Florida Senate - 2013              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 646
       
       
       
       
       
                                Barcode 256146                          
       
       588-01793A-13                                                   
       Proposed Committee Substitute by the Committee on Health Policy
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 394.4574, F.S.; providing that Medicaid
    4         prepaid behavioral health plans are responsible for
    5         enrolled mental health residents; providing that
    6         managing entities under contract with the Department
    7         of Children and Families are responsible for mental
    8         health residents who are not enrolled with a Medicaid
    9         prepaid behavioral health plan; deleting a provision
   10         to conform to changes made by the act; requiring that
   11         the community living support plan be completed and
   12         provided to the administrator of a facility upon the
   13         mental health resident’s admission; requiring the
   14         community living support plan to be updated when there
   15         is a significant change to the mental health
   16         resident’s behavioral health; requiring the case
   17         manager assigned to a mental health resident of an
   18         assisted living facility that holds a limited mental
   19         health license to keep a record of the date and time
   20         of face-to-face interactions with the resident and to
   21         make the record available to the responsible entity
   22         for inspection; requiring that the record be
   23         maintained for a specified time; requiring the
   24         responsible entity to ensure that there is adequate
   25         and consistent monitoring and enforcement of community
   26         living support plans and cooperative agreements and
   27         that concerns are reported to the appropriate
   28         regulatory oversight organization under certain
   29         circumstances; amending s. 400.0074, F.S.; providing
   30         that an administrative assessment conducted by a local
   31         council be comprehensive in nature and focus on
   32         factors affecting the rights, health, safety, and
   33         welfare of the residents of a nursing home; requiring
   34         a local council to conduct an exit consultation with
   35         the facility administrator or administrator designee
   36         to discuss issues and concerns in areas affecting
   37         rights, health, safety, and welfare of residents and
   38         make recommendations for improvement; amending s.
   39         400.0078, F.S.; requiring that residents of long-term
   40         care facilities be informed that retaliatory action
   41         cannot be taken against a resident for presenting
   42         grievances or for exercising any other resident right;
   43         amending s. 429.07, F.S.; providing that an extended
   44         congregate care license is issued to certain
   45         facilities that have been licensed as assisted living
   46         facilities under certain circumstances; providing the
   47         purpose of an extended congregate care license;
   48         providing that the initial extended congregate care
   49         license of an assisted living facility is provisional
   50         under certain circumstances; requiring the licensee to
   51         notify the Agency for Health Care Administration
   52         whenever it accepts a resident who qualifies for
   53         extended congregate care services; requiring the
   54         agency to inspect the facility for compliance with the
   55         requirements of an extended congregate care license;
   56         authorizing the agency to waive one of the required
   57         yearly monitoring visits under certain circumstances;
   58         authorizing the agency to deny or revoke a facility’s
   59         extended congregate care license for certain reasons
   60         or on certain grounds; requiring a registered nurse
   61         representing the agency to visit the facility at least
   62         annually, rather than twice a year, to monitor
   63         residents who are receiving limited nursing services;
   64         providing that the agency’s monitoring visits may be
   65         in conjunction with other agency inspections;
   66         authorizing the agency to waive one of the required
   67         yearly monitoring visits for certain facilities;
   68         amending s. 429.075, F.S.; requiring an assisted
   69         living facility that serves one or more mental health
   70         residents to obtain a limited mental health license;
   71         amending s. 429.14, F.S.; revising the actions in
   72         which the agency may deny, revoke, or suspend the
   73         license of an assisted living facility and impose an
   74         administrative fine; revising the criteria upon which
   75         the agency must deny or revoke the license of an
   76         assisted living facility; requiring the agency to
   77         impose an immediate moratorium on the license of an
   78         assisted living facility under certain circumstances;
   79         deleting a provision requiring the agency to provide a
   80         list of facilities with denied, suspended, or revoked
   81         licenses to the Department of Business and
   82         Professional Regulation; exempting a facility from the
   83         45-day notice requirement if it is required to
   84         relocate some or all of its residents; amending s.
   85         429.178, F.S.; conforming cross-references; amending
   86         s. 429.19, F.S.; revising the amounts and uses of
   87         administrative fines; requiring the agency to levy a
   88         fine for violations that are corrected before an
   89         inspection if noncompliance occurred within a
   90         specified period of time; deleting factors that the
   91         agency is required to consider to determine penalties
   92         and fines; amending s. 429.28, F.S.; requiring that
   93         residents of facilities be informed that the identity
   94         of the resident and complainant in a complaint made to
   95         the State Long-Term Care Ombudsman Program are
   96         confidential and that retaliatory action cannot be
   97         taken against a resident for presenting grievances or
   98         for exercising any other resident right; providing
   99         that a facility that terminates an individual’s
  100         residency is fined if good cause is not shown in
  101         court; amending s. 429.34, F.S.; requiring certain
  102         persons to report elder abuse in assisted living
  103         facilities; requiring the agency to regularly inspect
  104         every licensed assisted living facility; requiring the
  105         agency to conduct more frequent inspections under
  106         certain circumstances; requiring the licensee to pay a
  107         fee for the cost of additional inspections; requiring
  108         the agency to adjust the fee; amending s. 429.52,
  109         F.S.; requiring each newly hired employee of an
  110         assisted living facility to attend a preservice
  111         orientation provided by the assisted living facility;
  112         requiring the employee and administrator to sign an
  113         affidavit upon completion of the preservice
  114         orientation; requiring the assisted living facility to
  115         maintain the signed affidavit in each employee’s work
  116         file; conforming a cross-reference; requiring the
  117         Agency for Health Care Administration to study the
  118         reliability of facility surveys and submit to the
  119         Governor and the Legislature its findings and
  120         recommendations; requiring the agency to propose a
  121         rating system of assisted living facilities for
  122         consumers and create content for the agency’s website
  123         that makes available to consumers information
  124         regarding assisted living facilities; providing
  125         criteria for the content; providing an effective date.
  126  
  127  Be It Enacted by the Legislature of the State of Florida:
  128  
  129         Section 1. Section 394.4574, Florida Statutes, is amended
  130  to read:
  131         394.4574 Department Responsibilities for coordination of
  132  services for a mental health resident who resides in an assisted
  133  living facility that holds a limited mental health license.—
  134         (1) As used in this section, the term “mental health
  135  resident” “mental health resident,” for purposes of this
  136  section, means an individual who receives social security
  137  disability income due to a mental disorder as determined by the
  138  Social Security Administration or receives supplemental security
  139  income due to a mental disorder as determined by the Social
  140  Security Administration and receives optional state
  141  supplementation.
  142         (2) Medicaid prepaid behavioral health plans are
  143  responsible for enrolled mental health residents, and managing
  144  entities under contract with the department are responsible for
  145  mental health residents who are not enrolled with a Medicaid
  146  prepaid behavioral health plan. Each responsible entity shall
  147  The department must ensure that:
  148         (a) A mental health resident has been assessed by a
  149  psychiatrist, clinical psychologist, clinical social worker, or
  150  psychiatric nurse, or an individual who is supervised by one of
  151  these professionals, and determined to be appropriate to reside
  152  in an assisted living facility. The documentation must be
  153  provided to the administrator of the facility within 30 days
  154  after the mental health resident has been admitted to the
  155  facility. An evaluation completed upon discharge from a state
  156  mental hospital meets the requirements of this subsection
  157  related to appropriateness for placement as a mental health
  158  resident if it was completed within 90 days before prior to
  159  admission to the facility.
  160         (b) A cooperative agreement, as required in s. 429.075, is
  161  developed between the mental health care services provider that
  162  serves a mental health resident and the administrator of the
  163  assisted living facility with a limited mental health license in
  164  which the mental health resident is living. Any entity that
  165  provides Medicaid prepaid health plan services shall ensure the
  166  appropriate coordination of health care services with an
  167  assisted living facility in cases where a Medicaid recipient is
  168  both a member of the entity’s prepaid health plan and a resident
  169  of the assisted living facility. If the entity is at risk for
  170  Medicaid targeted case management and behavioral health
  171  services, the entity shall inform the assisted living facility
  172  of the procedures to follow should an emergent condition arise.
  173         (c) The community living support plan, as defined in s.
  174  429.02, has been prepared by a mental health resident and a
  175  mental health case manager of that resident in consultation with
  176  the administrator of the facility or the administrator’s
  177  designee. The plan must be completed and provided to the
  178  administrator of the assisted living facility with a limited
  179  mental health license in which the mental health resident lives
  180  upon the resident’s admission. The support plan and the
  181  agreement may be in one document.
  182         (d) The assisted living facility with a limited mental
  183  health license is provided with documentation that the
  184  individual meets the definition of a mental health resident.
  185         (e) The mental health services provider assigns a case
  186  manager to each mental health resident for whom the entity is
  187  responsible who lives in an assisted living facility with a
  188  limited mental health license. The case manager is responsible
  189  for coordinating the development of and implementation of the
  190  community living support plan defined in s. 429.02. The plan
  191  must be updated at least annually, or when there is a
  192  significant change to the resident’s behavioral health status,
  193  such as an inpatient admission or a change in behavioral status,
  194  medications, level of service, or residence. Each case manager
  195  shall keep a record of the date and time of any face-to-face
  196  interaction with the resident and make the record available to
  197  the responsible entity for inspection. The record must be
  198  retained for at least 2 years after the date of the most recent
  199  interaction.
  200         (f)Adequate and consistent monitoring and enforcement of
  201  community living support plans and cooperative agreements are
  202  conducted by the resident’s case manager.
  203         (g) Concerns are reported to the appropriate regulatory
  204  oversight organization if a regulated provider fails to deliver
  205  appropriate services or otherwise acts in a manner that has the
  206  potential to result in harm to the resident.
  207         (3) The Secretary of Children and Family Services, in
  208  consultation with the Agency for Health Care Administration,
  209  shall annually require each district administrator to develop,
  210  with community input, a detailed annual plan that demonstrates
  211  detailed plans that demonstrate how the district will ensure the
  212  provision of state-funded mental health and substance abuse
  213  treatment services to residents of assisted living facilities
  214  that hold a limited mental health license. These plans must be
  215  consistent with the substance abuse and mental health district
  216  plan developed pursuant to s. 394.75 and must address case
  217  management services; access to consumer-operated drop-in
  218  centers; access to services during evenings, weekends, and
  219  holidays; supervision of the clinical needs of the residents;
  220  and access to emergency psychiatric care.
  221         Section 2. Subsection (1) of section 400.0074, Florida
  222  Statutes, is amended, and paragraph (h) is added to subsection
  223  (2) of that section, to read:
  224         400.0074 Local ombudsman council onsite administrative
  225  assessments.—
  226         (1) In addition to any specific investigation conducted
  227  pursuant to a complaint, the local council shall conduct, at
  228  least annually, an onsite administrative assessment of each
  229  nursing home, assisted living facility, and adult family-care
  230  home within its jurisdiction. This administrative assessment
  231  must be comprehensive in nature and must shall focus on factors
  232  affecting the rights, health, safety, and welfare of the
  233  residents. Each local council is encouraged to conduct a similar
  234  onsite administrative assessment of each additional long-term
  235  care facility within its jurisdiction.
  236         (2) An onsite administrative assessment conducted by a
  237  local council shall be subject to the following conditions:
  238         (h) The local council shall conduct an exit consultation
  239  with the facility administrator or administrator designee to
  240  discuss issues and concerns in areas affecting the rights,
  241  health, safety, and welfare of the residents and make
  242  recommendations for improvement, if any.
  243         Section 3. Subsection (2) of section 400.0078, Florida
  244  Statutes, is amended to read:
  245         400.0078 Citizen access to State Long-Term Care Ombudsman
  246  Program services.—
  247         (2) Every resident or representative of a resident shall
  248  receive, Upon admission to a long-term care facility, each
  249  resident or representative of a resident must receive
  250  information regarding the purpose of the State Long-Term Care
  251  Ombudsman Program, the statewide toll-free telephone number for
  252  receiving complaints, information that retaliatory action cannot
  253  be taken against a resident for presenting grievances or for
  254  exercising any other resident right, and other relevant
  255  information regarding how to contact the program. Residents or
  256  their representatives must be furnished additional copies of
  257  this information upon request.
  258         Section 4. Paragraphs (b) and (c) of subsection (3) of
  259  section 429.07, Florida Statutes, are amended to read:
  260         429.07 License required; fee.—
  261         (3) In addition to the requirements of s. 408.806, each
  262  license granted by the agency must state the type of care for
  263  which the license is granted. Licenses shall be issued for one
  264  or more of the following categories of care: standard, extended
  265  congregate care, limited nursing services, or limited mental
  266  health.
  267         (b) An extended congregate care license shall be issued to
  268  facilities that have been licensed as assisted living facilities
  269  for 2 or more years and that provide providing, directly or
  270  through contract, services beyond those authorized in paragraph
  271  (a), including services performed by persons licensed under part
  272  I of chapter 464 and supportive services, as defined by rule, to
  273  persons who would otherwise be disqualified from continued
  274  residence in a facility licensed under this part. An extended
  275  congregate care license may also be issued to those facilities
  276  that have provisional extended congregate care licenses and meet
  277  the requirements for licensure under subparagraph 2. The primary
  278  purpose of extended congregate care services is to allow
  279  residents, as they become more impaired, the option of remaining
  280  in a familiar setting from which they would otherwise be
  281  disqualified for continued residency. A facility licensed to
  282  provide extended congregate care services may also admit an
  283  individual who exceeds the admission criteria for a facility
  284  with a standard license, if the individual is determined
  285  appropriate for admission to the extended congregate care
  286  facility.
  287         1. In order for extended congregate care services to be
  288  provided, the agency must first determine that all requirements
  289  established in law and rule are met and must specifically
  290  designate, on the facility’s license, that such services may be
  291  provided and whether the designation applies to all or part of
  292  the facility. Such designation may be made at the time of
  293  initial licensure or relicensure, or upon request in writing by
  294  a licensee under this part and part II of chapter 408. The
  295  notification of approval or the denial of the request shall be
  296  made in accordance with part II of chapter 408. Existing
  297  facilities qualifying to provide extended congregate care
  298  services must have maintained a standard license and may not
  299  have been subject to administrative sanctions during the
  300  previous 2 years, or since initial licensure if the facility has
  301  been licensed for less than 2 years, for any of the following
  302  reasons:
  303         a. A class I or class II violation;
  304         b. Three or more repeat or recurring class III violations
  305  of identical or similar resident care standards from which a
  306  pattern of noncompliance is found by the agency;
  307         c. Three or more class III violations that were not
  308  corrected in accordance with the corrective action plan approved
  309  by the agency;
  310         d. Violation of resident care standards which results in
  311  requiring the facility to employ the services of a consultant
  312  pharmacist or consultant dietitian;
  313         e. Denial, suspension, or revocation of a license for
  314  another facility licensed under this part in which the applicant
  315  for an extended congregate care license has at least 25 percent
  316  ownership interest; or
  317         f. Imposition of a moratorium pursuant to this part or part
  318  II of chapter 408 or initiation of injunctive proceedings.
  319         2.If an assisted living facility has been licensed for
  320  less than 2 years but meets all other licensure requirements for
  321  an extended congregate care license, it shall be issued a
  322  provisional extended congregate care license for a period of 6
  323  months. Within the first 3 months after the provisional license
  324  is issued, the licensee shall notify the agency when it has
  325  admitted an extended congregate care resident, after which an
  326  unannounced inspection shall be made to determine compliance
  327  with requirements of an extended congregate care license. If the
  328  licensee demonstrates compliance with all of the requirements of
  329  an extended congregate care license during the inspection, the
  330  licensee shall be issued an extended congregate care license. In
  331  addition to sanctions authorized under this part, if violations
  332  are found during the inspection and the licensee fails to
  333  demonstrate compliance with all assisted living requirements
  334  during a followup inspection, the licensee shall immediately
  335  suspend extended congregate care services, and the provisional
  336  extended congregate care license expires.
  337         3.2. A facility that is licensed to provide extended
  338  congregate care services shall maintain a written progress
  339  report on each person who receives services which describes the
  340  type, amount, duration, scope, and outcome of services that are
  341  rendered and the general status of the resident’s health. A
  342  registered nurse, or appropriate designee, representing the
  343  agency shall visit the facility at least twice a year quarterly
  344  to monitor residents who are receiving extended congregate care
  345  services and to determine if the facility is in compliance with
  346  this part, part II of chapter 408, and relevant rules. One of
  347  the visits may be in conjunction with the regular survey. The
  348  monitoring visits may be provided through contractual
  349  arrangements with appropriate community agencies. A registered
  350  nurse shall serve as part of the team that inspects the
  351  facility. The agency may waive one of the required yearly
  352  monitoring visits for a facility that has been licensed for at
  353  least 24 months to provide extended congregate care services,
  354  if, during the inspection, the registered nurse determines that
  355  extended congregate care services are being provided
  356  appropriately, and if the facility has held an extended
  357  congregate care license during the last 24 months, has had no
  358  class I or class II violations, has had and no uncorrected class
  359  III violations, and has had no confirmed ombudsman council
  360  complaints that resulted in a citation for licensure. The agency
  361  must first consult with the long-term care ombudsman council for
  362  the area in which the facility is located to determine if any
  363  complaints have been made and substantiated about the quality of
  364  services or care. The agency may not waive one of the required
  365  yearly monitoring visits if complaints have been made and
  366  substantiated.
  367         4.3. A facility that is licensed to provide extended
  368  congregate care services must:
  369         a. Demonstrate the capability to meet unanticipated
  370  resident service needs.
  371         b. Offer a physical environment that promotes a homelike
  372  setting, provides for resident privacy, promotes resident
  373  independence, and allows sufficient congregate space as defined
  374  by rule.
  375         c. Have sufficient staff available, taking into account the
  376  physical plant and firesafety features of the building, to
  377  assist with the evacuation of residents in an emergency.
  378         d. Adopt and follow policies and procedures that maximize
  379  resident independence, dignity, choice, and decisionmaking to
  380  permit residents to age in place, so that moves due to changes
  381  in functional status are minimized or avoided.
  382         e. Allow residents or, if applicable, a resident’s
  383  representative, designee, surrogate, guardian, or attorney in
  384  fact to make a variety of personal choices, participate in
  385  developing service plans, and share responsibility in
  386  decisionmaking.
  387         f. Implement the concept of managed risk.
  388         g. Provide, directly or through contract, the services of a
  389  person licensed under part I of chapter 464.
  390         h. In addition to the training mandated in s. 429.52,
  391  provide specialized training as defined by rule for facility
  392  staff.
  393         5.4. A facility that is licensed to provide extended
  394  congregate care services is exempt from the criteria for
  395  continued residency set forth in rules adopted under s. 429.41.
  396  A licensed facility must adopt its own requirements within
  397  guidelines for continued residency set forth by rule. However,
  398  the facility may not serve residents who require 24-hour nursing
  399  supervision. A licensed facility that provides extended
  400  congregate care services must also provide each resident with a
  401  written copy of facility policies governing admission and
  402  retention.
  403         5. The primary purpose of extended congregate care services
  404  is to allow residents, as they become more impaired, the option
  405  of remaining in a familiar setting from which they would
  406  otherwise be disqualified for continued residency. A facility
  407  licensed to provide extended congregate care services may also
  408  admit an individual who exceeds the admission criteria for a
  409  facility with a standard license, if the individual is
  410  determined appropriate for admission to the extended congregate
  411  care facility.
  412         6. Before the admission of an individual to a facility
  413  licensed to provide extended congregate care services, the
  414  individual must undergo a medical examination as provided in s.
  415  429.26(4) and the facility must develop a preliminary service
  416  plan for the individual.
  417         7. If When a facility can no longer provide or arrange for
  418  services in accordance with the resident’s service plan and
  419  needs and the facility’s policy, the facility must shall make
  420  arrangements for relocating the person in accordance with s.
  421  429.28(1)(k).
  422         8. Failure to provide extended congregate care services may
  423  result in denial of extended congregate care license renewal.
  424  
  425  The agency may deny or revoke a facility’s extended congregate
  426  care license for not meeting the standards of an extended
  427  congregate care license or for any of the grounds listed in this
  428  subsection.
  429         (c) A limited nursing services license shall be issued to a
  430  facility that provides services beyond those authorized in
  431  paragraph (a) and as specified in this paragraph.
  432         1. In order for limited nursing services to be provided in
  433  a facility licensed under this part, the agency must first
  434  determine that all requirements established in law and rule are
  435  met and must specifically designate, on the facility’s license,
  436  that such services may be provided. Such designation may be made
  437  at the time of initial licensure or licensure renewal
  438  relicensure, or upon request in writing by a licensee under this
  439  part and part II of chapter 408. Notification of approval or
  440  denial of such request shall be made in accordance with part II
  441  of chapter 408. An existing facility that qualifies facilities
  442  qualifying to provide limited nursing services must shall have
  443  maintained a standard license and may not have been subject to
  444  administrative sanctions that affect the health, safety, and
  445  welfare of residents for the previous 2 years or since initial
  446  licensure if the facility has been licensed for less than 2
  447  years.
  448         2. A facility Facilities that is are licensed to provide
  449  limited nursing services shall maintain a written progress
  450  report on each person who receives such nursing services. The,
  451  which report must describe describes the type, amount, duration,
  452  scope, and outcome of services that are rendered and the general
  453  status of the resident’s health. A registered nurse representing
  454  the agency shall visit the facility such facilities at least
  455  annually twice a year to monitor residents who are receiving
  456  limited nursing services and to determine if the facility is in
  457  compliance with applicable provisions of this part, part II of
  458  chapter 408, and related rules. The monitoring visits may be
  459  provided through contractual arrangements with appropriate
  460  community agencies. A registered nurse shall also serve as part
  461  of the team that inspects such facility. Visits may be in
  462  conjunction with other agency inspections. The agency may waive
  463  one of the required yearly monitoring visits for a facility that
  464  has:
  465         a. A limited nursing services license for at least 24
  466  months;
  467         b. No class I or class II violations and no uncorrected
  468  class III violations; and
  469         c. No confirmed ombudsman council complaints that resulted
  470  in a citation for licensure.
  471         3. A person who receives limited nursing services under
  472  this part must meet the admission criteria established by the
  473  agency for assisted living facilities. When a resident no longer
  474  meets the admission criteria for a facility licensed under this
  475  part, arrangements for relocating the person shall be made in
  476  accordance with s. 429.28(1)(k), unless the facility is licensed
  477  to provide extended congregate care services.
  478         Section 5. Section 429.075, Florida Statutes, is amended to
  479  read:
  480         429.075 Limited mental health license.—An assisted living
  481  facility that serves one three or more mental health residents
  482  must obtain a limited mental health license.
  483         (1) To obtain a limited mental health license, a facility
  484  must hold a standard license as an assisted living facility,
  485  must not have any current uncorrected deficiencies or
  486  violations, and must ensure that, within 6 months after
  487  receiving a limited mental health license, the facility
  488  administrator and the staff of the facility who are in direct
  489  contact with mental health residents must complete training of
  490  no less than 6 hours related to their duties. Such designation
  491  may be made at the time of initial licensure or relicensure or
  492  upon request in writing by a licensee under this part and part
  493  II of chapter 408. Notification of approval or denial of such
  494  request shall be made in accordance with this part, part II of
  495  chapter 408, and applicable rules. This training must will be
  496  provided by or approved by the Department of Children and Family
  497  Services.
  498         (2) A facility that is Facilities licensed to provide
  499  services to mental health residents must shall provide
  500  appropriate supervision and staffing to provide for the health,
  501  safety, and welfare of such residents.
  502         (3) A facility that has a limited mental health license
  503  must:
  504         (a) Have a copy of each mental health resident’s community
  505  living support plan and the cooperative agreement with the
  506  mental health care services provider. The support plan and the
  507  agreement may be combined.
  508         (b) Have documentation that is provided by the Department
  509  of Children and Family Services that each mental health resident
  510  has been assessed and determined to be able to live in the
  511  community in an assisted living facility that has with a limited
  512  mental health license.
  513         (c) Make the community living support plan available for
  514  inspection by the resident, the resident’s legal guardian, the
  515  resident’s health care surrogate, and other individuals who have
  516  a lawful basis for reviewing this document.
  517         (d) Assist the mental health resident in carrying out the
  518  activities identified in the individual’s community living
  519  support plan.
  520         (4) A facility that has with a limited mental health
  521  license may enter into a cooperative agreement with a private
  522  mental health provider. For purposes of the limited mental
  523  health license, the private mental health provider may act as
  524  the case manager.
  525         Section 6. Section 429.14, Florida Statutes, is amended to
  526  read:
  527         429.14 Administrative penalties.—
  528         (1) In addition to the requirements of part II of chapter
  529  408, the agency may deny, revoke, and suspend any license issued
  530  under this part and impose an administrative fine in the manner
  531  provided in chapter 120 against a licensee for a violation of
  532  any provision of this part, part II of chapter 408, or
  533  applicable rules, or for any of the following actions by a
  534  licensee, for the actions of any person subject to level 2
  535  background screening under s. 408.809, or for the actions of any
  536  facility staff employee:
  537         (a) An intentional or negligent act seriously affecting the
  538  health, safety, or welfare of a resident of the facility.
  539         (b) A The determination by the agency that the owner lacks
  540  the financial ability to provide continuing adequate care to
  541  residents.
  542         (c) Misappropriation or conversion of the property of a
  543  resident of the facility.
  544         (d) Failure to follow the criteria and procedures provided
  545  under part I of chapter 394 relating to the transportation,
  546  voluntary admission, and involuntary examination of a facility
  547  resident.
  548         (e) A citation of any of the following violations
  549  deficiencies as specified in s. 429.19:
  550         1. One or more cited class I violations deficiencies.
  551         2. Three or more cited class II violations deficiencies.
  552         3. Five or more cited class III violations deficiencies
  553  that have been cited on a single survey and have not been
  554  corrected within the times specified.
  555         (f) Failure to comply with the background screening
  556  standards of this part, s. 408.809(1), or chapter 435.
  557         (g) Violation of a moratorium.
  558         (h) Failure of the license applicant, the licensee during
  559  relicensure, or a licensee that holds a provisional license to
  560  meet the minimum license requirements of this part, or related
  561  rules, at the time of license application or renewal.
  562         (i) An intentional or negligent life-threatening act in
  563  violation of the uniform firesafety standards for assisted
  564  living facilities or other firesafety standards which that
  565  threatens the health, safety, or welfare of a resident of a
  566  facility, as communicated to the agency by the local authority
  567  having jurisdiction or the State Fire Marshal.
  568         (j) Knowingly operating any unlicensed facility or
  569  providing without a license any service that must be licensed
  570  under this chapter or chapter 400.
  571         (k) Any act constituting a ground upon which application
  572  for a license may be denied.
  573         (2) Upon notification by the local authority having
  574  jurisdiction or by the State Fire Marshal, the agency may deny
  575  or revoke the license of an assisted living facility that fails
  576  to correct cited fire code violations that affect or threaten
  577  the health, safety, or welfare of a resident of a facility.
  578         (3) The agency may deny or revoke a license of an to any
  579  applicant or controlling interest as defined in part II of
  580  chapter 408 which has or had a 25-percent or greater financial
  581  or ownership interest in any other facility that is licensed
  582  under this part, or in any entity licensed by this state or
  583  another state to provide health or residential care, if that
  584  which facility or entity during the 5 years prior to the
  585  application for a license closed due to financial inability to
  586  operate; had a receiver appointed or a license denied,
  587  suspended, or revoked; was subject to a moratorium; or had an
  588  injunctive proceeding initiated against it.
  589         (4) The agency shall deny or revoke the license of an
  590  assisted living facility if:
  591         (a)There are two moratoria, issued pursuant to this part
  592  or part II of chapter 408, within a 2-year period which are
  593  imposed by final order;
  594         (b)The facility is cited for two or more class I
  595  violations arising from unrelated circumstances during the same
  596  survey or investigation; or
  597         (c)The facility is cited for two or more class I
  598  violations arising from separate surveys or investigations
  599  within a 2-year period that has two or more class I violations
  600  that are similar or identical to violations identified by the
  601  agency during a survey, inspection, monitoring visit, or
  602  complaint investigation occurring within the previous 2 years.
  603         (5) An action taken by the agency to suspend, deny, or
  604  revoke a facility’s license under this part or part II of
  605  chapter 408, in which the agency claims that the facility owner
  606  or an employee of the facility has threatened the health,
  607  safety, or welfare of a resident of the facility must be heard
  608  by the Division of Administrative Hearings of the Department of
  609  Management Services within 120 days after receipt of the
  610  facility’s request for a hearing, unless that time limitation is
  611  waived by both parties. The administrative law judge shall must
  612  render a decision within 30 days after receipt of a proposed
  613  recommended order.
  614         (6) The agency shall impose an immediate moratorium, as
  615  provided under s. 408.814, on an assisted living facility that
  616  fails to provide the agency access to the facility or prohibits
  617  the agency from conducting a regulatory inspection. The licensee
  618  may not restrict agency staff in accessing and copying records
  619  or in conducting confidential interviews with facility staff or
  620  any individual who receives services from the facility provide
  621  to the Division of Hotels and Restaurants of the Department of
  622  Business and Professional Regulation, on a monthly basis, a list
  623  of those assisted living facilities that have had their licenses
  624  denied, suspended, or revoked or that are involved in an
  625  appellate proceeding pursuant to s. 120.60 related to the
  626  denial, suspension, or revocation of a license.
  627         (7) Agency notification of a license suspension or
  628  revocation, or denial of a license renewal, shall be posted and
  629  visible to the public at the facility.
  630         (8) If a facility is required to relocate some or all of
  631  its residents due to agency action, that facility is exempt from
  632  the 45 days’ notice requirement in s. 429.28(1)(k). This
  633  provision does not exempt the facility from any deadlines for
  634  corrective action set by the agency.
  635         Section 7. Paragraphs (a) and (b) of subsection (2) of
  636  section 429.178, Florida Statutes, are amended to read:
  637         429.178 Special care for persons with Alzheimer’s disease
  638  or other related disorders.—
  639         (2)(a) An individual who is employed by a facility that
  640  provides special care for residents with Alzheimer’s disease or
  641  other related disorders, and who has regular contact with such
  642  residents, must complete up to 4 hours of initial dementia
  643  specific training developed or approved by the department. The
  644  training must shall be completed within 3 months after beginning
  645  employment and satisfy shall satisfy the core training
  646  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  647         (b) A direct caregiver who is employed by a facility that
  648  provides special care for residents with Alzheimer’s disease or
  649  other related disorders, and who provides direct care to such
  650  residents, must complete the required initial training and 4
  651  additional hours of training developed or approved by the
  652  department. The training must shall be completed within 9 months
  653  after beginning employment and satisfy shall satisfy the core
  654  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  655         Section 8. Section 429.19, Florida Statutes, is amended to
  656  read:
  657         429.19 Violations; imposition of administrative fines;
  658  grounds.—
  659         (1) In addition to the requirements of part II of chapter
  660  408, the agency shall impose an administrative fine in the
  661  manner provided in chapter 120 for the violation of any
  662  provision of this part, part II of chapter 408, and applicable
  663  rules by an assisted living facility, for the actions of any
  664  person subject to level 2 background screening under s. 408.809,
  665  for the actions of any facility employee, or for an intentional
  666  or negligent act seriously affecting the health, safety, or
  667  welfare of a resident of the facility.
  668         (2) Each violation of this part and adopted rules must
  669  shall be classified according to the nature of the violation and
  670  the gravity of its probable effect on facility residents. The
  671  agency shall indicate the classification on the written notice
  672  of the violation as follows:
  673         (a) Class “I” violations are defined in s. 408.813. The
  674  agency shall impose an administrative fine of $7,500 for each a
  675  cited class I violation in a facility that is licensed for fewer
  676  than 100 beds at the time of the violation in an amount not less
  677  than $5,000 and not exceeding $10,000 for each violation. The
  678  agency shall impose an administrative fine of $11,250 for each
  679  cited class I violation in a facility that is licensed for 100
  680  or more beds at the time of the violation. If the noncompliance
  681  occurs within the prior 12 months, the fine must be levied for
  682  violations that are corrected before an inspection.
  683         (b) Class “II” violations are defined in s. 408.813. The
  684  agency shall impose an administrative fine of $3,000 for each a
  685  cited class II violation in a facility that is licensed for
  686  fewer than 100 beds at the time of the violation in an amount
  687  not less than $1,000 and not exceeding $5,000 for each
  688  violation. The agency shall impose an administrative fine of
  689  $4,500 for each cited class II violation in a facility that is
  690  licensed for 100 or more beds at the time of the violation.
  691         (c) Class “III” violations are defined in s. 408.813. The
  692  agency shall impose an administrative fine of $750 for each a
  693  cited class III violation in a facility that is licensed for
  694  fewer than 100 beds at the time of the violation in an amount
  695  not less than $500 and not exceeding $1,000 for each violation.
  696  The agency shall impose an administrative fine of $1,125 for
  697  each cited class III violation in a facility that is licensed
  698  for 100 or more beds at the time of the violation.
  699         (d) Class “IV” violations are defined in s. 408.813. The
  700  agency shall impose an administrative fine of $150 for each a
  701  cited class IV violation in a facility that is licensed for
  702  fewer than 100 beds at the time of the violation in an amount
  703  not less than $100 and not exceeding $200 for each violation.
  704  The agency shall impose an administrative fine of $225 for each
  705  cited class IV violation in a facility that is licensed for 100
  706  or more beds at the time of the violation.
  707         (e) Any fine imposed for class I and class II violations
  708  must be doubled if a facility was previously cited for one or
  709  more class I or class II violations during the agency’s last
  710  licensure inspection or any inspection or complaint
  711  investigation since the last licensure inspection.
  712         (f) Notwithstanding any other provision of law, a fine must
  713  be imposed for each class III and class IV violation, regardless
  714  of correction, if a facility was previously cited for one or
  715  more class III or class IV violations during the agency’s last
  716  licensure inspection or any inspection or complaint
  717  investigation since the last licensure inspection, for the same
  718  regulatory violation. A fine imposed for class III or class IV
  719  violations must be doubled if a facility was previously cited
  720  for one or more class III or class IV violations during the
  721  agency’s last two licensure inspections for the same regulatory
  722  violation.
  723         (g) Regardless of the class of violation cited, instead of
  724  the fine amounts listed in paragraphs (a)-(d), the agency shall
  725  impose an administrative fine of $500 if a facility is found not
  726  to be in compliance with the background screening requirements
  727  as provided in s. 408.809.
  728         (3) For purposes of this section, in determining if a
  729  penalty is to be imposed and in fixing the amount of the fine,
  730  the agency shall consider the following factors:
  731         (a) The gravity of the violation, including the probability
  732  that death or serious physical or emotional harm to a resident
  733  will result or has resulted, the severity of the action or
  734  potential harm, and the extent to which the provisions of the
  735  applicable laws or rules were violated.
  736         (b) Actions taken by the owner or administrator to correct
  737  violations.
  738         (c) Any previous violations.
  739         (d) The financial benefit to the facility of committing or
  740  continuing the violation.
  741         (e) The licensed capacity of the facility.
  742         (3)(4) Each day of continuing violation after the date
  743  established by the agency fixed for correction termination of
  744  the violation, as ordered by the agency, constitutes an
  745  additional, separate, and distinct violation.
  746         (4)(5)An Any action taken to correct a violation shall be
  747  documented in writing by the owner or administrator of the
  748  facility and verified through followup visits by agency
  749  personnel. The agency may impose a fine and, in the case of an
  750  owner-operated facility, revoke or deny a facility’s license
  751  when a facility administrator fraudulently misrepresents action
  752  taken to correct a violation.
  753         (5)(6)A Any facility whose owner fails to apply for a
  754  change-of-ownership license in accordance with part II of
  755  chapter 408 and operates the facility under the new ownership is
  756  subject to a fine of $5,000.
  757         (6)(7) In addition to any administrative fines imposed, the
  758  agency may assess a survey fee, equal to the lesser of one half
  759  of the facility’s biennial license and bed fee or $500, to cover
  760  the cost of conducting initial complaint investigations that
  761  result in the finding of a violation that was the subject of the
  762  complaint or monitoring visits conducted under s. 429.28(3)(c)
  763  to verify the correction of the violations.
  764         (7)(8) During an inspection, the agency shall make a
  765  reasonable attempt to discuss each violation with the owner or
  766  administrator of the facility, prior to written notification.
  767         (8)(9) The agency shall develop and disseminate an annual
  768  list of all facilities sanctioned or fined for violations of
  769  state standards, the number and class of violations involved,
  770  the penalties imposed, and the current status of cases. The list
  771  shall be disseminated, at no charge, to the Department of
  772  Elderly Affairs, the Department of Health, the Department of
  773  Children and Family Services, the Agency for Persons with
  774  Disabilities, the area agencies on aging, the Florida Statewide
  775  Advocacy Council, and the state and local ombudsman councils.
  776  The Department of Children and Family Services shall disseminate
  777  the list to service providers under contract to the department
  778  who are responsible for referring persons to a facility for
  779  residency. The agency may charge a fee commensurate with the
  780  cost of printing and postage to other interested parties
  781  requesting a copy of this list. This information may be provided
  782  electronically or through the agency’s Internet site.
  783         Section 9. Subsections (2) and (6) of section 429.28,
  784  Florida Statutes, are amended to read:
  785         429.28 Resident bill of rights.—
  786         (2) The administrator of a facility shall ensure that a
  787  written notice of the rights, obligations, and prohibitions set
  788  forth in this part is posted in a prominent place in each
  789  facility and read or explained to residents who cannot read. The
  790  This notice must shall include the name, address, and telephone
  791  numbers of the local ombudsman council and central abuse hotline
  792  and, if when applicable, Disability Rights Florida the Advocacy
  793  Center for Persons with Disabilities, Inc., and the Florida
  794  local advocacy council, where complaints may be lodged. The
  795  notice must state that a complaint made to the Office of State
  796  Long-Term Care Ombudsman or a local long-term care ombudsman
  797  council, the names and identities of the residents involved in
  798  the complaint, and the identity of complainants are kept
  799  confidential pursuant to s. 400.0077 and that retaliatory action
  800  cannot be taken against a resident for presenting grievances or
  801  for exercising any other resident right. The facility must
  802  ensure a resident’s access to a telephone to call the local
  803  ombudsman council, central abuse hotline, and Disability Rights
  804  Florida Advocacy Center for Persons with Disabilities, Inc., and
  805  the Florida local advocacy council.
  806         (6) A Any facility that which terminates the residency of
  807  an individual who participated in activities specified in
  808  subsection (5) must shall show good cause in a court of
  809  competent jurisdiction. If good cause is not shown, the agency
  810  shall impose a fine of $2,500 in addition to any other penalty
  811  assessed against the facility.
  812         Section 10. Section 429.34, Florida Statutes, is amended to
  813  read:
  814         429.34 Right of entry and inspection.—
  815         (1) In addition to the requirements of s. 408.811, any duly
  816  designated officer or employee of the department, the Department
  817  of Children and Family Services, the Medicaid Fraud Control Unit
  818  of the Office of the Attorney General, the state or local fire
  819  marshal, or a member of the state or local long-term care
  820  ombudsman council has shall have the right to enter unannounced
  821  upon and into the premises of any facility licensed pursuant to
  822  this part in order to determine the state of compliance with the
  823  provisions of this part, part II of chapter 408, and applicable
  824  rules. Data collected by the state or local long-term care
  825  ombudsman councils or the state or local advocacy councils may
  826  be used by the agency in investigations involving violations of
  827  regulatory standards. A person specified in this section who
  828  knows or has reasonable cause to suspect that a vulnerable adult
  829  has been or is being abused, neglected, or exploited shall
  830  immediately report such knowledge or suspicion to the central
  831  abuse hotline pursuant to chapter 415.
  832         (2) Each licensed assisted living facility must be
  833  inspected by the agency at least once every 24 months to
  834  determine compliance with this chapter and related rules. If an
  835  assisted living facility is cited for one or more class I
  836  violations or two or more class II violations arising from
  837  separate surveys within a 60-day period or due to unrelated
  838  circumstances during the same survey, the agency must conduct an
  839  additional licensure inspection within 6 months. In addition to
  840  any fines imposed on the facility under s. 429.19, the licensee
  841  must pay a fee for the cost of the additional inspection
  842  equivalent to the standard assisted living facility license and
  843  per-bed fees, without exception for beds designated for
  844  recipients of optional state supplementation. The agency shall
  845  adjust the fee in accordance with s. 408.805.
  846         Section 11. Present subsections (1) through (11) of section
  847  429.52, Florida Statutes, are redesignated as subsections (2)
  848  through (12), respectively, a new subsection (1) is added to
  849  that section, and present subsection (9) of that section is
  850  amended, to read:
  851         429.52 Staff training and educational programs; core
  852  educational requirement.—
  853         (1) Effective October 1, 2013, each new assisted living
  854  facility employee who has not previously completed core training
  855  must attend a preservice orientation provided by the facility
  856  before interacting with residents. The preservice orientation
  857  must be at least 2 hours in duration and cover topics that help
  858  the employee provide responsible care and respond to the needs
  859  of residents of the facility. Upon completion, the employee and
  860  the administrator of the facility must sign an affidavit stating
  861  that the employee completed the required preservice orientation.
  862  The facility must keep the affidavit in the employee’s work
  863  file.
  864         (10)(9) The training required by this section must shall be
  865  conducted by persons registered with the department as having
  866  the requisite experience and credentials to conduct the
  867  training. A person seeking to register as a trainer must provide
  868  the department with proof of completion of the minimum core
  869  training education requirements, successful passage of the
  870  competency test established under this section, and proof of
  871  compliance with the continuing education requirement in
  872  subsection (5)(4).
  873         Section 12. The Legislature finds that consistent
  874  regulation of assisted living facilities benefits residents and
  875  operators of such facilities. To determine whether surveys are
  876  consistent between surveys and surveyors, the Agency for Health
  877  Care Administration shall conduct a study of intersurveyor
  878  reliability for assisted living facilities. By November 1, 2013,
  879  the agency shall report to the Governor, the President of the
  880  Senate, and the Speaker of the House of Representatives its
  881  findings and make any recommendations to improve intersurveyor
  882  reliability.
  883         Section 13. The Legislature finds that consumers need
  884  additional information on the quality of care and service in
  885  assisted living facilities in order to select the best facility
  886  for themselves or their loved ones. Therefore, the Agency for
  887  Health Care Administration shall:
  888         (1)Propose a rating system for assisted living facilities.
  889  The proposal must include, but is not limited to, the data
  890  elements to be used, the method of collecting the data, the
  891  method of determining the rating, an estimate of the initial and
  892  ongoing costs of a rating system to both the agency and assisted
  893  living facilities, and a timetable for the implementation of the
  894  rating system for assisted living facilities. The agency shall
  895  submit its proposal to the Governor, the President of the
  896  Senate, and the Speaker of the House of Representatives by
  897  November 1, 2013.
  898         (2) By January 1, 2014, create a content that is easily
  899  accessible through the front page of the agency’s website. At a
  900  minimum, the content must include:
  901         (a)Information on each licensed assisted living facility,
  902  including, but not limited to:
  903         1.The name and address of the facility.
  904         2.The number and type of licensed beds in the facility.
  905         3.The types of licenses held by the facility.
  906         4.The facility’s license expiration date and status.
  907         5.Other relevant information that the agency currently
  908  collects.
  909         (b)A list of the facility’s cited violations with a
  910  summary of each violation which is presented in a manner that is
  911  understandable by the general public. If a facility has
  912  challenged a violation under chapter 120, that violation may not
  913  be published until imposed by final order.
  914         (c)Links to inspection reports that the agency has on
  915  file.
  916         (d)A monitored comment page, maintained by the agency,
  917  which allows members of the public to anonymously comment on
  918  assisted living facilities that are licensed to operate in the
  919  state. This comment page must, at a minimum, allow members of
  920  the public to post comments on their experiences with, or
  921  observations of, an assisted living facility and to review other
  922  people’s comments. Comments posted to the agency’s comment page
  923  may not contain profanity and are intended to provide meaningful
  924  feedback about the assisted living facility. The agency shall
  925  provide for a webpage moderator to review comments for profane
  926  content before the comments are posted to the page. An employee,
  927  owner, or controlling interest in an assisted living facility is
  928  prohibited from posting comments on the page.
  929         Section 14. This act shall take effect July 1, 2013.