Florida Senate - 2013                          SENATOR AMENDMENT
       Bill No. CS for CS for SB 966
                                Barcode 274970                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              

       Senator Latvala moved the following:
    1         Senate Amendment (with title amendment)
    3         Delete lines 1471 - 1817
    4  and insert:
    5         (5) A client admitted to a transitional living facility
    6  must be admitted upon prescription by a licensed physician,
    7  physician assistant, or advanced registered nurse practitioner
    8  and must remain under the care of a licensed physician,
    9  physician assistant, or advanced registered nurse practitioner
   10  for the duration of the client’s stay in the facility.
   11         (6) A transitional living facility may not admit a client
   12  whose primary admitting diagnosis is mental illness or an
   13  intellectual or a developmental disability.
   14         (7) An individual may not be admitted to a transitional
   15  living facility if the individual:
   16         (a) Presents significant risk of infection to other clients
   17  or personnel. A health care practitioner must provide
   18  documentation that the individual is free of apparent signs and
   19  symptoms of communicable disease;
   20         (b) Is a danger to self or others as determined by a
   21  physician, physician assistant, advanced registered nurse
   22  practitioner, or mental health practitioner licensed under
   23  chapter 490 or chapter 491, unless the facility provides
   24  adequate staffing and support to ensure patient safety;
   25         (c) Is bedridden; or
   26         (d) Requires 24-hour nursing supervision.
   27         (8) If the client meets the admission criteria, the medical
   28  or nursing director of the facility must complete an initial
   29  evaluation of the client’s functional skills, behavioral status,
   30  cognitive status, educational or vocational potential, medical
   31  status, psychosocial status, sensorimotor capacity, and other
   32  related skills and abilities within the first 72 hours after the
   33  client’s admission to the facility. An initial comprehensive
   34  treatment plan that delineates services to be provided and
   35  appropriate sources for such services must be implemented within
   36  the first 4 days after admission.
   37         (9) Each transitional living facility shall develop a
   38  discharge plan for each client before or upon admission to the
   39  facility. The discharge plan must identify the intended
   40  discharge site and possible alternative discharge sites. For
   41  each discharge site identified, the discharge plan must identify
   42  the skills, behaviors, and other conditions that the client must
   43  achieve to be appropriate for discharge. Discharge plans must be
   44  reviewed and updated as necessary, but no less often than once
   45  monthly.
   46         (10) As soon as practicable, a transitional living facility
   47  shall discharge a client when he or she no longer requires any
   48  of the specialized services described in s. 400.9971(7) or is
   49  not making measurable progress in accordance with his or her
   50  comprehensive treatment plan, or if the transitional living
   51  facility is no longer the most appropriate, least restrictive
   52  treatment option.
   53         (11) Each transitional living facility shall provide at
   54  least 30 days’ notice to clients of transfer or discharge plans,
   55  including the location of an acceptable transfer location if the
   56  client is unable to live independently. This requirement does
   57  not apply if a client voluntarily terminates residency.
   58         Section 38. Section 400.9974, Florida Statutes, is created
   59  to read:
   60         400.9974 Client comprehensive treatment plans; client
   61  services.—
   62         (1) Each transitional living facility shall develop a
   63  comprehensive treatment plan for each client as soon as
   64  possible, but no later than 30 days following development of the
   65  initial comprehensive treatment plan. Comprehensive treatment
   66  plans must be reviewed and updated if the client fails to meet
   67  projected improvements in the plan or if a significant change in
   68  the client’s condition occurs. Comprehensive treatment plans
   69  must be reviewed and updated at least once monthly.
   70  Comprehensive treatment plans must be developed by an
   71  interdisciplinary team consisting of the case manager, the
   72  program director, the nurse, and appropriate therapists. The
   73  client or, if appropriate, the client’s representative must be
   74  included in developing the comprehensive treatment plan.
   75         (2) The comprehensive treatment plan must include the
   76  following:
   77         (a) The physician’s, physician assistant’s, or advanced
   78  registered nurse practitioner’s orders and the client’s
   79  diagnosis, medical history, physical examination, and
   80  rehabilitative or restorative needs.
   81         (b) A preliminary nursing evaluation with physician’s,
   82  physician assistant’s, or advanced registered nurse
   83  practitioner’s orders for immediate care, completed on
   84  admission.
   85         (c) A comprehensive, accurate, reproducible, and
   86  standardized assessment of the client’s functional capability;
   87  the treatments designed to achieve skills, behaviors, and other
   88  conditions necessary to return to the community; and specific
   89  measurable goals.
   90         (d) Steps necessary for the client to achieve transition to
   91  the community and estimated length of time to achieve the goals.
   92         (3) The client or, if appropriate, the client’s
   93  representative must consent to the continued treatment at the
   94  transitional living facility. Consent may be for a period of up
   95  to 3 months. If such consent is not given, the transitional
   96  living facility shall discharge the client as soon as
   97  practicable.
   98         (4) Each client must receive the professional program
   99  services needed to implement the client’s comprehensive
  100  treatment plan.
  101         (5) The licensee must employ qualified professional staff
  102  to carry out and monitor the various professional interventions
  103  in accordance with the stated goals and objectives of every
  104  client’s comprehensive treatment plan.
  105         (6) Each client must receive a continuous treatment program
  106  that includes appropriate, consistent implementation of a
  107  program of specialized and general training, treatment, health
  108  services, and related services and that is directed toward:
  109         (a) The acquisition of the behaviors and skills necessary
  110  for the client to function with as much self-determination and
  111  independence as possible;
  112         (b) The prevention or deceleration of regression or loss of
  113  current optimal functional status; and
  114         (c) The management of behavioral issues that preclude
  115  independent functioning in the community.
  116         Section 39. Section 400.9975, Florida Statutes, is created
  117  to read:
  118         400.9975 Licensee responsibilities.—
  119         (1) The licensee shall ensure that each client:
  120         (a) Lives in a safe environment free from abuse, neglect,
  121  and exploitation.
  122         (b) Is treated with consideration and respect and with due
  123  recognition of personal dignity, individuality, and the need for
  124  privacy.
  125         (c) Retains and uses his or her own clothes and other
  126  personal property in his or her immediate living quarters, so as
  127  to maintain individuality and personal dignity, except when the
  128  licensee can demonstrate that such retention and use would be
  129  unsafe, impractical, or an infringement upon the rights of other
  130  clients.
  131         (d) Has unrestricted private communication, including
  132  receiving and sending unopened correspondence, access to a
  133  telephone, and visiting with any person of his or her choice.
  134  Upon request, the licensee shall make provisions to modify
  135  visiting hours for caregivers and guests. The facility shall
  136  restrict communication in accordance with any court order or
  137  written instruction of a client’s representative. Any
  138  restriction on a client’s communication for therapeutic reasons
  139  shall be documented and reviewed at least weekly and shall be
  140  removed as soon as it is no longer clinically indicated. The
  141  basis for the restriction shall be explained to the client and,
  142  if applicable, the client’s representative. The client shall
  143  nonetheless retain the right to call the abuse hotline, the
  144  agency, and Disability Rights Florida at any and all times.
  145         (e) Has the opportunity to participate in and benefits from
  146  community services and activities to achieve the highest
  147  possible level of independence, autonomy, and interaction within
  148  the community.
  149         (f) Has the opportunity to manage his or her financial
  150  affairs unless the client or, if applicable, the client’s
  151  representative authorizes the administrator of the facility to
  152  provide safekeeping for funds as provided in this part.
  153         (g) Has reasonable opportunity for regular exercise several
  154  times a week and to be outdoors at regular and frequent
  155  intervals except when prevented by inclement weather.
  156         (h) Has the opportunity to exercise civil and religious
  157  liberties, including the right to independent personal
  158  decisions. No religious belief or practice, including attendance
  159  at religious services, shall be imposed upon any client.
  160         (i) Has access to adequate and appropriate health care
  161  consistent with established and recognized standards within the
  162  community.
  163         (j) Has the ability to present grievances and recommend
  164  changes in policies, procedures, and services to the staff of
  165  the licensee, governing officials, or any other person without
  166  restraint, interference, coercion, discrimination, or reprisal.
  167  Each licensee shall establish a grievance procedure to
  168  facilitate a client’s ability to present grievances, including a
  169  system for investigating, tracking, managing, and responding to
  170  complaints by persons receiving services or individuals acting
  171  on their behalf, and an appeals process. This process must
  172  include access to Disability Rights Florida and other advocates
  173  and the right to be a member of, be active in, and associate
  174  with advocacy or special interest groups.
  175         (2) The licensee shall:
  176         (a) Promote participation of each client’s representative
  177  in the process of providing treatment to the client unless the
  178  representative’s participation is unobtainable or inappropriate.
  179         (b) Answer communications from each client’s family,
  180  guardians, and friends promptly and appropriately.
  181         (c) Promote visits by individuals with a relationship to
  182  the client at any reasonable hour, without requiring prior
  183  notice, or in any area of the facility which provides direct
  184  client care services to the client, consistent with the client’s
  185  and other clients’ privacy, unless the interdisciplinary team
  186  determines that such a visit would not be appropriate.
  187         (d) Promote leave from the facility for visits, trips, or
  188  vacations.
  189         (e) Promptly notify the client’s representative of any
  190  significant incidents or changes in the client’s condition,
  191  including, but not limited to, serious illness, accident, abuse,
  192  unauthorized absence, or death.
  193         (3) The administrator of a facility shall ensure that a
  194  written notice of licensee responsibilities is posted in a
  195  prominent place in each building where clients reside, and is
  196  read, or explained, to clients who cannot read. This notice must
  197  include the statewide toll-free telephone number for reporting
  198  complaints to the agency, must be provided to clients in a
  199  manner that is clearly legible, and must include the words: “To
  200  report a complaint regarding the services you receive, please
  201  call toll-free ...[telephone number]... or Disability Rights
  202  Florida ...[telephone number]...”; and the statewide toll-free
  203  telephone number for the central abuse hotline must be provided
  204  to clients in a manner that is clearly legible and must include
  205  the words: “To report abuse, neglect, or exploitation, please
  206  call toll-free ...[telephone number where complaints may be
  207  lodged]....” The licensee must ensure a client’s access to a
  208  telephone where telephone numbers required in this subsection
  209  are readily available to call the agency, central abuse hotline,
  210  or Disability Rights Florida.
  211         (4) A licensee or employee of a facility may not serve
  212  notice upon a client to leave the premises or take any other
  213  retaliatory action against any person solely due to the
  214  following:
  215         (a) The client or other person files an internal or
  216  external complaint or grievance regarding the facility.
  217         (b) The client or other person appears as a witness in any
  218  hearing inside or outside the facility.
  219         (5) Before or at the time of admission, the client and the
  220  client’s representative shall be provided with a copy of the
  221  licensee’s responsibilities as provided in this section,
  222  including grievance procedures and the telephone numbers
  223  provided in this section.
  224         (6) The licensee must develop and implement policies and
  225  procedures governing the release of any client information,
  226  including consent necessary from the client or the client’s
  227  representative.
  228         Section 40. Section 400.9976, Florida Statutes, is created
  229  to read:
  230         400.9976 Medication practices.—
  231         (1) An individual medication administration record must be
  232  maintained for each client. Each dose of medication, including a
  233  self-administered dose, shall be properly recorded in the
  234  client’s record. Each client who self-administers medication
  235  shall be given a pill organizer. Medication must be placed in
  236  the pill organizer by a nurse. A nurse shall document the date
  237  and time medication is placed into each client’s pill organizer.
  238  All medications must be administered in compliance with the
  239  physician’s orders.
  240         (2) If the interdisciplinary team determines that self
  241  administration of medications is an appropriate objective, and
  242  if the physician, physician assistant, or advanced registered
  243  nurse practitioner does not specify otherwise, a client must be
  244  taught to self-administer his or her medication without a staff
  245  person. This includes all forms of administration, including
  246  orally, via injection, and via suppository. The client’s
  247  physician, physician assistant, or advanced registered nurse
  248  practitioner must be informed of the interdisciplinary team’s
  249  decision that self-administration of medications is an objective
  250  for the client. A client may not self-administer medication
  251  until he or she demonstrates the competency to take the correct
  252  medication in the correct dosage at the correct time, to respond
  253  to missed doses, and to contact an appropriate person with
  254  questions.
  255         (3) Medication administration discrepancies and adverse
  256  drug reactions must be recorded and reported immediately to a
  257  physician, physician assistant, or advanced registered nurse
  258  practitioner.
  259         Section 41. Section 400.9977, Florida Statutes, is created
  260  to read:
  261         400.9977 Protection from abuse, neglect, mistreatment, and
  262  exploitation.—The licensee must develop and implement policies
  263  and procedures for the screening and training of employees; the
  264  protection of clients; and the prevention, identification,
  265  investigation, and reporting of abuse, neglect, and
  266  exploitation. This includes the licensee’s identification of
  267  clients whose personal histories render them at risk for abusing
  268  other clients, development of intervention strategies to prevent
  269  occurrences, monitoring for changes that would trigger abusive
  270  behavior, and reassessment of the interventions on a regular
  271  basis. A licensee shall implement procedures to:
  272         (1) Screen potential employees for a history of abuse,
  273  neglect, or mistreatment of clients. The screening shall include
  274  an attempt to obtain information from previous employers and
  275  current employers and verification with the appropriate
  276  licensing boards.
  277         (2) Train employees, through orientation and ongoing
  278  sessions, on issues related to abuse prohibition practices,
  279  including identification of abuse, neglect, mistreatment, and
  280  exploitation, appropriate interventions to deal with aggressive
  281  or catastrophic reactions of clients, the process to report
  282  allegations without fear of reprisal, and recognition of signs
  283  of frustration and stress that may lead to abuse.
  284         (3) Provide clients, families, and staff with information
  285  on how and to whom they may report concerns, incidents, and
  286  grievances without the fear of retribution and provide feedback
  287  regarding the concerns that have been expressed. A licensee must
  288  identify, correct, and intervene in situations in which abuse,
  289  neglect, mistreatment, or exploitation is likely to occur,
  290  including:
  291         (a) Evaluating the physical environment of the facility to
  292  identify characteristics that may make abuse or neglect more
  293  likely to occur, such as secluded areas.
  294         (b) Providing sufficient staff on each shift to meet the
  295  needs of the clients, and ensuring that the staff assigned have
  296  knowledge of the individual clients’ care needs. The licensee
  297  shall identify inappropriate behaviors of its staff, such as
  298  using derogatory language, rough handling, ignoring clients
  299  while giving care, and directing clients who need toileting
  300  assistance to urinate or defecate in their beds.
  301         (c) Assessing, planning care for, and monitoring clients
  302  with needs and behaviors that might lead to conflict or neglect,
  303  such as clients with a history of aggressive behaviors, clients
  304  who have behaviors such as entering other clients’ rooms,
  305  clients with self-injurious behaviors, clients with
  306  communication disorders, and clients who require heavy nursing
  307  care or are totally dependent on staff.
  308         (4) Identify events, such as suspicious bruising of
  309  clients, occurrences, patterns, and trends that may constitute
  310  abuse and determine the direction of the investigation.
  311         (5) Investigate different types of incidents, identify the
  312  staff member responsible for the initial reporting, investigate
  313  alleged violations, and report results to the proper
  314  authorities. The licensee must analyze the occurrences to
  315  determine what changes are needed, if any, to policies and
  316  procedures to prevent further occurrences and to take all
  317  necessary corrective action depending on the results of the
  318  investigation.
  319         (6) Protect clients from harm during an investigation.
  320         (7) Report all alleged violations and all substantiated
  321  incidents, as required under chapters 39 and 415, to the
  322  licensing authorities and all other agencies as required, and to
  323  report any knowledge it has of any actions by a court of law
  324  that would indicate an employee is unfit for service.
  325         Section 42. Section 400.9978, Florida Statutes, is created
  326  to read:
  327         400.9978 Restraints and seclusion; client safety.—
  328         (1) Each facility shall provide a therapeutic milieu that
  329  supports a culture of individual empowerment and responsibility.
  330  The health and safety of the client shall be the primary concern
  331  at all times.
  332         (2) The use of physical restraints must be ordered and
  333  documented by a physician, physician assistant, or advanced
  334  registered nurse practitioner and must be consistent with
  335  policies and procedures adopted by the facility. The client or,
  336  if applicable, the client’s representative must be informed of
  337  the facility’s physical restraint policies and procedures at the
  338  time of the client’s admission.
  339         (3) The use of chemical restraints is limited to prescribed
  340  dosages of medications as ordered by a physician, physician
  341  assistant, or advanced registered nurse practitioner and must be
  342  consistent with the client’s diagnosis and the policies and
  343  procedures adopted by the facility. The client and, if
  344  applicable, the client’s representative must be informed of the
  345  facility’s chemical restraint policies and procedures at the
  346  time of the client’s admission.
  347         (4) Based on a physician’s, physician assistant’s, or
  348  advanced registered nurse practitioner’s assessment, if a client
  349  exhibits symptoms that present an immediate risk of injury or
  350  death to self or others, a physician, physician assistant, or
  351  advanced registered nurse practitioner may issue an emergency
  352  treatment order to immediately administer rapid response
  353  psychotropic medications or other chemical restraints. Each
  354  emergency treatment order must be documented and maintained in
  355  the client’s record.
  356         (a) An emergency treatment order is effective for no more
  357  than 24 hours.
  358         (b) Whenever a client is medicated in accordance with this
  359  subsection, the client’s representative or responsible party and
  360  the client’s physician, physician assistant, or advanced
  361  registered nurse practitioner must be notified as soon as
  362  practicable.
  363         (5) A client who is prescribed and receiving a medication
  364  that can serve as a chemical restraint for a purpose other than
  365  an emergency treatment order must be evaluated by his or her
  366  physician, physician assistant, or advanced registered nurse
  367  practitioner at least monthly to assess the following:
  369  ================= T I T L E  A M E N D M E N T ================
  370         And the title is amended as follows:
  371         Delete lines 132 - 151
  372  and insert:
  373         extending certain medical practice privileges, duties,
  374         and responsibilities to physician assistants and
  375         advanced registered nurse practitioners; providing
  376         requirements for transitional living facilities
  377         relating to client admission, transfer, and discharge;
  378         creating s. 400.9974, F.S.; extending certain medical
  379         practice privileges, duties, and responsibilities to
  380         physician assistants and advanced registered nurse
  381         practitioners; requiring a comprehensive treatment
  382         plan to be developed for each client; providing plan
  383         requirements; creating s. 400.9975, F.S.; providing
  384         licensee responsibilities; providing notice
  385         requirements; prohibiting a licensee or employee of a
  386         facility from serving notice upon a client to leave
  387         the premises or take other retaliatory action;
  388         requiring the client and client’s representative to be
  389         provided with certain information; requiring the
  390         licensee to develop and implement certain policies and
  391         procedures; creating s. 400.9976, F.S.; extending
  392         certain medical practice privileges, duties, and
  393         responsibilities to physician assistants and advanced
  394         registered nurse practitioners; providing licensee
  395         requirements relating to medication practices;
  396         creating s. 400.9977, F.S.; providing requirements for
  397         the screening of potential employees and monitoring of
  398         employees for the protection of clients; requiring
  399         licensees to implement certain procedures; creating s.
  400         400.9978, F.S.; extending certain medical practice
  401         privileges, duties, and responsibilities to physician
  402         assistants and advanced registered nurse
  403         practitioners; requiring a facility to provide a