January 22, 2018
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       Florida Senate - 2009                                    SB 2286
       
       
       
       By Senator Gardiner
       
       
       
       
       9-01044A-09                                           20092286__
    1                        A bill to be entitled                      
    2         An act relating to licensure of health-care-related
    3         facilities; repealing s. 395.0199, F.S., relating to
    4         private utilization review in health care; amending
    5         ss. 395.405 and 400.0712, F.S.; conforming cross
    6         references to changes made by the act; repealing s.
    7         400.141(16), F.S., relating to a licensed facility's
    8         requirement to report the number of vacant beds in its
    9         facility which are available for resident occupancy;
   10         amending s. 400.147, F.S.; redefining the term
   11         “adverse incident”; deleting the agency's requirement
   12         to submit a report to the Legislature on adverse
   13         incidents occurring at nursing homes; amending s.
   14         400.195, F.S.; conforming a cross-reference; amending
   15         s. 400.464, F.S.; revising provisions relating to the
   16         licensure of home health agencies to conform to
   17         changes made by the act; amending s. 400.497, F.S.;
   18         conforming a cross-reference to changes made by the
   19         act; amending s. 400.506, F.S.; revising provisions
   20         relating to the licensure of nurse registries to
   21         conform to changes made by the act; repealing s.
   22         400.509, F.S., relating to registration of particular
   23         service providers that are exempt from licensure,
   24         certificates of registration, and regulation of
   25         registrants; amending s. 400.512, F.S.; revising
   26         provisions relating to the screening of home health
   27         agency personnel to conform to changes made by the
   28         act; amending s. 400.9935, F.S.; revising the legal
   29         responsibilities of a medical or clinic director of a
   30         health care clinic; revising the accreditation
   31         requirements for a clinic that is engaged in magnetic
   32         resonance imaging services; repealing s. 400.995,
   33         F.S., relating to agency administrative penalties;
   34         amending s. 408.803, F.S.; redefining the term “change
   35         of ownership” with regard to the Health Care Licensing
   36         Procedures Act; amending s. 408.806, F.S.; revising
   37         the license application process; authorizing the
   38         agency to provide electronic access to information or
   39         documents; amending s. 408.807, F.S.; revising the
   40         process to change ownership of certain health care
   41         facilities; amending s. 408.808, F.S.; authorizing the
   42         issuance of a provisional license to an applicant
   43         submitting an application for a change of ownership;
   44         amending s. 408.809, F.S.; revising the requirements
   45         for the background screening of applicants; providing
   46         an exception for rescreening; authorizing a person who
   47         has a disqualifying offense to continue to perform his
   48         or her duties under certain circumstances pending the
   49         outcome of the application for exemption; amending s.
   50         408.810, F.S.; revising minimum licensure
   51         requirements; amending s. 408.811, F.S.; revising
   52         inspection requirements; authorizing the agency to
   53         require an applicant or licensee to submit a plan of
   54         correction for deficiencies; amending s. 408.813,
   55         F.S.; classifying violations of the Health Care
   56         Licensing Procedures Act; amending s. 408.820, F.S.;
   57         conforming cross-references to changes made by the
   58         act; creating s. 408.821, F.S.; providing for
   59         emergency management planning; authorizing the
   60         issuance of an inactive license under certain
   61         circumstances; providing requirements for an inactive
   62         license; authorizing the agency to establish rules
   63         related to emergency management planning in
   64         consultation with the Department of Community Affairs;
   65         repealing s. 408.831(3) and (4), F.S., relating to the
   66         denial, suspension, or revocation of a license, or
   67         change of ownership; amending s. 409.901, F.S.;
   68         redefining the term “change of ownership” as it
   69         relates to the Medicaid program in this state;
   70         repealing s. 429.071, F.S., relating to a pilot
   71         program for an intergenerational respite care assisted
   72         living facility; amending s. 429.08, F.S.; authorizing
   73         the agency to provide certain information
   74         electronically or through the agency's website to
   75         referral providers, the Department of Children and
   76         Family Services, and the Department of Elderly
   77         Affairs; deleting the provision that required the
   78         field offices of the agency to establish local
   79         coordinating workgroups; amending s. 429.19, F.S.;
   80         revising the classification of violations; deleting a
   81         provision that requires the agency to make a
   82         reasonable attempt to discuss violations and recommend
   83         corrective actions to the owner or administrator of a
   84         facility; authorizing the agency to provide a list of
   85         sanctioned facilities electronically or through the
   86         agency's Internet site; amending s. 429.23, F.S.;
   87         redefining the term “adverse incident” with regard to
   88         the Assisted Living Facilities Act; deleting the
   89         agency's requirement to submit a report on reports of
   90         adverse incidents occurring at assisted living
   91         facilities; requiring that incidents of abuse,
   92         neglect, or exploitation be reported to the Department
   93         of Children and Family Services; repealing s.
   94         429.26(9), F.S., relating to the appropriateness of
   95         admission of an individual to an assisted care
   96         facility; amending s. 435.04, F.S.; authorizing
   97         certain employees of nursing homes, assisted care
   98         facilities, and related health care facilities to
   99         submit an affidavit of compliance with regard to
  100         background screening at the time of relicensure to the
  101         licensing agency; amending s. 435.05, F.S.;
  102         authorizing each employer that is required to conduct
  103         level 2 background screening to sign an affidavit at
  104         the time of relicensure; amending s. 483.031, F.S.;
  105         revising provisions relating to the exemption of
  106         certain clinical laboratories, to conform to changes
  107         made by the act; amending s. 483.041, F.S.; defining
  108         the term “waived test” as a test that the federal
  109         Centers for Medicare and Medicaid Services, rather
  110         than the Health Care Financing Administration, has
  111         determined qualifies for a certificate of waiver;
  112         repealing s. 483.106, F.S., relating to the
  113         application for a certificate of exemption for certain
  114         clinical laboratories; amending s. 483.172, F.S.;
  115         revising a provision relating to the assessment of a
  116         licensing fee for a certificate of exemption to
  117         conform to changes made by the act; amending s.
  118         483.23, F.S.; revising provisions relating to offenses
  119         regarding a clinical laboratory license to conform to
  120         changes made by the act; providing an effective date.
  121  
  122  Be It Enacted by the Legislature of the State of Florida:
  123  
  124         Section 1. Section 395.0199, Florida Statutes, is repealed.
  125         Section 2. Section 395.405, Florida Statutes, is amended to
  126  read:
  127         395.405 Rulemaking.—The department shall adopt and enforce
  128  all rules necessary to administer ss. 395.0199, 395.401,
  129  395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
  130         Section 3. Subsection (1) of section 400.0712, Florida
  131  Statutes, is amended to read:
  132         400.0712 Application for inactive license.—
  133         (1) As specified in s. 408.831(4) and this section, The
  134  agency may issue an inactive license to a nursing home facility
  135  for all or a portion of its beds. Any request by a licensee that
  136  a nursing home or portion of a nursing home become inactive must
  137  be submitted to the agency in the approved format. The facility
  138  may not initiate any suspension of services, notify residents,
  139  or initiate inactivity before receiving approval from the
  140  agency; and a licensee that violates this provision may not be
  141  issued an inactive license.
  142         Section 4. Subsection (16) of section 400.141, Florida
  143  Statutes, is repealed.
  144         Section 5. Subsections (5), (9), (10), (11), (12), (13),
  145  and (14) of section 400.147, Florida Statutes, are amended to
  146  read:
  147         400.147 Internal risk management and quality assurance
  148  program.—
  149         (5) For purposes of reporting to the agency under this
  150  section, the term “adverse incident” means:
  151         (a) An event over which facility personnel could exercise
  152  control and which is associated in whole or in part with the
  153  facility's intervention, rather than the condition for which
  154  such intervention occurred, and which results in one of the
  155  following:
  156         1. Death;
  157         2. Brain or spinal damage;
  158         3. Permanent disfigurement;
  159         4. Fracture or dislocation of bones or joints;
  160         5. A limitation of neurological, physical, or sensory
  161  function;
  162         6. Any condition that required medical attention to which
  163  the resident has not given his or her informed consent,
  164  including failure to honor advanced directives; or
  165         7. Any condition that required the transfer of the
  166  resident, within or outside the facility, to a unit providing a
  167  more acute level of care due to the adverse incident, rather
  168  than the resident's condition prior to the adverse incident; or
  169         8.An event that is reported to a law enforcement agency or
  170  its personnel; or
  171         (b)Abuse, neglect, or exploitation as defined in s.
  172  415.102;
  173         (c)Abuse, neglect and harm as defined in s. 39.01;
  174         (b)(d) Resident elopement, if the elopement places the
  175  resident at risk of harm or injury.; or
  176         (e)An event that is reported to law enforcement.
  177         (9)Abuse, neglect, or exploitation must be reported to the
  178  agency as required by 42 C.F.R. s. 483.13(c), and to the
  179  Department of Children and Family Services as required by
  180  chapters 39 and 415.
  181         (10)(9) By the 10th of each month, each facility subject to
  182  this section shall report any notice received pursuant to s.
  183  400.0233(2) and each initial complaint that was filed with the
  184  clerk of the court and served on the facility during the
  185  previous month by a resident or a resident's family member,
  186  guardian, conservator, or personal legal representative. The
  187  report must include the name of the resident, the resident's
  188  date of birth and social security number, the Medicaid
  189  identification number for Medicaid-eligible persons, the date or
  190  dates of the incident leading to the claim or dates of
  191  residency, if applicable, and the type of injury or violation of
  192  rights alleged to have occurred. Each facility shall also submit
  193  a copy of the notices received pursuant to s. 400.0233(2) and
  194  complaints filed with the clerk of the court. This report is
  195  confidential as provided by law and is not discoverable or
  196  admissible in any civil or administrative action, except in such
  197  actions brought by the agency to enforce the provisions of this
  198  part.
  199         (11)(10) The agency shall review, as part of its licensure
  200  inspection process, the internal risk management and quality
  201  assurance program at each facility regulated by this section to
  202  determine whether the program meets standards established in
  203  statutory laws and rules, is being conducted in a manner
  204  designed to reduce adverse incidents, and is appropriately
  205  reporting incidents as required by this section.
  206         (12)(11) There is no monetary liability on the part of, and
  207  a cause of action for damages may not arise against, any risk
  208  manager for the implementation and oversight of the internal
  209  risk management and quality assurance program in a facility
  210  licensed under this part as required by this section, or for any
  211  act or proceeding undertaken or performed within the scope of
  212  the functions of such internal risk management and quality
  213  assurance program if the risk manager acts without intentional
  214  fraud.
  215         (13)(12) If the agency, through its receipt of the adverse
  216  incident reports prescribed in subsection (7), or through any
  217  investigation, has a reasonable belief that conduct by a staff
  218  member or employee of a facility is grounds for disciplinary
  219  action by the appropriate regulatory board, the agency shall
  220  report this fact to the regulatory board.
  221         (14)(13) The agency may adopt rules to administer this
  222  section.
  223         (14)The agency shall annually submit to the Legislature a
  224  report on nursing home adverse incidents. The report must
  225  include the following information arranged by county:
  226         (a)The total number of adverse incidents.
  227         (b)A listing, by category, of the types of adverse
  228  incidents, the number of incidents occurring within each
  229  category, and the type of staff involved.
  230         (c)A listing, by category, of the types of injury caused
  231  and the number of injuries occurring within each category.
  232         (d)Types of liability claims filed based on an adverse
  233  incident or reportable injury.
  234         (e)Disciplinary action taken against staff, categorized by
  235  type of staff involved.
  236         Section 6. Paragraph (d) of subsection (1) of section
  237  400.195, Florida Statutes, is amended to read:
  238         400.195 Agency reporting requirements.—
  239         (1) For the period beginning June 30, 2001, and ending June
  240  30, 2005, the Agency for Health Care Administration shall
  241  provide a report to the Governor, the President of the Senate,
  242  and the Speaker of the House of Representatives with respect to
  243  nursing homes. The first report shall be submitted no later than
  244  December 30, 2002, and subsequent reports shall be submitted
  245  every 6 months thereafter. The report shall identify facilities
  246  based on their ownership characteristics, size, business
  247  structure, for-profit or not-for-profit status, and any other
  248  characteristics the agency determines useful in analyzing the
  249  varied segments of the nursing home industry and shall report: 
  250         (d) Information regarding deficiencies cited, including
  251  information used to develop the Nursing Home Guide WATCH LIST
  252  pursuant to s. 400.191, and applicable rules, a summary of data
  253  generated on nursing homes by Centers for Medicare and Medicaid
  254  Services Nursing Home Quality Information Project, and
  255  information collected pursuant to s. 400.147(10) s. 400.147(9),
  256  relating to litigation.
  257         Section 7. Paragraph (a) of subsection (4) of section
  258  400.464, Florida Statutes, is amended to read:
  259         400.464 Home health agencies to be licensed; expiration of
  260  license; exemptions; unlawful acts; penalties.—
  261         (4)(a) An organization that offers or advertises to the
  262  public any service for which licensure or registration is
  263  required under this part must include in the advertisement the
  264  license number or registration number issued to the organization
  265  by the agency. The agency shall assess a fine of not less than
  266  $100 to any licensee or registrant who fails to include the
  267  license or registration number when submitting the advertisement
  268  for publication, broadcast, or printing. The fine for a second
  269  or subsequent offense is $500. The holder of a license issued
  270  under this part may not advertise or indicate to the public that
  271  it holds a home health agency or nurse registry license other
  272  than the one it has been issued.
  273         Section 8. Section 400.497, Florida Statutes, is amended to
  274  read:
  275         400.497 Rules establishing minimum standards.—The agency
  276  shall adopt, publish, and enforce rules to implement part II of
  277  chapter 408 and this part, including, as applicable, s. 400.506
  278  ss. 400.506 and 400.509, which must provide reasonable and fair
  279  minimum standards relating to:
  280         (1) The home health aide competency test and home health
  281  aide training. The agency shall create the home health aide
  282  competency test and establish the curriculum and instructor
  283  qualifications for home health aide training. Licensed home
  284  health agencies may provide this training and shall furnish
  285  documentation of such training to other licensed home health
  286  agencies upon request. Successful passage of the competency test
  287  by home health aides may be substituted for the training
  288  required under this section and any rule adopted pursuant
  289  thereto.
  290         (2) Shared staffing. The agency shall allow shared staffing
  291  if the home health agency is part of a retirement community that
  292  provides multiple levels of care, is located on one campus, is
  293  licensed under this chapter or chapter 429, and otherwise meets
  294  the requirements of law and rule.
  295         (3) The criteria for the frequency of onsite licensure
  296  surveys.
  297         (4) Licensure application and renewal.
  298         (5) Oversight by the director of nursing. The agency shall
  299  develop rules related to:
  300         (a) Standards that address oversight responsibilities by
  301  the director of nursing of skilled nursing and personal care
  302  services provided by the home health agency's staff;
  303         (b) Requirements for a director of nursing to provide to
  304  the agency, upon request, a certified daily report of the home
  305  health services provided by a specified direct employee or
  306  contracted staff member on behalf of the home health agency. The
  307  agency may request a certified daily report only for a period
  308  not to exceed 2 years prior to the date of the request; and
  309         (c) A quality assurance program for home health services
  310  provided by the home health agency.
  311         (6) Conditions for using a recent unannounced licensure
  312  inspection for the inspection required in s. 408.806 related to
  313  a licensure application associated with a change in ownership of
  314  a licensed home health agency.
  315         (7) The requirements for onsite and electronic
  316  accessibility of supervisory personnel of home health agencies.
  317         (8) Information to be included in patients' records.
  318         (9) Geographic service areas.
  319         (10) Preparation of a comprehensive emergency management
  320  plan pursuant to s. 400.492.
  321         (a) The Agency for Health Care Administration shall adopt
  322  rules establishing minimum criteria for the plan and plan
  323  updates, with the concurrence of the Department of Health and in
  324  consultation with the Department of Community Affairs.
  325         (b) The rules must address the requirements in s. 400.492.
  326  In addition, the rules shall provide for the maintenance of
  327  patient-specific medication lists that can accompany patients
  328  who are transported from their homes.
  329         (c) The plan is subject to review and approval by the
  330  county health department. During its review, the county health
  331  department shall contact state and local health and medical
  332  stakeholders when necessary. The county health department shall
  333  complete its review to ensure that the plan is in accordance
  334  with the criteria in the Agency for Health Care Administration
  335  rules within 90 days after receipt of the plan and shall approve
  336  the plan or advise the home health agency of necessary
  337  revisions. If the home health agency fails to submit a plan or
  338  fails to submit the requested information or revisions to the
  339  county health department within 30 days after written
  340  notification from the county health department, the county
  341  health department shall notify the Agency for Health Care
  342  Administration. The agency shall notify the home health agency
  343  that its failure constitutes a deficiency, subject to a fine of
  344  $5,000 per occurrence. If the plan is not submitted, information
  345  is not provided, or revisions are not made as requested, the
  346  agency may impose the fine.
  347         (d) For any home health agency that operates in more than
  348  one county, the Department of Health shall review the plan,
  349  after consulting with state and local health and medical
  350  stakeholders when necessary. The department shall complete its
  351  review within 90 days after receipt of the plan and shall
  352  approve the plan or advise the home health agency of necessary
  353  revisions. The department shall make every effort to avoid
  354  imposing differing requirements on a home health agency that
  355  operates in more than one county as a result of differing or
  356  conflicting comprehensive plan requirements of the counties in
  357  which the home health agency operates.
  358         (e) The requirements in this subsection do not apply to:
  359         1. A facility that is certified under chapter 651 and has a
  360  licensed home health agency used exclusively by residents of the
  361  facility; or
  362         2. A retirement community that consists of residential
  363  units for independent living and either a licensed nursing home
  364  or an assisted living facility, and has a licensed home health
  365  agency used exclusively by the residents of the retirement
  366  community, provided the comprehensive emergency management plan
  367  for the facility or retirement community provides for continuous
  368  care of all residents with special needs during an emergency.
  369         Section 9. Paragraph (a) of subsection (6) of section
  370  400.506, Florida Statutes, is amended to read:
  371         400.506 Licensure of nurse registries; requirements;
  372  penalties.—
  373         (6)(a) A nurse registry may refer for contract in private
  374  residences registered nurses and licensed practical nurses
  375  registered and licensed under part I of chapter 464, certified
  376  nursing assistants certified under part II of chapter 464, home
  377  health aides who present documented proof of successful
  378  completion of the training required by rule of the agency, and
  379  companions or homemakers for the purposes of providing those
  380  services authorized under s. 400.509(1). A licensed nurse
  381  registry shall ensure that each certified nursing assistant
  382  referred for contract by the nurse registry and each home health
  383  aide referred for contract by the nurse registry is adequately
  384  trained to perform the tasks of a home health aide in the home
  385  setting. Each person referred by a nurse registry must provide
  386  current documentation that he or she is free from communicable
  387  diseases.
  388         Section 10. Section 400.509, Florida Statutes, is repealed.
  389         Section 11. Section 400.512, Florida Statutes, is amended
  390  to read:
  391         400.512 Screening of home health agency personnel and;
  392  nurse registry personnel; and companions and homemakers.—The
  393  agency shall require employment or contractor screening as
  394  provided in chapter 435, using the level 1 standards for
  395  screening set forth in that chapter, for home health agency
  396  personnel and; persons referred for employment by nurse
  397  registries; and persons employed by companion or homemaker
  398  services registered under s. 400.509.
  399         (1)(a) The Agency for Health Care Administration may, upon
  400  request, grant exemptions from disqualification from employment
  401  or contracting under this section as provided in s. 435.07,
  402  except for health care practitioners licensed by the Department
  403  of Health or a regulatory board within that department.
  404         (b) The appropriate regulatory board within the Department
  405  of Health, or that department itself when there is no board,
  406  may, upon request of the licensed health care practitioner,
  407  grant exemptions from disqualification from employment or
  408  contracting under this section as provided in s. 435.07.
  409         (2) The administrator of each home health agency and, the
  410  managing employee of each nurse registry, and the managing
  411  employee of each companion or homemaker service registered under
  412  s. 400.509 must sign an affidavit annually, under penalty of
  413  perjury, stating that all personnel hired or contracted with or
  414  registered on or after October 1, 2000, who enter the home of a
  415  patient or client in their service capacity have been screened.
  416         (3) As a prerequisite to operating as a home health agency
  417  or, nurse registry, or companion or homemaker service under s.
  418  400.509, the administrator or managing employee, respectively,
  419  must submit to the agency his or her name and any other
  420  information necessary to conduct a complete screening according
  421  to this section. The agency shall submit the information to the
  422  Department of Law Enforcement for state processing. The agency
  423  shall review the record of the administrator or manager with
  424  respect to the offenses specified in this section and shall
  425  notify the owner of its findings. If disposition information is
  426  missing on a criminal record, the administrator or manager, upon
  427  request of the agency, must obtain and supply within 30 days the
  428  missing disposition information to the agency. Failure to supply
  429  missing information within 30 days or to show reasonable efforts
  430  to obtain such information will result in automatic
  431  disqualification.
  432         (4) Proof of compliance with the screening requirements of
  433  chapter 435 shall be accepted in lieu of the requirements of
  434  this section if the person has been continuously employed or
  435  registered without a breach in service that exceeds 180 days,
  436  the proof of compliance is not more than 2 years old, and the
  437  person has been screened by the Department of Law Enforcement. A
  438  home health agency or, nurse registry, or companion or homemaker
  439  service registered under s. 400.509 shall directly provide proof
  440  of compliance to another home health agency or, nurse registry,
  441  or companion or homemaker service registered under s. 400.509.
  442  The recipient home health agency or, nurse registry, or
  443  companion or homemaker service registered under s. 400.509 may
  444  not accept any proof of compliance directly from the person who
  445  requires screening. Proof of compliance with the screening
  446  requirements of this section shall be provided upon request to
  447  the person screened by the home health agencies or; nurse
  448  registries; or companion or homemaker services registered under
  449  s. 400.509.
  450         (5) There is no monetary liability on the part of, and no
  451  cause of action for damages arises against, a licensed home
  452  health agency or, licensed nurse registry, or companion or
  453  homemaker service registered under s. 400.509, that, upon notice
  454  that the employee or contractor has been found guilty of,
  455  regardless of adjudication, or entered a plea of nolo contendere
  456  or guilty to, any offense prohibited under s. 435.03 or under
  457  any similar statute of another jurisdiction, terminates the
  458  employee or contractor, whether or not the employee or
  459  contractor has filed for an exemption with the agency in
  460  accordance with chapter 435 and whether or not the time for
  461  filing has expired.
  462         (6) The costs of processing the statewide correspondence
  463  criminal records checks must be borne by the home health agency
  464  or; the nurse registry; or the companion or homemaker service
  465  registered under s. 400.509, or by the person being screened, at
  466  the discretion of the home health agency or, nurse registry, or
  467  s. 400.509 registrant.
  468         Section 12. Subsections (1) and (7) of section 400.9935,
  469  Florida Statutes, are amended to read:
  470         400.9935 Clinic responsibilities.—
  471         (1) Each clinic shall appoint a medical director or clinic
  472  director who shall agree in writing to accept legal
  473  responsibility for the following activities on behalf of the
  474  clinic. The medical director or the clinic director shall:
  475         (a) Have signs identifying the medical director or clinic
  476  director posted in a conspicuous location within the clinic
  477  readily visible to all patients.
  478         (b) Ensure that all practitioners providing health care
  479  services or supplies to patients maintain a current active and
  480  unencumbered Florida license.
  481         (c) Review any patient referral contracts or agreements
  482  executed by the clinic.
  483         (d) Ensure that all health care practitioners at the clinic
  484  have active appropriate certification or licensure for the level
  485  of care being provided.
  486         (e) Serve as the clinic records owner as defined in s.
  487  456.057.
  488         (f) Ensure compliance with the recordkeeping, office
  489  surgery, and adverse incident reporting requirements of chapter
  490  456, the respective practice acts, and rules adopted under this
  491  part and part II of chapter 408.
  492         (g) Conduct systematic reviews of clinic billings to ensure
  493  that the billings are not fraudulent or unlawful. Upon discovery
  494  of an unlawful charge, the medical director or clinic director
  495  shall take immediate corrective action. If the clinic performs
  496  only the technical component of magnetic resonance imaging,
  497  static radiographs, computed tomography, or positron emission
  498  tomography, and provides the professional interpretation of such
  499  services, in a fixed facility that is accredited by the Joint
  500  Commission on Accreditation of Healthcare Organizations or the
  501  Accreditation Association for Ambulatory Health Care, and the
  502  American College of Radiology; and if, in the preceding quarter,
  503  the percentage of scans performed by that clinic which was
  504  billed to all personal injury protection insurance carriers was
  505  less than 15 percent, the chief financial officer of the clinic
  506  may, in a written acknowledgment provided to the agency, assume
  507  the responsibility for the conduct of the systematic reviews of
  508  clinic billings to ensure that the billings are not fraudulent
  509  or unlawful.
  510         (h)Not refer a patient to the clinic if the clinic
  511  performs magnetic resonance imaging, static radiographs,
  512  computed tomography, or positron emission tomography. The term
  513  “refer a patient” means the referral of one or more patients of
  514  the medical or clinical director or a member of the medical or
  515  clinical director's group practice to the clinic for magnetic
  516  resonance imaging, static radiographs, computed tomography, or
  517  positron emission tomography. A medical director who is found to
  518  violate this paragraph commits a felony of the third degree,
  519  punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
  520         (7)(a) Each clinic engaged in magnetic resonance imaging
  521  services must be accredited by the Joint Commission on
  522  Accreditation of Healthcare Organizations, the American College
  523  of Radiology, or the Accreditation Association for Ambulatory
  524  Health Care, within 1 year after licensure. A clinic that is
  525  accredited by the American College of Radiology or is within the
  526  original 1-year period after licensure and replaces its core
  527  magnetic resonance imaging equipment shall be given 1 year after
  528  the date on which the equipment is replaced to attain
  529  accreditation. However, a clinic may request a single, 6-month
  530  extension if it provides evidence to the agency establishing
  531  that, for good cause shown, such clinic can not be accredited
  532  within 1 year after licensure, and that such accreditation will
  533  be completed within the 6-month extension. After obtaining
  534  accreditation as required by this subsection, each such clinic
  535  must maintain accreditation as a condition of renewal of its
  536  license. A clinic that files a change-of-ownership application
  537  must comply with the original accreditation time requirements of
  538  the transferor. The agency shall deny a change-of-ownership
  539  application if the clinic is not in compliance with the
  540  accreditation requirements. If a clinic adds, replaces, or
  541  modifies equipment for magnetic resonance imaging and the
  542  accrediting agency requires new accreditation, the clinic must
  543  be accredited within 1 year after the addition, replacement, or
  544  modification, but may request a single 6-month extension if it
  545  provides evidence of good cause to the agency.
  546         (b) The agency may deny the application or revoke the
  547  license of any entity formed for the purpose of avoiding
  548  compliance with the accreditation provisions of this subsection
  549  and whose principals were previously principals of an entity
  550  that was unable to meet the accreditation requirements within
  551  the specified timeframes. The agency may adopt rules as to the
  552  accreditation of magnetic resonance imaging clinics.
  553         Section 13. Subsection (6) of section 400.995, Florida
  554  Statutes, is repealed.
  555         Section 14. Subsections (5) and (9) of section 408.803,
  556  Florida Statutes, are amended to read:
  557         408.803 Definitions.—As used in this part, the term:
  558         (5) “Change of ownership” means:
  559         (a) An event in which the licensee sells or otherwise
  560  transfers its ownership changes to a different individual or
  561  other legal entity;
  562         (b)An event in which an individual or other entity
  563  purchases, or in good faith intends to purchase, the licensed
  564  provider; or
  565         (c)An event in which 51 45 percent or more of the
  566  ownership, voting shares, membership, or controlling interest of
  567  a licensee is in any manner transferred or otherwise assigned.
  568  This paragraph does not apply to a licensee that is publicly
  569  traded on a recognized stock exchange in a corporation whose
  570  shares are not publicly traded on a recognized stock exchange is
  571  transferred or assigned, including the final transfer or
  572  assignment of multiple transfers or assignments over a 2-year
  573  period that cumulatively total 45 percent or greater. A change
  574  solely in the management company or board of directors is not a
  575  change of ownership.
  576         (9) “Licensee” means an individual, corporation,
  577  partnership, firm, association, or governmental entity, or other
  578  entity that is issued a permit, registration, certificate, or
  579  license by the agency. The licensee is legally responsible for
  580  all aspects of the provider operation.
  581         Section 15. Paragraph (a) of subsection (1), subsection
  582  (2), paragraph (c) of subsection (7), and subsection (8) of
  583  section 408.806, Florida Statutes, are amended to read:
  584         408.806 License application process.—
  585         (1) An application for licensure must be made to the agency
  586  on forms furnished by the agency, submitted under oath, and
  587  accompanied by the appropriate fee in order to be accepted and
  588  considered timely. The application must contain information
  589  required by authorizing statutes and applicable rules and must
  590  include:
  591         (a) The name, address, and social security number of:
  592         1. The applicant;
  593         2.The administrator or a similarly titled person who is
  594  responsible for the day-to-day operation of the provider;
  595         3.The financial officer or similarly titled person who is
  596  responsible for the financial operation of the provider; and
  597         4. Each controlling interest if the applicant or
  598  controlling interest is an individual.
  599         (2)(a) The applicant for a renewal license must submit an
  600  application that must be received by the agency at least 60
  601  days, but not more than 120 days, before prior to the expiration
  602  of the current license. An application received 120 days or more
  603  before the expiration date shall be returned to the applicant.
  604  If the renewal application and fee are received before prior to
  605  the license expiration date, the license shall not be deemed to
  606  have expired if the license expiration date occurs during the
  607  agency's review of the renewal application.
  608         (b) The applicant for initial licensure due to a change of
  609  ownership must submit an application that must be received by
  610  the agency at least 60 days before prior to the date of change
  611  of ownership.
  612         (c) For any other application or request, the applicant
  613  must submit an application or request that must be received by
  614  the agency at least 60 days before prior to the requested
  615  effective date, unless otherwise specified in authorizing
  616  statutes or applicable rules. An application received more than
  617  120 days before the requested effective date shall be returned
  618  to the applicant.
  619         (d) The agency shall notify the licensee by mail or
  620  electronically at least 90 days before prior to the expiration
  621  of a license that a renewal license is necessary to continue
  622  operation. The failure to timely submit a renewal application
  623  and license fee shall result in a $50 per day late fee charged
  624  to the licensee by the agency; however, the aggregate amount of
  625  the late fee may not exceed 50 percent of the licensure fee or
  626  $500, whichever is less. If an application is received after the
  627  required filing date and exhibits a hand-canceled postmark
  628  obtained from a United States post office dated on or before the
  629  required filing date, no fine will be levied.
  630         (7)
  631         (c) If an inspection is required by the authorizing statute
  632  for a license application other than an initial application, the
  633  inspection must be unannounced. This paragraph does not apply to
  634  inspections required pursuant to ss. 383.324, 395.0161(4),
  635  429.67(6), and 483.061(2).
  636         (8) The agency may establish procedures for the electronic
  637  notification and submission of required information, including,
  638  but not limited to:
  639         (a) Licensure applications.
  640         (b) Required signatures.
  641         (c) Payment of fees.
  642         (d) Notarization of applications.
  643  
  644  Requirements for electronic submission of any documents required
  645  by this part or authorizing statutes may be established by rule.
  646  As an alternative to sending documents as required by
  647  authorizing statutes, the agency may provide electronic access
  648  to information or documents.
  649         Section 16. Subsection (2) of section 408.807, Florida
  650  Statutes, is amended to read:
  651         408.807 Change of ownership.—Whenever a change of ownership
  652  occurs:
  653         (2) The transferee shall make application to the agency for
  654  a license within the timeframes required in s. 408.806. The
  655  effective date of the transfer must be submitted with the
  656  application. The effective date of licensure may not occur
  657  before the date of application. Final closing documents must be
  658  provided within 10 calendar days after the effective date of the
  659  transfer.
  660         Section 17. Subsection (2) of section 408.808, Florida
  661  Statutes, is amended to read:
  662         408.808 License categories.—
  663         (2) PROVISIONAL LICENSE.—A provisional license may be
  664  issued to an applicant pursuant to s. 408.809(3). An applicant
  665  against whom a proceeding denying or revoking a license is
  666  pending at the time of license renewal may be issued a
  667  provisional license effective until final action not subject to
  668  further appeal. A provisional license may also be issued to an
  669  applicant submitting an application for a change of ownership. A
  670  provisional license shall be limited in duration to a specific
  671  period that may not exceed 6 months, as determined by the
  672  agency.
  673         Section 18. Subsection (5) of section 408.809, Florida
  674  Statutes, is amended, and subsection (6) is added to that
  675  section, to read:
  676         408.809 Background screening; prohibited offenses.—
  677         (5) Notwithstanding the requirement in s. 435.04(5), in
  678  order to submit annually, the attestations required in ss.
  679  435.04(5) and 435.05(3) must be submitted at the time of license
  680  renewal. Background screening is not required to obtain a
  681  certificate of exemption issued under s. 483.106.
  682         (6)Effective October 1, 2009, in addition to the offenses
  683  listed in ss. 435.03 and 435.04, all persons required to undergo
  684  background screening pursuant to this part or authorizing
  685  statutes must not have been found guilty of, regardless of
  686  adjudication, or entered a plea of nolo contendere or guilty to,
  687  any offense prohibited under any of the following provisions of
  688  law or any similar statute of another jurisdiction:
  689         (a)Any authorizing statute, if the offense was a felony.
  690         (b)This chapter, if the offense was a felony.
  691         (c)Section 409.920, relating to Medicaid-provider fraud,
  692  if the offense was a felony.
  693         (d)Section 409.9201, relating to Medicaid fraud, if the
  694  offense was a felony.
  695         (e)Section 741.28, relating to domestic violence.
  696         (f)Chapter 784, relating to assault, battery, and culpable
  697  negligence, if the offense was a felony.
  698         (g)Section 810.02, relating to burglary.
  699         (h)Section 817.034, relating to fraudulent acts through
  700  mail, wire, radio, electromagnetic, photoelectronic, or
  701  photooptical systems.
  702         (i)Section 817.234, relating to false and fraudulent
  703  insurance claims.
  704         (j)Section 817.505, relating to patient brokering.
  705         (k)Section 817.568, relating to personal identification
  706  theft.
  707         (l)Section 817.60, relating to theft and obtaining credit
  708  cards through fraudulent means.
  709         (m)Section 817.61, relating to fraudulent use of credit
  710  cards if the offense was a felony.
  711         (n)Section 831.01, relating to forgery.
  712         (o)Section 831.02, relating to uttering forged
  713  instruments.
  714         (p)Section 831.07, relating to forging bank bills, checks,
  715  drafts, or promissory notes.
  716         (q)Section 831.09, relating to uttering forged bills,
  717  checks, drafts, or notes.
  718         (r)Section 831.30, relating to fraud in obtaining
  719  medicinal drugs.
  720         (s)Section 831.31, relating to the sale, manufacture,
  721  delivery, or possession with the intent to sell any counterfeit
  722  controlled substance, if the offense was a felony.
  723  
  724  A person employed or affiliated with a licensee on or before
  725  September 30, 2009, shall not be required by law to submit to
  726  rescreening if that licensee has in its possession written
  727  evidence that the person has been screened and qualified
  728  according to s. 435.03 or s. 435.04. However, if such person has
  729  a disqualifying offense listed in this section, he or she may
  730  apply for an exemption from the appropriate licensing agency
  731  before September 30, 2009, and if agreed to by the employer, may
  732  continue to perform his or her duties until the licensing agency
  733  renders a decision on the application for exemption for offenses
  734  listed in this section. Exemptions from disqualification may be
  735  granted pursuant to s. 435.07.
  736         Section 19. Subsection (3) of section 408.810, Florida
  737  Statutes, is amended to read:
  738         408.810 Minimum licensure requirements.—In addition to the
  739  licensure requirements specified in this part, authorizing
  740  statutes, and applicable rules, each applicant and licensee must
  741  comply with the requirements of this section in order to obtain
  742  and maintain a license.
  743         (3) Unless otherwise specified in this part, authorizing
  744  statutes, or applicable rules, any information required to be
  745  reported to the agency must be submitted within 21 calendar days
  746  after the report period or effective date of the information
  747  whichever occurs earlier, including, but not limited to, any
  748  change of:
  749         (a)Information contained in the most recent application
  750  for licensure; and
  751         (b)Required insurance or bonds.
  752         Section 20. Section 408.811, Florida Statutes, is amended,
  753  to read:
  754         408.811 Right of inspection; copies; inspection reports;
  755  plan for correction of deficiencies.—
  756         (1) An authorized officer or employee of the agency may
  757  make or cause to be made any inspection or investigation deemed
  758  necessary by the agency to determine the state of compliance
  759  with this part, authorizing statutes, and applicable rules. The
  760  right of inspection extends to any business that the agency has
  761  reason to believe is being operated as a provider without a
  762  license, but inspection of any business suspected of being
  763  operated without the appropriate license may not be made without
  764  the permission of the owner or person in charge unless a warrant
  765  is first obtained from a circuit court. Any application for a
  766  license issued under this part, authorizing statutes, or
  767  applicable rules constitutes permission for an appropriate
  768  inspection to verify the information submitted on or in
  769  connection with the application.
  770         (a) All inspections shall be unannounced, except as
  771  specified in s. 408.806.
  772         (b) Inspections for relicensure shall be conducted
  773  biennially unless otherwise specified by authorizing statutes or
  774  applicable rules.
  775         (2) Inspections conducted in conjunction with
  776  certification, comparable licensure requirements, or a
  777  recognized or approved accreditation organization may be
  778  accepted in lieu of a complete licensure inspection. However, a
  779  licensure inspection may also be conducted to review any
  780  licensure requirements that are not also requirements for
  781  certification.
  782         (3) The agency shall have access to and the licensee shall
  783  provide, or if requested send, copies of all provider records
  784  required during an inspection or other review at no cost to the
  785  agency, including records requested during an off-site review.
  786         (4)(a) Each licensee shall maintain as public information,
  787  available upon request, records of all inspection reports
  788  pertaining to that provider that have been filed by the agency
  789  unless those reports are exempt from or contain information that
  790  is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
  791  Constitution or is otherwise made confidential by law. Effective
  792  October 1, 2006, copies of such reports shall be retained in the
  793  records of the provider for at least 3 years following the date
  794  the reports are filed and issued, regardless of a change of
  795  ownership.
  796         (b) A licensee shall, upon the request of any person who
  797  has completed a written application with intent to be admitted
  798  by such provider, any person who is a client of such provider,
  799  or any relative, spouse, or guardian of any such person, furnish
  800  to the requester a copy of the last inspection report pertaining
  801  to the licensed provider that was issued by the agency or by an
  802  accrediting organization if such report is used in lieu of a
  803  licensure inspection.
  804         (5)Deficiencies must be corrected within 30 calendar days
  805  after the last day of an inspection or unless an alternative
  806  timeframe is required or approved by the agency.
  807         (6)The agency may require an applicant or licensee to
  808  submit a plan of correction for deficiencies. If required, the
  809  plan of correction must be filed with the agency within 10
  810  calendar days after notification unless an alternative timeframe
  811  is required.
  812         Section 21. Section 408.813, Florida Statutes, is amended
  813  to read:
  814         408.813 Administrative fines; violations.—As a penalty for
  815  any violation of this part, authorizing statutes, or applicable
  816  rules, the agency may impose an administrative fine.
  817         (1) Unless the amount or aggregate limitation of the fine
  818  is prescribed by authorizing statutes or applicable rules, the
  819  agency may establish criteria by rule for the amount or
  820  aggregate limitation of administrative fines applicable to this
  821  part, authorizing statutes, and applicable rules. Each day of
  822  violation constitutes a separate violation and is subject to a
  823  separate fine. For fines imposed by final order of the agency
  824  and not subject to further appeal, the violator shall pay the
  825  fine plus interest at the rate specified in s. 55.03 for each
  826  day beyond the date set by the agency for payment of the fine.
  827         (2)Violations of this part, authorizing statutes, or
  828  applicable rules, shall be classified according to the nature of
  829  the violation and the gravity of its probable effect on clients.
  830  The scope may be cited as isolated, patterned, or widespread. An
  831  isolated deficiency is a deficiency affecting one or a very
  832  limited number of clients, or involving one or a very limited
  833  number of staff, or a situation that occurred only occasionally
  834  or in a very limited number of locations. A patterned deficiency
  835  is a deficiency where more than a very limited number of clients
  836  are affected, or more than a very limited number of staff are
  837  involved, or the situation has occurred in several locations, or
  838  the same client or clients have been affected by repeated
  839  occurrences of the same deficient practice but the effect of the
  840  deficient practice is not found to be pervasive throughout the
  841  provider's facility. A widespread deficiency is a deficiency in
  842  which the problems causing the deficiency are pervasive in the
  843  provider's facility or represent systemic failure that has
  844  affected or has the potential to affect a large portion of the
  845  provider’s clients. The definitions of classification in this
  846  section control over conflicting definitions in authorizing
  847  statutes. This section does not affect the legislative
  848  determination of fine amounts in authorizing statutes.
  849  Violations shall be classified on the written notice as follows:
  850         (a)A class I violation is a condition or occurrence
  851  related to the operation and maintenance of a provider's
  852  facility or to the care of clients which the agency determines
  853  presents an imminent danger to the clients of the provider or a
  854  substantial probability that death or serious physical or
  855  emotional harm would result therefrom. The condition or practice
  856  constituting a class I violation shall be abated or eliminated
  857  within 24 hours, unless a fixed period, as determined by the
  858  agency, is required for correction. The agency shall impose an
  859  administrative fine for a cited class I violation in an amount
  860  determined by law. A fine shall be levied notwithstanding the
  861  correction of the violation.
  862         (b)A class II violation is a condition or occurrence
  863  related to the operation and maintenance of a provider's
  864  facility or to the care of clients which the agency determines
  865  directly threatens the physical or emotional health, safety, or
  866  security of the clients, other than a class I violation. The
  867  agency shall impose an administrative fine for a cited class II
  868  violation in an amount determined by law. A fine shall be levied
  869  notwithstanding the correction of the violation.
  870         (c)A class III violation is a condition or occurrence
  871  related to the operation and maintenance of a provider's
  872  facility or to the care of clients which the agency determines
  873  indirectly or potentially threatens the physical or emotional
  874  health, safety, or security of clients, other than a class I
  875  violation or a class II violation. The agency shall impose an
  876  administrative fine for a cited class III violation in an amount
  877  determined by law. A citation for a class III violation must
  878  specify the time within which the violation is required to be
  879  corrected. If a class III violation is corrected within the time
  880  specified, a fine shall not be imposed.
  881         (d)A class IV violation is a condition or occurrence
  882  related to the operation and maintenance of a provider's
  883  facility or to required reports, forms, or documents which does
  884  not have the potential of negatively affecting clients. This
  885  violation is of a type that the agency determines does not
  886  threaten the health, safety, or security of clients. The agency
  887  shall impose an administrative fine for a cited class IV
  888  violation in an amount determined by law. A citation for a class
  889  IV violation must specify the time within which the violation is
  890  required to be corrected. If a class IV violation is corrected
  891  within the time specified, a fine shall not be imposed.
  892         Section 22. Subsections (12), (21), and (26) of section
  893  408.820, Florida Statutes, are amended to read:
  894         408.820 Exemptions.—Except as prescribed in authorizing
  895  statutes, the following exemptions shall apply to specified
  896  requirements of this part:
  897         (12) Health care risk managers, as provided under part I of
  898  chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(10)
  899  408.810, and 408.811.
  900         (21) Transitional living facilities, as provided under part
  901  V of chapter 400, are exempt from s. 408.810(10) s. 408.810(7)
  902  (10).
  903         (26) Health care clinics, as provided under part X of
  904  chapter 400, are exempt from s. 408.810(6), (7), and (10) ss.
  905  408.809 and 408.810(1), (6), (7), and (10).
  906         Section 23. Section 408.821, Florida Statutes, is created
  907  to read:
  908         408.821Emergency management planning; emergency
  909  operations; inactive license.—
  910         (1)A licensee who is required by authorizing statutes to
  911  have an emergency operations plan must designate a liaison
  912  officer to serve as primary contact related to emergency
  913  operations.
  914         (2)An entity subject to this part may temporarily exceed
  915  its licensed capacity to act as a receiving provider in
  916  accordance with an approved emergency operations plan for up to
  917  15 days. While in an overcapacity status, each provider shall
  918  furnish or arrange for appropriate care and services to all
  919  clients. In addition, the agency may approve a request for
  920  overcapacity in excess of 15 days, and this approved request may
  921  be based upon satisfactory justification and need as provided by
  922  the receiving and sending providers.
  923         (3)(a)An inactive license may be issued to a licensee
  924  subject to this part when the provider is located in a
  925  geographic area where a state of emergency was declared by the
  926  Governor if the provider:
  927         1.Suffered damage to its operation during that state of
  928  emergency.
  929         2.Is currently licensed.
  930         3.Does not have a provisional license.
  931         4.Will be temporarily unable to provide services but is
  932  reasonably expected to resume services within 12 months.
  933         (b)An inactive license may be issued for a period not to
  934  exceed 12 months, but may be renewed by the agency for up to 12
  935  additional months upon demonstration to the agency of progress
  936  toward reopening. A request by a licensee for an inactive
  937  license or to extend the previously approved inactive period
  938  must be submitted in writing to the agency, accompanied by
  939  written justification for the inactive license which states the
  940  beginning and ending dates of inactivity and includes a plan for
  941  the transfer of any clients to other providers and appropriate
  942  licensure fees. Upon agency approval, the licensee shall notify
  943  clients of any necessary discharge or transfer as required by
  944  authorizing statutes or applicable rules. The beginning of the
  945  inactive licensing period shall be the date the provider ceases
  946  operations. The end of the inactive period shall become the
  947  licensee expiration date, and all licensure fees must be
  948  current, paid in full, and may be prorated. Reactivation of an
  949  inactive license requires the prior approval by the agency of a
  950  renewal application, including payment of licensure fees and
  951  agency inspections indicating compliance with all requirements
  952  of this part and applicable rules and statutes.
  953         (4)The agency may establish rules related to emergency
  954  management planning, communications, and operations in
  955  consultation with the Department of Community Affairs. A
  956  licensee providing residential or inpatient services shall use
  957  an online database approved by the agency to report information
  958  to the agency regarding the provider emergency status, planning,
  959  or operations.
  960         Section 24. Subsections (3) and (4) of section 408.831,
  961  Florida Statutes, are repealed.
  962         Section 25. Subsection (5) of section 409.901, Florida
  963  Statutes, is amended to read:
  964         409.901 Definitions; ss. 409.901-409.920.—As used in ss.
  965  409.901-409.920, except as otherwise specifically provided, the
  966  term:
  967         (5) “Change of ownership” means:
  968         (a)An event in which the ownership of the provider changes
  969  or intends to change to a different individual or other entity;
  970         (b) An event in which the provider changes to a different
  971  legal entity or in which 51 45 percent or more of the ownership,
  972  voting shares, membership, or controlling interest of the
  973  provider is in any manner transferred or otherwise assigned.
  974  This paragraph does not apply to a licensee that is publicly
  975  traded on a recognized stock exchange; or
  976         (c)Any event considered a change of ownership for
  977  licensure as defined in s. 408.803 if the provider is licensed
  978  or registered by the agency in a corporation whose shares are
  979  not publicly traded on a recognized stock exchange is
  980  transferred or assigned, including the final transfer or
  981  assignment of multiple transfers or assignments over a 2-year
  982  period that cumulatively total 45 percent or more.
  983  
  984  A change solely in the management company or board of directors
  985  is not a change of ownership.
  986         Section 26. Section 429.071, Florida Statutes, is repealed.
  987         Section 27. Section 429.08, Florida Statutes, is amended to
  988  read:
  989         429.08 Unlicensed facilities; referral of person for
  990  residency to unlicensed facility; penalties; verification of
  991  licensure status.—
  992         (1)(a) This section applies to the unlicensed operation of
  993  an assisted living facility in addition to the requirements of
  994  part II of chapter 408.
  995         (b) Except as provided under paragraph (d), any person who
  996  owns, operates, or maintains an unlicensed assisted living
  997  facility commits a felony of the third degree, punishable as
  998  provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
  999  continued operation is a separate offense.
 1000         (c) Any person found guilty of violating paragraph (a) a
 1001  second or subsequent time commits a felony of the second degree,
 1002  punishable as provided under s. 775.082, s. 775.083, or s.
 1003  775.084. Each day of continued operation is a separate offense.
 1004         (d) Any person who owns, operates, or maintains an
 1005  unlicensed assisted living facility due to a change in this part
 1006  or a modification in rule within 6 months after the effective
 1007  date of such change and who, within 10 working days after
 1008  receiving notification from the agency, fails to cease operation
 1009  or apply for a license under this part commits a felony of the
 1010  third degree, punishable as provided in s. 775.082, s. 775.083,
 1011  or s. 775.084. Each day of continued operation is a separate
 1012  offense.
 1013         (e) The agency shall provide to the department's elder
 1014  information and referral providers a list, by county, of
 1015  licensed assisted living facilities, to assist persons who are
 1016  considering an assisted living facility placement in locating a
 1017  licensed facility. This information may be provided
 1018  electronically or through the agency’s Internet website.
 1019         (2)Each field office of the Agency for Health Care
 1020  Administration shall establish a local coordinating workgroup
 1021  which includes representatives of local law enforcement
 1022  agencies, state attorneys, the Medicaid Fraud Control Unit of
 1023  the Department of Legal Affairs, local fire authorities, the
 1024  Department of Children and Family Services, the district long
 1025  term care ombudsman council, and the district human rights
 1026  advocacy committee to assist in identifying the operation of
 1027  unlicensed facilities and to develop and implement a plan to
 1028  ensure effective enforcement of state laws relating to such
 1029  facilities. The workgroup shall report its findings, actions,
 1030  and recommendations semiannually to the Director of Health
 1031  Quality Assurance of the agency.
 1032         (2)(3) It is unlawful to knowingly refer a person for
 1033  residency to an unlicensed assisted living facility; to an
 1034  assisted living facility the license of which is under denial or
 1035  has been suspended or revoked; or to an assisted living facility
 1036  that has a moratorium pursuant to part II of chapter 408. Any
 1037  person who violates this subsection commits a noncriminal
 1038  violation, punishable by a fine not exceeding $500 as provided
 1039  in s. 775.083.
 1040         (a) Any health care practitioner, as defined in s. 456.001,
 1041  who is aware of the operation of an unlicensed facility shall
 1042  report that facility to the agency. Failure to report a facility
 1043  that the practitioner knows or has reasonable cause to suspect
 1044  is unlicensed shall be reported to the practitioner's licensing
 1045  board.
 1046         (b) Any hospital or community mental health center licensed
 1047  under chapter 395 or chapter 394 which knowingly discharges a
 1048  patient or client to an unlicensed facility is subject to
 1049  sanction by the agency.
 1050         (c) Any employee of the agency or department, or the
 1051  Department of Children and Family Services, who knowingly refers
 1052  a person for residency to an unlicensed facility; to a facility
 1053  the license of which is under denial or has been suspended or
 1054  revoked; or to a facility that has a moratorium pursuant to part
 1055  II of chapter 408 is subject to disciplinary action by the
 1056  agency or department, or the Department of Children and Family
 1057  Services.
 1058         (d) The employer of any person who is under contract with
 1059  the agency or department, or the Department of Children and
 1060  Family Services, and who knowingly refers a person for residency
 1061  to an unlicensed facility; to a facility the license of which is
 1062  under denial or has been suspended or revoked; or to a facility
 1063  that has a moratorium pursuant to part II of chapter 408 shall
 1064  be fined and required to prepare a corrective action plan
 1065  designed to prevent such referrals.
 1066         (e) The agency shall provide the department and the
 1067  Department of Children and Family Services with a list of
 1068  licensed facilities within each county and shall update the list
 1069  at least quarterly. This information may be provided
 1070  electronically or through the agency’s Internet website.
 1071         (f) At least annually, the agency shall notify, in
 1072  appropriate trade publications, physicians licensed under
 1073  chapter 458 or chapter 459, hospitals licensed under chapter
 1074  395, nursing home facilities licensed under part II of chapter
 1075  400, and employees of the agency or the department, or the
 1076  Department of Children and Family Services, who are responsible
 1077  for referring persons for residency, that it is unlawful to
 1078  knowingly refer a person for residency to an unlicensed assisted
 1079  living facility and shall notify them of the penalty for
 1080  violating such prohibition. The department and the Department of
 1081  Children and Family Services shall, in turn, notify service
 1082  providers under contract to the respective departments who have
 1083  responsibility for resident referrals to facilities. Further,
 1084  the notice must direct each noticed facility and individual to
 1085  contact the appropriate agency office in order to verify the
 1086  licensure status of any facility before prior to referring any
 1087  person for residency. Each notice must include the name,
 1088  telephone number, and mailing address of the appropriate office
 1089  to contact.
 1090         Section 28. Section 429.19, Florida Statutes, is amended to
 1091  read:
 1092         429.19 Violations; imposition of administrative fines;
 1093  grounds.—
 1094         (1) In addition to the requirements of part II of chapter
 1095  408, the agency shall impose an administrative fine in the
 1096  manner provided in chapter 120 for the violation of any
 1097  provision of this part, part II of chapter 408, and applicable
 1098  rules by an assisted living facility, for the actions of any
 1099  person subject to level 2 background screening under s. 408.809,
 1100  for the actions of any facility employee, or for an intentional
 1101  or negligent act seriously affecting the health, safety, or
 1102  welfare of a resident of the facility.
 1103         (2) Each violation of this part and adopted rules shall be
 1104  classified according to the nature of the violation and the
 1105  gravity of its probable effect on facility residents. The agency
 1106  shall indicate the classification on the written notice of the
 1107  violation as follows:
 1108         (a) A class “I” violation is defined in s. 408.813.
 1109  violations are those conditions or occurrences related to the
 1110  operation and maintenance of a facility or to the personal care
 1111  of residents which the agency determines present an imminent
 1112  danger to the residents or guests of the facility or a
 1113  substantial probability that death or serious physical or
 1114  emotional harm would result therefrom. The condition or practice
 1115  constituting a class I violation shall be abated or eliminated
 1116  within 24 hours, unless a fixed period, as determined by the
 1117  agency, is required for correction. The agency shall impose an
 1118  administrative fine for a cited class I violation in an amount
 1119  not less than $5,000 and not exceeding $10,000 for each
 1120  violation. A fine may be levied notwithstanding the correction
 1121  of the violation.
 1122         (b) A class “II” violation is defined in s. 408.813.
 1123  violations are those conditions or occurrences related to the
 1124  operation and maintenance of a facility or to the personal care
 1125  of residents which the agency determines directly threaten the
 1126  physical or emotional health, safety, or security of the
 1127  facility residents, other than class I violations. The agency
 1128  shall impose an administrative fine for a cited class II
 1129  violation in an amount not less than $1,000 and not exceeding
 1130  $5,000 for each violation. A fine shall be levied
 1131  notwithstanding the correction of the violation.
 1132         (c) A class “III” violation is defined in s. 408.813.
 1133  violations are those conditions or occurrences related to the
 1134  operation and maintenance of a facility or to the personal care
 1135  of residents which the agency determines indirectly or
 1136  potentially threaten the physical or emotional health, safety,
 1137  or security of facility residents, other than class I or class
 1138  II violations. The agency shall impose an administrative fine
 1139  for a cited class III violation in an amount not less than $500
 1140  and not exceeding $1,000 for each violation. A citation for a
 1141  class III violation must specify the time within which the
 1142  violation is required to be corrected. If a class III violation
 1143  is corrected within the time specified, no fine may be imposed,
 1144  unless it is a repeated offense.
 1145         (d) A class “IV” violation is defined in 408.813.
 1146  violations are those conditions or occurrences related to the
 1147  operation and maintenance of a building or to required reports,
 1148  forms, or documents that do not have the potential of negatively
 1149  affecting residents. These violations are of a type that the
 1150  agency determines do not threaten the health, safety, or
 1151  security of residents of the facility. The agency shall impose
 1152  an administrative fine for a cited class IV violation in an
 1153  amount not less than $100 and not exceeding $200 for each
 1154  violation. A citation for a class IV violation must specify the
 1155  time within which the violation is required to be corrected. If
 1156  a class IV violation is corrected within the time specified, no
 1157  fine shall be imposed. Any class IV violation that is corrected
 1158  during the time an agency survey is being conducted will be
 1159  identified as an agency finding and not as a violation.
 1160         (3) For purposes of this section, in determining if a
 1161  penalty is to be imposed and in fixing the amount of the fine,
 1162  the agency shall consider the following factors:
 1163         (a) The gravity of the violation, including the probability
 1164  that death or serious physical or emotional harm to a resident
 1165  will result or has resulted, the severity of the action or
 1166  potential harm, and the extent to which the provisions of the
 1167  applicable laws or rules were violated.
 1168         (b) Actions taken by the owner or administrator to correct
 1169  violations.
 1170         (c) Any previous violations.
 1171         (d) The financial benefit to the facility of committing or
 1172  continuing the violation.
 1173         (e) The licensed capacity of the facility.
 1174         (4) Each day of continuing violation after the date fixed
 1175  for termination of the violation, as ordered by the agency,
 1176  constitutes an additional, separate, and distinct violation.
 1177         (5) Any action taken to correct a violation shall be
 1178  documented in writing by the owner or administrator of the
 1179  facility and verified through followup visits by agency
 1180  personnel. The agency may impose a fine and, in the case of an
 1181  owner-operated facility, revoke or deny a facility's license
 1182  when a facility administrator fraudulently misrepresents action
 1183  taken to correct a violation.
 1184         (6) Any facility whose owner fails to apply for a change
 1185  of-ownership license in accordance with part II of chapter 408
 1186  and operates the facility under the new ownership is subject to
 1187  a fine of $5,000.
 1188         (7) In addition to any administrative fines imposed, the
 1189  agency may assess a survey fee, equal to the lesser of one half
 1190  of the facility's biennial license and bed fee or $500, to cover
 1191  the cost of conducting initial complaint investigations that
 1192  result in the finding of a violation that was the subject of the
 1193  complaint or monitoring visits conducted under s. 429.28(3)(c)
 1194  to verify the correction of the violations.
 1195         (8)The agency, as an alternative to or in conjunction with
 1196  an administrative action against a facility for violations of
 1197  this part and adopted rules, shall make a reasonable attempt to
 1198  discuss each violation and recommended corrective action with
 1199  the owner or administrator of the facility, prior to written
 1200  notification. The agency, instead of fixing a period within
 1201  which the facility shall enter into compliance with standards,
 1202  may request a plan of corrective action from the facility which
 1203  demonstrates a good faith effort to remedy each violation by a
 1204  specific date, subject to the approval of the agency.
 1205         (8)(9) The agency shall develop and disseminate an annual
 1206  list of all facilities sanctioned or fined $5,000 or more for
 1207  violations of state standards, the number and class of
 1208  violations involved, the penalties imposed, and the current
 1209  status of cases. The list shall be disseminated, at no charge,
 1210  to the Department of Elderly Affairs, the Department of Health,
 1211  the Department of Children and Family Services, the Agency for
 1212  Persons with Disabilities, the area agencies on aging, the
 1213  Florida Statewide Advocacy Council, and the state and local
 1214  ombudsman councils. The Department of Children and Family
 1215  Services shall disseminate the list to service providers under
 1216  contract to the department who are responsible for referring
 1217  persons to a facility for residency. The agency may charge a fee
 1218  commensurate with the cost of printing and postage to other
 1219  interested parties requesting a copy of this list. This
 1220  information may be provided electronically or through the
 1221  agency's Internet site.
 1222         Section 29. Subsections (2) and (6) of section 429.23,
 1223  Florida Statutes, are amended to read:
 1224         429.23 Internal risk management and quality assurance
 1225  program; adverse incidents and reporting requirements.—
 1226         (2) Every facility licensed under this part is required to
 1227  maintain adverse incident reports. For purposes of this section,
 1228  the term, “adverse incident” means:
 1229         (a) An event over which facility personnel could exercise
 1230  control rather than as a result of the resident's condition and
 1231  results in:
 1232         1. Death;
 1233         2. Brain or spinal damage;
 1234         3. Permanent disfigurement;
 1235         4. Fracture or dislocation of bones or joints;
 1236         5. Any condition that required medical attention to which
 1237  the resident has not given his or her consent, including failure
 1238  to honor advanced directives;
 1239         6. Any condition that requires the transfer of the resident
 1240  from the facility to a unit providing more acute care due to the
 1241  incident rather than the resident's condition before the
 1242  incident; or.
 1243         7.An event that is reported to a law enforcement agency or
 1244  its personnel.
 1245         (b) Resident elopement, if the elopement places the
 1246  resident at risk of harm or injury Abuse, neglect, or
 1247  exploitation as defined in s. 415.102;
 1248         (c)Events reported to law enforcement; or
 1249         (d)Elopement.
 1250         (6) Any incident of abuse, neglect, or exploitation must be
 1251  reported to the Department of Children and Family Services as
 1252  required by chapter 415. The agency shall annually submit to the
 1253  Legislature a report on assisted living facility adverse
 1254  incident reports. The report must include the following
 1255  information arranged by county:
 1256         (a)A total number of adverse incidents;
 1257         (b)A listing, by category, of the type of adverse
 1258  incidents occurring within each category and the type of staff
 1259  involved;
 1260         (c)A listing, by category, of the types of injuries, if
 1261  any, and the number of injuries occurring within each category;
 1262         (d)Types of liability claims filed based on an adverse
 1263  incident report or reportable injury; and
 1264         (e)Disciplinary action taken against staff, categorized by
 1265  the type of staff involved.
 1266         Section 30. Subsection (9) of section 429.26, Florida
 1267  Statutes, is repealed.
 1268         Section 31. Subsection (5) of section 435.04, Florida
 1269  Statutes, is amended to read:
 1270         435.04 Level 2 screening standards.—
 1271         (5) Under penalty of perjury, all employees in such
 1272  positions of trust or responsibility shall attest to meeting the
 1273  requirements for qualifying for employment and agreeing to
 1274  inform the employer immediately if convicted of any of the
 1275  disqualifying offenses while employed by the employer. Each
 1276  employer of employees in such positions of trust or
 1277  responsibilities which is licensed or registered by a state
 1278  agency shall submit to the licensing agency annually or at the
 1279  time of relicensure, under penalty of perjury, an affidavit of
 1280  compliance with the provisions of this section.
 1281         Section 32. Subsection (3) of section 435.05, Florida
 1282  Statutes, is amended to read:
 1283         435.05 Requirements for covered employees.—Except as
 1284  otherwise provided by law, the following requirements shall
 1285  apply to covered employees:
 1286         (3) Each employer required to conduct level 2 background
 1287  screening must sign an affidavit annually or at the time of
 1288  relicensure, under penalty of perjury, stating that all covered
 1289  employees have been screened or are newly hired and are awaiting
 1290  the results of the required screening checks.
 1291         Section 33. Subsection (2) of section 483.031, Florida
 1292  Statutes, is amended to read:
 1293         483.031 Application of part; exemptions.—This part applies
 1294  to all clinical laboratories within this state, except:
 1295         (2) A clinical laboratory that performs only waived tests
 1296  and has received a certificate of exemption from the agency
 1297  under s. 483.106.
 1298         Section 34. Subsection (10) of section 483.041, Florida
 1299  Statutes, is amended to read:
 1300         483.041 Definitions.—As used in this part, the term:
 1301         (10) “Waived test” means a test that the federal Centers
 1302  for Medicare and Medicaid Services Health Care Financing
 1303  Administration has determined qualifies for a certificate of
 1304  waiver under the federal Clinical Laboratory Improvement
 1305  Amendments of 1988, and the federal rules adopted thereunder.
 1306         Section 35. Section 483.106, Florida Statutes, is repealed.
 1307         Section 36. Subsection (3) of section 483.172, Florida
 1308  Statutes, is amended to read:
 1309         483.172 License fees.—
 1310         (3) The agency shall assess a biennial fee of $100 for a
 1311  certificate of exemption and a $100 license fee for facilities
 1312  surveyed by an approved accrediting organization.
 1313         Section 37. Paragraph (a) of subsection (1) of section
 1314  483.23, Florida Statutes, is amended to read:
 1315         483.23 Offenses; criminal penalties.—
 1316         (1)(a) It is unlawful for any person to:
 1317         1. Operate, maintain, direct, or engage in the business of
 1318  operating a clinical laboratory unless she or he has obtained a
 1319  clinical laboratory license from the agency or is exempt under
 1320  s. 483.031.
 1321         2. Conduct, maintain, or operate a clinical laboratory,
 1322  other than an exempt laboratory or a laboratory operated under
 1323  s. 483.035, unless the clinical laboratory is under the direct
 1324  and responsible supervision and direction of a person licensed
 1325  under part III of this chapter.
 1326         3. Allow any person other than an individual licensed under
 1327  part III of this chapter to perform clinical laboratory
 1328  procedures, except in the operation of a laboratory exempt under
 1329  s. 483.031 or a laboratory operated under s. 483.035.
 1330         4. Violate or aid and abet in the violation of any
 1331  provision of this part or the rules adopted under this part.
 1332         Section 38. This act shall take effect upon becoming a law.

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