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       Florida Senate - 2010               CS for CS for CS for SB 2138
       By the Policy and Steering Committee on Ways and Means; the
       Committees on Children, Families, and Elder Affairs; and Health
       Regulation; and Senator Gardiner
       576-05035-10                                          20102138c3
    1                        A bill to be entitled                      
    2         An act relating to health care; repealing s.
    3         112.0455(10)(e), F.S., relating to a prohibition
    4         against applying the Drug-Free Workplace Act
    5         retroactively; repealing s. 383.325, F.S., relating to
    6         the requirement of a licensed facility under s.
    7         383.305, F.S., to maintain inspection reports;
    8         repealing s. 395.1046, F.S., relating to the
    9         investigation of complaints regarding hospitals;
   10         repealing s. 395.3037, F.S.; deleting definitions
   11         relating to obsolete provisions governing primary and
   12         comprehensive stroke centers; amending s. 400.0239,
   13         F.S.; deleting an obsolete provision; repealing s.
   14         400.147(10), F.S., relating to a requirement that a
   15         nursing home facility report any notice of a filing of
   16         a claim for a violation of a resident’s rights or a
   17         claim of negligence; repealing s. 400.148, F.S.,
   18         relating to the Medicaid “Up-or-Out” Quality of Care
   19         Contract Management Program; repealing s. 400.195,
   20         F.S., relating to reporting requirements for the
   21         Agency for Health Care Administration; amending s.
   22         400.476, F.S.; providing requirements for an
   23         alternative administrator of a home health agency;
   24         revising the duties of the administrator; revising the
   25         requirements for a director of nursing for a specified
   26         number of home health agencies; prohibiting a home
   27         health agency from using an individual as a home
   28         health aide unless the person has completed training
   29         and an evaluation program; requiring a home health
   30         aide to meet certain standards in order to be
   31         competent in performing certain tasks; requiring a
   32         home health agency and staff to comply with accepted
   33         professional standards; providing certain requirements
   34         for a written contract between certain personnel and
   35         the agency; requiring a home health agency to provide
   36         certain services through its employees; authorizing a
   37         home health agency to provide additional services with
   38         another organization; providing responsibilities of a
   39         home health agency when it provides home health aide
   40         services through another organization; requiring the
   41         home health agency to coordinate personnel who provide
   42         home health services; requiring personnel to
   43         communicate with the home health agency; amending s.
   44         400.487, F.S.; requiring a home health agency to
   45         provide a copy of the agreement between the agency and
   46         a patient which specifies the home health services to
   47         be provided; providing the rights that are protected
   48         by the home health agency; requiring the home health
   49         agency to furnish nursing services by or under the
   50         supervision of a registered nurse; requiring the home
   51         health agency to provide therapy services through a
   52         qualified therapist or therapy assistant; providing
   53         the duties and qualifications of a therapist and
   54         therapy assistant; requiring supervision by a physical
   55         therapist or occupational therapist of a physical
   56         therapist assistant or occupational therapist
   57         assistant; providing duties of a physical therapist
   58         assistant or occupational therapist assistant;
   59         providing for speech therapy services to be provided
   60         by a qualified speech pathologist or audiologist;
   61         providing for a plan of care; providing that only the
   62         staff of a home health agency may administer drugs and
   63         treatments as ordered by certain health professionals;
   64         providing requirements for verbal orders; providing
   65         duties of a registered nurse, licensed practical
   66         nurse, home health aide, and certified nursing
   67         assistant who work for a home health agency; providing
   68         for supervisory visits of services provided by a home
   69         health agency; repealing s. 408.802(11), F.S.,
   70         relating to the applicability of the Health Care
   71         Licensing Procedures Act to private review agents;
   72         repealing s. 409.912(15)(e), (f), and (g), F.S.,
   73         relating to a requirement for the Agency for Health
   74         Care Administration to submit a report to the
   75         Legislature regarding the operations of the CARE
   76         program; amending s. 409.91255, F.S.; transferring
   77         administrative responsibility for the application
   78         procedure for federally qualified health centers from
   79         the Department of Health to the Agency for Health Care
   80         Administration; requiring the Florida Association of
   81         Community Health Centers, Inc., to provide support and
   82         assume administrative costs for the program; repealing
   83         s. 429.12(2), F.S., relating to the sale or transfer
   84         of ownership of an assisted living facility; repealing
   85         s. 429.23(5), F.S., relating to each assisted living
   86         facility’s requirement to submit a report to the
   87         agency regarding liability claims filed against it;
   88         repealing s. 429.911(2)(a), F.S., relating to grounds
   89         for which the agency may take action against the owner
   90         of an adult day care center or its operator or
   91         employee; providing appropriations from the General
   92         Revenue Fund and the Medical Care Trust Fund to the
   93         Agency for Health Care Administration; providing for a
   94         recurring reduction in appropriations to the
   95         Department of Health; providing a contingency;
   96         providing an effective date.
   98  Be It Enacted by the Legislature of the State of Florida:
  100         Section 1. Paragraph (e) of subsection (10) of section
  101  112.0455, Florida Statutes, is repealed.
  102         Section 2. Section 383.325, Florida Statutes, is repealed.
  103         Section 3. Section 395.1046, Florida Statutes, is repealed.
  104         Section 4. Section 395.3037, Florida Statutes, is repealed.
  105         Section 5. Paragraph (g) of subsection (2) of section
  106  400.0239, Florida Statutes, is amended to read:
  107         400.0239 Quality of Long-Term Care Facility Improvement
  108  Trust Fund.—
  109         (2) Expenditures from the trust fund shall be allowable for
  110  direct support of the following:
  111         (g) Other initiatives authorized by the Centers for
  112  Medicare and Medicaid Services for the use of federal civil
  113  monetary penalties, including projects recommended through the
  114  Medicaid “Up-or-Out” Quality of Care Contract Management Program
  115  pursuant to s. 400.148.
  116         Section 6. Subsection (10) of section 400.147, Florida
  117  Statutes, is repealed.
  118         Section 7. Section 400.148, Florida Statutes, is repealed.
  119         Section 8. Section 400.195, Florida Statutes, is repealed.
  120         Section 9. Section 400.476, Florida Statutes, is amended to
  121  read:
  122         400.476 Staffing requirements; notifications; limitations
  123  on staffing services.—
  124         (1) ADMINISTRATOR.—
  125         (a) An administrator may manage only one home health
  126  agency, except that an administrator may manage up to five home
  127  health agencies if all five home health agencies have identical
  128  controlling interests as defined in s. 408.803 and are located
  129  within one agency geographic service area or within an
  130  immediately contiguous county. If the home health agency is
  131  licensed under this chapter and is part of a retirement
  132  community that provides multiple levels of care, an employee of
  133  the retirement community may administer the home health agency
  134  and up to a maximum of four entities licensed under this chapter
  135  or chapter 429 which all have identical controlling interests as
  136  defined in s. 408.803. An administrator shall designate, in
  137  writing, for each licensed entity, a qualified alternate
  138  administrator to serve during the administrator’s absence. An
  139  alternate administrator must meet the requirements in this
  140  paragraph and s. 400.462(1).
  141         (b) An administrator of a home health agency who is a
  142  licensed physician, physician assistant, or registered nurse
  143  licensed to practice in this state may also be the director of
  144  nursing for a home health agency. An administrator may serve as
  145  a director of nursing for up to the number of entities
  146  authorized in subsection (2) only if there are 10 or fewer full
  147  time equivalent employees and contracted personnel in each home
  148  health agency.
  149         (c) The administrator shall organize and direct the
  150  agency’s ongoing functions, maintain an ongoing liaison with the
  151  board members and the staff, employ qualified personnel and
  152  ensure adequate staff education and evaluations, ensure the
  153  accuracy of public informational materials and activities,
  154  implement an effective budgeting and accounting system, and
  155  ensure that the home health agency operates in compliance with
  156  this part and part II of chapter 408 and rules adopted for these
  157  laws.
  158         (d) The administrator shall clearly set forth in writing
  159  the organizational chart, services furnished, administrative
  160  control, and lines of authority for the delegation of
  161  responsibilities for patient care. These responsibilities must
  162  be readily identifiable. Administrative and supervisory
  163  functions may not be delegated to another agency or
  164  organization, and the primary home health agency shall monitor
  165  and control all services that are not furnished directly,
  166  including services provided through contracts.
  167         (2) DIRECTOR OF NURSING.—
  168         (a) A director of nursing may be the director of nursing
  169  for:
  170         1. Up to two licensed home health agencies if the agencies
  171  have identical controlling interests as defined in s. 408.803
  172  and are located within one agency geographic service area or
  173  within an immediately contiguous county; or
  174         2. Up to five licensed home health agencies if:
  175         a. All of the home health agencies have identical
  176  controlling interests as defined in s. 408.803;
  177         b. All of the home health agencies are located within one
  178  agency geographic service area or within an immediately
  179  contiguous county; and
  180         c. Each home health agency has a registered nurse who meets
  181  the qualifications of a director of nursing and who has a
  182  written delegation from the director of nursing to serve as the
  183  director of nursing for that home health agency when the
  184  director of nursing is not present; and.
  185         d. This person, or similarly qualified alternate, is
  186  available at all times during operating hours and participates
  187  in all activities relevant to the professional services
  188  furnished, including, but not limited to, the oversight of
  189  nursing services, home health aides, and certified nursing
  190  assistants, and assignment of personnel.
  192  If a home health agency licensed under this chapter is part of a
  193  retirement community that provides multiple levels of care, an
  194  employee of the retirement community may serve as the director
  195  of nursing of the home health agency and up to a maximum of four
  196  entities, other than home health agencies, licensed under this
  197  chapter or chapter 429 which all have identical controlling
  198  interests as defined in s. 408.803.
  199         (b) A home health agency that provides skilled nursing care
  200  may not operate for more than 30 calendar days without a
  201  director of nursing. A home health agency that provides skilled
  202  nursing care and the director of nursing of a home health agency
  203  must notify the agency within 10 business days after termination
  204  of the services of the director of nursing for the home health
  205  agency. A home health agency that provides skilled nursing care
  206  must notify the agency of the identity and qualifications of the
  207  new director of nursing within 10 days after the new director is
  208  hired. If a home health agency that provides skilled nursing
  209  care operates for more than 30 calendar days without a director
  210  of nursing, the home health agency commits a class II
  211  deficiency. In addition to the fine for a class II deficiency,
  212  the agency may issue a moratorium in accordance with s. 408.814
  213  or revoke the license. The agency shall fine a home health
  214  agency that fails to notify the agency as required in this
  215  paragraph $1,000 for the first violation and $2,000 for a repeat
  216  violation. The agency may not take administrative action against
  217  a home health agency if the director of nursing fails to notify
  218  the department upon termination of services as the director of
  219  nursing for the home health agency.
  220         (c) A home health agency that is not Medicare or Medicaid
  221  certified and does not provide skilled care or provides only
  222  physical, occupational, or speech therapy is not required to
  223  have a director of nursing and is exempt from paragraph (b).
  224         (3) TRAINING.—A home health agency shall ensure that each
  225  certified nursing assistant employed by or under contract with
  226  the home health agency and each home health aide employed by or
  227  under contract with the home health agency is adequately trained
  228  to perform the tasks of a home health aide in the home setting.
  229         (a) The home health agency may not use as a home health
  230  aide on a full-time, temporary, per diem, or other basis, any
  231  individual to provide services unless the individual has
  232  completed a training and competency evaluation program, or a
  233  competency evaluation program, as permitted in s. 400.497, which
  234  meets the minimum standards established by the agency in state
  235  rules.
  236         (b) A home health aide is not competent in any task for
  237  which he or she is evaluated as “unsatisfactory.” The aide must
  238  perform any such task only under direct supervision by a
  239  licensed nurse until he or she receives training in the task and
  240  satisfactorily passes a subsequent evaluation in performing the
  241  task. A home health aide has not successfully passed a
  242  competency evaluation if the aide does not have a passing score
  243  on the test as specified by agency rule.
  244         (4) STAFFING.—Staffing services may be provided anywhere
  245  within the state.
  246         (5) PERSONNEL.—
  247         (a) The home health agency and its staff must comply with
  248  accepted professional standards and principles that apply to
  249  professionals, including, but not limited to, the state practice
  250  acts and the home health agency’s policies and procedures.
  251         (b) If personnel under hourly or per-visit contracts are
  252  used by the home health agency, there must be a written contract
  253  between those personnel and the agency which specifies the
  254  following requirements:
  255         1. Acceptance for care only of patients by the primary home
  256  health agency.
  257         2. The services to be furnished.
  258         3. The necessity to conform to all applicable agency
  259  policies, including personnel qualifications.
  260         4. The responsibility for participating in developing plans
  261  of care.
  262         5. The manner in which services are controlled,
  263  coordinated, and evaluated by the primary home health agency.
  264         6. The procedures for submitting clinical and progress
  265  notes, scheduling of visits, and periodic patient evaluation.
  266         7. The procedures for payment for services furnished under
  267  the contract.
  268         (c) A home health agency shall directly provide at least
  269  one of the types of services through home health agency
  270  employees, but may provide additional services under
  271  arrangements with another agency or organization. Services
  272  furnished under such arrangements must have a written contract
  273  conforming to the requirements specified in paragraph (b).
  274         (d) If home health aide services are provided by an
  275  individual who is not employed directly by the home health
  276  agency, the services of the home health aide must be provided
  277  under arrangements as stated in paragraphs (b) and (c). If the
  278  home health agency chooses to provide home health aide services
  279  under arrangements with another organization, the
  280  responsibilities of the home health agency include, but are not
  281  limited to:
  282         1. Ensuring the overall quality of the care provided by the
  283  aide;
  284         2. Supervising the aide’s services as described in s.
  285  400.487; and
  286         3. Ensuring that each home health aide providing services
  287  under arrangements with another organization has met the
  288  training requirements or competency evaluation requirements of
  289  s. 400.497.
  290         (e) The home health agency shall coordinate the efforts of
  291  all personnel furnishing services, and the personnel shall
  292  maintain communication with the home health agency to ensure
  293  that personnel efforts support the objectives outlined in the
  294  plan of care. The clinical record or minutes of case conferences
  295  shall ensure that effective interchange, reporting, and
  296  coordination of patient care occurs.
  297         Section 10. Section 400.487, Florida Statutes, is amended
  298  to read:
  299         400.487 Home health service agreements; physician’s,
  300  physician assistant’s, and advanced registered nurse
  301  practitioner’s treatment orders; patient assessment;
  302  establishment and review of plan of care; provision of services;
  303  orders not to resuscitate.—
  304         (1) Services provided by a home health agency must be
  305  covered by an agreement between the home health agency and the
  306  patient or the patient’s legal representative specifying the
  307  home health services to be provided, the rates or charges for
  308  services paid with private funds, and the sources of payment,
  309  which may include Medicare, Medicaid, private insurance,
  310  personal funds, or a combination thereof. The home health agency
  311  shall provide a copy of the agreement to the patient or the
  312  patient’s legal representative. A home health agency providing
  313  skilled care must make an assessment of the patient’s needs
  314  within 48 hours after the start of services.
  315         (2) When required by the provisions of chapter 464; part I,
  316  part III, or part V of chapter 468; or chapter 486, the
  317  attending physician, physician assistant, or advanced registered
  318  nurse practitioner, acting within his or her respective scope of
  319  practice, shall establish treatment orders for a patient who is
  320  to receive skilled care. The treatment orders must be signed by
  321  the physician, physician assistant, or advanced registered nurse
  322  practitioner before a claim for payment for the skilled services
  323  is submitted by the home health agency. If the claim is
  324  submitted to a managed care organization, the treatment orders
  325  must be signed within the time allowed under the provider
  326  agreement. The treatment orders shall be reviewed, as frequently
  327  as the patient’s illness requires, by the physician, physician
  328  assistant, or advanced registered nurse practitioner in
  329  consultation with the home health agency.
  330         (3) A home health agency shall arrange for supervisory
  331  visits by a registered nurse to the home of a patient receiving
  332  home health aide services as specified in subsection (9) in
  333  accordance with the patient’s direction, approval, and agreement
  334  to pay the charge for the visits.
  335         (4) The home health agency shall protect and promote the
  336  rights of each individual under its care, including each of the
  337  following rights:
  338         (a) Notice of rights.—The home health agency shall provide
  339  the patient with a written notice of the patient’s rights in
  340  advance of furnishing care to the patient or during the initial
  341  evaluation visit before the initiation of treatment. The home
  342  health agency must maintain documentation showing that it has
  343  complied with the requirements of this section.
  344         (b) Exercise of rights and respect for property and
  345  person.
  346         1. The patient has the right to exercise his or her rights
  347  as a patient of the home health agency.
  348         2. The patient has the right to have his or her property
  349  treated with respect.
  350         3. The patient has the right to voice grievances regarding
  351  treatment or care that is or fails to be furnished, or regarding
  352  the lack of respect for property by anyone who is furnishing
  353  services on behalf of the home health agency, and not be
  354  subjected to discrimination or reprisal for doing so.
  355         4. The home health agency must investigate complaints made
  356  by a patient or the patient’s family or guardian regarding
  357  treatment or care that is or fails to be furnished, or regarding
  358  the lack of respect for the patient’s property by anyone
  359  furnishing services on behalf of the home health agency. The
  360  home health agency shall document the existence of the complaint
  361  and its resolution.
  362         5. The patient and his or her immediate family or
  363  representative must be informed of the right to report
  364  complaints via the statewide toll-free telephone number to the
  365  agency as required in s. 408.810.
  366         (c) Right to be informed and to participate in planning
  367  care and treatment.
  368         1. The patient has the right to be informed, in advance,
  369  about the care to be furnished and of any changes in the care to
  370  be furnished. The home health agency shall advise the patient in
  371  advance of which disciplines will furnish care and the frequency
  372  of visits proposed to be furnished. The home health agency must
  373  advise the patient in advance of any change in the plan of care
  374  before the change is made.
  375         2. The patient has the right to participate in the planning
  376  of the care. The home health agency must advise the patient in
  377  advance of the right to participate in planning the care or
  378  treatment and in planning changes in the care or treatment. Each
  379  patient has the right to be informed of and to participate in
  380  the planning of his or her care. Each patient must be provided,
  381  upon request, a copy of the plan of care established and
  382  maintained for that patient by the home health agency.
  383         (5) When nursing services are ordered, the home health
  384  agency to which a patient has been admitted for care must
  385  provide the initial admission visit, all service evaluation
  386  visits, and the discharge visit by a direct employee. Services
  387  provided by others under contractual arrangements to a home
  388  health agency must be monitored and managed by the admitting
  389  home health agency. The admitting home health agency is fully
  390  responsible for ensuring that all care provided through its
  391  employees or contract staff is delivered in accordance with this
  392  part and applicable rules.
  393         (6) The skilled care services provided by a home health
  394  agency, directly or under contract, must be supervised and
  395  coordinated in accordance with the plan of care. The home health
  396  agency shall furnish skilled nursing services by or under the
  397  supervision of a registered nurse and in accordance with the
  398  plan of care. Any therapy services offered directly or under
  399  arrangement by the home health agency must be provided by a
  400  qualified therapist or by a qualified therapy assistant under
  401  the supervision of a qualified therapist and in accordance with
  402  the plan of care.
  403         (a) Duties and qualifications.—A qualified therapist shall
  404  assist the physician in evaluating the level of function, help
  405  develop or revise the plan of care, prepare clinical and
  406  progress notes, advise and consult with the family and other
  407  agency personnel, and participate in in-service programs. The
  408  therapist or therapy assistant must meet the qualifications in
  409  the state practice acts and related applicable rules.
  410         (b) Physical therapy assistants and occupational therapy
  411  assistants.—Services provided by a physical therapy assistant or
  412  occupational therapy assistant must be under the supervision of
  413  a qualified physical therapist or occupational therapist as
  414  required in chapter 486 and part III of chapter 468,
  415  respectively, and related applicable rules. A physical therapy
  416  assistant or occupational therapy assistant shall perform
  417  services planned, delegated, and supervised by the therapist,
  418  assist in preparing clinical notes and progress reports,
  419  participate in educating the patient and his or her family, and
  420  participate in in-service programs.
  421         (c) Speech therapy services.—Speech therapy services shall
  422  be furnished only by or under supervision of a qualified speech
  423  pathologist or audiologist as required in part I of chapter 468
  424  and related applicable rules.
  425         (d) Care follows a written plan of care.—The plan of care
  426  shall be reviewed by the physician or health professional who
  427  provided the treatment orders pursuant to subsection (2) and
  428  home health agency personnel as often as the severity of the
  429  patient’s condition requires, but at least once every 60 days or
  430  more when there is a patient-elected transfer, a significant
  431  change in condition, or a discharge and return to the same home
  432  health agency during the 60-day episode. Professional staff of a
  433  home health agency shall promptly alert the physician or other
  434  health professional who provided the treatment orders of any
  435  change that suggests a need to alter the plan of care.
  436         (e) Administration of drugs and treatment.—Only
  437  professional staff of a home health agency may administer drugs
  438  and treatments as ordered by the physician or health
  439  professional pursuant to subsection (2), with the exception of
  440  influenza and pneumococcal polysaccharide vaccines, which may be
  441  administered according to the policy of the home health agency
  442  developed in consultation with a physician and after an
  443  assessment for contraindications. Verbal orders shall be in
  444  writing and signed and dated with the date of receipt by the
  445  registered nurse or qualified therapist who is responsible for
  446  furnishing or supervising the ordered service. A verbal order
  447  may be accepted only by personnel who are authorized to do so by
  448  applicable state laws, rules, and internal policies of the home
  449  health agency.
  450         (7) A registered nurse shall conduct the initial evaluation
  451  visit, regularly reevaluate the patient’s nursing needs,
  452  initiate the plan of care and necessary revisions, furnish those
  453  services requiring substantial and specialized nursing skill,
  454  initiate appropriate preventive and rehabilitative nursing
  455  procedures, prepare clinical and progress notes, coordinate
  456  services, inform the physician and other personnel of changes in
  457  the patient’s condition and needs, counsel the patient and his
  458  or her family in meeting nursing and related needs, participate
  459  in in-service programs, and supervise and teach other nursing
  460  personnel, unless the home health agency providing the home
  461  health aide services is not Medicare-certified or Medicaid
  462  certified and does not provide skilled care.
  463         (8) A licensed practical nurse shall furnish services in
  464  accordance with agency policies, prepare clinical and progress
  465  notes, assist the physician and registered nurse in performing
  466  specialized procedures, prepare equipment and materials for
  467  treatments observing aseptic technique as required, and assist
  468  the patient in learning appropriate self-care techniques.
  469         (9) A home health aide and certified nursing assistant
  470  shall provide services that are in the service provision plan
  471  provided in s. 400.491 and other services that the home health
  472  aide or certified nursing assistant is permitted to perform
  473  under state law. The duties of a home health aide or certified
  474  nursing assistant include the provision of hands-on personal
  475  care, performance of simple procedures as an extension of
  476  therapy or nursing services, assistance in ambulation or
  477  exercises, and assistance in administering medications that are
  478  ordinarily self-administered and are specified in agency rules.
  479  Any services by a home health aide which are offered by a home
  480  health agency must be provided by a qualified home health aide
  481  or certified nursing assistant.
  482         (a) Assignment and duties.—A home health aide or certified
  483  nursing assistant shall be assigned to a specific patient by a
  484  registered nurse, unless the home health agency providing the
  485  home health aide services is not Medicare-certified or Medicaid
  486  certified and does not provide skilled care. Written patient
  487  care instructions for the home health aide and certified nursing
  488  assistant must be prepared by the registered nurse or other
  489  appropriate professional who is responsible for the supervision
  490  of the home health aide and certified nursing assistant as
  491  stated in this section.
  492         (b) Supervision.—If a patient receives skilled nursing
  493  care, the registered nurse shall perform the supervisory visit.
  494  If the patient is not receiving skilled nursing care but is
  495  receiving physical therapy, occupational therapy, or speech
  496  language pathology services, the appropriate therapist may
  497  provide the supervision. A registered nurse or other
  498  professional must make an onsite visit to the patient’s home at
  499  least once every 2 weeks. The visit is not required while the
  500  aide is providing care.
  501         (c) Supervising visits.—If home health aide services are
  502  provided to a patient who is not receiving skilled nursing care,
  503  physical or occupational therapy, or speech-language pathology
  504  services, a registered nurse must make a supervisory visit to
  505  the patient’s home at least once every 60 days, unless the home
  506  health agency providing the home health aide services is not
  507  Medicare or Medicaid certified and does not provide skilled
  508  care, either directly or through contracts. The registered nurse
  509  shall ensure that the aide is properly caring for the patient
  510  and each supervisory visit must occur while the home health aide
  511  is providing patient care. In addition to the requirements in
  512  this subsection, a home health agency shall arrange for
  513  additional supervisory visits by a registered nurse to the home
  514  of a patient receiving home health aide services in accordance
  515  with the patient’s direction, approval, and agreement to pay the
  516  charge for the visits.
  517         (10)(7) Home health agency personnel may withhold or
  518  withdraw cardiopulmonary resuscitation if presented with an
  519  order not to resuscitate executed pursuant to s. 401.45. The
  520  agency shall adopt rules providing for the implementation of
  521  such orders. Home health personnel and agencies shall not be
  522  subject to criminal prosecution or civil liability, nor be
  523  considered to have engaged in negligent or unprofessional
  524  conduct, for withholding or withdrawing cardiopulmonary
  525  resuscitation pursuant to such an order and rules adopted by the
  526  agency.
  527         Section 11. Subsection (11) of section 408.802, Florida
  528  Statutes, is repealed.
  529         Section 12. Paragraphs (e), (f), and (g) of subsection (15)
  530  of section 409.912, Florida Statutes, are repealed.
  531         Section 13. Section 409.91255, Florida Statutes, is amended
  532  to read:
  533         409.91255 Federally qualified health center access
  534  program.—
  535         (1) SHORT TITLE.—This section may be cited as the
  536  “Community Health Center Access Program Act.”
  538         (a) The Legislature finds that, despite significant
  539  investments in health care programs, nearly 6 more than 2
  540  million low-income Floridians, primarily the working poor and
  541  minority populations, continue to lack access to basic health
  542  care services. Further, the Legislature recognizes that
  543  federally qualified health centers have a proven record of
  544  providing cost-effective, comprehensive primary and preventive
  545  health care and are uniquely qualified to address the lack of
  546  adequate health care services for the uninsured.
  547         (b) It is the intent of the Legislature to recognize the
  548  significance of increased federal investments in federally
  549  qualified health centers and to leverage that investment through
  550  the creation of a program to provide for the expansion of the
  551  primary and preventive health care services offered by federally
  552  qualified health centers. Further, such a program will support
  553  the coordination of federal, state, and local resources to
  554  assist such health centers in developing an expanded community
  555  based primary care delivery system.
  557  agency shall administer Department of Health shall develop a
  558  program for the expansion of federally qualified health centers
  559  for the purpose of providing comprehensive primary and
  560  preventive health care and urgent care services that may reduce
  561  the morbidity, mortality, and cost of care among the uninsured
  562  population of the state. The program shall provide for
  563  distribution of financial assistance to federally qualified
  564  health centers that apply and demonstrate a need for such
  565  assistance in order to sustain or expand the delivery of primary
  566  and preventive health care services. In selecting centers to
  567  receive this financial assistance, the program:
  568         (a) Shall give preference to communities that have few or
  569  no community-based primary care services or in which the current
  570  services are unable to meet the community’s needs. To assist in
  571  the assessment and identification of areas of critical need, a
  572  federally qualified health-center-based statewide assessment and
  573  strategic plan shall be developed by the Florida Association of
  574  Community Health Centers, Inc., every 5 years, beginning January
  575  1, 2011.
  576         (b) Shall require that primary care services be provided to
  577  the medically indigent using a sliding fee schedule based on
  578  income.
  579         (c) Shall promote allow innovative and creative uses of
  580  federal, state, and local health care resources.
  581         (d) Shall require that the funds provided be used to pay
  582  for operating costs of a projected expansion in patient
  583  caseloads or services or for capital improvement projects.
  584  Capital improvement projects may include renovations to existing
  585  facilities or construction of new facilities, provided that an
  586  expansion in patient caseloads or services to a new patient
  587  population will occur as a result of the capital expenditures.
  588  The agency department shall include in its standard contract
  589  document a requirement that any state funds provided for the
  590  purchase of or improvements to real property are contingent upon
  591  the contractor granting to the state a security interest in the
  592  property at least to the amount of the state funds provided for
  593  at least 5 years from the date of purchase or the completion of
  594  the improvements or as further required by law. The contract
  595  must include a provision that, as a condition of receipt of
  596  state funding for this purpose, the contractor agrees that, if
  597  it disposes of the property before the agency’s department’s
  598  interest is vacated, the contractor will refund the
  599  proportionate share of the state’s initial investment, as
  600  adjusted by depreciation.
  601         (e) Shall May require in-kind support from other sources.
  602         (f) Shall promote May encourage coordination among
  603  federally qualified health centers, other private sector
  604  providers, and publicly supported programs.
  605         (g) Shall promote allow the development of community
  606  emergency room diversion programs in conjunction with local
  607  resources, providing extended hours of operation to urgent care
  608  patients. Diversion programs shall include case management for
  609  emergency room followup care.
  610         (4) EVALUATION OF APPLICATIONS.—A review panel shall be
  611  established, consisting of four persons appointed by the
  612  Secretary of Health Care Administration State Surgeon General
  613  and three persons appointed by the chief executive officer of
  614  the Florida Association of Community Health Centers, Inc., to
  615  review all applications for financial assistance under the
  616  program. Applicants shall specify in the application whether the
  617  program funds will be used for the expansion of patient
  618  caseloads or services or for capital improvement projects to
  619  expand and improve patient facilities. The panel shall use the
  620  following elements in reviewing application proposals and shall
  621  determine the relative weight for scoring and evaluating these
  622  elements:
  623         (a) The target population to be served.
  624         (b) The health benefits to be provided.
  625         (c) The methods that will be used to measure cost
  626  effectiveness.
  627         (d) How patient satisfaction will be measured.
  628         (e) The proposed internal quality assurance process.
  629         (f) Projected health status outcomes.
  630         (g) How data will be collected to measure cost
  631  effectiveness, health status outcomes, and overall achievement
  632  of the goals of the proposal.
  633         (h) All resources, including cash, in-kind, voluntary, or
  634  other resources that will be dedicated to the proposal.
  636  shall Department of Health may contract with the Florida
  637  Association of Community Health Centers, Inc., to develop and
  638  coordinate administer the program and provide technical
  639  assistance to the federally qualified health centers selected to
  640  receive financial assistance. The contracted entity shall be
  641  responsible for program support and assume all costs related to
  642  administration of this program.
  643         Section 14. Subsection (2) of section 429.12, Florida
  644  Statutes, is repealed.
  645         Section 15. Subsection (5) of section 429.23, Florida
  646  Statutes, is repealed.
  647         Section 16. Paragraph (a) of subsection (2) of section
  648  429.911, Florida Statutes, is repealed.
  649         Section 17. (1)In addition to the appropriations contained
  650  in the General Appropriations Act for the 2010-2011 fiscal year,
  651  one full-time equivalent position and salary rate of 52,554 are
  652  authorized for and the sums of $75,000 from the General Revenue
  653  Fund and $75,000 from the Medical Care Trust Fund are
  654  appropriated to the Agency for Health Care Administration.
  655         (2) Notwithstanding the appropriations authorized in the
  656  General Appropriations Act for the 2010-2011 fiscal year for the
  657  Department of Health, one full-time equivalent position is
  658  abolished, salary rate is reduced by 52,554, and appropriations
  659  from the General Revenue Fund are reduced on a recurring basis
  660  by $75,000.
  661         (3) The appropriations made in subsection (1) are
  662  contingent upon the adjustments to appropriations made in
  663  subsection (2) becoming law.
  664         Section 18. This act shall take effect July 1, 2010.

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