Florida Senate - 2014                                     SB 248
       
       
        
       By the Committee on Children, Families, and Elder Affairs
       
       
       
       
       
       586-00461-14                                           2014248__
    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.; requiring
   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 nursing home residents; requiring a local
   34         council to conduct an exit consultation with the
   35         facility administrator or administrator designee to
   36         discuss issues and concerns in areas affecting the
   37         rights, health, safety, and welfare of residents and
   38         make recommendations for improvement; amending s.
   39         400.0078, F.S.; requiring that a resident or a
   40         representative of a resident of a long-term care
   41         facility be informed that retaliatory action cannot be
   42         taken against a resident for presenting grievances or
   43         for exercising any other resident right; amending s.
   44         429.02, F.S.; conforming a cross-reference; providing
   45         a definition; amending s. 429.07, F.S.; requiring that
   46         an extended congregate care license be issued to
   47         certain facilities that have been licensed as assisted
   48         living facilities under certain circumstances and
   49         authorizing the issuance of such license if a
   50         specified condition is met; providing the purpose of
   51         an extended congregate care license; providing that
   52         the initial extended congregate care license of an
   53         assisted living facility is provisional under certain
   54         circumstances; requiring a licensee to notify the
   55         Agency for Health Care Administration if it accepts a
   56         resident who qualifies for extended congregate care
   57         services; requiring the agency to inspect the facility
   58         for compliance with the requirements of an extended
   59         congregate care license; requiring the issuance of an
   60         extended congregate care license under certain
   61         circumstances; requiring the licensee to immediately
   62         suspend extended congregate care services under
   63         certain circumstances; requiring a registered nurse
   64         representing the agency to visit the facility at least
   65         twice a year, rather than quarterly, to monitor
   66         residents who are receiving extended congregate care
   67         services; authorizing the agency to waive one of the
   68         required yearly monitoring visits under certain
   69         circumstances; authorizing the agency to deny or
   70         revoke a facility’s extended congregate care license;
   71         requiring a registered nurse representing the agency
   72         to visit the facility at least annually, rather than
   73         twice a year, to monitor residents who are receiving
   74         limited nursing services; providing that such
   75         monitoring visits may be conducted in conjunction with
   76         other agency inspections; authorizing the agency to
   77         waive the required yearly monitoring visit for a
   78         facility that is licensed to provide limited nursing
   79         services under certain circumstances; amending s.
   80         429.075, F.S.; requiring an assisted living facility
   81         that serves one or more mental health residents to
   82         obtain a limited mental health license; amending s.
   83         429.14, F.S.; revising the circumstances under which
   84         the agency may deny, revoke, or suspend the license of
   85         an assisted living facility and impose an
   86         administrative fine; requiring the agency to deny or
   87         revoke the license of an assisted living facility
   88         under certain circumstances; requiring the agency to
   89         impose an immediate moratorium on the license of an
   90         assisted living facility under certain circumstances;
   91         deleting a provision requiring the agency to provide a
   92         list of facilities with denied, suspended, or revoked
   93         licenses to the Department of Business and
   94         Professional Regulation; exempting a facility from the
   95         45-day notice requirement if it is required to
   96         relocate some or all of its residents; amending s.
   97         429.178, F.S.; conforming cross-references; amending
   98         s. 429.19, F.S.; revising the amounts and uses of
   99         administrative fines; requiring the agency to levy a
  100         fine for violations that are corrected before an
  101         inspection if noncompliance occurred within a
  102         specified period of time; deleting factors that the
  103         agency is required to consider in determining
  104         penalties and fines; amending s. 429.256, F.S.;
  105         revising the term “assistance with self-administration
  106         of medication” as it relates to the Assisted Living
  107         Facilities Act; amending s. 429.28, F.S.; providing
  108         notice requirements to inform facility residents that
  109         the identity of the resident and complainant in any
  110         complaint made to the State Long-Term Care Ombudsman
  111         Program or a local long-term care ombudsman council is
  112         confidential and that retaliatory action cannot be
  113         taken against a resident for presenting grievances or
  114         for exercising any other resident right; requiring
  115         that a facility that terminates an individual’s
  116         residency after the filing of a complaint be fined if
  117         good cause is not shown for the termination; amending
  118         s. 429.34, F.S.; requiring certain persons to report
  119         elder abuse in assisted living facilities; requiring
  120         the agency to regularly inspect every licensed
  121         assisted living facility; requiring the agency to
  122         conduct more frequent inspections under certain
  123         circumstances; requiring the licensee to pay a fee for
  124         the cost of additional inspections; requiring the
  125         agency to annually adjust the fee; amending s. 429.41,
  126         F.S.; providing that certain staffing requirements
  127         apply only to residents in continuing care facilities
  128         who are receiving the relevant service; amending s.
  129         429.52, F.S.; requiring each newly hired employee of
  130         an assisted living facility to attend a preservice
  131         orientation provided by the assisted living facility;
  132         requiring the administrator to attest to the
  133         completion of the preservice orientation; requiring
  134         two additional hours of training for assistance with
  135         medication; conforming a cross-reference; creating s.
  136         429.55, F.S.; providing that a facility may apply for
  137         a flexible bed license; requiring a facility that has
  138         a flexible bed license to keep a log, specify certain
  139         information in a flexible bed contract, and retain
  140         certain records; requiring a licensed flexible bed
  141         facility to provide state surveyors with access to the
  142         log and certain independent living units; authorizing
  143         state surveyors to interview certain residents;
  144         providing that a flexible bed license does not
  145         preclude a resident from obtaining certain services;
  146         requiring the Office of Program Policy Analysis and
  147         Government Accountability to study the reliability of
  148         facility surveys and submit to the Governor and the
  149         Legislature its findings and recommendations;
  150         requiring the agency to implement a rating system of
  151         assisted living facilities by a specified date, adopt
  152         rules, and create content for the agency’s website
  153         that makes available to consumers information
  154         regarding assisted living facilities; providing
  155         criteria for the content; providing an effective date.
  156          
  157  Be It Enacted by the Legislature of the State of Florida:
  158  
  159         Section 1. Section 394.4574, Florida Statutes, is amended
  160  to read:
  161         394.4574 Department Responsibilities for coordination of
  162  services for a mental health resident who resides in an assisted
  163  living facility that holds a limited mental health license.—
  164         (1) As used in this section, the term “mental health
  165  resident” “mental health resident,” for purposes of this
  166  section, means an individual who receives social security
  167  disability income due to a mental disorder as determined by the
  168  Social Security Administration or receives supplemental security
  169  income due to a mental disorder as determined by the Social
  170  Security Administration and receives optional state
  171  supplementation.
  172         (2) Medicaid prepaid behavioral health plans are
  173  responsible for enrolled mental health residents, and managing
  174  entities under contract with the department are responsible for
  175  mental health residents who are not enrolled with a Medicaid
  176  prepaid behavioral health plan. A Medicaid prepaid behavioral
  177  health plan or a managing entity, as appropriate, shall The
  178  department must ensure that:
  179         (a) A mental health resident has been assessed by a
  180  psychiatrist, clinical psychologist, clinical social worker, or
  181  psychiatric nurse, or an individual who is supervised by one of
  182  these professionals, and determined to be appropriate to reside
  183  in an assisted living facility. The documentation must be
  184  provided to the administrator of the facility within 30 days
  185  after the mental health resident has been admitted to the
  186  facility. An evaluation completed upon discharge from a state
  187  mental hospital meets the requirements of this subsection
  188  related to appropriateness for placement as a mental health
  189  resident if it was completed within 90 days before prior to
  190  admission to the facility.
  191         (b) A cooperative agreement, as required in s. 429.075, is
  192  developed by between the mental health care services provider
  193  that serves a mental health resident and the administrator of
  194  the assisted living facility with a limited mental health
  195  license in which the mental health resident is living. Any
  196  entity that provides Medicaid prepaid health plan services shall
  197  ensure the appropriate coordination of health care services with
  198  an assisted living facility in cases where a Medicaid recipient
  199  is both a member of the entity’s prepaid health plan and a
  200  resident of the assisted living facility. If the entity is at
  201  risk for Medicaid targeted case management and behavioral health
  202  services, the entity shall inform the assisted living facility
  203  of the procedures to follow should an emergent condition arise.
  204         (c) The community living support plan, as defined in s.
  205  429.02, has been prepared by a mental health resident and his or
  206  her a mental health case manager of that resident in
  207  consultation with the administrator of the facility or the
  208  administrator’s designee. The plan must be completed and
  209  provided to the administrator of the assisted living facility
  210  with a limited mental health license in which the mental health
  211  resident lives upon the resident’s admission. The support plan
  212  and the agreement may be in one document.
  213         (d) The assisted living facility with a limited mental
  214  health license is provided with documentation that the
  215  individual meets the definition of a mental health resident.
  216         (e) The mental health services provider assigns a case
  217  manager to each mental health resident for whom the entity is
  218  responsible who lives in an assisted living facility with a
  219  limited mental health license. The case manager shall coordinate
  220  is responsible for coordinating the development of and
  221  implementation of the community living support plan defined in
  222  s. 429.02. The plan must be updated at least annually, or when
  223  there is a significant change in the resident’s behavioral
  224  health status, such as an inpatient admission or a change in
  225  medication, level of service, or residence. Each case manager
  226  shall keep a record of the date and time of any face-to-face
  227  interaction with the resident and make the record available to
  228  the responsible entity for inspection. The record must be
  229  retained for at least 2 years after the date of the most recent
  230  interaction.
  231         (f)Adequate and consistent monitoring and enforcement of
  232  community living support plans and cooperative agreements are
  233  conducted by the resident’s case manager.
  234         (g) Concerns are reported to the appropriate regulatory
  235  oversight organization if a regulated provider fails to deliver
  236  appropriate services or otherwise acts in a manner that has the
  237  potential to result in harm to the resident.
  238         (3) The Secretary of Children and Families Family Services,
  239  in consultation with the Agency for Health Care Administration,
  240  shall annually require each district administrator to develop,
  241  with community input, a detailed annual plan that demonstrates
  242  detailed plans that demonstrate how the district will ensure the
  243  provision of state-funded mental health and substance abuse
  244  treatment services to residents of assisted living facilities
  245  that hold a limited mental health license. This plan These plans
  246  must be consistent with the substance abuse and mental health
  247  district plan developed pursuant to s. 394.75 and must address
  248  case management services; access to consumer-operated drop-in
  249  centers; access to services during evenings, weekends, and
  250  holidays; supervision of the clinical needs of the residents;
  251  and access to emergency psychiatric care.
  252         Section 2. Subsection (1) of section 400.0074, Florida
  253  Statutes, is amended, and paragraph (h) is added to subsection
  254  (2) of that section, to read:
  255         400.0074 Local ombudsman council onsite administrative
  256  assessments.—
  257         (1) In addition to any specific investigation conducted
  258  pursuant to a complaint, the local council shall conduct, at
  259  least annually, an onsite administrative assessment of each
  260  nursing home, assisted living facility, and adult family-care
  261  home within its jurisdiction. This administrative assessment
  262  must be comprehensive in nature and must shall focus on factors
  263  affecting residents’ the rights, health, safety, and welfare of
  264  the residents. Each local council is encouraged to conduct a
  265  similar onsite administrative assessment of each additional
  266  long-term care facility within its jurisdiction.
  267         (2) An onsite administrative assessment conducted by a
  268  local council shall be subject to the following conditions:
  269         (h) The local council shall conduct an exit consultation
  270  with the facility administrator or administrator designee to
  271  discuss issues and concerns in areas affecting residents’
  272  rights, health, safety, and welfare and, if needed, make
  273  recommendations for improvement.
  274         Section 3. Subsection (2) of section 400.0078, Florida
  275  Statutes, is amended to read:
  276         400.0078 Citizen access to State Long-Term Care Ombudsman
  277  Program services.—
  278         (2) Every resident or representative of a resident shall
  279  receive, Upon admission to a long-term care facility, each
  280  resident or representative of a resident must receive
  281  information regarding the purpose of the State Long-Term Care
  282  Ombudsman Program, the statewide toll-free telephone number for
  283  receiving complaints, information that retaliatory action cannot
  284  be taken against a resident for presenting grievances or for
  285  exercising any other resident right, and other relevant
  286  information regarding how to contact the program. Each resident
  287  or his or her representative Residents or their representatives
  288  must be furnished additional copies of this information upon
  289  request.
  290         Section 4. Subsection (11) of section 429.02, Florida
  291  Statutes, is amended, present subsections (12) through (26) of
  292  that section are redesignated as subsections (13) through (27),
  293  respectively, and a new subsection (12) is added to that
  294  section, to read:
  295         429.02 Definitions.—When used in this part, the term:
  296         (11) “Extended congregate care” means acts beyond those
  297  authorized in subsection (17) which (16) that may be performed
  298  by persons licensed under pursuant to part I of chapter 464 by
  299  persons licensed thereunder while carrying out their
  300  professional duties, and other supportive services which may be
  301  specified by rule. The purpose of such services is to enable
  302  residents to age in place in a residential environment despite
  303  mental or physical limitations that might otherwise disqualify
  304  them from residency in a facility licensed under this part.
  305         (12) “Flexible bed” means a licensed bed designated to
  306  allow a continuing care facility licensed under chapter 651 or a
  307  retirement community that offers other services pursuant to this
  308  part in addition to nursing home, home health, or adult day care
  309  services licensed under this chapter or chapter 400 on a single
  310  campus to provide assisted living services for up to 15 percent
  311  of independent living residents residing in residential units
  312  designated for independent living on the campus. A flexible bed
  313  allows a resident who needs personal care services, but who does
  314  not require a secure care setting, to age in place. A flexible
  315  bed is reserved for individuals who have been a contract holder
  316  of a facility licensed under chapter 651 or a resident of a
  317  retirement community for at least 6 months.
  318         Section 5. Paragraphs (b) and (c) of subsection (3) of
  319  section 429.07, Florida Statutes, are amended to read:
  320         429.07 License required; fee.—
  321         (3) In addition to the requirements of s. 408.806, each
  322  license granted by the agency must state the type of care for
  323  which the license is granted. Licenses shall be issued for one
  324  or more of the following categories of care: standard, extended
  325  congregate care, limited nursing services, or limited mental
  326  health.
  327         (b) An extended congregate care license shall be issued to
  328  each facility that has been licensed as an assisted living
  329  facility for 2 or more years and that provides services
  330  facilities providing, directly or through contract, services
  331  beyond those authorized in paragraph (a), including services
  332  performed by persons licensed under part I of chapter 464 and
  333  supportive services, as defined by rule, to persons who would
  334  otherwise be disqualified from continued residence in a facility
  335  licensed under this part. An extended congregate care license
  336  may be issued to a facility that has a provisional extended
  337  congregate care license and meets the requirements for licensure
  338  under subparagraph 2. The primary purpose of extended congregate
  339  care services is to allow residents the option of remaining in a
  340  familiar setting from which they would otherwise be disqualified
  341  for continued residency as they become more impaired. A facility
  342  licensed to provide extended congregate care services may also
  343  admit an individual who exceeds the admission criteria for a
  344  facility with a standard license, if he or she is determined
  345  appropriate for admission to the extended congregate care
  346  facility.
  347         1. In order for extended congregate care services to be
  348  provided, the agency must first determine that all requirements
  349  established in law and rule are met and must specifically
  350  designate, on the facility’s license, that such services may be
  351  provided and whether the designation applies to all or part of
  352  the facility. This Such designation may be made at the time of
  353  initial licensure or relicensure, or upon request in writing by
  354  a licensee under this part and part II of chapter 408. The
  355  notification of approval or the denial of the request shall be
  356  made in accordance with part II of chapter 408. Each existing
  357  facility that qualifies facilities qualifying to provide
  358  extended congregate care services must have maintained a
  359  standard license and may not have been subject to administrative
  360  sanctions during the previous 2 years, or since initial
  361  licensure if the facility has been licensed for less than 2
  362  years, for any of the following reasons:
  363         a. A class I or class II violation;
  364         b. Three or more repeat or recurring class III violations
  365  of identical or similar resident care standards from which a
  366  pattern of noncompliance is found by the agency;
  367         c. Three or more class III violations that were not
  368  corrected in accordance with the corrective action plan approved
  369  by the agency;
  370         d. Violation of resident care standards which results in
  371  requiring the facility to employ the services of a consultant
  372  pharmacist or consultant dietitian;
  373         e. Denial, suspension, or revocation of a license for
  374  another facility licensed under this part in which the applicant
  375  for an extended congregate care license has at least 25 percent
  376  ownership interest; or
  377         f. Imposition of a moratorium pursuant to this part or part
  378  II of chapter 408 or initiation of injunctive proceedings.
  379  
  380  The agency may deny or revoke a facility’s extended congregate
  381  care license for not meeting the criteria for an extended
  382  congregate care license as provided in this subparagraph.
  383         2.If an assisted living facility has been licensed for
  384  less than 2 years but meets all other licensure requirements for
  385  an extended congregate care license, it shall be issued a
  386  provisional extended congregate care license for a period of 6
  387  months. Within the first 3 months after the provisional license
  388  is issued, the licensee shall notify the agency when it has
  389  admitted an extended congregate care resident, after which an
  390  unannounced inspection shall be made to determine compliance
  391  with requirements of an extended congregate care license. If the
  392  licensee demonstrates compliance with all of the requirements of
  393  an extended congregate care license during the inspection, the
  394  licensee shall be issued an extended congregate care license. In
  395  addition to sanctions authorized under this part, if violations
  396  are found during the inspection and the licensee fails to
  397  demonstrate compliance with all assisted living requirements
  398  during a followup inspection, the licensee shall immediately
  399  suspend extended congregate care services, and the provisional
  400  extended congregate care license expires.
  401         3.2. A facility that is licensed to provide extended
  402  congregate care services shall maintain a written progress
  403  report on each person who receives services which describes the
  404  type, amount, duration, scope, and outcome of services that are
  405  rendered and the general status of the resident’s health. A
  406  registered nurse, or appropriate designee, representing the
  407  agency shall visit the facility at least twice a year quarterly
  408  to monitor residents who are receiving extended congregate care
  409  services and to determine if the facility is in compliance with
  410  this part, part II of chapter 408, and relevant rules. One of
  411  the visits may be in conjunction with the regular survey. The
  412  monitoring visits may be provided through contractual
  413  arrangements with appropriate community agencies. A registered
  414  nurse shall serve as part of the team that inspects the
  415  facility. The agency may waive one of the required yearly
  416  monitoring visits for a facility that has:
  417         a. Held an extended congregate care license for at least 24
  418  months; been licensed for at least 24 months to provide extended
  419  congregate care services, if, during the inspection, the
  420  registered nurse determines that extended congregate care
  421  services are being provided appropriately, and if the facility
  422  has
  423         b. No class I or class II violations and no uncorrected
  424  class III violations; and.
  425         c. No confirmed ombudsman council complaints that resulted
  426  in a citation for licensure The agency must first consult with
  427  the long-term care ombudsman council for the area in which the
  428  facility is located to determine if any complaints have been
  429  made and substantiated about the quality of services or care.
  430  The agency may not waive one of the required yearly monitoring
  431  visits if complaints have been made and substantiated.
  432         4.3. A facility that is licensed to provide extended
  433  congregate care services must:
  434         a. Demonstrate the capability to meet unanticipated
  435  resident service needs.
  436         b. Offer a physical environment that promotes a homelike
  437  setting, provides for resident privacy, promotes resident
  438  independence, and allows sufficient congregate space as defined
  439  by rule.
  440         c. Have sufficient staff available, taking into account the
  441  physical plant and firesafety features of the building, to
  442  assist with the evacuation of residents in an emergency.
  443         d. Adopt and follow policies and procedures that maximize
  444  resident independence, dignity, choice, and decisionmaking to
  445  permit residents to age in place, so that moves due to changes
  446  in functional status are minimized or avoided.
  447         e. Allow residents or, if applicable, a resident’s
  448  representative, designee, surrogate, guardian, or attorney in
  449  fact to make a variety of personal choices, participate in
  450  developing service plans, and share responsibility in
  451  decisionmaking.
  452         f. Implement the concept of managed risk.
  453         g. Provide, directly or through contract, the services of a
  454  person licensed under part I of chapter 464.
  455         h. In addition to the training mandated in s. 429.52,
  456  provide specialized training as defined by rule for facility
  457  staff.
  458         5.4. A facility that is licensed to provide extended
  459  congregate care services is exempt from the criteria for
  460  continued residency set forth in rules adopted under s. 429.41.
  461  A licensed facility must adopt its own requirements within
  462  guidelines for continued residency set forth by rule. However,
  463  the facility may not serve residents who require 24-hour nursing
  464  supervision. A licensed facility that provides extended
  465  congregate care services must also provide each resident with a
  466  written copy of facility policies governing admission and
  467  retention.
  468         5. The primary purpose of extended congregate care services
  469  is to allow residents, as they become more impaired, the option
  470  of remaining in a familiar setting from which they would
  471  otherwise be disqualified for continued residency. A facility
  472  licensed to provide extended congregate care services may also
  473  admit an individual who exceeds the admission criteria for a
  474  facility with a standard license, if the individual is
  475  determined appropriate for admission to the extended congregate
  476  care facility.
  477         6. Before the admission of an individual to a facility
  478  licensed to provide extended congregate care services, the
  479  individual must undergo a medical examination as provided in s.
  480  429.26(4) and the facility must develop a preliminary service
  481  plan for the individual.
  482         7. If When a facility can no longer provide or arrange for
  483  services in accordance with the resident’s service plan and
  484  needs and the facility’s policy, the facility must shall make
  485  arrangements for relocating the person in accordance with s.
  486  429.28(1)(k).
  487         8. Failure to provide extended congregate care services may
  488  result in denial of extended congregate care license renewal.
  489         (c) A limited nursing services license shall be issued to a
  490  facility that provides services beyond those authorized in
  491  paragraph (a) and as specified in this paragraph.
  492         1. In order for limited nursing services to be provided in
  493  a facility licensed under this part, the agency must first
  494  determine that all requirements established in law and rule are
  495  met and must specifically designate, on the facility’s license,
  496  that such services may be provided. This Such designation may be
  497  made at the time of initial licensure or licensure renewal
  498  relicensure, or upon request in writing by a licensee under this
  499  part and part II of chapter 408. Notification of approval or
  500  denial of such request shall be made in accordance with part II
  501  of chapter 408. An existing facility that qualifies facilities
  502  qualifying to provide limited nursing services must shall have
  503  maintained a standard license and may not have been subject to
  504  administrative sanctions that affect the health, safety, and
  505  welfare of residents for the previous 2 years or since initial
  506  licensure if the facility has been licensed for less than 2
  507  years.
  508         2. A facility Facilities that is are licensed to provide
  509  limited nursing services shall maintain a written progress
  510  report on each person who receives such nursing services. The,
  511  which report must describe describes the type, amount, duration,
  512  scope, and outcome of services that are rendered and the general
  513  status of the resident’s health. A registered nurse representing
  514  the agency shall visit the facility such facilities at least
  515  annually twice a year to monitor residents who are receiving
  516  limited nursing services and to determine if the facility is in
  517  compliance with applicable provisions of this part, part II of
  518  chapter 408, and related rules. The monitoring visits may be
  519  provided through contractual arrangements with appropriate
  520  community agencies. A registered nurse shall also serve as part
  521  of the team that inspects such facility. Visits may be in
  522  conjunction with other agency inspections. The agency may waive
  523  the required yearly monitoring visit for a facility that has:
  524         a. Had a limited nursing services license for at least 24
  525  months;
  526         b. No class I or class II violations and no uncorrected
  527  class III violations; and
  528         c. No confirmed ombudsman council complaints that resulted
  529  in a citation for licensure.
  530         3. A person who receives limited nursing services under
  531  this part must meet the admission criteria established by the
  532  agency for assisted living facilities. When a resident no longer
  533  meets the admission criteria for a facility licensed under this
  534  part, arrangements for relocating the person shall be made in
  535  accordance with s. 429.28(1)(k), unless the facility is licensed
  536  to provide extended congregate care services.
  537         Section 6. Section 429.075, Florida Statutes, is amended to
  538  read:
  539         429.075 Limited mental health license.—An assisted living
  540  facility that serves one three or more mental health residents
  541  must obtain a limited mental health license.
  542         (1) To obtain a limited mental health license, a facility
  543  must hold a standard license as an assisted living facility,
  544  must not have any current uncorrected deficiencies or
  545  violations, and must ensure that, within 6 months after
  546  receiving a limited mental health license, the facility
  547  administrator and the staff of the facility who are in direct
  548  contact with mental health residents must complete training of
  549  no less than 6 hours related to their duties. This Such
  550  designation may be made at the time of initial licensure or
  551  relicensure or upon request in writing by a licensee under this
  552  part and part II of chapter 408. Notification of approval or
  553  denial of such request shall be made in accordance with this
  554  part, part II of chapter 408, and applicable rules. This
  555  training must will be provided by or approved by the Department
  556  of Children and Families Family Services.
  557         (2) A facility that is Facilities licensed to provide
  558  services to mental health residents must shall provide
  559  appropriate supervision and staffing to provide for the health,
  560  safety, and welfare of such residents.
  561         (3) A facility that has a limited mental health license
  562  must:
  563         (a) Have a copy of each mental health resident’s community
  564  living support plan and the cooperative agreement with the
  565  mental health care services provider. The support plan and the
  566  agreement may be combined.
  567         (b) Have documentation that is provided by the Department
  568  of Children and Families Family Services that each mental health
  569  resident has been assessed and determined to be able to live in
  570  the community in an assisted living facility that has with a
  571  limited mental health license.
  572         (c) Make the community living support plan available for
  573  inspection by the resident, the resident’s legal guardian or,
  574  the resident’s health care surrogate, and other individuals who
  575  have a lawful basis for reviewing this document.
  576         (d) Assist the mental health resident in carrying out the
  577  activities identified in the individual’s community living
  578  support plan.
  579         (4) A facility that has with a limited mental health
  580  license may enter into a cooperative agreement with a private
  581  mental health provider. For purposes of the limited mental
  582  health license, the private mental health provider may act as
  583  the case manager.
  584         Section 7. Section 429.14, Florida Statutes, is amended to
  585  read:
  586         429.14 Administrative penalties.—
  587         (1) In addition to the requirements of part II of chapter
  588  408, the agency may deny, revoke, and suspend any license issued
  589  under this part and impose an administrative fine in the manner
  590  provided in chapter 120 against a licensee for a violation of
  591  any provision of this part, part II of chapter 408, or
  592  applicable rules, or for any of the following actions by a
  593  licensee, for the actions of any person subject to level 2
  594  background screening under s. 408.809, or for the actions of any
  595  facility staff employee:
  596         (a) An intentional or negligent act seriously affecting the
  597  health, safety, or welfare of a resident of the facility.
  598         (b) A The determination by the agency that the owner lacks
  599  the financial ability to provide continuing adequate care to
  600  residents.
  601         (c) Misappropriation or conversion of the property of a
  602  resident of the facility.
  603         (d) Failure to follow the criteria and procedures provided
  604  under part I of chapter 394 relating to the transportation,
  605  voluntary admission, and involuntary examination of a facility
  606  resident.
  607         (e) A citation for of any of the following violations
  608  deficiencies as specified in s. 429.19:
  609         1. One or more cited class I violations deficiencies.
  610         2. Three or more cited class II violations deficiencies.
  611         3. Five or more cited class III violations deficiencies
  612  that have been cited on a single survey and have not been
  613  corrected within the times specified.
  614         (f) Failure to comply with the background screening
  615  standards of this part, s. 408.809(1), or chapter 435.
  616         (g) Violation of a moratorium.
  617         (h) Failure of the license applicant, the licensee during
  618  relicensure, or a licensee that holds a provisional license to
  619  meet the minimum license requirements of this part, or related
  620  rules, at the time of license application or renewal.
  621         (i) An intentional or negligent life-threatening act in
  622  violation of the uniform firesafety standards for assisted
  623  living facilities or other firesafety standards which that
  624  threatens the health, safety, or welfare of a resident of a
  625  facility, as communicated to the agency by the local authority
  626  having jurisdiction or the State Fire Marshal.
  627         (j) Knowingly operating any unlicensed facility or
  628  providing without a license any service that must be licensed
  629  under this chapter or chapter 400.
  630         (k) Any act constituting a ground upon which application
  631  for a license may be denied.
  632         (2) Upon notification by the local authority having
  633  jurisdiction or by the State Fire Marshal, the agency may deny
  634  or revoke the license of an assisted living facility that fails
  635  to correct cited fire code violations that affect or threaten
  636  the health, safety, or welfare of a resident of a facility.
  637         (3) The agency may deny or revoke a license of an to any
  638  applicant or controlling interest as defined in part II of
  639  chapter 408 which has or had a 25 percent 25-percent or greater
  640  financial or ownership interest in any other facility that is
  641  licensed under this part, or in any entity licensed by this
  642  state or another state to provide health or residential care, if
  643  that which facility or entity during the 5 years prior to the
  644  application for a license closed due to financial inability to
  645  operate; had a receiver appointed or a license denied,
  646  suspended, or revoked; was subject to a moratorium; or had an
  647  injunctive proceeding initiated against it.
  648         (4) The agency shall deny or revoke the license of an
  649  assisted living facility if:
  650         (a)There are two moratoria, issued pursuant to this part
  651  or part II of chapter 408, within a 2-year period which are
  652  imposed by final order;
  653         (b)The facility is cited for two or more class I
  654  violations arising from unrelated circumstances during the same
  655  survey or investigation; or
  656         (c)The facility is cited for two or more class I
  657  violations arising from separate surveys or investigations
  658  within a 2-year period that has two or more class I violations
  659  that are similar or identical to violations identified by the
  660  agency during a survey, inspection, monitoring visit, or
  661  complaint investigation occurring within the previous 2 years.
  662         (5) An action taken by the agency to suspend, deny, or
  663  revoke a facility’s license under this part or part II of
  664  chapter 408, in which the agency claims that the facility owner
  665  or an employee of the facility has threatened the health,
  666  safety, or welfare of a resident of the facility, must be heard
  667  by the Division of Administrative Hearings of the Department of
  668  Management Services within 120 days after receipt of the
  669  facility’s request for a hearing, unless that time limitation is
  670  waived by both parties. The administrative law judge shall must
  671  render a decision within 30 days after receipt of a proposed
  672  recommended order.
  673         (6) As provided under s. 408.814, the agency shall impose
  674  an immediate moratorium on an assisted living facility that
  675  fails to provide the agency access to the facility or prohibits
  676  the agency from conducting a regulatory inspection. The licensee
  677  may not restrict agency staff in accessing and copying records
  678  or in conducting confidential interviews with facility staff or
  679  any individual who receives services from the facility provide
  680  to the Division of Hotels and Restaurants of the Department of
  681  Business and Professional Regulation, on a monthly basis, a list
  682  of those assisted living facilities that have had their licenses
  683  denied, suspended, or revoked or that are involved in an
  684  appellate proceeding pursuant to s. 120.60 related to the
  685  denial, suspension, or revocation of a license.
  686         (7) Agency notification of a license suspension or
  687  revocation, or denial of a license renewal, shall be posted and
  688  visible to the public at the facility.
  689         (8) If a facility is required to relocate some or all of
  690  its residents due to agency action, that facility is exempt from
  691  the 45-days’ notice requirement imposed under s. 429.28(1)(k).
  692  This subsection does not exempt the facility from any deadlines
  693  for corrective action set by the agency.
  694         Section 8. Paragraphs (a) and (b) of subsection (2) of
  695  section 429.178, Florida Statutes, are amended to read:
  696         429.178 Special care for persons with Alzheimer’s disease
  697  or other related disorders.—
  698         (2)(a) An individual who is employed by a facility that
  699  provides special care for residents who have with Alzheimer’s
  700  disease or other related disorders, and who has regular contact
  701  with such residents, must complete up to 4 hours of initial
  702  dementia-specific training developed or approved by the
  703  department. The training must shall be completed within 3 months
  704  after beginning employment and satisfy shall satisfy the core
  705  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  706         (b) A direct caregiver who is employed by a facility that
  707  provides special care for residents who have with Alzheimer’s
  708  disease or other related disorders, and who provides direct care
  709  to such residents, must complete the required initial training
  710  and 4 additional hours of training developed or approved by the
  711  department. The training must shall be completed within 9 months
  712  after beginning employment and satisfy shall satisfy the core
  713  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  714         Section 9. Section 429.19, Florida Statutes, is amended to
  715  read:
  716         429.19 Violations; imposition of administrative fines;
  717  grounds.—
  718         (1) In addition to the requirements of part II of chapter
  719  408, the agency shall impose an administrative fine in the
  720  manner provided in chapter 120 for the violation of any
  721  provision of this part, part II of chapter 408, and applicable
  722  rules by an assisted living facility, for the actions of any
  723  person subject to level 2 background screening under s. 408.809,
  724  for the actions of any facility employee, or for an intentional
  725  or negligent act seriously affecting the health, safety, or
  726  welfare of a resident of the facility.
  727         (2) Each violation of this part and adopted rules must
  728  shall be classified according to the nature of the violation and
  729  the gravity of its probable effect on facility residents. The
  730  agency shall indicate the classification on the written notice
  731  of the violation as follows:
  732         (a) Class “I” violations are defined in s. 408.813. The
  733  agency shall impose an administrative fine of $7,500 for each a
  734  cited class I violation in a facility that is licensed for fewer
  735  than 100 beds at the time of the violation in an amount not less
  736  than $5,000 and not exceeding $10,000 for each violation. The
  737  agency shall impose an administrative fine of $11,250 for each
  738  cited class I violation in a facility that is licensed for 100
  739  or more beds at the time of the violation. If the noncompliance
  740  occurred within the prior 12 months, the fine must be levied for
  741  violations that are corrected before an inspection.
  742         (b) Class “II” violations are defined in s. 408.813. The
  743  agency shall impose an administrative fine of $3,000 for each a
  744  cited class II violation in a facility that is licensed for
  745  fewer than 100 beds at the time of the violation in an amount
  746  not less than $1,000 and not exceeding $5,000 for each
  747  violation. The agency shall impose an administrative fine of
  748  $4,500 for each cited class II violation in a facility that is
  749  licensed for 100 or more beds at the time of the violation.
  750         (c) Class “III” violations are defined in s. 408.813. The
  751  agency shall impose an administrative fine of $750 for each a
  752  cited class III violation in a facility that is licensed for
  753  fewer than 100 beds at the time of the violation in an amount
  754  not less than $500 and not exceeding $1,000 for each violation.
  755  The agency shall impose an administrative fine of $1,125 for
  756  each cited class III violation in a facility that is licensed
  757  for 100 or more beds at the time of the violation.
  758         (d) Class “IV” violations are defined in s. 408.813. The
  759  agency shall impose an administrative fine of $150 for each a
  760  cited class IV violation in a facility that is licensed for
  761  fewer than 100 beds at the time of the violation in an amount
  762  not less than $100 and not exceeding $200 for each violation.
  763  The agency shall impose an administrative fine of $225 for each
  764  cited class IV violation in a facility that is licensed for 100
  765  or more beds at the time of the violation.
  766         (e) Any fine imposed for a class I violation or a class II
  767  violation must be doubled if a facility was previously cited for
  768  one or more class I or class II violations during the agency’s
  769  last licensure inspection or any inspection or complaint
  770  investigation since the last licensure inspection.
  771         (f) Notwithstanding s. 408.813(2)(c) and (d) and s.
  772  408.832, a fine must be imposed for each class III or class IV
  773  violation, regardless of correction, if a facility was
  774  previously cited for one or more class III or class IV
  775  violations during the agency’s last licensure inspection or any
  776  inspection or complaint investigation since the last licensure
  777  inspection for the same regulatory violation. A fine imposed for
  778  class III or class IV violations must be doubled if a facility
  779  was previously cited for one or more class III or class IV
  780  violations during the agency’s last two licensure inspections
  781  for the same regulatory violation.
  782         (g) Regardless of the class of violation cited, instead of
  783  the fine amounts listed in paragraphs (a)-(d), the agency shall
  784  impose an administrative fine of $500 if a facility is found not
  785  to be in compliance with the background screening requirements
  786  as provided in s. 408.809.
  787         (3) For purposes of this section, in determining if a
  788  penalty is to be imposed and in fixing the amount of the fine,
  789  the agency shall consider the following factors:
  790         (a) The gravity of the violation, including the probability
  791  that death or serious physical or emotional harm to a resident
  792  will result or has resulted, the severity of the action or
  793  potential harm, and the extent to which the provisions of the
  794  applicable laws or rules were violated.
  795         (b) Actions taken by the owner or administrator to correct
  796  violations.
  797         (c) Any previous violations.
  798         (d) The financial benefit to the facility of committing or
  799  continuing the violation.
  800         (e) The licensed capacity of the facility.
  801         (3)(4) Each day of continuing violation after the date
  802  established by the agency fixed for correction termination of
  803  the violation, as ordered by the agency, constitutes an
  804  additional, separate, and distinct violation.
  805         (4)(5)An Any action taken to correct a violation shall be
  806  documented in writing by the owner or administrator of the
  807  facility and verified through followup visits by agency
  808  personnel. The agency may impose a fine and, in the case of an
  809  owner-operated facility, revoke or deny a facility’s license
  810  when a facility administrator fraudulently misrepresents action
  811  taken to correct a violation.
  812         (5)(6)A Any facility whose owner fails to apply for a
  813  change-of-ownership license in accordance with part II of
  814  chapter 408 and operates the facility under the new ownership is
  815  subject to a fine of $5,000.
  816         (6)(7) In addition to any administrative fines imposed, the
  817  agency may assess a survey fee, equal to the lesser of one half
  818  of the facility’s biennial license and bed fee or $500, to cover
  819  the cost of conducting initial complaint investigations that
  820  result in the finding of a violation that was the subject of the
  821  complaint or monitoring visits conducted under s. 429.28(3)(c)
  822  to verify the correction of the violations.
  823         (7)(8) During an inspection, the agency shall make a
  824  reasonable attempt to discuss each violation with the owner or
  825  administrator of the facility, prior to written notification.
  826         (8)(9) The agency shall develop and disseminate an annual
  827  list of all facilities sanctioned or fined for violations of
  828  state standards, the number and class of violations involved,
  829  the penalties imposed, and the current status of cases. The list
  830  shall be disseminated, at no charge, to the Department of
  831  Elderly Affairs, the Department of Health, the Department of
  832  Children and Families Family Services, the Agency for Persons
  833  with Disabilities, the area agencies on aging, the Florida
  834  Statewide Advocacy Council, and the state and local ombudsman
  835  councils. The Department of Children and Families Family
  836  Services shall disseminate the list to service providers under
  837  contract to the department who are responsible for referring
  838  persons to a facility for residency. The agency may charge a fee
  839  commensurate with the cost of printing and postage to other
  840  interested parties requesting a copy of this list. This
  841  information may be provided electronically or through the
  842  agency’s website Internet site.
  843         Section 10. Subsection (3) and paragraph (c) of subsection
  844  (4) of section 429.256, Florida Statutes, are amended to read:
  845         429.256 Assistance with self-administration of medication.—
  846         (3) Assistance with self-administration of medication
  847  includes:
  848         (a) Taking the medication, in its previously dispensed,
  849  properly labeled container, including an insulin syringe that is
  850  prefilled with the proper dosage by a pharmacist and an insulin
  851  pen that is prefilled by the manufacturer, from where it is
  852  stored, and bringing it to the resident.
  853         (b) In the presence of the resident, reading the label,
  854  opening the container, removing a prescribed amount of
  855  medication from the container, and closing the container,
  856  including removing the cap of a nebulizer, opening the unit dose
  857  of nebulizer solution, and pouring the prescribed premeasured
  858  dose of medication into the dispensing cup of the nebulizer.
  859         (c) Placing an oral dosage in the resident’s hand or
  860  placing the dosage in another container and helping the resident
  861  by lifting the container to his or her mouth.
  862         (d) Applying topical medications.
  863         (e) Returning the medication container to proper storage.
  864         (f) Keeping a record of when a resident receives assistance
  865  with self-administration under this section.
  866         (g) Assisting with the use of a nebulizer.
  867         (h) Using a glucometer to perform blood-glucose level
  868  checks.
  869         (i) Assisting with putting on and taking off antiembolism
  870  stockings.
  871         (j) Assisting with applying and removing an oxygen cannula.
  872         (k) Assisting with the use of a continuous positive airway
  873  pressure (CPAP) device.
  874         (l) Assisting with measuring vital signs.
  875         (m) Assisting with colostomy bags.
  876         (4) Assistance with self-administration does not include:
  877         (c) Administration of medications through intermittent
  878  positive pressure breathing machines or a nebulizer.
  879         Section 11. Subsections (2), (5), and (6) of section
  880  429.28, Florida Statutes, are amended to read:
  881         429.28 Resident bill of rights.—
  882         (2) The administrator of a facility shall ensure that a
  883  written notice of the rights, obligations, and prohibitions set
  884  forth in this part is posted in a prominent place in each
  885  facility and read or explained to residents who cannot read. The
  886  This notice must shall include the name, address, and telephone
  887  numbers of the local ombudsman council, the and central abuse
  888  hotline, and, if when applicable, Disability Rights Florida the
  889  Advocacy Center for Persons with Disabilities, Inc., and the
  890  Florida local advocacy council, where complaints may be lodged.
  891  The notice must state that a complaint made to the Office of
  892  State Long-Term Care Ombudsman or a local long-term care
  893  ombudsman council, the names and identities of the residents
  894  involved in the complaint, and the identity of complainants are
  895  kept confidential pursuant to s. 400.0077 and that retaliatory
  896  action cannot be taken against a resident for presenting
  897  grievances or for exercising any other resident right. The
  898  facility must ensure a resident’s access to a telephone to call
  899  the local ombudsman council, central abuse hotline, and
  900  Disability Rights Florida Advocacy Center for Persons with
  901  Disabilities, Inc., and the Florida local advocacy council.
  902         (5) A No facility or employee of a facility may not serve
  903  notice upon a resident to leave the premises or take any other
  904  retaliatory action against any person who:
  905         (a) Exercises any right set forth in this section.
  906         (b) Appears as a witness in any hearing, inside or outside
  907  the facility.
  908         (c) Files a civil action alleging a violation of the
  909  provisions of this part or notifies a state attorney or the
  910  Attorney General of a possible violation of such provisions.
  911         (6) A Any facility that which terminates the residency of
  912  an individual who participated in activities specified in
  913  subsection (5) must shall show good cause in a court of
  914  competent jurisdiction. If good cause is not shown, the agency
  915  shall impose a fine of $2,500 in addition to any other penalty
  916  assessed against the facility.
  917         Section 12. Section 429.34, Florida Statutes, is amended to
  918  read:
  919         429.34 Right of entry and inspection.—
  920         (1) In addition to the requirements of s. 408.811, any duly
  921  designated officer or employee of the department, the Department
  922  of Children and Families Family Services, the Medicaid Fraud
  923  Control Unit of the Office of the Attorney General, the state or
  924  local fire marshal, or a member of the state or local long-term
  925  care ombudsman council has shall have the right to enter
  926  unannounced upon and into the premises of any facility licensed
  927  pursuant to this part in order to determine the state of
  928  compliance with the provisions of this part, part II of chapter
  929  408, and applicable rules. Data collected by the state or local
  930  long-term care ombudsman councils or the state or local advocacy
  931  councils may be used by the agency in investigations involving
  932  violations of regulatory standards. A person specified in this
  933  section who knows or has reasonable cause to suspect that a
  934  vulnerable adult has been or is being abused, neglected, or
  935  exploited shall immediately report such knowledge or suspicion
  936  to the central abuse hotline pursuant to chapter 415.
  937         (2) The agency shall inspect each licensed assisted living
  938  facility at least once every 24 months to determine compliance
  939  with this chapter and related rules. If an assisted living
  940  facility is cited for one or more class I violations or two or
  941  more class II violations arising from separate surveys within a
  942  60-day period or due to unrelated circumstances during the same
  943  survey, the agency must conduct an additional licensure
  944  inspection within 6 months. In addition to any fines imposed on
  945  the facility under s. 429.19, the licensee shall pay a fee for
  946  the cost of the additional inspection equivalent to the standard
  947  assisted living facility license and per-bed fees, without
  948  exception for beds designated for recipients of optional state
  949  supplementation. The agency shall adjust the fee in accordance
  950  with s. 408.805.
  951         Section 13. Subsection (2) of section 429.41, Florida
  952  Statutes, is amended to read:
  953         429.41 Rules establishing standards.—
  954         (2) In adopting any rules pursuant to this part, the
  955  department, in conjunction with the agency, shall make distinct
  956  standards for facilities based upon facility size; the types of
  957  care provided; the physical and mental capabilities and needs of
  958  residents; the type, frequency, and amount of services and care
  959  offered; and the staffing characteristics of the facility. Rules
  960  developed pursuant to this section may shall not restrict the
  961  use of shared staffing and shared programming in facilities that
  962  are part of retirement communities that provide multiple levels
  963  of care and otherwise meet the requirements of law and rule. If
  964  a continuing care facility licensed under chapter 651 or a
  965  retirement community offering multiple levels of care authorizes
  966  assisted living services in a building or part of a building
  967  designated for independent living, staffing requirements
  968  established in rule apply only to residents who have contracted
  969  for, and are receiving, assisted living services. If a facility
  970  uses flexible beds, staffing requirements established in rule
  971  apply only to residents receiving services through the flexible
  972  bed license provided for by department rule. Except for uniform
  973  firesafety standards, the department shall adopt by rule
  974  separate and distinct standards for facilities with 16 or fewer
  975  beds and for facilities with 17 or more beds. The standards for
  976  facilities with 16 or fewer beds must shall be appropriate for a
  977  noninstitutional residential environment;, however, provided
  978  that the structure may not be is no more than two stories in
  979  height and all persons who cannot exit the facility unassisted
  980  in an emergency must reside on the first floor. The department,
  981  in conjunction with the agency, may make other distinctions
  982  among types of facilities as necessary to enforce the provisions
  983  of this part. Where appropriate, the agency shall offer
  984  alternate solutions for complying with established standards,
  985  based on distinctions made by the department and the agency
  986  relative to the physical characteristics of facilities and the
  987  types of care offered therein.
  988         Section 14. Present subsections (1) through (11) of section
  989  429.52, Florida Statutes, are renumbered as subsections (2)
  990  through (12), respectively, a new subsection (1) is added to
  991  that section, and present subsections (5) and (9) of that
  992  section are amended, to read:
  993         429.52 Staff training and educational programs; core
  994  educational requirement.—
  995         (1) Effective October 1, 2014, each new assisted living
  996  facility employee who has not previously completed core training
  997  must attend a preservice orientation provided by the facility
  998  before interacting with residents. The preservice orientation
  999  must be at least 2 hours in duration and cover topics that help
 1000  the employee provide responsible care and respond to the needs
 1001  of facility residents. At the time of license renewal and as
 1002  part of the license renewal application, each administrator of a
 1003  facility licensed by the agency must attest, under penalty of
 1004  perjury, to compliance with the provisions of this subsection.
 1005         (6)(5) Staff involved with the management of medications
 1006  and assisting with the self-administration of medications under
 1007  s. 429.256 must complete a minimum of 6 4 additional hours of
 1008  training provided by a registered nurse, licensed pharmacist, or
 1009  department staff. The department shall establish by rule the
 1010  minimum requirements of this additional training.
 1011         (10)(9) The training required by this section other than
 1012  the preservice orientation must shall be conducted by persons
 1013  registered with the department as having the requisite
 1014  experience and credentials to conduct the training. A person
 1015  seeking to register as a trainer must provide the department
 1016  with proof of completion of the minimum core training education
 1017  requirements, successful passage of the competency test
 1018  established under this section, and proof of compliance with the
 1019  continuing education requirement in subsection (5)(4).
 1020         Section 15. Section 429.55, Florida Statutes, is created to
 1021  read:
 1022         429.55Facilities licensed for flexible beds.—
 1023         (1) Beginning January 1, 2015, a facility may apply for a
 1024  flexible bed license.
 1025         (2)A facility that has a flexible bed license shall:
 1026         (a) Retain a log that lists the name of each resident who
 1027  has contracted for and is receiving assisted living services in
 1028  flexible bed living units, the unit number in which the resident
 1029  resides, the date the contract for the services commenced, the
 1030  date that services ended in the flexible bed living unit if
 1031  applicable, and documentation to demonstrate that minimum
 1032  staffing standards are met;
 1033         (b) Specify in the flexible bed contract the process that
 1034  will be used to determine when a resident is no longer eligible
 1035  for services provided through the flexible bed license. This
 1036  contract for services must also outline if the delivery of
 1037  services in a flexible bed living unit will be covered under the
 1038  existing residency agreement or will require a fee for service
 1039  payment; and
 1040         (c) Retain each flexible bed contract for 5 years after the
 1041  assisted living services end. All other records must be retained
 1042  for at least 2 years from the date of termination of the
 1043  services.
 1044         (3) Upon request, a facility that has a flexible bed
 1045  license must provide state surveyors with access to the log
 1046  described in paragraph (2)(a). State surveyors shall also have
 1047  access to independent living units occupied by residents who are
 1048  receiving services through the flexible bed license at the time
 1049  of any survey. State surveyors may interview any resident who
 1050  has received services through the flexible bed license since the
 1051  last biennial survey, but who is no longer receiving such
 1052  services.
 1053         (4) A flexible bed license does not preclude a resident who
 1054  lives in a building that has such a license from obtaining home
 1055  health services in accordance with the policies of the facility.
 1056         Section 16. The Legislature finds that consistent
 1057  regulation of assisted living facilities benefits residents and
 1058  operators of such facilities. To determine whether surveys are
 1059  consistent between surveys and surveyors, the Office of Program
 1060  Policy Analysis and Government Accountability (OPPAGA) shall
 1061  conduct a study of intersurveyor reliability for assisted living
 1062  facilities. By November 1, 2014, OPPAGA shall report its
 1063  findings to the Governor, the President of the Senate, and the
 1064  Speaker of the House of Representatives and make any
 1065  recommendations for improving intersurveyor reliability.
 1066         Section 17. The Legislature finds that consumers need
 1067  additional information on the quality of care and service in
 1068  assisted living facilities in order to select the best facility
 1069  for themselves or their loved ones. Therefore, the Agency for
 1070  Health Care Administration shall:
 1071         (1)Implement a rating system for assisted living
 1072  facilities by November 1, 2014. The agency shall adopt rules to
 1073  administer this subsection.
 1074         (2) By January 1, 2015, create content that is easily
 1075  accessible through the front page of the agency’s website. At a
 1076  minimum, the content must include:
 1077         (a)Information on each licensed assisted living facility,
 1078  including, but not limited to:
 1079         1.The name and address of the facility.
 1080         2.The number and type of licensed beds in the facility.
 1081         3.The types of licenses held by the facility.
 1082         4.The facility’s license expiration date and status.
 1083         5.Other relevant information that the agency currently
 1084  collects.
 1085         (b) A list of the facility’s violations, including, for
 1086  each violation:
 1087         1. A summary of the violation which is presented in a
 1088  manner understandable by the general public;
 1089         2. Any sanctions imposed by final order; and
 1090         3. A summary of any corrective action taken by the
 1091  facility.
 1092         (c) Links to inspection reports that the agency has on
 1093  file.
 1094         (d)A monitored comment page, maintained by the agency,
 1095  which allows members of the public to anonymously comment on
 1096  assisted living facilities that are licensed to operate in this
 1097  state. This comment page must, at a minimum, allow members of
 1098  the public to post comments on their experiences with, or
 1099  observations of, an assisted living facility and to review other
 1100  people’s comments. Comments posted to the agency’s comment page
 1101  may not contain profanity and are intended to provide meaningful
 1102  feedback about the assisted living facility. The agency shall
 1103  review comments for profane content before the comments are
 1104  posted to the page. A controlling interest, as defined in s.
 1105  408.803, Florida Statutes, in an assisted living facility, or an
 1106  employee or owner of an assisted living facility, is prohibited
 1107  from posting comments on the page, except that a controlling
 1108  interest, employee, or owner may respond to comments on the
 1109  page, and the agency shall ensure that the responses are
 1110  identified as being from a representative of the facility.
 1111         Section 18. This act shall take effect July 1, 2014.