CS/CS/CS/HB 1143

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., relating to the Drug-Free Workplace Act; deleting an
4	obsolete provision; amending s. 318.21, F.S.; revising
5	distribution of funds from civil penalties imposed for
6	traffic infractions by county courts; amending s.
7	381.00315, F.S.; directing the Department of Health to
8	accept funds from counties, municipalities, and certain
9	other entities for the purchase of certain products made
10	available under a contract of the United States Department
11	of Health and Human Services for the manufacture and
12	delivery of such products in response to a public health
13	emergency; amending s. 381.0072, F.S.; limiting Department
14	of Health food service inspections in nursing homes;
15	requiring the department to coordinate inspections with
16	the Agency for Health Care Administration; repealing s.
17	383.325, F.S., relating to confidentiality of inspection
18	reports of licensed birth center facilities; amending s.
19	395.002, F.S.; revising and deleting definitions
20	applicable to regulation of hospitals and other licensed
21	facilities; conforming a cross-reference; amending s.
22	395.003, F.S.; deleting an obsolete provision; conforming
23	a cross-reference; amending s. 395.0193, F.S.; requiring a
24	licensed facility to report certain peer review
25	information and final disciplinary actions to the Division
26	of Medical Quality Assurance of the Department of Health
27	rather than the Division of Health Quality Assurance of
28	the Agency for Health Care Administration; amending s.
29	395.1023, F.S.; providing for the Department of Children
30	and Family Services rather than the Department of Health
31	to perform certain functions with respect to child
32	protection cases; requiring certain hospitals to notify
33	the Department of Children and Family Services of
34	compliance; amending s. 395.1041, F.S., relating to
35	hospital emergency services and care; deleting obsolete
36	provisions; repealing s. 395.1046, F.S., relating to
37	complaint investigation procedures; amending s. 395.1055,
38	F.S.; requiring licensed facility beds to conform to
39	standards specified by the Agency for Health Care
40	Administration, the Florida Building Code, and the Florida
41	Fire Prevention Code; amending s. 395.10972, F.S.;
42	revising a reference to the Florida Society of Healthcare
43	Risk Management to conform to the current designation;
44	amending s. 395.2050, F.S.; revising a reference to the
45	federal Health Care Financing Administration to conform to
46	the current designation; amending s. 395.3036, F.S.;
47	correcting a reference; repealing s. 395.3037, F.S.,
48	relating to redundant definitions; amending ss. 154.11,
49	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
50	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
51	F.S.; revising references to the Joint Commission on
52	Accreditation of Healthcare Organizations, the Commission
53	on Accreditation of Rehabilitation Facilities, and the
54	Council on Accreditation to conform to their current
55	designations; amending s. 395.602, F.S.; revising the
56	definition of the term "rural hospital" to delete an
57	obsolete provision; amending s. 400.021, F.S.; revising
58	the definition of the term "geriatric outpatient clinic";
59	amending s. 400.0255, F.S.; correcting an obsolete cross-
60	reference to administrative rules; amending s. 400.063,
61	F.S.; deleting an obsolete provision; amending ss. 400.071
62	and 400.0712, F.S.; revising applicability of general
63	licensure requirements under part II of ch. 408, F.S., to
64	applications for nursing home licensure; revising
65	provisions governing inactive licenses; amending s.
66	400.111, F.S.; providing for disclosure of controlling
67	interest of a nursing home facility upon request by the
68	Agency for Health Care Administration; amending s.
69	400.1183, F.S.; revising grievance record maintenance and
70	reporting requirements for nursing homes; amending s.
71	400.141, F.S.; providing criteria for the provision of
72	respite services by nursing homes; requiring a written
73	plan of care; requiring a contract for services; requiring
74	resident release to caregivers to be designated in
75	writing; providing an exemption to the application of
76	discharge planning rules; providing for residents' rights;
77	providing for use of personal medications; providing terms
78	of respite stay; providing for communication of patient
79	information; requiring a physician order for care and
80	proof of a physical examination; providing for services
81	for respite patients and duties of facilities with respect
82	to such patients; conforming a cross-reference; requiring
83	facilities to maintain clinical records that meet
84	specified standards; providing a fine relating to an
85	admissions moratorium; deleting requirement for facilities
86	to submit certain information related to management
87	companies to the agency; deleting a requirement for
88	facilities to notify the agency of certain bankruptcy
89	filings to conform to changes made by the act; amending s.
90	400.142, F.S.; deleting language relating to agency
91	adoption of rules; amending 400.147, F.S.; revising
92	reporting requirements for licensed nursing home
93	facilities relating to adverse incidents; repealing s.
94	400.148, F.S., relating to the Medicaid "Up-or-Out"
95	Quality of Care Contract Management Program; amending s.
96	400.162, F.S., requiring nursing homes to provide a
97	resident property statement annually and upon request;
98	amending s. 400.179, F.S.; revising requirements for
99	nursing home lease bond alternative fees; deleting an
100	obsolete provision; amending s. 400.19, F.S.; revising
101	inspection requirements; repealing s. 400.195, F.S.,
102	relating to agency reporting requirements; amending s.
103	400.23, F.S.; deleting an obsolete provision; correcting a
104	reference; directing the agency to adopt rules for minimum
105	staffing standards in nursing homes that serve persons
106	under 21 years of age; providing minimum staffing
107	standards; amending s. 400.275, F.S.; revising agency
108	duties with regard to training nursing home surveyor
109	teams; revising requirements for team members; amending s.
110	400.484, F.S.; revising the schedule of home health agency
111	inspection violations; amending s. 400.606, F.S.; revising
112	the content requirements of the plan accompanying an
113	initial or change-of-ownership application for licensure
114	of a hospice; revising requirements relating to
115	certificates of need for certain hospice facilities;
116	amending s. 400.607, F.S.; revising grounds for agency
117	action against a hospice; amending s. 400.915, F.S.;
118	correcting an obsolete cross-reference to administrative
119	rules; amending s. 400.931, F.S.; deleting a requirement
120	that an applicant for a home medical equipment provider
121	license submit a surety bond to the agency; amending s.
122	400.932, F.S.; revising grounds for the imposition of
123	administrative penalties for certain violations by an
124	employee of a home medical equipment provider; amending s.
125	400.967, F.S.; revising the schedule of inspection
126	violations for intermediate care facilities for the
127	developmentally disabled; providing a penalty for certain
128	violations; amending s. 400.9905, F.S.; providing that
129	part X of ch, 400, F.S., the Health Care Clinic Act, does
130	not apply to an entity owned by a corporation with a
131	specified amount of annual sales of health care services
132	under certain circumstances or to an entity owned or
133	controlled by a publicly traded entity with a specified
134	amount of annual revenues; amending s. 400.991, F.S.;
135	conforming terminology; revising application requirements
136	relating to documentation of financial ability to operate
137	a mobile clinic; amending s. 408.034, F.S.; revising
138	agency authority relating to licensing of intermediate
139	care facilities for the developmentally disabled; amending
140	s. 408.036, F.S.; deleting an exemption from certain
141	certificate-of-need review requirements for a hospice or a
142	hospice inpatient facility; amending s. 408.043, F.S.;
143	revising requirements for certain freestanding inpatient
144	hospice care facilities to obtain a certificate of need;
145	amending s. 408.061, F.S.; revising health care facility
146	data reporting requirements; amending s. 408.10, F.S.;
147	removing agency authority to investigate certain consumer
148	complaints; amending s. 408.802, F.S.; removing
149	applicability of part II of ch. 408, F.S., relating to
150	general licensure requirements, to private review agents;
151	amending s. 408.804, F.S.; providing penalties for
152	altering, defacing, or falsifying a license certificate
153	issued by the agency or displaying such an altered,
154	defaced, or falsified certificate; amending s. 408.806,
155	F.S.; revising agency responsibilities for notification of
156	licensees of impending expiration of a license; requiring
157	payment of a late fee for a license application to be
158	considered complete under certain circumstances; amending
159	s. 408.810, F.S.; revising provisions relating to
160	information required for licensure; requiring proof of
161	submission of notice to a mortgagor or landlord regarding
162	provision of services requiring licensure; requiring
163	disclosure of information by a controlling interest of
164	certain court actions relating to financial instability
165	within a specified time period; amending s. 408.813, F.S.;
166	authorizing the agency to impose fines for unclassified
167	violations of part II of ch. 408, F.S.; amending s.
168	408.815, F.S.; authorizing the agency to extend a license
169	expiration date under certain circumstances; amending s.
170	409.221, F.S.; deleting a reporting requirement relating
171	to the consumer-directed care program; amending s.
172	409.91196, F.S.; conforming a cross-reference; amending s.
173	409.912, F.S.; revising procedures for implementation of a
174	Medicaid prescribed-drug spending-control program;
175	amending s. 429.07, F.S.; deleting the requirement for an
176	assisted living facility to obtain an additional license
177	in order to provide limited nursing services; deleting the
178	requirement for the agency to conduct quarterly monitoring
179	visits of facilities that hold a license to provide
180	extended congregate care services; deleting the
181	requirement for the department to report annually on the
182	status of and recommendations related to extended
183	congregate care; deleting the requirement for the agency
184	to conduct monitoring visits at least twice a year to
185	facilities providing limited nursing services; increasing
186	the licensure fees and the maximum fee required for the
187	standard license; increasing the licensure fees for the
188	extended congregate care license; eliminating the license
189	fee for the limited nursing services license; transferring
190	from another provision of law the requirement that a
191	biennial survey of an assisted living facility include
192	specific actions to determine whether the facility is
193	adequately protecting residents' rights; providing that an
194	assisted living facility that has a class I or class II
195	violation is subject to monitoring visits; requiring a
196	registered nurse to participate in certain monitoring
197	visits; amending s. 429.11, F.S.; revising licensure
198	application requirements for assisted living facilities to
199	eliminate provisional licenses; amending s. 429.12, F.S.;
200	revising notification requirements for the sale or
201	transfer of ownership of an assisted living facility;
202	amending s. 429.14, F.S.; removing a ground for the
203	imposition of an administrative penalty; clarifying
204	provisions relating to a facility's request for a hearing
205	under certain circumstances; authorizing the agency to
206	provide certain information relating to the licensure
207	status of assisted living facilities electronically or
208	through the agency's Internet website; amending s. 429.17,
209	F.S.; deleting provisions relating to the limited nursing
210	services license; revising agency responsibilities
211	regarding the issuance of conditional licenses; amending
212	s. 429.19, F.S.; clarifying that a monitoring fee may be
213	assessed in addition to an administrative fine; amending
214	s. 429.23, F.S.; deleting reporting requirements for
215	assisted living facilities relating to liability claims;
216	amending s. 429.255, F.S.; eliminating provisions
217	authorizing the use of volunteers to provide certain
218	health-care-related services in assisted living
219	facilities; authorizing assisted living facilities to
220	provide limited nursing services; requiring an assisted
221	living facility to be responsible for certain
222	recordkeeping and staff to be trained to monitor residents
223	receiving certain health-care-related services; amending
224	s. 429.28, F.S.; deleting a requirement for a biennial
225	survey of an assisted living facility, to conform to
226	changes made by the act; amending s. 429.35, F.S.;
227	authorizing the agency to provide certain information
228	relating to the inspections of assisted living facilities
229	electronically or through the agency's Internet website;
230	amending s. 429.41, F.S., relating to rulemaking;
231	conforming provisions to changes made by the act; amending
232	s. 429.53, F.S.; revising provisions relating to
233	consultation by the agency; revising a definition;
234	amending s. 429.54, F.S.; requiring licensed assisted
235	living facilities to electronically report certain data
236	semiannually to the agency in accordance with rules
237	adopted by the department; amending s. 429.71, F.S.;
238	revising schedule of inspection violations for adult
239	family-care homes; amending s. 429.911, F.S.; deleting a
240	ground for agency action against an adult day care center;
241	amending s. 429.915, F.S.; revising agency
242	responsibilities regarding the issuance of conditional
243	licenses; amending s. 483.294, F.S.; revising frequency of
244	agency inspections of multiphasic health testing centers;
245	amending s. 499.003, F.S.; defining the term "medical
246	convenience kit" for purposes of pt. I of ch. 499, F.S.;
247	providing an exception to applicability of the term;
248	removing a requirement that certain prescription drug
249	purchasers maintain a separate inventory of certain
250	prescription drugs; amending s. 633.081, F.S.; limiting
251	Fire Marshal inspections of nursing homes to once a year;
252	providing for additional inspections based on complaints
253	and violations identified in the course of orientation or
254	training activities; amending s. 766.202, F.S.; adding
255	persons licensed under part XIV of ch. 468, F.S., to the
256	definition of "health care provider"; amending ss.
257	394.4787, 400.0239, 408.07, 430.80, and 651.118, F.S.;
258	conforming terminology and cross-references; revising a
259	reference; providing an effective date.
260
261	Be It Enacted by the Legislature of the State of Florida:
262
263	Section 1.  Present paragraph (e) of subsection (10) and
264	paragraph (e) of subsection (14) of section 112.0455, Florida
265	Statutes, are amended, and paragraphs (f) through (k) of
266	subsection (10) of that section are redesignated as paragraphs
267	(e) through (j), respectively, to read:
268	112.0455  Drug-Free Workplace Act.-
269	(10)  EMPLOYER PROTECTION.-
270	(e)  Nothing in this section shall be construed to operate
271	retroactively, and nothing in this section shall abrogate the
272	right of an employer under state law to conduct drug tests prior
273	to January 1, 1990. A drug test conducted by an employer prior
274	to January 1, 1990, is not subject to this section.
275	(14)  DISCIPLINE REMEDIES.-
276	(e)  Upon resolving an appeal filed pursuant to paragraph
277	(c), and finding a violation of this section, the commission may
278	order the following relief:
279	1.  Rescind the disciplinary action, expunge related
280	records from the personnel file of the employee or job applicant
281	and reinstate the employee.
282	2.  Order compliance with paragraph (10)(f)(g).
283	3.  Award back pay and benefits.
284	4.  Award the prevailing employee or job applicant the
285	necessary costs of the appeal, reasonable attorney's fees, and
286	expert witness fees.
287	Section 2.  Paragraph (n) of subsection (1) of section
288	154.11, Florida Statutes, is amended to read:
289	154.11  Powers of board of trustees.-
290	(1)  The board of trustees of each public health trust
291	shall be deemed to exercise a public and essential governmental
292	function of both the state and the county and in furtherance
293	thereof it shall, subject to limitation by the governing body of
294	the county in which such board is located, have all of the
295	powers necessary or convenient to carry out the operation and
296	governance of designated health care facilities, including, but
297	without limiting the generality of, the foregoing:
298	(n)  To appoint originally the staff of physicians to
299	practice in any designated facility owned or operated by the
300	board and to approve the bylaws and rules to be adopted by the
301	medical staff of any designated facility owned and operated by
302	the board, such governing regulations to be in accordance with
303	the standards of The Joint Commission on the Accreditation of
304	Hospitals which provide, among other things, for the method of
305	appointing additional staff members and for the removal of staff
306	members.
307	Section 3.  Subsection (15) of section 318.21, Florida
308	Statutes, is amended to read:
309	318.21  Disposition of civil penalties by county courts.-
310	All civil penalties received by a county court pursuant to the
311	provisions of this chapter shall be distributed and paid monthly
312	as follows:
313	(15)  Of the additional fine assessed under s. 318.18(3)(e)
314	for a violation of s. 316.1893, 50 percent of the moneys
315	received from the fines shall be remitted to the Department of
316	Revenue and deposited into the Brain and Spinal Cord Injury
317	Trust Fund of Department of Health and shall be appropriated to
318	the Department of Health Agency for Health Care Administration
319	as general revenue to provide an enhanced Medicaid payment to
320	nursing homes that serve Medicaid recipients with spinal cord
321	injuries that are medically complex and who are technologically
322	and respiratory dependent with brain and spinal cord injuries.
323	The remaining 50 percent of the moneys received from the
324	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
325	the Department of Revenue and deposited into the Department of
326	Health Administrative Trust Fund to provide financial support to
327	certified trauma centers in the counties where enhanced penalty
328	zones are established to ensure the availability and
329	accessibility of trauma services. Funds deposited into the
330	Administrative Trust Fund under this subsection shall be
331	allocated as follows:
332	(a)  Fifty percent shall be allocated equally among all
333	Level I, Level II, and pediatric trauma centers in recognition
334	of readiness costs for maintaining trauma services.
335	(b)  Fifty percent shall be allocated among Level I, Level
336	II, and pediatric trauma centers based on each center's relative
337	volume of trauma cases as reported in the Department of Health
338	Trauma Registry.
339	Section 4.  Subsection (3) is added to section 381.00315,
340	Florida Statutes, to read:
341	381.00315  Public health advisories; public health
342	emergencies.-The State Health Officer is responsible for
343	declaring public health emergencies and issuing public health
344	advisories.
345	(3)  To facilitate effective emergency management, when the
346	United States Department of Health and Human Services contracts
347	for the manufacture and delivery of licensable products in
348	response to a public health emergency and the terms of those
349	contracts are made available to the states, the department shall
350	accept funds provided by counties, municipalities, and other
351	entities designated in the state emergency management plan
352	required under s. 252.35(2)(a) for the purpose of participation
353	in such contracts. The department shall deposit the funds into
354	the Grants and Donations Trust Fund and expend the funds on
355	behalf of the donor county, municipality, or other entity for
356	the purchase the licensable products made available under the
357	contract.
358	Section 5.  Paragraph (e) is added to subsection (2) of
359	section 381.0072, Florida Statutes, to read:
360	381.0072  Food service protection.-It shall be the duty of
361	the Department of Health to adopt and enforce sanitation rules
362	consistent with law to ensure the protection of the public from
363	food-borne illness. These rules shall provide the standards and
364	requirements for the storage, preparation, serving, or display
365	of food in food service establishments as defined in this
366	section and which are not permitted or licensed under chapter
367	500 or chapter 509.
368	(2)  DUTIES.-
369	(e)  The department shall inspect food service
370	establishments in nursing homes licensed under part II of
371	chapter 400 twice each year. The department may make additional
372	inspections only in response to complaints. The department shall
373	coordinate inspections with the Agency for Health Care
374	Administration, such that the department's inspection is at
375	least 60 days after a recertification visit by the Agency for
376	Health Care Administration.
377	Section 6.  Section 383.325, Florida Statutes, is repealed.
378	Section 7.  Subsection (7) of section 394.4787, Florida
379	Statutes, is amended to read:
380	394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
381	and 394.4789.-As used in this section and ss. 394.4786,
382	394.4788, and 394.4789:
383	(7)  "Specialty psychiatric hospital" means a hospital
384	licensed by the agency pursuant to s. 395.002(26)(28) and part
385	II of chapter 408 as a specialty psychiatric hospital.
386	Section 8.  Subsection (2) of section 394.741, Florida
387	Statutes, is amended to read:
388	394.741  Accreditation requirements for providers of
389	behavioral health care services.-
390	(2)  Notwithstanding any provision of law to the contrary,
391	accreditation shall be accepted by the agency and department in
392	lieu of the agency's and department's facility licensure onsite
393	review requirements and shall be accepted as a substitute for
394	the department's administrative and program monitoring
395	requirements, except as required by subsections (3) and (4),
396	for:
397	(a)  Any organization from which the department purchases
398	behavioral health care services that is accredited by The Joint
399	Commission on Accreditation of Healthcare Organizations or the
400	Council on Accreditation for Children and Family Services, or
401	has those services that are being purchased by the department
402	accredited by the Commission on Accreditation of Rehabilitation
403	Facilities CARF-the Rehabilitation Accreditation Commission.
404	(b)  Any mental health facility licensed by the agency or
405	any substance abuse component licensed by the department that is
406	accredited by The Joint Commission on Accreditation of
407	Healthcare Organizations, the Commission on Accreditation of
408	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
409	Commission, or the Council on Accreditation of Children and
410	Family Services.
411	(c)  Any network of providers from which the department or
412	the agency purchases behavioral health care services accredited
413	by The Joint Commission on Accreditation of Healthcare
414	Organizations, the Commission on Accreditation of Rehabilitation
415	Facilities CARF-the Rehabilitation Accreditation Commission, the
416	Council on Accreditation of Children and Family Services, or the
417	National Committee for Quality Assurance. A provider
418	organization, which is part of an accredited network, is
419	afforded the same rights under this part.
420	Section 9.  Present subsections (15) through (32) of
421	section 395.002, Florida Statutes, are renumbered as subsections
422	(14) through (28), respectively, and present subsections (1),
423	(14), (24), (30), and (31), and paragraph (c) of present
424	subsection (28) of that section are amended to read:
425	395.002  Definitions.-As used in this chapter:
426	(1)  "Accrediting organizations" means nationally
427	recognized or approved accrediting organizations whose standards
428	incorporate comparable licensure requirements as determined by
429	the agency the Joint Commission on Accreditation of Healthcare
430	Organizations, the American Osteopathic Association, the
431	Commission on Accreditation of Rehabilitation Facilities, and
432	the Accreditation Association for Ambulatory Health Care, Inc.
433	(14)  "Initial denial determination" means a determination
434	by a private review agent that the health care services
435	furnished or proposed to be furnished to a patient are
436	inappropriate, not medically necessary, or not reasonable.
437	(24)  "Private review agent" means any person or entity
438	which performs utilization review services for third-party
439	payors on a contractual basis for outpatient or inpatient
440	services. However, the term shall not include full-time
441	employees, personnel, or staff of health insurers, health
442	maintenance organizations, or hospitals, or wholly owned
443	subsidiaries thereof or affiliates under common ownership, when
444	performing utilization review for their respective hospitals,
445	health maintenance organizations, or insureds of the same
446	insurance group. For this purpose, health insurers, health
447	maintenance organizations, and hospitals, or wholly owned
448	subsidiaries thereof or affiliates under common ownership,
449	include such entities engaged as administrators of self-
450	insurance as defined in s. 624.031.
451	(26)(28)  "Specialty hospital" means any facility which
452	meets the provisions of subsection (12), and which regularly
453	makes available either:
454	(c)  Intensive residential treatment programs for children
455	and adolescents as defined in subsection (14) (15).
456	(30)  "Utilization review" means a system for reviewing the
457	medical necessity or appropriateness in the allocation of health
458	care resources of hospital services given or proposed to be
459	given to a patient or group of patients.
460	(31)  "Utilization review plan" means a description of the
461	policies and procedures governing utilization review activities
462	performed by a private review agent.
463	Section 10.  Paragraph (c) of subsection (1) and paragraph
464	(b) of subsection (2) of section 395.003, Florida Statutes, are
465	amended to read:
466	395.003  Licensure; denial, suspension, and revocation.-
467	(1)
468	(c)  Until July 1, 2006, additional emergency departments
469	located off the premises of licensed hospitals may not be
470	authorized by the agency.
471	(2)
472	(b)  The agency shall, at the request of a licensee that is
473	a teaching hospital as defined in s. 408.07(45), issue a single
474	license to a licensee for facilities that have been previously
475	licensed as separate premises, provided such separately licensed
476	facilities, taken together, constitute the same premises as
477	defined in s. 395.002(22)(23). Such license for the single
478	premises shall include all of the beds, services, and programs
479	that were previously included on the licenses for the separate
480	premises. The granting of a single license under this paragraph
481	shall not in any manner reduce the number of beds, services, or
482	programs operated by the licensee.
483	Section 11.  Paragraph (e) of subsection (2) and subsection
484	(4) of section 395.0193, Florida Statutes, are amended to read:
485	395.0193  Licensed facilities; peer review; disciplinary
486	powers; agency or partnership with physicians.-
487	(2)  Each licensed facility, as a condition of licensure,
488	shall provide for peer review of physicians who deliver health
489	care services at the facility. Each licensed facility shall
490	develop written, binding procedures by which such peer review
491	shall be conducted. Such procedures shall include:
492	(e)  Recording of agendas and minutes which do not contain
493	confidential material, for review by the Division of Medical
494	Quality Assurance of the department Health Quality Assurance of
495	the agency.
496	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
497	actions taken under subsection (3) shall be reported in writing
498	to the Division of Medical Quality Assurance of the department
499	Health Quality Assurance of the agency within 30 working days
500	after its initial occurrence, regardless of the pendency of
501	appeals to the governing board of the hospital. The notification
502	shall identify the disciplined practitioner, the action taken,
503	and the reason for such action. All final disciplinary actions
504	taken under subsection (3), if different from those which were
505	reported to the department agency within 30 days after the
506	initial occurrence, shall be reported within 10 working days to
507	the Division of Medical Quality Assurance of the department
508	Health Quality Assurance of the agency in writing and shall
509	specify the disciplinary action taken and the specific grounds
510	therefor. The division shall review each report and determine
511	whether it potentially involved conduct by the licensee that is
512	subject to disciplinary action, in which case s. 456.073 shall
513	apply. The reports are not subject to inspection under s.
514	119.07(1) even if the division's investigation results in a
515	finding of probable cause.
516	Section 12.  Section 395.1023, Florida Statutes, is amended
517	to read:
518	395.1023  Child abuse and neglect cases; duties.-Each
519	licensed facility shall adopt a protocol that, at a minimum,
520	requires the facility to:
521	(1)  Incorporate a facility policy that every staff member
522	has an affirmative duty to report, pursuant to chapter 39, any
523	actual or suspected case of child abuse, abandonment, or
524	neglect; and
525	(2)  In any case involving suspected child abuse,
526	abandonment, or neglect, designate, at the request of the
527	Department of Children and Family Services, a staff physician to
528	act as a liaison between the hospital and the Department of
529	Children and Family Services office which is investigating the
530	suspected abuse, abandonment, or neglect, and the child
531	protection team, as defined in s. 39.01, when the case is
532	referred to such a team.
533
534	Each general hospital and appropriate specialty hospital shall
535	comply with the provisions of this section and shall notify the
536	agency and the Department of Children and Family Services of its
537	compliance by sending a copy of its policy to the agency and the
538	Department of Children and Family Services as required by rule.
539	The failure by a general hospital or appropriate specialty
540	hospital to comply shall be punished by a fine not exceeding
541	$1,000, to be fixed, imposed, and collected by the agency. Each
542	day in violation is considered a separate offense.
543	Section 13.  Subsection (2) and paragraph (d) of subsection
544	(3) of section 395.1041, Florida Statutes, are amended to read:
545	395.1041  Access to emergency services and care.-
546	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
547	shall establish and maintain an inventory of hospitals with
548	emergency services. The inventory shall list all services within
549	the service capability of the hospital, and such services shall
550	appear on the face of the hospital license. Each hospital having
551	emergency services shall notify the agency of its service
552	capability in the manner and form prescribed by the agency. The
553	agency shall use the inventory to assist emergency medical
554	services providers and others in locating appropriate emergency
555	medical care. The inventory shall also be made available to the
556	general public. On or before August 1, 1992, the agency shall
557	request that each hospital identify the services which are
558	within its service capability. On or before November 1, 1992,
559	the agency shall notify each hospital of the service capability
560	to be included in the inventory. The hospital has 15 days from
561	the date of receipt to respond to the notice. By December 1,
562	1992, the agency shall publish a final inventory. Each hospital
563	shall reaffirm its service capability when its license is
564	renewed and shall notify the agency of the addition of a new
565	service or the termination of a service prior to a change in its
566	service capability.
567	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
568	FACILITY OR HEALTH CARE PERSONNEL.-
569	(d)1.  Every hospital shall ensure the provision of
570	services within the service capability of the hospital, at all
571	times, either directly or indirectly through an arrangement with
572	another hospital, through an arrangement with one or more
573	physicians, or as otherwise made through prior arrangements. A
574	hospital may enter into an agreement with another hospital for
575	purposes of meeting its service capability requirement, and
576	appropriate compensation or other reasonable conditions may be
577	negotiated for these backup services.
578	2.  If any arrangement requires the provision of emergency
579	medical transportation, such arrangement must be made in
580	consultation with the applicable provider and may not require
581	the emergency medical service provider to provide transportation
582	that is outside the routine service area of that provider or in
583	a manner that impairs the ability of the emergency medical
584	service provider to timely respond to prehospital emergency
585	calls.
586	3.  A hospital shall not be required to ensure service
587	capability at all times as required in subparagraph 1. if, prior
588	to the receiving of any patient needing such service capability,
589	such hospital has demonstrated to the agency that it lacks the
590	ability to ensure such capability and it has exhausted all
591	reasonable efforts to ensure such capability through backup
592	arrangements. In reviewing a hospital's demonstration of lack of
593	ability to ensure service capability, the agency shall consider
594	factors relevant to the particular case, including the
595	following:
596	a.  Number and proximity of hospitals with the same service
597	capability.
598	b.  Number, type, credentials, and privileges of
599	specialists.
600	c.  Frequency of procedures.
601	d.  Size of hospital.
602	4.  The agency shall publish proposed rules implementing a
603	reasonable exemption procedure by November 1, 1992. Subparagraph
604	1. shall become effective upon the effective date of said rules
605	or January 31, 1993, whichever is earlier. For a period not to
606	exceed 1 year from the effective date of subparagraph 1., a
607	hospital requesting an exemption shall be deemed to be exempt
608	from offering the service until the agency initially acts to
609	deny or grant the original request. The agency has 45 days from
610	the date of receipt of the request to approve or deny the
611	request. After the first year from the effective date of
612	subparagraph 1., If the agency fails to initially act within the
613	time period, the hospital is deemed to be exempt from offering
614	the service until the agency initially acts to deny the request.
615	Section 14.  Section 395.1046, Florida Statutes, is
616	repealed.
617	Section 15.  Paragraph (e) of subsection (1) of section
618	395.1055, Florida Statutes, is amended to read:
619	395.1055  Rules and enforcement.-
620	(1)  The agency shall adopt rules pursuant to ss.
621	120.536(1) and 120.54 to implement the provisions of this part,
622	which shall include reasonable and fair minimum standards for
623	ensuring that:
624	(e)  Licensed facility beds conform to minimum space,
625	equipment, and furnishings standards as specified by the agency,
626	the Florida Building Code, and the Florida Fire Prevention Code
627	department.
628	Section 16.  Subsection (1) of section 395.10972, Florida
629	Statutes, is amended to read:
630	395.10972  Health Care Risk Manager Advisory Council.-The
631	Secretary of Health Care Administration may appoint a seven-
632	member advisory council to advise the agency on matters
633	pertaining to health care risk managers. The members of the
634	council shall serve at the pleasure of the secretary. The
635	council shall designate a chair. The council shall meet at the
636	call of the secretary or at those times as may be required by
637	rule of the agency. The members of the advisory council shall
638	receive no compensation for their services, but shall be
639	reimbursed for travel expenses as provided in s. 112.061. The
640	council shall consist of individuals representing the following
641	areas:
642	(1)  Two shall be active health care risk managers,
643	including one risk manager who is recommended by and a member of
644	the Florida Society for of Healthcare Risk Management and
645	Patient Safety.
646	Section 17.  Subsection (3) of section 395.2050, Florida
647	Statutes, is amended to read:
648	395.2050  Routine inquiry for organ and tissue donation;
649	certification for procurement activities; death records review.-
650	(3)  Each organ procurement organization designated by the
651	federal Centers for Medicare and Medicaid Services Health Care
652	Financing Administration and licensed by the state shall conduct
653	an annual death records review in the organ procurement
654	organization's affiliated donor hospitals. The organ procurement
655	organization shall enlist the services of every Florida licensed
656	tissue bank and eye bank affiliated with or providing service to
657	the donor hospital and operating in the same service area to
658	participate in the death records review.
659	Section 18.  Subsection (2) of section 395.3036, Florida
660	Statutes, is amended to read:
661	395.3036  Confidentiality of records and meetings of
662	corporations that lease public hospitals or other public health
663	care facilities.-The records of a private corporation that
664	leases a public hospital or other public health care facility
665	are confidential and exempt from the provisions of s. 119.07(1)
666	and s. 24(a), Art. I of the State Constitution, and the meetings
667	of the governing board of a private corporation are exempt from
668	s. 286.011 and s. 24(b), Art. I of the State Constitution when
669	the public lessor complies with the public finance
670	accountability provisions of s. 155.40(5) with respect to the
671	transfer of any public funds to the private lessee and when the
672	private lessee meets at least three of the five following
673	criteria:
674	(2)  The public lessor and the private lessee do not
675	commingle any of their funds in any account maintained by either
676	of them, other than the payment of the rent and administrative
677	fees or the transfer of funds pursuant to s. 155.40     (2)
678	subsection (2).
679	Section 19.  Section 395.3037, Florida Statutes, is
680	repealed.
681	Section 20.  Subsections (1), (4), and (5) of section
682	395.3038, Florida Statutes, are amended to read:
683	395.3038  State-listed primary stroke centers and
684	comprehensive stroke centers; notification of hospitals.-
685	(1)  The agency shall make available on its website and to
686	the department a list of the name and address of each hospital
687	that meets the criteria for a primary stroke center and the name
688	and address of each hospital that meets the criteria for a
689	comprehensive stroke center. The list of primary and
690	comprehensive stroke centers shall include only those hospitals
691	that attest in an affidavit submitted to the agency that the
692	hospital meets the named criteria, or those hospitals that
693	attest in an affidavit submitted to the agency that the hospital
694	is certified as a primary or a comprehensive stroke center by
695	The Joint Commission on Accreditation of Healthcare
696	Organizations.
697	(4)  The agency shall adopt by rule criteria for a primary
698	stroke center which are substantially similar to the
699	certification standards for primary stroke centers of The Joint
700	Commission on Accreditation of Healthcare Organizations.
701	(5)  The agency shall adopt by rule criteria for a
702	comprehensive stroke center. However, if The Joint Commission on
703	Accreditation of Healthcare Organizations establishes criteria
704	for a comprehensive stroke center, the agency shall establish
705	criteria for a comprehensive stroke center which are
706	substantially similar to those criteria established by The Joint
707	Commission on Accreditation of Healthcare Organizations.
708	Section 21.  Paragraph (e) of subsection (2) of section
709	395.602, Florida Statutes, is amended to read:
710	395.602  Rural hospitals.-
711	(2)  DEFINITIONS.-As used in this part:
712	(e)  "Rural hospital" means an acute care hospital licensed
713	under this chapter, having 100 or fewer licensed beds and an
714	emergency room, which is:
715	1.  The sole provider within a county with a population
716	density of no greater than 100 persons per square mile;
717	2.  An acute care hospital, in a county with a population
718	density of no greater than 100 persons per square mile, which is
719	at least 30 minutes of travel time, on normally traveled roads
720	under normal traffic conditions, from any other acute care
721	hospital within the same county;
722	3.  A hospital supported by a tax district or subdistrict
723	whose boundaries encompass a population of 100 persons or fewer
724	per square mile;
725	4.  A hospital in a constitutional charter county with a
726	population of over 1 million persons that has imposed a local
727	option health service tax pursuant to law and in an area that
728	was directly impacted by a catastrophic event on August 24,
729	1992, for which the Governor of Florida declared a state of
730	emergency pursuant to chapter 125, and has 120 beds or less that
731	serves an agricultural community with an emergency room
732	utilization of no less than 20,000 visits and a Medicaid
733	inpatient utilization rate greater than 15 percent;
734	4.5.  A hospital with a service area that has a population
735	of 100 persons or fewer per square mile. As used in this
736	subparagraph, the term "service area" means the fewest number of
737	zip codes that account for 75 percent of the hospital's
738	discharges for the most recent 5-year period, based on
739	information available from the hospital inpatient discharge
740	database in the Florida Center for Health Information and Policy
741	Analysis at the Agency for Health Care Administration; or
742	5.6.  A hospital designated as a critical access hospital,
743	as defined in s. 408.07(15).
744
745	Population densities used in this paragraph must be based upon
746	the most recently completed United States census. A hospital
747	that received funds under s. 409.9116 for a quarter beginning no
748	later than July 1, 2002, is deemed to have been and shall
749	continue to be a rural hospital from that date through June 30,
750	2015, if the hospital continues to have 100 or fewer licensed
751	beds and an emergency room, or meets the criteria of
752	subparagraph 4. An acute care hospital that has not previously
753	been designated as a rural hospital and that meets the criteria
754	of this paragraph shall be granted such designation upon
755	application, including supporting documentation to the Agency
756	for Health Care Administration.
757	Section 22.  Subsection (8) of section 400.021, Florida
758	Statutes, is amended to read:
759	400.021  Definitions.-When used in this part, unless the
760	context otherwise requires, the term:
761	(8)  "Geriatric outpatient clinic" means a site for
762	providing outpatient health care to persons 60 years of age or
763	older, which is staffed by a registered nurse or a physician
764	assistant, or a licensed practical nurse under the direct
765	supervision of a registered nurse, advanced registered nurse
766	practitioner, or physician.
767	Section 23.  Paragraph (g) of subsection (2) of section
768	400.0239, Florida Statutes, is amended to read:
769	400.0239  Quality of Long-Term Care Facility Improvement
770	Trust Fund.-
771	(2)  Expenditures from the trust fund shall be allowable
772	for direct support of the following:
773	(g)  Other initiatives authorized by the Centers for
774	Medicare and Medicaid Services for the use of federal civil
775	monetary penalties, including projects recommended through the
776	Medicaid "Up-or-Out" Quality of Care Contract Management Program
777	pursuant to s. 400.148.
778	Section 24.  Subsection (15) of section 400.0255, Florida
779	Statutes, is amended to read
780	400.0255  Resident transfer or discharge; requirements and
781	procedures; hearings.-
782	(15)(a)  The department's Office of Appeals Hearings shall
783	conduct hearings under this section. The office shall notify the
784	facility of a resident's request for a hearing.
785	(b)  The department shall, by rule, establish procedures to
786	be used for fair hearings requested by residents. These
787	procedures shall be equivalent to the procedures used for fair
788	hearings for other Medicaid cases appearing in s. 409.285 and
789	applicable rules, chapter 10-2, part VI, Florida Administrative
790	Code. The burden of proof must be clear and convincing evidence.
791	A hearing decision must be rendered within 90 days after receipt
792	of the request for hearing.
793	(c)  If the hearing decision is favorable to the resident
794	who has been transferred or discharged, the resident must be
795	readmitted to the facility's first available bed.
796	(d)  The decision of the hearing officer shall be final.
797	Any aggrieved party may appeal the decision to the district
798	court of appeal in the appellate district where the facility is
799	located. Review procedures shall be conducted in accordance with
800	the Florida Rules of Appellate Procedure.
801	Section 25.  Subsection (2) of section 400.063, Florida
802	Statutes, is amended to read:
803	400.063  Resident protection.-
804	(2)  The agency is authorized to establish for each
805	facility, subject to intervention by the agency, a separate bank
806	account for the deposit to the credit of the agency of any
807	moneys received from the Health Care Trust Fund or any other
808	moneys received for the maintenance and care of residents in the
809	facility, and the agency is authorized to disburse moneys from
810	such account to pay obligations incurred for the purposes of
811	this section. The agency is authorized to requisition moneys
812	from the Health Care Trust Fund in advance of an actual need for
813	cash on the basis of an estimate by the agency of moneys to be
814	spent under the authority of this section. Any bank account
815	established under this section need not be approved in advance
816	of its creation as required by s. 17.58, but shall be secured by
817	depository insurance equal to or greater than the balance of
818	such account or by the pledge of collateral security in
819	conformance with criteria established in s. 18.11. The agency
820	shall notify the Chief Financial Officer of any such account so
821	established and shall make a quarterly accounting to the Chief
822	Financial Officer for all moneys deposited in such account.
823	Section 26.  Subsections (1) and (5) of section 400.071,
824	Florida Statutes, are amended to read:
825	400.071  Application for license.-
826	(1)  In addition to the requirements of part II of chapter
827	408, the application for a license shall be under oath and must
828	contain the following:
829	(a)  The location of the facility for which a license is
830	sought and an indication, as in the original application, that
831	such location conforms to the local zoning ordinances.
832	(b)  A signed affidavit disclosing any financial or
833	ownership interest that a controlling interest as defined in
834	part II of chapter 408 has held in the last 5 years in any
835	entity licensed by this state or any other state to provide
836	health or residential care which has closed voluntarily or
837	involuntarily; has filed for bankruptcy; has had a receiver
838	appointed; has had a license denied, suspended, or revoked; or
839	has had an injunction issued against it which was initiated by a
840	regulatory agency. The affidavit must disclose the reason any
841	such entity was closed, whether voluntarily or involuntarily.
842	(c)  The total number of beds and the total number of
843	Medicare and Medicaid certified beds.
844	(b)(d)  Information relating to the applicant and employees
845	which the agency requires by rule. The applicant must
846	demonstrate that sufficient numbers of qualified staff, by
847	training or experience, will be employed to properly care for
848	the type and number of residents who will reside in the
849	facility.
850	(c)(e)  Copies of any civil verdict or judgment involving
851	the applicant rendered within the 10 years preceding the
852	application, relating to medical negligence, violation of
853	residents' rights, or wrongful death. As a condition of
854	licensure, the licensee agrees to provide to the agency copies
855	of any new verdict or judgment involving the applicant, relating
856	to such matters, within 30 days after filing with the clerk of
857	the court. The information required in this paragraph shall be
858	maintained in the facility's licensure file and in an agency
859	database which is available as a public record.
860	(5)  As a condition of licensure, each facility must
861	establish and submit with its application a plan for quality
862	assurance and for conducting risk management.
863	Section 27.  Section 400.0712, Florida Statutes, is amended
864	to read:
865	400.0712  Application for inactive license.-
866	(1)  As specified in this section, the agency may issue an
867	inactive license to a nursing home facility for all or a portion
868	of its beds. Any request by a licensee that a nursing home or
869	portion of a nursing home become inactive must be submitted to
870	the agency in the approved format. The facility may not initiate
871	any suspension of services, notify residents, or initiate
872	inactivity before receiving approval from the agency; and a
873	licensee that violates this provision may not be issued an
874	inactive license.
875	(1)(2)  In addition to the powers granted under part II of
876	chapter 408, the agency may issue an inactive license to a
877	nursing home that chooses to use an unoccupied contiguous
878	portion of the facility for an alternative use to meet the needs
879	of elderly persons through the use of less restrictive, less
880	institutional services.
881	(a)  An inactive license issued under this subsection may
882	be granted for a period not to exceed the current licensure
883	expiration date but may be renewed by the agency at the time of
884	licensure renewal.
885	(b)  A request to extend the inactive license must be
886	submitted to the agency in the approved format and approved by
887	the agency in writing.
888	(c)  Nursing homes that receive an inactive license to
889	provide alternative services shall not receive preference for
890	participation in the Assisted Living for the Elderly Medicaid
891	waiver.
892	(2)(3)  The agency shall adopt rules pursuant to ss.
893	120.536(1) and 120.54 necessary to implement this section.
894	Section 28.  Section 400.111, Florida Statutes, is amended
895	to read:
896	400.111  Disclosure of controlling interest.-In addition to
897	the requirements of part II of chapter 408, when requested by
898	the agency, the licensee shall submit a signed affidavit
899	disclosing any financial or ownership interest that a
900	controlling interest has held within the last 5 years in any
901	entity licensed by the state or any other state to provide
902	health or residential care which entity has closed voluntarily
903	or involuntarily; has filed for bankruptcy; has had a receiver
904	appointed; has had a license denied, suspended, or revoked; or
905	has had an injunction issued against it which was initiated by a
906	regulatory agency. The affidavit must disclose the reason such
907	entity was closed, whether voluntarily or involuntarily.
908	Section 29.  Subsection (2) of section 400.1183, Florida
909	Statutes, is amended to read:
910	400.1183  Resident grievance procedures.-
911	(2)  Each facility shall maintain records of all grievances
912	for agency inspection and shall report to the agency at the time
913	of relicensure the total number of grievances handled during the
914	prior licensure period, a categorization of the cases underlying
915	the grievances, and the final disposition of the grievances.
916	Section 30.  Paragraphs (o) through (w) of subsection (1)
917	of section 400.141, Florida Statutes, are redesignated as
918	paragraphs (n) through (u), respectively, and present paragraphs
919	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
920	to read:
921	400.141  Administration and management of nursing home
922	facilities.-
923	(1)  Every licensed facility shall comply with all
924	applicable standards and rules of the agency and shall:
925	(f)  Be allowed and encouraged by the agency to provide
926	other needed services under certain conditions. If the facility
927	has a standard licensure status, and has had no class I or class
928	II deficiencies during the past 2 years or has been awarded a
929	Gold Seal under the program established in s. 400.235, it may be
930	encouraged by the agency to provide services, including, but not
931	limited to, respite and adult day services, which enable
932	individuals to move in and out of the facility. A facility is
933	not subject to any additional licensure requirements for
934	providing these services.
935	1.  Respite care may be offered to persons in need of
936	short-term or temporary nursing home services. For each person
937	admitted under the respite care program, the facility licensee
938	must:
939	a.  Have a written abbreviated plan of care that, at a
940	minimum, includes nutritional requirements, medication orders,
941	physician orders, nursing assessments, and dietary preferences.
942	The nursing or physician assessments may take the place of all
943	other assessments required for full-time residents.
944	b.  Have a contract that, at a minimum, specifies the
945	services to be provided to the respite resident, including
946	charges for services, activities, equipment, emergency medical
947	services, and the administration of medications. If multiple
948	respite admissions for a single person are anticipated, the
949	original contract is valid for 1 year after the date of
950	execution.
951	c.  Ensure that each resident is released to his or her
952	caregiver or an individual designated in writing by the
953	caregiver.
954	2.  A person admitted under the respite care program is:
955	a.  Exempt from requirements in rule related to discharge
956	planning.
957	b.  Covered by the resident's rights set forth in s.
958	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
959	shall not be considered trust funds subject to the requirements
960	of s. 400.022(1)(h) until the resident has been in the facility
961	for more than 14 consecutive days.
962	c.  Allowed to use his or her personal medications for the
963	respite stay if permitted by facility policy. The facility must
964	obtain a physician's orders for the medications. The caregiver
965	may provide information regarding the medications as part of the
966	nursing assessment, which must agree with the physician's
967	orders. Medications shall be released with the resident upon
968	discharge in accordance with current orders.
969	3.  A person receiving respite care is entitled to a total
970	of 60 days in the facility within a contract year or a calendar
971	year if the contract is for less than 12 months. However, each
972	single stay may not exceed 14 days. If a stay exceeds 14
973	consecutive days, the facility must comply with all assessment
974	and care planning requirements applicable to nursing home
975	residents.
976	4.  A person receiving respite care must reside in a
977	licensed nursing home bed.
978	5.  A prospective respite resident must provide medical
979	information from a physician, a physician assistant, or a nurse
980	practitioner and other information from the primary caregiver as
981	may be required by the facility prior to or at the time of
982	admission to receive respite care. The medical information must
983	include a physician's order for respite care and proof of a
984	physical examination by a licensed physician, physician
985	assistant, or nurse practitioner. The physician's order and
986	physical examination may be used to provide intermittent respite
987	care for up to 12 months after the date the order is written.
988	6.  The facility must assume the duties of the primary
989	caregiver. To ensure continuity of care and services, the
990	resident is entitled to retain his or her personal physician and
991	must have access to medically necessary services such as
992	physical therapy, occupational therapy, or speech therapy, as
993	needed. The facility must arrange for transportation to these
994	services if necessary. Respite care must be provided in
995	accordance with this part and rules adopted by the agency.
996	However, the agency shall, by rule, adopt modified requirements
997	for resident assessment, resident care plans, resident
998	contracts, physician orders, and other provisions, as
999	appropriate, for short-term or temporary nursing home services.
1000	7.  The agency shall allow for shared programming and staff
1001	in a facility which meets minimum standards and offers services
1002	pursuant to this paragraph, but, if the facility is cited for
1003	deficiencies in patient care, may require additional staff and
1004	programs appropriate to the needs of service recipients. A
1005	person who receives respite care may not be counted as a
1006	resident of the facility for purposes of the facility's licensed
1007	capacity unless that person receives 24-hour respite care. A
1008	person receiving either respite care for 24 hours or longer or
1009	adult day services must be included when calculating minimum
1010	staffing for the facility. Any costs and revenues generated by a
1011	nursing home facility from nonresidential programs or services
1012	shall be excluded from the calculations of Medicaid per diems
1013	for nursing home institutional care reimbursement.
1014	(g)  If the facility has a standard license or is a Gold
1015	Seal facility, exceeds the minimum required hours of licensed
1016	nursing and certified nursing assistant direct care per resident
1017	per day, and is part of a continuing care facility licensed
1018	under chapter 651 or a retirement community that offers other
1019	services pursuant to part III of this chapter or part I or part
1020	III of chapter 429 on a single campus, be allowed to share
1021	programming and staff. At the time of inspection and in the
1022	semiannual report required pursuant to paragraph (n) (o), a
1023	continuing care facility or retirement community that uses this
1024	option must demonstrate through staffing records that minimum
1025	staffing requirements for the facility were met. Licensed nurses
1026	and certified nursing assistants who work in the nursing home
1027	facility may be used to provide services elsewhere on campus if
1028	the facility exceeds the minimum number of direct care hours
1029	required per resident per day and the total number of residents
1030	receiving direct care services from a licensed nurse or a
1031	certified nursing assistant does not cause the facility to
1032	violate the staffing ratios required under s. 400.23(3)(a).
1033	Compliance with the minimum staffing ratios shall be based on
1034	total number of residents receiving direct care services,
1035	regardless of where they reside on campus. If the facility
1036	receives a conditional license, it may not share staff until the
1037	conditional license status ends. This paragraph does not
1038	restrict the agency's authority under federal or state law to
1039	require additional staff if a facility is cited for deficiencies
1040	in care which are caused by an insufficient number of certified
1041	nursing assistants or licensed nurses. The agency may adopt
1042	rules for the documentation necessary to determine compliance
1043	with this provision.
1044	(j)  Keep full records of resident admissions and
1045	discharges; medical and general health status, including medical
1046	records, personal and social history, and identity and address
1047	of next of kin or other persons who may have responsibility for
1048	the affairs of the residents; and individual resident care plans
1049	including, but not limited to, prescribed services, service
1050	frequency and duration, and service goals. The records shall be
1051	open to inspection by the agency. The facility must maintain
1052	clinical records on each resident in accordance with accepted
1053	professional standards and practices that are complete,
1054	accurately documented, readily accessible, and systematically
1055	organized.
1056	(n)  Submit to the agency the information specified in s.
1057	400.071(1)(b) for a management company within 30 days after the
1058	effective date of the management agreement.
1059	(n)(o)1.  Submit semiannually to the agency, or more
1060	frequently if requested by the agency, information regarding
1061	facility staff-to-resident ratios, staff turnover, and staff
1062	stability, including information regarding certified nursing
1063	assistants, licensed nurses, the director of nursing, and the
1064	facility administrator. For purposes of this reporting:
1065	a.  Staff-to-resident ratios must be reported in the
1066	categories specified in s. 400.23(3)(a) and applicable rules.
1067	The ratio must be reported as an average for the most recent
1068	calendar quarter.
1069	b.  Staff turnover must be reported for the most recent 12-
1070	month period ending on the last workday of the most recent
1071	calendar quarter prior to the date the information is submitted.
1072	The turnover rate must be computed quarterly, with the annual
1073	rate being the cumulative sum of the quarterly rates. The
1074	turnover rate is the total number of terminations or separations
1075	experienced during the quarter, excluding any employee
1076	terminated during a probationary period of 3 months or less,
1077	divided by the total number of staff employed at the end of the
1078	period for which the rate is computed, and expressed as a
1079	percentage.
1080	c.  The formula for determining staff stability is the
1081	total number of employees that have been employed for more than
1082	12 months, divided by the total number of employees employed at
1083	the end of the most recent calendar quarter, and expressed as a
1084	percentage.
1085	d.  A nursing facility that has failed to comply with state
1086	minimum-staffing requirements for 2 consecutive days is
1087	prohibited from accepting new admissions until the facility has
1088	achieved the minimum-staffing requirements for a period of 6
1089	consecutive days. For the purposes of this sub-subparagraph, any
1090	person who was a resident of the facility and was absent from
1091	the facility for the purpose of receiving medical care at a
1092	separate location or was on a leave of absence is not considered
1093	a new admission. Failure to impose such an admissions moratorium
1094	is subject to a $1,000 fine constitutes a class II deficiency.
1095	e.  A nursing facility which does not have a conditional
1096	license may be cited for failure to comply with the standards in
1097	s. 400.23(3)(a)1.a. only if it has failed to meet those
1098	standards on 2 consecutive days or if it has failed to meet at
1099	least 97 percent of those standards on any one day.
1100	f.  A facility which has a conditional license must be in
1101	compliance with the standards in s. 400.23(3)(a) at all times.
1102	2.  This paragraph does not limit the agency's ability to
1103	impose a deficiency or take other actions if a facility does not
1104	have enough staff to meet the residents' needs.
1105	(r)  Report to the agency any filing for bankruptcy
1106	protection by the facility or its parent corporation,
1107	divestiture or spin-off of its assets, or corporate
1108	reorganization within 30 days after the completion of such
1109	activity.
1110	Section 31.  Subsection (3) of section 400.142, Florida
1111	Statutes, is amended to read:
1112	400.142  Emergency medication kits; orders not to
1113	resuscitate.-
1114	(3)  Facility staff may withhold or withdraw
1115	cardiopulmonary resuscitation if presented with an order not to
1116	resuscitate executed pursuant to s. 401.45. The agency shall
1117	adopt rules providing for the implementation of such orders.
1118	Facility staff and facilities shall not be subject to criminal
1119	prosecution or civil liability, nor be considered to have
1120	engaged in negligent or unprofessional conduct, for withholding
1121	or withdrawing cardiopulmonary resuscitation pursuant to such an
1122	order and rules adopted by the agency. The absence of an order
1123	not to resuscitate executed pursuant to s. 401.45 does not
1124	preclude a physician from withholding or withdrawing
1125	cardiopulmonary resuscitation as otherwise permitted by law.
1126	Section 32.  Subsections (11) through (15) of section
1127	400.147, Florida Statutes, are renumbered as subsections (10)
1128	through (14), respectively, and present subsection (10) is
1129	amended to read:
1130	400.147  Internal risk management and quality assurance
1131	program.-
1132	(10)  By the 10th of each month, each facility subject to
1133	this section shall report any notice received pursuant to s.
1134	400.0233(2) and each initial complaint that was filed with the
1135	clerk of the court and served on the facility during the
1136	previous month by a resident or a resident's family member,
1137	guardian, conservator, or personal legal representative. The
1138	report must include the name of the resident, the resident's
1139	date of birth and social security number, the Medicaid
1140	identification number for Medicaid-eligible persons, the date or
1141	dates of the incident leading to the claim or dates of
1142	residency, if applicable, and the type of injury or violation of
1143	rights alleged to have occurred. Each facility shall also submit
1144	a copy of the notices received pursuant to s. 400.0233(2) and
1145	complaints filed with the clerk of the court. This report is
1146	confidential as provided by law and is not discoverable or
1147	admissible in any civil or administrative action, except in such
1148	actions brought by the agency to enforce the provisions of this
1149	part.
1150	Section 33.  Section 400.148, Florida Statutes, is
1151	repealed.
1152	Section 34.  Paragraph (f) of subsection (5) of section
1153	400.162, Florida Statutes, is amended to read:
1154	400.162  Property and personal affairs of residents.-
1155	(5)
1156	(f)  At least every 3 months, the licensee shall furnish
1157	the resident and the guardian, trustee, or conservator, if any,
1158	for the resident a complete and verified statement of all funds
1159	and other property to which this subsection applies, detailing
1160	the amounts and items received, together with their sources and
1161	disposition. For resident property, the licensee shall furnish
1162	such a statement annually and within 7 calendar days after a
1163	request for a statement. In any event, the licensee shall
1164	furnish such statements a statement annually and upon the
1165	discharge or transfer of a resident. Any governmental agency or
1166	private charitable agency contributing funds or other property
1167	on account of a resident also shall be entitled to receive such
1168	statements statement annually and upon discharge or transfer and
1169	such other report as it may require pursuant to law.
1170	Section 35.  Paragraphs (d) and (e) of subsection (2) of
1171	section 400.179, Florida Statutes, are amended to read:
1172	400.179  Liability for Medicaid underpayments and
1173	overpayments.-
1174	(2)  Because any transfer of a nursing facility may expose
1175	the fact that Medicaid may have underpaid or overpaid the
1176	transferor, and because in most instances, any such underpayment
1177	or overpayment can only be determined following a formal field
1178	audit, the liabilities for any such underpayments or
1179	overpayments shall be as follows:
1180	(d)  Where the transfer involves a facility that has been
1181	leased by the transferor:
1182	1.  The transferee shall, as a condition to being issued a
1183	license by the agency, acquire, maintain, and provide proof to
1184	the agency of a bond with a term of 30 months, renewable
1185	annually, in an amount not less than the total of 3 months'
1186	Medicaid payments to the facility computed on the basis of the
1187	preceding 12-month average Medicaid payments to the facility.
1188	2.  A leasehold licensee may meet the requirements of
1189	subparagraph 1. by payment of a nonrefundable fee, paid at
1190	initial licensure, paid at the time of any subsequent change of
1191	ownership, and paid annually thereafter, in the amount of 1
1192	percent of the total of 3 months' Medicaid payments to the
1193	facility computed on the basis of the preceding 12-month average
1194	Medicaid payments to the facility. If a preceding 12-month
1195	average is not available, projected Medicaid payments may be
1196	used. The fee shall be deposited into the Grants and Donations
1197	Trust Fund and shall be accounted for separately as a Medicaid
1198	nursing home overpayment account. These fees shall be used at
1199	the sole discretion of the agency to repay nursing home Medicaid
1200	overpayments. Payment of this fee shall not release the licensee
1201	from any liability for any Medicaid overpayments, nor shall
1202	payment bar the agency from seeking to recoup overpayments from
1203	the licensee and any other liable party. As a condition of
1204	exercising this lease bond alternative, licensees paying this
1205	fee must maintain an existing lease bond through the end of the
1206	30-month term period of that bond. The agency is herein granted
1207	specific authority to promulgate all rules pertaining to the
1208	administration and management of this account, including
1209	withdrawals from the account, subject to federal review and
1210	approval. This provision shall take effect upon becoming law and
1211	shall apply to any leasehold license application. The financial
1212	viability of the Medicaid nursing home overpayment account shall
1213	be determined by the agency through annual review of the account
1214	balance and the amount of total outstanding, unpaid Medicaid
1215	overpayments owing from leasehold licensees to the agency as
1216	determined by final agency audits. By March 31 of each year, the
1217	agency shall assess the cumulative fees collected under this
1218	subparagraph, minus any amounts used to repay nursing home
1219	Medicaid overpayments and amounts transferred to contribute to
1220	the General Revenue Fund pursuant to s. 215.20. If the net
1221	cumulative collections, minus amounts utilized to repay nursing
1222	home Medicaid overpayments, exceed $25 million, the provisions
1223	of this paragraph shall not apply for the subsequent fiscal
1224	year.
1225	3.  The leasehold licensee may meet the bond requirement
1226	through other arrangements acceptable to the agency. The agency
1227	is herein granted specific authority to promulgate rules
1228	pertaining to lease bond arrangements.
1229	4.  All existing nursing facility licensees, operating the
1230	facility as a leasehold, shall acquire, maintain, and provide
1231	proof to the agency of the 30-month bond required in
1232	subparagraph 1., above, on and after July 1, 1993, for each
1233	license renewal.
1234	5.  It shall be the responsibility of all nursing facility
1235	operators, operating the facility as a leasehold, to renew the
1236	30-month bond and to provide proof of such renewal to the agency
1237	annually.
1238	6.  Any failure of the nursing facility operator to
1239	acquire, maintain, renew annually, or provide proof to the
1240	agency shall be grounds for the agency to deny, revoke, and
1241	suspend the facility license to operate such facility and to
1242	take any further action, including, but not limited to,
1243	enjoining the facility, asserting a moratorium pursuant to part
1244	II of chapter 408, or applying for a receiver, deemed necessary
1245	to ensure compliance with this section and to safeguard and
1246	protect the health, safety, and welfare of the facility's
1247	residents. A lease agreement required as a condition of bond
1248	financing or refinancing under s. 154.213 by a health facilities
1249	authority or required under s. 159.30 by a county or
1250	municipality is not a leasehold for purposes of this paragraph
1251	and is not subject to the bond requirement of this paragraph.
1252	(e)  For the 2009-2010 fiscal year only, the provisions of
1253	paragraph (d) shall not apply. This paragraph expires July 1,
1254	2010.
1255	Section 36.  Subsection (3) of section 400.19, Florida
1256	Statutes, is amended to read:
1257	400.19  Right of entry and inspection.-
1258	(3)  The agency shall every 15 months conduct at least one
1259	unannounced inspection to determine compliance by the licensee
1260	with statutes, and with rules promulgated under the provisions
1261	of those statutes, governing minimum standards of construction,
1262	quality and adequacy of care, and rights of residents. The
1263	survey shall be conducted every 6 months for the next 2-year
1264	period if the facility has been cited for a class I deficiency,
1265	has been cited for two or more class II deficiencies arising
1266	from separate surveys or investigations within a 60-day period,
1267	or has had three or more substantiated complaints within a 6-
1268	month period, each resulting in at least one class I or class II
1269	deficiency. In addition to any other fees or fines in this part,
1270	the agency shall assess a fine for each facility that is subject
1271	to the 6-month survey cycle. The fine for the 2-year period
1272	shall be $6,000, one-half to be paid at the completion of each
1273	survey. The agency may adjust this fine by the change in the
1274	Consumer Price Index, based on the 12 months immediately
1275	preceding the increase, to cover the cost of the additional
1276	surveys. The agency shall verify through subsequent inspection
1277	that any deficiency identified during inspection is corrected.
1278	However, the agency may verify the correction of a class III or
1279	class IV deficiency unrelated to resident rights or resident
1280	care without reinspecting the facility if adequate written
1281	documentation has been received from the facility, which
1282	provides assurance that the deficiency has been corrected. The
1283	giving or causing to be given of advance notice of such
1284	unannounced inspections by an employee of the agency to any
1285	unauthorized person shall constitute cause for suspension of not
1286	fewer than 5 working days according to the provisions of chapter
1287	110.
1288	Section 37.  Section 400.195, Florida Statutes, is
1289	repealed.
1290	Section 38.  Subsection (5) of section 400.23, Florida
1291	Statutes, is amended to read:
1292	400.23  Rules; evaluation and deficiencies; licensure
1293	status.-
1294	(5)(a)  The agency, in collaboration with the Division of
1295	Children's Medical Services Network of the Department of Health,
1296	must, no later than December 31, 1993, adopt rules for minimum
1297	standards of care for persons under 21 years of age who reside
1298	in nursing home facilities. The rules must include a methodology
1299	for reviewing a nursing home facility under ss. 408.031-408.045
1300	which serves only persons under 21 years of age. A facility may
1301	be exempt from these standards for specific persons between 18
1302	and 21 years of age, if the person's physician agrees that
1303	minimum standards of care based on age are not necessary.
1304	(b)  The agency, in collaboration with the Division of
1305	Children's Medical Services Network, shall adopt rules for
1306	minimum staffing requirements for nursing home facilities that
1307	serve persons under 21 years of age, which shall apply in lieu
1308	of the standards contained in subsection (3).
1309	1.  For persons under 21 years of age who require skilled
1310	care, the requirements shall include a minimum combined average
1311	of licensed nurses, respiratory therapists, respiratory care
1312	practitioners, and certified nursing assistants of 3.9 hours of
1313	direct care per resident per day for each nursing home facility.
1314	2.  For persons under 21 years of age who are fragile, the
1315	requirements shall include a minimum combined average of
1316	licensed nurses, respiratory therapists, respiratory care
1317	practitioners, and certified nursing assistants of 5 hours of
1318	direct care per resident per day for each nursing home facility.
1319	Section 39.  Subsection (1) of section 400.275, Florida
1320	Statutes, is amended to read:
1321	400.275  Agency duties.-
1322	(1)  The agency shall ensure that each newly hired nursing
1323	home surveyor, as a part of basic training, is assigned full-
1324	time to a licensed nursing home for at least 2 days within a 7-
1325	day period to observe facility operations outside of the survey
1326	process before the surveyor begins survey responsibilities. Such
1327	observations may not be the sole basis of a deficiency citation
1328	against the facility. The agency may not assign an individual to
1329	be a member of a survey team for purposes of a survey,
1330	evaluation, or consultation visit at a nursing home facility in
1331	which the surveyor was an employee within the preceding 2 5
1332	years.
1333	Section 40.  Subsection (2) of section 400.484, Florida
1334	Statutes, is amended to read:
1335	400.484  Right of inspection; violations deficiencies;
1336	fines.-
1337	(2)  The agency shall impose fines for various classes of
1338	violations deficiencies in accordance with the following
1339	schedule:
1340	(a)  Class I violations are defined in s. 408.813. A class
1341	I deficiency is any act, omission, or practice that results in a
1342	patient's death, disablement, or permanent injury, or places a
1343	patient at imminent risk of death, disablement, or permanent
1344	injury. Upon finding a class I violation deficiency, the agency
1345	shall impose an administrative fine in the amount of $15,000 for
1346	each occurrence and each day that the violation deficiency
1347	exists.
1348	(b)  Class II violations are defined in s. 408.813. A class
1349	II deficiency is any act, omission, or practice that has a
1350	direct adverse effect on the health, safety, or security of a
1351	patient. Upon finding a class II violation deficiency, the
1352	agency shall impose an administrative fine in the amount of
1353	$5,000 for each occurrence and each day that the violation
1354	deficiency exists.
1355	(c)  Class III violations are defined in s. 408.813. A
1356	class III deficiency is any act, omission, or practice that has
1357	an indirect, adverse effect on the health, safety, or security
1358	of a patient. Upon finding an uncorrected or repeated class III
1359	violation deficiency, the agency shall impose an administrative
1360	fine not to exceed $1,000 for each occurrence and each day that
1361	the uncorrected or repeated violation deficiency exists.
1362	(d)  Class IV violations are defined in s. 408.813. A class
1363	IV deficiency is any act, omission, or practice related to
1364	required reports, forms, or documents which does not have the
1365	potential of negatively affecting patients. These violations are
1366	of a type that the agency determines do not threaten the health,
1367	safety, or security of patients. Upon finding an uncorrected or
1368	repeated class IV violation deficiency, the agency shall impose
1369	an administrative fine not to exceed $500 for each occurrence
1370	and each day that the uncorrected or repeated violation
1371	deficiency exists.
1372	Section 41.  Paragraph (i) of subsection (1) and subsection
1373	(4) of section 400.606, Florida Statutes, are amended to read:
1374	400.606  License; application; renewal; conditional license
1375	or permit; certificate of need.-
1376	(1)  In addition to the requirements of part II of chapter
1377	408, the initial application and change of ownership application
1378	must be accompanied by a plan for the delivery of home,
1379	residential, and homelike inpatient hospice services to
1380	terminally ill persons and their families. Such plan must
1381	contain, but need not be limited to:
1382	(i)  The projected annual operating cost of the hospice.
1383
1384	If the applicant is an existing licensed health care provider,
1385	the application must be accompanied by a copy of the most recent
1386	profit-loss statement and, if applicable, the most recent
1387	licensure inspection report.
1388	(4)  A freestanding hospice facility that is primarily
1389	engaged in providing inpatient and related services and that is
1390	not otherwise licensed as a health care facility shall be
1391	required to obtain a certificate of need. However, a
1392	freestanding hospice facility with six or fewer beds shall not
1393	be required to comply with institutional standards such as, but
1394	not limited to, standards requiring sprinkler systems, emergency
1395	electrical systems, or special lavatory devices.
1396	Section 42.  Subsection (2) of section 400.607, Florida
1397	Statutes, is amended to read:
1398	400.607  Denial, suspension, revocation of license;
1399	emergency actions; imposition of administrative fine; grounds.-
1400	(2)  A violation of this part, part II of chapter 408, or
1401	applicable rules Any of the following actions by a licensed
1402	hospice or any of its employees shall be grounds for
1403	administrative action by the agency against a hospice.:
1404	(a)  A violation of the provisions of this part, part II of
1405	chapter 408, or applicable rules.
1406	(b)  An intentional or negligent act materially affecting
1407	the health or safety of a patient.
1408	Section 43.  Section 400.915, Florida Statutes, is amended
1409	to read:
1410	400.915  Construction and renovation; requirements.-The
1411	requirements for the construction or renovation of a PPEC center
1412	shall comply with:
1413	(1)  The provisions of chapter 553, which pertain to
1414	building construction standards, including plumbing, electrical
1415	code, glass, manufactured buildings, accessibility for the
1416	physically disabled;
1417	(2)  The provisions of s. 633.022 and applicable rules
1418	pertaining to physical minimum standards for nonresidential
1419	child care physical facilities in rule 10M-12.003, Florida
1420	Administrative Code, Child Care Standards; and
1421	(3)  The standards or rules adopted pursuant to this part
1422	and part II of chapter 408.
1423	Section 44.  Subsection (1) of section 400.925, Florida
1424	Statutes, is amended to read:
1425	400.925  Definitions.-As used in this part, the term:
1426	(1)  "Accrediting organizations" means The Joint Commission
1427	on Accreditation of Healthcare Organizations or other national
1428	accreditation agencies whose standards for accreditation are
1429	comparable to those required by this part for licensure.
1430	Section 45.  Subsections (3) through (6) of section
1431	400.931, Florida Statutes, are renumbered as subsections (2)
1432	through (5), respectively, and present subsection (2) of that
1433	section is amended to read:
1434	400.931  Application for license; fee; provisional license;
1435	temporary permit.-
1436	(2)  As an alternative to submitting proof of financial
1437	ability to operate as required in s. 408.810(8), the applicant
1438	may submit a $50,000 surety bond to the agency.
1439	Section 46.  Subsection (2) of section 400.932, Florida
1440	Statutes, is amended to read:
1441	400.932  Administrative penalties.-
1442	(2)  A violation of this part, part II of chapter 408, or
1443	applicable rules Any of the following actions by an employee of
1444	a home medical equipment provider shall be are grounds for
1445	administrative action or penalties by the agency.:
1446	(a)  Violation of this part, part II of chapter 408, or
1447	applicable rules.
1448	(b)  An intentional, reckless, or negligent act that
1449	materially affects the health or safety of a patient.
1450	Section 47.  Subsection (3) of section 400.967, Florida
1451	Statutes, is amended to read:
1452	400.967  Rules and classification of violations
1453	deficiencies.-
1454	(3)  The agency shall adopt rules to provide that, when the
1455	criteria established under this part and part II of chapter 408
1456	are not met, such violations deficiencies shall be classified
1457	according to the nature of the violation deficiency. The agency
1458	shall indicate the classification on the face of the notice of
1459	deficiencies as follows:
1460	(a)  Class I violations deficiencies are defined in s.
1461	408.813 those which the agency determines present an imminent
1462	danger to the residents or guests of the facility or a
1463	substantial probability that death or serious physical harm
1464	would result therefrom. The condition or practice constituting a
1465	class I violation must be abated or eliminated immediately,
1466	unless a fixed period of time, as determined by the agency, is
1467	required for correction. A class I violation deficiency is
1468	subject to a civil penalty in an amount not less than $5,000 and
1469	not exceeding $10,000 for each violation deficiency. A fine may
1470	be levied notwithstanding the correction of the violation
1471	deficiency.
1472	(b)  Class II violations deficiencies are defined in s.
1473	408.813 those which the agency determines have a direct or
1474	immediate relationship to the health, safety, or security of the
1475	facility residents, other than class I deficiencies. A class II
1476	violation deficiency is subject to a civil penalty in an amount
1477	not less than $1,000 and not exceeding $5,000 for each violation
1478	deficiency. A citation for a class II violation deficiency shall
1479	specify the time within which the violation deficiency must be
1480	corrected. If a class II violation deficiency is corrected
1481	within the time specified, no civil penalty shall be imposed,
1482	unless it is a repeated offense.
1483	(c)  Class III violations deficiencies are defined in s.
1484	408.813 those which the agency determines to have an indirect or
1485	potential relationship to the health, safety, or security of the
1486	facility residents, other than class I or class II deficiencies.
1487	A class III violation deficiency is subject to a civil penalty
1488	of not less than $500 and not exceeding $1,000 for each
1489	deficiency. A citation for a class III violation deficiency
1490	shall specify the time within which the violation deficiency
1491	must be corrected. If a class III violation deficiency is
1492	corrected within the time specified, no civil penalty shall be
1493	imposed, unless it is a repeated offense.
1494	(d)  Class IV violations are defined in s. 408.813. Upon
1495	finding an uncorrected or repeated class IV violation, the
1496	agency shall impose an administrative fine not to exceed $500
1497	for each occurrence and each day that the uncorrected or
1498	repeated violation exists.
1499	Section 48.  Subsections (4) and (7) of section 400.9905,
1500	Florida Statutes, are amended to read:
1501	400.9905  Definitions.-
1502	(4)  "Clinic" means an entity at which health care services
1503	are provided to individuals and which tenders charges for
1504	reimbursement for such services, including a mobile clinic and a
1505	portable health service or equipment provider. For purposes of
1506	this part, the term does not include and the licensure
1507	requirements of this part do not apply to:
1508	(a)  Entities licensed or registered by the state under
1509	chapter 395; or entities licensed or registered by the state and
1510	providing only health care services within the scope of services
1511	authorized under their respective licenses granted under ss.
1512	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1513	chapter except part X, chapter 429, chapter 463, chapter 465,
1514	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1515	chapter 651; end-stage renal disease providers authorized under
1516	42 C.F.R. part 405, subpart U; or providers certified under 42
1517	C.F.R. part 485, subpart B or subpart H; or any entity that
1518	provides neonatal or pediatric hospital-based health care
1519	services or other health care services by licensed practitioners
1520	solely within a hospital licensed under chapter 395.
1521	(b)  Entities that own, directly or indirectly, entities
1522	licensed or registered by the state pursuant to chapter 395; or
1523	entities that own, directly or indirectly, entities licensed or
1524	registered by the state and providing only health care services
1525	within the scope of services authorized pursuant to their
1526	respective licenses granted under ss. 383.30-383.335, chapter
1527	390, chapter 394, chapter 397, this chapter except part X,
1528	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1529	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1530	disease providers authorized under 42 C.F.R. part 405, subpart
1531	U; or providers certified under 42 C.F.R. part 485, subpart B or
1532	subpart H; or any entity that provides neonatal or pediatric
1533	hospital-based health care services by licensed practitioners
1534	solely within a hospital licensed under chapter 395.
1535	(c)  Entities that are owned, directly or indirectly, by an
1536	entity licensed or registered by the state pursuant to chapter
1537	395; or entities that are owned, directly or indirectly, by an
1538	entity licensed or registered by the state and providing only
1539	health care services within the scope of services authorized
1540	pursuant to their respective licenses granted under ss. 383.30-
1541	383.335, chapter 390, chapter 394, chapter 397, this chapter
1542	except part X, chapter 429, chapter 463, chapter 465, chapter
1543	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1544	651; end-stage renal disease providers authorized under 42
1545	C.F.R. part 405, subpart U; or providers certified under 42
1546	C.F.R. part 485, subpart B or subpart H; or any entity that
1547	provides neonatal or pediatric hospital-based health care
1548	services by licensed practitioners solely within a hospital
1549	under chapter 395.
1550	(d)  Entities that are under common ownership, directly or
1551	indirectly, with an entity licensed or registered by the state
1552	pursuant to chapter 395; or entities that are under common
1553	ownership, directly or indirectly, with an entity licensed or
1554	registered by the state and providing only health care services
1555	within the scope of services authorized pursuant to their
1556	respective licenses granted under ss. 383.30-383.335, chapter
1557	390, chapter 394, chapter 397, this chapter except part X,
1558	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1559	part I of chapter 483, chapter 484, or chapter 651; end-stage
1560	renal disease providers authorized under 42 C.F.R. part 405,
1561	subpart U; or providers certified under 42 C.F.R. part 485,
1562	subpart B or subpart H; or any entity that provides neonatal or
1563	pediatric hospital-based health care services by licensed
1564	practitioners solely within a hospital licensed under chapter
1565	395.
1566	(e)  An entity that is exempt from federal taxation under
1567	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1568	under 26 U.S.C. s. 409 that has a board of trustees not less
1569	than two-thirds of which are Florida-licensed health care
1570	practitioners and provides only physical therapy services under
1571	physician orders, any community college or university clinic,
1572	and any entity owned or operated by the federal or state
1573	government, including agencies, subdivisions, or municipalities
1574	thereof.
1575	(f)  A sole proprietorship, group practice, partnership, or
1576	corporation that provides health care services by physicians
1577	covered by s. 627.419, that is directly supervised by one or
1578	more of such physicians, and that is wholly owned by one or more
1579	of those physicians or by a physician and the spouse, parent,
1580	child, or sibling of that physician.
1581	(g)  A sole proprietorship, group practice, partnership, or
1582	corporation that provides health care services by licensed
1583	health care practitioners under chapter 457, chapter 458,
1584	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1585	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1586	chapter 490, chapter 491, or part I, part III, part X, part
1587	XIII, or part XIV of chapter 468, or s. 464.012, which are
1588	wholly owned by one or more licensed health care practitioners,
1589	or the licensed health care practitioners set forth in this
1590	paragraph and the spouse, parent, child, or sibling of a
1591	licensed health care practitioner, so long as one of the owners
1592	who is a licensed health care practitioner is supervising the
1593	business activities and is legally responsible for the entity's
1594	compliance with all federal and state laws. However, a health
1595	care practitioner may not supervise services beyond the scope of
1596	the practitioner's license, except that, for the purposes of
1597	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1598	provides only services authorized pursuant to s. 456.053(3)(b)
1599	may be supervised by a licensee specified in s. 456.053(3)(b).
1600	(h)  Clinical facilities affiliated with an accredited
1601	medical school at which training is provided for medical
1602	students, residents, or fellows.
1603	(i)  Entities that provide only oncology or radiation
1604	therapy services by physicians licensed under chapter 458 or
1605	chapter 459 or entities that provide oncology or radiation
1606	therapy services by physicians licensed under chapter 458 or
1607	chapter 459 which are owned by a corporation whose shares are
1608	publicly traded on a recognized stock exchange.
1609	(j)  Clinical facilities affiliated with a college of
1610	chiropractic accredited by the Council on Chiropractic Education
1611	at which training is provided for chiropractic students.
1612	(k)  Entities that provide licensed practitioners to staff
1613	emergency departments or to deliver anesthesia services in
1614	facilities licensed under chapter 395 and that derive at least
1615	90 percent of their gross annual revenues from the provision of
1616	such services. Entities claiming an exemption from licensure
1617	under this paragraph must provide documentation demonstrating
1618	compliance.
1619	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1620	perinatology clinical facilities that are a publicly traded
1621	corporation or that are wholly owned, directly or indirectly, by
1622	a publicly traded corporation. As used in this paragraph, a
1623	publicly traded corporation is a corporation that issues
1624	securities traded on an exchange registered with the United
1625	States Securities and Exchange Commission as a national
1626	securities exchange.
1627	(m)  Entities that are owned by a corporation that has $250
1628	million or more in total annual sales of health care services
1629	provided by licensed health care practitioners if one or more of
1630	the owners of the entity is a health care practitioner who is
1631	licensed in this state, is responsible for supervising the
1632	business activities of the entity, and is legally responsible
1633	for the entity's compliance with state law for purposes of this
1634	section.
1635	(n)  Entities that are owned or controlled, directly or
1636	indirectly, by a publicly traded entity with $100 million or
1637	more, in the aggregate, in total annual revenues derived from
1638	providing health care services by licensed health care
1639	practitioners that are employed or contracted by an entity
1640	described in this paragraph.
1641	(7)  "Portable health service or equipment provider" means
1642	an entity that contracts with or employs persons to provide
1643	portable health care services or equipment to multiple locations
1644	performing treatment or diagnostic testing of individuals, that
1645	bills third-party payors for those services, and that otherwise
1646	meets the definition of a clinic in subsection (4).
1647	Section 49.  Paragraph (b) of subsection (1) and paragraph
1648	(c) of subsection (4) of section 400.991, Florida Statutes, are
1649	amended to read:
1650	400.991  License requirements; background screenings;
1651	prohibitions.-
1652	(1)
1653	(b)  Each mobile clinic must obtain a separate health care
1654	clinic license and must provide to the agency, at least
1655	quarterly, its projected street location to enable the agency to
1656	locate and inspect such clinic. A portable health service or
1657	equipment provider must obtain a health care clinic license for
1658	a single administrative office and is not required to submit
1659	quarterly projected street locations.
1660	(4)  In addition to the requirements of part II of chapter
1661	408, the applicant must file with the application satisfactory
1662	proof that the clinic is in compliance with this part and
1663	applicable rules, including:
1664	(c)  Proof of financial ability to operate as required
1665	under ss. s. 408.810(8) and 408.8065. As an alternative to
1666	submitting proof of financial ability to operate as required
1667	under s. 408.810(8), the applicant may file a surety bond of at
1668	least $500,000 which guarantees that the clinic will act in full
1669	conformity with all legal requirements for operating a clinic,
1670	payable to the agency. The agency may adopt rules to specify
1671	related requirements for such surety bond.
1672	Section 50.  Paragraph (g) of subsection (1) and paragraph
1673	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1674	amended to read:
1675	400.9935  Clinic responsibilities.-
1676	(1)  Each clinic shall appoint a medical director or clinic
1677	director who shall agree in writing to accept legal
1678	responsibility for the following activities on behalf of the
1679	clinic. The medical director or the clinic director shall:
1680	(g)  Conduct systematic reviews of clinic billings to
1681	ensure that the billings are not fraudulent or unlawful. Upon
1682	discovery of an unlawful charge, the medical director or clinic
1683	director shall take immediate corrective action. If the clinic
1684	performs only the technical component of magnetic resonance
1685	imaging, static radiographs, computed tomography, or positron
1686	emission tomography, and provides the professional
1687	interpretation of such services, in a fixed facility that is
1688	accredited by The Joint Commission on Accreditation of
1689	Healthcare Organizations or the Accreditation Association for
1690	Ambulatory Health Care, and the American College of Radiology;
1691	and if, in the preceding quarter, the percentage of scans
1692	performed by that clinic which was billed to all personal injury
1693	protection insurance carriers was less than 15 percent, the
1694	chief financial officer of the clinic may, in a written
1695	acknowledgment provided to the agency, assume the responsibility
1696	for the conduct of the systematic reviews of clinic billings to
1697	ensure that the billings are not fraudulent or unlawful.
1698	(7)(a)  Each clinic engaged in magnetic resonance imaging
1699	services must be accredited by The Joint Commission on
1700	Accreditation of Healthcare Organizations, the American College
1701	of Radiology, or the Accreditation Association for Ambulatory
1702	Health Care, within 1 year after licensure. A clinic that is
1703	accredited by the American College of Radiology or is within the
1704	original 1-year period after licensure and replaces its core
1705	magnetic resonance imaging equipment shall be given 1 year after
1706	the date on which the equipment is replaced to attain
1707	accreditation. However, a clinic may request a single, 6-month
1708	extension if it provides evidence to the agency establishing
1709	that, for good cause shown, such clinic cannot be accredited
1710	within 1 year after licensure, and that such accreditation will
1711	be completed within the 6-month extension. After obtaining
1712	accreditation as required by this subsection, each such clinic
1713	must maintain accreditation as a condition of renewal of its
1714	license. A clinic that files a change of ownership application
1715	must comply with the original accreditation timeframe
1716	requirements of the transferor. The agency shall deny a change
1717	of ownership application if the clinic is not in compliance with
1718	the accreditation requirements. When a clinic adds, replaces, or
1719	modifies magnetic resonance imaging equipment and the
1720	accreditation agency requires new accreditation, the clinic must
1721	be accredited within 1 year after the date of the addition,
1722	replacement, or modification but may request a single, 6-month
1723	extension if the clinic provides evidence of good cause to the
1724	agency.
1725	Section 51.  Subsection (2) of section 408.034, Florida
1726	Statutes, is amended to read:
1727	408.034  Duties and responsibilities of agency; rules.-
1728	(2)  In the exercise of its authority to issue licenses to
1729	health care facilities and health service providers, as provided
1730	under chapters 393 and 395 and parts II, and IV, and VIII of
1731	chapter 400, the agency may not issue a license to any health
1732	care facility or health service provider that fails to receive a
1733	certificate of need or an exemption for the licensed facility or
1734	service.
1735	Section 52.  Paragraph (d) of subsection (1) of section
1736	408.036, Florida Statutes, is amended to read:
1737	408.036  Projects subject to review; exemptions.-
1738	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1739	health-care-related projects, as described in paragraphs (a)-
1740	(g), are subject to review and must file an application for a
1741	certificate of need with the agency. The agency is exclusively
1742	responsible for determining whether a health-care-related
1743	project is subject to review under ss. 408.031-408.045.
1744	(d)  The establishment of a hospice or hospice inpatient
1745	facility, except as provided in s. 408.043.
1746	Section 53.  Subsection (2) of section 408.043, Florida
1747	Statutes, is amended to read:
1748	408.043  Special provisions.-
1749	(2)  HOSPICES.-When an application is made for a
1750	certificate of need to establish or to expand a hospice, the
1751	need for such hospice shall be determined on the basis of the
1752	need for and availability of hospice services in the community.
1753	The formula on which the certificate of need is based shall
1754	discourage regional monopolies and promote competition. The
1755	inpatient hospice care component of a hospice which is a
1756	freestanding facility, or a part of a facility, which is
1757	primarily engaged in providing inpatient care and related
1758	services and is not licensed as a health care facility shall
1759	also be required to obtain a certificate of need. Provision of
1760	hospice care by any current provider of health care is a
1761	significant change in service and therefore requires a
1762	certificate of need for such services.
1763	Section 54.  Paragraph (k) of subsection (3) of section
1764	408.05, Florida Statutes, is amended to read:
1765	408.05  Florida Center for Health Information and Policy
1766	Analysis.-
1767	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1768	produce comparable and uniform health information and statistics
1769	for the development of policy recommendations, the agency shall
1770	perform the following functions:
1771	(k)  Develop, in conjunction with the State Consumer Health
1772	Information and Policy Advisory Council, and implement a long-
1773	range plan for making available health care quality measures and
1774	financial data that will allow consumers to compare health care
1775	services. The health care quality measures and financial data
1776	the agency must make available shall include, but is not limited
1777	to, pharmaceuticals, physicians, health care facilities, and
1778	health plans and managed care entities. The agency shall submit
1779	the initial plan to the Governor, the President of the Senate,
1780	and the Speaker of the House of Representatives by January 1,
1781	2006, and shall update the plan and report on the status of its
1782	implementation annually thereafter. The agency shall also make
1783	the plan and status report available to the public on its
1784	Internet website. As part of the plan, the agency shall identify
1785	the process and timeframes for implementation, any barriers to
1786	implementation, and recommendations of changes in the law that
1787	may be enacted by the Legislature to eliminate the barriers. As
1788	preliminary elements of the plan, the agency shall:
1789	1.  Make available patient-safety indicators, inpatient
1790	quality indicators, and performance outcome and patient charge
1791	data collected from health care facilities pursuant to s.
1792	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1793	"inpatient quality indicators" shall be as defined by the
1794	Centers for Medicare and Medicaid Services, the National Quality
1795	Forum, The Joint Commission on Accreditation of Healthcare
1796	Organizations, the Agency for Healthcare Research and Quality,
1797	the Centers for Disease Control and Prevention, or a similar
1798	national entity that establishes standards to measure the
1799	performance of health care providers, or by other states. The
1800	agency shall determine which conditions, procedures, health care
1801	quality measures, and patient charge data to disclose based upon
1802	input from the council. When determining which conditions and
1803	procedures are to be disclosed, the council and the agency shall
1804	consider variation in costs, variation in outcomes, and
1805	magnitude of variations and other relevant information. When
1806	determining which health care quality measures to disclose, the
1807	agency:
1808	a.  Shall consider such factors as volume of cases; average
1809	patient charges; average length of stay; complication rates;
1810	mortality rates; and infection rates, among others, which shall
1811	be adjusted for case mix and severity, if applicable.
1812	b.  May consider such additional measures that are adopted
1813	by the Centers for Medicare and Medicaid Studies, National
1814	Quality Forum, The Joint Commission on Accreditation of
1815	Healthcare Organizations, the Agency for Healthcare Research and
1816	Quality, Centers for Disease Control and Prevention, or a
1817	similar national entity that establishes standards to measure
1818	the performance of health care providers, or by other states.
1819
1820	When determining which patient charge data to disclose, the
1821	agency shall include such measures as the average of
1822	undiscounted charges on frequently performed procedures and
1823	preventive diagnostic procedures, the range of procedure charges
1824	from highest to lowest, average net revenue per adjusted patient
1825	day, average cost per adjusted patient day, and average cost per
1826	admission, among others.
1827	2.  Make available performance measures, benefit design,
1828	and premium cost data from health plans licensed pursuant to
1829	chapter 627 or chapter 641. The agency shall determine which
1830	health care quality measures and member and subscriber cost data
1831	to disclose, based upon input from the council. When determining
1832	which data to disclose, the agency shall consider information
1833	that may be required by either individual or group purchasers to
1834	assess the value of the product, which may include membership
1835	satisfaction, quality of care, current enrollment or membership,
1836	coverage areas, accreditation status, premium costs, plan costs,
1837	premium increases, range of benefits, copayments and
1838	deductibles, accuracy and speed of claims payment, credentials
1839	of physicians, number of providers, names of network providers,
1840	and hospitals in the network. Health plans shall make available
1841	to the agency any such data or information that is not currently
1842	reported to the agency or the office.
1843	3.  Determine the method and format for public disclosure
1844	of data reported pursuant to this paragraph. The agency shall
1845	make its determination based upon input from the State Consumer
1846	Health Information and Policy Advisory Council. At a minimum,
1847	the data shall be made available on the agency's Internet
1848	website in a manner that allows consumers to conduct an
1849	interactive search that allows them to view and compare the
1850	information for specific providers. The website must include
1851	such additional information as is determined necessary to ensure
1852	that the website enhances informed decisionmaking among
1853	consumers and health care purchasers, which shall include, at a
1854	minimum, appropriate guidance on how to use the data and an
1855	explanation of why the data may vary from provider to provider.
1856	The data specified in subparagraph 1. shall be released no later
1857	than January 1, 2006, for the reporting of infection rates, and
1858	no later than October 1, 2005, for mortality rates and
1859	complication rates. The data specified in subparagraph 2. shall
1860	be released no later than October 1, 2006.
1861	4.  Publish on its website undiscounted charges for no
1862	fewer than 150 of the most commonly performed adult and
1863	pediatric procedures, including outpatient, inpatient,
1864	diagnostic, and preventative procedures.
1865	Section 55.  Paragraph (a) of subsection (1) of section
1866	408.061, Florida Statutes, is amended to read:
1867	408.061  Data collection; uniform systems of financial
1868	reporting; information relating to physician charges;
1869	confidential information; immunity.-
1870	(1)  The agency shall require the submission by health care
1871	facilities, health care providers, and health insurers of data
1872	necessary to carry out the agency's duties. Specifications for
1873	data to be collected under this section shall be developed by
1874	the agency with the assistance of technical advisory panels
1875	including representatives of affected entities, consumers,
1876	purchasers, and such other interested parties as may be
1877	determined by the agency.
1878	(a)  Data submitted by health care facilities, including
1879	the facilities as defined in chapter 395, shall include, but are
1880	not limited to: case-mix data, patient admission and discharge
1881	data, hospital emergency department data which shall include the
1882	number of patients treated in the emergency department of a
1883	licensed hospital reported by patient acuity level, data on
1884	hospital-acquired infections as specified by rule, data on
1885	complications as specified by rule, data on readmissions as
1886	specified by rule, with patient and provider-specific
1887	identifiers included, actual charge data by diagnostic groups,
1888	financial data, accounting data, operating expenses, expenses
1889	incurred for rendering services to patients who cannot or do not
1890	pay, interest charges, depreciation expenses based on the
1891	expected useful life of the property and equipment involved, and
1892	demographic data. The agency shall adopt nationally recognized
1893	risk adjustment methodologies or software consistent with the
1894	standards of the Agency for Healthcare Research and Quality and
1895	as selected by the agency for all data submitted as required by
1896	this section. Data may be obtained from documents such as, but
1897	not limited to: leases, contracts, debt instruments, itemized
1898	patient bills, medical record abstracts, and related diagnostic
1899	information. Reported data elements shall be reported
1900	electronically and in accordance with rule 59E-7.012, Florida
1901	Administrative Code. Data submitted shall be certified by the
1902	chief executive officer or an appropriate and duly authorized
1903	representative or employee of the licensed facility that the
1904	information submitted is true and accurate.
1905	Section 56.  Subsection (43) of section 408.07, Florida
1906	Statutes, is amended to read:
1907	408.07  Definitions.-As used in this chapter, with the
1908	exception of ss. 408.031-408.045, the term:
1909	(43)  "Rural hospital" means an acute care hospital
1910	licensed under chapter 395, having 100 or fewer licensed beds
1911	and an emergency room, and which is:
1912	(a)  The sole provider within a county with a population
1913	density of no greater than 100 persons per square mile;
1914	(b)  An acute care hospital, in a county with a population
1915	density of no greater than 100 persons per square mile, which is
1916	at least 30 minutes of travel time, on normally traveled roads
1917	under normal traffic conditions, from another acute care
1918	hospital within the same county;
1919	(c)  A hospital supported by a tax district or subdistrict
1920	whose boundaries encompass a population of 100 persons or fewer
1921	per square mile;
1922	(d)  A hospital with a service area that has a population
1923	of 100 persons or fewer per square mile. As used in this
1924	paragraph, the term "service area" means the fewest number of
1925	zip codes that account for 75 percent of the hospital's
1926	discharges for the most recent 5-year period, based on
1927	information available from the hospital inpatient discharge
1928	database in the Florida Center for Health Information and Policy
1929	Analysis at the Agency for Health Care Administration; or
1930	(e)  A critical access hospital.
1931
1932	Population densities used in this subsection must be based upon
1933	the most recently completed United States census. A hospital
1934	that received funds under s. 409.9116 for a quarter beginning no
1935	later than July 1, 2002, is deemed to have been and shall
1936	continue to be a rural hospital from that date through June 30,
1937	2015, if the hospital continues to have 100 or fewer licensed
1938	beds and an emergency room, or meets the criteria of s.
1939	395.602(2)(e)4. An acute care hospital that has not previously
1940	been designated as a rural hospital and that meets the criteria
1941	of this subsection shall be granted such designation upon
1942	application, including supporting documentation, to the Agency
1943	for Health Care Administration.
1944	Section 57.  Section 408.10, Florida Statutes, is amended
1945	to read:
1946	408.10  Consumer complaints.-The agency shall:
1947	(1)  publish and make available to the public a toll-free
1948	telephone number for the purpose of handling consumer complaints
1949	and shall serve as a liaison between consumer entities and other
1950	private entities and governmental entities for the disposition
1951	of problems identified by consumers of health care.
1952	(2)  Be empowered to investigate consumer complaints
1953	relating to problems with health care facilities' billing
1954	practices and issue reports to be made public in any cases where
1955	the agency determines the health care facility has engaged in
1956	billing practices which are unreasonable and unfair to the
1957	consumer.
1958	Section 58.  Subsections (12) through (30) of section
1959	408.802, Florida Statutes, are renumbered as subsections (11)
1960	through (29), respectively, and present subsection (11) of that
1961	section is amended to read:
1962	408.802  Applicability.-The provisions of this part apply
1963	to the provision of services that require licensure as defined
1964	in this part and to the following entities licensed, registered,
1965	or certified by the agency, as described in chapters 112, 383,
1966	390, 394, 395, 400, 429, 440, 483, and 765:
1967	(11)  Private review agents, as provided under part I of
1968	chapter 395.
1969	Section 59.  Subsection (3) is added to section 408.804,
1970	Florida Statutes, to read:
1971	408.804  License required; display.-
1972	(3)  Any person who knowingly alters, defaces, or falsifies
1973	a license certificate issued by the agency, or causes or
1974	procures any person to commit such an offense, commits a
1975	misdemeanor of the second degree, punishable as provided in s.
1976	775.082 or s 775.083. Any licensee or provider who displays an
1977	altered, defaced, or falsified license certificate is subject to
1978	the penalties set forth in s. 408.815 and an administrative fine
1979	of $1,000 for each day of illegal display.
1980	Section 60.  Paragraph (d) of subsection (2) of section
1981	408.806, Florida Statutes, is amended, present subsections (3)
1982	through (8) are renumbered as subsections (4) through (9),
1983	respectively, and a new subsection (3) is added to that section,
1984	to read:
1985	408.806  License application process.-
1986	(2)
1987	(d)  The agency shall notify the licensee by mail or
1988	electronically at least 90 days before the expiration of a
1989	license that a renewal license is necessary to continue
1990	operation. The licensee's failure to timely file submit a
1991	renewal application and license application fee with the agency
1992	shall result in a $50 per day late fee charged to the licensee
1993	by the agency; however, the aggregate amount of the late fee may
1994	not exceed 50 percent of the licensure fee or $500, whichever is
1995	less. The agency shall provide a courtesy notice to the licensee
1996	by United States mail, electronically, or by any other manner at
1997	its address of record or mailing address, if provided, at least
1998	90 days prior to the expiration of a license informing the
1999	licensee of the expiration of the license. If the agency does
2000	not provide the courtesy notice or the licensee does not receive
2001	the courtesy notice, the licensee continues to be legally
2002	obligated to timely file the renewal application and license
2003	application fee with the agency and is not excused from the
2004	payment of a late fee. If an application is received after the
2005	required filing date and exhibits a hand-canceled postmark
2006	obtained from a United States post office dated on or before the
2007	required filing date, no fine will be levied.
2008	(3)  Payment of the late fee is required to consider any
2009	late application complete, and failure to pay the late fee is
2010	considered an omission from the application.
2011	Section 61.  Subsections (6) and (9) of section 408.810,
2012	Florida Statutes, are amended to read:
2013	408.810  Minimum licensure requirements.-In addition to the
2014	licensure requirements specified in this part, authorizing
2015	statutes, and applicable rules, each applicant and licensee must
2016	comply with the requirements of this section in order to obtain
2017	and maintain a license.
2018	(6)(a)  An applicant must provide the agency with proof of
2019	the applicant's legal right to occupy the property before a
2020	license may be issued. Proof may include, but need not be
2021	limited to, copies of warranty deeds, lease or rental
2022	agreements, contracts for deeds, quitclaim deeds, or other such
2023	documentation.
2024	(b)  In the event the property is encumbered by a mortgage
2025	or is leased, an applicant must provide the agency with proof
2026	that the mortgagor or landlord has been provided written notice
2027	of the applicant's intent as mortgagee or tenant to provide
2028	services that require licensure and instruct the mortgagor or
2029	landlord to serve the agency by certified mail with copies of
2030	any foreclosure or eviction actions initiated by the mortgagor
2031	or landlord against the applicant.
2032	(9)  A controlling interest may not withhold from the
2033	agency any evidence of financial instability, including, but not
2034	limited to, checks returned due to insufficient funds,
2035	delinquent accounts, nonpayment of withholding taxes, unpaid
2036	utility expenses, nonpayment for essential services, or adverse
2037	court action concerning the financial viability of the provider
2038	or any other provider licensed under this part that is under the
2039	control of the controlling interest. A controlling interest
2040	shall notify the agency within 10 days after a court action to
2041	initiate bankruptcy, foreclosure, or eviction proceedings
2042	concerning the provider, in which the controlling interest is a
2043	petitioner or defendant. Any person who violates this subsection
2044	commits a misdemeanor of the second degree, punishable as
2045	provided in s. 775.082 or s. 775.083. Each day of continuing
2046	violation is a separate offense.
2047	Section 62.  Subsection (3) is added to section 408.813,
2048	Florida Statutes, to read:
2049	408.813  Administrative fines; violations.-As a penalty for
2050	any violation of this part, authorizing statutes, or applicable
2051	rules, the agency may impose an administrative fine.
2052	(3)  The agency may impose an administrative fine for a
2053	violation that does not qualify as a class I, class II, class
2054	III, or class IV violation. Unless otherwise specified by law,
2055	the amount of the fine shall not exceed $500 for each violation.
2056	Unclassified violations may include:
2057	(a)  Violating any term or condition of a license.
2058	(b)  Violating any provision of this part, authorizing
2059	statutes, or applicable rules.
2060	(c)  Exceeding licensed capacity.
2061	(d)  Providing services beyond the scope of the license.
2062	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2063	Section 63.  Subsection (5) is added to section 408.815,
2064	Florida Statutes, to read:
2065	408.815  License or application denial; revocation.-
2066	(5)  In order to ensure the health, safety, and welfare of
2067	clients when a license has been denied, revoked, or is set to
2068	terminate, the agency may extend the license expiration date for
2069	a period of up to 30 days for the sole purpose of allowing the
2070	safe and orderly discharge of clients. The agency may impose
2071	conditions on the extension, including, but not limited to,
2072	prohibiting or limiting admissions, expedited discharge
2073	planning, required status reports, and mandatory monitoring by
2074	the agency or third parties. In imposing these conditions, the
2075	agency shall take into consideration the nature and number of
2076	clients, the availability and location of acceptable alternative
2077	placements, and the ability of the licensee to continue
2078	providing care to the clients. The agency may terminate the
2079	extension or modify the conditions at any time. This authority
2080	is in addition to any other authority granted to the agency
2081	under chapter 120, this part, and authorizing statutes but
2082	creates no right or entitlement to an extension of a license
2083	expiration date.
2084	Section 64.  Paragraph (k) of subsection (4) of section
2085	409.221, Florida Statutes, is amended to read:
2086	409.221  Consumer-directed care program.-
2087	(4)  CONSUMER-DIRECTED CARE.-
2088	(k)  Reviews and reports.-The agency and the Departments of
2089	Elderly Affairs, Health, and Children and Family Services and
2090	the Agency for Persons with Disabilities shall each, on an
2091	ongoing basis, review and assess the implementation of the
2092	consumer-directed care program. By January 15 of each year, the
2093	agency shall submit a written report to the Legislature that
2094	includes each department's review of the program and contains
2095	recommendations for improvements to the program.
2096	Section 65.  Subsection (1) of section 409.91196, Florida
2097	Statutes, is amended to read:
2098	409.91196  Supplemental rebate agreements; public records
2099	and public meetings exemption.-
2100	(1)  The rebate amount, percent of rebate, manufacturer's
2101	pricing, and supplemental rebate, and other trade secrets as
2102	defined in s. 688.002 that the agency has identified for use in
2103	negotiations, held by the Agency for Health Care Administration
2104	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2105	119.07(1) and s. 24(a), Art. I of the State Constitution.
2106	Section 66.  Paragraph (a) of subsection (39) of section
2107	409.912, Florida Statutes, is amended to read:
2108	409.912  Cost-effective purchasing of health care.-The
2109	agency shall purchase goods and services for Medicaid recipients
2110	in the most cost-effective manner consistent with the delivery
2111	of quality medical care. To ensure that medical services are
2112	effectively utilized, the agency may, in any case, require a
2113	confirmation or second physician's opinion of the correct
2114	diagnosis for purposes of authorizing future services under the
2115	Medicaid program. This section does not restrict access to
2116	emergency services or poststabilization care services as defined
2117	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2118	shall be rendered in a manner approved by the agency. The agency
2119	shall maximize the use of prepaid per capita and prepaid
2120	aggregate fixed-sum basis services when appropriate and other
2121	alternative service delivery and reimbursement methodologies,
2122	including competitive bidding pursuant to s. 287.057, designed
2123	to facilitate the cost-effective purchase of a case-managed
2124	continuum of care. The agency shall also require providers to
2125	minimize the exposure of recipients to the need for acute
2126	inpatient, custodial, and other institutional care and the
2127	inappropriate or unnecessary use of high-cost services. The
2128	agency shall contract with a vendor to monitor and evaluate the
2129	clinical practice patterns of providers in order to identify
2130	trends that are outside the normal practice patterns of a
2131	provider's professional peers or the national guidelines of a
2132	provider's professional association. The vendor must be able to
2133	provide information and counseling to a provider whose practice
2134	patterns are outside the norms, in consultation with the agency,
2135	to improve patient care and reduce inappropriate utilization.
2136	The agency may mandate prior authorization, drug therapy
2137	management, or disease management participation for certain
2138	populations of Medicaid beneficiaries, certain drug classes, or
2139	particular drugs to prevent fraud, abuse, overuse, and possible
2140	dangerous drug interactions. The Pharmaceutical and Therapeutics
2141	Committee shall make recommendations to the agency on drugs for
2142	which prior authorization is required. The agency shall inform
2143	the Pharmaceutical and Therapeutics Committee of its decisions
2144	regarding drugs subject to prior authorization. The agency is
2145	authorized to limit the entities it contracts with or enrolls as
2146	Medicaid providers by developing a provider network through
2147	provider credentialing. The agency may competitively bid single-
2148	source-provider contracts if procurement of goods or services
2149	results in demonstrated cost savings to the state without
2150	limiting access to care. The agency may limit its network based
2151	on the assessment of beneficiary access to care, provider
2152	availability, provider quality standards, time and distance
2153	standards for access to care, the cultural competence of the
2154	provider network, demographic characteristics of Medicaid
2155	beneficiaries, practice and provider-to-beneficiary standards,
2156	appointment wait times, beneficiary use of services, provider
2157	turnover, provider profiling, provider licensure history,
2158	previous program integrity investigations and findings, peer
2159	review, provider Medicaid policy and billing compliance records,
2160	clinical and medical record audits, and other factors. Providers
2161	shall not be entitled to enrollment in the Medicaid provider
2162	network. The agency shall determine instances in which allowing
2163	Medicaid beneficiaries to purchase durable medical equipment and
2164	other goods is less expensive to the Medicaid program than long-
2165	term rental of the equipment or goods. The agency may establish
2166	rules to facilitate purchases in lieu of long-term rentals in
2167	order to protect against fraud and abuse in the Medicaid program
2168	as defined in s. 409.913. The agency may seek federal waivers
2169	necessary to administer these policies.
2170	(39)(a)  The agency shall implement a Medicaid prescribed-
2171	drug spending-control program that includes the following
2172	components:
2173	1.  A Medicaid preferred drug list, which shall be a
2174	listing of cost-effective therapeutic options recommended by the
2175	Medicaid Pharmacy and Therapeutics Committee established
2176	pursuant to s. 409.91195 and adopted by the agency for each
2177	therapeutic class on the preferred drug list. At the discretion
2178	of the committee, and when feasible, the preferred drug list
2179	should include at least two products in a therapeutic class. The
2180	agency may post the preferred drug list and updates to the
2181	preferred drug list on an Internet website without following the
2182	rulemaking procedures of chapter 120. Antiretroviral agents are
2183	excluded from the preferred drug list. The agency shall also
2184	limit the amount of a prescribed drug dispensed to no more than
2185	a 34-day supply unless the drug products' smallest marketed
2186	package is greater than a 34-day supply, or the drug is
2187	determined by the agency to be a maintenance drug in which case
2188	a 100-day maximum supply may be authorized. The agency is
2189	authorized to seek any federal waivers necessary to implement
2190	these cost-control programs and to continue participation in the
2191	federal Medicaid rebate program, or alternatively to negotiate
2192	state-only manufacturer rebates. The agency may adopt rules to
2193	implement this subparagraph. The agency shall continue to
2194	provide unlimited contraceptive drugs and items. The agency must
2195	establish procedures to ensure that:
2196	a.  There is a response to a request for prior consultation
2197	by telephone or other telecommunication device within 24 hours
2198	after receipt of a request for prior consultation; and
2199	b.  A 72-hour supply of the drug prescribed is provided in
2200	an emergency or when the agency does not provide a response
2201	within 24 hours as required by sub-subparagraph a.
2202	2.  Reimbursement to pharmacies for Medicaid prescribed
2203	drugs shall be set at the lesser of: the average wholesale price
2204	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2205	plus 4.75 percent, the federal upper limit (FUL), the state
2206	maximum allowable cost (SMAC), or the usual and customary (UAC)
2207	charge billed by the provider.
2208	3.  For a prescribed drug billed as a 340B prescribed
2209	medication, the claim must meet the requirements of the Deficit
2210	Reduction Act of 2005 and the federal 340B program, contain a
2211	national drug code, and be billed at the actual acquisition cost
2212	or payment shall be denied.
2213	4.3.  The agency shall develop and implement a process for
2214	managing the drug therapies of Medicaid recipients who are using
2215	significant numbers of prescribed drugs each month. The
2216	management process may include, but is not limited to,
2217	comprehensive, physician-directed medical-record reviews, claims
2218	analyses, and case evaluations to determine the medical
2219	necessity and appropriateness of a patient's treatment plan and
2220	drug therapies. The agency may contract with a private
2221	organization to provide drug-program-management services. The
2222	Medicaid drug benefit management program shall include
2223	initiatives to manage drug therapies for HIV/AIDS patients,
2224	patients using 20 or more unique prescriptions in a 180-day
2225	period, and the top 1,000 patients in annual spending. The
2226	agency shall enroll any Medicaid recipient in the drug benefit
2227	management program if he or she meets the specifications of this
2228	provision and is not enrolled in a Medicaid health maintenance
2229	organization.
2230	5.4.  The agency may limit the size of its pharmacy network
2231	based on need, competitive bidding, price negotiations,
2232	credentialing, or similar criteria. The agency shall give
2233	special consideration to rural areas in determining the size and
2234	location of pharmacies included in the Medicaid pharmacy
2235	network. A pharmacy credentialing process may include criteria
2236	such as a pharmacy's full-service status, location, size,
2237	patient educational programs, patient consultation, disease
2238	management services, and other characteristics. The agency may
2239	impose a moratorium on Medicaid pharmacy enrollment when it is
2240	determined that it has a sufficient number of Medicaid-
2241	participating providers. The agency must allow dispensing
2242	practitioners to participate as a part of the Medicaid pharmacy
2243	network regardless of the practitioner's proximity to any other
2244	entity that is dispensing prescription drugs under the Medicaid
2245	program. A dispensing practitioner must meet all credentialing
2246	requirements applicable to his or her practice, as determined by
2247	the agency.
2248	6.5.  The agency shall develop and implement a program that
2249	requires Medicaid practitioners who prescribe drugs to use a
2250	counterfeit-proof prescription pad for Medicaid prescriptions.
2251	The agency shall require the use of standardized counterfeit-
2252	proof prescription pads by Medicaid-participating prescribers or
2253	prescribers who write prescriptions for Medicaid recipients. The
2254	agency may implement the program in targeted geographic areas or
2255	statewide.
2256	7.6.  The agency may enter into arrangements that require
2257	manufacturers of generic drugs prescribed to Medicaid recipients
2258	to provide rebates of at least 15.1 percent of the average
2259	manufacturer price for the manufacturer's generic products.
2260	These arrangements shall require that if a generic-drug
2261	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2262	at a level below 15.1 percent, the manufacturer must provide a
2263	supplemental rebate to the state in an amount necessary to
2264	achieve a 15.1-percent rebate level.
2265	8.7.  The agency may establish a preferred drug list as
2266	described in this subsection, and, pursuant to the establishment
2267	of such preferred drug list, it is authorized to negotiate
2268	supplemental rebates from manufacturers that are in addition to
2269	those required by Title XIX of the Social Security Act and at no
2270	less than 14 percent of the average manufacturer price as
2271	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2272	the federal or supplemental rebate, or both, equals or exceeds
2273	29 percent. There is no upper limit on the supplemental rebates
2274	the agency may negotiate. The agency may determine that specific
2275	products, brand-name or generic, are competitive at lower rebate
2276	percentages. Agreement to pay the minimum supplemental rebate
2277	percentage will guarantee a manufacturer that the Medicaid
2278	Pharmaceutical and Therapeutics Committee will consider a
2279	product for inclusion on the preferred drug list. However, a
2280	pharmaceutical manufacturer is not guaranteed placement on the
2281	preferred drug list by simply paying the minimum supplemental
2282	rebate. Agency decisions will be made on the clinical efficacy
2283	of a drug and recommendations of the Medicaid Pharmaceutical and
2284	Therapeutics Committee, as well as the price of competing
2285	products minus federal and state rebates. The agency is
2286	authorized to contract with an outside agency or contractor to
2287	conduct negotiations for supplemental rebates. For the purposes
2288	of this section, the term "supplemental rebates" means cash
2289	rebates. Effective July 1, 2004, value-added programs as a
2290	substitution for supplemental rebates are prohibited. The agency
2291	is authorized to seek any federal waivers to implement this
2292	initiative.
2293	9.8.  The Agency for Health Care Administration shall
2294	expand home delivery of pharmacy products. To assist Medicaid
2295	patients in securing their prescriptions and reduce program
2296	costs, the agency shall expand its current mail-order-pharmacy
2297	diabetes-supply program to include all generic and brand-name
2298	drugs used by Medicaid patients with diabetes. Medicaid
2299	recipients in the current program may obtain nondiabetes drugs
2300	on a voluntary basis. This initiative is limited to the
2301	geographic area covered by the current contract. The agency may
2302	seek and implement any federal waivers necessary to implement
2303	this subparagraph.
2304	10.9.  The agency shall limit to one dose per month any
2305	drug prescribed to treat erectile dysfunction.
2306	11.10.a.  The agency may implement a Medicaid behavioral
2307	drug management system. The agency may contract with a vendor
2308	that has experience in operating behavioral drug management
2309	systems to implement this program. The agency is authorized to
2310	seek federal waivers to implement this program.
2311	b.  The agency, in conjunction with the Department of
2312	Children and Family Services, may implement the Medicaid
2313	behavioral drug management system that is designed to improve
2314	the quality of care and behavioral health prescribing practices
2315	based on best practice guidelines, improve patient adherence to
2316	medication plans, reduce clinical risk, and lower prescribed
2317	drug costs and the rate of inappropriate spending on Medicaid
2318	behavioral drugs. The program may include the following
2319	elements:
2320	(I)  Provide for the development and adoption of best
2321	practice guidelines for behavioral health-related drugs such as
2322	antipsychotics, antidepressants, and medications for treating
2323	bipolar disorders and other behavioral conditions; translate
2324	them into practice; review behavioral health prescribers and
2325	compare their prescribing patterns to a number of indicators
2326	that are based on national standards; and determine deviations
2327	from best practice guidelines.
2328	(II)  Implement processes for providing feedback to and
2329	educating prescribers using best practice educational materials
2330	and peer-to-peer consultation.
2331	(III)  Assess Medicaid beneficiaries who are outliers in
2332	their use of behavioral health drugs with regard to the numbers
2333	and types of drugs taken, drug dosages, combination drug
2334	therapies, and other indicators of improper use of behavioral
2335	health drugs.
2336	(IV)  Alert prescribers to patients who fail to refill
2337	prescriptions in a timely fashion, are prescribed multiple same-
2338	class behavioral health drugs, and may have other potential
2339	medication problems.
2340	(V)  Track spending trends for behavioral health drugs and
2341	deviation from best practice guidelines.
2342	(VI)  Use educational and technological approaches to
2343	promote best practices, educate consumers, and train prescribers
2344	in the use of practice guidelines.
2345	(VII)  Disseminate electronic and published materials.
2346	(VIII)  Hold statewide and regional conferences.
2347	(IX)  Implement a disease management program with a model
2348	quality-based medication component for severely mentally ill
2349	individuals and emotionally disturbed children who are high
2350	users of care.
2351	12.11.a.  The agency shall implement a Medicaid
2352	prescription drug management system. The agency may contract
2353	with a vendor that has experience in operating prescription drug
2354	management systems in order to implement this system. Any
2355	management system that is implemented in accordance with this
2356	subparagraph must rely on cooperation between physicians and
2357	pharmacists to determine appropriate practice patterns and
2358	clinical guidelines to improve the prescribing, dispensing, and
2359	use of drugs in the Medicaid program. The agency may seek
2360	federal waivers to implement this program.
2361	b.  The drug management system must be designed to improve
2362	the quality of care and prescribing practices based on best
2363	practice guidelines, improve patient adherence to medication
2364	plans, reduce clinical risk, and lower prescribed drug costs and
2365	the rate of inappropriate spending on Medicaid prescription
2366	drugs. The program must:
2367	(I)  Provide for the development and adoption of best
2368	practice guidelines for the prescribing and use of drugs in the
2369	Medicaid program, including translating best practice guidelines
2370	into practice; reviewing prescriber patterns and comparing them
2371	to indicators that are based on national standards and practice
2372	patterns of clinical peers in their community, statewide, and
2373	nationally; and determine deviations from best practice
2374	guidelines.
2375	(II)  Implement processes for providing feedback to and
2376	educating prescribers using best practice educational materials
2377	and peer-to-peer consultation.
2378	(III)  Assess Medicaid recipients who are outliers in their
2379	use of a single or multiple prescription drugs with regard to
2380	the numbers and types of drugs taken, drug dosages, combination
2381	drug therapies, and other indicators of improper use of
2382	prescription drugs.
2383	(IV)  Alert prescribers to patients who fail to refill
2384	prescriptions in a timely fashion, are prescribed multiple drugs
2385	that may be redundant or contraindicated, or may have other
2386	potential medication problems.
2387	(V)  Track spending trends for prescription drugs and
2388	deviation from best practice guidelines.
2389	(VI)  Use educational and technological approaches to
2390	promote best practices, educate consumers, and train prescribers
2391	in the use of practice guidelines.
2392	(VII)  Disseminate electronic and published materials.
2393	(VIII)  Hold statewide and regional conferences.
2394	(IX)  Implement disease management programs in cooperation
2395	with physicians and pharmacists, along with a model quality-
2396	based medication component for individuals having chronic
2397	medical conditions.
2398	13.12.  The agency is authorized to contract for drug
2399	rebate administration, including, but not limited to,
2400	calculating rebate amounts, invoicing manufacturers, negotiating
2401	disputes with manufacturers, and maintaining a database of
2402	rebate collections.
2403	14.13.  The agency may specify the preferred daily dosing
2404	form or strength for the purpose of promoting best practices
2405	with regard to the prescribing of certain drugs as specified in
2406	the General Appropriations Act and ensuring cost-effective
2407	prescribing practices.
2408	15.14.  The agency may require prior authorization for
2409	Medicaid-covered prescribed drugs. The agency may, but is not
2410	required to, prior-authorize the use of a product:
2411	a.  For an indication not approved in labeling;
2412	b.  To comply with certain clinical guidelines; or
2413	c.  If the product has the potential for overuse, misuse,
2414	or abuse.
2415
2416	The agency may require the prescribing professional to provide
2417	information about the rationale and supporting medical evidence
2418	for the use of a drug. The agency may post prior authorization
2419	criteria and protocol and updates to the list of drugs that are
2420	subject to prior authorization on an Internet website without
2421	amending its rule or engaging in additional rulemaking.
2422	16.15.  The agency, in conjunction with the Pharmaceutical
2423	and Therapeutics Committee, may require age-related prior
2424	authorizations for certain prescribed drugs. The agency may
2425	preauthorize the use of a drug for a recipient who may not meet
2426	the age requirement or may exceed the length of therapy for use
2427	of this product as recommended by the manufacturer and approved
2428	by the Food and Drug Administration. Prior authorization may
2429	require the prescribing professional to provide information
2430	about the rationale and supporting medical evidence for the use
2431	of a drug.
2432	17.16.  The agency shall implement a step-therapy prior
2433	authorization approval process for medications excluded from the
2434	preferred drug list. Medications listed on the preferred drug
2435	list must be used within the previous 12 months prior to the
2436	alternative medications that are not listed. The step-therapy
2437	prior authorization may require the prescriber to use the
2438	medications of a similar drug class or for a similar medical
2439	indication unless contraindicated in the Food and Drug
2440	Administration labeling. The trial period between the specified
2441	steps may vary according to the medical indication. The step-
2442	therapy approval process shall be developed in accordance with
2443	the committee as stated in s. 409.91195(7) and (8). A drug
2444	product may be approved without meeting the step-therapy prior
2445	authorization criteria if the prescribing physician provides the
2446	agency with additional written medical or clinical documentation
2447	that the product is medically necessary because:
2448	a.  There is not a drug on the preferred drug list to treat
2449	the disease or medical condition which is an acceptable clinical
2450	alternative;
2451	b.  The alternatives have been ineffective in the treatment
2452	of the beneficiary's disease; or
2453	c.  Based on historic evidence and known characteristics of
2454	the patient and the drug, the drug is likely to be ineffective,
2455	or the number of doses have been ineffective.
2456
2457	The agency shall work with the physician to determine the best
2458	alternative for the patient. The agency may adopt rules waiving
2459	the requirements for written clinical documentation for specific
2460	drugs in limited clinical situations.
2461	18.17.  The agency shall implement a return and reuse
2462	program for drugs dispensed by pharmacies to institutional
2463	recipients, which includes payment of a $5 restocking fee for
2464	the implementation and operation of the program. The return and
2465	reuse program shall be implemented electronically and in a
2466	manner that promotes efficiency. The program must permit a
2467	pharmacy to exclude drugs from the program if it is not
2468	practical or cost-effective for the drug to be included and must
2469	provide for the return to inventory of drugs that cannot be
2470	credited or returned in a cost-effective manner. The agency
2471	shall determine if the program has reduced the amount of
2472	Medicaid prescription drugs which are destroyed on an annual
2473	basis and if there are additional ways to ensure more
2474	prescription drugs are not destroyed which could safely be
2475	reused. The agency's conclusion and recommendations shall be
2476	reported to the Legislature by December 1, 2005.
2477	Section 67.  Subsections (3) and (4) of section 429.07,
2478	Florida Statutes, are amended, and subsections (6) and (7) are
2479	added to that section, to read:
2480	429.07  License required; fee; inspections.-
2481	(3)  In addition to the requirements of s. 408.806, each
2482	license granted by the agency must state the type of care for
2483	which the license is granted. Licenses shall be issued for one
2484	or more of the following categories of care: standard, extended
2485	congregate care, limited nursing services, or limited mental
2486	health.
2487	(a)  A standard license shall be issued to a facility
2488	facilities providing one or more of the personal services
2489	identified in s. 429.02. Such licensee facilities may also
2490	employ or contract with a person licensed under part I of
2491	chapter 464 to administer medications and perform other tasks as
2492	specified in s. 429.255.
2493	(b)  An extended congregate care license shall be issued to
2494	a licensee facilities providing, directly or through contract,
2495	services beyond those authorized in paragraph (a), including
2496	acts performed pursuant to part I of chapter 464 by persons
2497	licensed thereunder, and supportive services defined by rule to
2498	persons who otherwise would be disqualified from continued
2499	residence in a facility licensed under this part.
2500	1.  In order for extended congregate care services to be
2501	provided in a facility licensed under this part, the agency must
2502	first determine that all requirements established in law and
2503	rule are met and must specifically designate, on the facility's
2504	license, that such services may be provided and whether the
2505	designation applies to all or part of a facility. Such
2506	designation may be made at the time of initial licensure or
2507	relicensure, or upon request in writing by a licensee under this
2508	part and part II of chapter 408. Notification of approval or
2509	denial of such request shall be made in accordance with part II
2510	of chapter 408. An existing licensee facilities qualifying to
2511	provide extended congregate care services must have maintained a
2512	standard license and may not have been subject to administrative
2513	sanctions during the previous 2 years, or since initial
2514	licensure if the facility has been licensed for less than 2
2515	years, for any of the following reasons:
2516	a.  A class I or class II violation;
2517	b.  Three or more repeat or recurring class III violations
2518	of identical or similar resident care standards as specified in
2519	rule from which a pattern of noncompliance is found by the
2520	agency;
2521	c.  Three or more class III violations that were not
2522	corrected in accordance with the corrective action plan approved
2523	by the agency;
2524	d.  Violation of resident care standards resulting in a
2525	requirement to employ the services of a consultant pharmacist or
2526	consultant dietitian;
2527	e.  Denial, suspension, or revocation of a license for
2528	another facility under this part in which the applicant for an
2529	extended congregate care license has at least 25 percent
2530	ownership interest; or
2531	f.  Imposition of a moratorium pursuant to this part or
2532	part II of chapter 408 or initiation of injunctive proceedings.
2533	2.  A licensee Facilities that is are licensed to provide
2534	extended congregate care services shall maintain a written
2535	progress report for on each person who receives such services,
2536	and the which report must describe describes the type, amount,
2537	duration, scope, and outcome of services that are rendered and
2538	the general status of the resident's health. A registered nurse,
2539	or appropriate designee, representing the agency shall visit
2540	such facilities at least quarterly to monitor residents who are
2541	receiving extended congregate care services and to determine if
2542	the facility is in compliance with this part, part II of chapter
2543	408, and rules that relate to extended congregate care. One of
2544	these visits may be in conjunction with the regular survey. The
2545	monitoring visits may be provided through contractual
2546	arrangements with appropriate community agencies. A registered
2547	nurse shall serve as part of the team that inspects such
2548	facility. The agency may waive one of the required yearly
2549	monitoring visits for a facility that has been licensed for at
2550	least 24 months to provide extended congregate care services,
2551	if, during the inspection, the registered nurse determines that
2552	extended congregate care services are being provided
2553	appropriately, and if the facility has no class I or class II
2554	violations and no uncorrected class III violations. Before such
2555	decision is made, the agency shall consult with the long-term
2556	care ombudsman council for the area in which the facility is
2557	located to determine if any complaints have been made and
2558	substantiated about the quality of services or care. The agency
2559	may not waive one of the required yearly monitoring visits if
2560	complaints have been made and substantiated.
2561	3.  Licensees Facilities that are licensed to provide
2562	extended congregate care services shall:
2563	a.  Demonstrate the capability to meet unanticipated
2564	resident service needs.
2565	b.  Offer a physical environment that promotes a homelike
2566	setting, provides for resident privacy, promotes resident
2567	independence, and allows sufficient congregate space as defined
2568	by rule.
2569	c.  Have sufficient staff available, taking into account
2570	the physical plant and firesafety features of the building, to
2571	assist with the evacuation of residents in an emergency, as
2572	necessary.
2573	d.  Adopt and follow policies and procedures that maximize
2574	resident independence, dignity, choice, and decisionmaking to
2575	permit residents to age in place to the extent possible, so that
2576	moves due to changes in functional status are minimized or
2577	avoided.
2578	e.  Allow residents or, if applicable, a resident's
2579	representative, designee, surrogate, guardian, or attorney in
2580	fact to make a variety of personal choices, participate in
2581	developing service plans, and share responsibility in
2582	decisionmaking.
2583	f.  Implement the concept of managed risk.
2584	g.  Provide, either directly or through contract, the
2585	services of a person licensed pursuant to part I of chapter 464.
2586	h.  In addition to the training mandated in s. 429.52,
2587	provide specialized training as defined by rule for facility
2588	staff.
2589	4.  Licensees Facilities licensed to provide extended
2590	congregate care services are exempt from the criteria for
2591	continued residency as set forth in rules adopted under s.
2592	429.41. Licensees Facilities so licensed shall adopt their own
2593	requirements within guidelines for continued residency set forth
2594	by rule. However, such licensees facilities may not serve
2595	residents who require 24-hour nursing supervision. Licensees
2596	Facilities licensed to provide extended congregate care services
2597	shall provide each resident with a written copy of facility
2598	policies governing admission and retention.
2599	5.  The primary purpose of extended congregate care
2600	services is to allow residents, as they become more impaired,
2601	the option of remaining in a familiar setting from which they
2602	would otherwise be disqualified for continued residency. A
2603	facility licensed to provide extended congregate care services
2604	may also admit an individual who exceeds the admission criteria
2605	for a facility with a standard license, if the individual is
2606	determined appropriate for admission to the extended congregate
2607	care facility.
2608	6.  Before admission of an individual to a facility
2609	licensed to provide extended congregate care services, the
2610	individual must undergo a medical examination as provided in s.
2611	429.26(4) and the facility must develop a preliminary service
2612	plan for the individual.
2613	7.  When a licensee facility can no longer provide or
2614	arrange for services in accordance with the resident's service
2615	plan and needs and the licensee's facility's policy, the
2616	licensee facility shall make arrangements for relocating the
2617	person in accordance with s. 429.28(1)(k).
2618	8.  Failure to provide extended congregate care services
2619	may result in denial of extended congregate care license
2620	renewal.
2621	9.  No later than January 1 of each year, the department,
2622	in consultation with the agency, shall prepare and submit to the
2623	Governor, the President of the Senate, the Speaker of the House
2624	of Representatives, and the chairs of appropriate legislative
2625	committees, a report on the status of, and recommendations
2626	related to, extended congregate care services. The status report
2627	must include, but need not be limited to, the following
2628	information:
2629	a.  A description of the facilities licensed to provide
2630	such services, including total number of beds licensed under
2631	this part.
2632	b.  The number and characteristics of residents receiving
2633	such services.
2634	c.  The types of services rendered that could not be
2635	provided through a standard license.
2636	d.  An analysis of deficiencies cited during licensure
2637	inspections.
2638	e.  The number of residents who required extended
2639	congregate care services at admission and the source of
2640	admission.
2641	f.  Recommendations for statutory or regulatory changes.
2642	g.  The availability of extended congregate care to state
2643	clients residing in facilities licensed under this part and in
2644	need of additional services, and recommendations for
2645	appropriations to subsidize extended congregate care services
2646	for such persons.
2647	h.  Such other information as the department considers
2648	appropriate.
2649	(c)  A limited nursing services license shall be issued to
2650	a facility that provides services beyond those authorized in
2651	paragraph (a) and as specified in this paragraph.
2652	1.  In order for limited nursing services to be provided in
2653	a facility licensed under this part, the agency must first
2654	determine that all requirements established in law and rule are
2655	met and must specifically designate, on the facility's license,
2656	that such services may be provided. Such designation may be made
2657	at the time of initial licensure or relicensure, or upon request
2658	in writing by a licensee under this part and part II of chapter
2659	408. Notification of approval or denial of such request shall be
2660	made in accordance with part II of chapter 408. Existing
2661	facilities qualifying to provide limited nursing services shall
2662	have maintained a standard license and may not have been subject
2663	to administrative sanctions that affect the health, safety, and
2664	welfare of residents for the previous 2 years or since initial
2665	licensure if the facility has been licensed for less than 2
2666	years.
2667	2.  Facilities that are licensed to provide limited nursing
2668	services shall maintain a written progress report on each person
2669	who receives such nursing services, which report describes the
2670	type, amount, duration, scope, and outcome of services that are
2671	rendered and the general status of the resident's health. A
2672	registered nurse representing the agency shall visit such
2673	facilities at least twice a year to monitor residents who are
2674	receiving limited nursing services and to determine if the
2675	facility is in compliance with applicable provisions of this
2676	part, part II of chapter 408, and related rules. The monitoring
2677	visits may be provided through contractual arrangements with
2678	appropriate community agencies. A registered nurse shall also
2679	serve as part of the team that inspects such facility.
2680	3.  A person who receives limited nursing services under
2681	this part must meet the admission criteria established by the
2682	agency for assisted living facilities. When a resident no longer
2683	meets the admission criteria for a facility licensed under this
2684	part, arrangements for relocating the person shall be made in
2685	accordance with s. 429.28(1)(k), unless the facility is licensed
2686	to provide extended congregate care services.
2687	(4)  In accordance with s. 408.805, an applicant or
2688	licensee shall pay a fee for each license application submitted
2689	under this part, part II of chapter 408, and applicable rules.
2690	The amount of the fee shall be established by rule.
2691	(a)  The biennial license fee required of a facility is
2692	$356 $300 per license, with an additional fee of $67.50 $50 per
2693	resident based on the total licensed resident capacity of the
2694	facility, except that no additional fee will be assessed for
2695	beds designated for recipients of optional state supplementation
2696	payments provided for in s. 409.212. The total fee may not
2697	exceed $18,000 $10,000.
2698	(b)  In addition to the total fee assessed under paragraph
2699	(a), the agency shall require facilities that are licensed to
2700	provide extended congregate care services under this part to pay
2701	an additional fee per licensed facility. The amount of the
2702	biennial fee shall be $501 $400 per license, with an additional
2703	fee of $10 per resident based on the total licensed resident
2704	capacity of the facility.
2705	(c)  In addition to the total fee assessed under paragraph
2706	(a), the agency shall require facilities that are licensed to
2707	provide limited nursing services under this part to pay an
2708	additional fee per licensed facility. The amount of the biennial
2709	fee shall be $250 per license, with an additional fee of $10 per
2710	resident based on the total licensed resident capacity of the
2711	facility.
2712	(6)  In order to determine whether the facility is
2713	adequately protecting residents' rights as provided in s.
2714	429.28, the biennial survey shall include private informal
2715	conversations with a sample of residents and consultation with
2716	the ombudsman council in the planning and service area in which
2717	the facility is located to discuss residents' experiences within
2718	the facility.
2719	(7)  An assisted living facility that has been cited within
2720	the previous 24-month period for a class I or class II
2721	violation, regardless of the status of any enforcement or
2722	disciplinary action, is subject to periodic unannounced
2723	monitoring to determine if the facility is in compliance with
2724	this part, part II of chapter 408, and applicable rules.
2725	Monitoring may occur through a desk review or an onsite
2726	assessment. If the class I or class II violation relates to
2727	providing or failing to provide nursing care, a registered nurse
2728	must participate in at least two onsite monitoring visits within
2729	a 12-month period.
2730	Section 68.  Subsection (7) of section 429.11, Florida
2731	Statutes, is renumbered as subsection (6), and present
2732	subsection (6) of that section is amended to read:
2733	429.11  Initial application for license; provisional
2734	license.-
2735	(6)  In addition to the license categories available in s.
2736	408.808, a provisional license may be issued to an applicant
2737	making initial application for licensure or making application
2738	for a change of ownership. A provisional license shall be
2739	limited in duration to a specific period of time not to exceed 6
2740	months, as determined by the agency.
2741	Section 69.  Section 429.12, Florida Statutes, is amended
2742	to read:
2743	429.12  Sale or transfer of ownership of a facility.-It is
2744	the intent of the Legislature to protect the rights of the
2745	residents of an assisted living facility when the facility is
2746	sold or the ownership thereof is transferred. Therefore, in
2747	addition to the requirements of part II of chapter 408, whenever
2748	a facility is sold or the ownership thereof is transferred,
2749	including leasing:.
2750	(1)  The transferee shall notify the residents, in writing,
2751	of the change of ownership within 7 days after receipt of the
2752	new license.
2753	(2)  The transferor of a facility the license of which is
2754	denied pending an administrative hearing shall, as a part of the
2755	written change-of-ownership contract, advise the transferee that
2756	a plan of correction must be submitted by the transferee and
2757	approved by the agency at least 7 days before the change of
2758	ownership and that failure to correct the condition which
2759	resulted in the moratorium pursuant to part II of chapter 408 or
2760	denial of licensure is grounds for denial of the transferee's
2761	license.
2762	Section 70.  Paragraphs (b) through (l) of subsection (1)
2763	of section 429.14, Florida Statutes, are redesignated as
2764	paragraphs (a) through (k), respectively, and present paragraph
2765	(a) of subsection (1) and subsections (5) and (6) of that
2766	section are amended to read:
2767	429.14  Administrative penalties.-
2768	(1)  In addition to the requirements of part II of chapter
2769	408, the agency may deny, revoke, and suspend any license issued
2770	under this part and impose an administrative fine in the manner
2771	provided in chapter 120 against a licensee of an assisted living
2772	facility for a violation of any provision of this part, part II
2773	of chapter 408, or applicable rules, or for any of the following
2774	actions by a licensee of an assisted living facility, for the
2775	actions of any person subject to level 2 background screening
2776	under s. 408.809, or for the actions of any facility employee:
2777	(a)  An intentional or negligent act seriously affecting
2778	the health, safety, or welfare of a resident of the facility.
2779	(5)  An action taken by the agency to suspend, deny, or
2780	revoke a facility's license under this part or part II of
2781	chapter 408, in which the agency claims that the facility owner
2782	or an employee of the facility has threatened the health,
2783	safety, or welfare of a resident of the facility shall be heard
2784	by the Division of Administrative Hearings of the Department of
2785	Management Services within 120 days after receipt of the
2786	facility's request for a hearing, unless that time limitation is
2787	waived by both parties. The administrative law judge must render
2788	a decision within 30 days after receipt of a proposed
2789	recommended order.
2790	(6)  The agency shall provide to the Division of Hotels and
2791	Restaurants of the Department of Business and Professional
2792	Regulation, on a monthly basis, a list of those assisted living
2793	facilities that have had their licenses denied, suspended, or
2794	revoked or that are involved in an appellate proceeding pursuant
2795	to s. 120.60 related to the denial, suspension, or revocation of
2796	a license. This information may be provided electronically or
2797	through the agency's Internet website.
2798	Section 71.  Subsections (1), (4), and (5) of section
2799	429.17, Florida Statutes, are amended to read:
2800	429.17  Expiration of license; renewal; conditional
2801	license.-
2802	(1)  Limited nursing, Extended congregate care, and limited
2803	mental health licenses shall expire at the same time as the
2804	facility's standard license, regardless of when issued.
2805	(4)  In addition to the license categories available in s.
2806	408.808, a conditional license may be issued to an applicant for
2807	license renewal if the applicant fails to meet all standards and
2808	requirements for licensure. A conditional license issued under
2809	this subsection shall be limited in duration to a specific
2810	period of time not to exceed 6 months, as determined by the
2811	agency, and shall be accompanied by an agency-approved plan of
2812	correction.
2813	(5)  When an extended congregate care or limited nursing
2814	license is requested during a facility's biennial license
2815	period, the fee shall be prorated in order to permit the
2816	additional license to expire at the end of the biennial license
2817	period. The fee shall be calculated as of the date the
2818	additional license application is received by the agency.
2819	Section 72.  Subsection (7) of section 429.19, Florida
2820	Statutes, is amended to read:
2821	429.19  Violations; imposition of administrative fines;
2822	grounds.-
2823	(7)  In addition to any administrative fines imposed, the
2824	agency may assess a survey or monitoring fee, equal to the
2825	lesser of one half of the facility's biennial license and bed
2826	fee or $500, to cover the cost of conducting initial complaint
2827	investigations that result in the finding of a violation that
2828	was the subject of the complaint or to monitor the health,
2829	safety, or security of residents under s. 429.07     (7) monitoring
2830	visits conducted under s. 429.28(3)(c) to verify the correction
2831	of the violations.
2832	Section 73.  Subsections (6) through (10) of section
2833	429.23, Florida Statutes, are renumbered as subsections (5)
2834	through (9), respectively, and present subsection (5) of that
2835	section is amended to read:
2836	429.23  Internal risk management and quality assurance
2837	program; adverse incidents and reporting requirements.-
2838	(5)  Each facility shall report monthly to the agency any
2839	liability claim filed against it. The report must include the
2840	name of the resident, the dates of the incident leading to the
2841	claim, if applicable, and the type of injury or violation of
2842	rights alleged to have occurred. This report is not discoverable
2843	in any civil or administrative action, except in such actions
2844	brought by the agency to enforce the provisions of this part.
2845	Section 74.  Paragraph (a) of subsection (1) and subsection
2846	(2) of section 429.255, Florida Statutes, are amended to read:
2847	429.255  Use of personnel; emergency care.-
2848	(1)(a)  Persons under contract to the facility or, facility
2849	staff, or volunteers, who are licensed according to part I of
2850	chapter 464, or those persons exempt under s. 464.022(1), and
2851	others as defined by rule, may administer medications to
2852	residents, take residents' vital signs, manage individual weekly
2853	pill organizers for residents who self-administer medication,
2854	give prepackaged enemas ordered by a physician, observe
2855	residents, document observations on the appropriate resident's
2856	record, report observations to the resident's physician, and
2857	contract or allow residents or a resident's representative,
2858	designee, surrogate, guardian, or attorney in fact to contract
2859	with a third party, provided residents meet the criteria for
2860	appropriate placement as defined in s. 429.26. Persons under
2861	contract to the facility or facility staff who are licensed
2862	according to part I of chapter 464 may provide limited nursing
2863	services. Nursing assistants certified pursuant to part II of
2864	chapter 464 may take residents' vital signs as directed by a
2865	licensed nurse or physician. The facility is responsible for
2866	maintaining documentation of services provided under this
2867	paragraph as required by rule and ensuring that staff are
2868	adequately trained to monitor residents receiving these
2869	services.
2870	(2)  In facilities licensed to provide extended congregate
2871	care, persons under contract to the facility or, facility staff,
2872	or volunteers, who are licensed according to part I of chapter
2873	464, or those persons exempt under s. 464.022(1), or those
2874	persons certified as nursing assistants pursuant to part II of
2875	chapter 464, may also perform all duties within the scope of
2876	their license or certification, as approved by the facility
2877	administrator and pursuant to this part.
2878	Section 75.  Subsection (3) of section 429.28, Florida
2879	Statutes, is amended to read:
2880	429.28  Resident bill of rights.-
2881	(3)(a)  The agency shall conduct a survey to determine
2882	general compliance with facility standards and compliance with
2883	residents' rights as a prerequisite to initial licensure or
2884	licensure renewal.
2885	(b)  In order to determine whether the facility is
2886	adequately protecting residents' rights, the biennial survey
2887	shall include private informal conversations with a sample of
2888	residents and consultation with the ombudsman council in the
2889	planning and service area in which the facility is located to
2890	discuss residents' experiences within the facility.
2891	(c)  During any calendar year in which no survey is
2892	conducted, the agency shall conduct at least one monitoring
2893	visit of each facility cited in the previous year for a class I
2894	or class II violation, or more than three uncorrected class III
2895	violations.
2896	(d)  The agency may conduct periodic followup inspections
2897	as necessary to monitor the compliance of facilities with a
2898	history of any class I, class II, or class III violations that
2899	threaten the health, safety, or security of residents.
2900	(e)  The agency may conduct complaint investigations as
2901	warranted to investigate any allegations of noncompliance with
2902	requirements required under this part or rules adopted under
2903	this part.
2904	Section 76.  Subsection (2) of section 429.35, Florida
2905	Statutes, is amended to read:
2906	429.35  Maintenance of records; reports.-
2907	(2)  Within 60 days after the date of the biennial
2908	inspection visit required under s. 408.811 or within 30 days
2909	after the date of any interim visit, the agency shall forward
2910	the results of the inspection to the local ombudsman council in
2911	whose planning and service area, as defined in part II of
2912	chapter 400, the facility is located; to at least one public
2913	library or, in the absence of a public library, the county seat
2914	in the county in which the inspected assisted living facility is
2915	located; and, when appropriate, to the district Adult Services
2916	and Mental Health Program Offices. This information may be
2917	provided electronically or through the agency's Internet
2918	website.
2919	Section 77.  Paragraphs (i) and (j) of subsection (1) of
2920	section 429.41, Florida Statutes, are amended to read:
2921	429.41  Rules establishing standards.-
2922	(1)  It is the intent of the Legislature that rules
2923	published and enforced pursuant to this section shall include
2924	criteria by which a reasonable and consistent quality of
2925	resident care and quality of life may be ensured and the results
2926	of such resident care may be demonstrated. Such rules shall also
2927	ensure a safe and sanitary environment that is residential and
2928	noninstitutional in design or nature. It is further intended
2929	that reasonable efforts be made to accommodate the needs and
2930	preferences of residents to enhance the quality of life in a
2931	facility. The agency, in consultation with the department, may
2932	adopt rules to administer the requirements of part II of chapter
2933	408. In order to provide safe and sanitary facilities and the
2934	highest quality of resident care accommodating the needs and
2935	preferences of residents, the department, in consultation with
2936	the agency, the Department of Children and Family Services, and
2937	the Department of Health, shall adopt rules, policies, and
2938	procedures to administer this part, which must include
2939	reasonable and fair minimum standards in relation to:
2940	(i)  Facilities holding an a limited nursing, extended
2941	congregate care, or limited mental health license.
2942	(j)  The establishment of specific criteria to define
2943	appropriateness of resident admission and continued residency in
2944	a facility holding a standard, limited nursing, extended
2945	congregate care, and limited mental health license.
2946	Section 78.  Subsections (1) and (2) of section 429.53,
2947	Florida Statutes, are amended to read:
2948	429.53  Consultation by the agency.-
2949	(1)  The area offices of licensure and certification of the
2950	agency shall provide consultation to the following upon request:
2951	(a)  A licensee of a facility.
2952	(b)  A person interested in obtaining a license to operate
2953	a facility under this part.
2954	(2)  As used in this section, "consultation" includes:
2955	(a)  An explanation of the requirements of this part and
2956	rules adopted pursuant thereto;
2957	(b)  An explanation of the license application and renewal
2958	procedures;
2959	(c)  The provision of a checklist of general local and
2960	state approvals required prior to constructing or developing a
2961	facility and a listing of the types of agencies responsible for
2962	such approvals;
2963	(d)  An explanation of benefits and financial assistance
2964	available to a recipient of supplemental security income
2965	residing in a facility;
2966	(c)(e)  Any other information which the agency deems
2967	necessary to promote compliance with the requirements of this
2968	part; and
2969	(f)  A preconstruction review of a facility to ensure
2970	compliance with agency rules and this part.
2971	Section 79.  Subsections (1) and (2) of section 429.54,
2972	Florida Statutes, are renumbered as subsections (2) and (3),
2973	respectively, and a new subsection (1) is added to that section
2974	to read:
2975	429.54  Collection of information; local subsidy.-
2976	(1)  A facility that is licensed under this part must
2977	report electronically to the agency semiannually data related to
2978	the facility, including, but not limited to, the total number of
2979	residents, the number of residents who are receiving limited
2980	mental health services, the number of residents who are
2981	receiving extended congregate care services, the number of
2982	residents who are receiving limited nursing services, and
2983	professional staffing employed by or under contract with the
2984	licensee to provide resident services. The department, in
2985	consultation with the agency, shall adopt rules to administer
2986	this subsection.
2987	Section 80.  Subsections (1) and (5) of section 429.71,
2988	Florida Statutes, are amended to read:
2989	429.71  Classification of violations deficiencies;
2990	administrative fines.-
2991	(1)  In addition to the requirements of part II of chapter
2992	408 and in addition to any other liability or penalty provided
2993	by law, the agency may impose an administrative fine on a
2994	provider according to the following classification:
2995	(a)  Class I violations are defined in s. 408.813 those
2996	conditions or practices related to the operation and maintenance
2997	of an adult family-care home or to the care of residents which
2998	the agency determines present an imminent danger to the
2999	residents or guests of the facility or a substantial probability
3000	that death or serious physical or emotional harm would result
3001	therefrom. The condition or practice that constitutes a class I
3002	violation must be abated or eliminated within 24 hours, unless a
3003	fixed period, as determined by the agency, is required for
3004	correction. A class I violation deficiency is subject to an
3005	administrative fine in an amount not less than $500 and not
3006	exceeding $1,000 for each violation. A fine may be levied
3007	notwithstanding the correction of the deficiency.
3008	(b)  Class II violations are defined in s. 408.813 those
3009	conditions or practices related to the operation and maintenance
3010	of an adult family-care home or to the care of residents which
3011	the agency determines directly threaten the physical or
3012	emotional health, safety, or security of the residents, other
3013	than class I violations. A class II violation is subject to an
3014	administrative fine in an amount not less than $250 and not
3015	exceeding $500 for each violation. A citation for a class II
3016	violation must specify the time within which the violation is
3017	required to be corrected. If a class II violation is corrected
3018	within the time specified, no civil penalty shall be imposed,
3019	unless it is a repeated offense.
3020	(c)  Class III violations are defined in s. 408.813 those
3021	conditions or practices related to the operation and maintenance
3022	of an adult family-care home or to the care of residents which
3023	the agency determines indirectly or potentially threaten the
3024	physical or emotional health, safety, or security of residents,
3025	other than class I or class II violations. A class III violation
3026	is subject to an administrative fine in an amount not less than
3027	$100 and not exceeding $250 for each violation. A citation for a
3028	class III violation shall specify the time within which the
3029	violation is required to be corrected. If a class III violation
3030	is corrected within the time specified, no civil penalty shall
3031	be imposed, unless it is a repeated violation offense.
3032	(d)  Class IV violations are defined in s. 408.813 those
3033	conditions or occurrences related to the operation and
3034	maintenance of an adult family-care home, or related to the
3035	required reports, forms, or documents, which do not have the
3036	potential of negatively affecting the residents. A provider that
3037	does not correct A class IV violation within the time limit
3038	specified by the agency is subject to an administrative fine in
3039	an amount not less than $50 and not exceeding $100 for each
3040	violation. Any class IV violation that is corrected during the
3041	time the agency survey is conducted will be identified as an
3042	agency finding and not as a violation, unless it is a repeat
3043	violation.
3044	(5)  As an alternative to or in conjunction with an
3045	administrative action against a provider, the agency may request
3046	a plan of corrective action that demonstrates a good faith
3047	effort to remedy each violation by a specific date, subject to
3048	the approval of the agency.
3049	Section 81.  Paragraphs (b) through (e) of subsection (2)
3050	of section 429.911, Florida Statutes, are redesignated as
3051	paragraphs (a) through (d), respectively, and present paragraph
3052	(a) of that subsection is amended to read:
3053	429.911  Denial, suspension, revocation of license;
3054	emergency action; administrative fines; investigations and
3055	inspections.-
3056	(2)  Each of the following actions by the owner of an adult
3057	day care center or by its operator or employee is a ground for
3058	action by the agency against the owner of the center or its
3059	operator or employee:
3060	(a)  An intentional or negligent act materially affecting
3061	the health or safety of center participants.
3062	Section 82.  Section 429.915, Florida Statutes, is amended
3063	to read:
3064	429.915  Conditional license.-In addition to the license
3065	categories available in part II of chapter 408, the agency may
3066	issue a conditional license to an applicant for license renewal
3067	or change of ownership if the applicant fails to meet all
3068	standards and requirements for licensure. A conditional license
3069	issued under this subsection must be limited to a specific
3070	period not exceeding 6 months, as determined by the agency, and
3071	must be accompanied by an approved plan of correction.
3072	Section 83.  Paragraphs (b) and (h) of subsection (3) of
3073	section 430.80, Florida Statutes, are amended to read:
3074	430.80  Implementation of a teaching nursing home pilot
3075	project.-
3076	(3)  To be designated as a teaching nursing home, a nursing
3077	home licensee must, at a minimum:
3078	(b)  Participate in a nationally recognized accreditation
3079	program and hold a valid accreditation, such as the
3080	accreditation awarded by The Joint Commission on Accreditation
3081	of Healthcare Organizations;
3082	(h)  Maintain insurance coverage pursuant to s.
3083	400.141(1)(q)(s) or proof of financial responsibility in a
3084	minimum amount of $750,000. Such proof of financial
3085	responsibility may include:
3086	1.  Maintaining an escrow account consisting of cash or
3087	assets eligible for deposit in accordance with s. 625.52; or
3088	2.  Obtaining and maintaining pursuant to chapter 675 an
3089	unexpired, irrevocable, nontransferable and nonassignable letter
3090	of credit issued by any bank or savings association organized
3091	and existing under the laws of this state or any bank or savings
3092	association organized under the laws of the United States that
3093	has its principal place of business in this state or has a
3094	branch office which is authorized to receive deposits in this
3095	state. The letter of credit shall be used to satisfy the
3096	obligation of the facility to the claimant upon presentment of a
3097	final judgment indicating liability and awarding damages to be
3098	paid by the facility or upon presentment of a settlement
3099	agreement signed by all parties to the agreement when such final
3100	judgment or settlement is a result of a liability claim against
3101	the facility.
3102	Section 84.  Paragraph (a) of subsection (2) of section
3103	440.13, Florida Statutes, is amended to read:
3104	440.13  Medical services and supplies; penalty for
3105	violations; limitations.-
3106	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3107	(a)  Subject to the limitations specified elsewhere in this
3108	chapter, the employer shall furnish to the employee such
3109	medically necessary remedial treatment, care, and attendance for
3110	such period as the nature of the injury or the process of
3111	recovery may require, which is in accordance with established
3112	practice parameters and protocols of treatment as provided for
3113	in this chapter, including medicines, medical supplies, durable
3114	medical equipment, orthoses, prostheses, and other medically
3115	necessary apparatus. Remedial treatment, care, and attendance,
3116	including work-hardening programs or pain-management programs
3117	accredited by the Commission on Accreditation of Rehabilitation
3118	Facilities or The Joint Commission on the Accreditation of
3119	Health Organizations or pain-management programs affiliated with
3120	medical schools, shall be considered as covered treatment only
3121	when such care is given based on a referral by a physician as
3122	defined in this chapter. Medically necessary treatment, care,
3123	and attendance does not include chiropractic services in excess
3124	of 24 treatments or rendered 12 weeks beyond the date of the
3125	initial chiropractic treatment, whichever comes first, unless
3126	the carrier authorizes additional treatment or the employee is
3127	catastrophically injured.
3128
3129	Failure of the carrier to timely comply with this subsection
3130	shall be a violation of this chapter and the carrier shall be
3131	subject to penalties as provided for in s. 440.525.
3132	Section 85.  Section 483.294, Florida Statutes, is amended
3133	to read:
3134	483.294  Inspection of centers.-In accordance with s.
3135	408.811, the agency shall biennially, at least once annually,
3136	inspect the premises and operations of all centers subject to
3137	licensure under this part.
3138	Section 86.  Subsections (32) through (54) of section
3139	499.003, Florida Statutes, are renumbered as subsections (33)
3140	through (55), respectively, present subsection (42) and
3141	paragraph (a) of present subsection (53) are amended, and a new
3142	subsection (32) is added to that subsection, to read:
3143	499.003  Definitions of terms used in this part.-As used in
3144	this part, the term:
3145	(32)  "Medical convenience kit" means packages or units
3146	that contain combination products as defined in 21 C.F.R. s.
3147	3.2(e)(2).
3148	(43)(42)  "Prescription drug" means a prescription,
3149	medicinal, or legend drug, including, but not limited to,
3150	finished dosage forms or active ingredients subject to, defined
3151	by, or described by s. 503(b) of the Federal Food, Drug, and
3152	Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3153	(11), subsection (46) (45), or subsection (53) (52).
3154	(54)(53)  "Wholesale distribution" means distribution of
3155	prescription drugs to persons other than a consumer or patient,
3156	but does not include:
3157	(a)  Any of the following activities, which is not a
3158	violation of s. 499.005(21) if such activity is conducted in
3159	accordance with s. 499.01(2)(g):
3160	1.  The purchase or other acquisition by a hospital or
3161	other health care entity that is a member of a group purchasing
3162	organization of a prescription drug for its own use from the
3163	group purchasing organization or from other hospitals or health
3164	care entities that are members of that organization.
3165	2.  The sale, purchase, or trade of a prescription drug or
3166	an offer to sell, purchase, or trade a prescription drug by a
3167	charitable organization described in s. 501(c)(3) of the
3168	Internal Revenue Code of 1986, as amended and revised, to a
3169	nonprofit affiliate of the organization to the extent otherwise
3170	permitted by law.
3171	3.  The sale, purchase, or trade of a prescription drug or
3172	an offer to sell, purchase, or trade a prescription drug among
3173	hospitals or other health care entities that are under common
3174	control. For purposes of this subparagraph, "common control"
3175	means the power to direct or cause the direction of the
3176	management and policies of a person or an organization, whether
3177	by ownership of stock, by voting rights, by contract, or
3178	otherwise.
3179	4.  The sale, purchase, trade, or other transfer of a
3180	prescription drug from or for any federal, state, or local
3181	government agency or any entity eligible to purchase
3182	prescription drugs at public health services prices pursuant to
3183	Pub. L. No. 102-585, s. 602 to a contract provider or its
3184	subcontractor for eligible patients of the agency or entity
3185	under the following conditions:
3186	a.  The agency or entity must obtain written authorization
3187	for the sale, purchase, trade, or other transfer of a
3188	prescription drug under this subparagraph from the State Surgeon
3189	General or his or her designee.
3190	b.  The contract provider or subcontractor must be
3191	authorized by law to administer or dispense prescription drugs.
3192	c.  In the case of a subcontractor, the agency or entity
3193	must be a party to and execute the subcontract.
3194	d.  A contract provider or subcontractor must maintain
3195	separate and apart from other prescription drug inventory any
3196	prescription drugs of the agency or entity in its possession.
3197	d.e.  The contract provider and subcontractor must maintain
3198	and produce immediately for inspection all records of movement
3199	or transfer of all the prescription drugs belonging to the
3200	agency or entity, including, but not limited to, the records of
3201	receipt and disposition of prescription drugs. Each contractor
3202	and subcontractor dispensing or administering these drugs must
3203	maintain and produce records documenting the dispensing or
3204	administration. Records that are required to be maintained
3205	include, but are not limited to, a perpetual inventory itemizing
3206	drugs received and drugs dispensed by prescription number or
3207	administered by patient identifier, which must be submitted to
3208	the agency or entity quarterly.
3209	e.f.  The contract provider or subcontractor may administer
3210	or dispense the prescription drugs only to the eligible patients
3211	of the agency or entity or must return the prescription drugs
3212	for or to the agency or entity. The contract provider or
3213	subcontractor must require proof from each person seeking to
3214	fill a prescription or obtain treatment that the person is an
3215	eligible patient of the agency or entity and must, at a minimum,
3216	maintain a copy of this proof as part of the records of the
3217	contractor or subcontractor required under sub-subparagraph d.
3218	e.
3219	f.g.  In addition to the departmental inspection authority
3220	set forth in s. 499.051, the establishment of the contract
3221	provider and subcontractor and all records pertaining to
3222	prescription drugs subject to this subparagraph shall be subject
3223	to inspection by the agency or entity. All records relating to
3224	prescription drugs of a manufacturer under this subparagraph
3225	shall be subject to audit by the manufacturer of those drugs,
3226	without identifying individual patient information.
3227	Section 87.  Paragraph (i) is added to subsection (3) of
3228	section 499.01212, Florida Statutes, to read:
3229	499.01212  Pedigree paper.-
3230	(3)  EXCEPTIONS.-A pedigree paper is not required for:
3231	(i)  The wholesale distribution of prescription drugs
3232	contained within a medical convenience kit if:
3233	1.  The medical convenience kit is assembled in an
3234	establishment that is registered as a medical device
3235	manufacturer with the United States Food and Drug
3236	Administration;
3237	2.  The medical convenience kit manufacturer purchased the
3238	prescription drug directly from the manufacturer or from a
3239	wholesaler that purchased the prescription drug directly from
3240	the manufacturer;
3241	3.  The medical convenience kit manufacturer complies with
3242	federal law for the distribution of the prescription drugs
3243	within the kit; and
3244	4.  The drugs contained in the medical convenience kit are:
3245	a.  Intravenous solutions intended for the replenishment of
3246	fluids and electrolytes;
3247	b.  Products intended to maintain the equilibrium of water
3248	and minerals in the body;
3249	c.  Products intended for irrigation or reconstitution;
3250	d.  Anesthetics; or
3251	e.  Anticoagulants.
3252
3253	This exemption does not apply to a convenience kit containing
3254	any controlled substance that appears in a schedule contained in
3255	or subject to chapter 893 or the federal Comprehensive Drug
3256	Abuse Prevention and Control Act of 1970.
3257	Section 88.  Subsection (1) of section 627.645, Florida
3258	Statutes, is amended to read:
3259	627.645  Denial of health insurance claims restricted.-
3260	(1)  No claim for payment under a health insurance policy
3261	or self-insured program of health benefits for treatment, care,
3262	or services in a licensed hospital which is accredited by The
3263	Joint Commission on the Accreditation of Hospitals, the American
3264	Osteopathic Association, or the Commission on the Accreditation
3265	of Rehabilitative Facilities shall be denied because such
3266	hospital lacks major surgical facilities and is primarily of a
3267	rehabilitative nature, if such rehabilitation is specifically
3268	for treatment of physical disability.
3269	Section 89.  Paragraph (c) of subsection (2) of section
3270	627.668, Florida Statutes, is amended to read:
3271	627.668  Optional coverage for mental and nervous disorders
3272	required; exception.-
3273	(2)  Under group policies or contracts, inpatient hospital
3274	benefits, partial hospitalization benefits, and outpatient
3275	benefits consisting of durational limits, dollar amounts,
3276	deductibles, and coinsurance factors shall not be less favorable
3277	than for physical illness generally, except that:
3278	(c)  Partial hospitalization benefits shall be provided
3279	under the direction of a licensed physician. For purposes of
3280	this part, the term "partial hospitalization services" is
3281	defined as those services offered by a program accredited by The
3282	Joint Commission on Accreditation of Hospitals (JCAH) or in
3283	compliance with equivalent standards. Alcohol rehabilitation
3284	programs accredited by The Joint Commission on Accreditation of
3285	Hospitals or approved by the state and licensed drug abuse
3286	rehabilitation programs shall also be qualified providers under
3287	this section. In any benefit year, if partial hospitalization
3288	services or a combination of inpatient and partial
3289	hospitalization are utilized, the total benefits paid for all
3290	such services shall not exceed the cost of 30 days of inpatient
3291	hospitalization for psychiatric services, including physician
3292	fees, which prevail in the community in which the partial
3293	hospitalization services are rendered. If partial
3294	hospitalization services benefits are provided beyond the limits
3295	set forth in this paragraph, the durational limits, dollar
3296	amounts, and coinsurance factors thereof need not be the same as
3297	those applicable to physical illness generally.
3298	Section 90.  Subsection (3) of section 627.669, Florida
3299	Statutes, is amended to read:
3300	627.669  Optional coverage required for substance abuse
3301	impaired persons; exception.-
3302	(3)  The benefits provided under this section shall be
3303	applicable only if treatment is provided by, or under the
3304	supervision of, or is prescribed by, a licensed physician or
3305	licensed psychologist and if services are provided in a program
3306	accredited by The Joint Commission on Accreditation of Hospitals
3307	or approved by the state.
3308	Section 91.  Paragraph (a) of subsection (1) of section
3309	627.736, Florida Statutes, is amended to read:
3310	627.736  Required personal injury protection benefits;
3311	exclusions; priority; claims.-
3312	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3313	with the security requirements of s. 627.733 shall provide
3314	personal injury protection to the named insured, relatives
3315	residing in the same household, persons operating the insured
3316	motor vehicle, passengers in such motor vehicle, and other
3317	persons struck by such motor vehicle and suffering bodily injury
3318	while not an occupant of a self-propelled vehicle, subject to
3319	the provisions of subsection (2) and paragraph (4)(e), to a
3320	limit of $10,000 for loss sustained by any such person as a
3321	result of bodily injury, sickness, disease, or death arising out
3322	of the ownership, maintenance, or use of a motor vehicle as
3323	follows:
3324	(a)  Medical benefits.-Eighty percent of all reasonable
3325	expenses for medically necessary medical, surgical, X-ray,
3326	dental, and rehabilitative services, including prosthetic
3327	devices, and medically necessary ambulance, hospital, and
3328	nursing services. However, the medical benefits shall provide
3329	reimbursement only for such services and care that are lawfully
3330	provided, supervised, ordered, or prescribed by a physician
3331	licensed under chapter 458 or chapter 459, a dentist licensed
3332	under chapter 466, or a chiropractic physician licensed under
3333	chapter 460 or that are provided by any of the following persons
3334	or entities:
3335	1.  A hospital or ambulatory surgical center licensed under
3336	chapter 395.
3337	2.  A person or entity licensed under ss. 401.2101-401.45
3338	that provides emergency transportation and treatment.
3339	3.  An entity wholly owned by one or more physicians
3340	licensed under chapter 458 or chapter 459, chiropractic
3341	physicians licensed under chapter 460, or dentists licensed
3342	under chapter 466 or by such practitioner or practitioners and
3343	the spouse, parent, child, or sibling of that practitioner or
3344	those practitioners.
3345	4.  An entity wholly owned, directly or indirectly, by a
3346	hospital or hospitals.
3347	5.  A health care clinic licensed under ss. 400.990-400.995
3348	that is:
3349	a.  Accredited by The Joint Commission on Accreditation of
3350	Healthcare Organizations, the American Osteopathic Association,
3351	the Commission on Accreditation of Rehabilitation Facilities, or
3352	the Accreditation Association for Ambulatory Health Care, Inc.;
3353	or
3354	b.  A health care clinic that:
3355	(I)  Has a medical director licensed under chapter 458,
3356	chapter 459, or chapter 460;
3357	(II)  Has been continuously licensed for more than 3 years
3358	or is a publicly traded corporation that issues securities
3359	traded on an exchange registered with the United States
3360	Securities and Exchange Commission as a national securities
3361	exchange; and
3362	(III)  Provides at least four of the following medical
3363	specialties:
3364	(A)  General medicine.
3365	(B)  Radiography.
3366	(C)  Orthopedic medicine.
3367	(D)  Physical medicine.
3368	(E)  Physical therapy.
3369	(F)  Physical rehabilitation.
3370	(G)  Prescribing or dispensing outpatient prescription
3371	medication.
3372	(H)  Laboratory services.
3373
3374	The Financial Services Commission shall adopt by rule the form
3375	that must be used by an insurer and a health care provider
3376	specified in subparagraph 3., subparagraph 4., or subparagraph
3377	5. to document that the health care provider meets the criteria
3378	of this paragraph, which rule must include a requirement for a
3379	sworn statement or affidavit.
3380
3381	Only insurers writing motor vehicle liability insurance in this
3382	state may provide the required benefits of this section, and no
3383	such insurer shall require the purchase of any other motor
3384	vehicle coverage other than the purchase of property damage
3385	liability coverage as required by s. 627.7275 as a condition for
3386	providing such required benefits. Insurers may not require that
3387	property damage liability insurance in an amount greater than
3388	$10,000 be purchased in conjunction with personal injury
3389	protection. Such insurers shall make benefits and required
3390	property damage liability insurance coverage available through
3391	normal marketing channels. Any insurer writing motor vehicle
3392	liability insurance in this state who fails to comply with such
3393	availability requirement as a general business practice shall be
3394	deemed to have violated part IX of chapter 626, and such
3395	violation shall constitute an unfair method of competition or an
3396	unfair or deceptive act or practice involving the business of
3397	insurance; and any such insurer committing such violation shall
3398	be subject to the penalties afforded in such part, as well as
3399	those which may be afforded elsewhere in the insurance code.
3400	Section 92.  Section 633.081, Florida Statutes, is amended
3401	to read:
3402	633.081  Inspection of buildings and equipment; orders;
3403	firesafety inspection training requirements; certification;
3404	disciplinary action.-The State Fire Marshal and her or his
3405	agents shall, at any reasonable hour, when the department has
3406	reasonable cause to believe that a violation of this chapter or
3407	s. 509.215, or a rule promulgated thereunder, or a minimum
3408	firesafety code adopted by a local authority, may exist, inspect
3409	any and all buildings and structures which are subject to the
3410	requirements of this chapter or s. 509.215 and rules promulgated
3411	thereunder. The authority to inspect shall extend to all
3412	equipment, vehicles, and chemicals which are located within the
3413	premises of any such building or structure. The State Fire
3414	Marshal and her or his agents shall inspect nursing homes
3415	licensed under part II of chapter 400 only once every calendar
3416	year and upon receiving a complaint forming the basis of a
3417	reasonable cause to believe that a violation of this chapter or
3418	s. 509.215, or a rule promulgated thereunder, or a minimum
3419	firesafety code adopted by a local authority may exist and upon
3420	identifying such a violation in the course of conducting
3421	orientation or training activities within a nursing home.
3422	(1)  Each county, municipality, and special district that
3423	has firesafety enforcement responsibilities shall employ or
3424	contract with a firesafety inspector. The firesafety inspector
3425	must conduct all firesafety inspections that are required by
3426	law. The governing body of a county, municipality, or special
3427	district that has firesafety enforcement responsibilities may
3428	provide a schedule of fees to pay only the costs of inspections
3429	conducted pursuant to this subsection and related administrative
3430	expenses. Two or more counties, municipalities, or special
3431	districts that have firesafety enforcement responsibilities may
3432	jointly employ or contract with a firesafety inspector.
3433	(2)  Every firesafety inspection conducted pursuant to
3434	state or local firesafety requirements shall be by a person
3435	certified as having met the inspection training requirements set
3436	by the State Fire Marshal. Such person shall:
3437	(a)  Be a high school graduate or the equivalent as
3438	determined by the department;
3439	(b)  Not have been found guilty of, or having pleaded
3440	guilty or nolo contendere to, a felony or a crime punishable by
3441	imprisonment of 1 year or more under the law of the United
3442	States, or of any state thereof, which involves moral turpitude,
3443	without regard to whether a judgment of conviction has been
3444	entered by the court having jurisdiction of such cases;
3445	(c)  Have her or his fingerprints on file with the
3446	department or with an agency designated by the department;
3447	(d)  Have good moral character as determined by the
3448	department;
3449	(e)  Be at least 18 years of age;
3450	(f)  Have satisfactorily completed the firesafety inspector
3451	certification examination as prescribed by the department; and
3452	(g)1.  Have satisfactorily completed, as determined by the
3453	department, a firesafety inspector training program of not less
3454	than 200 hours established by the department and administered by
3455	agencies and institutions approved by the department for the
3456	purpose of providing basic certification training for firesafety
3457	inspectors; or
3458	2.  Have received in another state training which is
3459	determined by the department to be at least equivalent to that
3460	required by the department for approved firesafety inspector
3461	education and training programs in this state.
3462	(3)  Each special state firesafety inspection which is
3463	required by law and is conducted by or on behalf of an agency of
3464	the state must be performed by an individual who has met the
3465	provision of subsection (2), except that the duration of the
3466	training program shall not exceed 120 hours of specific training
3467	for the type of property that such special state firesafety
3468	inspectors are assigned to inspect.
3469	(4)  A firefighter certified pursuant to s. 633.35 may
3470	conduct firesafety inspections, under the supervision of a
3471	certified firesafety inspector, while on duty as a member of a
3472	fire department company conducting inservice firesafety
3473	inspections without being certified as a firesafety inspector,
3474	if such firefighter has satisfactorily completed an inservice
3475	fire department company inspector training program of at least
3476	24 hours' duration as provided by rule of the department.
3477	(5)  Every firesafety inspector or special state firesafety
3478	inspector certificate is valid for a period of 3 years from the
3479	date of issuance. Renewal of certification shall be subject to
3480	the affected person's completing proper application for renewal
3481	and meeting all of the requirements for renewal as established
3482	under this chapter or by rule promulgated thereunder, which
3483	shall include completion of at least 40 hours during the
3484	preceding 3-year period of continuing education as required by
3485	the rule of the department or, in lieu thereof, successful
3486	passage of an examination as established by the department.
3487	(6)  The State Fire Marshal may deny, refuse to renew,
3488	suspend, or revoke the certificate of a firesafety inspector or
3489	special state firesafety inspector if it finds that any of the
3490	following grounds exist:
3491	(a)  Any cause for which issuance of a certificate could
3492	have been refused had it then existed and been known to the
3493	State Fire Marshal.
3494	(b)  Violation of this chapter or any rule or order of the
3495	State Fire Marshal.
3496	(c)  Falsification of records relating to the certificate.
3497	(d)  Having been found guilty of or having pleaded guilty
3498	or nolo contendere to a felony, whether or not a judgment of
3499	conviction has been entered.
3500	(e)  Failure to meet any of the renewal requirements.
3501	(f)  Having been convicted of a crime in any jurisdiction
3502	which directly relates to the practice of fire code inspection,
3503	plan review, or administration.
3504	(g)  Making or filing a report or record that the
3505	certificateholder knows to be false, or knowingly inducing
3506	another to file a false report or record, or knowingly failing
3507	to file a report or record required by state or local law, or
3508	knowingly impeding or obstructing such filing, or knowingly
3509	inducing another person to impede or obstruct such filing.
3510	(h)  Failing to properly enforce applicable fire codes or
3511	permit requirements within this state which the
3512	certificateholder knows are applicable by committing willful
3513	misconduct, gross negligence, gross misconduct, repeated
3514	negligence, or negligence resulting in a significant danger to
3515	life or property.
3516	(i)  Accepting labor, services, or materials at no charge
3517	or at a noncompetitive rate from any person who performs work
3518	that is under the enforcement authority of the certificateholder
3519	and who is not an immediate family member of the
3520	certificateholder. For the purpose of this paragraph, the term
3521	"immediate family member" means a spouse, child, parent,
3522	sibling, grandparent, aunt, uncle, or first cousin of the person
3523	or the person's spouse or any person who resides in the primary
3524	residence of the certificateholder.
3525	(7)  The department shall provide by rule for the
3526	certification of firesafety inspectors.
3527	Section 93.  Subsection (12) of section 641.495, Florida
3528	Statutes, is amended to read:
3529	641.495  Requirements for issuance and maintenance of
3530	certificate.-
3531	(12)  The provisions of part I of chapter 395 do not apply
3532	to a health maintenance organization that, on or before January
3533	1, 1991, provides not more than 10 outpatient holding beds for
3534	short-term and hospice-type patients in an ambulatory care
3535	facility for its members, provided that such health maintenance
3536	organization maintains current accreditation by The Joint
3537	Commission on Accreditation of Health Care Organizations, the
3538	Accreditation Association for Ambulatory Health Care, or the
3539	National Committee for Quality Assurance.
3540	Section 94.  Subsection (13) of section 651.118, Florida
3541	Statutes, is amended to read:
3542	651.118  Agency for Health Care Administration;
3543	certificates of need; sheltered beds; community beds.-
3544	(13)  Residents, as defined in this chapter, are not
3545	considered new admissions for the purpose of s.
3546	400.141(1)(n)(o)1.d.
3547	Section 95.  Subsection (2) of section 766.1015, Florida
3548	Statutes, is amended to read:
3549	766.1015  Civil immunity for members of or consultants to
3550	certain boards, committees, or other entities.-
3551	(2)  Such committee, board, group, commission, or other
3552	entity must be established in accordance with state law or in
3553	accordance with requirements of The Joint Commission on
3554	Accreditation of Healthcare Organizations, established and duly
3555	constituted by one or more public or licensed private hospitals
3556	or behavioral health agencies, or established by a governmental
3557	agency. To be protected by this section, the act, decision,
3558	omission, or utterance may not be made or done in bad faith or
3559	with malicious intent.
3560	Section 96.  Subsection (4) of section 766.202, Florida
3561	Statutes, is amended to read:
3562	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3563	766.201-766.212, the term:
3564	(4)  "Health care provider" means any hospital, ambulatory
3565	surgical center, or mobile surgical facility as defined and
3566	licensed under chapter 395; a birth center licensed under
3567	chapter 383; any person licensed under chapter 458, chapter 459,
3568	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3569	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3570	or chapter 486; a clinical lab licensed under chapter 483; a
3571	health maintenance organization certificated under part I of
3572	chapter 641; a blood bank; a plasma center; an industrial
3573	clinic; a renal dialysis facility; or a professional association
3574	partnership, corporation, joint venture, or other association
3575	for professional activity by health care providers.
3576	Section 97.  This act shall take effect July 1, 2010.

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