November 26, 2020
Print This PagePrint This Page

  *
Session:
Bill #:
Session:
Chamber: View Search Tips
Search Term:
Year: View Search Tips
Search Term:
       Florida Senate - 2010                                    SB 2434
       
       
       
       By Senator Gardiner
       
       
       
       
       9-01842-10                                            20102434__
    1                        A bill to be entitled                      
    2         An act relating to health care; repealing s.
    3         112.0455(10)(e), F.S., relating to a prohibition
    4         against applying the Drug-Free Workplace Act
    5         retroactively; amending ss. 154.11, 395.3038, 400.925,
    6         400.9935, 408.05, 440.13, 627.645, 627.668, 627.669,
    7         627.736, 641.495, and 766.1015, F.S.; changing
    8         references to the Joint Commission on the
    9         Accreditation of Healthcare Organizations to the
   10         “Joint Commission”; amending s. 318.21, F.S.;
   11         requiring that a specified percentage of fines
   12         collected from certain civil penalties levied by
   13         county courts for traffic infractions be deposited
   14         into the Brain and Spinal Cord Injury Rehabilitation
   15         Trust Fund within the Department of Health for use for
   16         Medicaid recipients who have spinal cord injuries;
   17         repealing s. 383.325, F.S., relating to records of
   18         licensed birth center facilities; amending s. 394.741
   19         F.S.; changing references to the Council on
   20         Accreditation for Children and Family Services to the
   21         “Council on Accreditation”; amending s. 394.4787,
   22         F.S.; conforming a cross-reference; amending s.
   23         395.002, F.S.; redefining the term “accrediting
   24         organizations” as it relates to hospital licensure and
   25         regulation; deleting definitions of the terms “initial
   26         denial determination,” “private review agent,”
   27         “utilization review,” and “utilization review plan” as
   28         they relate to hospital licensure and regulation;
   29         amending s. 395.003, F.S.; deleting an obsolete
   30         provision; conforming a cross-reference; amending s.
   31         395.0193, F.S.; requiring the Division of Medical
   32         Quality Assurance within the Department of Health
   33         rather than the Agency for Health Care Administration
   34         to review certain peer review reports and disciplinary
   35         actions; amending s. 395.1023, F.S.; requiring a
   36         licensed facility to adopt a protocol to designate a
   37         physician to act as a liaison between the Department
   38         of Children and Family Services, rather than the
   39         Department of Health, and the licensed facility in
   40         cases involving suspected child abuse; amending s.
   41         395.1041, F.S., relating to emergency services;
   42         deleting obsolete provisions; repealing s. 395.1046,
   43         F.S., relating to the investigation of complaints
   44         regarding hospitals; amending s. 395.1055, F.S.;
   45         requiring the agency to adopt rules that ensure that
   46         licensed facility beds conform to certain standards as
   47         specified by the agency, the Florida Building Code,
   48         and the Florida Fire Prevention Code; amending s.
   49         395.10972, F.S.; changing a reference to the Florida
   50         Society of Healthcare Risk Management to the “Florida
   51         Society for Healthcare Risk Management and Patient
   52         Safety”; amending s. 395.2050, F.S.; providing that
   53         the federal Centers for Medicare and Medicaid
   54         Services, rather than the federal Health Care
   55         Financing Administration, designates organ procurement
   56         organizations; amending s. 395.3036, F.S.; correcting
   57         a cross-reference; repealing s. 395.3037, F.S.;
   58         deleting obsolete definitions; amending s. 395.602,
   59         F.S.; revising the definition of a “rural hospital” as
   60         it relates to hospital licensure and regulation;
   61         amending s. 400.021, F.S.; revising the definition of
   62         a “geriatric outpatient clinic” with regard to
   63         staffing; amending s. 400.063, F.S.; removing an
   64         obsolete provision; amending s. 400.071, F.S.;
   65         revising the requirements for an application for a
   66         license to operate a nursing home facility; amending
   67         s. 400.0712, F.S.; deleting a provision related to the
   68         issuance of an inactive license to a nursing home;
   69         amending s. 400.111, F.S.; specifying that the
   70         required disclosure of a financial or ownership
   71         interest is contingent upon a request by the agency;
   72         amending s. 400.1183, F.S.; requiring nursing home
   73         facilities to maintain records of grievances for
   74         agency inspection; deleting a requirement that a
   75         facility report the number of grievances handled
   76         during the prior licensure period; amending s.
   77         400.141, F.S.; conforming a cross-reference; deleting
   78         the requirement that a facility submit to the agency
   79         information regarding a management company with which
   80         it has entered into an agreement; specifying a fine
   81         for a nursing facility’s failure to impose an
   82         admissions moratorium if it has failed to comply with
   83         state minimum-staffing requirements; deleting the
   84         requirement for a facility to report to the agency any
   85         filing of bankruptcy protection, divestiture, or
   86         corporate reorganization; amending s. 400.142, F.S.;
   87         removing obsolete provisions requiring the agency to
   88         adopt certain rules; repealing s. 400.147(10), F.S.,
   89         relating to a requirement that a nursing home report
   90         any notice of a filing of a claim for a violation of a
   91         resident’s rights or a claim of negligence; repealing
   92         s. 400.148, F.S., relating to the Medicaid “Up-or-Out”
   93         Quality of Care Contract Management Program; amending
   94         s. 400.19, F.S.; authorizing the agency to verify the
   95         correction of certain violations without reinspection,
   96         even when they are related to resident rights or
   97         resident care, after an unannounced inspection of a
   98         nursing home; repealing s. 400.195, F.S., relating to
   99         reporting requirements; deleting obsolete provisions;
  100         amending s. 400.23, F.S.; changing a reference to the
  101         Division of Children’s Medical Services to the
  102         “Division of Children’s Medical Services Network”;
  103         deleting an obsolete provision; amending s. 400.275,
  104         F.S.; deleting a requirement that the agency ensure
  105         that a newly hired nursing home surveyor is assigned
  106         full time to a licensed nursing home to observe
  107         facility operations; amending ss. 400.484, 400.967,
  108         and 429.71, F.S.; redesignating class I, II, III, and
  109         IV deficiencies as class I, II, III, and IV
  110         “violations”; amending s. 400.606, F.S.; eliminating a
  111         requirement that the plan for the delivery of home,
  112         residential, and homelike inpatient hospice services
  113         for terminally ill patients and their families include
  114         projected annual operating costs; amending s. 400.607,
  115         F.S.; revising the grounds under which the agency may
  116         take administrative action against a hospice; amending
  117         s. 400.931, F.S.; deleting a provision allowing an
  118         applicant for a license to be a home medical equipment
  119         provider to submit a surety bond to the agency;
  120         amending s. 400.932, F.S.; revising the grounds under
  121         which the agency may take administrative action
  122         against a home medical equipment provider; amending s.
  123         400.933, F.S.; prohibiting a home medical equipment
  124         provider from providing a survey or inspection of an
  125         accrediting organization in lieu of periodic agency
  126         inspection if the provider’s licensure is conditional;
  127         amending s. 400.953, F.S.; deleting a requirement that
  128         the general manager of a home medical equipment
  129         provider annually sign an affidavit regarding the
  130         background screening of personnel; providing
  131         requirements for submission of the affidavit; amending
  132         s. 400.9905, F.S.; specifying that certain licensure
  133         requirements do not apply to certain orthotic or
  134         prosthetic pediatric cardiology or perinatology
  135         clinical facilities; redefining the term “portable
  136         service or equipment provider” as it relates to the
  137         Health Care Clinic Act; amending s. 400.991, F.S.;
  138         conforming a provision to changes made by the act;
  139         revising application requirements to show proof of
  140         financial ability to operate a health care clinic;
  141         amending s. 408.034, F.S.; prohibiting the agency from
  142         issuing a license to a health care facility that
  143         applies for a license to operate an intermediate care
  144         facility for developmentally disabled persons under
  145         certain circumstances; amending s. 408.036, F.S.,
  146         relating to certificates of need; conforming a
  147         provision to changes made by the act; amending s.
  148         408.043, F.S.; requiring a freestanding facility or a
  149         part of the facility that is the inpatient hospice
  150         care component of a hospice to obtain a certificate of
  151         need, regardless of whether it is primarily engaged in
  152         providing inpatient care and related services;
  153         amending s. 408.061, F.S.; revising requirements for
  154         the reporting of certified data elements by health
  155         care facilities; amending s. 408.10, F.S.; authorizing
  156         the agency to provide staffing for a toll-free phone
  157         number for the purpose of handling consumer complaints
  158         regarding a health care facility; repealing s.
  159         408.802(11), F.S., relating to the applicability of
  160         the Health Care Licensing Procedures Act to private
  161         review agents; amending s. 408.804, F.S.; providing a
  162         criminal penalty for altering, defacing, or falsifying
  163         a license certificate of certain health care
  164         providers; providing civil penalties for displaying an
  165         altered, defaced, or falsified license certificate;
  166         amending s. 408.806, F.S.; requiring the agency to
  167         provide a courtesy notice to a licensee regarding the
  168         expiration of a licensee’s license; providing that
  169         failure of the agency to provide the courtesy notice
  170         or failure of the licensee to receive the notice does
  171         not excuse the licensee from timely renewing its
  172         license; providing that payment of the late fee is
  173         required for a later application; amending s. 408.810,
  174         F.S.; revising the requirements for obtaining and
  175         maintaining a license for certain health care
  176         providers and those who own a controlling interest in
  177         a health care provider; amending s. 408.813, F.S.;
  178         authorizing the agency to impose administrative fines
  179         for unclassified violations and identifying some of
  180         those violations; amending s. 408.815, F.S.;
  181         authorizing the agency to extend the expiration date
  182         of a license for the purpose of the safe and orderly
  183         discharge of clients; authorizing the agency to impose
  184         conditions on the extension; amending s. 409.906,
  185         F.S.; requiring the agency, in consultation with the
  186         Department of Elderly Affairs, to phase out the adult
  187         day health care waiver program; requiring adult day
  188         health care waiver providers, in consultation with
  189         resource centers for the aged, to assist in the
  190         transition of enrollees from the waiver program;
  191         repealing s. 409.221(4)(k), F.S., relating to the
  192         responsibility of the agency, the Department of
  193         Elderly Affairs, the Department of Health, the
  194         Department of Children and Family Services, and the
  195         Agency for Persons with Disabilities to review and
  196         assess the implementation of the consumer-directed
  197         care program and the agency’s responsibility to submit
  198         a report to the Legislature; repealing s.
  199         409.912(15)(e), (f), and (g), F.S., relating to a
  200         requirement that the Agency for Health Care
  201         Administration submit a report to the Legislature
  202         regarding the operation of the CARES program; amending
  203         s. 429.11, F.S.; deleting a provision authorizing
  204         issuance of a provisional license to operate as an
  205         assisted living facility; repealing s. 429.12(2),
  206         F.S., relating to the sale or transfer of ownership of
  207         an assisted living facility; amending s. 429.14, F.S.;
  208         authorizing the agency to provide to the Division of
  209         Hotels and Restaurants of the Department of Business
  210         and Professional Regulation, by electronic means or
  211         through the agency’s website, information regarding
  212         the denial, suspension, or revocation of a license;
  213         amending s. 429.17, F.S.; revising the requirements
  214         for a conditional license to operate an assisted
  215         living facility; repealing s. 429.23(5), F.S.,
  216         relating to a requirement that each assisted living
  217         facility submit a report to the agency regarding
  218         liability claims filed against it; amending s. 429.35,
  219         F.S.; authorizing the agency to provide to the local
  220         ombudsman council, electronically or through the
  221         agency’s website, information regarding the results of
  222         an inspection; amending s. 429.53, F.S.; requiring the
  223         agency, rather than the agency’s area offices of
  224         licensure and certification, to provide consultation
  225         to certain persons and licensees regarding assisted
  226         living facilities; redefining the term “consultation”
  227         as it relates to assisted living facilities; amending
  228         s. 429.65, F.S.; redefining the term “adult family
  229         care home” as it relates to the Adult Family-Care Home
  230         Act; repealing s. 429.911, F.S., relating to the
  231         denial, suspension, or revocation of a license to
  232         operate an adult day care center; amending s. 429.915,
  233         F.S.; revising requirements for a conditional license
  234         to operate an adult day care center; amending s.
  235         430.80, F.S.; conforming a cross-reference; amending
  236         s. 483.294, F.S.; requiring the agency to biennially,
  237         rather than at least annually, inspect the premises
  238         and operations of multiphasic health testing centers;
  239         providing effective dates.
  240  
  241  Be It Enacted by the Legislature of the State of Florida:
  242  
  243         Section 1. Paragraph (e) of subsection (10) of section
  244  112.0455, Florida Statutes, is repealed.
  245         Section 2. Paragraph (n) of subsection (1) of section
  246  154.11, Florida Statutes, is amended to read:
  247         154.11 Powers of board of trustees.—
  248         (1) The board of trustees of each public health trust shall
  249  be deemed to exercise a public and essential governmental
  250  function of both the state and the county and in furtherance
  251  thereof it shall, subject to limitation by the governing body of
  252  the county in which such board is located, have all of the
  253  powers necessary or convenient to carry out the operation and
  254  governance of designated health care facilities, including, but
  255  without limiting the generality of, the foregoing:
  256         (n) To make original appointments of appoint originally the
  257  staff of physicians to practice in any designated facility owned
  258  or operated by the board and to approve the bylaws and rules to
  259  be adopted by the medical staff of any designated facility owned
  260  and operated by the board., Such governing regulations must to
  261  be in accordance with the standards of the Joint Commission and
  262  must on the Accreditation of Hospitals which provide, among
  263  other things, for the method of appointing additional staff
  264  members and for the removal of staff members.
  265         Section 3. Subsection (15) of section 318.21, Florida
  266  Statutes, is amended to read:
  267         318.21 Disposition of civil penalties by county courts.—All
  268  civil penalties received by a county court pursuant to the
  269  provisions of this chapter shall be distributed and paid monthly
  270  as follows:
  271         (15) Of the additional fine assessed under s. 318.18(3)(e)
  272  for a violation of s. 316.1893, 50 percent of the moneys
  273  received from the fines shall be remitted to the Department of
  274  Revenue and deposited into the Brain and Spinal Cord Injury
  275  Trust Fund within the Department of Health and shall be
  276  appropriated to the Department of Health Agency for Health Care
  277  Administration as general revenue to provide an enhanced
  278  Medicaid payment to nursing homes that serve adult Medicaid
  279  recipients with brain and spinal cord injuries that are
  280  medically complex and that are technologically and respiratory
  281  dependent. The remaining 50 percent of the moneys received from
  282  the enhanced fine imposed under s. 318.18(3)(e) shall be
  283  remitted to the Department of Revenue and deposited into the
  284  Department of Health Administrative Trust Fund to provide
  285  financial support to certified trauma centers in the counties
  286  where enhanced penalty zones are established to ensure the
  287  availability and accessibility of trauma services. Funds
  288  deposited into the Administrative Trust Fund under this
  289  subsection shall be allocated as follows:
  290         (a) Fifty percent shall be allocated equally among all
  291  Level I, Level II, and pediatric trauma centers in recognition
  292  of readiness costs for maintaining trauma services.
  293         (b) Fifty percent shall be allocated among Level I, Level
  294  II, and pediatric trauma centers based on each center’s relative
  295  volume of trauma cases as reported in the Department of Health
  296  Trauma Registry.
  297         Section 4. Section 383.325, Florida Statutes, is repealed.
  298         Section 5. Subsection (2) of section 394.741, Florida
  299  Statutes, is amended to read:
  300         394.741 Accreditation requirements for providers of
  301  behavioral health care services.—
  302         (2) Notwithstanding any provision of law to the contrary,
  303  accreditation shall be accepted by the agency and department in
  304  lieu of the agency’s and department’s facility licensure onsite
  305  review requirements and shall be accepted as a substitute for
  306  the department’s administrative and program monitoring
  307  requirements, except as required by subsections (3) and (4),
  308  for:
  309         (a) Any organization from which the department purchases
  310  behavioral health care services that is accredited by the Joint
  311  Commission on Accreditation of Healthcare Organizations or the
  312  Council on Accreditation for Children and Family Services, or
  313  has those services that are being purchased by the department
  314  accredited by CARF—the Rehabilitation Accreditation Commission.
  315         (b) Any mental health facility licensed by the agency or
  316  any substance abuse component licensed by the department that is
  317  accredited by the Joint Commission on Accreditation of
  318  Healthcare Organizations, CARF—the Rehabilitation Accreditation
  319  Commission, or the Council on Accreditation of Children and
  320  Family Services.
  321         (c) Any network of providers from which the department or
  322  the agency purchases behavioral health care services accredited
  323  by the Joint Commission on Accreditation of Healthcare
  324  Organizations, CARF—the Rehabilitation Accreditation Commission,
  325  the Council on Accreditation of Children and Family Services, or
  326  the National Committee for Quality Assurance. A provider
  327  organization that, which is part of an accredited network, is
  328  afforded the same rights under this part.
  329         Section 6. Subsection (7) of section 394.4787, Florida
  330  Statutes, is amended to read:
  331         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and
  332  394.4789.—As used in this section and ss. 394.4786, 394.4788,
  333  and 394.4789:
  334         (7) “Specialty psychiatric hospital” means a hospital
  335  licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
  336  and part II of chapter 408 as a specialty psychiatric hospital.
  337         Section 7. Section 395.002, Florida Statutes, is amended to
  338  read:
  339         395.002 Definitions.—As used in this chapter the term:
  340         (1) “Accrediting organizations” means nationally recognized
  341  or approved accrediting organizations whose standards
  342  incorporate comparable licensure requirements as determined by
  343  the agency the Joint Commission on Accreditation of Healthcare
  344  Organizations, the American Osteopathic Association, the
  345  Commission on Accreditation of Rehabilitation Facilities, and
  346  the Accreditation Association for Ambulatory Health Care, Inc.
  347         (2) “Agency” means the Agency for Health Care
  348  Administration.
  349         (3) “Ambulatory surgical center” or “mobile surgical
  350  facility” means a facility that has as its the primary purpose
  351  the provision of which is to provide elective surgical care, in
  352  which the patient is admitted to and discharged from the such
  353  facility within the same working day and is not permitted to
  354  stay overnight, and which is not part of a hospital. However, a
  355  facility existing for the primary purpose of performing
  356  terminations of pregnancy, an office maintained by a physician
  357  for the practice of medicine, or an office maintained for the
  358  practice of dentistry shall not be construed to be an ambulatory
  359  surgical center, provided that any facility or office that which
  360  is certified or seeks certification as a Medicare ambulatory
  361  surgical center shall be licensed as an ambulatory surgical
  362  center pursuant to s. 395.003. Any structure or vehicle in which
  363  a physician maintains an office and practices surgery, and which
  364  can appear to the public to be a mobile office because the
  365  structure or vehicle operates at more than one address, shall be
  366  construed to be a mobile surgical facility.
  367         (4) “Biomedical waste” means any solid or liquid waste as
  368  defined in s. 381.0098(2)(a).
  369         (5) “Clinical privileges” means the privileges granted to a
  370  physician or other licensed health care practitioner to render
  371  patient care services in a hospital, but does not include the
  372  privilege of admitting patients.
  373         (6) “Department” means the Department of Health.
  374         (7) “Director” means any member of the official board of
  375  directors as reported in the organization’s annual corporate
  376  report to the Florida Department of State, or, if no such report
  377  is made, any member of the operating board of directors. The
  378  term excludes members of separate, restricted boards that serve
  379  only in an advisory capacity to the operating board.
  380         (8) “Emergency medical condition” means:
  381         (a) A medical condition manifesting itself by acute
  382  symptoms of sufficient severity, which may include severe pain,
  383  such that the absence of immediate medical attention could
  384  reasonably be expected to result in any of the following:
  385         1. Serious jeopardy to patient health, including a pregnant
  386  woman or fetus.
  387         2. Serious impairment to bodily functions.
  388         3. Serious dysfunction of any bodily organ or part.
  389         (b) With respect to a pregnant woman:
  390         1. That there is inadequate time to effect safe transfer to
  391  another hospital prior to delivery;
  392         2. That a transfer may pose a threat to the health and
  393  safety of the patient or fetus; or
  394         3. That there is evidence of the onset and persistence of
  395  uterine contractions or rupture of the membranes.
  396         (9) “Emergency services and care” means medical screening,
  397  examination, and evaluation by a physician, or, to the extent
  398  permitted by applicable law, by other appropriate personnel
  399  under the supervision of a physician, to determine if an
  400  emergency medical condition exists and, if it does, the care,
  401  treatment, or surgery by a physician necessary to relieve or
  402  eliminate the emergency medical condition, within the service
  403  capability of the facility.
  404         (10) “General hospital” means any facility that which meets
  405  the provisions of subsection (12) and which regularly makes its
  406  facilities and services available to the general population.
  407         (11) “Governmental unit” means the state or any county,
  408  municipality, or other political subdivision, or any department,
  409  division, board, or other agency of any of the foregoing.
  410         (12) “Hospital” means any establishment that:
  411         (a) Offers services more intensive than those required for
  412  room, board, personal services, and general nursing care, and
  413  offers facilities and beds for use beyond 24 hours by
  414  individuals requiring diagnosis, treatment, or care for illness,
  415  injury, deformity, infirmity, abnormality, disease, or
  416  pregnancy; and
  417         (b) Regularly makes available at least clinical laboratory
  418  services, diagnostic X-ray services, and treatment facilities
  419  for surgery or obstetrical care, or other definitive medical
  420  treatment of similar extent, except that a critical access
  421  hospital, as defined in s. 408.07, shall not be required to make
  422  available treatment facilities for surgery, obstetrical care, or
  423  similar services as long as it maintains its critical access
  424  hospital designation and shall be required to make such
  425  facilities available only if it ceases to be designated as a
  426  critical access hospital.
  427  
  428  However, the provisions of this chapter does do not apply to any
  429  institution conducted by or for the adherents of any well
  430  recognized church or religious denomination that depends
  431  exclusively upon prayer or spiritual means to heal, care for, or
  432  treat any person. For purposes of local zoning matters, the term
  433  “hospital” includes a medical office building located on the
  434  same premises as a hospital facility, provided the land on which
  435  the medical office building is constructed is zoned for use as a
  436  hospital; provided the premises were zoned for hospital purposes
  437  on January 1, 1992.
  438         (13) “Hospital bed” means a hospital accommodation that
  439  which is ready for immediate occupancy, or is capable of being
  440  made ready for occupancy within 48 hours, excluding provision of
  441  staffing, and which conforms to minimum space, equipment, and
  442  furnishings standards as specified by rule of the agency for the
  443  provision of services specified in this section to a single
  444  patient.
  445         (14)“Initial denial determination” means a determination
  446  by a private review agent that the health care services
  447  furnished or proposed to be furnished to a patient are
  448  inappropriate, not medically necessary, or not reasonable.
  449         (14)(15) “Intensive residential treatment programs for
  450  children and adolescents” means a specialty hospital accredited
  451  by an accrediting organization as defined in subsection (1)
  452  which provides 24-hour care and which has the primary functions
  453  of diagnosis and treatment of patients under the age of 18
  454  having psychiatric disorders in order to restore such patients
  455  to an optimal level of functioning.
  456         (15)(16) “Licensed facility” means a hospital, ambulatory
  457  surgical center, or mobile surgical facility licensed in
  458  accordance with this chapter.
  459         (16)(17) “Lifesafety” means the control and prevention of
  460  fire and other life-threatening conditions on a premises for the
  461  purpose of preserving human life.
  462         (17)(18) “Managing employee” means the administrator or
  463  other similarly titled individual who is responsible for the
  464  daily operation of the facility.
  465         (18)(19) “Medical staff” means physicians licensed under
  466  chapter 458 or chapter 459 with privileges in a licensed
  467  facility, as well as other licensed health care practitioners
  468  with clinical privileges as approved by a licensed facility’s
  469  governing board.
  470         (19)(20) “Medically necessary transfer” means a transfer
  471  made necessary because the patient is in immediate need of
  472  treatment for an emergency medical condition for which the
  473  facility lacks service capability or is at service capacity.
  474         (20)(21) “Mobile surgical facility” is a mobile facility in
  475  which licensed health care professionals provide elective
  476  surgical care under contract with the Department of Corrections
  477  or a private correctional facility operating pursuant to chapter
  478  957 and in which inmate patients are admitted to and discharged
  479  from said facility within the same working day and are not
  480  permitted to stay overnight. However, mobile surgical facilities
  481  may only provide health care services to the inmate patients of
  482  the Department of Corrections, or inmate patients of a private
  483  correctional facility operating pursuant to chapter 957, and not
  484  to the general public.
  485         (21)(22) “Person” means any individual, partnership,
  486  corporation, association, or governmental unit.
  487         (22)(23) “Premises” means those buildings, beds, and
  488  equipment located at the address of the licensed facility and
  489  all other buildings, beds, and equipment for the provision of
  490  hospital, ambulatory surgical, or mobile surgical care located
  491  in such reasonable proximity to the address of the licensed
  492  facility as to appear to the public to be under the dominion and
  493  control of the licensee. For any licensee that is a teaching
  494  hospital as defined in s. 408.07(45), reasonable proximity
  495  includes any buildings, beds, services, programs, and equipment
  496  under the dominion and control of the licensee that are located
  497  at a site with a main address that is within 1 mile of the main
  498  address of the licensed facility; and all such buildings, beds,
  499  and equipment may, at the request of a licensee or applicant, be
  500  included on the facility license as a single premises.
  501         (24)“Private review agent” means any person or entity
  502  which performs utilization review services for third-party
  503  payors on a contractual basis for outpatient or inpatient
  504  services. However, the term shall not include full-time
  505  employees, personnel, or staff of health insurers, health
  506  maintenance organizations, or hospitals, or wholly owned
  507  subsidiaries thereof or affiliates under common ownership, when
  508  performing utilization review for their respective hospitals,
  509  health maintenance organizations, or insureds of the same
  510  insurance group. For this purpose, health insurers, health
  511  maintenance organizations, and hospitals, or wholly owned
  512  subsidiaries thereof or affiliates under common ownership,
  513  include such entities engaged as administrators of self
  514  insurance as defined in s. 624.031.
  515         (23)(25) “Service capability” means all services offered by
  516  the facility where identification of services offered is
  517  evidenced by the appearance of the service in a patient’s
  518  medical record or itemized bill.
  519         (24)(26) “At service capacity” means the temporary
  520  inability of a hospital to provide a service that which is
  521  within the service capability of the hospital, due to maximum
  522  use of the service at the time of the request for the service.
  523         (25)(27) “Specialty bed” means a bed, other than a general
  524  bed, designated on the face of the hospital license for a
  525  dedicated use.
  526         (26)(28) “Specialty hospital” means any facility that which
  527  meets the provisions of subsection (12), and which regularly
  528  makes available either:
  529         (a) The range of medical services offered by general
  530  hospitals, but restricted to a defined age or gender group of
  531  the population;
  532         (b) A restricted range of services appropriate to the
  533  diagnosis, care, and treatment of patients with specific
  534  categories of medical or psychiatric illnesses or disorders; or
  535         (c) Intensive residential treatment programs for children
  536  and adolescents as defined in subsection (15).
  537         (27)(29) “Stabilized” means, with respect to an emergency
  538  medical condition, that no material deterioration of the
  539  condition is likely, within reasonable medical probability, to
  540  result from the transfer of the patient from a hospital.
  541         (30)“Utilization review” means a system for reviewing the
  542  medical necessity or appropriateness in the allocation of health
  543  care resources of hospital services given or proposed to be
  544  given to a patient or group of patients.
  545         (31)“Utilization review plan” means a description of the
  546  policies and procedures governing utilization review activities
  547  performed by a private review agent.
  548         (28)(32) “Validation inspection” means an inspection of the
  549  premises of a licensed facility by the agency to assess whether
  550  a review by an accrediting organization has adequately evaluated
  551  the licensed facility according to minimum state standards.
  552         Section 8. Subsection (1) and paragraph (b) of subsection
  553  (2) of section 395.003, Florida Statutes, are amended to read:
  554         395.003 Licensure; denial, suspension, and revocation.—
  555         (1)(a) The requirements of part II of chapter 408 apply to
  556  the provision of services that require licensure pursuant to ss.
  557  395.001-395.1065 and part II of chapter 408 and to entities
  558  licensed by or applying for such licensure from the Agency for
  559  Health Care Administration pursuant to ss. 395.001-395.1065. A
  560  license issued by the agency is required in order to operate a
  561  hospital, ambulatory surgical center, or mobile surgical
  562  facility in this state.
  563         (b)1. It is unlawful for a person to use or advertise to
  564  the public, in any way or by any medium whatsoever, any facility
  565  as a “hospital,” “ambulatory surgical center,” or “mobile
  566  surgical facility” unless such facility has first secured a
  567  license under the provisions of this part.
  568         2. This part does not apply to veterinary hospitals or to
  569  commercial business establishments using the word “hospital,”
  570  “ambulatory surgical center,” or “mobile surgical facility” as a
  571  part of a trade name if no treatment of human beings is
  572  performed on the premises of such establishments.
  573         (c)Until July 1, 2006, additional emergency departments
  574  located off the premises of licensed hospitals may not be
  575  authorized by the agency.
  576         (2)
  577         (b) The agency shall, at the request of a licensee that is
  578  a teaching hospital as defined in s. 408.07(45), issue a single
  579  license to a licensee for facilities that have been previously
  580  licensed as separate premises, provided such separately licensed
  581  facilities, taken together, constitute the same premises as
  582  defined in s. 395.002(22) s. 395.002(23). Such license for the
  583  single premises shall include all of the beds, services, and
  584  programs that were previously included on the licenses for the
  585  separate premises. The granting of a single license under this
  586  paragraph shall not in any manner reduce the number of beds,
  587  services, or programs operated by the licensee.
  588         Section 9. Paragraph (e) of subsection (2) and subsection
  589  (4) of section 395.0193, Florida Statutes, are amended to read:
  590         395.0193 Licensed facilities; peer review; disciplinary
  591  powers; agency or partnership with physicians.—
  592         (2) Each licensed facility, as a condition of licensure,
  593  shall provide for peer review of physicians who deliver health
  594  care services at the facility. Each licensed facility shall
  595  develop written, binding procedures by which such peer review
  596  shall be conducted. Such procedures shall include:
  597         (e) Recording of agendas and minutes that which do not
  598  contain confidential material, for review by the Division of
  599  Medical Quality Assurance of the department Health Quality
  600  Assurance of the agency.
  601         (4) Pursuant to ss. 458.337 and 459.016, any disciplinary
  602  actions taken under subsection (3) shall be reported in writing
  603  to the Division of Medical Quality Assurance of the department
  604  Health Quality Assurance of the agency within 30 working days
  605  after its initial occurrence, regardless of the pendency of
  606  appeals to the governing board of the hospital. The notification
  607  shall identify the disciplined practitioner, the action taken,
  608  and the reason for such action. All final disciplinary actions
  609  taken under subsection (3), if different from those which were
  610  reported to the department agency within 30 days after the
  611  initial occurrence, shall be reported within 10 working days to
  612  the Division of Medical Quality Assurance of the department
  613  Health Quality Assurance of the agency in writing and shall
  614  specify the disciplinary action taken and the specific grounds
  615  therefor. The division shall review each report and determine
  616  whether it potentially involved conduct by the licensee that is
  617  subject to disciplinary action, in which case s. 456.073 shall
  618  apply. The reports are not subject to inspection under s.
  619  119.07(1) even if the division’s investigation results in a
  620  finding of probable cause.
  621         Section 10. Section 395.1023, Florida Statutes, is amended
  622  to read:
  623         395.1023 Child abuse and neglect cases; duties.—Each
  624  licensed facility shall adopt a protocol that, at a minimum,
  625  requires the facility to:
  626         (1) Incorporate a facility policy that every staff member
  627  has an affirmative duty to report, pursuant to chapter 39, any
  628  actual or suspected case of child abuse, abandonment, or
  629  neglect; and
  630         (2) In any case involving suspected child abuse,
  631  abandonment, or neglect, designate, at the request of the
  632  Department of Children and Family Services department, a staff
  633  physician to act as a liaison between the hospital and the
  634  Department of Children and Family Services office that which is
  635  investigating the suspected abuse, abandonment, or neglect, and
  636  the child protection team, as defined in s. 39.01, when the case
  637  is referred to such a team.
  638  
  639  Each general hospital and appropriate specialty hospital shall
  640  comply with the provisions of this section and shall notify the
  641  agency and the Department of Children and Family Services
  642  department of its compliance by sending a copy of its policy to
  643  the agency and the Department of Children and Family Services
  644  department as required by rule. The failure by a general
  645  hospital or appropriate specialty hospital to comply shall be
  646  punished by a fine not exceeding $1,000, to be fixed, imposed,
  647  and collected by the agency. Each day in violation is considered
  648  a separate offense.
  649         Section 11. Subsection (2) and paragraph (d) of subsection
  650  (3) of section 395.1041, Florida Statutes, are amended to read:
  651         395.1041 Access to emergency services and care.—
  652         (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency
  653  shall establish and maintain an inventory of hospitals with
  654  emergency services. The inventory shall list all services within
  655  the service capability of the hospital, and such services shall
  656  appear on the face of the hospital license. Each hospital having
  657  emergency services shall notify the agency of its service
  658  capability in the manner and form prescribed by the agency. The
  659  agency shall use the inventory to assist emergency medical
  660  services providers and others in locating appropriate emergency
  661  medical care. The inventory shall also be made available to the
  662  general public. On or before August 1, 1992, the agency shall
  663  request that each hospital identify the services which are
  664  within its service capability. On or before November 1, 1992,
  665  the agency shall notify each hospital of the service capability
  666  to be included in the inventory. The hospital has 15 days from
  667  the date of receipt to respond to the notice. By December 1,
  668  1992, the agency shall publish a final inventory. Each hospital
  669  shall reaffirm its service capability when its license is
  670  renewed and shall notify the agency of the addition of a new
  671  service or the termination of a service prior to a change in its
  672  service capability.
  673         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
  674  FACILITY OR HEALTH CARE PERSONNEL.—
  675         (d)1. Every hospital shall ensure the provision of services
  676  within the service capability of the hospital, at all times,
  677  either directly or indirectly through an arrangement with
  678  another hospital, through an arrangement with one or more
  679  physicians, or as otherwise made through prior arrangements. A
  680  hospital may enter into an agreement with another hospital for
  681  purposes of meeting its service capability requirement, and
  682  appropriate compensation or other reasonable conditions may be
  683  negotiated for these backup services.
  684         2. If any arrangement requires the provision of emergency
  685  medical transportation, such arrangement must be made in
  686  consultation with the applicable provider and may not require
  687  the emergency medical service provider to provide transportation
  688  that is outside the routine service area of that provider or in
  689  a manner that impairs the ability of the emergency medical
  690  service provider to timely respond to prehospital emergency
  691  calls.
  692         3. A hospital shall not be required to ensure service
  693  capability at all times as required in subparagraph 1. if, prior
  694  to the receiving of any patient needing such service capability,
  695  such hospital has demonstrated to the agency that it lacks the
  696  ability to ensure such capability and it has exhausted all
  697  reasonable efforts to ensure such capability through backup
  698  arrangements. In reviewing a hospital’s demonstration of lack of
  699  ability to ensure service capability, the agency shall consider
  700  factors relevant to the particular case, including the
  701  following:
  702         a. Number and proximity of hospitals with the same service
  703  capability.
  704         b. Number, type, credentials, and privileges of
  705  specialists.
  706         c. Frequency of procedures.
  707         d. Size of hospital.
  708         4. The agency shall publish proposed rules implementing a
  709  reasonable exemption procedure by November 1, 1992. Subparagraph
  710  1. shall become effective upon the effective date of said rules
  711  or January 31, 1993, whichever is earlier. For a period not to
  712  exceed 1 year from the effective date of subparagraph 1., a
  713  hospital requesting an exemption shall be deemed to be exempt
  714  from offering the service until the agency initially acts to
  715  deny or grant the original request. The agency has 45 days from
  716  the date of receipt of the request to approve or deny the
  717  request. After the first year from the effective date of
  718  subparagraph 1., If the agency fails to initially act within the
  719  time period, the hospital is deemed to be exempt from offering
  720  the service until the agency initially acts to deny the request.
  721         Section 12. Section 395.1046, Florida Statutes, is
  722  repealed.
  723         Section 13. Paragraph (e) of subsection (1) of section
  724  395.1055, Florida Statutes, is amended to read:
  725         395.1055 Rules and enforcement.—
  726         (1) The agency shall adopt rules pursuant to ss. 120.536(1)
  727  and 120.54 to implement the provisions of this part, which shall
  728  include reasonable and fair minimum standards for ensuring that:
  729         (e) Licensed facility beds conform to minimum space,
  730  equipment, and furnishings standards as specified by the agency,
  731  the Florida Building Code, and the Florida Fire Prevention Code
  732  department.
  733         Section 14. Subsection (1) of section 395.10972, Florida
  734  Statutes, is amended to read:
  735         395.10972 Health Care Risk Manager Advisory Council.—The
  736  Secretary of Health Care Administration may appoint a seven
  737  member advisory council to advise the agency on matters
  738  pertaining to health care risk managers. The members of the
  739  council shall serve at the pleasure of the secretary. The
  740  council shall designate a chair. The council shall meet at the
  741  call of the secretary or at those times as may be required by
  742  rule of the agency. The members of the advisory council shall
  743  receive no compensation for their services, but shall be
  744  reimbursed for travel expenses as provided in s. 112.061. The
  745  council shall consist of individuals representing the following
  746  areas:
  747         (1) Two shall be active health care risk managers,
  748  including one risk manager who is recommended by and a member of
  749  the Florida Society for of Healthcare Risk Management and
  750  Patient Safety.
  751         Section 15. Subsection (3) of section 395.2050, Florida
  752  Statutes, is amended to read:
  753         395.2050 Routine inquiry for organ and tissue donation;
  754  certification for procurement activities; death records review.—
  755         (3) Each organ procurement organization designated by the
  756  federal Centers for Medicare and Medicaid Services Health Care
  757  Financing Administration and licensed by the state shall conduct
  758  an annual death records review in the organ procurement
  759  organization’s affiliated donor hospitals. The organ procurement
  760  organization shall enlist the services of every Florida licensed
  761  tissue bank and eye bank affiliated with or providing service to
  762  the donor hospital and operating in the same service area to
  763  participate in the death records review.
  764         Section 16. Subsection (2) of section 395.3036, Florida
  765  Statutes, is amended to read:
  766         395.3036 Confidentiality of records and meetings of
  767  corporations that lease public hospitals or other public health
  768  care facilities.—The records of a private corporation that
  769  leases a public hospital or other public health care facility
  770  are confidential and exempt from the provisions of s. 119.07(1)
  771  and s. 24(a), Art. I of the State Constitution, and the meetings
  772  of the governing board of a private corporation are exempt from
  773  s. 286.011 and s. 24(b), Art. I of the State Constitution when
  774  the public lessor complies with the public finance
  775  accountability provisions of s. 155.40(5) with respect to the
  776  transfer of any public funds to the private lessee and when the
  777  private lessee meets at least three of the five following
  778  criteria:
  779         (2) The public lessor and the private lessee do not
  780  commingle any of their funds in any account maintained by either
  781  of them, other than the payment of the rent and administrative
  782  fees or the transfer of funds pursuant to subsection (5) (2).
  783         Section 17. Section 395.3037, Florida Statutes, is
  784  repealed.
  785         Section 18. Subsections (1), (4), and (5) of section
  786  395.3038, Florida Statutes, are amended to read:
  787         395.3038 State-listed primary stroke centers and
  788  comprehensive stroke centers; notification of hospitals.—
  789         (1) The agency shall make available on its website and to
  790  the department a list of the name and address of each hospital
  791  that meets the criteria for a primary stroke center and the name
  792  and address of each hospital that meets the criteria for a
  793  comprehensive stroke center. The list of primary and
  794  comprehensive stroke centers shall include only those hospitals
  795  that attest in an affidavit submitted to the agency that the
  796  hospital meets the named criteria, or those hospitals that
  797  attest in an affidavit submitted to the agency that the hospital
  798  is certified as a primary or a comprehensive stroke center by
  799  the Joint Commission on Accreditation of Healthcare
  800  Organizations.
  801         (4) The agency shall adopt by rule criteria for a primary
  802  stroke center which are substantially similar to the
  803  certification standards for primary stroke centers of the Joint
  804  Commission on Accreditation of Healthcare Organizations.
  805         (5) The agency shall adopt by rule criteria for a
  806  comprehensive stroke center. However, if the Joint Commission on
  807  Accreditation of Healthcare Organizations establishes criteria
  808  for a comprehensive stroke center, the agency shall establish
  809  criteria for a comprehensive stroke center which are
  810  substantially similar to those criteria established by the Joint
  811  Commission on Accreditation of Healthcare Organizations.
  812         Section 19. Subsection (2) of section 395.602, Florida
  813  Statutes, is amended to read:
  814         395.602 Rural hospitals.—
  815         (2) DEFINITIONS.—As used in this part:
  816         (a) “Emergency care hospital” means a medical facility that
  817  which provides:
  818         1. Emergency medical treatment; and
  819         2. Inpatient care to ill or injured persons prior to their
  820  transportation to another hospital or provides inpatient medical
  821  care to persons needing care for a period of up to 96 hours. The
  822  96-hour limitation on inpatient care does not apply to respite,
  823  skilled nursing, hospice, or other nonacute care patients.
  824         (b) “Essential access community hospital” means any
  825  facility that which:
  826         1. Has at least 100 beds;
  827         2. Is located more than 35 miles from any other essential
  828  access community hospital, rural referral center, or urban
  829  hospital meeting criteria for classification as a regional
  830  referral center;
  831         3. Is part of a network that includes rural primary care
  832  hospitals;
  833         4. Provides emergency and medical backup services to rural
  834  primary care hospitals in its rural health network;
  835         5. Extends staff privileges to rural primary care hospital
  836  physicians in its network; and
  837         6. Accepts patients transferred from rural primary care
  838  hospitals in its network.
  839         (c) “Inactive rural hospital bed” means a licensed acute
  840  care hospital bed, as defined in s. 395.002(13), that is
  841  inactive in that it cannot be occupied by acute care inpatients.
  842         (d) “Rural area health education center” means an area
  843  health education center (AHEC), as authorized by Pub. L. No. 94
  844  484, which provides services in a county with a population
  845  density of no greater than 100 persons per square mile.
  846         (e) “Rural hospital” means an acute care hospital licensed
  847  under this chapter which has, having 100 or fewer licensed beds
  848  and an emergency room and, which is:
  849         1. The sole provider within a county with a population
  850  density of no greater than 100 persons per square mile;
  851         2. An acute care hospital, in a county with a population
  852  density of no greater than 100 persons per square mile, which is
  853  at least 30 minutes of travel time, on normally traveled roads
  854  under normal traffic conditions, from any other acute care
  855  hospital within the same county;
  856         3. A hospital supported by a tax district or subdistrict
  857  whose boundaries encompass a population of 100 persons or fewer
  858  per square mile;
  859         4.A hospital in a constitutional charter county with a
  860  population of over 1 million persons that has imposed a local
  861  option health service tax pursuant to law and in an area that
  862  was directly impacted by a catastrophic event on August 24,
  863  1992, for which the Governor of Florida declared a state of
  864  emergency pursuant to chapter 125, and has 120 beds or less that
  865  serves an agricultural community with an emergency room
  866  utilization of no less than 20,000 visits and a Medicaid
  867  inpatient utilization rate greater than 15 percent;
  868         4.5. A hospital with a service area that has a population
  869  of 100 persons or fewer per square mile. As used in this
  870  subparagraph, the term “service area” means the fewest number of
  871  zip codes that account for 75 percent of the hospital’s
  872  discharges for the most recent 5-year period, based on
  873  information available from the hospital inpatient discharge
  874  database in the Florida Center for Health Information and Policy
  875  Analysis at the Agency for Health Care Administration; or
  876         5.6. A hospital designated as a critical access hospital,
  877  as defined in s. 408.07(15).
  878  
  879  Population densities used in this paragraph must be based upon
  880  the most recently completed United States census. A hospital
  881  that received funds under s. 409.9116 for a quarter beginning no
  882  later than July 1, 2002, is deemed to have been and shall
  883  continue to be a rural hospital from that date through June 30,
  884  2015, if the hospital continues to have 100 or fewer licensed
  885  beds and an emergency room, or meets the criteria of
  886  subparagraph 4. An acute care hospital that has not previously
  887  been designated as a rural hospital and that meets the criteria
  888  of this paragraph shall be granted such designation upon
  889  application, including supporting documentation to the Agency
  890  for Health Care Administration.
  891         (f) “Rural primary care hospital” means any facility
  892  meeting the criteria in paragraph (e) or s. 395.605 which
  893  provides:
  894         1. Twenty-four-hour emergency medical care;
  895         2. Temporary inpatient care for periods of 72 hours or less
  896  to patients requiring stabilization before discharge or transfer
  897  to another hospital. The 72-hour limitation does not apply to
  898  respite, skilled nursing, hospice, or other nonacute care
  899  patients; and
  900         3. Has no more than six licensed acute care inpatient beds.
  901         (g) “Swing-bed” means a bed that which can be used
  902  interchangeably as either a hospital, skilled nursing facility
  903  (SNF), or intermediate care facility (ICF) bed pursuant to 42
  904  C.F.R. parts 405, 435, 440, 442, and 447.
  905         Section 20. Subsection (8) of section 400.021, Florida
  906  Statutes, is amended to read:
  907         400.021 Definitions.—When used in this part, unless the
  908  context otherwise requires, the term:
  909         (8) “Geriatric outpatient clinic” means a site for
  910  providing outpatient health care to persons 60 years of age or
  911  older, which is staffed by a registered nurse or a physician
  912  assistant, a licensed practical nurse under the direct
  913  supervision of a registered nurse, or an advanced registered
  914  nurse practitioner.
  915         Section 21. Subsection (2) of section 400.063, Florida
  916  Statutes, is amended to read:
  917         400.063 Resident protection.—
  918         (2) The agency is authorized to establish for each
  919  facility, subject to intervention by the agency, a separate bank
  920  account for the deposit to the credit of the agency of any
  921  moneys received from the Health Care Trust Fund or any other
  922  moneys received for the maintenance and care of residents in the
  923  facility, and the agency is authorized to disburse moneys from
  924  such account to pay obligations incurred for the purposes of
  925  this section. The agency is authorized to requisition moneys
  926  from the Health Care Trust Fund in advance of an actual need for
  927  cash on the basis of an estimate by the agency of moneys to be
  928  spent under the authority of this section. Any bank account
  929  established under this section need not be approved in advance
  930  of its creation as required by s. 17.58, but shall be secured by
  931  depository insurance equal to or greater than the balance of
  932  such account or by the pledge of collateral security in
  933  conformance with criteria established in s. 18.11. The agency
  934  shall notify the Chief Financial Officer of any such account so
  935  established and shall make a quarterly accounting to the Chief
  936  Financial Officer for all moneys deposited in such account.
  937         Section 22. Subsections (1) and (5) of section 400.071,
  938  Florida Statutes, are amended to read:
  939         400.071 Application for license.—
  940         (1) In addition to the requirements of part II of chapter
  941  408, the application for a license shall be under oath and must
  942  contain the following:
  943         (a) The location of the facility for which a license is
  944  sought and an indication, as in the original application, that
  945  such location conforms to the local zoning ordinances.
  946         (b)A signed affidavit disclosing any financial or
  947  ownership interest that a controlling interest as defined in
  948  part II of chapter 408 has held in the last 5 years in any
  949  entity licensed by this state or any other state to provide
  950  health or residential care which has closed voluntarily or
  951  involuntarily; has filed for bankruptcy; has had a receiver
  952  appointed; has had a license denied, suspended, or revoked; or
  953  has had an injunction issued against it which was initiated by a
  954  regulatory agency. The affidavit must disclose the reason any
  955  such entity was closed, whether voluntarily or involuntarily.
  956         (c)The total number of beds and the total number of
  957  Medicare and Medicaid certified beds.
  958         (b)(d) Information relating to the applicant and employees
  959  which the agency requires by rule. The applicant must
  960  demonstrate that sufficient numbers of qualified staff, by
  961  training or experience, will be employed to properly care for
  962  the type and number of residents who will reside in the
  963  facility.
  964         (c)(e) Copies of any civil verdict or judgment involving
  965  the applicant rendered within the 10 years preceding the
  966  application, relating to medical negligence, violation of
  967  residents’ rights, or wrongful death. As a condition of
  968  licensure, the licensee agrees to provide to the agency copies
  969  of any new verdict or judgment involving the applicant, relating
  970  to such matters, within 30 days after filing with the clerk of
  971  the court. The information required in this paragraph shall be
  972  maintained in the facility’s licensure file and in an agency
  973  database that which is available as a public record.
  974         (5) As a condition of licensure, each facility must
  975  establish and submit with its application a plan for quality
  976  assurance and for conducting risk management.
  977         Section 23. Section 400.0712, Florida Statutes, is amended
  978  to read:
  979         400.0712 Application for inactive license.—
  980         (1)As specified in this section, the agency may issue an
  981  inactive license to a nursing home facility for all or a portion
  982  of its beds. Any request by a licensee that a nursing home or
  983  portion of a nursing home become inactive must be submitted to
  984  the agency in the approved format. The facility may not initiate
  985  any suspension of services, notify residents, or initiate
  986  inactivity before receiving approval from the agency; and a
  987  licensee that violates this provision may not be issued an
  988  inactive license.
  989         (1)(2)In addition to the authority granted in part II of
  990  chapter 408, the agency may issue an inactive license to a
  991  nursing home that chooses to use an unoccupied contiguous
  992  portion of the facility for an alternative use to meet the needs
  993  of elderly persons through the use of less restrictive, less
  994  institutional services.
  995         (a) An inactive license issued under this subsection may be
  996  granted for a period not to exceed the current licensure
  997  expiration date but may be renewed by the agency at the time of
  998  licensure renewal.
  999         (b) A request to extend the inactive license must be
 1000  submitted to the agency in the approved format and approved by
 1001  the agency in writing.
 1002         (c) Nursing homes that receive an inactive license to
 1003  provide alternative services shall not receive preference for
 1004  participation in the Assisted Living for the Elderly Medicaid
 1005  waiver.
 1006         (2)(3) The agency shall adopt rules pursuant to ss.
 1007  120.536(1) and 120.54 necessary to administer implement this
 1008  section.
 1009         Section 24. Section 400.111, Florida Statutes, is amended
 1010  to read:
 1011         400.111 Disclosure of controlling interest.—In addition to
 1012  the requirements of part II of chapter 408, when requested by
 1013  the agency, the licensee shall submit a signed affidavit
 1014  disclosing any financial or ownership interest that a
 1015  controlling interest has held within the last 5 years in any
 1016  entity licensed by the state or any other state to provide
 1017  health or residential care if that which entity has closed
 1018  voluntarily or involuntarily; has filed for bankruptcy; has had
 1019  a receiver appointed; has had a license denied, suspended, or
 1020  revoked; or has had an injunction issued against it which was
 1021  initiated by a regulatory agency. The affidavit must disclose
 1022  the reason such entity was closed, whether voluntarily or
 1023  involuntarily.
 1024         Section 25. Section 400.1183, Florida Statutes, is amended
 1025  to read:
 1026         400.1183 Resident grievance procedures.—
 1027         (1) Every nursing home must have a grievance procedure
 1028  available to its residents and their families. The grievance
 1029  procedure must include:
 1030         (a) An explanation of how to pursue redress of a grievance.
 1031         (b) The names, job titles, and telephone numbers of the
 1032  employees responsible for implementing the facility’s grievance
 1033  procedure. The list must include the address and the toll-free
 1034  telephone numbers of the ombudsman and the agency.
 1035         (c) A simple description of the process through which a
 1036  resident may, at any time, contact the toll-free telephone
 1037  hotline of the ombudsman or the agency to report the unresolved
 1038  grievance.
 1039         (d) A procedure for providing assistance to residents who
 1040  cannot prepare a written grievance without help.
 1041         (2) Each facility shall maintain records of all grievances
 1042  for agency inspection and shall report to the agency at the time
 1043  of relicensure the total number of grievances handled during the
 1044  prior licensure period, a categorization of the cases underlying
 1045  the grievances, and the final disposition of the grievances.
 1046         (3) Each facility must respond to the grievance within a
 1047  reasonable time after its submission.
 1048         (4) The agency may investigate any grievance at any time.
 1049         Section 26. Section 400.141, Florida Statutes, is amended
 1050  to read:
 1051         400.141 Administration and management of nursing home
 1052  facilities.—
 1053         (1) Every licensed facility shall comply with all
 1054  applicable standards and rules of the agency and shall:
 1055         (a) Be under the administrative direction and charge of a
 1056  licensed administrator.
 1057         (b) Appoint a medical director licensed pursuant to chapter
 1058  458 or chapter 459. The agency may establish by rule more
 1059  specific criteria for the appointment of a medical director.
 1060         (c) Have available the regular, consultative, and emergency
 1061  services of physicians licensed by the state.
 1062         (d) Provide for resident use of a community pharmacy as
 1063  specified in s. 400.022(1)(q). Any other law to the contrary
 1064  notwithstanding, a registered pharmacist licensed in Florida,
 1065  that is under contract with a facility licensed under this
 1066  chapter or chapter 429, shall repackage a nursing facility
 1067  resident’s bulk prescription medication that which has been
 1068  packaged by another pharmacist licensed in any state in the
 1069  United States into a unit dose system compatible with the system
 1070  used by the nursing facility, if the pharmacist is requested to
 1071  offer such service. In order to be eligible for the repackaging,
 1072  a resident or the resident’s spouse must receive prescription
 1073  medication benefits provided through a former employer as part
 1074  of his or her retirement benefits, a qualified pension plan as
 1075  specified in s. 4972 of the Internal Revenue Code, a federal
 1076  retirement program as specified under 5 C.F.R. s. 831, or a
 1077  long-term care policy as defined in s. 627.9404(1). A pharmacist
 1078  who correctly repackages and relabels the medication and the
 1079  nursing facility that which correctly administers such
 1080  repackaged medication under this paragraph may not be held
 1081  liable in any civil or administrative action arising from the
 1082  repackaging. In order to be eligible for the repackaging, a
 1083  nursing facility resident for whom the medication is to be
 1084  repackaged shall sign an informed consent form provided by the
 1085  facility which includes an explanation of the repackaging
 1086  process and which notifies the resident of the immunities from
 1087  liability provided in this paragraph. A pharmacist who
 1088  repackages and relabels prescription medications, as authorized
 1089  under this paragraph, may charge a reasonable fee for costs
 1090  resulting from the implementation of this provision.
 1091         (e) Provide for the access of the facility residents to
 1092  dental and other health-related services, recreational services,
 1093  rehabilitative services, and social work services appropriate to
 1094  their needs and conditions and not directly furnished by the
 1095  licensee. When a geriatric outpatient nurse clinic is conducted
 1096  in accordance with rules adopted by the agency, outpatients
 1097  attending such clinic shall not be counted as part of the
 1098  general resident population of the nursing home facility, nor
 1099  shall the nursing staff of the geriatric outpatient clinic be
 1100  counted as part of the nursing staff of the facility, until the
 1101  outpatient clinic load exceeds 15 a day.
 1102         (f) Be allowed and encouraged by the agency to provide
 1103  other needed services under certain conditions. If the facility
 1104  has a standard licensure status, and has had no class I or class
 1105  II violations deficiencies during the past 2 years or has been
 1106  awarded a Gold Seal under the program established in s. 400.235,
 1107  it may be encouraged by the agency to provide services,
 1108  including, but not limited to, respite and adult day services
 1109  that, which enable individuals to move in and out of the
 1110  facility. A facility is not subject to any additional licensure
 1111  requirements for providing these services. Respite care may be
 1112  offered to persons in need of short-term or temporary nursing
 1113  home services. Respite care must be provided in accordance with
 1114  this part and rules adopted by the agency. However, the agency
 1115  shall, by rule, adopt modified requirements for resident
 1116  assessment, resident care plans, resident contracts, physician
 1117  orders, and other provisions, as appropriate, for short-term or
 1118  temporary nursing home services. The agency shall allow for
 1119  shared programming and staff in a facility that which meets
 1120  minimum standards and offers services pursuant to this
 1121  paragraph, but, if the facility is cited for deficiencies in
 1122  patient care, may require additional staff and programs
 1123  appropriate to the needs of service recipients. A person who
 1124  receives respite care may not be counted as a resident of the
 1125  facility for purposes of the facility’s licensed capacity unless
 1126  that person receives 24-hour respite care. A person receiving
 1127  either respite care for 24 hours or longer or adult day services
 1128  must be included when calculating minimum staffing for the
 1129  facility. Any costs and revenues generated by a nursing home
 1130  facility from nonresidential programs or services shall be
 1131  excluded from the calculations of Medicaid per diems for nursing
 1132  home institutional care reimbursement.
 1133         (g) If the facility has a standard license or is a Gold
 1134  Seal facility, exceeds the minimum required hours of licensed
 1135  nursing and certified nursing assistant direct care per resident
 1136  per day, and is part of a continuing care facility licensed
 1137  under chapter 651 or a retirement community that offers other
 1138  services pursuant to part III of this chapter or part I or part
 1139  III of chapter 429 on a single campus, be allowed to share
 1140  programming and staff. At the time of inspection and in the
 1141  semiannual report required pursuant to paragraph (o), a
 1142  continuing care facility or retirement community that uses this
 1143  option must demonstrate through staffing records that minimum
 1144  staffing requirements for the facility were met. Licensed nurses
 1145  and certified nursing assistants who work in the nursing home
 1146  facility may be used to provide services elsewhere on campus if
 1147  the facility exceeds the minimum number of direct care hours
 1148  required per resident per day and the total number of residents
 1149  receiving direct care services from a licensed nurse or a
 1150  certified nursing assistant does not cause the facility to
 1151  violate the staffing ratios required under s. 400.23(3)(a).
 1152  Compliance with the minimum staffing ratios shall be based on
 1153  total number of residents receiving direct care services,
 1154  regardless of where they reside on campus. If the facility
 1155  receives a conditional license, it may not share staff until the
 1156  conditional license status ends. This paragraph does not
 1157  restrict the agency’s authority under federal or state law to
 1158  require additional staff if a facility is cited for deficiencies
 1159  in care which are caused by an insufficient number of certified
 1160  nursing assistants or licensed nurses. The agency may adopt
 1161  rules for the documentation necessary to determine compliance
 1162  with this provision.
 1163         (h) Maintain the facility premises and equipment and
 1164  conduct its operations in a safe and sanitary manner.
 1165         (i) If the licensee furnishes food service, provide a
 1166  wholesome and nourishing diet sufficient to meet generally
 1167  accepted standards of proper nutrition for its residents and
 1168  provide such therapeutic diets as may be prescribed by attending
 1169  physicians. In making rules to implement this paragraph, the
 1170  agency shall be guided by standards recommended by nationally
 1171  recognized professional groups and associations with knowledge
 1172  of dietetics.
 1173         (j) Keep full records of resident admissions and
 1174  discharges; medical and general health status, including medical
 1175  records, personal and social history, and identity and address
 1176  of next of kin or other persons who may have responsibility for
 1177  the affairs of the residents; and individual resident care plans
 1178  including, but not limited to, prescribed services, service
 1179  frequency and duration, and service goals. The records shall be
 1180  open to inspection by the agency.
 1181         (k) Keep such fiscal records of its operations and
 1182  conditions as may be necessary to provide information pursuant
 1183  to this part.
 1184         (l) Furnish copies of personnel records for employees
 1185  affiliated with such facility, to any other facility licensed by
 1186  this state requesting this information pursuant to this part.
 1187  Such information contained in the records may include, but is
 1188  not limited to, disciplinary matters and any reason for
 1189  termination. Any facility releasing such records pursuant to
 1190  this part shall be considered to be acting in good faith and may
 1191  not be held liable for information contained in such records,
 1192  absent a showing that the facility maliciously falsified such
 1193  records.
 1194         (m) Publicly display a poster provided by the agency
 1195  containing the names, addresses, and telephone numbers for the
 1196  state’s abuse hotline, the State Long-Term Care Ombudsman, the
 1197  Agency for Health Care Administration consumer hotline, the
 1198  Advocacy Center for Persons with Disabilities, the Florida
 1199  Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
 1200  with a clear description of the assistance to be expected from
 1201  each.
 1202         (n)Submit to the agency the information specified in s.
 1203  400.071(1)(b) for a management company within 30 days after the
 1204  effective date of the management agreement.
 1205         (n)(o)1. Submit semiannually to the agency, or more
 1206  frequently if requested by the agency, information regarding
 1207  facility staff-to-resident ratios, staff turnover, and staff
 1208  stability, including information regarding certified nursing
 1209  assistants, licensed nurses, the director of nursing, and the
 1210  facility administrator. For purposes of this reporting:
 1211         a. Staff-to-resident ratios must be reported in the
 1212  categories specified in s. 400.23(3)(a) and applicable rules.
 1213  The ratio must be reported as an average for the most recent
 1214  calendar quarter.
 1215         b. Staff turnover must be reported for the most recent 12
 1216  month period ending on the last workday of the most recent
 1217  calendar quarter prior to the date the information is submitted.
 1218  The turnover rate must be computed quarterly, with the annual
 1219  rate being the cumulative sum of the quarterly rates. The
 1220  turnover rate is the total number of terminations or separations
 1221  experienced during the quarter, excluding any employee
 1222  terminated during a probationary period of 3 months or less,
 1223  divided by the total number of staff employed at the end of the
 1224  period for which the rate is computed, and expressed as a
 1225  percentage.
 1226         c. The formula for determining staff stability is the total
 1227  number of employees who that have been employed for more than 12
 1228  months, divided by the total number of employees employed at the
 1229  end of the most recent calendar quarter, and expressed as a
 1230  percentage.
 1231         d. A nursing facility that has failed to comply with state
 1232  minimum-staffing requirements for 2 consecutive days is
 1233  prohibited from accepting new admissions until the facility has
 1234  achieved the minimum-staffing requirements for a period of 6
 1235  consecutive days. For the purposes of this sub-subparagraph, any
 1236  person who was a resident of the facility and was absent from
 1237  the facility for the purpose of receiving medical care at a
 1238  separate location or was on a leave of absence is not considered
 1239  a new admission. Failure to impose such an admissions moratorium
 1240  constitutes a class II violation, and the agency shall fine the
 1241  nursing facility $1,000 for such violation deficiency.
 1242         e. A nursing facility that which does not have a
 1243  conditional license may be cited for failure to comply with the
 1244  standards in s. 400.23(3)(a)1.a. only if it has failed to meet
 1245  those standards on 2 consecutive days or if it has failed to
 1246  meet at least 97 percent of those standards on any one day.
 1247         f. A facility that which has a conditional license must be
 1248  in compliance with the standards in s. 400.23(3)(a) at all
 1249  times.
 1250         2. This paragraph does not limit the agency’s ability to
 1251  impose a deficiency or take other actions if a facility does not
 1252  have enough staff to meet the residents’ needs.
 1253         (o)(p) Notify a licensed physician when a resident exhibits
 1254  signs of dementia or cognitive impairment or has a change of
 1255  condition in order to rule out the presence of an underlying
 1256  physiological condition that may be contributing to such
 1257  dementia or impairment. The notification must occur within 30
 1258  days after the acknowledgment of such signs by facility staff.
 1259  If an underlying condition is determined to exist, the facility
 1260  shall arrange, with the appropriate health care provider, the
 1261  necessary care and services to treat the condition.
 1262         (p)(q) If the facility implements a dining and hospitality
 1263  attendant program, ensure that the program is developed and
 1264  implemented under the supervision of the facility director of
 1265  nursing. A licensed nurse, licensed speech or occupational
 1266  therapist, or a registered dietitian must conduct training of
 1267  dining and hospitality attendants. A person employed by a
 1268  facility as a dining and hospitality attendant must perform
 1269  tasks under the direct supervision of a licensed nurse.
 1270         (r)Report to the agency any filing for bankruptcy
 1271  protection by the facility or its parent corporation,
 1272  divestiture or spin-off of its assets, or corporate
 1273  reorganization within 30 days after the completion of such
 1274  activity.
 1275         (q)(s) Maintain general and professional liability
 1276  insurance coverage that is in force at all times. In lieu of
 1277  general and professional liability insurance coverage, a state
 1278  designated teaching nursing home and its affiliated assisted
 1279  living facilities created under s. 430.80 may demonstrate proof
 1280  of financial responsibility as provided in s. 430.80(3)(h).
 1281         (r)(t) Maintain in the medical record for each resident a
 1282  daily chart of certified nursing assistant services provided to
 1283  the resident. The certified nursing assistant who is caring for
 1284  the resident must complete this record by the end of his or her
 1285  shift. This record must indicate assistance with activities of
 1286  daily living, assistance with eating, and assistance with
 1287  drinking, and must record each offering of nutrition and
 1288  hydration for those residents whose plan of care or assessment
 1289  indicates a risk for malnutrition or dehydration.
 1290         (s)(u) Before November 30 of each year, subject to the
 1291  availability of an adequate supply of the necessary vaccine,
 1292  provide for immunizations against influenza viruses to all its
 1293  consenting residents in accordance with the recommendations of
 1294  the United States Centers for Disease Control and Prevention,
 1295  subject to exemptions for medical contraindications and
 1296  religious or personal beliefs. Subject to these exemptions, any
 1297  consenting person who becomes a resident of the facility after
 1298  November 30 but before March 31 of the following year must be
 1299  immunized within 5 working days after becoming a resident.
 1300  Immunization shall not be provided to any resident who provides
 1301  documentation that he or she has been immunized as required by
 1302  this paragraph. This paragraph does not prohibit a resident from
 1303  receiving the immunization from his or her personal physician if
 1304  he or she so chooses. A resident who chooses to receive the
 1305  immunization from his or her personal physician shall provide
 1306  proof of immunization to the facility. The agency may adopt and
 1307  enforce any rules necessary to comply with or administer
 1308  implement this paragraph subsection.
 1309         (t)(v) Assess all residents for eligibility for
 1310  pneumococcal polysaccharide vaccination (PPV) and vaccinate
 1311  residents when indicated within 60 days after the effective date
 1312  of this act in accordance with the recommendations of the United
 1313  States Centers for Disease Control and Prevention, subject to
 1314  exemptions for medical contraindications and religious or
 1315  personal beliefs. Residents admitted after the effective date of
 1316  this act shall be assessed within 5 working days of admission
 1317  and, when indicated, vaccinated within 60 days in accordance
 1318  with the recommendations of the United States Centers for
 1319  Disease Control and Prevention, subject to exemptions for
 1320  medical contraindications and religious or personal beliefs.
 1321  Immunization shall not be provided to any resident who provides
 1322  documentation that he or she has been immunized as required by
 1323  this paragraph. This paragraph does not prohibit a resident from
 1324  receiving the immunization from his or her personal physician if
 1325  he or she so chooses. A resident who chooses to receive the
 1326  immunization from his or her personal physician shall provide
 1327  proof of immunization to the facility. The agency may adopt and
 1328  enforce any rules necessary to comply with or administer
 1329  implement this paragraph.
 1330         (u)(w) Annually encourage and promote to its employees the
 1331  benefits associated with immunizations against influenza viruses
 1332  in accordance with the recommendations of the United States
 1333  Centers for Disease Control and Prevention. The agency may adopt
 1334  and enforce any rules necessary to comply with or administer
 1335  implement this paragraph.
 1336         (2) Facilities that have been awarded a Gold Seal under the
 1337  program established in s. 400.235 may develop a plan to provide
 1338  certified nursing assistant training as prescribed by federal
 1339  regulations and state rules and may apply to the agency for
 1340  approval of their program.
 1341         Section 27. Subsection (3) of section 400.142, Florida
 1342  Statutes, is amended to read:
 1343         400.142 Emergency medication kits; orders not to
 1344  resuscitate.—
 1345         (3) Facility staff may withhold or withdraw cardiopulmonary
 1346  resuscitation if presented with an order not to resuscitate
 1347  executed pursuant to s. 401.45. The agency shall adopt rules
 1348  providing for the implementation of such orders. Facility staff
 1349  and facilities are shall not be subject to criminal prosecution
 1350  or civil liability, nor be considered to have engaged in
 1351  negligent or unprofessional conduct, for withholding or
 1352  withdrawing cardiopulmonary resuscitation pursuant to such an
 1353  order and rules adopted by the agency. The absence of an order
 1354  not to resuscitate executed pursuant to s. 401.45 does not
 1355  preclude a physician from withholding or withdrawing
 1356  cardiopulmonary resuscitation as otherwise permitted by law.
 1357         Section 28. Subsection (10) of section 400.147, Florida
 1358  Statutes, is repealed.
 1359         Section 29. Section 400.148, Florida Statutes, is repealed.
 1360         Section 30. Subsection (3) of section 400.19, Florida
 1361  Statutes, is amended to read:
 1362         400.19 Right of entry and inspection.—
 1363         (3) The agency shall every 15 months conduct at least one
 1364  unannounced inspection to determine compliance by the licensee
 1365  with statutes, and with rules promulgated under the provisions
 1366  of those statutes, governing minimum standards of construction,
 1367  quality and adequacy of care, and rights of residents. The
 1368  survey shall be conducted every 6 months for the next 2-year
 1369  period if the facility has been cited for a class I deficiency,
 1370  has been cited for two or more class II violations deficiencies
 1371  arising from separate surveys or investigations within a 60-day
 1372  period, or has had three or more substantiated complaints within
 1373  a 6-month period, each resulting in at least one class I or
 1374  class II deficiency. In addition to any other fees or fines in
 1375  this part, the agency shall assess a fine for each facility that
 1376  is subject to the 6-month survey cycle. The fine for the 2-year
 1377  period shall be $6,000, one-half to be paid at the completion of
 1378  each survey. The agency may adjust this fine by the change in
 1379  the Consumer Price Index, based on the 12 months immediately
 1380  preceding the increase, to cover the cost of the additional
 1381  surveys. The agency shall verify through subsequent inspection
 1382  that any deficiency identified during inspection is corrected.
 1383  However, the agency may verify the correction of a class III or
 1384  class IV violation deficiency unrelated to resident rights or
 1385  resident care without reinspecting the facility if adequate
 1386  written documentation has been received from the facility, which
 1387  provides assurance that the deficiency has been corrected. The
 1388  giving or causing to be given of advance notice of such
 1389  unannounced inspections by an employee of the agency to any
 1390  unauthorized person shall constitute cause for suspension of not
 1391  fewer than 5 working days according to the provisions of chapter
 1392  110.
 1393         Section 31. Section 400.195, Florida Statutes, is repealed.
 1394         Section 32. Subsection (5) of section 400.23, Florida
 1395  Statutes, is amended to read:
 1396         400.23 Rules; evaluation and deficiencies; licensure
 1397  status.—
 1398         (5) The agency, in collaboration with the Division of
 1399  Children’s Medical Services Network of the Department of Health,
 1400  must, no later than December 31, 1993, adopt rules for minimum
 1401  standards of care for persons under 21 years of age who reside
 1402  in nursing home facilities. The rules must include a methodology
 1403  for reviewing a nursing home facility under ss. 408.031-408.045
 1404  which serves only persons under 21 years of age. A facility may
 1405  be exempt from these standards for specific persons between 18
 1406  and 21 years of age, if the person’s physician agrees that
 1407  minimum standards of care based on age are not necessary.
 1408         Section 33. Subsection (1) of section 400.275, Florida
 1409  Statutes, is amended to read:
 1410         400.275 Agency duties.—
 1411         (1) The agency shall ensure that each newly hired nursing
 1412  home surveyor, as a part of basic training, is assigned full
 1413  time to a licensed nursing home for at least 2 days within a 7
 1414  day period to observe facility operations outside of the survey
 1415  process before the surveyor begins survey responsibilities. Such
 1416  observations may not be the sole basis of a deficiency citation
 1417  against the facility. The agency may not assign an individual to
 1418  be a member of a survey team for purposes of a survey,
 1419  evaluation, or consultation visit at a nursing home facility in
 1420  which the surveyor was an employee within the preceding 5 years.
 1421         Section 34. Section 400.484, Florida Statutes, is amended
 1422  to read:
 1423         400.484 Right of inspection; violations deficiencies;
 1424  fines.—
 1425         (1) In addition to the requirements of s. 408.811, the
 1426  agency may make such inspections and investigations as are
 1427  necessary in order to determine the state of compliance with
 1428  this part, part II of chapter 408, and applicable rules.
 1429         (2) The agency shall impose fines for various classes of
 1430  violations deficiencies in accordance with the following
 1431  schedule:
 1432         (a) A class I violation is defined in s. 408.813. A class I
 1433  deficiency is any act, omission, or practice that results in a
 1434  patient’s death, disablement, or permanent injury, or places a
 1435  patient at imminent risk of death, disablement, or permanent
 1436  injury. Upon finding a class I violation deficiency, the agency
 1437  shall impose an administrative fine in the amount of $15,000 for
 1438  each occurrence and each day that the violation deficiency
 1439  exists.
 1440         (b) A class II violation is defined in s. 408.813. A class
 1441  II deficiency is any act, omission, or practice that has a
 1442  direct adverse effect on the health, safety, or security of a
 1443  patient. Upon finding a class II violation deficiency, the
 1444  agency shall impose an administrative fine in the amount of
 1445  $5,000 for each occurrence and each day that the violation
 1446  deficiency exists.
 1447         (c) A class III violation is defined in s. 408.813. A class
 1448  III deficiency is any act, omission, or practice that has an
 1449  indirect, adverse effect on the health, safety, or security of a
 1450  patient. Upon finding an uncorrected or repeated class III
 1451  violation deficiency, the agency shall impose an administrative
 1452  fine not to exceed $1,000 for each occurrence and each day that
 1453  the uncorrected or repeated violation deficiency exists.
 1454         (d) A class IV violation is defined in s. 408.813. A class
 1455  IV deficiency is any act, omission, or practice related to
 1456  required reports, forms, or documents which does not have the
 1457  potential of negatively affecting patients. These violations are
 1458  of a type that the agency determines do not threaten the health,
 1459  safety, or security of patients. Upon finding an uncorrected or
 1460  repeated class IV violation deficiency, the agency shall impose
 1461  an administrative fine not to exceed $500 for each occurrence
 1462  and each day that the uncorrected or repeated violation
 1463  deficiency exists.
 1464         (3) In addition to any other penalties imposed pursuant to
 1465  this section or part, the agency may assess costs related to an
 1466  investigation that results in a successful prosecution,
 1467  excluding costs associated with an attorney’s time.
 1468         Section 35. Subsections (1) and (4) of section 400.606,
 1469  Florida Statutes, are amended to read:
 1470         400.606 License; application; renewal; conditional license
 1471  or permit; certificate of need.—
 1472         (1) In addition to the requirements of part II of chapter
 1473  408, the initial application and change of ownership application
 1474  must be accompanied by a plan for the delivery of home,
 1475  residential, and homelike inpatient hospice services to
 1476  terminally ill persons and their families. Such plan must
 1477  contain, but need not be limited to:
 1478         (a) The estimated average number of terminally ill persons
 1479  to be served monthly.
 1480         (b) The geographic area in which hospice services will be
 1481  available.
 1482         (c) A listing of services that which are or will be
 1483  provided, either directly by the applicant or through
 1484  contractual arrangements with existing providers.
 1485         (d) Provisions for the implementation of hospice home care
 1486  within 3 months after licensure.
 1487         (e) Provisions for the implementation of hospice homelike
 1488  inpatient care within 12 months after licensure.
 1489         (f) The number and disciplines of professional staff to be
 1490  employed.
 1491         (g) The name and qualifications of any existing or
 1492  potential contractee.
 1493         (h) A plan for attracting and training volunteers.
 1494         (i)The projected annual operating cost of the hospice.
 1495  
 1496  If the applicant is an existing licensed health care provider,
 1497  the application must be accompanied by a copy of the most recent
 1498  profit-loss statement and, if applicable, the most recent
 1499  licensure inspection report.
 1500         (4) A freestanding hospice facility that is primarily
 1501  engaged in providing inpatient and related services and that is
 1502  not otherwise licensed as a health care facility shall be
 1503  required to obtain a certificate of need. However, a
 1504  freestanding hospice facility with six or fewer beds shall not
 1505  be required to comply with institutional standards such as, but
 1506  not limited to, standards requiring sprinkler systems, emergency
 1507  electrical systems, or special lavatory devices.
 1508         Section 36. Subsection (2) of section 400.607, Florida
 1509  Statutes, is amended to read:
 1510         400.607 Denial, suspension, revocation of license;
 1511  emergency actions; imposition of administrative fine; grounds.—
 1512         (2) A violation of the provisions of this part, part II of
 1513  chapter 408, or applicable rules Any of the following actions by
 1514  a licensed hospice or any of its employees shall be grounds for
 1515  administrative action by the agency against a hospice.:
 1516         (a)A violation of the provisions of this part, part II of
 1517  chapter 408, or applicable rules.
 1518         (b)An intentional or negligent act materially affecting
 1519  the health or safety of a patient.
 1520         Section 37. Subsection (1) of section 400.925, Florida
 1521  Statutes, is amended to read:
 1522         400.925 Definitions.—As used in this part, the term:
 1523         (1) “Accrediting organizations” means the Joint Commission
 1524  on Accreditation of Healthcare Organizations or other national
 1525  accreditation agencies whose standards for accreditation are
 1526  comparable to those required by this part for licensure.
 1527         Section 38. Section 400.931, Florida Statutes, is amended
 1528  to read:
 1529         400.931 Application for license; fee; provisional license;
 1530  temporary permit.—
 1531         (1) In addition to the requirements of part II of chapter
 1532  408, the applicant must file with the application satisfactory
 1533  proof that the home medical equipment provider is in compliance
 1534  with this part and applicable rules, including:
 1535         (a) A report, by category, of the equipment to be provided,
 1536  indicating those offered either directly by the applicant or
 1537  through contractual arrangements with existing providers.
 1538  Categories of equipment include:
 1539         1. Respiratory modalities.
 1540         2. Ambulation aids.
 1541         3. Mobility aids.
 1542         4. Sickroom setup.
 1543         5. Disposables.
 1544         (b) A report, by category, of the services to be provided,
 1545  indicating those offered either directly by the applicant or
 1546  through contractual arrangements with existing providers.
 1547  Categories of services include:
 1548         1. Intake.
 1549         2. Equipment selection.
 1550         3. Delivery.
 1551         4. Setup and installation.
 1552         5. Patient training.
 1553         6. Ongoing service and maintenance.
 1554         7. Retrieval.
 1555         (c) A listing of those with whom the applicant contracts,
 1556  both the providers the applicant uses to provide equipment or
 1557  services to its consumers and the providers for whom the
 1558  applicant provides services or equipment.
 1559         (2)As an alternative to submitting proof of financial
 1560  ability to operate as required in s. 408.810(8), the applicant
 1561  may submit a $50,000 surety bond to the agency.
 1562         (2)(3) As specified in part II of chapter 408, the home
 1563  medical equipment provider must also obtain and maintain
 1564  professional and commercial liability insurance. Proof of
 1565  liability insurance, as defined in s. 624.605, must be submitted
 1566  with the application. The agency shall set the required amounts
 1567  of liability insurance by rule, but the required amount must not
 1568  be less than $250,000 per claim. In the case of contracted
 1569  services, it is required that the contractor must have liability
 1570  insurance not less than $250,000 per claim.
 1571         (3)(4) When a change of the general manager of a home
 1572  medical equipment provider occurs, the licensee must notify the
 1573  agency of the change within 45 days.
 1574         (4)(5) In accordance with s. 408.805, an applicant or a
 1575  licensee shall pay a fee for each license application submitted
 1576  under this part, part II of chapter 408, and applicable rules.
 1577  The amount of the fee shall be established by rule and may not
 1578  exceed $300 per biennium. The agency shall set the fees in an
 1579  amount that is sufficient to cover its costs in carrying out its
 1580  responsibilities under this part. However, state, county, or
 1581  municipal governments applying for licenses under this part are
 1582  exempt from the payment of license fees.
 1583         (5)(6) An applicant for initial licensure, renewal, or
 1584  change of ownership shall also pay an inspection fee not to
 1585  exceed $400, which shall be paid by all applicants except those
 1586  not subject to licensure inspection by the agency as described
 1587  in s. 400.933.
 1588         Section 39. Subsection (2) of section 400.932, Florida
 1589  Statutes, is amended to read:
 1590         400.932 Administrative penalties.—
 1591         (2) A violation of this part, part II of chapter 408, or
 1592  applicable rules Any of the following actions by an employee of
 1593  a home medical equipment provider is are grounds for
 1594  administrative action or penalties by the agency.:
 1595         (a)Violation of this part, part II of chapter 408, or
 1596  applicable rules.
 1597         (b)An intentional, reckless, or negligent act that
 1598  materially affects the health or safety of a patient.
 1599         Section 40. Subsection (2) of section 400.933, Florida
 1600  Statutes, is amended to read:
 1601         400.933 Licensure inspections and investigations.—
 1602         (2) The agency shall accept, in lieu of its own periodic
 1603  inspections for licensure, submission of the following:
 1604         (a) The survey or inspection of an accrediting
 1605  organization, provided the accreditation of the licensed home
 1606  medical equipment provider is not conditional or provisional and
 1607  provided the licensed home medical equipment provider authorizes
 1608  release of, and the agency receives the report of, the
 1609  accrediting organization; or
 1610         (b) A copy of a valid medical oxygen retail establishment
 1611  permit issued by the Department of Health, pursuant to chapter
 1612  499.
 1613         Section 41. Subsection (2) of section 400.953, Florida
 1614  Statutes, is amended to read:
 1615         400.953 Background screening of home medical equipment
 1616  provider personnel.—The agency shall require employment
 1617  screening as provided in chapter 435, using the level 1
 1618  standards for screening set forth in that chapter, for home
 1619  medical equipment provider personnel.
 1620         (2) The general manager of each home medical equipment
 1621  provider must sign an affidavit annually, under penalty of
 1622  perjury, stating that all home medical equipment provider
 1623  personnel hired on or after July 1, 1999, who enter the home of
 1624  a patient in the capacity of their employment have been screened
 1625  and that its remaining personnel have worked for the home
 1626  medical equipment provider continuously since before July 1,
 1627  1999. This attestation must be submitted in accordance with s.
 1628  408.809(6).
 1629         Section 42. Section 400.967, Florida Statutes, is amended
 1630  to read:
 1631         400.967 Rules and classification of violations
 1632  deficiencies.—
 1633         (1) It is the intent of the Legislature that rules adopted
 1634  and enforced under this part and part II of chapter 408 include
 1635  criteria by which a reasonable and consistent quality of
 1636  resident care may be ensured, the results of such resident care
 1637  can be demonstrated, and safe and sanitary facilities can be
 1638  provided.
 1639         (2) Pursuant to the intention of the Legislature, the
 1640  agency, in consultation with the Agency for Persons with
 1641  Disabilities and the Department of Elderly Affairs, shall adopt
 1642  and enforce rules to administer this part and part II of chapter
 1643  408, which shall include reasonable and fair criteria governing:
 1644         (a) The location and construction of the facility;
 1645  including fire and life safety, plumbing, heating, cooling,
 1646  lighting, ventilation, and other housing conditions that will
 1647  ensure the health, safety, and comfort of residents. The agency
 1648  shall establish standards for facilities and equipment to
 1649  increase the extent to which new facilities and a new wing or
 1650  floor added to an existing facility after July 1, 2000, are
 1651  structurally capable of serving as shelters only for residents,
 1652  staff, and families of residents and staff, and equipped to be
 1653  self-supporting during and immediately following disasters. The
 1654  Agency for Health Care Administration shall work with facilities
 1655  licensed under this part and report to the Governor and the
 1656  Legislature by April 1, 2000, its recommendations for cost
 1657  effective renovation standards to be applied to existing
 1658  facilities. In making such rules, the agency shall be guided by
 1659  criteria recommended by nationally recognized, reputable
 1660  professional groups and associations having knowledge concerning
 1661  such subject matters. The agency shall update or revise such
 1662  criteria as the need arises. All facilities must comply with
 1663  those lifesafety code requirements and building code standards
 1664  applicable at the time of approval of their construction plans.
 1665  The agency may require alterations to a building if it
 1666  determines that an existing condition constitutes a distinct
 1667  hazard to life, health, or safety. The agency shall adopt fair
 1668  and reasonable rules setting forth conditions under which
 1669  existing facilities undergoing additions, alterations,
 1670  conversions, renovations, or repairs are required to comply with
 1671  the most recent updated or revised standards.
 1672         (b) The number and qualifications of all personnel,
 1673  including management, medical nursing, and other personnel,
 1674  having responsibility for any part of the care given to
 1675  residents.
 1676         (c) All sanitary conditions within the facility and its
 1677  surroundings, including water supply, sewage disposal, food
 1678  handling, and general hygiene, which will ensure the health and
 1679  comfort of residents.
 1680         (d) The equipment essential to the health and welfare of
 1681  the residents.
 1682         (e) A uniform accounting system.
 1683         (f) The care, treatment, and maintenance of residents and
 1684  measurement of the quality and adequacy thereof.
 1685         (g) The preparation and annual update of a comprehensive
 1686  emergency management plan. The agency shall adopt rules
 1687  establishing minimum criteria for the plan after consultation
 1688  with the Department of Community Affairs. At a minimum, the
 1689  rules must provide for plan components that address emergency
 1690  evacuation transportation; adequate sheltering arrangements;
 1691  postdisaster activities, including emergency power, food, and
 1692  water; postdisaster transportation; supplies; staffing;
 1693  emergency equipment; individual identification of residents and
 1694  transfer of records; and responding to family inquiries. The
 1695  comprehensive emergency management plan is subject to review and
 1696  approval by the local emergency management agency. During its
 1697  review, the local emergency management agency shall ensure that
 1698  the following agencies, at a minimum, are given the opportunity
 1699  to review the plan: the Department of Elderly Affairs, the
 1700  Agency for Persons with Disabilities, the Agency for Health Care
 1701  Administration, and the Department of Community Affairs. Also,
 1702  appropriate volunteer organizations must be given the
 1703  opportunity to review the plan. The local emergency management
 1704  agency shall complete its review within 60 days and either
 1705  approve the plan or advise the facility of necessary revisions.
 1706         (h) The use of restraint and seclusion. Such rules must be
 1707  consistent with recognized best practices; prohibit inherently
 1708  dangerous restraint or seclusion procedures; establish
 1709  limitations on the use and duration of restraint and seclusion;
 1710  establish measures to ensure the safety of clients and staff
 1711  during an incident of restraint or seclusion; establish
 1712  procedures for staff to follow before, during, and after
 1713  incidents of restraint or seclusion, including individualized
 1714  plans for the use of restraints or seclusion in emergency
 1715  situations; establish professional qualifications of and
 1716  training for staff who may order or be engaged in the use of
 1717  restraint or seclusion; establish requirements for facility data
 1718  collection and reporting relating to the use of restraint and
 1719  seclusion; and establish procedures relating to the
 1720  documentation of the use of restraint or seclusion in the
 1721  client’s facility or program record.
 1722         (3) The agency shall adopt rules to provide that, when the
 1723  criteria established under this part and part II of chapter 408
 1724  are not met, such violations deficiencies shall be classified
 1725  according to the nature of the violation deficiency. The agency
 1726  shall indicate the classification on the face of the notice of
 1727  violations deficiencies as follows:
 1728         (a) Class I violations deficiencies are defined in s.
 1729  408.813. those which the agency determines present an imminent
 1730  danger to the residents or guests of the facility or a
 1731  substantial probability that death or serious physical harm
 1732  would result therefrom. The condition or practice constituting a
 1733  class I violation must be abated or eliminated immediately,
 1734  unless a fixed period of time, as determined by the agency, is
 1735  required for correction. A class I violation deficiency is
 1736  subject to a civil penalty in an amount not less than $5,000 and
 1737  not exceeding $10,000 for each violation deficiency. A fine may
 1738  be levied notwithstanding the correction of the violation
 1739  deficiency.
 1740         (b) Class II violations deficiencies are defined in s.
 1741  408.813. those which the agency determines have a direct or
 1742  immediate relationship to the health, safety, or security of the
 1743  facility residents, other than class I deficiencies. A class II
 1744  violation deficiency is subject to a civil penalty in an amount
 1745  not less than $1,000 and not exceeding $5,000 for each
 1746  deficiency. A citation for a class II violation deficiency shall
 1747  specify the time within which the violation deficiency must be
 1748  corrected. If a class II violation deficiency is corrected
 1749  within the time specified, no civil penalty shall be imposed,
 1750  unless it is a repeated offense.
 1751         (c) Class III violations deficiencies are defined in s.
 1752  408.813. those which the agency determines to have an indirect
 1753  or potential relationship to the health, safety, or security of
 1754  the facility residents, other than class I or class II
 1755  deficiencies. A class III violation deficiency is subject to a
 1756  civil penalty of not less than $500 and not exceeding $1,000 for
 1757  each violation deficiency. A citation for a class III violation
 1758  deficiency shall specify the time within which the violation
 1759  deficiency must be corrected. If a class III violation
 1760  deficiency is corrected within the time specified, no civil
 1761  penalty shall be imposed, unless it is a repeated offense.
 1762         (d)Class IV violations are defined in s. 408.813.
 1763         (4) The agency shall approve or disapprove the plans and
 1764  specifications within 60 days after receipt of the final plans
 1765  and specifications. The agency may be granted one 15-day
 1766  extension for the review period, if the secretary of the agency
 1767  so approves. If the agency fails to act within the specified
 1768  time, it is deemed to have approved the plans and
 1769  specifications. When the agency disapproves plans and
 1770  specifications, it must set forth in writing the reasons for
 1771  disapproval. Conferences and consultations may be provided as
 1772  necessary.
 1773         (5) The agency may charge an initial fee of $2,000 for
 1774  review of plans and construction on all projects, no part of
 1775  which is refundable. The agency may also collect a fee, not to
 1776  exceed 1 percent of the estimated construction cost or the
 1777  actual cost of review, whichever is less, for the portion of the
 1778  review that which encompasses initial review through the initial
 1779  revised construction document review. The agency may collect its
 1780  actual costs on all subsequent portions of the review and
 1781  construction inspections. Initial fee payment must accompany the
 1782  initial submission of plans and specifications. Any subsequent
 1783  payment that is due is payable upon receipt of the invoice from
 1784  the agency. Notwithstanding any other provision of law, all
 1785  money received by the agency under this section shall be deemed
 1786  to be trust funds, to be held and applied solely for the
 1787  operations required under this section.
 1788         Section 43. Paragraph (l) of subsection (4) and subsection
 1789  (7) of section 400.9905, Florida Statutes, are amended to read:
 1790         400.9905 Definitions.—
 1791         (4) “Clinic” means an entity where at which health care
 1792  services are provided to individuals and which tenders charges
 1793  for reimbursement for such services, including a mobile clinic
 1794  and a portable equipment provider. For purposes of this part,
 1795  the term does not include and the licensure requirements of this
 1796  part do not apply to:
 1797         (l) Orthotic or prosthetic pediatric cardiology, or
 1798  perinatology clinical facilities that are a publicly traded
 1799  corporation or that are wholly owned, directly or indirectly, by
 1800  a publicly traded corporation. As used in this paragraph, a
 1801  publicly traded corporation is a corporation that issues
 1802  securities traded on an exchange registered with the United
 1803  States Securities and Exchange Commission as a national
 1804  securities exchange.
 1805         (7) “Portable service or equipment provider” means an
 1806  entity that contracts with or employs persons to provide
 1807  portable health care services or equipment to multiple locations
 1808  which performing treatment or diagnostic testing of individuals,
 1809  that bills third-party payors for those services, and which that
 1810  otherwise meets the definition of a clinic in subsection (4).
 1811         Section 44. Subsections (1) and (4) of section 400.991,
 1812  Florida Statutes, are amended to read:
 1813         400.991 License requirements; background screenings;
 1814  prohibitions.—
 1815         (1)(a) The requirements of part II of chapter 408 apply to
 1816  the provision of services that require licensure pursuant to
 1817  this part and part II of chapter 408 and to entities licensed by
 1818  or applying for such licensure from the agency pursuant to this
 1819  part. A license issued by the agency is required in order to
 1820  operate a clinic in this state. Each clinic location shall be
 1821  licensed separately regardless of whether the clinic is operated
 1822  under the same business name or management as another clinic.
 1823         (b) Each mobile clinic must obtain a separate health care
 1824  clinic license and must provide to the agency, at least
 1825  quarterly, its projected street location to enable the agency to
 1826  locate and inspect such clinic. A portable equipment and health
 1827  services provider must obtain a health care clinic license for a
 1828  single administrative office and is not required to submit
 1829  quarterly projected street locations.
 1830         (4) In addition to the requirements of part II of chapter
 1831  408, the applicant must file with the application satisfactory
 1832  proof that the clinic is in compliance with this part and
 1833  applicable rules, including:
 1834         (a) A listing of services to be provided either directly by
 1835  the applicant or through contractual arrangements with existing
 1836  providers;
 1837         (b) The number and discipline of each professional staff
 1838  member to be employed; and
 1839         (c) Proof of financial ability to operate as required under
 1840  ss. 408.8065 and s. 408.810(8). As an alternative to submitting
 1841  proof of financial ability to operate as required under s.
 1842  408.810(8), the applicant may file a surety bond of at least
 1843  $500,000 which guarantees that the clinic will act in full
 1844  conformity with all legal requirements for operating a clinic,
 1845  payable to the agency. The agency may adopt rules to specify
 1846  related requirements for such surety bond.
 1847         Section 45. Paragraph (g) of subsection (1) and paragraph
 1848  (a) of subsection (7) of section 400.9935, Florida Statutes, are
 1849  amended to read:
 1850         400.9935 Clinic responsibilities.—
 1851         (1) Each clinic shall appoint a medical director or clinic
 1852  director who shall agree in writing to accept legal
 1853  responsibility for the following activities on behalf of the
 1854  clinic. The medical director or the clinic director shall:
 1855         (g) Conduct systematic reviews of clinic billings to ensure
 1856  that the billings are not fraudulent or unlawful. Upon discovery
 1857  of an unlawful charge, the medical director or clinic director
 1858  shall take immediate corrective action. If the clinic performs
 1859  only the technical component of magnetic resonance imaging,
 1860  static radiographs, computed tomography, or positron emission
 1861  tomography, and provides the professional interpretation of such
 1862  services, in a fixed facility that is accredited by the Joint
 1863  Commission on Accreditation of Healthcare Organizations or the
 1864  Accreditation Association for Ambulatory Health Care, and the
 1865  American College of Radiology; and if, in the preceding quarter,
 1866  the percentage of scans performed by that clinic which was
 1867  billed to all personal injury protection insurance carriers was
 1868  less than 15 percent, the chief financial officer of the clinic
 1869  may, in a written acknowledgment provided to the agency, assume
 1870  the responsibility for the conduct of the systematic reviews of
 1871  clinic billings to ensure that the billings are not fraudulent
 1872  or unlawful.
 1873         (7)(a) Each clinic engaged in magnetic resonance imaging
 1874  services must be accredited by the Joint Commission on
 1875  Accreditation of Healthcare Organizations, the American College
 1876  of Radiology, or the Accreditation Association for Ambulatory
 1877  Health Care, within 1 year after licensure. A clinic that is
 1878  accredited by the American College of Radiology or is within the
 1879  original 1-year period after licensure and replaces its core
 1880  magnetic resonance imaging equipment shall be given 1 year after
 1881  the date on which the equipment is replaced to attain
 1882  accreditation. However, a clinic may request a single, 6-month
 1883  extension if it provides evidence to the agency establishing
 1884  that, for good cause shown, such clinic cannot be accredited
 1885  within 1 year after licensure, and that such accreditation will
 1886  be completed within the 6-month extension. After obtaining
 1887  accreditation as required by this subsection, each such clinic
 1888  must maintain accreditation as a condition of renewal of its
 1889  license. A clinic that files a change of ownership application
 1890  must comply with the original accreditation timeframe
 1891  requirements of the transferor. The agency shall deny a change
 1892  of ownership application if the clinic is not in compliance with
 1893  the accreditation requirements. When a clinic adds, replaces, or
 1894  modifies magnetic resonance imaging equipment and the
 1895  accreditation agency requires new accreditation, the clinic must
 1896  be accredited within 1 year after the date of the addition,
 1897  replacement, or modification but may request a single, 6-month
 1898  extension if the clinic provides evidence of good cause to the
 1899  agency.
 1900         Section 46. Subsection (2) of section 408.034, Florida
 1901  Statutes, is amended to read:
 1902         408.034 Duties and responsibilities of agency; rules.—
 1903         (2) In the exercise of its authority to issue licenses to
 1904  health care facilities and health service providers, as provided
 1905  under chapters 393 and 395 and parts II, and IV, and VIII of
 1906  chapter 400, the agency may not issue a license to any health
 1907  care facility or health service provider that fails to receive a
 1908  certificate of need or an exemption for the licensed facility or
 1909  service.
 1910         Section 47. Paragraph (d) of subsection (1) of section
 1911  408.036, Florida Statutes, is amended to read:
 1912         408.036 Projects subject to review; exemptions.—
 1913         (1) APPLICABILITY.—Unless exempt under subsection (3), all
 1914  health-care-related projects, as described in paragraphs (a)
 1915  (g), are subject to review and must file an application for a
 1916  certificate of need with the agency. The agency is exclusively
 1917  responsible for determining whether a health-care-related
 1918  project is subject to review under ss. 408.031-408.045.
 1919         (d) The establishment of a hospice or hospice inpatient
 1920  facility, except as provided in s. 408.043.
 1921         Section 48. Subsection (2) of section 408.043, Florida
 1922  Statutes, is amended to read:
 1923         408.043 Special provisions.—
 1924         (2) HOSPICES.—When an application is made for a certificate
 1925  of need to establish or to expand a hospice, the need for such
 1926  hospice shall be determined on the basis of the need for and
 1927  availability of hospice services in the community. The formula
 1928  on which the certificate of need is based shall discourage
 1929  regional monopolies and promote competition. The inpatient
 1930  hospice care component of a hospice that which is a freestanding
 1931  facility, or a part of a facility, which is primarily engaged in
 1932  providing inpatient care and related services and is not
 1933  licensed as a health care facility shall also be required to
 1934  obtain a certificate of need. Provision of hospice care by any
 1935  current provider of health care is a significant change in
 1936  service and therefore requires a certificate of need for such
 1937  services.
 1938         Section 49. Paragraph (k) of subsection (3) of section
 1939  408.05, Florida Statutes, is amended to read:
 1940         408.05 Florida Center for Health Information and Policy
 1941  Analysis.—
 1942         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to
 1943  produce comparable and uniform health information and statistics
 1944  for the development of policy recommendations, the agency shall
 1945  perform the following functions:
 1946         (k) Develop, in conjunction with the State Consumer Health
 1947  Information and Policy Advisory Council, and implement a long
 1948  range plan for making available health care quality measures and
 1949  financial data that will allow consumers to compare health care
 1950  services. The health care quality measures and financial data
 1951  the agency must make available shall include, but is not limited
 1952  to, pharmaceuticals, physicians, health care facilities, and
 1953  health plans and managed care entities. The agency shall submit
 1954  the initial plan to the Governor, the President of the Senate,
 1955  and the Speaker of the House of Representatives by January 1,
 1956  2006, and shall update the plan and report on the status of its
 1957  implementation annually thereafter. The agency shall also make
 1958  the plan and status report available to the public on its
 1959  Internet website. As part of the plan, the agency shall identify
 1960  the process and timeframes for implementation, any barriers to
 1961  implementation, and recommendations of changes in the law that
 1962  may be enacted by the Legislature to eliminate the barriers. As
 1963  preliminary elements of the plan, the agency shall:
 1964         1. Make available patient-safety indicators, inpatient
 1965  quality indicators, and performance outcome and patient charge
 1966  data collected from health care facilities pursuant to s.
 1967  408.061(1)(a) and (2). The terms “patient-safety indicators” and
 1968  “inpatient quality indicators” shall be as defined by the
 1969  Centers for Medicare and Medicaid Services, the National Quality
 1970  Forum, the Joint Commission on Accreditation of Healthcare
 1971  Organizations, the Agency for Healthcare Research and Quality,
 1972  the Centers for Disease Control and Prevention, or a similar
 1973  national entity that establishes standards to measure the
 1974  performance of health care providers, or by other states. The
 1975  agency shall determine which conditions, procedures, health care
 1976  quality measures, and patient charge data to disclose based upon
 1977  input from the council. When determining which conditions and
 1978  procedures are to be disclosed, the council and the agency shall
 1979  consider variation in costs, variation in outcomes, and
 1980  magnitude of variations and other relevant information. When
 1981  determining which health care quality measures to disclose, the
 1982  agency:
 1983         a. Shall consider such factors as volume of cases; average
 1984  patient charges; average length of stay; complication rates;
 1985  mortality rates; and infection rates, among others, which shall
 1986  be adjusted for case mix and severity, if applicable.
 1987         b. May consider such additional measures that are adopted
 1988  by the Centers for Medicare and Medicaid Studies, National
 1989  Quality Forum, the Joint Commission on Accreditation of
 1990  Healthcare Organizations, the Agency for Healthcare Research and
 1991  Quality, Centers for Disease Control and Prevention, or a
 1992  similar national entity that establishes standards to measure
 1993  the performance of health care providers, or by other states.
 1994  
 1995  When determining which patient charge data to disclose, the
 1996  agency shall include such measures as the average of
 1997  undiscounted charges on frequently performed procedures and
 1998  preventive diagnostic procedures, the range of procedure charges
 1999  from highest to lowest, average net revenue per adjusted patient
 2000  day, average cost per adjusted patient day, and average cost per
 2001  admission, among others.
 2002         2. Make available performance measures, benefit design, and
 2003  premium cost data from health plans licensed pursuant to chapter
 2004  627 or chapter 641. The agency shall determine which health care
 2005  quality measures and member and subscriber cost data to
 2006  disclose, based upon input from the council. When determining
 2007  which data to disclose, the agency shall consider information
 2008  that may be required by either individual or group purchasers to
 2009  assess the value of the product, which may include membership
 2010  satisfaction, quality of care, current enrollment or membership,
 2011  coverage areas, accreditation status, premium costs, plan costs,
 2012  premium increases, range of benefits, copayments and
 2013  deductibles, accuracy and speed of claims payment, credentials
 2014  of physicians, number of providers, names of network providers,
 2015  and hospitals in the network. Health plans shall make available
 2016  to the agency any such data or information that is not currently
 2017  reported to the agency or the office.
 2018         3. Determine the method and format for public disclosure of
 2019  data reported pursuant to this paragraph. The agency shall make
 2020  its determination based upon input from the State Consumer
 2021  Health Information and Policy Advisory Council. At a minimum,
 2022  the data shall be made available on the agency’s Internet
 2023  website in a manner that allows consumers to conduct an
 2024  interactive search that allows them to view and compare the
 2025  information for specific providers. The website must include
 2026  such additional information as is determined necessary to ensure
 2027  that the website enhances informed decisionmaking among
 2028  consumers and health care purchasers, which shall include, at a
 2029  minimum, appropriate guidance on how to use the data and an
 2030  explanation of why the data may vary from provider to provider.
 2031  The data specified in subparagraph 1. shall be released no later
 2032  than January 1, 2006, for the reporting of infection rates, and
 2033  no later than October 1, 2005, for mortality rates and
 2034  complication rates. The data specified in subparagraph 2. shall
 2035  be released no later than October 1, 2006.
 2036         4. Publish on its website undiscounted charges for no fewer
 2037  than 150 of the most commonly performed adult and pediatric
 2038  procedures, including outpatient, inpatient, diagnostic, and
 2039  preventative procedures.
 2040         Section 50. Paragraph (a) of subsection (1) of section
 2041  408.061, Florida Statutes, is amended to read:
 2042         408.061 Data collection; uniform systems of financial
 2043  reporting; information relating to physician charges;
 2044  confidential information; immunity.—
 2045         (1) The agency shall require the submission by health care
 2046  facilities, health care providers, and health insurers of data
 2047  necessary to carry out the agency’s duties. Specifications for
 2048  data to be collected under this section shall be developed by
 2049  the agency with the assistance of technical advisory panels
 2050  including representatives of affected entities, consumers,
 2051  purchasers, and such other interested parties as may be
 2052  determined by the agency.
 2053         (a) Data submitted by health care facilities, including the
 2054  facilities as defined in chapter 395, shall include, but are not
 2055  limited to: case-mix data, patient admission and discharge data,
 2056  hospital emergency department data that which shall include the
 2057  number of patients treated in the emergency department of a
 2058  licensed hospital reported by patient acuity level, data on
 2059  hospital-acquired infections as specified by rule, data on
 2060  complications as specified by rule, data on readmissions as
 2061  specified by rule, with patient and provider-specific
 2062  identifiers included, actual charge data by diagnostic groups,
 2063  financial data, accounting data, operating expenses, expenses
 2064  incurred for rendering services to patients who cannot or do not
 2065  pay, interest charges, depreciation expenses based on the
 2066  expected useful life of the property and equipment involved, and
 2067  demographic data. The agency shall adopt nationally recognized
 2068  risk adjustment methodologies or software consistent with the
 2069  standards of the Agency for Healthcare Research and Quality and
 2070  as selected by the agency for all data submitted as required by
 2071  this section. Data may be obtained from documents such as, but
 2072  not limited to: leases, contracts, debt instruments, itemized
 2073  patient bills, medical record abstracts, and related diagnostic
 2074  information. Reported data elements shall be reported
 2075  electronically and in accordance with rule 59E-7.012, Florida
 2076  Administrative Code. Data submitted shall be certified by the
 2077  chief executive officer or an appropriate and duly authorized
 2078  representative or employee of the licensed facility that the
 2079  information submitted is true and accurate.
 2080         Section 51. Subsection (1) of section 408.10, Florida
 2081  Statutes, is amended to read:
 2082         408.10 Consumer complaints.—The agency shall:
 2083         (1) Publish and make available to the public a toll-free
 2084  telephone number for the purpose of handling consumer complaints
 2085  and shall serve as a liaison between consumer entities and other
 2086  private entities and governmental entities for the disposition
 2087  of problems identified by consumers of health care. The agency
 2088  may provide staffing for this toll-free number through agency
 2089  staff or other arrangements.
 2090         Section 52. Subsection (11) of section 408.802, Florida
 2091  Statutes, is repealed.
 2092         Section 53. Effective October 1, 2010, subsection (3) is
 2093  added to section 408.804, Florida Statutes, to read:
 2094         408.804 License required; display.—
 2095         (3)A person who knowingly alters, defaces, or falsifies
 2096  any license certificate issued by the agency, or causes or
 2097  procures another person to commit such an offense, commits a
 2098  misdemeanor of the second degree, punishable as provided in s.
 2099  775.082 or s. 775.083. Any licensee or provider who displays an
 2100  altered, defaced, or falsified license certificate is subject to
 2101  the penalties set forth in s. 408.815 and an administrative fine
 2102  of $1,000 for each day of illegal display.
 2103         Section 54. Paragraph (d) of subsection (2) of section
 2104  408.806, Florida Statutes, is amended to read:
 2105         408.806 License application process.—
 2106         (2)
 2107         (d) The agency shall notify the licensee by mail or
 2108  electronically at least 90 days before the expiration of a
 2109  license that a renewal license is necessary to continue
 2110  operation. The failure of the licensee to timely submit a
 2111  renewal application and license application fee with the agency
 2112  shall result in a $50 per day late fee charged to the licensee
 2113  by the agency; however, the aggregate amount of the late fee may
 2114  not exceed 50 percent of the licensure fee or $500, whichever is
 2115  less. The agency shall provide a courtesy notice to the licensee
 2116  by United States mail, electronically, or by any other manner at
 2117  its address of record at least 90 days before the expiration of
 2118  a license informing the licensee of the expiration of the
 2119  license. Any failure of the agency to provide the courtesy
 2120  notice or any failure of the licensee to receive the courtesy
 2121  notice does not excuse the licensee from the legal obligation to
 2122  timely file the renewal application and license application fee
 2123  with the agency and does not mitigate the late fee. Payment of
 2124  the late fee is required in order for any late application to be
 2125  complete, and failure to pay the late fee is an omission from
 2126  the application. If an application is received after the
 2127  required filing date and exhibits a hand-canceled postmark
 2128  obtained from a United States post office dated on or before the
 2129  required filing date, no fine will be levied.
 2130         Section 55. Subsections (6) and (9) of section 408.810,
 2131  Florida Statutes, are amended to read:
 2132         408.810 Minimum licensure requirements.—In addition to the
 2133  licensure requirements specified in this part, authorizing
 2134  statutes, and applicable rules, each applicant and licensee must
 2135  comply with the requirements of this section in order to obtain
 2136  and maintain a license.
 2137         (6)(a) An applicant must provide the agency with proof of
 2138  the applicant’s legal right to occupy the property before a
 2139  license may be issued. Proof may include, but need not be
 2140  limited to, copies of warranty deeds, lease or rental
 2141  agreements, contracts for deeds, quitclaim deeds, or other such
 2142  documentation.
 2143         (b)If the property is encumbered by a mortgage or is
 2144  leased, an applicant must provide the agency with proof that the
 2145  mortgagor or landlord has received written notice of the
 2146  applicant’s intent, as mortgagee or tenant, to provide services
 2147  that require licensure and with instructions that the agency
 2148  must be served by certified mail with copies of any actions
 2149  initiated by the mortgagor or landlord against applicant.
 2150         (9) A controlling interest may not withhold from the agency
 2151  any evidence of financial instability, including, but not
 2152  limited to, checks returned due to insufficient funds,
 2153  delinquent accounts, nonpayment of withholding taxes, unpaid
 2154  utility expenses, nonpayment for essential services, or adverse
 2155  court action concerning the financial viability of the provider
 2156  or any other provider licensed under this part which that is
 2157  under the control of the controlling interest. A controlling
 2158  interest shall notify the agency within 10 days after a court
 2159  action, including, but not limited to, the initiation of
 2160  bankruptcy proceedings, foreclosure, or eviction proceedings in
 2161  which the controlling interest is a petitioner or defendant. Any
 2162  person who violates this subsection commits a misdemeanor of the
 2163  second degree, punishable as provided in s. 775.082 or s.
 2164  775.083. Each day of continuing violation is a separate offense.
 2165         Section 56. Paragraph (e) is added to subsection (2) of
 2166  section 408.813, Florida Statutes, to read:
 2167         408.813 Administrative fines; violations.—As a penalty for
 2168  any violation of this part, authorizing statutes, or applicable
 2169  rules, the agency may impose an administrative fine.
 2170         (2) Violations of this part, authorizing statutes, or
 2171  applicable rules shall be classified according to the nature of
 2172  the violation and the gravity of its probable effect on clients.
 2173  The scope of a violation may be cited as an isolated, patterned,
 2174  or widespread deficiency. An isolated deficiency is a deficiency
 2175  affecting one or a very limited number of clients, or involving
 2176  one or a very limited number of staff, or a situation that
 2177  occurred only occasionally or in a very limited number of
 2178  locations. A patterned deficiency is a deficiency in which more
 2179  than a very limited number of clients are affected, or more than
 2180  a very limited number of staff are involved, or the situation
 2181  has occurred in several locations, or the same client or clients
 2182  have been affected by repeated occurrences of the same deficient
 2183  practice but the effect of the deficient practice is not found
 2184  to be pervasive throughout the provider. A widespread deficiency
 2185  is a deficiency in which the problems causing the deficiency are
 2186  pervasive in the provider or represent systemic failure that has
 2187  affected or has the potential to affect a large portion of the
 2188  provider’s clients. This subsection does not affect the
 2189  legislative determination of the amount of a fine imposed under
 2190  authorizing statutes. Violations shall be classified on the
 2191  written notice as follows:
 2192         (e)The agency may impose an administrative fine for
 2193  violations that do not qualify as class I, class II, class III,
 2194  or class IV violations. The amount of the fine may not exceed
 2195  $500 for each violation. Unclassified violations may include:
 2196         1.Violating any term or condition of a license.
 2197         2.Violating any provision of this part, authorizing
 2198  statutes, or applicable rules.
 2199         3.Exceeding licensed capacity without authorization.
 2200         4.Providing services beyond the scope of the license.
 2201         5.Violating a moratorium.
 2202         Section 57. Subsection (5) is added to section 408.815,
 2203  Florida Statutes, to read:
 2204         408.815 License or application denial; revocation.—
 2205         (5)In order to ensure the health, safety, and welfare of
 2206  clients when a license has been denied or revoked or is set to
 2207  terminate, the agency may extend the license expiration date for
 2208  up to 60 days after denial, revocation, or termination for the
 2209  sole purpose of allowing the safe and orderly discharge of
 2210  clients. The agency may impose conditions on the extension,
 2211  including, but not limited to, prohibiting or limiting
 2212  admissions, expediting discharge planning, submitting required
 2213  status reports, and mandatory monitoring by the agency or third
 2214  parties. The agency may terminate the extension or modify the
 2215  conditions at any time at its discretion. Upon the discharge of
 2216  the final client, the extension shall immediately terminate and
 2217  the provider shall cease operation and promptly surrender its
 2218  license certificate to the agency. During the extension, the
 2219  provider must continue to meet all other requirements of this
 2220  part, authorizing statutes, and applicable rules. This authority
 2221  is in addition to any other authority granted to the agency
 2222  under chapter 120, this part, and the authorizing statutes, but
 2223  does not create any right or entitlement to an extension of a
 2224  license expiration date.
 2225         Section 58. Paragraph (d) is added to subsection (13) of
 2226  section 409.906, Florida Statutes, to read:
 2227         409.906 Optional Medicaid services.—Subject to specific
 2228  appropriations, the agency may make payments for services which
 2229  are optional to the state under Title XIX of the Social Security
 2230  Act and are furnished by Medicaid providers to recipients who
 2231  are determined to be eligible on the dates on which the services
 2232  were provided. Any optional service that is provided shall be
 2233  provided only when medically necessary and in accordance with
 2234  state and federal law. Optional services rendered by providers
 2235  in mobile units to Medicaid recipients may be restricted or
 2236  prohibited by the agency. Nothing in this section shall be
 2237  construed to prevent or limit the agency from adjusting fees,
 2238  reimbursement rates, lengths of stay, number of visits, or
 2239  number of services, or making any other adjustments necessary to
 2240  comply with the availability of moneys and any limitations or
 2241  directions provided for in the General Appropriations Act or
 2242  chapter 216. If necessary to safeguard the state’s systems of
 2243  providing services to elderly and disabled persons and subject
 2244  to the notice and review provisions of s. 216.177, the Governor
 2245  may direct the Agency for Health Care Administration to amend
 2246  the Medicaid state plan to delete the optional Medicaid service
 2247  known as “Intermediate Care Facilities for the Developmentally
 2248  Disabled.” Optional services may include:
 2249         (13) HOME AND COMMUNITY-BASED SERVICES.—
 2250         (d)The agency, in consultation with the Department of
 2251  Elderly Affairs, shall phase out the adult day health care
 2252  waiver program and transfer existing waiver enrollees to other
 2253  appropriate home and community-based service programs. Effective
 2254  July 1, 2010, the adult day health care waiver program shall
 2255  cease to enroll new members. Existing enrollees in the adult day
 2256  health care program shall receive counseling regarding available
 2257  options and shall be offered an alternative home and community
 2258  based services program based on eligibility and personal choice.
 2259  Each enrollee in the waiver program shall continue to receive
 2260  home and community-based services without interruption in the
 2261  enrollee’s program of choice. The providers of the adult day
 2262  health care waiver program, in consultation with resource
 2263  centers for the aged, shall assist in the transition of
 2264  enrollees and cease provision of adult day health care waiver
 2265  services by December 31, 2010. The agency may seek federal
 2266  waiver approval to administer this change.
 2267         Section 59. Paragraph (k) of subsection (4) of section
 2268  409.221, Florida Statutes, is repealed.
 2269         Section 60. Paragraphs (e), (f), and (g) of subsection (15)
 2270  of section 409.912, Florida Statutes, are repealed.
 2271         Section 61. Section 429.11, Florida Statutes, is amended to
 2272  read:
 2273         429.11 Initial application for license; provisional
 2274  license.—
 2275         (1) Each applicant for licensure must comply with all
 2276  provisions of part II of chapter 408 and must:
 2277         (a) Identify all other homes or facilities, including the
 2278  addresses and the license or licenses under which they operate,
 2279  if applicable, which are currently operated by the applicant or
 2280  administrator and which provide housing, meals, and personal
 2281  services to residents.
 2282         (b) Provide the location of the facility for which a
 2283  license is sought and documentation, signed by the appropriate
 2284  local government official, which states that the applicant has
 2285  met local zoning requirements.
 2286         (c) Provide the name, address, date of birth, social
 2287  security number, education, and experience of the administrator,
 2288  if different from the applicant.
 2289         (2) The applicant shall provide proof of liability
 2290  insurance as defined in s. 624.605.
 2291         (3) If the applicant is a community residential home, the
 2292  applicant must provide proof that it has met the requirements
 2293  specified in chapter 419.
 2294         (4) The applicant must furnish proof that the facility has
 2295  received a satisfactory firesafety inspection. The local
 2296  authority having jurisdiction or the State Fire Marshal must
 2297  conduct the inspection within 30 days after written request by
 2298  the applicant.
 2299         (5) The applicant must furnish documentation of a
 2300  satisfactory sanitation inspection of the facility by the county
 2301  health department.
 2302         (6)In addition to the license categories available in s.
 2303  408.808, a provisional license may be issued to an applicant
 2304  making initial application for licensure or making application
 2305  for a change of ownership. A provisional license shall be
 2306  limited in duration to a specific period of time not to exceed 6
 2307  months, as determined by the agency.
 2308         (6)(7) A county or municipality may not issue an
 2309  occupational license that is being obtained for the purpose of
 2310  operating a facility regulated under this part without first
 2311  ascertaining that the applicant has been licensed to operate
 2312  such facility at the specified location or locations by the
 2313  agency. The agency shall furnish to local agencies responsible
 2314  for issuing occupational licenses sufficient instruction for
 2315  making such determinations.
 2316         Section 62. Subsection (2) of section 429.12, Florida
 2317  Statutes, is repealed.
 2318         Section 63. Subsections (5) and (6) of section 429.14,
 2319  Florida Statutes, are amended to read:
 2320         429.14 Administrative penalties.—
 2321         (5) An action taken by the agency to suspend, deny, or
 2322  revoke a facility’s license under this part or part II of
 2323  chapter 408, in which the agency claims that the facility owner
 2324  or an employee of the facility has threatened the health,
 2325  safety, or welfare of a resident of the facility shall be heard
 2326  by the Division of Administrative Hearings of the Department of
 2327  Management Services within 120 days after receipt of the
 2328  facility’s request for a hearing, unless that time limitation is
 2329  waived by both parties. The administrative law judge must render
 2330  a decision within 30 days after receipt of a proposed
 2331  recommended order.
 2332         (6) The agency shall provide to the Division of Hotels and
 2333  Restaurants of the Department of Business and Professional
 2334  Regulation, on a monthly basis, a list of those assisted living
 2335  facilities that have had their licenses denied, suspended, or
 2336  revoked or that are involved in an appellate proceeding pursuant
 2337  to s. 120.60 related to the denial, suspension, or revocation of
 2338  a license. This information may be provided electronically or
 2339  through the agency’s Internet website.
 2340         Section 64. Subsection (4) of section 429.17, Florida
 2341  Statutes, is amended to read:
 2342         429.17 Expiration of license; renewal; conditional
 2343  license.—
 2344         (4) In addition to the license categories available in s.
 2345  408.808, a conditional license may be issued to an applicant for
 2346  license renewal if the applicant fails to meet all standards and
 2347  requirements for licensure. A conditional license issued under
 2348  this subsection shall be limited in duration to a specific
 2349  period of time not to exceed 6 months, as determined by the
 2350  agency, and shall be accompanied by an agency-approved plan of
 2351  correction.
 2352         Section 65. Subsection (5) of section 429.23, Florida
 2353  Statutes, is repealed.
 2354         Section 66. Subsection (2) of section 429.35, Florida
 2355  Statutes, is amended to read:
 2356         429.35 Maintenance of records; reports.—
 2357         (2) Within 60 days after the date of the biennial
 2358  inspection visit required under s. 408.811 or within 30 days
 2359  after the date of any interim visit, the agency shall forward
 2360  the results of the inspection to the local ombudsman council in
 2361  whose planning and service area, as defined in part II of
 2362  chapter 400, the facility is located; to at least one public
 2363  library or, in the absence of a public library, the county seat
 2364  in the county in which the inspected assisted living facility is
 2365  located; and, when appropriate, to the district Adult Services
 2366  and Mental Health Program Offices. This information may be
 2367  provided electronically or through the agency’s Internet site.
 2368         Section 67. Section 429.53, Florida Statutes, is amended to
 2369  read:
 2370         429.53 Consultation by the agency.—
 2371         (1) The area offices of licensure and certification of the
 2372  agency shall provide consultation to the following upon request:
 2373         (a) A licensee of a facility.
 2374         (b) A person interested in obtaining a license to operate a
 2375  facility under this part.
 2376         (2) As used in this section, “consultation” includes:
 2377         (a) An explanation of the requirements of this part and
 2378  rules adopted pursuant thereto;
 2379         (b) An explanation of the license application and renewal
 2380  procedures; and
 2381         (c)The provision of a checklist of general local and state
 2382  approvals required prior to constructing or developing a
 2383  facility and a listing of the types of agencies responsible for
 2384  such approvals;
 2385         (d)An explanation of benefits and financial assistance
 2386  available to a recipient of supplemental security income
 2387  residing in a facility;
 2388         (c)(e) Any other information which the agency deems
 2389  necessary to promote compliance with the requirements of this
 2390  part; and
 2391         (f)A preconstruction review of a facility to ensure
 2392  compliance with agency rules and this part.
 2393         (3) The agency may charge a fee commensurate with the cost
 2394  of providing consultation under this section.
 2395         Section 68. Subsections (2) and (11) of section 429.65,
 2396  Florida Statutes, are amended to read:
 2397         429.65 Definitions.—As used in this part, the term:
 2398         (2) “Adult family-care home” means a full-time, family-type
 2399  living arrangement, in a private home, under which up to two
 2400  individuals a person who reside in the home and own or rent owns
 2401  or rents the home provide provides room, board, and personal
 2402  care, on a 24-hour basis, for no more than five disabled adults
 2403  or frail elders who are not relatives. The following family-type
 2404  living arrangements are not required to be licensed as an adult
 2405  family-care home:
 2406         (a) An arrangement whereby the person who resides in the
 2407  home and owns or rents the home provides room, board, and
 2408  personal services for not more than two adults who do not
 2409  receive optional state supplementation under s. 409.212. The
 2410  person who provides the housing, meals, and personal care must
 2411  own or rent the home and reside therein.
 2412         (b) An arrangement whereby the person who owns or rents the
 2413  home provides room, board, and personal services only to his or
 2414  her relatives.
 2415         (c) An establishment that is licensed as an assisted living
 2416  facility under this chapter.
 2417         (11) “Provider” means up to two individuals a person who
 2418  are is licensed to operate an adult family-care home.
 2419         Section 69. Section 429.71, Florida Statutes, is amended to
 2420  read:
 2421         429.71 Classification of violations deficiencies;
 2422  administrative fines.—
 2423         (1) In addition to the requirements of part II of chapter
 2424  408 and in addition to any other liability or penalty provided
 2425  by law, the agency may impose an administrative fine on a
 2426  provider according to the following classification:
 2427         (a) Class I violations are defined in s. 408.813. those
 2428  conditions or practices related to the operation and maintenance
 2429  of an adult family-care home or to the care of residents which
 2430  the agency determines present an imminent danger to the
 2431  residents or guests of the facility or a substantial probability
 2432  that death or serious physical or emotional harm would result
 2433  therefrom. The condition or practice that constitutes a class I
 2434  violation must be abated or eliminated within 24 hours, unless a
 2435  fixed period, as determined by the agency, is required for
 2436  correction. A class I violation deficiency is subject to an
 2437  administrative fine in an amount not less than $500 and not
 2438  exceeding $1,000 for each violation. A fine may be levied
 2439  notwithstanding the correction of the violation deficiency.
 2440         (b) Class II violations are defined in s. 408.813. those
 2441  conditions or practices related to the operation and maintenance
 2442  of an adult family-care home or to the care of residents which
 2443  the agency determines directly threaten the physical or
 2444  emotional health, safety, or security of the residents, other
 2445  than class I violations. A class II violation is subject to an
 2446  administrative fine in an amount not less than $250 and not
 2447  exceeding $500 for each violation. A citation for a class II
 2448  violation must specify the time within which the violation is
 2449  required to be corrected. If a class II violation is corrected
 2450  within the time specified, no civil penalty shall be imposed,
 2451  unless it is a repeated offense.
 2452         (c) Class III violations are defined in s. 408.813. those
 2453  conditions or practices related to the operation and maintenance
 2454  of an adult family-care home or to the care of residents which
 2455  the agency determines indirectly or potentially threaten the
 2456  physical or emotional health, safety, or security of residents,
 2457  other than class I or class II violations. A class III violation
 2458  is subject to an administrative fine in an amount not less than
 2459  $100 and not exceeding $250 for each violation. A citation for a
 2460  class III violation shall specify the time within which the
 2461  violation is required to be corrected. If a class III violation
 2462  is corrected within the time specified, no civil penalty shall
 2463  be imposed, unless it is a repeated offense.
 2464         (d) Class IV violations are defined in s. 408.813. those
 2465  conditions or occurrences related to the operation and
 2466  maintenance of an adult family-care home, or related to the
 2467  required reports, forms, or documents, which do not have the
 2468  potential of negatively affecting the residents. A provider that
 2469  does not correct A class IV violation within the time limit
 2470  specified by the agency is subject to an administrative fine in
 2471  an amount not less than $50 and not exceeding $100 for each
 2472  violation. Any class IV violation that is corrected during the
 2473  time the agency survey is conducted will be identified as an
 2474  agency finding and not as a violation.
 2475         (2) The agency may impose an administrative fine for
 2476  violations that which do not qualify as class I, class II, class
 2477  III, or class IV violations. The amount of the fine may shall
 2478  not exceed $250 for each violation or $2,000 in the aggregate.
 2479  Unclassified violations may include:
 2480         (a) Violating any term or condition of a license.
 2481         (b) Violating any provision of this part, part II of
 2482  chapter 408, or applicable rules.
 2483         (c) Failure to follow the criteria and procedures provided
 2484  under part I of chapter 394 relating to the transportation,
 2485  voluntary admission, and involuntary examination of adult
 2486  family-care home residents.
 2487         (d) Exceeding licensed capacity.
 2488         (e) Providing services beyond the scope of the license.
 2489         (f) Violating a moratorium.
 2490         (3) Each day during which a violation occurs constitutes a
 2491  separate offense.
 2492         (4) In determining whether a penalty is to be imposed, and
 2493  in fixing the amount of any penalty to be imposed, the agency
 2494  must consider:
 2495         (a) The gravity of the violation.
 2496         (b) Actions taken by the provider to correct a violation.
 2497         (c) Any previous violation by the provider.
 2498         (d) The financial benefit to the provider of committing or
 2499  continuing the violation.
 2500         (5)As an alternative to or in conjunction with an
 2501  administrative action against a provider, the agency may request
 2502  a plan of corrective action that demonstrates a good faith
 2503  effort to remedy each violation by a specific date, subject to
 2504  the approval of the agency.
 2505         (5)(6) The department shall set forth, by rule, notice
 2506  requirements and procedures for correction of deficiencies.
 2507         Section 70. Section 429.911, Florida Statutes, is repealed.
 2508         Section 71. Section 429.915, Florida Statutes, is amended
 2509  to read:
 2510         429.915 Conditional license.—In addition to the license
 2511  categories available in part II of chapter 408, the agency may
 2512  issue a conditional license to an applicant for license renewal
 2513  or change of ownership if the applicant fails to meet all
 2514  standards and requirements for licensure. A conditional license
 2515  issued under this subsection must be limited to a specific
 2516  period not exceeding 6 months, as determined by the agency, and
 2517  must be accompanied by an approved plan of correction.
 2518         Section 72. Subsection (3) of section 430.80, Florida
 2519  Statutes, is amended to read:
 2520         430.80 Implementation of a teaching nursing home pilot
 2521  project.—
 2522         (3) To be designated as a teaching nursing home, a nursing
 2523  home licensee must, at a minimum:
 2524         (a) Provide a comprehensive program of integrated senior
 2525  services that include institutional services and community-based
 2526  services;
 2527         (b) Participate in a nationally recognized accreditation
 2528  program and hold a valid accreditation, such as the
 2529  accreditation awarded by the Joint Commission on Accreditation
 2530  of Healthcare Organizations;
 2531         (c) Have been in business in this state for a minimum of 10
 2532  consecutive years;
 2533         (d) Demonstrate an active program in multidisciplinary
 2534  education and research that relates to gerontology;
 2535         (e) Have a formalized contractual relationship with at
 2536  least one accredited health profession education program located
 2537  in this state;
 2538         (f) Have a formalized contractual relationship with an
 2539  accredited hospital that is designated by law as a teaching
 2540  hospital; and
 2541         (g) Have senior staff members who hold formal faculty
 2542  appointments at universities, which must include at least one
 2543  accredited health profession education program.
 2544         (h) Maintain insurance coverage pursuant to s.
 2545  400.141(1)(q) s. 400.141(1)(s) or proof of financial
 2546  responsibility in a minimum amount of $750,000. Such proof of
 2547  financial responsibility may include:
 2548         1. Maintaining an escrow account consisting of cash or
 2549  assets eligible for deposit in accordance with s. 625.52; or
 2550         2. Obtaining and maintaining pursuant to chapter 675 an
 2551  unexpired, irrevocable, nontransferable and nonassignable letter
 2552  of credit issued by any bank or savings association organized
 2553  and existing under the laws of this state or any bank or savings
 2554  association organized under the laws of the United States which
 2555  that has its principal place of business in this state or which
 2556  has a branch office that which is authorized to receive deposits
 2557  in this state. The letter of credit shall be used to satisfy the
 2558  obligation of the facility to the claimant upon presentment of a
 2559  final judgment indicating liability and awarding damages to be
 2560  paid by the facility or upon presentment of a settlement
 2561  agreement signed by all parties to the agreement when such final
 2562  judgment or settlement is a result of a liability claim against
 2563  the facility.
 2564         Section 73. Paragraph (a) of subsection (2) of section
 2565  440.13, Florida Statutes, is amended to read:
 2566         440.13 Medical services and supplies; penalty for
 2567  violations; limitations.—
 2568         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
 2569         (a) Subject to the limitations specified elsewhere in this
 2570  chapter, the employer shall furnish to the employee such
 2571  medically necessary remedial treatment, care, and attendance for
 2572  such period as the nature of the injury or the process of
 2573  recovery may require, which is in accordance with established
 2574  practice parameters and protocols of treatment as provided for
 2575  in this chapter, including medicines, medical supplies, durable
 2576  medical equipment, orthoses, prostheses, and other medically
 2577  necessary apparatus. Remedial treatment, care, and attendance,
 2578  including work-hardening programs or pain-management programs
 2579  accredited by the Commission on Accreditation of Rehabilitation
 2580  Facilities or Joint Commission on the Accreditation of Health
 2581  Organizations or pain-management programs affiliated with
 2582  medical schools, shall be considered as covered treatment only
 2583  when such care is given based on a referral by a physician as
 2584  defined in this chapter. Medically necessary treatment, care,
 2585  and attendance does not include chiropractic services in excess
 2586  of 24 treatments or rendered 12 weeks beyond the date of the
 2587  initial chiropractic treatment, whichever comes first, unless
 2588  the carrier authorizes additional treatment or the employee is
 2589  catastrophically injured.
 2590  
 2591  Failure of the carrier to timely comply with this subsection
 2592  shall be a violation of this chapter and the carrier shall be
 2593  subject to penalties as provided for in s. 440.525.
 2594         Section 74. Section 483.294, Florida Statutes, is amended
 2595  to read:
 2596         483.294 Inspection of centers.—In accordance with s.
 2597  408.811, the agency shall biennially, at least once annually,
 2598  inspect the premises and operations of all centers subject to
 2599  licensure under this part.
 2600         Section 75. Subsection (1) of section 627.645, Florida
 2601  Statutes, is amended to read:
 2602         627.645 Denial of health insurance claims restricted.—
 2603         (1) A No claim for payment under a health insurance policy
 2604  or self-insured program of health benefits for treatment, care,
 2605  or services in a licensed hospital that which is accredited by
 2606  the Joint Commission on the Accreditation of Hospitals, the
 2607  American Osteopathic Association, or the Commission on the
 2608  Accreditation of Rehabilitative Facilities may not shall be
 2609  denied because the such hospital lacks major surgical facilities
 2610  and is primarily of a rehabilitative nature, if such
 2611  rehabilitation is specifically for treatment of physical
 2612  disability.
 2613         Section 76. Paragraph (c) of subsection (2) of section
 2614  627.668, Florida Statutes, is amended to read:
 2615         627.668 Optional coverage for mental and nervous disorders
 2616  required; exception.—
 2617         (2) Under group policies or contracts, inpatient hospital
 2618  benefits, partial hospitalization benefits, and outpatient
 2619  benefits consisting of durational limits, dollar amounts,
 2620  deductibles, and coinsurance factors shall not be less favorable
 2621  than for physical illness generally, except that:
 2622         (c) Partial hospitalization benefits shall be provided
 2623  under the direction of a licensed physician. For purposes of
 2624  this part, the term “partial hospitalization services” is
 2625  defined as those services offered by a program accredited by the
 2626  Joint Commission on Accreditation of Hospitals (JCAH) or in
 2627  compliance with equivalent standards. Alcohol rehabilitation
 2628  programs accredited by the Joint Commission on Accreditation of
 2629  Hospitals or approved by the state and licensed drug abuse
 2630  rehabilitation programs shall also be qualified providers under
 2631  this section. In any benefit year, if partial hospitalization
 2632  services or a combination of inpatient and partial
 2633  hospitalization are utilized, the total benefits paid for all
 2634  such services shall not exceed the cost of 30 days of inpatient
 2635  hospitalization for psychiatric services, including physician
 2636  fees, which prevail in the community in which the partial
 2637  hospitalization services are rendered. If partial
 2638  hospitalization services benefits are provided beyond the limits
 2639  set forth in this paragraph, the durational limits, dollar
 2640  amounts, and coinsurance factors thereof need not be the same as
 2641  those applicable to physical illness generally.
 2642         Section 77. Subsection (3) of section 627.669, Florida
 2643  Statutes, is amended to read:
 2644         627.669 Optional coverage required for substance abuse
 2645  impaired persons; exception.—
 2646         (3) The benefits provided under this section shall be
 2647  applicable only if treatment is provided by, or under the
 2648  supervision of, or is prescribed by, a licensed physician or
 2649  licensed psychologist and if services are provided in a program
 2650  accredited by the Joint Commission on Accreditation of Hospitals
 2651  or approved by the state.
 2652         Section 78. Paragraph (a) of subsection (1) of section
 2653  627.736, Florida Statutes, is amended to read:
 2654         627.736 Required personal injury protection benefits;
 2655  exclusions; priority; claims.—
 2656         (1) REQUIRED BENEFITS.—Every insurance policy complying
 2657  with the security requirements of s. 627.733 shall provide
 2658  personal injury protection to the named insured, relatives
 2659  residing in the same household, persons operating the insured
 2660  motor vehicle, passengers in such motor vehicle, and other
 2661  persons struck by such motor vehicle and suffering bodily injury
 2662  while not an occupant of a self-propelled vehicle, subject to
 2663  the provisions of subsection (2) and paragraph (4)(e), to a
 2664  limit of $10,000 for loss sustained by any such person as a
 2665  result of bodily injury, sickness, disease, or death arising out
 2666  of the ownership, maintenance, or use of a motor vehicle as
 2667  follows:
 2668         (a) Medical benefits.—Eighty percent of all reasonable
 2669  expenses for medically necessary medical, surgical, X-ray,
 2670  dental, and rehabilitative services, including prosthetic
 2671  devices, and medically necessary ambulance, hospital, and
 2672  nursing services. However, the medical benefits shall provide
 2673  reimbursement only for such services and care that are lawfully
 2674  provided, supervised, ordered, or prescribed by a physician
 2675  licensed under chapter 458 or chapter 459, a dentist licensed
 2676  under chapter 466, or a chiropractic physician licensed under
 2677  chapter 460 or that are provided by any of the following persons
 2678  or entities:
 2679         1. A hospital or ambulatory surgical center licensed under
 2680  chapter 395.
 2681         2. A person or entity licensed under ss. 401.2101-401.45
 2682  which that provides emergency transportation and treatment.
 2683         3. An entity wholly owned by one or more physicians
 2684  licensed under chapter 458 or chapter 459, chiropractic
 2685  physicians licensed under chapter 460, or dentists licensed
 2686  under chapter 466 or by such practitioner or practitioners and
 2687  the spouse, parent, child, or sibling of that practitioner or
 2688  those practitioners.
 2689         4. An entity wholly owned, directly or indirectly, by a
 2690  hospital or hospitals.
 2691         5. A health care clinic licensed under ss. 400.990-400.995
 2692  which that is:
 2693         a. Accredited by the Joint Commission on Accreditation of
 2694  Healthcare Organizations, the American Osteopathic Association,
 2695  the Commission on Accreditation of Rehabilitation Facilities, or
 2696  the Accreditation Association for Ambulatory Health Care, Inc.;
 2697  or
 2698         b. A health care clinic that:
 2699         (I) Has a medical director licensed under chapter 458,
 2700  chapter 459, or chapter 460;
 2701         (II) Has been continuously licensed for more than 3 years
 2702  or is a publicly traded corporation that issues securities
 2703  traded on an exchange registered with the United States
 2704  Securities and Exchange Commission as a national securities
 2705  exchange; and
 2706         (III) Provides at least four of the following medical
 2707  specialties:
 2708         (A) General medicine.
 2709         (B) Radiography.
 2710         (C) Orthopedic medicine.
 2711         (D) Physical medicine.
 2712         (E) Physical therapy.
 2713         (F) Physical rehabilitation.
 2714         (G) Prescribing or dispensing outpatient prescription
 2715  medication.
 2716         (H) Laboratory services.
 2717  
 2718  The Financial Services Commission shall adopt by rule the form
 2719  that must be used by an insurer and a health care provider
 2720  specified in subparagraph 3., subparagraph 4., or subparagraph
 2721  5. to document that the health care provider meets the criteria
 2722  of this paragraph. This, which rule must include a requirement
 2723  for a sworn statement or affidavit.
 2724  
 2725  Only insurers writing motor vehicle liability insurance in this
 2726  state may provide the required benefits of this section, and no
 2727  such insurer shall require the purchase of any other motor
 2728  vehicle coverage other than the purchase of property damage
 2729  liability coverage as required by s. 627.7275 as a condition for
 2730  providing such required benefits. Insurers may not require that
 2731  property damage liability insurance in an amount greater than
 2732  $10,000 be purchased in conjunction with personal injury
 2733  protection. Such insurers shall make benefits and required
 2734  property damage liability insurance coverage available through
 2735  normal marketing channels. Any insurer writing motor vehicle
 2736  liability insurance in this state who fails to comply with such
 2737  availability requirement as a general business practice shall be
 2738  deemed to have violated part IX of chapter 626, and such
 2739  violation shall constitute an unfair method of competition or an
 2740  unfair or deceptive act or practice involving the business of
 2741  insurance; and any such insurer committing such violation shall
 2742  be subject to the penalties afforded in such part, as well as
 2743  those which may be afforded elsewhere in the insurance code.
 2744         Section 79. Subsection (12) of section 641.495, Florida
 2745  Statutes, is amended to read:
 2746         641.495 Requirements for issuance and maintenance of
 2747  certificate.—
 2748         (12) The provisions of part I of chapter 395 do not apply
 2749  to a health maintenance organization that, on or before January
 2750  1, 1991, provides not more than 10 outpatient holding beds for
 2751  short-term and hospice-type patients in an ambulatory care
 2752  facility for its members, provided that such health maintenance
 2753  organization maintains current accreditation by the Joint
 2754  Commission on Accreditation of Health Care Organizations, the
 2755  Accreditation Association for Ambulatory Health Care, or the
 2756  National Committee for Quality Assurance.
 2757         Section 80. Subsection (2) of section 766.1015, Florida
 2758  Statutes, is amended to read:
 2759         766.1015 Civil immunity for members of or consultants to
 2760  certain boards, committees, or other entities.—
 2761         (2) Such committee, board, group, commission, or other
 2762  entity must be established in accordance with state law or in
 2763  accordance with requirements of the Joint Commission on
 2764  Accreditation of Healthcare Organizations, established and duly
 2765  constituted by one or more public or licensed private hospitals
 2766  or behavioral health agencies, or established by a governmental
 2767  agency. To be protected by this section, the act, decision,
 2768  omission, or utterance may not be made or done in bad faith or
 2769  with malicious intent.
 2770         Section 81. Except as otherwise expressly provided in this
 2771  act, this act shall take effect July 1, 2010.

Site Map
Session:   Bills ·   Calendars ·   Bound Journals ·   Citator ·   Search ·   Appropriations ·   Redistricting ·   Bill Information Reports
Committee Publications
Historical Information
Statutes:   Introduction ·   View Statutes ·   Search Statutes
Flsenate.gov
Disclaimer: The information on this system is unverified. The journals or printed bills of the respective chambers should be consulted for official purposes.    Copyright © 2000-2020 State of Florida.     Privacy Statement     Contact Us     Get Acrobat Reader