  exemptions for medical contraindications and religious or
 1370  personal beliefs. Residents admitted after the effective date of
 1371  this act shall be assessed within 5 working days of admission
 1372  and, when indicated, vaccinated within 60 days in accordance
 1373  with the recommendations of the United States Centers for
 1374  Disease Control and Prevention, subject to exemptions for
 1375  medical contraindications and religious or personal beliefs.
 1376  Immunization shall not be provided to any resident who provides
 1377  documentation that he or she has been immunized as required by
 1378  this paragraph. This paragraph does not prohibit a resident from
 1379  receiving the immunization from his or her personal physician if
 1380  he or she so chooses. A resident who chooses to receive the
 1381  immunization from his or her personal physician shall provide
 1382  proof of immunization to the facility. The agency may adopt and
 1383  enforce any rules necessary to comply with or administer
 1384  implement this paragraph.
 1385         (u)(w) Annually encourage and promote to its employees the
 1386  benefits associated with immunizations against influenza viruses
 1387  in accordance with the recommendations of the United States
 1388  Centers for Disease Control and Prevention. The agency may adopt
 1389  and enforce any rules necessary to comply with or administer
 1390  implement this paragraph.
 1391         Section 29. Subsection (3) of section 400.142, Florida
 1392  Statutes, is amended to read:
 1393         400.142 Emergency medication kits; orders not to
 1394  resuscitate.—
 1395         (3) Facility staff may withhold or withdraw cardiopulmonary
 1396  resuscitation if presented with an order not to resuscitate
 1397  executed pursuant to s. 401.45. The agency shall adopt rules
 1398  providing for the implementation of such orders. Facility staff
 1399  and facilities shall not be subject to criminal prosecution or
 1400  civil liability, nor be considered to have engaged in negligent
 1401  or unprofessional conduct, for withholding or withdrawing
 1402  cardiopulmonary resuscitation pursuant to such an order and
 1403  rules adopted by the agency. The absence of an order not to
 1404  resuscitate executed pursuant to s. 401.45 does not preclude a
 1405  physician from withholding or withdrawing cardiopulmonary
 1406  resuscitation as otherwise permitted by law.
 1407         Section 30. Subsection (10) of section 400.147, Florida
 1408  Statutes, is repealed.
 1409         Section 31. Section 400.148, Florida Statutes, is repealed.
 1410         Section 32. Subsection (3) of section 400.19, Florida
 1411  Statutes, is amended to read:
 1412         400.19 Right of entry and inspection.—
 1413         (3) The agency shall every 15 months conduct at least one
 1414  unannounced inspection to determine compliance by the licensee
 1415  with statutes, and with rules promulgated under the provisions
 1416  of those statutes, governing minimum standards of construction,
 1417  quality and adequacy of care, and rights of residents. The
 1418  survey shall be conducted every 6 months for the next 2-year
 1419  period if the facility has been cited for a class I deficiency,
 1420  has been cited for two or more class II deficiencies arising
 1421  from separate surveys or investigations within a 60-day period,
 1422  or has had three or more substantiated complaints within a 6
 1423  month period, each resulting in at least one class I or class II
 1424  deficiency. In addition to any other fees or fines in this part,
 1425  the agency shall assess a fine for each facility that is subject
 1426  to the 6-month survey cycle. The fine for the 2-year period
 1427  shall be $6,000, one-half to be paid at the completion of each
 1428  survey. The agency may adjust this fine by the change in the
 1429  Consumer Price Index, based on the 12 months immediately
 1430  preceding the increase, to cover the cost of the additional
 1431  surveys. The agency shall verify through subsequent inspection
 1432  that any deficiency identified during inspection is corrected.
 1433  However, the agency may verify the correction of a class III or
 1434  class IV deficiency unrelated to resident rights or resident
 1435  care without reinspecting the facility if adequate written
 1436  documentation has been received from the facility, which
 1437  provides assurance that the deficiency has been corrected. The
 1438  giving or causing to be given of advance notice of such
 1439  unannounced inspections by an employee of the agency to any
 1440  unauthorized person shall constitute cause for suspension of not
 1441  fewer than 5 working days according to the provisions of chapter
 1442  110.
 1443         Section 33. Section 400.195, Florida Statutes, is repealed.
 1444         Section 34. Subsection (5) of section 400.23, Florida
 1445  Statutes, is amended to read:
 1446         400.23 Rules; evaluation and deficiencies; licensure
 1447  status.—
 1448         (5) The agency, in collaboration with the Division of
 1449  Children’s Medical Services Network of the Department of Health,
 1450  must, no later than December 31, 1993, adopt rules for minimum
 1451  standards of care for persons under 21 years of age who reside
 1452  in nursing home facilities. The rules must include a methodology
 1453  for reviewing a nursing home facility under ss. 408.031-408.045
 1454  which serves only persons under 21 years of age. A facility may
 1455  be exempt from these standards for specific persons between 18
 1456  and 21 years of age, if the person’s physician agrees that
 1457  minimum standards of care based on age are not necessary.
 1458         Section 35. Subsection (1) of section 400.275, Florida
 1459  Statutes, is amended to read:
 1460         400.275 Agency duties.—
 1461         (1) The agency shall ensure that each newly hired nursing
 1462  home surveyor, as a part of basic training, is assigned full
 1463  time to a licensed nursing home for at least 2 days within a 7
 1464  day period to observe facility operations outside of the survey
 1465  process before the surveyor begins survey responsibilities. Such
 1466  observations may not be the sole basis of a deficiency citation
 1467  against the facility. The agency may not assign an individual to
 1468  be a member of a survey team for purposes of a survey,
 1469  evaluation, or consultation visit at a nursing home facility in
 1470  which the surveyor was an employee within the preceding 5 years.
 1471         Section 36. Subsections (2) and (14) of section 400.462,
 1472  Florida Statutes, are amended, present subsections (27), (28),
 1473  and (29) of that section are renumbered as subsections (28),
 1474  (29), and (30), respectively, and new subsections (27) and (31)
 1475  are added to that section, to read:
 1476         400.462 Definitions.—As used in this part, the term:
 1477         (2) “Admission” means a decision by the home health agency,
 1478  during or after an evaluation visit with the patient to the
 1479  patient’s home, that there is reasonable expectation that the
 1480  patient’s medical, nursing, and social needs for skilled care
 1481  can be adequately met by the agency in the patient’s place of
 1482  residence. Admission includes completion of an agreement with
 1483  the patient or the patient’s legal representative to provide
 1484  home health services as required in s. 400.487(1).
 1485         (14) “Home health services” means health and medical
 1486  services and medical supplies furnished by an organization to an
 1487  individual in the individual’s home or place of residence. The
 1488  term includes organizations that provide one or more of the
 1489  following:
 1490         (a) Nursing care.
 1491         (b) Physical, occupational, respiratory, or speech therapy.
 1492         (c) Home health aide services.
 1493         (d) Dietetics and nutrition practice and nutrition
 1494  counseling.
 1495         (e) Medical supplies and durable medical equipment,
 1496  restricted to drugs and biologicals prescribed by a physician.
 1497         (27) “Primary home health agency” means the agency that is
 1498  responsible for the services furnished to patients and for
 1499  implementation of the plan of care.
 1500         (31) “Temporary” means short term, such as for employee
 1501  absences, temporary skill shortages, seasonal workloads.
 1502         Section 37. Section 400.476, Florida Statutes, is amended
 1503  to read:
 1504         400.476 Staffing requirements; notifications; limitations
 1505  on staffing services.—
 1506         (1) ADMINISTRATOR.—
 1507         (a) An administrator may manage only one home health
 1508  agency, except that an administrator may manage up to five home
 1509  health agencies if all five home health agencies have identical
 1510  controlling interests as defined in s. 408.803 and are located
 1511  within one agency geographic service area or within an
 1512  immediately contiguous county. If the home health agency is
 1513  licensed under this chapter and is part of a retirement
 1514  community that provides multiple levels of care, an employee of
 1515  the retirement community may administer the home health agency
 1516  and up to a maximum of four entities licensed under this chapter
 1517  or chapter 429 which all have identical controlling interests as
 1518  defined in s. 408.803. An administrator shall designate, in
 1519  writing, for each licensed entity, a qualified alternate
 1520  administrator to serve during the administrator’s absence. An
 1521  alternate administrator must meet the requirements in this
 1522  paragraph and s. 400.462(1).
 1523         (b) An administrator of a home health agency who is a
 1524  licensed physician, physician assistant, or registered nurse
 1525  licensed to practice in this state may also be the director of
 1526  nursing for a home health agency. An administrator may serve as
 1527  a director of nursing for up to the number of entities
 1528  authorized in subsection (2) only if there are 10 or fewer full
 1529  time equivalent employees and contracted personnel in each home
 1530  health agency.
 1531         (c) The administrator shall organize and direct the
 1532  agency’s ongoing functions, maintain an ongoing liaison with the
 1533  board members and the staff, employ qualified personnel and
 1534  ensure adequate staff education and evaluations, ensures the
 1535  accuracy of public informational materials and activities,
 1536  implement an effective budgeting and accounting system, and
 1537  ensures that the home health agency operates in compliance with
 1538  this part and part II of chapter 408 and rules adopted for these
 1539  laws.
 1540         (d) The administrator shall clearly set forth in writing
 1541  the organizational chart, services furnished, administrative
 1542  control, and lines of authority for the delegation of
 1543  responsibilities for patient care. These responsibilities must
 1544  be readily identifiable. Administrative and supervisory
 1545  functions may not be delegated to another agency or
 1546  organization, and the primary home health agency shall monitor
 1547  and control all services that are not furnished directly,
 1548  including services provided through contracts.
 1549         (2) DIRECTOR OF NURSING.—
 1550         (a) A director of nursing may be the director of nursing
 1551  for:
 1552         1. Up to two licensed home health agencies if the agencies
 1553  have identical controlling interests as defined in s. 408.803
 1554  and are located within one agency geographic service area or
 1555  within an immediately contiguous county; or
 1556         2. Up to five licensed home health agencies if:
 1557         a. All of the home health agencies have identical
 1558  controlling interests as defined in s. 408.803;
 1559         b. All of the home health agencies are located within one
 1560  agency geographic service area or within an immediately
 1561  contiguous county; and
 1562         c. Each home health agency has a registered nurse who meets
 1563  the qualifications of a director of nursing and who has a
 1564  written delegation from the director of nursing to serve as the
 1565  director of nursing for that home health agency when the
 1566  director of nursing is not present; and.
 1567         d. This person, or similarly qualified alternate, is
 1568  available at all times during operating hours and participates
 1569  in all activities relevant to the professional services
 1570  furnished, including, but not limited to, the oversight of
 1571  nursing services, home health aides, and certified nursing
 1572  assistants, and assignment of personnel.
 1573  
 1574  If a home health agency licensed under this chapter is part of a
 1575  retirement community that provides multiple levels of care, an
 1576  employee of the retirement community may serve as the director
 1577  of nursing of the home health agency and up to a maximum of four
 1578  entities, other than home health agencies, licensed under this
 1579  chapter or chapter 429 which all have identical controlling
 1580  interests as defined in s. 408.803.
 1581         (b) A home health agency that provides skilled nursing care
 1582  may not operate for more than 30 calendar days without a
 1583  director of nursing. A home health agency that provides skilled
 1584  nursing care and the director of nursing of a home health agency
 1585  must notify the agency within 10 business days after termination
 1586  of the services of the director of nursing for the home health
 1587  agency. A home health agency that provides skilled nursing care
 1588  must notify the agency of the identity and qualifications of the
 1589  new director of nursing within 10 days after the new director is
 1590  hired. If a home health agency that provides skilled nursing
 1591  care operates for more than 30 calendar days without a director
 1592  of nursing, the home health agency commits a class II
 1593  deficiency. In addition to the fine for a class II deficiency,
 1594  the agency may issue a moratorium in accordance with s. 408.814
 1595  or revoke the license. The agency shall fine a home health
 1596  agency that fails to notify the agency as required in this
 1597  paragraph $1,000 for the first violation and $2,000 for a repeat
 1598  violation. The agency may not take administrative action against
 1599  a home health agency if the director of nursing fails to notify
 1600  the department upon termination of services as the director of
 1601  nursing for the home health agency.
 1602         (c) A home health agency that is not Medicare or Medicaid
 1603  certified and does not provide skilled care or provides only
 1604  physical, occupational, or speech therapy is not required to
 1605  have a director of nursing and is exempt from paragraph (b).
 1606         (3) TRAINING.—A home health agency shall ensure that each
 1607  certified nursing assistant employed by or under contract with
 1608  the home health agency and each home health aide employed by or
 1609  under contract with the home health agency is adequately trained
 1610  to perform the tasks of a home health aide in the home setting.
 1611         (a) The home health agency may not use as a home health
 1612  aide on a full-time, temporary, per diem, or other basis, any
 1613  individual to provide services unless the individual has
 1614  completed a training and competency evaluation program, or a
 1615  competency evaluation program, as permitted in s. 400.497 which
 1616  meets the minimum standards established by the agency in state
 1617  rules.
 1618         (b) A home health aide is not competent in any task for
 1619  which he or she is evaluated as “unsatisfactory.” The aide must
 1620  perform any such task only under direct supervision by a
 1621  licensed nurse until he or she receives training in the task and
 1622  satisfactorily passes a subsequent evaluation in performing the
 1623  task. A home health aide has not successfully passed a
 1624  competency evaluation if the aide does not have a passing score
 1625  on the test as specified by agency rule.
 1626         (4) STAFFING.—Staffing services may be provided anywhere
 1627  within the state.
 1628         (5) PERSONNEL.—
 1629         (a) The home health agency and its staff must comply with
 1630  accepted professional standards and principles that apply to
 1631  professionals, including, but not limited to, the state practice
 1632  acts and the home health agency’s policies and procedures.
 1633         (b) If personnel under hourly or per-visit contracts are
 1634  used by the home health agency, there must be a written contract
 1635  between those personnel and the agency which specifies the
 1636  following requirements:
 1637         1. Acceptance for care only of patients by the primary home
 1638  health agency.
 1639         2. The services to be furnished.
 1640         3. The necessity to conform to all applicable agency
 1641  policies, including personnel qualifications.
 1642         4. The responsibility for participating in developing plans
 1643  of care.
 1644         5. The manner in which services are controlled,
 1645  coordinated, and evaluated by the primary home health agency.
 1646         6. The procedures for submitting clinical and progress
 1647  notes, scheduling of visits, and periodic patient evaluation.
 1648         7. The procedures for payment for services furnished under
 1649  the contract.
 1650         (c) A home health agency shall directly provide at least
 1651  one of the types of services through home health agency
 1652  employees, but may provide additional services under
 1653  arrangements with another agency or organization. Services
 1654  furnished under such arrangements must have a written contract
 1655  conforming with the requirements specified in paragraph (b).
 1656         (d) If home health aide services are provided by an
 1657  individual who is not employed directly by the home health
 1658  agency, the services of the home health aide must be provided
 1659  under arrangements as stated in paragraphs (b) and (c). If the
 1660  home health agency chooses to provide home health aide services
 1661  under arrangements with another organization, the
 1662  responsibilities of the home health agency include, but are not
 1663  limited to:
 1664         1. Ensuring the overall quality of the care provided by the
 1665  aide;
 1666         2. Supervising the aide’s services as described in s.
 1667  400.487; and
 1668         3. Ensuring that each home health aide providing services
 1669  under arrangements with another organization has met the
 1670  training requirements or competency evaluation requirements of
 1671  s. 400.497.
 1672         (e) The home health agency shall coordinate the efforts of
 1673  all personnel furnishing services, and the personnel shall
 1674  maintain communication with the home health agency to ensure
 1675  that personnel efforts support the objectives outlined in the
 1676  plan of care. The clinical record or minutes of case conferences
 1677  shall ensure that effective interchange, reporting, and
 1678  coordination of patient care occurs.
 1679         Section 38. Section 400.484, Florida Statutes, is amended
 1680  to read:
 1681         400.484 Right of inspection; violations deficiencies;
 1682  fines.—
 1683         (1) In addition to the requirements of s. 408.811, the
 1684  agency may make such inspections and investigations as are
 1685  necessary in order to determine the state of compliance with
 1686  this part, part II of chapter 408, and applicable rules.
 1687         (2) The agency shall impose fines for various classes of
 1688  deficiencies in accordance with the following schedule:
 1689         (a) Class I violations are defined in s. 408.813. A class I
 1690  deficiency is any act, omission, or practice that results in a
 1691  patient’s death, disablement, or permanent injury, or places a
 1692  patient at imminent risk of death, disablement, or permanent
 1693  injury. Upon finding a class I violation deficiency, the agency
 1694  shall impose an administrative fine in the amount of $15,000 for
 1695  each occurrence and each day that the violation deficiency
 1696  exists.
 1697         (b) Class II violations are defined in s. 408.813. A class
 1698  II deficiency is any act, omission, or practice that has a
 1699  direct adverse effect on the health, safety, or security of a
 1700  patient. Upon finding a class II violation deficiency, the
 1701  agency shall impose an administrative fine in the amount of
 1702  $5,000 for each occurrence and each day that the violation
 1703  deficiency exists.
 1704         (c) Class III violations are defined in s. 408.813. A class
 1705  III deficiency is any act, omission, or practice that has an
 1706  indirect, adverse effect on the health, safety, or security of a
 1707  patient. Upon finding an uncorrected or repeated class III
 1708  violation deficiency, the agency shall impose an administrative
 1709  fine not to exceed $1,000 for each occurrence and each day that
 1710  the uncorrected or repeated violation deficiency exists.
 1711         (d) Class IV violations are defined in s. 408.813. A class
 1712  IV deficiency is any act, omission, or practice related to
 1713  required reports, forms, or documents which does not have the
 1714  potential of negatively affecting patients. These violations are
 1715  of a type that the agency determines do not threaten the health,
 1716  safety, or security of patients. Upon finding an uncorrected or
 1717  repeated class IV violation deficiency, the agency shall impose
 1718  an administrative fine not to exceed $500 for each occurrence
 1719  and each day that the uncorrected or repeated violation
 1720  deficiency exists.
 1721         (3) In addition to any other penalties imposed pursuant to
 1722  this section or part, the agency may assess costs related to an
 1723  investigation that results in a successful prosecution,
 1724  excluding costs associated with an attorney’s time.
 1725         Section 39. Section 400.487, Florida Statutes, is amended
 1726  to read:
 1727         400.487 Home health service agreements; physician’s,
 1728  physician assistant’s, and advanced registered nurse
 1729  practitioner’s treatment orders; patient assessment;
 1730  establishment and review of plan of care; provision of services;
 1731  orders not to resuscitate.—
 1732         (1) Services provided by a home health agency must be
 1733  covered by an agreement between the home health agency and the
 1734  patient or the patient’s legal representative specifying the
 1735  home health services to be provided, the rates or charges for
 1736  services paid with private funds, and the sources of payment,
 1737  which may include Medicare, Medicaid, private insurance,
 1738  personal funds, or a combination thereof. The home health agency
 1739  shall provide a copy of the agreement to the patient or the
 1740  patient’s legal representative. A home health agency providing
 1741  skilled care must make an assessment of the patient’s needs
 1742  within 48 hours after the start of services.
 1743         (2) When required by the provisions of chapter 464; part I,
 1744  part III, or part V of chapter 468; or chapter 486, the
 1745  attending physician, physician assistant, or advanced registered
 1746  nurse practitioner, acting within his or her respective scope of
 1747  practice, shall establish treatment orders for a patient who is
 1748  to receive skilled care. The treatment orders must be signed by
 1749  the physician, physician assistant, or advanced registered nurse
 1750  practitioner before a claim for payment for the skilled services
 1751  is submitted by the home health agency. If the claim is
 1752  submitted to a managed care organization, the treatment orders
 1753  must be signed within the time allowed under the provider
 1754  agreement. The treatment orders shall be reviewed, as frequently
 1755  as the patient’s illness requires, by the physician, physician
 1756  assistant, or advanced registered nurse practitioner in
 1757  consultation with the home health agency.
 1758         (3) A home health agency shall arrange for supervisory
 1759  visits by a registered nurse to the home of a patient receiving
 1760  home health aide services as specified in subsection (9) in
 1761  accordance with the patient’s direction, approval, and agreement
 1762  to pay the charge for the visits.
 1763         (4) The home health agency shall protect and promote the
 1764  rights of each individual under its care, including each of the
 1765  following rights:
 1766         (a) Notice of rights.—The home health agency shall provide
 1767  the patient with a written notice of the patient’s rights in
 1768  advance of furnishing care to the patient or during the initial
 1769  evaluation visit before the initiation of treatment. The home
 1770  health agency must maintain documentation showing that it has
 1771  complied with the requirements of this section.
 1772         (b) Exercise of rights and respect for property and
 1773  person.
 1774         1. The patient has the right to exercise his or her rights
 1775  as a patient of the home health agency.
 1776         2. The patient has the right to have his or her property
 1777  treated with respect.
 1778         3. The patient has the right to voice grievances regarding
 1779  treatment or care that is or fails to be furnished, or regarding
 1780  the lack of respect for property by anyone who is furnishing
 1781  services on behalf of the home health agency, and not be
 1782  subjected to discrimination or reprisal for doing so.
 1783         4. The home health agency must investigate complaints made
 1784  by a patient or the patient’s family or guardian regarding
 1785  treatment or care that is or fails to be furnished, or regarding
 1786  the lack of respect for the patient’s property by anyone
 1787  furnishing services on behalf of the home health agency. The
 1788  home health agency shall document the existence of the complaint
 1789  and its resolution.
 1790         5. The patient and his or her immediate family or
 1791  representative must be informed of the right to report
 1792  complaints via the statewide toll-free telephone number to the
 1793  agency as required in s. 408.810.
 1794         (c) Right to be informed and to participate in planning
 1795  care and treatment.
 1796         1. The patient has the right to be informed, in advance,
 1797  about the care to be furnished and of any changes in the care to
 1798  be furnished. The home health agency shall advise the patient in
 1799  advance of which disciplines will furnish care and the frequency
 1800  of visits proposed to be furnished. The home health agency must
 1801  advise the patient in advance of any change in the plan of care
 1802  before the change is made.
 1803         2. The patient has the right to participate in the planning
 1804  of the care. The home health agency must advise the patient in
 1805  advance of the right to participate in planning the care or
 1806  treatment and in planning changes in the care or treatment. Each
 1807  patient has the right to be informed of and to participate in
 1808  the planning of his or her care. Each patient must be provided,
 1809  upon request, a copy of the plan of care established and
 1810  maintained for that patient by the home health agency.
 1811         (5) When nursing services are ordered, the home health
 1812  agency to which a patient has been admitted for care must
 1813  provide the initial admission visit, all service evaluation
 1814  visits, and the discharge visit by a direct employee. Services
 1815  provided by others under contractual arrangements to a home
 1816  health agency must be monitored and managed by the admitting
 1817  home health agency. The admitting home health agency is fully
 1818  responsible for ensuring that all care provided through its
 1819  employees or contract staff is delivered in accordance with this
 1820  part and applicable rules.
 1821         (6) The skilled care services provided by a home health
 1822  agency, directly or under contract, must be supervised and
 1823  coordinated in accordance with the plan of care. The home health
 1824  agency shall furnish skilled nursing services by or under the
 1825  supervision of a registered nurse and in accordance with the
 1826  plan of care. Any therapy services offered directly or under
 1827  arrangement by the home health agency must be provided by a
 1828  qualified therapist or by a qualified therapy assistant under
 1829  the supervision of a qualified therapist and in accordance with
 1830  the plan of care.
 1831         (a) Duties and qualifications.—A qualified therapist shall
 1832  assist the physician in evaluating the level of function, help
 1833  develop or revise the plan of care, prepare clinical and
 1834  progress notes, advise and consult with the family and other
 1835  agency personnel, and participate in in-service programs. The
 1836  therapist or therapy assistant must meet the qualifications in
 1837  the state practice acts and related applicable rules.
 1838         (b) Physical therapy assistants and occupational therapy
 1839  assistants.—Services provided by a physical therapy assistant or
 1840  occupational therapy assistant must be under the supervision of
 1841  a qualified physical therapist or occupational therapist as
 1842  required in chapter 486 and part III of chapter 468,
 1843  respectively, and related applicable rules. A physical therapy
 1844  assistant or occupational therapy assistant shall perform
 1845  services planned, delegated, and supervised by the therapist,
 1846  assist in preparing clinical notes and progress reports,
 1847  participate in educating the patient and his or her family, and
 1848  participate in in-service programs.
 1849         (c) Speech therapy services.—Speech therapy services shall
 1850  be furnished only by or under supervision of a qualified speech
 1851  pathologist or audiologist as required in part I of chapter 468
 1852  and related applicable rules.
 1853         (d) Care follows a written plan of care.—The plan of care
 1854  shall be reviewed by the physician or health professional who
 1855  provided the treatment orders pursuant to subsection (2) and
 1856  home health agency personnel as often as the severity of the
 1857  patient’s condition requires, but at least once every 60 days or
 1858  more when there is a beneficiary-elected transfer, a significant
 1859  change in condition resulting in a change in the case-mix
 1860  assignment, or a discharge and return to the same home health
 1861  agency during the 60-day episode. Professional staff of a home
 1862  health agency shall promptly alert the physician or other health
 1863  professional who provided the treatment orders of any change
 1864  that suggests a need to alter the plan of care.
 1865         (e) Administration of drugs and treatment.—Only
 1866  professional staff of a home health agency may administer drugs
 1867  and treatments as ordered by the physician or health
 1868  professional pursuant to subsection (2), with the exception of
 1869  influenza and pneumococcal polysaccharide vaccines, which may be
 1870  administered according to the policy of the home health agency
 1871  developed in consultation with a physician and after an
 1872  assessment for contraindications. The physician or health
 1873  professional, as provided in subsection (2), shall put any
 1874  verbal order in writing and sign and date it with the date of
 1875  receipt by the registered nurse or qualified therapist who is
 1876  responsible for furnishing or supervising the ordered service. A
 1877  verbal order may be accepted only by personnel who are
 1878  authorized to do so by applicable state laws, rules, and
 1879  internal policies of the home health agency.
 1880         (7) A registered nurse shall conduct the initial evaluation
 1881  visit, regularly reevaluate the patient’s nursing needs,
 1882  initiate the plan of care and necessary revisions, furnish those
 1883  services requiring substantial and specialized nursing skill,
 1884  initiate appropriate preventive and rehabilitative nursing
 1885  procedures, prepare clinical and progress notes, coordinate
 1886  services, inform the physician and other personnel of changes in
 1887  the patient’s condition and needs, counsel the patient and his
 1888  or her family in meeting nursing and related needs, participate
 1889  in in-service programs, and supervise and teach other nursing
 1890  personnel.
 1891         (8) A licensed practical nurse shall furnish services in
 1892  accordance with agency policies, prepare clinical and progress
 1893  notes, assist the physician and registered nurse in performing
 1894  specialized procedures, prepare equipment and materials for
 1895  treatments observing aseptic technique as required, and assist
 1896  the patient in learning appropriate self-care techniques.
 1897         (9) A home health aide and certified nursing assistant
 1898  shall provide services that are ordered by the physician in the
 1899  plan of care and that the aide or assistant is permitted to
 1900  perform under state law. The duties of a home health aide or
 1901  certified nursing assistant include the provision of hands-on
 1902  personal care, performance of simple procedures as an extension
 1903  of therapy or nursing services, assistance in ambulation or
 1904  exercises, and assistance in administering medications that are
 1905  ordinarily self-administered and are specified in agency rules.
 1906  Any services by a home health aide which are offered by a home
 1907  health agency must be provided by a qualified home health aide
 1908  or certified nursing assistant.
 1909         (a) Assignment and duties.—A home health aide or certified
 1910  nursing assistant shall be assigned to a specific patient by a
 1911  registered nurse. Written patient care instructions for the home
 1912  health aide and certified nursing assistant must be prepared by
 1913  the registered nurse or other appropriate professional who is
 1914  responsible for the supervision of the home health aide and
 1915  certified nursing assistant as stated in this section.
 1916         (b) Supervision.—If a patient receives skilled nursing
 1917  care, the registered nurse shall perform the supervisory visit.
 1918  If the patient is not receiving skilled nursing care but is
 1919  receiving physical therapy, occupational therapy, or speech
 1920  language pathology services, the appropriate therapist may
 1921  provide the supervision. A registered nurse or other
 1922  professional must make an onsite visit to the patient’s home at
 1923  least once every 2 weeks. The visit is not required while the
 1924  aide is providing care.
 1925         (c) Supervising visits.—If home health aide services are
 1926  provided to a patient who is not receiving skilled nursing care,
 1927  physical or occupational therapy, or speech-language pathology
 1928  services, a registered nurse must make a supervisory visit to
 1929  the patient’s home at least once every 60 days. The registered
 1930  nurse shall ensure that the aide is properly caring for the
 1931  patient and each supervisory visit must occur while the home
 1932  health aide is providing patient care.
 1933         (10)(7) Home health agency personnel may withhold or
 1934  withdraw cardiopulmonary resuscitation if presented with an
 1935  order not to resuscitate executed pursuant to s. 401.45. The
 1936  agency shall adopt rules providing for the implementation of
 1937  such orders. Home health personnel and agencies shall not be
 1938  subject to criminal prosecution or civil liability, nor be
 1939  considered to have engaged in negligent or unprofessional
 1940  conduct, for withholding or withdrawing cardiopulmonary
 1941  resuscitation pursuant to such an order and rules adopted by the
 1942  agency.
 1943         Section 40. Subsections (1) and (4) of section 400.606,
 1944  Florida Statutes, are amended to read:
 1945         400.606 License; application; renewal; conditional license
 1946  or permit; certificate of need.—
 1947         (1) In addition to the requirements of part II of chapter
 1948  408, the initial application and change of ownership application
 1949  must be accompanied by a plan for the delivery of home,
 1950  residential, and homelike inpatient hospice services to
 1951  terminally ill persons and their families. Such plan must
 1952  contain, but need not be limited to:
 1953         (a) The estimated average number of terminally ill persons
 1954  to be served monthly.
 1955         (b) The geographic area in which hospice services will be
 1956  available.
 1957         (c) A listing of services which are or will be provided,
 1958  either directly by the applicant or through contractual
 1959  arrangements with existing providers.
 1960         (d) Provisions for the implementation of hospice home care
 1961  within 3 months after licensure.
 1962         (e) Provisions for the implementation of hospice homelike
 1963  inpatient care within 12 months after licensure.
 1964         (f) The number and disciplines of professional staff to be
 1965  employed.
 1966         (g) The name and qualifications of any existing or
 1967  potential contractee.
 1968         (h) A plan for attracting and training volunteers.
 1969         (i)The projected annual operating cost of the hospice.
 1970  
 1971  If the applicant is an existing licensed health care provider,
 1972  the application must be accompanied by a copy of the most recent
 1973  profit-loss statement and, if applicable, the most recent
 1974  licensure inspection report.
 1975         (4) A freestanding hospice facility that is primarily
 1976  engaged in providing inpatient and related services and that is
 1977  not otherwise licensed as a health care facility shall be
 1978  required to obtain a certificate of need. However, a
 1979  freestanding hospice facility with six or fewer beds shall not
 1980  be required to comply with institutional standards such as, but
 1981  not limited to, standards requiring sprinkler systems, emergency
 1982  electrical systems, or special lavatory devices.
 1983         Section 41. Subsection (2) of section 400.607, Florida
 1984  Statutes, is amended to read:
 1985         400.607 Denial, suspension, revocation of license;
 1986  emergency actions; imposition of administrative fine; grounds.—
 1987         (2) A violation of the provisions of this part, part II of
 1988  chapter 408, or applicable rules Any of the following actions by
 1989  a licensed hospice or any of its employees shall be grounds for
 1990  administrative action by the agency against a hospice.:
 1991         (a)A violation of the provisions of this part, part II of
 1992  chapter 408, or applicable rules.
 1993         (b)An intentional or negligent act materially affecting
 1994  the health or safety of a patient.
 1995         Section 42. Subsection (1) of section 400.925, Florida
 1996  Statutes, is amended to read:
 1997         400.925 Definitions.—As used in this part, the term:
 1998         (1) “Accrediting organizations” means the Joint Commission
 1999  on Accreditation of Healthcare Organizations or other national
 2000  accreditation agencies whose standards for accreditation are
 2001  comparable to those required by this part for licensure.
 2002         Section 43. Section 400.931, Florida Statutes, is amended
 2003  to read:
 2004         400.931 Application for license; fee; provisional license;
 2005  temporary permit.—
 2006         (1) In addition to the requirements of part II of chapter
 2007  408, the applicant must file with the application satisfactory
 2008  proof that the home medical equipment provider is in compliance
 2009  with this part and applicable rules, including:
 2010         (a) A report, by category, of the equipment to be provided,
 2011  indicating those offered either directly by the applicant or
 2012  through contractual arrangements with existing providers.
 2013  Categories of equipment include:
 2014         1. Respiratory modalities.
 2015         2. Ambulation aids.
 2016         3. Mobility aids.
 2017         4. Sickroom setup.
 2018         5. Disposables.
 2019         (b) A report, by category, of the services to be provided,
 2020  indicating those offered either directly by the applicant or
 2021  through contractual arrangements with existing providers.
 2022  Categories of services include:
 2023         1. Intake.
 2024         2. Equipment selection.
 2025         3. Delivery.
 2026         4. Setup and installation.
 2027         5. Patient training.
 2028         6. Ongoing service and maintenance.
 2029         7. Retrieval.
 2030         (c) A listing of those with whom the applicant contracts,
 2031  both the providers the applicant uses to provide equipment or
 2032  services to its consumers and the providers for whom the
 2033  applicant provides services or equipment.
 2034         (2)As an alternative to submitting proof of financial
 2035  ability to operate as required in s. 408.810(8), the applicant
 2036  may submit a $50,000 surety bond to the agency.
 2037         (2)(3) As specified in part II of chapter 408, the home
 2038  medical equipment provider must also obtain and maintain
 2039  professional and commercial liability insurance. Proof of
 2040  liability insurance, as defined in s. 624.605, must be submitted
 2041  with the application. The agency shall set the required amounts
 2042  of liability insurance by rule, but the required amount must not
 2043  be less than $250,000 per claim. In the case of contracted
 2044  services, it is required that the contractor have liability
 2045  insurance not less than $250,000 per claim.
 2046         (3)(4) When a change of the general manager of a home
 2047  medical equipment provider occurs, the licensee must notify the
 2048  agency of the change within 45 days.
 2049         (4)(5) In accordance with s. 408.805, an applicant or a
 2050  licensee shall pay a fee for each license application submitted
 2051  under this part, part II of chapter 408, and applicable rules.
 2052  The amount of the fee shall be established by rule and may not
 2053  exceed $300 per biennium. The agency shall set the fees in an
 2054  amount that is sufficient to cover its costs in carrying out its
 2055  responsibilities under this part. However, state, county, or
 2056  municipal governments applying for licenses under this part are
 2057  exempt from the payment of license fees.
 2058         (5)(6) An applicant for initial licensure, renewal, or
 2059  change of ownership shall also pay an inspection fee not to
 2060  exceed $400, which shall be paid by all applicants except those
 2061  not subject to licensure inspection by the agency as described
 2062  in s. 400.933.
 2063         Section 44. Subsection (2) of section 400.932, Florida
 2064  Statutes, is amended to read:
 2065         400.932 Administrative penalties.—
 2066         (2) A violation of this part, part II of chapter 408, or
 2067  applicable rules Any of the following actions by an employee of
 2068  a home medical equipment provider are grounds for administrative
 2069  action or penalties by the agency.:
 2070         (a)Violation of this part, part II of chapter 408, or
 2071  applicable rules.
 2072         (b)An intentional, reckless, or negligent act that
 2073  materially affects the health or safety of a patient.
 2074         Section 45. Subsection (2) of section 400.933, Florida
 2075  Statutes, is amended to read:
 2076         400.933 Licensure inspections and investigations.—
 2077         (2) The agency shall accept, in lieu of its own periodic
 2078  inspections for licensure, submission of the following:
 2079         (a) The survey or inspection of an accrediting
 2080  organization, provided the accreditation of the licensed home
 2081  medical equipment provider is not conditional or provisional and
 2082  provided the licensed home medical equipment provider authorizes
 2083  release of, and the agency receives the report of, the
 2084  accrediting organization; or
 2085         (b) A copy of a valid medical oxygen retail establishment
 2086  permit issued by the Department of Health, pursuant to chapter
 2087  499.
 2088         Section 46. Subsection (2) of section 400.953, Florida
 2089  Statutes, is amended to read:
 2090         400.953 Background screening of home medical equipment
 2091  provider personnel.—The agency shall require employment
 2092  screening as provided in chapter 435, using the level 1
 2093  standards for screening set forth in that chapter, for home
 2094  medical equipment provider personnel.
 2095         (2) The general manager of each home medical equipment
 2096  provider must sign an affidavit annually, under penalty of
 2097  perjury, stating that all home medical equipment provider
 2098  personnel hired on or after July 1, 1999, who enter the home of
 2099  a patient in the capacity of their employment have been screened
 2100  and that its remaining personnel have worked for the home
 2101  medical equipment provider continuously since before July 1,
 2102  1999. This attestation must be submitted in accordance with s.
 2103  408.809(6).
 2104         Section 47. Section 400.967, Florida Statutes, is amended
 2105  to read:
 2106         400.967 Rules and classification of violations
 2107  deficiencies.—
 2108         (1) It is the intent of the Legislature that rules adopted
 2109  and enforced under this part and part II of chapter 408 include
 2110  criteria by which a reasonable and consistent quality of
 2111  resident care may be ensured, the results of such resident care
 2112  can be demonstrated, and safe and sanitary facilities can be
 2113  provided.
 2114         (2) Pursuant to the intention of the Legislature, the
 2115  agency, in consultation with the Agency for Persons with
 2116  Disabilities and the Department of Elderly Affairs, shall adopt
 2117  and enforce rules to administer this part and part II of chapter
 2118  408, which shall include reasonable and fair criteria governing:
 2119         (a) The location and construction of the facility;
 2120  including fire and life safety, plumbing, heating, cooling,
 2121  lighting, ventilation, and other housing conditions that will
 2122  ensure the health, safety, and comfort of residents. The agency
 2123  shall establish standards for facilities and equipment to
 2124  increase the extent to which new facilities and a new wing or
 2125  floor added to an existing facility after July 1, 2000, are
 2126  structurally capable of serving as shelters only for residents,
 2127  staff, and families of residents and staff, and equipped to be
 2128  self-supporting during and immediately following disasters. The
 2129  Agency for Health Care Administration shall work with facilities
 2130  licensed under this part and report to the Governor and the
 2131  Legislature by April 1, 2000, its recommendations for cost
 2132  effective renovation standards to be applied to existing
 2133  facilities. In making such rules, the agency shall be guided by
 2134  criteria recommended by nationally recognized, reputable
 2135  professional groups and associations having knowledge concerning
 2136  such subject matters. The agency shall update or revise such
 2137  criteria as the need arises. All facilities must comply with
 2138  those lifesafety code requirements and building code standards
 2139  applicable at the time of approval of their construction plans.
 2140  The agency may require alterations to a building if it
 2141  determines that an existing condition constitutes a distinct
 2142  hazard to life, health, or safety. The agency shall adopt fair
 2143  and reasonable rules setting forth conditions under which
 2144  existing facilities undergoing additions, alterations,
 2145  conversions, renovations, or repairs are required to comply with
 2146  the most recent updated or revised standards.
 2147         (b) The number and qualifications of all personnel,
 2148  including management, medical nursing, and other personnel,
 2149  having responsibility for any part of the care given to
 2150  residents.
 2151         (c) All sanitary conditions within the facility and its
 2152  surroundings, including water supply, sewage disposal, food
 2153  handling, and general hygiene, which will ensure the health and
 2154  comfort of residents.
 2155         (d) The equipment essential to the health and welfare of
 2156  the residents.
 2157         (e) A uniform accounting system.
 2158         (f) The care, treatment, and maintenance of residents and
 2159  measurement of the quality and adequacy thereof.
 2160         (g) The preparation and annual update of a comprehensive
 2161  emergency management plan. The agency shall adopt rules
 2162  establishing minimum criteria for the plan after consultation
 2163  with the Department of Community Affairs. At a minimum, the
 2164  rules must provide for plan components that address emergency
 2165  evacuation transportation; adequate sheltering arrangements;
 2166  postdisaster activities, including emergency power, food, and
 2167  water; postdisaster transportation; supplies; staffing;
 2168  emergency equipment; individual identification of residents and
 2169  transfer of records; and responding to family inquiries. The
 2170  comprehensive emergency management plan is subject to review and
 2171  approval by the local emergency management agency. During its
 2172  review, the local emergency management agency shall ensure that
 2173  the following agencies, at a minimum, are given the opportunity
 2174  to review the plan: the Department of Elderly Affairs, the
 2175  Agency for Persons with Disabilities, the Agency for Health Care
 2176  Administration, and the Department of Community Affairs. Also,
 2177  appropriate volunteer organizations must be given the
 2178  opportunity to review the plan. The local emergency management
 2179  agency shall complete its review within 60 days and either
 2180  approve the plan or advise the facility of necessary revisions.
 2181         (h) The use of restraint and seclusion. Such rules must be
 2182  consistent with recognized best practices; prohibit inherently
 2183  dangerous restraint or seclusion procedures; establish
 2184  limitations on the use and duration of restraint and seclusion;
 2185  establish measures to ensure the safety of clients and staff
 2186  during an incident of restraint or seclusion; establish
 2187  procedures for staff to follow before, during, and after
 2188  incidents of restraint or seclusion, including individualized
 2189  plans for the use of restraints or seclusion in emergency
 2190  situations; establish professional qualifications of and
 2191  training for staff who may order or be engaged in the use of
 2192  restraint or seclusion; establish requirements for facility data
 2193  collection and reporting relating to the use of restraint and
 2194  seclusion; and establish procedures relating to the
 2195  documentation of the use of restraint or seclusion in the
 2196  client’s facility or program record.
 2197         (3) The agency shall adopt rules to provide that, when the
 2198  criteria established under this part and part II of chapter 408
 2199  are not met, such violations deficiencies shall be classified
 2200  according to the nature of the violation deficiency. The agency
 2201  shall indicate the classification on the face of the notice of
 2202  violations deficiencies as follows:
 2203         (a) Class I violations deficiencies are defined in s.
 2204  408.813. those which the agency determines present an imminent
 2205  danger to the residents or guests of the facility or a
 2206  substantial probability that death or serious physical harm
 2207  would result therefrom. The condition or practice constituting a
 2208  class I violation must be abated or eliminated immediately,
 2209  unless a fixed period of time, as determined by the agency, is
 2210  required for correction. A class I violation deficiency is
 2211  subject to a civil penalty in an amount not less than $5,000 and
 2212  not exceeding $10,000 for each violation deficiency. A fine may
 2213  be levied notwithstanding the correction of the violation
 2214  deficiency.
 2215         (b) Class II violations deficiencies are defined in s.
 2216  408.813. those which the agency determines have a direct or
 2217  immediate relationship to the health, safety, or security of the
 2218  facility residents, other than class I deficiencies. A class II
 2219  violation deficiency is subject to a civil penalty in an amount
 2220  not less than $1,000 and not exceeding $5,000 for each
 2221  deficiency. A citation for a class II violation deficiency shall
 2222  specify the time within which the violation deficiency must be
 2223  corrected. If a class II violation deficiency is corrected
 2224  within the time specified, no civil penalty shall be imposed,
 2225  unless it is a repeated offense.
 2226         (c) Class III violations deficiencies are defined in s.
 2227  408.813. those which the agency determines to have an indirect
 2228  or potential relationship to the health, safety, or security of
 2229  the facility residents, other than class I or class II
 2230  deficiencies. A class III violation deficiency is subject to a
 2231  civil penalty of not less than $500 and not exceeding $1,000 for
 2232  each violation deficiency. A citation for a class III violation
 2233  deficiency shall specify the time within which the violation
 2234  deficiency must be corrected. If a class III violation
 2235  deficiency is corrected within the time specified, no civil
 2236  penalty shall be imposed, unless it is a repeated offense.
 2237         (d) Class IV violations are defined in s. 408.813.
 2238         (4) The agency shall approve or disapprove the plans and
 2239  specifications within 60 days after receipt of the final plans
 2240  and specifications. The agency may be granted one 15-day
 2241  extension for the review period, if the secretary of the agency
 2242  so approves. If the agency fails to act within the specified
 2243  time, it is deemed to have approved the plans and
 2244  specifications. When the agency disapproves plans and
 2245  specifications, it must set forth in writing the reasons for
 2246  disapproval. Conferences and consultations may be provided as
 2247  necessary.
 2248         (5) The agency may charge an initial fee of $2,000 for
 2249  review of plans and construction on all projects, no part of
 2250  which is refundable. The agency may also collect a fee, not to
 2251  exceed 1 percent of the estimated construction cost or the
 2252  actual cost of review, whichever is less, for the portion of the
 2253  review which encompasses initial review through the initial
 2254  revised construction document review. The agency may collect its
 2255  actual costs on all subsequent portions of the review and
 2256  construction inspections. Initial fee payment must accompany the
 2257  initial submission of plans and specifications. Any subsequent
 2258  payment that is due is payable upon receipt of the invoice from
 2259  the agency. Notwithstanding any other provision of law, all
 2260  money received by the agency under this section shall be deemed
 2261  to be trust funds, to be held and applied solely for the
 2262  operations required under this section.
 2263         Section 48. Subsection (1) of section 400.969, Florida
 2264  Statutes, is amended to read:
 2265         400.969 Violation of part; penalties.—
 2266         (1) In addition to the requirements of part II of chapter
 2267  408, and except as provided in s. 400.967(3), a violation of any
 2268  provision of federal certification required pursuant to
 2269  400.960(8), this part, part II of chapter 408, or applicable
 2270  rules is punishable by payment of an administrative or civil
 2271  penalty not to exceed $5,000.
 2272         Section 49. Subsection (7) of section 400.9905, Florida
 2273  Statutes, is amended to read:
 2274         400.9905 Definitions.—
 2275         (7) “Portable service or equipment provider” means an
 2276  entity that contracts with or employs persons to provide
 2277  portable service or equipment to multiple locations which
 2278  performing treatment or diagnostic testing of individuals, that
 2279  bills third-party payors for those services, and that otherwise
 2280  meets the definition of a clinic in subsection (4).
 2281         Section 50. Subsections (1) and (4) of section 400.991,
 2282  Florida Statutes, are amended to read:
 2283         400.991 License requirements; background screenings;
 2284  prohibitions.—
 2285         (1)(a) The requirements of part II of chapter 408 apply to
 2286  the provision of services that require licensure pursuant to
 2287  this part and part II of chapter 408 and to entities licensed by
 2288  or applying for such licensure from the agency pursuant to this
 2289  part. A license issued by the agency is required in order to
 2290  operate a clinic in this state. Each clinic location shall be
 2291  licensed separately regardless of whether the clinic is operated
 2292  under the same business name or management as another clinic.
 2293         (b) Each mobile clinic must obtain a separate health care
 2294  clinic license and must provide to the agency, at least
 2295  quarterly, its projected street location to enable the agency to
 2296  locate and inspect such clinic. A portable equipment and health
 2297  services provider must obtain a health care clinic license for a
 2298  single administrative office and is not required to submit
 2299  quarterly projected street locations.
 2300         (4) In addition to the requirements of part II of chapter
 2301  408, the applicant must file with the application satisfactory
 2302  proof that the clinic is in compliance with this part and
 2303  applicable rules, including:
 2304         (a) A listing of services to be provided either directly by
 2305  the applicant or through contractual arrangements with existing
 2306  providers;
 2307         (b) The number and discipline of each professional staff
 2308  member to be employed; and
 2309         (c) Proof of financial ability to operate as required under
 2310  ss. 408.810(8) and 408.8065 s. 408.810(8). As an alternative to
 2311  submitting proof of financial ability to operate as required
 2312  under s. 408.810(8), the applicant may file a surety bond of at
 2313  least $500,000 which guarantees that the clinic will act in full
 2314  conformity with all legal requirements for operating a clinic,
 2315  payable to the agency. The agency may adopt rules to specify
 2316  related requirements for such surety bond.
 2317         Section 51. Paragraph (g) of subsection (1) and paragraph
 2318  (a) of subsection (7) of section 400.9935, Florida Statutes, are
 2319  amended to read:
 2320         400.9935 Clinic responsibilities.—
 2321         (1) Each clinic shall appoint a medical director or clinic
 2322  director who shall agree in writing to accept legal
 2323  responsibility for the following activities on behalf of the
 2324  clinic. The medical director or the clinic director shall:
 2325         (g) Conduct systematic reviews of clinic billings to ensure
 2326  that the billings are not fraudulent or unlawful. Upon discovery
 2327  of an unlawful charge, the medical director or clinic director
 2328  shall take immediate corrective action. If the clinic performs
 2329  only the technical component of magnetic resonance imaging,
 2330  static radiographs, computed tomography, or positron emission
 2331  tomography, and provides the professional interpretation of such
 2332  services, in a fixed facility that is accredited by the Joint
 2333  Commission on Accreditation of Healthcare Organizations or the
 2334  Accreditation Association for Ambulatory Health Care, and the
 2335  American College of Radiology; and if, in the preceding quarter,
 2336  the percentage of scans performed by that clinic which was
 2337  billed to all personal injury protection insurance carriers was
 2338  less than 15 percent, the chief financial officer of the clinic
 2339  may, in a written acknowledgment provided to the agency, assume
 2340  the responsibility for the conduct of the systematic reviews of
 2341  clinic billings to ensure that the billings are not fraudulent
 2342  or unlawful.
 2343         (7)(a) Each clinic engaged in magnetic resonance imaging
 2344  services must be accredited by the Joint Commission on
 2345  Accreditation of Healthcare Organizations, the American College
 2346  of Radiology, or the Accreditation Association for Ambulatory
 2347  Health Care, within 1 year after licensure. A clinic that is
 2348  accredited by the American College of Radiology or is within the
 2349  original 1-year period after licensure and replaces its core
 2350  magnetic resonance imaging equipment shall be given 1 year after
 2351  the date on which the equipment is replaced to attain
 2352  accreditation. However, a clinic may request a single, 6-month
 2353  extension if it provides evidence to the agency establishing
 2354  that, for good cause shown, such clinic cannot be accredited
 2355  within 1 year after licensure, and that such accreditation will
 2356  be completed within the 6-month extension. After obtaining
 2357  accreditation as required by this subsection, each such clinic
 2358  must maintain accreditation as a condition of renewal of its
 2359  license. A clinic that files a change of ownership application
 2360  must comply with the original accreditation timeframe
 2361  requirements of the transferor. The agency shall deny a change
 2362  of ownership application if the clinic is not in compliance with
 2363  the accreditation requirements. When a clinic adds, replaces, or
 2364  modifies magnetic resonance imaging equipment and the
 2365  accreditation agency requires new accreditation, the clinic must
 2366  be accredited within 1 year after the date of the addition,
 2367  replacement, or modification but may request a single, 6-month
 2368  extension if the clinic provides evidence of good cause to the
 2369  agency.
 2370         Section 52. Subsection (2) of section 408.034, Florida
 2371  Statutes, is amended to read:
 2372         408.034 Duties and responsibilities of agency; rules.—
 2373         (2) In the exercise of its authority to issue licenses to
 2374  health care facilities and health service providers, as provided
 2375  under chapters 393 and 395 and parts II, and IV, and VIII of
 2376  chapter 400, the agency may not issue a license to any health
 2377  care facility or health service provider that fails to receive a
 2378  certificate of need or an exemption for the licensed facility or
 2379  service.
 2380         Section 53. Paragraph (d) of subsection (1) of section
 2381  408.036, Florida Statutes, is amended to read:
 2382         408.036 Projects subject to review; exemptions.—
 2383         (1) APPLICABILITY.—Unless exempt under subsection (3), all
 2384  health-care-related projects, as described in paragraphs (a)
 2385  (g), are subject to review and must file an application for a
 2386  certificate of need with the agency. The agency is exclusively
 2387  responsible for determining whether a health-care-related
 2388  project is subject to review under ss. 408.031-408.045.
 2389         (d) The establishment of a hospice or hospice inpatient
 2390  facility, except as provided in s. 408.043.
 2391         Section 54. Subsection (2) of section 408.043, Florida
 2392  Statutes, is amended to read:
 2393         408.043 Special provisions.—
 2394         (2) HOSPICES.—When an application is made for a certificate
 2395  of need to establish or to expand a hospice, the need for such
 2396  hospice shall be determined on the basis of the need for and
 2397  availability of hospice services in the community. The formula
 2398  on which the certificate of need is based shall discourage
 2399  regional monopolies and promote competition. The inpatient
 2400  hospice care component of a hospice which is a freestanding
 2401  facility, or a part of a facility, which is primarily engaged in
 2402  providing inpatient care and related services and is not
 2403  licensed as a health care facility shall also be required to
 2404  obtain a certificate of need. Provision of hospice care by any
 2405  current provider of health care is a significant change in
 2406  service and therefore requires a certificate of need for such
 2407  services.
 2408         Section 55. Paragraph (k) of subsection (3) of section
 2409  408.05, Florida Statutes, is amended to read:
 2410         408.05 Florida Center for Health Information and Policy
 2411  Analysis.—
 2412         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
 2413  produce comparable and uniform health information and statistics
 2414  for the development of policy recommendations, the agency shall
 2415  perform the following functions:
 2416         (k) Develop, in conjunction with the State Consumer Health
 2417  Information and Policy Advisory Council, and implement a long
 2418  range plan for making available health care quality measures and
 2419  financial data that will allow consumers to compare health care
 2420  services. The health care quality measures and financial data
 2421  the agency must make available shall include, but is not limited
 2422  to, pharmaceuticals, physicians, health care facilities, and
 2423  health plans and managed care entities. The agency shall submit
 2424  the initial plan to the Governor, the President of the Senate,
 2425  and the Speaker of the House of Representatives by January 1,
 2426  2006, and shall update the plan and report on the status of its
 2427  implementation annually thereafter. The agency shall also make
 2428  the plan and status report available to the public on its
 2429  Internet website. As part of the plan, the agency shall identify
 2430  the process and timeframes for implementation, any barriers to
 2431  implementation, and recommendations of changes in the law that
 2432  may be enacted by the Legislature to eliminate the barriers. As
 2433  preliminary elements of the plan, the agency shall:
 2434         1. Make available patient-safety indicators, inpatient
 2435  quality indicators, and performance outcome and patient charge
 2436  data collected from health care facilities pursuant to s.
 2437  408.061(1)(a) and (2). The terms “patient-safety indicators” and
 2438  “inpatient quality indicators” shall be as defined by the
 2439  Centers for Medicare and Medicaid Services, the National Quality
 2440  Forum, the Joint Commission on Accreditation of Healthcare
 2441  Organizations, the Agency for Healthcare Research and Quality,
 2442  the Centers for Disease Control and Prevention, or a similar
 2443  national entity that establishes standards to measure the
 2444  performance of health care providers, or by other states. The
 2445  agency shall determine which conditions, procedures, health care
 2446  quality measures, and patient charge data to disclose based upon
 2447  input from the council. When determining which conditions and
 2448  procedures are to be disclosed, the council and the agency shall
 2449  consider variation in costs, variation in outcomes, and
 2450  magnitude of variations and other relevant information. When
 2451  determining which health care quality measures to disclose, the
 2452  agency:
 2453         a. Shall consider such factors as volume of cases; average
 2454  patient charges; average length of stay; complication rates;
 2455  mortality rates; and infection rates, among others, which shall
 2456  be adjusted for case mix and severity, if applicable.
 2457         b. May consider such additional measures that are adopted
 2458  by the Centers for Medicare and Medicaid Studies, National
 2459  Quality Forum, the Joint Commission on Accreditation of
 2460  Healthcare Organizations, the Agency for Healthcare Research and
 2461  Quality, Centers for Disease Control and Prevention, or a
 2462  similar national entity that establishes standards to measure
 2463  the performance of health care providers, or by other states.
 2464  
 2465  When determining which patient charge data to disclose, the
 2466  agency shall include such measures as the average of
 2467  undiscounted charges on frequently performed procedures and
 2468  preventive diagnostic procedures, the range of procedure charges
 2469  from highest to lowest, average net revenue per adjusted patient
 2470  day, average cost per adjusted patient day, and average cost per
 2471  admission, among others.
 2472         2. Make available performance measures, benefit design, and
 2473  premium cost data from health plans licensed pursuant to chapter
 2474  627 or chapter 641. The agency shall determine which health care
 2475  quality measures and member and subscriber cost data to
 2476  disclose, based upon input from the council. When determining
 2477  which data to disclose, the agency shall consider information
 2478  that may be required by either individual or group purchasers to
 2479  assess the value of the product, which may include membership
 2480  satisfaction, quality of care, current enrollment or membership,
 2481  coverage areas, accreditation status, premium costs, plan costs,
 2482  premium increases, range of benefits, copayments and
 2483  deductibles, accuracy and speed of claims payment, credentials
 2484  of physicians, number of providers, names of network providers,
 2485  and hospitals in the network. Health plans shall make available
 2486  to the agency any such data or information that is not currently
 2487  reported to the agency or the office.
 2488         3. Determine the method and format for public disclosure of
 2489  data reported pursuant to this paragraph. The agency shall make
 2490  its determination based upon input from the State Consumer
 2491  Health Information and Policy Advisory Council. At a minimum,
 2492  the data shall be made available on the agency’s Internet
 2493  website in a manner that allows consumers to conduct an
 2494  interactive search that allows them to view and compare the
 2495  information for specific providers. The website must include
 2496  such additional information as is determined necessary to ensure
 2497  that the website enhances informed decisionmaking among
 2498  consumers and health care purchasers, which shall include, at a
 2499  minimum, appropriate guidance on how to use the data and an
 2500  explanation of why the data may vary from provider to provider.
 2501  The data specified in subparagraph 1. shall be released no later
 2502  than January 1, 2006, for the reporting of infection rates, and
 2503  no later than October 1, 2005, for mortality rates and
 2504  complication rates. The data specified in subparagraph 2. shall
 2505  be released no later than October 1, 2006.
 2506         4. Publish on its website undiscounted charges for no fewer
 2507  than 150 of the most commonly performed adult and pediatric
 2508  procedures, including outpatient, inpatient, diagnostic, and
 2509  preventative procedures.
 2510         Section 56. Paragraph (a) of subsection (1) of section
 2511  408.061, Florida Statutes, is amended to read:
 2512         408.061 Data collection; uniform systems of financial
 2513  reporting; information relating to physician charges;
 2514  confidential information; immunity.—
 2515         (1) The agency shall require the submission by health care
 2516  facilities, health care providers, and health insurers of data
 2517  necessary to carry out the agency’s duties. Specifications for
 2518  data to be collected under this section shall be developed by
 2519  the agency with the assistance of technical advisory panels
 2520  including representatives of affected entities, consumers,
 2521  purchasers, and such other interested parties as may be
 2522  determined by the agency.
 2523         (a) Data submitted by health care facilities, including the
 2524  facilities as defined in chapter 395, shall include, but are not
 2525  limited to: case-mix data, patient admission and discharge data,
 2526  hospital emergency department data which shall include the
 2527  number of patients treated in the emergency department of a
 2528  licensed hospital reported by patient acuity level, data on
 2529  hospital-acquired infections as specified by rule, data on
 2530  complications as specified by rule, data on readmissions as
 2531  specified by rule, with patient and provider-specific
 2532  identifiers included, actual charge data by diagnostic groups,
 2533  financial data, accounting data, operating expenses, expenses
 2534  incurred for rendering services to patients who cannot or do not
 2535  pay, interest charges, depreciation expenses based on the
 2536  expected useful life of the property and equipment involved, and
 2537  demographic data. The agency shall adopt nationally recognized
 2538  risk adjustment methodologies or software consistent with the
 2539  standards of the Agency for Healthcare Research and Quality and
 2540  as selected by the agency for all data submitted as required by
 2541  this section. Data may be obtained from documents such as, but
 2542  not limited to: leases, contracts, debt instruments, itemized
 2543  patient bills, medical record abstracts, and related diagnostic
 2544  information. Reported data elements shall be reported
 2545  electronically and in accordance with rule 59E-7.012, Florida
 2546  Administrative Code. Data submitted shall be certified by the
 2547  chief executive officer or an appropriate and duly authorized
 2548  representative or employee of the licensed facility that the
 2549  information submitted is true and accurate.
 2550         Section 57. Subsection (1) of section 408.10, Florida
 2551  Statutes, is amended to read:
 2552         408.10 Consumer complaints.—The agency shall:
 2553         (1) Publish and make available to the public a toll-free
 2554  telephone number for the purpose of handling consumer complaints
 2555  and shall serve as a liaison between consumer entities and other
 2556  private entities and governmental entities for the disposition
 2557  of problems identified by consumers of health care. The agency
 2558  may provide staffing for this toll-free number through agency
 2559  staff or other arrangements.
 2560         Section 58. Subsection (11) of section 408.802, Florida
 2561  Statutes, is repealed.
 2562         Section 59. Effective October 1, 2010, subsection (3) is
 2563  added to section 408.804, Florida Statutes, to read:
 2564         408.804 License required; display.—
 2565         (3) Any person who knowingly alters, defaces, or falsifies
 2566  any license certificate issued by the agency, or causes or
 2567  procures any person to commit such an offense, commits a
 2568  misdemeanor of the second degree, punishable as provided in s.
 2569  775.082 or s. 775.083. Any licensee or provider who displays an
 2570  altered, defaced, or falsified license certificate is subject to
 2571  the penalties set forth in s. 408.815 and an administrative fine
 2572  of $1,000 for each day of illegal display.
 2573         Section 60. Paragraph (d) of subsection (2) of section
 2574  408.806, Florida Statutes, is amended to read:
 2575         408.806 License application process.—
 2576         (2)(d) The agency shall notify the licensee by mail or
 2577  electronically at least 90 days before the expiration of a
 2578  license that a renewal license is necessary to continue
 2579  operation. The licensee’s failure to timely file submit a
 2580  renewal application and license application fee with the agency
 2581  shall result in a $50 per day late fee charged to the licensee
 2582  by the agency; however, the aggregate amount of the late fee may
 2583  not exceed 50 percent of the licensure fee or $500, whichever is
 2584  less. The agency shall provide a courtesy notice to the licensee
 2585  by United States mail, electronically, or by any other manner at
 2586  its address of record at least 90 days before the expiration of
 2587  a license informing the licensee of the expiration of the
 2588  license. Any failure of the agency to provide the courtesy
 2589  notice or any failure of the licensee to receive the courtesy
 2590  notice does not excuse the licensee from the legal obligation to
 2591  timely file the renewal application and license application fee
 2592  with the agency and does not mitigate the late fee. Payment of
 2593  the late fee is required in order for any late application to be
 2594  complete, and failure to pay the late fee is an omission from
 2595  the application. If an application is received after the
 2596  required filing date and exhibits a hand-canceled postmark
 2597  obtained from a United States post office dated on or before the
 2598  required filing date, no fine will be levied.
 2599         Section 61. Subsections (6) and (9) of section 408.810,
 2600  Florida Statutes, are amended to read:
 2601         408.810 Minimum licensure requirements.—In addition to the
 2602  licensure requirements specified in this part, authorizing
 2603  statutes, and applicable rules, each applicant and licensee must
 2604  comply with the requirements of this section in order to obtain
 2605  and maintain a license.
 2606         (6)(a) An applicant must provide the agency with proof of
 2607  the applicant’s legal right to occupy the property before a
 2608  license may be issued. Proof may include, but need not be
 2609  limited to, copies of warranty deeds, lease or rental
 2610  agreements, contracts for deeds, quitclaim deeds, or other such
 2611  documentation.
 2612         (b) If the property is encumbered by a mortgage or is
 2613  leased, an applicant must provide the agency with proof that the
 2614  mortgagor or landlord has received written notice of the
 2615  applicant’s intent as mortgagee or tenant to provide services
 2616  that require licensure and instructions that the agency be
 2617  served by certified mail with copies of any actions initiated by
 2618  the mortgagor or landlord against applicant.
 2619         (9) A controlling interest may not withhold from the agency
 2620  any evidence of financial instability, including, but not
 2621  limited to, checks returned due to insufficient funds,
 2622  delinquent accounts, nonpayment of withholding taxes, unpaid
 2623  utility expenses, nonpayment for essential services, or adverse
 2624  court action concerning the financial viability of the provider
 2625  or any other provider licensed under this part that is under the
 2626  control of the controlling interest. A controlling interest
 2627  shall notify the agency within 10 days after a court action,
 2628  including, but not limited to, the initiation of bankruptcy
 2629  proceedings, foreclosure, or eviction proceedings, in which the
 2630  controlling interest is a petitioner or defendant. Any person
 2631  who violates this subsection commits a misdemeanor of the second
 2632  degree, punishable as provided in s. 775.082 or s. 775.083. Each
 2633  day of continuing violation is a separate offense.
 2634         Section 62. Paragraph (a) of subsection (6) of section
 2635  408.811, Florida Statutes, is amended to read:
 2636         408.811 Right of inspection; copies; inspection reports;
 2637  plan for correction of deficiencies.—
 2638         (6)(a) Each licensee shall maintain as public information,
 2639  available upon request, records of all inspection reports
 2640  pertaining to that provider that have been filed by the agency
 2641  unless those reports are exempt from or contain information that
 2642  is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
 2643  Constitution or is otherwise made confidential by law. Effective
 2644  October 1, 2006, copies of such reports shall be retained in the
 2645  records of the provider for at least 3 years following the date
 2646  the reports are filed and issued, regardless of a change of
 2647  ownership. The inspection report is not subject to challenge
 2648  under s. 120.569 or s. 120.57.
 2649         Section 63. Subsection (2) of section 408.813, Florida
 2650  Statutes, is amended to read:
 2651         408.813 Administrative fines; violations.—As a penalty for
 2652  any violation of this part, authorizing statutes, or applicable
 2653  rules, the agency may impose an administrative fine.
 2654         (2)(a) Violations of this part, authorizing statutes, or
 2655  applicable rules shall be classified according to the nature of
 2656  the violation and the gravity of its probable effect on clients.
 2657  The scope of a violation may be cited as an isolated, patterned,
 2658  or widespread deficiency. An isolated deficiency is a deficiency
 2659  affecting one or a very limited number of clients, or involving
 2660  one or a very limited number of staff, or a situation that
 2661  occurred only occasionally or in a very limited number of
 2662  locations. A patterned deficiency is a deficiency in which more
 2663  than a very limited number of clients are affected, or more than
 2664  a very limited number of staff are involved, or the situation
 2665  has occurred in several locations, or the same client or clients
 2666  have been affected by repeated occurrences of the same deficient
 2667  practice but the effect of the deficient practice is not found
 2668  to be pervasive throughout the provider. A widespread deficiency
 2669  is a deficiency in which the problems causing the deficiency are
 2670  pervasive in the provider or represent systemic failure that has
 2671  affected or has the potential to affect a large portion of the
 2672  provider’s clients. This subsection does not affect the
 2673  legislative determination of the amount of a fine imposed under
 2674  authorizing statutes. Violations shall be classified on the
 2675  written notice as follows:
 2676         1.(a) Class “I” violations are those conditions or
 2677  occurrences related to the operation and maintenance of a
 2678  provider or to the care of clients which the agency determines
 2679  present an imminent danger to the clients of the provider or a
 2680  substantial probability that death or serious physical or
 2681  emotional harm would result therefrom. The condition or practice
 2682  constituting a class I violation shall be abated or eliminated
 2683  within 24 hours, unless a fixed period, as determined by the
 2684  agency, is required for correction. The agency shall impose an
 2685  administrative fine as provided by law for a cited class I
 2686  violation. A fine shall be levied notwithstanding the correction
 2687  of the violation.
 2688         2.(b) Class “II” violations are those conditions or
 2689  occurrences related to the operation and maintenance of a
 2690  provider or to the care of clients which the agency determines
 2691  directly threaten the physical or emotional health, safety, or
 2692  security of the clients, other than class I violations. The
 2693  agency shall impose an administrative fine as provided by law
 2694  for a cited class II violation. A fine shall be levied
 2695  notwithstanding the correction of the violation.
 2696         3.(c) Class “III” violations are those conditions or
 2697  occurrences related to the operation and maintenance of a
 2698  provider or to the care of clients which the agency determines
 2699  indirectly or potentially threaten the physical or emotional
 2700  health, safety, or security of clients, other than class I or
 2701  class II violations. The agency shall impose an administrative
 2702  fine as provided in this section for a cited class III
 2703  violation. A citation for a class III violation must specify the
 2704  time within which the violation is required to be corrected. If
 2705  a class III violation is corrected within the time specified, a
 2706  fine may not be imposed.
 2707         4.(d) Class “IV” violations are those conditions or
 2708  occurrences related to the operation and maintenance of a
 2709  provider or to required reports, forms, or documents that do not
 2710  have the potential of negatively affecting clients. These
 2711  violations are of a type that the agency determines do not
 2712  threaten the health, safety, or security of clients. The agency
 2713  shall impose an administrative fine as provided in this section
 2714  for a cited class IV violation. A citation for a class IV
 2715  violation must specify the time within which the violation is
 2716  required to be corrected. If a class IV violation is corrected
 2717  within the time specified, a fine may not be imposed.
 2718         (b) The agency may impose an administrative fine for
 2719  violations that do not qualify as class I, class II, class III,
 2720  or class IV violations. The amount of the fine may not exceed
 2721  $500 for each violation. Unclassified violations may include:
 2722         1. Violating any term or condition of a license.
 2723         2. Violating any provision of this part, authorizing
 2724  statutes, or applicable rules.
 2725         3. Exceeding licensed capacity without authorization.
 2726         4. Providing services beyond the scope of the license.
 2727         5. Violating a moratorium.
 2728         Section 64. Subsection (5) is added to section 408.815,
 2729  Florida Statutes, to read:
 2730         408.815 License or application denial; revocation.—
 2731         (5) In order to ensure the health, safety, and welfare of
 2732  clients where a license has been denied, revoked, or is set to
 2733  terminate, the agency may extend the license expiration date for
 2734  up to 60 days after denial, revocation, or termination the sole
 2735  purpose of allowing the safe and orderly discharge of clients.
 2736  The agency may impose conditions on the extension, including,
 2737  but not limited to, prohibiting or limiting admissions,
 2738  expediting discharge planning, submitting required status
 2739  reports, and mandatory monitoring by the agency or third
 2740  parties. The agency may terminate the extension or modify the
 2741  conditions at any time at its discretion. Upon the discharge of
 2742  the final client, the extension shall immediately terminate and
 2743  the provider shall cease operation and promptly surrender its
 2744  license certificate to the agency. During the extension, the
 2745  provider must continue to meet all other requirements of this
 2746  part, authorizing statutes, and applicable rules. This authority
 2747  is in addition to any other authority granted to the agency
 2748  under chapter 120, this part, and the authorizing statutes, but
 2749  does not create any right or entitlement to an extension of a
 2750  license expiration date.
 2751         Section 65. Paragraph (d) is added to subsection (13) of
 2752  section 409.906, Florida Statutes, to read:
 2753         409.906 Optional Medicaid services.—Subject to specific
 2754  appropriations, the agency may make payments for services which
 2755  are optional to the state under Title XIX of the Social Security
 2756  Act and are furnished by Medicaid providers to recipients who
 2757  are determined to be eligible on the dates on which the services
 2758  were provided. Any optional service that is provided shall be
 2759  provided only when medically necessary and in accordance with
 2760  state and federal law. Optional services rendered by providers
 2761  in mobile units to Medicaid recipients may be restricted or
 2762  prohibited by the agency. Nothing in this section shall be
 2763  construed to prevent or limit the agency from adjusting fees,
 2764  reimbursement rates, lengths of stay, number of visits, or
 2765  number of services, or making any other adjustments necessary to
 2766  comply with the availability of moneys and any limitations or
 2767  directions provided for in the General Appropriations Act or
 2768  chapter 216. If necessary to safeguard the state’s systems of
 2769  providing services to elderly and disabled persons and subject
 2770  to the notice and review provisions of s. 216.177, the Governor
 2771  may direct the Agency for Health Care Administration to amend
 2772  the Medicaid state plan to delete the optional Medicaid service
 2773  known as “Intermediate Care Facilities for the Developmentally
 2774  Disabled.” Optional services may include:
 2775         (13) HOME AND COMMUNITY-BASED SERVICES.—
 2776         (d) The agency, in consultation with the Department of
 2777  Elderly Affairs, shall phase out the adult day health care
 2778  waiver program and transfer existing waiver enrollees to other
 2779  appropriate home and community-based service programs. Effective
 2780  July 1, 2010, the adult day health care waiver program shall
 2781  cease to enroll new members. Existing enrollees in the adult day
 2782  health care program shall receive counseling regarding available
 2783  options and shall be offered an alternative home and community
 2784  based services program based on eligibility and personal choice.
 2785  Each enrollee in the waiver program shall continue to receive
 2786  home and community-based services without interruption in the
 2787  enrollee’s program of choice. The providers of the adult day
 2788  health care waiver program, in consultation with the resource
 2789  centers for the aged, shall assist in the transition of
 2790  enrollees and cease provision of adult day health care waiver
 2791  services by December 31, 2010. The agency may seek federal
 2792  waiver approval to administer this change.
 2793         Section 66. Paragraph (k) of subsection (4) of section
 2794  409.221, Florida Statutes, is repealed.
 2795         Section 67. Paragraphs (e), (f), and (g) of subsection (15)
 2796  of section 409.912, Florida Statutes, are repealed.
 2797         Section 68. Section 429.11, Florida Statutes, is amended to
 2798  read:
 2799         429.11 Initial application for license; provisional
 2800  license.—
 2801         (1) Each applicant for licensure must comply with all
 2802  provisions of part II of chapter 408 and must:
 2803         (a) Identify all other homes or facilities, including the
 2804  addresses and the license or licenses under which they operate,
 2805  if applicable, which are currently operated by the applicant or
 2806  administrator and which provide housing, meals, and personal
 2807  services to residents.
 2808         (b) Provide the location of the facility for which a
 2809  license is sought and documentation, signed by the appropriate
 2810  local government official, which states that the applicant has
 2811  met local zoning requirements.
 2812         (c) Provide the name, address, date of birth, social
 2813  security number, education, and experience of the administrator,
 2814  if different from the applicant.
 2815         (2) The applicant shall provide proof of liability
 2816  insurance as defined in s. 624.605.
 2817         (3) If the applicant is a community residential home, the
 2818  applicant must provide proof that it has met the requirements
 2819  specified in chapter 419.
 2820         (4) The applicant must furnish proof that the facility has
 2821  received a satisfactory firesafety inspection. The local
 2822  authority having jurisdiction or the State Fire Marshal must
 2823  conduct the inspection within 30 days after written request by
 2824  the applicant.
 2825         (5) The applicant must furnish documentation of a
 2826  satisfactory sanitation inspection of the facility by the county
 2827  health department.
 2828         (6)In addition to the license categories available in s.
 2829  408.808, a provisional license may be issued to an applicant
 2830  making initial application for licensure or making application
 2831  for a change of ownership. A provisional license shall be
 2832  limited in duration to a specific period of time not to exceed 6
 2833  months, as determined by the agency.
 2834         (6)(7) A county or municipality may not issue an
 2835  occupational license that is being obtained for the purpose of
 2836  operating a facility regulated under this part without first
 2837  ascertaining that the applicant has been licensed to operate
 2838  such facility at the specified location or locations by the
 2839  agency. The agency shall furnish to local agencies responsible
 2840  for issuing occupational licenses sufficient instruction for
 2841  making such determinations.
 2842         Section 69. Subsection (2) of section 429.12, Florida
 2843  Statutes, is repealed.
 2844         Section 70. Subsections (5) and (6) of section 429.14,
 2845  Florida Statutes, are amended to read:
 2846         429.14 Administrative penalties.—
 2847         (5) An action taken by the agency to suspend, deny, or
 2848  revoke a facility’s license under this part or part II of
 2849  chapter 408, in which the agency claims that the facility owner
 2850  or an employee of the facility has threatened the health,
 2851  safety, or welfare of a resident of the facility shall be heard
 2852  by the Division of Administrative Hearings of the Department of
 2853  Management Services within 120 days after receipt of the
 2854  facility’s request for a hearing, unless that time limitation is
 2855  waived by both parties. The administrative law judge must render
 2856  a decision within 30 days after receipt of a proposed
 2857  recommended order.
 2858         (6) The agency shall provide to the Division of Hotels and
 2859  Restaurants of the Department of Business and Professional
 2860  Regulation, on a monthly basis, a list of those assisted living
 2861  facilities that have had their licenses denied, suspended, or
 2862  revoked or that are involved in an appellate proceeding pursuant
 2863  to s. 120.60 related to the denial, suspension, or revocation of
 2864  a license. This information may be provided electronically or
 2865  through the agency’s Internet website.
 2866         Section 71. Subsection (4) of section 429.17, Florida
 2867  Statutes, is amended to read:
 2868         429.17 Expiration of license; renewal; conditional
 2869  license.—
 2870         (4) In addition to the license categories available in s.
 2871  408.808, a conditional license may be issued to an applicant for
 2872  license renewal if the applicant fails to meet all standards and
 2873  requirements for licensure. A conditional license issued under
 2874  this subsection shall be limited in duration to a specific
 2875  period of time not to exceed 6 months, as determined by the
 2876  agency, and shall be accompanied by an agency-approved plan of
 2877  correction.
 2878         Section 72. Subsection (5) of section 429.23, Florida
 2879  Statutes, is repealed.
 2880         Section 73. Subsection (2) of section 429.35, Florida
 2881  Statutes, is amended to read:
 2882         429.35 Maintenance of records; reports.—
 2883         (2) Within 60 days after the date of the biennial
 2884  inspection visit required under s. 408.811 or within 30 days
 2885  after the date of any interim visit, the agency shall forward
 2886  the results of the inspection to the local ombudsman council in
 2887  whose planning and service area, as defined in part II of
 2888  chapter 400, the facility is located; to at least one public
 2889  library or, in the absence of a public library, the county seat
 2890  in the county in which the inspected assisted living facility is
 2891  located; and, when appropriate, to the district Adult Services
 2892  and Mental Health Program Offices. This information may be
 2893  provided electronically or through the agency’s Internet site.
 2894         Section 74. Section 429.53, Florida Statutes, is amended to
 2895  read:
 2896         429.53 Consultation by the agency.—
 2897         (1) The area offices of licensure and certification of the
 2898  agency shall provide consultation to the following upon request:
 2899         (a) A licensee of a facility.
 2900         (b) A person interested in obtaining a license to operate a
 2901  facility under this part.
 2902         (2) As used in this section, “consultation” includes:
 2903         (a) An explanation of the requirements of this part and
 2904  rules adopted pursuant thereto;
 2905         (b) An explanation of the license application and renewal
 2906  procedures; and
 2907         (c)The provision of a checklist of general local and state
 2908  approvals required prior to constructing or developing a
 2909  facility and a listing of the types of agencies responsible for
 2910  such approvals;
 2911         (d)An explanation of benefits and financial assistance
 2912  available to a recipient of supplemental security income
 2913  residing in a facility;
 2914         (c)(e) Any other information that which the agency deems
 2915  necessary to promote compliance with the requirements of this
 2916  part.; and
 2917         (f)A preconstruction review of a facility to ensure
 2918  compliance with agency rules and this part.
 2919         (3) The agency may charge a fee commensurate with the cost
 2920  of providing consultation under this section.
 2921         Section 75. Subsections (2) and (11) of section 429.65,
 2922  Florida Statutes, are amended to read:
 2923         429.65 Definitions.—As used in this part, the term:
 2924         (2) “Adult family-care home” means a full-time, family-type
 2925  living arrangement, in a private home, under which up to two
 2926  individuals a person who reside in the home and own or rent owns
 2927  or rents the home provide provides room, board, and personal
 2928  care, on a 24-hour basis, for no more than five disabled adults
 2929  or frail elders who are not relatives. The following family-type
 2930  living arrangements are not required to be licensed as an adult
 2931  family-care home:
 2932         (a) An arrangement whereby the person who resides in the
 2933  home and owns or rents the home provides room, board, and
 2934  personal services for not more than two adults who do not
 2935  receive optional state supplementation under s. 409.212. The
 2936  person who provides the housing, meals, and personal care must
 2937  own or rent the home and reside therein.
 2938         (b) An arrangement whereby the person who owns or rents the
 2939  home provides room, board, and personal services only to his or
 2940  her relatives.
 2941         (c) An establishment that is licensed as an assisted living
 2942  facility under this chapter.
 2943         (11) “Provider” means one or two individuals a person who
 2944  are is licensed to operate an adult family-care home.
 2945         Section 76. Section 429.71, Florida Statutes, is amended to
 2946  read:
 2947         429.71 Classification of violations deficiencies;
 2948  administrative fines.—
 2949         (1) In addition to the requirements of part II of chapter
 2950  408 and in addition to any other liability or penalty provided
 2951  by law, the agency may impose an administrative fine on a
 2952  provider according to the following classification:
 2953         (a) Class I violations are defined in s. 408.813. those
 2954  conditions or practices related to the operation and maintenance
 2955  of an adult family-care home or to the care of residents which
 2956  the agency determines present an imminent danger to the
 2957  residents or guests of the facility or a substantial probability
 2958  that death or serious physical or emotional harm would result
 2959  therefrom. The condition or practice that constitutes a class I
 2960  violation must be abated or eliminated within 24 hours, unless a
 2961  fixed period, as determined by the agency, is required for
 2962  correction. A class I violation deficiency is subject to an
 2963  administrative fine in an amount not less than $500 and not
 2964  exceeding $1,000 for each violation. A fine may be levied
 2965  notwithstanding the correction of the violation deficiency.
 2966         (b) Class II violations are defined in s. 408.813. those
 2967  conditions or practices related to the operation and maintenance
 2968  of an adult family-care home or to the care of residents which
 2969  the agency determines directly threaten the physical or
 2970  emotional health, safety, or security of the residents, other
 2971  than class I violations. A class II violation is subject to an
 2972  administrative fine in an amount not less than $250 and not
 2973  exceeding $500 for each violation. A citation for a class II
 2974  violation must specify the time within which the violation is
 2975  required to be corrected. If a class II violation is corrected
 2976  within the time specified, no civil penalty shall be imposed,
 2977  unless it is a repeated offense.
 2978         (c) Class III violations are defined in s. 408.813. those
 2979  conditions or practices related to the operation and maintenance
 2980  of an adult family-care home or to the care of residents which
 2981  the agency determines indirectly or potentially threaten the
 2982  physical or emotional health, safety, or security of residents,
 2983  other than class I or class II violations. A class III violation
 2984  is subject to an administrative fine in an amount not less than
 2985  $100 and not exceeding $250 for each violation. A citation for a
 2986  class III violation shall specify the time within which the
 2987  violation is required to be corrected. If a class III violation
 2988  is corrected within the time specified, no civil penalty shall
 2989  be imposed, unless it is a repeated offense.
 2990         (d) Class IV violations are defined in s. 408.813. those
 2991  conditions or occurrences related to the operation and
 2992  maintenance of an adult family-care home, or related to the
 2993  required reports, forms, or documents, which do not have the
 2994  potential of negatively affecting the residents. A provider that
 2995  does not correct A class IV violation within the time limit
 2996  specified by the agency is subject to an administrative fine in
 2997  an amount not less than $50 and not exceeding $100 for each
 2998  violation. Any class IV violation that is corrected during the
 2999  time the agency survey is conducted will be identified as an
 3000  agency finding and not as a violation.
 3001         (2) The agency may impose an administrative fine for
 3002  violations which do not qualify as class I, class II, class III,
 3003  or class IV violations. The amount of the fine may shall not
 3004  exceed $250 for each violation or $2,000 in the aggregate.
 3005  Unclassified violations may include:
 3006         (a) Violating any term or condition of a license.
 3007         (b) Violating any provision of this part, part II of
 3008  chapter 408, or applicable rules.
 3009         (c) Failure to follow the criteria and procedures provided
 3010  under part I of chapter 394 relating to the transportation,
 3011  voluntary admission, and involuntary examination of adult
 3012  family-care home residents.
 3013         (d) Exceeding licensed capacity.
 3014         (e) Providing services beyond the scope of the license.
 3015         (f) Violating a moratorium.
 3016         (3) Each day during which a violation occurs constitutes a
 3017  separate offense.
 3018         (4) In determining whether a penalty is to be imposed, and
 3019  in fixing the amount of any penalty to be imposed, the agency
 3020  must consider:
 3021         (a) The gravity of the violation.
 3022         (b) Actions taken by the provider to correct a violation.
 3023         (c) Any previous violation by the provider.
 3024         (d) The financial benefit to the provider of committing or
 3025  continuing the violation.
 3026         (5)As an alternative to or in conjunction with an
 3027  administrative action against a provider, the agency may request
 3028  a plan of corrective action that demonstrates a good faith
 3029  effort to remedy each violation by a specific date, subject to
 3030  the approval of the agency.
 3031         Section 77. Section 429.911, Florida Statutes, is repealed.
 3032         Section 78. Section 429.915, Florida Statutes, is amended
 3033  to read:
 3034         429.915 Conditional license.—In addition to the license
 3035  categories available in part II of chapter 408, the agency may
 3036  issue a conditional license to an applicant for license renewal
 3037  or change of ownership if the applicant fails to meet all
 3038  standards and requirements for licensure. A conditional license
 3039  issued under this subsection must be limited to a specific
 3040  period not exceeding 6 months, as determined by the agency, and
 3041  must be accompanied by an approved plan of correction.
 3042         Section 79. Subsection (3) of section 430.80, Florida
 3043  Statutes, is amended to read:
 3044         430.80 Implementation of a teaching nursing home pilot
 3045  project.—
 3046         (3) To be designated as a teaching nursing home, a nursing
 3047  home licensee must, at a minimum:
 3048         (a) Provide a comprehensive program of integrated senior
 3049  services that include institutional services and community-based
 3050  services;
 3051         (b) Participate in a nationally recognized accreditation
 3052  program and hold a valid accreditation, such as the
 3053  accreditation awarded by the Joint Commission on Accreditation
 3054  of Healthcare Organizations;
 3055         (c) Have been in business in this state for a minimum of 10
 3056  consecutive years;
 3057         (d) Demonstrate an active program in multidisciplinary
 3058  education and research that relates to gerontology;
 3059         (e) Have a formalized contractual relationship with at
 3060  least one accredited health profession education program located
 3061  in this state;
 3062         (f) Have a formalized contractual relationship with an
 3063  accredited hospital that is designated by law as a teaching
 3064  hospital; and
 3065         (g) Have senior staff members who hold formal faculty
 3066  appointments at universities, which must include at least one
 3067  accredited health profession education program.
 3068         (h) Maintain insurance coverage pursuant to s.
 3069  400.141(1)(q) s. 400.141(1)(s) or proof of financial
 3070  responsibility in a minimum amount of $750,000. Such proof of
 3071  financial responsibility may include:
 3072         1. Maintaining an escrow account consisting of cash or
 3073  assets eligible for deposit in accordance with s. 625.52; or
 3074         2. Obtaining and maintaining pursuant to chapter 675 an
 3075  unexpired, irrevocable, nontransferable and nonassignable letter
 3076  of credit issued by any bank or savings association organized
 3077  and existing under the laws of this state or any bank or savings
 3078  association organized under the laws of the United States that
 3079  has its principal place of business in this state or has a
 3080  branch office which is authorized to receive deposits in this
 3081  state. The letter of credit shall be used to satisfy the
 3082  obligation of the facility to the claimant upon presentment of a
 3083  final judgment indicating liability and awarding damages to be
 3084  paid by the facility or upon presentment of a settlement
 3085  agreement signed by all parties to the agreement when such final
 3086  judgment or settlement is a result of a liability claim against
 3087  the facility.
 3088         Section 80. Paragraph (a) of subsection (2) of section
 3089  440.13, Florida Statutes, is amended to read:
 3090         440.13 Medical services and supplies; penalty for
 3091  violations; limitations.—
 3092         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
 3093         (a) Subject to the limitations specified elsewhere in this
 3094  chapter, the employer shall furnish to the employee such
 3095  medically necessary remedial treatment, care, and attendance for
 3096  such period as the nature of the injury or the process of
 3097  recovery may require, which is in accordance with established
 3098  practice parameters and protocols of treatment as provided for
 3099  in this chapter, including medicines, medical supplies, durable
 3100  medical equipment, orthoses, prostheses, and other medically
 3101  necessary apparatus. Remedial treatment, care, and attendance,
 3102  including work-hardening programs or pain-management programs
 3103  accredited by the Commission on Accreditation of Rehabilitation
 3104  Facilities or the Joint Commission on the Accreditation of
 3105  Health Organizations or pain-management programs affiliated with
 3106  medical schools, shall be considered as covered treatment only
 3107  when such care is given based on a referral by a physician as
 3108  defined in this chapter. Medically necessary treatment, care,
 3109  and attendance does not include chiropractic services in excess
 3110  of 24 treatments or rendered 12 weeks beyond the date of the
 3111  initial chiropractic treatment, whichever comes first, unless
 3112  the carrier authorizes additional treatment or the employee is
 3113  catastrophically injured.
 3114  
 3115  Failure of the carrier to timely comply with this subsection
 3116  shall be a violation of this chapter and the carrier shall be
 3117  subject to penalties as provided for in s. 440.525.
 3118         Section 81. Section 483.294, Florida Statutes, is amended
 3119  to read:
 3120         483.294 Inspection of centers.—In accordance with s.
 3121  408.811, the agency shall biennially, at least once annually,
 3122  inspect the premises and operations of all centers subject to
 3123  licensure under this part.
 3124         Section 82. Subsection (1) of section 627.645, Florida
 3125  Statutes, is amended to read:
 3126         627.645 Denial of health insurance claims restricted.—
 3127         (1) A No claim for payment under a health insurance policy
 3128  or self-insured program of health benefits for treatment, care,
 3129  or services in a licensed hospital which is accredited by the
 3130  Joint Commission on the Accreditation of Hospitals, the American
 3131  Osteopathic Association, or the Commission on the Accreditation
 3132  of Rehabilitative Facilities may not shall be denied because
 3133  such hospital lacks major surgical facilities and is primarily
 3134  of a rehabilitative nature, if such rehabilitation is
 3135  specifically for treatment of physical disability.
 3136         Section 83. Paragraph (c) of subsection (2) of section
 3137  627.668, Florida Statutes, is amended to read:
 3138         627.668 Optional coverage for mental and nervous disorders
 3139  required; exception.—
 3140         (2) Under group policies or contracts, inpatient hospital
 3141  benefits, partial hospitalization benefits, and outpatient
 3142  benefits consisting of durational limits, dollar amounts,
 3143  deductibles, and coinsurance factors shall not be less favorable
 3144  than for physical illness generally, except that:
 3145         (c) Partial hospitalization benefits shall be provided
 3146  under the direction of a licensed physician. For purposes of
 3147  this part, the term “partial hospitalization services” is
 3148  defined as those services offered by a program accredited by the
 3149  Joint Commission on Accreditation of Hospitals (JCAH) or in
 3150  compliance with equivalent standards. Alcohol rehabilitation
 3151  programs accredited by the Joint Commission on Accreditation of
 3152  Hospitals or approved by the state and licensed drug abuse
 3153  rehabilitation programs shall also be qualified providers under
 3154  this section. In any benefit year, if partial hospitalization
 3155  services or a combination of inpatient and partial
 3156  hospitalization are utilized, the total benefits paid for all
 3157  such services shall not exceed the cost of 30 days of inpatient
 3158  hospitalization for psychiatric services, including physician
 3159  fees, which prevail in the community in which the partial
 3160  hospitalization services are rendered. If partial
 3161  hospitalization services benefits are provided beyond the limits
 3162  set forth in this paragraph, the durational limits, dollar
 3163  amounts, and coinsurance factors thereof need not be the same as
 3164  those applicable to physical illness generally.
 3165         Section 84. Subsection (3) of section 627.669, Florida
 3166  Statutes, is amended to read:
 3167         627.669 Optional coverage required for substance abuse
 3168  impaired persons; exception.—
 3169         (3) The benefits provided under this section shall be
 3170  applicable only if treatment is provided by, or under the
 3171  supervision of, or is prescribed by, a licensed physician or
 3172  licensed psychologist and if services are provided in a program
 3173  accredited by the Joint Commission on Accreditation of Hospitals
 3174  or approved by the state.
 3175         Section 85. Paragraph (a) of subsection (1) of section
 3176  627.736, Florida Statutes, is amended to read:
 3177         627.736 Required personal injury protection benefits;
 3178  exclusions; priority; claims.—
 3179         (1) REQUIRED BENEFITS.—Every insurance policy complying
 3180  with the security requirements of s. 627.733 shall provide
 3181  personal injury protection to the named insured, relatives
 3182  residing in the same household, persons operating the insured
 3183  motor vehicle, passengers in such motor vehicle, and other
 3184  persons struck by such motor vehicle and suffering bodily injury
 3185  while not an occupant of a self-propelled vehicle, subject to
 3186  the provisions of subsection (2) and paragraph (4)(e), to a
 3187  limit of $10,000 for loss sustained by any such person as a
 3188  result of bodily injury, sickness, disease, or death arising out
 3189  of the ownership, maintenance, or use of a motor vehicle as
 3190  follows:
 3191         (a) Medical benefits.—Eighty percent of all reasonable
 3192  expenses for medically necessary medical, surgical, X-ray,
 3193  dental, and rehabilitative services, including prosthetic
 3194  devices, and medically necessary ambulance, hospital, and
 3195  nursing services. However, the medical benefits shall provide
 3196  reimbursement only for such services and care that are lawfully
 3197  provided, supervised, ordered, or prescribed by a physician
 3198  licensed under chapter 458 or chapter 459, a dentist licensed
 3199  under chapter 466, or a chiropractic physician licensed under
 3200  chapter 460 or that are provided by any of the following persons
 3201  or entities:
 3202         1. A hospital or ambulatory surgical center licensed under
 3203  chapter 395.
 3204         2. A person or entity licensed under ss. 401.2101-401.45
 3205  that provides emergency transportation and treatment.
 3206         3. An entity wholly owned by one or more physicians
 3207  licensed under chapter 458 or chapter 459, chiropractic
 3208  physicians licensed under chapter 460, or dentists licensed
 3209  under chapter 466 or by such practitioner or practitioners and
 3210  the spouse, parent, child, or sibling of that practitioner or
 3211  those practitioners.
 3212         4. An entity wholly owned, directly or indirectly, by a
 3213  hospital or hospitals.
 3214         5. A health care clinic licensed under ss. 400.990-400.995
 3215  that is:
 3216         a. Accredited by the Joint Commission on Accreditation of
 3217  Healthcare Organizations, the American Osteopathic Association,
 3218  the Commission on Accreditation of Rehabilitation Facilities, or
 3219  the Accreditation Association for Ambulatory Health Care, Inc.;
 3220  or
 3221         b. A health care clinic that:
 3222         (I) Has a medical director licensed under chapter 458,
 3223  chapter 459, or chapter 460;
 3224         (II) Has been continuously licensed for more than 3 years
 3225  or is a publicly traded corporation that issues securities
 3226  traded on an exchange registered with the United States
 3227  Securities and Exchange Commission as a national securities
 3228  exchange; and
 3229         (III) Provides at least four of the following medical
 3230  specialties:
 3231         (A) General medicine.
 3232         (B) Radiography.
 3233         (C) Orthopedic medicine.
 3234         (D) Physical medicine.
 3235         (E) Physical therapy.
 3236         (F) Physical rehabilitation.
 3237         (G) Prescribing or dispensing outpatient prescription
 3238  medication.
 3239         (H) Laboratory services.
 3240  
 3241  The Financial Services Commission shall adopt by rule the form
 3242  that must be used by an insurer and a health care provider
 3243  specified in subparagraph 3., subparagraph 4., or subparagraph
 3244  5. to document that the health care provider meets the criteria
 3245  of this paragraph, which rule must include a requirement for a
 3246  sworn statement or affidavit.
 3247  
 3248  Only insurers writing motor vehicle liability insurance in this
 3249  state may provide the required benefits of this section, and no
 3250  such insurer shall require the purchase of any other motor
 3251  vehicle coverage other than the purchase of property damage
 3252  liability coverage as required by s. 627.7275 as a condition for
 3253  providing such required benefits. Insurers may not require that
 3254  property damage liability insurance in an amount greater than
 3255  $10,000 be purchased in conjunction with personal injury
 3256  protection. Such insurers shall make benefits and required
 3257  property damage liability insurance coverage available through
 3258  normal marketing channels. Any insurer writing motor vehicle
 3259  liability insurance in this state who fails to comply with such
 3260  availability requirement as a general business practice shall be
 3261  deemed to have violated part IX of chapter 626, and such
 3262  violation shall constitute an unfair method of competition or an
 3263  unfair or deceptive act or practice involving the business of
 3264  insurance; and any such insurer committing such violation shall
 3265  be subject to the penalties afforded in such part, as well as
 3266  those which may be afforded elsewhere in the insurance code.
 3267         Section 86. Subsection (12) of section 641.495, Florida
 3268  Statutes, is amended to read:
 3269         641.495 Requirements for issuance and maintenance of
 3270  certificate.—
 3271         (12) The provisions of part I of chapter 395 do not apply
 3272  to a health maintenance organization that, on or before January
 3273  1, 1991, provides not more than 10 outpatient holding beds for
 3274  short-term and hospice-type patients in an ambulatory care
 3275  facility for its members, provided that such health maintenance
 3276  organization maintains current accreditation by the Joint
 3277  Commission on Accreditation of Health Care Organizations, the
 3278  Accreditation Association for Ambulatory Health Care, or the
 3279  National Committee for Quality Assurance.
 3280         Section 87. Subsection (13) of section 651.118, Florida
 3281  Statutes, is amended to read:
 3282         651.118 Agency for Health Care Administration; certificates
 3283  of need; sheltered beds; community beds.—
 3284         (13) Residents, as defined in this chapter, are not
 3285  considered new admissions for the purpose of s. 400.141(1)(n)1.d
 3286  s. 400.141(1)(o)1.d.
 3287         Section 88. Subsection (2) of section 766.1015, Florida
 3288  Statutes, is amended to read:
 3289         766.1015 Civil immunity for members of or consultants to
 3290  certain boards, committees, or other entities.—
 3291         (2) Such committee, board, group, commission, or other
 3292  entity must be established in accordance with state law or in
 3293  accordance with requirements of the Joint Commission on
 3294  Accreditation of Healthcare Organizations, established and duly
 3295  constituted by one or more public or licensed private hospitals
 3296  or behavioral health agencies, or established by a governmental
 3297  agency. To be protected by this section, the act, decision,
 3298  omission, or utterance may not be made or done in bad faith or
 3299  with malicious intent.
 3300         Section 89. Except as otherwise expressly provided in this
 3301  act, this act shall take effect July 1, 2010.

Site Map
Session:   Bills ·   Calendars ·   Bound Journals ·   Citator ·   Search ·   Appropriations ·   Redistricting ·   Bill Information Reports
Committee Publications
Historical Information
Statutes:   Introduction ·   View Statutes ·   Search Statutes
Flsenate.gov
Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes.    Copyright © 2000-2019 State of Florida.     Privacy Statement     Contact Us     Get Acrobat Reader