Bill Text: FL S0658 | 2012 | Regular Session | Introduced


Bill Title: Assisted Living Facilities

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2012-03-09 - Died in Health Regulation [S0658 Detail]

Download: Florida-2012-S0658-Introduced.html
       Florida Senate - 2012                                     SB 658
       
       
       
       By Senator Wise
       
       
       
       
       5-00629-12                                             2012658__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         creating the Florida Assisted Living Quality
    4         Improvement Initiative Pilot Project; providing
    5         purpose; providing definitions; limiting the pilot
    6         project to specified area offices of the Agency for
    7         Health Care Administration; providing for statewide
    8         expansion of the pilot program on December 31, 2017,
    9         unless repealed by the Legislature; providing criteria
   10         for participation in the pilot project; providing
   11         duties of the agency for implementation of the pilot
   12         project; requiring the agency to use an electronic
   13         data collection system for quality assurance;
   14         providing for establishment of a data collection
   15         workgroup and providing its duties; authorizing the
   16         agency to establish a fee for facilities that use the
   17         data collection system; providing system requirements;
   18         providing for establishment of a monitoring workgroup
   19         and providing its duties, including a report to the
   20         Governor and Legislature; providing for development,
   21         in collaboration with the Medicaid Fraud Unit, of an
   22         interagency task force to conduct investigations of
   23         certain facilities and revoke licenses, suspend
   24         payments, and relocate residents for substantial
   25         noncompliance or failure to provide adequate care;
   26         authorizing the agency to impose a fine for transfers
   27         or discharges from a hospital to an assisted living
   28         facility that do not meet certain standards; providing
   29         for development and implementation of a statewide
   30         administrator certification program; requiring an
   31         assisted living facility to employ a certified
   32         administrator as a condition for continued licensure;
   33         providing requirements for and limitations on
   34         certified administrators; requiring the administrator
   35         of a licensed facility that is eligible to participate
   36         in the pilot project to notify the agency when the
   37         facility enrolls in the pilot project; requiring each
   38         facility, before enrollment, to execute a memorandum
   39         of agreement that includes a provision authorizing the
   40         agency to terminate the facility’s participation in
   41         the pilot project; prohibiting a facility from
   42         challenging or appealing the agency’s decision under
   43         ch. 120, F.S.; providing for annual open enrollment;
   44         providing that a facility’s enrollment in the pilot
   45         project does not prohibit the facility from seeking
   46         alternative accreditation; requiring the agency to
   47         establish quality improvement teams; providing for the
   48         composition and duties of a quality improvement team;
   49         providing conditions for a quality improvement team to
   50         terminate the operation of an assisted living
   51         facility; providing for the resumption of inspections
   52         by the agency if a facility’s participation in the
   53         pilot project is terminated; requiring compliance with
   54         agency rules before an assisted living facility may be
   55         reenrolled in the pilot project; requiring the agency
   56         to approve or reject a facility’s request for
   57         termination of participation in the pilot project;
   58         requiring that the facility be subject to survey,
   59         inspection, and monitoring visits by the agency;
   60         providing that reports and documents generated by a
   61         quality improvement team may not be used in certain
   62         tort actions; authorizing the Department of Elderly
   63         Affairs to adopt rules and impose fees and
   64         requirements for providers of core training; providing
   65         educational requirements for assisted living facility
   66         administrators; providing an effective date.
   67  
   68  Be It Enacted by the Legislature of the State of Florida:
   69  
   70         Section 1. Florida Assisted Living Quality Improvement
   71  Initiative Pilot Project.—
   72         (1) The Florida Assisted Living Quality Improvement
   73  Initiative Pilot Project is created to identify best practices
   74  for providing care to residents of licensed assisted living
   75  facilities, improve regulatory oversight and protection of
   76  residents, promote increased information sharing, collaboration,
   77  and implementation of best practices by frontline caregivers,
   78  and develop, in collaboration with the facility, a quality
   79  improvement plan to reduce the need for institutional care.
   80         (2) As used in this section, the term:
   81         (a) “Agency” means the Agency for Health Care
   82  Administration.
   83         (b) “Department” means the Department of Elderly Affairs.
   84         (3) The pilot project shall be limited to 150 facilities in
   85  each of agency areas 4, 5, 6, 8, and 11. The pilot project shall
   86  expand statewide on December 31, 2017, unless repealed by the
   87  Legislature. A facility is eligible to participate in the pilot
   88  project if the facility has not been cited for a class I or
   89  class II violation and has no more than five uncorrected class
   90  III violations on the prior two annual surveys and on any survey
   91  that resulted from a complaint.
   92         (4) To implement the pilot project, the agency shall,
   93  within funds appropriated:
   94         (a) Establish an enrollment process and a timeline for
   95  implementation of the pilot project.
   96         (b) Establish a method to measure facility improvement and
   97  collect data with respect to critical factors that affect
   98  quality of care and occupancy rates.
   99         (c) Use electronic means to collect data on facility
  100  quality assurance.
  101         (d) Establish a data collection workgroup to develop
  102  criteria for a request for proposal to implement a statewide
  103  data collection system. The request for proposal must specify
  104  the data elements that the data collection system must capture
  105  and how the data will be used to track quality of care and
  106  occupancy rates. The agency may reallocate funding within its
  107  budget to implement the system in the pilot project areas. An
  108  assisted living facility that receives Medicaid funding must use
  109  the data collection system. The agency may establish a fee for
  110  users of the data collection system. The agency shall require
  111  that the data collection system:
  112         1. Be compatible with changes in long-term care resulting
  113  from Medicaid reform enacted by the Federal Government.
  114         2. Permit user access from all parts of the system of care
  115  associated with licensed assisted living facilities that receive
  116  Medicaid funding.
  117         3. Permit frontline caregivers to collect defined data
  118  elements that indicate a change in a resident’s condition and
  119  employ intuitive technology to forecast patient care needs and
  120  trends in facility quality improvement.
  121         4. Provide online training videos to improve the skills of
  122  frontline caregivers. A training provider may make online
  123  training material available via the statewide data collection
  124  system. Training shall be provided on a subscription basis and
  125  shall include online competency examinations for caregivers. The
  126  system shall verify the identity of the subscriber and the
  127  amount of time the subscriber participates in online training.
  128  This information shall be made available to the agency through
  129  electronic means.
  130         5. Include specialized training for staff who care for
  131  adults with mental illness, which shall include aggression
  132  control training, information regarding involuntary commitment
  133  procedures under the Baker Act, how to recognize a change in
  134  mental condition, use of psychiatric medications, how to manage
  135  difficult behaviors of adults with mental illness, and other
  136  training in services provided by the state mental health
  137  services delivery system.
  138         6. Include a technical interface between a mental health
  139  provider and an assisted living facility if the provider and the
  140  facility have established a cooperative agreement, as defined in
  141  s. 429.02(8), Florida Statutes. The interface shall permit a
  142  mental health case manager to review client information and care
  143  trends associated with residents of an assisted living facility.
  144  A case manager shall record any face-to-face contact with a
  145  resident and update the community living support plan in real
  146  time when changes are needed. The agency survey staff and the
  147  department shall have access to this information for agency
  148  monitoring purposes.
  149         (e) Establish a monitoring workgroup, to be comprised of
  150  representatives of state agencies that regulate assisted living
  151  facilities, owners of assisted living facilities, and other
  152  interested parties, to:
  153         1. Develop a request for information, establish
  154  requirements for certification, and approve proposed fees by
  155  July 1, 2013.
  156         2. Review survey forms, the inspection process, and how
  157  compliance is determined to ensure the safety and protection of
  158  residents who reside in a licensed assisted living facility.
  159         3. Develop a streamlined regulatory oversight system.
  160         4. Monitor the implementation of the pilot project.
  161         5. Propose specific changes to implement a cost-effective
  162  oversight system for assisted living facilities.
  163         6. Establish a plan that uses an abbreviated survey process
  164  to enable agency surveyors to concentrate on facilities that
  165  require greater oversight and that includes appropriately
  166  trained lead assisted living facility surveyors.
  167         7. Submit a report of its findings to the Governor, the
  168  President of the Senate, and the Speaker of the House of
  169  Representatives by January 1, 2013.
  170         (f) In collaboration with the Medicaid Fraud Control Unit,
  171  develop an interagency task force to investigate facilities that
  172  have failed to improve care for residents, are suspected of
  173  operating without a license, or have been subject to fines or
  174  other sanctions. The agency shall be the lead agency and shall
  175  schedule random onsite inspections of such facilities to
  176  evaluate compliance with assisted living facility standards and
  177  Medicaid rules. The task force may revoke a facility’s license
  178  if substantial noncompliance is found. The task force may
  179  suspend payments to the facility and relocate residents who are
  180  not receiving appropriate care.
  181         (g) Review discharge plans for a patient who is being
  182  transferred from a hospital to an assisted living facility,
  183  require the hospital to complete a health assessment of the
  184  patient signed by a licensed health care professional prior to
  185  discharge, and provide a copy of the assessment to the
  186  administrator of the assisted living facility before the patient
  187  is discharged. The agency shall levy a $500 fine for each
  188  transfer or discharge from a hospital that fails to meet the
  189  requirements of this paragraph.
  190         (h) Work with private-sector providers of certification to
  191  develop and implement a statewide administrator certification
  192  program. Each certified assisted living facility administrator
  193  must pass a competency examination every 4 years and is
  194  responsible for renewing the certification. An assisted living
  195  facility must employ a certified administrator as a condition
  196  for continued licensure. A certified assisted living facility
  197  administrator may not supervise more than three facilities. The
  198  certification must be posted in a visible place in the facility.
  199  Each facility must have a certified administrator on call at all
  200  times.
  201         (5) The administrator of a licensed facility that is
  202  eligible to participate in the pilot project shall notify the
  203  agency when the facility agrees to enroll in the pilot project.
  204  Enrollment in the pilot project is voluntary but may be required
  205  if the agency determines that enrollment in the pilot project is
  206  necessary to improve the quality of care offered by the
  207  facility. The agency shall enroll the first 150 eligible
  208  facilities in each authorized agency area that seek enrollment.
  209  Before enrollment, each facility must execute a memorandum of
  210  agreement with the agency that includes a provision authorizing
  211  the agency to terminate the facility’s participation in the
  212  pilot project at will. The agency’s decision to terminate a
  213  facility’s participation in the pilot project may not be
  214  challenged or appealed under chapter 120, Florida Statutes.
  215         (6) The open enrollment period to participate in the pilot
  216  project begins January 1 and ends March 1 each year. A
  217  facility’s enrollment in the pilot project does not prohibit the
  218  facility from seeking alternative accreditation from a
  219  recognized health care accreditation organization, such as the
  220  Commission on Accreditation of Rehabilitative Facilities or the
  221  Joint Commission.
  222         (7) The agency, within funds appropriated by the
  223  Legislature, shall establish an assisted living facility quality
  224  improvement team in each pilot project area for the purpose of
  225  evaluating and improving the quality of facilities participating
  226  in the pilot project.
  227         (a) A quality improvement team shall include:
  228         1. An agency lead surveyor who has received training
  229  relating to the requirements for providing care to residents of
  230  an assisted living facility, who shall head the team.
  231         2. A quality improvement specialist who has professional
  232  expertise or a background in working with behavioral health
  233  needs or elder and aging needs.
  234         3. A registered nurse.
  235         4. A licensed dietician.
  236         5. If the facility being evaluated is an assisted living
  237  facility with a limited mental health license is being
  238  evaluated, a mental health professional.
  239         (b) A quality improvement team shall:
  240         1. Establish criteria for quality improvement plans, which
  241  shall include an evaluation of the plan based upon client access
  242  to adequate care, provision of personal services and support,
  243  adequate documentation and reporting of client information,
  244  supervision and training of the staff and residents, and
  245  compliance with physical plant and safety standards that promote
  246  independence and dignity for facility residents.
  247         2. Evaluate the progress of the facility in meeting the
  248  goals of the quality improvement plan.
  249         3. Conduct an annual assessment and followup visits as
  250  needed to monitor the progress of the facility in meeting the
  251  goals of the quality improvement plan.
  252         4. Consult with the owner and administrator of the facility
  253  in meeting plan requirements, create electronic systems to
  254  monitor compliance with agency rules, ensure that training
  255  standards established under s. 429.52, Florida Statutes, are
  256  met, and work to help ensure an adequate system of care that
  257  provides access to community-based services that would improve
  258  the care of the residents and the conditions in the facility.
  259         5. Maintain records of the assessments and ongoing efforts
  260  to assist the facility in meeting quality improvement goals.
  261         6. Use electronic means to capture data and generate
  262  reports relating to compliance with the quality improvement
  263  plan.
  264         (8) A quality improvement team may terminate a facility
  265  that has failed to meet the goals of the plan from the pilot
  266  project after reasonable efforts are made to seek cooperation
  267  and assistance from the owner and the administrator of the
  268  facility. If a facility is terminated under these conditions,
  269  the facility’s participation in the pilot project is
  270  automatically terminated.
  271         (9) If a facility’s participation in the pilot project is
  272  terminated, the quality improvement team shall notify the
  273  Division of Health Quality Assurance of the agency, and that
  274  facility shall be subject to the survey, inspection, and
  275  monitoring visits conducted under s. 408.811, Florida Statutes.
  276  The facility is not eligible to reenroll in the pilot project
  277  until the agency has certified that the facility is in
  278  substantial compliance with agency rules.
  279         (10) A facility may terminate its participation in the
  280  pilot project, and the agency shall require the facility to be
  281  subject to the survey, inspection, and monitoring visits
  282  conducted pursuant to s. 408.811, Florida Statutes. If such
  283  termination is sought, the facility administrator shall notify
  284  the agency area office in writing and specify the reasons the
  285  facility seeks to terminate its participation in the pilot
  286  project. The agency shall approve or reject the request under
  287  the terms and conditions of the memorandum of agreement
  288  completed by the facility before enrolling in the pilot project.
  289         (11) Reports and documents generated by a quality
  290  improvement team may not be used in any tort action sought
  291  against the licenseholder of an enrolled facility.
  292         (12) The Department of Elderly Affairs may adopt rules,
  293  impose fees, and provide requirements necessary to certify
  294  providers that seek to offer the assisted living facility staff
  295  core training. The department shall review the total number of
  296  hours required for completion of core training, which shall be
  297  at least 40 hours. The department may charge a fee for core
  298  training and revoke certification for core trainers that fail to
  299  meet requirements as established under department rule. Fees
  300  imposed under this subsection may not, in the aggregate, exceed
  301  the costs necessary to adequately administer the certification
  302  process for providers of core training.
  303         (13) An assisted living facility administrator must
  304  complete a minimum of 40 hours in the core training program,
  305  have a minimum of 5 years’ administrative experience at a
  306  licensed assisted living facility, or have a 4-year
  307  baccalaureate degree from an accredited college or university.
  308  An administrator must obtain 8 hours of continuing education in
  309  areas that relate to the number and type of residents served at
  310  the assisted living facility. The administrator may enroll in
  311  online education courses or other accredited programs that offer
  312  continuing education units, class credits, or a department
  313  approved curriculum by an assisted living core training
  314  provider.
  315         Section 2. This act shall take effect July 1, 2012.

feedback