Florida Senate - 2014 PROPOSED COMMITTEE SUBSTITUTE
Bill No. SB 248
Ì877366NÎ877366
HP.HP.00765
1 Proposed Committee Substitute by the Committee on Health Policy
2 A bill to be entitled
3 An act relating to assisted living facilities;
4 amending s. 394.4574, F.S.; providing that Medicaid
5 managed care plans are responsible for enrolled mental
6 health residents; providing that managing entities
7 under contract with the Department of Children and
8 Families are responsible for mental health residents
9 who are not enrolled with a Medicaid managed care
10 plan; deleting a provision to conform to changes made
11 by the act; requiring that the community living
12 support plan be completed and provided to the
13 administrator of a facility upon the mental health
14 resident’s admission; requiring the community living
15 support plan to be updated when there is a significant
16 change to the mental health resident’s behavioral
17 health; requiring the case manager assigned to a
18 mental health resident of an assisted living facility
19 that holds a limited mental health license to keep a
20 record of the date and time of face-to-face
21 interactions with the resident and to make the record
22 available to the responsible entity for inspection;
23 requiring that the record be maintained for a
24 specified time; requiring the responsible entity to
25 ensure that there is adequate and consistent
26 monitoring and enforcement of community living support
27 plans and cooperative agreements and that concerns are
28 reported to the appropriate regulatory oversight
29 organization under certain circumstances; amending s.
30 400.0074, F.S.; requiring that an administrative
31 assessment conducted by a local council be
32 comprehensive in nature and focus on factors affecting
33 the rights, health, safety, and welfare of nursing
34 home residents; requiring a local council to conduct
35 an exit consultation with the facility administrator
36 or administrator designee to discuss issues and
37 concerns in areas affecting the rights, health,
38 safety, and welfare of residents and make
39 recommendations for improvement; amending s. 400.0078,
40 F.S.; requiring that a resident or a representative of
41 a resident of a long-term care facility be informed
42 that retaliatory action cannot be taken against a
43 resident for presenting grievances or for exercising
44 any other resident right; amending s. 429.07, F.S.;
45 requiring that an extended congregate care license be
46 issued to certain facilities that have been licensed
47 as assisted living facilities under certain
48 circumstances and authorizing the issuance of such
49 license if a specified condition is met; providing the
50 purpose of an extended congregate care license;
51 providing that the initial extended congregate care
52 license of an assisted living facility is provisional
53 under certain circumstances; requiring a licensee to
54 notify the Agency for Health Care Administration if it
55 accepts a resident who qualifies for extended
56 congregate care services; requiring the agency to
57 inspect the facility for compliance with the
58 requirements of an extended congregate care license;
59 requiring the issuance of an extended congregate care
60 license under certain circumstances; requiring the
61 licensee to immediately suspend extended congregate
62 care services under certain circumstances; requiring a
63 registered nurse representing the agency to visit the
64 facility at least twice a year, rather than quarterly,
65 to monitor residents who are receiving extended
66 congregate care services; authorizing the agency to
67 waive one of the required yearly monitoring visits
68 under certain circumstances; authorizing the agency to
69 deny or revoke a facility’s extended congregate care
70 license; requiring a registered nurse representing the
71 agency to visit the facility at least annually, rather
72 than twice a year, to monitor residents who are
73 receiving limited nursing services; providing that
74 such monitoring visits may be conducted in conjunction
75 with other agency inspections; authorizing the agency
76 to waive the required yearly monitoring visit for a
77 facility that is licensed to provide limited nursing
78 services under certain circumstances; amending s.
79 429.075, F.S.; requiring an assisted living facility
80 that serves one or more mental health residents to
81 obtain a limited mental health license; amending s.
82 429.14, F.S.; revising the circumstances under which
83 the agency may deny, revoke, or suspend the license of
84 an assisted living facility and impose an
85 administrative fine; requiring the agency to deny or
86 revoke the license of an assisted living facility
87 under certain circumstances; requiring the agency to
88 impose an immediate moratorium on the license of an
89 assisted living facility under certain circumstances;
90 deleting a provision requiring the agency to provide a
91 list of facilities with denied, suspended, or revoked
92 licenses to the Department of Business and
93 Professional Regulation; exempting a facility from the
94 45-day notice requirement if it is required to
95 relocate some or all of its residents; amending s.
96 429.178, F.S.; conforming cross-references; amending
97 s. 429.19, F.S.; revising the amounts and uses of
98 administrative fines; requiring the agency to levy a
99 fine for violations that are corrected before an
100 inspection if noncompliance occurred within a
101 specified period of time; deleting factors that the
102 agency is required to consider in determining
103 penalties and fines; amending s. 429.256, F.S.;
104 revising the term “assistance with self-administration
105 of medication” as it relates to the Assisted Living
106 Facilities Act; amending s. 429.28, F.S.; providing
107 notice requirements to inform facility residents that
108 the identity of the resident and complainant in any
109 complaint made to the State Long-Term Care Ombudsman
110 Program or a local long-term care ombudsman council is
111 confidential and that retaliatory action cannot be
112 taken against a resident for presenting grievances or
113 for exercising any other resident right; requiring
114 that a facility that terminates an individual’s
115 residency after the filing of a complaint be fined if
116 good cause is not shown for the termination; amending
117 s. 429.34, F.S.; requiring certain persons to report
118 elder abuse in assisted living facilities; requiring
119 the agency to regularly inspect every licensed
120 assisted living facility; requiring the agency to
121 conduct more frequent inspections under certain
122 circumstances; requiring the licensee to pay a fee for
123 the cost of additional inspections; requiring the
124 agency to annually adjust the fee; amending s. 429.41,
125 F.S.; providing that certain staffing requirements
126 apply only to residents in continuing care facilities
127 who are receiving the relevant service; amending s.
128 429.52, F.S.; requiring each newly hired employee of
129 an assisted living facility to attend a preservice
130 orientation provided by the assisted living facility;
131 requiring the employee and administrator to sign a
132 statement that the employee completed the required
133 pre-service orientation and keep the signed statement
134 in the employee’s personnel record; requiring two
135 additional hours of training for assistance with
136 medication; conforming a cross-reference; creating s.
137 429.55, F.S.; requiring the Office of Program Policy
138 Analysis and Government Accountability to study the
139 reliability of facility surveys and submit to the
140 Governor and the Legislature its findings and
141 recommendations; requiring the agency to implement a
142 rating system of assisted living facilities by a
143 specified date, adopt rules, and create content for
144 the agency’s website that makes available to consumers
145 information regarding assisted living facilities;
146 providing criteria for the content; providing an
147 effective date.
148
149 Be It Enacted by the Legislature of the State of Florida:
150
151 Section 1. Section 394.4574, Florida Statutes, is amended
152 to read:
153 394.4574 Department Responsibilities for coordination of
154 services for a mental health resident who resides in an assisted
155 living facility that holds a limited mental health license.—
156 (1) As used in this section, the term “mental health
157 resident” “mental health resident,” for purposes of this
158 section, means an individual who receives social security
159 disability income due to a mental disorder as determined by the
160 Social Security Administration or receives supplemental security
161 income due to a mental disorder as determined by the Social
162 Security Administration and receives optional state
163 supplementation.
164 (2) Medicaid managed care plans are responsible for
165 Medicaid enrolled mental health residents, and managing entities
166 under contract with the department are responsible for mental
167 health residents who are not enrolled in a Medicaid health plan.
168 A Medicaid managed care plan or a managing entity, as
169 appropriate, shall The department must ensure that:
170 (a) A mental health resident has been assessed by a
171 psychiatrist, clinical psychologist, clinical social worker, or
172 psychiatric nurse, or an individual who is supervised by one of
173 these professionals, and determined to be appropriate to reside
174 in an assisted living facility. The documentation must be
175 provided to the administrator of the facility within 30 days
176 after the mental health resident has been admitted to the
177 facility. An evaluation completed upon discharge from a state
178 mental hospital meets the requirements of this subsection
179 related to appropriateness for placement as a mental health
180 resident if it was completed within 90 days before prior to
181 admission to the facility.
182 (b) A cooperative agreement, as required in s. 429.075, is
183 developed by between the mental health care services provider
184 that serves a mental health resident and the administrator of
185 the assisted living facility with a limited mental health
186 license in which the mental health resident is living. Any
187 entity that provides Medicaid prepaid health plan services shall
188 ensure the appropriate coordination of health care services with
189 an assisted living facility in cases where a Medicaid recipient
190 is both a member of the entity’s prepaid health plan and a
191 resident of the assisted living facility. If the entity is at
192 risk for Medicaid targeted case management and behavioral health
193 services, the entity shall inform the assisted living facility
194 of the procedures to follow should an emergent condition arise.
195 (c) The community living support plan, as defined in s.
196 429.02, has been prepared by a mental health resident and his or
197 her a mental health case manager of that resident in
198 consultation with the administrator of the facility or the
199 administrator’s designee. The plan must be completed and
200 provided to the administrator of the assisted living facility
201 with a limited mental health license in which the mental health
202 resident lives upon the resident’s admission. The support plan
203 and the agreement may be in one document.
204 (d) The assisted living facility with a limited mental
205 health license is provided with documentation that the
206 individual meets the definition of a mental health resident.
207 (e) The mental health services provider assigns a case
208 manager to each mental health resident for whom the entity is
209 responsible who lives in an assisted living facility with a
210 limited mental health license. The case manager shall coordinate
211 is responsible for coordinating the development of and
212 implementation of the community living support plan defined in
213 s. 429.02. The plan must be updated at least annually, or when
214 there is a significant change in the resident’s behavioral
215 health status, such as an inpatient admission or a change in
216 medication, level of service, or residence. Each case manager
217 shall keep a record of the date and time of any face-to-face
218 interaction with the resident and make the record available to
219 the responsible entity for inspection. The record must be
220 retained for at least 2 years after the date of the most recent
221 interaction.
222 (f) Adequate and consistent monitoring and enforcement of
223 community living support plans and cooperative agreements are
224 conducted by the resident’s case manager.
225 (g) Concerns are reported to the appropriate regulatory
226 oversight organization if a regulated provider fails to deliver
227 appropriate services or otherwise acts in a manner that has the
228 potential to result in harm to the resident.
229 (3) The Secretary of Children and Families Family Services,
230 in consultation with the Agency for Health Care Administration,
231 shall annually require each district administrator to develop,
232 with community input, a detailed annual plan that demonstrates
233 detailed plans that demonstrate how the district will ensure the
234 provision of state-funded mental health and substance abuse
235 treatment services to residents of assisted living facilities
236 that hold a limited mental health license. This plan These plans
237 must be consistent with the substance abuse and mental health
238 district plan developed pursuant to s. 394.75 and must address
239 case management services; access to consumer-operated drop-in
240 centers; access to services during evenings, weekends, and
241 holidays; supervision of the clinical needs of the residents;
242 and access to emergency psychiatric care.
243 Section 2. Subsection (1) of section 400.0074, Florida
244 Statutes, is amended, and paragraph (h) is added to subsection
245 (2) of that section, to read:
246 400.0074 Local ombudsman council onsite administrative
247 assessments.—
248 (1) In addition to any specific investigation conducted
249 pursuant to a complaint, the local council shall conduct, at
250 least annually, an onsite administrative assessment of each
251 nursing home, assisted living facility, and adult family-care
252 home within its jurisdiction. This administrative assessment
253 must be comprehensive in nature and must shall focus on factors
254 affecting residents’ the rights, health, safety, and welfare of
255 the residents. Each local council is encouraged to conduct a
256 similar onsite administrative assessment of each additional
257 long-term care facility within its jurisdiction.
258 (2) An onsite administrative assessment conducted by a
259 local council shall be subject to the following conditions:
260 (h) The local council shall conduct an exit consultation
261 with the facility administrator or administrator designee to
262 discuss issues and concerns in areas affecting residents’
263 rights, health, safety, and welfare and, if needed, make
264 recommendations for improvement.
265 Section 3. Subsection (2) of section 400.0078, Florida
266 Statutes, is amended to read:
267 400.0078 Citizen access to State Long-Term Care Ombudsman
268 Program services.—
269 (2) Every resident or representative of a resident shall
270 receive, Upon admission to a long-term care facility, each
271 resident or representative of a resident must receive
272 information regarding the purpose of the State Long-Term Care
273 Ombudsman Program, the statewide toll-free telephone number for
274 receiving complaints, information that retaliatory action cannot
275 be taken against a resident for presenting grievances or for
276 exercising any other resident right, and other relevant
277 information regarding how to contact the program. Each resident
278 or his or her representative Residents or their representatives
279 must be furnished additional copies of this information upon
280 request.
281 Section 4. Paragraphs (b) and (c) of subsection (3) of
282 section 429.07, Florida Statutes, are amended to read:
283 429.07 License required; fee.—
284 (3) In addition to the requirements of s. 408.806, each
285 license granted by the agency must state the type of care for
286 which the license is granted. Licenses shall be issued for one
287 or more of the following categories of care: standard, extended
288 congregate care, limited nursing services, or limited mental
289 health.
290 (b) An extended congregate care license shall be issued to
291 each facility that has been licensed as an assisted living
292 facility for 2 or more years and that provides services
293 facilities providing, directly or through contract, services
294 beyond those authorized in paragraph (a), including services
295 performed by persons licensed under part I of chapter 464 and
296 supportive services, as defined by rule, to persons who would
297 otherwise be disqualified from continued residence in a facility
298 licensed under this part. An extended congregate care license
299 may be issued to a facility that has a provisional extended
300 congregate care license and meets the requirements for licensure
301 under subparagraph 2. The primary purpose of extended congregate
302 care services is to allow residents the option of remaining in a
303 familiar setting from which they would otherwise be disqualified
304 for continued residency as they become more impaired. A facility
305 licensed to provide extended congregate care services may also
306 admit an individual who exceeds the admission criteria for a
307 facility with a standard license, if he or she is determined
308 appropriate for admission to the extended congregate care
309 facility.
310 1. In order for extended congregate care services to be
311 provided, the agency must first determine that all requirements
312 established in law and rule are met and must specifically
313 designate, on the facility’s license, that such services may be
314 provided and whether the designation applies to all or part of
315 the facility. This Such designation may be made at the time of
316 initial licensure or relicensure, or upon request in writing by
317 a licensee under this part and part II of chapter 408. The
318 notification of approval or the denial of the request shall be
319 made in accordance with part II of chapter 408. Each existing
320 facility that qualifies facilities qualifying to provide
321 extended congregate care services must have maintained a
322 standard license and may not have been subject to administrative
323 sanctions during the previous 2 years, or since initial
324 licensure if the facility has been licensed for less than 2
325 years, for any of the following reasons:
326 a. A class I or class II violation;
327 b. Three or more repeat or recurring class III violations
328 of identical or similar resident care standards from which a
329 pattern of noncompliance is found by the agency;
330 c. Three or more class III violations that were not
331 corrected in accordance with the corrective action plan approved
332 by the agency;
333 d. Violation of resident care standards which results in
334 requiring the facility to employ the services of a consultant
335 pharmacist or consultant dietitian;
336 e. Denial, suspension, or revocation of a license for
337 another facility licensed under this part in which the applicant
338 for an extended congregate care license has at least 25 percent
339 ownership interest; or
340 f. Imposition of a moratorium pursuant to this part or part
341 II of chapter 408 or initiation of injunctive proceedings.
342
343 The agency may deny or revoke a facility’s extended congregate
344 care license for not meeting the criteria for an extended
345 congregate care license as provided in this subparagraph.
346 2. If an assisted living facility has been licensed
347 for less than 2 years, the initial extended congregate care
348 license must be provisional and may not exceed 6 months. Within
349 the first 3 months after the provisional license is issued, the
350 licensee shall notify the agency, in writing, when it has
351 admitted at least one extended congregate care resident, after
352 which an unannounced inspection shall be made to determine
353 compliance with requirements of an extended congregate care
354 license. Failure to admit an extended congregate care resident
355 within the first 3 months shall render the extended congregate
356 care license void. A licensee with a provisional extended
357 congregate care license that demonstrates compliance with all of
358 the requirements of an extended congregate care license during
359 the inspection, shall be issued an extended congregate care
360 license. In addition to sanctions authorized under this part, if
361 violations are found during the inspection and the licensee
362 fails to demonstrate compliance with all assisted living
363 requirements during a follow-up inspection, the licensee shall
364 immediately suspend extended congregate care services, and the
365 provisional extended congregate care license expires. The agency
366 may extend the provisional license for not more than one month
367 in order to complete a follow-up visit.
368 3.2. A facility that is licensed to provide extended
369 congregate care services shall maintain a written progress
370 report on each person who receives services which describes the
371 type, amount, duration, scope, and outcome of services that are
372 rendered and the general status of the resident’s health. A
373 registered nurse, or appropriate designee, representing the
374 agency shall visit the facility at least twice a year quarterly
375 to monitor residents who are receiving extended congregate care
376 services and to determine if the facility is in compliance with
377 this part, part II of chapter 408, and relevant rules. One of
378 the visits may be in conjunction with the regular survey. The
379 monitoring visits may be provided through contractual
380 arrangements with appropriate community agencies. A registered
381 nurse shall serve as part of the team that inspects the
382 facility. The agency may waive one of the required yearly
383 monitoring visits for a facility that has:
384 a. Held an extended congregate care license for at least 24
385 months; been licensed for at least 24 months to provide extended
386 congregate care services, if, during the inspection, the
387 registered nurse determines that extended congregate care
388 services are being provided appropriately, and if the facility
389 has
390 b. No class I or class II violations and no uncorrected
391 class III violations; and.
392 c. No ombudsman council complaints that resulted in a
393 citation for licensure The agency must first consult with the
394 long-term care ombudsman council for the area in which the
395 facility is located to determine if any complaints have been
396 made and substantiated about the quality of services or care.
397 The agency may not waive one of the required yearly monitoring
398 visits if complaints have been made and substantiated.
399 4.3. A facility that is licensed to provide extended
400 congregate care services must:
401 a. Demonstrate the capability to meet unanticipated
402 resident service needs.
403 b. Offer a physical environment that promotes a homelike
404 setting, provides for resident privacy, promotes resident
405 independence, and allows sufficient congregate space as defined
406 by rule.
407 c. Have sufficient staff available, taking into account the
408 physical plant and firesafety features of the building, to
409 assist with the evacuation of residents in an emergency.
410 d. Adopt and follow policies and procedures that maximize
411 resident independence, dignity, choice, and decisionmaking to
412 permit residents to age in place, so that moves due to changes
413 in functional status are minimized or avoided.
414 e. Allow residents or, if applicable, a resident’s
415 representative, designee, surrogate, guardian, or attorney in
416 fact to make a variety of personal choices, participate in
417 developing service plans, and share responsibility in
418 decisionmaking.
419 f. Implement the concept of managed risk.
420 g. Provide, directly or through contract, the services of a
421 person licensed under part I of chapter 464.
422 h. In addition to the training mandated in s. 429.52,
423 provide specialized training as defined by rule for facility
424 staff.
425 5.4. A facility that is licensed to provide extended
426 congregate care services is exempt from the criteria for
427 continued residency set forth in rules adopted under s. 429.41.
428 A licensed facility must adopt its own requirements within
429 guidelines for continued residency set forth by rule. However,
430 the facility may not serve residents who require 24-hour nursing
431 supervision. A licensed facility that provides extended
432 congregate care services must also provide each resident with a
433 written copy of facility policies governing admission and
434 retention.
435 5. The primary purpose of extended congregate care services
436 is to allow residents, as they become more impaired, the option
437 of remaining in a familiar setting from which they would
438 otherwise be disqualified for continued residency. A facility
439 licensed to provide extended congregate care services may also
440 admit an individual who exceeds the admission criteria for a
441 facility with a standard license, if the individual is
442 determined appropriate for admission to the extended congregate
443 care facility.
444 6. Before the admission of an individual to a facility
445 licensed to provide extended congregate care services, the
446 individual must undergo a medical examination as provided in s.
447 429.26(4) and the facility must develop a preliminary service
448 plan for the individual.
449 7. If When a facility can no longer provide or arrange for
450 services in accordance with the resident’s service plan and
451 needs and the facility’s policy, the facility must shall make
452 arrangements for relocating the person in accordance with s.
453 429.28(1)(k).
454 8. Failure to provide extended congregate care services may
455 result in denial of extended congregate care license renewal.
456 (c) A limited nursing services license shall be issued to a
457 facility that provides services beyond those authorized in
458 paragraph (a) and as specified in this paragraph.
459 1. In order for limited nursing services to be provided in
460 a facility licensed under this part, the agency must first
461 determine that all requirements established in law and rule are
462 met and must specifically designate, on the facility’s license,
463 that such services may be provided. This Such designation may be
464 made at the time of initial licensure or licensure renewal
465 relicensure, or upon request in writing by a licensee under this
466 part and part II of chapter 408. Notification of approval or
467 denial of such request shall be made in accordance with part II
468 of chapter 408. An existing facility that qualifies facilities
469 qualifying to provide limited nursing services must shall have
470 maintained a standard license and may not have been subject to
471 administrative sanctions that affect the health, safety, and
472 welfare of residents for the previous 2 years or since initial
473 licensure if the facility has been licensed for less than 2
474 years.
475 2. A facility Facilities that is are licensed to provide
476 limited nursing services shall maintain a written progress
477 report on each person who receives such nursing services. The,
478 which report must describe describes the type, amount, duration,
479 scope, and outcome of services that are rendered and the general
480 status of the resident’s health. A registered nurse representing
481 the agency shall visit the facility such facilities at least
482 annually twice a year to monitor residents who are receiving
483 limited nursing services and to determine if the facility is in
484 compliance with applicable provisions of this part, part II of
485 chapter 408, and related rules. The monitoring visits may be
486 provided through contractual arrangements with appropriate
487 community agencies. A registered nurse shall also serve as part
488 of the team that inspects such facility. Visits may be in
489 conjunction with other agency inspections. The agency may waive
490 the required yearly monitoring visit for a facility that has:
491 a. Had a limited nursing services license for at least 24
492 months;
493 b. No class I or class II violations and no uncorrected
494 class III violations; and
495 c. No ombudsman council complaints that resulted in a
496 citation for licensure.
497 3. A person who receives limited nursing services under
498 this part must meet the admission criteria established by the
499 agency for assisted living facilities. When a resident no longer
500 meets the admission criteria for a facility licensed under this
501 part, arrangements for relocating the person shall be made in
502 accordance with s. 429.28(1)(k), unless the facility is licensed
503 to provide extended congregate care services.
504 Section 5. Section 429.075, Florida Statutes, is amended to
505 read:
506 429.075 Limited mental health license.—An assisted living
507 facility that serves one three or more mental health residents
508 must obtain a limited mental health license.
509 (1) To obtain a limited mental health license, a facility
510 must hold a standard license as an assisted living facility,
511 must not have any current uncorrected deficiencies or
512 violations, and must ensure that, within 6 months after
513 receiving a limited mental health license, the facility
514 administrator and the staff of the facility who are in direct
515 contact with mental health residents must complete training of
516 no less than 6 hours related to their duties. This Such
517 designation may be made at the time of initial licensure or
518 relicensure or upon request in writing by a licensee under this
519 part and part II of chapter 408. Notification of approval or
520 denial of such request shall be made in accordance with this
521 part, part II of chapter 408, and applicable rules. This
522 training must will be provided by or approved by the Department
523 of Children and Families Family Services.
524 (2) A facility that is Facilities licensed to provide
525 services to mental health residents must shall provide
526 appropriate supervision and staffing to provide for the health,
527 safety, and welfare of such residents.
528 (3) A facility that has a limited mental health license
529 must:
530 (a) Have a copy of each mental health resident’s community
531 living support plan and the cooperative agreement with the
532 mental health care services provider. The support plan and the
533 agreement may be combined.
534 (b) Have documentation that is provided by the Department
535 of Children and Families Family Services that each mental health
536 resident has been assessed and determined to be able to live in
537 the community in an assisted living facility that has with a
538 limited mental health license.
539 (c) Make the community living support plan available for
540 inspection by the resident, the resident’s legal guardian or,
541 the resident’s health care surrogate, and other individuals who
542 have a lawful basis for reviewing this document.
543 (d) Assist the mental health resident in carrying out the
544 activities identified in the individual’s community living
545 support plan.
546 (4) A facility that has with a limited mental health
547 license may enter into a cooperative agreement with a private
548 mental health provider. For purposes of the limited mental
549 health license, the private mental health provider may act as
550 the case manager.
551 Section 6. Section 429.14, Florida Statutes, is amended to
552 read:
553 429.14 Administrative penalties.—
554 (1) In addition to the requirements of part II of chapter
555 408, the agency may deny, revoke, and suspend any license issued
556 under this part and impose an administrative fine in the manner
557 provided in chapter 120 against a licensee for a violation of
558 any provision of this part, part II of chapter 408, or
559 applicable rules, or for any of the following actions by a
560 licensee, for the actions of any person subject to level 2
561 background screening under s. 408.809, or for the actions of any
562 facility staff employee:
563 (a) An intentional or negligent act seriously affecting the
564 health, safety, or welfare of a resident of the facility.
565 (b) A The determination by the agency that the owner lacks
566 the financial ability to provide continuing adequate care to
567 residents.
568 (c) Misappropriation or conversion of the property of a
569 resident of the facility.
570 (d) Failure to follow the criteria and procedures provided
571 under part I of chapter 394 relating to the transportation,
572 voluntary admission, and involuntary examination of a facility
573 resident.
574 (e) A citation for of any of the following violations
575 deficiencies as specified in s. 429.19:
576 1. One or more cited class I violations deficiencies.
577 2. Three or more cited class II violations deficiencies.
578 3. Five or more cited class III violations deficiencies
579 that have been cited on a single survey and have not been
580 corrected within the times specified.
581 (f) Failure to comply with the background screening
582 standards of this part, s. 408.809(1), or chapter 435.
583 (g) Violation of a moratorium.
584 (h) Failure of the license applicant, the licensee during
585 relicensure, or a licensee that holds a provisional license to
586 meet the minimum license requirements of this part, or related
587 rules, at the time of license application or renewal.
588 (i) An intentional or negligent life-threatening act in
589 violation of the uniform firesafety standards for assisted
590 living facilities or other firesafety standards which that
591 threatens the health, safety, or welfare of a resident of a
592 facility, as communicated to the agency by the local authority
593 having jurisdiction or the State Fire Marshal.
594 (j) Knowingly operating any unlicensed facility or
595 providing without a license any service that must be licensed
596 under this chapter or chapter 400.
597 (k) Any act constituting a ground upon which application
598 for a license may be denied.
599 (2) Upon notification by the local authority having
600 jurisdiction or by the State Fire Marshal, the agency may deny
601 or revoke the license of an assisted living facility that fails
602 to correct cited fire code violations that affect or threaten
603 the health, safety, or welfare of a resident of a facility.
604 (3) The agency may deny or revoke a license of an to any
605 applicant or controlling interest as defined in part II of
606 chapter 408 which has or had a 25 percent 25-percent or greater
607 financial or ownership interest in any other facility that is
608 licensed under this part, or in any entity licensed by this
609 state or another state to provide health or residential care, if
610 that which facility or entity during the 5 years prior to the
611 application for a license closed due to financial inability to
612 operate; had a receiver appointed or a license denied,
613 suspended, or revoked; was subject to a moratorium; or had an
614 injunctive proceeding initiated against it.
615 (4) The agency shall deny or revoke the license of an
616 assisted living facility if:
617 (a) There are two moratoria, issued pursuant to this part
618 or part II of chapter 408, within a 2-year period which are
619 imposed by final order;
620 (b) The facility is cited for two or more class I
621 violations arising from unrelated circumstances during the same
622 survey or investigation; or
623 (c) The facility is cited for two or more class I
624 violations arising from separate surveys or investigations
625 within a 2-year period that has two or more class I violations
626 that are similar or identical to violations identified by the
627 agency during a survey, inspection, monitoring visit, or
628 complaint investigation occurring within the previous 2 years.
629 (5) An action taken by the agency to suspend, deny, or
630 revoke a facility’s license under this part or part II of
631 chapter 408, in which the agency claims that the facility owner
632 or an employee of the facility has threatened the health,
633 safety, or welfare of a resident of the facility, must be heard
634 by the Division of Administrative Hearings of the Department of
635 Management Services within 120 days after receipt of the
636 facility’s request for a hearing, unless that time limitation is
637 waived by both parties. The administrative law judge shall must
638 render a decision within 30 days after receipt of a proposed
639 recommended order.
640 (6) As provided under s. 408.814, the agency shall impose
641 an immediate moratorium on an assisted living facility that
642 fails to provide the agency access to the facility or prohibits
643 the agency from conducting a regulatory inspection. The licensee
644 may not restrict agency staff in accessing and copying records
645 or in conducting confidential interviews with facility staff or
646 any individual who receives services from the facility provide
647 to the Division of Hotels and Restaurants of the Department of
648 Business and Professional Regulation, on a monthly basis, a list
649 of those assisted living facilities that have had their licenses
650 denied, suspended, or revoked or that are involved in an
651 appellate proceeding pursuant to s. 120.60 related to the
652 denial, suspension, or revocation of a license.
653 (7) Agency notification of a license suspension or
654 revocation, or denial of a license renewal, shall be posted and
655 visible to the public at the facility.
656 (8) If a facility is required to relocate some or all of
657 its residents due to agency action, that facility is exempt from
658 the 45-days’ notice requirement imposed under s. 429.28(1)(k).
659 This subsection does not exempt the facility from any deadlines
660 for corrective action set by the agency.
661 Section 7. Paragraphs (a) and (b) of subsection (2) of
662 section 429.178, Florida Statutes, are amended to read:
663 429.178 Special care for persons with Alzheimer’s disease
664 or other related disorders.—
665 (2)(a) An individual who is employed by a facility that
666 provides special care for residents who have with Alzheimer’s
667 disease or other related disorders, and who has regular contact
668 with such residents, must complete up to 4 hours of initial
669 dementia-specific training developed or approved by the
670 department. The training must shall be completed within 3 months
671 after beginning employment and satisfy shall satisfy the core
672 training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
673 (b) A direct caregiver who is employed by a facility that
674 provides special care for residents who have with Alzheimer’s
675 disease or other related disorders, and who provides direct care
676 to such residents, must complete the required initial training
677 and 4 additional hours of training developed or approved by the
678 department. The training must shall be completed within 9 months
679 after beginning employment and satisfy shall satisfy the core
680 training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
681 Section 8. Section 429.19, Florida Statutes, is amended to
682 read:
683 429.19 Violations; imposition of administrative fines;
684 grounds.—
685 (1) In addition to the requirements of part II of chapter
686 408, the agency shall impose an administrative fine in the
687 manner provided in chapter 120 for the violation of any
688 provision of this part, part II of chapter 408, and applicable
689 rules by an assisted living facility, for the actions of any
690 person subject to level 2 background screening under s. 408.809,
691 for the actions of any facility employee, or for an intentional
692 or negligent act seriously affecting the health, safety, or
693 welfare of a resident of the facility.
694 (2) Each violation of this part and adopted rules must
695 shall be classified according to the nature of the violation and
696 the gravity of its probable effect on facility residents. The
697 agency shall indicate the classification on the written notice
698 of the violation as follows:
699 (a) Class “I” violations are defined in s. 408.813. The
700 agency shall impose an administrative fine of $7,500 for each a
701 cited class I violation in a facility that is licensed for fewer
702 than 100 beds at the time of the violation in an amount not less
703 than $5,000 and not exceeding $10,000 for each violation. The
704 agency shall impose an administrative fine of $11,250 for each
705 cited class I violation in a facility that is licensed for 100
706 or more beds at the time of the violation. If the agency has
707 knowledge of a class I violation which occurred within 12 months
708 prior to an inspection, a fine must be levied for that violation
709 whether or not the noncompliance was corrected before the
710 inspection.
711 (b) Class “II” violations are defined in s. 408.813. The
712 agency shall impose an administrative fine of $3,000 for each a
713 cited class II violation in a facility that is licensed for
714 fewer than 100 beds at the time of the violation in an amount
715 not less than $1,000 and not exceeding $5,000 for each
716 violation. The agency shall impose an administrative fine of
717 $4,500 for each cited class II violation in a facility that is
718 licensed for 100 or more beds at the time of the violation.
719 (c) Class “III” violations are defined in s. 408.813. The
720 agency shall impose an administrative fine of $750 for each a
721 cited class III violation in a facility that is licensed for
722 fewer than 100 beds at the time of the violation in an amount
723 not less than $500 and not exceeding $1,000 for each violation.
724 The agency shall impose an administrative fine of $1,125 for
725 each cited class III violation in a facility that is licensed
726 for 100 or more beds at the time of the violation.
727 (d) Class “IV” violations are defined in s. 408.813. The
728 agency shall impose an administrative fine of $150 for each a
729 cited class IV violation in a facility that is licensed for
730 fewer than 100 beds at the time of the violation in an amount
731 not less than $100 and not exceeding $200 for each violation.
732 The agency shall impose an administrative fine of $225 for each
733 cited class IV violation in a facility that is licensed for 100
734 or more beds at the time of the violation.
735 (e) Any fine imposed for a class I violation or a class II
736 violation must be doubled if a facility was previously cited for
737 one or more class I or class II violations during the agency’s
738 last licensure inspection or any inspection or complaint
739 investigation since the last licensure inspection.
740 (f) Notwithstanding s. 408.813(2)(c) and (d) and s.
741 408.832, a fine must be imposed for each class III or class IV
742 violation, regardless of correction, if a facility was
743 previously cited for one or more class III or class IV
744 violations during the agency’s last licensure inspection or any
745 inspection or complaint investigation since the last licensure
746 inspection for the same regulatory violation. A fine imposed for
747 class III or class IV violations must be doubled if a facility
748 was previously cited for one or more class III or class IV
749 violations during the agency’s last two licensure inspections
750 for the same regulatory violation.
751 (3) For purposes of this section, in determining if a
752 penalty is to be imposed and in fixing the amount of the fine,
753 the agency shall consider the following factors:
754 (a) The gravity of the violation, including the probability
755 that death or serious physical or emotional harm to a resident
756 will result or has resulted, the severity of the action or
757 potential harm, and the extent to which the provisions of the
758 applicable laws or rules were violated.
759 (b) Actions taken by the owner or administrator to correct
760 violations.
761 (c) Any previous violations.
762 (d) The financial benefit to the facility of committing or
763 continuing the violation.
764 (e) The licensed capacity of the facility.
765 (3)(4) Each day of continuing violation after the date
766 established by the agency fixed for correction termination of
767 the violation, as ordered by the agency, constitutes an
768 additional, separate, and distinct violation.
769 (4)(5) An Any action taken to correct a violation shall be
770 documented in writing by the owner or administrator of the
771 facility and verified through followup visits by agency
772 personnel. The agency may impose a fine and, in the case of an
773 owner-operated facility, revoke or deny a facility’s license
774 when a facility administrator fraudulently misrepresents action
775 taken to correct a violation.
776 (5)(6) A Any facility whose owner fails to apply for a
777 change-of-ownership license in accordance with part II of
778 chapter 408 and operates the facility under the new ownership is
779 subject to a fine of $5,000.
780 (6)(7) In addition to any administrative fines imposed, the
781 agency may assess a survey fee, equal to the lesser of one half
782 of the facility’s biennial license and bed fee or $500, to cover
783 the cost of conducting initial complaint investigations that
784 result in the finding of a violation that was the subject of the
785 complaint or monitoring visits conducted under s. 429.28(3)(c)
786 to verify the correction of the violations.
787 (7)(8) During an inspection, the agency shall make a
788 reasonable attempt to discuss each violation with the owner or
789 administrator of the facility, prior to written notification.
790 (8)(9) The agency shall develop and disseminate an annual
791 list of all facilities sanctioned or fined for violations of
792 state standards, the number and class of violations involved,
793 the penalties imposed, and the current status of cases. The list
794 shall be disseminated, at no charge, to the Department of
795 Elderly Affairs, the Department of Health, the Department of
796 Children and Families Family Services, the Agency for Persons
797 with Disabilities, the area agencies on aging, the Florida
798 Statewide Advocacy Council, and the state and local ombudsman
799 councils. The Department of Children and Families Family
800 Services shall disseminate the list to service providers under
801 contract to the department who are responsible for referring
802 persons to a facility for residency. The agency may charge a fee
803 commensurate with the cost of printing and postage to other
804 interested parties requesting a copy of this list. This
805 information may be provided electronically or through the
806 agency’s website Internet site.
807 Section 9. Subsection (3) and paragraph (c) of subsection
808 (4) of section 429.256, Florida Statutes, are amended to read:
809 429.256 Assistance with self-administration of medication.—
810 (3) Assistance with self-administration of medication
811 includes:
812 (a) Taking the medication, in its previously dispensed,
813 properly labeled container, including an insulin syringe that is
814 prefilled with the proper dosage by a pharmacist and an insulin
815 pen that is prefilled by the manufacturer, from where it is
816 stored, and bringing it to the resident.
817 (b) In the presence of the resident, reading the label,
818 opening the container, removing a prescribed amount of
819 medication from the container, and closing the container.
820 (c) Placing an oral dosage in the resident’s hand or
821 placing the dosage in another container and helping the resident
822 by lifting the container to his or her mouth.
823 (d) Applying topical medications.
824 (e) Returning the medication container to proper storage.
825 (f) Keeping a record of when a resident receives assistance
826 with self-administration under this section.
827 (g) Assisting with the use of a nebulizer, including
828 removing the cap of a nebulizer, opening the unit dose of
829 nebulizer solution, and pouring the prescribed premeasured dose
830 of medication into the dispensing cup of the nebulizer.
831 (h) Using a glucometer to perform blood-glucose level
832 checks.
833 (i) Assisting with putting on and taking off antiembolism
834 stockings.
835 (j) Assisting with applying and removing an oxygen cannula,
836 but not with titrating the prescribed oxygen settings.
837 (k) Assisting with the use of a continuous positive airway
838 pressure (CPAP) device, but not with titrating the prescribed
839 setting of the device.
840 (l) Assisting with measuring vital signs.
841 (m) Assisting with colostomy bags.
842 (4) Assistance with self-administration does not include:
843 (c) Administration of medications through intermittent
844 positive pressure breathing machines or a nebulizer.
845 Section 10. Subsections (2), (5), and (6) of section
846 429.28, Florida Statutes, are amended to read:
847 429.28 Resident bill of rights.—
848 (2) The administrator of a facility shall ensure that a
849 written notice of the rights, obligations, and prohibitions set
850 forth in this part is posted in a prominent place in each
851 facility and read or explained to residents who cannot read. The
852 This notice must shall include the name, address, and telephone
853 numbers of the local ombudsman council, the and central abuse
854 hotline, and, if when applicable, Disability Rights Florida the
855 Advocacy Center for Persons with Disabilities, Inc., and the
856 Florida local advocacy council, where complaints may be lodged.
857 The notice must state that a complaint made to the Office of
858 State Long-Term Care Ombudsman or a local long-term care
859 ombudsman council, the names and identities of the residents
860 involved in the complaint, and the identity of complainants are
861 kept confidential pursuant to s. 400.0077 and that retaliatory
862 action cannot be taken against a resident for presenting
863 grievances or for exercising any other resident right. The
864 facility must ensure a resident’s access to a telephone to call
865 the local ombudsman council, central abuse hotline, and
866 Disability Rights Florida Advocacy Center for Persons with
867 Disabilities, Inc., and the Florida local advocacy council.
868 (5) A No facility or employee of a facility may not serve
869 notice upon a resident to leave the premises or take any other
870 retaliatory action against any person who:
871 (a) Exercises any right set forth in this section.
872 (b) Appears as a witness in any hearing, inside or outside
873 the facility.
874 (c) Files a civil action alleging a violation of the
875 provisions of this part or notifies a state attorney or the
876 Attorney General of a possible violation of such provisions.
877 (6) A Any facility that which terminates the residency of
878 an individual who participated in activities specified in
879 subsection (5) must shall show good cause in a court of
880 competent jurisdiction. If good cause is not shown, the agency
881 shall impose a fine of $2,500 in addition to any other penalty
882 assessed against the facility.
883 Section 11. Section 429.34, Florida Statutes, is amended to
884 read:
885 429.34 Right of entry and inspection.—
886 (1) In addition to the requirements of s. 408.811, any duly
887 designated officer or employee of the department, the Department
888 of Children and Families Family Services, the Medicaid Fraud
889 Control Unit of the Office of the Attorney General, the state or
890 local fire marshal, or a member of the state or local long-term
891 care ombudsman council has shall have the right to enter
892 unannounced upon and into the premises of any facility licensed
893 pursuant to this part in order to determine the state of
894 compliance with the provisions of this part, part II of chapter
895 408, and applicable rules. Data collected by the state or local
896 long-term care ombudsman councils or the state or local advocacy
897 councils may be used by the agency in investigations involving
898 violations of regulatory standards. A person specified in this
899 section who knows or has reasonable cause to suspect that a
900 vulnerable adult has been or is being abused, neglected, or
901 exploited shall immediately report such knowledge or suspicion
902 to the central abuse hotline pursuant to chapter 415.
903 (2) The agency shall inspect each licensed assisted living
904 facility at least once every 24 months to determine compliance
905 with this chapter and related rules. If an assisted living
906 facility is cited for one or more class I violations or two or
907 more class II violations arising from separate surveys within a
908 60-day period or due to unrelated circumstances during the same
909 survey, the agency must conduct an additional licensure
910 inspection within 6 months. In addition to any fines imposed on
911 the facility under s. 429.19, the licensee shall pay a fee for
912 the cost of the additional inspection equivalent to the standard
913 assisted living facility license and per-bed fees, without
914 exception for beds designated for recipients of optional state
915 supplementation. The agency shall adjust the fee in accordance
916 with s. 408.805.
917 Section 12. Subsection (2) of section 429.41, Florida
918 Statutes, is amended to read:
919 429.41 Rules establishing standards.—
920 (2) In adopting any rules pursuant to this part, the
921 department, in conjunction with the agency, shall make distinct
922 standards for facilities based upon facility size; the types of
923 care provided; the physical and mental capabilities and needs of
924 residents; the type, frequency, and amount of services and care
925 offered; and the staffing characteristics of the facility. Rules
926 developed pursuant to this section may shall not restrict the
927 use of shared staffing and shared programming in facilities that
928 are part of retirement communities that provide multiple levels
929 of care and otherwise meet the requirements of law and rule. If
930 a continuing care facility licensed under chapter 651 or a
931 retirement community offering multiple levels of care licenses a
932 building or part of a building designated for independent living
933 for assisted living, staffing requirements established in rule
934 apply only to residents who receive personal, limited nursing,
935 or extended congregate care services under this part. Such
936 facilities shall retain a log listing the names and unit number
937 for residents receiving these services. The log must be
938 available to surveyors upon request. Except for uniform
939 firesafety standards, the department shall adopt by rule
940 separate and distinct standards for facilities with 16 or fewer
941 beds and for facilities with 17 or more beds. The standards for
942 facilities with 16 or fewer beds must shall be appropriate for a
943 noninstitutional residential environment;, however, provided
944 that the structure may not be is no more than two stories in
945 height and all persons who cannot exit the facility unassisted
946 in an emergency must reside on the first floor. The department,
947 in conjunction with the agency, may make other distinctions
948 among types of facilities as necessary to enforce the provisions
949 of this part. Where appropriate, the agency shall offer
950 alternate solutions for complying with established standards,
951 based on distinctions made by the department and the agency
952 relative to the physical characteristics of facilities and the
953 types of care offered therein.
954 Section 13. Present subsections (1) through (11) of section
955 429.52, Florida Statutes, are renumbered as subsections (2)
956 through (12), respectively, a new subsection (1) is added to
957 that section, and present subsections (5) and (9) of that
958 section are amended, to read:
959 429.52 Staff training and educational programs; core
960 educational requirement.—
961 (1) Effective October 1, 2014, each new assisted living
962 facility employee who has not previously completed core training
963 must attend a preservice orientation provided by the facility
964 before interacting with residents. The preservice orientation
965 must be at least 2 hours in duration and cover topics that help
966 the employee provide responsible care and respond to the needs
967 of facility residents. Upon completion, the employee and the
968 administrator of the facility must sign a statement that the
969 employee completed the required pre-service orientation. The
970 facility must keep the signed statement in the employee’s
971 personnel record.
972 (6)(5) Staff involved with the management of medications
973 and assisting with the self-administration of medications under
974 s. 429.256 must complete a minimum of 6 4 additional hours of
975 training provided by a registered nurse, licensed pharmacist, or
976 department staff. The department shall establish by rule the
977 minimum requirements of this additional training.
978 (10)(9) The training required by this section other than
979 the preservice orientation must shall be conducted by persons
980 registered with the department as having the requisite
981 experience and credentials to conduct the training. A person
982 seeking to register as a trainer must provide the department
983 with proof of completion of the minimum core training education
984 requirements, successful passage of the competency test
985 established under this section, and proof of compliance with the
986 continuing education requirement in subsection (5)(4).
987 Section 14. The Legislature finds that consistent
988 regulation of assisted living facilities benefits residents and
989 operators of such facilities. To determine whether surveys are
990 consistent between surveys and surveyors, the Office of Program
991 Policy Analysis and Government Accountability (OPPAGA) shall
992 conduct a study of intersurveyor reliability for assisted living
993 facilities. By November 1, 2014, OPPAGA shall report its
994 findings to the Governor, the President of the Senate, and the
995 Speaker of the House of Representatives and make any
996 recommendations for improving intersurveyor reliability.
997 Section 15. The Legislature finds that consumers need
998 additional information on the quality of care and service in
999 assisted living facilities in order to select the best facility
1000 for themselves or their loved ones. Therefore, the Agency for
1001 Health Care Administration shall:
1002 (1) Implement a rating system for assisted living
1003 facilities by March 1, 2015 . The agency shall adopt rules to
1004 administer this subsection.
1005 (2) By November 1, 2014 create content that is easily
1006 accessible through the front page of the agency’s website. At a
1007 minimum, the content must include:
1008 (a) Information on each licensed assisted living facility,
1009 including, but not limited to:
1010 1. The name and address of the facility.
1011 2. The number and type of licensed beds in the facility.
1012 3. The types of licenses held by the facility.
1013 4. The facility’s license expiration date and status.
1014 5. Other relevant information that the agency currently
1015 collects.
1016 (b) A list of the facility’s violations, including, for
1017 each violation:
1018 1. A summary of the violation which is presented in a
1019 manner understandable by the general public;
1020 2. Any sanctions imposed by final order; and
1021 3. The date the corrective action was confirmed by the
1022 agency.
1023 (c) Links to inspection reports that the agency has on
1024 file.
1025 (d) A monitored comment page, maintained by the agency,
1026 which allows members of the public to anonymously comment on
1027 assisted living facilities that are licensed to operate in this
1028 state. This comment page must, at a minimum, allow members of
1029 the public to post comments on their experiences with, or
1030 observations of, an assisted living facility and to review other
1031 people’s comments. Comments posted to the agency’s comment page
1032 may not contain profanity and are intended to provide meaningful
1033 feedback about the assisted living facility. The agency shall
1034 review comments for profane content before the comments are
1035 posted to the page. A controlling interest, as defined in s.
1036 408.803, Florida Statutes, in an assisted living facility, or an
1037 employee or owner of an assisted living facility, is prohibited
1038 from posting comments on the page, except that a controlling
1039 interest, employee, or owner may respond to comments on the
1040 page, and the agency shall ensure that the responses are
1041 identified as being from a representative of the facility.
1042 Section 16. This act shall take effect July 1, 2014.