April 25, 2018
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       Florida Senate - 2009                             CS for SB 2286
       
       
       
       By the Committee on Health Regulation; and Senator Gardiner
       
       
       
       
       588-03429-09                                          20092286c1
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Health Care
    3         Administration; repealing s. 395.0199, F.S., relating
    4         to private utilization review of health care services;
    5         amending ss. 395.405 and 400.0712, F.S.; conforming
    6         cross-references; repealing s. 400.118(2), F.S.;
    7         removing provisions requiring quality-of-care monitors
    8         for nursing facilities in agency district offices;
    9         amending s. 400.141, F.S.; deleting a requirement that
   10         licensed nursing home facilities provide the agency
   11         with a monthly report on the number of vacant beds in
   12         the facility; amending s. 400.147, F.S.; revising the
   13         definition of the term “adverse incident” for
   14         reporting purposes; requiring abuse, neglect, and
   15         exploitation to be reported to the agency and the
   16         Department of Children and Family Services; deleting a
   17         requirement that the agency submit an annual report on
   18         nursing home adverse incidents to the Legislature;
   19         amending s. 400.162, F.S.; revising requirements for
   20         policies and procedures regarding the safekeeping of a
   21         resident’s personal effects and property; amending s.
   22         400.195, F.S.; conforming a cross-reference; amending
   23         s. 400.23, F.S.; deleting the requirement of the
   24         agency to adopt rules regarding the eating assistance
   25         provided to residents; amending s. 400.506, F.S.;
   26         providing an exception for the agency to deny,
   27         suspend, or revoke the license of a nurse registry;
   28         amending s. 400.9935, F.S.; revising accreditation
   29         requirements for clinics providing magnetic resonance
   30         imaging services; amending s. 400.995, F.S.; revising
   31         agency responsibilities with respect to agency
   32         administrative penalties; amending s. 408.803, F.S.;
   33         revising definitions applicable to part II of ch. 408,
   34         F.S., the “Health Care Licensing Procedures Act”;
   35         amending s. 408.806, F.S.; revising contents of and
   36         procedures relating to health care provider
   37         applications for licensure; providing an exception
   38         from certain licensure inspections for adult family
   39         care homes; authorizing the agency to provide
   40         electronic access to certain information and
   41         documents; amending s. 408.808, F.S.; providing for a
   42         provisional license to be issued to applicants
   43         applying for a change of ownership; providing a time
   44         limit on provisional licenses; amending s. 408.809,
   45         F.S.; revising provisions relating to background
   46         screening of specified employees; requiring health
   47         care providers to submit to the agency an affidavit of
   48         compliance with background screening requirements at
   49         the time of license renewal; deleting a provision to
   50         conform to changes made by the act; amending s.
   51         408.810, F.S.; revising provisions relating to
   52         information required for licensure; amending s.
   53         408.811, F.S.; providing for certain inspections to be
   54         accepted in lieu of complete licensure inspections;
   55         granting agency access to records requested during an
   56         offsite review; providing timeframes for correction of
   57         certain deficiencies and submission of plans to
   58         correct the deficiencies; amending s. 408.813, F.S.;
   59         providing classifications of violations of part II of
   60         ch. 408, F.S.; providing for fines; amending s.
   61         408.820, F.S.; revising applicability of certain
   62         exemptions from specified requirements of part II of
   63         ch. 408, F.S.; creating s. 408.821, F.S.; requiring
   64         entities regulated or licensed by the agency to
   65         designate a liaison officer for emergency operations;
   66         authorizing entities regulated or licensed by the
   67         agency to temporarily exceed their licensed capacity
   68         to act as receiving providers under specified
   69         circumstances; providing requirements that apply while
   70         such entities are in an overcapacity status; providing
   71         for issuance of an inactive license to such licensees
   72         under specified conditions; providing requirements and
   73         procedures with respect to the issuance and
   74         reactivation of an inactive license; authorizing the
   75         agency to adopt rules; amending s. 408.831, F.S.;
   76         deleting provisions relating to the authorization for
   77         entities regulated or licensed by the agency to exceed
   78         their licensed capacity to act as receiving facilities
   79         and issuance and reactivation of inactive licenses;
   80         amending s. 409.221, F.S.; conforming a cross
   81         reference; amending s. 409.901, F.S.; redefining the
   82         term “change of ownership” as it relates to Medicaid
   83         providers; repealing s. 429.071, F.S., relating to the
   84         intergenerational respite care assisted living
   85         facility pilot program; amending s. 429.08, F.S.;
   86         authorizing the agency to provide information
   87         regarding licensed assisted living facilities on its
   88         Internet website; abolishing local coordinating
   89         workgroups established by agency field offices;
   90         amending s. 429.14, F.S.; conforming a reference;
   91         amending s. 429.19, F.S.; revising agency procedures
   92         for imposition of fines for violations of part I of
   93         ch. 429, F.S., the “Assisted Living Facilities Act”;
   94         amending s. 429.23, F.S.; redefining the term “adverse
   95         incident” for reporting purposes; requiring abuse,
   96         neglect, and exploitation to be reported to the agency
   97         and the Department of Children and Family Services;
   98         deleting a requirement that the agency submit an
   99         annual report on assisted living facility adverse
  100         incidents to the Legislature; repealing s. 429.26(9),
  101         F.S., relating to the removal of the requirement for a
  102         resident of an assisted living facility to undergo
  103         examinations and evaluations under certain
  104         circumstances; amending s. 430.80, F.S.; conforming a
  105         cross-reference; amending ss. 435.04 and 435.05, F.S.;
  106         requiring employers of certain employees to submit an
  107         affidavit of compliance with level 2 screening
  108         requirements at the time of license renewal; amending
  109         s. 483.031, F.S.; revising a provision relating to the
  110         exemption of certain clinical laboratories, to conform
  111         to changes made by the act; amending s. 483.041, F.S.;
  112         redefining the term “waived test” as it is used in
  113         part I of ch. 483, F.S., the “Florida Clinical
  114         Laboratory Law”; repealing s. 483.106, F.S., relating
  115         to applications for certificates of exemption by
  116         clinical laboratories that perform certain tests;
  117         amending ss. 483.172 and 651.118, F.S.; conforming
  118         provisions and a cross-reference; providing an
  119         effective date.
  120  
  121  Be It Enacted by the Legislature of the State of Florida:
  122  
  123         Section 1. Section 395.0199, Florida Statutes, is repealed.
  124         Section 2. Section 395.405, Florida Statutes, is amended to
  125  read:
  126         395.405 Rulemaking.—The department shall adopt and enforce
  127  all rules necessary to administer ss. 395.0199, 395.401,
  128  395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
  129         Section 3. Subsection (1) of section 400.0712, Florida
  130  Statutes, is amended to read:
  131         400.0712 Application for inactive license.—
  132         (1) As specified in s. 408.831(4) and this section, the
  133  agency may issue an inactive license to a nursing home facility
  134  for all or a portion of its beds. Any request by a licensee that
  135  a nursing home or portion of a nursing home become inactive must
  136  be submitted to the agency in the approved format. The facility
  137  may not initiate any suspension of services, notify residents,
  138  or initiate inactivity before receiving approval from the
  139  agency; and a licensee that violates this provision may not be
  140  issued an inactive license.
  141         Section 4. Subsection (2) of section 400.118, Florida
  142  Statutes, is repealed.
  143         Section 5. Section 400.141, Florida Statutes, is amended to
  144  read:
  145         400.141 Administration and management of nursing home
  146  facilities.—
  147         (1) Every licensed facility shall comply with all
  148  applicable standards and rules of the agency and shall:
  149         (a)(1) Be under the administrative direction and charge of
  150  a licensed administrator.
  151         (b)(2) Appoint a medical director licensed pursuant to
  152  chapter 458 or chapter 459. The agency may establish by rule
  153  more specific criteria for the appointment of a medical
  154  director.
  155         (c)(3) Have available the regular, consultative, and
  156  emergency services of physicians licensed by the state.
  157         (d)(4) Provide for resident use of a community pharmacy as
  158  specified in s. 400.022(1)(q). Any other law to the contrary
  159  notwithstanding, a registered pharmacist licensed in Florida,
  160  that is under contract with a facility licensed under this
  161  chapter or chapter 429, shall repackage a nursing facility
  162  resident’s bulk prescription medication which has been packaged
  163  by another pharmacist licensed in any state in the United States
  164  into a unit dose system compatible with the system used by the
  165  nursing facility, if the pharmacist is requested to offer such
  166  service. In order to be eligible for the repackaging, a resident
  167  or the resident’s spouse must receive prescription medication
  168  benefits provided through a former employer as part of his or
  169  her retirement benefits, a qualified pension plan as specified
  170  in s. 4972 of the Internal Revenue Code, a federal retirement
  171  program as specified under 5 C.F.R. s. 831, or a long-term care
  172  policy as defined in s. 627.9404(1). A pharmacist who correctly
  173  repackages and relabels the medication and the nursing facility
  174  which correctly administers such repackaged medication under the
  175  provisions of this paragraph may subsection shall not be held
  176  liable in any civil or administrative action arising from the
  177  repackaging. In order to be eligible for the repackaging, a
  178  nursing facility resident for whom the medication is to be
  179  repackaged shall sign an informed consent form provided by the
  180  facility which includes an explanation of the repackaging
  181  process and which notifies the resident of the immunities from
  182  liability provided in this paragraph herein. A pharmacist who
  183  repackages and relabels prescription medications, as authorized
  184  under this paragraph subsection, may charge a reasonable fee for
  185  costs resulting from the implementation of this provision.
  186         (e)(5) Provide for the access of the facility residents to
  187  dental and other health-related services, recreational services,
  188  rehabilitative services, and social work services appropriate to
  189  their needs and conditions and not directly furnished by the
  190  licensee. When a geriatric outpatient nurse clinic is conducted
  191  in accordance with rules adopted by the agency, outpatients
  192  attending such clinic shall not be counted as part of the
  193  general resident population of the nursing home facility, nor
  194  shall the nursing staff of the geriatric outpatient clinic be
  195  counted as part of the nursing staff of the facility, until the
  196  outpatient clinic load exceeds 15 a day.
  197         (f)(6) Be allowed and encouraged by the agency to provide
  198  other needed services under certain conditions. If the facility
  199  has a standard licensure status, and has had no class I or class
  200  II deficiencies during the past 2 years or has been awarded a
  201  Gold Seal under the program established in s. 400.235, it may be
  202  encouraged by the agency to provide services, including, but not
  203  limited to, respite and adult day services, which enable
  204  individuals to move in and out of the facility. A facility is
  205  not subject to any additional licensure requirements for
  206  providing these services. Respite care may be offered to persons
  207  in need of short-term or temporary nursing home services.
  208  Respite care must be provided in accordance with this part and
  209  rules adopted by the agency. However, the agency shall, by rule,
  210  adopt modified requirements for resident assessment, resident
  211  care plans, resident contracts, physician orders, and other
  212  provisions, as appropriate, for short-term or temporary nursing
  213  home services. The agency shall allow for shared programming and
  214  staff in a facility which meets minimum standards and offers
  215  services pursuant to this paragraph subsection, but, if the
  216  facility is cited for deficiencies in patient care, may require
  217  additional staff and programs appropriate to the needs of
  218  service recipients. A person who receives respite care may not
  219  be counted as a resident of the facility for purposes of the
  220  facility’s licensed capacity unless that person receives 24-hour
  221  respite care. A person receiving either respite care for 24
  222  hours or longer or adult day services must be included when
  223  calculating minimum staffing for the facility. Any costs and
  224  revenues generated by a nursing home facility from
  225  nonresidential programs or services shall be excluded from the
  226  calculations of Medicaid per diems for nursing home
  227  institutional care reimbursement.
  228         (g)(7) If the facility has a standard license or is a Gold
  229  Seal facility, exceeds the minimum required hours of licensed
  230  nursing and certified nursing assistant direct care per resident
  231  per day, and is part of a continuing care facility licensed
  232  under chapter 651 or a retirement community that offers other
  233  services pursuant to part III of this chapter or part I or part
  234  III of chapter 429 on a single campus, be allowed to share
  235  programming and staff. At the time of inspection and in the
  236  semiannual report required pursuant to paragraph (o) subsection
  237  (15), a continuing care facility or retirement community that
  238  uses this option must demonstrate through staffing records that
  239  minimum staffing requirements for the facility were met.
  240  Licensed nurses and certified nursing assistants who work in the
  241  nursing home facility may be used to provide services elsewhere
  242  on campus if the facility exceeds the minimum number of direct
  243  care hours required per resident per day and the total number of
  244  residents receiving direct care services from a licensed nurse
  245  or a certified nursing assistant does not cause the facility to
  246  violate the staffing ratios required under s. 400.23(3)(a).
  247  Compliance with the minimum staffing ratios shall be based on
  248  total number of residents receiving direct care services,
  249  regardless of where they reside on campus. If the facility
  250  receives a conditional license, it may not share staff until the
  251  conditional license status ends. This paragraph subsection does
  252  not restrict the agency’s authority under federal or state law
  253  to require additional staff if a facility is cited for
  254  deficiencies in care which are caused by an insufficient number
  255  of certified nursing assistants or licensed nurses. The agency
  256  may adopt rules for the documentation necessary to determine
  257  compliance with this provision.
  258         (h)(8) Maintain the facility premises and equipment and
  259  conduct its operations in a safe and sanitary manner.
  260         (i)(9) If the licensee furnishes food service, provide a
  261  wholesome and nourishing diet sufficient to meet generally
  262  accepted standards of proper nutrition for its residents and
  263  provide such therapeutic diets as may be prescribed by attending
  264  physicians. In making rules to implement this paragraph
  265  subsection, the agency shall be guided by standards recommended
  266  by nationally recognized professional groups and associations
  267  with knowledge of dietetics.
  268         (j)(10) Keep full records of resident admissions and
  269  discharges; medical and general health status, including medical
  270  records, personal and social history, and identity and address
  271  of next of kin or other persons who may have responsibility for
  272  the affairs of the residents; and individual resident care plans
  273  including, but not limited to, prescribed services, service
  274  frequency and duration, and service goals. The records shall be
  275  open to inspection by the agency.
  276         (k)(11) Keep such fiscal records of its operations and
  277  conditions as may be necessary to provide information pursuant
  278  to this part.
  279         (l)(12) Furnish copies of personnel records for employees
  280  affiliated with such facility, to any other facility licensed by
  281  this state requesting this information pursuant to this part.
  282  Such information contained in the records may include, but is
  283  not limited to, disciplinary matters and any reason for
  284  termination. Any facility releasing such records pursuant to
  285  this part shall be considered to be acting in good faith and may
  286  not be held liable for information contained in such records,
  287  absent a showing that the facility maliciously falsified such
  288  records.
  289         (m)(13) Publicly display a poster provided by the agency
  290  containing the names, addresses, and telephone numbers for the
  291  state’s abuse hotline, the State Long-Term Care Ombudsman, the
  292  Agency for Health Care Administration consumer hotline, the
  293  Advocacy Center for Persons with Disabilities, the Florida
  294  Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
  295  with a clear description of the assistance to be expected from
  296  each.
  297         (n)(14) Submit to the agency the information specified in
  298  s. 400.071(1)(b) for a management company within 30 days after
  299  the effective date of the management agreement.
  300         (o)1.(15) Submit semiannually to the agency, or more
  301  frequently if requested by the agency, information regarding
  302  facility staff-to-resident ratios, staff turnover, and staff
  303  stability, including information regarding certified nursing
  304  assistants, licensed nurses, the director of nursing, and the
  305  facility administrator. For purposes of this reporting:
  306         a.(a) Staff-to-resident ratios must be reported in the
  307  categories specified in s. 400.23(3)(a) and applicable rules.
  308  The ratio must be reported as an average for the most recent
  309  calendar quarter.
  310         b.(b) Staff turnover must be reported for the most recent
  311  12-month period ending on the last workday of the most recent
  312  calendar quarter prior to the date the information is submitted.
  313  The turnover rate must be computed quarterly, with the annual
  314  rate being the cumulative sum of the quarterly rates. The
  315  turnover rate is the total number of terminations or separations
  316  experienced during the quarter, excluding any employee
  317  terminated during a probationary period of 3 months or less,
  318  divided by the total number of staff employed at the end of the
  319  period for which the rate is computed, and expressed as a
  320  percentage.
  321         c.(c) The formula for determining staff stability is the
  322  total number of employees that have been employed for more than
  323  12 months, divided by the total number of employees employed at
  324  the end of the most recent calendar quarter, and expressed as a
  325  percentage.
  326         d.(d) A nursing facility that has failed to comply with
  327  state minimum-staffing requirements for 2 consecutive days is
  328  prohibited from accepting new admissions until the facility has
  329  achieved the minimum-staffing requirements for a period of 6
  330  consecutive days. For the purposes of this sub-subparagraph
  331  paragraph, any person who was a resident of the facility and was
  332  absent from the facility for the purpose of receiving medical
  333  care at a separate location or was on a leave of absence is not
  334  considered a new admission. Failure to impose such an admissions
  335  moratorium constitutes a class II deficiency.
  336         e.(e) A nursing facility which does not have a conditional
  337  license may be cited for failure to comply with the standards in
  338  s. 400.23(3)(a)1.a. only if it has failed to meet those
  339  standards on 2 consecutive days or if it has failed to meet at
  340  least 97 percent of those standards on any one day.
  341         f.(f) A facility which has a conditional license must be in
  342  compliance with the standards in s. 400.23(3)(a) at all times.
  343  
  344         2.Nothing in This paragraph does not section shall limit
  345  the agency’s ability to impose a deficiency or take other
  346  actions if a facility does not have enough staff to meet the
  347  residents’ needs.
  348         (16)Report monthly the number of vacant beds in the
  349  facility which are available for resident occupancy on the day
  350  the information is reported.
  351         (p)(17) Notify a licensed physician when a resident
  352  exhibits signs of dementia or cognitive impairment or has a
  353  change of condition in order to rule out the presence of an
  354  underlying physiological condition that may be contributing to
  355  such dementia or impairment. The notification must occur within
  356  30 days after the acknowledgment of such signs by facility
  357  staff. If an underlying condition is determined to exist, the
  358  facility shall arrange, with the appropriate health care
  359  provider, the necessary care and services to treat the
  360  condition.
  361         (q)(18) If the facility implements a dining and hospitality
  362  attendant program, ensure that the program is developed and
  363  implemented under the supervision of the facility director of
  364  nursing. A licensed nurse, licensed speech or occupational
  365  therapist, or a registered dietitian must conduct training of
  366  dining and hospitality attendants. A person employed by a
  367  facility as a dining and hospitality attendant must perform
  368  tasks under the direct supervision of a licensed nurse.
  369         (r)(19) Report to the agency any filing for bankruptcy
  370  protection by the facility or its parent corporation,
  371  divestiture or spin-off of its assets, or corporate
  372  reorganization within 30 days after the completion of such
  373  activity.
  374         (s)(20) Maintain general and professional liability
  375  insurance coverage that is in force at all times. In lieu of
  376  general and professional liability insurance coverage, a state
  377  designated teaching nursing home and its affiliated assisted
  378  living facilities created under s. 430.80 may demonstrate proof
  379  of financial responsibility as provided in s. 430.80(3)(h).
  380         (t)(21) Maintain in the medical record for each resident a
  381  daily chart of certified nursing assistant services provided to
  382  the resident. The certified nursing assistant who is caring for
  383  the resident must complete this record by the end of his or her
  384  shift. This record must indicate assistance with activities of
  385  daily living, assistance with eating, and assistance with
  386  drinking, and must record each offering of nutrition and
  387  hydration for those residents whose plan of care or assessment
  388  indicates a risk for malnutrition or dehydration.
  389         (u)(22) Before November 30 of each year, subject to the
  390  availability of an adequate supply of the necessary vaccine,
  391  provide for immunizations against influenza viruses to all its
  392  consenting residents in accordance with the recommendations of
  393  the United States Centers for Disease Control and Prevention,
  394  subject to exemptions for medical contraindications and
  395  religious or personal beliefs. Subject to these exemptions, any
  396  consenting person who becomes a resident of the facility after
  397  November 30 but before March 31 of the following year must be
  398  immunized within 5 working days after becoming a resident.
  399  Immunization shall not be provided to any resident who provides
  400  documentation that he or she has been immunized as required by
  401  this paragraph subsection. This paragraph subsection does not
  402  prohibit a resident from receiving the immunization from his or
  403  her personal physician if he or she so chooses. A resident who
  404  chooses to receive the immunization from his or her personal
  405  physician shall provide proof of immunization to the facility.
  406  The agency may adopt and enforce any rules necessary to comply
  407  with or implement this subsection.
  408         (v)(23) Assess all residents for eligibility for
  409  pneumococcal polysaccharide vaccination (PPV) and vaccinate
  410  residents when indicated within 60 days after the effective date
  411  of this act in accordance with the recommendations of the United
  412  States Centers for Disease Control and Prevention, subject to
  413  exemptions for medical contraindications and religious or
  414  personal beliefs. Residents admitted after the effective date of
  415  this act shall be assessed within 5 working days of admission
  416  and, when indicated, vaccinated within 60 days in accordance
  417  with the recommendations of the United States Centers for
  418  Disease Control and Prevention, subject to exemptions for
  419  medical contraindications and religious or personal beliefs.
  420  Immunization shall not be provided to any resident who provides
  421  documentation that he or she has been immunized as required by
  422  this paragraph subsection. This paragraph subsection does not
  423  prohibit a resident from receiving the immunization from his or
  424  her personal physician if he or she so chooses. A resident who
  425  chooses to receive the immunization from his or her personal
  426  physician shall provide proof of immunization to the facility.
  427  The agency may adopt and enforce any rules necessary to comply
  428  with or implement this paragraph subsection.
  429         (w)(24) Annually encourage and promote to its employees the
  430  benefits associated with immunizations against influenza viruses
  431  in accordance with the recommendations of the United States
  432  Centers for Disease Control and Prevention. The agency may adopt
  433  and enforce any rules necessary to comply with or implement this
  434  paragraph subsection.
  435         (2) Facilities that have been awarded a Gold Seal under the
  436  program established in s. 400.235 may develop a plan to provide
  437  certified nursing assistant training as prescribed by federal
  438  regulations and state rules and may apply to the agency for
  439  approval of their program.
  440         Section 6. Subsections (5), (9), (10), (11), (12), (13),
  441  (14), and (15) of section 400.147, Florida Statutes, are amended
  442  to read:
  443         400.147 Internal risk management and quality assurance
  444  program.—
  445         (5) For purposes of reporting to the agency under this
  446  section, the term “adverse incident” means:
  447         (a) An event over which facility personnel could exercise
  448  control and which is associated in whole or in part with the
  449  facility’s intervention, rather than the condition for which
  450  such intervention occurred, and which results in one of the
  451  following:
  452         1. Death;
  453         2. Brain or spinal damage;
  454         3. Permanent disfigurement;
  455         4. Fracture or dislocation of bones or joints;
  456         5. A limitation of neurological, physical, or sensory
  457  function;
  458         6. Any condition that required medical attention to which
  459  the resident has not given his or her informed consent,
  460  including failure to honor advanced directives; or
  461         7. Any condition that required the transfer of the
  462  resident, within or outside the facility, to a unit providing a
  463  more acute level of care due to the adverse incident, rather
  464  than the resident’s condition prior to the adverse incident; or
  465         8.An event that is reported to law enforcement or its
  466  personnel for investigation; or
  467         (b)Abuse, neglect, or exploitation as defined in s.
  468  415.102;
  469         (c)Abuse, neglect and harm as defined in s. 39.01;
  470         (b)(d) Resident elopement, if the elopement places the
  471  resident at risk of harm or injury.; or
  472         (e)An event that is reported to law enforcement.
  473         (9)Abuse, neglect, or exploitation must be reported to the
  474  agency as required by 42 C.F.R. s. 483.13(c) and to the
  475  department as required by chapters 39 and 415.
  476         (10)(9) By the 10th of each month, each facility subject to
  477  this section shall report any notice received pursuant to s.
  478  400.0233(2) and each initial complaint that was filed with the
  479  clerk of the court and served on the facility during the
  480  previous month by a resident or a resident’s family member,
  481  guardian, conservator, or personal legal representative. The
  482  report must include the name of the resident, the resident’s
  483  date of birth and social security number, the Medicaid
  484  identification number for Medicaid-eligible persons, the date or
  485  dates of the incident leading to the claim or dates of
  486  residency, if applicable, and the type of injury or violation of
  487  rights alleged to have occurred. Each facility shall also submit
  488  a copy of the notices received pursuant to s. 400.0233(2) and
  489  complaints filed with the clerk of the court. This report is
  490  confidential as provided by law and is not discoverable or
  491  admissible in any civil or administrative action, except in such
  492  actions brought by the agency to enforce the provisions of this
  493  part.
  494         (11)(10) The agency shall review, as part of its licensure
  495  inspection process, the internal risk management and quality
  496  assurance program at each facility regulated by this section to
  497  determine whether the program meets standards established in
  498  statutory laws and rules, is being conducted in a manner
  499  designed to reduce adverse incidents, and is appropriately
  500  reporting incidents as required by this section.
  501         (12)(11) There is no monetary liability on the part of, and
  502  a cause of action for damages may not arise against, any risk
  503  manager for the implementation and oversight of the internal
  504  risk management and quality assurance program in a facility
  505  licensed under this part as required by this section, or for any
  506  act or proceeding undertaken or performed within the scope of
  507  the functions of such internal risk management and quality
  508  assurance program if the risk manager acts without intentional
  509  fraud.
  510         (13)(12) If the agency, through its receipt of the adverse
  511  incident reports prescribed in subsection (7), or through any
  512  investigation, has a reasonable belief that conduct by a staff
  513  member or employee of a facility is grounds for disciplinary
  514  action by the appropriate regulatory board, the agency shall
  515  report this fact to the regulatory board.
  516         (14)(13) The agency may adopt rules to administer this
  517  section.
  518         (14)The agency shall annually submit to the Legislature a
  519  report on nursing home adverse incidents. The report must
  520  include the following information arranged by county:
  521         (a)The total number of adverse incidents.
  522         (b)A listing, by category, of the types of adverse
  523  incidents, the number of incidents occurring within each
  524  category, and the type of staff involved.
  525         (c)A listing, by category, of the types of injury caused
  526  and the number of injuries occurring within each category.
  527         (d)Types of liability claims filed based on an adverse
  528  incident or reportable injury.
  529         (e)Disciplinary action taken against staff, categorized by
  530  type of staff involved.
  531         (15) Information gathered by a credentialing organization
  532  under a quality assurance program is not discoverable from the
  533  credentialing organization. This subsection does not limit
  534  discovery of, access to, or use of facility records, including
  535  those records from which the credentialing organization gathered
  536  its information.
  537         Section 7. Subsection (3) of section 400.162, Florida
  538  Statutes, is amended to read:
  539         400.162 Property and personal affairs of residents.—
  540         (3) A licensee shall provide for the safekeeping of
  541  personal effects, funds, and other property of the resident in
  542  the facility. Whenever necessary for the protection of
  543  valuables, or in order to avoid unreasonable responsibility
  544  therefor, the licensee may require that such valuables be
  545  excluded or removed from the facility and kept at some place not
  546  subject to the control of the licensee. At the request of a
  547  resident, the facility shall mark the resident’s personal
  548  property with the resident’s name or another type of
  549  identification, without defacing the property. Any theft or loss
  550  of a resident’s personal property shall be documented by the
  551  facility. The facility shall develop policies and procedures to
  552  minimize the risk of theft or loss of the personal property of
  553  residents. A copy of the policy shall be provided to every
  554  employee and to each resident and the resident’s representative
  555  if appropriate at admission and when revised. Facility policies
  556  must include provisions related to reporting theft or loss of a
  557  resident’s property to law enforcement and any facility waiver
  558  of liability for loss or theft. The facility shall post notice
  559  of these policies and procedures, and any revision thereof, in
  560  places accessible to residents.
  561         Section 8. Paragraph (d) of subsection (1) of section
  562  400.195, Florida Statutes, is amended to read:
  563         400.195 Agency reporting requirements.—
  564         (1) For the period beginning June 30, 2001, and ending June
  565  30, 2005, the Agency for Health Care Administration shall
  566  provide a report to the Governor, the President of the Senate,
  567  and the Speaker of the House of Representatives with respect to
  568  nursing homes. The first report shall be submitted no later than
  569  December 30, 2002, and subsequent reports shall be submitted
  570  every 6 months thereafter. The report shall identify facilities
  571  based on their ownership characteristics, size, business
  572  structure, for-profit or not-for-profit status, and any other
  573  characteristics the agency determines useful in analyzing the
  574  varied segments of the nursing home industry and shall report: 
  575         (d) Information regarding deficiencies cited, including
  576  information used to develop the Nursing Home Guide WATCH LIST
  577  pursuant to s. 400.191, and applicable rules, a summary of data
  578  generated on nursing homes by Centers for Medicare and Medicaid
  579  Services Nursing Home Quality Information Project, and
  580  information collected pursuant to s. 400.147(10) s. 400.147(9),
  581  relating to litigation.
  582         Section 9. Subsection (3) of section 400.23, Florida
  583  Statutes, is amended to read:
  584         400.23 Rules; evaluation and deficiencies; licensure
  585  status.—
  586         (3)(a)1. The agency shall adopt rules providing minimum
  587  staffing requirements for nursing homes. These requirements
  588  shall include, for each nursing home facility:
  589         a. A minimum certified nursing assistant staffing of 2.6
  590  hours of direct care per resident per day beginning January 1,
  591  2003, and increasing to 2.7 hours of direct care per resident
  592  per day beginning January 1, 2007. Beginning January 1, 2002, no
  593  facility shall staff below one certified nursing assistant per
  594  20 residents, and a minimum licensed nursing staffing of 1.0
  595  hour of direct care per resident per day but never below one
  596  licensed nurse per 40 residents.
  597         b. Beginning January 1, 2007, a minimum weekly average
  598  certified nursing assistant staffing of 2.9 hours of direct care
  599  per resident per day. For the purpose of this sub-subparagraph,
  600  a week is defined as Sunday through Saturday.
  601         2. Nursing assistants employed under s. 400.211(2) may be
  602  included in computing the staffing ratio for certified nursing
  603  assistants only if their job responsibilities include only
  604  nursing-assistant-related duties.
  605         3. Each nursing home must document compliance with staffing
  606  standards as required under this paragraph and post daily the
  607  names of staff on duty for the benefit of facility residents and
  608  the public.
  609         4. The agency shall recognize the use of licensed nurses
  610  for compliance with minimum staffing requirements for certified
  611  nursing assistants, provided that the facility otherwise meets
  612  the minimum staffing requirements for licensed nurses and that
  613  the licensed nurses are performing the duties of a certified
  614  nursing assistant. Unless otherwise approved by the agency,
  615  licensed nurses counted toward the minimum staffing requirements
  616  for certified nursing assistants must exclusively perform the
  617  duties of a certified nursing assistant for the entire shift and
  618  not also be counted toward the minimum staffing requirements for
  619  licensed nurses. If the agency approved a facility’s request to
  620  use a licensed nurse to perform both licensed nursing and
  621  certified nursing assistant duties, the facility must allocate
  622  the amount of staff time specifically spent on certified nursing
  623  assistant duties for the purpose of documenting compliance with
  624  minimum staffing requirements for certified and licensed nursing
  625  staff. In no event may the hours of a licensed nurse with dual
  626  job responsibilities be counted twice.
  627         (b) The agency shall adopt rules to allow properly trained
  628  staff of a nursing facility, in addition to certified nursing
  629  assistants and licensed nurses, to assist residents with eating.
  630  The rules shall specify the minimum training requirements and
  631  shall specify the physiological conditions or disorders of
  632  residents which would necessitate that the eating assistance be
  633  provided by nursing personnel of the facility. Nonnursing staff
  634  providing eating assistance to residents under the provisions of
  635  this subsection shall not count toward compliance with minimum
  636  staffing standards.
  637         (c) Licensed practical nurses licensed under chapter 464
  638  who are providing nursing services in nursing home facilities
  639  under this part may supervise the activities of other licensed
  640  practical nurses, certified nursing assistants, and other
  641  unlicensed personnel providing services in such facilities in
  642  accordance with rules adopted by the Board of Nursing.
  643         Section 10. Paragraph (a) of subsection (15) of section
  644  400.506, Florida Statutes, is amended to read:
  645         400.506 Licensure of nurse registries; requirements;
  646  penalties.—
  647         (15)(a) The agency may deny, suspend, or revoke the license
  648  of a nurse registry and shall impose a fine of $5,000 against a
  649  nurse registry that:
  650         1. Provides services to residents in an assisted living
  651  facility for which the nurse registry does not receive fair
  652  market value remuneration.
  653         2. Provides staffing to an assisted living facility for
  654  which the nurse registry does not receive fair market value
  655  remuneration.
  656         3. Fails to provide the agency, upon request, with copies
  657  of all contracts with assisted living facilities which were
  658  executed within the last 5 years.
  659         4. Gives remuneration to a case manager, discharge planner,
  660  facility-based staff member, or third-party vendor who is
  661  involved in the discharge planning process of a facility
  662  licensed under chapter 395 or this chapter and from whom the
  663  nurse registry receives referrals, except that this subparagraph
  664  does not apply to a nurse registry that does not participate in
  665  the Medicaid or Medicare program.
  666         5. Gives remuneration to a physician, a member of the
  667  physician’s office staff, or an immediate family member of the
  668  physician, and the nurse registry received a patient referral in
  669  the last 12 months from that physician or the physician’s office
  670  staff, except that this subparagraph does not apply to a nurse
  671  registry that does not participate in the Medicaid or Medicare
  672  program.
  673         Section 11. Paragraph (a) of subsection (7) of section
  674  400.9935, Florida Statutes, is amended to read:
  675         400.9935 Clinic responsibilities.—
  676         (7)(a) Each clinic engaged in magnetic resonance imaging
  677  services must be accredited by the Joint Commission on
  678  Accreditation of Healthcare Organizations, the American College
  679  of Radiology, or the Accreditation Association for Ambulatory
  680  Health Care, within 1 year after licensure. A clinic that is
  681  accredited by the American College of Radiology or is within the
  682  original 1-year period after licensure and replaces its core
  683  magnetic resonance imaging equipment shall be given 1 year after
  684  the date on which the equipment is replaced to attain
  685  accreditation. However, a clinic may request a single, 6-month
  686  extension if it provides evidence to the agency establishing
  687  that, for good cause shown, such clinic cannot can not be
  688  accredited within 1 year after licensure, and that such
  689  accreditation will be completed within the 6-month extension.
  690  After obtaining accreditation as required by this subsection,
  691  each such clinic must maintain accreditation as a condition of
  692  renewal of its license. A clinic that files a change of
  693  ownership application must comply with the original
  694  accreditation timeframe requirements of the transferor. The
  695  agency shall deny a change of ownership application if the
  696  clinic is not in compliance with the accreditation requirements.
  697  When a clinic adds, replaces, or modifies magnetic resonance
  698  imaging equipment and the accreditation agency requires new
  699  accreditation, the clinic must be accredited within 1 year after
  700  the date of the addition, replacement, or modification but may
  701  request a single, 6-month extension if the clinic provides
  702  evidence of good cause to the agency.
  703         Section 12. Subsection (6) of section 400.995, Florida
  704  Statutes, is amended to read:
  705         400.995 Agency administrative penalties.—
  706         (6) During an inspection, the agency, as an alternative to
  707  or in conjunction with an administrative action against a clinic
  708  for violations of this part and adopted rules, shall make a
  709  reasonable attempt to discuss each violation and recommended
  710  corrective action with the owner, medical director, or clinic
  711  director of the clinic, prior to written notification. The
  712  agency, instead of fixing a period within which the clinic shall
  713  enter into compliance with standards, may request a plan of
  714  corrective action from the clinic which demonstrates a good
  715  faith effort to remedy each violation by a specific date,
  716  subject to the approval of the agency.
  717         Section 13. Subsections (5) and (9) of section 408.803,
  718  Florida Statutes, are amended to read:
  719         408.803 Definitions.—As used in this part, the term:
  720         (5) “Change of ownership” means:
  721         (a) An event in which the licensee sells or otherwise
  722  transfers its ownership changes to a different individual or
  723  legal entity as evidenced by a change in federal employer
  724  identification number or taxpayer identification number; or
  725         (b)An event in which 51 45 percent or more of the
  726  ownership, voting shares, membership, or controlling interest of
  727  a licensee is in any manner transferred or otherwise assigned.
  728  This paragraph does not apply to a licensee that is publicly
  729  traded on a recognized stock exchange in a corporation whose
  730  shares are not publicly traded on a recognized stock exchange is
  731  transferred or assigned, including the final transfer or
  732  assignment of multiple transfers or assignments over a 2-year
  733  period that cumulatively total 45 percent or greater.
  734  
  735  A change solely in the management company or board of directors
  736  is not a change of ownership.
  737         (9) “Licensee” means an individual, corporation,
  738  partnership, firm, association, or governmental entity, or other
  739  entity that is issued a permit, registration, certificate, or
  740  license by the agency. The licensee is legally responsible for
  741  all aspects of the provider operation.
  742         Section 14. Paragraph (a) of subsection (1), subsection
  743  (2), paragraph (c) of subsection (7), and subsection (8) of
  744  section 408.806, Florida Statutes, are amended to read:
  745         408.806 License application process.—
  746         (1) An application for licensure must be made to the agency
  747  on forms furnished by the agency, submitted under oath, and
  748  accompanied by the appropriate fee in order to be accepted and
  749  considered timely. The application must contain information
  750  required by authorizing statutes and applicable rules and must
  751  include:
  752         (a) The name, address, and social security number of:
  753         1. The applicant;
  754         2.The administrator or a similarly titled person who is
  755  responsible for the day-to-day operation of the provider;
  756         3.The financial officer or similarly titled person who is
  757  responsible for the financial operation of the licensee or
  758  provider; and
  759         4. Each controlling interest if the applicant or
  760  controlling interest is an individual.
  761         (2)(a) The applicant for a renewal license must submit an
  762  application that must be received by the agency at least 60 days
  763  but no more than 120 days before prior to the expiration of the
  764  current license. An application received more than 120 days
  765  before the expiration of the current license shall be returned
  766  to the applicant. If the renewal application and fee are
  767  received prior to the license expiration date, the license shall
  768  not be deemed to have expired if the license expiration date
  769  occurs during the agency’s review of the renewal application.
  770         (b) The applicant for initial licensure due to a change of
  771  ownership must submit an application that must be received by
  772  the agency at least 60 days prior to the date of change of
  773  ownership.
  774         (c) For any other application or request, the applicant
  775  must submit an application or request that must be received by
  776  the agency at least 60 days but no more than 120 days before
  777  prior to the requested effective date, unless otherwise
  778  specified in authorizing statutes or applicable rules. An
  779  application received more than 120 days before the requested
  780  effective date shall be returned to the applicant.
  781         (d) The agency shall notify the licensee by mail or
  782  electronically at least 90 days before prior to the expiration
  783  of a license that a renewal license is necessary to continue
  784  operation. The failure to timely submit a renewal application
  785  and license fee shall result in a $50 per day late fee charged
  786  to the licensee by the agency; however, the aggregate amount of
  787  the late fee may not exceed 50 percent of the licensure fee or
  788  $500, whichever is less. If an application is received after the
  789  required filing date and exhibits a hand-canceled postmark
  790  obtained from a United States post office dated on or before the
  791  required filing date, no fine will be levied.
  792         (7)
  793         (c) If an inspection is required by the authorizing statute
  794  for a license application other than an initial application, the
  795  inspection must be unannounced. This paragraph does not apply to
  796  inspections required pursuant to ss. 383.324, 395.0161(4),
  797  429.67(6), and 483.061(2).
  798         (8) The agency may establish procedures for the electronic
  799  notification and submission of required information, including,
  800  but not limited to:
  801         (a) Licensure applications.
  802         (b) Required signatures.
  803         (c) Payment of fees.
  804         (d) Notarization of applications.
  805  
  806  Requirements for electronic submission of any documents required
  807  by this part or authorizing statutes may be established by rule.
  808  As an alternative to sending documents as required by
  809  authorizing statutes, the agency may provide electronic access
  810  to information or documents.
  811         Section 15. Subsection (2) of section 408.808, Florida
  812  Statutes, is amended to read:
  813         408.808 License categories.—
  814         (2) PROVISIONAL LICENSE.—A provisional license may be
  815  issued to an applicant pursuant to s. 408.809(3). An applicant
  816  against whom a proceeding denying or revoking a license is
  817  pending at the time of license renewal may be issued a
  818  provisional license effective until final action not subject to
  819  further appeal. A provisional license may also be issued to an
  820  applicant applying for a change of ownership. A provisional
  821  license shall be limited in duration to a specific period of
  822  time, not to exceed 12 months, as determined by the agency.
  823         Section 16. Subsection (5) of section 408.809, Florida
  824  Statutes, is amended, and subsection (6) is added to that
  825  section, to read:
  826         408.809 Background screening; prohibited offenses.—
  827         (5) Effective October 1, 2009, in addition to the offenses
  828  listed in ss. 435.03 and 435.04, all persons required to undergo
  829  background screening pursuant to this part or authorizing
  830  statutes must not have been found guilty of, regardless of
  831  adjudication, or entered a plea of nolo contendere or guilty to,
  832  any of the following offenses or any similar offense of another
  833  jurisdiction:
  834         (a)Any authorizing statutes, if the offense was a felony.
  835         (b)This chapter, if the offense was a felony.
  836         (c)Section 409.920, relating to Medicaid provider fraud,
  837  if the offense was a felony.
  838         (d)Section 409.9201, relating to Medicaid fraud, if the
  839  offense was a felony.
  840         (e)Section 741.28, relating to domestic violence.
  841         (f)Chapter 784, relating to assault, battery, and culpable
  842  negligence, if the offense was a felony.
  843         (g)Section 810.02, relating to burglary.
  844         (h)Section 817.034, relating to fraudulent acts through
  845  mail, wire, radio, electromagnetic, photoelectronic, or
  846  photooptical systems.
  847         (i)Section 817.234, relating to false and fraudulent
  848  insurance claims.
  849         (j)Section 817.505, relating to patient brokering.
  850         (k)Section 817.568, relating to criminal use of personal
  851  identification information.
  852         (l)Section 817.60, relating to obtaining a credit card
  853  through fraudulent means.
  854         (m)Section 817.61, relating to fraudulent use of credit
  855  cards, if the offense was a felony.
  856         (n)Section 831.01, relating to forgery.
  857         (o)Section 831.02, relating to uttering forged
  858  instruments.
  859         (p)Section 831.07, relating to forging bank bills, checks,
  860  drafts, or promissory notes.
  861         (q)Section 831.09, relating to uttering forged bank bills,
  862  checks, drafts, or promissory notes.
  863         (r)Section 831.30, relating to fraud in obtaining
  864  medicinal drugs.
  865         (s)Section 831.31, relating to the sale, manufacture,
  866  delivery, or possession with the intent to sell, manufacture, or
  867  deliver any counterfeit controlled substance, if the offense was
  868  a felony.
  869  
  870  A person who serves as a controlling interest of or is employed
  871  by a licensee on September 30, 2009, is not required by law to
  872  submit to rescreening if that licensee has in its possession
  873  written evidence that the person has been screened and qualified
  874  according to the standards specified in s. 435.03 or s. 435.04.
  875  However, if such person has a disqualifying offense listed in
  876  this section, he or she may apply for an exemption from the
  877  appropriate licensing agency before September 30, 2009, and if
  878  agreed to by the employer, may continue to perform his or her
  879  duties until the licensing agency renders a decision on the
  880  application for exemption for offenses listed in this section.
  881  Exemptions from disqualification may be granted pursuant to s.
  882  435.07. Background screening is not required to obtain a
  883  certificate of exemption issued under s. 483.106.
  884         (6)The attestations required under ss. 435.04(5) and
  885  435.05(3) must be submitted at the time of license renewal,
  886  notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
  887  which require annual submission of an affidavit of compliance
  888  with background screening requirements.
  889         Section 17. Subsection (3) of section 408.810, Florida
  890  Statutes, is amended to read:
  891         408.810 Minimum licensure requirements.—In addition to the
  892  licensure requirements specified in this part, authorizing
  893  statutes, and applicable rules, each applicant and licensee must
  894  comply with the requirements of this section in order to obtain
  895  and maintain a license.
  896         (3) Unless otherwise specified in this part, authorizing
  897  statutes, or applicable rules, any information required to be
  898  reported to the agency must be submitted within 21 calendar days
  899  after the report period or effective date of the information,
  900  whichever is earlier, including, but not limited to, any change
  901  of:
  902         (a)Information contained in the most recent application
  903  for licensure.
  904         (b)Required insurance or bonds.
  905         Section 18. Section 408.811, Florida Statutes, is amended
  906  to read:
  907         408.811 Right of inspection; copies; inspection reports;
  908  plan for correction of deficiencies.—
  909         (1) An authorized officer or employee of the agency may
  910  make or cause to be made any inspection or investigation deemed
  911  necessary by the agency to determine the state of compliance
  912  with this part, authorizing statutes, and applicable rules. The
  913  right of inspection extends to any business that the agency has
  914  reason to believe is being operated as a provider without a
  915  license, but inspection of any business suspected of being
  916  operated without the appropriate license may not be made without
  917  the permission of the owner or person in charge unless a warrant
  918  is first obtained from a circuit court. Any application for a
  919  license issued under this part, authorizing statutes, or
  920  applicable rules constitutes permission for an appropriate
  921  inspection to verify the information submitted on or in
  922  connection with the application.
  923         (a) All inspections shall be unannounced, except as
  924  specified in s. 408.806.
  925         (b) Inspections for relicensure shall be conducted
  926  biennially unless otherwise specified by authorizing statutes or
  927  applicable rules.
  928         (2) Inspections conducted in conjunction with
  929  certification, comparable licensure requirements, or a
  930  recognized or approved accreditation organization may be
  931  accepted in lieu of a complete licensure inspection. However, a
  932  licensure inspection may also be conducted to review any
  933  licensure requirements that are not also requirements for
  934  certification.
  935         (3) The agency shall have access to and the licensee shall
  936  provide, or if requested send, copies of all provider records
  937  required during an inspection or other review at no cost to the
  938  agency, including records requested during an offsite review.
  939         (4)A deficiency must be corrected within 30 calendar days
  940  after the provider is notified of inspection results unless an
  941  alternative timeframe is required or approved by the agency.
  942         (5)The agency may require an applicant or licensee to
  943  submit a plan of correction for deficiencies. If required, the
  944  plan of correction must be filed with the agency within 10
  945  calendar days after notification unless an alternative timeframe
  946  is required.
  947         (6)(a)(4)(a) Each licensee shall maintain as public
  948  information, available upon request, records of all inspection
  949  reports pertaining to that provider that have been filed by the
  950  agency unless those reports are exempt from or contain
  951  information that is exempt from s. 119.07(1) and s. 24(a), Art.
  952  I of the State Constitution or is otherwise made confidential by
  953  law. Effective October 1, 2006, copies of such reports shall be
  954  retained in the records of the provider for at least 3 years
  955  following the date the reports are filed and issued, regardless
  956  of a change of ownership.
  957         (b) A licensee shall, upon the request of any person who
  958  has completed a written application with intent to be admitted
  959  by such provider, any person who is a client of such provider,
  960  or any relative, spouse, or guardian of any such person, furnish
  961  to the requester a copy of the last inspection report pertaining
  962  to the licensed provider that was issued by the agency or by an
  963  accrediting organization if such report is used in lieu of a
  964  licensure inspection.
  965         Section 19. Section 408.813, Florida Statutes, is amended
  966  to read:
  967         408.813 Administrative fines; violations.—As a penalty for
  968  any violation of this part, authorizing statutes, or applicable
  969  rules, the agency may impose an administrative fine.
  970         (1) Unless the amount or aggregate limitation of the fine
  971  is prescribed by authorizing statutes or applicable rules, the
  972  agency may establish criteria by rule for the amount or
  973  aggregate limitation of administrative fines applicable to this
  974  part, authorizing statutes, and applicable rules. Each day of
  975  violation constitutes a separate violation and is subject to a
  976  separate fine. For fines imposed by final order of the agency
  977  and not subject to further appeal, the violator shall pay the
  978  fine plus interest at the rate specified in s. 55.03 for each
  979  day beyond the date set by the agency for payment of the fine.
  980         (2)Violations of this part, authorizing statutes, or
  981  applicable rules shall be classified according to the nature of
  982  the violation and the gravity of its probable effect on clients.
  983  The scope of a violation may be cited as an isolated, patterned,
  984  or widespread deficiency. An isolated deficiency is a deficiency
  985  affecting one or a very limited number of clients, or involving
  986  one or a very limited number of staff, or a situation that
  987  occurred only occasionally or in a very limited number of
  988  locations. A patterned deficiency is a deficiency in which more
  989  than a very limited number of clients are affected, or more than
  990  a very limited number of staff are involved, or the situation
  991  has occurred in several locations, or the same client or clients
  992  have been affected by repeated occurrences of the same deficient
  993  practice but the effect of the deficient practice is not found
  994  to be pervasive throughout the provider. A widespread deficiency
  995  is a deficiency in which the problems causing the deficiency are
  996  pervasive in the provider or represent systemic failure that has
  997  affected or has the potential to affect a large portion of the
  998  provider’s clients. This subsection does not affect the
  999  legislative determination of the amount of a fine imposed under
 1000  authorizing statutes. Violations shall be classified on the
 1001  written notice as follows:
 1002         (a)Class “I” violations are those conditions or
 1003  occurrences related to the operation and maintenance of a
 1004  provider or to the care of clients which the agency determines
 1005  present an imminent danger to the clients of the provider or a
 1006  substantial probability that death or serious physical or
 1007  emotional harm would result therefrom. The condition or practice
 1008  constituting a class I violation shall be abated or eliminated
 1009  within 24 hours, unless a fixed period, as determined by the
 1010  agency, is required for correction. The agency shall impose an
 1011  administrative fine as provided by law for a cited class I
 1012  violation. A fine shall be levied notwithstanding the correction
 1013  of the violation.
 1014         (b)Class “II” violations are those conditions or
 1015  occurrences related to the operation and maintenance of a
 1016  provider or to the care of clients which the agency determines
 1017  directly threaten the physical or emotional health, safety, or
 1018  security of the clients, other than class I violations. The
 1019  agency shall impose an administrative fine as provided by law
 1020  for a cited class II violation. A fine shall be levied
 1021  notwithstanding the correction of the violation.
 1022         (c)Class “III” violations are those conditions or
 1023  occurrences related to the operation and maintenance of a
 1024  provider or to the care of clients which the agency determines
 1025  indirectly or potentially threaten the physical or emotional
 1026  health, safety, or security of clients, other than class I or
 1027  class II violations. The agency shall impose an administrative
 1028  fine as provided in this section for a cited class III
 1029  violation. A citation for a class III violation must specify the
 1030  time within which the violation is required to be corrected. If
 1031  a class III violation is corrected within the time specified, a
 1032  fine may not be imposed.
 1033         (d)Class “IV” violations are those conditions or
 1034  occurrences related to the operation and maintenance of a
 1035  provider or to required reports, forms, or documents that do not
 1036  have the potential of negatively affecting clients. These
 1037  violations are of a type that the agency determines do not
 1038  threaten the health, safety, or security of clients. The agency
 1039  shall impose an administrative fine as provided in this section
 1040  for a cited class IV violation. A citation for a class IV
 1041  violation must specify the time within which the violation is
 1042  required to be corrected. If a class IV violation is corrected
 1043  within the time specified, a fine may not be imposed.
 1044         Section 20. Subsections (11), (12), (13), (14), (15), (16),
 1045  (17), (18), (19), (20), (21), (22), (23), (24), (25), (26),
 1046  (27), (28), and (29) of section 408.820, Florida Statutes, are
 1047  amended to read:
 1048         408.820 Exemptions.—Except as prescribed in authorizing
 1049  statutes, the following exemptions shall apply to specified
 1050  requirements of this part:
 1051         (11)Private review agents, as provided under part I of
 1052  chapter 395, are exempt from ss. 408.806(7), 408.810, and
 1053  408.811.
 1054         (11)(12) Health care risk managers, as provided under part
 1055  I of chapter 395, are exempt from ss. 408.806(7), 408.810(4)
 1056  (10) 408.810, and 408.811.
 1057         (12)(13) Nursing homes, as provided under part II of
 1058  chapter 400, are exempt from s. 408.810(7).
 1059         (13)(14) Assisted living facilities, as provided under part
 1060  I of chapter 429, are exempt from s. 408.810(10).
 1061         (14)(15) Home health agencies, as provided under part III
 1062  of chapter 400, are exempt from s. 408.810(10).
 1063         (15)(16) Nurse registries, as provided under part III of
 1064  chapter 400, are exempt from s. 408.810(6) and (10).
 1065         (16)(17) Companion services or homemaker services
 1066  providers, as provided under part III of chapter 400, are exempt
 1067  from s. 408.810(6)-(10).
 1068         (17)(18) Adult day care centers, as provided under part III
 1069  of chapter 429, are exempt from s. 408.810(10).
 1070         (18)(19) Adult family-care homes, as provided under part II
 1071  of chapter 429, are exempt from s. 408.810(7)-(10).
 1072         (18)(20) Homes for special services, as provided under part
 1073  V of chapter 400, are exempt from s. 408.810(7)-(10).
 1074         (20)(21) Transitional living facilities, as provided under
 1075  part V of chapter 400, are exempt from s. 408.810(10) s.
 1076  408.810(7)-(10).
 1077         (21)(22) Prescribed pediatric extended care centers, as
 1078  provided under part VI of chapter 400, are exempt from s.
 1079  408.810(10).
 1080         (22)(23) Home medical equipment providers, as provided
 1081  under part VII of chapter 400, are exempt from s. 408.810(10).
 1082         (23)(24) Intermediate care facilities for persons with
 1083  developmental disabilities, as provided under part VIII of
 1084  chapter 400, are exempt from s. 408.810(7).
 1085         (24)(25) Health care services pools, as provided under part
 1086  IX of chapter 400, are exempt from s. 408.810(6)-(10).
 1087         (25)(26) Health care clinics, as provided under part X of
 1088  chapter 400, are exempt from s. 408.810(6), (7), (10) ss.
 1089  408.809 and 408.810(1), (6), (7), and (10).
 1090         (26)(27) Clinical laboratories, as provided under part I of
 1091  chapter 483, are exempt from s. 408.810(5)-(10).
 1092         (27)(28) Multiphasic health testing centers, as provided
 1093  under part II of chapter 483, are exempt from s. 408.810(5)
 1094  (10).
 1095         (28)(29) Organ and tissue procurement agencies, as provided
 1096  under chapter 765, are exempt from s. 408.810(5)-(10).
 1097         Section 21. Section 408.821, Florida Statutes, is created
 1098  to read:
 1099         408.821Emergency management planning; emergency
 1100  operations; inactive license.—
 1101         (1)A licensee required by authorizing statutes to have an
 1102  emergency operations plan must designate a safety liaison to
 1103  serve as the primary contact for emergency operations.
 1104         (2)An entity subject to this part may temporarily exceed
 1105  its licensed capacity to act as a receiving provider in
 1106  accordance with an approved emergency operations plan for up to
 1107  15 days. While in an overcapacity status, each provider must
 1108  furnish or arrange for appropriate care and services to all
 1109  clients. In addition, the agency may approve requests for
 1110  overcapacity in excess of 15 days, which approvals may be based
 1111  upon satisfactory justification and need as provided by the
 1112  receiving and sending providers.
 1113         (3)(a)An inactive license may be issued to a licensee
 1114  subject to this section when the provider is located in a
 1115  geographic area in which a state of emergency was declared by
 1116  the Governor if the provider:
 1117         1.Suffered damage to its operation during the state of
 1118  emergency.
 1119         2.Is currently licensed.
 1120         3.Does not have a provisional license.
 1121         4.Will be temporarily unable to provide services but is
 1122  reasonably expected to resume services within 12 months.
 1123         (b)An inactive license may be issued for a period not to
 1124  exceed 12 months but may be renewed by the agency for up to 12
 1125  additional months upon demonstration to the agency of progress
 1126  toward reopening. A request by a licensee for an inactive
 1127  license or to extend the previously approved inactive period
 1128  must be submitted in writing to the agency, accompanied by
 1129  written justification for the inactive license, which states the
 1130  beginning and ending dates of inactivity and includes a plan for
 1131  the transfer of any clients to other providers and appropriate
 1132  licensure fees. Upon agency approval, the licensee shall notify
 1133  clients of any necessary discharge or transfer as required by
 1134  authorizing statutes or applicable rules. The beginning of the
 1135  inactive licensure period shall be the date the provider ceases
 1136  operations. The end of the inactive period shall become the
 1137  license expiration date, and all licensure fees must be current,
 1138  must be paid in full, and may be prorated. Reactivation of an
 1139  inactive license requires the prior approval by the agency of a
 1140  renewal application, including payment of licensure fees and
 1141  agency inspections indicating compliance with all requirements
 1142  of this part and applicable rules and statutes.
 1143         (4)The agency may adopt rules relating to emergency
 1144  management planning, communications, and operations. Licensees
 1145  providing residential or inpatient services must utilize an
 1146  online database approved by the agency to report information to
 1147  the agency regarding the provider’s emergency status, planning,
 1148  or operations.
 1149         Section 22. Section 408.831, Florida Statutes, is amended
 1150  to read:
 1151         408.831 Denial, suspension, or revocation of a license,
 1152  registration, certificate, or application.—
 1153         (1) In addition to any other remedies provided by law, the
 1154  agency may deny each application or suspend or revoke each
 1155  license, registration, or certificate of entities regulated or
 1156  licensed by it:
 1157         (a) If the applicant, licensee, or a licensee subject to
 1158  this part which shares a common controlling interest with the
 1159  applicant has failed to pay all outstanding fines, liens, or
 1160  overpayments assessed by final order of the agency or final
 1161  order of the Centers for Medicare and Medicaid Services, not
 1162  subject to further appeal, unless a repayment plan is approved
 1163  by the agency; or
 1164         (b) For failure to comply with any repayment plan.
 1165         (2) In reviewing any application requesting a change of
 1166  ownership or change of the licensee, registrant, or
 1167  certificateholder, the transferor shall, prior to agency
 1168  approval of the change, repay or make arrangements to repay any
 1169  amounts owed to the agency. Should the transferor fail to repay
 1170  or make arrangements to repay the amounts owed to the agency,
 1171  the issuance of a license, registration, or certificate to the
 1172  transferee shall be delayed until repayment or until
 1173  arrangements for repayment are made.
 1174         (3)An entity subject to this section may exceed its
 1175  licensed capacity to act as a receiving facility in accordance
 1176  with an emergency operations plan for clients of evacuating
 1177  providers from a geographic area where an evacuation order has
 1178  been issued by a local authority having jurisdiction. While in
 1179  an overcapacity status, each provider must furnish or arrange
 1180  for appropriate care and services to all clients. In addition,
 1181  the agency may approve requests for overcapacity beyond 15 days,
 1182  which approvals may be based upon satisfactory justification and
 1183  need as provided by the receiving and sending facilities.
 1184         (4)(a)An inactive license may be issued to a licensee
 1185  subject to this section when the provider is located in a
 1186  geographic area where a state of emergency was declared by the
 1187  Governor if the provider:
 1188         1.Suffered damage to its operation during that state of
 1189  emergency.
 1190         2.Is currently licensed.
 1191         3.Does not have a provisional license.
 1192         4.Will be temporarily unable to provide services but is
 1193  reasonably expected to resume services within 12 months.
 1194         (b)An inactive license may be issued for a period not to
 1195  exceed 12 months but may be renewed by the agency for up to 12
 1196  additional months upon demonstration to the agency of progress
 1197  toward reopening. A request by a licensee for an inactive
 1198  license or to extend the previously approved inactive period
 1199  must be submitted in writing to the agency, accompanied by
 1200  written justification for the inactive license, which states the
 1201  beginning and ending dates of inactivity and includes a plan for
 1202  the transfer of any clients to other providers and appropriate
 1203  licensure fees. Upon agency approval, the licensee shall notify
 1204  clients of any necessary discharge or transfer as required by
 1205  authorizing statutes or applicable rules. The beginning of the
 1206  inactive licensure period shall be the date the provider ceases
 1207  operations. The end of the inactive period shall become the
 1208  licensee expiration date, and all licensure fees must be
 1209  current, paid in full, and may be prorated. Reactivation of an
 1210  inactive license requires the prior approval by the agency of a
 1211  renewal application, including payment of licensure fees and
 1212  agency inspections indicating compliance with all requirements
 1213  of this part and applicable rules and statutes.
 1214         (3)(5) This section provides standards of enforcement
 1215  applicable to all entities licensed or regulated by the Agency
 1216  for Health Care Administration. This section controls over any
 1217  conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
 1218  400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
 1219  those chapters.
 1220         Section 23. Paragraph (e) of subsection (4) of section
 1221  409.221, Florida Statutes, is amended to read:
 1222         409.221 Consumer-directed care program.—
 1223         (4) CONSUMER-DIRECTED CARE.—
 1224         (e) Services.—Consumers shall use the budget allowance only
 1225  to pay for home and community-based services that meet the
 1226  consumer’s long-term care needs and are a cost-efficient use of
 1227  funds. Such services may include, but are not limited to, the
 1228  following:
 1229         1. Personal care.
 1230         2. Homemaking and chores, including housework, meals,
 1231  shopping, and transportation.
 1232         3. Home modifications and assistive devices which may
 1233  increase the consumer’s independence or make it possible to
 1234  avoid institutional placement.
 1235         4. Assistance in taking self-administered medication.
 1236         5. Day care and respite care services, including those
 1237  provided by nursing home facilities pursuant to s. 400.141(1)(f)
 1238  s. 400.141(6) or by adult day care facilities licensed pursuant
 1239  to s. 429.907.
 1240         6. Personal care and support services provided in an
 1241  assisted living facility.
 1242         Section 24. Subsection (5) of section 409.901, Florida
 1243  Statutes, is amended to read:
 1244         409.901 Definitions; ss. 409.901-409.920.—As used in ss.
 1245  409.901-409.920, except as otherwise specifically provided, the
 1246  term:
 1247         (5) “Change of ownership” means:
 1248         (a) An event in which the provider ownership changes to a
 1249  different individual legal entity as evidenced by a change in
 1250  federal employer identification number or taxpayer
 1251  identification number; or
 1252         (b)An event in which 51 45 percent or more of the
 1253  ownership, voting shares, membership, or controlling interest of
 1254  a provider is in any manner transferred or otherwise assigned.
 1255  This paragraph does not apply to a licensee that is publicly
 1256  traded on a recognized stock exchange; or
 1257         (c)When the provider is licensed or registered by the
 1258  agency, an event considered a change of ownership for licensure
 1259  as defined in s. 408.803 in a corporation whose shares are not
 1260  publicly traded on a recognized stock exchange is transferred or
 1261  assigned, including the final transfer or assignment of multiple
 1262  transfers or assignments over a 2-year period that cumulatively
 1263  total 45 percent or more.
 1264  
 1265  A change solely in the management company or board of directors
 1266  is not a change of ownership.
 1267         Section 25. Section 429.071, Florida Statutes, is repealed.
 1268         Section 26. Paragraph (e) of subsection (1) and subsections
 1269  (2) and (3) of section 429.08, Florida Statutes, are amended to
 1270  read:
 1271         429.08 Unlicensed facilities; referral of person for
 1272  residency to unlicensed facility; penalties; verification of
 1273  licensure status.—
 1274         (1)
 1275         (e) The agency shall publish provide to the department’s
 1276  elder information and referral providers a list, by county, of
 1277  licensed assisted living facilities, to assist persons who are
 1278  considering an assisted living facility placement in locating a
 1279  licensed facility. This information may be provided
 1280  electronically or through the agency’s Internet site.
 1281         (2)Each field office of the Agency for Health Care
 1282  Administration shall establish a local coordinating workgroup
 1283  which includes representatives of local law enforcement
 1284  agencies, state attorneys, the Medicaid Fraud Control Unit of
 1285  the Department of Legal Affairs, local fire authorities, the
 1286  Department of Children and Family Services, the district long
 1287  term care ombudsman council, and the district human rights
 1288  advocacy committee to assist in identifying the operation of
 1289  unlicensed facilities and to develop and implement a plan to
 1290  ensure effective enforcement of state laws relating to such
 1291  facilities. The workgroup shall report its findings, actions,
 1292  and recommendations semiannually to the Director of Health
 1293  Quality Assurance of the agency.
 1294         (2)(3) It is unlawful to knowingly refer a person for
 1295  residency to an unlicensed assisted living facility; to an
 1296  assisted living facility the license of which is under denial or
 1297  has been suspended or revoked; or to an assisted living facility
 1298  that has a moratorium pursuant to part II of chapter 408. Any
 1299  person who violates this subsection commits a noncriminal
 1300  violation, punishable by a fine not exceeding $500 as provided
 1301  in s. 775.083.
 1302         (a) Any health care practitioner, as defined in s. 456.001,
 1303  who is aware of the operation of an unlicensed facility shall
 1304  report that facility to the agency. Failure to report a facility
 1305  that the practitioner knows or has reasonable cause to suspect
 1306  is unlicensed shall be reported to the practitioner’s licensing
 1307  board.
 1308         (b) Any provider as defined in s. 408.803 hospital or
 1309  community mental health center licensed under chapter 395 or
 1310  chapter 394 which knowingly discharges a patient or client to an
 1311  unlicensed facility is subject to sanction by the agency.
 1312         (c) Any employee of the agency or department, or the
 1313  Department of Children and Family Services, who knowingly refers
 1314  a person for residency to an unlicensed facility; to a facility
 1315  the license of which is under denial or has been suspended or
 1316  revoked; or to a facility that has a moratorium pursuant to part
 1317  II of chapter 408 is subject to disciplinary action by the
 1318  agency or department, or the Department of Children and Family
 1319  Services.
 1320         (d) The employer of any person who is under contract with
 1321  the agency or department, or the Department of Children and
 1322  Family Services, and who knowingly refers a person for residency
 1323  to an unlicensed facility; to a facility the license of which is
 1324  under denial or has been suspended or revoked; or to a facility
 1325  that has a moratorium pursuant to part II of chapter 408 shall
 1326  be fined and required to prepare a corrective action plan
 1327  designed to prevent such referrals.
 1328         (e)The agency shall provide the department and the
 1329  Department of Children and Family Services with a list of
 1330  licensed facilities within each county and shall update the list
 1331  at least quarterly.
 1332         (f)At least annually, the agency shall notify, in
 1333  appropriate trade publications, physicians licensed under
 1334  chapter 458 or chapter 459, hospitals licensed under chapter
 1335  395, nursing home facilities licensed under part II of chapter
 1336  400, and employees of the agency or the department, or the
 1337  Department of Children and Family Services, who are responsible
 1338  for referring persons for residency, that it is unlawful to
 1339  knowingly refer a person for residency to an unlicensed assisted
 1340  living facility and shall notify them of the penalty for
 1341  violating such prohibition. The department and the Department of
 1342  Children and Family Services shall, in turn, notify service
 1343  providers under contract to the respective departments who have
 1344  responsibility for resident referrals to facilities. Further,
 1345  the notice must direct each noticed facility and individual to
 1346  contact the appropriate agency office in order to verify the
 1347  licensure status of any facility prior to referring any person
 1348  for residency. Each notice must include the name, telephone
 1349  number, and mailing address of the appropriate office to
 1350  contact.
 1351         Section 27. Paragraph (e) of subsection (1) of section
 1352  429.14, Florida Statutes, is amended to read:
 1353         429.14 Administrative penalties.—
 1354         (1) In addition to the requirements of part II of chapter
 1355  408, the agency may deny, revoke, and suspend any license issued
 1356  under this part and impose an administrative fine in the manner
 1357  provided in chapter 120 against a licensee of an assisted living
 1358  facility for a violation of any provision of this part, part II
 1359  of chapter 408, or applicable rules, or for any of the following
 1360  actions by a licensee of an assisted living facility, for the
 1361  actions of any person subject to level 2 background screening
 1362  under s. 408.809, or for the actions of any facility employee:
 1363         (e) A citation of any of the following deficiencies as
 1364  specified defined in s. 429.19:
 1365         1. One or more cited class I deficiencies.
 1366         2. Three or more cited class II deficiencies.
 1367         3. Five or more cited class III deficiencies that have been
 1368  cited on a single survey and have not been corrected within the
 1369  times specified.
 1370         Section 28. Section 429.19, Florida Statutes, is amended to
 1371  read:
 1372         429.19 Violations; imposition of administrative fines;
 1373  grounds.—
 1374         (1) In addition to the requirements of part II of chapter
 1375  408, the agency shall impose an administrative fine in the
 1376  manner provided in chapter 120 for the violation of any
 1377  provision of this part, part II of chapter 408, and applicable
 1378  rules by an assisted living facility, for the actions of any
 1379  person subject to level 2 background screening under s. 408.809,
 1380  for the actions of any facility employee, or for an intentional
 1381  or negligent act seriously affecting the health, safety, or
 1382  welfare of a resident of the facility.
 1383         (2) Each violation of this part and adopted rules shall be
 1384  classified according to the nature of the violation and the
 1385  gravity of its probable effect on facility residents. The agency
 1386  shall indicate the classification on the written notice of the
 1387  violation as follows:
 1388         (a) Class “I” violations are defined in s. 408.813 those
 1389  conditions or occurrences related to the operation and
 1390  maintenance of a facility or to the personal care of residents
 1391  which the agency determines present an imminent danger to the
 1392  residents or guests of the facility or a substantial probability
 1393  that death or serious physical or emotional harm would result
 1394  therefrom. The condition or practice constituting a class I
 1395  violation shall be abated or eliminated within 24 hours, unless
 1396  a fixed period, as determined by the agency, is required for
 1397  correction. The agency shall impose an administrative fine for a
 1398  cited class I violation in an amount not less than $5,000 and
 1399  not exceeding $10,000 for each violation. A fine may be levied
 1400  notwithstanding the correction of the violation.
 1401         (b) Class “II” violations are defined in s. 408.813 those
 1402  conditions or occurrences related to the operation and
 1403  maintenance of a facility or to the personal care of residents
 1404  which the agency determines directly threaten the physical or
 1405  emotional health, safety, or security of the facility residents,
 1406  other than class I violations. The agency shall impose an
 1407  administrative fine for a cited class II violation in an amount
 1408  not less than $1,000 and not exceeding $5,000 for each
 1409  violation. A fine shall be levied notwithstanding the correction
 1410  of the violation.
 1411         (c) Class “III” violations are defined in s. 408.813 those
 1412  conditions or occurrences related to the operation and
 1413  maintenance of a facility or to the personal care of residents
 1414  which the agency determines indirectly or potentially threaten
 1415  the physical or emotional health, safety, or security of
 1416  facility residents, other than class I or class II violations.
 1417  The agency shall impose an administrative fine for a cited class
 1418  III violation in an amount not less than $500 and not exceeding
 1419  $1,000 for each violation. A citation for a class III violation
 1420  must specify the time within which the violation is required to
 1421  be corrected. If a class III violation is corrected within the
 1422  time specified, no fine may be imposed, unless it is a repeated
 1423  offense.
 1424         (d) Class “IV” violations are defined in s. 408.813 those
 1425  conditions or occurrences related to the operation and
 1426  maintenance of a building or to required reports, forms, or
 1427  documents that do not have the potential of negatively affecting
 1428  residents. These violations are of a type that the agency
 1429  determines do not threaten the health, safety, or security of
 1430  residents of the facility. The agency shall impose an
 1431  administrative fine for a cited class IV violation in an amount
 1432  not less than $100 and not exceeding $200 for each violation. A
 1433  citation for a class IV violation must specify the time within
 1434  which the violation is required to be corrected. If a class IV
 1435  violation is corrected within the time specified, no fine shall
 1436  be imposed. Any class IV violation that is corrected during the
 1437  time an agency survey is being conducted will be identified as
 1438  an agency finding and not as a violation.
 1439         (3) For purposes of this section, in determining if a
 1440  penalty is to be imposed and in fixing the amount of the fine,
 1441  the agency shall consider the following factors:
 1442         (a) The gravity of the violation, including the probability
 1443  that death or serious physical or emotional harm to a resident
 1444  will result or has resulted, the severity of the action or
 1445  potential harm, and the extent to which the provisions of the
 1446  applicable laws or rules were violated.
 1447         (b) Actions taken by the owner or administrator to correct
 1448  violations.
 1449         (c) Any previous violations.
 1450         (d) The financial benefit to the facility of committing or
 1451  continuing the violation.
 1452         (e) The licensed capacity of the facility.
 1453         (4) Each day of continuing violation after the date fixed
 1454  for termination of the violation, as ordered by the agency,
 1455  constitutes an additional, separate, and distinct violation.
 1456         (5) During an inspection, any action taken to correct a
 1457  violation shall be documented in writing by the owner or
 1458  administrator of the facility and verified through followup
 1459  visits by agency personnel. The agency may impose a fine and, in
 1460  the case of an owner-operated facility, revoke or deny a
 1461  facility’s license when a facility administrator fraudulently
 1462  misrepresents action taken to correct a violation.
 1463         (6) Any facility whose owner fails to apply for a change
 1464  of-ownership license in accordance with part II of chapter 408
 1465  and operates the facility under the new ownership is subject to
 1466  a fine of $5,000.
 1467         (7) In addition to any administrative fines imposed, the
 1468  agency may assess a survey fee, equal to the lesser of one half
 1469  of the facility’s biennial license and bed fee or $500, to cover
 1470  the cost of conducting initial complaint investigations that
 1471  result in the finding of a violation that was the subject of the
 1472  complaint or monitoring visits conducted under s. 429.28(3)(c)
 1473  to verify the correction of the violations.
 1474         (8) The agency, as an alternative to or in conjunction with
 1475  an administrative action against a facility for violations of
 1476  this part and adopted rules, shall make a reasonable attempt to
 1477  discuss each violation and recommended corrective action with
 1478  the owner or administrator of the facility, prior to written
 1479  notification. The agency, instead of fixing a period within
 1480  which the facility shall enter into compliance with standards,
 1481  may request a plan of corrective action from the facility which
 1482  demonstrates a good faith effort to remedy each violation by a
 1483  specific date, subject to the approval of the agency.
 1484         (9) The agency shall develop and disseminate an annual list
 1485  of all facilities sanctioned or fined $5,000 or more for
 1486  violations of state standards, the number and class of
 1487  violations involved, the penalties imposed, and the current
 1488  status of cases. The list shall be disseminated, at no charge,
 1489  to the Department of Elderly Affairs, the Department of Health,
 1490  the Department of Children and Family Services, the Agency for
 1491  Persons with Disabilities, the area agencies on aging, the
 1492  Florida Statewide Advocacy Council, and the state and local
 1493  ombudsman councils. The Department of Children and Family
 1494  Services shall disseminate the list to service providers under
 1495  contract to the department who are responsible for referring
 1496  persons to a facility for residency. The agency may charge a fee
 1497  commensurate with the cost of printing and postage to other
 1498  interested parties requesting a copy of this list. This
 1499  information may be provided electronically or through the
 1500  agency’s Internet site.
 1501         Section 29. Subsections (2) and (6) of section 429.23,
 1502  Florida Statutes, are amended to read:
 1503         429.23 Internal risk management and quality assurance
 1504  program; adverse incidents and reporting requirements.—
 1505         (2) Every facility licensed under this part is required to
 1506  maintain adverse incident reports. For purposes of this section,
 1507  the term, “adverse incident” means:
 1508         (a) An event over which facility personnel could exercise
 1509  control rather than as a result of the resident’s condition and
 1510  results in:
 1511         1. Death;
 1512         2. Brain or spinal damage;
 1513         3. Permanent disfigurement;
 1514         4. Fracture or dislocation of bones or joints;
 1515         5. Any condition that required medical attention to which
 1516  the resident has not given his or her consent, including failure
 1517  to honor advanced directives;
 1518         6. Any condition that requires the transfer of the resident
 1519  from the facility to a unit providing more acute care due to the
 1520  incident rather than the resident’s condition before the
 1521  incident; or.
 1522         7.An event that is reported to law enforcement or its
 1523  personnel for investigation; or
 1524         (b)Abuse, neglect, or exploitation as defined in s.
 1525  415.102;
 1526         (c)Events reported to law enforcement; or
 1527         (b)(d)Resident elopement, if the elopement places the
 1528  resident at risk of harm or injury.
 1529         (6) Abuse, neglect, or exploitation must be reported to the
 1530  Department of Children and Family Services as required under
 1531  chapter 415 The agency shall annually submit to the Legislature
 1532  a report on assisted living facility adverse incident reports.
 1533  The report must include the following information arranged by
 1534  county:
 1535         (a)A total number of adverse incidents;
 1536         (b)A listing, by category, of the type of adverse
 1537  incidents occurring within each category and the type of staff
 1538  involved;
 1539         (c)A listing, by category, of the types of injuries, if
 1540  any, and the number of injuries occurring within each category;
 1541         (d)Types of liability claims filed based on an adverse
 1542  incident report or reportable injury; and
 1543         (e)Disciplinary action taken against staff, categorized by
 1544  the type of staff involved.
 1545         Section 30. Subsection (9) of section 429.26, Florida
 1546  Statutes, is repealed.
 1547         Section 31. Subsection (3) of section 430.80, Florida
 1548  Statutes, is amended to read:
 1549         430.80 Implementation of a teaching nursing home pilot
 1550  project.—
 1551         (3) To be designated as a teaching nursing home, a nursing
 1552  home licensee must, at a minimum:
 1553         (a) Provide a comprehensive program of integrated senior
 1554  services that include institutional services and community-based
 1555  services;
 1556         (b) Participate in a nationally recognized accreditation
 1557  program and hold a valid accreditation, such as the
 1558  accreditation awarded by the Joint Commission on Accreditation
 1559  of Healthcare Organizations;
 1560         (c) Have been in business in this state for a minimum of 10
 1561  consecutive years;
 1562         (d) Demonstrate an active program in multidisciplinary
 1563  education and research that relates to gerontology;
 1564         (e) Have a formalized contractual relationship with at
 1565  least one accredited health profession education program located
 1566  in this state;
 1567         (f) Have a formalized contractual relationship with an
 1568  accredited hospital that is designated by law as a teaching
 1569  hospital; and
 1570         (g) Have senior staff members who hold formal faculty
 1571  appointments at universities, which must include at least one
 1572  accredited health profession education program.
 1573         (h) Maintain insurance coverage pursuant to s.
 1574  400.141(1)(s) s. 400.141(20) or proof of financial
 1575  responsibility in a minimum amount of $750,000. Such proof of
 1576  financial responsibility may include:
 1577         1. Maintaining an escrow account consisting of cash or
 1578  assets eligible for deposit in accordance with s. 625.52; or
 1579         2. Obtaining and maintaining pursuant to chapter 675 an
 1580  unexpired, irrevocable, nontransferable and nonassignable letter
 1581  of credit issued by any bank or savings association organized
 1582  and existing under the laws of this state or any bank or savings
 1583  association organized under the laws of the United States that
 1584  has its principal place of business in this state or has a
 1585  branch office which is authorized to receive deposits in this
 1586  state. The letter of credit shall be used to satisfy the
 1587  obligation of the facility to the claimant upon presentment of a
 1588  final judgment indicating liability and awarding damages to be
 1589  paid by the facility or upon presentment of a settlement
 1590  agreement signed by all parties to the agreement when such final
 1591  judgment or settlement is a result of a liability claim against
 1592  the facility.
 1593         Section 32. Subsection (5) of section 435.04, Florida
 1594  Statutes, is amended to read:
 1595         435.04 Level 2 screening standards.—
 1596         (5) Under penalty of perjury, all employees in such
 1597  positions of trust or responsibility shall attest to meeting the
 1598  requirements for qualifying for employment and agreeing to
 1599  inform the employer immediately if convicted of any of the
 1600  disqualifying offenses while employed by the employer. Each
 1601  employer of employees in such positions of trust or
 1602  responsibilities which is licensed or registered by a state
 1603  agency shall submit to the licensing agency annually or at the
 1604  time of license renewal, under penalty of perjury, an affidavit
 1605  of compliance with the provisions of this section.
 1606         Section 33. Subsection (3) of section 435.05, Florida
 1607  Statutes, is amended to read:
 1608         435.05 Requirements for covered employees.—Except as
 1609  otherwise provided by law, the following requirements shall
 1610  apply to covered employees:
 1611         (3) Each employer required to conduct level 2 background
 1612  screening must sign an affidavit annually or at the time of
 1613  license renewal, under penalty of perjury, stating that all
 1614  covered employees have been screened or are newly hired and are
 1615  awaiting the results of the required screening checks.
 1616         Section 34. Subsection (2) of section 483.031, Florida
 1617  Statutes, is amended to read:
 1618         483.031 Application of part; exemptions.—This part applies
 1619  to all clinical laboratories within this state, except:
 1620         (2) A clinical laboratory that performs only waived tests
 1621  and has received a certificate of exemption from the agency
 1622  under s. 483.106.
 1623         Section 35. Subsection (10) of section 483.041, Florida
 1624  Statutes, is amended to read:
 1625         483.041 Definitions.—As used in this part, the term:
 1626         (10) “Waived test” means a test that the federal Centers
 1627  for Medicare and Medicaid Services Health Care Financing
 1628  Administration has determined qualifies for a certificate of
 1629  waiver under the federal Clinical Laboratory Improvement
 1630  Amendments of 1988, and the federal rules adopted thereunder.
 1631         Section 36. Section 483.106, Florida Statutes, is repealed.
 1632         Section 37. Subsection (3) of section 483.172, Florida
 1633  Statutes, is amended to read:
 1634         483.172 License fees.—
 1635         (3) The agency shall assess a biennial fee of $100 for a
 1636  certificate of exemption and a $100 biennial license fee under
 1637  this section for facilities surveyed by an approved accrediting
 1638  organization.
 1639         Section 38. Subsection (13) of section 651.118, Florida
 1640  Statutes, is amended to read:
 1641         651.118 Agency for Health Care Administration; certificates
 1642  of need; sheltered beds; community beds.—
 1643         (13) Residents, as defined in this chapter, are not
 1644  considered new admissions for the purpose of s. 400.141
 1645  (1)(o)1.d. s. 400.141(15)(d).
 1646         Section 39. This act shall take effect upon becoming a law.

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