Bill Text: FL S0966 | 2013 | Regular Session | Comm Sub
Bill Title: Health Care
Spectrum: Slight Partisan Bill (? 2-1)
Status: (Introduced - Dead) 2013-05-03 - Died on Calendar, companion bill(s) passed, see CS/HB 1071 (Ch. 2013-93), CS/CS/HB 1159 (Ch. 2013-153), SB 1520 (Ch. 2013-48) [S0966 Detail]
Download: Florida-2013-S0966-Comm_Sub.html
Florida Senate - 2013 CS for CS for SB 966
By the Committees on Appropriations; and Health Policy; and
Senator Bean
576-04681-13 2013966c2
1 A bill to be entitled
2 An act relating to health care; amending s. 112.0455,
3 F.S.; deleting a monthly reporting requirement for
4 laboratories; amending s. 154.11, F.S.; revising
5 references to certain accrediting organizations to
6 conform to changes made by the act; amending s.
7 322.142, F.S.; allowing the Department of Highway
8 Safety and Motor Vehicles to share driver license
9 photographs with the Agency for Health Care
10 Administration pursuant to an interagency agreement;
11 revising references to certain accrediting
12 organizations to conform to changes made by the act;
13 amending s. 381.745, F.S.; revising a definition;
14 amending s. 381.75, F.S.; revising the duties of the
15 Department of Health as they relate to transitional
16 living facilities; amending s. 381.78, F.S.;
17 conforming provisions to changes made by the act;
18 creating s. 385.2035, F.S.; designating the Florida
19 Hospital Sanford-Burnham Translational Research
20 Institute for Metabolism and Diabetes as a resource
21 for diabetes research in this state; amending s.
22 394.4574, F.S.; providing that Medicaid prepaid
23 behavioral health plans are responsible for enrolled
24 mental health residents; providing that managing
25 entities under contract with the Department of
26 Children and Families are responsible for mental
27 health residents who are not enrolled with a Medicaid
28 prepaid behavioral health plan; deleting a provision
29 to conform to changes made by the act; requiring that
30 the community living support plan be completed and
31 provided to the administrator of a facility upon the
32 mental health resident’s admission; requiring the
33 community living support plan to be updated when there
34 is a significant change to the mental health
35 resident’s behavioral health; requiring the case
36 manager assigned to a mental health resident of an
37 assisted living facility that holds a limited mental
38 health license to keep a record of the date and time
39 of face-to-face interactions with the resident and to
40 make the record available to the responsible entity
41 for inspection; requiring that the record be
42 maintained for a specified time; requiring the
43 responsible entity to ensure that there is adequate
44 and consistent monitoring and enforcement of community
45 living support plans and cooperative agreements and
46 that concerns are reported to the appropriate
47 regulatory oversight organization under certain
48 circumstances; amending s. 394.741, F.S.; revising
49 references to certain accrediting organizations to
50 conform to changes made by the act; amending s.
51 395.0161, F.S.; deleting a requirement that hospitals
52 pay certain inspection fees at the time of the
53 inspection; repealing s. 395.1046, F.S., relating to
54 the investigation by the Agency for Health Care
55 Administration of certain complaints against
56 hospitals; amending s. 395.3038, F.S.; deleting an
57 obsolete provision relating to stroke centers;
58 revising references to certain accrediting
59 organizations to conform; repealing s. 395.40, F.S.;
60 amending s. 395.4001, F.S.; revising the definition of
61 the terms “level II trauma center” and “trauma
62 center”; amending s. 395.401, F.S.; revising the
63 components of plans for local and regional trauma
64 services systems; amending s. 395.4015, F.S.;
65 requiring regional trauma plans to recognize trauma
66 service areas that reflect well established patient
67 flow patterns; amending s. 395.402, F.S., repealing
68 provisions relating to the Department of Health’s
69 assignment of counties to trauma service areas;
70 repealing outdated provisions requiring the Department
71 of Health to conduct a study; repealing provisions
72 requiring the Department of Health to annually review
73 the assignment of counties to trauma service centers;
74 repealing provisions regarding the number of trauma
75 centers in each trauma service area and in the state;
76 amending s. 395.4025, F.S.; establishing criteria for
77 designating Level II trauma centers in areas with
78 limited access to trauma center services; retaining
79 trauma center designation for centers designated or
80 provisionally approved as of July 1, 2013; amending s.
81 395.405, F.S., removing rulemaking authority for s.
82 395.402, F.S.; amending s. 395.701, F.S.; revising the
83 definition of the term “hospital” for purposes of
84 annual assessments on net operating revenues for
85 inpatient and outpatient services to fund public
86 medical assistance; repealing s. 395.7015, F.S.,
87 relating to annual assessments on health care
88 entities; amending s. 395.7016, F.S.; revising a
89 cross-reference to conform to changes made by the act;
90 amending ss. 397.403, F.S.; amending s. 400.0074,
91 F.S.; providing that an administrative assessment
92 conducted by a local council be comprehensive in
93 nature and focus on factors affecting the rights,
94 health, safety, and welfare of the residents of a
95 nursing home; requiring a local council to conduct an
96 exit consultation with the facility administrator or
97 administrator designee to discuss issues and concerns
98 in areas affecting rights, health, safety, and welfare
99 of residents and make recommendations for improvement;
100 revising references to certain accrediting
101 organizations to conform to changes made by the act;
102 amending s. 400.0078, F.S.; requiring that residents
103 of long-term care facilities be informed that
104 retaliatory action cannot be taken against a resident
105 for presenting grievances or for exercising any other
106 resident right; amending s. 400.462, F.S.; defining
107 the term “home health agency” to include a Nurse
108 Registry under certain circumstances; amending s.
109 400.464, F.S.; exempting the delivery of certain home
110 dialysis services from licensure requirements;
111 repealing s. 400.805, F.S.; relating to transitional
112 living facilities; providing that every transitional
113 living facility licensed under s. 400.805, F.S., on or
114 before a specified date is licensed under the
115 provisions of the act; amending s. 400.925, F.S.;
116 revising references to certain accrediting
117 organizations to conform to changes made by the act;
118 amending s. 400.93, F.S.; providing that transitional
119 living facilities licensed under part XI of ch. 400,
120 F.S., are exempt from home medical equipment provider
121 licensure; amending s. 400.9905, F.S.; revising a
122 definition; amending s. 400.9935, F.S.; revising
123 references to certain accrediting organizations to
124 conform to changes made by the act; creating part XI
125 of ch. 400, F.S., entitled “Transitional Living
126 Facilities”; creating s. 400.9970, F.S.; providing
127 legislative intent; creating s. 400.9971, F.S.;
128 providing definitions; creating s. 400.9972, F.S.;
129 requiring the licensure of transitional living
130 facilities; providing fees; providing license
131 application requirements; creating s. 400.9973, F.S.;
132 providing requirements for transitional living
133 facilities relating to client admission, transfer, and
134 discharge; creating s. 400.9974, F.S.; requiring a
135 comprehensive treatment plan to be developed for each
136 client; providing plan requirements; creating s.
137 400.9975, F.S.; providing licensee responsibilities;
138 providing notice requirements; prohibiting a licensee
139 or employee of a facility from serving notice upon a
140 client to leave the premises or take other retaliatory
141 action; requiring the client and client’s
142 representative to be provided with certain
143 information; requiring the licensee to develop and
144 implement certain policies and procedures; creating s.
145 400.9976, F.S.; providing licensee requirements
146 relating to medication practices; creating s.
147 400.9977, F.S.; providing requirements for the
148 screening of potential employees and monitoring of
149 employees for the protection of clients; requiring
150 licensees to implement certain procedures; creating s.
151 400.9978, F.S.; requiring a facility to provide a
152 therapeutic milieu that supports a culture of
153 individual empowerment and responsibility; providing
154 that the health and safety of the client is the
155 primary concern of the facility; providing
156 requirements and limitations for the use of physical
157 restraints, seclusion, and chemical restraint
158 medication on clients; requiring the Agency for Health
159 Care Administration to adopt rules; creating s.
160 400.9979, F.S.; providing background screening
161 requirements; requiring the licensee to maintain
162 certain personnel records; providing administrative
163 responsibilities for licensees; providing
164 recordkeeping requirements; creating s. 400.9980,
165 F.S.; providing requirements relating to property and
166 personal affairs of clients; providing requirements
167 for a licensee with respect to obtaining surety bonds;
168 providing recordkeeping requirements relating to the
169 safekeeping of personal effects; providing
170 requirements for trust funds received by licensee and
171 credited to the client; providing a penalty for
172 certain misuse of a resident’s personal needs
173 allowance; providing criminal penalties for
174 violations; providing for the disposition of property
175 in the event of the death of a client; authorizing the
176 Agency for Health Care Administration to adopt rules;
177 creating s. 400.9981, F.S.; authorizing the agency to
178 adopt and enforce certain rules; creating s. 400.9982,
179 F.S.; providing procedures relating to violations and
180 penalties; providing administrative fines for
181 specified classes of violations; creating s. 400.9983,
182 F.S.; authorizing the agency to apply certain
183 provisions with regard to receivership proceedings;
184 creating s. 400.9984, F.S.; requiring the Agency for
185 Health Care Administration, the Department of Health,
186 the Agency for Persons with Disabilities, and the
187 Department of Children and Families to develop
188 electronic systems for certain purposes; amending s.
189 402.7306, F.S.; revising a reference to certain
190 accrediting organizations to conform to changes made
191 by the act; amending s. 408.061, F.S.; exempting
192 hospitals operated by state agencies from certain
193 annual fiscal experience reporting requirements;
194 amending s. 408.20, F.S.; exempting hospitals operated
195 by state agencies from certain assessments; amending
196 ss. 408.802 and 408.820, F.S.; conforming a provision
197 to changes made by the act; amending s. 408.809, F.S.;
198 adding additional disqualifying offenses to background
199 screening provisions; amending s. 409.9122, F.S.;
200 deleting a requirement that Medicaid recipients with
201 HIV/AIDS be referred to a Health Maintenance
202 Organization under contract with the agency; requiring
203 Medicaid recipients diagnosed with HIV/AIDS be
204 assigned to a managed care plan that is a health
205 maintenance organization under ch. 641, F.S., that is
206 under contract with the agency, and that offers a
207 delivery system through a university-based teaching
208 and research-oriented organization specializing in
209 treating individuals with HIV/AIDS; amending s.
210 409.966; F.S.; revising references to certain
211 accrediting organizations to conform to changes made
212 by the act; amending s. 409.967, F.S.; requiring a
213 managed care plan to permit enrollees to continue
214 receiving certain drugs that are removed from the
215 plan’s formulary; revising references to certain
216 accrediting organizations to conform to changes made
217 by the act; amending s. 429.07, F.S.; providing that
218 an extended congregate care license is issued to
219 certain facilities that have been licensed as assisted
220 living facilities under certain circumstances;
221 providing the purpose of an extended congregate care
222 license; providing that the initial extended
223 congregate care license of an assisted living facility
224 is provisional under certain circumstances; requiring
225 the licensee to notify the Agency for Health Care
226 Administration whenever it accepts a resident who
227 qualifies for extended congregate care services;
228 requiring the agency to inspect the facility for
229 compliance with the requirements of an extended
230 congregate care license; authorizing the agency to
231 waive one of the required yearly monitoring visits
232 under certain circumstances; authorizing the agency to
233 deny or revoke a facility’s extended congregate care
234 license for certain reasons or on certain grounds;
235 requiring a registered nurse representing the agency
236 to visit the facility at least annually, rather than
237 twice a year, to monitor residents who are receiving
238 limited nursing services; providing that the agency’s
239 monitoring visits may be in conjunction with other
240 agency inspections; authorizing the agency to waive
241 one of the required yearly monitoring visits for
242 certain facilities; amending s. 429.075, F.S.;
243 requiring an assisted living facility that serves one
244 or more mental health residents to obtain a limited
245 mental health license; amending s. 429.14, F.S.;
246 revising the actions in which the agency may deny,
247 revoke, or suspend the license of an assisted living
248 facility and impose an administrative fine; revising
249 the criteria upon which the agency must deny or revoke
250 the license of an assisted living facility; requiring
251 the agency to impose an immediate moratorium on the
252 license of an assisted living facility under certain
253 circumstances; deleting a provision requiring the
254 agency to provide a list of facilities with denied,
255 suspended, or revoked licenses to the Department of
256 Business and Professional Regulation; exempting a
257 facility from the 45-day notice requirement if it is
258 required to relocate some or all of its residents;
259 amending s. 429.178, F.S.; conforming cross
260 references; amending s. 429.19, F.S.; revising the
261 amounts and uses of administrative fines; requiring
262 the agency to levy a fine for violations that are
263 corrected before an inspection if noncompliance
264 occurred within a specified period of time; deleting
265 factors that the agency is required to consider to
266 determine penalties and fines; amending s. 429.26,
267 F.S.; providing that certain residents may be admitted
268 to a standard licensed assisted living facility under
269 certain circumstances; amending s. 429.28, F.S.;
270 requiring that residents of facilities be informed
271 that the identity of the resident and complainant in a
272 complaint made to the State Long-Term Care Ombudsman
273 Program is confidential and that retaliatory action
274 cannot be taken against a resident for presenting
275 grievances or for exercising any other resident right;
276 providing that a facility that terminates an
277 individual’s residency is fined if good cause is not
278 shown in court; amending s. 429.34, F.S.; requiring
279 certain persons to report elder abuse in assisted
280 living facilities; requiring the agency to regularly
281 inspect every licensed assisted living facility;
282 requiring the agency to conduct more frequent
283 inspections under certain circumstances; requiring the
284 licensee to pay a fee for the cost of additional
285 inspections; requiring the agency to adjust the fee;
286 amending s. 429.52, F.S.; requiring each newly hired
287 employee of an assisted living facility to attend a
288 preservice orientation provided by the assisted living
289 facility; requiring the employee and administrator to
290 sign an affidavit upon completion of the preservice
291 orientation; requiring the assisted living facility to
292 maintain the signed affidavit in each employee’s work
293 file; conforming a cross-reference; requiring the
294 Agency for Health Care Administration to study the
295 reliability of facility surveys and submit to the
296 Governor and the Legislature its findings and
297 recommendations; requiring the agency to propose a
298 rating system of assisted living facilities for
299 consumers and create content for the agency’s website
300 that makes available to consumers information
301 regarding assisted living facilities; providing
302 criteria for the content; amending s. 430.80, F.S.;
303 revising references to certain accrediting
304 organizations to conform to changes made by the act;
305 amending s. 435.04, F.S.; revising information to be
306 submitted for a background screening; adding
307 additional disqualifying offenses; amending s. 435.07,
308 F.S.; revising terminology; requiring that individuals
309 seeking an exemption from disqualification have
310 completed all nonmonetary conditions imposed by the
311 court for the disqualifying felony; requiring that all
312 persons seeking an exemption from disqualification pay
313 any court-ordered monetary penalty in full before
314 being eligible to apply; amending s. 435.12, F.S.;
315 requiring that a photograph of the person taken at the
316 time the fingerprints are processed be submitted to
317 the Care Provider Background Screening Clearinghouse
318 before submission of the electronic fingerprints;
319 requiring specified information to be included with
320 the initiation of the screening registration within
321 the clearinghouse; amending s. 440.102, F.S.; revising
322 certain drug-testing standards for laboratories;
323 deleting a requirement that a laboratory comply with
324 certain criteria to conduct an initial analysis of
325 test specimens; deleting a monthly reporting
326 requirement for laboratories; amending s. 440.13,
327 F.S.; revising references to certain accrediting
328 organizations to conform to changes made by the act;
329 creating s. 465.1902, F.S.; providing that regulation
330 of the licensure, activity, and operation of
331 pharmacies and pharmacists is preempted to the state;
332 prohibiting a local government or political
333 subdivision of the state from enacting or enforcing an
334 ordinance that imposes a levy, charge, or fee upon, or
335 that otherwise regulates, pharmacies and pharmacists,
336 except for ordinances regarding local business taxes
337 and land development; amending s. 499.003, F.S.;
338 exempting prescription drugs transferred either
339 directly or through a hospital’s or health care
340 entity’s supplier or the manufacturer for the purpose
341 of repackaging from the definition of the term
342 “wholesale distribution”; amending s. 499.01, F.S.;
343 requiring a permit for prescription drug repackagers
344 located in other states who repackage and distribute
345 drugs for limited purposes into this state; amending
346 s. 499.01212, F.S.; requiring pedigree papers for
347 transfers pursuant to s. 499.003(54)(b)7., F.S., to
348 include specified information; amending 499.041, F.S.;
349 assessing an onsite inspection fee on a prescription
350 drug repackager applicant or licensee located out of
351 the state; amending ss. 627.645, 627.668, 627.669,
352 627.736, 641.495, and 766.1015, F.S.; revising
353 references to certain accrediting organizations to
354 conform to changes made by the act; creating s.
355 893.0552, F.S.; providing that regulation of the
356 licensure, activity, and operation of pain-management
357 clinics is preempted to the state under certain
358 circumstances; authorizing a local government or
359 political subdivision of the state to enact certain
360 ordinances regarding local business taxes and land
361 development; providing an effective date.
362
363
364 Be It Enacted by the Legislature of the State of Florida:
365
366 Section 1. Paragraphs (d) and (e) of subsection (12) of
367 section 112.0455, Florida Statutes, are amended to read:
368 112.0455 Drug-Free Workplace Act.—
369 (12) DRUG-TESTING STANDARDS; LABORATORIES.—
370 (d) The laboratory shall submit to the Agency for Health
371 Care Administration a monthly report with statistical
372 information regarding the testing of employees and job
373 applicants. The reports shall include information on the methods
374 of analyses conducted, the drugs tested for, the number of
375 positive and negative results for both initial and confirmation
376 tests, and any other information deemed appropriate by the
377 Agency for Health Care Administration. No monthly report shall
378 identify specific employees or job applicants.
379 (d)(e) Laboratories shall provide technical assistance to
380 the employer, employee, or job applicant for the purpose of
381 interpreting any positive confirmed test results which could
382 have been caused by prescription or nonprescription medication
383 taken by the employee or job applicant.
384 Section 2. Paragraph (n) of subsection (1) of section
385 154.11, Florida Statutes, is amended to read:
386 154.11 Powers of board of trustees.—
387 (1) The board of trustees of each public health trust shall
388 be deemed to exercise a public and essential governmental
389 function of both the state and the county and in furtherance
390 thereof it shall, subject to limitation by the governing body of
391 the county in which such board is located, have all of the
392 powers necessary or convenient to carry out the operation and
393 governance of designated health care facilities, including, but
394 without limiting the generality of, the foregoing:
395 (n) To appoint originally the staff of physicians to
396 practice in a any designated facility owned or operated by the
397 board and to approve the bylaws and rules to be adopted by the
398 medical staff of a any designated facility owned and operated by
399 the board, such governing regulations to be in accordance with
400 the standards of the Joint Commission, the American Osteopathic
401 Association/Healthcare Facilities Accreditation Program, or a
402 national accrediting organization that is approved by the
403 Centers for Medicare and Medicaid Services and whose standards
404 incorporate comparable licensure regulations required by the
405 state on the Accreditation of Hospitals which provide, among
406 other things, for the method of appointing additional staff
407 members and for the removal of staff members.
408 Section 3. Subsection (4) of section 322.142, Florida
409 Statutes, is amended to read:
410 322.142 Color photographic or digital imaged licenses.—
411 (4) The department may maintain a film negative or print
412 file. The department shall maintain a record of the digital
413 image and signature of the licensees, together with other data
414 required by the department for identification and retrieval.
415 Reproductions from the file or digital record are exempt from
416 the provisions of s. 119.07(1) and shall be made and issued only
417 for departmental administrative purposes; for the issuance of
418 duplicate licenses; in response to law enforcement agency
419 requests; to the Department of Business and Professional
420 Regulation pursuant to an interagency agreement for the purpose
421 of accessing digital images for reproduction of licenses issued
422 by the Department of Business and Professional Regulation; to
423 the Department of State pursuant to an interagency agreement to
424 facilitate determinations of eligibility of voter registration
425 applicants and registered voters in accordance with ss. 98.045
426 and 98.075; to the Department of Revenue pursuant to an
427 interagency agreement for use in establishing paternity and
428 establishing, modifying, or enforcing support obligations in
429 Title IV-D cases; to the Department of Children and Family
430 Services pursuant to an interagency agreement to conduct
431 protective investigations under part III of chapter 39 and
432 chapter 415; to the Department of Children and Family Services
433 pursuant to an interagency agreement specifying the number of
434 employees in each of that department’s regions to be granted
435 access to the records for use as verification of identity to
436 expedite the determination of eligibility for public assistance
437 and for use in public assistance fraud investigations; to the
438 Agency for Health Care Administration pursuant to an interagency
439 agreement for the purpose of verifying photographs in the Care
440 Provider Background Screening Clearinghouse authorized in s.
441 435.12; to the Department of Financial Services pursuant to an
442 interagency agreement to facilitate the location of owners of
443 unclaimed property, the validation of unclaimed property claims,
444 and the identification of fraudulent or false claims; or to
445 district medical examiners pursuant to an interagency agreement
446 for the purpose of identifying a deceased individual,
447 determining cause of death, and notifying next of kin of any
448 investigations, including autopsies and other laboratory
449 examinations, authorized in s. 406.011.
450 Section 4. Subsection (9) of section 381.745, Florida
451 Statutes, is amended to read:
452 381.745 Definitions; ss. 381.739-381.79.—As used in ss.
453 381.739-381.79, the term:
454 (9) “Transitional living facility,” for the purpose of this
455 part, means a state-approved facility, as defined and licensed
456 under chapter 400 or chapter 429, or a facility approved by the
457 brain and spinal cord injury program in accordance with this
458 chapter.
459 Section 5. Section 381.75, Florida Statutes, is amended to
460 read:
461 381.75 Duties and responsibilities of the department, of
462 transitional living facilities, and of residents.—Consistent
463 with the mandate of s. 381.7395, the department shall develop
464 and administer a multilevel treatment program for individuals
465 who sustain brain or spinal cord injuries and who are referred
466 to the brain and spinal cord injury program.
467 (1) Within 15 days after any report of an individual who
468 has sustained a brain or spinal cord injury, the department
469 shall notify the individual or the most immediate available
470 family members of their right to assistance from the state, the
471 services available, and the eligibility requirements.
472 (2) The department shall refer individuals who have brain
473 or spinal cord injuries to other state agencies to assure that
474 rehabilitative services, if desired, are obtained by that
475 individual.
476 (3) The department, in consultation with emergency medical
477 service, shall develop standards for an emergency medical
478 evacuation system that will ensure that all individuals who
479 sustain traumatic brain or spinal cord injuries are transported
480 to a department-approved trauma center that meets the standards
481 and criteria established by the emergency medical service and
482 the acute-care standards of the brain and spinal cord injury
483 program.
484 (4) The department shall develop standards for designation
485 of rehabilitation centers to provide rehabilitation services for
486 individuals who have brain or spinal cord injuries.
487 (5) The department shall determine the appropriate number
488 of designated acute-care facilities, inpatient rehabilitation
489 centers, and outpatient rehabilitation centers, needed based on
490 incidence, volume of admissions, and other appropriate criteria.
491 (6) The department shall develop standards for designation
492 of transitional living facilities to provide transitional living
493 services for individuals who participate in the brain and spinal
494 cord injury program the opportunity to adjust to their
495 disabilities and to develop physical and functional skills in a
496 supported living environment.
497 (a) The Agency for Health Care Administration, in
498 consultation with the department, shall develop rules for the
499 licensure of transitional living facilities for individuals who
500 have brain or spinal cord injuries.
501 (b) The goal of a transitional living program for
502 individuals who have brain or spinal cord injuries is to assist
503 each individual who has such a disability to achieve a higher
504 level of independent functioning and to enable that person to
505 reenter the community. The program shall be focused on preparing
506 participants to return to community living.
507 (c) A transitional living facility for an individual who
508 has a brain or spinal cord injury shall provide to such
509 individual, in a residential setting, a goal-oriented treatment
510 program designed to improve the individual’s physical,
511 cognitive, communicative, behavioral, psychological, and social
512 functioning, as well as to provide necessary support and
513 supervision. A transitional living facility shall offer at least
514 the following therapies: physical, occupational, speech,
515 neuropsychology, independent living skills training, behavior
516 analysis for programs serving brain-injured individuals, health
517 education, and recreation.
518 (d) All residents shall use the transitional living
519 facility as a temporary measure and not as a permanent home or
520 domicile. The transitional living facility shall develop an
521 initial treatment plan for each resident within 3 days after the
522 resident’s admission. The transitional living facility shall
523 develop a comprehensive plan of treatment and a discharge plan
524 for each resident as soon as practical, but no later than 30
525 days after the resident’s admission. Each comprehensive
526 treatment plan and discharge plan must be reviewed and updated
527 as necessary, but no less often than quarterly. This subsection
528 does not require the discharge of an individual who continues to
529 require any of the specialized services described in paragraph
530 (c) or who is making measurable progress in accordance with that
531 individual’s comprehensive treatment plan. The transitional
532 living facility shall discharge any individual who has an
533 appropriate discharge site and who has achieved the goals of his
534 or her discharge plan or who is no longer making progress toward
535 the goals established in the comprehensive treatment plan and
536 the discharge plan. The discharge location must be the least
537 restrictive environment in which an individual’s health, well
538 being, and safety is preserved.
539 (7) Recipients of services, under this section, from any of
540 the facilities referred to in this section shall pay a fee based
541 on ability to pay.
542 Section 6. Subsection (4) of section 381.78, Florida
543 Statutes, is amended to read:
544 381.78 Advisory council on brain and spinal cord injuries.—
545 (4) The council shall:
546 (a) provide advice and expertise to the department in the
547 preparation, implementation, and periodic review of the brain
548 and spinal cord injury program.
549 (b) Annually appoint a five-member committee composed of
550 one individual who has a brain injury or has a family member
551 with a brain injury, one individual who has a spinal cord injury
552 or has a family member with a spinal cord injury, and three
553 members who shall be chosen from among these representative
554 groups: physicians, other allied health professionals,
555 administrators of brain and spinal cord injury programs, and
556 representatives from support groups with expertise in areas
557 related to the rehabilitation of individuals who have brain or
558 spinal cord injuries, except that one and only one member of the
559 committee shall be an administrator of a transitional living
560 facility. Membership on the council is not a prerequisite for
561 membership on this committee.
562 1. The committee shall perform onsite visits to those
563 transitional living facilities identified by the Agency for
564 Health Care Administration as being in possible violation of the
565 statutes and rules regulating such facilities. The committee
566 members have the same rights of entry and inspection granted
567 under s. 400.805(4) to designated representatives of the agency.
568 2. Factual findings of the committee resulting from an
569 onsite investigation of a facility pursuant to subparagraph 1.
570 shall be adopted by the agency in developing its administrative
571 response regarding enforcement of statutes and rules regulating
572 the operation of the facility.
573 3. Onsite investigations by the committee shall be funded
574 by the Health Care Trust Fund.
575 4. Travel expenses for committee members shall be
576 reimbursed in accordance with s. 112.061.
577 5. Members of the committee shall recuse themselves from
578 participating in any investigation that would create a conflict
579 of interest under state law, and the council shall replace the
580 member, either temporarily or permanently.
581 Section 7. Section 385.2035, Florida Statutes, is created
582 to read:
583 385.2035 Resource for research in the prevention and
584 treatment of diabetes.—The Florida Hospital Sanford-Burnham
585 Translational Research Institute for Metabolism and Diabetes is
586 designated as a resource in this state for research in the
587 prevention and treatment of diabetes.
588 Section 8. Section 394.4574, Florida Statutes, is amended
589 to read:
590 394.4574 Department Responsibilities for coordination of
591 services for a mental health resident who resides in an assisted
592 living facility that holds a limited mental health license.—
593 (1) As used in this section, the term “mental health
594 resident” “mental health resident,” for purposes of this
595 section, means an individual who receives social security
596 disability income due to a mental disorder as determined by the
597 Social Security Administration or receives supplemental security
598 income due to a mental disorder as determined by the Social
599 Security Administration and receives optional state
600 supplementation.
601 (2) Medicaid prepaid behavioral health plans are
602 responsible for enrolled mental health residents, and managing
603 entities under contract with the department are responsible for
604 mental health residents who are not enrolled with a Medicaid
605 prepaid behavioral health plan. Each responsible entity shall
606 The department must ensure that:
607 (a) A mental health resident has been assessed by a
608 psychiatrist, clinical psychologist, clinical social worker, or
609 psychiatric nurse, or an individual who is supervised by one of
610 these professionals, and determined to be appropriate to reside
611 in an assisted living facility. The documentation must be
612 provided to the administrator of the facility within 30 days
613 after the mental health resident has been admitted to the
614 facility. An evaluation completed upon discharge from a state
615 mental hospital meets the requirements of this subsection
616 related to appropriateness for placement as a mental health
617 resident if it was completed within 90 days before prior to
618 admission to the facility.
619 (b) A cooperative agreement, as required in s. 429.075, is
620 developed between the mental health care services provider that
621 serves a mental health resident and the administrator of the
622 assisted living facility with a limited mental health license in
623 which the mental health resident is living. Any entity that
624 provides Medicaid prepaid health plan services shall ensure the
625 appropriate coordination of health care services with an
626 assisted living facility in cases where a Medicaid recipient is
627 both a member of the entity’s prepaid health plan and a resident
628 of the assisted living facility. If the entity is at risk for
629 Medicaid targeted case management and behavioral health
630 services, the entity shall inform the assisted living facility
631 of the procedures to follow should an emergent condition arise.
632 (c) The community living support plan, as defined in s.
633 429.02, has been prepared by a mental health resident and a
634 mental health case manager of that resident in consultation with
635 the administrator of the facility or the administrator’s
636 designee. The plan must be completed and provided to the
637 administrator of the assisted living facility with a limited
638 mental health license in which the mental health resident lives
639 upon the resident’s admission. The support plan and the
640 agreement may be in one document.
641 (d) The assisted living facility with a limited mental
642 health license is provided with documentation that the
643 individual meets the definition of a mental health resident.
644 (e) The mental health services provider assigns a case
645 manager to each mental health resident for whom the entity is
646 responsible who lives in an assisted living facility with a
647 limited mental health license. The case manager is responsible
648 for coordinating the development of and implementation of the
649 community living support plan defined in s. 429.02. The plan
650 must be updated at least annually, or when there is a
651 significant change to the resident’s behavioral health status,
652 such as an inpatient admission or a change in behavioral status,
653 medications, level of service, or residence. Each case manager
654 shall keep a record of the date and time of any face-to-face
655 interaction with the resident and make the record available to
656 the responsible entity for inspection. The record must be
657 retained for at least 2 years after the date of the most recent
658 interaction.
659 (f) Adequate and consistent monitoring and enforcement of
660 community living support plans and cooperative agreements are
661 conducted by the resident’s case manager.
662 (g) Concerns are reported to the appropriate regulatory
663 oversight organization if a regulated provider fails to deliver
664 appropriate services or otherwise acts in a manner that has the
665 potential to result in harm to the resident.
666 (3) The Secretary of Children and Family Services, in
667 consultation with the Agency for Health Care Administration,
668 shall annually require each district administrator to develop,
669 with community input, a detailed annual plan that demonstrates
670 detailed plans that demonstrate how the district will ensure the
671 provision of state-funded mental health and substance abuse
672 treatment services to residents of assisted living facilities
673 that hold a limited mental health license. These plans must be
674 consistent with the substance abuse and mental health district
675 plan developed pursuant to s. 394.75 and must address case
676 management services; access to consumer-operated drop-in
677 centers; access to services during evenings, weekends, and
678 holidays; supervision of the clinical needs of the residents;
679 and access to emergency psychiatric care.
680 Section 9. Subsection (2) of section 394.741, Florida
681 Statutes, is amended to read:
682 394.741 Accreditation requirements for providers of
683 behavioral health care services.—
684 (2) Notwithstanding any provision of law to the contrary,
685 accreditation shall be accepted by the agency and department in
686 lieu of the agency’s and department’s facility licensure onsite
687 review requirements and shall be accepted as a substitute for
688 the department’s administrative and program monitoring
689 requirements, except as required by subsections (3) and (4),
690 for:
691 (a) An Any organization from which the department purchases
692 behavioral health care services which that is accredited by the
693 Joint Commission, American Osteopathic Association/the
694 Healthcare Facilities Accreditation Program, a national
695 accrediting organization that is approved by the Centers for
696 Medicare and Medicaid Services and whose standards incorporate
697 comparable licensure regulations required by the state, on
698 Accreditation of Healthcare Organizations or the Council on
699 Accreditation for Children and Family Services, or CARF
700 International for the has those services that are being
701 purchased by the department accredited by CARF—the
702 Rehabilitation Accreditation Commission.
703 (b) A Any mental health facility licensed by the agency or
704 a any substance abuse component licensed by the department which
705 that is accredited by the Joint Commission, the American
706 Osteopathic Association/Healthcare Facilities Accreditation
707 Program, a national accrediting organization that is approved by
708 the Centers for Medicare and Medicaid Services and whose
709 standards incorporate comparable licensure regulations required
710 by the state, CARF International on Accreditation of Healthcare
711 Organizations, CARF—the Rehabilitation Accreditation Commission,
712 or the Council on Accreditation of Children and Family Services.
713 (c) A Any network of providers from which the department or
714 the agency purchases behavioral health care services accredited
715 by the Joint Commission, the American Osteopathic
716 Association/Healthcare Facilities Accreditation Program, a
717 national accrediting organization that is approved by the
718 Centers for Medicare and Medicaid Services and whose standards
719 incorporate comparable licensure regulations required by the
720 state, CARF International on Accreditation of Healthcare
721 Organizations, CARF—the Rehabilitation Accreditation Commission,
722 the Council on Accreditation of Children and Family Services, or
723 the National Committee for Quality Assurance. A provider
724 organization that, which is part of an accredited network, is
725 afforded the same rights under this part.
726 Section 10. Subsection (3) of section 395.0161, Florida
727 Statutes, is amended to read:
728 395.0161 Licensure inspection.—
729 (3) In accordance with s. 408.805, an applicant or licensee
730 shall pay a fee for each license application submitted under
731 this part, part II of chapter 408, and applicable rules. With
732 the exception of state-operated licensed facilities, each
733 facility licensed under this part shall pay to the agency, at
734 the time of inspection, the following fees:
735 (a) Inspection for licensure.—A fee shall be paid which is
736 not less than $8 per hospital bed, nor more than $12 per
737 hospital bed, except that the minimum fee shall be $400 per
738 facility.
739 (b) Inspection for lifesafety only.—A fee shall be paid
740 which is not less than 75 cents per hospital bed, nor more than
741 $1.50 per hospital bed, except that the minimum fee shall be $40
742 per facility.
743 Section 11. Section 395.1046, Florida Statutes, is
744 repealed.
745 Section 12. Section 395.3038, Florida Statutes, is amended
746 to read:
747 395.3038 State-listed primary stroke centers and
748 comprehensive stroke centers; notification of hospitals.—
749 (1) The agency shall make available on its website and to
750 the department a list of the name and address of each hospital
751 that meets the criteria for a primary stroke center and the name
752 and address of each hospital that meets the criteria for a
753 comprehensive stroke center. The list of primary and
754 comprehensive stroke centers must shall include only those
755 hospitals that attest in an affidavit submitted to the agency
756 that the hospital meets the named criteria, or those hospitals
757 that attest in an affidavit submitted to the agency that the
758 hospital is certified as a primary or a comprehensive stroke
759 center by the Joint Commission, the American Osteopathic
760 Association/Healthcare Facilities Accreditation Program, or a
761 national accrediting organization that is approved by the
762 Centers for Medicare and Medicaid Services and whose standards
763 incorporate comparable licensure regulations required by the
764 state on Accreditation of Healthcare Organizations.
765 (2)(a) If a hospital no longer chooses to meet the criteria
766 for a primary or comprehensive stroke center, the hospital shall
767 notify the agency and the agency shall immediately remove the
768 hospital from the list.
769 (b)1. This subsection does not apply if the hospital is
770 unable to provide stroke treatment services for a period of time
771 not to exceed 2 months. The hospital shall immediately notify
772 all local emergency medical services providers when the
773 temporary unavailability of stroke treatment services begins and
774 when the services resume.
775 2. If stroke treatment services are unavailable for more
776 than 2 months, the agency shall remove the hospital from the
777 list of primary or comprehensive stroke centers until the
778 hospital notifies the agency that stroke treatment services have
779 been resumed.
780 (3) The agency shall notify all hospitals in this state by
781 February 15, 2005, that the agency is compiling a list of
782 primary stroke centers and comprehensive stroke centers in this
783 state. The notice shall include an explanation of the criteria
784 necessary for designation as a primary stroke center and the
785 criteria necessary for designation as a comprehensive stroke
786 center. The notice shall also advise hospitals of the process by
787 which a hospital might be added to the list of primary or
788 comprehensive stroke centers.
789 (3)(4) The agency shall adopt by rule criteria for a
790 primary stroke center which are substantially similar to the
791 certification standards for primary stroke centers of the Joint
792 Commission, the American Osteopathic Association/Healthcare
793 Facilities Accreditation Program, or a national accrediting
794 organization that is approved by the Centers for Medicare and
795 Medicaid Services and whose standards incorporate comparable
796 licensure regulations required by the state on Accreditation of
797 Healthcare Organizations.
798 (4)(5) The agency shall adopt by rule criteria for a
799 comprehensive stroke center. However, if the Joint Commission,
800 the American Osteopathic Association/Healthcare Facilities
801 Accreditation Program, or a national accrediting organization
802 that is approved by the Centers for Medicare and Medicaid
803 Services and whose standards incorporate comparable licensure
804 regulations required by the state on Accreditation of Healthcare
805 Organizations establishes criteria for a comprehensive stroke
806 center, the agency shall establish criteria for a comprehensive
807 stroke center which are substantially similar to those criteria
808 established by the Joint Commission, the American Osteopathic
809 Association/Healthcare Facilities Accreditation Program, or such
810 national accrediting organization on Accreditation of Healthcare
811 Organizations.
812 (5)(6) This act is not a medical practice guideline and may
813 not be used to restrict the authority of a hospital to provide
814 services for which it is licensed has received a license under
815 chapter 395. The Legislature intends that all patients be
816 treated individually based on each patient’s needs and
817 circumstances.
818 Section 13. Section 395.40, Florida Statutes, is repealed.
819 Section 14. Paragraph (a) of subsection (7) and subsection
820 (14) of section 395.4001, Florida Statutes, are amended to read:
821 395.4001 Definitions.—As used in this part, the term:
822 (7) “Level II trauma center” means a trauma center that:
823 (a) Is verified by the department to be in substantial
824 compliance with Level II trauma center standards and has been
825 approved by the department to operate as a Level II trauma
826 center or is designated pursuant to s. 395.4025(14).
827 (14) “Trauma center” means a hospital that has been
828 verified by the department to be in substantial compliance with
829 the requirements in s. 395.4025 and has been approved by the
830 department to operate as a Level I trauma center, Level II
831 trauma center, or pediatric trauma center, or is designated by
832 the department as a Level II trauma center pursuant to
833 s. 395.4025(14).
834 Section 15. Paragraph (b) of subsection (1) and paragraph
835 (3) of section 395.401, Florida Statutes, are amended to read:
836 395.401 Trauma services system plans; approval of trauma
837 centers and pediatric trauma centers; procedures; renewal.—
838 (1)
839 (b) The local and regional trauma agencies shall develop
840 and submit to the department plans for local and regional trauma
841 services systems. The plans must include, at a minimum, the
842 following components:
843 1. The organizational structure of the trauma system.
844 2. Prehospital care management guidelines for triage and
845 transportation of trauma cases.
846 3. Flow patterns of trauma cases and transportation system
847 design and resources, including air transportation services,
848 provision for interfacility trauma transfer, and the prehospital
849 transportation of trauma victims. The trauma agency shall plan
850 for the development of a system of transportation of trauma
851 alert victims to trauma centers where the distance or time to a
852 trauma center or transportation resources diminish access by
853 trauma alert victims.
854 4. The number and location of needed trauma centers based
855 on local needs, population, and location and distribution of
856 resources.
857 4.5. Data collection regarding system operation and patient
858 outcome.
859 5.6. Periodic performance evaluation of the trauma system
860 and its components.
861 6.7. The use of air transport services within the
862 jurisdiction of the local trauma agency.
863 7.8. Public information and education about the trauma
864 system.
865 8.9. Emergency medical services communication system usage
866 and dispatching.
867 9.10. The coordination and integration between the trauma
868 center and other acute care hospitals.
869 10.11. Medical control and accountability.
870 11.12. Quality control and system evaluation.
871 (3) The department may withdraw local or regional agency
872 authority, prescribe corrective actions, or use the
873 administrative remedies as provided in s. 395.1065 for the
874 violation of any provision of this section and ss. 395.4015,
875 395.402, 395.4025, 395.403, 395.404, and 395.4045 or rules
876 adopted thereunder. All amounts collected pursuant to this
877 subsection shall be deposited into the Emergency Medical
878 Services Trust Fund provided in s. 401.34.
879 Section 16. Subsection (1) of section 395.4015, Florida
880 Statutes, is amended to read:
881 395.4015 State regional trauma planning; trauma regions.—
882 (1) The department shall establish a state trauma system
883 plan. As part of the state trauma system plan, the department
884 shall establish trauma regions that cover all geographical areas
885 of the state and have boundaries that are coterminous with the
886 boundaries of the regional domestic security task forces
887 established under s. 943.0312. These regions may serve as the
888 basis for the development of department-approved local or
889 regional trauma plans. However, such regional plans shall
890 recognize trauma service areas that reflect well established
891 patient flow patterns. The delivery of trauma services by or in
892 coordination with a trauma agency established before July 1,
893 2004, may continue in accordance with public and private
894 agreements and operational procedures entered into as provided
895 in s. 395.401.
896 Section 17. Section 395.402, Florida Statutes, is amended
897 to read:
898 395.402 Trauma service areas; number and location of trauma
899 centers.—
900 (1) The Legislature recognizes the need for a statewide,
901 cohesive, uniform, and integrated trauma system. Within the
902 trauma service areas, Level I and Level II trauma centers shall
903 each be capable of annually treating a minimum of 1,000 and 500
904 patients, respectively, with an injury severity score (ISS) of 9
905 or greater. Level II trauma centers in counties with a
906 population of more than 500,000 shall have the capacity to care
907 for 1,000 patients per year.
908 (2) Trauma service areas as defined in this section are to
909 be utilized until the Department of Health completes an
910 assessment of the trauma system and reports its finding to the
911 Governor, the President of the Senate, the Speaker of the House
912 of Representatives, and the substantive legislative committees.
913 The report shall be submitted by February 1, 2005. The
914 department shall review the existing trauma system and determine
915 whether it is effective in providing trauma care uniformly
916 throughout the state. The assessment shall:
917 (a) Consider aligning trauma service areas within the
918 trauma region boundaries as established in July 2004.
919 (b) Review the number and level of trauma centers needed
920 for each trauma service area to provide a statewide integrated
921 trauma system.
922 (c) Establish criteria for determining the number and level
923 of trauma centers needed to serve the population in a defined
924 trauma service area or region.
925 (d) Consider including criteria within trauma center
926 approval standards based upon the number of trauma victims
927 served within a service area.
928 (e) Review the Regional Domestic Security Task Force
929 structure and determine whether integrating the trauma system
930 planning with interagency regional emergency and disaster
931 planning efforts is feasible and identify any duplication of
932 efforts between the two entities.
933 (f) Make recommendations regarding a continued revenue
934 source which shall include a local participation requirement.
935 (g) Make recommendations regarding a formula for the
936 distribution of funds identified for trauma centers which shall
937 address incentives for new centers where needed and the need to
938 maintain effective trauma care in areas served by existing
939 centers, with consideration for the volume of trauma patients
940 served, and the amount of charity care provided.
941 (3) In conducting such assessment and subsequent annual
942 reviews, the department shall consider:
943 (a) The recommendations made as part of the regional trauma
944 system plans submitted by regional trauma agencies.
945 (b) Stakeholder recommendations.
946 (c) The geographical composition of an area to ensure rapid
947 access to trauma care by patients.
948 (d) Historical patterns of patient referral and transfer in
949 an area.
950 (e) Inventories of available trauma care resources,
951 including professional medical staff.
952 (f) Population growth characteristics.
953 (g) Transportation capabilities, including ground and air
954 transport.
955 (h) Medically appropriate ground and air travel times.
956 (i) Recommendations of the Regional Domestic Security Task
957 Force.
958 (j) The actual number of trauma victims currently being
959 served by each trauma center.
960 (k) Other appropriate criteria.
961 (4) Annually thereafter, the department shall review the
962 assignment of the 67 counties to trauma service areas, in
963 addition to the requirements of paragraphs (2)(b)-(g) and
964 subsection (3). County assignments are made for the purpose of
965 developing a system of trauma centers. Revisions made by the
966 department shall take into consideration the recommendations
967 made as part of the regional trauma system plans approved by the
968 department and the recommendations made as part of the state
969 trauma system plan. In cases where a trauma service area is
970 located within the boundaries of more than one trauma region,
971 the trauma service area’s needs, response capability, and system
972 requirements shall be considered by each trauma region served by
973 that trauma service area in its regional system plan. Until the
974 department completes the February 2005 assessment, the
975 assignment of counties shall remain as established in this
976 section.
977 (a) The following trauma service areas are hereby
978 established:
979 (1)1. Trauma service area 1 shall consist of Escambia,
980 Okaloosa, Santa Rosa, and Walton Counties.
981 (2)2. Trauma service area 2 shall consist of Bay, Gulf,
982 Holmes, and Washington Counties.
983 (3)3. Trauma service area 3 shall consist of Calhoun,
984 Franklin, Gadsden, Jackson, Jefferson, Leon, Liberty, Madison,
985 Taylor, and Wakulla Counties.
986 (4)4. Trauma service area 4 shall consist of Alachua,
987 Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy,
988 Putnam, Suwannee, and Union Counties.
989 (5)5. Trauma service area 5 shall consist of Baker, Clay,
990 Duval, Nassau, and St. Johns Counties.
991 (6)6. Trauma service area 6 shall consist of Citrus,
992 Hernando, and Marion Counties.
993 (7)7. Trauma service area 7 shall consist of Flagler and
994 Volusia Counties.
995 (8)8. Trauma service area 8 shall consist of Lake, Orange,
996 Osceola, Seminole, and Sumter Counties.
997 (9)9. Trauma service area 9 shall consist of Pasco and
998 Pinellas Counties.
999 (10)10. Trauma service area 10 shall consist of
1000 Hillsborough County.
1001 (11)11. Trauma service area 11 shall consist of Hardee,
1002 Highlands, and Polk Counties.
1003 (12)12. Trauma service area 12 shall consist of Brevard and
1004 Indian River Counties.
1005 (13)13. Trauma service area 13 shall consist of DeSoto,
1006 Manatee, and Sarasota Counties.
1007 (14)14. Trauma service area 14 shall consist of Martin,
1008 Okeechobee, and St. Lucie Counties.
1009 (15)15. Trauma service area 15 shall consist of Charlotte,
1010 Glades, Hendry, and Lee Counties.
1011 (16)16. Trauma service area 16 shall consist of Palm Beach
1012 County.
1013 (17)17. Trauma service area 17 shall consist of Collier
1014 County.
1015 (18)18. Trauma service area 18 shall consist of Broward
1016 County.
1017 (19)19. Trauma service area 19 shall consist of Miami-Dade
1018 and Monroe Counties.
1019 (b) Each trauma service area should have at least one Level
1020 I or Level II trauma center. The department shall allocate, by
1021 rule, the number of trauma centers needed for each trauma
1022 service area.
1023 (c) There shall be no more than a total of 44 trauma
1024 centers in the state.
1025 Section 18. Subsections (12) and (14) of section 395.4025,
1026 Florida Statutes, are amended and subsection (15) is added to
1027 that section to read:
1028 395.4025 Trauma centers; selection; quality assurance;
1029 records.—
1030 (12) Patient care, transport, or treatment records or
1031 reports, or patient care quality assurance proceedings, records,
1032 or reports obtained or made pursuant to this section, s.
1033 395.3025(4)(f), s. 395.401, s. 395.4015, s. 395.402, s. 395.403,
1034 s. 395.404, s. 395.4045, s. 395.405, s. 395.50, or s. 395.51
1035 must be held confidential by the department or its agent and are
1036 exempt from the provisions of s. 119.07(1). Patient care quality
1037 assurance proceedings, records, or reports obtained or made
1038 pursuant to these sections are not subject to discovery or
1039 introduction into evidence in any civil or administrative
1040 action.
1041 (14) Notwithstanding the procedures established pursuant to
1042 subsections (1) through (13) in this section, hospitals located
1043 in areas with limited access to trauma center services shall be
1044 designated by the department as a Level II trauma center based
1045 on documentation of a valid certificate of trauma center
1046 verification from the American College of Surgeons. Areas with
1047 limited access to trauma center services are defined by the
1048 following criteria:
1049 (a) The hospital is located in a trauma service area with a
1050 population greater than 600,000 persons but a population density
1051 of less than 300 persons per square mile; and,
1052 (b) The hospital is located in a county with no designated
1053 or provisional trauma center; and,
1054 (c) The hospital is located at least 15 miles or 20 minutes
1055 travel time by ground transport from the nearest trauma center.
1056 any other provisions of this section and rules adopted
1057 pursuant to this section, until the department has conducted the
1058 review provided under s. 395.402, only hospitals located in
1059 trauma services areas where there is no existing trauma center
1060 may apply.
1061 (15) Trauma centers designated as Level I, Level II, or
1062 pediatric trauma centers as of July 1, 2013 shall retain such
1063 designation unless the department determines the hospital is no
1064 longer able to comply with the adopted standards for such
1065 centers. A trauma center provisionally approved as a Level II
1066 trauma center as of July 1, 2013 may complete the application
1067 process through verification by the department as a Level II
1068 Trauma Center.
1069 Section 19. Section 395.405, Florida Statutes, is amended
1070 to read
1071 395.405 Rulemaking.—The department shall adopt and enforce
1072 all rules necessary to administer ss. 395.401, 395.4015,
1073 395.402, 395.4025, 395.403, 395.404, and 395.4045.
1074 Section 20. Paragraph (c) of subsection (1) of section
1075 395.701, Florida Statutes, is amended to read:
1076 395.701 Annual assessments on net operating revenues for
1077 inpatient and outpatient services to fund public medical
1078 assistance; administrative fines for failure to pay assessments
1079 when due; exemption.—
1080 (1) For the purposes of this section, the term:
1081 (c) “Hospital” means a health care institution as defined
1082 in s. 395.002(12), but does not include any hospital operated by
1083 a state the agency or the Department of Corrections.
1084 Section 21. Section 395.7015, Florida Statutes, is
1085 repealed.
1086 Section 22. Section 395.7016, Florida Statutes, is amended
1087 to read:
1088 395.7016 Annual appropriation.—The Legislature shall
1089 appropriate each fiscal year from either the General Revenue
1090 Fund or the Agency for Health Care Administration Tobacco
1091 Settlement Trust Fund an amount sufficient to replace the funds
1092 lost due to reduction by chapter 2000-256, Laws of Florida, of
1093 the assessment on other health care entities under s. 395.7015,
1094 and the reduction by chapter 2000-256 in the assessment on
1095 hospitals under s. 395.701, and to maintain federal approval of
1096 the reduced amount of funds deposited into the Public Medical
1097 Assistance Trust Fund under s. 395.701, as state match for the
1098 state’s Medicaid program.
1099 Section 23. Subsection (3) of section 397.403, Florida
1100 Statutes, is amended to read:
1101 397.403 License application.—
1102 (3) The department shall accept proof of accreditation by
1103 CARF International, the Commission on Accreditation of
1104 Rehabilitation Facilities(CARF) or the Joint Commission, the
1105 American Osteopathic Association/Healthcare Facilities
1106 Accreditation Program, or a national accrediting organization
1107 that is approved by the Centers for Medicare and Medicaid
1108 Services and whose standards incorporate comparable licensure
1109 regulations required by the state; or through another any other
1110 nationally recognized certification process that is acceptable
1111 to the department and meets the minimum licensure requirements
1112 under this chapter, in lieu of requiring the applicant to submit
1113 the information required by paragraphs (1)(a)-(c).
1114 Section 24. Subsection (1) of section 400.0074, Florida
1115 Statutes, is amended, and paragraph (h) is added to subsection
1116 (2) of that section, to read:
1117 400.0074 Local ombudsman council onsite administrative
1118 assessments.—
1119 (1) In addition to any specific investigation conducted
1120 pursuant to a complaint, the local council shall conduct, at
1121 least annually, an onsite administrative assessment of each
1122 nursing home, assisted living facility, and adult family-care
1123 home within its jurisdiction. This administrative assessment
1124 must be comprehensive in nature and must shall focus on factors
1125 affecting the rights, health, safety, and welfare of the
1126 residents. Each local council is encouraged to conduct a similar
1127 onsite administrative assessment of each additional long-term
1128 care facility within its jurisdiction.
1129 (2) An onsite administrative assessment conducted by a
1130 local council shall be subject to the following conditions:
1131 (h) The local council shall conduct an exit consultation
1132 with the facility administrator or administrator designee to
1133 discuss issues and concerns in areas affecting the rights,
1134 health, safety, and welfare of the residents and make
1135 recommendations for improvement, if any.
1136 Section 25. Subsection (2) of section 400.0078, Florida
1137 Statutes, is amended to read:
1138 400.0078 Citizen access to State Long-Term Care Ombudsman
1139 Program services.—
1140 (2) Every resident or representative of a resident shall
1141 receive, Upon admission to a long-term care facility, each
1142 resident or representative of a resident must receive
1143 information regarding the purpose of the State Long-Term Care
1144 Ombudsman Program, the statewide toll-free telephone number for
1145 receiving complaints, information that retaliatory action cannot
1146 be taken against a resident for presenting grievances or for
1147 exercising any other resident right, and other relevant
1148 information regarding how to contact the program. Residents or
1149 their representatives must be furnished additional copies of
1150 this information upon request.
1151 Section 26. Subsection (21) of section 400.462, Florida
1152 Statutes, is amended to read:
1153 400.462 Definitions.—As used in this part, the term:
1154 (21) “Nurse registry” means any person that procures,
1155 offers, promises, or attempts to secure health-care-related
1156 contracts for registered nurses, licensed practical nurses,
1157 certified nursing assistants, home health aides, companions, or
1158 homemakers, who are compensated by fees as independent
1159 contractors, including, but not limited to, contracts for the
1160 provision of services to patients and contracts to provide
1161 private duty or staffing services to health care facilities
1162 licensed under chapter 395, this chapter, or chapter 429 or
1163 other business entities. For the purposes of the delivery of
1164 services under s. 627.94071(5), a nurse registry may be
1165 considered a “home health agency” as defined in s. 400.462(12).
1166 Section 27. Present paragraphs (b) through (n) of
1167 subsection (5) of section 400.464, Florida Statutes, are
1168 redesignated as paragraphs (c) through (o), respectively, and a
1169 new paragraph (b) is added to that subsection, to read:
1170 400.464 Home health agencies to be licensed; expiration of
1171 license; exemptions; unlawful acts; penalties.—
1172 (5) The following are exempt from the licensure
1173 requirements of this part:
1174 (b) The delivery of home dialysis services provided
1175 directly, or through a subcontract, by an end-stage renal
1176 disease provider certified under 42 C.F.R. part 405, subpart U.
1177 Section 28. Section 400.805, Florida Statutes, is repealed.
1178 Section 29. Subsection (1) of section 400.925, Florida
1179 Statutes, is amended to read:
1180 400.925 Definitions.—As used in this part, the term:
1181 (1) “Accrediting organizations” means the Joint Commission,
1182 the American Osteopathic Association/Healthcare Facilities
1183 Accreditation Program, a national accrediting organization that
1184 is approved by the Centers for Medicare and Medicaid Services
1185 and whose standards incorporate comparable licensure regulations
1186 required by the state, on Accreditation of Healthcare
1187 Organizations or other national accrediting accreditation
1188 agencies whose standards for accreditation are comparable to
1189 those required by this part for licensure.
1190 Section 30. Subsection (5) of section 400.93, Florida
1191 Statutes, is amended to read:
1192 400.93 Licensure required; exemptions; unlawful acts;
1193 penalties.—
1194 (5) The following are exempt from home medical equipment
1195 provider licensure, unless they have a separate company,
1196 corporation, or division that is in the business of providing
1197 home medical equipment and services for sale or rent to
1198 consumers at their regular or temporary place of residence
1199 pursuant to the provisions of this part:
1200 (a) Providers operated by the Department of Health or
1201 Federal Government.
1202 (b) Nursing homes licensed under part II.
1203 (c) Assisted living facilities licensed under chapter 429,
1204 when serving their residents.
1205 (d) Home health agencies licensed under part III.
1206 (e) Hospices licensed under part IV.
1207 (f) Intermediate care facilities, homes for special
1208 services, and transitional living facilities licensed under part
1209 V.
1210 (g) Transitional living facilities licensed under part XI.
1211 (h)(g) Hospitals and ambulatory surgical centers licensed
1212 under chapter 395.
1213 (i)(h) Manufacturers and wholesale distributors when not
1214 selling directly to consumers.
1215 (j)(i) Licensed health care practitioners who utilize home
1216 medical equipment in the course of their practice, but do not
1217 sell or rent home medical equipment to their patients.
1218 (k)(j) Pharmacies licensed under chapter 465.
1219 Section 31. Paragraphs (l) and (m) of subsection (4) of
1220 section 400.9905, Florida Statutes, is amended to read:
1221 400.9905 Definitions.—
1222 (4) “Clinic” means an entity where health care services are
1223 provided to individuals and which tenders charges for
1224 reimbursement for such services, including a mobile clinic and a
1225 portable equipment provider. As used in this part, the term does
1226 not include and the licensure requirements of this part do not
1227 apply to:
1228 (l) Orthotic, or prosthetic, pediatric cardiology, or
1229 perinatology clinical facilities or anesthesia clinical
1230 facilities that are not otherwise exempt under paragraph (a) or
1231 paragraph (k) and that are a publicly traded corporation or that
1232 are wholly owned, directly or indirectly, by a publicly traded
1233 corporation. As used in this paragraph, a publicly traded
1234 corporation is a corporation that issues securities traded on an
1235 exchange registered with the United States Securities and
1236 Exchange Commission as a national securities exchange.
1237 (m) Entities that are owned by a corporation that has $250
1238 million or more in total annual sales of health care services
1239 provided by licensed health care practitioners where one or more
1240 of the persons responsible for the operations of the entity
1241 owners is a health care practitioner who is licensed in this
1242 state and who is responsible for supervising the business
1243 activities of the entity and is legally responsible for the
1244 entity’s compliance with state law for purposes of this part.
1245
1246 Notwithstanding this subsection, an entity shall be deemed a
1247 clinic and must be licensed under this part in order to receive
1248 reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
1249 627.730-627.7405, unless exempted under s. 627.736(5)(h).
1250 Section 32. Paragraph (g) of subsection (1) and subsection
1251 (7) of section 400.9935, Florida Statutes, are amended to read:
1252 400.9935 Clinic responsibilities.—
1253 (1) Each clinic shall appoint a medical director or clinic
1254 director who shall agree in writing to accept legal
1255 responsibility for the following activities on behalf of the
1256 clinic. The medical director or the clinic director shall:
1257 (g) Conduct systematic reviews of clinic billings to ensure
1258 that the billings are not fraudulent or unlawful. Upon discovery
1259 of an unlawful charge, the medical director or clinic director
1260 shall take immediate corrective action. If the clinic performs
1261 only the technical component of magnetic resonance imaging,
1262 static radiographs, computed tomography, or positron emission
1263 tomography, and provides the professional interpretation of such
1264 services, in a fixed facility that is accredited by the Joint
1265 Commission, the American Osteopathic Association/Healthcare
1266 Facilities Accreditation Program, on Accreditation of Healthcare
1267 Organizations or the Accreditation Association for Ambulatory
1268 Health Care, Inc., or a national accrediting organization that
1269 is approved by the Centers for Medicare and Medicaid Services
1270 and whose standards incorporate comparable licensure regulations
1271 required by the state; and the American College of Radiology;
1272 and if, in the preceding quarter, the percentage of scans
1273 performed by that clinic which was billed to all personal injury
1274 protection insurance carriers was less than 15 percent, the
1275 chief financial officer of the clinic may, in a written
1276 acknowledgment provided to the agency, assume the responsibility
1277 for the conduct of the systematic reviews of clinic billings to
1278 ensure that the billings are not fraudulent or unlawful.
1279 (7)(a) Each clinic engaged in magnetic resonance imaging
1280 services must be accredited by the Joint Commission, the
1281 American Osteopathic Association/Healthcare Facilities
1282 Accreditation Program, a national accrediting organization that
1283 is approved by the Centers for Medicare and Medicaid Services
1284 and whose standards incorporate comparable licensure regulations
1285 required by the state on Accreditation of Healthcare
1286 Organizations, the American College of Radiology, or the
1287 Accreditation Association for Ambulatory Health Care, Inc.,
1288 within 1 year after licensure. A clinic that is accredited by
1289 the American College of Radiology or that is within the original
1290 1-year period after licensure and replaces its core magnetic
1291 resonance imaging equipment shall be given 1 year after the date
1292 on which the equipment is replaced to attain accreditation.
1293 However, a clinic may request a single, 6-month extension if it
1294 provides evidence to the agency establishing that, for good
1295 cause shown, such clinic cannot be accredited within 1 year
1296 after licensure, and that such accreditation will be completed
1297 within the 6-month extension. After obtaining accreditation as
1298 required by this subsection, each such clinic must maintain
1299 accreditation as a condition of renewal of its license. A clinic
1300 that files a change of ownership application must comply with
1301 the original accreditation timeframe requirements of the
1302 transferor. The agency shall deny a change of ownership
1303 application if the clinic is not in compliance with the
1304 accreditation requirements. When a clinic adds, replaces, or
1305 modifies magnetic resonance imaging equipment and the
1306 accrediting accreditation agency requires new accreditation, the
1307 clinic must be accredited within 1 year after the date of the
1308 addition, replacement, or modification but may request a single,
1309 6-month extension if the clinic provides evidence of good cause
1310 to the agency.
1311 (b) The agency may deny the application or revoke the
1312 license of an any entity formed for the purpose of avoiding
1313 compliance with the accreditation provisions of this subsection
1314 and whose principals were previously principals of an entity
1315 that was unable to meet the accreditation requirements within
1316 the specified timeframes. The agency may adopt rules as to the
1317 accreditation of magnetic resonance imaging clinics.
1318 Section 33. Sections 400.9970 through 400.9984, Florida
1319 Statutes, are designated as part XI of chapter 400, Florida
1320 Statutes, entitled “Transitional Living Facilities.”
1321 Section 34. Section 400.9970, Florida Statutes, is created
1322 to read:
1323 400.9970 Legislative intent.—It is the intent of the
1324 Legislature to provide for the licensure of transitional living
1325 facilities and require the development, establishment, and
1326 enforcement of basic standards by the Agency for Health Care
1327 Administration to ensure quality of care and services to clients
1328 in transitional living facilities. It is the policy of the state
1329 that the least restrictive appropriate available treatment be
1330 used based on the individual needs and best interest of the
1331 client and consistent with optimum improvement of the client’s
1332 condition. The goal of a transitional living program for
1333 individuals who have brain or spinal cord injuries is to assist
1334 each individual who has such an injury to achieve a higher level
1335 of independent functioning and to enable that individual to
1336 reenter the community. It is also the policy of this state that
1337 the use of restraints and seclusion of clients is justified only
1338 as an emergency safety measure to be used in response to danger
1339 to the client or others. It is, therefore, the intent of the
1340 Legislature to achieve an ongoing reduction in the use of
1341 restraints and seclusion in programs and facilities that serve
1342 persons who have brain injury or spinal cord injuries.
1343 Section 35. Section 400.9971, Florida Statutes, is created
1344 to read:
1345 400.9971 Definitions.—As used in this part, the term:
1346 (1) “Agency” means the Agency for Health Care
1347 Administration.
1348 (2) “Chemical restraint” means a pharmacologic drug that
1349 physically limits, restricts, or deprives an individual of
1350 movement or mobility, is used for client protection or safety,
1351 and is not required for the treatment of medical conditions or
1352 symptoms.
1353 (3) “Client’s representative” means the parent of a child
1354 client or the client’s guardian, designated representative or
1355 designee, surrogate, or attorney in fact.
1356 (4) “Department” means the Department of Health.
1357 (5) “Physical restraint” means any manual method to
1358 restrict freedom of movement of or normal access to an
1359 individual’s body or a physical or mechanical device, material,
1360 or equipment attached or adjacent to the individual’s body so
1361 that he or she cannot easily remove the restraint and which
1362 restricts freedom of movement of or normal access to one’s body,
1363 including, but not limited to, a half-bed rail, a full-bed rail,
1364 a geriatric chair, and a posey restraint. The term includes any
1365 device that was not specifically manufactured as a restraint but
1366 that has been altered, arranged, or otherwise used for this
1367 purpose. The term does not include bandage material used for the
1368 purpose of binding a wound or injury.
1369 (6) “Seclusion” means the physical segregation of a person
1370 in any fashion or the involuntary isolation of a person in a
1371 room or area from which the person is prevented from leaving.
1372 The prevention may be by physical barrier or by a staff member
1373 who is acting in a manner, or who is physically situated, so as
1374 to prevent the person from leaving the room or area. For
1375 purposes of this chapter, the term does not mean isolation due
1376 to a person’s medical condition or symptoms.
1377 (7) “Transitional living facility” means a site where
1378 specialized health care services are provided, including, but
1379 not limited to, rehabilitative services, behavior modification,
1380 community reentry training, aids for independent living, and
1381 counseling to individuals who have brain injuries or spinal cord
1382 injuries. The term does not require a provider that is licensed
1383 by the agency to obtain a separate transitional living facility
1384 license to serve persons who have brain injuries or spinal cord
1385 injuries as long as the services provided are within the scope
1386 of the provider’s license.
1387 Section 36. Section 400.9972, Florida Statutes, is created
1388 to read:
1389 400.9972 License required; fee; application.—
1390 (1) The requirements of part II of chapter 408 apply to the
1391 provision of services that require licensure pursuant to this
1392 part and part II of chapter 408 and to entities licensed by or
1393 applying for such licensure from the agency pursuant to this
1394 part. A license issued by the agency is required for the
1395 operation of a transitional living facility in this state. Every
1396 transitional living facility licensed under s. 400.805 on or
1397 before July 1, 2013, shall be granted a license under the
1398 provisions of part XI of chapter 400.
1399 (2) In accordance with this part, an applicant or a
1400 licensee shall pay a fee for each license application submitted
1401 under this part. The license fee shall consist of a $4,588
1402 license fee and a $90 per-bed fee per biennium and shall conform
1403 to the annual adjustment authorized in s. 408.805.
1404 (3) Each applicant for licensure must provide the
1405 following:
1406 (a) The location of the facility for which a license is
1407 sought and documentation, signed by the appropriate local
1408 government official, which states that the applicant has met
1409 local zoning requirements.
1410 (b) Proof of liability insurance as provided in s. 624.605.
1411 (c) Proof of compliance with local zoning requirements,
1412 including compliance with the requirements of chapter 419 if the
1413 proposed facility is a community residential home.
1414 (d) Proof that the facility has received a satisfactory
1415 firesafety inspection.
1416 (e) Documentation of a satisfactory sanitation inspection
1417 of the facility by the county health department.
1418
1419 The applicant’s proposed facility must attain and continuously
1420 maintain accreditation by an accrediting organization
1421 specializing in evaluating rehabilitation facilities whose
1422 standards incorporate comparable licensure regulations required
1423 by the state. An applicant for licensure as a transitional
1424 living facility must acquire accreditation within 12 months
1425 after the issuance of an initial license. The agency shall
1426 accept the accreditation survey report of the accrediting
1427 organization in lieu of conducting a licensure inspection if the
1428 standards included in the survey report are determined by the
1429 agency to document that the facility is in substantial
1430 compliance with state licensure requirements. The applicant
1431 shall submit to the agency within 10 days after receipt a copy
1432 of any accreditation survey report and evidence of the
1433 accreditation decision subsequent to a survey by the accrediting
1434 organization on the facility. This part does not preclude the
1435 agency from conducting periodic inspections of a transitional
1436 living facility to ensure compliance with all licensure
1437 requirements, and as it deems necessary to carry out the
1438 functions of the agency. An inspection may be conducted to
1439 ensure compliance with licensure requirements of this part, to
1440 validate the inspection process of accrediting organizations, to
1441 respond to licensure complaints, or to protect the public health
1442 and safety.
1443 Section 37. Section 400.9973, Florida Statutes, is created
1444 to read:
1445 400.9973 Client admission, transfer, and discharge.—
1446 (1) Each transitional living facility must have written
1447 policies and procedures governing the admission, transfer, and
1448 discharge of clients.
1449 (2) The admission of each client to a transitional living
1450 facility must be in accordance with the licensee’s policies and
1451 procedures.
1452 (3) A client admitted to a transitional living facility
1453 must have a brain or spinal cord injury, such as a lesion to the
1454 spinal cord or cauda equina syndrome, with evidence of
1455 significant involvement of two of the following deficits or
1456 dysfunctions:
1457 (a) A motor deficit.
1458 (b) A sensory deficit.
1459 (c) Bowel and bladder dysfunction.
1460 (d) An acquired internal or external injury to the skull,
1461 the brain, or the brain’s covering, whether caused by a
1462 traumatic or nontraumatic event, which produces an altered state
1463 of consciousness or an anatomic motor, sensory, cognitive, or
1464 behavioral deficit.
1465 (4) A client whose medical condition and diagnosis do not
1466 positively identify a cause of the client’s condition, whose
1467 symptoms are inconsistent with the known cause of injury, or
1468 whose recovery is inconsistent with the known medical condition
1469 may be admitted to a transitional living facility for evaluation
1470 for a period not to exceed 90 days.
1471 (5) A client admitted to a transitional living facility
1472 must be admitted upon prescription by a licensed physician and
1473 must remain under the care of a licensed physician for the
1474 duration of the client’s stay in the facility.
1475 (6) A transitional living facility may not admit a client
1476 whose primary admitting diagnosis is mental illness or an
1477 intellectual or a developmental disability.
1478 (7) An individual may not be admitted to a transitional
1479 living facility if the individual:
1480 (a) Presents significant risk of infection to other clients
1481 or personnel. A health care practitioner must provide
1482 documentation that the individual is free of apparent signs and
1483 symptoms of communicable disease;
1484 (b) Is a danger to self or others as determined by a
1485 physician or mental health practitioner licensed under chapter
1486 490 or chapter 491, unless the facility provides adequate
1487 staffing and support to ensure patient safety;
1488 (c) Is bedridden; or
1489 (d) Requires 24-hour nursing supervision.
1490 (8) If the client meets the admission criteria, the medical
1491 or nursing director of the facility must complete an initial
1492 evaluation of the client’s functional skills, behavioral status,
1493 cognitive status, educational or vocational potential, medical
1494 status, psychosocial status, sensorimotor capacity, and other
1495 related skills and abilities within the first 72 hours after the
1496 client’s admission to the facility. An initial comprehensive
1497 treatment plan that delineates services to be provided and
1498 appropriate sources for such services must be implemented within
1499 the first 4 days after admission.
1500 (9) Each transitional living facility shall develop a
1501 discharge plan for each client before or upon admission to the
1502 facility. The discharge plan must identify the intended
1503 discharge site and possible alternative discharge sites. For
1504 each discharge site identified, the discharge plan must identify
1505 the skills, behaviors, and other conditions that the client must
1506 achieve to be appropriate for discharge. Discharge plans must be
1507 reviewed and updated as necessary, but no less often than once
1508 monthly.
1509 (10) As soon as practicable, a transitional living facility
1510 shall discharge a client when he or she no longer requires any
1511 of the specialized services described in s. 400.9971(7) or is
1512 not making measurable progress in accordance with his or her
1513 comprehensive treatment plan, or if the transitional living
1514 facility is no longer the most appropriate, least restrictive
1515 treatment option.
1516 (11) Each transitional living facility shall provide at
1517 least 30 days’ notice to clients of transfer or discharge plans,
1518 including the location of an acceptable transfer location if the
1519 client is unable to live independently. This requirement does
1520 not apply if a client voluntarily terminates residency.
1521 Section 38. Section 400.9974, Florida Statutes, is created
1522 to read:
1523 400.9974 Client comprehensive treatment plans; client
1524 services.—
1525 (1) Each transitional living facility shall develop a
1526 comprehensive treatment plan for each client as soon as
1527 possible, but no later than 30 days following development of the
1528 initial comprehensive treatment plan. Comprehensive treatment
1529 plans must be reviewed and updated if the client fails to meet
1530 projected improvements in the plan or if a significant change in
1531 the client’s condition occurs. Comprehensive treatment plans
1532 must be reviewed and updated at least once monthly.
1533 Comprehensive treatment plans must be developed by an
1534 interdisciplinary team consisting of the case manager, the
1535 program director, the nurse, and appropriate therapists. The
1536 client or, if appropriate, the client’s representative must be
1537 included in developing the comprehensive treatment plan.
1538 (2) The comprehensive treatment plan must include the
1539 following:
1540 (a) The physician’s orders and the client’s diagnosis,
1541 medical history, physical examination, and rehabilitative or
1542 restorative needs.
1543 (b) A preliminary nursing evaluation with physician’s
1544 orders for immediate care, completed on admission.
1545 (c) A comprehensive, accurate, reproducible, and
1546 standardized assessment of the client’s functional capability;
1547 the treatments designed to achieve skills, behaviors, and other
1548 conditions necessary to return to the community; and specific
1549 measurable goals.
1550 (d) Steps necessary for the client to achieve transition to
1551 the community and estimated length of time to achieve the goals.
1552 (3) The client or, if appropriate, the client’s
1553 representative must consent to the continued treatment at the
1554 transitional living facility. Consent may be for a period of up
1555 to 3 months. If such consent is not given, the transitional
1556 living facility shall discharge the client as soon as
1557 practicable.
1558 (4) Each client must receive the professional program
1559 services needed to implement the client’s comprehensive
1560 treatment plan.
1561 (5) The licensee must employ qualified professional staff
1562 to carry out and monitor the various professional interventions
1563 in accordance with the stated goals and objectives of every
1564 client’s comprehensive treatment plan.
1565 (6) Each client must receive a continuous treatment program
1566 that includes appropriate, consistent implementation of a
1567 program of specialized and general training, treatment, health
1568 services, and related services and that is directed toward:
1569 (a) The acquisition of the behaviors and skills necessary
1570 for the client to function with as much self-determination and
1571 independence as possible;
1572 (b) The prevention or deceleration of regression or loss of
1573 current optimal functional status; and
1574 (c) The management of behavioral issues that preclude
1575 independent functioning in the community.
1576 Section 39. Section 400.9975, Florida Statutes, is created
1577 to read:
1578 400.9975 Licensee responsibilities.—
1579 (1) The licensee shall ensure that each client:
1580 (a) Lives in a safe environment free from abuse, neglect,
1581 and exploitation.
1582 (b) Is treated with consideration and respect and with due
1583 recognition of personal dignity, individuality, and the need for
1584 privacy.
1585 (c) Retains and uses his or her own clothes and other
1586 personal property in his or her immediate living quarters, so as
1587 to maintain individuality and personal dignity, except when the
1588 licensee can demonstrate that such retention and use would be
1589 unsafe, impractical, or an infringement upon the rights of other
1590 clients.
1591 (d) Has unrestricted private communication, including
1592 receiving and sending unopened correspondence, access to a
1593 telephone, and visiting with any person of his or her choice.
1594 Upon request, the licensee shall make provisions to modify
1595 visiting hours for caregivers and guests. The facility shall
1596 restrict communication in accordance with any court order or
1597 written instruction of a client’s representative. Any
1598 restriction on a client’s communication for therapeutic reasons
1599 shall be documented and reviewed at least weekly and shall be
1600 removed as soon as it is no longer clinically indicated. The
1601 basis for the restriction shall be explained to the client and,
1602 if applicable, the client’s representative. The client shall
1603 nonetheless retain the right to call the abuse hotline, the
1604 agency, and Disability Rights Florida at any and all times.
1605 (e) Has the opportunity to participate in and benefits from
1606 community services and activities to achieve the highest
1607 possible level of independence, autonomy, and interaction within
1608 the community.
1609 (f) Has the opportunity to manage his or her financial
1610 affairs unless the client or, if applicable, the client’s
1611 representative authorizes the administrator of the facility to
1612 provide safekeeping for funds as provided in this part.
1613 (g) Has reasonable opportunity for regular exercise several
1614 times a week and to be outdoors at regular and frequent
1615 intervals except when prevented by inclement weather.
1616 (h) Has the opportunity to exercise civil and religious
1617 liberties, including the right to independent personal
1618 decisions. No religious belief or practice, including attendance
1619 at religious services, shall be imposed upon any client.
1620 (i) Has access to adequate and appropriate health care
1621 consistent with established and recognized standards within the
1622 community.
1623 (j) Has the ability to present grievances and recommend
1624 changes in policies, procedures, and services to the staff of
1625 the licensee, governing officials, or any other person without
1626 restraint, interference, coercion, discrimination, or reprisal.
1627 Each licensee shall establish a grievance procedure to
1628 facilitate a client’s ability to present grievances, including a
1629 system for investigating, tracking, managing, and responding to
1630 complaints by persons receiving services or individuals acting
1631 on their behalf, and an appeals process. This process must
1632 include access to Disability Rights Florida and other advocates
1633 and the right to be a member of, be active in, and associate
1634 with advocacy or special interest groups.
1635 (2) The licensee shall:
1636 (a) Promote participation of each client’s representative
1637 in the process of providing treatment to the client unless the
1638 representative’s participation is unobtainable or inappropriate.
1639 (b) Answer communications from each client’s family,
1640 guardians, and friends promptly and appropriately.
1641 (c) Promote visits by individuals with a relationship to
1642 the client at any reasonable hour, without requiring prior
1643 notice, or in any area of the facility which provides direct
1644 client care services to the client, consistent with the client’s
1645 and other clients’ privacy, unless the interdisciplinary team
1646 determines that such a visit would not be appropriate.
1647 (d) Promote leave from the facility for visits, trips, or
1648 vacations.
1649 (e) Promptly notify the client’s representative of any
1650 significant incidents or changes in the client’s condition,
1651 including, but not limited to, serious illness, accident, abuse,
1652 unauthorized absence, or death.
1653 (3) The administrator of a facility shall ensure that a
1654 written notice of licensee responsibilities is posted in a
1655 prominent place in each building where clients reside, and is
1656 read, or explained, to clients who cannot read. This notice must
1657 include the statewide toll-free telephone number for reporting
1658 complaints to the agency, must be provided to clients in a
1659 manner that is clearly legible, and must include the words: “To
1660 report a complaint regarding the services you receive, please
1661 call toll-free ...[telephone number]... or Disability Rights
1662 Florida ...[telephone number]...”; and the statewide toll-free
1663 telephone number for the central abuse hotline must be provided
1664 to clients in a manner that is clearly legible and must include
1665 the words: “To report abuse, neglect, or exploitation, please
1666 call toll-free ...[telephone number where complaints may be
1667 lodged]....” The licensee must ensure a client’s access to a
1668 telephone where telephone numbers required in this subsection
1669 are readily available to call the agency, central abuse hotline,
1670 or Disability Rights Florida.
1671 (4) A licensee or employee of a facility may not serve
1672 notice upon a client to leave the premises or take any other
1673 retaliatory action against any person solely due to the
1674 following:
1675 (a) The client or other person files an internal or
1676 external complaint or grievance regarding the facility.
1677 (b) The client or other person appears as a witness in any
1678 hearing inside or outside the facility.
1679 (5) Before or at the time of admission, the client and the
1680 client’s representative shall be provided with a copy of the
1681 licensee’s responsibilities as provided in this section,
1682 including grievance procedures and the telephone numbers
1683 provided in this section.
1684 (6) The licensee must develop and implement policies and
1685 procedures governing the release of any client information,
1686 including consent necessary from the client or the client’s
1687 representative.
1688 Section 40. Section 400.9976, Florida Statutes, is created
1689 to read:
1690 400.9976 Medication practices.—
1691 (1) An individual medication administration record must be
1692 maintained for each client. Each dose of medication, including a
1693 self-administered dose, shall be properly recorded in the
1694 client’s record. Each client who self-administers medication
1695 shall be given a pill organizer. Medication must be placed in
1696 the pill organizer by a nurse. A nurse shall document the date
1697 and time medication is placed into each client’s pill organizer.
1698 All medications must be administered in compliance with the
1699 physician’s orders.
1700 (2) If the interdisciplinary team determines that self
1701 administration of medications is an appropriate objective, and
1702 if the physician does not specify otherwise, a client must be
1703 taught to self-administer his or her medication without a staff
1704 person. This includes all forms of administration, including
1705 orally, via injection, and via suppository. The client’s
1706 physician must be informed of the interdisciplinary team’s
1707 decision that self-administration of medications is an objective
1708 for the client. A client may not self-administer medication
1709 until he or she demonstrates the competency to take the correct
1710 medication in the correct dosage at the correct time, to respond
1711 to missed doses, and to contact an appropriate person with
1712 questions.
1713 (3) Medication administration discrepancies and adverse
1714 drug reactions must be recorded and reported immediately to a
1715 physician.
1716 Section 41. Section 400.9977, Florida Statutes, is created
1717 to read:
1718 400.9977 Protection from abuse, neglect, mistreatment, and
1719 exploitation.—The licensee must develop and implement policies
1720 and procedures for the screening and training of employees; the
1721 protection of clients; and the prevention, identification,
1722 investigation, and reporting of abuse, neglect, and
1723 exploitation. This includes the licensee’s identification of
1724 clients whose personal histories render them at risk for abusing
1725 other clients, development of intervention strategies to prevent
1726 occurrences, monitoring for changes that would trigger abusive
1727 behavior, and reassessment of the interventions on a regular
1728 basis. A licensee shall implement procedures to:
1729 (1) Screen potential employees for a history of abuse,
1730 neglect, or mistreatment of clients. The screening shall include
1731 an attempt to obtain information from previous employers and
1732 current employers and verification with the appropriate
1733 licensing boards.
1734 (2) Train employees, through orientation and ongoing
1735 sessions, on issues related to abuse prohibition practices,
1736 including identification of abuse, neglect, mistreatment, and
1737 exploitation, appropriate interventions to deal with aggressive
1738 or catastrophic reactions of clients, the process to report
1739 allegations without fear of reprisal, and recognition of signs
1740 of frustration and stress that may lead to abuse.
1741 (3) Provide clients, families, and staff with information
1742 on how and to whom they may report concerns, incidents, and
1743 grievances without the fear of retribution and provide feedback
1744 regarding the concerns that have been expressed. A licensee must
1745 identify, correct, and intervene in situations in which abuse,
1746 neglect, mistreatment, or exploitation is likely to occur,
1747 including:
1748 (a) Evaluating the physical environment of the facility to
1749 identify characteristics that may make abuse or neglect more
1750 likely to occur, such as secluded areas.
1751 (b) Providing sufficient staff on each shift to meet the
1752 needs of the clients, and ensuring that the staff assigned have
1753 knowledge of the individual clients’ care needs. The licensee
1754 shall identify inappropriate behaviors of its staff, such as
1755 using derogatory language, rough handling, ignoring clients
1756 while giving care, and directing clients who need toileting
1757 assistance to urinate or defecate in their beds.
1758 (c) Assessing, planning care for, and monitoring clients
1759 with needs and behaviors that might lead to conflict or neglect,
1760 such as clients with a history of aggressive behaviors, clients
1761 who have behaviors such as entering other clients’ rooms,
1762 clients with self-injurious behaviors, clients with
1763 communication disorders, and clients who require heavy nursing
1764 care or are totally dependent on staff.
1765 (4) Identify events, such as suspicious bruising of
1766 clients, occurrences, patterns, and trends that may constitute
1767 abuse and determine the direction of the investigation.
1768 (5) Investigate different types of incidents, identify the
1769 staff member responsible for the initial reporting, investigate
1770 alleged violations, and report results to the proper
1771 authorities. The licensee must analyze the occurrences to
1772 determine what changes are needed, if any, to policies and
1773 procedures to prevent further occurrences and to take all
1774 necessary corrective action depending on the results of the
1775 investigation.
1776 (6) Protect clients from harm during an investigation.
1777 (7) Report all alleged violations and all substantiated
1778 incidents, as required under chapters 39 and 415, to the
1779 licensing authorities and all other agencies as required, and to
1780 report any knowledge it has of any actions by a court of law
1781 that would indicate an employee is unfit for service.
1782 Section 42. Section 400.9978, Florida Statutes, is created
1783 to read:
1784 400.9978 Restraints and seclusion; client safety.—
1785 (1) Each facility shall provide a therapeutic milieu that
1786 supports a culture of individual empowerment and responsibility.
1787 The health and safety of the client shall be the primary concern
1788 at all times.
1789 (2) The use of physical restraints must be ordered and
1790 documented by a physician and must be consistent with policies
1791 and procedures adopted by the facility. The client or, if
1792 applicable, the client’s representative must be informed of the
1793 facility’s physical restraint policies and procedures at the
1794 time of the client’s admission.
1795 (3) The use of chemical restraints is limited to prescribed
1796 dosages of medications as ordered by a physician and must be
1797 consistent with the client’s diagnosis and the policies and
1798 procedures adopted by the facility. The client and, if
1799 applicable, the client’s representative must be informed of the
1800 facility’s chemical restraint policies and procedures at the
1801 time of the client’s admission.
1802 (4) Based on a physician’s assessment, if a client exhibits
1803 symptoms that present an immediate risk of injury or death to
1804 self or others, a physician may issue an emergency treatment
1805 order to immediately administer rapid response psychotropic
1806 medications or other chemical restraints. Each emergency
1807 treatment order must be documented and maintained in the
1808 client’s record.
1809 (a) An emergency treatment order is effective for no more
1810 than 24 hours.
1811 (b) Whenever a client is medicated in accordance with this
1812 subsection, the client’s representative or responsible party and
1813 the client’s physician must be notified as soon as practicable.
1814 (5) A client who is prescribed and receiving a medication
1815 that can serve as a chemical restraint for a purpose other than
1816 an emergency treatment order must be evaluated by his or her
1817 physician at least monthly to assess the following:
1818 (a) The continued need for the medication.
1819 (b) The level of the medication in the client’s blood, as
1820 appropriate.
1821 (c) The need for adjustments in the prescription.
1822 (6) The licensee shall ensure that clients are free from
1823 unnecessary drugs and physical restraints and are provided
1824 treatment to reduce dependency on drugs and physical restraints.
1825 (7) The licensee may use physical restraints and seclusion
1826 only as authorized by the facility’s written physical restraint
1827 and seclusion policies, which must be in compliance with this
1828 section and applicable rules.
1829 (8) Interventions to manage dangerous client behavior must
1830 be employed with sufficient safeguards and supervision to ensure
1831 that the safety, welfare, and civil and human rights of each
1832 client are adequately protected.
1833 (9) A facility shall notify the parent or guardian of a
1834 client each time restraint or seclusion is used. Such
1835 notification must be within 24 hours from the time the restraint
1836 or seclusion occurs. Reasonable efforts must be taken to notify
1837 the parent or guardian by telephone or e-mail, or both, and
1838 these efforts must be documented.
1839 (10) The agency may adopt by rule standards and procedures
1840 relating to the use of restraints, restraint positioning,
1841 seclusion, and emergency treatment orders for psychotropic
1842 medications, restraint, and seclusion. These rules must include
1843 duration of restraint use, staff training, client observation
1844 during restraint, and documentation and reporting standards.
1845 Section 43. Section 400.9979, Florida Statutes, is created
1846 to read:
1847 400.9979 Background screening; administration and
1848 management.—
1849 (1) The agency shall require level 2 background screening
1850 for personnel as required in s. 408.809(1)(e) pursuant to s.
1851 408.809 and chapter 435.
1852 (2) The licensee shall maintain personnel records for each
1853 staff member which contain, at a minimum, documentation of
1854 background screening, if applicable, a job description,
1855 documentation of compliance with all training requirements of
1856 this part or applicable rule, the employment application,
1857 references, a copy of all job performance evaluations, and, for
1858 each staff member who performs services for which licensure or
1859 certification is required, a copy of all licenses or
1860 certification held by the staff member.
1861 (3) The licensee must:
1862 (a) Develop and implement infection control policies and
1863 procedures and include such policies and procedures in the
1864 licensee’s policy manual.
1865 (b) Maintain liability insurance as defined in s. 624.605.
1866 (c) Designate one person as an administrator who is
1867 responsible and accountable for the overall management of the
1868 facility.
1869 (d) Designate a person in writing to be responsible for the
1870 facility when the administrator is absent from the facility for
1871 more than 24 hours.
1872 (e) Designate in writing a program director who is
1873 responsible for supervising the therapeutic and behavioral staff
1874 and who determines the levels of supervision and the room
1875 placement for each client.
1876 (f) Designate in writing a person to be responsible when
1877 the program director is absent from the facility for more than
1878 24 hours.
1879 (g) Obtain approval of the comprehensive emergency
1880 management plan, pursuant to s. 400.9981(2)(e), from the local
1881 emergency management agency. Pending the approval of the plan,
1882 the local emergency management agency shall ensure that the
1883 following agencies, at a minimum, are given the opportunity to
1884 review the plan: the Department of Health, the Agency for Health
1885 Care Administration, and the Division of Emergency Management.
1886 Appropriate volunteer organizations must also be given the
1887 opportunity to review the plan. The local emergency management
1888 agency shall complete its review within 60 days and either
1889 approve the plan or advise the licensee of necessary revisions.
1890 (h) Maintain written records in a form and system that
1891 comply with medical and business practices and make such records
1892 available in the facility for review or submission to the agency
1893 upon request. The records shall include:
1894 1. A daily census record that indicates the number of
1895 clients currently receiving services in the facility, including
1896 information regarding any public funding of such clients.
1897 2. A record of all accidents or unusual incidents involving
1898 any client or staff member which caused, or had the potential to
1899 cause, injury or harm to any person or property within the
1900 facility. Such records must contain a clear description of each
1901 accident or incident, the names of the persons involved, a
1902 description of all medical or other services provided to these
1903 persons specifying who provided such services, and the steps
1904 taken to prevent recurrence of such accidents or incidents.
1905 3. A copy of current agreements with third-party providers.
1906 4. A copy of current agreements with each consultant
1907 employed by the licensee and documentation of each consultant’s
1908 visits and required written, dated reports.
1909 Section 44. Section 400.9980, Florida Statutes, is created
1910 to read:
1911 400.9980 Property and personal affairs of clients.—
1912 (1) A client shall be given the option of using his or her
1913 own belongings, as space permits; choosing his or her roommate
1914 if practical and not clinically contraindicated; and, whenever
1915 possible, unless the client is adjudicated incompetent or
1916 incapacitated under state law, managing his or her own affairs.
1917 (2) The admission of a client to a facility and his or her
1918 presence therein shall not confer on a licensee, administrator,
1919 employee, or representative thereof any authority to manage,
1920 use, or dispose of any property of the client, nor shall such
1921 admission or presence confer on any of such persons any
1922 authority or responsibility for the personal affairs of the
1923 client except that which may be necessary for the safe
1924 management of the facility or for the safety of the client.
1925 (3) A licensee, administrator, employee, or representative
1926 thereof may:
1927 (a) Not act as the guardian, trustee, or conservator for
1928 any client or any of such client’s property.
1929 (b) Act as a competent client’s payee for social security,
1930 veteran’s, or railroad benefits if the client provides consent
1931 and the licensee files a surety bond with the agency in an
1932 amount equal to twice the average monthly aggregate income or
1933 personal funds due to the client, or expendable for the client’s
1934 account, which are received by a licensee.
1935 (c) Act as the power of attorney for a client if the
1936 licensee has filed a surety bond with the agency in an amount
1937 equal to twice the average monthly income of the client, plus
1938 the value of any client’s property under the control of the
1939 attorney in fact.
1940
1941 The bond under paragraph (b) or paragraph (c) shall be executed
1942 by the licensee as principal and a licensed surety company. The
1943 bond shall be conditioned upon the faithful compliance of the
1944 licensee with the requirements of licensure and shall be payable
1945 to the agency for the benefit of any client who suffers a
1946 financial loss as a result of the misuse or misappropriation of
1947 funds held pursuant to this subsection. Any surety company that
1948 cancels or does not renew the bond of any licensee shall notify
1949 the agency in writing not less than 30 days in advance of such
1950 action, giving the reason for the cancellation or nonrenewal.
1951 Any licensee, administrator, employee, or representative thereof
1952 who is granted power of attorney for any client of the facility
1953 shall, on a monthly basis, notify the client in writing of any
1954 transaction made on behalf of the client pursuant to this
1955 subsection, and a copy of such notification given to the client
1956 shall be retained in each client’s file and available for agency
1957 inspection.
1958 (4) A licensee, upon mutual consent with the client, shall
1959 provide for the safekeeping in the facility of the client’s
1960 personal effects of a value not in excess of $1,000 and the
1961 client’s funds not in excess of $500 cash and shall keep
1962 complete and accurate records of all such funds and personal
1963 effects received. If a client is absent from a facility for 24
1964 hours or more, the licensee may provide for the safekeeping of
1965 the client’s personal effects of a value in excess of $1,000.
1966 (5) Any funds or other property belonging to or due to a
1967 client or expendable for his or her account which is received by
1968 a licensee shall be trust funds and shall be kept separate from
1969 the funds and property of the licensee and other clients or
1970 shall be specifically credited to such client. Such trust funds
1971 shall be used or otherwise expended only for the account of the
1972 client. At least once every month, unless upon order of a court
1973 of competent jurisdiction, the licensee shall furnish the client
1974 and the client’s representative a complete and verified
1975 statement of all funds and other property to which this
1976 subsection applies, detailing the amount and items received,
1977 together with their sources and disposition. In any event, the
1978 licensee shall furnish such statement annually and upon the
1979 discharge or transfer of a client. Any governmental agency or
1980 private charitable agency contributing funds or other property
1981 to the account of a client shall also be entitled to receive
1982 such statement monthly and upon the discharge or transfer of the
1983 client.
1984 (6)(a) In addition to any damages or civil penalties to
1985 which a person is subject, any person who:
1986 1. Intentionally withholds a client’s personal funds,
1987 personal property, or personal needs allowance, or who demands,
1988 beneficially receives, or contracts for payment of all or any
1989 part of a client’s personal property or personal needs allowance
1990 in satisfaction of the facility rate for supplies and services;
1991 or
1992 2. Borrows from or pledges any personal funds of a client,
1993 other than the amount agreed to by written contract under s.
1994 429.24,
1995
1996 commits a misdemeanor of the first degree, punishable as
1997 provided in s. 775.082 or s. 775.083.
1998 (b) Any licensee or any administrator, employee, or
1999 representative thereof who is granted power of attorney for any
2000 client of the facility and who misuses or misappropriates funds
2001 obtained through this power commits a felony of the third
2002 degree, punishable as provided in s. 775.082, s. 775.083, or s.
2003 775.084.
2004 (7) In the event of the death of a client, a licensee shall
2005 return all refunds, funds, and property held in trust to the
2006 client’s personal representative, if one has been appointed at
2007 the time the licensee disburses such funds, or, if not, to the
2008 client’s spouse or adult next of kin named in a beneficiary
2009 designation form provided by the licensee to the client. If the
2010 client has no spouse or adult next of kin or such person cannot
2011 be located, funds due the client shall be placed in an interest
2012 bearing account and all property held in trust by the licensee
2013 shall be safeguarded until such time as the funds and property
2014 are disbursed pursuant to the Florida Probate Code. Such funds
2015 shall be kept separate from the funds and property of the
2016 licensee and other clients of the facility. If the funds of the
2017 deceased client are not disbursed pursuant to the Florida
2018 Probate Code within 2 years after the client’s death, the funds
2019 shall be deposited in the Health Care Trust Fund administered by
2020 the agency.
2021 (8) The agency, by rule, may clarify terms and specify
2022 procedures and documentation necessary to administer the
2023 provisions of this section relating to the proper management of
2024 clients’ funds and personal property and the execution of surety
2025 bonds.
2026 Section 45. Section 400.9981, Florida Statutes, is created
2027 to read:
2028 400.9981 Rules establishing standards.—
2029 (1) It is the intent of the Legislature that rules
2030 published and enforced pursuant to this part and part II of
2031 chapter 408 include criteria to ensure reasonable and consistent
2032 quality of care and client safety. Rules should make reasonable
2033 efforts to accommodate the needs and preferences of clients to
2034 enhance the quality of life in transitional living facilities.
2035 (2) The agency may adopt and enforce rules to implement
2036 this part and part II of chapter 408, which shall include
2037 reasonable and fair criteria in relation to the following:
2038 (a) The location of transitional living facilities.
2039 (b) The number of qualifications of all personnel,
2040 including management, medical, nursing, and other professional
2041 personnel and nursing assistants and support personnel having
2042 responsibility for any part of the care given to clients. The
2043 licensee must have enough qualified professional staff available
2044 to carry out and monitor the various professional interventions
2045 in accordance with the stated goals and objectives of each
2046 comprehensive treatment plan.
2047 (c) Requirements for personnel procedures, reporting
2048 procedures, and documentation necessary to implement this part.
2049 (d) Services provided to clients of transitional living
2050 facilities.
2051 (e) The preparation and annual update of a comprehensive
2052 emergency management plan in consultation with the Division of
2053 Emergency Management. At a minimum, the rules must provide for
2054 plan components that address emergency evacuation
2055 transportation; adequate sheltering arrangements; postdisaster
2056 activities, including provision of emergency power, food, and
2057 water; postdisaster transportation; supplies; staffing;
2058 emergency equipment; individual identification of clients and
2059 transfer of records; communication with families; and responses
2060 to family inquiries.
2061 Section 46. Section 400.9982, Florida Statutes, is created
2062 to read:
2063 400.9982 Violations; penalties.—
2064 (1) Each violation of this part and rules adopted pursuant
2065 thereto shall be classified according to the nature of the
2066 violation and the gravity of its probable effect on facility
2067 clients. The agency shall indicate the classification on the
2068 written notice of the violation as follows:
2069 (a) Class “I” violations are defined in s. 408.813. The
2070 agency shall issue a citation regardless of correction and
2071 impose an administrative fine of $5,000 for an isolated
2072 violation, $7,500 for a patterned violation, and $10,000 for a
2073 widespread violation. Violations may be identified and a fine
2074 must be levied notwithstanding the correction of the deficiency
2075 giving rise to the violation.
2076 (b) Class “II” violations are defined in s. 408.813. The
2077 agency shall impose an administrative fine of $1,000 for an
2078 isolated violation, $2,500 for a patterned violation, and $5,000
2079 for a widespread violation. A fine must be levied
2080 notwithstanding the correction of the deficiency giving rise to
2081 the violation.
2082 (c) Class “III” violations are defined in s. 408.813. The
2083 agency shall impose an administrative fine of $500 for an
2084 isolated violation, $750 for a patterned violation, and $1,000
2085 for a widespread violation. If a deficiency giving rise to a
2086 class III violation is corrected within the time specified by
2087 the agency, a fine may not be imposed.
2088 (d) Class “IV” violations are defined in s. 408.813. The
2089 agency shall impose an administrative fine for a cited class IV
2090 violation in an amount not less than $100 and not exceeding $200
2091 for each violation. If a deficiency giving rise to a class IV
2092 violation is corrected within the time specified by the agency,
2093 a fine may not be imposed.
2094 Section 47. Section 400.9983, Florida Statutes, is created
2095 to read:
2096 400.9983 Receivership proceedings.—The agency may apply s.
2097 429.22 with regard to receivership proceedings for transitional
2098 living facilities.
2099 Section 48. Section 400.9984, Florida Statutes, is created
2100 to read:
2101 400.9984 Interagency communication.—The agency, the
2102 department, the Agency for Persons with Disabilities, and the
2103 Department of Children and Families shall develop electronic
2104 systems to ensure that relevant information pertaining to the
2105 regulation of transitional living facilities and clients is
2106 timely and effectively communicated among agencies in order to
2107 facilitate the protection of clients. Electronic sharing of
2108 information shall include, at a minimum, a brain and spinal cord
2109 injury registry and a client abuse registry.
2110 Section 49. Subsections (1) and (2) of section 402.7306,
2111 Florida Statutes, are amended to read:
2112 402.7306 Administrative monitoring of child welfare
2113 providers, and administrative, licensure, and programmatic
2114 monitoring of mental health and substance abuse service
2115 providers.—The Department of Children and Family Services, the
2116 Department of Health, the Agency for Persons with Disabilities,
2117 the Agency for Health Care Administration, community-based care
2118 lead agencies, managing entities as defined in s. 394.9082, and
2119 agencies who have contracted with monitoring agents shall
2120 identify and implement changes that improve the efficiency of
2121 administrative monitoring of child welfare services, and the
2122 administrative, licensure, and programmatic monitoring of mental
2123 health and substance abuse service providers. For the purpose of
2124 this section, the term “mental health and substance abuse
2125 service provider” means a provider who provides services to this
2126 state’s priority population as defined in s. 394.674. To assist
2127 with that goal, each such agency shall adopt the following
2128 policies:
2129 (1) Limit administrative monitoring to once every 3 years
2130 if the child welfare provider is accredited by the Joint
2131 Commission, a national accrediting organization that is approved
2132 by the Centers for Medicare and Medicaid Services and whose
2133 standards incorporate comparable licensure regulations required
2134 by the state, CARF International the Commission on Accreditation
2135 of Rehabilitation Facilities, or the Council on Accreditation.
2136 If the accrediting body does not require documentation that the
2137 state agency requires, that documentation shall be requested by
2138 the state agency and may be posted by the service provider on
2139 the data warehouse for the agency’s review. Notwithstanding the
2140 survey or inspection of an accrediting organization specified in
2141 this subsection, an agency specified in and subject to this
2142 section may continue to monitor the service provider as
2143 necessary with respect to:
2144 (a) Ensuring that services for which the agency is paying
2145 are being provided.
2146 (b) Investigating complaints or suspected problems and
2147 monitoring the service provider’s compliance with any resulting
2148 negotiated terms and conditions, including provisions relating
2149 to consent decrees that are unique to a specific service and are
2150 not statements of general applicability.
2151 (c) Ensuring compliance with federal and state laws,
2152 federal regulations, or state rules if such monitoring does not
2153 duplicate the accrediting organization’s review pursuant to
2154 accreditation standards.
2155
2156 Medicaid certification and precertification reviews are exempt
2157 from this subsection to ensure Medicaid compliance.
2158 (2) Limit administrative, licensure, and programmatic
2159 monitoring to once every 3 years if the mental health or
2160 substance abuse service provider is accredited by the Joint
2161 Commission, the American Osteopathic Association/Healthcare
2162 Facilities Accreditation Program, a national accrediting
2163 organization that is approved by the Centers for Medicare and
2164 Medicaid Services and whose standards incorporate comparable
2165 licensure regulations required by the state, CARF International
2166 the Commission on Accreditation of Rehabilitation Facilities, or
2167 the Council on Accreditation. If the services being monitored
2168 are not the services for which the provider is accredited, the
2169 limitations of this subsection do not apply. If the accrediting
2170 body does not require documentation that the state agency
2171 requires, that documentation, except documentation relating to
2172 licensure applications and fees, must be requested by the state
2173 agency and may be posted by the service provider on the data
2174 warehouse for the agency’s review. Notwithstanding the survey or
2175 inspection of an accrediting organization specified in this
2176 subsection, an agency specified in and subject to this section
2177 may continue to monitor the service provider as necessary with
2178 respect to:
2179 (a) Ensuring that services for which the agency is paying
2180 are being provided.
2181 (b) Investigating complaints, identifying problems that
2182 would affect the safety or viability of the service provider,
2183 and monitoring the service provider’s compliance with any
2184 resulting negotiated terms and conditions, including provisions
2185 relating to consent decrees that are unique to a specific
2186 service and are not statements of general applicability.
2187 (c) Ensuring compliance with federal and state laws,
2188 federal regulations, or state rules if such monitoring does not
2189 duplicate the accrediting organization’s review pursuant to
2190 accreditation standards.
2191
2192 Federal certification and precertification reviews are exempt
2193 from this subsection to ensure Medicaid compliance.
2194 Section 50. Subsection (4) of section 408.061, Florida
2195 Statutes, is amended to read:
2196 408.061 Data collection; uniform systems of financial
2197 reporting; information relating to physician charges;
2198 confidential information; immunity.—
2199 (4) Within 120 days after the end of its fiscal year, each
2200 health care facility, excluding continuing care facilities,
2201 hospitals operated by state agencies, and nursing homes as
2202 defined in s. 408.07(14) and (37), shall file with the agency,
2203 on forms adopted by the agency and based on the uniform system
2204 of financial reporting, its actual financial experience for that
2205 fiscal year, including expenditures, revenues, and statistical
2206 measures. Such data may be based on internal financial reports
2207 which are certified to be complete and accurate by the provider.
2208 However, hospitals’ actual financial experience shall be their
2209 audited actual experience. Every nursing home shall submit to
2210 the agency, in a format designated by the agency, a statistical
2211 profile of the nursing home residents. The agency, in
2212 conjunction with the Department of Elderly Affairs and the
2213 Department of Health, shall review these statistical profiles
2214 and develop recommendations for the types of residents who might
2215 more appropriately be placed in their homes or other
2216 noninstitutional settings.
2217 Section 51. Subsection (4) of section 408.20, Florida
2218 Statutes, is amended to read:
2219 408.20 Assessments; Health Care Trust Fund.—
2220 (4) Hospitals operated by state agencies the Department of
2221 Children and Family Services, the Department of Health, or the
2222 Department of Corrections are exempt from the assessments
2223 required under this section.
2224 Section 52. Subsection (21) of section 408.802, Florida
2225 Statutes, is amended to read:
2226 408.802 Applicability.—The provisions of this part apply to
2227 the provision of services that require licensure as defined in
2228 this part and to the following entities licensed, registered, or
2229 certified by the agency, as described in chapters 112, 383, 390,
2230 394, 395, 400, 429, 440, 483, and 765:
2231 (21) Transitional living facilities, as provided under part
2232 XI V of chapter 400.
2233 Section 53. Subsection (4) of section 408.809, Florida
2234 Statutes, is amended to read:
2235 408.809 Background screening; prohibited offenses.—
2236 (4) In addition to the offenses listed in s. 435.04, all
2237 persons required to undergo background screening pursuant to
2238 this part or authorizing statutes must not have an arrest
2239 awaiting final disposition for, must not have been found guilty
2240 of, regardless of adjudication, or entered a plea of nolo
2241 contendere or guilty to, and must not have been adjudicated
2242 delinquent and the record not have been sealed or expunged for
2243 any of the following offenses or any similar offense of another
2244 jurisdiction:
2245 (a) Any authorizing statutes, if the offense was a felony.
2246 (b) This chapter, if the offense was a felony.
2247 (c) Section 409.920, relating to Medicaid provider fraud.
2248 (d) Section 409.9201, relating to Medicaid fraud.
2249 (e) Section 741.28, relating to domestic violence.
2250 (f) Section 777.04, relating to attempts, solicitation, and
2251 conspiracy to commit an offense listed in this subsection.
2252 (g)(f) Section 817.034, relating to fraudulent acts through
2253 mail, wire, radio, electromagnetic, photoelectronic, or
2254 photooptical systems.
2255 (h)(g) Section 817.234, relating to false and fraudulent
2256 insurance claims.
2257 (i) Section 817.481, relating to obtaining goods by using
2258 false, expired, etc., credit cards, if the offense was a felony.
2259 (j) Section 817.50, relating to fraudulently obtaining
2260 goods, services, etc., from a health care provider.
2261 (k)(h) Section 817.505, relating to patient brokering.
2262 (l)(i) Section 817.568, relating to criminal use of
2263 personal identification information.
2264 (m)(j) Section 817.60, relating to obtaining a credit card
2265 through fraudulent means.
2266 (n)(k) Section 817.61, relating to fraudulent use of credit
2267 cards, if the offense was a felony.
2268 (o)(l) Section 831.01, relating to forgery.
2269 (p)(m) Section 831.02, relating to uttering forged
2270 instruments.
2271 (q)(n) Section 831.07, relating to forging bank bills,
2272 checks, drafts, or promissory notes.
2273 (r)(o) Section 831.09, relating to uttering forged bank
2274 bills, checks, drafts, or promissory notes.
2275 (s)(p) Section 831.30, relating to fraud in obtaining
2276 medicinal drugs.
2277 (t)(q) Section 831.31, relating to the sale, manufacture,
2278 delivery, or possession with the intent to sell, manufacture, or
2279 deliver any counterfeit controlled substance, if the offense was
2280 a felony.
2281 (u) Section 895.03, relating to racketeering and illegal
2282 debts.
2283 (v) Section 896.101, relating to the Florida Money
2284 Laundering Act.
2285 Section 54. Subsection (20) of section 408.820, Florida
2286 Statutes, is amended to read:
2287 408.820 Exemptions.—Except as prescribed in authorizing
2288 statutes, the following exemptions shall apply to specified
2289 requirements of this part:
2290 (20) Transitional living facilities, as provided under part
2291 XI V of chapter 400, are exempt from s. 408.810(10).
2292 Section 55. Subsections (3) through (21) of section
2293 409.9122, Florida Statutes, are renumbered as subsection (4)
2294 through (22), paragraphs (l) and (m) of subsection (2) of that
2295 section are amended, and a new subsection (3) is added to that
2296 section, to read:
2297 409.9122 Mandatory Medicaid managed care enrollment;
2298 programs and procedures.—
2299 (2)
2300 (l) If the Medicaid recipient is diagnosed with HIV/AIDS,
2301 the agency shall assign the Medicaid recipient to a managed care
2302 plan that is a health maintenance organization authorized under
2303 chapter 641, is under contract with the agency on July 1, 2011,
2304 and which offers a delivery system through a university-based
2305 teaching and research-oriented organization that specializes in
2306 providing health care services and treatment for individuals
2307 diagnosed with HIV/AIDS.
2308 (l)(m) Notwithstanding the provisions of chapter 287, the
2309 agency may, at its discretion, renew cost-effective contracts
2310 for choice counseling services once or more for such periods as
2311 the agency may decide. However, all such renewals may not
2312 combine to exceed a total period longer than the term of the
2313 original contract.
2314
2315 This subsection expires October 1, 2014.
2316 (3) If the Medicaid recipient is diagnosed with HIV/AIDS,
2317 the agency shall assign the Medicaid recipient to a managed care
2318 plan that is a health maintenance organization authorized under
2319 chapter 641, is under contract with the agency as an HIV/AIDS
2320 specialty plan, and offers a delivery system through a
2321 university-based teaching and research-oriented organization
2322 that specializes in providing health care services and treatment
2323 for individuals diagnosed with HIV/AIDS.
2324 Section 56. Paragraph (a) of subsection (3) of section
2325 409.966, Florida Statutes, is amended to read:
2326 409.966 Eligible plans; selection.—
2327 (3) QUALITY SELECTION CRITERIA.—
2328 (a) The invitation to negotiate must specify the criteria
2329 and the relative weight of the criteria that will be used for
2330 determining the acceptability of the reply and guiding the
2331 selection of the organizations with which the agency negotiates.
2332 In addition to criteria established by the agency, the agency
2333 shall consider the following factors in the selection of
2334 eligible plans:
2335 1. Accreditation by the National Committee for Quality
2336 Assurance, the Joint Commission, the American Osteopathic
2337 Association/Healthcare Facilities Accreditation Program, a
2338 national accrediting organization that is approved by the
2339 Centers for Medicare and Medicaid Services and whose standards
2340 incorporate comparable licensure regulations required by the
2341 state, or another nationally recognized accrediting body.
2342 2. Experience serving similar populations, including the
2343 organization’s record in achieving specific quality standards
2344 with similar populations.
2345 3. Availability and accessibility of primary care and
2346 specialty physicians in the provider network.
2347 4. Establishment of community partnerships with providers
2348 that create opportunities for reinvestment in community-based
2349 services.
2350 5. Organization commitment to quality improvement and
2351 documentation of achievements in specific quality improvement
2352 projects, including active involvement by organization
2353 leadership.
2354 6. Provision of additional benefits, particularly dental
2355 care and disease management, and other initiatives that improve
2356 health outcomes.
2357 7. Evidence that an eligible plan has written agreements or
2358 signed contracts or has made substantial progress in
2359 establishing relationships with providers before the plan
2360 submitting a response.
2361 8. Comments submitted in writing by an any enrolled
2362 Medicaid provider relating to a specifically identified plan
2363 participating in the procurement in the same region as the
2364 submitting provider.
2365 9. Documentation of policies and procedures for preventing
2366 fraud and abuse.
2367 10. The business relationship an eligible plan has with
2368 another any other eligible plan that responds to the invitation
2369 to negotiate.
2370 Section 57. Paragraphs (c) and (e) of subsection (2) of
2371 section 409.967, Florida Statutes, are amended to read:
2372 409.967 Managed care plan accountability.—
2373 (2) The agency shall establish such contract requirements
2374 as are necessary for the operation of the statewide managed care
2375 program. In addition to any other provisions the agency may deem
2376 necessary, the contract must require:
2377 (c) Access.—
2378 1. The agency shall establish specific standards for the
2379 number, type, and regional distribution of providers in managed
2380 care plan networks to ensure access to care for both adults and
2381 children. Each plan must maintain a regionwide network of
2382 providers in sufficient numbers to meet the access standards for
2383 specific medical services for all recipients enrolled in the
2384 plan. The exclusive use of mail-order pharmacies may not be
2385 sufficient to meet network access standards. Consistent with the
2386 standards established by the agency, provider networks may
2387 include providers located outside the region. A plan may
2388 contract with a new hospital facility before the date the
2389 hospital becomes operational if the hospital has commenced
2390 construction, will be licensed and operational by January 1,
2391 2013, and a final order has issued in any civil or
2392 administrative challenge. Each plan shall establish and maintain
2393 an accurate and complete electronic database of contracted
2394 providers, including information about licensure or
2395 registration, locations and hours of operation, specialty
2396 credentials and other certifications, specific performance
2397 indicators, and such other information as the agency deems
2398 necessary. The database must be available online to both the
2399 agency and the public and have the capability to compare the
2400 availability of providers to network adequacy standards and to
2401 accept and display feedback from each provider’s patients. Each
2402 plan shall submit quarterly reports to the agency identifying
2403 the number of enrollees assigned to each primary care provider.
2404 2. Each managed care plan must publish any prescribed drug
2405 formulary or preferred drug list on the plan’s website in a
2406 manner that is accessible to and searchable by enrollees and
2407 providers. The plan must update the list within 24 hours after
2408 making a change. Each plan must ensure that the prior
2409 authorization process for prescribed drugs is readily accessible
2410 to health care providers, including posting appropriate contact
2411 information on its website and providing timely responses to
2412 providers. For Medicaid recipients diagnosed with hemophilia who
2413 have been prescribed anti-hemophilic-factor replacement
2414 products, the agency shall provide for those products and
2415 hemophilia overlay services through the agency’s hemophilia
2416 disease management program.
2417 3. Managed care plans, and their fiscal agents or
2418 intermediaries, must accept prior authorization requests for any
2419 service electronically.
2420 4. Managed care plans must permit an enrollee who was
2421 receiving a prescription drug and was on the plan’s formulary
2422 and subsequently removed or changed, to continue receiving that
2423 drug if the provider submits a written request demonstrating
2424 that the drug is medically necessary, and the enrollee meets
2425 clinical criteria to receive the drug.
2426 (e) Continuous improvement.—The agency shall establish
2427 specific performance standards and expected milestones or
2428 timelines for improving performance over the term of the
2429 contract.
2430 1. Each managed care plan shall establish an internal
2431 health care quality improvement system, including enrollee
2432 satisfaction and disenrollment surveys. The quality improvement
2433 system must include incentives and disincentives for network
2434 providers.
2435 2. Each plan must collect and report the Health Plan
2436 Employer Data and Information Set (HEDIS) measures, as specified
2437 by the agency. These measures must be published on the plan’s
2438 website in a manner that allows recipients to reliably compare
2439 the performance of plans. The agency shall use the HEDIS
2440 measures as a tool to monitor plan performance.
2441 3. Each managed care plan must be accredited by the
2442 National Committee for Quality Assurance, the Joint Commission,
2443 a national accrediting organization that is approved by the
2444 Centers for Medicare and Medicaid Services and whose standards
2445 incorporate comparable licensure regulations required by the
2446 state, or another nationally recognized accrediting body, or
2447 have initiated the accreditation process, within 1 year after
2448 the contract is executed. The agency shall suspend automatic
2449 assignment under ss. 409.977 and 409.984 for a any plan not
2450 accredited within 18 months after executing the contract, the
2451 agency shall suspend automatic assignment under s. 409.977 and
2452 409.984.
2453 4. By the end of the fourth year of the first contract
2454 term, the agency shall issue a request for information to
2455 determine whether cost savings could be achieved by contracting
2456 for plan oversight and monitoring, including analysis of
2457 encounter data, assessment of performance measures, and
2458 compliance with other contractual requirements.
2459 Section 58. Paragraphs (b) and (c) of subsection (3) of
2460 section 429.07, Florida Statutes, are amended to read:
2461 429.07 License required; fee.—
2462 (3) In addition to the requirements of s. 408.806, each
2463 license granted by the agency must state the type of care for
2464 which the license is granted. Licenses shall be issued for one
2465 or more of the following categories of care: standard, extended
2466 congregate care, limited nursing services, or limited mental
2467 health.
2468 (b) An extended congregate care license shall be issued to
2469 facilities that have been licensed as assisted living facilities
2470 for 2 or more years and that provide providing, directly or
2471 through contract, services beyond those authorized in paragraph
2472 (a), including services performed by persons licensed under part
2473 I of chapter 464 and supportive services, as defined by rule, to
2474 persons who would otherwise be disqualified from continued
2475 residence in a facility licensed under this part. An extended
2476 congregate care license may also be issued to those facilities
2477 that have provisional extended congregate care licenses and meet
2478 the requirements for licensure under subparagraph 2. The primary
2479 purpose of extended congregate care services is to allow
2480 residents, as they become more impaired, the option of remaining
2481 in a familiar setting from which they would otherwise be
2482 disqualified for continued residency. A facility licensed to
2483 provide extended congregate care services may also admit an
2484 individual who exceeds the admission criteria for a facility
2485 with a standard license, if the individual is determined
2486 appropriate for admission to the extended congregate care
2487 facility.
2488 1. In order for extended congregate care services to be
2489 provided, the agency must first determine that all requirements
2490 established in law and rule are met and must specifically
2491 designate, on the facility’s license, that such services may be
2492 provided and whether the designation applies to all or part of
2493 the facility. Such designation may be made at the time of
2494 initial licensure or relicensure, or upon request in writing by
2495 a licensee under this part and part II of chapter 408. The
2496 notification of approval or the denial of the request shall be
2497 made in accordance with part II of chapter 408. Existing
2498 facilities qualifying to provide extended congregate care
2499 services must have maintained a standard license and may not
2500 have been subject to administrative sanctions during the
2501 previous 2 years, or since initial licensure if the facility has
2502 been licensed for less than 2 years, for any of the following
2503 reasons:
2504 a. A class I or class II violation;
2505 b. Three or more repeat or recurring class III violations
2506 of identical or similar resident care standards from which a
2507 pattern of noncompliance is found by the agency;
2508 c. Three or more class III violations that were not
2509 corrected in accordance with the corrective action plan approved
2510 by the agency;
2511 d. Violation of resident care standards which results in
2512 requiring the facility to employ the services of a consultant
2513 pharmacist or consultant dietitian;
2514 e. Denial, suspension, or revocation of a license for
2515 another facility licensed under this part in which the applicant
2516 for an extended congregate care license has at least 25 percent
2517 ownership interest; or
2518 f. Imposition of a moratorium pursuant to this part or part
2519 II of chapter 408 or initiation of injunctive proceedings.
2520 2. If an assisted living facility has been licensed for
2521 less than 2 years but meets all other licensure requirements for
2522 an extended congregate care license, it shall be issued a
2523 provisional extended congregate care license for a period of 6
2524 months. Within the first 3 months after the provisional license
2525 is issued, the licensee shall notify the agency when it has
2526 admitted an extended congregate care resident, after which an
2527 unannounced inspection shall be made to determine compliance
2528 with requirements of an extended congregate care license. If the
2529 licensee demonstrates compliance with all of the requirements of
2530 an extended congregate care license during the inspection, the
2531 licensee shall be issued an extended congregate care license. In
2532 addition to sanctions authorized under this part, if violations
2533 are found during the inspection and the licensee fails to
2534 demonstrate compliance with all assisted living requirements
2535 during a followup inspection, the licensee shall immediately
2536 suspend extended congregate care services, and the provisional
2537 extended congregate care license expires.
2538 3.2. A facility that is licensed to provide extended
2539 congregate care services shall maintain a written progress
2540 report on each person who receives services which describes the
2541 type, amount, duration, scope, and outcome of services that are
2542 rendered and the general status of the resident’s health. A
2543 registered nurse, or appropriate designee, representing the
2544 agency shall visit the facility at least twice a year quarterly
2545 to monitor residents who are receiving extended congregate care
2546 services and to determine if the facility is in compliance with
2547 this part, part II of chapter 408, and relevant rules. One of
2548 the visits may be in conjunction with the regular survey. The
2549 monitoring visits may be provided through contractual
2550 arrangements with appropriate community agencies. A registered
2551 nurse shall serve as part of the team that inspects the
2552 facility. The agency may waive one of the required yearly
2553 monitoring visits for a facility that has been licensed for at
2554 least 24 months to provide extended congregate care services,
2555 if, during the inspection, the registered nurse determines that
2556 extended congregate care services are being provided
2557 appropriately, and if the facility has held an extended
2558 congregate care license during the last 24 months, has had no
2559 class I or class II violations, has had and no uncorrected class
2560 III violations, and has had no confirmed ombudsman council
2561 complaints that resulted in a citation for licensure. The agency
2562 must first consult with the long-term care ombudsman council for
2563 the area in which the facility is located to determine if any
2564 complaints have been made and substantiated about the quality of
2565 services or care. The agency may not waive one of the required
2566 yearly monitoring visits if complaints have been made and
2567 substantiated.
2568 4.3. A facility that is licensed to provide extended
2569 congregate care services must:
2570 a. Demonstrate the capability to meet unanticipated
2571 resident service needs.
2572 b. Offer a physical environment that promotes a homelike
2573 setting, provides for resident privacy, promotes resident
2574 independence, and allows sufficient congregate space as defined
2575 by rule.
2576 c. Have sufficient staff available, taking into account the
2577 physical plant and firesafety features of the building, to
2578 assist with the evacuation of residents in an emergency.
2579 d. Adopt and follow policies and procedures that maximize
2580 resident independence, dignity, choice, and decisionmaking to
2581 permit residents to age in place, so that moves due to changes
2582 in functional status are minimized or avoided.
2583 e. Allow residents or, if applicable, a resident’s
2584 representative, designee, surrogate, guardian, or attorney in
2585 fact to make a variety of personal choices, participate in
2586 developing service plans, and share responsibility in
2587 decisionmaking.
2588 f. Implement the concept of managed risk.
2589 g. Provide, directly or through contract, the services of a
2590 person licensed under part I of chapter 464.
2591 h. In addition to the training mandated in s. 429.52,
2592 provide specialized training as defined by rule for facility
2593 staff.
2594 5.4. A facility that is licensed to provide extended
2595 congregate care services is exempt from the criteria for
2596 continued residency set forth in rules adopted under s. 429.41.
2597 A licensed facility must adopt its own requirements within
2598 guidelines for continued residency set forth by rule. However,
2599 the facility may not serve residents who require 24-hour nursing
2600 supervision. A licensed facility that provides extended
2601 congregate care services must also provide each resident with a
2602 written copy of facility policies governing admission and
2603 retention.
2604 5. The primary purpose of extended congregate care services
2605 is to allow residents, as they become more impaired, the option
2606 of remaining in a familiar setting from which they would
2607 otherwise be disqualified for continued residency. A facility
2608 licensed to provide extended congregate care services may also
2609 admit an individual who exceeds the admission criteria for a
2610 facility with a standard license, if the individual is
2611 determined appropriate for admission to the extended congregate
2612 care facility.
2613 6. Before the admission of an individual to a facility
2614 licensed to provide extended congregate care services, the
2615 individual must undergo a medical examination as provided in s.
2616 429.26(4) and the facility must develop a preliminary service
2617 plan for the individual.
2618 7. If When a facility can no longer provide or arrange for
2619 services in accordance with the resident’s service plan and
2620 needs and the facility’s policy, the facility must shall make
2621 arrangements for relocating the person in accordance with s.
2622 429.28(1)(k).
2623 8. Failure to provide extended congregate care services may
2624 result in denial of extended congregate care license renewal.
2625
2626 The agency may deny or revoke a facility’s extended congregate
2627 care license for not meeting the standards of an extended
2628 congregate care license or for any of the grounds listed in this
2629 subsection.
2630 (c) A limited nursing services license shall be issued to a
2631 facility that provides services beyond those authorized in
2632 paragraph (a) and as specified in this paragraph.
2633 1. In order for limited nursing services to be provided in
2634 a facility licensed under this part, the agency must first
2635 determine that all requirements established in law and rule are
2636 met and must specifically designate, on the facility’s license,
2637 that such services may be provided. Such designation may be made
2638 at the time of initial licensure or licensure renewal
2639 relicensure, or upon request in writing by a licensee under this
2640 part and part II of chapter 408. Notification of approval or
2641 denial of such request shall be made in accordance with part II
2642 of chapter 408. An existing facility that qualifies facilities
2643 qualifying to provide limited nursing services must shall have
2644 maintained a standard license and may not have been subject to
2645 administrative sanctions that affect the health, safety, and
2646 welfare of residents for the previous 2 years or since initial
2647 licensure if the facility has been licensed for less than 2
2648 years.
2649 2. A facility Facilities that is are licensed to provide
2650 limited nursing services shall maintain a written progress
2651 report on each person who receives such nursing services. The,
2652 which report must describe describes the type, amount, duration,
2653 scope, and outcome of services that are rendered and the general
2654 status of the resident’s health. A registered nurse representing
2655 the agency shall visit the facility such facilities at least
2656 annually twice a year to monitor residents who are receiving
2657 limited nursing services and to determine if the facility is in
2658 compliance with applicable provisions of this part, part II of
2659 chapter 408, and related rules. The monitoring visits may be
2660 provided through contractual arrangements with appropriate
2661 community agencies. A registered nurse shall also serve as part
2662 of the team that inspects such facility. Visits may be in
2663 conjunction with other agency inspections. The agency may waive
2664 one of the required yearly monitoring visits for a facility that
2665 has:
2666 a. A limited nursing services license for at least 24
2667 months;
2668 b. No class I or class II violations and no uncorrected
2669 class III violations; and
2670 c. No confirmed ombudsman council complaints that resulted
2671 in a citation for licensure.
2672 3. A person who receives limited nursing services under
2673 this part must meet the admission criteria established by the
2674 agency for assisted living facilities. When a resident no longer
2675 meets the admission criteria for a facility licensed under this
2676 part, arrangements for relocating the person shall be made in
2677 accordance with s. 429.28(1)(k), unless the facility is licensed
2678 to provide extended congregate care services.
2679 Section 59. Section 429.075, Florida Statutes, is amended
2680 to read:
2681 429.075 Limited mental health license.—An assisted living
2682 facility that serves one three or more mental health residents
2683 must obtain a limited mental health license.
2684 (1) To obtain a limited mental health license, a facility
2685 must hold a standard license as an assisted living facility,
2686 must not have any current uncorrected deficiencies or
2687 violations, and must ensure that, within 6 months after
2688 receiving a limited mental health license, the facility
2689 administrator and the staff of the facility who are in direct
2690 contact with mental health residents must complete training of
2691 no less than 6 hours related to their duties. Such designation
2692 may be made at the time of initial licensure or relicensure or
2693 upon request in writing by a licensee under this part and part
2694 II of chapter 408. Notification of approval or denial of such
2695 request shall be made in accordance with this part, part II of
2696 chapter 408, and applicable rules. This training must will be
2697 provided by or approved by the Department of Children and Family
2698 Services.
2699 (2) A facility that is Facilities licensed to provide
2700 services to mental health residents must shall provide
2701 appropriate supervision and staffing to provide for the health,
2702 safety, and welfare of such residents.
2703 (3) A facility that has a limited mental health license
2704 must:
2705 (a) Have a copy of each mental health resident’s community
2706 living support plan and the cooperative agreement with the
2707 mental health care services provider. The support plan and the
2708 agreement may be combined.
2709 (b) Have documentation that is provided by the Department
2710 of Children and Family Services that each mental health resident
2711 has been assessed and determined to be able to live in the
2712 community in an assisted living facility that has with a limited
2713 mental health license.
2714 (c) Make the community living support plan available for
2715 inspection by the resident, the resident’s legal guardian, the
2716 resident’s health care surrogate, and other individuals who have
2717 a lawful basis for reviewing this document.
2718 (d) Assist the mental health resident in carrying out the
2719 activities identified in the individual’s community living
2720 support plan.
2721 (4) A facility that has with a limited mental health
2722 license may enter into a cooperative agreement with a private
2723 mental health provider. For purposes of the limited mental
2724 health license, the private mental health provider may act as
2725 the case manager.
2726 Section 60. Section 429.14, Florida Statutes, is amended to
2727 read:
2728 429.14 Administrative penalties.—
2729 (1) In addition to the requirements of part II of chapter
2730 408, the agency may deny, revoke, and suspend any license issued
2731 under this part and impose an administrative fine in the manner
2732 provided in chapter 120 against a licensee for a violation of
2733 any provision of this part, part II of chapter 408, or
2734 applicable rules, or for any of the following actions by a
2735 licensee, for the actions of any person subject to level 2
2736 background screening under s. 408.809, or for the actions of any
2737 facility staff employee:
2738 (a) An intentional or negligent act seriously affecting the
2739 health, safety, or welfare of a resident of the facility.
2740 (b) A The determination by the agency that the owner lacks
2741 the financial ability to provide continuing adequate care to
2742 residents.
2743 (c) Misappropriation or conversion of the property of a
2744 resident of the facility.
2745 (d) Failure to follow the criteria and procedures provided
2746 under part I of chapter 394 relating to the transportation,
2747 voluntary admission, and involuntary examination of a facility
2748 resident.
2749 (e) A citation of any of the following violations
2750 deficiencies as specified in s. 429.19:
2751 1. One or more cited class I violations deficiencies.
2752 2. Three or more cited class II violations deficiencies.
2753 3. Five or more cited class III violations deficiencies
2754 that have been cited on a single survey and have not been
2755 corrected within the times specified.
2756 (f) Failure to comply with the background screening
2757 standards of this part, s. 408.809(1), or chapter 435.
2758 (g) Violation of a moratorium.
2759 (h) Failure of the license applicant, the licensee during
2760 relicensure, or a licensee that holds a provisional license to
2761 meet the minimum license requirements of this part, or related
2762 rules, at the time of license application or renewal.
2763 (i) An intentional or negligent life-threatening act in
2764 violation of the uniform firesafety standards for assisted
2765 living facilities or other firesafety standards which that
2766 threatens the health, safety, or welfare of a resident of a
2767 facility, as communicated to the agency by the local authority
2768 having jurisdiction or the State Fire Marshal.
2769 (j) Knowingly operating any unlicensed facility or
2770 providing without a license any service that must be licensed
2771 under this chapter or chapter 400.
2772 (k) Any act constituting a ground upon which application
2773 for a license may be denied.
2774 (2) Upon notification by the local authority having
2775 jurisdiction or by the State Fire Marshal, the agency may deny
2776 or revoke the license of an assisted living facility that fails
2777 to correct cited fire code violations that affect or threaten
2778 the health, safety, or welfare of a resident of a facility.
2779 (3) The agency may deny or revoke a license of an to any
2780 applicant or controlling interest as defined in part II of
2781 chapter 408 which has or had a 25-percent or greater financial
2782 or ownership interest in any other facility that is licensed
2783 under this part, or in any entity licensed by this state or
2784 another state to provide health or residential care, if that
2785 which facility or entity during the 5 years prior to the
2786 application for a license closed due to financial inability to
2787 operate; had a receiver appointed or a license denied,
2788 suspended, or revoked; was subject to a moratorium; or had an
2789 injunctive proceeding initiated against it.
2790 (4) The agency shall deny or revoke the license of an
2791 assisted living facility if:
2792 (a) There are two moratoria, issued pursuant to this part
2793 or part II of chapter 408, within a 2-year period which are
2794 imposed by final order;
2795 (b) The facility is cited for two or more class I
2796 violations arising from unrelated circumstances during the same
2797 survey or investigation; or
2798 (c) The facility is cited for two or more class I
2799 violations arising from separate surveys or investigations
2800 within a 2-year period that has two or more class I violations
2801 that are similar or identical to violations identified by the
2802 agency during a survey, inspection, monitoring visit, or
2803 complaint investigation occurring within the previous 2 years.
2804 (5) An action taken by the agency to suspend, deny, or
2805 revoke a facility’s license under this part or part II of
2806 chapter 408, in which the agency claims that the facility owner
2807 or an employee of the facility has threatened the health,
2808 safety, or welfare of a resident of the facility must be heard
2809 by the Division of Administrative Hearings of the Department of
2810 Management Services within 120 days after receipt of the
2811 facility’s request for a hearing, unless that time limitation is
2812 waived by both parties. The administrative law judge shall must
2813 render a decision within 30 days after receipt of a proposed
2814 recommended order.
2815 (6) The agency shall impose an immediate moratorium, as
2816 provided under s. 408.814, on an assisted living facility that
2817 fails to provide the agency access to the facility or prohibits
2818 the agency from conducting a regulatory inspection. The licensee
2819 may not restrict agency staff in accessing and copying records
2820 or in conducting confidential interviews with facility staff or
2821 any individual who receives services from the facility provide
2822 to the Division of Hotels and Restaurants of the Department of
2823 Business and Professional Regulation, on a monthly basis, a list
2824 of those assisted living facilities that have had their licenses
2825 denied, suspended, or revoked or that are involved in an
2826 appellate proceeding pursuant to s. 120.60 related to the
2827 denial, suspension, or revocation of a license.
2828 (7) Agency notification of a license suspension or
2829 revocation, or denial of a license renewal, shall be posted and
2830 visible to the public at the facility.
2831 (8) If a facility is required to relocate some or all of
2832 its residents due to agency action, that facility is exempt from
2833 the 45 days’ notice requirement in s. 429.28(1)(k). This
2834 provision does not exempt the facility from any deadlines for
2835 corrective action set by the agency.
2836 Section 61. Paragraphs (a) and (b) of subsection (2) of
2837 section 429.178, Florida Statutes, are amended to read:
2838 429.178 Special care for persons with Alzheimer’s disease
2839 or other related disorders.—
2840 (2)(a) An individual who is employed by a facility that
2841 provides special care for residents with Alzheimer’s disease or
2842 other related disorders, and who has regular contact with such
2843 residents, must complete up to 4 hours of initial dementia
2844 specific training developed or approved by the department. The
2845 training must shall be completed within 3 months after beginning
2846 employment and satisfy shall satisfy the core training
2847 requirements of s. 429.52(3)(g) s. 429.52(2)(g).
2848 (b) A direct caregiver who is employed by a facility that
2849 provides special care for residents with Alzheimer’s disease or
2850 other related disorders, and who provides direct care to such
2851 residents, must complete the required initial training and 4
2852 additional hours of training developed or approved by the
2853 department. The training must shall be completed within 9 months
2854 after beginning employment and satisfy shall satisfy the core
2855 training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
2856 Section 62. Section 429.19, Florida Statutes, is amended to
2857 read:
2858 429.19 Violations; imposition of administrative fines;
2859 grounds.—
2860 (1) In addition to the requirements of part II of chapter
2861 408, the agency shall impose an administrative fine in the
2862 manner provided in chapter 120 for the violation of any
2863 provision of this part, part II of chapter 408, and applicable
2864 rules by an assisted living facility, for the actions of any
2865 person subject to level 2 background screening under s. 408.809,
2866 for the actions of any facility employee, or for an intentional
2867 or negligent act seriously affecting the health, safety, or
2868 welfare of a resident of the facility.
2869 (2) Each violation of this part and adopted rules must
2870 shall be classified according to the nature of the violation and
2871 the gravity of its probable effect on facility residents. The
2872 agency shall indicate the classification on the written notice
2873 of the violation as follows:
2874 (a) Class “I” violations are defined in s. 408.813. The
2875 agency shall impose an administrative fine of $7,500 for each a
2876 cited class I violation in a facility that is licensed for fewer
2877 than 100 beds at the time of the violation in an amount not less
2878 than $5,000 and not exceeding $10,000 for each violation. The
2879 agency shall impose an administrative fine of $11,250 for each
2880 cited class I violation in a facility that is licensed for 100
2881 or more beds at the time of the violation. If the noncompliance
2882 occurs within the prior 12 months, the fine must be levied for
2883 violations that are corrected before an inspection.
2884 (b) Class “II” violations are defined in s. 408.813. The
2885 agency shall impose an administrative fine of $3,000 for each a
2886 cited class II violation in a facility that is licensed for
2887 fewer than 100 beds at the time of the violation in an amount
2888 not less than $1,000 and not exceeding $5,000 for each
2889 violation. The agency shall impose an administrative fine of
2890 $4,500 for each cited class II violation in a facility that is
2891 licensed for 100 or more beds at the time of the violation.
2892 (c) Class “III” violations are defined in s. 408.813. The
2893 agency shall impose an administrative fine of $750 for each a
2894 cited class III violation in a facility that is licensed for
2895 fewer than 100 beds at the time of the violation in an amount
2896 not less than $500 and not exceeding $1,000 for each violation.
2897 The agency shall impose an administrative fine of $1,125 for
2898 each cited class III violation in a facility that is licensed
2899 for 100 or more beds at the time of the violation.
2900 (d) Class “IV” violations are defined in s. 408.813. The
2901 agency shall impose an administrative fine of $150 for each a
2902 cited class IV violation in a facility that is licensed for
2903 fewer than 100 beds at the time of the violation in an amount
2904 not less than $100 and not exceeding $200 for each violation.
2905 The agency shall impose an administrative fine of $225 for each
2906 cited class IV violation in a facility that is licensed for 100
2907 or more beds at the time of the violation.
2908 (e) Any fine imposed for class I and class II violations
2909 must be doubled if a facility was previously cited for one or
2910 more class I or class II violations during the agency’s last
2911 licensure inspection or any inspection or complaint
2912 investigation since the last licensure inspection.
2913 (f) Notwithstanding s. 408.813(2)(c) and (d) and s.
2914 408.832, a fine must be imposed for each class III and class IV
2915 violation, regardless of correction, if a facility was
2916 previously cited for one or more class III or class IV
2917 violations during the agency’s last licensure inspection or any
2918 inspection or complaint investigation since the last licensure
2919 inspection, for the same regulatory violation. A fine imposed
2920 for class III or class IV violations must be doubled if a
2921 facility was previously cited for one or more class III or class
2922 IV violations during the agency’s last two licensure inspections
2923 for the same regulatory violation.
2924 (g) Regardless of the class of violation cited, instead of
2925 the fine amounts listed in paragraphs (a)-(d), the agency shall
2926 impose an administrative fine of $500 if a facility is found not
2927 to be in compliance with the background screening requirements
2928 as provided in s. 408.809.
2929 (3) For purposes of this section, in determining if a
2930 penalty is to be imposed and in fixing the amount of the fine,
2931 the agency shall consider the following factors:
2932 (a) The gravity of the violation, including the probability
2933 that death or serious physical or emotional harm to a resident
2934 will result or has resulted, the severity of the action or
2935 potential harm, and the extent to which the provisions of the
2936 applicable laws or rules were violated.
2937 (b) Actions taken by the owner or administrator to correct
2938 violations.
2939 (c) Any previous violations.
2940 (d) The financial benefit to the facility of committing or
2941 continuing the violation.
2942 (e) The licensed capacity of the facility.
2943 (3)(4) Each day of continuing violation after the date
2944 established by the agency fixed for correction termination of
2945 the violation, as ordered by the agency, constitutes an
2946 additional, separate, and distinct violation.
2947 (4)(5) An Any action taken to correct a violation shall be
2948 documented in writing by the owner or administrator of the
2949 facility and verified through followup visits by agency
2950 personnel. The agency may impose a fine and, in the case of an
2951 owner-operated facility, revoke or deny a facility’s license
2952 when a facility administrator fraudulently misrepresents action
2953 taken to correct a violation.
2954 (5)(6) A Any facility whose owner fails to apply for a
2955 change-of-ownership license in accordance with part II of
2956 chapter 408 and operates the facility under the new ownership is
2957 subject to a fine of $5,000.
2958 (6)(7) In addition to any administrative fines imposed, the
2959 agency may assess a survey fee, equal to the lesser of one half
2960 of the facility’s biennial license and bed fee or $500, to cover
2961 the cost of conducting initial complaint investigations that
2962 result in the finding of a violation that was the subject of the
2963 complaint or monitoring visits conducted under s. 429.28(3)(c)
2964 to verify the correction of the violations.
2965 (7)(8) During an inspection, the agency shall make a
2966 reasonable attempt to discuss each violation with the owner or
2967 administrator of the facility, prior to written notification.
2968 (8)(9) The agency shall develop and disseminate an annual
2969 list of all facilities sanctioned or fined for violations of
2970 state standards, the number and class of violations involved,
2971 the penalties imposed, and the current status of cases. The list
2972 shall be disseminated, at no charge, to the Department of
2973 Elderly Affairs, the Department of Health, the Department of
2974 Children and Family Services, the Agency for Persons with
2975 Disabilities, the area agencies on aging, the Florida Statewide
2976 Advocacy Council, and the state and local ombudsman councils.
2977 The Department of Children and Family Services shall disseminate
2978 the list to service providers under contract to the department
2979 who are responsible for referring persons to a facility for
2980 residency. The agency may charge a fee commensurate with the
2981 cost of printing and postage to other interested parties
2982 requesting a copy of this list. This information may be provided
2983 electronically or through the agency’s Internet site.
2984 Section 63. Subsection (1) of section 429.26, Florida
2985 Statutes, is amended to read:
2986 429.26 Appropriateness of placements; examinations of
2987 residents.—
2988 (1) The owner or administrator of a facility is responsible
2989 for determining the appropriateness of admission of an
2990 individual to the facility and for determining the continued
2991 appropriateness of residence of an individual in the facility. A
2992 determination shall be based upon an assessment of the
2993 strengths, needs, and preferences of the resident, the care and
2994 services offered or arranged for by the facility in accordance
2995 with facility policy, and any limitations in law or rule related
2996 to admission criteria or continued residency for the type of
2997 license held by the facility under this part. A resident who
2998 requires assistance with portable oxygen, colostomy care, and
2999 anti-embolism stockings or hosiery, and who otherwise meets the
3000 admission criteria, may be admitted to a standard licensed
3001 assisted living facility as long as the facility has a licensed
3002 nurse on staff or under contract to perform the services. A
3003 resident may not be moved from one facility to another without
3004 consultation with and agreement from the resident or, if
3005 applicable, the resident’s representative or designee or the
3006 resident’s family, guardian, surrogate, or attorney in fact. In
3007 the case of a resident who has been placed by the department or
3008 the Department of Children and Family Services, the
3009 administrator must notify the appropriate contact person in the
3010 applicable department.
3011 Section 64. Subsections (2) and (6) of section 429.28,
3012 Florida Statutes, are amended to read:
3013 429.28 Resident bill of rights.—
3014 (2) The administrator of a facility shall ensure that a
3015 written notice of the rights, obligations, and prohibitions set
3016 forth in this part is posted in a prominent place in each
3017 facility and read or explained to residents who cannot read. The
3018 This notice must shall include the name, address, and telephone
3019 numbers of the local ombudsman council and central abuse hotline
3020 and, if when applicable, Disability Rights Florida the Advocacy
3021 Center for Persons with Disabilities, Inc., and the Florida
3022 local advocacy council, where complaints may be lodged. The
3023 notice must state that a complaint made to the Office of State
3024 Long-Term Care Ombudsman or a local long-term care ombudsman
3025 council, the names and identities of the residents involved in
3026 the complaint, and the identity of complainants are kept
3027 confidential pursuant to s. 400.0077 and that retaliatory action
3028 cannot be taken against a resident for presenting grievances or
3029 for exercising any other resident right. The facility must
3030 ensure a resident’s access to a telephone to call the local
3031 ombudsman council, central abuse hotline, and Disability Rights
3032 Florida Advocacy Center for Persons with Disabilities, Inc., and
3033 the Florida local advocacy council.
3034 (6) A Any facility that which terminates the residency of
3035 an individual who participated in activities specified in
3036 subsection (5) must shall show good cause in a court of
3037 competent jurisdiction. If good cause is not shown, the agency
3038 shall impose a fine of $2,500 in addition to any other penalty
3039 assessed against the facility.
3040 Section 65. Section 429.34, Florida Statutes, is amended to
3041 read:
3042 429.34 Right of entry and inspection.—
3043 (1) In addition to the requirements of s. 408.811, any duly
3044 designated officer or employee of the department, the Department
3045 of Children and Family Services, the Medicaid Fraud Control Unit
3046 of the Office of the Attorney General, the state or local fire
3047 marshal, or a member of the state or local long-term care
3048 ombudsman council has shall have the right to enter unannounced
3049 upon and into the premises of any facility licensed pursuant to
3050 this part in order to determine the state of compliance with the
3051 provisions of this part, part II of chapter 408, and applicable
3052 rules. Data collected by the state or local long-term care
3053 ombudsman councils or the state or local advocacy councils may
3054 be used by the agency in investigations involving violations of
3055 regulatory standards. A person specified in this section who
3056 knows or has reasonable cause to suspect that a vulnerable adult
3057 has been or is being abused, neglected, or exploited shall
3058 immediately report such knowledge or suspicion to the central
3059 abuse hotline pursuant to chapter 415.
3060 (2) Each licensed assisted living facility must be
3061 inspected by the agency at least once every 24 months to
3062 determine compliance with this chapter and related rules. If an
3063 assisted living facility is cited for one or more class I
3064 violations or two or more class II violations arising from
3065 separate surveys within a 60-day period or due to unrelated
3066 circumstances during the same survey, the agency must conduct an
3067 additional licensure inspection within 6 months. In addition to
3068 any fines imposed on the facility under s. 429.19, the licensee
3069 must pay a fee for the cost of the additional inspection
3070 equivalent to the standard assisted living facility license and
3071 per-bed fees, without exception for beds designated for
3072 recipients of optional state supplementation. The agency shall
3073 adjust the fee in accordance with s. 408.805.
3074 Section 66. Present subsections (1) through (11) of section
3075 429.52, Florida Statutes, are redesignated as subsections (2)
3076 through (12), respectively, a new subsection (1) is added to
3077 that section, and present subsection (9) of that section is
3078 amended, to read:
3079 429.52 Staff training and educational programs; core
3080 educational requirement.—
3081 (1) Effective October 1, 2013, each new assisted living
3082 facility employee who has not previously completed core training
3083 must attend a preservice orientation provided by the facility
3084 before interacting with residents. The preservice orientation
3085 must be at least 2 hours in duration and cover topics that help
3086 the employee provide responsible care and respond to the needs
3087 of residents of the facility. Upon completion, the employee and
3088 the administrator of the facility must sign an affidavit stating
3089 that the employee completed the required preservice orientation.
3090 The facility must keep the affidavit in the employee’s work
3091 file.
3092 (10)(9) The training required by this section must shall be
3093 conducted by persons registered with the department as having
3094 the requisite experience and credentials to conduct the
3095 training. A person seeking to register as a trainer must provide
3096 the department with proof of completion of the minimum core
3097 training education requirements, successful passage of the
3098 competency test established under this section, and proof of
3099 compliance with the continuing education requirement in
3100 subsection (5)(4).
3101 Section 67. The Legislature finds that consistent
3102 regulation of assisted living facilities benefits residents and
3103 operators of such facilities. To determine whether surveys are
3104 consistent between surveys and surveyors, the Agency for Health
3105 Care Administration shall conduct a study of intersurveyor
3106 reliability for assisted living facilities. By November 1, 2013,
3107 the agency shall report to the Governor, the President of the
3108 Senate, and the Speaker of the House of Representatives its
3109 findings and make any recommendations to improve intersurveyor
3110 reliability.
3111 Section 68. The Legislature finds that consumers need
3112 additional information on the quality of care and service in
3113 assisted living facilities in order to select the best facility
3114 for themselves or their loved ones. Therefore, the Agency for
3115 Health Care Administration shall:
3116 (1) Propose a rating system for assisted living facilities.
3117 The proposal must include, but is not limited to, the data
3118 elements to be used, the method of collecting the data, the
3119 method of determining the rating, an estimate of the initial and
3120 ongoing costs of a rating system to both the agency and assisted
3121 living facilities, and a timetable for the implementation of the
3122 rating system for assisted living facilities. The agency shall
3123 submit its proposal to the Governor, the President of the
3124 Senate, and the Speaker of the House of Representatives by
3125 November 1, 2013.
3126 (2) By January 1, 2014, create a content that is easily
3127 accessible through the front page of the agency’s website. At a
3128 minimum, the content must include:
3129 (a) Information on each licensed assisted living facility,
3130 including, but not limited to:
3131 1. The name and address of the facility.
3132 2. The number and type of licensed beds in the facility.
3133 3. The types of licenses held by the facility.
3134 4. The facility’s license expiration date and status.
3135 5. Other relevant information that the agency currently
3136 collects.
3137 (b) A list of the facility’s violations, including, for
3138 each violation:
3139 1. A summary of the violation which is presented in a
3140 manner understandable by the general public;
3141 2. Any sanctions imposed by final order; and
3142 3. A summary of any corrective action taken by the
3143 facility.
3144 (c) Links to inspection reports that the agency has on
3145 file.
3146 (d) A monitored comment page, maintained by the agency,
3147 which allows members of the public to anonymously comment on
3148 assisted living facilities that are licensed to operate in the
3149 state. This comment page must, at a minimum, allow members of
3150 the public to post comments on their experiences with, or
3151 observations of, an assisted living facility and to review other
3152 people’s comments. Comments posted to the agency’s comment page
3153 may not contain profanity and are intended to provide meaningful
3154 feedback about the assisted living facility. The agency shall
3155 provide for a webpage moderator to review comments for profane
3156 content before the comments are posted to the page. An employee,
3157 owner, or controlling interest in an assisted living facility is
3158 prohibited from posting comments on the page.
3159 Section 69. Paragraph (b) of subsection (3) of section
3160 430.80, Florida Statutes, is amended to read:
3161 430.80 Implementation of a teaching nursing home pilot
3162 project.—
3163 (3) To be designated as a teaching nursing home, a nursing
3164 home licensee must, at a minimum:
3165 (b) Participate in a nationally recognized accrediting
3166 accreditation program and hold a valid accreditation, such as
3167 the accreditation awarded by the Joint Commission on
3168 Accreditation of Healthcare Organizations, a national
3169 accrediting organization that is approved by the Centers for
3170 Medicare and Medicaid Services and whose standards incorporate
3171 comparable licensure regulations required by the state, or, at
3172 the time of initial designation, possess a Gold Seal Award as
3173 conferred by the state on its licensed nursing home;
3174 Section 70. Paragraphs (d) through (yy) of subsection (2)
3175 of section 435.04, Florida Statutes, are redesignated as
3176 paragraphs (e) through (zz), respectively, paragraph (e) of
3177 subsection (1) of that section is amended, and a new paragraph
3178 (d) is added to subsection (2) of that section, to read:
3179 435.04 Level 2 screening standards.—
3180 (1)
3181 (e) Vendors who submit fingerprints on behalf of employers
3182 must:
3183 1. Meet the requirements of s. 943.053; and
3184 2. Have the ability to communicate electronically with the
3185 state agency accepting screening results from the Department of
3186 Law Enforcement and provide the first, middle, and last name;
3187 social security number; date of birth; mailing address; sex; and
3188 race of the applicant a photograph of the applicant taken at the
3189 time the fingerprints are submitted.
3190 (2) The security background investigations under this
3191 section must ensure that no persons subject to the provisions of
3192 this section have been arrested for and are awaiting final
3193 disposition of, have been found guilty of, regardless of
3194 adjudication, or entered a plea of nolo contendere or guilty to,
3195 or have been adjudicated delinquent and the record has not been
3196 sealed or expunged for, any offense prohibited under any of the
3197 following provisions of state law or similar law of another
3198 jurisdiction:
3199 (d) Section 777.04, relating to attempts, solicitation, and
3200 conspiracy to commit an offense listed in this subsection.
3201 Section 71. Subsections (1) and (2) of section 435.07,
3202 Florida Statutes, are amended to read:
3203 435.07 Exemptions from disqualification.—Unless otherwise
3204 provided by law, the provisions of this section apply to
3205 exemptions from disqualification for disqualifying offenses
3206 revealed pursuant to background screenings required under this
3207 chapter, regardless of whether those disqualifying offenses are
3208 listed in this chapter or other laws.
3209 (1)(a) The head of the appropriate agency may grant to any
3210 employee otherwise disqualified from employment an exemption
3211 from disqualification for:
3212 1.(a) Felonies for which at least 3 years have elapsed
3213 since the applicant for the exemption has completed or been
3214 lawfully released from confinement, supervision, or nonmonetary
3215 condition imposed by the court sanction for the disqualifying
3216 felony;
3217 2.(b) Misdemeanors prohibited under any of the statutes
3218 cited in this chapter or under similar statutes of other
3219 jurisdictions for which the applicant for the exemption has
3220 completed or been lawfully released from confinement,
3221 supervision, or nonmonetary condition imposed by the court
3222 sanction;
3223 3.(c) Offenses that were felonies when committed but that
3224 are now misdemeanors and for which the applicant for the
3225 exemption has completed or been lawfully released from
3226 confinement, supervision, or nonmonetary condition imposed by
3227 the court sanction; or
3228 4.(d) Findings of delinquency. For offenses that would be
3229 felonies if committed by an adult and the record has not been
3230 sealed or expunged, the exemption may not be granted until at
3231 least 3 years have elapsed since the applicant for the exemption
3232 has completed or been lawfully released from confinement,
3233 supervision, or nonmonetary condition imposed by the court
3234 sanction for the disqualifying offense.
3235 (b) A person who wishes to apply for an exemption who was
3236 ordered to pay any amount for any fee, fine, fund, lien, civil
3237 judgment, application, costs of prosecution, trust, or
3238 restitution as part of the judgment and sentence for any
3239 disqualifying felony or misdemeanor must have paid the court
3240 ordered amount in full before being eligible for an exemption.
3241
3242 For the purposes of this subsection, the term “felonies” means
3243 both felonies prohibited under any of the statutes cited in this
3244 chapter or under similar statutes of other jurisdictions.
3245 (2) Persons employed, or applicants for employment, by
3246 treatment providers who treat adolescents 13 years of age and
3247 older who are disqualified from employment solely because of
3248 crimes under s. 817.563, s. 893.13, or s. 893.147 may be
3249 exempted from disqualification from employment pursuant to this
3250 chapter without application of the waiting period in
3251 subparagraph (1)(a)1 paragraph (1)(a).
3252 Section 72. Subsection (2) of section 435.12, Florida
3253 Statutes, is amended to read:
3254 435.12 Care Provider Background Screening Clearinghouse.—
3255 (2)(a) To ensure that the information in the clearinghouse
3256 is current, the fingerprints of an employee required to be
3257 screened by a specified agency and included in the clearinghouse
3258 must be:
3259 1. Retained by the Department of Law Enforcement pursuant
3260 to s. 943.05(2)(g) and (h) and (3), and the Department of Law
3261 Enforcement must report the results of searching those
3262 fingerprints against state incoming arrest fingerprint
3263 submissions to the Agency for Health Care Administration for
3264 inclusion in the clearinghouse.
3265 2. Resubmitted for a Federal Bureau of Investigation
3266 national criminal history check every 5 years until such time as
3267 the fingerprints are retained by the Federal Bureau of
3268 Investigation.
3269 3. Subject to retention on a 5-year renewal basis with fees
3270 collected at the time of initial submission or resubmission of
3271 fingerprints.
3272 4. Submitted with a photograph of the person taken at the
3273 time the fingerprints are submitted.
3274 (b) Until such time as the fingerprints are retained at the
3275 Federal Bureau of Investigation, an employee with a break in
3276 service of more than 90 days from a position that requires
3277 screening by a specified agency must submit to a national
3278 screening if the person returns to a position that requires
3279 screening by a specified agency.
3280 (c) An employer of persons subject to screening by a
3281 specified agency must register with the clearinghouse and
3282 maintain the employment status of all employees within the
3283 clearinghouse. Initial employment status and any changes in
3284 status must be reported within 10 business days.
3285 (d) An employer must register and initiate all criminal
3286 history checks through the clearinghouse before referring an
3287 employee or potential employee for electronic fingerprint
3288 submission to the Department of Law Enforcement. The
3289 registration must include the employee’s full name (first,
3290 middle, last), social security number, date of birth, mailing
3291 address, sex, and race.
3292 Section 73. Paragraphs (b) and (d) of subsection (9) of
3293 section 440.102, Florida Statutes, are amended to read:
3294 440.102 Drug-free workplace program requirements.—The
3295 following provisions apply to a drug-free workplace program
3296 implemented pursuant to law or to rules adopted by the Agency
3297 for Health Care Administration:
3298 (9) DRUG-TESTING STANDARDS FOR LABORATORIES.—
3299 (b) A laboratory may analyze initial or confirmation test
3300 specimens only if:
3301 1. The laboratory obtains a license under part II of
3302 chapter 408 and s. 112.0455(17). Each applicant for licensure
3303 and each licensee must comply with all requirements of this
3304 section, part II of chapter 408, and applicable rules.
3305 2. The laboratory has written procedures to ensure the
3306 chain of custody.
3307 3. The laboratory follows proper quality control
3308 procedures, including, but not limited to:
3309 a. The use of internal quality controls, including the use
3310 of samples of known concentrations which are used to check the
3311 performance and calibration of testing equipment, and periodic
3312 use of blind samples for overall accuracy.
3313 b. An internal review and certification process for drug
3314 test results, conducted by a person qualified to perform that
3315 function in the testing laboratory.
3316 c. Security measures implemented by the testing laboratory
3317 to preclude adulteration of specimens and drug test results.
3318 d. Other necessary and proper actions taken to ensure
3319 reliable and accurate drug test results.
3320 (d) The laboratory shall submit to the Agency for Health
3321 Care Administration a monthly report with statistical
3322 information regarding the testing of employees and job
3323 applicants. The report must include information on the methods
3324 of analysis conducted, the drugs tested for, the number of
3325 positive and negative results for both initial tests and
3326 confirmation tests, and any other information deemed appropriate
3327 by the Agency for Health Care Administration. A monthly report
3328 must not identify specific employees or job applicants.
3329 Section 74. Paragraph (a) of subsection (2) of section
3330 440.13, Florida Statutes, is amended to read:
3331 440.13 Medical services and supplies; penalty for
3332 violations; limitations.—
3333 (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.—
3334 (a) Subject to the limitations specified elsewhere in this
3335 chapter, the employer shall furnish to the employee such
3336 medically necessary remedial treatment, care, and attendance for
3337 such period as the nature of the injury or the process of
3338 recovery may require, which is in accordance with established
3339 practice parameters and protocols of treatment as provided for
3340 in this chapter, including medicines, medical supplies, durable
3341 medical equipment, orthoses, prostheses, and other medically
3342 necessary apparatus. Remedial treatment, care, and attendance,
3343 including work-hardening programs or pain-management programs
3344 accredited by CARF International, the Commission on
3345 Accreditation of Rehabilitation Facilities or Joint Commission,
3346 the American Osteopathic Association/Healthcare Facilities
3347 Accreditation Program, or a national accrediting organization
3348 that is approved by the Centers for Medicare and Medicaid
3349 Services and whose standards incorporate comparable licensure
3350 regulations required by the state, on the Accreditation of
3351 Health Organizations or pain-management programs affiliated with
3352 medical schools, shall be considered as covered treatment only
3353 when such care is given based on a referral by a physician as
3354 defined in this chapter. Medically necessary treatment, care,
3355 and attendance does not include chiropractic services in excess
3356 of 24 treatments or rendered 12 weeks beyond the date of the
3357 initial chiropractic treatment, whichever comes first, unless
3358 the carrier authorizes additional treatment or the employee is
3359 catastrophically injured.
3360
3361 Failure of the carrier to timely comply with this subsection
3362 shall be a violation of this chapter and the carrier shall be
3363 subject to penalties as provided for in s. 440.525.
3364 Section 75. Section 465.1902, Florida Statutes, is created
3365 to read:
3366 465.1902 Preemption.—This chapter preempts to the state all
3367 regulation of the licensure, activity, and operation of
3368 pharmacies and pharmacists as defined in this chapter. A local
3369 government or political subdivision of the state may not enact
3370 or enforce an ordinance that imposes a levy, charge, or fee
3371 upon, or that otherwise regulates, pharmacies and pharmacists as
3372 defined in this chapter, except that this preemption does not
3373 prohibit a local government or political subdivision from
3374 enacting an ordinance regarding the following:
3375 (1) Local business taxes adopted pursuant to chapter 205.
3376 (2) Land use development regulations adopted pursuant to
3377 chapter 163, which include regulation of any aspect of
3378 development, including a subdivision, building construction,
3379 sign regulation, and any other regulation concerning the
3380 development of land, landscaping, or tree protection, and which
3381 do not include restrictions on pain-management services, health
3382 care services, or the prescribing of controlled substances.
3383 Section 76. Paragraph (b) of subsection (54) of section
3384 499.003, Florida Statutes, is amended to read:
3385 499.003 Definitions of terms used in this part.—As used in
3386 this part, the term:
3387 (54) “Wholesale distribution” means distribution of
3388 prescription drugs to persons other than a consumer or patient,
3389 but does not include:
3390 (a) Any of the following activities, which is not a
3391 violation of s. 499.005(21) or s. 499.0051(13)(f) if such
3392 activity is conducted in accordance with s. 499.01(2)(g):
3393 1. The purchase or other acquisition by a hospital or other
3394 health care entity that is a member of a group purchasing
3395 organization of a prescription drug for its own use from the
3396 group purchasing organization or from other hospitals or health
3397 care entities that are members of that organization.
3398 2. The sale, purchase, or trade of a prescription drug or
3399 an offer to sell, purchase, or trade a prescription drug by a
3400 charitable organization described in s. 501(c)(3) of the
3401 Internal Revenue Code of 1986, as amended and revised, to a
3402 nonprofit affiliate of the organization to the extent otherwise
3403 permitted by law.
3404 3. The sale, purchase, or trade of a prescription drug or
3405 an offer to sell, purchase, or trade a prescription drug among
3406 hospitals or other health care entities that are under common
3407 control. For purposes of this subparagraph, “common control”
3408 means the power to direct or cause the direction of the
3409 management and policies of a person or an organization, whether
3410 by ownership of stock, by voting rights, by contract, or
3411 otherwise.
3412 4. The sale, purchase, trade, or other transfer of a
3413 prescription drug from or for any federal, state, or local
3414 government agency or any entity eligible to purchase
3415 prescription drugs at public health services prices pursuant to
3416 Pub. L. No. 102-585, s. 602 to a contract provider or its
3417 subcontractor for eligible patients of the agency or entity
3418 under the following conditions:
3419 a. The agency or entity must obtain written authorization
3420 for the sale, purchase, trade, or other transfer of a
3421 prescription drug under this subparagraph from the Secretary of
3422 Business and Professional Regulation or his or her designee.
3423 b. The contract provider or subcontractor must be
3424 authorized by law to administer or dispense prescription drugs.
3425 c. In the case of a subcontractor, the agency or entity
3426 must be a party to and execute the subcontract.
3427 d. The contract provider and subcontractor must maintain
3428 and produce immediately for inspection all records of movement
3429 or transfer of all the prescription drugs belonging to the
3430 agency or entity, including, but not limited to, the records of
3431 receipt and disposition of prescription drugs. Each contractor
3432 and subcontractor dispensing or administering these drugs must
3433 maintain and produce records documenting the dispensing or
3434 administration. Records that are required to be maintained
3435 include, but are not limited to, a perpetual inventory itemizing
3436 drugs received and drugs dispensed by prescription number or
3437 administered by patient identifier, which must be submitted to
3438 the agency or entity quarterly.
3439 e. The contract provider or subcontractor may administer or
3440 dispense the prescription drugs only to the eligible patients of
3441 the agency or entity or must return the prescription drugs for
3442 or to the agency or entity. The contract provider or
3443 subcontractor must require proof from each person seeking to
3444 fill a prescription or obtain treatment that the person is an
3445 eligible patient of the agency or entity and must, at a minimum,
3446 maintain a copy of this proof as part of the records of the
3447 contractor or subcontractor required under sub-subparagraph d.
3448 f. In addition to the departmental inspection authority set
3449 forth in s. 499.051, the establishment of the contract provider
3450 and subcontractor and all records pertaining to prescription
3451 drugs subject to this subparagraph shall be subject to
3452 inspection by the agency or entity. All records relating to
3453 prescription drugs of a manufacturer under this subparagraph
3454 shall be subject to audit by the manufacturer of those drugs,
3455 without identifying individual patient information.
3456 (b) Any of the following activities, which is not a
3457 violation of s. 499.005(21) or s. 499.0051(13)(f) if such
3458 activity is conducted in accordance with rules established by
3459 the department:
3460 1. The sale, purchase, or trade of a prescription drug
3461 among federal, state, or local government health care entities
3462 that are under common control and are authorized to purchase
3463 such prescription drug.
3464 2. The sale, purchase, or trade of a prescription drug or
3465 an offer to sell, purchase, or trade a prescription drug for
3466 emergency medical reasons. For purposes of this subparagraph,
3467 the term “emergency medical reasons” includes transfers of
3468 prescription drugs by a retail pharmacy to another retail
3469 pharmacy to alleviate a temporary shortage.
3470 3. The transfer of a prescription drug acquired by a
3471 medical director on behalf of a licensed emergency medical
3472 services provider to that emergency medical services provider
3473 and its transport vehicles for use in accordance with the
3474 provider’s license under chapter 401.
3475 4. The revocation of a sale or the return of a prescription
3476 drug to the person’s prescription drug wholesale supplier.
3477 5. The donation of a prescription drug by a health care
3478 entity to a charitable organization that has been granted an
3479 exemption under s. 501(c)(3) of the Internal Revenue Code of
3480 1986, as amended, and that is authorized to possess prescription
3481 drugs.
3482 6. The transfer of a prescription drug by a person
3483 authorized to purchase or receive prescription drugs to a person
3484 licensed or permitted to handle reverse distributions or
3485 destruction under the laws of the jurisdiction in which the
3486 person handling the reverse distribution or destruction receives
3487 the drug.
3488 7. The transfer of a prescription drug by a hospital or
3489 other health care entity, either directly or through the
3490 hospital’s or health care entity’s prescription drug wholesale
3491 supplier or the manufacturer, to a person licensed under this
3492 part to repackage prescription drugs for the purpose of
3493 repackaging the prescription drug for use by that hospital, or
3494 other health care entity and other health care entities that are
3495 under common control, and the transfer of the drugs by the
3496 repackager to the hospital or other healthcare entity, if
3497 ownership of the prescription drugs remains with the hospital or
3498 other health care entity at all times. In addition to the
3499 recordkeeping requirements of s. 499.0121(6), the hospital or
3500 health care entity that transfers prescription drugs pursuant to
3501 this subparagraph must reconcile all drugs transferred and
3502 returned and resolve any discrepancies in a timely manner. The
3503 repackager must comply with the recordkeeping requirements of s.
3504 499.01212(2).
3505 Section 77. Paragraph (b) of subsection (2) of section
3506 499.01, Florida Statutes, is amended to read
3507 499.01 Permits.—
3508 (2) The following permits are established:
3509 (b) Prescription drug repackager permit.—A prescription
3510 drug repackager permit is required for any person that
3511 repackages a prescription drug in this state or any person
3512 located in another state who repackages and distributes
3513 prescription drugs in or into this state which are received in a
3514 transfer pursuant to s. 499.003(54)(b)7.
3515 1. A person that operates an establishment permitted as a
3516 prescription drug repackager may engage in wholesale
3517 distribution of prescription drugs repackaged at that
3518 establishment and must comply with all the provisions of this
3519 part and the rules adopted under this part that apply to a
3520 wholesale distributor.
3521 2. A prescription drug repackager must comply with all
3522 appropriate state and federal good manufacturing practices.
3523 Section 78. Subsection (2) of section 499.01212, Florida
3524 Statutes, is amended to read:
3525 499.01212 Pedigree paper.—
3526 (2) FORMAT.—A pedigree paper must contain the following
3527 information:
3528 (a) For the wholesale distribution of a prescription drug
3529 within the normal distribution chain or pursuant to a transfer
3530 described in s. 499.003(54)(b)7. if the wholesale distributor
3531 purchased the specific unit of the prescription drug directly
3532 from the manufacturer and the wholesale distributor transfers
3533 title to the prescription drug within the normal distribution
3534 chain, but delivers physical possession to a repackager licensed
3535 under this part:
3536 1. The following statement: “This wholesale distributor
3537 purchased the specific unit of the prescription drug directly
3538 from the manufacturer.”
3539 2. The manufacturer’s national drug code identifier and the
3540 name and address of the wholesale distributor and the purchaser
3541 of the prescription drug.
3542 3. The name of the prescription drug as it appears on the
3543 label.
3544 4. The quantity, dosage form, and strength of the
3545 prescription drug.
3546
3547 The wholesale distributor must also maintain and make available
3548 to the department, upon request, the point of origin of the
3549 prescription drugs, including intracompany transfers, the date
3550 of the shipment from the manufacturer to the wholesale
3551 distributor, the lot numbers of such drugs, and the invoice
3552 numbers from the manufacturer. If a repackager further
3553 distributes prescription drugs to a hospital or other health
3554 care entity pursuant to s. 499.003(54)(b)7., and the hospital or
3555 other health care entity receives the statement from the
3556 wholesale distributor in this subsection, the repackager’s
3557 pedigree paper must contain the statement from the wholesale
3558 distributor in this subsection, along with the lot numbers of
3559 the prescription drugs, the name and address of the repackager
3560 and his or her signature, the date of receipt, and the name and
3561 address of the person authorized by law to purchase prescription
3562 drugs for the purpose of administering or dispensing the drug,
3563 as defined in s. 465.003.
3564 (b) For all other wholesale distributions of prescription
3565 drugs and all other transfers of prescription drugs by
3566 repackagers pursuant to s. 499.003(54)(b)7.:
3567 1. The quantity, dosage form, and strength of the
3568 prescription drugs.
3569 2. The lot numbers of the prescription drugs.
3570 3. The name and address of each owner of the prescription
3571 drug and his or her signature.
3572 4. Shipping information, including the name and address of
3573 each person certifying delivery or receipt of the prescription
3574 drug.
3575 5. An invoice number, a shipping document number, or
3576 another number uniquely identifying the transaction.
3577 6. A certification that the recipient wholesale distributor
3578 has authenticated the pedigree papers.
3579 7. The unique serialization of the prescription drug, if
3580 the manufacturer or repackager has uniquely serialized the
3581 individual prescription drug unit.
3582 8. The name, address, telephone number, and, if available,
3583 e-mail contact information of each wholesale distributor
3584 involved in the chain of the prescription drug’s custody.
3585
3586 When an affiliated group member obtains title to a prescription
3587 drug before distributing the prescription drug as the
3588 manufacturer under s. 499.003(31)(e), information regarding the
3589 distribution between those affiliated group members may be
3590 omitted from a pedigree paper required under this paragraph for
3591 subsequent distributions of that prescription drug.
3592 Section 79. Subsection (8) of section 499.041, Florida
3593 Statutes, is amended to read
3594 499.041 Schedule of fees for drug, device, and cosmetic
3595 applications and permits, product registrations, and free-sale
3596 certificates.—
3597 (8) The department shall assess a prescription drug
3598 repackager applicant or permittee physically located outside of
3599 the state or an out-of-state prescription drug wholesale
3600 distributor applicant or permittee an onsite inspection fee of
3601 not less than $1,000 or more than $3,000 annually, to be based
3602 on the actual cost of the inspection if an onsite inspection is
3603 performed by agents of the department.
3604 Section 80. Subsection (1) of section 627.645, Florida
3605 Statutes, is amended to read:
3606 627.645 Denial of health insurance claims restricted.—
3607 (1) A No claim for payment under a health insurance policy
3608 or self-insured program of health benefits for treatment, care,
3609 or services in a licensed hospital that which is accredited by
3610 the Joint Commission, the American Osteopathic
3611 Association/Healthcare Facilities Accreditation Program, a
3612 national accrediting organization that is approved by the
3613 Centers for Medicare and Medicaid Services and whose standards
3614 incorporate comparable licensure regulations required by the
3615 state on the Accreditation of Hospitals, the American
3616 Osteopathic Association, or CARF International may not the
3617 Commission on the Accreditation of Rehabilitative Facilities
3618 shall be denied because such hospital lacks major surgical
3619 facilities and is primarily of a rehabilitative nature, if such
3620 rehabilitation is specifically for treatment of physical
3621 disability.
3622 Section 81. Paragraph (c) of subsection (2) of section
3623 627.668, Florida Statutes, is amended to read:
3624 627.668 Optional coverage for mental and nervous disorders
3625 required; exception.—
3626 (2) Under group policies or contracts, inpatient hospital
3627 benefits, partial hospitalization benefits, and outpatient
3628 benefits consisting of durational limits, dollar amounts,
3629 deductibles, and coinsurance factors shall not be less favorable
3630 than for physical illness generally, except that:
3631 (c) Partial hospitalization benefits shall be provided
3632 under the direction of a licensed physician. For purposes of
3633 this part, the term “partial hospitalization services” is
3634 defined as those services offered by a program that is
3635 accredited by the Joint Commission, the American Osteopathic
3636 Association/Healthcare Facilities Accreditation Program, or a
3637 national accrediting organization approved by the Centers for
3638 Medicare and Medicaid Services and whose standards incorporate
3639 comparable licensure regulations required by the state; on
3640 Accreditation of Hospitals (JCAH) or that is in compliance with
3641 equivalent standards. Alcohol rehabilitation programs accredited
3642 by the Joint Commission on Accreditation of Hospitals or
3643 approved by the state and licensed drug abuse rehabilitation
3644 programs shall also be qualified providers under this section.
3645 In a given any benefit year, if partial hospitalization services
3646 or a combination of inpatient and partial hospitalization are
3647 used utilized, the total benefits paid for all such services may
3648 shall not exceed the cost of 30 days after of inpatient
3649 hospitalization for psychiatric services, including physician
3650 fees, which prevail in the community in which the partial
3651 hospitalization services are rendered. If partial
3652 hospitalization services benefits are provided beyond the limits
3653 set forth in this paragraph, the durational limits, dollar
3654 amounts, and coinsurance factors thereof need not be the same as
3655 those applicable to physical illness generally.
3656 Section 82. Subsection (3) of section 627.669, Florida
3657 Statutes, is amended to read:
3658 627.669 Optional coverage required for substance abuse
3659 impaired persons; exception.—
3660 (3) The benefits provided under this section are shall be
3661 applicable only if treatment is provided by, or under the
3662 supervision of, or is prescribed by, a licensed physician or
3663 licensed psychologist and if services are provided in a program
3664 that is accredited by the Joint Commission, the American
3665 Osteopathic Association/Healthcare Facilities Accreditation
3666 Program, or a national accrediting organization that is approved
3667 by the Centers for Medicare and Medicaid Services and whose
3668 standards incorporate comparable licensure regulations required
3669 by the state on Accreditation of Hospitals or that is approved
3670 by the state.
3671 Section 83. Paragraph (a) of subsection (1) of section
3672 627.736, Florida Statutes, is amended to read:
3673 627.736 Required personal injury protection benefits;
3674 exclusions; priority; claims.—
3675 (1) REQUIRED BENEFITS.—An insurance policy complying with
3676 the security requirements of s. 627.733 must provide personal
3677 injury protection to the named insured, relatives residing in
3678 the same household, persons operating the insured motor vehicle,
3679 passengers in the motor vehicle, and other persons struck by the
3680 motor vehicle and suffering bodily injury while not an occupant
3681 of a self-propelled vehicle, subject to subsection (2) and
3682 paragraph (4)(e), to a limit of $10,000 in medical and
3683 disability benefits and $5,000 in death benefits resulting from
3684 bodily injury, sickness, disease, or death arising out of the
3685 ownership, maintenance, or use of a motor vehicle as follows:
3686 (a) Medical benefits.—Eighty percent of all reasonable
3687 expenses for medically necessary medical, surgical, X-ray,
3688 dental, and rehabilitative services, including prosthetic
3689 devices and medically necessary ambulance, hospital, and nursing
3690 services if the individual receives initial services and care
3691 pursuant to subparagraph 1. within 14 days after the motor
3692 vehicle accident. The medical benefits provide reimbursement
3693 only for:
3694 1. Initial services and care that are lawfully provided,
3695 supervised, ordered, or prescribed by a physician licensed under
3696 chapter 458 or chapter 459, a dentist licensed under chapter
3697 466, or a chiropractic physician licensed under chapter 460 or
3698 that are provided in a hospital or in a facility that owns, or
3699 is wholly owned by, a hospital. Initial services and care may
3700 also be provided by a person or entity licensed under part III
3701 of chapter 401 which provides emergency transportation and
3702 treatment.
3703 2. Upon referral by a provider described in subparagraph
3704 1., followup services and care consistent with the underlying
3705 medical diagnosis rendered pursuant to subparagraph 1. which may
3706 be provided, supervised, ordered, or prescribed only by a
3707 physician licensed under chapter 458 or chapter 459, a
3708 chiropractic physician licensed under chapter 460, a dentist
3709 licensed under chapter 466, or, to the extent permitted by
3710 applicable law and under the supervision of such physician,
3711 osteopathic physician, chiropractic physician, or dentist, by a
3712 physician assistant licensed under chapter 458 or chapter 459 or
3713 an advanced registered nurse practitioner licensed under chapter
3714 464. Followup services and care may also be provided by any of
3715 the following persons or entities:
3716 a. A hospital or ambulatory surgical center licensed under
3717 chapter 395.
3718 b. An entity wholly owned by one or more physicians
3719 licensed under chapter 458 or chapter 459, chiropractic
3720 physicians licensed under chapter 460, or dentists licensed
3721 under chapter 466 or by such practitioners and the spouse,
3722 parent, child, or sibling of such practitioners.
3723 c. An entity that owns or is wholly owned, directly or
3724 indirectly, by a hospital or hospitals.
3725 d. A physical therapist licensed under chapter 486, based
3726 upon a referral by a provider described in this subparagraph.
3727 e. A health care clinic licensed under part X of chapter
3728 400 which is accredited by the Joint Commission, the American
3729 Osteopathic Association/Healthcare Facilities Accreditation
3730 Program, a national accrediting organization that is approved by
3731 the Centers for Medicare and Medicaid Services and whose
3732 standards incorporate comparable licensure regulations required
3733 by the state, CARF International on Accreditation of Healthcare
3734 Organizations, the American Osteopathic Association, the
3735 Commission on Accreditation of Rehabilitation Facilities, or the
3736 Accreditation Association for Ambulatory Health Care, Inc., or
3737 (I) Has a medical director licensed under chapter 458,
3738 chapter 459, or chapter 460;
3739 (II) Has been continuously licensed for more than 3 years
3740 or is a publicly traded corporation that issues securities
3741 traded on an exchange registered with the United States
3742 Securities and Exchange Commission as a national securities
3743 exchange; and
3744 (III) Provides at least four of the following medical
3745 specialties:
3746 (A) General medicine.
3747 (B) Radiography.
3748 (C) Orthopedic medicine.
3749 (D) Physical medicine.
3750 (E) Physical therapy.
3751 (F) Physical rehabilitation.
3752 (G) Prescribing or dispensing outpatient prescription
3753 medication.
3754 (H) Laboratory services.
3755 3. Reimbursement for services and care provided in
3756 subparagraph 1. or subparagraph 2. up to $10,000 if a physician
3757 licensed under chapter 458 or chapter 459, a dentist licensed
3758 under chapter 466, a physician assistant licensed under chapter
3759 458 or chapter 459, or an advanced registered nurse practitioner
3760 licensed under chapter 464 has determined that the injured
3761 person had an emergency medical condition.
3762 4. Reimbursement for services and care provided in
3763 subparagraph 1. or subparagraph 2. is limited to $2,500 if a any
3764 provider listed in subparagraph 1. or subparagraph 2. determines
3765 that the injured person did not have an emergency medical
3766 condition.
3767 5. Medical benefits do not include massage as defined in s.
3768 480.033 or acupuncture as defined in s. 457.102, regardless of
3769 the person, entity, or licensee providing massage or
3770 acupuncture, and a licensed massage therapist or licensed
3771 acupuncturist may not be reimbursed for medical benefits under
3772 this section.
3773 6. The Financial Services Commission shall adopt by rule
3774 the form that must be used by an insurer and a health care
3775 provider specified in sub-subparagraph 2.b., sub-subparagraph
3776 2.c., or sub-subparagraph 2.e. to document that the health care
3777 provider meets the criteria of this paragraph. Such, which rule
3778 must include a requirement for a sworn statement or affidavit.
3779
3780 Only insurers writing motor vehicle liability insurance in this
3781 state may provide the required benefits of this section, and
3782 such insurer may not require the purchase of any other motor
3783 vehicle coverage other than the purchase of property damage
3784 liability coverage as required by s. 627.7275 as a condition for
3785 providing such benefits. Insurers may not require that property
3786 damage liability insurance in an amount greater than $10,000 be
3787 purchased in conjunction with personal injury protection. Such
3788 insurers shall make benefits and required property damage
3789 liability insurance coverage available through normal marketing
3790 channels. An insurer writing motor vehicle liability insurance
3791 in this state who fails to comply with such availability
3792 requirement as a general business practice violates part IX of
3793 chapter 626, and such violation constitutes an unfair method of
3794 competition or an unfair or deceptive act or practice involving
3795 the business of insurance. An insurer committing such violation
3796 is subject to the penalties provided under that part, as well as
3797 those provided elsewhere in the insurance code.
3798 Section 84. Subsection (12) of section 641.495, Florida
3799 Statutes, is amended to read:
3800 641.495 Requirements for issuance and maintenance of
3801 certificate.—
3802 (12) The provisions of part I of chapter 395 do not apply
3803 to a health maintenance organization that, on or before January
3804 1, 1991, provides not more than 10 outpatient holding beds for
3805 short-term and hospice-type patients in an ambulatory care
3806 facility for its members, provided that such health maintenance
3807 organization maintains current accreditation by the Joint
3808 Commission on Accreditation of Health Care Organizations, a
3809 national accrediting organization that is approved by the
3810 Centers for Medicare and Medicaid Services and whose standards
3811 incorporate comparable licensure regulations required by the
3812 state, the Accreditation Association for Ambulatory Health Care,
3813 Inc., or the National Committee for Quality Assurance.
3814 Section 85. Subsection (2) of section 766.1015, Florida
3815 Statutes, is amended to read:
3816 766.1015 Civil immunity for members of or consultants to
3817 certain boards, committees, or other entities.—
3818 (2) Such committee, board, group, commission, or other
3819 entity must be established in accordance with state law, or in
3820 accordance with requirements of the Joint Commission, the
3821 American Osteopathic Association/Healthcare Facilities
3822 Accreditation Program, or a national accrediting organization
3823 that is approved by the Centers for Medicare and Medicaid
3824 Services and whose standards incorporate comparable licensure
3825 regulations required by the state on Accreditation of Healthcare
3826 Organizations, established and duly constituted by one or more
3827 public or licensed private hospitals or behavioral health
3828 agencies, or established by a governmental agency. To be
3829 protected by this section, the act, decision, omission, or
3830 utterance may not be made or done in bad faith or with malicious
3831 intent.
3832 Section 86. Section 893.0552, Florida Statutes, is created
3833 to read:
3834 893.0552 Preemption of regulation.—
3835 (1) This section preempts to the state all regulation of
3836 the licensure, activity, and operation of pain-management
3837 clinics as defined in ss. 458.3265 and 459.0137 in the following
3838 circumstances:
3839 (a) The clinic is wholly owned and operated by a physician
3840 who performs interventional pain procedures of the type
3841 routinely billed using surgical codes, who has never been
3842 suspended or revoked for prescribing a controlled substance in
3843 Schedule II or Schedule III of s. 893.03 and drugs containing
3844 Alprazolam in excessive or inappropriate quantities that are not
3845 in the best interest of a patient, and who:
3846 1. Has completed a fellowship in pain medicine which is
3847 approved by the Accreditation Council for Graduate Medical
3848 Education or the American Osteopathic Association;
3849 2. Is board-certified in pain medicine by the American
3850 Board of Pain Medicine, board-certified by the American Board of
3851 Interventional Pain Physicians; or
3852 3. Has a board certification or subcertification in pain
3853 management or pain medicine by a specialty board approved by the
3854 American Board of Medical Specialties or the American
3855 Osteopathic Association.
3856 (b) The clinic is wholly owned and operated by a physician
3857 multispecialty practice if one or more board-eligible or board
3858 certified medical specialists has one of the qualifications
3859 specified in subparagraph (a)1., subparagraph (a)2., or
3860 subparagraph (a)3., performs interventional pain procedures of
3861 the type routinely billed using surgical codes, and has never
3862 been suspended or revoked for prescribing a controlled substance
3863 in Schedule II or Schedule III of s. 893.03 and drugs containing
3864 Alprazolam in excessive or inappropriate quantities that are not
3865 in the best interest of a patient.
3866 (2) Notwithstanding subsection (1), the preemption does not
3867 prohibit a local government or political subdivision from
3868 enacting an ordinance regarding local business taxes adopted
3869 pursuant to chapter 205 and land use development regulations
3870 adopted pursuant to chapter 163. A pain-management clinic in
3871 which the regulation of its licensure, activity, and operation
3872 is preempted to the state pursuant to subsection (1) is a
3873 permissible use in a land use or zoning category that permits
3874 hospitals and other health care facilities or clinics as defined
3875 in chapter 395 or s. 408.07. Upon the request of a local
3876 government, a pain-management clinic must annually demonstrate
3877 that it qualifies for preemption pursuant to subsection (1).
3878 Section 87. This act shall take effect July 1, 2013.
