Florida Senate - 2012 SENATOR AMENDMENT
Bill No. CS/HB 7133, 2nd Eng.
Senate . House
Floor: 1/AD/2R . Floor: SENA1/RC
03/09/2012 03:56 PM . 03/09/2012 08:47 PM
Senators Storms, Rich, and Garcia moved the following:
1 Senate Amendment (with title amendment)
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 394.4574, Florida Statutes, is amended
6 to read:
7 394.4574 Department responsibilities for a mental health
8 resident who resides in an assisted living facility
that holds a
9 limited mental health license.—
10 (1) The term “mental health resident,” for purposes of this
11 section, means an individual who receives social security
12 disability income due to a mental disorder as determined by the
13 Social Security Administration or receives supplemental security
14 income due to a mental disorder as determined by the Social
15 Security Administration and receives optional state
17 (2) The department must ensure that:
18 (a) A mental health resident has been assessed by a
19 psychiatrist, clinical psychologist, clinical social worker, or
20 psychiatric nurse, or an individual who is supervised by one of
21 these professionals, and determined to be appropriate to reside
22 in an assisted living facility. The documentation must be
23 provided to the administrator of the facility within 30 days
24 after the mental health resident has been admitted to the
25 facility. An evaluation completed upon discharge from a state
26 mental hospital meets the requirements of this subsection
27 related to appropriateness for placement as a mental health
28 resident if it was completed within 90 days prior to admission
29 to the facility.
30 (b) A cooperative agreement, as required in s. 429.0751
31 429.075, is developed between the mental health care services
32 provider that serves a mental health resident and the
33 administrator of the assisted living facility with a limited
34 mental health license in which the mental health resident is
35 living. The cooperative agreement must provide detailed
36 information concerning case management services; access to
37 consumer-operated drop-in centers; reliable access to services
38 during evenings, weekends, and holidays which avoids the use of
39 hospital emergency departments except in emergencies;
40 supervision of clinical needs of the residents; and access to
41 emergency psychiatric care. Any entity that provides Medicaid
42 prepaid health plan services shall ensure the appropriate
43 coordination of health care services with an assisted living
44 facility in cases where a Medicaid recipient is both a member of
45 the entity’s prepaid health plan and a resident of the assisted
46 living facility. If the entity is at risk for Medicaid targeted
47 case management and behavioral health services, the entity shall
48 inform the assisted living facility of the procedures to follow
49 should an emergent condition arise.
50 (c) The community living support plan, as defined in s.
51 429.02, has been prepared by a mental health resident and a
52 mental health case manager of that resident in consultation with
53 the administrator of the facility or the administrator’s
54 designee. The plan must be provided to the administrator of the
55 assisted living facility with a limited mental health license in
56 which the mental health resident lives. The support plan and the
57 agreement may be in one document.
58 (d) The assisted living facility with a limited mental
59 health license is provided with documentation that the
60 individual meets the definition of a mental health resident.
61 (e) The mental health services provider assigns a case
62 manager to each mental health resident who lives in an assisted
63 living facility with a limited mental health license. The case
64 manager is responsible for coordinating the development of and
65 implementation of the community living support plan defined in
66 s. 429.02. The plan must be updated as needed, but at least
67 annually to ensure that the ongoing needs of the resident are
68 addressed. The community living support plan must include a
69 detailed description of how the clinical needs of the resident
70 will be supervised, how often the case manager will see the
71 resident, and how the resident may access the case manager, and
72 must identify conditions indicative of a change in the condition
73 of the resident which might warrant changes in clinical
74 supervision or which might prompt the assisted living facility
75 to contact the case manager on behalf of the resident and the
76 steps that will be taken to ensure that the resident receives
77 appropriate emergency psychiatric care through the mental health
78 provider. Each case manager shall keep a record of the date and
79 time of any face-to-face interaction with the mental health
80 resident and make the record available to the department for
81 inspection. The record must be retained for 2 years after the
82 date of the most recent interaction.
84 The department shall adopt rules to implement the community
85 living support plans and cooperative agreements established
86 under this section.
87 (f) There is adequate and consistent monitoring and
88 enforcement of community living support plans and cooperative
89 agreements by the department.
90 (3) Medicaid prepaid health plans shall ensure the
91 appropriate coordination of health care services with an
92 assisted living facility when a Medicaid recipient is both a
93 member of the entity’s prepaid health plan and a resident of the
94 assisted living facility. If the Medicaid prepaid plan is
95 responsible for Medicaid targeted case management and behavioral
96 health services, the plan shall inform the assisted living
97 facility of the procedures to follow should an emergency
98 condition arise.
99 (4) The department shall include in contracts with mental
100 health service providers provisions that require the service
101 provider to assign a case manager for a mental health resident,
102 prepare a community living support plan, enter into a
103 cooperative agreement with the assisted living facility, and
104 otherwise comply with the provisions of this section. The
105 department shall establish and impose contract penalties for
106 mental health service providers under contract with the
107 department which fail to comply with this section.
108 (5) The Agency for Health Care Administration shall include
109 in contracts with Medicaid prepaid health plans provisions that
110 require the mental health service provider to prepare a
111 community living support plan, enter into a cooperative
112 agreement with the assisted living facility, and otherwise
113 comply with the provisions of this section. The agency shall
114 also establish and impose contract penalties for Medicaid
115 prepaid health plans that fail to comply with the provisions of
116 this section.
117 (6) The department shall enter into an interagency
118 agreement with the Agency for Health Care Administration which
119 delineates their respective responsibilities and procedures for
120 enforcing the requirements of this section with respect to
121 assisted living facilities and mental health service providers.
122 (7) (3) The Secretary of Children and Family Services, in
123 consultation with the Agency for Health Care Administration,
124 shall annually require each district administrator to develop,
125 with community input, detailed plans that demonstrate how the
126 district will ensure the provision of state-funded mental health
127 and substance abuse treatment services to residents of assisted
128 living facilities that hold a limited mental health license.
129 These plans must be consistent with the substance abuse and
130 mental health district plan developed pursuant to s. 394.75 and
131 must address case management services; access to consumer
132 operated drop-in centers; access to services during evenings,
133 weekends, and holidays; supervision of the clinical needs of the
134 residents; and access to emergency psychiatric care.
135 Section 2. Subsection (1) of section 395.002, Florida
136 Statutes, is amended to read:
137 395.002 Definitions.—As used in this chapter:
138 (1) “Accrediting organizations” means national
139 accreditation organizations that are approved by the Centers for
140 Medicare and Medicaid Services and whose standards incorporate
141 comparable licensure regulations required by the state the Joint
142 Commission on Accreditation of Healthcare Organizations, the
143 American Osteopathic Association, the Commission on
144 Accreditation of Rehabilitation Facilities, and the
145 Accreditation Association for Ambulatory Health Care, Inc.
146 Section 3. Section 395.1051, Florida Statutes, is amended
147 to read:
148 395.1051 Duty to notify patients.—
149 (1) An appropriately trained person designated by each
150 licensed facility shall inform each patient, or an individual
151 identified pursuant to s. 765.401(1), in person about adverse
152 incidents that result in serious harm to the patient.
153 Notification of outcomes of care that result in harm to the
154 patient under this section does shall not constitute an
155 acknowledgment or admission of liability and may not , nor can it
156 be introduced as evidence.
157 (2) A hospital must provide notice to all obstetrical
158 physicians with privileges at the hospital at least 120 days
159 before the hospital closes an obstetrics department or ceases to
160 provide obstetrical services.
161 Section 4. Subsection (2) of section 400.0078, Florida
162 Statutes, is amended to read:
163 400.0078 Citizen access to State Long-Term Care Ombudsman
164 Program services.—
165 (2) Every resident or representative of a resident shall
166 receive, Upon admission to a long-term care facility, each
167 resident or representative of a resident must receive
168 information regarding:
169 (a)1. The purpose of the State Long-Term Care Ombudsman
170 Program; ,
171 2. The statewide toll-free telephone number for receiving
172 complaints; ,
173 3. The residents’ rights under s. 429.28, including
174 information that retaliatory action cannot be taken against a
175 resident for presenting grievances or for exercising any of
176 these rights; and
177 4. Other relevant information regarding how to contact the
179 (b) Residents or their representatives must be furnished
180 additional copies of this information upon request.
181 Section 5. Subsection (3) of section 408.05, Florida
182 Statutes, is amended to read:
183 408.05 Florida Center for Health Information and Policy
185 (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—The agency
186 shall collect, compile, analyze, and distribute In order to
187 produce comparable and uniform health information and
188 statistics. Such information shall be used for developing the
189 development of policy recommendations, evaluating program and
190 provider performance, and facilitating the independent and
191 collaborative quality improvement activities of providers,
192 payors, and others involved in the delivery of health services.
193 The agency shall perform the following functions:
194 (a) Coordinate the activities of state agencies involved in
195 the design and implementation of the comprehensive health
196 information system.
197 (b) Undertake research, development, and evaluation
198 respecting the comprehensive health information system.
199 (c) Review the statistical activities of state agencies to
200 ensure that they are consistent with the comprehensive health
201 information system.
202 (d) Develop written agreements with local, state, and
203 federal agencies for the sharing of health-care-related data or
204 using the facilities and services of such agencies. State
205 agencies, local health councils, and other agencies under state
206 contract shall assist the center in obtaining, compiling, and
207 transferring health-care-related data maintained by state and
208 local agencies. Written agreements must specify the types,
209 methods, and periodicity of data exchanges and specify the types
210 of data that will be transferred to the center.
211 (e) Establish by rule the types of data collected,
212 compiled, processed, used, or shared. Decisions regarding center
213 data sets should be made based on consultation with the State
214 Consumer Health Information and Policy Advisory Council and
215 other public and private users regarding the types of data which
216 should be collected and their uses. The center shall establish
217 standardized means for collecting health information and
218 statistics under laws and rules administered by the agency.
219 (f) Establish minimum health-care-related data sets which
220 are necessary on a continuing basis to fulfill the collection
221 requirements of the center and which shall be used by state
222 agencies in collecting and compiling health-care-related data.
223 The agency shall periodically review ongoing health care data
224 collections of the Department of Health and other state agencies
225 to determine if the collections are being conducted in
226 accordance with the established minimum sets of data.
227 (g) Establish advisory standards to ensure the quality of
228 health statistical and epidemiological data collection,
229 processing, and analysis by local, state, and private
231 (h) Prescribe standards for the publication of health-care
232 related data reported pursuant to this section which ensure the
233 reporting of accurate, valid, reliable, complete, and comparable
234 data. Such standards should include advisory warnings to users
235 of the data regarding the status and quality of any data
236 reported by or available from the center.
237 (i) Prescribe standards for the maintenance and
238 preservation of the center’s data. This should include methods
239 for archiving data, retrieval of archived data, and data editing
240 and verification.
241 (j) Ensure that strict quality control measures are
242 maintained for the dissemination of data through publications,
243 studies, or user requests.
244 (k) Develop, in conjunction with the State Consumer Health
245 Information and Policy Advisory Council, and implement a long
246 range plan for making available health care quality measures and
247 financial data that will allow consumers to compare health care
248 services. The health care quality measures and financial data
249 the agency must make available shall include, but is not limited
250 to, pharmaceuticals, physicians, health care facilities, and
251 health plans and managed care entities. The agency shall update
252 the plan and report on the status of its implementation
253 annually. The agency shall also make the plan and status report
254 available to the public on its Internet website. As part of the
255 plan, the agency shall identify the process and timeframes for
256 implementation, any barriers to implementation, and
257 recommendations of changes in the law that may be enacted by the
258 Legislature to eliminate the barriers. As preliminary elements
259 of the plan, the agency shall:
260 1. Make available patient-safety indicators, inpatient
261 quality indicators, and performance outcome and patient charge
262 data collected from health care facilities pursuant to s.
263 408.061(1)(a) and (2). The terms “patient-safety indicators” and
264 “inpatient quality indicators” shall be as defined by the
265 Centers for Medicare and Medicaid Services, the National Quality
266 Forum, the Joint Commission on Accreditation of Healthcare
267 Organizations, the Agency for Healthcare Research and Quality,
268 the Centers for Disease Control and Prevention, or a similar
269 national entity that establishes standards to measure the
270 performance of health care providers, or by other states. The
271 agency shall determine which conditions, procedures, health care
272 quality measures, and patient charge data to disclose based upon
273 input from the council. When determining which conditions and
274 procedures are to be disclosed, the council and the agency shall
275 consider variation in costs, variation in outcomes, and
276 magnitude of variations and other relevant information. When
277 determining which health care quality measures to disclose, the
279 a. Shall consider such factors as volume of cases; average
280 patient charges; average length of stay; complication rates;
281 mortality rates; and infection rates, among others, which shall
282 be adjusted for case mix and severity, if applicable.
283 b. May consider such additional measures that are adopted
284 by the Centers for Medicare and Medicaid Studies, National
285 Quality Forum, the Joint Commission on Accreditation of
286 Healthcare Organizations, the Agency for Healthcare Research and
287 Quality, Centers for Disease Control and Prevention, or a
288 similar national entity that establishes standards to measure
289 the performance of health care providers, or by other states.
291 When determining which patient charge data to disclose, the
292 agency shall include such measures as the average of
293 undiscounted charges on frequently performed procedures and
294 preventive diagnostic procedures, the range of procedure charges
295 from highest to lowest, average net revenue per adjusted patient
296 day, average cost per adjusted patient day, and average cost per
297 admission, among others.
298 2. Make available performance measures, benefit design, and
299 premium cost data from health plans licensed pursuant to chapter
300 627 or chapter 641. The agency shall determine which health care
301 quality measures and member and subscriber cost data to
302 disclose, based upon input from the council. When determining
303 which data to disclose, the agency shall consider information
304 that may be required by either individual or group purchasers to
305 assess the value of the product, which may include membership
306 satisfaction, quality of care, current enrollment or membership,
307 coverage areas, accreditation status, premium costs, plan costs,
308 premium increases, range of benefits, copayments and
309 deductibles, accuracy and speed of claims payment, credentials
310 of physicians, number of providers, names of network providers,
311 and hospitals in the network. Health plans shall make available
312 to the agency any such data or information that is not currently
313 reported to the agency or the office.
314 3. Determine the method and format for public disclosure of
315 data reported pursuant to this paragraph. The agency shall make
316 its determination based upon input from the State Consumer
317 Health Information and Policy Advisory Council. At a minimum,
318 the data shall be made available on the agency’s Internet
319 website in a manner that allows consumers to conduct an
320 interactive search that allows them to view and compare the
321 information for specific providers. The website must include
322 such additional information as is determined necessary to ensure
323 that the website enhances informed decisionmaking among
324 consumers and health care purchasers, which shall include, at a
325 minimum, appropriate guidance on how to use the data and an
326 explanation of why the data may vary from provider to provider.
327 4. Publish on its website undiscounted charges for no fewer
328 than 150 of the most commonly performed adult and pediatric
329 procedures, including outpatient, inpatient, diagnostic, and
330 preventative procedures.
331 (l) Assist quality improvement collaboratives by releasing
332 information to the providers, payors, or entities representing
333 and working on behalf of providers and payors. The agency shall
334 release such data, which is deemed necessary for the
335 administration of the Medicaid program, to quality improvement
336 collaboratives for evaluation of the incidence of potentially
337 preventable events.
338 Section 6. Paragraph (c) of subsection (4) of section
339 409.212, Florida Statutes, is amended to read:
340 409.212 Optional supplementation.—
341 (4) In addition to the amount of optional supplementation
342 provided by the state, a person may receive additional
343 supplementation from third parties to contribute to his or her
344 cost of care. Additional supplementation may be provided under
345 the following conditions:
346 (c) The additional supplementation shall not exceed four
347 two times the provider rate recognized under the optional state
348 supplementation program.
349 Section 7. Section 409.986, Florida Statutes, is created to
351 409.986 Quality adjustments to Medicaid rates.—
352 (1) As used in this section, the term:
353 (a) “Expected rate” means the risk-adjusted rate for each
354 provider that accounts for the severity of illness, diagnosis
355 related groups, and the age of a patient.
356 (b) “Hospital-acquired infections” means infections not
357 present and without evidence of incubation at the time of
358 admission to a hospital.
359 (c) “Observed rate” means the actual number for each
360 provider of potentially preventable events divided by the number
361 of cases in which potentially preventable events may have
363 (d) “Potentially preventable admission” means an admission
364 of a person to a hospital that might have reasonably been
365 prevented with adequate access to ambulatory care or health care
367 (e) “Potentially preventable ancillary service” means a
368 health care service provided or ordered by a physician or other
369 health care provider to supplement or support the evaluation or
370 treatment of a patient, including a diagnostic test, laboratory
371 test, therapy service, or radiology service, that may not be
372 reasonably necessary for the provision of quality health care or
374 (f) “Potentially preventable complication” means a harmful
375 event or negative outcome with respect to a person, including an
376 infection or surgical complication, that:
377 1. Occurs after the person’s admission to a hospital; and
378 2. May have resulted from the care, lack of care, or
379 treatment provided during the hospital stay rather than from a
380 natural progression of an underlying disease.
381 (g) “Potentially preventable emergency department visit”
382 means treatment of a person in a hospital emergency room or
383 freestanding emergency medical care facility for a condition
384 that does not require or should not have required emergency
385 medical attention because the condition can or could have been
386 treated or prevented by a physician or other health care
387 provider in a nonemergency setting.
388 (h) “Potentially preventable event” means a potentially
389 preventable admission, a potentially preventable ancillary
390 service, a potentially preventable complication, a potentially
391 preventable emergency department visit, a potentially
392 preventable readmission, or a combination of those events.
393 (i) “Potentially preventable readmission” means a return
394 hospitalization of a person within 15 days that may have
395 resulted from deficiencies in the care or treatment provided to
396 the person during a previous hospital stay or from deficiencies
397 in posthospital discharge followup. The term does not include a
398 hospital readmission necessitated by the occurrence of unrelated
399 events after the discharge. The term includes the readmission of
400 a person to a hospital for:
401 1. The same condition or procedure for which the person was
402 previously admitted;
403 2. An infection or other complication resulting from care
404 previously provided; or
405 3. A condition or procedure that indicates that a surgical
406 intervention performed during a previous admission was
407 unsuccessful in achieving the anticipated outcome.
408 (j) “Quality improvement collaboration” means a structured
409 process involving multiple providers and subject matter experts
410 to focus on a specific aspect of quality care in order to
411 analyze past performance and plan, implement, and evaluate
412 specific improvement methods.
413 (2) The agency shall establish and implement methodologies
414 to adjust Medicaid payment rates for hospitals, nursing homes,
415 and managed care plans based on evidence of improved patient
416 outcomes. Payment adjustments shall be dependent on
417 consideration of specific outcome measures for each provider
418 category, documented activities by providers to improve
419 performance, and evidence of significant improvement over time.
420 Measurement of outcomes shall include appropriate risk
421 adjustments, exclude cases that cannot be determined to be
422 preventable, and waive adjustments for providers with too few
423 cases to calculate reliable rates.
424 (a) Performance-based payment adjustments may be made up to
425 1 percent of each qualified provider’s rate for hospital
426 inpatient services, hospital outpatient services, nursing home
427 care, and the plan-specific capitation rate for prepaid health
428 plans. Adjustments for activities to improve performance may be
429 made up to 0.25 percent based on evidence of a provider’s
430 engagement in activities specified in this section.
431 (b) Outcome measures shall be established for a base year,
432 which may be state fiscal year 2010-2011 or a more recent 12
433 month period.
434 (3) Methodologies established pursuant to this section
435 shall use existing databases, including Medicaid claims,
436 encounter data compiled pursuant to s. 409.9122(14), and
437 hospital discharge data compiled pursuant to s. 408.061(1)(a).
438 To the extent possible, the agency shall use methods for
439 determining outcome measures in use by other payors.
440 (4) The agency shall seek any necessary federal approval
441 for the performance payment system and implement the system in
442 the 2015-2016 state fiscal year.
443 (5) The agency may appoint a technical advisory panel for
444 each provider category in order to solicit advice and
445 recommendations during the development and implementation of the
446 performance payment system.
447 (6) The performance payment system for hospitals shall
448 apply to general hospitals as defined in s. 395.002. The outcome
449 measures used to allocate positive payment adjustments shall
450 consist of one or more potentially preventable events such as
451 potentially preventable readmissions and potentially preventable
453 (a) For each 12-month period after the base year, the
454 agency shall determine the expected rate and the observed rate
455 for specific outcome indicators for each hospital. The
456 difference between the expected and observed rates shall be used
457 to establish a performance rate for each hospital. Hospitals
458 shall be ranked based on performance rates.
459 (b) For at least the first three rate-setting periods after
460 the performance payment system is implemented, a positive
461 payment adjustment shall be made to hospitals in the top 10
462 percentiles, based on their performance rates, and the 10
463 hospitals with the best year-to-year improvement among those
464 hospitals that did not rank in the top 10 percentiles. After the
465 third period of performance payment, the agency may replace the
466 criteria specified in this subsection with quantified benchmarks
467 for determining which providers qualify for positive payment
469 (c) Quality improvement activities that may earn positive
470 payment adjustments include:
471 1. Complying with requirements that reduce hospital
472 acquired infections pursuant to s. 395.1055(1)(b); or
473 2. Actively engaging in a quality improvement collaboration
474 that focuses on reducing potentially preventable admissions,
475 potentially preventable readmissions, or hospital-acquired
477 (7) The performance payment system for skilled nursing
478 facilities shall apply to facilities licensed pursuant to part
479 II of chapter 400 with current Medicaid provider service
480 agreements. The agency, after consultation with the technical
481 advisory panel established in subsection (5), shall select
482 outcome measures to be used to allocate positive payment
483 adjustments. The outcome measures shall be consistent with the
484 federal Quality Assurance and Performance Improvement
485 requirements and include one or more of the following clinical
486 care areas: pressure sores, falls, or hospitalizations.
487 (a) For each 12-month period after the base year, the
488 agency shall determine the expected rate and the observed rate
489 for specific outcome indicators for each skilled nursing
490 facility. The difference between the expected and observed rates
491 shall be used to establish a performance rate for each skilled
492 nursing facility. Facilities shall be ranked based on
493 performance rates.
494 (b) For at least the first three rate-setting periods after
495 the performance payment system is implemented, a positive
496 payment adjustment shall be made to facilities in the top three
497 percentiles, based on their performance rates, and the 10
498 facilities with the best year-to-year improvement among
499 facilities that did not rank in the top three percentiles. After
500 the third period of performance payment, the agency may replace
501 the criteria specified in this subsection with quantified
502 benchmarks for determining which facilities qualify for positive
503 payment adjustments.
504 (c) Quality improvement activities that may earn positive
505 payment adjustments include:
506 1. Actively engaging in a comprehensive fall-prevention
508 2. Actively engaging in a quality improvement collaboration
509 that focuses on reducing potentially preventable hospital
510 admissions or reducing the percentage of residents with pressure
511 ulcers that are new or worsened.
512 (8) A performance payment system shall apply to all managed
513 care plans. The outcome measures used to allocate positive
514 payment adjustments shall consist of one or more potentially
515 preventable events, such as potentially preventable initial
516 hospital admissions, potentially preventable emergency
517 department visits, or potentially preventable ancillary
519 (a) For each 12-month period after the base year, the
520 agency shall determine the expected rate and the observed rate
521 for specific outcome indicators for each managed care plan. The
522 difference between the expected and observed rates shall be used
523 to establish a performance rate for each plan. Managed care
524 plans shall be ranked based on performance rates.
525 (b) For at least the first three rate-setting periods after
526 the performance payment system is implemented, a positive
527 payment adjustment shall be made to the top 10 managed care
528 plans. After the third period during which the performance
529 payment system is implemented, the agency may replace the
530 criteria specified in this subsection with quantified benchmarks
531 for determining which plans qualify for positive payment
533 (9) Payment adjustments made pursuant to this section may
534 not result in expenditures that exceed the amounts appropriated
535 in the General Appropriations Act for hospitals, nursing homes,
536 and managed care plans.
537 Section 8. Paragraph (a) of subsection (1) of section
538 415.1034, Florida Statutes, is amended to read:
539 415.1034 Mandatory reporting of abuse, neglect, or
540 exploitation of vulnerable adults; mandatory reports of death.—
541 (1) MANDATORY REPORTING.—
542 (a) Any person, including, but not limited to , any:
543 1. A physician, osteopathic physician, medical examiner,
544 chiropractic physician, nurse, paramedic, emergency medical
545 technician, or hospital personnel engaged in the admission,
546 examination, care, or treatment of vulnerable adults;
547 2. A health professional or mental health professional
548 other than one listed in subparagraph 1.;
549 3. A practitioner who relies solely on spiritual means for
551 4. Nursing home staff; assisted living facility staff;
552 adult day care center staff; adult family-care home staff;
553 social worker; or other professional adult care, residential, or
554 institutional staff;
555 5. A state, county, or municipal criminal justice employee
556 or law enforcement officer;
557 6. An employee of the Department of Business and
558 Professional Regulation conducting inspections of public lodging
559 establishments under s. 509.032;
560 7. A Florida advocacy council member or long-term care
561 ombudsman council member; or
562 8. A bank, savings and loan, or credit union officer,
563 trustee, or employee; or ,
564 9. An employee or agent of a state or local agency who has
565 regulatory responsibilities over state-licensed facilities, or
566 who provides services to persons residing in a state-licensed
569 who knows, or has reasonable cause to suspect, that a vulnerable
570 adult has been or is being abused, neglected, or exploited must
571 shall immediately report such knowledge or suspicion to the
572 central abuse hotline.
573 Section 9. Subsections (5), (7), (8), and (11) of section
574 429.02, Florida Statutes, are amended, present subsections (6)
575 through (14) of that section are redesignated as subsections (7)
576 through (15), respectively, present subsections (15) through
577 (26) of that section are redesignated as subsections (17)
578 through (28), respectively, and new subsections (6) and (16) are
579 added to that section, to read:
580 429.02 Definitions.—When used in this part, the term:
581 (5) “Assisted living facility” or “facility” means any
582 building or buildings, section or distinct part of a building,
583 private home, boarding home, home for the aged, or other
584 residential facility, whether operated for profit or not, which
585 undertakes through its ownership or management to provide
586 housing, meals, and one or more personal services for a period
587 exceeding 24 hours to one or more adults who are not relatives
588 of the owner or administrator.
589 (6) “Board” means the Board of Long Term Care
590 Administrators established under s. 468.1665.
591 (8) (7) “Community living support plan” means a written
592 document prepared by a mental health resident and the resident’s
593 mental health case manager in consultation with the
594 administrator of an assisted living facility with a limited
595 mental health license or the administrator’s designee. A copy
596 must be provided to the administrator. The plan must include
597 information about the supports, services, and special needs of
598 the resident which enable the resident to live in the assisted
599 living facility and a method by which facility staff can
600 recognize and respond to the signs and symptoms particular to
601 that resident which indicate the need for professional services.
602 (9) (8) “Cooperative agreement” means a written statement of
603 understanding between a mental health care provider and the
604 administrator of the assisted living facility with a limited
605 mental health license in which a mental health resident is
606 living. The agreement must specify directions for accessing
607 emergency and after-hours care for the mental health resident. A
608 single cooperative agreement may service all mental health
609 residents who are clients of the same mental health care
611 (12) (11) “Extended congregate care” means acts beyond those
612 authorized in subsection (18) which subsection (16) that may be
613 performed pursuant to part I of chapter 464 by persons licensed
614 thereunder while carrying out their professional duties, and
615 other supportive services which may be specified by rule. The
616 purpose of such services is to enable residents to age in place
617 in a residential environment despite mental or physical
618 limitations that might otherwise disqualify them from residency
619 in a facility licensed under this part.
620 (16) “Mental health surveyor” means a person:
621 (a) Licensed under chapter 458, chapter 459, chapter 464,
622 chapter 490, or chapter 491 who provides mental health services
623 as defined under s. 394.67 or has received training approved by
624 the agency;
625 (b) Who has a baccalaureate degree with a concentration in
626 mental health from an accredited college or university and at
627 least 5 years of experience providing services that improve an
628 individual’s mental health or that treat mental illness; or
629 (c) Who is a surveyor employed by the agency and has
630 received training approved by the agency that enables the
631 individual to effectively perform surveys of facilities with a
632 mental health resident to ensure the mental health residents are
633 receiving services consistent with the community living support
635 Section 10. Subsection (1) and paragraphs (b) and (c) of
636 subsection (3) of section 429.07, Florida Statutes, are amended,
637 to read:
638 429.07 License required; fee.—
639 (1) The requirements of part II of chapter 408 apply to the
640 provision of services that require licensure pursuant to this
641 part and part II of chapter 408 and to entities licensed by or
642 applying for such licensure from the agency pursuant to this
643 part. A license issued by the agency is required in order to
644 operate an assisted living facility in this state. Effective
645 July 1, 2013, an assisted living facility may not operate in
646 this state unless the facility is under the management of an
647 assisted living facility administrator licensed pursuant to part
648 II of chapter 468.
649 (3) In addition to the requirements of s. 408.806, each
650 license granted by the agency must state the type of care for
651 which the license is granted. Licenses shall be issued for one
652 or more of the following categories of care: standard, extended
653 congregate care, limited nursing services, or limited mental
655 (b) An extended congregate care license shall be issued to
656 facilities providing, directly or through contract, services
657 beyond those authorized in paragraph (a), including services
658 performed by persons licensed under part I of chapter 464 and
659 supportive services, as defined by rule, to persons who would
660 otherwise be disqualified from continued residence in a facility
661 licensed under this part.
662 1. In order for extended congregate care services to be
663 provided, the agency must first determine that all requirements
664 established in law and rule are met and must specifically
665 designate, on the facility’s license, that such services may be
666 provided and whether the designation applies to all or part of
667 the facility. Such designation may be made at the time of
668 initial licensure or relicensure, or upon request in writing by
669 a licensee under this part and part II of chapter 408. The
670 notification of approval or the denial of the request shall be
671 made in accordance with part II of chapter 408. Existing
672 facilities qualifying to provide extended congregate care
673 services must have maintained a standard license and may not
674 have been subject to administrative sanctions during the
675 previous 2 years, or since initial licensure if the facility has
676 been licensed for less than 2 years, for any of the following
678 a. A class I or class II violation;
679 b. Three or more repeat or recurring class III violations
680 of identical or similar resident care standards from which a
681 pattern of noncompliance is found by the agency;
682 c. Three or more class III violations that were not
683 corrected in accordance with the corrective action plan approved
684 by the agency;
685 d. Violation of resident care standards which results in
686 requiring the facility to employ the services of a consultant
687 pharmacist or consultant dietitian;
688 e. Denial, suspension, or revocation of a license for
689 another facility licensed under this part in which the applicant
690 for an extended congregate care license has at least 25 percent
691 ownership interest; or
692 f. Imposition of a moratorium pursuant to this part or part
693 II of chapter 408 or initiation of injunctive proceedings.
694 2. A facility that is licensed to provide extended
695 congregate care services must shall maintain a written progress
696 report on each person who receives services which describes the
697 type, amount, duration, scope, and outcome of services that are
698 rendered and the general status of the resident’s health. A
699 registered nurse, or appropriate designee, representing the
700 agency shall visit the facility at least once a year quarterly
701 to monitor residents who are receiving extended congregate care
702 services and to determine if the facility is in compliance with
703 this part, part II of chapter 408, and relevant rules. One of
704 the visits may be in conjunction with the regular survey. The
705 monitoring visits may be provided through contractual
706 arrangements with appropriate community agencies. A registered
707 nurse shall serve as part of the team that inspects the
708 facility. The agency may waive a monitoring visit during the
709 licensure cycle one of the required yearly monitoring visits for
710 a facility that has been licensed for at least 24 months to
711 provide extended congregate care services, if, during the
712 inspection, the registered nurse determines that extended
713 congregate care services are being provided appropriately, and
714 if the facility has no:
715 a. Class I or class II violations and no uncorrected class
716 III violations; .
717 b. Citations for licensure violation which resulted from
718 referrals by the ombudsman to the agency; or
719 c. Citations for a licensure violation which resulted from
720 complaints to the agency. The agency must first consult with the
721 long-term care ombudsman council for the area in which the
722 facility is located to determine if any complaints have been
723 made and substantiated about the quality of services or care.
724 The agency may not waive one of the required yearly monitoring
725 visits if complaints have been made and substantiated.
726 3. A facility that is licensed to provide extended
727 congregate care services must:
728 a. Demonstrate the capability to meet unanticipated
729 resident service needs.
730 b. Offer a physical environment that promotes a homelike
731 setting, provides for resident privacy, promotes resident
732 independence, and allows sufficient congregate space as defined
733 by rule.
734 c. Have sufficient staff available, taking into account the
735 physical plant and firesafety features of the building, to
736 assist with the evacuation of residents in an emergency.
737 d. Adopt and follow policies and procedures that maximize
738 resident independence, dignity, choice, and decisionmaking to
739 permit residents to age in place, so that moves due to changes
740 in functional status are minimized or avoided.
741 e. Allow residents or, if applicable, a resident’s
742 representative, designee, surrogate, guardian, or attorney in
743 fact to make a variety of personal choices, participate in
744 developing service plans, and share responsibility in
746 f. Implement the concept of managed risk.
747 g. Provide, directly or through contract, the services of a
748 person licensed under part I of chapter 464.
749 h. In addition to the training mandated in s. 429.52,
750 provide specialized training as defined by rule for facility
752 4. A facility that is licensed to provide extended
753 congregate care services is exempt from the criteria for
754 continued residency set forth in rules adopted under s. 429.41.
755 A licensed facility must adopt its own requirements within
756 guidelines for continued residency set forth by rule. However,
757 the facility may not serve residents who require 24-hour nursing
758 supervision. A licensed facility that provides extended
759 congregate care services must also provide each resident with a
760 written copy of facility policies governing admission and
762 5. The primary purpose of extended congregate care services
763 is to allow residents, as they become more impaired, the option
764 of remaining in a familiar setting from which they would
765 otherwise be disqualified for continued residency. A facility
766 licensed to provide extended congregate care services may also
767 admit an individual who exceeds the admission criteria for a
768 facility with a standard license, if the individual is
769 determined appropriate for admission to the extended congregate
770 care facility.
771 6. Before the admission of an individual to a facility
772 licensed to provide extended congregate care services, the
773 individual must undergo a medical examination as provided in s.
774 429.26(4) and the facility must develop a preliminary service
775 plan for the individual.
776 7. If When a facility can no longer provide or arrange for
777 services in accordance with the resident’s service plan and
778 needs and the facility’s policy, the facility must shall make
779 arrangements for relocating the person in accordance with s.
781 8. Failure to provide extended congregate care services may
782 result in denial of extended congregate care license renewal.
783 (c) A limited nursing services license shall be issued to a
784 facility that provides services beyond those authorized in
785 paragraph (a) and as specified in this paragraph.
786 1. In order for limited nursing services to be provided in
787 a facility licensed under this part, the agency must first
788 determine that all requirements established in law and rule are
789 met and must specifically designate, on the facility’s license,
790 that such services may be provided. Such designation may be made
791 at the time of initial licensure or relicensure, or upon request
792 in writing by a licensee under this part and part II of chapter
793 408. Notification of approval or denial of such request shall be
794 made in accordance with part II of chapter 408. Existing
795 facilities qualifying to provide limited nursing services shall
796 have maintained a standard license and may not have been subject
797 to administrative sanctions that affect the health, safety, and
798 welfare of residents for the previous 2 years or since initial
799 licensure if the facility has been licensed for less than 2
801 2. Facilities that are licensed to provide limited nursing
802 services shall maintain a written progress report on each person
803 who receives such nursing services, which report describes the
804 type, amount, duration, scope, and outcome of services that are
805 rendered and the general status of the resident’s health. A
806 registered nurse representing the agency shall visit such
807 facilities at least once twice a year to monitor residents who
808 are receiving limited nursing services and to determine if the
809 facility is in compliance with applicable provisions of this
810 part, part II of chapter 408, and related rules. The monitoring
811 visits may be provided through contractual arrangements with
812 appropriate community agencies. A registered nurse shall also
813 serve as part of the team that inspects such facility. The
814 agency may waive a monitoring visit during the licensure cycle
815 for a facility that has been licensed for at least 24 months to
816 provide limited nursing services if the facility has no:
817 a. Class I or class II violations and no uncorrected class
818 III violations;
819 b. Citations for licensure violation which resulted from
820 referrals by the ombudsman to the agency; or
821 c. Citations for a licensure violation which resulted from
822 complaints to the agency.
823 3. A person who receives limited nursing services under
824 this part must meet the admission criteria established by the
825 agency for assisted living facilities. When a resident no longer
826 meets the admission criteria for a facility licensed under this
827 part, arrangements for relocating the person shall be made in
828 accordance with s. 429.28(1)(k), unless the facility is licensed
829 to provide extended congregate care services.
830 Section 11. Section 429.075, Florida Statutes, is amended
831 to read:
832 429.075 Limited mental health license.—In order to provide
833 services to three or more mental health residents, an assisted
834 living facility that serves three or more mental health
835 residents must obtain a limited mental health license.
836 (1) To obtain a limited mental health license, a facility:
837 (a) Must hold and maintain a standard license as an
838 assisted living facility; and ,
839 (b) Must not have been subject to administrative sanctions
840 during the previous 2 years, or since initial licensure if the
841 facility has been licensed for less than 2 years, for any of the
842 following reasons:
843 1. One or more class I violations imposed by final agency
845 2. Two or more class II violations imposed by final agency
847 3. Three or more class III violations that were not
848 corrected in accordance with s. 408.811(4);
849 4. Three or more class III violations that were not
850 corrected in accordance within the time specified by the agency
851 for correction;
852 5. Denial, suspension, or revocation of a license for
853 another facility licensed under this part in which the applicant
854 had at least a 25 percent ownership interest; or
855 6. Imposition of a moratorium pursuant to this part or part
856 II of chapter 408 or initiation of injunctive proceedings. any
857 current uncorrected deficiencies or violations, and must ensure
859 (2) Within 3 6 months after receiving a limited mental
860 health license, the facility administrator and the staff of the
861 facility who are in direct contact with mental health residents
862 must complete training of no less than 6 hours related to their
863 duties. This training shall be created in accordance with s.
864 429.52 or approved by the Department of Children and Family
865 Services. A training provider may charge a reasonable fee for
866 the training. Such designation
867 (3) Application for a limited mental health license may be
868 made at the time of initial licensure or relicensure or upon
869 request in writing by a licensee under this part and part II of
870 chapter 408. Notification of agency approval or denial of such
871 license must request shall be made in accordance with this part,
872 part II of chapter 408, and applicable rules. This training will
873 be provided by or approved by the Department of Children and
874 Family Services.
875 (4) (2) Facilities licensed to provide services to mental
876 health residents shall provide appropriate supervision and
877 staffing to provide for the health, safety, and welfare of such
879 (3) A facility that has a limited mental health license
881 (a) Have a copy of each mental health resident’s community
882 living support plan and the cooperative agreement with the
883 mental health care services provider. The support plan and the
884 agreement may be combined.
885 (b) Have documentation that is provided by the Department
886 of Children and Family Services that each mental health resident
887 has been assessed and determined to be able to live in the
888 community in an assisted living facility with a limited mental
889 health license.
890 (c) Make the community living support plan available for
891 inspection by the resident, the resident’s legal guardian, the
892 resident’s health care surrogate, and other individuals who have
893 a lawful basis for reviewing this document.
894 (d) Assist the mental health resident in carrying out the
895 activities identified in the individual’s community living
896 support plan.
897 (4) A facility with a limited mental health license may
898 enter into a cooperative agreement with a private mental health
899 provider. For purposes of the limited mental health license, the
900 private mental health provider may act as the case manager.
901 (5) Effective January 1, 2013, a mental health surveyor
902 shall serve as part of the team that inspects a facility with
903 mental health residents, and may conduct the inspection without
904 other agency representatives. The role of the mental health
905 surveyor is to determine the facility’s compliance in meeting
906 obligations specified in the cooperative agreement pursuant to
907 s. 394.4574. The agency shall enter into an interagency
908 agreement with the Department of Children and Family Services to
909 receive from the contracted community agencies reports
910 concerning compliance with the requirements of cooperative
911 agreements and community support plans under s. 394.4574
912 applicable to a licensed facility, and whether the mental health
913 residents are receiving the services required under those
914 documents while residing in the licensed facility. Monitoring
915 visits shall occur at least twice a year. The agency may waive a
916 monitoring visit for a facility that has been licensed for at
917 least 24 months to provide limited mental health services if the
918 mental health surveyor determines the cooperative agreements and
919 community support plans are in compliance with applicable
920 requirements and the mental health residents are receiving the
921 appropriate services under those documents while residing in the
922 licensed facility and the facility has no:
923 (a) Class I or class II violations and no uncorrected class
924 III violations;
925 (b) Citations for a licensure violation which resulted from
926 referrals by the ombudsman to the agency; or
927 (c) Citations for a licensure violation which resulted from
928 complaints to the agency.
929 Section 12. Section 429.0751, Florida Statutes, is created
930 to read:
931 429.0751 Mental health residents.—An assisted living
932 facility that has one or more mental health residents must:
933 (1) Enter into a cooperative agreement with the mental
934 health care service provider responsible for providing services
935 to the mental health resident, including a mental health care
936 service provider responsible for providing private pay services
937 to the mental health resident, to ensure coordination of care.
938 (2) Consult with the mental health case manager and the
939 mental health resident in developing a community living support
940 plan and maintaining a copy of each mental health resident’s
941 community living support plan.
942 (3) Make the community living support plan available for
943 inspection by the resident, the resident’s legal guardian, the
944 resident’s health care surrogate, and other individuals who have
945 a lawful basis for reviewing this document.
946 (4) Assist the mental health resident in carrying out the
947 activities identified in the individual’s community living
948 support plan.
949 (5) Have documentation that is provided by the Department
950 of Children and Family Services which indicates that each mental
951 health resident has been assessed and determined to be able to
952 live in the community in an assisted living facility.
953 Section 13. Subsection (4) of section 429.14, Florida
954 Statutes, is amended to read:
955 429.14 Administrative penalties.—
956 (4) The agency shall deny or revoke the license of an
957 assisted living facility that:
958 (a) Has two or more class I violations and had a class I or
959 class II violation from separate monitoring visits, surveys, or
960 investigations that are similar or identical to violations
961 identified by the agency during a survey, inspection, monitoring
962 visit, or complaint investigation occurring within the previous
963 2 years; or .
964 (b) Commits a class I violation that causes the death of a
965 resident or an intentional or negligent act that, based on a
966 court’s findings, caused the death of a resident.
967 Section 14. Section 429.176, Florida Statutes, is amended
968 to read:
969 429.176 Notice of change of Administrator; managers.—
970 (1) An administrator may be responsible for up to three
971 assisted living facilities if all three assisted living
972 facilities have identical controlling interests as defined in s.
973 408.803 and are located within 50 miles of each other. If an
974 administrator is responsible for more than one assisted living
975 facility, a manager must be appointed for each facility to
976 assume responsibility for the facility during the
977 administrator’s absence. The manager must be reported to the
978 agency within 10 days after appointment.
979 (2) If , during the period for which a license is issued,
980 the owner changes administrators, the administrator changes, the
981 licensee owner must notify the agency of the change and the name
982 and license number of the new administrator within 10 days after
983 the change and provide documentation within 90 days that the new
984 administrator has completed the applicable core educational
985 requirements under s. 429.52.
986 (3) If an administrator leaves the employment of an
987 assisted living facility, and a licensed administrator is not
988 named as required in subsection (2), the assisted living
989 facility must notify the agency within 2 days after the
990 administrator’s departure and may operate for up to 3 months
991 with a manager who will assume responsibility for the operation
992 of the facility during that period. The manager must have
993 completed the 40-hour administrator core training and
994 successfully passed the examination described in s. 429.52(6)
995 with a score of 80 percent.
996 (4) A manager of a facility who assumes responsibility for
997 the operation of the facility during the absence of an
998 administrator in accordance with subsection (1) must have
999 completed the 40-hour administrator core training and
1000 successfully passed the examination described in s. 429.52(6)
1001 with a score of 80 percent within 30 days after being employed
1002 as, or becoming, a facility manager.
1003 Section 15. Paragraphs (a) and (b) of subsection (2) of
1004 section 429.178, Florida Statutes, are amended to read:
1005 429.178 Special care for persons with Alzheimer’s disease
1006 or other related disorders.—
1007 (2)(a) Staff, including an administrator, An individual who
1008 is employed by a facility that provides special care for
1009 residents who have with Alzheimer’s disease or other related
1010 disorders, and who has regular contact with such residents, must
1011 complete up to 4 hours of initial dementia-specific training
1012 developed or approved by the department. The training must shall
1013 be completed within 3 months after beginning employment and
1014 shall satisfy the core training requirements of s. 429.52 (2)(g).
1015 (b) A direct caregiver who is employed by a facility that
1016 provides special care for residents who have with Alzheimer’s
1017 disease or other related disorders, and who provides direct care
1018 to such residents, must complete the required initial training
1019 required in paragraph (a) and 4 additional hours of training
1020 developed or approved by the department. The training must shall
1021 be completed within 6 9 months after beginning employment and
1022 shall satisfy the core training requirements of s. 429.52 (2)(g).
1023 Section 16. Subsection (2) of section 429.19, Florida
1024 Statutes, is amended to read:
1025 429.19 Violations; imposition of administrative fines;
1027 (2) Each violation of this part and adopted rules shall be
1028 classified according to the nature of the violation and the
1029 gravity of its probable effect on facility residents as provided
1030 in s. 408.813.
1031 (a) The agency shall indicate the classification on the
1032 written notice of the violation as follows:
1033 1. (a) Class “I” violations are defined in s. 408.813. the
1034 agency shall issue a citation regardless of correction and
1035 impose an administrative fine for a cited class I violation in
1036 an amount not less than $5,000 and not exceeding $10,000 for
1037 each violation.
1038 2. (b) Class “II” violations are defined in s. 408.813. the
1039 agency shall issue a citation regardless of correction and
1040 impose an administrative fine for a cited class II violation in
1041 an amount not less than $1,000 and not exceeding $5,000 for each
1043 3. (c) Class “III” violations are defined in s. 408.813. the
1044 agency shall impose an administrative fine for a cited class III
1045 violation in an amount not less than $500 and not exceeding
1046 $1,000 for each violation.
1047 4. (d) Class “IV” violations are defined in s. 408.813. the
1048 agency shall impose an administrative fine for a cited class IV
1049 violation in an amount not less than $100 and not exceeding $200
1050 for each violation.
1051 (b) In lieu of the penalties provided in paragraph (a), the
1052 agency shall impose a $10,000 penalty for a violation that
1053 results in the death of a resident. This administrative fine is
1054 in addition to the penalty provided in paragraph (4) of s.
1056 (c) Notwithstanding paragraph (a), if the assisted living
1057 facility is cited for a class I or class II violation and within
1058 24 months the facility is cited for another class I or class II
1059 violation, the agency shall double the fine for the subsequent
1060 violation if the violation is in the same class as the previous
1062 Section 17. Section 429.195, Florida Statutes, is amended
1063 to read:
1064 429.195 Rebates prohibited; penalties.—
1065 (1) It is unlawful for any assisted living facility
1066 licensed under this part to contract or promise to pay or
1067 receive any commission, bonus, kickback, or rebate or engage in
1068 any split-fee arrangement in any form whatsoever with any
1069 person, health care provider, or health care facility as
1070 provided in s. 817.505 physician, surgeon, organization, agency,
1071 or person, either directly or indirectly, for residents referred
1072 to an assisted living facility licensed under this part. A
1073 facility may employ or contract with persons to market the
1074 facility, provided the employee or contract provider clearly
1075 indicates that he or she represents the facility. A person or
1076 agency independent of the facility may provide placement or
1077 referral services for a fee to individuals seeking assistance in
1078 finding a suitable facility; however, any fee paid for placement
1079 or referral services must be paid by the individual looking for
1080 a facility, not by the facility.
1081 (2) This section does not apply to:
1082 (a) Any individual employed by the assisted living facility
1083 or with whom the facility contracts to market the facility if
1084 the individual clearly indicates that he or she works with or
1085 for the facility.
1086 (b) Payments by an assisted living facility to a referral
1087 service that provides information, consultation, or referrals to
1088 consumers to assist them in finding appropriate care or housing
1089 options for seniors or disabled adults, if such referred
1090 consumers are not Medicaid recipients.
1091 (c) A resident of an assisted living facility who refers to
1092 the assisted living facility a friend, family member, or other
1093 individual with whom the resident has a personal relationship,
1094 in which case the assisted living facility may provide a
1095 monetary reward to the resident for making such referral.
1096 (3) (2) A violation of this section shall be considered
1097 patient brokering and is punishable as provided in s. 817.505.
1098 Section 18. Paragraph (j) is added to subsection (3) of
1099 section 817.505, Florida Statutes, to read:
1100 817.505 Patient brokering prohibited; exceptions;
1102 (3) This section shall not apply to:
1103 (j) Any payment permitted under s. 429.195(2).
1104 Section 19. Section 429.231, Florida Statutes, is created
1105 to read:
1106 429.231 Advisory council, membership, duties.—
1107 (1) The department shall establish an advisory council to
1108 review the facts and circumstances of unexpected deaths in
1109 assisted living facilities and of elopements that result in harm
1110 to a resident. The purpose of this review is to:
1111 (a) Achieve a greater understanding of the causes and
1112 contributing factors of the unexpected deaths and elopements.
1113 (b) Identify any gaps, deficiencies, or problems in the
1114 delivery of services to the residents.
1115 (2) Based on the review, the advisory council shall make
1116 recommendations for:
1117 (a) Industry best practices that could be used to prevent
1118 unexpected deaths and elopements.
1119 (b) Training and educational requirements for employees and
1120 administrators of assisted living facilities.
1121 (c) Changes in the law, rules, or other policies to prevent
1122 unexpected deaths and elopements.
1123 (3) The advisory council shall prepare an annual
1124 statistical report on the incidence and causes of unexpected
1125 deaths in assisted living facilities and of elopements that
1126 result in harm to residents during the prior calendar year. The
1127 advisory council shall submit a copy of the report by December
1128 31 of each year to the Governor, the President of the Senate,
1129 and the Speaker of the House of Representatives. The report may
1130 make recommendations for state action, including specific
1131 policy, procedural, regulatory, or statutory changes, and any
1132 other recommended preventive action.
1133 (4) The advisory council shall consist of the following
1135 (a) The Secretary of Elderly Affairs, or a designee, who
1136 shall be the chair.
1137 (b) The Secretary of Health Care Administration, or a
1139 (c) The Secretary of Children and Family Services, or a
1141 (d) The State Long-Term Care Ombudsman, or a designee.
1142 (e) The following persons who are selected by the Governor:
1143 1. An owner or administrator of an assisted living facility
1144 with fewer than 17 beds.
1145 2. An owner or administrator of an assisted living facility
1146 with 17 or more beds.
1147 3. An owner or administrator or an assisted living facility
1148 with a limited mental health license.
1149 4. A representative from each of three statewide
1150 associations that represent assisted living facilities.
1151 5. A resident of an assisted living facility.
1152 (5) The advisory council shall meet at least twice each
1153 calendar year or at the call of the chair. The chair may appoint
1154 ad hoc committees as necessary to carry out the duties of the
1156 (6) The members of the advisory council selected by the
1157 Governor shall be appointed to staggered terms of office which
1158 may not exceed 2 years. Members are eligible for reappointment.
1159 (7) Members of the advisory council shall serve without
1160 compensation but are entitled to reimbursement for per diem and
1161 travel expenses incurred in the performance of their duties as
1162 provided in s. 112.061 and to the extent that funds are
1164 Section 20. Effective October 1, 2012, subsections (1) and
1165 (2) of section 429.28, Florida Statutes, are amended to read:
1166 429.28 Resident bill of rights.—
1167 (1) A No resident of a facility may not shall be deprived
1168 of any civil or legal rights, benefits, or privileges guaranteed
1169 by law, the Constitution of the State of Florida, or the
1170 Constitution of the United States as a resident of a facility.
1171 Every resident of a facility shall have the right to:
1172 (a) Live in a safe and decent living environment, free from
1173 abuse and neglect.
1174 (b) Be treated with consideration and respect and with due
1175 recognition of personal dignity, individuality, and the need for
1177 (c) Retain and use his or her own clothes and other
1178 personal property in his or her immediate living quarters, so as
1179 to maintain individuality and personal dignity, except when the
1180 facility can demonstrate that such would be unsafe, impractical,
1181 or an infringement upon the rights of other residents.
1182 (d) Unrestricted private communication, including receiving
1183 and sending unopened correspondence, access to a telephone, and
1184 visiting with any person of his or her choice, at any time
1185 between the hours of 9 a.m. and 9 p.m. at a minimum. Upon
1186 request, the facility shall make provisions to extend visiting
1187 hours for caregivers and out-of-town guests, and in other
1188 similar situations.
1189 (e) Freedom to participate in and benefit from community
1190 services and activities and to achieve the highest possible
1191 level of independence, autonomy, and interaction within the
1193 (f) Manage his or her financial affairs unless the resident
1194 or, if applicable, the resident’s representative, designee,
1195 surrogate, guardian, or attorney in fact authorizes the
1196 administrator of the facility to provide safekeeping for funds
1197 as provided in s. 429.27.
1198 (g) Share a room with his or her spouse if both are
1199 residents of the facility.
1200 (h) Reasonable opportunity for regular exercise several
1201 times a week and to be outdoors at regular and frequent
1202 intervals except when prevented by inclement weather.
1203 (i) Exercise civil and religious liberties, including the
1204 right to independent personal decisions. No religious beliefs or
1205 practices, nor any attendance at religious services, shall be
1206 imposed upon any resident.
1207 (j) Access to adequate and appropriate health care
1208 consistent with established and recognized standards within the
1210 (k) At least 30 45 days’ notice of relocation or
1211 termination of residency from the facility unless, for medical
1212 reasons, the resident is certified by a physician to require an
1213 emergency relocation to a facility providing a more skilled
1214 level of care or the resident engages in a pattern of conduct
1215 that is harmful or offensive to other residents. In the case of
1216 a resident who has been adjudicated mentally incapacitated, the
1217 guardian shall be given at least 30 45 days’ notice of a
1218 nonemergency relocation or residency termination. Reasons for
1219 relocation shall be set forth in writing. A resident or the
1220 resident’s legal guardian or representative may file a grievance
1221 with the facility pursuant to s. 429.281 in response to
1222 receiving a notice of relocation or termination of residency
1223 from the facility. If a grievance is filed, the effective date
1224 of the relocation or termination or residency is extended at
1225 least 15 days. In order for a facility to terminate the
1226 residency of an individual without notice as provided herein,
1227 the facility shall show good cause in a court of competent
1229 (l) Present grievances and recommend changes in policies,
1230 procedures, and services to the staff of the facility, governing
1231 officials, or any other person without restraint, interference,
1232 coercion, discrimination, or reprisal. Each facility shall
1233 establish a grievance procedure to facilitate the residents’
1234 exercise of this right. This right includes access to ombudsman
1235 volunteers and advocates and the right to be a member of, to be
1236 active in, and to associate with advocacy or special interest
1238 (2) The administrator of a facility shall ensure that a
1239 written notice of the rights, obligations, and prohibitions set
1240 forth in this part is posted in a prominent place in each
1241 facility and read or explained to residents who cannot read. The
1242 This notice must shall include the name, address, and telephone
1243 numbers of the local ombudsman council and central abuse hotline
1244 and, if when applicable, Disability Rights Florida the Advocacy
1245 Center for Persons with Disabilities, Inc., and the Florida
1246 local advocacy council, where complaints may be lodged. The
1247 notice must state that the names or identities of the
1248 complainants or residents involved in a complaint made to the
1249 Office of State Long-Term Care Ombudsman or a local long-term
1250 care ombudsman council are confidential unless the resident
1251 authorizes disclosure in order for the ombudsman to attempt to
1252 resolve the complaint. The facility must ensure a resident’s
1253 access to a telephone to call the local ombudsman council,
1254 central abuse hotline, Disability Rights Florida Advocacy Center
1255 for Persons with Disabilities, Inc., and the Florida local
1256 advocacy council.
1257 Section 21. Effective October 1, 2012, section 429.281,
1258 Florida Statutes, is created to read:
1259 429.281 Grievances for resident relocation or termination
1260 of residency.—
1261 (1) As used in this section, the term:
1262 (a) “Relocation” means to move a resident from one facility
1263 to another facility that is responsible for the resident’s care.
1264 (b) “Termination of residency” means the release of a
1265 resident from a facility that ceases to be responsible for the
1266 resident’s care.
1267 (2) Each facility licensed under this part must comply with
1268 s. 429.28(1)(k) when a decision is made to relocate or terminate
1269 the residency of a resident.
1270 (3) Except as provided in s. 429.28(1)(k), at least 30 days
1271 before a proposed relocation or termination of residency, the
1272 facility must provide advance notice of the proposed relocation
1273 or termination of residency to the resident and to a family
1274 member, if known, or the resident’s legal guardian or
1276 (4) The notice must be in writing and contain at a minimum,
1277 the following:
1278 (a) The date on which the notice is provided to the
1279 resident or resident’s legal guardian or representative;
1280 (b) The effective date of the relocation or termination of
1281 residency if the resident:
1282 1. Does not file a grievance; and
1283 2. Files a grievance, which may not be less than 15 days
1284 after the effective date if a grievance is not filed;
1285 (c) Information about the facility’s procedures for filing
1286 a grievance which is presented in a concise, straightforward
1287 manner and is written at an eighth-grade reading level;
1288 (d) Information about how to seek assistance from the local
1289 long-term care ombudsman council for a grievance;
1290 (e) The location to which the resident is being relocated,
1291 if known; and
1292 (f) The reason that the resident is being relocated or the
1293 residency is being terminated, along with a supporting
1295 (5) A resident may be relocated or have his or her
1296 residency terminated by the facility only if:
1297 (a) The resident’s needs cannot be met in the facility;
1298 (b) The resident no longer needs the services provided by
1299 the facility;
1300 (c) The health or safety of individuals in the facility is
1301 endangered by the resident;
1302 (d) The resident, resident’s family, or resident’s visitors
1303 cause disruption in the facility’s normal environment;
1304 (e) The contract for residency between the resident and the
1305 facility has expired; or
1306 (f) The resident has failed, after reasonable and
1307 appropriate notice, to pay.
1308 (6) A resident is entitled to challenge a facility’s
1309 proposed relocation or termination of residency through the
1310 facility’s grievance procedure. The grievance must be filed
1311 within 15 days after receipt of the notice of relocation or
1312 termination of residency. If the resident files a grievance, the
1313 resident may not be required to leave the facility until at
1314 least 45 days after the notice of proposed relocation or
1315 termination of residency is received by the resident or the
1316 resident’s legal guardian or representative.
1317 (7) A resident may request that the local long-term care
1318 ombudsman council review any notice of relocation or termination
1319 of residency given to the resident. If requested, the local
1320 long-term care ombudsman council shall assist the resident, or
1321 the resident’s legal guardian or representative, with filing a
1322 grievance and completing the grievance process.
1323 (8) Unless an emergency relocation is necessary as provided
1324 in this section, the facility may not impede the resident’s
1325 right to remain in the facility, and the resident may remain in
1326 the facility until the outcome of the grievance, which must be
1327 completed within 45 days after receipt of the notice of
1328 relocation or termination of residency, unless both the facility
1329 and the resident, or the resident’s legal guardian or
1330 representative, agree to extend the deadline for the conclusion
1331 of the grievance process. The facility must ensure that
1332 responsible representatives of the facility are reasonably
1333 available to participate in the grievance process.
1334 (9) This section applies to relocations or terminations of
1335 residency which are initiated by the assisted living facility,
1336 and does not apply to those initiated by the resident or by the
1337 resident’s physician, legal guardian, or representative.
1338 (10) This section does not affect the rights the resident
1339 has to seek civil remedies.
1340 Section 22. Section 429.34, Florida Statutes, is amended to
1342 429.34 Right of entry and inspection.—
1343 (1) In addition to the requirements of s. 408.811, a any
1344 duly designated officer or employee of the department, the
1345 Department of Children and Family Services, the Medicaid Fraud
1346 Control Unit of the Office of the Attorney General, the state or
1347 local fire marshal, or a member of the state or local long-term
1348 care ombudsman council may shall have the right to enter
1349 unannounced upon and into the premises of any facility licensed
1350 pursuant to this part in order to determine the state of
1351 compliance with the provisions of this part, part II of chapter
1352 408, and applicable rules. Data collected by the state or local
1353 long-term care ombudsman councils or the state or local advocacy
1354 councils may be used by the agency in investigations involving
1355 violations of regulatory standards.
1356 (2) In accordance with s. 408.811, every 24 months the
1357 agency shall conduct at least one unannounced inspection to
1358 determine compliance with this part, part II of chapter 408, and
1359 applicable rules. If the assisted living facility is accredited
1360 by the Joint Commission, the Council on Accreditation, or the
1361 Commission on Accreditation of Rehabilitation Facilities, the
1362 agency may conduct unannounced inspections less frequently, but
1363 in no event less than once every 5 years.
1364 (a) Two additional inspections shall be conducted every 6
1365 months for the next year if the assisted living facility has
1366 been cited for a class I violation or two or more class II
1367 violations arising from separate inspections within a 6-month
1368 period. In addition to any fines imposed on an assisted living
1369 facility under s. 429.19, the agency shall assess a fee of $69
1370 per bed for each of the additional two inspections, not to
1371 exceed $12,000 per inspection.
1372 (b) The agency shall verify through subsequent inspections
1373 that any violation identified during an inspection is corrected.
1374 However, the agency may verify the correction of a class III or
1375 class IV violation unrelated to resident rights or resident care
1376 without reinspection if the facility submits adequate written
1377 documentation that the violation has been corrected.
1378 (3) The agency is designated the central agency for
1379 tracking complaints that involve potential licensure violations
1380 to ensure a timely response to allegations regarding facilities
1381 and the initiation of licensure enforcement action, if
1382 warranted. Any other state agency regulating, or providing
1383 services to residents of, assisted living facilities, including
1384 the department, the Agency for Persons with Disabilities, the
1385 Department of Health, the Long-Term Care Ombudsman Council, and
1386 the Department of Children and Family Services, must report any
1387 allegations or complaints that have been substantiated or are
1388 likely to have occurred to the agency within 2 business days if
1389 the report reflects serious and immediate risk to residents. All
1390 other referrals must be made within 10 business days.
1391 (4) The agency shall have lead surveyors in each field
1392 office who specialize in assessing assisted living facilities.
1393 The lead surveyors shall provide initial and ongoing training to
1394 surveyors who will be inspecting and monitoring facilities. The
1395 lead surveyors shall ensure that consistent inspection and
1396 monitoring assessments are conducted.
1397 (5) The agency shall have one statewide lead surveyor who
1398 specializes in assisted living facility inspections. The lead
1399 surveyor shall coordinate communication between lead surveyors
1400 of assisted living facilities throughout the state and ensure
1401 statewide consistency in applying facility inspection laws and
1403 Section 23. Paragraph (l) of subsection (1) and subsections
1404 (2) and (5) of section 429.41, Florida Statutes, are amended to
1406 429.41 Rules establishing standards.—
1407 (1) It is the intent of the Legislature that rules
1408 published and enforced pursuant to this section shall include
1409 criteria by which a reasonable and consistent quality of
1410 resident care and quality of life may be ensured and the results
1411 of such resident care may be demonstrated. Such rules shall also
1412 ensure a safe and sanitary environment that is residential and
1413 noninstitutional in design or nature. It is further intended
1414 that reasonable efforts be made to accommodate the needs and
1415 preferences of residents to enhance the quality of life in a
1416 facility. The agency, in consultation with the department, may
1417 adopt rules to administer the requirements of part II of chapter
1418 408. In order to provide safe and sanitary facilities and the
1419 highest quality of resident care accommodating the needs and
1420 preferences of residents, the department, in consultation with
1421 the agency, the Department of Children and Family Services, and
1422 the Department of Health, shall adopt rules, policies, and
1423 procedures to administer this part, which must include
1424 reasonable and fair minimum standards in relation to:
1425 (l) The establishment of specific policies and procedures
1426 on resident elopement. Facilities shall conduct a minimum of two
1427 resident elopement drills each year. All administrators and
1428 direct care staff shall participate in the drills. Facilities
1429 shall document the drills. Each calendar year, the agency shall
1430 observe the elopement drills of 10 percent of the licensed
1431 facilities in the state. The facilities must be randomly
1432 selected by the agency and the elopement drills must coincide
1433 with an inspection or survey conducted by the agency. If an
1434 agency employee observes an elopement drill that does not meet
1435 licensure standards, the agency shall cite violations in
1436 accordance with s. 429.19(2).
1437 (2) In adopting any rules pursuant to this part, the
1438 department, in conjunction with the agency, shall make distinct
1439 standards for facilities based upon facility size; the types of
1440 care provided; the physical and mental capabilities and needs of
1441 residents; the type, frequency, and amount of services and care
1442 offered; and the staffing characteristics of the facility. Rules
1443 developed pursuant to this section may shall not restrict the
1444 use of shared staffing and shared programming in facilities that
1445 are part of retirement communities that provide multiple levels
1446 of care and otherwise meet the requirements of law and rule.
1447 Except for uniform firesafety standards, the department shall
1448 adopt by rule separate and distinct standards for facilities
1449 with 16 or fewer beds and for facilities with 17 or more beds.
1450 The standards for facilities with 16 or fewer beds must shall be
1451 appropriate for a noninstitutional residential environment if ,
1452 provided that the structure is no more than two stories in
1453 height and all persons who cannot exit the facility unassisted
1454 in an emergency reside on the first floor. The department, in
1455 conjunction with the agency, may make other distinctions among
1456 types of facilities as necessary to enforce the provisions of
1457 this part. If Where appropriate, the agency shall offer
1458 alternate solutions for complying with established standards,
1459 based on distinctions made by the department and the agency
1460 relative to the physical characteristics of facilities and the
1461 types of care offered therein.
1462 (5) In order to allocate resources efficiently, the agency
1463 shall conduct may use an abbreviated biennial standard licensure
1464 inspection that consists of a review of key quality-of-care
1465 standards in lieu of a full inspection in a facility that has a
1466 good record of past performance. However, a full inspection must
1467 be conducted in a facility that has a history of class I or
1468 class II violations, uncorrected class III violations, confirmed
1469 ombudsman council complaints that resulted in a citation for
1470 licensure, or confirmed licensure complaints which resulted in a
1471 citation for a licensure violation, within the previous
1472 licensure period immediately preceding the inspection or if a
1473 potentially serious problem is identified during the abbreviated
1474 inspection. The agency, in consultation with the department,
1475 shall develop the key quality-of-care standards with input from
1476 the State Long-Term Care Ombudsman Council and representatives
1477 of provider groups for incorporation into its rules.
1478 Section 24. Subsection (1) of section 429.49, Florida
1479 Statutes, is amended to read:
1480 429.49 Resident records; penalties for alteration.—
1481 (1) Any person who fraudulently alters, defaces, or
1482 falsifies any medical or other record of an assisted living
1483 facility, or causes or procures any such offense to be
1484 committed, commits a misdemeanor of the first second degree,
1485 punishable as provided in s. 775.082 or s. 775.083.
1486 Section 25. Section 429.515, Florida Statutes, is created
1487 to read:
1488 429.515 Preservice orientation.—
1489 (1) Each employee, including an administrator, of an
1490 assisted living facility who is newly hired on or after July 1,
1491 2012, must attend a preservice orientation provided by the
1492 facility which covers topics that will enable the employee to
1493 relate and respond to the residents of the facility. The
1494 orientation must be at least 2 hours in duration, be available
1495 in English and, if the employee is not fluent in English but is
1496 fluent in Spanish, Spanish, and, at a minimum, cover the
1497 following topics:
1498 (a) Care of persons who have Alzheimer’s disease or other
1499 related disorders.
1500 (b) Deescalation techniques.
1501 (c) Aggression control.
1502 (d) Elopement prevention.
1503 (e) Behavior management.
1504 (2) Upon completion of the preservice orientation, the
1505 administrator or owner of the facility must sign an affidavit,
1506 under penalty of perjury, stating that the employee completed
1507 the preservice orientation. The administrator of the facility
1508 must maintain the signed affidavit in the employee’s work file.
1509 Section 26. Section 429.52, Florida Statutes, is amended to
1511 (Substantial rewording of section. See
1512 s. 429.52, F.S., for present text.)
1513 429.52 Training; examination; tutorial; continuing
1515 (1) Staff, other than administrators, hired on or after
1516 January 1, 2013, who provide regular or direct care to residents
1517 must complete a 20-hour staff training curriculum, and an
1518 interactive online tutorial that demonstrates an understanding
1519 of the training. The training and tutorial must be completed
1520 within 90 days after employment and is in addition to the
1521 preservice orientation required under s. 429.515. The department
1522 may grant an exemption from the applicable hours to nurses,
1523 certified nursing assistants, or home health aides who can
1524 demonstrate completion of training that is substantially similar
1525 to all or portions of the staff training curriculum.
1526 (2) Staff, other than administrators, providing regular or
1527 direct care to residents must participate in a minimum of 4
1528 hours of continuing education every 2 years. The continuing
1529 education may be offered through online courses. Continuing
1530 education hours completed for specialty licenses and facilities
1531 that serve mental health residents pursuant to subsection (8)
1532 may count toward completion of the continuing education hours
1533 required under this subsection.
1534 (3) A certificate must be provided to each person upon
1535 completion of the training required in this section. A copy of
1536 the certificate must be maintained in the employee’s work file.
1537 (4) A person who can document that he or she has completed
1538 the training and continuing education required by this section
1539 is not required to retake the training or continuing education
1540 for the applicable 2-year cycle upon employment with a different
1541 facility if the break in employment does not exceed 6 months.
1542 (5) The department, in consultation with stakeholders, the
1543 agency, the Department of Children and Family Services, the
1544 Department of Health, and their agents, shall develop the
1546 (a) Assisted living facility administrator core training
1547 that includes at least 40 hours of training. The curriculum, at
1548 a minimum, must cover the following topics:
1549 1. State law and rules relating to assisted living
1551 2. Resident rights and the identification and reporting of
1552 abuse, neglect, and exploitation.
1553 3. The special needs of elderly persons, persons who have
1554 mental illness, and persons who have developmental disabilities
1555 and how to meet those needs.
1556 4. Nutrition and food service, including acceptable
1557 sanitation practices for preparing, storing, and serving food.
1558 5. Medication management, recordkeeping, and proper
1559 techniques for assisting residents who self-administer
1561 6. Firesafety requirements, including procedures for fire
1562 evacuation drills and other emergency procedures.
1563 7. The care of persons who have Alzheimer’s disease and
1564 related disorders.
1565 8. Elopement prevention.
1566 9. Aggression and behavior management, deescalation
1567 techniques, and proper protocols and procedures relating to the
1568 Baker Act as provided in part I of chapter 394.
1569 10. Do-not-resuscitate orders.
1570 11. Infection control.
1571 12. Admission and continued residency.
1572 13. Phases of care and interacting with residents.
1573 14. Best practices in the industry.
1574 15. Business operations, including, but not limited to,
1575 human resources, financial management, and supervision of staff.
1576 (b) A continuing education curriculum of 16 hours for
1577 licensed assisted living facility administrators and managers
1578 when the administrator is responsible for more than one
1579 facility. Continuing education must include topics similar to
1580 those of the core training in paragraph (a), and may include
1581 additional subject matter that enhances the knowledge, skills,
1582 and abilities of assisted living facility administrators, as
1583 adopted by rule.
1584 (c) Specialty training, continuing education, examinations,
1585 and tutorials for the requirements in subsection (8).
1586 (6) The department, in consultation with the agency, the
1587 Department of Children and Family Services, the Department of
1588 Health, and their agents, shall develop an assisted living
1589 facility administrator examination that tests the applicant’s
1590 knowledge and training of the core training topics listed in
1591 subsection (5) and an examination covering the continuing
1592 education topics developed under that subsection.
1593 (7) The department, in consultation with stakeholders, the
1594 agency, and the Department of Children and Family Services shall
1595 develop the standardized staff training curriculum and
1596 continuing education required under subsections (1) and (2). The
1597 curriculum must include at least 20 hours of inservice training,
1598 with at least 1 hour of training per topic, covering at least
1599 the following topics:
1600 (a) Reporting major incidents.
1601 (b) Reporting adverse incidents.
1602 (c) Facility emergency procedures, including chain-of
1603 command and staff member roles relating to emergency evacuation.
1604 (d) Resident rights in an assisted living facility.
1605 (e) Recognizing and reporting resident abuse, neglect, and
1607 (f) Resident behavior and needs.
1608 (g) Providing assistance with the activities of daily
1610 (h) Infection control.
1611 (i) Aggression and behavior management and deescalation
1613 (8) Additional specialty training and continuing education
1614 for assisted living facility staff and administrators is
1615 required as follows:
1616 (a) If a facility holds an extended congregate care
1618 1. The administrator and manager, if the administrator is
1619 responsible for more than one facility, must complete a minimum
1620 of 4 hours of courses that train and educate administrators and
1621 managers on the special needs and care of residents requiring
1622 extended congregate care within 90 days after employment or
1623 after the facility receives an extended congregate care license.
1624 Administrators and managers are required to complete 4 hours of
1625 continuing education on relevant topics every 2 years.
1626 2. Staff who provides regular and direct care to residents
1627 receiving extended congregate care services must complete a
1628 minimum of 2 hours of courses that train and educate staff on
1629 the special needs and care of those requiring limited nursing
1630 services. The training must be completed within 90 days after
1631 employment or after the facility receives a limited nursing
1632 services license. Staff is also required to complete 2 hours of
1633 continuing education on relevant topics every 2 years.
1634 (b) If a facility holds a limited nursing services license:
1635 1. The administrator and manager, if the administrator is
1636 responsible for more than one facility, must complete a minimum
1637 of 4 hours of courses that train and educate administrators on
1638 the special needs and care of those residents requiring limited
1639 nursing services within 90 days after employment or after the
1640 facility receives a limited nursing services license.
1641 2. Staff providing regular and direct care to residents
1642 receiving limited nursing services must complete a minimum of 2
1643 hours of courses that train and educate staff on the special
1644 needs and care of those requiring limited nursing services. The
1645 training must be completed within 90 days after employment or
1646 after the facility receives a limited nursing services license.
1647 (c)1. The administrator, and manager if the administrator
1648 is responsible for more than one facility, must complete a
1649 minimum of 8 hours of courses that train and educate
1650 administrators and managers on the special needs and care of
1651 mental health residents within 90 days after employment, the
1652 facility receives a mental health license, or begins caring for
1653 a mental health resident. Administrators and managers are
1654 required to complete 4 hours of continuing education on relevant
1655 topics every 2 years. An administrator and manager, if the
1656 administrator is responsible for more than one facility, must
1657 pass an examination related to the administrator’s training with
1658 a minimum score of 80 percent. An administrator and manager must
1659 complete an online interactive tutorial related to the
1660 continuing education in order to demonstrate an understanding of
1661 the material and receive a certificate of completion.
1662 2. Staff who provide regular or direct care to mental
1663 health residents must complete a minimum of 6 hours of
1664 department-approved mental health training within 90 days after
1665 beginning employment, after the facility begins serving a mental
1666 health resident, or after the facility receives a limited mental
1667 health license. Staff must also complete 4 hours of continuing
1668 education every 2 years that enhances the ability to care for
1669 mental health residents. A staff member must complete an online
1670 interactive tutorial related to the training and continuing
1671 education in order to demonstrate an understanding of the
1672 material and receive a certificate of completion. A staff member
1673 who does not complete the initial training tutorial within the
1674 90 days may not provide regular or direct care to mental health
1675 residents until he or she successfully completes the tutorial.
1676 (d) Staff, including administrators, who prepare or serve
1677 food must receive a minimum of 1 hour of inservice training in
1678 safe food handling practices within 30 days after beginning
1680 (e) Staff, including administrators, must receive at least
1681 1 hour of inservice training on the facility’s resident
1682 elopement response policies and procedures within 30 days after
1683 beginning employment.
1684 1. A copy of the facility’s resident elopement response
1685 policies and procedures must be provided to staff and the
1687 2. Staff members and the administrator must demonstrate
1688 understanding and competency in the implementation of the
1689 elopement response policies and procedures.
1690 (f) Staff, including the administrator, involved with the
1691 management of medications and the assistance with self
1692 administration of medications under s. 429.256 must complete a
1693 minimum of 4 additional hours of training provided by a
1694 registered nurse, licensed pharmacist, or department staff
1695 member. The department shall establish by rule the minimum
1696 requirements of this training, including continuing education
1698 (9) Other facility staff members shall participate in
1699 training relevant to their job duties and as specified by rule.
1700 (10) The department, in consultation with a panel of at
1701 least three mental health professionals, the agency, and the
1702 Department of Children and Family Services, and their agents
1703 shall develop a limited mental health curriculum, examination,
1704 and on-line interactive tutorial.
1705 (11) The agency or department may require or cause to be
1706 provided the training or education of staff of an assisted
1707 living facility beyond that which is required under this part if
1708 the agency or department determines that there are problems in a
1709 facility which could be reduced through specific staff training
1710 or education.
1711 (12) Existing curricula, examinations, and tutorials may be
1712 used, modified, or enhanced as appropriate. To the extent
1713 funding is available, the department may contract for assistance
1714 with the development, review, updating of the training,
1715 examinations, and on-line tutorials required under this section.
1717 All training, examinations, and tutorials must be developed and
1718 offered in English and Spanish, and must be reviewed at least
1719 annually and updated as needed to reflect changes in the law,
1720 rules, and best practices. The participant or the participant’s
1721 employer shall pay any fee associated with the training,
1722 continuing education, tutorial, or examination.
1723 Section 27. Section 429.522, Florida Statutes, is created
1724 to read:
1725 429.522 Assisted living training providers; certification.—
1726 (1) Effective January 1, 2013, an individual seeking to
1727 provide assisted living training in this state must be certified
1728 by the department. The applicant must provide the department
1729 with proof of completion of the minimum core training
1730 requirements, successful passage of the assisted living facility
1731 administrator examination, and proof of compliance with
1732 continuing education requirements for assisted living facility
1733 administrators since completion of core training.
1734 (2) A person seeking to be certified as a trainer must
1736 (a) Provide proof of completion of a 4-year baccalaureate
1737 degree from an accredited college or university and must have
1738 worked in a management position in an assisted living facility
1739 for 3 years after obtaining certification in core training
1741 (b) Have worked in a management position in an assisted
1742 living facility for 5 years after being core certified and have
1743 1 year of teaching experience as an educator or staff trainer
1744 for persons who work in assisted living facilities or other
1745 long-term care settings;
1746 (c) Have been previously employed as a trainer of core
1747 training courses for the department;
1748 (d) Have at least 5 years of employment with the agency as
1749 a surveyor of assisted living facilities;
1750 (e) Have at least 5 years of employment as an educator or
1751 staff trainer for persons working in an assisted living facility
1752 or another long-term care setting;
1753 (f) Have a 4-year baccalaureate degree from an accredited
1754 college or university and at least 4 years of experience as an
1755 educator or staff trainer for persons working in an assisted
1756 living facility or another long-term care setting after
1757 receiving certification in core courses; or
1758 (g) Meet other qualification criteria as defined by rule of
1759 the department.
1760 (3) Training may also be provided by:
1761 (a) A Florida College System institution;
1762 (b) Any nonpublic postsecondary education institution
1763 licensed or exempted from licensure pursuant to chapter 1005; or
1764 (c) A statewide entity which represents and provides
1765 technical assistance to assisted living facilities that
1766 contracts with the department to provide training. The
1767 department may specify minimum trainer qualifications in the
1769 (4) The department shall provide oversight of the assisted
1770 living training providers. The department shall adopt rules to
1771 establish requirements for trainer certification and
1772 recertification requirements, including continuing education
1773 requirements, disciplinary action that may be taken against a
1774 trainer, a trainer decertification process, and required
1775 electronic reporting of persons who have successfully completed
1776 training courses.
1777 (5) If funding is available, by January 1, 2013, the
1778 department shall develop and maintain an electronic database,
1779 accessible to the public, which lists all persons holding
1780 certification as an assisted living trainer, including any
1781 history of violations. Assisted living trainers shall keep a
1782 record of individuals who complete training and shall submit the
1783 record to the department electronically within 24 hours after
1784 the completion of a course in order for the department to
1785 include the information in the database.
1786 Section 28. Section 429.54, Florida Statutes, is amended to
1788 429.54 Collection of information; local subsidy;
1789 interagency communication; facility reporting.—
1790 (1) To enable the department to collect the information
1791 requested by the Legislature regarding the actual cost of
1792 providing room, board, and personal care in assisted living
1793 facilities, the department may is authorized to conduct field
1794 visits and audits of facilities as may be necessary. The owners
1795 of randomly sampled facilities shall submit such reports,
1796 audits, and accountings of cost as the department may require by
1797 rule; however, provided that such reports, audits, and
1798 accountings may not be more than shall be the minimum necessary
1799 to implement the provisions of this subsection section. Any
1800 facility selected to participate in the study shall cooperate
1801 with the department by providing cost of operation information
1802 to interviewers.
1803 (2) Local governments or organizations may contribute to
1804 the cost of care of local facility residents by further
1805 subsidizing the rate of state-authorized payment to such
1806 facilities. Implementation of local subsidy shall require
1807 departmental approval and may shall not result in reductions in
1808 the state supplement.
1809 (3) Subject to the availability of funds, the agency, the
1810 department, the Department of Children and Family Services, the
1811 Department of Health, and the Agency for Persons with
1812 Disabilities shall develop or modify electronic systems of
1813 communication among state-supported automated systems to ensure
1814 that relevant information pertaining to the regulation of
1815 assisted living facilities and facility staff is timely and
1816 effectively communicated among agencies in order to facilitate
1817 the protection of residents.
1818 (4) All assisted living facilities shall submit electronic
1819 reports to the agency twice a year.
1820 (a) The reports must represent facility data on March 30
1821 and September 30 of each year and be submitted within 15
1822 calendar days. The following information and must be submitted:
1823 1. The number of beds in the facility;
1824 2. The number of occupied beds;
1825 3. The number of residents, by age group, younger than 65
1826 years of age, from 65 to 74 years of age, from 75 to 84 years of
1827 age, and 85 years of age or older;
1828 4. The number of residents who are mental health residents,
1829 who are receiving extended congregate care, who are receiving
1830 limited nursing services, and who are receiving hospice care;
1831 5. If there is a facility waiting list, the number of
1832 individuals on the waiting list and the type of services or care
1833 they require, if known;
1834 6. The number of residents receiving optional state
1835 supplementation; and
1836 7. The number of residents who are Medicaid recipients and
1837 the type of waiver used to fund their assisted living facility
1838 certification care.
1839 (b) The agency must maintain electronically the electronic
1840 information submitted and, at a minimum, use the information to
1841 track trends in resident populations and needs.
1842 (c) Reporting under this subsection begins March 1, 2013,
1843 and expires July 1, 2017.
1844 Section 29. The Division of Statutory Revision is requested
1845 to rename part II of chapter 468, Florida Statutes, consisting
1846 of ss. 468.1635-468.1756, Florida Statutes, as “Nursing Home and
1847 Assisted Living Facility Administration.”
1848 Section 30. Section 468.1635, Florida Statutes, is amended
1849 to read:
1850 468.1635 Purpose.—The sole legislative purpose for enacting
1851 this part chapter is to ensure that every nursing home
1852 administrator and assisted living facility administrator
1853 practicing in this state meets minimum requirements for safe
1854 practice. It is the legislative intent that nursing home
1855 administrators and assisted living facility administrators who
1856 fall below minimum competency or who otherwise present a danger
1857 to the public shall be prohibited from practicing in this state.
1858 Section 31. Section 468.1645, Florida Statutes, is amended
1859 to read:
1860 468.1645 Administrator license required.—
1861 (1) A No nursing home in the state may not operate in this
1862 state unless it is under the management of a nursing home
1863 administrator, and effective July 1, 2013, an assisted living
1864 facility may not operate in this state unless it is under the
1865 management of an assisted living facility administrator who
1866 holds a currently valid license, provisional license, or
1867 temporary license.
1868 (2) Nothing in This part, and or in the rules adopted
1869 pursuant to this part, do not hereunder shall require an
1870 administrator of a any facility or institution operated by and
1871 for persons who rely exclusively upon treatment by spiritual
1872 means through prayer, in accordance with the creed or tenets of
1873 any organized church or religious denomination, to be licensed
1874 as a nursing home administrator or assisted living facility
1875 administrator if the administrator is employed only to
1876 administer in such facilities or institutions for the care and
1877 treatment of the sick.
1878 Section 32. Section 468.1655, Florida Statutes, is amended
1879 to read:
1880 468.1655 Definitions.—As used in this part:
1881 (1) “Assisted living facility” means a facility licensed
1882 under part I of chapter 429.
1883 (2) “Assisted living facility administrator” means a person
1884 who is licensed to engage in the practice of assisted living
1885 facility administration in this state under the authority of
1886 this part.
1887 (3) “Assisted living facility administrator certification”
1888 means a professional credential awarded by a contracted third
1889 party credentialing entity to individuals who demonstrate core
1890 competency in the practice of assisted living facility
1891 administration and who meet the education, background screening,
1892 and other criteria specified by the board for licensure as an
1893 assisted living facility administrator.
1894 (4) (1) “Board” means the Board of Long-Term Care Nursing
1895 Home Administrators.
1896 (5) (2) “Department” means the Department of Health.
1897 (6) “Long-term care” means any service provided in
1898 facilities licensed under part II of chapter 400 or part I of
1899 chapter 429.
1900 (7) (3) “Nursing home administrator” means a person who is
1901 licensed to engage in the practice of nursing home
1902 administration in this state under the authority of this part.
1903 (8) “Practice of assisted living facility administration”
1904 means any service requiring education, training, or experience
1905 in assisted living facility administration and its application
1906 to the planning, organizing, staffing, directing, and
1907 controlling of the total management of an assisted living
1908 facility. A person is practicing or offering to practice
1909 assisted living facility administration if such person:
1910 (a) Practices any of the above services.
1911 (b) Holds himself or herself out as able to perform, or
1912 does perform, any form of assisted living facility
1913 administration by written or verbal claim, sign, advertisement,
1914 letterhead, or card; or in any other way represents himself or
1915 herself to be, or implies that he or she is, an assisted living
1916 facility administrator.
1917 (9) (4) “Practice of nursing home administration” means any
1918 service requiring education, training, or experience in nursing
1919 home administration education, training, or experience and the
1920 application of such to the planning, organizing, staffing,
1921 directing, and controlling of the total management of a nursing
1922 home. A person is practicing or offering shall be construed to
1923 practice or to offer to practice nursing home administration if
1924 the person who:
1925 (a) Practices any of the above services.
1926 (b) Holds himself or herself out as able to perform, or
1927 does perform, any form of nursing home administration by written
1928 or verbal claim, sign, advertisement, letterhead, or card; or in
1929 any other way represents himself or herself to be, or implies
1930 that he or she is, a nursing home administrator.
1931 (10) (5) “Nursing home” means an institution or facility
1932 licensed as such under part II of chapter 400.
1933 Section 33. Section 468.1665, Florida Statutes, is amended
1934 to read:
1935 468.1665 Board of Long-Term Care Nursing Home
1936 Administrators; membership; appointment; terms.—
1937 (1) The Board of Long-Term Care Nursing Home Administrators
1938 is created within the department and shall consist of eleven
1939 seven members, to be appointed by the Governor and confirmed by
1940 the Senate to a term of 4 years or for a term to complete an
1941 unexpired vacancy.
1942 (2) Three members of the board must be licensed nursing
1943 home administrators. Three members of the board must be licensed
1944 assisted living facility administrators. Two members of the
1945 board must be health care practitioners. Three The remaining two
1946 members of the board must be laypersons who are not, and have
1947 never been, nursing home or assisted living facility
1948 administrators or members of any health care profession or
1949 occupation, and at least one of these laypersons must be a
1950 resident of an assisted living facility. At least one member of
1951 the board must be 60 years of age or older.
1952 (3) Only board members who are nursing home administrators
1953 may have a direct financial interest in any nursing home. Only
1954 board members who are assisted living facility administrators
1955 may have a direct financial interest in any assisted living
1957 (4) All provisions of chapter 456 relating to activities of
1958 regulatory boards shall apply.
1959 Section 34. Section 468.1685, Florida Statutes, is amended
1960 to read:
1961 468.1685 Powers and duties of board and department.—It is
1962 the function and duty of the board, together with the
1963 department, to:
1964 (1) Adopt rules pursuant to ss. 120.536 (1) and 120.54 to
1965 implement the provisions of this part conferring duties upon the
1967 (2) Develop, impose, and enforce specific standards within
1968 the scope of the general qualifications established by this part
1969 which must be met by individuals in order to receive licenses as
1970 nursing home or assisted living facility administrators. These
1971 standards shall be designed to ensure that nursing home and
1972 assisted living facility administrators are individuals of good
1973 character and otherwise suitable and, by training or experience
1974 in the field of health care facility institutional
1975 administration, qualified to serve as nursing home or assisted
1976 living facility administrators.
1977 (3) Develop by appropriate techniques, including
1978 examinations and investigations, a method for determining
1979 whether an individual meets such standards. The board shall
1980 contract with one or more third-party credentialing entities for
1981 the purpose of certifying assisted living facility
1982 administrators. A third-party credentialing entity must be a
1983 nonprofit organization that has met nationally recognized
1984 standards for developing and administering professional
1985 certification programs. The contract must require that a third
1986 party credentialing entity:
1987 (a) Verify that the applicant for licensure as an assisted
1988 living facility administrator meets the requirements for
1989 licensure under part I of chapter 429 and this part;
1990 (b) Develop or assist the Department of Elderly Affairs
1991 with developing the training and testing materials under s.
1992 429.52 using nationally recognized certification and
1993 psychometric standards;
1994 (c) Maintain an Internet-based database, accessible to the
1995 public, of all persons holding an assisted living facility
1996 administrator certification; and
1997 (d) Require and verify continuing education consistent with
1998 s. 429.52 and, at least, biennial certification renewal for
1999 persons holding an assisted living facility administrator
2001 (4) Issue licenses to qualified individuals meeting the
2002 standards of the board and revoke or suspend licenses previously
2003 issued by the board if when the individual holding such license
2004 is determined to have failed to conform substantially conform to
2005 the requirements of such standards.
2006 (5) Establish by rule and carry out procedures , by rule,
2007 designed to ensure that licensed nursing home or assisted living
2008 facility administrators will comply with the standards adopted
2009 by the board.
2010 (6) Receive, investigate, and take appropriate action with
2011 respect to any charge or complaint filed with the department to
2012 the effect that a licensed nursing home or assisted living
2013 facility administrator has failed to comply with the
2014 requirements or standards adopted by the board.
2015 (7) Conduct a continuing study and investigation of nursing
2016 homes and assisted living facilities and the administrators of
2017 nursing homes and assisted living facilities in order to improve
2018 the standards imposed for the licensing of such administrators
2019 and the procedures and methods for enforcing such standards with
2020 respect to licensed administrators of nursing homes who have
2021 been licensed as such.
2022 (8) Set up procedures by rule for advising and acting
2023 together with the department of Health and other boards of other
2024 health professions in matters affecting procedures and methods
2025 for effectively enforcing the purpose of this part and the
2026 administration of chapters 400 and 429.
2027 Section 35. Section 468.1695, Florida Statutes, is amended
2028 to read:
2029 468.1695 Licensure by examination; licensure by
2031 (1) Any person desiring to be licensed as a nursing home
2032 administrator shall apply to the department to take the
2033 licensure examination. The examination shall be given at least
2034 two times a year and shall include, but not be limited to,
2035 questions on the subjects of nursing home administration such
2037 (a) Applicable standards of nursing home health and safety;
2038 (b) Federal, state, and local health and safety laws and
2040 (c) General administration;
2041 (d) Psychology of patient care;
2042 (e) Principles of medical care;
2043 (f) Personal and social care;
2044 (g) Therapeutic and supportive care and services in long
2045 term care;
2046 (h) Departmental organization and management;
2047 (i) Community interrelationships; and
2048 (j) Terminology.
2050 The board may, by rule, adopt use of a national examination in
2051 lieu of part or all of the examination required by this part.
2052 (2) The department shall examine each applicant for a
2053 nursing home administrator license who the board certifies has
2054 completed the application form and remitted an examination fee
2055 set by the board not to exceed $250 and who:
2056 (a)1. Holds a baccalaureate degree from an accredited
2057 college or university and majored in health care administration
2058 or has credit for at least 60 semester hours in subjects, as
2059 prescribed by rule of the board, which prepare the applicant for
2060 total management of a nursing home; and
2061 2. Has fulfilled the requirements of a college-affiliated
2062 or university-affiliated internship in nursing home
2063 administration or of a 1,000-hour nursing home administrator-in
2064 training program prescribed by the board; or
2065 (b)1. Holds a baccalaureate degree from an accredited
2066 college or university; and
2067 2.a. Has fulfilled the requirements of a 2,000-hour nursing
2068 home administrator-in-training program prescribed by the board;
2070 b. Has 1 year of management experience allowing for the
2071 application of executive duties and skills, including the
2072 staffing, budgeting, and directing of resident care, dietary,
2073 and bookkeeping departments within a skilled nursing facility,
2074 hospital, hospice, assisted living facility with a minimum of 60
2075 licensed beds, or geriatric residential treatment program and,
2076 if such experience is not in a skilled nursing facility, has
2077 fulfilled the requirements of a 1,000-hour nursing home
2078 administrator-in-training program prescribed by the board.
2079 (3) The department shall issue a license to practice
2080 nursing home administration to any applicant who successfully
2081 completes the examination in accordance with this section and
2082 otherwise meets the requirements of this part. The department
2083 shall not issue a license to any applicant who is under
2084 investigation in this state or another jurisdiction for an
2085 offense which would constitute a violation of s. 468.1745 or s.
2086 468.1755. Upon completion of the investigation, the provisions
2087 of s. 468.1755 shall apply.
2088 (4) The board may by rule establish a preceptor
2089 certification and recertification fee not to exceed $100 which
2090 shall be remitted by those individuals seeking board approval to
2091 act as preceptors in administrator-in-training programs as
2092 prescribed by the board. This Said fee may be charged at the
2093 time of application for initial certification and at the time of
2094 application for recertification. The board may by rule establish
2095 a trainee application fee not to exceed $500 to defray the costs
2096 of the board’s supervision of the administrator-in-training
2097 program, to be remitted by those individuals seeking to undergo
2098 a board prescribed administrator-in-training program.
2099 (5) Any person desiring to be licensed as an assisted
2100 living facility administrator must apply to the department,
2101 remit a nonrefundable fee set by the board not to exceed $150,
2102 and provide proof of a current and valid assisted living
2103 facility administrator certification. If the board is unable to
2104 contract with a third-party credentialing entity, the department
2105 shall verify an applicant’s compliance with all requirements for
2106 certification and licensure and the submission of a valid
2107 assisted living facility administrator certification as a
2108 prerequisite for licensure is waived.
2109 (6) An assisted living facility administrator certification
2110 must be issued by a third-party credentialing entity that
2111 certifies that the individual:
2112 (a) Is at least 21 years old;
2113 (b) Holds a 4-year baccalaureate degree from an accredited
2114 college or university, including completion of coursework in
2115 health care, gerontology, or geriatrics; holds a 4-year
2116 baccalaureate degree from an accredited college or university
2117 and has at least 2 years of experience in direct care in or
2118 management of an assisted living facility or nursing home; or
2119 holds a 2-year associate degree and has at least 4 years of
2120 experience in direct care in an assisted living facility or
2121 nursing home;
2122 (c) Has completed a least 40 hours of core training;
2123 (d) Has passed an examination that documents core
2124 competencies in the training required for assisted living
2125 facility administrators prior to licensure with a minimum score
2126 of 80 percent;
2127 (e) Has completed background screening pursuant to ss.
2128 429.174 and 456.0365; and
2129 (f) Otherwise meets the requirements of this part and part
2130 I of chapter 429.
2131 (7) A person who is continuously employed as an assisted
2132 living facility administrator, or a nursing home administrator
2133 who is employed as a nursing home administrator, between July 1,
2134 2012 and January 1, 2013, is eligible for certification as an
2135 assisted living facility administrator without meeting the
2136 requirements in subsection (6) if:
2137 (a) The applicant completed the core training, examination,
2138 and continuing education requirements under chapter 429 which
2139 were in effect on June 30, 2012; and
2140 (b) The applicant was not the administrator of an assisted
2141 living facility or nursing home that was cited by final agency
2142 action for a class I or class II violation within the 2 years
2143 before January 1, 2013.
2144 (8) A person who is at least 21 years old; completes the
2145 core training and successfully passes the core training
2146 examination between January 1, 2011, and January 1, 2013; has
2147 completed background screening for licensure, has been
2148 continuously employed by an assisted living facility between
2149 January 1, 2011, and January 1, 2013; and has never been
2150 employed as an administrator of an assisted living facility is
2151 eligible for certification as an assisted living facility
2152 administrator without meeting the requirements in subsection (6)
2153 if the person submits an application before July 1, 2013.
2154 (9) A licensed assisted living facility administrator
2155 applying for licensure renewal must submit an application, remit
2156 a renewal fee of $150, and demonstrate that he or she has
2157 obtained and maintained his or her assisted living facility
2158 administrator certification that substantiates that he or she
2159 has completed at least 16 hours of general continuing education,
2160 any specialty training and continuing education required based
2161 on licensure of the facility or the resident’s served for which
2162 the applicant is an administrator, has successfully passed all
2163 required examinations, and satisfies all other requirements for
2164 licensure renewal under this part and part I of chapter 429.
2165 (10) The board and the department may adopt rules for
2166 licensure forms, staggered license expirations dates, prorated
2167 licensure fees, and certification to implement the licensure and
2168 relicensure of assisted living facility administrators.
2169 Section 36. Subsection (1) of section 468.1705, Florida
2170 Statutes, is amended to read:
2171 468.1705 Licensure by endorsement; temporary license.—
2172 (1) The department shall issue a nursing home administrator
2173 license by endorsement to an any applicant who, upon applying to
2174 the department and remitting a fee set by the board not to
2175 exceed $500, demonstrates to the board that he or she:
2176 (a) Meets one of the following requirements:
2177 1. Holds a valid active license to practice nursing home
2178 administration in another state of the United States if ,
2179 provided that the current requirements for licensure in that
2180 state are substantially equivalent to, or more stringent than,
2181 current requirements in this state; or
2182 2. Meets the qualifications for licensure in s. 468.1695;
2184 (b)1. Has successfully completed a national examination
2185 which is substantially equivalent to, or more stringent than,
2186 the examination given by the department;
2187 2. Has passed an examination on the laws and rules of this
2188 state governing the administration of nursing homes; and
2189 3. Has worked as a fully licensed nursing home
2190 administrator for 2 years within the 5-year period immediately
2191 preceding the application by endorsement.
2192 Section 37. Section 468.1745, Florida Statutes, is amended
2193 to read:
2194 468.1745 Prohibitions; penalties.—
2195 (1) A No person may not shall:
2196 (a) Practice nursing home administration unless the person
2197 holds an active license to practice nursing home administration.
2198 (b) Use the name or title “nursing home administrator” if
2199 when the person has not been licensed pursuant to this part act.
2200 (c) Present as his or her own the license of another.
2201 (d) Give false or forged evidence to the board or a member
2202 thereof for the purpose of obtaining a license.
2203 (e) Use or attempt to use a nursing home administrator’s
2204 license or an assisted living facility administrator’s license
2205 that which has been suspended or revoked.
2206 (f) Knowingly employ unlicensed persons in the practice of
2207 nursing home administration or assisted living facility
2209 (g) Knowingly conceal information relative to violations of
2210 this part.
2211 (h) Practice assisted living facility administration unless
2212 the person holds an active license to practice assisted living
2213 facility administration.
2214 (i) Use the name or title “assisted living facility
2215 administrator” if the person has not been licensed pursuant to
2216 this part.
2217 (2) Any person who violates the provisions of this section
2218 is guilty of a misdemeanor of the second degree, punishable as
2219 provided in s. 775.082 or s. 775.083.
2220 Section 38. Section 468.1755, Florida Statutes, is amended
2221 to read:
2222 468.1755 Disciplinary proceedings.—
2223 (1) The following acts constitute grounds for denial of a
2224 nursing home administrator license, assisted living facility
2225 administrator license, or disciplinary action, as specified in
2226 s. 456.072(2):
2227 (a) Violation of any provision of s. 456.072(1) or s.
2229 (b) Attempting to procure a license to practice nursing
2230 home administration or assisted living facility administration
2231 by bribery, by fraudulent misrepresentation, or through an error
2232 of the department or the board.
2233 (c) Having a license to practice nursing home
2234 administration or assisted living facility administration
2235 revoked, suspended, or otherwise acted against, including the
2236 denial of licensure, by the licensing authority of another
2237 state, territory, or country.
2238 (d) Being convicted or found guilty, regardless of
2239 adjudication, of a crime in any jurisdiction which relates to
2240 the practice of nursing home administration, assisted living
2241 facility administration, or the ability to practice nursing home
2242 administration or assisted living facility administration. Any
2243 plea of nolo contendere shall be considered a conviction for
2244 purposes of this part.
2245 (e) Making or filing a report or record which the licensee
2246 knows to be false, intentionally failing to file a report or
2247 record required by state or federal law, willfully impeding or
2248 obstructing such filing, or inducing another person to impede or
2249 obstruct such filing. Such reports or records shall include only
2250 those which are signed in the capacity of a licensed nursing
2251 home administrator or licensed assisted living facility
2253 (f) Authorizing the discharge or transfer of a resident by
2254 a nursing home administrator for a reason other than those
2255 provided in ss. 400.022 and 400.0255.
2256 (g) Advertising goods or services in a manner which is
2257 fraudulent, false, deceptive, or misleading in form or content.
2258 (h) Fraud or deceit, negligence, incompetence, or
2259 misconduct in the practice of nursing home administration or
2260 assisted living facility administration.
2261 (i) Violation of a lawful order of the board or department
2262 previously entered in a disciplinary hearing or failing to
2263 comply with a lawfully issued subpoena of the board or
2265 (j) Practicing with a revoked, suspended, inactive, or
2266 delinquent license.
2267 (k) Repeatedly acting in a manner inconsistent with the
2268 health, safety, or welfare of the patients of the facility in
2269 which he or she is the administrator.
2270 (l) Being unable to practice nursing home administration or
2271 assisted living facility administration with reasonable skill
2272 and safety to patients by reason of illness, drunkenness, use of
2273 drugs, narcotics, chemicals, or any other material or substance
2274 or as a result of any mental or physical condition. In enforcing
2275 this paragraph, upon a finding of the State Surgeon General or
2276 his or her designee that probable cause exists to believe that
2277 the licensee is unable to serve as a nursing home administrator
2278 or assisted living facility administrator due to the reasons
2279 stated in this paragraph, the department shall have the
2280 authority to issue an order to compel the licensee to submit to
2281 a mental or physical examination by a physician designated by
2282 the department. If the licensee refuses to comply with such
2283 order, the department’s order directing such examination may be
2284 enforced by filing a petition for enforcement in the circuit
2285 court where the licensee resides or serves as a nursing home
2286 administrator or assisted living facility administrator. The
2287 licensee against whom the petition is filed shall not be named
2288 or identified by initials in any public court records or
2289 documents, and the proceedings shall be closed to the public.
2290 The department shall be entitled to the summary procedure
2291 provided in s. 51.011. A licensee affected under this paragraph
2292 shall have the opportunity, at reasonable intervals, to
2293 demonstrate that he or she can resume the competent practice of
2294 nursing home administration or assisted living facility
2295 administration with reasonable skill and safety to patients.
2296 (m) Willfully or repeatedly violating any of the provisions
2297 of the law, code, or rules of the licensing or supervising
2298 authority or agency of the state or political subdivision
2299 thereof having jurisdiction of the operation and licensing of
2300 nursing homes or assisted living facilities.
2301 (n) Paying, giving, causing to be paid or given, or
2302 offering to pay or to give to any person a commission or other
2303 valuable consideration for the solicitation or procurement,
2304 either directly or indirectly, of nursing home usage or assisted
2305 living facility usage, except as specifically authorized by law.
2306 (o) Willfully permitting unauthorized disclosure of
2307 information relating to a patient or his or her records.
2308 (p) Discriminating with respect to patients, residents,
2309 employees, or staff on account of race, religion, color, sex, or
2310 national origin.
2311 (q) Failing to implement an ongoing quality assurance
2312 program by a nursing home administrator which is directed by an
2313 interdisciplinary team that meets at least every other month.
2314 (r) Violating any provision of this chapter or chapter 456,
2315 or any rules adopted pursuant thereto.
2316 (2) The board may enter an order denying nursing home
2317 administrator licensure, assisted living facility administrator
2318 licensure, or imposing any of the penalties in s. 456.072(2)
2319 against any applicant for licensure or licensee who:
2320 (a) Is found guilty of violating any provision of
2321 subsection (1) of this section or who is found guilty of
2322 violating any provision of s. 456.072(1).
2323 (b) Has a controlling interest in or knowingly participates
2324 in one or more violations at an assisted living facility or
2325 nursing home which results in denial or revocation of an
2326 assisted living facility license or nursing home license.
2327 (c) Has a controlling interest in or knowingly operates an
2328 unlicensed assisted living facility.
2329 (3) The board may deny or revoke the application for
2330 licensure or the license of an assisted living facility
2331 administrator if the licensee or applicant knowingly
2332 participated in intentional misconduct, engaged in conduct that
2333 constitutes gross negligence, or was the administrator of record
2334 when the facility was cited for violations within the previous 3
2335 years that resulted in a resident’s death or which contributed
2336 to the death of a resident.
2337 (4) (3) The department shall reissue the license of a
2338 disciplined licensee upon certification by the board that the
2339 disciplined licensee has complied with all of the terms and
2340 conditions set forth in the final order.
2341 Section 39. Section 468.1756, Florida Statutes, is amended
2342 to read:
2343 468.1756 Statute of limitations.—An administrative
2344 complaint may only be filed pursuant to s. 456.073 for an act
2345 listed in s. 468.1755 s. 468.1755 (1)(c)-(q) within 4 years after
2346 from the time of the incident giving rise to the complaint, or
2347 within 4 years after from the time the incident is discovered or
2348 should have been discovered.
2349 Section 40. Assisted living facility streamlining task
2351 (1) The Agency for Health Care Administration shall create
2352 a task force consisting of at least one representative of the
2353 agency, the Department of Elderly Affairs, the Department of
2354 Children and Family Services, the Department of Health, and the
2355 Office of State Long-Term Care Ombudsman.
2356 (2) The purpose of the task force is to determine whether
2357 agencies currently have overlapping regulatory responsibilities
2358 over assisted living facilities and whether increased efficiency
2359 and effectiveness may be realized by transferring,
2360 consolidating, eliminating, or modifying such oversight between
2362 (3) The task force shall meet at least three times and
2363 submit a report to the Governor, the President of the Senate,
2364 and the Speaker of the House of Representatives by January 1,
2365 2013, which includes the task force’s findings and
2366 recommendations pertaining to streamlining agency oversight and
2367 improving the effectiveness of regulatory functions.
2368 (4) The task force is terminated effective March 1, 2013.
2369 Section 41. For fiscal year 2012-2013:
2370 (1) Six full-time equivalent positions, with associated
2371 salary rate of 243,720, are authorized and the sum of $375,000
2372 in recurring funds from the Health Care Trust Fund of the Agency
2373 for Health Care Administration are appropriated to the Agency
2374 for Health Care Administration;
2375 (2) One full-time equivalent position, with associated
2376 salary rate of 40,620 is authorized and the sum of $62,500 in
2377 recurring funds from the Medical Quality Assistance Trust Fund
2378 of the Department of Health; and
2379 (3) One full-time equivalent position, with associated
2380 salary rate of 40,620 is authorized and the sum of $62,500 in
2381 recurring funds from the Operations and Maintenance Trust Fund
2382 of the Department of Elderly Affairs are appropriated to the
2383 Department of Elderly Affairs
2385 for the purpose of carrying out the regulatory activities
2386 provided in this act.
2387 Section 42. Except as otherwise expressly provided in this
2388 act, this act shall take effect July 1, 2012.
2390 ================= T I T L E A M E N D M E N T ================
2391 And the title is amended as follows:
2392 Delete everything before the enacting clause
2393 and insert:
2394 A bill to be entitled
2396 An act relating to quality improvement initiates for
2397 entities regulated by the Agency for Health Care
2398 Administration; amending s. 394.4574, F.S.; revising
2399 the duties of the case manager for, and requirements
2400 relating to the cooperative agreement and the
2401 community living support plan of, a mental health
2402 resident of an assisted living facility; amending s.
2403 395.002, F.S.; revising the definition of the term
2404 “accrediting organization” as it relates to hospital
2405 licensing and regulation; amending s. 395.1051, F.S.;
2406 requiring that hospital provide notice to obstetrical
2407 physicians before the hospital closes on an obstetrics
2408 department or ceases to provide obstetrical services;
2409 amending s. 400.0078, F.S.; requiring that residents
2410 of long-term care facilities be informed about the
2411 confidentiality of the identity of the complainant of
2412 a complaint received by the State Long-Term Care
2413 Ombudsman Program; amending s. 408.05, F.S.; requiring
2414 that the Agency for Health Care Administration
2415 collect, compile, and analyze health information and
2416 statistics; providing uses for the information;
2417 conforming provisions to changes made by the act;
2418 revising functions of the agency; amending s. 409.212,
2419 F.S.; increasing a limitation on additional
2420 supplementation a person may receive from third
2421 parties that contribute to his or her cost of care;
2422 creating s. 409.986, F.S.; providing definitions;
2423 directing the agency to establish and implement
2424 methodologies to adjust Medicaid rates for hospitals,
2425 nursing homes, and managed care plans; providing
2426 criteria for and limits on the amount of Medicaid
2427 payment rate adjustments; directing the agency to seek
2428 federal approval to implement a performance payment
2429 system; providing for implementation of the system in
2430 the 2015-2016 fiscal year; authorizing the agency to
2431 appoint a technical advisory panel; providing
2432 applicability of the performance payment system to
2433 general hospitals, skilled nursing facilities, and
2434 managed care plans and providing criteria therefor;
2435 amending s. 415.1034, F.S.; adding certain employees
2436 or agents of a state or local agency to the list of
2437 persons who must report the known or suspected abuse
2438 of a vulnerable adult to the abuse hotline; amending
2439 s. 429.02, F.S.; providing definitions for “board” and
2440 “mental health surveyor”; amending s. 429.07, F.S.;
2441 prohibiting an assisted living facility from operating
2442 unless the facility is under the management of an
2443 assisted living facility administrator; authorizing
2444 the waiver of certain monitoring requirements under
2445 certain conditions; amending s. 429.075, F.S.;
2446 revising the criteria preventing a licensed facility
2447 from receiving a limited mental health license;
2448 requiring that a mental health surveyor be part of the
2449 team inspecting a facility that has mental health
2450 residents; providing the role of the mental health
2451 surveyor; requiring that the Agency for Health Care
2452 Administration enter into an interagency agreement
2453 with the Department of Children and Family Services to
2454 receive certain reports; providing for monitoring
2455 visits; creating s. 429.0751, F.S.; specifying
2456 responsibilities of assisted living facilities that
2457 have one or more mental health residents; amending s.
2458 429.14, F.S.; revising the conditions for mandatory
2459 license denial or revocation; requiring the revocation
2460 of a facility license for certain violations that
2461 result in the death of a resident; amending s.
2462 429.176, F.S.; authorizing one administrator for
2463 multiple facilities under certain conditions;
2464 authorizing qualified facility managers during the
2465 temporary absence of an administrator; amending s.
2466 429.178, F.S.; revising training requirements for
2467 staff who provide care for persons who have
2468 Alzheimer’s disease and related disorders; amending s.
2469 429.19, F.S.; authorizing the Agency for Health Care
2470 Administration to impose certain citations and fines
2471 regardless of correction of a violation, an increased
2472 fine for certain violations that result in the death
2473 of a resident, and doubled fines; amending s. 429.195,
2474 F.S.; prohibiting an assisted living facility from
2475 contracting or promising to pay or receive certain
2476 monies with a person, health care provider, or health
2477 care facility; providing for nonapplication; amending
2478 s. 817.505, F.S.; providing that it is not patient
2479 brokering for an assisted living facility to offer
2480 payment under certain circumstances; creating s.
2481 429.231, F.S.; creating an advisory council to review
2482 unexpected deaths and elopements; providing for
2483 membership and duties; amending s. 429.28, F.S.;
2484 authorizing a resident to file a grievance with a
2485 facility when a notice of relocation or termination of
2486 residency has been received; requiring residents of
2487 facilities to be informed about the confidentiality of
2488 the identity of the resident and complainant of a
2489 complaint made to the State Long-Term Care Ombudsman
2490 Program unless the resident authorizes disclosure;
2491 creating s. 429.281, F.S.; establishing procedures for
2492 a resident grievance process upon notification of
2493 resident relocation or termination of residency;
2494 amending s. 429.34, F.S.; requiring that the agency
2495 conduct unannounced inspections of assisted living
2496 facilities; authorizing the agency to assess a fee for
2497 additional inspections; requiring that the agency
2498 verify corrected violations through subsequent
2499 inspections; authorizing the agency to verify the
2500 correction of certain violations unrelated to resident
2501 rights or resident care without inspection under
2502 certain circumstances; providing that the agency is
2503 designated as the central agency for tracking facility
2504 complaints; specifying timeframes for other state
2505 agencies to submit reports to the agency; requiring
2506 the agency to have lead surveyors who specialize in
2507 assessing facilities; amending s. 429.41, F.S.;
2508 requiring the agency to observe the elopement drills
2509 of a randomly selected group of facilities; requiring
2510 the agency to conduct an abbreviated biennial
2511 licensure inspection; amending s. 429.49, F.S.;
2512 increasing the criminal penalty for altering facility
2513 records; creating s. 429.515, F.S.; requiring new
2514 facility employees to attend a preservice orientation;
2515 providing requirements for such orientation; amending
2516 s. 429.52, F.S.; revising training, examination, and
2517 continuing education requirements for facility staff,
2518 including administrators; providing for the use of
2519 interactive online tutorials; requiring the Department
2520 of Elderly Affairs to develop training, examinations,
2521 and tutorials; creating s. 429.522, F.S.; requiring
2522 training providers to be certified by the Department
2523 of Elderly Affairs and provide trainer oversight;
2524 providing trainer requirements; requiring the
2525 department to maintain an electronic database of
2526 certified providers and persons who complete training
2527 if funding is available; amending s. 429.54, F.S.;
2528 requiring specified state agencies to have an
2529 electronic system of communication pertaining to the
2530 regulation of facilities; requiring facilities to
2531 submit certain facility and resident information
2532 electronically to the agency twice yearly; providing
2533 for the maintenance and use of such information;
2534 providing for expiration of this requirement;
2535 providing a directive to the Division of Statutory
2536 Revision; amending s. 468.1635, F.S.; revising the
2537 purpose of part II of ch. 468, F.S., to include
2538 assisted living administrators; amending s. 468.1645,
2539 F.S.; requiring assisted living facilities to be
2540 operated under the management of a licensed
2541 administrator; amending s. 468.1655, F.S.; revising
2542 and providing definitions; amending s. 468.1665, F.S.;
2543 renaming the Board of Nursing Home Administrators as
2544 the “Board of Long-Term Care Administrators”;
2545 providing for membership; prohibiting certain
2546 conflicts of interest with respect to board members;
2547 amending s. 468.1685, F.S.; revising duties of the
2548 board to include contracting with third-party
2549 credentialing entities for the purpose of certifying
2550 an assisted living facility administrator; amending s.
2551 468.1695, F.S.; providing for licensure of assisted
2552 living facility administrators through certification;
2553 providing licensure requirements; establishing a
2554 maximum fee; amending s. 468.1705, F.S., relating to
2555 licensure by endorsement; conforming provisions to
2556 changes made by the act; amending s. 468.1745, F.S.;
2557 providing requirements for who must be licensed as an
2558 assisted living facility administrator; amending s.
2559 468.1755, F.S.; conforming provisions to changes made
2560 by the act; providing grounds for disciplinary action
2561 for assisted living facility administrators; amending
2562 s. 468.1756, F.S.; conforming provisions to changes
2563 made by the act; providing effective dates.