CS/CS/HB 1143

1	A bill to be entitled
2	An act relating to the reduction and simplification of
3	health care provider regulation; amending s. 112.0455,
4	F.S., relating to the Drug-Free Workplace Act; deleting an
5	obsolete provision; amending s. 318.21, F.S.; revising
6	distribution of funds from civil penalties imposed for
7	traffic infractions by county courts; amending s.
8	381.0072, F.S.; limiting Department of Health food service
9	inspections in nursing homes; requiring the department to
10	coordinate inspections with the Agency for Health Care
11	Administration; repealing s. 383.325, F.S., relating to
12	confidentiality of inspection reports of licensed birth
13	center facilities; amending s. 395.002, F.S.; revising and
14	deleting definitions applicable to regulation of hospitals
15	and other licensed facilities; conforming a cross-
16	reference; amending s. 395.003, F.S.; deleting an obsolete
17	provision; conforming a cross-reference; amending s.
18	395.0193, F.S.; requiring a licensed facility to report
19	certain peer review information and final disciplinary
20	actions to the Division of Medical Quality Assurance of
21	the Department of Health rather than the Division of
22	Health Quality Assurance of the Agency for Health Care
23	Administration; amending s. 395.1023, F.S.; providing for
24	the Department of Children and Family Services rather than
25	the Department of Health to perform certain functions with
26	respect to child protection cases; requiring certain
27	hospitals to notify the Department of Children and Family
28	Services of compliance; amending s. 395.1041, F.S.,
29	relating to hospital emergency services and care; deleting
30	obsolete provisions; repealing s. 395.1046, F.S., relating
31	to complaint investigation procedures; amending s.
32	395.1055, F.S.; requiring licensed facility beds to
33	conform to standards specified by the Agency for Health
34	Care Administration, the Florida Building Code, and the
35	Florida Fire Prevention Code; amending s. 395.10972, F.S.;
36	revising a reference to the Florida Society of Healthcare
37	Risk Management to conform to the current designation;
38	amending s. 395.2050, F.S.; revising a reference to the
39	federal Health Care Financing Administration to conform to
40	the current designation; amending s. 395.3036, F.S.;
41	correcting a reference; repealing s. 395.3037, F.S.,
42	relating to redundant definitions; amending ss. 154.11,
43	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
44	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
45	F.S.; revising references to the Joint Commission on
46	Accreditation of Healthcare Organizations, the Commission
47	on Accreditation of Rehabilitation Facilities, and the
48	Council on Accreditation to conform to their current
49	designations; amending s. 395.602, F.S.; revising the
50	definition of the term "rural hospital" to delete an
51	obsolete provision; amending s. 400.021, F.S.; revising
52	the definition of the term "geriatric outpatient clinic";
53	amending s. 400.063, F.S.; deleting an obsolete provision;
54	amending ss. 400.071 and 400.0712, F.S.; revising
55	applicability of general licensure requirements under pt.
56	II of ch. 408, F.S., to applications for nursing home
57	licensure; revising provisions governing inactive
58	licenses; amending s. 400.111, F.S.; providing for
59	disclosure of controlling interest of a nursing home
60	facility upon request by the Agency for Health Care
61	Administration; amending s. 400.1183, F.S.; revising
62	grievance record maintenance and reporting requirements
63	for nursing homes; amending s. 400.141, F.S.; providing
64	criteria for the provision of respite services by nursing
65	homes; requiring a written plan of care; requiring a
66	contract for services; requiring resident release to
67	caregivers to be designated in writing; providing an
68	exemption to the application of discharge planning rules;
69	providing for residents' rights; providing for use of
70	personal medications; providing terms of respite stay;
71	providing for communication of patient information;
72	requiring a physician order for care and proof of a
73	physical examination; providing for services for respite
74	patients and duties of facilities with respect to such
75	patients; conforming a cross-reference; requiring
76	facilities to maintain clinical records that meet
77	specified standards; providing a fine relating to an
78	admissions moratorium; deleting requirement for facilities
79	to submit certain information related to management
80	companies to the agency; deleting a requirement for
81	facilities to notify the agency of certain bankruptcy
82	filings to conform to changes made by the act; amending s.
83	400.142, F.S.; deleting language relating to agency
84	adoption of rules; amending 400.147, F.S.; revising
85	reporting requirements for licensed nursing home
86	facilities relating to adverse incidents; repealing s.
87	400.148, F.S., relating to the Medicaid "Up-or-Out"
88	Quality of Care Contract Management Program; amending s.
89	400.162, F.S., requiring nursing homes to provide a
90	resident property statement annually and upon request;
91	amending s. 400.179, F.S.; revising requirements for
92	nursing home lease bond alternative fees; deleting an
93	obsolete provision; amending s. 400.19, F.S.; revising
94	inspection requirements; repealing s. 400.195, F.S.,
95	relating to agency reporting requirements; amending s.
96	400.23, F.S.; deleting an obsolete provision; clarifying a
97	reference; amending s. 400.275, F.S.; revising agency
98	duties with regard to training nursing home surveyor
99	teams; revising requirements for team members; amending s.
100	400.484, F.S.; revising the schedule of home health agency
101	inspection violations; amending s. 400.606, F.S.; revising
102	the content requirements of the plan accompanying an
103	initial or change-of-ownership application for licensure
104	of a hospice; revising requirements relating to
105	certificates of need for certain hospice facilities;
106	amending s. 400.607, F.S.; revising grounds for agency
107	action against a hospice; amending s. 400.931, F.S.;
108	deleting a requirement that an applicant for a home
109	medical equipment provider license submit a surety bond to
110	the agency; amending s. 400.932, F.S.; revising grounds
111	for the imposition of administrative penalties for certain
112	violations by an employee of a home medical equipment
113	provider; amending s. 400.967, F.S.; revising the schedule
114	of inspection violations for intermediate care facilities
115	for the developmentally disabled; providing a penalty for
116	certain violations; amending s. 400.9905, F.S.; providing
117	that pt. X of ch, 400, F.S., the Health Care Clinic Act,
118	does not apply to an entity owned by a corporation with a
119	specified amount of annual sales of health care services
120	under certain circumstances; amending s. 400.991, F.S.;
121	conforming terminology; revising application requirements
122	relating to documentation of financial ability to operate
123	a mobile clinic; amending s. 408.034, F.S.; revising
124	agency authority relating to licensing of intermediate
125	care facilities for the developmentally disabled; amending
126	s. 408.036, F.S.; deleting an exemption from certain
127	certificate-of-need review requirements for a hospice or a
128	hospice inpatient facility; amending s. 408.043, F.S.;
129	revising requirements for certain freestanding inpatient
130	hospice care facilities to obtain a certificate of need;
131	amending s. 408.061, F.S.; revising health care facility
132	data reporting requirements; amending s. 408.10, F.S.;
133	removing agency authority to investigate certain consumer
134	complaints; amending s. 408.802, F.S.; removing
135	applicability of pt. II of ch. 408, F.S., relating to
136	general licensure requirements, to private review agents;
137	amending s. 408.804, F.S.; providing penalties for
138	altering, defacing, or falsifying a license certificate
139	issued by the agency or displaying such an altered,
140	defaced, or falsified certificate; amending s. 408.806,
141	F.S.; revising agency responsibilities for notification of
142	licensees of impending expiration of a license; requiring
143	payment of a late fee for a license application to be
144	considered complete under certain circumstances; amending
145	s. 408.810, F.S.; revising provisions relating to
146	information required for licensure; requiring proof of
147	submission of notice to a mortgagor or landlord regarding
148	provision of services requiring licensure; requiring
149	disclosure of information by a controlling interest of
150	certain court actions relating to financial instability
151	within a specified time period; amending s. 408.813, F.S.;
152	authorizing the agency to impose fines for unclassified
153	violations of pt. II of ch. 408, F.S.; amending s.
154	408.815, F.S.; authorizing the agency to extend a license
155	expiration date under certain circumstances; amending s.
156	409.221, F.S.; deleting a reporting requirement relating
157	to the consumer-directed care program; amending s. 429.07,
158	F.S.; deleting the requirement for an assisted living
159	facility to obtain an additional license in order to
160	provide limited nursing services; deleting the requirement
161	for the agency to conduct quarterly monitoring visits of
162	facilities that hold a license to provide extended
163	congregate care services; deleting the requirement for the
164	department to report annually on the status of and
165	recommendations related to extended congregate care;
166	deleting the requirement for the agency to conduct
167	monitoring visits at least twice a year to facilities
168	providing limited nursing services; increasing the
169	licensure fees and the maximum fee required for the
170	standard license; increasing the licensure fees for the
171	extended congregate care license; eliminating the license
172	fee for the limited nursing services license; transferring
173	from another provision of law the requirement that a
174	biennial survey of an assisted living facility include
175	specific actions to determine whether the facility is
176	adequately protecting residents' rights; providing that an
177	assisted living facility that has a class I or class II
178	violation is subject to monitoring visits; requiring a
179	registered nurse to participate in certain monitoring
180	visits; amending s. 429.11, F.S.; revising licensure
181	application requirements for assisted living facilities to
182	eliminate provisional licenses; amending s. 429.12, F.S.;
183	revising notification requirements for the sale or
184	transfer of ownership of an assisted living facility;
185	amending s. 429.14, F.S.; removing a ground for the
186	imposition of an administrative penalty; clarifying
187	language relating to a facility's request for a hearing
188	under certain circumstances; authorizing the agency to
189	provide certain information relating to the licensure
190	status of assisted living facilities electronically or
191	through the agency's Internet website; amending s. 429.17,
192	F.S.; deleting provisions relating to the limited nursing
193	services license; revising agency responsibilities
194	regarding the issuance of conditional licenses; amending
195	s. 429.19, F.S.; clarifying that a monitoring fee may be
196	assessed in addition to an administrative fine; amending
197	s. 429.23, F.S.; deleting reporting requirements for
198	assisted living facilities relating to liability claims;
199	amending s. 429.255, F.S.; eliminating provisions
200	authorizing the use of volunteers to provide certain
201	health-care-related services in assisted living
202	facilities; authorizing assisted living facilities to
203	provide limited nursing services; requiring an assisted
204	living facility to be responsible for certain
205	recordkeeping and staff to be trained to monitor residents
206	receiving certain health-care-related services; amending
207	s. 429.28, F.S.; deleting a requirement for a biennial
208	survey of an assisted living facility, to conform to
209	changes made by the act; amending s. 429.35, F.S.;
210	authorizing the agency to provide certain information
211	relating to the inspections of assisted living facilities
212	electronically or through the agency's Internet website;
213	amending s. 429.41, F.S., relating to rulemaking;
214	conforming provisions to changes made by the act; amending
215	s. 429.53, F.S.; revising provisions relating to
216	consultation by the agency; revising a definition;
217	amending s. 429.54, F.S.; requiring licensed assisted
218	living facilities to electronically report certain data
219	semiannually to the agency in accordance with rules
220	adopted by the department; amending s. 429.71, F.S.;
221	revising schedule of inspection violations for adult
222	family-care homes; amending s. 429.911, F.S.; deleting a
223	ground for agency action against an adult day care center;
224	amending s. 429.915, F.S.; revising agency
225	responsibilities regarding the issuance of conditional
226	licenses; amending s. 483.294, F.S.; revising frequency of
227	agency inspections of multiphasic health testing centers;
228	amending s. 499.003, F.S.; removing a requirement that
229	certain prescription drug purchasers maintain a separate
230	inventory of certain prescription drugs; amending s.
231	499.01212, F.S.; exempting prescription drugs contained in
232	sealed medical convenience kits from the pedigree paper
233	requirements under specified circumstances; amending s.
234	633.081, F.S.; limiting Fire Marshal inspections of
235	nursing homes to once a year; providing for additional
236	inspections based on complaints and violations identified
237	in the course of orientation or training activities;
238	amending s. 766.202, F.S.; adding persons licensed under
239	pt. XIV of ch. 468, F.S., to the definition of "health
240	care provider"; amending ss. 394.4787, 400.0239, 408.07,
241	430.80, and 651.118, F.S.; conforming terminology and
242	cross-references; revising a reference; providing an
243	effective date.
244
245	Be It Enacted by the Legislature of the State of Florida:
246
247	Section 1.  Present paragraph (e) of subsection (10) and
248	paragraph (e) of subsection (14) of section 112.0455, Florida
249	Statutes, are amended, and paragraphs (f) through (k) of
250	subsection (10) of that section are redesignated as paragraphs
251	(e) through (j), respectively, to read:
252	112.0455  Drug-Free Workplace Act.-
253	(10)  EMPLOYER PROTECTION.-
254	(e)  Nothing in this section shall be construed to operate
255	retroactively, and nothing in this section shall abrogate the
256	right of an employer under state law to conduct drug tests prior
257	to January 1, 1990. A drug test conducted by an employer prior
258	to January 1, 1990, is not subject to this section.
259	(14)  DISCIPLINE REMEDIES.-
260	(e)  Upon resolving an appeal filed pursuant to paragraph
261	(c), and finding a violation of this section, the commission may
262	order the following relief:
263	1.  Rescind the disciplinary action, expunge related
264	records from the personnel file of the employee or job applicant
265	and reinstate the employee.
266	2.  Order compliance with paragraph (10)(f)(g).
267	3.  Award back pay and benefits.
268	4.  Award the prevailing employee or job applicant the
269	necessary costs of the appeal, reasonable attorney's fees, and
270	expert witness fees.
271	Section 2.  Paragraph (n) of subsection (1) of section
272	154.11, Florida Statutes, is amended to read:
273	154.11  Powers of board of trustees.-
274	(1)  The board of trustees of each public health trust
275	shall be deemed to exercise a public and essential governmental
276	function of both the state and the county and in furtherance
277	thereof it shall, subject to limitation by the governing body of
278	the county in which such board is located, have all of the
279	powers necessary or convenient to carry out the operation and
280	governance of designated health care facilities, including, but
281	without limiting the generality of, the foregoing:
282	(n)  To appoint originally the staff of physicians to
283	practice in any designated facility owned or operated by the
284	board and to approve the bylaws and rules to be adopted by the
285	medical staff of any designated facility owned and operated by
286	the board, such governing regulations to be in accordance with
287	the standards of The Joint Commission on the Accreditation of
288	Hospitals which provide, among other things, for the method of
289	appointing additional staff members and for the removal of staff
290	members.
291	Section 3.  Subsection (15) of section 318.21, Florida
292	Statutes, is amended to read:
293	318.21  Disposition of civil penalties by county courts.-
294	All civil penalties received by a county court pursuant to the
295	provisions of this chapter shall be distributed and paid monthly
296	as follows:
297	(15)  Of the additional fine assessed under s. 318.18(3)(e)
298	for a violation of s. 316.1893, 50 percent of the moneys
299	received from the fines shall be remitted to the Department of
300	Revenue and deposited into the Brain and Spinal Cord Injury
301	Trust Fund of Department of Health and shall be appropriated to
302	the Department of Health Agency for Health Care Administration
303	as general revenue to provide an enhanced Medicaid payment to
304	nursing homes that serve Medicaid recipients with spinal cord
305	injuries that are medically complex and who are technologically
306	and respiratory dependent with brain and spinal cord injuries.
307	The remaining 50 percent of the moneys received from the
308	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
309	the Department of Revenue and deposited into the Department of
310	Health Administrative Trust Fund to provide financial support to
311	certified trauma centers in the counties where enhanced penalty
312	zones are established to ensure the availability and
313	accessibility of trauma services. Funds deposited into the
314	Administrative Trust Fund under this subsection shall be
315	allocated as follows:
316	(a)  Fifty percent shall be allocated equally among all
317	Level I, Level II, and pediatric trauma centers in recognition
318	of readiness costs for maintaining trauma services.
319	(b)  Fifty percent shall be allocated among Level I, Level
320	II, and pediatric trauma centers based on each center's relative
321	volume of trauma cases as reported in the Department of Health
322	Trauma Registry.
323	Section 4.  Paragraph (e) is added to subsection (2) of
324	section 381.0072, Florida Statutes, to read:
325	381.0072  Food service protection.-It shall be the duty of
326	the Department of Health to adopt and enforce sanitation rules
327	consistent with law to ensure the protection of the public from
328	food-borne illness. These rules shall provide the standards and
329	requirements for the storage, preparation, serving, or display
330	of food in food service establishments as defined in this
331	section and which are not permitted or licensed under chapter
332	500 or chapter 509.
333	(2)  DUTIES.-
334	(e)  The department shall inspect food service
335	establishments in nursing homes licensed under part II of
336	chapter 400 twice each year. The department may make additional
337	inspections only in response to complaints. The department shall
338	coordinate inspections with the Agency for Health Care
339	Administration, such that the department's inspection is at
340	least 60 days after a recertification visit by the Agency for
341	Health Care Administration.
342	Section 5.  Section 383.325, Florida Statutes, is repealed.
343	Section 6.  Subsection (7) of section 394.4787, Florida
344	Statutes, is amended to read:
345	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
346	and 394.4789.-As used in this section and ss. 394.4786,
347	394.4788, and 394.4789:
348	(7)  "Specialty psychiatric hospital" means a hospital
349	licensed by the agency pursuant to s. 395.002(26)(28) and part
350	II of chapter 408 as a specialty psychiatric hospital.
351	Section 7.  Subsection (2) of section 394.741, Florida
352	Statutes, is amended to read:
353	394.741  Accreditation requirements for providers of
354	behavioral health care services.-
355	(2)  Notwithstanding any provision of law to the contrary,
356	accreditation shall be accepted by the agency and department in
357	lieu of the agency's and department's facility licensure onsite
358	review requirements and shall be accepted as a substitute for
359	the department's administrative and program monitoring
360	requirements, except as required by subsections (3) and (4),
361	for:
362	(a)  Any organization from which the department purchases
363	behavioral health care services that is accredited by The Joint
364	Commission on Accreditation of Healthcare Organizations or the
365	Council on Accreditation for Children and Family Services, or
366	has those services that are being purchased by the department
367	accredited by the Commission on Accreditation of Rehabilitation
368	Facilities CARF-the Rehabilitation Accreditation Commission.
369	(b)  Any mental health facility licensed by the agency or
370	any substance abuse component licensed by the department that is
371	accredited by The Joint Commission on Accreditation of
372	Healthcare Organizations, the Commission on Accreditation of
373	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
374	Commission, or the Council on Accreditation of Children and
375	Family Services.
376	(c)  Any network of providers from which the department or
377	the agency purchases behavioral health care services accredited
378	by The Joint Commission on Accreditation of Healthcare
379	Organizations, the Commission on Accreditation of Rehabilitation
380	Facilities CARF-the Rehabilitation Accreditation Commission, the
381	Council on Accreditation of Children and Family Services, or the
382	National Committee for Quality Assurance. A provider
383	organization, which is part of an accredited network, is
384	afforded the same rights under this part.
385	Section 8.  Present subsections (15) through (32) of
386	section 395.002, Florida Statutes, are renumbered as subsections
387	(14) through (28), respectively, and present subsections (1),
388	(14), (24), (30), and (31), and paragraph (c) of present
389	subsection (28) of that section are amended to read:
390	395.002  Definitions.-As used in this chapter:
391	(1)  "Accrediting organizations" means nationally
392	recognized or approved accrediting organizations whose standards
393	incorporate comparable licensure requirements as determined by
394	the agency the Joint Commission on Accreditation of Healthcare
395	Organizations, the American Osteopathic Association, the
396	Commission on Accreditation of Rehabilitation Facilities, and
397	the Accreditation Association for Ambulatory Health Care, Inc.
398	(14)  "Initial denial determination" means a determination
399	by a private review agent that the health care services
400	furnished or proposed to be furnished to a patient are
401	inappropriate, not medically necessary, or not reasonable.
402	(24)  "Private review agent" means any person or entity
403	which performs utilization review services for third-party
404	payors on a contractual basis for outpatient or inpatient
405	services. However, the term shall not include full-time
406	employees, personnel, or staff of health insurers, health
407	maintenance organizations, or hospitals, or wholly owned
408	subsidiaries thereof or affiliates under common ownership, when
409	performing utilization review for their respective hospitals,
410	health maintenance organizations, or insureds of the same
411	insurance group. For this purpose, health insurers, health
412	maintenance organizations, and hospitals, or wholly owned
413	subsidiaries thereof or affiliates under common ownership,
414	include such entities engaged as administrators of self-
415	insurance as defined in s. 624.031.
416	(26)(28)  "Specialty hospital" means any facility which
417	meets the provisions of subsection (12), and which regularly
418	makes available either:
419	(c)  Intensive residential treatment programs for children
420	and adolescents as defined in subsection (14) (15).
421	(30)  "Utilization review" means a system for reviewing the
422	medical necessity or appropriateness in the allocation of health
423	care resources of hospital services given or proposed to be
424	given to a patient or group of patients.
425	(31)  "Utilization review plan" means a description of the
426	policies and procedures governing utilization review activities
427	performed by a private review agent.
428	Section 9.  Paragraph (c) of subsection (1) and paragraph
429	(b) of subsection (2) of section 395.003, Florida Statutes, are
430	amended to read:
431	395.003  Licensure; denial, suspension, and revocation.-
432	(1)
433	(c)  Until July 1, 2006, additional emergency departments
434	located off the premises of licensed hospitals may not be
435	authorized by the agency.
436	(2)
437	(b)  The agency shall, at the request of a licensee that is
438	a teaching hospital as defined in s. 408.07(45), issue a single
439	license to a licensee for facilities that have been previously
440	licensed as separate premises, provided such separately licensed
441	facilities, taken together, constitute the same premises as
442	defined in s. 395.002(22)(23). Such license for the single
443	premises shall include all of the beds, services, and programs
444	that were previously included on the licenses for the separate
445	premises. The granting of a single license under this paragraph
446	shall not in any manner reduce the number of beds, services, or
447	programs operated by the licensee.
448	Section 10.  Paragraph (e) of subsection (2) and subsection
449	(4) of section 395.0193, Florida Statutes, are amended to read:
450	395.0193  Licensed facilities; peer review; disciplinary
451	powers; agency or partnership with physicians.-
452	(2)  Each licensed facility, as a condition of licensure,
453	shall provide for peer review of physicians who deliver health
454	care services at the facility. Each licensed facility shall
455	develop written, binding procedures by which such peer review
456	shall be conducted. Such procedures shall include:
457	(e)  Recording of agendas and minutes which do not contain
458	confidential material, for review by the Division of Medical
459	Quality Assurance of the department Health Quality Assurance of
460	the agency.
461	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
462	actions taken under subsection (3) shall be reported in writing
463	to the Division of Medical Quality Assurance of the department
464	Health Quality Assurance of the agency within 30 working days
465	after its initial occurrence, regardless of the pendency of
466	appeals to the governing board of the hospital. The notification
467	shall identify the disciplined practitioner, the action taken,
468	and the reason for such action. All final disciplinary actions
469	taken under subsection (3), if different from those which were
470	reported to the department agency within 30 days after the
471	initial occurrence, shall be reported within 10 working days to
472	the Division of Medical Quality Assurance of the department
473	Health Quality Assurance of the agency in writing and shall
474	specify the disciplinary action taken and the specific grounds
475	therefor. The division shall review each report and determine
476	whether it potentially involved conduct by the licensee that is
477	subject to disciplinary action, in which case s. 456.073 shall
478	apply. The reports are not subject to inspection under s.
479	119.07(1) even if the division's investigation results in a
480	finding of probable cause.
481	Section 11.  Section 395.1023, Florida Statutes, is amended
482	to read:
483	395.1023  Child abuse and neglect cases; duties.-Each
484	licensed facility shall adopt a protocol that, at a minimum,
485	requires the facility to:
486	(1)  Incorporate a facility policy that every staff member
487	has an affirmative duty to report, pursuant to chapter 39, any
488	actual or suspected case of child abuse, abandonment, or
489	neglect; and
490	(2)  In any case involving suspected child abuse,
491	abandonment, or neglect, designate, at the request of the
492	Department of Children and Family Services, a staff physician to
493	act as a liaison between the hospital and the Department of
494	Children and Family Services office which is investigating the
495	suspected abuse, abandonment, or neglect, and the child
496	protection team, as defined in s. 39.01, when the case is
497	referred to such a team.
498
499	Each general hospital and appropriate specialty hospital shall
500	comply with the provisions of this section and shall notify the
501	agency and the Department of Children and Family Services of its
502	compliance by sending a copy of its policy to the agency and the
503	Department of Children and Family Services as required by rule.
504	The failure by a general hospital or appropriate specialty
505	hospital to comply shall be punished by a fine not exceeding
506	$1,000, to be fixed, imposed, and collected by the agency. Each
507	day in violation is considered a separate offense.
508	Section 12.  Subsection (2) and paragraph (d) of subsection
509	(3) of section 395.1041, Florida Statutes, are amended to read:
510	395.1041  Access to emergency services and care.-
511	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
512	shall establish and maintain an inventory of hospitals with
513	emergency services. The inventory shall list all services within
514	the service capability of the hospital, and such services shall
515	appear on the face of the hospital license. Each hospital having
516	emergency services shall notify the agency of its service
517	capability in the manner and form prescribed by the agency. The
518	agency shall use the inventory to assist emergency medical
519	services providers and others in locating appropriate emergency
520	medical care. The inventory shall also be made available to the
521	general public. On or before August 1, 1992, the agency shall
522	request that each hospital identify the services which are
523	within its service capability. On or before November 1, 1992,
524	the agency shall notify each hospital of the service capability
525	to be included in the inventory. The hospital has 15 days from
526	the date of receipt to respond to the notice. By December 1,
527	1992, the agency shall publish a final inventory. Each hospital
528	shall reaffirm its service capability when its license is
529	renewed and shall notify the agency of the addition of a new
530	service or the termination of a service prior to a change in its
531	service capability.
532	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
533	FACILITY OR HEALTH CARE PERSONNEL.-
534	(d)1.  Every hospital shall ensure the provision of
535	services within the service capability of the hospital, at all
536	times, either directly or indirectly through an arrangement with
537	another hospital, through an arrangement with one or more
538	physicians, or as otherwise made through prior arrangements. A
539	hospital may enter into an agreement with another hospital for
540	purposes of meeting its service capability requirement, and
541	appropriate compensation or other reasonable conditions may be
542	negotiated for these backup services.
543	2.  If any arrangement requires the provision of emergency
544	medical transportation, such arrangement must be made in
545	consultation with the applicable provider and may not require
546	the emergency medical service provider to provide transportation
547	that is outside the routine service area of that provider or in
548	a manner that impairs the ability of the emergency medical
549	service provider to timely respond to prehospital emergency
550	calls.
551	3.  A hospital shall not be required to ensure service
552	capability at all times as required in subparagraph 1. if, prior
553	to the receiving of any patient needing such service capability,
554	such hospital has demonstrated to the agency that it lacks the
555	ability to ensure such capability and it has exhausted all
556	reasonable efforts to ensure such capability through backup
557	arrangements. In reviewing a hospital's demonstration of lack of
558	ability to ensure service capability, the agency shall consider
559	factors relevant to the particular case, including the
560	following:
561	a.  Number and proximity of hospitals with the same service
562	capability.
563	b.  Number, type, credentials, and privileges of
564	specialists.
565	c.  Frequency of procedures.
566	d.  Size of hospital.
567	4.  The agency shall publish proposed rules implementing a
568	reasonable exemption procedure by November 1, 1992. Subparagraph
569	1. shall become effective upon the effective date of said rules
570	or January 31, 1993, whichever is earlier. For a period not to
571	exceed 1 year from the effective date of subparagraph 1., a
572	hospital requesting an exemption shall be deemed to be exempt
573	from offering the service until the agency initially acts to
574	deny or grant the original request. The agency has 45 days from
575	the date of receipt of the request to approve or deny the
576	request. After the first year from the effective date of
577	subparagraph 1., If the agency fails to initially act within the
578	time period, the hospital is deemed to be exempt from offering
579	the service until the agency initially acts to deny the request.
580	Section 13.  Section 395.1046, Florida Statutes, is
581	repealed.
582	Section 14.  Paragraph (e) of subsection (1) of section
583	395.1055, Florida Statutes, is amended to read:
584	395.1055  Rules and enforcement.-
585	(1)  The agency shall adopt rules pursuant to ss.
586	120.536(1) and 120.54 to implement the provisions of this part,
587	which shall include reasonable and fair minimum standards for
588	ensuring that:
589	(e)  Licensed facility beds conform to minimum space,
590	equipment, and furnishings standards as specified by the agency,
591	the Florida Building Code, and the Florida Fire Prevention Code
592	department.
593	Section 15.  Subsection (1) of section 395.10972, Florida
594	Statutes, is amended to read:
595	395.10972  Health Care Risk Manager Advisory Council.-The
596	Secretary of Health Care Administration may appoint a seven-
597	member advisory council to advise the agency on matters
598	pertaining to health care risk managers. The members of the
599	council shall serve at the pleasure of the secretary. The
600	council shall designate a chair. The council shall meet at the
601	call of the secretary or at those times as may be required by
602	rule of the agency. The members of the advisory council shall
603	receive no compensation for their services, but shall be
604	reimbursed for travel expenses as provided in s. 112.061. The
605	council shall consist of individuals representing the following
606	areas:
607	(1)  Two shall be active health care risk managers,
608	including one risk manager who is recommended by and a member of
609	the Florida Society for of Healthcare Risk Management and
610	Patient Safety.
611	Section 16.  Subsection (3) of section 395.2050, Florida
612	Statutes, is amended to read:
613	395.2050  Routine inquiry for organ and tissue donation;
614	certification for procurement activities; death records review.-
615	(3)  Each organ procurement organization designated by the
616	federal Centers for Medicare and Medicaid Services Health Care
617	Financing Administration and licensed by the state shall conduct
618	an annual death records review in the organ procurement
619	organization's affiliated donor hospitals. The organ procurement
620	organization shall enlist the services of every Florida licensed
621	tissue bank and eye bank affiliated with or providing service to
622	the donor hospital and operating in the same service area to
623	participate in the death records review.
624	Section 17.  Subsection (2) of section 395.3036, Florida
625	Statutes, is amended to read:
626	395.3036  Confidentiality of records and meetings of
627	corporations that lease public hospitals or other public health
628	care facilities.-The records of a private corporation that
629	leases a public hospital or other public health care facility
630	are confidential and exempt from the provisions of s. 119.07(1)
631	and s. 24(a), Art. I of the State Constitution, and the meetings
632	of the governing board of a private corporation are exempt from
633	s. 286.011 and s. 24(b), Art. I of the State Constitution when
634	the public lessor complies with the public finance
635	accountability provisions of s. 155.40(5) with respect to the
636	transfer of any public funds to the private lessee and when the
637	private lessee meets at least three of the five following
638	criteria:
639	(2)  The public lessor and the private lessee do not
640	commingle any of their funds in any account maintained by either
641	of them, other than the payment of the rent and administrative
642	fees or the transfer of funds pursuant to s. 155.40(2)
643	subsection (2).
644	Section 18.  Section 395.3037, Florida Statutes, is
645	repealed.
646	Section 19.  Subsections (1), (4), and (5) of section
647	395.3038, Florida Statutes, are amended to read:
648	395.3038  State-listed primary stroke centers and
649	comprehensive stroke centers; notification of hospitals.-
650	(1)  The agency shall make available on its website and to
651	the department a list of the name and address of each hospital
652	that meets the criteria for a primary stroke center and the name
653	and address of each hospital that meets the criteria for a
654	comprehensive stroke center. The list of primary and
655	comprehensive stroke centers shall include only those hospitals
656	that attest in an affidavit submitted to the agency that the
657	hospital meets the named criteria, or those hospitals that
658	attest in an affidavit submitted to the agency that the hospital
659	is certified as a primary or a comprehensive stroke center by
660	The Joint Commission on Accreditation of Healthcare
661	Organizations.
662	(4)  The agency shall adopt by rule criteria for a primary
663	stroke center which are substantially similar to the
664	certification standards for primary stroke centers of The Joint
665	Commission on Accreditation of Healthcare Organizations.
666	(5)  The agency shall adopt by rule criteria for a
667	comprehensive stroke center. However, if The Joint Commission on
668	Accreditation of Healthcare Organizations establishes criteria
669	for a comprehensive stroke center, the agency shall establish
670	criteria for a comprehensive stroke center which are
671	substantially similar to those criteria established by The Joint
672	Commission on Accreditation of Healthcare Organizations.
673	Section 20.  Paragraph (e) of subsection (2) of section
674	395.602, Florida Statutes, is amended to read:
675	395.602  Rural hospitals.-
676	(2)  DEFINITIONS.-As used in this part:
677	(e)  "Rural hospital" means an acute care hospital licensed
678	under this chapter, having 100 or fewer licensed beds and an
679	emergency room, which is:
680	1.  The sole provider within a county with a population
681	density of no greater than 100 persons per square mile;
682	2.  An acute care hospital, in a county with a population
683	density of no greater than 100 persons per square mile, which is
684	at least 30 minutes of travel time, on normally traveled roads
685	under normal traffic conditions, from any other acute care
686	hospital within the same county;
687	3.  A hospital supported by a tax district or subdistrict
688	whose boundaries encompass a population of 100 persons or fewer
689	per square mile;
690	4.  A hospital in a constitutional charter county with a
691	population of over 1 million persons that has imposed a local
692	option health service tax pursuant to law and in an area that
693	was directly impacted by a catastrophic event on August 24,
694	1992, for which the Governor of Florida declared a state of
695	emergency pursuant to chapter 125, and has 120 beds or less that
696	serves an agricultural community with an emergency room
697	utilization of no less than 20,000 visits and a Medicaid
698	inpatient utilization rate greater than 15 percent;
699	4.5.  A hospital with a service area that has a population
700	of 100 persons or fewer per square mile. As used in this
701	subparagraph, the term "service area" means the fewest number of
702	zip codes that account for 75 percent of the hospital's
703	discharges for the most recent 5-year period, based on
704	information available from the hospital inpatient discharge
705	database in the Florida Center for Health Information and Policy
706	Analysis at the Agency for Health Care Administration; or
707	5.6.  A hospital designated as a critical access hospital,
708	as defined in s. 408.07(15).
709
710	Population densities used in this paragraph must be based upon
711	the most recently completed United States census. A hospital
712	that received funds under s. 409.9116 for a quarter beginning no
713	later than July 1, 2002, is deemed to have been and shall
714	continue to be a rural hospital from that date through June 30,
715	2015, if the hospital continues to have 100 or fewer licensed
716	beds and an emergency room, or meets the criteria of
717	subparagraph 4. An acute care hospital that has not previously
718	been designated as a rural hospital and that meets the criteria
719	of this paragraph shall be granted such designation upon
720	application, including supporting documentation to the Agency
721	for Health Care Administration.
722	Section 21.  Subsection (8) of section 400.021, Florida
723	Statutes, is amended to read:
724	400.021  Definitions.-When used in this part, unless the
725	context otherwise requires, the term:
726	(8)  "Geriatric outpatient clinic" means a site for
727	providing outpatient health care to persons 60 years of age or
728	older, which is staffed by a registered nurse or a physician
729	assistant, or a licensed practical nurse under the direct
730	supervision of a registered nurse, advanced registered nurse
731	practitioner, or physician.
732	Section 22.  Paragraph (g) of subsection (2) of section
733	400.0239, Florida Statutes, is amended to read:
734	400.0239  Quality of Long-Term Care Facility Improvement
735	Trust Fund.-
736	(2)  Expenditures from the trust fund shall be allowable
737	for direct support of the following:
738	(g)  Other initiatives authorized by the Centers for
739	Medicare and Medicaid Services for the use of federal civil
740	monetary penalties, including projects recommended through the
741	Medicaid "Up-or-Out" Quality of Care Contract Management Program
742	pursuant to s. 400.148.
743	Section 23.  Subsection (2) of section 400.063, Florida
744	Statutes, is amended to read:
745	400.063  Resident protection.-
746	(2)  The agency is authorized to establish for each
747	facility, subject to intervention by the agency, a separate bank
748	account for the deposit to the credit of the agency of any
749	moneys received from the Health Care Trust Fund or any other
750	moneys received for the maintenance and care of residents in the
751	facility, and the agency is authorized to disburse moneys from
752	such account to pay obligations incurred for the purposes of
753	this section. The agency is authorized to requisition moneys
754	from the Health Care Trust Fund in advance of an actual need for
755	cash on the basis of an estimate by the agency of moneys to be
756	spent under the authority of this section. Any bank account
757	established under this section need not be approved in advance
758	of its creation as required by s. 17.58, but shall be secured by
759	depository insurance equal to or greater than the balance of
760	such account or by the pledge of collateral security in
761	conformance with criteria established in s. 18.11. The agency
762	shall notify the Chief Financial Officer of any such account so
763	established and shall make a quarterly accounting to the Chief
764	Financial Officer for all moneys deposited in such account.
765	Section 24.  Subsections (1) and (5) of section 400.071,
766	Florida Statutes, are amended to read:
767	400.071  Application for license.-
768	(1)  In addition to the requirements of part II of chapter
769	408, the application for a license shall be under oath and must
770	contain the following:
771	(a)  The location of the facility for which a license is
772	sought and an indication, as in the original application, that
773	such location conforms to the local zoning ordinances.
774	(b)  A signed affidavit disclosing any financial or
775	ownership interest that a controlling interest as defined in
776	part II of chapter 408 has held in the last 5 years in any
777	entity licensed by this state or any other state to provide
778	health or residential care which has closed voluntarily or
779	involuntarily; has filed for bankruptcy; has had a receiver
780	appointed; has had a license denied, suspended, or revoked; or
781	has had an injunction issued against it which was initiated by a
782	regulatory agency. The affidavit must disclose the reason any
783	such entity was closed, whether voluntarily or involuntarily.
784	(c)  The total number of beds and the total number of
785	Medicare and Medicaid certified beds.
786	(b)(d)  Information relating to the applicant and employees
787	which the agency requires by rule. The applicant must
788	demonstrate that sufficient numbers of qualified staff, by
789	training or experience, will be employed to properly care for
790	the type and number of residents who will reside in the
791	facility.
792	(c)(e)  Copies of any civil verdict or judgment involving
793	the applicant rendered within the 10 years preceding the
794	application, relating to medical negligence, violation of
795	residents' rights, or wrongful death. As a condition of
796	licensure, the licensee agrees to provide to the agency copies
797	of any new verdict or judgment involving the applicant, relating
798	to such matters, within 30 days after filing with the clerk of
799	the court. The information required in this paragraph shall be
800	maintained in the facility's licensure file and in an agency
801	database which is available as a public record.
802	(5)  As a condition of licensure, each facility must
803	establish and submit with its application a plan for quality
804	assurance and for conducting risk management.
805	Section 25.  Section 400.0712, Florida Statutes, is amended
806	to read:
807	400.0712  Application for inactive license.-
808	(1)  As specified in this section, the agency may issue an
809	inactive license to a nursing home facility for all or a portion
810	of its beds. Any request by a licensee that a nursing home or
811	portion of a nursing home become inactive must be submitted to
812	the agency in the approved format. The facility may not initiate
813	any suspension of services, notify residents, or initiate
814	inactivity before receiving approval from the agency; and a
815	licensee that violates this provision may not be issued an
816	inactive license.
817	(1)(2)  In addition to the powers granted under part II of
818	chapter 408, the agency may issue an inactive license to a
819	nursing home that chooses to use an unoccupied contiguous
820	portion of the facility for an alternative use to meet the needs
821	of elderly persons through the use of less restrictive, less
822	institutional services.
823	(a)  An inactive license issued under this subsection may
824	be granted for a period not to exceed the current licensure
825	expiration date but may be renewed by the agency at the time of
826	licensure renewal.
827	(b)  A request to extend the inactive license must be
828	submitted to the agency in the approved format and approved by
829	the agency in writing.
830	(c)  Nursing homes that receive an inactive license to
831	provide alternative services shall not receive preference for
832	participation in the Assisted Living for the Elderly Medicaid
833	waiver.
834	(2)(3)  The agency shall adopt rules pursuant to ss.
835	120.536(1) and 120.54 necessary to implement this section.
836	Section 26.  Section 400.111, Florida Statutes, is amended
837	to read:
838	400.111  Disclosure of controlling interest.-In addition to
839	the requirements of part II of chapter 408, when requested by
840	the agency, the licensee shall submit a signed affidavit
841	disclosing any financial or ownership interest that a
842	controlling interest has held within the last 5 years in any
843	entity licensed by the state or any other state to provide
844	health or residential care which entity has closed voluntarily
845	or involuntarily; has filed for bankruptcy; has had a receiver
846	appointed; has had a license denied, suspended, or revoked; or
847	has had an injunction issued against it which was initiated by a
848	regulatory agency. The affidavit must disclose the reason such
849	entity was closed, whether voluntarily or involuntarily.
850	Section 27.  Subsection (2) of section 400.1183, Florida
851	Statutes, is amended to read:
852	400.1183  Resident grievance procedures.-
853	(2)  Each facility shall maintain records of all grievances
854	for agency inspection and shall report to the agency at the time
855	of relicensure the total number of grievances handled during the
856	prior licensure period, a categorization of the cases underlying
857	the grievances, and the final disposition of the grievances.
858	Section 28.  Paragraphs (o) through (w) of subsection (1)
859	of section 400.141, Florida Statutes, are redesignated as
860	paragraphs (n) through (u), respectively, and present paragraphs
861	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
862	to read:
863	400.141  Administration and management of nursing home
864	facilities.-
865	(1)  Every licensed facility shall comply with all
866	applicable standards and rules of the agency and shall:
867	(f)  Be allowed and encouraged by the agency to provide
868	other needed services under certain conditions. If the facility
869	has a standard licensure status, and has had no class I or class
870	II deficiencies during the past 2 years or has been awarded a
871	Gold Seal under the program established in s. 400.235, it may be
872	encouraged by the agency to provide services, including, but not
873	limited to, respite and adult day services, which enable
874	individuals to move in and out of the facility. A facility is
875	not subject to any additional licensure requirements for
876	providing these services.
877	1.  Respite care may be offered to persons in need of
878	short-term or temporary nursing home services. For each person
879	admitted under the respite care program, the facility licensee
880	must:
881	a.  Have a written abbreviated plan of care that, at a
882	minimum, includes nutritional requirements, medication orders,
883	physician orders, nursing assessments, and dietary preferences.
884	The nursing or physician assessments may take the place of all
885	other assessments required for full-time residents.
886	b.  Have a contract that, at a minimum, specifies the
887	services to be provided to the respite resident, including
888	charges for services, activities, equipment, emergency medical
889	services, and the administration of medications. If multiple
890	respite admissions for a single person are anticipated, the
891	original contract is valid for 1 year after the date of
892	execution.
893	c.  Ensure that each resident is released to his or her
894	caregiver or an individual designated in writing by the
895	caregiver.
896	2.  A person admitted under the respite care program is:
897	a.  Exempt from requirements in rule related to discharge
898	planning.
899	b.  Covered by the resident's rights set forth in s.
900	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
901	shall not be considered trust funds subject to the requirements
902	of s. 400.022(1)(h) until the resident has been in the facility
903	for more than 14 consecutive days.
904	c.  Allowed to use his or her personal medications for the
905	respite stay if permitted by facility policy. The facility must
906	obtain a physician's orders for the medications. The caregiver
907	may provide information regarding the medications as part of the
908	nursing assessment, which must agree with the physician's
909	orders. Medications shall be released with the resident upon
910	discharge in accordance with current orders.
911	3.  A person receiving respite care is entitled to a total
912	of 60 days in the facility within a contract year or a calendar
913	year if the contract is for less than 12 months. However, each
914	single stay may not exceed 14 days. If a stay exceeds 14
915	consecutive days, the facility must comply with all assessment
916	and care planning requirements applicable to nursing home
917	residents.
918	4.  A person receiving respite care must reside in a
919	licensed nursing home bed.
920	5.  A prospective respite resident must provide medical
921	information from a physician, a physician assistant, or a nurse
922	practitioner and other information from the primary caregiver as
923	may be required by the facility prior to or at the time of
924	admission to receive respite care. The medical information must
925	include a physician's order for respite care and proof of a
926	physical examination by a licensed physician, physician
927	assistant, or nurse practitioner. The physician's order and
928	physical examination may be used to provide intermittent respite
929	care for up to 12 months after the date the order is written.
930	6.  The facility must assume the duties of the primary
931	caregiver. To ensure continuity of care and services, the
932	resident is entitled to retain his or her personal physician and
933	must have access to medically necessary services such as
934	physical therapy, occupational therapy, or speech therapy, as
935	needed. The facility must arrange for transportation to these
936	services if necessary. Respite care must be provided in
937	accordance with this part and rules adopted by the agency.
938	However, the agency shall, by rule, adopt modified requirements
939	for resident assessment, resident care plans, resident
940	contracts, physician orders, and other provisions, as
941	appropriate, for short-term or temporary nursing home services.
942	7.  The agency shall allow for shared programming and staff
943	in a facility which meets minimum standards and offers services
944	pursuant to this paragraph, but, if the facility is cited for
945	deficiencies in patient care, may require additional staff and
946	programs appropriate to the needs of service recipients. A
947	person who receives respite care may not be counted as a
948	resident of the facility for purposes of the facility's licensed
949	capacity unless that person receives 24-hour respite care. A
950	person receiving either respite care for 24 hours or longer or
951	adult day services must be included when calculating minimum
952	staffing for the facility. Any costs and revenues generated by a
953	nursing home facility from nonresidential programs or services
954	shall be excluded from the calculations of Medicaid per diems
955	for nursing home institutional care reimbursement.
956	(g)  If the facility has a standard license or is a Gold
957	Seal facility, exceeds the minimum required hours of licensed
958	nursing and certified nursing assistant direct care per resident
959	per day, and is part of a continuing care facility licensed
960	under chapter 651 or a retirement community that offers other
961	services pursuant to part III of this chapter or part I or part
962	III of chapter 429 on a single campus, be allowed to share
963	programming and staff. At the time of inspection and in the
964	semiannual report required pursuant to paragraph (n) (o), a
965	continuing care facility or retirement community that uses this
966	option must demonstrate through staffing records that minimum
967	staffing requirements for the facility were met. Licensed nurses
968	and certified nursing assistants who work in the nursing home
969	facility may be used to provide services elsewhere on campus if
970	the facility exceeds the minimum number of direct care hours
971	required per resident per day and the total number of residents
972	receiving direct care services from a licensed nurse or a
973	certified nursing assistant does not cause the facility to
974	violate the staffing ratios required under s. 400.23(3)(a).
975	Compliance with the minimum staffing ratios shall be based on
976	total number of residents receiving direct care services,
977	regardless of where they reside on campus. If the facility
978	receives a conditional license, it may not share staff until the
979	conditional license status ends. This paragraph does not
980	restrict the agency's authority under federal or state law to
981	require additional staff if a facility is cited for deficiencies
982	in care which are caused by an insufficient number of certified
983	nursing assistants or licensed nurses. The agency may adopt
984	rules for the documentation necessary to determine compliance
985	with this provision.
986	(j)  Keep full records of resident admissions and
987	discharges; medical and general health status, including medical
988	records, personal and social history, and identity and address
989	of next of kin or other persons who may have responsibility for
990	the affairs of the residents; and individual resident care plans
991	including, but not limited to, prescribed services, service
992	frequency and duration, and service goals. The records shall be
993	open to inspection by the agency. The facility must maintain
994	clinical records on each resident in accordance with accepted
995	professional standards and practices that are complete,
996	accurately documented, readily accessible, and systematically
997	organized.
998	(n)  Submit to the agency the information specified in s.
999	400.071(1)(b) for a management company within 30 days after the
1000	effective date of the management agreement.
1001	(n)(o)1.  Submit semiannually to the agency, or more
1002	frequently if requested by the agency, information regarding
1003	facility staff-to-resident ratios, staff turnover, and staff
1004	stability, including information regarding certified nursing
1005	assistants, licensed nurses, the director of nursing, and the
1006	facility administrator. For purposes of this reporting:
1007	a.  Staff-to-resident ratios must be reported in the
1008	categories specified in s. 400.23(3)(a) and applicable rules.
1009	The ratio must be reported as an average for the most recent
1010	calendar quarter.
1011	b.  Staff turnover must be reported for the most recent 12-
1012	month period ending on the last workday of the most recent
1013	calendar quarter prior to the date the information is submitted.
1014	The turnover rate must be computed quarterly, with the annual
1015	rate being the cumulative sum of the quarterly rates. The
1016	turnover rate is the total number of terminations or separations
1017	experienced during the quarter, excluding any employee
1018	terminated during a probationary period of 3 months or less,
1019	divided by the total number of staff employed at the end of the
1020	period for which the rate is computed, and expressed as a
1021	percentage.
1022	c.  The formula for determining staff stability is the
1023	total number of employees that have been employed for more than
1024	12 months, divided by the total number of employees employed at
1025	the end of the most recent calendar quarter, and expressed as a
1026	percentage.
1027	d.  A nursing facility that has failed to comply with state
1028	minimum-staffing requirements for 2 consecutive days is
1029	prohibited from accepting new admissions until the facility has
1030	achieved the minimum-staffing requirements for a period of 6
1031	consecutive days. For the purposes of this sub-subparagraph, any
1032	person who was a resident of the facility and was absent from
1033	the facility for the purpose of receiving medical care at a
1034	separate location or was on a leave of absence is not considered
1035	a new admission. Failure to impose such an admissions moratorium
1036	is subject to a $1,000 fine constitutes a class II deficiency.
1037	e.  A nursing facility which does not have a conditional
1038	license may be cited for failure to comply with the standards in
1039	s. 400.23(3)(a)1.a. only if it has failed to meet those
1040	standards on 2 consecutive days or if it has failed to meet at
1041	least 97 percent of those standards on any one day.
1042	f.  A facility which has a conditional license must be in
1043	compliance with the standards in s. 400.23(3)(a) at all times.
1044	2.  This paragraph does not limit the agency's ability to
1045	impose a deficiency or take other actions if a facility does not
1046	have enough staff to meet the residents' needs.
1047	(r)  Report to the agency any filing for bankruptcy
1048	protection by the facility or its parent corporation,
1049	divestiture or spin-off of its assets, or corporate
1050	reorganization within 30 days after the completion of such
1051	activity.
1052	Section 29.  Subsection (3) of section 400.142, Florida
1053	Statutes, is amended to read:
1054	400.142  Emergency medication kits; orders not to
1055	resuscitate.-
1056	(3)  Facility staff may withhold or withdraw
1057	cardiopulmonary resuscitation if presented with an order not to
1058	resuscitate executed pursuant to s. 401.45. The agency shall
1059	adopt rules providing for the implementation of such orders.
1060	Facility staff and facilities shall not be subject to criminal
1061	prosecution or civil liability, nor be considered to have
1062	engaged in negligent or unprofessional conduct, for withholding
1063	or withdrawing cardiopulmonary resuscitation pursuant to such an
1064	order and rules adopted by the agency. The absence of an order
1065	not to resuscitate executed pursuant to s. 401.45 does not
1066	preclude a physician from withholding or withdrawing
1067	cardiopulmonary resuscitation as otherwise permitted by law.
1068	Section 30.  Subsections (11) through (15) of section
1069	400.147, Florida Statutes, are renumbered as subsections (10)
1070	through (14), respectively, and present subsection (10) is
1071	amended to read:
1072	400.147  Internal risk management and quality assurance
1073	program.-
1074	(10)  By the 10th of each month, each facility subject to
1075	this section shall report any notice received pursuant to s.
1076	400.0233(2) and each initial complaint that was filed with the
1077	clerk of the court and served on the facility during the
1078	previous month by a resident or a resident's family member,
1079	guardian, conservator, or personal legal representative. The
1080	report must include the name of the resident, the resident's
1081	date of birth and social security number, the Medicaid
1082	identification number for Medicaid-eligible persons, the date or
1083	dates of the incident leading to the claim or dates of
1084	residency, if applicable, and the type of injury or violation of
1085	rights alleged to have occurred. Each facility shall also submit
1086	a copy of the notices received pursuant to s. 400.0233(2) and
1087	complaints filed with the clerk of the court. This report is
1088	confidential as provided by law and is not discoverable or
1089	admissible in any civil or administrative action, except in such
1090	actions brought by the agency to enforce the provisions of this
1091	part.
1092	Section 31.  Section 400.148, Florida Statutes, is
1093	repealed.
1094	Section 32.  Paragraph (f) of subsection (5) of section
1095	400.162, Florida Statutes, is amended to read:
1096	400.162  Property and personal affairs of residents.-
1097	(5)
1098	(f)  At least every 3 months, the licensee shall furnish
1099	the resident and the guardian, trustee, or conservator, if any,
1100	for the resident a complete and verified statement of all funds
1101	and other property to which this subsection applies, detailing
1102	the amounts and items received, together with their sources and
1103	disposition. For resident property, the licensee shall furnish
1104	such a statement annually and within 7 calendar days after a
1105	request for a statement. In any event, the licensee shall
1106	furnish such statements a statement annually and upon the
1107	discharge or transfer of a resident. Any governmental agency or
1108	private charitable agency contributing funds or other property
1109	on account of a resident also shall be entitled to receive such
1110	statements statement annually and upon discharge or transfer and
1111	such other report as it may require pursuant to law.
1112	Section 33.  Paragraphs (d) and (e) of subsection (2) of
1113	section 400.179, Florida Statutes, are amended to read:
1114	400.179  Liability for Medicaid underpayments and
1115	overpayments.-
1116	(2)  Because any transfer of a nursing facility may expose
1117	the fact that Medicaid may have underpaid or overpaid the
1118	transferor, and because in most instances, any such underpayment
1119	or overpayment can only be determined following a formal field
1120	audit, the liabilities for any such underpayments or
1121	overpayments shall be as follows:
1122	(d)  Where the transfer involves a facility that has been
1123	leased by the transferor:
1124	1.  The transferee shall, as a condition to being issued a
1125	license by the agency, acquire, maintain, and provide proof to
1126	the agency of a bond with a term of 30 months, renewable
1127	annually, in an amount not less than the total of 3 months'
1128	Medicaid payments to the facility computed on the basis of the
1129	preceding 12-month average Medicaid payments to the facility.
1130	2.  A leasehold licensee may meet the requirements of
1131	subparagraph 1. by payment of a nonrefundable fee, paid at
1132	initial licensure, paid at the time of any subsequent change of
1133	ownership, and paid annually thereafter, in the amount of 1
1134	percent of the total of 3 months' Medicaid payments to the
1135	facility computed on the basis of the preceding 12-month average
1136	Medicaid payments to the facility. If a preceding 12-month
1137	average is not available, projected Medicaid payments may be
1138	used. The fee shall be deposited into the Grants and Donations
1139	Trust Fund and shall be accounted for separately as a Medicaid
1140	nursing home overpayment account. These fees shall be used at
1141	the sole discretion of the agency to repay nursing home Medicaid
1142	overpayments. Payment of this fee shall not release the licensee
1143	from any liability for any Medicaid overpayments, nor shall
1144	payment bar the agency from seeking to recoup overpayments from
1145	the licensee and any other liable party. As a condition of
1146	exercising this lease bond alternative, licensees paying this
1147	fee must maintain an existing lease bond through the end of the
1148	30-month term period of that bond. The agency is herein granted
1149	specific authority to promulgate all rules pertaining to the
1150	administration and management of this account, including
1151	withdrawals from the account, subject to federal review and
1152	approval. This provision shall take effect upon becoming law and
1153	shall apply to any leasehold license application. The financial
1154	viability of the Medicaid nursing home overpayment account shall
1155	be determined by the agency through annual review of the account
1156	balance and the amount of total outstanding, unpaid Medicaid
1157	overpayments owing from leasehold licensees to the agency as
1158	determined by final agency audits. By March 31 of each year, the
1159	agency shall assess the cumulative fees collected under this
1160	subparagraph, minus any amounts used to repay nursing home
1161	Medicaid overpayments and amounts transferred to contribute to
1162	the General Revenue Fund pursuant to s. 215.20. If the net
1163	cumulative collections, minus amounts utilized to repay nursing
1164	home Medicaid overpayments, exceed $25 million, the provisions
1165	of this paragraph shall not apply for the subsequent fiscal
1166	year.
1167	3.  The leasehold licensee may meet the bond requirement
1168	through other arrangements acceptable to the agency. The agency
1169	is herein granted specific authority to promulgate rules
1170	pertaining to lease bond arrangements.
1171	4.  All existing nursing facility licensees, operating the
1172	facility as a leasehold, shall acquire, maintain, and provide
1173	proof to the agency of the 30-month bond required in
1174	subparagraph 1., above, on and after July 1, 1993, for each
1175	license renewal.
1176	5.  It shall be the responsibility of all nursing facility
1177	operators, operating the facility as a leasehold, to renew the
1178	30-month bond and to provide proof of such renewal to the agency
1179	annually.
1180	6.  Any failure of the nursing facility operator to
1181	acquire, maintain, renew annually, or provide proof to the
1182	agency shall be grounds for the agency to deny, revoke, and
1183	suspend the facility license to operate such facility and to
1184	take any further action, including, but not limited to,
1185	enjoining the facility, asserting a moratorium pursuant to part
1186	II of chapter 408, or applying for a receiver, deemed necessary
1187	to ensure compliance with this section and to safeguard and
1188	protect the health, safety, and welfare of the facility's
1189	residents. A lease agreement required as a condition of bond
1190	financing or refinancing under s. 154.213 by a health facilities
1191	authority or required under s. 159.30 by a county or
1192	municipality is not a leasehold for purposes of this paragraph
1193	and is not subject to the bond requirement of this paragraph.
1194	(e)  For the 2009-2010 fiscal year only, the provisions of
1195	paragraph (d) shall not apply. This paragraph expires July 1,
1196	2010.
1197	Section 34.  Subsection (3) of section 400.19, Florida
1198	Statutes, is amended to read:
1199	400.19  Right of entry and inspection.-
1200	(3)  The agency shall every 15 months conduct at least one
1201	unannounced inspection to determine compliance by the licensee
1202	with statutes, and with rules promulgated under the provisions
1203	of those statutes, governing minimum standards of construction,
1204	quality and adequacy of care, and rights of residents. The
1205	survey shall be conducted every 6 months for the next 2-year
1206	period if the facility has been cited for a class I deficiency,
1207	has been cited for two or more class II deficiencies arising
1208	from separate surveys or investigations within a 60-day period,
1209	or has had three or more substantiated complaints within a 6-
1210	month period, each resulting in at least one class I or class II
1211	deficiency. In addition to any other fees or fines in this part,
1212	the agency shall assess a fine for each facility that is subject
1213	to the 6-month survey cycle. The fine for the 2-year period
1214	shall be $6,000, one-half to be paid at the completion of each
1215	survey. The agency may adjust this fine by the change in the
1216	Consumer Price Index, based on the 12 months immediately
1217	preceding the increase, to cover the cost of the additional
1218	surveys. The agency shall verify through subsequent inspection
1219	that any deficiency identified during inspection is corrected.
1220	However, the agency may verify the correction of a class III or
1221	class IV deficiency unrelated to resident rights or resident
1222	care without reinspecting the facility if adequate written
1223	documentation has been received from the facility, which
1224	provides assurance that the deficiency has been corrected. The
1225	giving or causing to be given of advance notice of such
1226	unannounced inspections by an employee of the agency to any
1227	unauthorized person shall constitute cause for suspension of not
1228	fewer than 5 working days according to the provisions of chapter
1229	110.
1230	Section 35.  Section 400.195, Florida Statutes, is
1231	repealed.
1232	Section 36.  Subsection (5) of section 400.23, Florida
1233	Statutes, is amended to read:
1234	400.23  Rules; evaluation and deficiencies; licensure
1235	status.-
1236	(5)  The agency, in collaboration with the Division of
1237	Children's Medical Services Network of the Department of Health,
1238	must, no later than December 31, 1993, adopt rules for minimum
1239	standards of care for persons under 21 years of age who reside
1240	in nursing home facilities. The rules must include a methodology
1241	for reviewing a nursing home facility under ss. 408.031-408.045
1242	which serves only persons under 21 years of age. A facility may
1243	be exempt from these standards for specific persons between 18
1244	and 21 years of age, if the person's physician agrees that
1245	minimum standards of care based on age are not necessary.
1246	Section 37.  Subsection (1) of section 400.275, Florida
1247	Statutes, is amended to read:
1248	400.275  Agency duties.-
1249	(1)  The agency shall ensure that each newly hired nursing
1250	home surveyor, as a part of basic training, is assigned full-
1251	time to a licensed nursing home for at least 2 days within a 7-
1252	day period to observe facility operations outside of the survey
1253	process before the surveyor begins survey responsibilities. Such
1254	observations may not be the sole basis of a deficiency citation
1255	against the facility. The agency may not assign an individual to
1256	be a member of a survey team for purposes of a survey,
1257	evaluation, or consultation visit at a nursing home facility in
1258	which the surveyor was an employee within the preceding 2 5
1259	years.
1260	Section 38.  Subsection (2) of section 400.484, Florida
1261	Statutes, is amended to read:
1262	400.484  Right of inspection; violations deficiencies;
1263	fines.-
1264	(2)  The agency shall impose fines for various classes of
1265	violations deficiencies in accordance with the following
1266	schedule:
1267	(a)  Class I violations are defined in s. 408.813. A class
1268	I deficiency is any act, omission, or practice that results in a
1269	patient's death, disablement, or permanent injury, or places a
1270	patient at imminent risk of death, disablement, or permanent
1271	injury. Upon finding a class I violation deficiency, the agency
1272	shall impose an administrative fine in the amount of $15,000 for
1273	each occurrence and each day that the violation deficiency
1274	exists.
1275	(b)  Class II violations are defined in s. 408.813. A class
1276	II deficiency is any act, omission, or practice that has a
1277	direct adverse effect on the health, safety, or security of a
1278	patient. Upon finding a class II violation deficiency, the
1279	agency shall impose an administrative fine in the amount of
1280	$5,000 for each occurrence and each day that the violation
1281	deficiency exists.
1282	(c)  Class III violations are defined in s. 408.813. A
1283	class III deficiency is any act, omission, or practice that has
1284	an indirect, adverse effect on the health, safety, or security
1285	of a patient. Upon finding an uncorrected or repeated class III
1286	violation deficiency, the agency shall impose an administrative
1287	fine not to exceed $1,000 for each occurrence and each day that
1288	the uncorrected or repeated violation deficiency exists.
1289	(d)  Class IV violations are defined in s. 408.813. A class
1290	IV deficiency is any act, omission, or practice related to
1291	required reports, forms, or documents which does not have the
1292	potential of negatively affecting patients. These violations are
1293	of a type that the agency determines do not threaten the health,
1294	safety, or security of patients. Upon finding an uncorrected or
1295	repeated class IV violation deficiency, the agency shall impose
1296	an administrative fine not to exceed $500 for each occurrence
1297	and each day that the uncorrected or repeated violation
1298	deficiency exists.
1299	Section 39.  Paragraph (i) of subsection (1) and subsection
1300	(4) of section 400.606, Florida Statutes, are amended to read:
1301	400.606  License; application; renewal; conditional license
1302	or permit; certificate of need.-
1303	(1)  In addition to the requirements of part II of chapter
1304	408, the initial application and change of ownership application
1305	must be accompanied by a plan for the delivery of home,
1306	residential, and homelike inpatient hospice services to
1307	terminally ill persons and their families. Such plan must
1308	contain, but need not be limited to:
1309	(i)  The projected annual operating cost of the hospice.
1310
1311	If the applicant is an existing licensed health care provider,
1312	the application must be accompanied by a copy of the most recent
1313	profit-loss statement and, if applicable, the most recent
1314	licensure inspection report.
1315	(4)  A freestanding hospice facility that is primarily
1316	engaged in providing inpatient and related services and that is
1317	not otherwise licensed as a health care facility shall be
1318	required to obtain a certificate of need. However, a
1319	freestanding hospice facility with six or fewer beds shall not
1320	be required to comply with institutional standards such as, but
1321	not limited to, standards requiring sprinkler systems, emergency
1322	electrical systems, or special lavatory devices.
1323	Section 40.  Subsection (2) of section 400.607, Florida
1324	Statutes, is amended to read:
1325	400.607  Denial, suspension, revocation of license;
1326	emergency actions; imposition of administrative fine; grounds.-
1327	(2)  A violation of this part, part II of chapter 408, or
1328	applicable rules Any of the following actions by a licensed
1329	hospice or any of its employees shall be grounds for
1330	administrative action by the agency against a hospice.:
1331	(a)  A violation of the provisions of this part, part II of
1332	chapter 408, or applicable rules.
1333	(b)  An intentional or negligent act materially affecting
1334	the health or safety of a patient.
1335	Section 41.  Subsection (1) of section 400.925, Florida
1336	Statutes, is amended to read:
1337	400.925  Definitions.-As used in this part, the term:
1338	(1)  "Accrediting organizations" means The Joint Commission
1339	on Accreditation of Healthcare Organizations or other national
1340	accreditation agencies whose standards for accreditation are
1341	comparable to those required by this part for licensure.
1342	Section 42.  Subsections (3) through (6) of section
1343	400.931, Florida Statutes, are renumbered as subsections (2)
1344	through (5), respectively, and present subsection (2) of that
1345	section is amended to read:
1346	400.931  Application for license; fee; provisional license;
1347	temporary permit.-
1348	(2)  As an alternative to submitting proof of financial
1349	ability to operate as required in s. 408.810(8), the applicant
1350	may submit a $50,000 surety bond to the agency.
1351	Section 43.  Subsection (2) of section 400.932, Florida
1352	Statutes, is amended to read:
1353	400.932  Administrative penalties.-
1354	(2)  A violation of this part, part II of chapter 408, or
1355	applicable rules Any of the following actions by an employee of
1356	a home medical equipment provider shall be are grounds for
1357	administrative action or penalties by the agency.:
1358	(a)  Violation of this part, part II of chapter 408, or
1359	applicable rules.
1360	(b)  An intentional, reckless, or negligent act that
1361	materially affects the health or safety of a patient.
1362	Section 44.  Subsection (3) of section 400.967, Florida
1363	Statutes, is amended to read:
1364	400.967  Rules and classification of violations
1365	deficiencies.-
1366	(3)  The agency shall adopt rules to provide that, when the
1367	criteria established under this part and part II of chapter 408
1368	are not met, such violations deficiencies shall be classified
1369	according to the nature of the violation deficiency. The agency
1370	shall indicate the classification on the face of the notice of
1371	deficiencies as follows:
1372	(a)  Class I violations deficiencies are defined in s.
1373	408.813 those which the agency determines present an imminent
1374	danger to the residents or guests of the facility or a
1375	substantial probability that death or serious physical harm
1376	would result therefrom. The condition or practice constituting a
1377	class I violation must be abated or eliminated immediately,
1378	unless a fixed period of time, as determined by the agency, is
1379	required for correction. A class I violation deficiency is
1380	subject to a civil penalty in an amount not less than $5,000 and
1381	not exceeding $10,000 for each violation deficiency. A fine may
1382	be levied notwithstanding the correction of the violation
1383	deficiency.
1384	(b)  Class II violations deficiencies are defined in s.
1385	408.813 those which the agency determines have a direct or
1386	immediate relationship to the health, safety, or security of the
1387	facility residents, other than class I deficiencies. A class II
1388	violation deficiency is subject to a civil penalty in an amount
1389	not less than $1,000 and not exceeding $5,000 for each violation
1390	deficiency. A citation for a class II violation deficiency shall
1391	specify the time within which the violation deficiency must be
1392	corrected. If a class II violation deficiency is corrected
1393	within the time specified, no civil penalty shall be imposed,
1394	unless it is a repeated offense.
1395	(c)  Class III violations deficiencies are defined in s.
1396	408.813 those which the agency determines to have an indirect or
1397	potential relationship to the health, safety, or security of the
1398	facility residents, other than class I or class II deficiencies.
1399	A class III violation deficiency is subject to a civil penalty
1400	of not less than $500 and not exceeding $1,000 for each
1401	deficiency. A citation for a class III violation deficiency
1402	shall specify the time within which the violation deficiency
1403	must be corrected. If a class III violation deficiency is
1404	corrected within the time specified, no civil penalty shall be
1405	imposed, unless it is a repeated offense.
1406	(d)  Class IV violations are defined in s. 408.813. Upon
1407	finding an uncorrected or repeated class IV violation, the
1408	agency shall impose an administrative fine not to exceed $500
1409	for each occurrence and each day that the uncorrected or
1410	repeated violation exists.
1411	Section 45.  Subsections (4) and (7) of section 400.9905,
1412	Florida Statutes, are amended to read:
1413	400.9905  Definitions.-
1414	(4)  "Clinic" means an entity at which health care services
1415	are provided to individuals and which tenders charges for
1416	reimbursement for such services, including a mobile clinic and a
1417	portable health service or equipment provider. For purposes of
1418	this part, the term does not include and the licensure
1419	requirements of this part do not apply to:
1420	(a)  Entities licensed or registered by the state under
1421	chapter 395; or entities licensed or registered by the state and
1422	providing only health care services within the scope of services
1423	authorized under their respective licenses granted under ss.
1424	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1425	chapter except part X, chapter 429, chapter 463, chapter 465,
1426	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1427	chapter 651; end-stage renal disease providers authorized under
1428	42 C.F.R. part 405, subpart U; or providers certified under 42
1429	C.F.R. part 485, subpart B or subpart H; or any entity that
1430	provides neonatal or pediatric hospital-based health care
1431	services or other health care services by licensed practitioners
1432	solely within a hospital licensed under chapter 395.
1433	(b)  Entities that own, directly or indirectly, entities
1434	licensed or registered by the state pursuant to chapter 395; or
1435	entities that own, directly or indirectly, entities licensed or
1436	registered by the state and providing only health care services
1437	within the scope of services authorized pursuant to their
1438	respective licenses granted under ss. 383.30-383.335, chapter
1439	390, chapter 394, chapter 397, this chapter except part X,
1440	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1441	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1442	disease providers authorized under 42 C.F.R. part 405, subpart
1443	U; or providers certified under 42 C.F.R. part 485, subpart B or
1444	subpart H; or any entity that provides neonatal or pediatric
1445	hospital-based health care services by licensed practitioners
1446	solely within a hospital licensed under chapter 395.
1447	(c)  Entities that are owned, directly or indirectly, by an
1448	entity licensed or registered by the state pursuant to chapter
1449	395; or entities that are owned, directly or indirectly, by an
1450	entity licensed or registered by the state and providing only
1451	health care services within the scope of services authorized
1452	pursuant to their respective licenses granted under ss. 383.30-
1453	383.335, chapter 390, chapter 394, chapter 397, this chapter
1454	except part X, chapter 429, chapter 463, chapter 465, chapter
1455	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1456	651; end-stage renal disease providers authorized under 42
1457	C.F.R. part 405, subpart U; or providers certified under 42
1458	C.F.R. part 485, subpart B or subpart H; or any entity that
1459	provides neonatal or pediatric hospital-based health care
1460	services by licensed practitioners solely within a hospital
1461	under chapter 395.
1462	(d)  Entities that are under common ownership, directly or
1463	indirectly, with an entity licensed or registered by the state
1464	pursuant to chapter 395; or entities that are under common
1465	ownership, directly or indirectly, with an entity licensed or
1466	registered by the state and providing only health care services
1467	within the scope of services authorized pursuant to their
1468	respective licenses granted under ss. 383.30-383.335, chapter
1469	390, chapter 394, chapter 397, this chapter except part X,
1470	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1471	part I of chapter 483, chapter 484, or chapter 651; end-stage
1472	renal disease providers authorized under 42 C.F.R. part 405,
1473	subpart U; or providers certified under 42 C.F.R. part 485,
1474	subpart B or subpart H; or any entity that provides neonatal or
1475	pediatric hospital-based health care services by licensed
1476	practitioners solely within a hospital licensed under chapter
1477	395.
1478	(e)  An entity that is exempt from federal taxation under
1479	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1480	under 26 U.S.C. s. 409 that has a board of trustees not less
1481	than two-thirds of which are Florida-licensed health care
1482	practitioners and provides only physical therapy services under
1483	physician orders, any community college or university clinic,
1484	and any entity owned or operated by the federal or state
1485	government, including agencies, subdivisions, or municipalities
1486	thereof.
1487	(f)  A sole proprietorship, group practice, partnership, or
1488	corporation that provides health care services by physicians
1489	covered by s. 627.419, that is directly supervised by one or
1490	more of such physicians, and that is wholly owned by one or more
1491	of those physicians or by a physician and the spouse, parent,
1492	child, or sibling of that physician.
1493	(g)  A sole proprietorship, group practice, partnership, or
1494	corporation that provides health care services by licensed
1495	health care practitioners under chapter 457, chapter 458,
1496	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1497	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1498	chapter 490, chapter 491, or part I, part III, part X, part
1499	XIII, or part XIV of chapter 468, or s. 464.012, which are
1500	wholly owned by one or more licensed health care practitioners,
1501	or the licensed health care practitioners set forth in this
1502	paragraph and the spouse, parent, child, or sibling of a
1503	licensed health care practitioner, so long as one of the owners
1504	who is a licensed health care practitioner is supervising the
1505	business activities and is legally responsible for the entity's
1506	compliance with all federal and state laws. However, a health
1507	care practitioner may not supervise services beyond the scope of
1508	the practitioner's license, except that, for the purposes of
1509	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1510	provides only services authorized pursuant to s. 456.053(3)(b)
1511	may be supervised by a licensee specified in s. 456.053(3)(b).
1512	(h)  Clinical facilities affiliated with an accredited
1513	medical school at which training is provided for medical
1514	students, residents, or fellows.
1515	(i)  Entities that provide only oncology or radiation
1516	therapy services by physicians licensed under chapter 458 or
1517	chapter 459 or entities that provide oncology or radiation
1518	therapy services by physicians licensed under chapter 458 or
1519	chapter 459 which are owned by a corporation whose shares are
1520	publicly traded on a recognized stock exchange.
1521	(j)  Clinical facilities affiliated with a college of
1522	chiropractic accredited by the Council on Chiropractic Education
1523	at which training is provided for chiropractic students.
1524	(k)  Entities that provide licensed practitioners to staff
1525	emergency departments or to deliver anesthesia services in
1526	facilities licensed under chapter 395 and that derive at least
1527	90 percent of their gross annual revenues from the provision of
1528	such services. Entities claiming an exemption from licensure
1529	under this paragraph must provide documentation demonstrating
1530	compliance.
1531	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1532	perinatology clinical facilities that are a publicly traded
1533	corporation or that are wholly owned, directly or indirectly, by
1534	a publicly traded corporation. As used in this paragraph, a
1535	publicly traded corporation is a corporation that issues
1536	securities traded on an exchange registered with the United
1537	States Securities and Exchange Commission as a national
1538	securities exchange.
1539	(m)  Entities that are owned by a corporation that has $250
1540	million or more in total annual sales of health care services
1541	provided by licensed health care practitioners if one or more of
1542	the owners of the entity is a health care practitioner who is
1543	licensed in this state, is responsible for supervising the
1544	business activities of the entity, and is legally responsible
1545	for the entity's compliance with state law for purposes of this
1546	section.
1547	(7)  "Portable health service or equipment provider" means
1548	an entity that contracts with or employs persons to provide
1549	portable health care services or equipment to multiple locations
1550	performing treatment or diagnostic testing of individuals, that
1551	bills third-party payors for those services, and that otherwise
1552	meets the definition of a clinic in subsection (4).
1553	Section 46.  Paragraph (b) of subsection (1) and paragraph
1554	(c) of subsection (4) of section 400.991, Florida Statutes, are
1555	amended to read:
1556	400.991  License requirements; background screenings;
1557	prohibitions.-
1558	(1)
1559	(b)  Each mobile clinic must obtain a separate health care
1560	clinic license and must provide to the agency, at least
1561	quarterly, its projected street location to enable the agency to
1562	locate and inspect such clinic. A portable health service or
1563	equipment provider must obtain a health care clinic license for
1564	a single administrative office and is not required to submit
1565	quarterly projected street locations.
1566	(4)  In addition to the requirements of part II of chapter
1567	408, the applicant must file with the application satisfactory
1568	proof that the clinic is in compliance with this part and
1569	applicable rules, including:
1570	(c)  Proof of financial ability to operate as required
1571	under ss. s. 408.810(8) and 408.8065. As an alternative to
1572	submitting proof of financial ability to operate as required
1573	under s. 408.810(8), the applicant may file a surety bond of at
1574	least $500,000 which guarantees that the clinic will act in full
1575	conformity with all legal requirements for operating a clinic,
1576	payable to the agency. The agency may adopt rules to specify
1577	related requirements for such surety bond.
1578	Section 47.  Paragraph (g) of subsection (1) and paragraph
1579	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1580	amended to read:
1581	400.9935  Clinic responsibilities.-
1582	(1)  Each clinic shall appoint a medical director or clinic
1583	director who shall agree in writing to accept legal
1584	responsibility for the following activities on behalf of the
1585	clinic. The medical director or the clinic director shall:
1586	(g)  Conduct systematic reviews of clinic billings to
1587	ensure that the billings are not fraudulent or unlawful. Upon
1588	discovery of an unlawful charge, the medical director or clinic
1589	director shall take immediate corrective action. If the clinic
1590	performs only the technical component of magnetic resonance
1591	imaging, static radiographs, computed tomography, or positron
1592	emission tomography, and provides the professional
1593	interpretation of such services, in a fixed facility that is
1594	accredited by The Joint Commission on Accreditation of
1595	Healthcare Organizations or the Accreditation Association for
1596	Ambulatory Health Care, and the American College of Radiology;
1597	and if, in the preceding quarter, the percentage of scans
1598	performed by that clinic which was billed to all personal injury
1599	protection insurance carriers was less than 15 percent, the
1600	chief financial officer of the clinic may, in a written
1601	acknowledgment provided to the agency, assume the responsibility
1602	for the conduct of the systematic reviews of clinic billings to
1603	ensure that the billings are not fraudulent or unlawful.
1604	(7)(a)  Each clinic engaged in magnetic resonance imaging
1605	services must be accredited by The Joint Commission on
1606	Accreditation of Healthcare Organizations, the American College
1607	of Radiology, or the Accreditation Association for Ambulatory
1608	Health Care, within 1 year after licensure. A clinic that is
1609	accredited by the American College of Radiology or is within the
1610	original 1-year period after licensure and replaces its core
1611	magnetic resonance imaging equipment shall be given 1 year after
1612	the date on which the equipment is replaced to attain
1613	accreditation. However, a clinic may request a single, 6-month
1614	extension if it provides evidence to the agency establishing
1615	that, for good cause shown, such clinic cannot be accredited
1616	within 1 year after licensure, and that such accreditation will
1617	be completed within the 6-month extension. After obtaining
1618	accreditation as required by this subsection, each such clinic
1619	must maintain accreditation as a condition of renewal of its
1620	license. A clinic that files a change of ownership application
1621	must comply with the original accreditation timeframe
1622	requirements of the transferor. The agency shall deny a change
1623	of ownership application if the clinic is not in compliance with
1624	the accreditation requirements. When a clinic adds, replaces, or
1625	modifies magnetic resonance imaging equipment and the
1626	accreditation agency requires new accreditation, the clinic must
1627	be accredited within 1 year after the date of the addition,
1628	replacement, or modification but may request a single, 6-month
1629	extension if the clinic provides evidence of good cause to the
1630	agency.
1631	Section 48.  Subsection (2) of section 408.034, Florida
1632	Statutes, is amended to read:
1633	408.034  Duties and responsibilities of agency; rules.-
1634	(2)  In the exercise of its authority to issue licenses to
1635	health care facilities and health service providers, as provided
1636	under chapters 393 and 395 and parts II, and IV, and VIII of
1637	chapter 400, the agency may not issue a license to any health
1638	care facility or health service provider that fails to receive a
1639	certificate of need or an exemption for the licensed facility or
1640	service.
1641	Section 49.  Paragraph (d) of subsection (1) of section
1642	408.036, Florida Statutes, is amended to read:
1643	408.036  Projects subject to review; exemptions.-
1644	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1645	health-care-related projects, as described in paragraphs (a)-
1646	(g), are subject to review and must file an application for a
1647	certificate of need with the agency. The agency is exclusively
1648	responsible for determining whether a health-care-related
1649	project is subject to review under ss. 408.031-408.045.
1650	(d)  The establishment of a hospice or hospice inpatient
1651	facility, except as provided in s. 408.043.
1652	Section 50.  Subsection (2) of section 408.043, Florida
1653	Statutes, is amended to read:
1654	408.043  Special provisions.-
1655	(2)  HOSPICES.-When an application is made for a
1656	certificate of need to establish or to expand a hospice, the
1657	need for such hospice shall be determined on the basis of the
1658	need for and availability of hospice services in the community.
1659	The formula on which the certificate of need is based shall
1660	discourage regional monopolies and promote competition. The
1661	inpatient hospice care component of a hospice which is a
1662	freestanding facility, or a part of a facility, which is
1663	primarily engaged in providing inpatient care and related
1664	services and is not licensed as a health care facility shall
1665	also be required to obtain a certificate of need. Provision of
1666	hospice care by any current provider of health care is a
1667	significant change in service and therefore requires a
1668	certificate of need for such services.
1669	Section 51.  Paragraph (k) of subsection (3) of section
1670	408.05, Florida Statutes, is amended to read:
1671	408.05  Florida Center for Health Information and Policy
1672	Analysis.-
1673	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1674	produce comparable and uniform health information and statistics
1675	for the development of policy recommendations, the agency shall
1676	perform the following functions:
1677	(k)  Develop, in conjunction with the State Consumer Health
1678	Information and Policy Advisory Council, and implement a long-
1679	range plan for making available health care quality measures and
1680	financial data that will allow consumers to compare health care
1681	services. The health care quality measures and financial data
1682	the agency must make available shall include, but is not limited
1683	to, pharmaceuticals, physicians, health care facilities, and
1684	health plans and managed care entities. The agency shall submit
1685	the initial plan to the Governor, the President of the Senate,
1686	and the Speaker of the House of Representatives by January 1,
1687	2006, and shall update the plan and report on the status of its
1688	implementation annually thereafter. The agency shall also make
1689	the plan and status report available to the public on its
1690	Internet website. As part of the plan, the agency shall identify
1691	the process and timeframes for implementation, any barriers to
1692	implementation, and recommendations of changes in the law that
1693	may be enacted by the Legislature to eliminate the barriers. As
1694	preliminary elements of the plan, the agency shall:
1695	1.  Make available patient-safety indicators, inpatient
1696	quality indicators, and performance outcome and patient charge
1697	data collected from health care facilities pursuant to s.
1698	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1699	"inpatient quality indicators" shall be as defined by the
1700	Centers for Medicare and Medicaid Services, the National Quality
1701	Forum, The Joint Commission on Accreditation of Healthcare
1702	Organizations, the Agency for Healthcare Research and Quality,
1703	the Centers for Disease Control and Prevention, or a similar
1704	national entity that establishes standards to measure the
1705	performance of health care providers, or by other states. The
1706	agency shall determine which conditions, procedures, health care
1707	quality measures, and patient charge data to disclose based upon
1708	input from the council. When determining which conditions and
1709	procedures are to be disclosed, the council and the agency shall
1710	consider variation in costs, variation in outcomes, and
1711	magnitude of variations and other relevant information. When
1712	determining which health care quality measures to disclose, the
1713	agency:
1714	a.  Shall consider such factors as volume of cases; average
1715	patient charges; average length of stay; complication rates;
1716	mortality rates; and infection rates, among others, which shall
1717	be adjusted for case mix and severity, if applicable.
1718	b.  May consider such additional measures that are adopted
1719	by the Centers for Medicare and Medicaid Studies, National
1720	Quality Forum, The Joint Commission on Accreditation of
1721	Healthcare Organizations, the Agency for Healthcare Research and
1722	Quality, Centers for Disease Control and Prevention, or a
1723	similar national entity that establishes standards to measure
1724	the performance of health care providers, or by other states.
1725
1726	When determining which patient charge data to disclose, the
1727	agency shall include such measures as the average of
1728	undiscounted charges on frequently performed procedures and
1729	preventive diagnostic procedures, the range of procedure charges
1730	from highest to lowest, average net revenue per adjusted patient
1731	day, average cost per adjusted patient day, and average cost per
1732	admission, among others.
1733	2.  Make available performance measures, benefit design,
1734	and premium cost data from health plans licensed pursuant to
1735	chapter 627 or chapter 641. The agency shall determine which
1736	health care quality measures and member and subscriber cost data
1737	to disclose, based upon input from the council. When determining
1738	which data to disclose, the agency shall consider information
1739	that may be required by either individual or group purchasers to
1740	assess the value of the product, which may include membership
1741	satisfaction, quality of care, current enrollment or membership,
1742	coverage areas, accreditation status, premium costs, plan costs,
1743	premium increases, range of benefits, copayments and
1744	deductibles, accuracy and speed of claims payment, credentials
1745	of physicians, number of providers, names of network providers,
1746	and hospitals in the network. Health plans shall make available
1747	to the agency any such data or information that is not currently
1748	reported to the agency or the office.
1749	3.  Determine the method and format for public disclosure
1750	of data reported pursuant to this paragraph. The agency shall
1751	make its determination based upon input from the State Consumer
1752	Health Information and Policy Advisory Council. At a minimum,
1753	the data shall be made available on the agency's Internet
1754	website in a manner that allows consumers to conduct an
1755	interactive search that allows them to view and compare the
1756	information for specific providers. The website must include
1757	such additional information as is determined necessary to ensure
1758	that the website enhances informed decisionmaking among
1759	consumers and health care purchasers, which shall include, at a
1760	minimum, appropriate guidance on how to use the data and an
1761	explanation of why the data may vary from provider to provider.
1762	The data specified in subparagraph 1. shall be released no later
1763	than January 1, 2006, for the reporting of infection rates, and
1764	no later than October 1, 2005, for mortality rates and
1765	complication rates. The data specified in subparagraph 2. shall
1766	be released no later than October 1, 2006.
1767	4.  Publish on its website undiscounted charges for no
1768	fewer than 150 of the most commonly performed adult and
1769	pediatric procedures, including outpatient, inpatient,
1770	diagnostic, and preventative procedures.
1771	Section 52.  Paragraph (a) of subsection (1) of section
1772	408.061, Florida Statutes, is amended to read:
1773	408.061  Data collection; uniform systems of financial
1774	reporting; information relating to physician charges;
1775	confidential information; immunity.-
1776	(1)  The agency shall require the submission by health care
1777	facilities, health care providers, and health insurers of data
1778	necessary to carry out the agency's duties. Specifications for
1779	data to be collected under this section shall be developed by
1780	the agency with the assistance of technical advisory panels
1781	including representatives of affected entities, consumers,
1782	purchasers, and such other interested parties as may be
1783	determined by the agency.
1784	(a)  Data submitted by health care facilities, including
1785	the facilities as defined in chapter 395, shall include, but are
1786	not limited to: case-mix data, patient admission and discharge
1787	data, hospital emergency department data which shall include the
1788	number of patients treated in the emergency department of a
1789	licensed hospital reported by patient acuity level, data on
1790	hospital-acquired infections as specified by rule, data on
1791	complications as specified by rule, data on readmissions as
1792	specified by rule, with patient and provider-specific
1793	identifiers included, actual charge data by diagnostic groups,
1794	financial data, accounting data, operating expenses, expenses
1795	incurred for rendering services to patients who cannot or do not
1796	pay, interest charges, depreciation expenses based on the
1797	expected useful life of the property and equipment involved, and
1798	demographic data. The agency shall adopt nationally recognized
1799	risk adjustment methodologies or software consistent with the
1800	standards of the Agency for Healthcare Research and Quality and
1801	as selected by the agency for all data submitted as required by
1802	this section. Data may be obtained from documents such as, but
1803	not limited to: leases, contracts, debt instruments, itemized
1804	patient bills, medical record abstracts, and related diagnostic
1805	information. Reported data elements shall be reported
1806	electronically and in accordance with rule 59E-7.012, Florida
1807	Administrative Code. Data submitted shall be certified by the
1808	chief executive officer or an appropriate and duly authorized
1809	representative or employee of the licensed facility that the
1810	information submitted is true and accurate.
1811	Section 53.  Subsection (43) of section 408.07, Florida
1812	Statutes, is amended to read:
1813	408.07  Definitions.-As used in this chapter, with the
1814	exception of ss. 408.031-408.045, the term:
1815	(43)  "Rural hospital" means an acute care hospital
1816	licensed under chapter 395, having 100 or fewer licensed beds
1817	and an emergency room, and which is:
1818	(a)  The sole provider within a county with a population
1819	density of no greater than 100 persons per square mile;
1820	(b)  An acute care hospital, in a county with a population
1821	density of no greater than 100 persons per square mile, which is
1822	at least 30 minutes of travel time, on normally traveled roads
1823	under normal traffic conditions, from another acute care
1824	hospital within the same county;
1825	(c)  A hospital supported by a tax district or subdistrict
1826	whose boundaries encompass a population of 100 persons or fewer
1827	per square mile;
1828	(d)  A hospital with a service area that has a population
1829	of 100 persons or fewer per square mile. As used in this
1830	paragraph, the term "service area" means the fewest number of
1831	zip codes that account for 75 percent of the hospital's
1832	discharges for the most recent 5-year period, based on
1833	information available from the hospital inpatient discharge
1834	database in the Florida Center for Health Information and Policy
1835	Analysis at the Agency for Health Care Administration; or
1836	(e)  A critical access hospital.
1837
1838	Population densities used in this subsection must be based upon
1839	the most recently completed United States census. A hospital
1840	that received funds under s. 409.9116 for a quarter beginning no
1841	later than July 1, 2002, is deemed to have been and shall
1842	continue to be a rural hospital from that date through June 30,
1843	2015, if the hospital continues to have 100 or fewer licensed
1844	beds and an emergency room, or meets the criteria of s.
1845	395.602(2)(e)4. An acute care hospital that has not previously
1846	been designated as a rural hospital and that meets the criteria
1847	of this subsection shall be granted such designation upon
1848	application, including supporting documentation, to the Agency
1849	for Health Care Administration.
1850	Section 54.  Section 408.10, Florida Statutes, is amended
1851	to read:
1852	408.10  Consumer complaints.-The agency shall:
1853	(1)  publish and make available to the public a toll-free
1854	telephone number for the purpose of handling consumer complaints
1855	and shall serve as a liaison between consumer entities and other
1856	private entities and governmental entities for the disposition
1857	of problems identified by consumers of health care.
1858	(2)  Be empowered to investigate consumer complaints
1859	relating to problems with health care facilities' billing
1860	practices and issue reports to be made public in any cases where
1861	the agency determines the health care facility has engaged in
1862	billing practices which are unreasonable and unfair to the
1863	consumer.
1864	Section 55.  Subsections (12) through (30) of section
1865	408.802, Florida Statutes, are renumbered as subsections (11)
1866	through (29), respectively, and present subsection (11) of that
1867	section is amended to read:
1868	408.802  Applicability.-The provisions of this part apply
1869	to the provision of services that require licensure as defined
1870	in this part and to the following entities licensed, registered,
1871	or certified by the agency, as described in chapters 112, 383,
1872	390, 394, 395, 400, 429, 440, 483, and 765:
1873	(11)  Private review agents, as provided under part I of
1874	chapter 395.
1875	Section 56.  Subsection (3) is added to section 408.804,
1876	Florida Statutes, to read:
1877	408.804  License required; display.-
1878	(3)  Any person who knowingly alters, defaces, or falsifies
1879	a license certificate issued by the agency, or causes or
1880	procures any person to commit such an offense, commits a
1881	misdemeanor of the second degree, punishable as provided in s.
1882	775.082 or s 775.083. Any licensee or provider who displays an
1883	altered, defaced, or falsified license certificate is subject to
1884	the penalties set forth in s. 408.815 and an administrative fine
1885	of $1,000 for each day of illegal display.
1886	Section 57.  Paragraph (d) of subsection (2) of section
1887	408.806, Florida Statutes, is amended, present subsections (3)
1888	through (8) are renumbered as subsections (4) through (9),
1889	respectively, and a new subsection (3) is added to that section,
1890	to read:
1891	408.806  License application process.-
1892	(2)
1893	(d)  The agency shall notify the licensee by mail or
1894	electronically at least 90 days before the expiration of a
1895	license that a renewal license is necessary to continue
1896	operation. The licensee's failure to timely file submit a
1897	renewal application and license application fee with the agency
1898	shall result in a $50 per day late fee charged to the licensee
1899	by the agency; however, the aggregate amount of the late fee may
1900	not exceed 50 percent of the licensure fee or $500, whichever is
1901	less. The agency shall provide a courtesy notice to the licensee
1902	by United States mail, electronically, or by any other manner at
1903	its address of record or mailing address, if provided, at least
1904	90 days prior to the expiration of a license informing the
1905	licensee of the expiration of the license. If the agency does
1906	not provide the courtesy notice or the licensee does not receive
1907	the courtesy notice, the licensee continues to be legally
1908	obligated to timely file the renewal application and license
1909	application fee with the agency and is not excused from the
1910	payment of a late fee. If an application is received after the
1911	required filing date and exhibits a hand-canceled postmark
1912	obtained from a United States post office dated on or before the
1913	required filing date, no fine will be levied.
1914	(3)  Payment of the late fee is required to consider any
1915	late application complete, and failure to pay the late fee is
1916	considered an omission from the application.
1917	Section 58.  Subsections (6) and (9) of section 408.810,
1918	Florida Statutes, are amended to read:
1919	408.810  Minimum licensure requirements.-In addition to the
1920	licensure requirements specified in this part, authorizing
1921	statutes, and applicable rules, each applicant and licensee must
1922	comply with the requirements of this section in order to obtain
1923	and maintain a license.
1924	(6)(a)  An applicant must provide the agency with proof of
1925	the applicant's legal right to occupy the property before a
1926	license may be issued. Proof may include, but need not be
1927	limited to, copies of warranty deeds, lease or rental
1928	agreements, contracts for deeds, quitclaim deeds, or other such
1929	documentation.
1930	(b)  In the event the property is encumbered by a mortgage
1931	or is leased, an applicant must provide the agency with proof
1932	that the mortgagor or landlord has been provided written notice
1933	of the applicant's intent as mortgagee or tenant to provide
1934	services that require licensure and instruct the mortgagor or
1935	landlord to serve the agency by certified mail with copies of
1936	any foreclosure or eviction actions initiated by the mortgagor
1937	or landlord against the applicant.
1938	(9)  A controlling interest may not withhold from the
1939	agency any evidence of financial instability, including, but not
1940	limited to, checks returned due to insufficient funds,
1941	delinquent accounts, nonpayment of withholding taxes, unpaid
1942	utility expenses, nonpayment for essential services, or adverse
1943	court action concerning the financial viability of the provider
1944	or any other provider licensed under this part that is under the
1945	control of the controlling interest. A controlling interest
1946	shall notify the agency within 10 days after a court action to
1947	initiate bankruptcy, foreclosure, or eviction proceedings
1948	concerning the provider, in which the controlling interest is a
1949	petitioner or defendant. Any person who violates this subsection
1950	commits a misdemeanor of the second degree, punishable as
1951	provided in s. 775.082 or s. 775.083. Each day of continuing
1952	violation is a separate offense.
1953	Section 59.  Subsection (3) is added to section 408.813,
1954	Florida Statutes, to read:
1955	408.813  Administrative fines; violations.-As a penalty for
1956	any violation of this part, authorizing statutes, or applicable
1957	rules, the agency may impose an administrative fine.
1958	(3)  The agency may impose an administrative fine for a
1959	violation that does not qualify as a class I, class II, class
1960	III, or class IV violation. Unless otherwise specified by law,
1961	the amount of the fine shall not exceed $500 for each violation.
1962	Unclassified violations may include:
1963	(a)  Violating any term or condition of a license.
1964	(b)  Violating any provision of this part, authorizing
1965	statutes, or applicable rules.
1966	(c)  Exceeding licensed capacity.
1967	(d)  Providing services beyond the scope of the license.
1968	(e)  Violating a moratorium imposed pursuant to s. 408.814.
1969	Section 60.  Subsection (5) is added to section 408.815,
1970	Florida Statutes, to read:
1971	408.815  License or application denial; revocation.-
1972	(5)  In order to ensure the health, safety, and welfare of
1973	clients when a license has been denied, revoked, or is set to
1974	terminate, the agency may extend the license expiration date for
1975	a period of up to 30 days for the sole purpose of allowing the
1976	safe and orderly discharge of clients. The agency may impose
1977	conditions on the extension, including, but not limited to,
1978	prohibiting or limiting admissions, expedited discharge
1979	planning, required status reports, and mandatory monitoring by
1980	the agency or third parties. In imposing these conditions, the
1981	agency shall take into consideration the nature and number of
1982	clients, the availability and location of acceptable alternative
1983	placements, and the ability of the licensee to continue
1984	providing care to the clients. The agency may terminate the
1985	extension or modify the conditions at any time. This authority
1986	is in addition to any other authority granted to the agency
1987	under chapter 120, this part, and authorizing statutes but
1988	creates no right or entitlement to an extension of a license
1989	expiration date.
1990	Section 61.  Paragraph (k) of subsection (4) of section
1991	409.221, Florida Statutes, is amended to read:
1992	409.221  Consumer-directed care program.-
1993	(4)  CONSUMER-DIRECTED CARE.-
1994	(k)  Reviews and reports.-The agency and the Departments of
1995	Elderly Affairs, Health, and Children and Family Services and
1996	the Agency for Persons with Disabilities shall each, on an
1997	ongoing basis, review and assess the implementation of the
1998	consumer-directed care program. By January 15 of each year, the
1999	agency shall submit a written report to the Legislature that
2000	includes each department's review of the program and contains
2001	recommendations for improvements to the program.
2002	Section 62.  Subsections (3) and (4) of section 429.07,
2003	Florida Statutes, are amended, and subsections (6) and (7) are
2004	added to that section, to read:
2005	429.07  License required; fee; inspections.-
2006	(3)  In addition to the requirements of s. 408.806, each
2007	license granted by the agency must state the type of care for
2008	which the license is granted. Licenses shall be issued for one
2009	or more of the following categories of care: standard, extended
2010	congregate care, limited nursing services, or limited mental
2011	health.
2012	(a)  A standard license shall be issued to a facility
2013	facilities providing one or more of the personal services
2014	identified in s. 429.02. Such licensee facilities may also
2015	employ or contract with a person licensed under part I of
2016	chapter 464 to administer medications and perform other tasks as
2017	specified in s. 429.255.
2018	(b)  An extended congregate care license shall be issued to
2019	a licensee facilities providing, directly or through contract,
2020	services beyond those authorized in paragraph (a), including
2021	acts performed pursuant to part I of chapter 464 by persons
2022	licensed thereunder, and supportive services defined by rule to
2023	persons who otherwise would be disqualified from continued
2024	residence in a facility licensed under this part.
2025	1.  In order for extended congregate care services to be
2026	provided in a facility licensed under this part, the agency must
2027	first determine that all requirements established in law and
2028	rule are met and must specifically designate, on the facility's
2029	license, that such services may be provided and whether the
2030	designation applies to all or part of a facility. Such
2031	designation may be made at the time of initial licensure or
2032	relicensure, or upon request in writing by a licensee under this
2033	part and part II of chapter 408. Notification of approval or
2034	denial of such request shall be made in accordance with part II
2035	of chapter 408. An existing licensee facilities qualifying to
2036	provide extended congregate care services must have maintained a
2037	standard license and may not have been subject to administrative
2038	sanctions during the previous 2 years, or since initial
2039	licensure if the facility has been licensed for less than 2
2040	years, for any of the following reasons:
2041	a.  A class I or class II violation;
2042	b.  Three or more repeat or recurring class III violations
2043	of identical or similar resident care standards as specified in
2044	rule from which a pattern of noncompliance is found by the
2045	agency;
2046	c.  Three or more class III violations that were not
2047	corrected in accordance with the corrective action plan approved
2048	by the agency;
2049	d.  Violation of resident care standards resulting in a
2050	requirement to employ the services of a consultant pharmacist or
2051	consultant dietitian;
2052	e.  Denial, suspension, or revocation of a license for
2053	another facility under this part in which the applicant for an
2054	extended congregate care license has at least 25 percent
2055	ownership interest; or
2056	f.  Imposition of a moratorium pursuant to this part or
2057	part II of chapter 408 or initiation of injunctive proceedings.
2058	2.  A licensee Facilities that is are licensed to provide
2059	extended congregate care services shall maintain a written
2060	progress report for on each person who receives such services,
2061	and the which report must describe describes the type, amount,
2062	duration, scope, and outcome of services that are rendered and
2063	the general status of the resident's health. A registered nurse,
2064	or appropriate designee, representing the agency shall visit
2065	such facilities at least quarterly to monitor residents who are
2066	receiving extended congregate care services and to determine if
2067	the facility is in compliance with this part, part II of chapter
2068	408, and rules that relate to extended congregate care. One of
2069	these visits may be in conjunction with the regular survey. The
2070	monitoring visits may be provided through contractual
2071	arrangements with appropriate community agencies. A registered
2072	nurse shall serve as part of the team that inspects such
2073	facility. The agency may waive one of the required yearly
2074	monitoring visits for a facility that has been licensed for at
2075	least 24 months to provide extended congregate care services,
2076	if, during the inspection, the registered nurse determines that
2077	extended congregate care services are being provided
2078	appropriately, and if the facility has no class I or class II
2079	violations and no uncorrected class III violations. Before such
2080	decision is made, the agency shall consult with the long-term
2081	care ombudsman council for the area in which the facility is
2082	located to determine if any complaints have been made and
2083	substantiated about the quality of services or care. The agency
2084	may not waive one of the required yearly monitoring visits if
2085	complaints have been made and substantiated.
2086	3.  Licensees Facilities that are licensed to provide
2087	extended congregate care services shall:
2088	a.  Demonstrate the capability to meet unanticipated
2089	resident service needs.
2090	b.  Offer a physical environment that promotes a homelike
2091	setting, provides for resident privacy, promotes resident
2092	independence, and allows sufficient congregate space as defined
2093	by rule.
2094	c.  Have sufficient staff available, taking into account
2095	the physical plant and firesafety features of the building, to
2096	assist with the evacuation of residents in an emergency, as
2097	necessary.
2098	d.  Adopt and follow policies and procedures that maximize
2099	resident independence, dignity, choice, and decisionmaking to
2100	permit residents to age in place to the extent possible, so that
2101	moves due to changes in functional status are minimized or
2102	avoided.
2103	e.  Allow residents or, if applicable, a resident's
2104	representative, designee, surrogate, guardian, or attorney in
2105	fact to make a variety of personal choices, participate in
2106	developing service plans, and share responsibility in
2107	decisionmaking.
2108	f.  Implement the concept of managed risk.
2109	g.  Provide, either directly or through contract, the
2110	services of a person licensed pursuant to part I of chapter 464.
2111	h.  In addition to the training mandated in s. 429.52,
2112	provide specialized training as defined by rule for facility
2113	staff.
2114	4.  Licensees Facilities licensed to provide extended
2115	congregate care services are exempt from the criteria for
2116	continued residency as set forth in rules adopted under s.
2117	429.41. Licensees Facilities so licensed shall adopt their own
2118	requirements within guidelines for continued residency set forth
2119	by rule. However, such licensees facilities may not serve
2120	residents who require 24-hour nursing supervision. Licensees
2121	Facilities licensed to provide extended congregate care services
2122	shall provide each resident with a written copy of facility
2123	policies governing admission and retention.
2124	5.  The primary purpose of extended congregate care
2125	services is to allow residents, as they become more impaired,
2126	the option of remaining in a familiar setting from which they
2127	would otherwise be disqualified for continued residency. A
2128	facility licensed to provide extended congregate care services
2129	may also admit an individual who exceeds the admission criteria
2130	for a facility with a standard license, if the individual is
2131	determined appropriate for admission to the extended congregate
2132	care facility.
2133	6.  Before admission of an individual to a facility
2134	licensed to provide extended congregate care services, the
2135	individual must undergo a medical examination as provided in s.
2136	429.26(4) and the facility must develop a preliminary service
2137	plan for the individual.
2138	7.  When a licensee facility can no longer provide or
2139	arrange for services in accordance with the resident's service
2140	plan and needs and the licensee's facility's policy, the
2141	licensee facility shall make arrangements for relocating the
2142	person in accordance with s. 429.28(1)(k).
2143	8.  Failure to provide extended congregate care services
2144	may result in denial of extended congregate care license
2145	renewal.
2146	9.  No later than January 1 of each year, the department,
2147	in consultation with the agency, shall prepare and submit to the
2148	Governor, the President of the Senate, the Speaker of the House
2149	of Representatives, and the chairs of appropriate legislative
2150	committees, a report on the status of, and recommendations
2151	related to, extended congregate care services. The status report
2152	must include, but need not be limited to, the following
2153	information:
2154	a.  A description of the facilities licensed to provide
2155	such services, including total number of beds licensed under
2156	this part.
2157	b.  The number and characteristics of residents receiving
2158	such services.
2159	c.  The types of services rendered that could not be
2160	provided through a standard license.
2161	d.  An analysis of deficiencies cited during licensure
2162	inspections.
2163	e.  The number of residents who required extended
2164	congregate care services at admission and the source of
2165	admission.
2166	f.  Recommendations for statutory or regulatory changes.
2167	g.  The availability of extended congregate care to state
2168	clients residing in facilities licensed under this part and in
2169	need of additional services, and recommendations for
2170	appropriations to subsidize extended congregate care services
2171	for such persons.
2172	h.  Such other information as the department considers
2173	appropriate.
2174	(c)  A limited nursing services license shall be issued to
2175	a facility that provides services beyond those authorized in
2176	paragraph (a) and as specified in this paragraph.
2177	1.  In order for limited nursing services to be provided in
2178	a facility licensed under this part, the agency must first
2179	determine that all requirements established in law and rule are
2180	met and must specifically designate, on the facility's license,
2181	that such services may be provided. Such designation may be made
2182	at the time of initial licensure or relicensure, or upon request
2183	in writing by a licensee under this part and part II of chapter
2184	408. Notification of approval or denial of such request shall be
2185	made in accordance with part II of chapter 408. Existing
2186	facilities qualifying to provide limited nursing services shall
2187	have maintained a standard license and may not have been subject
2188	to administrative sanctions that affect the health, safety, and
2189	welfare of residents for the previous 2 years or since initial
2190	licensure if the facility has been licensed for less than 2
2191	years.
2192	2.  Facilities that are licensed to provide limited nursing
2193	services shall maintain a written progress report on each person
2194	who receives such nursing services, which report describes the
2195	type, amount, duration, scope, and outcome of services that are
2196	rendered and the general status of the resident's health. A
2197	registered nurse representing the agency shall visit such
2198	facilities at least twice a year to monitor residents who are
2199	receiving limited nursing services and to determine if the
2200	facility is in compliance with applicable provisions of this
2201	part, part II of chapter 408, and related rules. The monitoring
2202	visits may be provided through contractual arrangements with
2203	appropriate community agencies. A registered nurse shall also
2204	serve as part of the team that inspects such facility.
2205	3.  A person who receives limited nursing services under
2206	this part must meet the admission criteria established by the
2207	agency for assisted living facilities. When a resident no longer
2208	meets the admission criteria for a facility licensed under this
2209	part, arrangements for relocating the person shall be made in
2210	accordance with s. 429.28(1)(k), unless the facility is licensed
2211	to provide extended congregate care services.
2212	(4)  In accordance with s. 408.805, an applicant or
2213	licensee shall pay a fee for each license application submitted
2214	under this part, part II of chapter 408, and applicable rules.
2215	The amount of the fee shall be established by rule.
2216	(a)  The biennial license fee required of a facility is
2217	$356 $300 per license, with an additional fee of $67.50 $50 per
2218	resident based on the total licensed resident capacity of the
2219	facility, except that no additional fee will be assessed for
2220	beds designated for recipients of optional state supplementation
2221	payments provided for in s. 409.212. The total fee may not
2222	exceed $18,000 $10,000.
2223	(b)  In addition to the total fee assessed under paragraph
2224	(a), the agency shall require facilities that are licensed to
2225	provide extended congregate care services under this part to pay
2226	an additional fee per licensed facility. The amount of the
2227	biennial fee shall be $501 $400 per license, with an additional
2228	fee of $10 per resident based on the total licensed resident
2229	capacity of the facility.
2230	(c)  In addition to the total fee assessed under paragraph
2231	(a), the agency shall require facilities that are licensed to
2232	provide limited nursing services under this part to pay an
2233	additional fee per licensed facility. The amount of the biennial
2234	fee shall be $250 per license, with an additional fee of $10 per
2235	resident based on the total licensed resident capacity of the
2236	facility.
2237	(6)  In order to determine whether the facility is
2238	adequately protecting residents' rights as provided in s.
2239	429.28, the biennial survey shall include private informal
2240	conversations with a sample of residents and consultation with
2241	the ombudsman council in the planning and service area in which
2242	the facility is located to discuss residents' experiences within
2243	the facility.
2244	(7)  An assisted living facility that has been cited within
2245	the previous 24-month period for a class I or class II
2246	violation, regardless of the status of any enforcement or
2247	disciplinary action, is subject to periodic unannounced
2248	monitoring to determine if the facility is in compliance with
2249	this part, part II of chapter 408, and applicable rules.
2250	Monitoring may occur through a desk review or an onsite
2251	assessment. If the class I or class II violation relates to
2252	providing or failing to provide nursing care, a registered nurse
2253	must participate in at least two onsite monitoring visits within
2254	a 12-month period.
2255	Section 63.  Subsection (7) of section 429.11, Florida
2256	Statutes, is renumbered as subsection (6), and present
2257	subsection (6) of that section is amended to read:
2258	429.11  Initial application for license; provisional
2259	license.-
2260	(6)  In addition to the license categories available in s.
2261	408.808, a provisional license may be issued to an applicant
2262	making initial application for licensure or making application
2263	for a change of ownership. A provisional license shall be
2264	limited in duration to a specific period of time not to exceed 6
2265	months, as determined by the agency.
2266	Section 64.  Section 429.12, Florida Statutes, is amended
2267	to read:
2268	429.12  Sale or transfer of ownership of a facility.-It is
2269	the intent of the Legislature to protect the rights of the
2270	residents of an assisted living facility when the facility is
2271	sold or the ownership thereof is transferred. Therefore, in
2272	addition to the requirements of part II of chapter 408, whenever
2273	a facility is sold or the ownership thereof is transferred,
2274	including leasing:.
2275	(1)  The transferee shall notify the residents, in writing,
2276	of the change of ownership within 7 days after receipt of the
2277	new license.
2278	(2)  The transferor of a facility the license of which is
2279	denied pending an administrative hearing shall, as a part of the
2280	written change-of-ownership contract, advise the transferee that
2281	a plan of correction must be submitted by the transferee and
2282	approved by the agency at least 7 days before the change of
2283	ownership and that failure to correct the condition which
2284	resulted in the moratorium pursuant to part II of chapter 408 or
2285	denial of licensure is grounds for denial of the transferee's
2286	license.
2287	Section 65.  Paragraphs (b) through (l) of subsection (1)
2288	of section 429.14, Florida Statutes, are redesignated as
2289	paragraphs (a) through (k), respectively, and present paragraph
2290	(a) of subsection (1) and subsections (5) and (6) of that
2291	section are amended to read:
2292	429.14  Administrative penalties.-
2293	(1)  In addition to the requirements of part II of chapter
2294	408, the agency may deny, revoke, and suspend any license issued
2295	under this part and impose an administrative fine in the manner
2296	provided in chapter 120 against a licensee of an assisted living
2297	facility for a violation of any provision of this part, part II
2298	of chapter 408, or applicable rules, or for any of the following
2299	actions by a licensee of an assisted living facility, for the
2300	actions of any person subject to level 2 background screening
2301	under s. 408.809, or for the actions of any facility employee:
2302	(a)  An intentional or negligent act seriously affecting
2303	the health, safety, or welfare of a resident of the facility.
2304	(5)  An action taken by the agency to suspend, deny, or
2305	revoke a facility's license under this part or part II of
2306	chapter 408, in which the agency claims that the facility owner
2307	or an employee of the facility has threatened the health,
2308	safety, or welfare of a resident of the facility shall be heard
2309	by the Division of Administrative Hearings of the Department of
2310	Management Services within 120 days after receipt of the
2311	facility's request for a hearing, unless that time limitation is
2312	waived by both parties. The administrative law judge must render
2313	a decision within 30 days after receipt of a proposed
2314	recommended order.
2315	(6)  The agency shall provide to the Division of Hotels and
2316	Restaurants of the Department of Business and Professional
2317	Regulation, on a monthly basis, a list of those assisted living
2318	facilities that have had their licenses denied, suspended, or
2319	revoked or that are involved in an appellate proceeding pursuant
2320	to s. 120.60 related to the denial, suspension, or revocation of
2321	a license. This information may be provided electronically or
2322	through the agency's Internet website.
2323	Section 66.  Subsections (1), (4), and (5) of section
2324	429.17, Florida Statutes, are amended to read:
2325	429.17  Expiration of license; renewal; conditional
2326	license.-
2327	(1)  Limited nursing, Extended congregate care, and limited
2328	mental health licenses shall expire at the same time as the
2329	facility's standard license, regardless of when issued.
2330	(4)  In addition to the license categories available in s.
2331	408.808, a conditional license may be issued to an applicant for
2332	license renewal if the applicant fails to meet all standards and
2333	requirements for licensure. A conditional license issued under
2334	this subsection shall be limited in duration to a specific
2335	period of time not to exceed 6 months, as determined by the
2336	agency, and shall be accompanied by an agency-approved plan of
2337	correction.
2338	(5)  When an extended congregate care or limited nursing
2339	license is requested during a facility's biennial license
2340	period, the fee shall be prorated in order to permit the
2341	additional license to expire at the end of the biennial license
2342	period. The fee shall be calculated as of the date the
2343	additional license application is received by the agency.
2344	Section 67.  Subsection (7) of section 429.19, Florida
2345	Statutes, is amended to read:
2346	429.19  Violations; imposition of administrative fines;
2347	grounds.-
2348	(7)  In addition to any administrative fines imposed, the
2349	agency may assess a survey or monitoring fee, equal to the
2350	lesser of one half of the facility's biennial license and bed
2351	fee or $500, to cover the cost of conducting initial complaint
2352	investigations that result in the finding of a violation that
2353	was the subject of the complaint or to monitor the health,
2354	safety, or security of residents under s. 429.07(7) monitoring
2355	visits conducted under s. 429.28(3)(c) to verify the correction
2356	of the violations.
2357	Section 68.  Subsections (6) through (10) of section
2358	429.23, Florida Statutes, are renumbered as subsections (5)
2359	through (9), respectively, and present subsection (5) of that
2360	section is amended to read:
2361	429.23  Internal risk management and quality assurance
2362	program; adverse incidents and reporting requirements.-
2363	(5)  Each facility shall report monthly to the agency any
2364	liability claim filed against it. The report must include the
2365	name of the resident, the dates of the incident leading to the
2366	claim, if applicable, and the type of injury or violation of
2367	rights alleged to have occurred. This report is not discoverable
2368	in any civil or administrative action, except in such actions
2369	brought by the agency to enforce the provisions of this part.
2370	Section 69.  Paragraph (a) of subsection (1) and subsection
2371	(2) of section 429.255, Florida Statutes, are amended to read:
2372	429.255  Use of personnel; emergency care.-
2373	(1)(a)  Persons under contract to the facility or, facility
2374	staff, or volunteers, who are licensed according to part I of
2375	chapter 464, or those persons exempt under s. 464.022(1), and
2376	others as defined by rule, may administer medications to
2377	residents, take residents' vital signs, manage individual weekly
2378	pill organizers for residents who self-administer medication,
2379	give prepackaged enemas ordered by a physician, observe
2380	residents, document observations on the appropriate resident's
2381	record, report observations to the resident's physician, and
2382	contract or allow residents or a resident's representative,
2383	designee, surrogate, guardian, or attorney in fact to contract
2384	with a third party, provided residents meet the criteria for
2385	appropriate placement as defined in s. 429.26. Persons under
2386	contract to the facility or facility staff who are licensed
2387	according to part I of chapter 464 may provide limited nursing
2388	services. Nursing assistants certified pursuant to part II of
2389	chapter 464 may take residents' vital signs as directed by a
2390	licensed nurse or physician. The facility is responsible for
2391	maintaining documentation of services provided under this
2392	paragraph as required by rule and ensuring that staff are
2393	adequately trained to monitor residents receiving these
2394	services.
2395	(2)  In facilities licensed to provide extended congregate
2396	care, persons under contract to the facility or, facility staff,
2397	or volunteers, who are licensed according to part I of chapter
2398	464, or those persons exempt under s. 464.022(1), or those
2399	persons certified as nursing assistants pursuant to part II of
2400	chapter 464, may also perform all duties within the scope of
2401	their license or certification, as approved by the facility
2402	administrator and pursuant to this part.
2403	Section 70.  Subsection (3) of section 429.28, Florida
2404	Statutes, is amended to read:
2405	429.28  Resident bill of rights.-
2406	(3)(a)  The agency shall conduct a survey to determine
2407	general compliance with facility standards and compliance with
2408	residents' rights as a prerequisite to initial licensure or
2409	licensure renewal.
2410	(b)  In order to determine whether the facility is
2411	adequately protecting residents' rights, the biennial survey
2412	shall include private informal conversations with a sample of
2413	residents and consultation with the ombudsman council in the
2414	planning and service area in which the facility is located to
2415	discuss residents' experiences within the facility.
2416	(c)  During any calendar year in which no survey is
2417	conducted, the agency shall conduct at least one monitoring
2418	visit of each facility cited in the previous year for a class I
2419	or class II violation, or more than three uncorrected class III
2420	violations.
2421	(d)  The agency may conduct periodic followup inspections
2422	as necessary to monitor the compliance of facilities with a
2423	history of any class I, class II, or class III violations that
2424	threaten the health, safety, or security of residents.
2425	(e)  The agency may conduct complaint investigations as
2426	warranted to investigate any allegations of noncompliance with
2427	requirements required under this part or rules adopted under
2428	this part.
2429	Section 71.  Subsection (2) of section 429.35, Florida
2430	Statutes, is amended to read:
2431	429.35  Maintenance of records; reports.-
2432	(2)  Within 60 days after the date of the biennial
2433	inspection visit required under s. 408.811 or within 30 days
2434	after the date of any interim visit, the agency shall forward
2435	the results of the inspection to the local ombudsman council in
2436	whose planning and service area, as defined in part II of
2437	chapter 400, the facility is located; to at least one public
2438	library or, in the absence of a public library, the county seat
2439	in the county in which the inspected assisted living facility is
2440	located; and, when appropriate, to the district Adult Services
2441	and Mental Health Program Offices. This information may be
2442	provided electronically or through the agency's Internet
2443	website.
2444	Section 72.  Paragraphs (i) and (j) of subsection (1) of
2445	section 429.41, Florida Statutes, are amended to read:
2446	429.41  Rules establishing standards.-
2447	(1)  It is the intent of the Legislature that rules
2448	published and enforced pursuant to this section shall include
2449	criteria by which a reasonable and consistent quality of
2450	resident care and quality of life may be ensured and the results
2451	of such resident care may be demonstrated. Such rules shall also
2452	ensure a safe and sanitary environment that is residential and
2453	noninstitutional in design or nature. It is further intended
2454	that reasonable efforts be made to accommodate the needs and
2455	preferences of residents to enhance the quality of life in a
2456	facility. The agency, in consultation with the department, may
2457	adopt rules to administer the requirements of part II of chapter
2458	408. In order to provide safe and sanitary facilities and the
2459	highest quality of resident care accommodating the needs and
2460	preferences of residents, the department, in consultation with
2461	the agency, the Department of Children and Family Services, and
2462	the Department of Health, shall adopt rules, policies, and
2463	procedures to administer this part, which must include
2464	reasonable and fair minimum standards in relation to:
2465	(i)  Facilities holding an a limited nursing, extended
2466	congregate care, or limited mental health license.
2467	(j)  The establishment of specific criteria to define
2468	appropriateness of resident admission and continued residency in
2469	a facility holding a standard, limited nursing, extended
2470	congregate care, and limited mental health license.
2471	Section 73.  Subsections (1) and (2) of section 429.53,
2472	Florida Statutes, are amended to read:
2473	429.53  Consultation by the agency.-
2474	(1)  The area offices of licensure and certification of the
2475	agency shall provide consultation to the following upon request:
2476	(a)  A licensee of a facility.
2477	(b)  A person interested in obtaining a license to operate
2478	a facility under this part.
2479	(2)  As used in this section, "consultation" includes:
2480	(a)  An explanation of the requirements of this part and
2481	rules adopted pursuant thereto;
2482	(b)  An explanation of the license application and renewal
2483	procedures;
2484	(c)  The provision of a checklist of general local and
2485	state approvals required prior to constructing or developing a
2486	facility and a listing of the types of agencies responsible for
2487	such approvals;
2488	(d)  An explanation of benefits and financial assistance
2489	available to a recipient of supplemental security income
2490	residing in a facility;
2491	(c)(e)  Any other information which the agency deems
2492	necessary to promote compliance with the requirements of this
2493	part; and
2494	(f)  A preconstruction review of a facility to ensure
2495	compliance with agency rules and this part.
2496	Section 74.  Subsections (1) and (2) of section 429.54,
2497	Florida Statutes, are renumbered as subsections (2) and (3),
2498	respectively, and a new subsection (1) is added to that section
2499	to read:
2500	429.54  Collection of information; local subsidy.-
2501	(1)  A facility that is licensed under this part must
2502	report electronically to the agency semiannually data related to
2503	the facility, including, but not limited to, the total number of
2504	residents, the number of residents who are receiving limited
2505	mental health services, the number of residents who are
2506	receiving extended congregate care services, the number of
2507	residents who are receiving limited nursing services, and
2508	professional staffing employed by or under contract with the
2509	licensee to provide resident services. The department, in
2510	consultation with the agency, shall adopt rules to administer
2511	this subsection.
2512	Section 75.  Subsections (1) and (5) of section 429.71,
2513	Florida Statutes, are amended to read:
2514	429.71  Classification of violations deficiencies;
2515	administrative fines.-
2516	(1)  In addition to the requirements of part II of chapter
2517	408 and in addition to any other liability or penalty provided
2518	by law, the agency may impose an administrative fine on a
2519	provider according to the following classification:
2520	(a)  Class I violations are defined in s. 408.813 those
2521	conditions or practices related to the operation and maintenance
2522	of an adult family-care home or to the care of residents which
2523	the agency determines present an imminent danger to the
2524	residents or guests of the facility or a substantial probability
2525	that death or serious physical or emotional harm would result
2526	therefrom. The condition or practice that constitutes a class I
2527	violation must be abated or eliminated within 24 hours, unless a
2528	fixed period, as determined by the agency, is required for
2529	correction. A class I violation deficiency is subject to an
2530	administrative fine in an amount not less than $500 and not
2531	exceeding $1,000 for each violation. A fine may be levied
2532	notwithstanding the correction of the deficiency.
2533	(b)  Class II violations are defined in s. 408.813 those
2534	conditions or practices related to the operation and maintenance
2535	of an adult family-care home or to the care of residents which
2536	the agency determines directly threaten the physical or
2537	emotional health, safety, or security of the residents, other
2538	than class I violations. A class II violation is subject to an
2539	administrative fine in an amount not less than $250 and not
2540	exceeding $500 for each violation. A citation for a class II
2541	violation must specify the time within which the violation is
2542	required to be corrected. If a class II violation is corrected
2543	within the time specified, no civil penalty shall be imposed,
2544	unless it is a repeated offense.
2545	(c)  Class III violations are defined in s. 408.813 those
2546	conditions or practices related to the operation and maintenance
2547	of an adult family-care home or to the care of residents which
2548	the agency determines indirectly or potentially threaten the
2549	physical or emotional health, safety, or security of residents,
2550	other than class I or class II violations. A class III violation
2551	is subject to an administrative fine in an amount not less than
2552	$100 and not exceeding $250 for each violation. A citation for a
2553	class III violation shall specify the time within which the
2554	violation is required to be corrected. If a class III violation
2555	is corrected within the time specified, no civil penalty shall
2556	be imposed, unless it is a repeated violation offense.
2557	(d)  Class IV violations are defined in s. 408.813 those
2558	conditions or occurrences related to the operation and
2559	maintenance of an adult family-care home, or related to the
2560	required reports, forms, or documents, which do not have the
2561	potential of negatively affecting the residents. A provider that
2562	does not correct A class IV violation within the time limit
2563	specified by the agency is subject to an administrative fine in
2564	an amount not less than $50 and not exceeding $100 for each
2565	violation. Any class IV violation that is corrected during the
2566	time the agency survey is conducted will be identified as an
2567	agency finding and not as a violation, unless it is a repeat
2568	violation.
2569	(5)  As an alternative to or in conjunction with an
2570	administrative action against a provider, the agency may request
2571	a plan of corrective action that demonstrates a good faith
2572	effort to remedy each violation by a specific date, subject to
2573	the approval of the agency.
2574	Section 76.  Paragraphs (b) through (e) of subsection (2)
2575	of section 429.911, Florida Statutes, are redesignated as
2576	paragraphs (a) through (d), respectively, and present paragraph
2577	(a) of that subsection is amended to read:
2578	429.911  Denial, suspension, revocation of license;
2579	emergency action; administrative fines; investigations and
2580	inspections.-
2581	(2)  Each of the following actions by the owner of an adult
2582	day care center or by its operator or employee is a ground for
2583	action by the agency against the owner of the center or its
2584	operator or employee:
2585	(a)  An intentional or negligent act materially affecting
2586	the health or safety of center participants.
2587	Section 77.  Section 429.915, Florida Statutes, is amended
2588	to read:
2589	429.915  Conditional license.-In addition to the license
2590	categories available in part II of chapter 408, the agency may
2591	issue a conditional license to an applicant for license renewal
2592	or change of ownership if the applicant fails to meet all
2593	standards and requirements for licensure. A conditional license
2594	issued under this subsection must be limited to a specific
2595	period not exceeding 6 months, as determined by the agency, and
2596	must be accompanied by an approved plan of correction.
2597	Section 78.  Paragraphs (b) and (h) of subsection (3) of
2598	section 430.80, Florida Statutes, are amended to read:
2599	430.80  Implementation of a teaching nursing home pilot
2600	project.-
2601	(3)  To be designated as a teaching nursing home, a nursing
2602	home licensee must, at a minimum:
2603	(b)  Participate in a nationally recognized accreditation
2604	program and hold a valid accreditation, such as the
2605	accreditation awarded by The Joint Commission on Accreditation
2606	of Healthcare Organizations;
2607	(h)  Maintain insurance coverage pursuant to s.
2608	400.141(1)(q)(s) or proof of financial responsibility in a
2609	minimum amount of $750,000. Such proof of financial
2610	responsibility may include:
2611	1.  Maintaining an escrow account consisting of cash or
2612	assets eligible for deposit in accordance with s. 625.52; or
2613	2.  Obtaining and maintaining pursuant to chapter 675 an
2614	unexpired, irrevocable, nontransferable and nonassignable letter
2615	of credit issued by any bank or savings association organized
2616	and existing under the laws of this state or any bank or savings
2617	association organized under the laws of the United States that
2618	has its principal place of business in this state or has a
2619	branch office which is authorized to receive deposits in this
2620	state. The letter of credit shall be used to satisfy the
2621	obligation of the facility to the claimant upon presentment of a
2622	final judgment indicating liability and awarding damages to be
2623	paid by the facility or upon presentment of a settlement
2624	agreement signed by all parties to the agreement when such final
2625	judgment or settlement is a result of a liability claim against
2626	the facility.
2627	Section 79.  Paragraph (a) of subsection (2) of section
2628	440.13, Florida Statutes, is amended to read:
2629	440.13  Medical services and supplies; penalty for
2630	violations; limitations.-
2631	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2632	(a)  Subject to the limitations specified elsewhere in this
2633	chapter, the employer shall furnish to the employee such
2634	medically necessary remedial treatment, care, and attendance for
2635	such period as the nature of the injury or the process of
2636	recovery may require, which is in accordance with established
2637	practice parameters and protocols of treatment as provided for
2638	in this chapter, including medicines, medical supplies, durable
2639	medical equipment, orthoses, prostheses, and other medically
2640	necessary apparatus. Remedial treatment, care, and attendance,
2641	including work-hardening programs or pain-management programs
2642	accredited by the Commission on Accreditation of Rehabilitation
2643	Facilities or The Joint Commission on the Accreditation of
2644	Health Organizations or pain-management programs affiliated with
2645	medical schools, shall be considered as covered treatment only
2646	when such care is given based on a referral by a physician as
2647	defined in this chapter. Medically necessary treatment, care,
2648	and attendance does not include chiropractic services in excess
2649	of 24 treatments or rendered 12 weeks beyond the date of the
2650	initial chiropractic treatment, whichever comes first, unless
2651	the carrier authorizes additional treatment or the employee is
2652	catastrophically injured.
2653
2654	Failure of the carrier to timely comply with this subsection
2655	shall be a violation of this chapter and the carrier shall be
2656	subject to penalties as provided for in s. 440.525.
2657	Section 80.  Section 483.294, Florida Statutes, is amended
2658	to read:
2659	483.294  Inspection of centers.-In accordance with s.
2660	408.811, the agency shall biennially, at least once annually,
2661	inspect the premises and operations of all centers subject to
2662	licensure under this part.
2663	Section 81.  Paragraph (a) of subsection (53) of section
2664	499.003, Florida Statutes, is amended to read:
2665	499.003  Definitions of terms used in this part.-As used in
2666	this part, the term:
2667	(53)  "Wholesale distribution" means distribution of
2668	prescription drugs to persons other than a consumer or patient,
2669	but does not include:
2670	(a)  Any of the following activities, which is not a
2671	violation of s. 499.005(21) if such activity is conducted in
2672	accordance with s. 499.01(2)(g):
2673	1.  The purchase or other acquisition by a hospital or
2674	other health care entity that is a member of a group purchasing
2675	organization of a prescription drug for its own use from the
2676	group purchasing organization or from other hospitals or health
2677	care entities that are members of that organization.
2678	2.  The sale, purchase, or trade of a prescription drug or
2679	an offer to sell, purchase, or trade a prescription drug by a
2680	charitable organization described in s. 501(c)(3) of the
2681	Internal Revenue Code of 1986, as amended and revised, to a
2682	nonprofit affiliate of the organization to the extent otherwise
2683	permitted by law.
2684	3.  The sale, purchase, or trade of a prescription drug or
2685	an offer to sell, purchase, or trade a prescription drug among
2686	hospitals or other health care entities that are under common
2687	control. For purposes of this subparagraph, "common control"
2688	means the power to direct or cause the direction of the
2689	management and policies of a person or an organization, whether
2690	by ownership of stock, by voting rights, by contract, or
2691	otherwise.
2692	4.  The sale, purchase, trade, or other transfer of a
2693	prescription drug from or for any federal, state, or local
2694	government agency or any entity eligible to purchase
2695	prescription drugs at public health services prices pursuant to
2696	Pub. L. No. 102-585, s. 602 to a contract provider or its
2697	subcontractor for eligible patients of the agency or entity
2698	under the following conditions:
2699	a.  The agency or entity must obtain written authorization
2700	for the sale, purchase, trade, or other transfer of a
2701	prescription drug under this subparagraph from the State Surgeon
2702	General or his or her designee.
2703	b.  The contract provider or subcontractor must be
2704	authorized by law to administer or dispense prescription drugs.
2705	c.  In the case of a subcontractor, the agency or entity
2706	must be a party to and execute the subcontract.
2707	d.  A contract provider or subcontractor must maintain
2708	separate and apart from other prescription drug inventory any
2709	prescription drugs of the agency or entity in its possession.
2710	d.e.  The contract provider and subcontractor must maintain
2711	and produce immediately for inspection all records of movement
2712	or transfer of all the prescription drugs belonging to the
2713	agency or entity, including, but not limited to, the records of
2714	receipt and disposition of prescription drugs. Each contractor
2715	and subcontractor dispensing or administering these drugs must
2716	maintain and produce records documenting the dispensing or
2717	administration. Records that are required to be maintained
2718	include, but are not limited to, a perpetual inventory itemizing
2719	drugs received and drugs dispensed by prescription number or
2720	administered by patient identifier, which must be submitted to
2721	the agency or entity quarterly.
2722	e.f.  The contract provider or subcontractor may administer
2723	or dispense the prescription drugs only to the eligible patients
2724	of the agency or entity or must return the prescription drugs
2725	for or to the agency or entity. The contract provider or
2726	subcontractor must require proof from each person seeking to
2727	fill a prescription or obtain treatment that the person is an
2728	eligible patient of the agency or entity and must, at a minimum,
2729	maintain a copy of this proof as part of the records of the
2730	contractor or subcontractor required under sub-subparagraph d.
2731	e.
2732	f.g.  In addition to the departmental inspection authority
2733	set forth in s. 499.051, the establishment of the contract
2734	provider and subcontractor and all records pertaining to
2735	prescription drugs subject to this subparagraph shall be subject
2736	to inspection by the agency or entity. All records relating to
2737	prescription drugs of a manufacturer under this subparagraph
2738	shall be subject to audit by the manufacturer of those drugs,
2739	without identifying individual patient information.
2740	Section 82.  Paragraph (i) is added to subsection (3) of
2741	section 499.01212, Florida Statutes, to read:
2742	499.01212  Pedigree paper.-
2743	(3)  EXCEPTIONS.-A pedigree paper is not required for:
2744	(i)  The wholesale distribution of prescription drugs
2745	contained within a sealed medical convenience kit if the kit:
2746	1.  Is assembled in an establishment that is registered as
2747	a medical device manufacturer with the Food and Drug
2748	Administration; and
2749	2.  Does not contain any controlled substance that appears
2750	in any schedule contained in or subject to chapter 893 or the
2751	federal Comprehensive Drug Abuse Prevention and Control Act of
2752	1970.
2753	Section 83.  Subsection (1) of section 627.645, Florida
2754	Statutes, is amended to read:
2755	627.645  Denial of health insurance claims restricted.-
2756	(1)  No claim for payment under a health insurance policy
2757	or self-insured program of health benefits for treatment, care,
2758	or services in a licensed hospital which is accredited by The
2759	Joint Commission on the Accreditation of Hospitals, the American
2760	Osteopathic Association, or the Commission on the Accreditation
2761	of Rehabilitative Facilities shall be denied because such
2762	hospital lacks major surgical facilities and is primarily of a
2763	rehabilitative nature, if such rehabilitation is specifically
2764	for treatment of physical disability.
2765	Section 84.  Paragraph (c) of subsection (2) of section
2766	627.668, Florida Statutes, is amended to read:
2767	627.668  Optional coverage for mental and nervous disorders
2768	required; exception.-
2769	(2)  Under group policies or contracts, inpatient hospital
2770	benefits, partial hospitalization benefits, and outpatient
2771	benefits consisting of durational limits, dollar amounts,
2772	deductibles, and coinsurance factors shall not be less favorable
2773	than for physical illness generally, except that:
2774	(c)  Partial hospitalization benefits shall be provided
2775	under the direction of a licensed physician. For purposes of
2776	this part, the term "partial hospitalization services" is
2777	defined as those services offered by a program accredited by The
2778	Joint Commission on Accreditation of Hospitals (JCAH) or in
2779	compliance with equivalent standards. Alcohol rehabilitation
2780	programs accredited by The Joint Commission on Accreditation of
2781	Hospitals or approved by the state and licensed drug abuse
2782	rehabilitation programs shall also be qualified providers under
2783	this section. In any benefit year, if partial hospitalization
2784	services or a combination of inpatient and partial
2785	hospitalization are utilized, the total benefits paid for all
2786	such services shall not exceed the cost of 30 days of inpatient
2787	hospitalization for psychiatric services, including physician
2788	fees, which prevail in the community in which the partial
2789	hospitalization services are rendered. If partial
2790	hospitalization services benefits are provided beyond the limits
2791	set forth in this paragraph, the durational limits, dollar
2792	amounts, and coinsurance factors thereof need not be the same as
2793	those applicable to physical illness generally.
2794	Section 85.  Subsection (3) of section 627.669, Florida
2795	Statutes, is amended to read:
2796	627.669  Optional coverage required for substance abuse
2797	impaired persons; exception.-
2798	(3)  The benefits provided under this section shall be
2799	applicable only if treatment is provided by, or under the
2800	supervision of, or is prescribed by, a licensed physician or
2801	licensed psychologist and if services are provided in a program
2802	accredited by The Joint Commission on Accreditation of Hospitals
2803	or approved by the state.
2804	Section 86.  Paragraph (a) of subsection (1) of section
2805	627.736, Florida Statutes, is amended to read:
2806	627.736  Required personal injury protection benefits;
2807	exclusions; priority; claims.-
2808	(1)  REQUIRED BENEFITS.-Every insurance policy complying
2809	with the security requirements of s. 627.733 shall provide
2810	personal injury protection to the named insured, relatives
2811	residing in the same household, persons operating the insured
2812	motor vehicle, passengers in such motor vehicle, and other
2813	persons struck by such motor vehicle and suffering bodily injury
2814	while not an occupant of a self-propelled vehicle, subject to
2815	the provisions of subsection (2) and paragraph (4)(e), to a
2816	limit of $10,000 for loss sustained by any such person as a
2817	result of bodily injury, sickness, disease, or death arising out
2818	of the ownership, maintenance, or use of a motor vehicle as
2819	follows:
2820	(a)  Medical benefits.-Eighty percent of all reasonable
2821	expenses for medically necessary medical, surgical, X-ray,
2822	dental, and rehabilitative services, including prosthetic
2823	devices, and medically necessary ambulance, hospital, and
2824	nursing services. However, the medical benefits shall provide
2825	reimbursement only for such services and care that are lawfully
2826	provided, supervised, ordered, or prescribed by a physician
2827	licensed under chapter 458 or chapter 459, a dentist licensed
2828	under chapter 466, or a chiropractic physician licensed under
2829	chapter 460 or that are provided by any of the following persons
2830	or entities:
2831	1.  A hospital or ambulatory surgical center licensed under
2832	chapter 395.
2833	2.  A person or entity licensed under ss. 401.2101-401.45
2834	that provides emergency transportation and treatment.
2835	3.  An entity wholly owned by one or more physicians
2836	licensed under chapter 458 or chapter 459, chiropractic
2837	physicians licensed under chapter 460, or dentists licensed
2838	under chapter 466 or by such practitioner or practitioners and
2839	the spouse, parent, child, or sibling of that practitioner or
2840	those practitioners.
2841	4.  An entity wholly owned, directly or indirectly, by a
2842	hospital or hospitals.
2843	5.  A health care clinic licensed under ss. 400.990-400.995
2844	that is:
2845	a.  Accredited by The Joint Commission on Accreditation of
2846	Healthcare Organizations, the American Osteopathic Association,
2847	the Commission on Accreditation of Rehabilitation Facilities, or
2848	the Accreditation Association for Ambulatory Health Care, Inc.;
2849	or
2850	b.  A health care clinic that:
2851	(I)  Has a medical director licensed under chapter 458,
2852	chapter 459, or chapter 460;
2853	(II)  Has been continuously licensed for more than 3 years
2854	or is a publicly traded corporation that issues securities
2855	traded on an exchange registered with the United States
2856	Securities and Exchange Commission as a national securities
2857	exchange; and
2858	(III)  Provides at least four of the following medical
2859	specialties:
2860	(A)  General medicine.
2861	(B)  Radiography.
2862	(C)  Orthopedic medicine.
2863	(D)  Physical medicine.
2864	(E)  Physical therapy.
2865	(F)  Physical rehabilitation.
2866	(G)  Prescribing or dispensing outpatient prescription
2867	medication.
2868	(H)  Laboratory services.
2869
2870	The Financial Services Commission shall adopt by rule the form
2871	that must be used by an insurer and a health care provider
2872	specified in subparagraph 3., subparagraph 4., or subparagraph
2873	5. to document that the health care provider meets the criteria
2874	of this paragraph, which rule must include a requirement for a
2875	sworn statement or affidavit.
2876
2877	Only insurers writing motor vehicle liability insurance in this
2878	state may provide the required benefits of this section, and no
2879	such insurer shall require the purchase of any other motor
2880	vehicle coverage other than the purchase of property damage
2881	liability coverage as required by s. 627.7275 as a condition for
2882	providing such required benefits. Insurers may not require that
2883	property damage liability insurance in an amount greater than
2884	$10,000 be purchased in conjunction with personal injury
2885	protection. Such insurers shall make benefits and required
2886	property damage liability insurance coverage available through
2887	normal marketing channels. Any insurer writing motor vehicle
2888	liability insurance in this state who fails to comply with such
2889	availability requirement as a general business practice shall be
2890	deemed to have violated part IX of chapter 626, and such
2891	violation shall constitute an unfair method of competition or an
2892	unfair or deceptive act or practice involving the business of
2893	insurance; and any such insurer committing such violation shall
2894	be subject to the penalties afforded in such part, as well as
2895	those which may be afforded elsewhere in the insurance code.
2896	Section 87.  Section 633.081, Florida Statutes, is amended
2897	to read:
2898	633.081  Inspection of buildings and equipment; orders;
2899	firesafety inspection training requirements; certification;
2900	disciplinary action.-The State Fire Marshal and her or his
2901	agents shall, at any reasonable hour, when the department has
2902	reasonable cause to believe that a violation of this chapter or
2903	s. 509.215, or a rule promulgated thereunder, or a minimum
2904	firesafety code adopted by a local authority, may exist, inspect
2905	any and all buildings and structures which are subject to the
2906	requirements of this chapter or s. 509.215 and rules promulgated
2907	thereunder. The authority to inspect shall extend to all
2908	equipment, vehicles, and chemicals which are located within the
2909	premises of any such building or structure. The State Fire
2910	Marshal and her or his agents shall inspect nursing homes
2911	licensed under part II of chapter 400 only once every calendar
2912	year and upon receiving a complaint forming the basis of a
2913	reasonable cause to believe that a violation of this chapter or
2914	s. 509.215, or a rule promulgated thereunder, or a minimum
2915	firesafety code adopted by a local authority may exist and upon
2916	identifying such a violation in the course of conducting
2917	orientation or training activities within a nursing home.
2918	(1)  Each county, municipality, and special district that
2919	has firesafety enforcement responsibilities shall employ or
2920	contract with a firesafety inspector. The firesafety inspector
2921	must conduct all firesafety inspections that are required by
2922	law. The governing body of a county, municipality, or special
2923	district that has firesafety enforcement responsibilities may
2924	provide a schedule of fees to pay only the costs of inspections
2925	conducted pursuant to this subsection and related administrative
2926	expenses. Two or more counties, municipalities, or special
2927	districts that have firesafety enforcement responsibilities may
2928	jointly employ or contract with a firesafety inspector.
2929	(2)  Every firesafety inspection conducted pursuant to
2930	state or local firesafety requirements shall be by a person
2931	certified as having met the inspection training requirements set
2932	by the State Fire Marshal. Such person shall:
2933	(a)  Be a high school graduate or the equivalent as
2934	determined by the department;
2935	(b)  Not have been found guilty of, or having pleaded
2936	guilty or nolo contendere to, a felony or a crime punishable by
2937	imprisonment of 1 year or more under the law of the United
2938	States, or of any state thereof, which involves moral turpitude,
2939	without regard to whether a judgment of conviction has been
2940	entered by the court having jurisdiction of such cases;
2941	(c)  Have her or his fingerprints on file with the
2942	department or with an agency designated by the department;
2943	(d)  Have good moral character as determined by the
2944	department;
2945	(e)  Be at least 18 years of age;
2946	(f)  Have satisfactorily completed the firesafety inspector
2947	certification examination as prescribed by the department; and
2948	(g)1.  Have satisfactorily completed, as determined by the
2949	department, a firesafety inspector training program of not less
2950	than 200 hours established by the department and administered by
2951	agencies and institutions approved by the department for the
2952	purpose of providing basic certification training for firesafety
2953	inspectors; or
2954	2.  Have received in another state training which is
2955	determined by the department to be at least equivalent to that
2956	required by the department for approved firesafety inspector
2957	education and training programs in this state.
2958	(3)  Each special state firesafety inspection which is
2959	required by law and is conducted by or on behalf of an agency of
2960	the state must be performed by an individual who has met the
2961	provision of subsection (2), except that the duration of the
2962	training program shall not exceed 120 hours of specific training
2963	for the type of property that such special state firesafety
2964	inspectors are assigned to inspect.
2965	(4)  A firefighter certified pursuant to s. 633.35 may
2966	conduct firesafety inspections, under the supervision of a
2967	certified firesafety inspector, while on duty as a member of a
2968	fire department company conducting inservice firesafety
2969	inspections without being certified as a firesafety inspector,
2970	if such firefighter has satisfactorily completed an inservice
2971	fire department company inspector training program of at least
2972	24 hours' duration as provided by rule of the department.
2973	(5)  Every firesafety inspector or special state firesafety
2974	inspector certificate is valid for a period of 3 years from the
2975	date of issuance. Renewal of certification shall be subject to
2976	the affected person's completing proper application for renewal
2977	and meeting all of the requirements for renewal as established
2978	under this chapter or by rule promulgated thereunder, which
2979	shall include completion of at least 40 hours during the
2980	preceding 3-year period of continuing education as required by
2981	the rule of the department or, in lieu thereof, successful
2982	passage of an examination as established by the department.
2983	(6)  The State Fire Marshal may deny, refuse to renew,
2984	suspend, or revoke the certificate of a firesafety inspector or
2985	special state firesafety inspector if it finds that any of the
2986	following grounds exist:
2987	(a)  Any cause for which issuance of a certificate could
2988	have been refused had it then existed and been known to the
2989	State Fire Marshal.
2990	(b)  Violation of this chapter or any rule or order of the
2991	State Fire Marshal.
2992	(c)  Falsification of records relating to the certificate.
2993	(d)  Having been found guilty of or having pleaded guilty
2994	or nolo contendere to a felony, whether or not a judgment of
2995	conviction has been entered.
2996	(e)  Failure to meet any of the renewal requirements.
2997	(f)  Having been convicted of a crime in any jurisdiction
2998	which directly relates to the practice of fire code inspection,
2999	plan review, or administration.
3000	(g)  Making or filing a report or record that the
3001	certificateholder knows to be false, or knowingly inducing
3002	another to file a false report or record, or knowingly failing
3003	to file a report or record required by state or local law, or
3004	knowingly impeding or obstructing such filing, or knowingly
3005	inducing another person to impede or obstruct such filing.
3006	(h)  Failing to properly enforce applicable fire codes or
3007	permit requirements within this state which the
3008	certificateholder knows are applicable by committing willful
3009	misconduct, gross negligence, gross misconduct, repeated
3010	negligence, or negligence resulting in a significant danger to
3011	life or property.
3012	(i)  Accepting labor, services, or materials at no charge
3013	or at a noncompetitive rate from any person who performs work
3014	that is under the enforcement authority of the certificateholder
3015	and who is not an immediate family member of the
3016	certificateholder. For the purpose of this paragraph, the term
3017	"immediate family member" means a spouse, child, parent,
3018	sibling, grandparent, aunt, uncle, or first cousin of the person
3019	or the person's spouse or any person who resides in the primary
3020	residence of the certificateholder.
3021	(7)  The department shall provide by rule for the
3022	certification of firesafety inspectors.
3023	Section 88.  Subsection (12) of section 641.495, Florida
3024	Statutes, is amended to read:
3025	641.495  Requirements for issuance and maintenance of
3026	certificate.-
3027	(12)  The provisions of part I of chapter 395 do not apply
3028	to a health maintenance organization that, on or before January
3029	1, 1991, provides not more than 10 outpatient holding beds for
3030	short-term and hospice-type patients in an ambulatory care
3031	facility for its members, provided that such health maintenance
3032	organization maintains current accreditation by The Joint
3033	Commission on Accreditation of Health Care Organizations, the
3034	Accreditation Association for Ambulatory Health Care, or the
3035	National Committee for Quality Assurance.
3036	Section 89.  Subsection (13) of section 651.118, Florida
3037	Statutes, is amended to read:
3038	651.118  Agency for Health Care Administration;
3039	certificates of need; sheltered beds; community beds.-
3040	(13)  Residents, as defined in this chapter, are not
3041	considered new admissions for the purpose of s.
3042	400.141(1)(n)(o)1.d.
3043	Section 90.  Subsection (2) of section 766.1015, Florida
3044	Statutes, is amended to read:
3045	766.1015  Civil immunity for members of or consultants to
3046	certain boards, committees, or other entities.-
3047	(2)  Such committee, board, group, commission, or other
3048	entity must be established in accordance with state law or in
3049	accordance with requirements of The Joint Commission on
3050	Accreditation of Healthcare Organizations, established and duly
3051	constituted by one or more public or licensed private hospitals
3052	or behavioral health agencies, or established by a governmental
3053	agency. To be protected by this section, the act, decision,
3054	omission, or utterance may not be made or done in bad faith or
3055	with malicious intent.
3056	Section 91.  Subsection (4) of section 766.202, Florida
3057	Statutes, is amended to read:
3058	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3059	766.201-766.212, the term:
3060	(4)  "Health care provider" means any hospital, ambulatory
3061	surgical center, or mobile surgical facility as defined and
3062	licensed under chapter 395; a birth center licensed under
3063	chapter 383; any person licensed under chapter 458, chapter 459,
3064	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3065	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3066	or chapter 486; a clinical lab licensed under chapter 483; a
3067	health maintenance organization certificated under part I of
3068	chapter 641; a blood bank; a plasma center; an industrial
3069	clinic; a renal dialysis facility; or a professional association
3070	partnership, corporation, joint venture, or other association
3071	for professional activity by health care providers.
3072	Section 92.  This act shall take effect July 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.