Bill Text: FL S2138 | 2010 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health Care [SPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2010-04-30 - Died on Calendar, companion bill(s) passed, see HB 5311 (Ch. 2010-161), CS/CS/SB 1412 (Ch. 2010-102) [S2138 Detail]

Download: Florida-2010-S2138-Introduced.html

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Florida Senate - 2010                                    SB 2138 
 
By Senator Gardiner 
9-01107-10                                            20102138__ 
1                        A bill to be entitled 
2         An act relating to health care; amending s. 1.01, 
3         F.S.; defining the term “Joint Commission”; repealing 
4         s. 112.0455(10)(e), F.S., relating to a prohibition 
5         against applying the Drug-Free Workplace Act 
6         retroactively; amending s. 154.11, F.S.; renaming the 
7         Joint Commission on the Accreditation of Hospitals as 
8         the “Joint Commission”; amending s. 318.21, F.S.; 
9         requiring that certain fines received by the county 
10         court for traffic infractions be remitted to the 
11         Department of Revenue for deposit into the Brain and 
12         Spinal Cord Injury Rehabilitation Trust Fund within 
13         the Department of Health for use for Medicaid 
14         recipients who have spinal cord injuries; repealing s. 
15         383.325, F.S., relating to the requirement of a 
16         licensed facility under s. 383.305, F.S., to maintain 
17         inspection reports; amending s. 394.4787, F.S.; 
18         conforming a cross-reference; amending s. 394.741, 
19         F.S.; renaming the Joint Commission on the 
20         Accreditation of Healthcare Organizations as the 
21         “Joint Commission”; renaming the Council on 
22         Accreditation for Children and Family Services as the 
23         “Council on Accreditation”; amending s. 395.002, F.S.; 
24         redefining the term “accrediting organizations” as it 
25         relates to hospital licensure and regulation; deleting 
26         the definitions for the terms “initial denial 
27         determination,” “private review agent,” and 
28         “utilization review plan” as they relate to hospital 
29         licensure and regulation; amending s. 395.003, F.S.; 
30         deleting a provision that prohibits the Agency for 
31         Health Care Administration from authorizing emergency 
32         departments that are located off the premises of a 
33         licensed hospital; amending s. 395.0193, F.S.; 
34         requiring the Division of Medical Quality Assurance 
35         within the Department of Health to conduct the reviews 
36         of the recordings of agendas and minutes of licensed 
37         facilities; requiring the Division of Medical Quality 
38         Assurance within the Department of Health to report 
39         disciplinary actions rather than the Division of 
40         Health Quality Assurance within the Agency for Health 
41         Care Administration; amending s. 395.1023, F.S.; 
42         requiring a licensed facility to adopt a protocol to 
43         designate a physician in cases involving suspected 
44         child abuse at the request of the Department of 
45         Children and Family Services rather than the 
46         Department of Health; amending s. 395.1041, F.S.; 
47         deleting provisions that require the Agency for Health 
48         Care Administration to request a hospital to identify 
49         its services, notify each hospital of the service 
50         capability to be included in the inventory, and 
51         publish a final inventory; deleting obsolete 
52         provisions; repealing s. 395.1046, F.S., relating to 
53         the investigation of complaints regarding hospitals; 
54         amending s. 395.1055, F.S.; requiring the agency to 
55         adopt rules that ensure that licensed facility beds 
56         conform to certain standards as specified by the 
57         agency, the Florida Building Code, and the Florida 
58         Fire Prevention Code; amending s. 395.10972, F.S.; 
59         renaming the Florida Society of Healthcare Risk 
60         Management as the “Florida Society for Healthcare Risk 
61         Management and Patient Safety”; amending s. 395.2050, 
62         F.S.; providing for an organ procurement organization 
63         to be designated by the federal Centers for Medicare 
64         and Medicaid Services rather than the federal Health 
65         Care Financing Administration; amending s. 395.3036, 
66         F.S.; correcting a cross-reference; repealing s. 
67         395.3037, F.S.; deleting definitions relating to 
68         obsolete provisions governing primary and 
69         comprehensive stroke centers; amending s. 395.3038, 
70         F.S.; renaming the Joint Commission on the 
71         Accreditation of Healthcare Organizations as the 
72         “Joint Commission”; amending s. 395.602, F.S.; 
73         redefining the term “rural hospital” as it relates to 
74         hospital licensure and regulation; amending s. 
75         400.021, F.S.; redefining the term “geriatric 
76         outpatient clinic” as it relates to nursing homes; 
77         amending ss. 400.0239 and 400.063, F.S., relating to 
78         trust funds; deleting obsolete provisions; amending s. 
79         400.071, F.S.; revising the requirements for an 
80         application for a license to operate a nursing home 
81         facility; amending s. 400.0712, F.S.; deleting the 
82         agency’s authority to issue an inactive license to a 
83         nursing home facility; amending s. 400.111, F.S.; 
84         requiring the agency to request a licensee to submit 
85         an affidavit disclosing financial or ownership 
86         interest that a controlling interest has held in 
87         certain entities; amending s. 400.1183, F.S.; 
88         requiring nursing home facilities to maintain records 
89         of grievances for agency inspection; deleting a 
90         requirement that a facility report the number of 
91         grievances handled during the prior licensure period; 
92         amending s. 400.141, F.S.; conforming a cross 
93         reference; deleting the requirement that a facility 
94         submit to the agency information regarding a 
95         management company with which it has entered into an 
96         agreement; specifying a fine for a nursing facility’s 
97         failure to impose an admissions moratorium for not 
98         complying with state minimum-staffing requirements; 
99         deleting the requirement for a facility to report to 
100         the agency any filing of bankruptcy protection, 
101         divestiture, or corporate reorganization; amending s. 
102         400.142, F.S.; deleting a provision that requires the 
103         agency to adopt rules regarding orders not to 
104         resuscitate; repealing s. 400.147(10), F.S., relating 
105         to a requirement that a nursing home facility report 
106         any notice of a filing of a claim for a violation of a 
107         resident’s rights or a claim of negligence; repealing 
108         s. 400.148, F.S., relating to the Medicaid “Up-or-Out” 
109         Quality of Care Contract Management Program; amending 
110         s. 400.19, F.S.; authorizing the agency to verify the 
111         correction of certain deficiencies after an 
112         unannounced inspection of a nursing home facility; 
113         repealing s. 400.195, F.S., relating to agency 
114         reporting requirements; amending s. 400.23, F.S.; 
115         renaming the Children’s Medical Services of the 
116         Department of Health as the “Children’s Medical 
117         Services Network”; deleting an obsolete provision; 
118         amending s. 400.275, F.S.; deleting a requirement that 
119         the agency ensure that a newly hired nursing home 
120         surveyor is assigned full time to a licensed nursing 
121         home to observe facility operations; amending s. 
122         400.462, F.S.; revising definitions with regard to the 
123         Home Health Services Act; defining the terms “primary 
124         home health agency” and “temporary” with regard to the 
125         Home Health Services Act; amending s. 400.476, F.S.; 
126         providing requirements for an alternative 
127         administrator of a home health agency; revising the 
128         duties of the administrator; revising the requirements 
129         for a director of nursing for a specified number of 
130         home health agencies; prohibiting a home health agency 
131         from using an individual as a home health aide unless 
132         the person has completed training and an evaluation 
133         program; requiring a home health aide to meet certain 
134         standards in order to be competent in performing 
135         certain tasks; requiring a home health agency and 
136         staff to comply with accepted professional standards; 
137         providing certain requirements for a written contract 
138         between certain personnel and the agency; requiring a 
139         home health agency to provide certain services through 
140         its employees; authorizing a home health agency to 
141         provide additional services with another organization; 
142         providing responsibilities of a home health agency 
143         when it provides home health aide services through 
144         another organization; requiring the home health agency 
145         to coordinate personnel that provide home health 
146         services; requiring personnel to communicate with the 
147         home health agency; amending s. 400.484, F.S.; 
148         redefining class I, II, III, and IV deficiencies as 
149         class I, II, III, and IV violations; amending s. 
150         400.487, F.S.; requiring a home health agency to 
151         provide a copy of the agreement between the agency and 
152         a patient which specifies the home health services to 
153         be provided; providing the rights that are protected 
154         by the home health agency; requiring the home health 
155         agency to furnish nursing services by or under the 
156         supervision of a registered nurse; requiring the home 
157         health agency to provide therapy services through a 
158         qualified therapist or therapy assistant; providing 
159         the duties and qualifications of a therapist and 
160         therapy assistant; requiring supervision by a physical 
161         therapist or occupational therapist of a physical 
162         therapist assistant or occupational therapist 
163         assistant; providing duties of a physical therapist 
164         assistant or occupational therapist assistant; 
165         providing for speech therapy services to be provided 
166         by a qualified speech pathologist or audiologist; 
167         providing for a plan of care; providing that only the 
168         staff of a home health agency may administer drugs and 
169         treatments as ordered by certain health professionals; 
170         providing requirements for verbal orders; providing 
171         duties of a registered nurse, licensed practical 
172         nurse, home health aide, and certified nursing 
173         assistant who work for a home health agency; amending 
174         s. 400.606, F.S.; revising the requirements for the 
175         plan for the delivery of home, residential, and 
176         homelike inpatient hospice services for terminally ill 
177         patients and their families; amending s. 400.607, 
178         F.S.; revising the grounds under which the agency may 
179         take administrative action against a hospice; amending 
180         s. 400.925, F.S.; renaming the Joint Commission on the 
181         Accreditation of Healthcare Organizations as the 
182         “Joint Commission” within the definition of the term 
183         “accrediting organizations” as it relates to home 
184         medical equipment providers; amending s. 400.931, 
185         F.S.; deleting the requirement that an applicant for a 
186         license to be a home medical equipment provider submit 
187         a surety bond to the agency; amending s. 400.932, 
188         F.S.; revising the grounds under which the agency may 
189         take administrative action against a home medical 
190         equipment provider; amending s. 400.933, F.S.; 
191         prohibiting a home medical equipment provider from 
192         submitting a survey or inspection of an accrediting 
193         organization if the home medical equipment provider’s 
194         licensure is conditional or provisional; amending s. 
195         400.953, F.S.; deleting the requirement of a general 
196         manager of a home medical equipment provider to 
197         annually sign an affidavit regarding the background 
198         screening of personnel; providing requirements for 
199         submission of the affidavit; amending s. 400.967, 
200         F.S.; redefining class I, II, III, and IV deficiencies 
201         as class I, II, III, and IV violations as they relate 
202         to intermediate care facilities for developmentally 
203         disabled persons; amending s. 400.969, F.S.; revising 
204         the grounds for an administrative or civil penalty; 
205         amending s. 400.9905, F.S.; redefining the term 
206         “portable service or equipment provider” as it relates 
207         to the Health Care Clinic Act; amending s. 400.991, 
208         F.S.; conforming a provision to changes made by the 
209         act; revising application requirements to show proof 
210         of financial ability to operate a health care clinic; 
211         amending s. 400.9935, F.S.; renaming the Joint 
212         Commission on the Accreditation of Healthcare 
213         Organizations as the “Joint Commission” for purposes 
214         of the Health Care Clinic Act; amending s. 408.034, 
215         F.S.; prohibiting the agency from issuing a license to 
216         a health care facility that applies for a license to 
217         operate an intermediate care facility for 
218         developmentally disabled persons under certain 
219         conditions; amending s. 408.036, F.S., relating to 
220         certificates of need; conforming a provision to 
221         changes made by the act; amending s. 408.043, F.S.; 
222         requiring a freestanding facility or a part of the 
223         facility that is the inpatient hospice care component 
224         of a hospice to obtain a certificate of need; amending 
225         s. 408.05, F.S.; renaming the Joint Commission on the 
226         Accreditation of Healthcare Organizations as the 
227         “Joint Commission”; amending s. 408.061, F.S.; 
228         revising requirements for the reporting of certified 
229         data elements by health care facilities; amending s. 
230         408.10, F.S.; authorizing the agency to provide 
231         staffing for a toll-free phone number for the purpose 
232         of handling consumer complaints regarding a health 
233         care facility; repealing s. 408.802(11), F.S., 
234         relating to the applicability of the Health Care 
235         Licensing Procedures Act to private review agents; 
236         amending s. 408.804, F.S.; providing a criminal 
237         penalty for altering, defacing, or falsifying a 
238         license certificate of certain health care providers; 
239         providing civil penalties for displaying an altered, 
240         defaced, or falsified license certificate; amending s. 
241         408.806, F.S.; requiring the agency to provide a 
242         courtesy notice to a licensee regarding the expiration 
243         of a licensee’s license; providing that failure of the 
244         agency to provide the courtesy notice or failure of 
245         the licensee to receive the notice is not an excuse 
246         for the licensee to timely renew its license; 
247         providing that payment of the late fee is required for 
248         a later application; amending s. 408.810, F.S.; 
249         revising the requirements for obtaining and 
250         maintaining a license for certain health care 
251         providers and those who own a controlling interest in 
252         a health care provider; amending s. 408.811, F.S.; 
253         providing that a licensee’s inspection report is not 
254         subject to administrative challenge; amending s. 
255         408.813, F.S.; authorizing the agency to impose 
256         administrative fines for unclassified violations; 
257         amending s. 408.815, F.S.; authorizing the agency to 
258         extend the expiration date of a license for the 
259         purpose of the safe and orderly discharge of clients; 
260         authorizing the agency to impose conditions on the 
261         extension; amending s. 409.906, F.S.; requiring the 
262         agency, in consultation with the Department of Elderly 
263         Affairs, to phase out the adult day health care waiver 
264         program; requiring adult day health care waiver 
265         providers, in consultation with resource centers for 
266         the aged to assist in the transition of enrollees from 
267         the waiver program; repealing s. 409.221(4)(k), F.S., 
268         relating to the responsibility of the agency, the 
269         Department of Elderly Affairs, the Department of 
270         Health, the Department of Children and Family 
271         Services, and the Agency for Persons with Disabilities 
272         to review and assess the implementation of the 
273         consumer-directed care program and the agency’s 
274         responsibility to submit a report to the Legislature; 
275         repealing s. 409.912(15)(e), (f), and (g), F.S., 
276         relating to a requirement for the Agency for Health 
277         Care Administration to submit a report to the 
278         Legislature regarding the operations of the CARE 
279         program; amending s. 429.11, F.S.; deleting provisions 
280         relating to a provisional license to operate as an 
281         assisted living facility; repealing s. 429.12(2), 
282         F.S., relating to the sale or transfer of ownership of 
283         an assisted living facility; amending s. 429.14, F.S.; 
284         authorizing the agency to provide electronically or 
285         through the agency’s Internet site information 
286         regarding the denial, suspension, or revocation of a 
287         license to the Division of Hotels and Restaurants of 
288         the Department of Business and Professional 
289         Regulation; amending s. 429.17, F.S.; revising the 
290         requirements for a conditional license to operate an 
291         assisted living facility; repealing s. 429.23(5), 
292         F.S., relating to each assisted living facility’s 
293         requirement to submit a report to the agency regarding 
294         liability claims filed against it; amending s. 429.35, 
295         F.S.; authorizing the agency to provide electronically 
296         or through the agency’s Internet website information 
297         regarding the results of an inspection to the local 
298         ombudsman council; amending s. 429.53, F.S.; requiring 
299         the agency, rather than the agency’s area offices of 
300         licensure and certification, to provide consultation 
301         to certain persons and licensees regarding assisted 
302         living facilities; redefining the term “consultation” 
303         as it relates to assisted living facilities; amending 
304         s. 429.65, F.S.; redefining the term “adult family 
305         care home” as it relates to the Adult Family-Care Home 
306         Act; amending s. 429.71, F.S.; redefining class I, II, 
307         III, and IV deficiencies as class I, II, III, and IV 
308         violations as they relate to adult family-care homes; 
309         repealing s. 429.911, F.S., relating to the denial, 
310         suspension, or revocation of a license to operate an 
311         adult day care center; amending s. 429.915, F.S.; 
312         revising requirements for a conditional license to 
313         operate an adult day care center; amending s. 430.80, 
314         F.S.; conforming a cross-reference; renaming the Joint 
315         Commission on the Accreditation of Healthcare 
316         Organizations to the Joint Commission; amending s. 
317         440.13, F.S.; renaming the Joint Commission on the 
318         Accreditation of Healthcare Organizations as the 
319         “Joint Commission”; amending s. 483.294, F.S.; 
320         requiring the agency to biennially inspect the 
321         premises and operations of multiphasic health testing 
322         centers; amending ss. 627.645, 627.668, and 627.669, 
323         F.S.; renaming the Joint Commission on the 
324         Accreditation of Hospitals to the Joint Commission; 
325         amending ss. 627.736 and 641.495 F.S.; renaming the 
326         Joint Commission on the Accreditation of Healthcare 
327         Organizations as the “Joint Commission”; amending s. 
328         651.118, F.S.; conforming a cross-reference; amending 
329         s. 766.1015, F.S.; renaming the Joint Commission on 
330         the Accreditation of Healthcare Organizations as the 
331         “Joint Commission”; providing effective dates. 
332 
333  Be It Enacted by the Legislature of the State of Florida: 
334 
335         Section 1. Subsection (16) is added to section 1.01, 
336  Florida Statutes, to read: 
337         1.01 Definitions.—In construing these statutes and each and 
338  every word, phrase, or part hereof, where the context will 
339  permit: 
340         (16) The term “Joint Commission” means the independent, 
341  not-for-profit organization that evaluates and accredits 
342  hospitals and health care organizations and programs in the 
343  United States. The Joint Commission was formerly known as the 
344  Joint Commission on Accreditation of Hospitals (JCAH) and the 
345  Joint Commission on Accreditation of Healthcare Organizations 
346  (JCAHO). 
347         Section 2. Paragraph (e) of subsection (10) of section 
348  112.0455, Florida Statutes, is repealed. 
349         Section 3. Paragraph (n) of subsection (1) of section 
350  154.11, Florida Statutes, is amended to read: 
351         154.11 Powers of board of trustees.— 
352         (1) The board of trustees of each public health trust shall 
353  be deemed to exercise a public and essential governmental 
354  function of both the state and the county and in furtherance 
355  thereof it shall, subject to limitation by the governing body of 
356  the county in which such board is located, have all of the 
357  powers necessary or convenient to carry out the operation and 
358  governance of designated health care facilities, including, but 
359  without limiting the generality of, the foregoing: 
360         (n) To appoint originally the staff of physicians to 
361  practice in any designated facility owned or operated by the 
362  board and to approve the bylaws and rules to be adopted by the 
363  medical staff of any designated facility owned and operated by 
364  the board, such governing regulations to be in accordance with 
365  the standards of the Joint Commission on the Accreditation of 
366  Hospitals which provide, among other things, for the method of 
367  appointing additional staff members and for the removal of staff 
368  members. 
369         Section 4. Subsection (15) of section 318.21, Florida 
370  Statutes, is amended to read: 
371         318.21 Disposition of civil penalties by county courts.—All 
372  civil penalties received by a county court pursuant to the 
373  provisions of this chapter shall be distributed and paid monthly 
374  as follows: 
375         (15) Of the additional fine assessed under s. 318.18(3)(e) 
376  for a violation of s. 316.1893, 50 percent of the moneys 
377  received from the fines shall be remitted to the Department of 
378  Revenue and deposited into Brain and Spinal Cord Injury 
379  Rehabilitation Trust Fund within Department of Health and shall 
380  be appropriated to the Department of Health Agency for Health 
381  Care Administration as general revenue to provide an enhanced 
382  Medicaid payment to nursing homes that serve Medicaid recipients 
383  with brain and spinal cord injuries that are medically complex, 
384  technologically dependent, and respiratory dependent. The 
385  remaining 50 percent of the moneys received from the enhanced 
386  fine imposed under s. 318.18(3)(e) shall be remitted to the 
387  Department of Revenue and deposited into the Department of 
388  Health Administrative Trust Fund to provide financial support to 
389  certified trauma centers in the counties where enhanced penalty 
390  zones are established to ensure the availability and 
391  accessibility of trauma services. Funds deposited into the 
392  Administrative Trust Fund under this subsection shall be 
393  allocated as follows: 
394         (a) Fifty percent shall be allocated equally among all 
395  Level I, Level II, and pediatric trauma centers in recognition 
396  of readiness costs for maintaining trauma services. 
397         (b) Fifty percent shall be allocated among Level I, Level 
398  II, and pediatric trauma centers based on each center’s relative 
399  volume of trauma cases as reported in the Department of Health 
400  Trauma Registry. 
401         Section 5. Section 383.325, Florida Statutes, is repealed. 
402         Section 6. Subsection (7) of section 394.4787, Florida 
403  Statutes, is amended to read: 
404         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and 
405  394.4789.—As used in this section and ss. 394.4786, 394.4788, 
406  and 394.4789: 
407         (7) “Specialty psychiatric hospital” means a hospital 
408  licensed by the agency pursuant to s. 395.002(26) s. 395.002(28) 
409  and part II of chapter 408 as a specialty psychiatric hospital. 
410         Section 7. Subsection (2) of section 394.741, Florida 
411  Statutes, is amended to read: 
412         394.741 Accreditation requirements for providers of 
413  behavioral health care services.— 
414         (2) Notwithstanding any provision of law to the contrary, 
415  accreditation shall be accepted by the agency and department in 
416  lieu of the agency’s and department’s facility licensure onsite 
417  review requirements and shall be accepted as a substitute for 
418  the department’s administrative and program monitoring 
419  requirements, except as required by subsections (3) and (4), 
420  for: 
421         (a) Any organization from which the department purchases 
422  behavioral health care services that is accredited by the Joint 
423  Commission on Accreditation of Healthcare Organizations or the 
424  Council on Accreditation for Children and Family Services, or 
425  has those services that are being purchased by the department 
426  accredited by CARF—the Rehabilitation Accreditation Commission. 
427         (b) Any mental health facility licensed by the agency or 
428  any substance abuse component licensed by the department that is 
429  accredited by the Joint Commission on Accreditation of 
430  Healthcare Organizations, CARF—the Rehabilitation Accreditation 
431  Commission, or the Council on Accreditation of Children and 
432  Family Services. 
433         (c) Any network of providers from which the department or 
434  the agency purchases behavioral health care services accredited 
435  by the Joint Commission on Accreditation of Healthcare 
436  Organizations, CARF—the Rehabilitation Accreditation Commission, 
437  the Council on Accreditation of Children and Family Services, or 
438  the National Committee for Quality Assurance. A provider 
439  organization, which is part of an accredited network, is 
440  afforded the same rights under this part. 
441         Section 8. Section 395.002, Florida Statutes, is amended to 
442  read: 
443         395.002 Definitions.—As used in this chapter, the term: 
444         (1) “Accrediting organizations” means nationally recognized 
445  or approved accrediting organizations whose standards 
446  incorporate comparable licensure requirements as determined by 
447  the agency. the Joint Commission on Accreditation of Healthcare 
448  Organizations, the American Osteopathic Association, the 
449  Commission on Accreditation of Rehabilitation Facilities, and 
450  the Accreditation Association for Ambulatory Health Care, Inc. 
451         (2) “Agency” means the Agency for Health Care 
452  Administration. 
453         (3) “Ambulatory surgical center” or “mobile surgical 
454  facility” means a facility the primary purpose of which is to 
455  provide elective surgical care, in which the patient is admitted 
456  to and discharged from such facility within the same working day 
457  and is not permitted to stay overnight, and which is not part of 
458  a hospital. However, a facility existing for the primary purpose 
459  of performing terminations of pregnancy, an office maintained by 
460  a physician for the practice of medicine, or an office 
461  maintained for the practice of dentistry shall not be construed 
462  to be an ambulatory surgical center, provided that any facility 
463  or office which is certified or seeks certification as a 
464  Medicare ambulatory surgical center shall be licensed as an 
465  ambulatory surgical center pursuant to s. 395.003. Any structure 
466  or vehicle in which a physician maintains an office and 
467  practices surgery, and which can appear to the public to be a 
468  mobile office because the structure or vehicle operates at more 
469  than one address, shall be construed to be a mobile surgical 
470  facility. 
471         (4) “Biomedical waste” means any solid or liquid waste as 
472  defined in s. 381.0098(2)(a). 
473         (5) “Clinical privileges” means the privileges granted to a 
474  physician or other licensed health care practitioner to render 
475  patient care services in a hospital, but does not include the 
476  privilege of admitting patients. 
477         (6) “Department” means the Department of Health. 
478         (7) “Director” means any member of the official board of 
479  directors as reported in the organization’s annual corporate 
480  report to the Florida Department of State, or, if no such report 
481  is made, any member of the operating board of directors. The 
482  term excludes members of separate, restricted boards that serve 
483  only in an advisory capacity to the operating board. 
484         (8) “Emergency medical condition” means: 
485         (a) A medical condition manifesting itself by acute 
486  symptoms of sufficient severity, which may include severe pain, 
487  such that the absence of immediate medical attention could 
488  reasonably be expected to result in any of the following: 
489         1. Serious jeopardy to patient health, including a pregnant 
490  woman or fetus. 
491         2. Serious impairment to bodily functions. 
492         3. Serious dysfunction of any bodily organ or part. 
493         (b) With respect to a pregnant woman: 
494         1. That there is inadequate time to effect safe transfer to 
495  another hospital prior to delivery; 
496         2. That a transfer may pose a threat to the health and 
497  safety of the patient or fetus; or 
498         3. That there is evidence of the onset and persistence of 
499  uterine contractions or rupture of the membranes. 
500         (9) “Emergency services and care” means medical screening, 
501  examination, and evaluation by a physician, or, to the extent 
502  permitted by applicable law, by other appropriate personnel 
503  under the supervision of a physician, to determine if an 
504  emergency medical condition exists and, if it does, the care, 
505  treatment, or surgery by a physician necessary to relieve or 
506  eliminate the emergency medical condition, within the service 
507  capability of the facility. 
508         (10) “General hospital” means any facility which meets the 
509  provisions of subsection (12) and which regularly makes its 
510  facilities and services available to the general population. 
511         (11) “Governmental unit” means the state or any county, 
512  municipality, or other political subdivision, or any department, 
513  division, board, or other agency of any of the foregoing. 
514         (12) “Hospital” means any establishment that: 
515         (a) Offers services more intensive than those required for 
516  room, board, personal services, and general nursing care, and 
517  offers facilities and beds for use beyond 24 hours by 
518  individuals requiring diagnosis, treatment, or care for illness, 
519  injury, deformity, infirmity, abnormality, disease, or 
520  pregnancy; and 
521         (b) Regularly makes available at least clinical laboratory 
522  services, diagnostic X-ray services, and treatment facilities 
523  for surgery or obstetrical care, or other definitive medical 
524  treatment of similar extent, except that a critical access 
525  hospital, as defined in s. 408.07, shall not be required to make 
526  available treatment facilities for surgery, obstetrical care, or 
527  similar services as long as it maintains its critical access 
528  hospital designation and shall be required to make such 
529  facilities available only if it ceases to be designated as a 
530  critical access hospital. 
531 
532  However, the provisions of this chapter do not apply to any 
533  institution conducted by or for the adherents of any well 
534  recognized church or religious denomination that depends 
535  exclusively upon prayer or spiritual means to heal, care for, or 
536  treat any person. For purposes of local zoning matters, the term 
537  “hospital” includes a medical office building located on the 
538  same premises as a hospital facility, provided the land on which 
539  the medical office building is constructed is zoned for use as a 
540  hospital; provided the premises were zoned for hospital purposes 
541  on January 1, 1992. 
542         (13) “Hospital bed” means a hospital accommodation which is 
543  ready for immediate occupancy, or is capable of being made ready 
544  for occupancy within 48 hours, excluding provision of staffing, 
545  and which conforms to minimum space, equipment, and furnishings 
546  standards as specified by rule of the agency for the provision 
547  of services specified in this section to a single patient. 
548         (14) “Initial denial determination” means a determination 
549  by a private review agent that the health care services 
550  furnished or proposed to be furnished to a patient are 
551  inappropriate, not medically necessary, or not reasonable. 
552         (14)(15) “Intensive residential treatment programs for 
553  children and adolescents” means a specialty hospital accredited 
554  by an accrediting organization as defined in subsection (1) 
555  which provides 24-hour care and which has the primary functions 
556  of diagnosis and treatment of patients under the age of 18 
557  having psychiatric disorders in order to restore such patients 
558  to an optimal level of functioning. 
559         (15)(16) “Licensed facility” means a hospital, ambulatory 
560  surgical center, or mobile surgical facility licensed in 
561  accordance with this chapter. 
562         (16)(17) “Lifesafety” means the control and prevention of 
563  fire and other life-threatening conditions on a premises for the 
564  purpose of preserving human life. 
565         (17)(18) “Managing employee” means the administrator or 
566  other similarly titled individual who is responsible for the 
567  daily operation of the facility. 
568         (18)(19) “Medical staff” means physicians licensed under 
569  chapter 458 or chapter 459 with privileges in a licensed 
570  facility, as well as other licensed health care practitioners 
571  with clinical privileges as approved by a licensed facility’s 
572  governing board. 
573         (19)(20) “Medically necessary transfer” means a transfer 
574  made necessary because the patient is in immediate need of 
575  treatment for an emergency medical condition for which the 
576  facility lacks service capability or is at service capacity. 
577         (20)(21) “Mobile surgical facility” is a mobile facility in 
578  which licensed health care professionals provide elective 
579  surgical care under contract with the Department of Corrections 
580  or a private correctional facility operating pursuant to chapter 
581  957 and in which inmate patients are admitted to and discharged 
582  from said facility within the same working day and are not 
583  permitted to stay overnight. However, mobile surgical facilities 
584  may only provide health care services to the inmate patients of 
585  the Department of Corrections, or inmate patients of a private 
586  correctional facility operating pursuant to chapter 957, and not 
587  to the general public. 
588         (21)(22) “Person” means any individual, partnership, 
589  corporation, association, or governmental unit. 
590         (22)(23) “Premises” means those buildings, beds, and 
591  equipment located at the address of the licensed facility and 
592  all other buildings, beds, and equipment for the provision of 
593  hospital, ambulatory surgical, or mobile surgical care located 
594  in such reasonable proximity to the address of the licensed 
595  facility as to appear to the public to be under the dominion and 
596  control of the licensee. For any licensee that is a teaching 
597  hospital as defined in s. 408.07(45), reasonable proximity 
598  includes any buildings, beds, services, programs, and equipment 
599  under the dominion and control of the licensee that are located 
600  at a site with a main address that is within 1 mile of the main 
601  address of the licensed facility; and all such buildings, beds, 
602  and equipment may, at the request of a licensee or applicant, be 
603  included on the facility license as a single premises. 
604         (24) “Private review agent” means any person or entity 
605  which performs utilization review services for third-party 
606  payors on a contractual basis for outpatient or inpatient 
607  services. However, the term shall not include full-time 
608  employees, personnel, or staff of health insurers, health 
609  maintenance organizations, or hospitals, or wholly owned 
610  subsidiaries thereof or affiliates under common ownership, when 
611  performing utilization review for their respective hospitals, 
612  health maintenance organizations, or insureds of the same 
613  insurance group. For this purpose, health insurers, health 
614  maintenance organizations, and hospitals, or wholly owned 
615  subsidiaries thereof or affiliates under common ownership, 
616  include such entities engaged as administrators of self 
617  insurance as defined in s. 624.031. 
618         (23)(25) “Service capability” means all services offered by 
619  the facility where identification of services offered is 
620  evidenced by the appearance of the service in a patient’s 
621  medical record or itemized bill. 
622         (24)(26) “At service capacity” means the temporary 
623  inability of a hospital to provide a service which is within the 
624  service capability of the hospital, due to maximum use of the 
625  service at the time of the request for the service. 
626         (25)(27) “Specialty bed” means a bed, other than a general 
627  bed, designated on the face of the hospital license for a 
628  dedicated use. 
629         (26)(28) “Specialty hospital” means any facility which 
630  meets the provisions of subsection (12), and which regularly 
631  makes available either: 
632         (a) The range of medical services offered by general 
633  hospitals, but restricted to a defined age or gender group of 
634  the population; 
635         (b) A restricted range of services appropriate to the 
636  diagnosis, care, and treatment of patients with specific 
637  categories of medical or psychiatric illnesses or disorders; or 
638         (c) Intensive residential treatment programs for children 
639  and adolescents as defined in subsection (14) (15). 
640         (27)(29) “Stabilized” means, with respect to an emergency 
641  medical condition, that no material deterioration of the 
642  condition is likely, within reasonable medical probability, to 
643  result from the transfer of the patient from a hospital. 
644         (30) “Utilization review” means a system for reviewing the 
645  medical necessity or appropriateness in the allocation of health 
646  care resources of hospital services given or proposed to be 
647  given to a patient or group of patients. 
648         (31) “Utilization review plan” means a description of the 
649  policies and procedures governing utilization review activities 
650  performed by a private review agent. 
651         (28)(32) “Validation inspection” means an inspection of the 
652  premises of a licensed facility by the agency to assess whether 
653  a review by an accrediting organization has adequately evaluated 
654  the licensed facility according to minimum state standards. 
655         Section 9. Subsection (1) of section 395.003, Florida 
656  Statutes, is amended to read: 
657         395.003 Licensure; denial, suspension, and revocation.— 
658         (1)(a) The requirements of part II of chapter 408 apply to 
659  the provision of services that require licensure pursuant to ss. 
660  395.001-395.1065 and part II of chapter 408 and to entities 
661  licensed by or applying for such licensure from the Agency for 
662  Health Care Administration pursuant to ss. 395.001-395.1065. A 
663  license issued by the agency is required in order to operate a 
664  hospital, ambulatory surgical center, or mobile surgical 
665  facility in this state. 
666         (b)1. It is unlawful for a person to use or advertise to 
667  the public, in any way or by any medium whatsoever, any facility 
668  as a “hospital,” “ambulatory surgical center,” or “mobile 
669  surgical facility” unless such facility has first secured a 
670  license under the provisions of this part. 
671         2. This part does not apply to veterinary hospitals or to 
672  commercial business establishments using the word “hospital,” 
673  “ambulatory surgical center,” or “mobile surgical facility” as a 
674  part of a trade name if no treatment of human beings is 
675  performed on the premises of such establishments. 
676         (c) Until July 1, 2006, additional emergency departments 
677  located off the premises of licensed hospitals may not be 
678  authorized by the agency. 
679         Section 10. Paragraph (e) of subsection (2) and subsection 
680  (4) of section 395.0193, Florida Statutes, are amended to read: 
681         395.0193 Licensed facilities; peer review; disciplinary 
682  powers; agency or partnership with physicians.— 
683         (2) Each licensed facility, as a condition of licensure, 
684  shall provide for peer review of physicians who deliver health 
685  care services at the facility. Each licensed facility shall 
686  develop written, binding procedures by which such peer review 
687  shall be conducted. Such procedures shall include: 
688         (e) Recording of agendas and minutes which do not contain 
689  confidential material, for review by the Division of Medical 
690  Quality Assurance of the department Health Quality Assurance of 
691  the agency. 
692         (4) Pursuant to ss. 458.337 and 459.016, any disciplinary 
693  actions taken under subsection (3) shall be reported in writing 
694  to the Division of Medical Quality Assurance of the department 
695  Health Quality Assurance of the agency within 30 working days 
696  after its initial occurrence, regardless of the pendency of 
697  appeals to the governing board of the hospital. The notification 
698  shall identify the disciplined practitioner, the action taken, 
699  and the reason for such action. All final disciplinary actions 
700  taken under subsection (3), if different from those which were 
701  reported to the department agency within 30 days after the 
702  initial occurrence, shall be reported within 10 working days to 
703  the Division of Medical Quality Assurance of the department 
704  Health Quality Assurance of the agency in writing and shall 
705  specify the disciplinary action taken and the specific grounds 
706  therefor. The division shall review each report and determine 
707  whether it potentially involved conduct by the licensee that is 
708  subject to disciplinary action, in which case s. 456.073 shall 
709  apply. The reports are not subject to inspection under s. 
710  119.07(1) even if the division’s investigation results in a 
711  finding of probable cause. 
712         Section 11. Section 395.1023, Florida Statutes, is amended 
713  to read: 
714         395.1023 Child abuse and neglect cases; duties.—Each 
715  licensed facility shall adopt a protocol that, at a minimum, 
716  requires the facility to: 
717         (1) Incorporate a facility policy that every staff member 
718  has an affirmative duty to report, pursuant to chapter 39, any 
719  actual or suspected case of child abuse, abandonment, or 
720  neglect; and 
721         (2) In any case involving suspected child abuse, 
722  abandonment, or neglect, designate, at the request of the 
723  Department of Children and Family Services, a staff physician to 
724  act as a liaison between the hospital and the Department of 
725  Children and Family Services office which is investigating the 
726  suspected abuse, abandonment, or neglect, and the child 
727  protection team, as defined in s. 39.01, when the case is 
728  referred to such a team. 
729 
730  Each general hospital and appropriate specialty hospital shall 
731  comply with the provisions of this section and shall notify the 
732  agency and the Department of Children and Family Services of its 
733  compliance by sending a copy of its policy to the agency and the 
734  Department of Children and Family Services as required by rule. 
735  The failure by a general hospital or appropriate specialty 
736  hospital to comply shall be punished by a fine not exceeding 
737  $1,000, to be fixed, imposed, and collected by the agency. Each 
738  day in violation is considered a separate offense. 
739         Section 12. Subsection (2) and paragraph (d) of subsection 
740  (3) of section 395.1041, Florida Statutes, are amended to read: 
741         395.1041 Access to emergency services and care.— 
742         (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency 
743  shall establish and maintain an inventory of hospitals with 
744  emergency services. The inventory shall list all services within 
745  the service capability of the hospital, and such services shall 
746  appear on the face of the hospital license. Each hospital having 
747  emergency services shall notify the agency of its service 
748  capability in the manner and form prescribed by the agency. The 
749  agency shall use the inventory to assist emergency medical 
750  services providers and others in locating appropriate emergency 
751  medical care. The inventory shall also be made available to the 
752  general public. On or before August 1, 1992, the agency shall 
753  request that each hospital identify the services which are 
754  within its service capability. On or before November 1, 1992, 
755  the agency shall notify each hospital of the service capability 
756  to be included in the inventory. The hospital has 15 days from 
757  the date of receipt to respond to the notice. By December 1, 
758  1992, the agency shall publish a final inventory. Each hospital 
759  shall reaffirm its service capability when its license is 
760  renewed and shall notify the agency of the addition of a new 
761  service or the termination of a service prior to a change in its 
762  service capability. 
763         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 
764  FACILITY OR HEALTH CARE PERSONNEL.— 
765         (d)1. Every hospital shall ensure the provision of services 
766  within the service capability of the hospital, at all times, 
767  either directly or indirectly through an arrangement with 
768  another hospital, through an arrangement with one or more 
769  physicians, or as otherwise made through prior arrangements. A 
770  hospital may enter into an agreement with another hospital for 
771  purposes of meeting its service capability requirement, and 
772  appropriate compensation or other reasonable conditions may be 
773  negotiated for these backup services. 
774         2. If any arrangement requires the provision of emergency 
775  medical transportation, such arrangement must be made in 
776  consultation with the applicable provider and may not require 
777  the emergency medical service provider to provide transportation 
778  that is outside the routine service area of that provider or in 
779  a manner that impairs the ability of the emergency medical 
780  service provider to timely respond to prehospital emergency 
781  calls. 
782         3. A hospital shall not be required to ensure service 
783  capability at all times as required in subparagraph 1. if, prior 
784  to the receiving of any patient needing such service capability, 
785  such hospital has demonstrated to the agency that it lacks the 
786  ability to ensure such capability and it has exhausted all 
787  reasonable efforts to ensure such capability through backup 
788  arrangements. In reviewing a hospital’s demonstration of lack of 
789  ability to ensure service capability, the agency shall consider 
790  factors relevant to the particular case, including the 
791  following: 
792         a. Number and proximity of hospitals with the same service 
793  capability. 
794         b. Number, type, credentials, and privileges of 
795  specialists. 
796         c. Frequency of procedures. 
797         d. Size of hospital. 
798         4. The agency shall publish proposed rules implementing a 
799  reasonable exemption procedure by November 1, 1992. Subparagraph 
800  1. shall become effective upon the effective date of said rules 
801  or January 31, 1993, whichever is earlier. For a period not to 
802  exceed 1 year from the effective date of subparagraph 1., a 
803  hospital requesting an exemption shall be deemed to be exempt 
804  from offering the service until the agency initially acts to 
805  deny or grant the original request. The agency has 45 days from 
806  the date of receipt of the request to approve or deny the 
807  request. After the first year from the effective date of 
808  subparagraph 1., If the agency fails to initially act within the 
809  time period, the hospital is deemed to be exempt from offering 
810  the service until the agency initially acts to deny the request. 
811         Section 13. Section 395.1046, Florida Statutes, is 
812  repealed. 
813         Section 14. Paragraph (e) of subsection (1) of section 
814  395.1055, Florida Statutes, is amended to read: 
815         395.1055 Rules and enforcement.— 
816         (1) The agency shall adopt rules pursuant to ss. 120.536(1) 
817  and 120.54 to implement the provisions of this part, which shall 
818  include reasonable and fair minimum standards for ensuring that: 
819         (e) Licensed facility beds conform to minimum space, 
820  equipment, and furnishings standards as specified by the agency, 
821  the Florida Building Code, and the Florida Fire Prevention Code 
822  department. 
823         Section 15. Subsection (1) of section 395.10972, Florida 
824  Statutes, is amended to read: 
825         395.10972 Health Care Risk Manager Advisory Council.—The 
826  Secretary of Health Care Administration may appoint a seven 
827  member advisory council to advise the agency on matters 
828  pertaining to health care risk managers. The members of the 
829  council shall serve at the pleasure of the secretary. The 
830  council shall designate a chair. The council shall meet at the 
831  call of the secretary or at those times as may be required by 
832  rule of the agency. The members of the advisory council shall 
833  receive no compensation for their services, but shall be 
834  reimbursed for travel expenses as provided in s. 112.061. The 
835  council shall consist of individuals representing the following 
836  areas: 
837         (1) Two shall be active health care risk managers, 
838  including one risk manager who is recommended by and a member of 
839  the Florida Society for of Healthcare Risk Management and 
840  Patient Safety. 
841         Section 16. Subsection (3) of section 395.2050, Florida 
842  Statutes, is amended to read: 
843         395.2050 Routine inquiry for organ and tissue donation; 
844  certification for procurement activities; death records review.— 
845         (3) Each organ procurement organization designated by the 
846  federal Centers for Medicare and Medicaid Services Health Care 
847  Financing Administration and licensed by the state shall conduct 
848  an annual death records review in the organ procurement 
849  organization’s affiliated donor hospitals. The organ procurement 
850  organization shall enlist the services of every Florida licensed 
851  tissue bank and eye bank affiliated with or providing service to 
852  the donor hospital and operating in the same service area to 
853  participate in the death records review. 
854         Section 17. Subsection (2) of section 395.3036, Florida 
855  Statutes, is amended to read: 
856         395.3036 Confidentiality of records and meetings of 
857  corporations that lease public hospitals or other public health 
858  care facilities.—The records of a private corporation that 
859  leases a public hospital or other public health care facility 
860  are confidential and exempt from the provisions of s. 119.07(1) 
861  and s. 24(a), Art. I of the State Constitution, and the meetings 
862  of the governing board of a private corporation are exempt from 
863  s. 286.011 and s. 24(b), Art. I of the State Constitution when 
864  the public lessor complies with the public finance 
865  accountability provisions of s. 155.40(5) with respect to the 
866  transfer of any public funds to the private lessee and when the 
867  private lessee meets at least three of the five following 
868  criteria: 
869         (2) The public lessor and the private lessee do not 
870  commingle any of their funds in any account maintained by either 
871  of them, other than the payment of the rent and administrative 
872  fees or the transfer of funds pursuant to subsection (5) (2). 
873         Section 18. Section 395.3037, Florida Statutes, is 
874  repealed. 
875         Section 19. Subsections (1), (4), and (5) of section 
876  395.3038, Florida Statutes, are amended to read: 
877         395.3038 State-listed primary stroke centers and 
878  comprehensive stroke centers; notification of hospitals.— 
879         (1) The agency shall make available on its website and to 
880  the department a list of the name and address of each hospital 
881  that meets the criteria for a primary stroke center and the name 
882  and address of each hospital that meets the criteria for a 
883  comprehensive stroke center. The list of primary and 
884  comprehensive stroke centers shall include only those hospitals 
885  that attest in an affidavit submitted to the agency that the 
886  hospital meets the named criteria, or those hospitals that 
887  attest in an affidavit submitted to the agency that the hospital 
888  is certified as a primary or a comprehensive stroke center by 
889  the Joint Commission on Accreditation of Healthcare 
890  Organizations. 
891         (4) The agency shall adopt by rule criteria for a primary 
892  stroke center which are substantially similar to the 
893  certification standards for primary stroke centers of the Joint 
894  Commission on Accreditation of Healthcare Organizations. 
895         (5) The agency shall adopt by rule criteria for a 
896  comprehensive stroke center. However, if the Joint Commission on 
897  Accreditation of Healthcare Organizations establishes criteria 
898  for a comprehensive stroke center, the agency shall establish 
899  criteria for a comprehensive stroke center which are 
900  substantially similar to those criteria established by the Joint 
901  Commission on Accreditation of Healthcare Organizations. 
902         Section 20. Subsection (2) of section 395.602, Florida 
903  Statutes, is amended to read: 
904         395.602 Rural hospitals.— 
905         (2) DEFINITIONS.—As used in this part: 
906         (e) “Rural hospital” means an acute care hospital licensed 
907  under this chapter, having 100 or fewer licensed beds and an 
908  emergency room, which is: 
909         1. The sole provider within a county with a population 
910  density of no greater than 100 persons per square mile; 
911         2. An acute care hospital, in a county with a population 
912  density of no greater than 100 persons per square mile, which is 
913  at least 30 minutes of travel time, on normally traveled roads 
914  under normal traffic conditions, from any other acute care 
915  hospital within the same county; 
916         3. A hospital supported by a tax district or subdistrict 
917  whose boundaries encompass a population of 100 persons or fewer 
918  per square mile; 
919         4. A hospital in a constitutional charter county with a 
920  population of over 1 million persons that has imposed a local 
921  option health service tax pursuant to law and in an area that 
922  was directly impacted by a catastrophic event on August 24, 
923  1992, for which the Governor of Florida declared a state of 
924  emergency pursuant to chapter 125, and has 120 beds or less that 
925  serves an agricultural community with an emergency room 
926  utilization of no less than 20,000 visits and a Medicaid 
927  inpatient utilization rate greater than 15 percent; 
928         4.5. A hospital with a service area that has a population 
929  of 100 persons or fewer per square mile. As used in this 
930  subparagraph, the term “service area” means the fewest number of 
931  zip codes that account for 75 percent of the hospital’s 
932  discharges for the most recent 5-year period, based on 
933  information available from the hospital inpatient discharge 
934  database in the Florida Center for Health Information and Policy 
935  Analysis at the Agency for Health Care Administration; or 
936         5.6. A hospital designated as a critical access hospital, 
937  as defined in s. 408.07(15). 
938 
939  Population densities used in this paragraph must be based upon 
940  the most recently completed United States census. A hospital 
941  that received funds under s. 409.9116 for a quarter beginning no 
942  later than July 1, 2002, is deemed to have been and shall 
943  continue to be a rural hospital from that date through June 30, 
944  2015, if the hospital continues to have 100 or fewer licensed 
945  beds and an emergency room, or meets the criteria of 
946  subparagraph 4. An acute care hospital that has not previously 
947  been designated as a rural hospital and that meets the criteria 
948  of this paragraph shall be granted such designation upon 
949  application, including supporting documentation to the Agency 
950  for Health Care Administration. 
951         Section 21. Subsection (8) of section 400.021, Florida 
952  Statutes, is amended to read: 
953         400.021 Definitions.—When used in this part, unless the 
954  context otherwise requires, the term: 
955         (8) “Geriatric outpatient clinic” means a site for 
956  providing outpatient health care to persons 60 years of age or 
957  older, which is staffed by a registered nurse, or a physician 
958  assistant, a licensed practical nurse under the direct 
959  supervision of a registered nurse, or an advanced registered 
960  nurse practitioner. 
961         Section 22. Paragraph (g) of subsection (2) of section 
962  400.0239, Florida Statutes, is amended to read: 
963         400.0239 Quality of Long-Term Care Facility Improvement 
964  Trust Fund.— 
965         (2) Expenditures from the trust fund shall be allowable for 
966  direct support of the following: 
967         (g) Other initiatives authorized by the Centers for 
968  Medicare and Medicaid Services for the use of federal civil 
969  monetary penalties, including projects recommended through the 
970  Medicaid “Up-or-Out” Quality of Care Contract Management Program 
971  pursuant to s. 400.148. 
972         Section 23. Subsection (2) of section 400.063, Florida 
973  Statutes, is amended to read: 
974         400.063 Resident protection.— 
975         (2) The agency is authorized to establish for each 
976  facility, subject to intervention by the agency, a separate bank 
977  account for the deposit to the credit of the agency of any 
978  moneys received from the Health Care Trust Fund or any other 
979  moneys received for the maintenance and care of residents in the 
980  facility, and the agency is authorized to disburse moneys from 
981  such account to pay obligations incurred for the purposes of 
982  this section. The agency is authorized to requisition moneys 
983  from the Health Care Trust Fund in advance of an actual need for 
984  cash on the basis of an estimate by the agency of moneys to be 
985  spent under the authority of this section. Any bank account 
986  established under this section need not be approved in advance 
987  of its creation as required by s. 17.58, but shall be secured by 
988  depository insurance equal to or greater than the balance of 
989  such account or by the pledge of collateral security in 
990  conformance with criteria established in s. 18.11. The agency 
991  shall notify the Chief Financial Officer of any such account so 
992  established and shall make a quarterly accounting to the Chief 
993  Financial Officer for all moneys deposited in such account. 
994         Section 24. Subsections (1) and (5) of section 400.071, 
995  Florida Statutes, are amended to read: 
996         400.071 Application for license.— 
997         (1) In addition to the requirements of part II of chapter 
998  408, the application for a license shall be under oath and must 
999  contain the following: 
1000         (a) The location of the facility for which a license is 
1001  sought and an indication, as in the original application, that 
1002  such location conforms to the local zoning ordinances. 
1003         (b) A signed affidavit disclosing any financial or 
1004  ownership interest that a controlling interest as defined in 
1005  part II of chapter 408 has held in the last 5 years in any 
1006  entity licensed by this state or any other state to provide 
1007  health or residential care which has closed voluntarily or 
1008  involuntarily; has filed for bankruptcy; has had a receiver 
1009  appointed; has had a license denied, suspended, or revoked; or 
1010  has had an injunction issued against it which was initiated by a 
1011  regulatory agency. The affidavit must disclose the reason any 
1012  such entity was closed, whether voluntarily or involuntarily. 
1013         (c) The total number of beds and the total number of 
1014  Medicare and Medicaid certified beds. 
1015         (b)(d) Information relating to the applicant and employees 
1016  which the agency requires by rule. The applicant must 
1017  demonstrate that sufficient numbers of qualified staff, by 
1018  training or experience, will be employed to properly care for 
1019  the type and number of residents who will reside in the 
1020  facility. 
1021         (c)(e) Copies of any civil verdict or judgment involving 
1022  the applicant rendered within the 10 years preceding the 
1023  application, relating to medical negligence, violation of 
1024  residents’ rights, or wrongful death. As a condition of 
1025  licensure, the licensee agrees to provide to the agency copies 
1026  of any new verdict or judgment involving the applicant, relating 
1027  to such matters, within 30 days after filing with the clerk of 
1028  the court. The information required in this paragraph shall be 
1029  maintained in the facility’s licensure file and in an agency 
1030  database which is available as a public record. 
1031         (5) As a condition of licensure, each facility must 
1032  establish and submit with its application a plan for quality 
1033  assurance and for conducting risk management. 
1034         Section 25. Section 400.0712, Florida Statutes, is amended 
1035  to read: 
1036         400.0712 Application for inactive license.— 
1037         (1) As specified in this section, the agency may issue an 
1038  inactive license to a nursing home facility for all or a portion 
1039  of its beds. Any request by a licensee that a nursing home or 
1040  portion of a nursing home become inactive must be submitted to 
1041  the agency in the approved format. The facility may not initiate 
1042  any suspension of services, notify residents, or initiate 
1043  inactivity before receiving approval from the agency; and a 
1044  licensee that violates this provision may not be issued an 
1045  inactive license. 
1046         (1)(2) In addition to the authority granted in part II of 
1047  chapter 408, the agency may issue an inactive license to a 
1048  nursing home that chooses to use an unoccupied contiguous 
1049  portion of the facility for an alternative use to meet the needs 
1050  of elderly persons through the use of less restrictive, less 
1051  institutional services. 
1052         (a) An inactive license issued under this subsection may be 
1053  granted for a period not to exceed the current licensure 
1054  expiration date but may be renewed by the agency at the time of 
1055  licensure renewal. 
1056         (b) A request to extend the inactive license must be 
1057  submitted to the agency in the approved format and approved by 
1058  the agency in writing. 
1059         (c) Nursing homes that receive an inactive license to 
1060  provide alternative services shall not receive preference for 
1061  participation in the Assisted Living for the Elderly Medicaid 
1062  waiver. 
1063         (2)(3) The agency shall adopt rules pursuant to ss. 
1064  120.536(1) and 120.54 necessary to administer implement this 
1065  section. 
1066         Section 26. Section 400.111, Florida Statutes, is amended 
1067  to read: 
1068         400.111 Disclosure of controlling interest.—In addition to 
1069  the requirements of part II of chapter 408, when requested by 
1070  the agency, the licensee shall submit a signed affidavit 
1071  disclosing any financial or ownership interest that a 
1072  controlling interest has held within the last 5 years in any 
1073  entity licensed by the state or any other state to provide 
1074  health or residential care which entity has closed voluntarily 
1075  or involuntarily; has filed for bankruptcy; has had a receiver 
1076  appointed; has had a license denied, suspended, or revoked; or 
1077  has had an injunction issued against it which was initiated by a 
1078  regulatory agency. The affidavit must disclose the reason such 
1079  entity was closed, whether voluntarily or involuntarily. 
1080         Section 27. Section 400.1183, Florida Statutes, is amended 
1081  to read: 
1082         400.1183 Resident grievance procedures.— 
1083         (1) Every nursing home must have a grievance procedure 
1084  available to its residents and their families. The grievance 
1085  procedure must include: 
1086         (a) An explanation of how to pursue redress of a grievance. 
1087         (b) The names, job titles, and telephone numbers of the 
1088  employees responsible for implementing the facility’s grievance 
1089  procedure. The list must include the address and the toll-free 
1090  telephone numbers of the ombudsman and the agency. 
1091         (c) A simple description of the process through which a 
1092  resident may, at any time, contact the toll-free telephone 
1093  hotline of the ombudsman or the agency to report the unresolved 
1094  grievance. 
1095         (d) A procedure for providing assistance to residents who 
1096  cannot prepare a written grievance without help. 
1097         (2) Each facility shall maintain records of all grievances 
1098  for agency inspection and shall report to the agency at the time 
1099  of relicensure the total number of grievances handled during the 
1100  prior licensure period, a categorization of the cases underlying 
1101  the grievances, and the final disposition of the grievances. 
1102         (3) Each facility must respond to the grievance within a 
1103  reasonable time after its submission. 
1104         (4) The agency may investigate any grievance at any time. 
1105         Section 28. Subsection (1) of section 400.141, Florida 
1106  Statutes, is amended to read: 
1107         400.141 Administration and management of nursing home 
1108  facilities.— 
1109         (1) Every licensed facility shall comply with all 
1110  applicable standards and rules of the agency and shall: 
1111         (a) Be under the administrative direction and charge of a 
1112  licensed administrator. 
1113         (b) Appoint a medical director licensed pursuant to chapter 
1114  458 or chapter 459. The agency may establish by rule more 
1115  specific criteria for the appointment of a medical director. 
1116         (c) Have available the regular, consultative, and emergency 
1117  services of physicians licensed by the state. 
1118         (d) Provide for resident use of a community pharmacy as 
1119  specified in s. 400.022(1)(q). Any other law to the contrary 
1120  notwithstanding, a registered pharmacist licensed in Florida, 
1121  that is under contract with a facility licensed under this 
1122  chapter or chapter 429, shall repackage a nursing facility 
1123  resident’s bulk prescription medication which has been packaged 
1124  by another pharmacist licensed in any state in the United States 
1125  into a unit dose system compatible with the system used by the 
1126  nursing facility, if the pharmacist is requested to offer such 
1127  service. In order to be eligible for the repackaging, a resident 
1128  or the resident’s spouse must receive prescription medication 
1129  benefits provided through a former employer as part of his or 
1130  her retirement benefits, a qualified pension plan as specified 
1131  in s. 4972 of the Internal Revenue Code, a federal retirement 
1132  program as specified under 5 C.F.R. s. 831, or a long-term care 
1133  policy as defined in s. 627.9404(1). A pharmacist who correctly 
1134  repackages and relabels the medication and the nursing facility 
1135  which correctly administers such repackaged medication under 
1136  this paragraph may not be held liable in any civil or 
1137  administrative action arising from the repackaging. In order to 
1138  be eligible for the repackaging, a nursing facility resident for 
1139  whom the medication is to be repackaged shall sign an informed 
1140  consent form provided by the facility which includes an 
1141  explanation of the repackaging process and which notifies the 
1142  resident of the immunities from liability provided in this 
1143  paragraph. A pharmacist who repackages and relabels prescription 
1144  medications, as authorized under this paragraph, may charge a 
1145  reasonable fee for costs resulting from the implementation of 
1146  this provision. 
1147         (e) Provide for the access of the facility residents to 
1148  dental and other health-related services, recreational services, 
1149  rehabilitative services, and social work services appropriate to 
1150  their needs and conditions and not directly furnished by the 
1151  licensee. When a geriatric outpatient nurse clinic is conducted 
1152  in accordance with rules adopted by the agency, outpatients 
1153  attending such clinic shall not be counted as part of the 
1154  general resident population of the nursing home facility, nor 
1155  shall the nursing staff of the geriatric outpatient clinic be 
1156  counted as part of the nursing staff of the facility, until the 
1157  outpatient clinic load exceeds 15 a day. 
1158         (f) Be allowed and encouraged by the agency to provide 
1159  other needed services under certain conditions. If the facility 
1160  has a standard licensure status, and has had no class I or class 
1161  II deficiencies during the past 2 years or has been awarded a 
1162  Gold Seal under the program established in s. 400.235, it may be 
1163  encouraged by the agency to provide services, including, but not 
1164  limited to, respite and adult day services, which enable 
1165  individuals to move in and out of the facility. A facility is 
1166  not subject to any additional licensure requirements for 
1167  providing these services. Respite care may be offered to persons 
1168  in need of short-term or temporary nursing home services. 
1169  Respite care must be provided in accordance with this part and 
1170  rules adopted by the agency. However, the agency shall, by rule, 
1171  adopt modified requirements for resident assessment, resident 
1172  care plans, resident contracts, physician orders, and other 
1173  provisions, as appropriate, for short-term or temporary nursing 
1174  home services. The agency shall allow for shared programming and 
1175  staff in a facility which meets minimum standards and offers 
1176  services pursuant to this paragraph, but, if the facility is 
1177  cited for deficiencies in patient care, may require additional 
1178  staff and programs appropriate to the needs of service 
1179  recipients. A person who receives respite care may not be 
1180  counted as a resident of the facility for purposes of the 
1181  facility’s licensed capacity unless that person receives 24-hour 
1182  respite care. A person receiving either respite care for 24 
1183  hours or longer or adult day services must be included when 
1184  calculating minimum staffing for the facility. Any costs and 
1185  revenues generated by a nursing home facility from 
1186  nonresidential programs or services shall be excluded from the 
1187  calculations of Medicaid per diems for nursing home 
1188  institutional care reimbursement. 
1189         (g) If the facility has a standard license or is a Gold 
1190  Seal facility, exceeds the minimum required hours of licensed 
1191  nursing and certified nursing assistant direct care per resident 
1192  per day, and is part of a continuing care facility licensed 
1193  under chapter 651 or a retirement community that offers other 
1194  services pursuant to part III of this chapter or part I or part 
1195  III of chapter 429 on a single campus, be allowed to share 
1196  programming and staff. At the time of inspection and in the 
1197  semiannual report required pursuant to paragraph (n) (o), a 
1198  continuing care facility or retirement community that uses this 
1199  option must demonstrate through staffing records that minimum 
1200  staffing requirements for the facility were met. Licensed nurses 
1201  and certified nursing assistants who work in the nursing home 
1202  facility may be used to provide services elsewhere on campus if 
1203  the facility exceeds the minimum number of direct care hours 
1204  required per resident per day and the total number of residents 
1205  receiving direct care services from a licensed nurse or a 
1206  certified nursing assistant does not cause the facility to 
1207  violate the staffing ratios required under s. 400.23(3)(a). 
1208  Compliance with the minimum staffing ratios shall be based on 
1209  total number of residents receiving direct care services, 
1210  regardless of where they reside on campus. If the facility 
1211  receives a conditional license, it may not share staff until the 
1212  conditional license status ends. This paragraph does not 
1213  restrict the agency’s authority under federal or state law to 
1214  require additional staff if a facility is cited for deficiencies 
1215  in care which are caused by an insufficient number of certified 
1216  nursing assistants or licensed nurses. The agency may adopt 
1217  rules for the documentation necessary to determine compliance 
1218  with this provision. 
1219         (h) Maintain the facility premises and equipment and 
1220  conduct its operations in a safe and sanitary manner. 
1221         (i) If the licensee furnishes food service, provide a 
1222  wholesome and nourishing diet sufficient to meet generally 
1223  accepted standards of proper nutrition for its residents and 
1224  provide such therapeutic diets as may be prescribed by attending 
1225  physicians. In making rules to implement this paragraph, the 
1226  agency shall be guided by standards recommended by nationally 
1227  recognized professional groups and associations with knowledge 
1228  of dietetics. 
1229         (j) Keep full records of resident admissions and 
1230  discharges; medical and general health status, including medical 
1231  records, personal and social history, and identity and address 
1232  of next of kin or other persons who may have responsibility for 
1233  the affairs of the residents; and individual resident care plans 
1234  including, but not limited to, prescribed services, service 
1235  frequency and duration, and service goals. The records shall be 
1236  open to inspection by the agency. 
1237         (k) Keep such fiscal records of its operations and 
1238  conditions as may be necessary to provide information pursuant 
1239  to this part. 
1240         (l) Furnish copies of personnel records for employees 
1241  affiliated with such facility, to any other facility licensed by 
1242  this state requesting this information pursuant to this part. 
1243  Such information contained in the records may include, but is 
1244  not limited to, disciplinary matters and any reason for 
1245  termination. Any facility releasing such records pursuant to 
1246  this part shall be considered to be acting in good faith and may 
1247  not be held liable for information contained in such records, 
1248  absent a showing that the facility maliciously falsified such 
1249  records. 
1250         (m) Publicly display a poster provided by the agency 
1251  containing the names, addresses, and telephone numbers for the 
1252  state’s abuse hotline, the State Long-Term Care Ombudsman, the 
1253  Agency for Health Care Administration consumer hotline, the 
1254  Advocacy Center for Persons with Disabilities, the Florida 
1255  Statewide Advocacy Council, and the Medicaid Fraud Control Unit, 
1256  with a clear description of the assistance to be expected from 
1257  each. 
1258         (n) Submit to the agency the information specified in s. 
1259  400.071(1)(b) for a management company within 30 days after the 
1260  effective date of the management agreement. 
1261         (n)(o)1. Submit semiannually to the agency, or more 
1262  frequently if requested by the agency, information regarding 
1263  facility staff-to-resident ratios, staff turnover, and staff 
1264  stability, including information regarding certified nursing 
1265  assistants, licensed nurses, the director of nursing, and the 
1266  facility administrator. For purposes of this reporting: 
1267         a. Staff-to-resident ratios must be reported in the 
1268  categories specified in s. 400.23(3)(a) and applicable rules. 
1269  The ratio must be reported as an average for the most recent 
1270  calendar quarter. 
1271         b. Staff turnover must be reported for the most recent 12 
1272  month period ending on the last workday of the most recent 
1273  calendar quarter prior to the date the information is submitted. 
1274  The turnover rate must be computed quarterly, with the annual 
1275  rate being the cumulative sum of the quarterly rates. The 
1276  turnover rate is the total number of terminations or separations 
1277  experienced during the quarter, excluding any employee 
1278  terminated during a probationary period of 3 months or less, 
1279  divided by the total number of staff employed at the end of the 
1280  period for which the rate is computed, and expressed as a 
1281  percentage. 
1282         c. The formula for determining staff stability is the total 
1283  number of employees that have been employed for more than 12 
1284  months, divided by the total number of employees employed at the 
1285  end of the most recent calendar quarter, and expressed as a 
1286  percentage. 
1287         d. A nursing facility that has failed to comply with state 
1288  minimum-staffing requirements for 2 consecutive days is 
1289  prohibited from accepting new admissions until the facility has 
1290  achieved the minimum-staffing requirements for a period of 6 
1291  consecutive days. For the purposes of this sub-subparagraph, any 
1292  person who was a resident of the facility and was absent from 
1293  the facility for the purpose of receiving medical care at a 
1294  separate location or was on a leave of absence is not considered 
1295  a new admission. The agency shall fine the nursing facility 
1296  $1,000 if it fails Failure to impose such an admissions 
1297  moratorium constitutes a class II deficiency. 
1298         e. A nursing facility which does not have a conditional 
1299  license may be cited for failure to comply with the standards in 
1300  s. 400.23(3)(a)1.a. only if it has failed to meet those 
1301  standards on 2 consecutive days or if it has failed to meet at 
1302  least 97 percent of those standards on any one day. 
1303         f. A facility which has a conditional license must be in 
1304  compliance with the standards in s. 400.23(3)(a) at all times. 
1305         2. This paragraph does not limit the agency’s ability to 
1306  impose a deficiency or take other actions if a facility does not 
1307  have enough staff to meet the residents’ needs. 
1308         (o)(p) Notify a licensed physician when a resident exhibits 
1309  signs of dementia or cognitive impairment or has a change of 
1310  condition in order to rule out the presence of an underlying 
1311  physiological condition that may be contributing to such 
1312  dementia or impairment. The notification must occur within 30 
1313  days after the acknowledgment of such signs by facility staff. 
1314  If an underlying condition is determined to exist, the facility 
1315  shall arrange, with the appropriate health care provider, the 
1316  necessary care and services to treat the condition. 
1317         (p)(q) If the facility implements a dining and hospitality 
1318  attendant program, ensure that the program is developed and 
1319  implemented under the supervision of the facility director of 
1320  nursing. A licensed nurse, licensed speech or occupational 
1321  therapist, or a registered dietitian must conduct training of 
1322  dining and hospitality attendants. A person employed by a 
1323  facility as a dining and hospitality attendant must perform 
1324  tasks under the direct supervision of a licensed nurse. 
1325         (r) Report to the agency any filing for bankruptcy 
1326  protection by the facility or its parent corporation, 
1327  divestiture or spin-off of its assets, or corporate 
1328  reorganization within 30 days after the completion of such 
1329  activity. 
1330         (q)(s) Maintain general and professional liability 
1331  insurance coverage that is in force at all times. In lieu of 
1332  general and professional liability insurance coverage, a state 
1333  designated teaching nursing home and its affiliated assisted 
1334  living facilities created under s. 430.80 may demonstrate proof 
1335  of financial responsibility as provided in s. 430.80(3)(h). 
1336         (r)(t) Maintain in the medical record for each resident a 
1337  daily chart of certified nursing assistant services provided to 
1338  the resident. The certified nursing assistant who is caring for 
1339  the resident must complete this record by the end of his or her 
1340  shift. This record must indicate assistance with activities of 
1341  daily living, assistance with eating, and assistance with 
1342  drinking, and must record each offering of nutrition and 
1343  hydration for those residents whose plan of care or assessment 
1344  indicates a risk for malnutrition or dehydration. 
1345         (s)(u) Before November 30 of each year, subject to the 
1346  availability of an adequate supply of the necessary vaccine, 
1347  provide for immunizations against influenza viruses to all its 
1348  consenting residents in accordance with the recommendations of 
1349  the United States Centers for Disease Control and Prevention, 
1350  subject to exemptions for medical contraindications and 
1351  religious or personal beliefs. Subject to these exemptions, any 
1352  consenting person who becomes a resident of the facility after 
1353  November 30 but before March 31 of the following year must be 
1354  immunized within 5 working days after becoming a resident. 
1355  Immunization shall not be provided to any resident who provides 
1356  documentation that he or she has been immunized as required by 
1357  this paragraph. This paragraph does not prohibit a resident from 
1358  receiving the immunization from his or her personal physician if 
1359  he or she so chooses. A resident who chooses to receive the 
1360  immunization from his or her personal physician shall provide 
1361  proof of immunization to the facility. The agency may adopt and 
1362  enforce any rules necessary to comply with or administer 
1363  implement this paragraph subsection. 
1364         (t)(v) Assess all residents for eligibility for 
1365  pneumococcal polysaccharide vaccination (PPV) and vaccinate 
1366  residents when indicated within 60 days after the effective date 
1367  of this act in accordance with the recommendations of the United 
1368  States Centers for Disease Control and Prevention, subject to 
1369  exemptions for medical contraindications and religious or 
1370  personal beliefs. Residents admitted after the effective date of 
1371  this act shall be assessed within 5 working days of admission 
1372  and, when indicated, vaccinated within 60 days in accordance 
1373  with the recommendations of the United States Centers for 
1374  Disease Control and Prevention, subject to exemptions for 
1375  medical contraindications and religious or personal beliefs. 
1376  Immunization shall not be provided to any resident who provides 
1377  documentation that he or she has been immunized as required by 
1378  this paragraph. This paragraph does not prohibit a resident from 
1379  receiving the immunization from his or her personal physician if 
1380  he or she so chooses. A resident who chooses to receive the 
1381  immunization from his or her personal physician shall provide 
1382  proof of immunization to the facility. The agency may adopt and 
1383  enforce any rules necessary to comply with or administer 
1384  implement this paragraph. 
1385         (u)(w) Annually encourage and promote to its employees the 
1386  benefits associated with immunizations against influenza viruses 
1387  in accordance with the recommendations of the United States 
1388  Centers for Disease Control and Prevention. The agency may adopt 
1389  and enforce any rules necessary to comply with or administer 
1390  implement this paragraph. 
1391         Section 29. Subsection (3) of section 400.142, Florida 
1392  Statutes, is amended to read: 
1393         400.142 Emergency medication kits; orders not to 
1394  resuscitate.— 
1395         (3) Facility staff may withhold or withdraw cardiopulmonary 
1396  resuscitation if presented with an order not to resuscitate 
1397  executed pursuant to s. 401.45. The agency shall adopt rules 
1398  providing for the implementation of such orders. Facility staff 
1399  and facilities shall not be subject to criminal prosecution or 
1400  civil liability, nor be considered to have engaged in negligent 
1401  or unprofessional conduct, for withholding or withdrawing 
1402  cardiopulmonary resuscitation pursuant to such an order and 
1403  rules adopted by the agency. The absence of an order not to 
1404  resuscitate executed pursuant to s. 401.45 does not preclude a 
1405  physician from withholding or withdrawing cardiopulmonary 
1406  resuscitation as otherwise permitted by law. 
1407         Section 30. Subsection (10) of section 400.147, Florida 
1408  Statutes, is repealed. 
1409         Section 31. Section 400.148, Florida Statutes, is repealed. 
1410         Section 32. Subsection (3) of section 400.19, Florida 
1411  Statutes, is amended to read: 
1412         400.19 Right of entry and inspection.— 
1413         (3) The agency shall every 15 months conduct at least one 
1414  unannounced inspection to determine compliance by the licensee 
1415  with statutes, and with rules promulgated under the provisions 
1416  of those statutes, governing minimum standards of construction, 
1417  quality and adequacy of care, and rights of residents. The 
1418  survey shall be conducted every 6 months for the next 2-year 
1419  period if the facility has been cited for a class I deficiency, 
1420  has been cited for two or more class II deficiencies arising 
1421  from separate surveys or investigations within a 60-day period, 
1422  or has had three or more substantiated complaints within a 6 
1423  month period, each resulting in at least one class I or class II 
1424  deficiency. In addition to any other fees or fines in this part, 
1425  the agency shall assess a fine for each facility that is subject 
1426  to the 6-month survey cycle. The fine for the 2-year period 
1427  shall be $6,000, one-half to be paid at the completion of each 
1428  survey. The agency may adjust this fine by the change in the 
1429  Consumer Price Index, based on the 12 months immediately 
1430  preceding the increase, to cover the cost of the additional 
1431  surveys. The agency shall verify through subsequent inspection 
1432  that any deficiency identified during inspection is corrected. 
1433  However, the agency may verify the correction of a class III or 
1434  class IV deficiency unrelated to resident rights or resident 
1435  care without reinspecting the facility if adequate written 
1436  documentation has been received from the facility, which 
1437  provides assurance that the deficiency has been corrected. The 
1438  giving or causing to be given of advance notice of such 
1439  unannounced inspections by an employee of the agency to any 
1440  unauthorized person shall constitute cause for suspension of not 
1441  fewer than 5 working days according to the provisions of chapter 
1442  110. 
1443         Section 33. Section 400.195, Florida Statutes, is repealed. 
1444         Section 34. Subsection (5) of section 400.23, Florida 
1445  Statutes, is amended to read: 
1446         400.23 Rules; evaluation and deficiencies; licensure 
1447  status.— 
1448         (5) The agency, in collaboration with the Division of 
1449  Children’s Medical Services Network of the Department of Health, 
1450  must, no later than December 31, 1993, adopt rules for minimum 
1451  standards of care for persons under 21 years of age who reside 
1452  in nursing home facilities. The rules must include a methodology 
1453  for reviewing a nursing home facility under ss. 408.031-408.045 
1454  which serves only persons under 21 years of age. A facility may 
1455  be exempt from these standards for specific persons between 18 
1456  and 21 years of age, if the person’s physician agrees that 
1457  minimum standards of care based on age are not necessary. 
1458         Section 35. Subsection (1) of section 400.275, Florida 
1459  Statutes, is amended to read: 
1460         400.275 Agency duties.— 
1461         (1) The agency shall ensure that each newly hired nursing 
1462  home surveyor, as a part of basic training, is assigned full 
1463  time to a licensed nursing home for at least 2 days within a 7 
1464  day period to observe facility operations outside of the survey 
1465  process before the surveyor begins survey responsibilities. Such 
1466  observations may not be the sole basis of a deficiency citation 
1467  against the facility. The agency may not assign an individual to 
1468  be a member of a survey team for purposes of a survey, 
1469  evaluation, or consultation visit at a nursing home facility in 
1470  which the surveyor was an employee within the preceding 5 years. 
1471         Section 36. Subsections (2) and (14) of section 400.462, 
1472  Florida Statutes, are amended, present subsections (27), (28), 
1473  and (29) of that section are renumbered as subsections (28), 
1474  (29), and (30), respectively, and new subsections (27) and (31) 
1475  are added to that section, to read: 
1476         400.462 Definitions.—As used in this part, the term: 
1477         (2) “Admission” means a decision by the home health agency, 
1478  during or after an evaluation visit with the patient to the 
1479  patient’s home, that there is reasonable expectation that the 
1480  patient’s medical, nursing, and social needs for skilled care 
1481  can be adequately met by the agency in the patient’s place of 
1482  residence. Admission includes completion of an agreement with 
1483  the patient or the patient’s legal representative to provide 
1484  home health services as required in s. 400.487(1). 
1485         (14) “Home health services” means health and medical 
1486  services and medical supplies furnished by an organization to an 
1487  individual in the individual’s home or place of residence. The 
1488  term includes organizations that provide one or more of the 
1489  following: 
1490         (a) Nursing care. 
1491         (b) Physical, occupational, respiratory, or speech therapy. 
1492         (c) Home health aide services. 
1493         (d) Dietetics and nutrition practice and nutrition 
1494  counseling. 
1495         (e) Medical supplies and durable medical equipment, 
1496  restricted to drugs and biologicals prescribed by a physician. 
1497         (27) “Primary home health agency” means the agency that is 
1498  responsible for the services furnished to patients and for 
1499  implementation of the plan of care. 
1500         (31) “Temporary” means short term, such as for employee 
1501  absences, temporary skill shortages, seasonal workloads. 
1502         Section 37. Section 400.476, Florida Statutes, is amended 
1503  to read: 
1504         400.476 Staffing requirements; notifications; limitations 
1505  on staffing services.— 
1506         (1) ADMINISTRATOR.— 
1507         (a) An administrator may manage only one home health 
1508  agency, except that an administrator may manage up to five home 
1509  health agencies if all five home health agencies have identical 
1510  controlling interests as defined in s. 408.803 and are located 
1511  within one agency geographic service area or within an 
1512  immediately contiguous county. If the home health agency is 
1513  licensed under this chapter and is part of a retirement 
1514  community that provides multiple levels of care, an employee of 
1515  the retirement community may administer the home health agency 
1516  and up to a maximum of four entities licensed under this chapter 
1517  or chapter 429 which all have identical controlling interests as 
1518  defined in s. 408.803. An administrator shall designate, in 
1519  writing, for each licensed entity, a qualified alternate 
1520  administrator to serve during the administrator’s absence. An 
1521  alternate administrator must meet the requirements in this 
1522  paragraph and s. 400.462(1). 
1523         (b) An administrator of a home health agency who is a 
1524  licensed physician, physician assistant, or registered nurse 
1525  licensed to practice in this state may also be the director of 
1526  nursing for a home health agency. An administrator may serve as 
1527  a director of nursing for up to the number of entities 
1528  authorized in subsection (2) only if there are 10 or fewer full 
1529  time equivalent employees and contracted personnel in each home 
1530  health agency. 
1531         (c) The administrator shall organize and direct the 
1532  agency’s ongoing functions, maintain an ongoing liaison with the 
1533  board members and the staff, employ qualified personnel and 
1534  ensure adequate staff education and evaluations, ensures the 
1535  accuracy of public informational materials and activities, 
1536  implement an effective budgeting and accounting system, and 
1537  ensures that the home health agency operates in compliance with 
1538  this part and part II of chapter 408 and rules adopted for these 
1539  laws. 
1540         (d) The administrator shall clearly set forth in writing 
1541  the organizational chart, services furnished, administrative 
1542  control, and lines of authority for the delegation of 
1543  responsibilities for patient care. These responsibilities must 
1544  be readily identifiable. Administrative and supervisory 
1545  functions may not be delegated to another agency or 
1546  organization, and the primary home health agency shall monitor 
1547  and control all services that are not furnished directly, 
1548  including services provided through contracts. 
1549         (2) DIRECTOR OF NURSING.— 
1550         (a) A director of nursing may be the director of nursing 
1551  for: 
1552         1. Up to two licensed home health agencies if the agencies 
1553  have identical controlling interests as defined in s. 408.803 
1554  and are located within one agency geographic service area or 
1555  within an immediately contiguous county; or 
1556         2. Up to five licensed home health agencies if: 
1557         a. All of the home health agencies have identical 
1558  controlling interests as defined in s. 408.803; 
1559         b. All of the home health agencies are located within one 
1560  agency geographic service area or within an immediately 
1561  contiguous county; and 
1562         c. Each home health agency has a registered nurse who meets 
1563  the qualifications of a director of nursing and who has a 
1564  written delegation from the director of nursing to serve as the 
1565  director of nursing for that home health agency when the 
1566  director of nursing is not present; and. 
1567         d. This person, or similarly qualified alternate, is 
1568  available at all times during operating hours and participates 
1569  in all activities relevant to the professional services 
1570  furnished, including, but not limited to, the oversight of 
1571  nursing services, home health aides, and certified nursing 
1572  assistants, and assignment of personnel. 
1573 
1574  If a home health agency licensed under this chapter is part of a 
1575  retirement community that provides multiple levels of care, an 
1576  employee of the retirement community may serve as the director 
1577  of nursing of the home health agency and up to a maximum of four 
1578  entities, other than home health agencies, licensed under this 
1579  chapter or chapter 429 which all have identical controlling 
1580  interests as defined in s. 408.803. 
1581         (b) A home health agency that provides skilled nursing care 
1582  may not operate for more than 30 calendar days without a 
1583  director of nursing. A home health agency that provides skilled 
1584  nursing care and the director of nursing of a home health agency 
1585  must notify the agency within 10 business days after termination 
1586  of the services of the director of nursing for the home health 
1587  agency. A home health agency that provides skilled nursing care 
1588  must notify the agency of the identity and qualifications of the 
1589  new director of nursing within 10 days after the new director is 
1590  hired. If a home health agency that provides skilled nursing 
1591  care operates for more than 30 calendar days without a director 
1592  of nursing, the home health agency commits a class II 
1593  deficiency. In addition to the fine for a class II deficiency, 
1594  the agency may issue a moratorium in accordance with s. 408.814 
1595  or revoke the license. The agency shall fine a home health 
1596  agency that fails to notify the agency as required in this 
1597  paragraph $1,000 for the first violation and $2,000 for a repeat 
1598  violation. The agency may not take administrative action against 
1599  a home health agency if the director of nursing fails to notify 
1600  the department upon termination of services as the director of 
1601  nursing for the home health agency. 
1602         (c) A home health agency that is not Medicare or Medicaid 
1603  certified and does not provide skilled care or provides only 
1604  physical, occupational, or speech therapy is not required to 
1605  have a director of nursing and is exempt from paragraph (b). 
1606         (3) TRAINING.—A home health agency shall ensure that each 
1607  certified nursing assistant employed by or under contract with 
1608  the home health agency and each home health aide employed by or 
1609  under contract with the home health agency is adequately trained 
1610  to perform the tasks of a home health aide in the home setting. 
1611         (a) The home health agency may not use as a home health 
1612  aide on a full-time, temporary, per diem, or other basis, any 
1613  individual to provide services unless the individual has 
1614  completed a training and competency evaluation program, or a 
1615  competency evaluation program, as permitted in s. 400.497 which 
1616  meets the minimum standards established by the agency in state 
1617  rules. 
1618         (b) A home health aide is not competent in any task for 
1619  which he or she is evaluated as “unsatisfactory.” The aide must 
1620  perform any such task only under direct supervision by a 
1621  licensed nurse until he or she receives training in the task and 
1622  satisfactorily passes a subsequent evaluation in performing the 
1623  task. A home health aide has not successfully passed a 
1624  competency evaluation if the aide does not have a passing score 
1625  on the test as specified by agency rule. 
1626         (4) STAFFING.—Staffing services may be provided anywhere 
1627  within the state. 
1628         (5) PERSONNEL.— 
1629         (a) The home health agency and its staff must comply with 
1630  accepted professional standards and principles that apply to 
1631  professionals, including, but not limited to, the state practice 
1632  acts and the home health agency’s policies and procedures. 
1633         (b) If personnel under hourly or per-visit contracts are 
1634  used by the home health agency, there must be a written contract 
1635  between those personnel and the agency which specifies the 
1636  following requirements: 
1637         1. Acceptance for care only of patients by the primary home 
1638  health agency. 
1639         2. The services to be furnished. 
1640         3. The necessity to conform to all applicable agency 
1641  policies, including personnel qualifications. 
1642         4. The responsibility for participating in developing plans 
1643  of care. 
1644         5. The manner in which services are controlled, 
1645  coordinated, and evaluated by the primary home health agency. 
1646         6. The procedures for submitting clinical and progress 
1647  notes, scheduling of visits, and periodic patient evaluation. 
1648         7. The procedures for payment for services furnished under 
1649  the contract. 
1650         (c) A home health agency shall directly provide at least 
1651  one of the types of services through home health agency 
1652  employees, but may provide additional services under 
1653  arrangements with another agency or organization. Services 
1654  furnished under such arrangements must have a written contract 
1655  conforming with the requirements specified in paragraph (b). 
1656         (d) If home health aide services are provided by an 
1657  individual who is not employed directly by the home health 
1658  agency, the services of the home health aide must be provided 
1659  under arrangements as stated in paragraphs (b) and (c). If the 
1660  home health agency chooses to provide home health aide services 
1661  under arrangements with another organization, the 
1662  responsibilities of the home health agency include, but are not 
1663  limited to: 
1664         1. Ensuring the overall quality of the care provided by the 
1665  aide; 
1666         2. Supervising the aide’s services as described in s. 
1667  400.487; and 
1668         3. Ensuring that each home health aide providing services 
1669  under arrangements with another organization has met the 
1670  training requirements or competency evaluation requirements of 
1671  s. 400.497. 
1672         (e) The home health agency shall coordinate the efforts of 
1673  all personnel furnishing services, and the personnel shall 
1674  maintain communication with the home health agency to ensure 
1675  that personnel efforts support the objectives outlined in the 
1676  plan of care. The clinical record or minutes of case conferences 
1677  shall ensure that effective interchange, reporting, and 
1678  coordination of patient care occurs. 
1679         Section 38. Section 400.484, Florida Statutes, is amended 
1680  to read: 
1681         400.484 Right of inspection; violations deficiencies; 
1682  fines.— 
1683         (1) In addition to the requirements of s. 408.811, the 
1684  agency may make such inspections and investigations as are 
1685  necessary in order to determine the state of compliance with 
1686  this part, part II of chapter 408, and applicable rules. 
1687         (2) The agency shall impose fines for various classes of 
1688  deficiencies in accordance with the following schedule: 
1689         (a) Class I violations are defined in s. 408.813. A class I 
1690  deficiency is any act, omission, or practice that results in a 
1691  patient’s death, disablement, or permanent injury, or places a 
1692  patient at imminent risk of death, disablement, or permanent 
1693  injury. Upon finding a class I violation deficiency, the agency 
1694  shall impose an administrative fine in the amount of $15,000 for 
1695  each occurrence and each day that the violation deficiency 
1696  exists. 
1697         (b) Class II violations are defined in s. 408.813. A class 
1698  II deficiency is any act, omission, or practice that has a 
1699  direct adverse effect on the health, safety, or security of a 
1700  patient. Upon finding a class II violation deficiency, the 
1701  agency shall impose an administrative fine in the amount of 
1702  $5,000 for each occurrence and each day that the violation 
1703  deficiency exists. 
1704         (c) Class III violations are defined in s. 408.813. A class 
1705  III deficiency is any act, omission, or practice that has an 
1706  indirect, adverse effect on the health, safety, or security of a 
1707  patient. Upon finding an uncorrected or repeated class III 
1708  violation deficiency, the agency shall impose an administrative 
1709  fine not to exceed $1,000 for each occurrence and each day that 
1710  the uncorrected or repeated violation deficiency exists. 
1711         (d) Class IV violations are defined in s. 408.813. A class 
1712  IV deficiency is any act, omission, or practice related to 
1713  required reports, forms, or documents which does not have the 
1714  potential of negatively affecting patients. These violations are 
1715  of a type that the agency determines do not threaten the health, 
1716  safety, or security of patients. Upon finding an uncorrected or 
1717  repeated class IV violation deficiency, the agency shall impose 
1718  an administrative fine not to exceed $500 for each occurrence 
1719  and each day that the uncorrected or repeated violation 
1720  deficiency exists. 
1721         (3) In addition to any other penalties imposed pursuant to 
1722  this section or part, the agency may assess costs related to an 
1723  investigation that results in a successful prosecution, 
1724  excluding costs associated with an attorney’s time. 
1725         Section 39. Section 400.487, Florida Statutes, is amended 
1726  to read: 
1727         400.487 Home health service agreements; physician’s, 
1728  physician assistant’s, and advanced registered nurse 
1729  practitioner’s treatment orders; patient assessment; 
1730  establishment and review of plan of care; provision of services; 
1731  orders not to resuscitate.— 
1732         (1) Services provided by a home health agency must be 
1733  covered by an agreement between the home health agency and the 
1734  patient or the patient’s legal representative specifying the 
1735  home health services to be provided, the rates or charges for 
1736  services paid with private funds, and the sources of payment, 
1737  which may include Medicare, Medicaid, private insurance, 
1738  personal funds, or a combination thereof. The home health agency 
1739  shall provide a copy of the agreement to the patient or the 
1740  patient’s legal representative. A home health agency providing 
1741  skilled care must make an assessment of the patient’s needs 
1742  within 48 hours after the start of services. 
1743         (2) When required by the provisions of chapter 464; part I, 
1744  part III, or part V of chapter 468; or chapter 486, the 
1745  attending physician, physician assistant, or advanced registered 
1746  nurse practitioner, acting within his or her respective scope of 
1747  practice, shall establish treatment orders for a patient who is 
1748  to receive skilled care. The treatment orders must be signed by 
1749  the physician, physician assistant, or advanced registered nurse 
1750  practitioner before a claim for payment for the skilled services 
1751  is submitted by the home health agency. If the claim is 
1752  submitted to a managed care organization, the treatment orders 
1753  must be signed within the time allowed under the provider 
1754  agreement. The treatment orders shall be reviewed, as frequently 
1755  as the patient’s illness requires, by the physician, physician 
1756  assistant, or advanced registered nurse practitioner in 
1757  consultation with the home health agency. 
1758         (3) A home health agency shall arrange for supervisory 
1759  visits by a registered nurse to the home of a patient receiving 
1760  home health aide services as specified in subsection (9) in 
1761  accordance with the patient’s direction, approval, and agreement 
1762  to pay the charge for the visits. 
1763         (4) The home health agency shall protect and promote the 
1764  rights of each individual under its care, including each of the 
1765  following rights: 
1766         (a) Notice of rights.—The home health agency shall provide 
1767  the patient with a written notice of the patient’s rights in 
1768  advance of furnishing care to the patient or during the initial 
1769  evaluation visit before the initiation of treatment. The home 
1770  health agency must maintain documentation showing that it has 
1771  complied with the requirements of this section. 
1772         (b) Exercise of rights and respect for property and 
1773  person.— 
1774         1. The patient has the right to exercise his or her rights 
1775  as a patient of the home health agency. 
1776         2. The patient has the right to have his or her property 
1777  treated with respect. 
1778         3. The patient has the right to voice grievances regarding 
1779  treatment or care that is or fails to be furnished, or regarding 
1780  the lack of respect for property by anyone who is furnishing 
1781  services on behalf of the home health agency, and not be 
1782  subjected to discrimination or reprisal for doing so. 
1783         4. The home health agency must investigate complaints made 
1784  by a patient or the patient’s family or guardian regarding 
1785  treatment or care that is or fails to be furnished, or regarding 
1786  the lack of respect for the patient’s property by anyone 
1787  furnishing services on behalf of the home health agency. The 
1788  home health agency shall document the existence of the complaint 
1789  and its resolution. 
1790         5. The patient and his or her immediate family or 
1791  representative must be informed of the right to report 
1792  complaints via the statewide toll-free telephone number to the 
1793  agency as required in s. 408.810. 
1794         (c) Right to be informed and to participate in planning 
1795  care and treatment.— 
1796         1. The patient has the right to be informed, in advance, 
1797  about the care to be furnished and of any changes in the care to 
1798  be furnished. The home health agency shall advise the patient in 
1799  advance of which disciplines will furnish care and the frequency 
1800  of visits proposed to be furnished. The home health agency must 
1801  advise the patient in advance of any change in the plan of care 
1802  before the change is made. 
1803         2. The patient has the right to participate in the planning 
1804  of the care. The home health agency must advise the patient in 
1805  advance of the right to participate in planning the care or 
1806  treatment and in planning changes in the care or treatment. Each 
1807  patient has the right to be informed of and to participate in 
1808  the planning of his or her care. Each patient must be provided, 
1809  upon request, a copy of the plan of care established and 
1810  maintained for that patient by the home health agency. 
1811         (5) When nursing services are ordered, the home health 
1812  agency to which a patient has been admitted for care must 
1813  provide the initial admission visit, all service evaluation 
1814  visits, and the discharge visit by a direct employee. Services 
1815  provided by others under contractual arrangements to a home 
1816  health agency must be monitored and managed by the admitting 
1817  home health agency. The admitting home health agency is fully 
1818  responsible for ensuring that all care provided through its 
1819  employees or contract staff is delivered in accordance with this 
1820  part and applicable rules. 
1821         (6) The skilled care services provided by a home health 
1822  agency, directly or under contract, must be supervised and 
1823  coordinated in accordance with the plan of care. The home health 
1824  agency shall furnish skilled nursing services by or under the 
1825  supervision of a registered nurse and in accordance with the 
1826  plan of care. Any therapy services offered directly or under 
1827  arrangement by the home health agency must be provided by a 
1828  qualified therapist or by a qualified therapy assistant under 
1829  the supervision of a qualified therapist and in accordance with 
1830  the plan of care. 
1831         (a) Duties and qualifications.—A qualified therapist shall 
1832  assist the physician in evaluating the level of function, help 
1833  develop or revise the plan of care, prepare clinical and 
1834  progress notes, advise and consult with the family and other 
1835  agency personnel, and participate in in-service programs. The 
1836  therapist or therapy assistant must meet the qualifications in 
1837  the state practice acts and related applicable rules. 
1838         (b) Physical therapy assistants and occupational therapy 
1839  assistants.—Services provided by a physical therapy assistant or 
1840  occupational therapy assistant must be under the supervision of 
1841  a qualified physical therapist or occupational therapist as 
1842  required in chapter 486 and part III of chapter 468, 
1843  respectively, and related applicable rules. A physical therapy 
1844  assistant or occupational therapy assistant shall perform 
1845  services planned, delegated, and supervised by the therapist, 
1846  assist in preparing clinical notes and progress reports, 
1847  participate in educating the patient and his or her family, and 
1848  participate in in-service programs. 
1849         (c) Speech therapy services.—Speech therapy services shall 
1850  be furnished only by or under supervision of a qualified speech 
1851  pathologist or audiologist as required in part I of chapter 468 
1852  and related applicable rules. 
1853         (d) Care follows a written plan of care.—The plan of care 
1854  shall be reviewed by the physician or health professional who 
1855  provided the treatment orders pursuant to subsection (2) and 
1856  home health agency personnel as often as the severity of the 
1857  patient’s condition requires, but at least once every 60 days or 
1858  more when there is a beneficiary-elected transfer, a significant 
1859  change in condition resulting in a change in the case-mix 
1860  assignment, or a discharge and return to the same home health 
1861  agency during the 60-day episode. Professional staff of a home 
1862  health agency shall promptly alert the physician or other health 
1863  professional who provided the treatment orders of any change 
1864  that suggests a need to alter the plan of care. 
1865         (e) Administration of drugs and treatment.—Only 
1866  professional staff of a home health agency may administer drugs 
1867  and treatments as ordered by the physician or health 
1868  professional pursuant to subsection (2), with the exception of 
1869  influenza and pneumococcal polysaccharide vaccines, which may be 
1870  administered according to the policy of the home health agency 
1871  developed in consultation with a physician and after an 
1872  assessment for contraindications. The physician or health 
1873  professional, as provided in subsection (2), shall put any 
1874  verbal order in writing and sign and date it with the date of 
1875  receipt by the registered nurse or qualified therapist who is 
1876  responsible for furnishing or supervising the ordered service. A 
1877  verbal order may be accepted only by personnel who are 
1878  authorized to do so by applicable state laws, rules, and 
1879  internal policies of the home health agency. 
1880         (7) A registered nurse shall conduct the initial evaluation 
1881  visit, regularly reevaluate the patient’s nursing needs, 
1882  initiate the plan of care and necessary revisions, furnish those 
1883  services requiring substantial and specialized nursing skill, 
1884  initiate appropriate preventive and rehabilitative nursing 
1885  procedures, prepare clinical and progress notes, coordinate 
1886  services, inform the physician and other personnel of changes in 
1887  the patient’s condition and needs, counsel the patient and his 
1888  or her family in meeting nursing and related needs, participate 
1889  in in-service programs, and supervise and teach other nursing 
1890  personnel. 
1891         (8) A licensed practical nurse shall furnish services in 
1892  accordance with agency policies, prepare clinical and progress 
1893  notes, assist the physician and registered nurse in performing 
1894  specialized procedures, prepare equipment and materials for 
1895  treatments observing aseptic technique as required, and assist 
1896  the patient in learning appropriate self-care techniques. 
1897         (9) A home health aide and certified nursing assistant 
1898  shall provide services that are ordered by the physician in the 
1899  plan of care and that the aide or assistant is permitted to 
1900  perform under state law. The duties of a home health aide or 
1901  certified nursing assistant include the provision of hands-on 
1902  personal care, performance of simple procedures as an extension 
1903  of therapy or nursing services, assistance in ambulation or 
1904  exercises, and assistance in administering medications that are 
1905  ordinarily self-administered and are specified in agency rules. 
1906  Any services by a home health aide which are offered by a home 
1907  health agency must be provided by a qualified home health aide 
1908  or certified nursing assistant. 
1909         (a) Assignment and duties.—A home health aide or certified 
1910  nursing assistant shall be assigned to a specific patient by a 
1911  registered nurse. Written patient care instructions for the home 
1912  health aide and certified nursing assistant must be prepared by 
1913  the registered nurse or other appropriate professional who is 
1914  responsible for the supervision of the home health aide and 
1915  certified nursing assistant as stated in this section. 
1916         (b) Supervision.—If a patient receives skilled nursing 
1917  care, the registered nurse shall perform the supervisory visit. 
1918  If the patient is not receiving skilled nursing care but is 
1919  receiving physical therapy, occupational therapy, or speech 
1920  language pathology services, the appropriate therapist may 
1921  provide the supervision. A registered nurse or other 
1922  professional must make an onsite visit to the patient’s home at 
1923  least once every 2 weeks. The visit is not required while the 
1924  aide is providing care. 
1925         (c) Supervising visits.—If home health aide services are 
1926  provided to a patient who is not receiving skilled nursing care, 
1927  physical or occupational therapy, or speech-language pathology 
1928  services, a registered nurse must make a supervisory visit to 
1929  the patient’s home at least once every 60 days. The registered 
1930  nurse shall ensure that the aide is properly caring for the 
1931  patient and each supervisory visit must occur while the home 
1932  health aide is providing patient care. 
1933         (10)(7) Home health agency personnel may withhold or 
1934  withdraw cardiopulmonary resuscitation if presented with an 
1935  order not to resuscitate executed pursuant to s. 401.45. The 
1936  agency shall adopt rules providing for the implementation of 
1937  such orders. Home health personnel and agencies shall not be 
1938  subject to criminal prosecution or civil liability, nor be 
1939  considered to have engaged in negligent or unprofessional 
1940  conduct, for withholding or withdrawing cardiopulmonary 
1941  resuscitation pursuant to such an order and rules adopted by the 
1942  agency. 
1943         Section 40. Subsections (1) and (4) of section 400.606, 
1944  Florida Statutes, are amended to read: 
1945         400.606 License; application; renewal; conditional license 
1946  or permit; certificate of need.— 
1947         (1) In addition to the requirements of part II of chapter 
1948  408, the initial application and change of ownership application 
1949  must be accompanied by a plan for the delivery of home, 
1950  residential, and homelike inpatient hospice services to 
1951  terminally ill persons and their families. Such plan must 
1952  contain, but need not be limited to: 
1953         (a) The estimated average number of terminally ill persons 
1954  to be served monthly. 
1955         (b) The geographic area in which hospice services will be 
1956  available. 
1957         (c) A listing of services which are or will be provided, 
1958  either directly by the applicant or through contractual 
1959  arrangements with existing providers. 
1960         (d) Provisions for the implementation of hospice home care 
1961  within 3 months after licensure. 
1962         (e) Provisions for the implementation of hospice homelike 
1963  inpatient care within 12 months after licensure. 
1964         (f) The number and disciplines of professional staff to be 
1965  employed. 
1966         (g) The name and qualifications of any existing or 
1967  potential contractee. 
1968         (h) A plan for attracting and training volunteers. 
1969         (i) The projected annual operating cost of the hospice. 
1970 
1971  If the applicant is an existing licensed health care provider, 
1972  the application must be accompanied by a copy of the most recent 
1973  profit-loss statement and, if applicable, the most recent 
1974  licensure inspection report. 
1975         (4) A freestanding hospice facility that is primarily 
1976  engaged in providing inpatient and related services and that is 
1977  not otherwise licensed as a health care facility shall be 
1978  required to obtain a certificate of need. However, a 
1979  freestanding hospice facility with six or fewer beds shall not 
1980  be required to comply with institutional standards such as, but 
1981  not limited to, standards requiring sprinkler systems, emergency 
1982  electrical systems, or special lavatory devices. 
1983         Section 41. Subsection (2) of section 400.607, Florida 
1984  Statutes, is amended to read: 
1985         400.607 Denial, suspension, revocation of license; 
1986  emergency actions; imposition of administrative fine; grounds.— 
1987         (2) A violation of the provisions of this part, part II of 
1988  chapter 408, or applicable rules Any of the following actions by 
1989  a licensed hospice or any of its employees shall be grounds for 
1990  administrative action by the agency against a hospice.: 
1991         (a) A violation of the provisions of this part, part II of 
1992  chapter 408, or applicable rules. 
1993         (b) An intentional or negligent act materially affecting 
1994  the health or safety of a patient. 
1995         Section 42. Subsection (1) of section 400.925, Florida 
1996  Statutes, is amended to read: 
1997         400.925 Definitions.—As used in this part, the term: 
1998         (1) “Accrediting organizations” means the Joint Commission 
1999  on Accreditation of Healthcare Organizations or other national 
2000  accreditation agencies whose standards for accreditation are 
2001  comparable to those required by this part for licensure. 
2002         Section 43. Section 400.931, Florida Statutes, is amended 
2003  to read: 
2004         400.931 Application for license; fee; provisional license; 
2005  temporary permit.— 
2006         (1) In addition to the requirements of part II of chapter 
2007  408, the applicant must file with the application satisfactory 
2008  proof that the home medical equipment provider is in compliance 
2009  with this part and applicable rules, including: 
2010         (a) A report, by category, of the equipment to be provided, 
2011  indicating those offered either directly by the applicant or 
2012  through contractual arrangements with existing providers. 
2013  Categories of equipment include: 
2014         1. Respiratory modalities. 
2015         2. Ambulation aids. 
2016         3. Mobility aids. 
2017         4. Sickroom setup. 
2018         5. Disposables. 
2019         (b) A report, by category, of the services to be provided, 
2020  indicating those offered either directly by the applicant or 
2021  through contractual arrangements with existing providers. 
2022  Categories of services include: 
2023         1. Intake. 
2024         2. Equipment selection. 
2025         3. Delivery. 
2026         4. Setup and installation. 
2027         5. Patient training. 
2028         6. Ongoing service and maintenance. 
2029         7. Retrieval. 
2030         (c) A listing of those with whom the applicant contracts, 
2031  both the providers the applicant uses to provide equipment or 
2032  services to its consumers and the providers for whom the 
2033  applicant provides services or equipment. 
2034         (2) As an alternative to submitting proof of financial 
2035  ability to operate as required in s. 408.810(8), the applicant 
2036  may submit a $50,000 surety bond to the agency. 
2037         (2)(3) As specified in part II of chapter 408, the home 
2038  medical equipment provider must also obtain and maintain 
2039  professional and commercial liability insurance. Proof of 
2040  liability insurance, as defined in s. 624.605, must be submitted 
2041  with the application. The agency shall set the required amounts 
2042  of liability insurance by rule, but the required amount must not 
2043  be less than $250,000 per claim. In the case of contracted 
2044  services, it is required that the contractor have liability 
2045  insurance not less than $250,000 per claim. 
2046         (3)(4) When a change of the general manager of a home 
2047  medical equipment provider occurs, the licensee must notify the 
2048  agency of the change within 45 days. 
2049         (4)(5) In accordance with s. 408.805, an applicant or a 
2050  licensee shall pay a fee for each license application submitted 
2051  under this part, part II of chapter 408, and applicable rules. 
2052  The amount of the fee shall be established by rule and may not 
2053  exceed $300 per biennium. The agency shall set the fees in an 
2054  amount that is sufficient to cover its costs in carrying out its 
2055  responsibilities under this part. However, state, county, or 
2056  municipal governments applying for licenses under this part are 
2057  exempt from the payment of license fees. 
2058         (5)(6) An applicant for initial licensure, renewal, or 
2059  change of ownership shall also pay an inspection fee not to 
2060  exceed $400, which shall be paid by all applicants except those 
2061  not subject to licensure inspection by the agency as described 
2062  in s. 400.933. 
2063         Section 44. Subsection (2) of section 400.932, Florida 
2064  Statutes, is amended to read: 
2065         400.932 Administrative penalties.— 
2066         (2) A violation of this part, part II of chapter 408, or 
2067  applicable rules Any of the following actions by an employee of 
2068  a home medical equipment provider are grounds for administrative 
2069  action or penalties by the agency.: 
2070         (a) Violation of this part, part II of chapter 408, or 
2071  applicable rules. 
2072         (b) An intentional, reckless, or negligent act that 
2073  materially affects the health or safety of a patient. 
2074         Section 45. Subsection (2) of section 400.933, Florida 
2075  Statutes, is amended to read: 
2076         400.933 Licensure inspections and investigations.— 
2077         (2) The agency shall accept, in lieu of its own periodic 
2078  inspections for licensure, submission of the following: 
2079         (a) The survey or inspection of an accrediting 
2080  organization, provided the accreditation of the licensed home 
2081  medical equipment provider is not conditional or provisional and 
2082  provided the licensed home medical equipment provider authorizes 
2083  release of, and the agency receives the report of, the 
2084  accrediting organization; or 
2085         (b) A copy of a valid medical oxygen retail establishment 
2086  permit issued by the Department of Health, pursuant to chapter 
2087  499. 
2088         Section 46. Subsection (2) of section 400.953, Florida 
2089  Statutes, is amended to read: 
2090         400.953 Background screening of home medical equipment 
2091  provider personnel.—The agency shall require employment 
2092  screening as provided in chapter 435, using the level 1 
2093  standards for screening set forth in that chapter, for home 
2094  medical equipment provider personnel. 
2095         (2) The general manager of each home medical equipment 
2096  provider must sign an affidavit annually, under penalty of 
2097  perjury, stating that all home medical equipment provider 
2098  personnel hired on or after July 1, 1999, who enter the home of 
2099  a patient in the capacity of their employment have been screened 
2100  and that its remaining personnel have worked for the home 
2101  medical equipment provider continuously since before July 1, 
2102  1999. This attestation must be submitted in accordance with s. 
2103  408.809(6). 
2104         Section 47. Section 400.967, Florida Statutes, is amended 
2105  to read: 
2106         400.967 Rules and classification of violations 
2107  deficiencies.— 
2108         (1) It is the intent of the Legislature that rules adopted 
2109  and enforced under this part and part II of chapter 408 include 
2110  criteria by which a reasonable and consistent quality of 
2111  resident care may be ensured, the results of such resident care 
2112  can be demonstrated, and safe and sanitary facilities can be 
2113  provided. 
2114         (2) Pursuant to the intention of the Legislature, the 
2115  agency, in consultation with the Agency for Persons with 
2116  Disabilities and the Department of Elderly Affairs, shall adopt 
2117  and enforce rules to administer this part and part II of chapter 
2118  408, which shall include reasonable and fair criteria governing: 
2119         (a) The location and construction of the facility; 
2120  including fire and life safety, plumbing, heating, cooling, 
2121  lighting, ventilation, and other housing conditions that will 
2122  ensure the health, safety, and comfort of residents. The agency 
2123  shall establish standards for facilities and equipment to 
2124  increase the extent to which new facilities and a new wing or 
2125  floor added to an existing facility after July 1, 2000, are 
2126  structurally capable of serving as shelters only for residents, 
2127  staff, and families of residents and staff, and equipped to be 
2128  self-supporting during and immediately following disasters. The 
2129  Agency for Health Care Administration shall work with facilities 
2130  licensed under this part and report to the Governor and the 
2131  Legislature by April 1, 2000, its recommendations for cost 
2132  effective renovation standards to be applied to existing 
2133  facilities. In making such rules, the agency shall be guided by 
2134  criteria recommended by nationally recognized, reputable 
2135  professional groups and associations having knowledge concerning 
2136  such subject matters. The agency shall update or revise such 
2137  criteria as the need arises. All facilities must comply with 
2138  those lifesafety code requirements and building code standards 
2139  applicable at the time of approval of their construction plans. 
2140  The agency may require alterations to a building if it 
2141  determines that an existing condition constitutes a distinct 
2142  hazard to life, health, or safety. The agency shall adopt fair 
2143  and reasonable rules setting forth conditions under which 
2144  existing facilities undergoing additions, alterations, 
2145  conversions, renovations, or repairs are required to comply with 
2146  the most recent updated or revised standards. 
2147         (b) The number and qualifications of all personnel, 
2148  including management, medical nursing, and other personnel, 
2149  having responsibility for any part of the care given to 
2150  residents. 
2151         (c) All sanitary conditions within the facility and its 
2152  surroundings, including water supply, sewage disposal, food 
2153  handling, and general hygiene, which will ensure the health and 
2154  comfort of residents. 
2155         (d) The equipment essential to the health and welfare of 
2156  the residents. 
2157         (e) A uniform accounting system. 
2158         (f) The care, treatment, and maintenance of residents and 
2159  measurement of the quality and adequacy thereof. 
2160         (g) The preparation and annual update of a comprehensive 
2161  emergency management plan. The agency shall adopt rules 
2162  establishing minimum criteria for the plan after consultation 
2163  with the Department of Community Affairs. At a minimum, the 
2164  rules must provide for plan components that address emergency 
2165  evacuation transportation; adequate sheltering arrangements; 
2166  postdisaster activities, including emergency power, food, and 
2167  water; postdisaster transportation; supplies; staffing; 
2168  emergency equipment; individual identification of residents and 
2169  transfer of records; and responding to family inquiries. The 
2170  comprehensive emergency management plan is subject to review and 
2171  approval by the local emergency management agency. During its 
2172  review, the local emergency management agency shall ensure that 
2173  the following agencies, at a minimum, are given the opportunity 
2174  to review the plan: the Department of Elderly Affairs, the 
2175  Agency for Persons with Disabilities, the Agency for Health Care 
2176  Administration, and the Department of Community Affairs. Also, 
2177  appropriate volunteer organizations must be given the 
2178  opportunity to review the plan. The local emergency management 
2179  agency shall complete its review within 60 days and either 
2180  approve the plan or advise the facility of necessary revisions. 
2181         (h) The use of restraint and seclusion. Such rules must be 
2182  consistent with recognized best practices; prohibit inherently 
2183  dangerous restraint or seclusion procedures; establish 
2184  limitations on the use and duration of restraint and seclusion; 
2185  establish measures to ensure the safety of clients and staff 
2186  during an incident of restraint or seclusion; establish 
2187  procedures for staff to follow before, during, and after 
2188  incidents of restraint or seclusion, including individualized 
2189  plans for the use of restraints or seclusion in emergency 
2190  situations; establish professional qualifications of and 
2191  training for staff who may order or be engaged in the use of 
2192  restraint or seclusion; establish requirements for facility data 
2193  collection and reporting relating to the use of restraint and 
2194  seclusion; and establish procedures relating to the 
2195  documentation of the use of restraint or seclusion in the 
2196  client’s facility or program record. 
2197         (3) The agency shall adopt rules to provide that, when the 
2198  criteria established under this part and part II of chapter 408 
2199  are not met, such violations deficiencies shall be classified 
2200  according to the nature of the violation deficiency. The agency 
2201  shall indicate the classification on the face of the notice of 
2202  violations deficiencies as follows: 
2203         (a) Class I violations deficiencies are defined in s. 
2204  408.813. those which the agency determines present an imminent 
2205  danger to the residents or guests of the facility or a 
2206  substantial probability that death or serious physical harm 
2207  would result therefrom. The condition or practice constituting a 
2208  class I violation must be abated or eliminated immediately, 
2209  unless a fixed period of time, as determined by the agency, is 
2210  required for correction. A class I violation deficiency is 
2211  subject to a civil penalty in an amount not less than $5,000 and 
2212  not exceeding $10,000 for each violation deficiency. A fine may 
2213  be levied notwithstanding the correction of the violation 
2214  deficiency. 
2215         (b) Class II violations deficiencies are defined in s. 
2216  408.813. those which the agency determines have a direct or 
2217  immediate relationship to the health, safety, or security of the 
2218  facility residents, other than class I deficiencies. A class II 
2219  violation deficiency is subject to a civil penalty in an amount 
2220  not less than $1,000 and not exceeding $5,000 for each 
2221  deficiency. A citation for a class II violation deficiency shall 
2222  specify the time within which the violation deficiency must be 
2223  corrected. If a class II violation deficiency is corrected 
2224  within the time specified, no civil penalty shall be imposed, 
2225  unless it is a repeated offense. 
2226         (c) Class III violations deficiencies are defined in s. 
2227  408.813. those which the agency determines to have an indirect 
2228  or potential relationship to the health, safety, or security of 
2229  the facility residents, other than class I or class II 
2230  deficiencies. A class III violation deficiency is subject to a 
2231  civil penalty of not less than $500 and not exceeding $1,000 for 
2232  each violation deficiency. A citation for a class III violation 
2233  deficiency shall specify the time within which the violation 
2234  deficiency must be corrected. If a class III violation 
2235  deficiency is corrected within the time specified, no civil 
2236  penalty shall be imposed, unless it is a repeated offense. 
2237         (d) Class IV violations are defined in s. 408.813. 
2238         (4) The agency shall approve or disapprove the plans and 
2239  specifications within 60 days after receipt of the final plans 
2240  and specifications. The agency may be granted one 15-day 
2241  extension for the review period, if the secretary of the agency 
2242  so approves. If the agency fails to act within the specified 
2243  time, it is deemed to have approved the plans and 
2244  specifications. When the agency disapproves plans and 
2245  specifications, it must set forth in writing the reasons for 
2246  disapproval. Conferences and consultations may be provided as 
2247  necessary. 
2248         (5) The agency may charge an initial fee of $2,000 for 
2249  review of plans and construction on all projects, no part of 
2250  which is refundable. The agency may also collect a fee, not to 
2251  exceed 1 percent of the estimated construction cost or the 
2252  actual cost of review, whichever is less, for the portion of the 
2253  review which encompasses initial review through the initial 
2254  revised construction document review. The agency may collect its 
2255  actual costs on all subsequent portions of the review and 
2256  construction inspections. Initial fee payment must accompany the 
2257  initial submission of plans and specifications. Any subsequent 
2258  payment that is due is payable upon receipt of the invoice from 
2259  the agency. Notwithstanding any other provision of law, all 
2260  money received by the agency under this section shall be deemed 
2261  to be trust funds, to be held and applied solely for the 
2262  operations required under this section. 
2263         Section 48. Subsection (1) of section 400.969, Florida 
2264  Statutes, is amended to read: 
2265         400.969 Violation of part; penalties.— 
2266         (1) In addition to the requirements of part II of chapter 
2267  408, and except as provided in s. 400.967(3), a violation of any 
2268  provision of federal certification required pursuant to 
2269  400.960(8), this part, part II of chapter 408, or applicable 
2270  rules is punishable by payment of an administrative or civil 
2271  penalty not to exceed $5,000. 
2272         Section 49. Subsection (7) of section 400.9905, Florida 
2273  Statutes, is amended to read: 
2274         400.9905 Definitions.— 
2275         (7) “Portable service or equipment provider” means an 
2276  entity that contracts with or employs persons to provide 
2277  portable service or equipment to multiple locations which 
2278  performing treatment or diagnostic testing of individuals, that 
2279  bills third-party payors for those services, and that otherwise 
2280  meets the definition of a clinic in subsection (4). 
2281         Section 50. Subsections (1) and (4) of section 400.991, 
2282  Florida Statutes, are amended to read: 
2283         400.991 License requirements; background screenings; 
2284  prohibitions.— 
2285         (1)(a) The requirements of part II of chapter 408 apply to 
2286  the provision of services that require licensure pursuant to 
2287  this part and part II of chapter 408 and to entities licensed by 
2288  or applying for such licensure from the agency pursuant to this 
2289  part. A license issued by the agency is required in order to 
2290  operate a clinic in this state. Each clinic location shall be 
2291  licensed separately regardless of whether the clinic is operated 
2292  under the same business name or management as another clinic. 
2293         (b) Each mobile clinic must obtain a separate health care 
2294  clinic license and must provide to the agency, at least 
2295  quarterly, its projected street location to enable the agency to 
2296  locate and inspect such clinic. A portable equipment and health 
2297  services provider must obtain a health care clinic license for a 
2298  single administrative office and is not required to submit 
2299  quarterly projected street locations. 
2300         (4) In addition to the requirements of part II of chapter 
2301  408, the applicant must file with the application satisfactory 
2302  proof that the clinic is in compliance with this part and 
2303  applicable rules, including: 
2304         (a) A listing of services to be provided either directly by 
2305  the applicant or through contractual arrangements with existing 
2306  providers; 
2307         (b) The number and discipline of each professional staff 
2308  member to be employed; and 
2309         (c) Proof of financial ability to operate as required under 
2310  ss. 408.810(8) and 408.8065 s. 408.810(8). As an alternative to 
2311  submitting proof of financial ability to operate as required 
2312  under s. 408.810(8), the applicant may file a surety bond of at 
2313  least $500,000 which guarantees that the clinic will act in full 
2314  conformity with all legal requirements for operating a clinic, 
2315  payable to the agency. The agency may adopt rules to specify 
2316  related requirements for such surety bond. 
2317         Section 51. Paragraph (g) of subsection (1) and paragraph 
2318  (a) of subsection (7) of section 400.9935, Florida Statutes, are 
2319  amended to read: 
2320         400.9935 Clinic responsibilities.— 
2321         (1) Each clinic shall appoint a medical director or clinic 
2322  director who shall agree in writing to accept legal 
2323  responsibility for the following activities on behalf of the 
2324  clinic. The medical director or the clinic director shall: 
2325         (g) Conduct systematic reviews of clinic billings to ensure 
2326  that the billings are not fraudulent or unlawful. Upon discovery 
2327  of an unlawful charge, the medical director or clinic director 
2328  shall take immediate corrective action. If the clinic performs 
2329  only the technical component of magnetic resonance imaging, 
2330  static radiographs, computed tomography, or positron emission 
2331  tomography, and provides the professional interpretation of such 
2332  services, in a fixed facility that is accredited by the Joint 
2333  Commission on Accreditation of Healthcare Organizations or the 
2334  Accreditation Association for Ambulatory Health Care, and the 
2335  American College of Radiology; and if, in the preceding quarter, 
2336  the percentage of scans performed by that clinic which was 
2337  billed to all personal injury protection insurance carriers was 
2338  less than 15 percent, the chief financial officer of the clinic 
2339  may, in a written acknowledgment provided to the agency, assume 
2340  the responsibility for the conduct of the systematic reviews of 
2341  clinic billings to ensure that the billings are not fraudulent 
2342  or unlawful. 
2343         (7)(a) Each clinic engaged in magnetic resonance imaging 
2344  services must be accredited by the Joint Commission on 
2345  Accreditation of Healthcare Organizations, the American College 
2346  of Radiology, or the Accreditation Association for Ambulatory 
2347  Health Care, within 1 year after licensure. A clinic that is 
2348  accredited by the American College of Radiology or is within the 
2349  original 1-year period after licensure and replaces its core 
2350  magnetic resonance imaging equipment shall be given 1 year after 
2351  the date on which the equipment is replaced to attain 
2352  accreditation. However, a clinic may request a single, 6-month 
2353  extension if it provides evidence to the agency establishing 
2354  that, for good cause shown, such clinic cannot be accredited 
2355  within 1 year after licensure, and that such accreditation will 
2356  be completed within the 6-month extension. After obtaining 
2357  accreditation as required by this subsection, each such clinic 
2358  must maintain accreditation as a condition of renewal of its 
2359  license. A clinic that files a change of ownership application 
2360  must comply with the original accreditation timeframe 
2361  requirements of the transferor. The agency shall deny a change 
2362  of ownership application if the clinic is not in compliance with 
2363  the accreditation requirements. When a clinic adds, replaces, or 
2364  modifies magnetic resonance imaging equipment and the 
2365  accreditation agency requires new accreditation, the clinic must 
2366  be accredited within 1 year after the date of the addition, 
2367  replacement, or modification but may request a single, 6-month 
2368  extension if the clinic provides evidence of good cause to the 
2369  agency. 
2370         Section 52. Subsection (2) of section 408.034, Florida 
2371  Statutes, is amended to read: 
2372         408.034 Duties and responsibilities of agency; rules.— 
2373         (2) In the exercise of its authority to issue licenses to 
2374  health care facilities and health service providers, as provided 
2375  under chapters 393 and 395 and parts II, and IV, and VIII of 
2376  chapter 400, the agency may not issue a license to any health 
2377  care facility or health service provider that fails to receive a 
2378  certificate of need or an exemption for the licensed facility or 
2379  service. 
2380         Section 53. Paragraph (d) of subsection (1) of section 
2381  408.036, Florida Statutes, is amended to read: 
2382         408.036 Projects subject to review; exemptions.— 
2383         (1) APPLICABILITY.—Unless exempt under subsection (3), all 
2384  health-care-related projects, as described in paragraphs (a) 
2385  (g), are subject to review and must file an application for a 
2386  certificate of need with the agency. The agency is exclusively 
2387  responsible for determining whether a health-care-related 
2388  project is subject to review under ss. 408.031-408.045. 
2389         (d) The establishment of a hospice or hospice inpatient 
2390  facility, except as provided in s. 408.043. 
2391         Section 54. Subsection (2) of section 408.043, Florida 
2392  Statutes, is amended to read: 
2393         408.043 Special provisions.— 
2394         (2) HOSPICES.—When an application is made for a certificate 
2395  of need to establish or to expand a hospice, the need for such 
2396  hospice shall be determined on the basis of the need for and 
2397  availability of hospice services in the community. The formula 
2398  on which the certificate of need is based shall discourage 
2399  regional monopolies and promote competition. The inpatient 
2400  hospice care component of a hospice which is a freestanding 
2401  facility, or a part of a facility, which is primarily engaged in 
2402  providing inpatient care and related services and is not 
2403  licensed as a health care facility shall also be required to 
2404  obtain a certificate of need. Provision of hospice care by any 
2405  current provider of health care is a significant change in 
2406  service and therefore requires a certificate of need for such 
2407  services. 
2408         Section 55. Paragraph (k) of subsection (3) of section 
2409  408.05, Florida Statutes, is amended to read: 
2410         408.05 Florida Center for Health Information and Policy 
2411  Analysis.— 
2412         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to 
2413  produce comparable and uniform health information and statistics 
2414  for the development of policy recommendations, the agency shall 
2415  perform the following functions: 
2416         (k) Develop, in conjunction with the State Consumer Health 
2417  Information and Policy Advisory Council, and implement a long 
2418  range plan for making available health care quality measures and 
2419  financial data that will allow consumers to compare health care 
2420  services. The health care quality measures and financial data 
2421  the agency must make available shall include, but is not limited 
2422  to, pharmaceuticals, physicians, health care facilities, and 
2423  health plans and managed care entities. The agency shall submit 
2424  the initial plan to the Governor, the President of the Senate, 
2425  and the Speaker of the House of Representatives by January 1, 
2426  2006, and shall update the plan and report on the status of its 
2427  implementation annually thereafter. The agency shall also make 
2428  the plan and status report available to the public on its 
2429  Internet website. As part of the plan, the agency shall identify 
2430  the process and timeframes for implementation, any barriers to 
2431  implementation, and recommendations of changes in the law that 
2432  may be enacted by the Legislature to eliminate the barriers. As 
2433  preliminary elements of the plan, the agency shall: 
2434         1. Make available patient-safety indicators, inpatient 
2435  quality indicators, and performance outcome and patient charge 
2436  data collected from health care facilities pursuant to s. 
2437  408.061(1)(a) and (2). The terms “patient-safety indicators” and 
2438  “inpatient quality indicators” shall be as defined by the 
2439  Centers for Medicare and Medicaid Services, the National Quality 
2440  Forum, the Joint Commission on Accreditation of Healthcare 
2441  Organizations, the Agency for Healthcare Research and Quality, 
2442  the Centers for Disease Control and Prevention, or a similar 
2443  national entity that establishes standards to measure the 
2444  performance of health care providers, or by other states. The 
2445  agency shall determine which conditions, procedures, health care 
2446  quality measures, and patient charge data to disclose based upon 
2447  input from the council. When determining which conditions and 
2448  procedures are to be disclosed, the council and the agency shall 
2449  consider variation in costs, variation in outcomes, and 
2450  magnitude of variations and other relevant information. When 
2451  determining which health care quality measures to disclose, the 
2452  agency: 
2453         a. Shall consider such factors as volume of cases; average 
2454  patient charges; average length of stay; complication rates; 
2455  mortality rates; and infection rates, among others, which shall 
2456  be adjusted for case mix and severity, if applicable. 
2457         b. May consider such additional measures that are adopted 
2458  by the Centers for Medicare and Medicaid Studies, National 
2459  Quality Forum, the Joint Commission on Accreditation of 
2460  Healthcare Organizations, the Agency for Healthcare Research and 
2461  Quality, Centers for Disease Control and Prevention, or a 
2462  similar national entity that establishes standards to measure 
2463  the performance of health care providers, or by other states. 
2464 
2465  When determining which patient charge data to disclose, the 
2466  agency shall include such measures as the average of 
2467  undiscounted charges on frequently performed procedures and 
2468  preventive diagnostic procedures, the range of procedure charges 
2469  from highest to lowest, average net revenue per adjusted patient 
2470  day, average cost per adjusted patient day, and average cost per 
2471  admission, among others. 
2472         2. Make available performance measures, benefit design, and 
2473  premium cost data from health plans licensed pursuant to chapter 
2474  627 or chapter 641. The agency shall determine which health care 
2475  quality measures and member and subscriber cost data to 
2476  disclose, based upon input from the council. When determining 
2477  which data to disclose, the agency shall consider information 
2478  that may be required by either individual or group purchasers to 
2479  assess the value of the product, which may include membership 
2480  satisfaction, quality of care, current enrollment or membership, 
2481  coverage areas, accreditation status, premium costs, plan costs, 
2482  premium increases, range of benefits, copayments and 
2483  deductibles, accuracy and speed of claims payment, credentials 
2484  of physicians, number of providers, names of network providers, 
2485  and hospitals in the network. Health plans shall make available 
2486  to the agency any such data or information that is not currently 
2487  reported to the agency or the office. 
2488         3. Determine the method and format for public disclosure of 
2489  data reported pursuant to this paragraph. The agency shall make 
2490  its determination based upon input from the State Consumer 
2491  Health Information and Policy Advisory Council. At a minimum, 
2492  the data shall be made available on the agency’s Internet 
2493  website in a manner that allows consumers to conduct an 
2494  interactive search that allows them to view and compare the 
2495  information for specific providers. The website must include 
2496  such additional information as is determined necessary to ensure 
2497  that the website enhances informed decisionmaking among 
2498  consumers and health care purchasers, which shall include, at a 
2499  minimum, appropriate guidance on how to use the data and an 
2500  explanation of why the data may vary from provider to provider. 
2501  The data specified in subparagraph 1. shall be released no later 
2502  than January 1, 2006, for the reporting of infection rates, and 
2503  no later than October 1, 2005, for mortality rates and 
2504  complication rates. The data specified in subparagraph 2. shall 
2505  be released no later than October 1, 2006. 
2506         4. Publish on its website undiscounted charges for no fewer 
2507  than 150 of the most commonly performed adult and pediatric 
2508  procedures, including outpatient, inpatient, diagnostic, and 
2509  preventative procedures. 
2510         Section 56. Paragraph (a) of subsection (1) of section 
2511  408.061, Florida Statutes, is amended to read: 
2512         408.061 Data collection; uniform systems of financial 
2513  reporting; information relating to physician charges; 
2514  confidential information; immunity.— 
2515         (1) The agency shall require the submission by health care 
2516  facilities, health care providers, and health insurers of data 
2517  necessary to carry out the agency’s duties. Specifications for 
2518  data to be collected under this section shall be developed by 
2519  the agency with the assistance of technical advisory panels 
2520  including representatives of affected entities, consumers, 
2521  purchasers, and such other interested parties as may be 
2522  determined by the agency. 
2523         (a) Data submitted by health care facilities, including the 
2524  facilities as defined in chapter 395, shall include, but are not 
2525  limited to: case-mix data, patient admission and discharge data, 
2526  hospital emergency department data which shall include the 
2527  number of patients treated in the emergency department of a 
2528  licensed hospital reported by patient acuity level, data on 
2529  hospital-acquired infections as specified by rule, data on 
2530  complications as specified by rule, data on readmissions as 
2531  specified by rule, with patient and provider-specific 
2532  identifiers included, actual charge data by diagnostic groups, 
2533  financial data, accounting data, operating expenses, expenses 
2534  incurred for rendering services to patients who cannot or do not 
2535  pay, interest charges, depreciation expenses based on the 
2536  expected useful life of the property and equipment involved, and 
2537  demographic data. The agency shall adopt nationally recognized 
2538  risk adjustment methodologies or software consistent with the 
2539  standards of the Agency for Healthcare Research and Quality and 
2540  as selected by the agency for all data submitted as required by 
2541  this section. Data may be obtained from documents such as, but 
2542  not limited to: leases, contracts, debt instruments, itemized 
2543  patient bills, medical record abstracts, and related diagnostic 
2544  information. Reported data elements shall be reported 
2545  electronically and in accordance with rule 59E-7.012, Florida 
2546  Administrative Code. Data submitted shall be certified by the 
2547  chief executive officer or an appropriate and duly authorized 
2548  representative or employee of the licensed facility that the 
2549  information submitted is true and accurate. 
2550         Section 57. Subsection (1) of section 408.10, Florida 
2551  Statutes, is amended to read: 
2552         408.10 Consumer complaints.—The agency shall: 
2553         (1) Publish and make available to the public a toll-free 
2554  telephone number for the purpose of handling consumer complaints 
2555  and shall serve as a liaison between consumer entities and other 
2556  private entities and governmental entities for the disposition 
2557  of problems identified by consumers of health care. The agency 
2558  may provide staffing for this toll-free number through agency 
2559  staff or other arrangements. 
2560         Section 58. Subsection (11) of section 408.802, Florida 
2561  Statutes, is repealed. 
2562         Section 59. Effective October 1, 2010, subsection (3) is 
2563  added to section 408.804, Florida Statutes, to read: 
2564         408.804 License required; display.— 
2565         (3) Any person who knowingly alters, defaces, or falsifies 
2566  any license certificate issued by the agency, or causes or 
2567  procures any person to commit such an offense, commits a 
2568  misdemeanor of the second degree, punishable as provided in s. 
2569  775.082 or s. 775.083. Any licensee or provider who displays an 
2570  altered, defaced, or falsified license certificate is subject to 
2571  the penalties set forth in s. 408.815 and an administrative fine 
2572  of $1,000 for each day of illegal display. 
2573         Section 60. Paragraph (d) of subsection (2) of section 
2574  408.806, Florida Statutes, is amended to read: 
2575         408.806 License application process.— 
2576         (2)(d) The agency shall notify the licensee by mail or 
2577  electronically at least 90 days before the expiration of a 
2578  license that a renewal license is necessary to continue 
2579  operation. The licensee’s failure to timely file submit a 
2580  renewal application and license application fee with the agency 
2581  shall result in a $50 per day late fee charged to the licensee 
2582  by the agency; however, the aggregate amount of the late fee may 
2583  not exceed 50 percent of the licensure fee or $500, whichever is 
2584  less. The agency shall provide a courtesy notice to the licensee 
2585  by United States mail, electronically, or by any other manner at 
2586  its address of record at least 90 days before the expiration of 
2587  a license informing the licensee of the expiration of the 
2588  license. Any failure of the agency to provide the courtesy 
2589  notice or any failure of the licensee to receive the courtesy 
2590  notice does not excuse the licensee from the legal obligation to 
2591  timely file the renewal application and license application fee 
2592  with the agency and does not mitigate the late fee. Payment of 
2593  the late fee is required in order for any late application to be 
2594  complete, and failure to pay the late fee is an omission from 
2595  the application. If an application is received after the 
2596  required filing date and exhibits a hand-canceled postmark 
2597  obtained from a United States post office dated on or before the 
2598  required filing date, no fine will be levied. 
2599         Section 61. Subsections (6) and (9) of section 408.810, 
2600  Florida Statutes, are amended to read: 
2601         408.810 Minimum licensure requirements.—In addition to the 
2602  licensure requirements specified in this part, authorizing 
2603  statutes, and applicable rules, each applicant and licensee must 
2604  comply with the requirements of this section in order to obtain 
2605  and maintain a license. 
2606         (6)(a) An applicant must provide the agency with proof of 
2607  the applicant’s legal right to occupy the property before a 
2608  license may be issued. Proof may include, but need not be 
2609  limited to, copies of warranty deeds, lease or rental 
2610  agreements, contracts for deeds, quitclaim deeds, or other such 
2611  documentation. 
2612         (b) If the property is encumbered by a mortgage or is 
2613  leased, an applicant must provide the agency with proof that the 
2614  mortgagor or landlord has received written notice of the 
2615  applicant’s intent as mortgagee or tenant to provide services 
2616  that require licensure and instructions that the agency be 
2617  served by certified mail with copies of any actions initiated by 
2618  the mortgagor or landlord against applicant. 
2619         (9) A controlling interest may not withhold from the agency 
2620  any evidence of financial instability, including, but not 
2621  limited to, checks returned due to insufficient funds, 
2622  delinquent accounts, nonpayment of withholding taxes, unpaid 
2623  utility expenses, nonpayment for essential services, or adverse 
2624  court action concerning the financial viability of the provider 
2625  or any other provider licensed under this part that is under the 
2626  control of the controlling interest. A controlling interest 
2627  shall notify the agency within 10 days after a court action, 
2628  including, but not limited to, the initiation of bankruptcy 
2629  proceedings, foreclosure, or eviction proceedings, in which the 
2630  controlling interest is a petitioner or defendant. Any person 
2631  who violates this subsection commits a misdemeanor of the second 
2632  degree, punishable as provided in s. 775.082 or s. 775.083. Each 
2633  day of continuing violation is a separate offense. 
2634         Section 62. Paragraph (a) of subsection (6) of section 
2635  408.811, Florida Statutes, is amended to read: 
2636         408.811 Right of inspection; copies; inspection reports; 
2637  plan for correction of deficiencies.— 
2638         (6)(a) Each licensee shall maintain as public information, 
2639  available upon request, records of all inspection reports 
2640  pertaining to that provider that have been filed by the agency 
2641  unless those reports are exempt from or contain information that 
2642  is exempt from s. 119.07(1) and s. 24(a), Art. I of the State 
2643  Constitution or is otherwise made confidential by law. Effective 
2644  October 1, 2006, copies of such reports shall be retained in the 
2645  records of the provider for at least 3 years following the date 
2646  the reports are filed and issued, regardless of a change of 
2647  ownership. The inspection report is not subject to challenge 
2648  under s. 120.569 or s. 120.57. 
2649         Section 63. Subsection (2) of section 408.813, Florida 
2650  Statutes, is amended to read: 
2651         408.813 Administrative fines; violations.—As a penalty for 
2652  any violation of this part, authorizing statutes, or applicable 
2653  rules, the agency may impose an administrative fine. 
2654         (2)(a) Violations of this part, authorizing statutes, or 
2655  applicable rules shall be classified according to the nature of 
2656  the violation and the gravity of its probable effect on clients. 
2657  The scope of a violation may be cited as an isolated, patterned, 
2658  or widespread deficiency. An isolated deficiency is a deficiency 
2659  affecting one or a very limited number of clients, or involving 
2660  one or a very limited number of staff, or a situation that 
2661  occurred only occasionally or in a very limited number of 
2662  locations. A patterned deficiency is a deficiency in which more 
2663  than a very limited number of clients are affected, or more than 
2664  a very limited number of staff are involved, or the situation 
2665  has occurred in several locations, or the same client or clients 
2666  have been affected by repeated occurrences of the same deficient 
2667  practice but the effect of the deficient practice is not found 
2668  to be pervasive throughout the provider. A widespread deficiency 
2669  is a deficiency in which the problems causing the deficiency are 
2670  pervasive in the provider or represent systemic failure that has 
2671  affected or has the potential to affect a large portion of the 
2672  provider’s clients. This subsection does not affect the 
2673  legislative determination of the amount of a fine imposed under 
2674  authorizing statutes. Violations shall be classified on the 
2675  written notice as follows: 
2676         1.(a) Class “I” violations are those conditions or 
2677  occurrences related to the operation and maintenance of a 
2678  provider or to the care of clients which the agency determines 
2679  present an imminent danger to the clients of the provider or a 
2680  substantial probability that death or serious physical or 
2681  emotional harm would result therefrom. The condition or practice 
2682  constituting a class I violation shall be abated or eliminated 
2683  within 24 hours, unless a fixed period, as determined by the 
2684  agency, is required for correction. The agency shall impose an 
2685  administrative fine as provided by law for a cited class I 
2686  violation. A fine shall be levied notwithstanding the correction 
2687  of the violation. 
2688         2.(b) Class “II” violations are those conditions or 
2689  occurrences related to the operation and maintenance of a 
2690  provider or to the care of clients which the agency determines 
2691  directly threaten the physical or emotional health, safety, or 
2692  security of the clients, other than class I violations. The 
2693  agency shall impose an administrative fine as provided by law 
2694  for a cited class II violation. A fine shall be levied 
2695  notwithstanding the correction of the violation. 
2696         3.(c) Class “III” violations are those conditions or 
2697  occurrences related to the operation and maintenance of a 
2698  provider or to the care of clients which the agency determines 
2699  indirectly or potentially threaten the physical or emotional 
2700  health, safety, or security of clients, other than class I or 
2701  class II violations. The agency shall impose an administrative 
2702  fine as provided in this section for a cited class III 
2703  violation. A citation for a class III violation must specify the 
2704  time within which the violation is required to be corrected. If 
2705  a class III violation is corrected within the time specified, a 
2706  fine may not be imposed. 
2707         4.(d) Class “IV” violations are those conditions or 
2708  occurrences related to the operation and maintenance of a 
2709  provider or to required reports, forms, or documents that do not 
2710  have the potential of negatively affecting clients. These 
2711  violations are of a type that the agency determines do not 
2712  threaten the health, safety, or security of clients. The agency 
2713  shall impose an administrative fine as provided in this section 
2714  for a cited class IV violation. A citation for a class IV 
2715  violation must specify the time within which the violation is 
2716  required to be corrected. If a class IV violation is corrected 
2717  within the time specified, a fine may not be imposed. 
2718         (b) The agency may impose an administrative fine for 
2719  violations that do not qualify as class I, class II, class III, 
2720  or class IV violations. The amount of the fine may not exceed 
2721  $500 for each violation. Unclassified violations may include: 
2722         1. Violating any term or condition of a license. 
2723         2. Violating any provision of this part, authorizing 
2724  statutes, or applicable rules. 
2725         3. Exceeding licensed capacity without authorization. 
2726         4. Providing services beyond the scope of the license. 
2727         5. Violating a moratorium. 
2728         Section 64. Subsection (5) is added to section 408.815, 
2729  Florida Statutes, to read: 
2730         408.815 License or application denial; revocation.— 
2731         (5) In order to ensure the health, safety, and welfare of 
2732  clients where a license has been denied, revoked, or is set to 
2733  terminate, the agency may extend the license expiration date for 
2734  up to 60 days after denial, revocation, or termination the sole 
2735  purpose of allowing the safe and orderly discharge of clients. 
2736  The agency may impose conditions on the extension, including, 
2737  but not limited to, prohibiting or limiting admissions, 
2738  expediting discharge planning, submitting required status 
2739  reports, and mandatory monitoring by the agency or third 
2740  parties. The agency may terminate the extension or modify the 
2741  conditions at any time at its discretion. Upon the discharge of 
2742  the final client, the extension shall immediately terminate and 
2743  the provider shall cease operation and promptly surrender its 
2744  license certificate to the agency. During the extension, the 
2745  provider must continue to meet all other requirements of this 
2746  part, authorizing statutes, and applicable rules. This authority 
2747  is in addition to any other authority granted to the agency 
2748  under chapter 120, this part, and the authorizing statutes, but 
2749  does not create any right or entitlement to an extension of a 
2750  license expiration date. 
2751         Section 65. Paragraph (d) is added to subsection (13) of 
2752  section 409.906, Florida Statutes, to read: 
2753         409.906 Optional Medicaid services.—Subject to specific 
2754  appropriations, the agency may make payments for services which 
2755  are optional to the state under Title XIX of the Social Security 
2756  Act and are furnished by Medicaid providers to recipients who 
2757  are determined to be eligible on the dates on which the services 
2758  were provided. Any optional service that is provided shall be 
2759  provided only when medically necessary and in accordance with 
2760  state and federal law. Optional services rendered by providers 
2761  in mobile units to Medicaid recipients may be restricted or 
2762  prohibited by the agency. Nothing in this section shall be 
2763  construed to prevent or limit the agency from adjusting fees, 
2764  reimbursement rates, lengths of stay, number of visits, or 
2765  number of services, or making any other adjustments necessary to 
2766  comply with the availability of moneys and any limitations or 
2767  directions provided for in the General Appropriations Act or 
2768  chapter 216. If necessary to safeguard the state’s systems of 
2769  providing services to elderly and disabled persons and subject 
2770  to the notice and review provisions of s. 216.177, the Governor 
2771  may direct the Agency for Health Care Administration to amend 
2772  the Medicaid state plan to delete the optional Medicaid service 
2773  known as “Intermediate Care Facilities for the Developmentally 
2774  Disabled.” Optional services may include: 
2775         (13) HOME AND COMMUNITY-BASED SERVICES.— 
2776         (d) The agency, in consultation with the Department of 
2777  Elderly Affairs, shall phase out the adult day health care 
2778  waiver program and transfer existing waiver enrollees to other 
2779  appropriate home and community-based service programs. Effective 
2780  July 1, 2010, the adult day health care waiver program shall 
2781  cease to enroll new members. Existing enrollees in the adult day 
2782  health care program shall receive counseling regarding available 
2783  options and shall be offered an alternative home and community 
2784  based services program based on eligibility and personal choice. 
2785  Each enrollee in the waiver program shall continue to receive 
2786  home and community-based services without interruption in the 
2787  enrollee’s program of choice. The providers of the adult day 
2788  health care waiver program, in consultation with the resource 
2789  centers for the aged, shall assist in the transition of 
2790  enrollees and cease provision of adult day health care waiver 
2791  services by December 31, 2010. The agency may seek federal 
2792  waiver approval to administer this change. 
2793         Section 66. Paragraph (k) of subsection (4) of section 
2794  409.221, Florida Statutes, is repealed. 
2795         Section 67. Paragraphs (e), (f), and (g) of subsection (15) 
2796  of section 409.912, Florida Statutes, are repealed. 
2797         Section 68. Section 429.11, Florida Statutes, is amended to 
2798  read: 
2799         429.11 Initial application for license; provisional 
2800  license.— 
2801         (1) Each applicant for licensure must comply with all 
2802  provisions of part II of chapter 408 and must: 
2803         (a) Identify all other homes or facilities, including the 
2804  addresses and the license or licenses under which they operate, 
2805  if applicable, which are currently operated by the applicant or 
2806  administrator and which provide housing, meals, and personal 
2807  services to residents. 
2808         (b) Provide the location of the facility for which a 
2809  license is sought and documentation, signed by the appropriate 
2810  local government official, which states that the applicant has 
2811  met local zoning requirements. 
2812         (c) Provide the name, address, date of birth, social 
2813  security number, education, and experience of the administrator, 
2814  if different from the applicant. 
2815         (2) The applicant shall provide proof of liability 
2816  insurance as defined in s. 624.605. 
2817         (3) If the applicant is a community residential home, the 
2818  applicant must provide proof that it has met the requirements 
2819  specified in chapter 419. 
2820         (4) The applicant must furnish proof that the facility has 
2821  received a satisfactory firesafety inspection. The local 
2822  authority having jurisdiction or the State Fire Marshal must 
2823  conduct the inspection within 30 days after written request by 
2824  the applicant. 
2825         (5) The applicant must furnish documentation of a 
2826  satisfactory sanitation inspection of the facility by the county 
2827  health department. 
2828         (6) In addition to the license categories available in s. 
2829  408.808, a provisional license may be issued to an applicant 
2830  making initial application for licensure or making application 
2831  for a change of ownership. A provisional license shall be 
2832  limited in duration to a specific period of time not to exceed 6 
2833  months, as determined by the agency. 
2834         (6)(7) A county or municipality may not issue an 
2835  occupational license that is being obtained for the purpose of 
2836  operating a facility regulated under this part without first 
2837  ascertaining that the applicant has been licensed to operate 
2838  such facility at the specified location or locations by the 
2839  agency. The agency shall furnish to local agencies responsible 
2840  for issuing occupational licenses sufficient instruction for 
2841  making such determinations. 
2842         Section 69. Subsection (2) of section 429.12, Florida 
2843  Statutes, is repealed. 
2844         Section 70. Subsections (5) and (6) of section 429.14, 
2845  Florida Statutes, are amended to read: 
2846         429.14 Administrative penalties.— 
2847         (5) An action taken by the agency to suspend, deny, or 
2848  revoke a facility’s license under this part or part II of 
2849  chapter 408, in which the agency claims that the facility owner 
2850  or an employee of the facility has threatened the health, 
2851  safety, or welfare of a resident of the facility shall be heard 
2852  by the Division of Administrative Hearings of the Department of 
2853  Management Services within 120 days after receipt of the 
2854  facility’s request for a hearing, unless that time limitation is 
2855  waived by both parties. The administrative law judge must render 
2856  a decision within 30 days after receipt of a proposed 
2857  recommended order. 
2858         (6) The agency shall provide to the Division of Hotels and 
2859  Restaurants of the Department of Business and Professional 
2860  Regulation, on a monthly basis, a list of those assisted living 
2861  facilities that have had their licenses denied, suspended, or 
2862  revoked or that are involved in an appellate proceeding pursuant 
2863  to s. 120.60 related to the denial, suspension, or revocation of 
2864  a license. This information may be provided electronically or 
2865  through the agency’s Internet website. 
2866         Section 71. Subsection (4) of section 429.17, Florida 
2867  Statutes, is amended to read: 
2868         429.17 Expiration of license; renewal; conditional 
2869  license.— 
2870         (4) In addition to the license categories available in s. 
2871  408.808, a conditional license may be issued to an applicant for 
2872  license renewal if the applicant fails to meet all standards and 
2873  requirements for licensure. A conditional license issued under 
2874  this subsection shall be limited in duration to a specific 
2875  period of time not to exceed 6 months, as determined by the 
2876  agency, and shall be accompanied by an agency-approved plan of 
2877  correction. 
2878         Section 72. Subsection (5) of section 429.23, Florida 
2879  Statutes, is repealed. 
2880         Section 73. Subsection (2) of section 429.35, Florida 
2881  Statutes, is amended to read: 
2882         429.35 Maintenance of records; reports.— 
2883         (2) Within 60 days after the date of the biennial 
2884  inspection visit required under s. 408.811 or within 30 days 
2885  after the date of any interim visit, the agency shall forward 
2886  the results of the inspection to the local ombudsman council in 
2887  whose planning and service area, as defined in part II of 
2888  chapter 400, the facility is located; to at least one public 
2889  library or, in the absence of a public library, the county seat 
2890  in the county in which the inspected assisted living facility is 
2891  located; and, when appropriate, to the district Adult Services 
2892  and Mental Health Program Offices. This information may be 
2893  provided electronically or through the agency’s Internet site. 
2894         Section 74. Section 429.53, Florida Statutes, is amended to 
2895  read: 
2896         429.53 Consultation by the agency.— 
2897         (1) The area offices of licensure and certification of the 
2898  agency shall provide consultation to the following upon request: 
2899         (a) A licensee of a facility. 
2900         (b) A person interested in obtaining a license to operate a 
2901  facility under this part. 
2902         (2) As used in this section, “consultation” includes: 
2903         (a) An explanation of the requirements of this part and 
2904  rules adopted pursuant thereto; 
2905         (b) An explanation of the license application and renewal 
2906  procedures; and 
2907         (c) The provision of a checklist of general local and state 
2908  approvals required prior to constructing or developing a 
2909  facility and a listing of the types of agencies responsible for 
2910  such approvals; 
2911         (d) An explanation of benefits and financial assistance 
2912  available to a recipient of supplemental security income 
2913  residing in a facility; 
2914         (c)(e) Any other information that which the agency deems 
2915  necessary to promote compliance with the requirements of this 
2916  part.; and 
2917         (f) A preconstruction review of a facility to ensure 
2918  compliance with agency rules and this part. 
2919         (3) The agency may charge a fee commensurate with the cost 
2920  of providing consultation under this section. 
2921         Section 75. Subsections (2) and (11) of section 429.65, 
2922  Florida Statutes, are amended to read: 
2923         429.65 Definitions.—As used in this part, the term: 
2924         (2) “Adult family-care home” means a full-time, family-type 
2925  living arrangement, in a private home, under which up to two 
2926  individuals a person who reside in the home and own or rent owns 
2927  or rents the home provide provides room, board, and personal 
2928  care, on a 24-hour basis, for no more than five disabled adults 
2929  or frail elders who are not relatives. The following family-type 
2930  living arrangements are not required to be licensed as an adult 
2931  family-care home: 
2932         (a) An arrangement whereby the person who resides in the 
2933  home and owns or rents the home provides room, board, and 
2934  personal services for not more than two adults who do not 
2935  receive optional state supplementation under s. 409.212. The 
2936  person who provides the housing, meals, and personal care must 
2937  own or rent the home and reside therein. 
2938         (b) An arrangement whereby the person who owns or rents the 
2939  home provides room, board, and personal services only to his or 
2940  her relatives. 
2941         (c) An establishment that is licensed as an assisted living 
2942  facility under this chapter. 
2943         (11) “Provider” means one or two individuals a person who 
2944  are is licensed to operate an adult family-care home. 
2945         Section 76. Section 429.71, Florida Statutes, is amended to 
2946  read: 
2947         429.71 Classification of violations deficiencies; 
2948  administrative fines.— 
2949         (1) In addition to the requirements of part II of chapter 
2950  408 and in addition to any other liability or penalty provided 
2951  by law, the agency may impose an administrative fine on a 
2952  provider according to the following classification: 
2953         (a) Class I violations are defined in s. 408.813. those 
2954  conditions or practices related to the operation and maintenance 
2955  of an adult family-care home or to the care of residents which 
2956  the agency determines present an imminent danger to the 
2957  residents or guests of the facility or a substantial probability 
2958  that death or serious physical or emotional harm would result 
2959  therefrom. The condition or practice that constitutes a class I 
2960  violation must be abated or eliminated within 24 hours, unless a 
2961  fixed period, as determined by the agency, is required for 
2962  correction. A class I violation deficiency is subject to an 
2963  administrative fine in an amount not less than $500 and not 
2964  exceeding $1,000 for each violation. A fine may be levied 
2965  notwithstanding the correction of the violation deficiency. 
2966         (b) Class II violations are defined in s. 408.813. those 
2967  conditions or practices related to the operation and maintenance 
2968  of an adult family-care home or to the care of residents which 
2969  the agency determines directly threaten the physical or 
2970  emotional health, safety, or security of the residents, other 
2971  than class I violations. A class II violation is subject to an 
2972  administrative fine in an amount not less than $250 and not 
2973  exceeding $500 for each violation. A citation for a class II 
2974  violation must specify the time within which the violation is 
2975  required to be corrected. If a class II violation is corrected 
2976  within the time specified, no civil penalty shall be imposed, 
2977  unless it is a repeated offense. 
2978         (c) Class III violations are defined in s. 408.813. those 
2979  conditions or practices related to the operation and maintenance 
2980  of an adult family-care home or to the care of residents which 
2981  the agency determines indirectly or potentially threaten the 
2982  physical or emotional health, safety, or security of residents, 
2983  other than class I or class II violations. A class III violation 
2984  is subject to an administrative fine in an amount not less than 
2985  $100 and not exceeding $250 for each violation. A citation for a 
2986  class III violation shall specify the time within which the 
2987  violation is required to be corrected. If a class III violation 
2988  is corrected within the time specified, no civil penalty shall 
2989  be imposed, unless it is a repeated offense. 
2990         (d) Class IV violations are defined in s. 408.813. those 
2991  conditions or occurrences related to the operation and 
2992  maintenance of an adult family-care home, or related to the 
2993  required reports, forms, or documents, which do not have the 
2994  potential of negatively affecting the residents. A provider that 
2995  does not correct A class IV violation within the time limit 
2996  specified by the agency is subject to an administrative fine in 
2997  an amount not less than $50 and not exceeding $100 for each 
2998  violation. Any class IV violation that is corrected during the 
2999  time the agency survey is conducted will be identified as an 
3000  agency finding and not as a violation. 
3001         (2) The agency may impose an administrative fine for 
3002  violations which do not qualify as class I, class II, class III, 
3003  or class IV violations. The amount of the fine may shall not 
3004  exceed $250 for each violation or $2,000 in the aggregate. 
3005  Unclassified violations may include: 
3006         (a) Violating any term or condition of a license. 
3007         (b) Violating any provision of this part, part II of 
3008  chapter 408, or applicable rules. 
3009         (c) Failure to follow the criteria and procedures provided 
3010  under part I of chapter 394 relating to the transportation, 
3011  voluntary admission, and involuntary examination of adult 
3012  family-care home residents. 
3013         (d) Exceeding licensed capacity. 
3014         (e) Providing services beyond the scope of the license. 
3015         (f) Violating a moratorium. 
3016         (3) Each day during which a violation occurs constitutes a 
3017  separate offense. 
3018         (4) In determining whether a penalty is to be imposed, and 
3019  in fixing the amount of any penalty to be imposed, the agency 
3020  must consider: 
3021         (a) The gravity of the violation. 
3022         (b) Actions taken by the provider to correct a violation. 
3023         (c) Any previous violation by the provider. 
3024         (d) The financial benefit to the provider of committing or 
3025  continuing the violation. 
3026         (5) As an alternative to or in conjunction with an 
3027  administrative action against a provider, the agency may request 
3028  a plan of corrective action that demonstrates a good faith 
3029  effort to remedy each violation by a specific date, subject to 
3030  the approval of the agency. 
3031         Section 77. Section 429.911, Florida Statutes, is repealed. 
3032         Section 78. Section 429.915, Florida Statutes, is amended 
3033  to read: 
3034         429.915 Conditional license.—In addition to the license 
3035  categories available in part II of chapter 408, the agency may 
3036  issue a conditional license to an applicant for license renewal 
3037  or change of ownership if the applicant fails to meet all 
3038  standards and requirements for licensure. A conditional license 
3039  issued under this subsection must be limited to a specific 
3040  period not exceeding 6 months, as determined by the agency, and 
3041  must be accompanied by an approved plan of correction. 
3042         Section 79. Subsection (3) of section 430.80, Florida 
3043  Statutes, is amended to read: 
3044         430.80 Implementation of a teaching nursing home pilot 
3045  project.— 
3046         (3) To be designated as a teaching nursing home, a nursing 
3047  home licensee must, at a minimum: 
3048         (a) Provide a comprehensive program of integrated senior 
3049  services that include institutional services and community-based 
3050  services; 
3051         (b) Participate in a nationally recognized accreditation 
3052  program and hold a valid accreditation, such as the 
3053  accreditation awarded by the Joint Commission on Accreditation 
3054  of Healthcare Organizations; 
3055         (c) Have been in business in this state for a minimum of 10 
3056  consecutive years; 
3057         (d) Demonstrate an active program in multidisciplinary 
3058  education and research that relates to gerontology; 
3059         (e) Have a formalized contractual relationship with at 
3060  least one accredited health profession education program located 
3061  in this state; 
3062         (f) Have a formalized contractual relationship with an 
3063  accredited hospital that is designated by law as a teaching 
3064  hospital; and 
3065         (g) Have senior staff members who hold formal faculty 
3066  appointments at universities, which must include at least one 
3067  accredited health profession education program. 
3068         (h) Maintain insurance coverage pursuant to s. 
3069  400.141(1)(q) s. 400.141(1)(s) or proof of financial 
3070  responsibility in a minimum amount of $750,000. Such proof of 
3071  financial responsibility may include: 
3072         1. Maintaining an escrow account consisting of cash or 
3073  assets eligible for deposit in accordance with s. 625.52; or 
3074         2. Obtaining and maintaining pursuant to chapter 675 an 
3075  unexpired, irrevocable, nontransferable and nonassignable letter 
3076  of credit issued by any bank or savings association organized 
3077  and existing under the laws of this state or any bank or savings 
3078  association organized under the laws of the United States that 
3079  has its principal place of business in this state or has a 
3080  branch office which is authorized to receive deposits in this 
3081  state. The letter of credit shall be used to satisfy the 
3082  obligation of the facility to the claimant upon presentment of a 
3083  final judgment indicating liability and awarding damages to be 
3084  paid by the facility or upon presentment of a settlement 
3085  agreement signed by all parties to the agreement when such final 
3086  judgment or settlement is a result of a liability claim against 
3087  the facility. 
3088         Section 80. Paragraph (a) of subsection (2) of section 
3089  440.13, Florida Statutes, is amended to read: 
3090         440.13 Medical services and supplies; penalty for 
3091  violations; limitations.— 
3092         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.— 
3093         (a) Subject to the limitations specified elsewhere in this 
3094  chapter, the employer shall furnish to the employee such 
3095  medically necessary remedial treatment, care, and attendance for 
3096  such period as the nature of the injury or the process of 
3097  recovery may require, which is in accordance with established 
3098  practice parameters and protocols of treatment as provided for 
3099  in this chapter, including medicines, medical supplies, durable 
3100  medical equipment, orthoses, prostheses, and other medically 
3101  necessary apparatus. Remedial treatment, care, and attendance, 
3102  including work-hardening programs or pain-management programs 
3103  accredited by the Commission on Accreditation of Rehabilitation 
3104  Facilities or the Joint Commission on the Accreditation of 
3105  Health Organizations or pain-management programs affiliated with 
3106  medical schools, shall be considered as covered treatment only 
3107  when such care is given based on a referral by a physician as 
3108  defined in this chapter. Medically necessary treatment, care, 
3109  and attendance does not include chiropractic services in excess 
3110  of 24 treatments or rendered 12 weeks beyond the date of the 
3111  initial chiropractic treatment, whichever comes first, unless 
3112  the carrier authorizes additional treatment or the employee is 
3113  catastrophically injured. 
3114 
3115  Failure of the carrier to timely comply with this subsection 
3116  shall be a violation of this chapter and the carrier shall be 
3117  subject to penalties as provided for in s. 440.525. 
3118         Section 81. Section 483.294, Florida Statutes, is amended 
3119  to read: 
3120         483.294 Inspection of centers.—In accordance with s. 
3121  408.811, the agency shall biennially, at least once annually, 
3122  inspect the premises and operations of all centers subject to 
3123  licensure under this part. 
3124         Section 82. Subsection (1) of section 627.645, Florida 
3125  Statutes, is amended to read: 
3126         627.645 Denial of health insurance claims restricted.— 
3127         (1) A No claim for payment under a health insurance policy 
3128  or self-insured program of health benefits for treatment, care, 
3129  or services in a licensed hospital which is accredited by the 
3130  Joint Commission on the Accreditation of Hospitals, the American 
3131  Osteopathic Association, or the Commission on the Accreditation 
3132  of Rehabilitative Facilities may not shall be denied because 
3133  such hospital lacks major surgical facilities and is primarily 
3134  of a rehabilitative nature, if such rehabilitation is 
3135  specifically for treatment of physical disability. 
3136         Section 83. Paragraph (c) of subsection (2) of section 
3137  627.668, Florida Statutes, is amended to read: 
3138         627.668 Optional coverage for mental and nervous disorders 
3139  required; exception.— 
3140         (2) Under group policies or contracts, inpatient hospital 
3141  benefits, partial hospitalization benefits, and outpatient 
3142  benefits consisting of durational limits, dollar amounts, 
3143  deductibles, and coinsurance factors shall not be less favorable 
3144  than for physical illness generally, except that: 
3145         (c) Partial hospitalization benefits shall be provided 
3146  under the direction of a licensed physician. For purposes of 
3147  this part, the term “partial hospitalization services” is 
3148  defined as those services offered by a program accredited by the 
3149  Joint Commission on Accreditation of Hospitals (JCAH) or in 
3150  compliance with equivalent standards. Alcohol rehabilitation 
3151  programs accredited by the Joint Commission on Accreditation of 
3152  Hospitals or approved by the state and licensed drug abuse 
3153  rehabilitation programs shall also be qualified providers under 
3154  this section. In any benefit year, if partial hospitalization 
3155  services or a combination of inpatient and partial 
3156  hospitalization are utilized, the total benefits paid for all 
3157  such services shall not exceed the cost of 30 days of inpatient 
3158  hospitalization for psychiatric services, including physician 
3159  fees, which prevail in the community in which the partial 
3160  hospitalization services are rendered. If partial 
3161  hospitalization services benefits are provided beyond the limits 
3162  set forth in this paragraph, the durational limits, dollar 
3163  amounts, and coinsurance factors thereof need not be the same as 
3164  those applicable to physical illness generally. 
3165         Section 84. Subsection (3) of section 627.669, Florida 
3166  Statutes, is amended to read: 
3167         627.669 Optional coverage required for substance abuse 
3168  impaired persons; exception.— 
3169         (3) The benefits provided under this section shall be 
3170  applicable only if treatment is provided by, or under the 
3171  supervision of, or is prescribed by, a licensed physician or 
3172  licensed psychologist and if services are provided in a program 
3173  accredited by the Joint Commission on Accreditation of Hospitals 
3174  or approved by the state. 
3175         Section 85. Paragraph (a) of subsection (1) of section 
3176  627.736, Florida Statutes, is amended to read: 
3177         627.736 Required personal injury protection benefits; 
3178  exclusions; priority; claims.— 
3179         (1) REQUIRED BENEFITS.—Every insurance policy complying 
3180  with the security requirements of s. 627.733 shall provide 
3181  personal injury protection to the named insured, relatives 
3182  residing in the same household, persons operating the insured 
3183  motor vehicle, passengers in such motor vehicle, and other 
3184  persons struck by such motor vehicle and suffering bodily injury 
3185  while not an occupant of a self-propelled vehicle, subject to 
3186  the provisions of subsection (2) and paragraph (4)(e), to a 
3187  limit of $10,000 for loss sustained by any such person as a 
3188  result of bodily injury, sickness, disease, or death arising out 
3189  of the ownership, maintenance, or use of a motor vehicle as 
3190  follows: 
3191         (a) Medical benefits.—Eighty percent of all reasonable 
3192  expenses for medically necessary medical, surgical, X-ray, 
3193  dental, and rehabilitative services, including prosthetic 
3194  devices, and medically necessary ambulance, hospital, and 
3195  nursing services. However, the medical benefits shall provide 
3196  reimbursement only for such services and care that are lawfully 
3197  provided, supervised, ordered, or prescribed by a physician 
3198  licensed under chapter 458 or chapter 459, a dentist licensed 
3199  under chapter 466, or a chiropractic physician licensed under 
3200  chapter 460 or that are provided by any of the following persons 
3201  or entities: 
3202         1. A hospital or ambulatory surgical center licensed under 
3203  chapter 395. 
3204         2. A person or entity licensed under ss. 401.2101-401.45 
3205  that provides emergency transportation and treatment. 
3206         3. An entity wholly owned by one or more physicians 
3207  licensed under chapter 458 or chapter 459, chiropractic 
3208  physicians licensed under chapter 460, or dentists licensed 
3209  under chapter 466 or by such practitioner or practitioners and 
3210  the spouse, parent, child, or sibling of that practitioner or 
3211  those practitioners. 
3212         4. An entity wholly owned, directly or indirectly, by a 
3213  hospital or hospitals. 
3214         5. A health care clinic licensed under ss. 400.990-400.995 
3215  that is: 
3216         a. Accredited by the Joint Commission on Accreditation of 
3217  Healthcare Organizations, the American Osteopathic Association, 
3218  the Commission on Accreditation of Rehabilitation Facilities, or 
3219  the Accreditation Association for Ambulatory Health Care, Inc.; 
3220  or 
3221         b. A health care clinic that: 
3222         (I) Has a medical director licensed under chapter 458, 
3223  chapter 459, or chapter 460; 
3224         (II) Has been continuously licensed for more than 3 years 
3225  or is a publicly traded corporation that issues securities 
3226  traded on an exchange registered with the United States 
3227  Securities and Exchange Commission as a national securities 
3228  exchange; and 
3229         (III) Provides at least four of the following medical 
3230  specialties: 
3231         (A) General medicine. 
3232         (B) Radiography. 
3233         (C) Orthopedic medicine. 
3234         (D) Physical medicine. 
3235         (E) Physical therapy. 
3236         (F) Physical rehabilitation. 
3237         (G) Prescribing or dispensing outpatient prescription 
3238  medication. 
3239         (H) Laboratory services. 
3240 
3241  The Financial Services Commission shall adopt by rule the form 
3242  that must be used by an insurer and a health care provider 
3243  specified in subparagraph 3., subparagraph 4., or subparagraph 
3244  5. to document that the health care provider meets the criteria 
3245  of this paragraph, which rule must include a requirement for a 
3246  sworn statement or affidavit. 
3247 
3248  Only insurers writing motor vehicle liability insurance in this 
3249  state may provide the required benefits of this section, and no 
3250  such insurer shall require the purchase of any other motor 
3251  vehicle coverage other than the purchase of property damage 
3252  liability coverage as required by s. 627.7275 as a condition for 
3253  providing such required benefits. Insurers may not require that 
3254  property damage liability insurance in an amount greater than 
3255  $10,000 be purchased in conjunction with personal injury 
3256  protection. Such insurers shall make benefits and required 
3257  property damage liability insurance coverage available through 
3258  normal marketing channels. Any insurer writing motor vehicle 
3259  liability insurance in this state who fails to comply with such 
3260  availability requirement as a general business practice shall be 
3261  deemed to have violated part IX of chapter 626, and such 
3262  violation shall constitute an unfair method of competition or an 
3263  unfair or deceptive act or practice involving the business of 
3264  insurance; and any such insurer committing such violation shall 
3265  be subject to the penalties afforded in such part, as well as 
3266  those which may be afforded elsewhere in the insurance code. 
3267         Section 86. Subsection (12) of section 641.495, Florida 
3268  Statutes, is amended to read: 
3269         641.495 Requirements for issuance and maintenance of 
3270  certificate.— 
3271         (12) The provisions of part I of chapter 395 do not apply 
3272  to a health maintenance organization that, on or before January 
3273  1, 1991, provides not more than 10 outpatient holding beds for 
3274  short-term and hospice-type patients in an ambulatory care 
3275  facility for its members, provided that such health maintenance 
3276  organization maintains current accreditation by the Joint 
3277  Commission on Accreditation of Health Care Organizations, the 
3278  Accreditation Association for Ambulatory Health Care, or the 
3279  National Committee for Quality Assurance. 
3280         Section 87. Subsection (13) of section 651.118, Florida 
3281  Statutes, is amended to read: 
3282         651.118 Agency for Health Care Administration; certificates 
3283  of need; sheltered beds; community beds.— 
3284         (13) Residents, as defined in this chapter, are not 
3285  considered new admissions for the purpose of s. 400.141(1)(n)1.d 
3286  s. 400.141(1)(o)1.d. 
3287         Section 88. Subsection (2) of section 766.1015, Florida 
3288  Statutes, is amended to read: 
3289         766.1015 Civil immunity for members of or consultants to 
3290  certain boards, committees, or other entities.— 
3291         (2) Such committee, board, group, commission, or other 
3292  entity must be established in accordance with state law or in 
3293  accordance with requirements of the Joint Commission on 
3294  Accreditation of Healthcare Organizations, established and duly 
3295  constituted by one or more public or licensed private hospitals 
3296  or behavioral health agencies, or established by a governmental 
3297  agency. To be protected by this section, the act, decision, 
3298  omission, or utterance may not be made or done in bad faith or 
3299  with malicious intent. 
3300         Section 89. Except as otherwise expressly provided in this 
3301  act, this act shall take effect July 1, 2010.