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