Florida Senate - 2014                          SENATOR AMENDMENT
       Bill No. CS/CS/HB 7113, 2nd Eng.
       
       
       
       
       
       
                                Ì182606(Î182606                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
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               Floor: 10/AD/2R         .                                
             05/01/2014 06:10 PM       .                                
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       Senator Sobel moved the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Between lines 1370 and 1371
    4  insert:
    5         Section 24. Section 394.4574, Florida Statutes, is amended
    6  to read:
    7         394.4574 Department Responsibilities for coordination of
    8  services for a mental health resident who resides in an assisted
    9  living facility that holds a limited mental health license.—
   10         (1) As used in this section, the term “mental health
   11  resident” “mental health resident,” for purposes of this
   12  section, means an individual who receives social security
   13  disability income due to a mental disorder as determined by the
   14  Social Security Administration or receives supplemental security
   15  income due to a mental disorder as determined by the Social
   16  Security Administration and receives optional state
   17  supplementation.
   18         (2) Medicaid managed care plans are responsible for
   19  Medicaid-enrolled mental health residents, and managing entities
   20  under contract with the department are responsible for mental
   21  health residents who are not enrolled in a Medicaid health plan.
   22  A Medicaid managed care plan or a managing entity, as
   23  appropriate, shall The department must ensure that:
   24         (a) A mental health resident has been assessed by a
   25  psychiatrist, clinical psychologist, clinical social worker, or
   26  psychiatric nurse, or an individual who is supervised by one of
   27  these professionals, and determined to be appropriate to reside
   28  in an assisted living facility. The documentation must be
   29  provided to the administrator of the facility within 30 days
   30  after the mental health resident has been admitted to the
   31  facility. An evaluation completed upon discharge from a state
   32  mental hospital meets the requirements of this subsection
   33  related to appropriateness for placement as a mental health
   34  resident if it was completed within 90 days before prior to
   35  admission to the facility.
   36         (b) A cooperative agreement, as required in s. 429.075, is
   37  developed by between the mental health care services provider
   38  that serves a mental health resident and the administrator of
   39  the assisted living facility with a limited mental health
   40  license in which the mental health resident is living. Any
   41  entity that provides Medicaid prepaid health plan services shall
   42  ensure the appropriate coordination of health care services with
   43  an assisted living facility in cases where a Medicaid recipient
   44  is both a member of the entity’s prepaid health plan and a
   45  resident of the assisted living facility. If the entity is at
   46  risk for Medicaid targeted case management and behavioral health
   47  services, the entity shall inform the assisted living facility
   48  of the procedures to follow should an emergent condition arise.
   49         (c) The community living support plan, as defined in s.
   50  429.02, has been prepared by a mental health resident and his or
   51  her a mental health case manager of that resident in
   52  consultation with the administrator of the facility or the
   53  administrator’s designee. The plan must be completed and
   54  provided to the administrator of the assisted living facility
   55  with a limited mental health license in which the mental health
   56  resident lives within 30 days after the resident’s admission.
   57  The support plan and the agreement may be in one document.
   58         (d) The assisted living facility with a limited mental
   59  health license is provided with documentation that the
   60  individual meets the definition of a mental health resident.
   61         (e) The mental health services provider assigns a case
   62  manager to each mental health resident for whom the entity is
   63  responsible who lives in an assisted living facility with a
   64  limited mental health license. The case manager shall coordinate
   65  is responsible for coordinating the development of and
   66  implementation of the community living support plan defined in
   67  s. 429.02. The plan must be updated at least annually, or when
   68  there is a significant change in the resident’s behavioral
   69  health status, such as an inpatient admission or a change in
   70  medication, level of service, or residence. Each case manager
   71  shall keep a record of the date and time of any face-to-face
   72  interaction with the resident and make the record available to
   73  the responsible entity for inspection. The record must be
   74  retained for at least 2 years after the date of the most recent
   75  interaction.
   76         (f)Adequate and consistent monitoring and enforcement of
   77  community living support plans and cooperative agreements are
   78  conducted by the resident’s case manager.
   79         (g) Concerns are reported to the appropriate regulatory
   80  oversight organization if a regulated provider fails to deliver
   81  appropriate services or otherwise acts in a manner that has the
   82  potential to result in harm to the resident.
   83         (3) The Secretary of Children and Families Family Services,
   84  in consultation with the Agency for Health Care Administration,
   85  shall annually require each district administrator to develop,
   86  with community input, a detailed annual plan that demonstrates
   87  detailed plans that demonstrate how the district will ensure the
   88  provision of state-funded mental health and substance abuse
   89  treatment services to residents of assisted living facilities
   90  that hold a limited mental health license. This plan These plans
   91  must be consistent with the substance abuse and mental health
   92  district plan developed pursuant to s. 394.75 and must address
   93  case management services; access to consumer-operated drop-in
   94  centers; access to services during evenings, weekends, and
   95  holidays; supervision of the clinical needs of the residents;
   96  and access to emergency psychiatric care.
   97         Section 25. Subsection (1) of section 400.0074, Florida
   98  Statutes, is amended, and paragraph (h) is added to subsection
   99  (2) of that section, to read:
  100         400.0074 Local ombudsman council onsite administrative
  101  assessments.—
  102         (1) In addition to any specific investigation conducted
  103  pursuant to a complaint, the local council shall conduct, at
  104  least annually, an onsite administrative assessment of each
  105  nursing home, assisted living facility, and adult family-care
  106  home within its jurisdiction. This administrative assessment
  107  must be comprehensive in nature and must shall focus on factors
  108  affecting residents’ the rights, health, safety, and welfare of
  109  the residents. Each local council is encouraged to conduct a
  110  similar onsite administrative assessment of each additional
  111  long-term care facility within its jurisdiction.
  112         (2) An onsite administrative assessment conducted by a
  113  local council shall be subject to the following conditions:
  114         (h) The local council shall conduct an exit consultation
  115  with the facility administrator or administrator designee to
  116  discuss issues and concerns in areas affecting residents’
  117  rights, health, safety, and welfare and, if needed, make
  118  recommendations for improvement.
  119         Section 26. Subsection (2) of section 400.0078, Florida
  120  Statutes, is amended to read:
  121         400.0078 Citizen access to State Long-Term Care Ombudsman
  122  Program services.—
  123         (2) Every resident or representative of a resident shall
  124  receive, Upon admission to a long-term care facility, each
  125  resident or representative of a resident must receive
  126  information regarding the purpose of the State Long-Term Care
  127  Ombudsman Program, the statewide toll-free telephone number for
  128  receiving complaints, information that retaliatory action cannot
  129  be taken against a resident for presenting grievances or for
  130  exercising any other resident right, and other relevant
  131  information regarding how to contact the program. Each resident
  132  or his or her representative Residents or their representatives
  133  must be furnished additional copies of this information upon
  134  request.
  135         Section 27. Subsection (13) of section 429.02, Florida
  136  Statutes, is amended to read:
  137         429.02 Definitions.—When used in this part, the term:
  138         (13) “Limited nursing services” means acts that may be
  139  performed by a person licensed under pursuant to part I of
  140  chapter 464 by persons licensed thereunder while carrying out
  141  their professional duties but limited to those acts which the
  142  department specifies by rule. Acts which may be specified by
  143  rule as allowable Limited nursing services shall be for persons
  144  who meet the admission criteria established by the department
  145  for assisted living facilities and shall not be complex enough
  146  to require 24-hour nursing supervision and may include such
  147  services as the application and care of routine dressings, and
  148  care of casts, braces, and splints.
  149         Section 28. Paragraphs (b) and (c) of subsection (3) of
  150  section 429.07, Florida Statutes, are amended to read:
  151         429.07 License required; fee.—
  152         (3) In addition to the requirements of s. 408.806, each
  153  license granted by the agency must state the type of care for
  154  which the license is granted. Licenses shall be issued for one
  155  or more of the following categories of care: standard, extended
  156  congregate care, limited nursing services, or limited mental
  157  health.
  158         (b) An extended congregate care license shall be issued to
  159  each facility that has been licensed as an assisted living
  160  facility for 2 or more years and that provides services
  161  facilities providing, directly or through contract, services
  162  beyond those authorized in paragraph (a), including services
  163  performed by persons licensed under part I of chapter 464 and
  164  supportive services, as defined by rule, to persons who would
  165  otherwise be disqualified from continued residence in a facility
  166  licensed under this part. An extended congregate care license
  167  may be issued to a facility that has a provisional extended
  168  congregate care license and meets the requirements for licensure
  169  under subparagraph 2. The primary purpose of extended congregate
  170  care services is to allow residents the option of remaining in a
  171  familiar setting from which they would otherwise be disqualified
  172  for continued residency as they become more impaired. A facility
  173  licensed to provide extended congregate care services may also
  174  admit an individual who exceeds the admission criteria for a
  175  facility with a standard license, if he or she is determined
  176  appropriate for admission to the extended congregate care
  177  facility.
  178         1. In order for extended congregate care services to be
  179  provided, the agency must first determine that all requirements
  180  established in law and rule are met and must specifically
  181  designate, on the facility’s license, that such services may be
  182  provided and whether the designation applies to all or part of
  183  the facility. This Such designation may be made at the time of
  184  initial licensure or licensure renewal relicensure, or upon
  185  request in writing by a licensee under this part and part II of
  186  chapter 408. The notification of approval or the denial of the
  187  request shall be made in accordance with part II of chapter 408.
  188  Each existing facility that qualifies facilities qualifying to
  189  provide extended congregate care services must have maintained a
  190  standard license and may not have been subject to administrative
  191  sanctions during the previous 2 years, or since initial
  192  licensure if the facility has been licensed for less than 2
  193  years, for any of the following reasons:
  194         a. A class I or class II violation;
  195         b. Three or more repeat or recurring class III violations
  196  of identical or similar resident care standards from which a
  197  pattern of noncompliance is found by the agency;
  198         c. Three or more class III violations that were not
  199  corrected in accordance with the corrective action plan approved
  200  by the agency;
  201         d. Violation of resident care standards which results in
  202  requiring the facility to employ the services of a consultant
  203  pharmacist or consultant dietitian;
  204         e. Denial, suspension, or revocation of a license for
  205  another facility licensed under this part in which the applicant
  206  for an extended congregate care license has at least 25 percent
  207  ownership interest; or
  208         f. Imposition of a moratorium pursuant to this part or part
  209  II of chapter 408 or initiation of injunctive proceedings.
  210  
  211  The agency may deny or revoke a facility’s extended congregate
  212  care license for not meeting the criteria for an extended
  213  congregate care license as provided in this subparagraph.
  214         2.If an assisted living facility has been licensed for
  215  less than 2 years, the initial extended congregate care license
  216  must be provisional and may not exceed 6 months. Within the
  217  first 3 months after the provisional license is issued, the
  218  licensee shall notify the agency, in writing, when it has
  219  admitted at least one extended congregate care resident, after
  220  which an unannounced inspection shall be made to determine
  221  compliance with requirements of an extended congregate care
  222  license. Failure to admit an extended congregate care resident
  223  within the first 3 months shall render the extended congregate
  224  care license void. A licensee that has a provisional extended
  225  congregate care license which demonstrates compliance with all
  226  of the requirements of an extended congregate care license
  227  during the inspection shall be issued an extended congregate
  228  care license. In addition to sanctions authorized under this
  229  part, if violations are found during the inspection and the
  230  licensee fails to demonstrate compliance with all assisted
  231  living requirements during a followup inspection, the licensee
  232  shall immediately suspend extended congregate care services, and
  233  the provisional extended congregate care license expires. The
  234  agency may extend the provisional license for not more than 1
  235  month in order to complete a followup visit.
  236         3.2. A facility that is licensed to provide extended
  237  congregate care services shall maintain a written progress
  238  report on each person who receives services which describes the
  239  type, amount, duration, scope, and outcome of services that are
  240  rendered and the general status of the resident’s health. A
  241  registered nurse, or appropriate designee, representing the
  242  agency shall visit the facility at least twice a year quarterly
  243  to monitor residents who are receiving extended congregate care
  244  services and to determine if the facility is in compliance with
  245  this part, part II of chapter 408, and relevant rules. One of
  246  the visits may be in conjunction with the regular survey. The
  247  monitoring visits may be provided through contractual
  248  arrangements with appropriate community agencies. A registered
  249  nurse shall serve as part of the team that inspects the
  250  facility. The agency may waive one of the required yearly
  251  monitoring visits for a facility that has:
  252         a. Held an extended congregate care license for at least 24
  253  months; been licensed for at least 24 months to provide extended
  254  congregate care services, if, during the inspection, the
  255  registered nurse determines that extended congregate care
  256  services are being provided appropriately, and if the facility
  257  has
  258         b. No class I or class II violations and no uncorrected
  259  class III violations; and.
  260         c. No ombudsman council complaints that resulted in a
  261  citation for licensure The agency must first consult with the
  262  long-term care ombudsman council for the area in which the
  263  facility is located to determine if any complaints have been
  264  made and substantiated about the quality of services or care.
  265  The agency may not waive one of the required yearly monitoring
  266  visits if complaints have been made and substantiated.
  267         4.3. A facility that is licensed to provide extended
  268  congregate care services must:
  269         a. Demonstrate the capability to meet unanticipated
  270  resident service needs.
  271         b. Offer a physical environment that promotes a homelike
  272  setting, provides for resident privacy, promotes resident
  273  independence, and allows sufficient congregate space as defined
  274  by rule.
  275         c. Have sufficient staff available, taking into account the
  276  physical plant and firesafety features of the building, to
  277  assist with the evacuation of residents in an emergency.
  278         d. Adopt and follow policies and procedures that maximize
  279  resident independence, dignity, choice, and decisionmaking to
  280  permit residents to age in place, so that moves due to changes
  281  in functional status are minimized or avoided.
  282         e. Allow residents or, if applicable, a resident’s
  283  representative, designee, surrogate, guardian, or attorney in
  284  fact to make a variety of personal choices, participate in
  285  developing service plans, and share responsibility in
  286  decisionmaking.
  287         f. Implement the concept of managed risk.
  288         g. Provide, directly or through contract, the services of a
  289  person licensed under part I of chapter 464.
  290         h. In addition to the training mandated in s. 429.52,
  291  provide specialized training as defined by rule for facility
  292  staff.
  293         5.4. A facility that is licensed to provide extended
  294  congregate care services is exempt from the criteria for
  295  continued residency set forth in rules adopted under s. 429.41.
  296  A licensed facility must adopt its own requirements within
  297  guidelines for continued residency set forth by rule. However,
  298  the facility may not serve residents who require 24-hour nursing
  299  supervision. A licensed facility that provides extended
  300  congregate care services must also provide each resident with a
  301  written copy of facility policies governing admission and
  302  retention.
  303         5. The primary purpose of extended congregate care services
  304  is to allow residents, as they become more impaired, the option
  305  of remaining in a familiar setting from which they would
  306  otherwise be disqualified for continued residency. A facility
  307  licensed to provide extended congregate care services may also
  308  admit an individual who exceeds the admission criteria for a
  309  facility with a standard license, if the individual is
  310  determined appropriate for admission to the extended congregate
  311  care facility.
  312         6. Before the admission of an individual to a facility
  313  licensed to provide extended congregate care services, the
  314  individual must undergo a medical examination as provided in s.
  315  429.26(4) and the facility must develop a preliminary service
  316  plan for the individual.
  317         7. If When a facility can no longer provide or arrange for
  318  services in accordance with the resident’s service plan and
  319  needs and the facility’s policy, the facility must shall make
  320  arrangements for relocating the person in accordance with s.
  321  429.28(1)(k).
  322         8. Failure to provide extended congregate care services may
  323  result in denial of extended congregate care license renewal.
  324         (c) A limited nursing services license shall be issued to a
  325  facility that provides services beyond those authorized in
  326  paragraph (a) and as specified in this paragraph.
  327         1. In order for limited nursing services to be provided in
  328  a facility licensed under this part, the agency must first
  329  determine that all requirements established in law and rule are
  330  met and must specifically designate, on the facility’s license,
  331  that such services may be provided. This Such designation may be
  332  made at the time of initial licensure or licensure renewal
  333  relicensure, or upon request in writing by a licensee under this
  334  part and part II of chapter 408. Notification of approval or
  335  denial of such request shall be made in accordance with part II
  336  of chapter 408. An existing facility that qualifies facilities
  337  qualifying to provide limited nursing services must shall have
  338  maintained a standard license and may not have been subject to
  339  administrative sanctions that affect the health, safety, and
  340  welfare of residents for the previous 2 years or since initial
  341  licensure if the facility has been licensed for less than 2
  342  years.
  343         2. A facility Facilities that is are licensed to provide
  344  limited nursing services shall maintain a written progress
  345  report on each person who receives such nursing services. The,
  346  which report must describe describes the type, amount, duration,
  347  scope, and outcome of services that are rendered and the general
  348  status of the resident’s health. A registered nurse representing
  349  the agency shall visit the facility such facilities at least
  350  annually twice a year to monitor residents who are receiving
  351  limited nursing services and to determine if the facility is in
  352  compliance with applicable provisions of this part, part II of
  353  chapter 408, and related rules. The monitoring visits may be
  354  provided through contractual arrangements with appropriate
  355  community agencies. A registered nurse shall also serve as part
  356  of the team that inspects such facility. Visits may be in
  357  conjunction with other agency inspections. The agency may waive
  358  the required yearly monitoring visit for a facility that has:
  359         a. Had a limited nursing services license for at least 24
  360  months;
  361         b. No class I or class II violations and no uncorrected
  362  class III violations; and
  363         c. No ombudsman council complaints that resulted in a
  364  citation for licensure.
  365         3. A person who receives limited nursing services under
  366  this part must meet the admission criteria established by the
  367  agency for assisted living facilities. When a resident no longer
  368  meets the admission criteria for a facility licensed under this
  369  part, arrangements for relocating the person shall be made in
  370  accordance with s. 429.28(1)(k), unless the facility is licensed
  371  to provide extended congregate care services.
  372         Section 29. Section 429.075, Florida Statutes, is amended
  373  to read:
  374         429.075 Limited mental health license.—An assisted living
  375  facility that serves one three or more mental health residents
  376  must obtain a limited mental health license.
  377         (1) To obtain a limited mental health license, a facility
  378  must hold a standard license as an assisted living facility,
  379  must not have any current uncorrected deficiencies or
  380  violations, and must ensure that, within 6 months after
  381  receiving a limited mental health license, the facility
  382  administrator and the staff of the facility who are in direct
  383  contact with mental health residents must complete training of
  384  no less than 6 hours related to their duties. This Such
  385  designation may be made at the time of initial licensure or
  386  relicensure or upon request in writing by a licensee under this
  387  part and part II of chapter 408. Notification of approval or
  388  denial of such request shall be made in accordance with this
  389  part, part II of chapter 408, and applicable rules. This
  390  training must will be provided by or approved by the Department
  391  of Children and Families Family Services.
  392         (2) A facility that is Facilities licensed to provide
  393  services to mental health residents must shall provide
  394  appropriate supervision and staffing to provide for the health,
  395  safety, and welfare of such residents.
  396         (3) A facility that has a limited mental health license
  397  must:
  398         (a) Have a copy of each mental health resident’s community
  399  living support plan and the cooperative agreement with the
  400  mental health care services provider or provide written evidence
  401  that a request for the community living support plan and the
  402  cooperative agreement was sent to the Medicaid managed care plan
  403  or managing entity under contract with the Department of
  404  Children and Families within 72 hours after admission. The
  405  support plan and the agreement may be combined.
  406         (b) Have documentation that is provided by the Department
  407  of Children and Families Family Services that each mental health
  408  resident has been assessed and determined to be able to live in
  409  the community in an assisted living facility that has with a
  410  limited mental health license or provide written evidence that a
  411  request for documentation was sent to the Department of Children
  412  and Families within 72 hours after admission.
  413         (c) Make the community living support plan available for
  414  inspection by the resident, the resident’s legal guardian or,
  415  the resident’s health care surrogate, and other individuals who
  416  have a lawful basis for reviewing this document.
  417         (d) Assist the mental health resident in carrying out the
  418  activities identified in the individual’s community living
  419  support plan.
  420         (4) A facility that has with a limited mental health
  421  license may enter into a cooperative agreement with a private
  422  mental health provider. For purposes of the limited mental
  423  health license, the private mental health provider may act as
  424  the case manager.
  425         Section 30. Section 429.14, Florida Statutes, is amended to
  426  read:
  427         429.14 Administrative penalties.—
  428         (1) In addition to the requirements of part II of chapter
  429  408, the agency may deny, revoke, and suspend any license issued
  430  under this part and impose an administrative fine in the manner
  431  provided in chapter 120 against a licensee for a violation of
  432  any provision of this part, part II of chapter 408, or
  433  applicable rules, or for any of the following actions by a
  434  licensee, for the actions of any person subject to level 2
  435  background screening under s. 408.809, or for the actions of any
  436  facility staff employee:
  437         (a) An intentional or negligent act seriously affecting the
  438  health, safety, or welfare of a resident of the facility.
  439         (b) A The determination by the agency that the owner lacks
  440  the financial ability to provide continuing adequate care to
  441  residents.
  442         (c) Misappropriation or conversion of the property of a
  443  resident of the facility.
  444         (d) Failure to follow the criteria and procedures provided
  445  under part I of chapter 394 relating to the transportation,
  446  voluntary admission, and involuntary examination of a facility
  447  resident.
  448         (e) A citation for of any of the following violations
  449  deficiencies as specified in s. 429.19:
  450         1. One or more cited class I violations deficiencies.
  451         2. Three or more cited class II violations deficiencies.
  452         3. Five or more cited class III violations deficiencies
  453  that have been cited on a single survey and have not been
  454  corrected within the times specified.
  455         (f) Failure to comply with the background screening
  456  standards of this part, s. 408.809(1), or chapter 435.
  457         (g) Violation of a moratorium.
  458         (h) Failure of the license applicant, the licensee during
  459  licensure renewal relicensure, or a licensee that holds a
  460  provisional license to meet the minimum license requirements of
  461  this part, or related rules, at the time of license application
  462  or renewal.
  463         (i) An intentional or negligent life-threatening act in
  464  violation of the uniform firesafety standards for assisted
  465  living facilities or other firesafety standards which that
  466  threatens the health, safety, or welfare of a resident of a
  467  facility, as communicated to the agency by the local authority
  468  having jurisdiction or the State Fire Marshal.
  469         (j) Knowingly operating any unlicensed facility or
  470  providing without a license any service that must be licensed
  471  under this chapter or chapter 400.
  472         (k) Any act constituting a ground upon which application
  473  for a license may be denied.
  474         (2) Upon notification by the local authority having
  475  jurisdiction or by the State Fire Marshal, the agency may deny
  476  or revoke the license of an assisted living facility that fails
  477  to correct cited fire code violations that affect or threaten
  478  the health, safety, or welfare of a resident of a facility.
  479         (3) The agency may deny or revoke a license of an to any
  480  applicant or controlling interest as defined in part II of
  481  chapter 408 which has or had a 25 percent 25-percent or greater
  482  financial or ownership interest in any other facility that is
  483  licensed under this part, or in any entity licensed by this
  484  state or another state to provide health or residential care, if
  485  that which facility or entity during the 5 years before prior to
  486  the application for a license closed due to financial inability
  487  to operate; had a receiver appointed or a license denied,
  488  suspended, or revoked; was subject to a moratorium; or had an
  489  injunctive proceeding initiated against it.
  490         (4) The agency shall deny or revoke the license of an
  491  assisted living facility if:
  492         (a)There are two moratoria, issued pursuant to this part
  493  or part II of chapter 408, within a 2-year period which are
  494  imposed by final order;
  495         (b)The facility is cited for two or more class I
  496  violations arising from unrelated circumstances during the same
  497  survey or investigation; or
  498         (c)The facility is cited for two or more class I
  499  violations arising from separate surveys or investigations
  500  within a 2-year period that has two or more class I violations
  501  that are similar or identical to violations identified by the
  502  agency during a survey, inspection, monitoring visit, or
  503  complaint investigation occurring within the previous 2 years.
  504         (5) An action taken by the agency to suspend, deny, or
  505  revoke a facility’s license under this part or part II of
  506  chapter 408, in which the agency claims that the facility owner
  507  or an employee of the facility has threatened the health,
  508  safety, or welfare of a resident of the facility, must be heard
  509  by the Division of Administrative Hearings of the Department of
  510  Management Services within 120 days after receipt of the
  511  facility’s request for a hearing, unless that time limitation is
  512  waived by both parties. The administrative law judge shall must
  513  render a decision within 30 days after receipt of a proposed
  514  recommended order.
  515         (6) As provided under s. 408.814, the agency shall impose
  516  an immediate moratorium on an assisted living facility that
  517  fails to provide the agency access to the facility or prohibits
  518  the agency from conducting a regulatory inspection. The licensee
  519  may not restrict agency staff in accessing and copying records
  520  or in conducting confidential interviews with facility staff or
  521  any individual who receives services from the facility provide
  522  to the Division of Hotels and Restaurants of the Department of
  523  Business and Professional Regulation, on a monthly basis, a list
  524  of those assisted living facilities that have had their licenses
  525  denied, suspended, or revoked or that are involved in an
  526  appellate proceeding pursuant to s. 120.60 related to the
  527  denial, suspension, or revocation of a license.
  528         (7) Agency notification of a license suspension or
  529  revocation, or denial of a license renewal, shall be posted and
  530  visible to the public at the facility.
  531         (8) If a facility is required to relocate some or all of
  532  its residents due to agency action, that facility is exempt from
  533  the 45 days’ notice requirement imposed under s. 429.28(1)(k).
  534  This subsection does not exempt the facility from any deadlines
  535  for corrective action set by the agency.
  536         Section 31. Paragraphs (a) and (b) of subsection (2) of
  537  section 429.178, Florida Statutes, are amended to read:
  538         429.178 Special care for persons with Alzheimer’s disease
  539  or other related disorders.—
  540         (2)(a) An individual who is employed by a facility that
  541  provides special care for residents who have with Alzheimer’s
  542  disease or other related disorders, and who has regular contact
  543  with such residents, must complete up to 4 hours of initial
  544  dementia-specific training developed or approved by the
  545  department. The training must shall be completed within 3 months
  546  after beginning employment and satisfy shall satisfy the core
  547  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  548         (b) A direct caregiver who is employed by a facility that
  549  provides special care for residents who have with Alzheimer’s
  550  disease or other related disorders, and who provides direct care
  551  to such residents, must complete the required initial training
  552  and 4 additional hours of training developed or approved by the
  553  department. The training must shall be completed within 9 months
  554  after beginning employment and satisfy shall satisfy the core
  555  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  556         Section 32. Section 429.19, Florida Statutes, is amended to
  557  read:
  558         429.19 Violations; imposition of administrative fines;
  559  grounds.—
  560         (1) In addition to the requirements of part II of chapter
  561  408, the agency shall impose an administrative fine in the
  562  manner provided in chapter 120 for the violation of any
  563  provision of this part, part II of chapter 408, and applicable
  564  rules by an assisted living facility, for the actions of any
  565  person subject to level 2 background screening under s. 408.809,
  566  for the actions of any facility employee, or for an intentional
  567  or negligent act seriously affecting the health, safety, or
  568  welfare of a resident of the facility.
  569         (2) Each violation of this part and adopted rules must
  570  shall be classified according to the nature of the violation and
  571  the gravity of its probable effect on facility residents. The
  572  scope of a violation may be cited as an isolated, patterned, or
  573  widespread deficiency. An isolated deficiency is a deficiency
  574  affecting one or a very limited number of residents, or
  575  involving one or a very limited number of staff, or a situation
  576  that occurred only occasionally or in a very limited number of
  577  locations. A patterned deficiency is a deficiency in which more
  578  than a very limited number of residents are affected, or more
  579  than a very limited number of staff are affected, or the
  580  situation has occurred in several locations, or the same
  581  resident or residents have been affected by repeated occurrences
  582  of the same deficient practice but the effect of the deficient
  583  practice is not found to be pervasive throughout the facility. A
  584  widespread deficiency is a deficiency in which the problems
  585  causing the deficiency are pervasive in the facility or
  586  represent systemic failure that has affected or has the
  587  potential to affect a large portion of the facility’s residents.
  588         (a) The agency shall indicate the classification on the
  589  written notice of the violation as follows:
  590         1.(a) Class “I” violations are defined in s. 408.813. The
  591  agency shall impose an administrative fine for a cited class I
  592  violation of $5,000 for an isolated deficiency; $7,500 for a
  593  patterned deficiency; and $10,000 for a widespread deficiency.
  594  If the agency has knowledge of a class I violation that occurred
  595  within 12 months before an inspection, a fine must be levied for
  596  that violation, regardless of whether the noncompliance is
  597  corrected before the inspection in an amount not less than
  598  $5,000 and not exceeding $10,000 for each violation.
  599         2.(b) Class “II” violations are defined in s. 408.813. The
  600  agency shall impose an administrative fine for a cited class II
  601  violation of $1,000 for an isolated deficiency; $3,000 for a
  602  patterned deficiency; and $5,000 for a widespread deficiency in
  603  an amount not less than $1,000 and not exceeding $5,000 for each
  604  violation.
  605         3.(c) Class “III” violations are defined in s. 408.813. The
  606  agency shall impose an administrative fine for a cited class III
  607  violation of $500 for an isolated deficiency; $750 for a
  608  patterned deficiency; and $1,000 for a widespread deficiency in
  609  an amount not less than $500 and not exceeding $1,000 for each
  610  violation.
  611         4.(d) Class “IV” violations are defined in s. 408.813. The
  612  agency shall impose an administrative fine for a cited class IV
  613  violation of $100 for an isolated deficiency; $150 for a
  614  patterned deficiency; and $200 for a widespread deficiency in an
  615  amount not less than $100 and not exceeding $200 for each
  616  violation.
  617         (b) Any fine imposed for a class I violation or a class II
  618  violation must be doubled if a facility was previously cited for
  619  one or more class I or class II violations during the agency’s
  620  last licensure inspection or any inspection or complaint
  621  investigation since the last licensure inspection.
  622         (c) Notwithstanding ss. 408.813(2)(c) and 408.832, if a
  623  facility is cited for 10 or more class III violations during an
  624  inspection or survey, the agency shall impose a fine for each
  625  violation.
  626         (d) Notwithstanding the fine amounts specified in
  627  subparagraphs (a)1.-4., and regardless of the class of violation
  628  cited, the agency shall impose an administrative fine of $500 on
  629  a facility that is found not to be in compliance with the
  630  background screening requirements as provided in s. 408.809.
  631         (3) For purposes of this section, in determining if a
  632  penalty is to be imposed and in fixing the amount of the fine,
  633  the agency shall consider the following factors:
  634         (a) The gravity of the violation, including the probability
  635  that death or serious physical or emotional harm to a resident
  636  will result or has resulted, the severity of the action or
  637  potential harm, and the extent to which the provisions of the
  638  applicable laws or rules were violated.
  639         (b) Actions taken by the owner or administrator to correct
  640  violations.
  641         (c) Any previous violations.
  642         (d) The financial benefit to the facility of committing or
  643  continuing the violation.
  644         (e) The licensed capacity of the facility.
  645         (3)(4) Each day of continuing violation after the date
  646  established by the agency fixed for correction termination of
  647  the violation, as ordered by the agency, constitutes an
  648  additional, separate, and distinct violation.
  649         (4)(5)An Any action taken to correct a violation shall be
  650  documented in writing by the owner or administrator of the
  651  facility and verified through followup visits by agency
  652  personnel. The agency may impose a fine and, in the case of an
  653  owner-operated facility, revoke or deny a facility’s license
  654  when a facility administrator fraudulently misrepresents action
  655  taken to correct a violation.
  656         (5)(6)A Any facility whose owner fails to apply for a
  657  change-of-ownership license in accordance with part II of
  658  chapter 408 and operates the facility under the new ownership is
  659  subject to a fine of $5,000.
  660         (6)(7) In addition to any administrative fines imposed, the
  661  agency may assess a survey fee, equal to the lesser of one half
  662  of the facility’s biennial license and bed fee or $500, to cover
  663  the cost of conducting initial complaint investigations that
  664  result in the finding of a violation that was the subject of the
  665  complaint or monitoring visits conducted under s. 429.28(3)(c)
  666  to verify the correction of the violations.
  667         (7)(8) During an inspection, the agency shall make a
  668  reasonable attempt to discuss each violation with the owner or
  669  administrator of the facility, before prior to written
  670  notification.
  671         (8)(9) The agency shall develop and disseminate an annual
  672  list of all facilities sanctioned or fined for violations of
  673  state standards, the number and class of violations involved,
  674  the penalties imposed, and the current status of cases. The list
  675  shall be disseminated, at no charge, to the Department of
  676  Elderly Affairs, the Department of Health, the Department of
  677  Children and Families Family Services, the Agency for Persons
  678  with Disabilities, the area agencies on aging, the Florida
  679  Statewide Advocacy Council, and the state and local ombudsman
  680  councils. The Department of Children and Families Family
  681  Services shall disseminate the list to service providers under
  682  contract to the department who are responsible for referring
  683  persons to a facility for residency. The agency may charge a fee
  684  commensurate with the cost of printing and postage to other
  685  interested parties requesting a copy of this list. This
  686  information may be provided electronically or through the
  687  agency’s website Internet site.
  688         Section 33. Subsection (3) and paragraph (c) of subsection
  689  (4) of section 429.256, Florida Statutes, are amended to read:
  690         429.256 Assistance with self-administration of medication.—
  691         (3) Assistance with self-administration of medication
  692  includes:
  693         (a) Taking the medication, in its previously dispensed,
  694  properly labeled container, including an insulin syringe that is
  695  prefilled with the proper dosage by a pharmacist and an insulin
  696  pen that is prefilled by the manufacturer, from where it is
  697  stored, and bringing it to the resident.
  698         (b) In the presence of the resident, reading the label,
  699  opening the container, removing a prescribed amount of
  700  medication from the container, and closing the container.
  701         (c) Placing an oral dosage in the resident’s hand or
  702  placing the dosage in another container and helping the resident
  703  by lifting the container to his or her mouth.
  704         (d) Applying topical medications.
  705         (e) Returning the medication container to proper storage.
  706         (f) Keeping a record of when a resident receives assistance
  707  with self-administration under this section.
  708         (g) Assisting with the use of a nebulizer, including
  709  removing the cap of a nebulizer, opening the unit dose of
  710  nebulizer solution, and pouring the prescribed premeasured dose
  711  of medication into the dispensing cup of the nebulizer.
  712         (h) Using a glucometer to perform blood-glucose level
  713  checks.
  714         (i) Assisting with putting on and taking off antiembolism
  715  stockings.
  716         (j) Assisting with applying and removing an oxygen cannula,
  717  but not with titrating the prescribed oxygen settings.
  718         (k) Assisting with the use of a continuous positive airway
  719  pressure (CPAP) device, but not with titrating the prescribed
  720  setting of the device.
  721         (l) Assisting with measuring vital signs.
  722         (m) Assisting with colostomy bags.
  723         (4) Assistance with self-administration does not include:
  724         (c) Administration of medications through intermittent
  725  positive pressure breathing machines or a nebulizer.
  726         Section 34. Subsections (2), (5), and (6) of section
  727  429.28, Florida Statutes, are amended to read:
  728         429.28 Resident bill of rights.—
  729         (2) The administrator of a facility shall ensure that a
  730  written notice of the rights, obligations, and prohibitions set
  731  forth in this part is posted in a prominent place in each
  732  facility and read or explained to residents who cannot read. The
  733  This notice must shall include the name, address, and telephone
  734  numbers of the local ombudsman council, the and central abuse
  735  hotline, and, if when applicable, Disability Rights Florida the
  736  Advocacy Center for Persons with Disabilities, Inc., and the
  737  Florida local advocacy council, where complaints may be lodged.
  738  The notice must state that a complaint made to the Office of
  739  State Long-Term Care Ombudsman or a local long-term care
  740  ombudsman council, the names and identities of the residents
  741  involved in the complaint, and the identity of complainants are
  742  kept confidential pursuant to s. 400.0077 and that retaliatory
  743  action cannot be taken against a resident for presenting
  744  grievances or for exercising any other resident right. The
  745  facility must ensure a resident’s access to a telephone to call
  746  the local ombudsman council, central abuse hotline, and
  747  Disability Rights Florida Advocacy Center for Persons with
  748  Disabilities, Inc., and the Florida local advocacy council.
  749         (5) A No facility or employee of a facility may not serve
  750  notice upon a resident to leave the premises or take any other
  751  retaliatory action against any person who:
  752         (a) Exercises any right set forth in this section.
  753         (b) Appears as a witness in any hearing, inside or outside
  754  the facility.
  755         (c) Files a civil action alleging a violation of the
  756  provisions of this part or notifies a state attorney or the
  757  Attorney General of a possible violation of such provisions.
  758         (6) A Any facility that which terminates the residency of
  759  an individual who participated in activities specified in
  760  subsection (5) must shall show good cause in a court of
  761  competent jurisdiction. If good cause is not shown, the agency
  762  shall impose a fine of $2,500 in addition to any other penalty
  763  assessed against the facility.
  764         Section 35. Section 429.34, Florida Statutes, is amended to
  765  read:
  766         429.34 Right of entry and inspection.—
  767         (1) In addition to the requirements of s. 408.811, any duly
  768  designated officer or employee of the department, the Department
  769  of Children and Families Family Services, the Medicaid Fraud
  770  Control Unit of the Office of the Attorney General, the state or
  771  local fire marshal, or a member of the state or local long-term
  772  care ombudsman council has shall have the right to enter
  773  unannounced upon and into the premises of any facility licensed
  774  pursuant to this part in order to determine the state of
  775  compliance with the provisions of this part, part II of chapter
  776  408, and applicable rules. Data collected by the state or local
  777  long-term care ombudsman councils or the state or local advocacy
  778  councils may be used by the agency in investigations involving
  779  violations of regulatory standards. A person specified in this
  780  section who knows or has reasonable cause to suspect that a
  781  vulnerable adult has been or is being abused, neglected, or
  782  exploited shall immediately report such knowledge or suspicion
  783  to the central abuse hotline pursuant to chapter 415.
  784         (2) The agency shall inspect each licensed assisted living
  785  facility at least once every 24 months to determine compliance
  786  with this chapter and related rules. If an assisted living
  787  facility is cited for one or more class I violations or two or
  788  more class II violations arising from separate surveys within a
  789  60-day period or due to unrelated circumstances during the same
  790  survey, the agency must conduct an additional licensure
  791  inspection within 6 months. In addition to any fines imposed on
  792  the facility under s. 429.19, the licensee shall pay a fee for
  793  the cost of the additional inspection equivalent to the standard
  794  assisted living facility license and per-bed fees, without
  795  exception for beds designated for recipients of optional state
  796  supplementation. The agency shall adjust the fee in accordance
  797  with s. 408.805.
  798         Section 36. Subsection (2) of section 429.41, Florida
  799  Statutes, is amended to read:
  800         429.41 Rules establishing standards.—
  801         (2) In adopting any rules pursuant to this part, the
  802  department, in conjunction with the agency, shall make distinct
  803  standards for facilities based upon facility size; the types of
  804  care provided; the physical and mental capabilities and needs of
  805  residents; the type, frequency, and amount of services and care
  806  offered; and the staffing characteristics of the facility. Rules
  807  developed pursuant to this section may shall not restrict the
  808  use of shared staffing and shared programming in facilities that
  809  are part of retirement communities that provide multiple levels
  810  of care and otherwise meet the requirements of law and rule. If
  811  a continuing care facility licensed under chapter 651 or a
  812  retirement community offering multiple levels of care obtains a
  813  license pursuant to this chapter for a building or part of a
  814  building designated for independent living, staffing
  815  requirements established in rule apply only to residents who
  816  receive personal services, limited nursing services, or extended
  817  congregate care services under this part. Such facilities shall
  818  retain a log listing the names and unit number for residents
  819  receiving these services. The log must be available to surveyors
  820  upon request. Except for uniform firesafety standards, the
  821  department shall adopt by rule separate and distinct standards
  822  for facilities with 16 or fewer beds and for facilities with 17
  823  or more beds. The standards for facilities with 16 or fewer beds
  824  must shall be appropriate for a noninstitutional residential
  825  environment;, however, provided that the structure may not be is
  826  no more than two stories in height and all persons who cannot
  827  exit the facility unassisted in an emergency must reside on the
  828  first floor. The department, in conjunction with the agency, may
  829  make other distinctions among types of facilities as necessary
  830  to enforce the provisions of this part. Where appropriate, the
  831  agency shall offer alternate solutions for complying with
  832  established standards, based on distinctions made by the
  833  department and the agency relative to the physical
  834  characteristics of facilities and the types of care offered
  835  therein.
  836         Section 37. Present subsections (1) through (11) of section
  837  429.52, Florida Statutes, are redesignated as subsections (2)
  838  through (12), respectively, a new subsection (1) is added to
  839  that section, and present subsections (5) and (9) of that
  840  section are amended, to read:
  841         429.52 Staff training and educational programs; core
  842  educational requirement.—
  843         (1) Effective October 1, 2014, each new assisted living
  844  facility employee who has not previously completed core training
  845  must attend a preservice orientation provided by the facility
  846  before interacting with residents. The preservice orientation
  847  must be at least 2 hours in duration and cover topics that help
  848  the employee provide responsible care and respond to the needs
  849  of facility residents. Upon completion, the employee and the
  850  administrator of the facility must sign a statement that the
  851  employee completed the required preservice orientation. The
  852  facility must keep the signed statement in the employee’s
  853  personnel record.
  854         (6)(5) Staff involved with the management of medications
  855  and assisting with the self-administration of medications under
  856  s. 429.256 must complete a minimum of 6 4 additional hours of
  857  training provided by a registered nurse, licensed pharmacist, or
  858  department staff. The department shall establish by rule the
  859  minimum requirements of this additional training.
  860         (10)(9) The training required by this section other than
  861  the preservice orientation must shall be conducted by persons
  862  registered with the department as having the requisite
  863  experience and credentials to conduct the training. A person
  864  seeking to register as a trainer must provide the department
  865  with proof of completion of the minimum core training education
  866  requirements, successful passage of the competency test
  867  established under this section, and proof of compliance with the
  868  continuing education requirement in subsection (5) (4).
  869         Section 38. The Legislature finds that consistent
  870  regulation of assisted living facilities benefits residents and
  871  operators of such facilities. To determine whether surveys are
  872  consistent between surveys and surveyors, the Office of Program
  873  Policy Analysis and Government Accountability (OPPAGA) shall
  874  conduct a study of intersurveyor reliability for assisted living
  875  facilities. By November 1, 2014, OPPAGA shall report its
  876  findings to the Governor, the President of the Senate, and the
  877  Speaker of the House of Representatives and make any
  878  recommendations for improving intersurveyor reliability.
  879         Section 39. Section 429.55, Florida Statutes, is created to
  880  read:
  881         429.55 Public access to data; rating system and comment
  882  page.—
  883         (1) The Legislature finds that consumers need additional
  884  information on the quality of care and service in assisted
  885  living facilities in order to select the best facility for
  886  themselves or their loved ones.
  887         (2) By March 1, 2015, the agency shall implement a rating
  888  system for assisted living facilities based on facility
  889  inspections, violations, complaints, and agency visits to assist
  890  consumers and residents. The agency may adopt rules to
  891  administer this subsection.
  892         (3) By November 1, 2014, the agency shall provide,
  893  maintain, and update at least quarterly, electronically
  894  accessible data on assisted living facilities. Such data must be
  895  searchable, downloadable, and available in generally accepted
  896  formats. The agency shall include all content in its possession
  897  on November 1, 2014, on the website and add additional content
  898  from facilities when the facility license is renewed. At a
  899  minimum, such data must include:
  900         (a) Information on each assisted living facility licensed
  901  under this part, including:
  902         1. The name and address of the facility.
  903         2. The number and type of licensed beds in the facility.
  904         3. The types of licenses held by the facility.
  905         4. The facility’s license expiration date and status.
  906         5. Proprietary or nonproprietary status of the licensee.
  907         6. Any affiliation with a company or other organization
  908  owning or managing more than one assisted living facility in
  909  this state.
  910         7. The total number of clients that the facility is
  911  licensed to serve and the most recently available occupancy
  912  levels.
  913         8. The number of private and semiprivate rooms offered.
  914         9. The bed-hold policy.
  915         10. The religious affiliation, if any, of the assisted
  916  living facility.
  917         11. The languages spoken by the staff.
  918         12. Availability of nurses.
  919         13. Forms of payment accepted, including, but not limited
  920  to, Medicaid, Medicaid long-term managed care, private
  921  insurance, health maintenance organization, United States
  922  Department of Veterans Affairs, CHAMPUS program, or workers’
  923  compensation coverage.
  924         14. Indication if the licensee is operating under
  925  bankruptcy protection.
  926         15. Recreational and other programs available.
  927         16. Special care units or programs offered.
  928         17. Whether the facility is a part of a retirement
  929  community that offers other services pursuant to this part or
  930  part III of this chapter, part II or part III of chapter 400, or
  931  chapter 651.
  932         18. Links to the State Long-Term Care Ombudsman Program
  933  website and the program’s statewide toll-free telephone number.
  934         19. Links to the websites of the providers or their
  935  affiliates.
  936         20. Other relevant information that the agency currently
  937  collects.
  938         (b) A list of the facility’s violations, including, for
  939  each violation:
  940         1. A summary of the violation presented in a manner
  941  understandable by the general public;
  942         2. Any sanctions imposed by final order; and
  943         3. The date the corrective action was confirmed by the
  944  agency.
  945         (c) Links to inspection reports on file with the agency.
  946         (4) The agency shall provide a monitored comment webpage
  947  that allows members of the public to comment on specific
  948  assisted living facilities licensed to operate in this state. At
  949  a minimum, the comment webpage must allow members of the public
  950  to identify themselves, provide comments on their experiences
  951  with, or observations of, an assisted living facility, and view
  952  others’ comments.
  953         (a) The agency shall review comments for profanities and
  954  redact any profanities before posting the comments to the
  955  webpage. After redacting any profanities, the agency shall post
  956  all comments, and shall retain all comments as they were
  957  originally submitted, which are subject to the requirements of
  958  chapter 119 and which shall be retained by the agency for
  959  inspection by the public without further redaction pursuant to
  960  retention schedules and disposal processes for such records.
  961         (b) A controlling interest, as defined in s. 408.803 in an
  962  assisted living facility, or an employee or owner of an assisted
  963  living facility, is prohibited from posting comments on the
  964  page. A controlling interest, employee, or owner may respond to
  965  comments on the page, and the agency shall ensure that such
  966  responses are identified as being from a representative of the
  967  facility.
  968         (5) The agency may provide links to third-party websites
  969  that use the data published pursuant to this section to assist
  970  consumers in evaluating the quality of care and service in
  971  assisted living facilities.
  972         Section 40. For the 2014-2015 fiscal year, the sums of
  973  $156,943 in recurring funds and $7,546 in nonrecurring funds
  974  from the Health Care Trust Fund and two full-time equivalent
  975  senior attorney positions with associated salary rate of 103,652
  976  are appropriated to the Agency for Health Care Administration
  977  for the purpose of implementing the regulatory provisions of
  978  this act.
  979         Section 41. For the 2014-2015 fiscal year, for the purpose
  980  of implementing and maintaining the public information website
  981  enhancements provided under this act:
  982         (1) The sums of $72,435 in recurring funds and $3,773 in
  983  nonrecurring funds from the Health Care Trust Fund and one full
  984  time equivalent health services and facilities consultant
  985  position with associated salary rate of 46,560 are appropriated
  986  to the Agency for Health Care Administration;
  987         (2) The sums of $30,000 in recurring funds and $15,000 in
  988  nonrecurring funds from the Health Care Trust Fund are
  989  appropriated to the Agency for Health Care Administration for
  990  software purchase, installation, and maintenance services; and
  991         (3) The sums of $2,474 in recurring funds and $82,806 in
  992  nonrecurring funds from the Health Care Trust Fund are
  993  appropriated to the Agency for Health Care Administration for
  994  contracted services.
  995  
  996  ================= T I T L E  A M E N D M E N T ================
  997  And the title is amended as follows:
  998         Between lines 136 and 137
  999  insert:
 1000         amending s. 394.4574, F.S.; providing that Medicaid
 1001         managed care plans are responsible for enrolled mental
 1002         health residents; providing that managing entities
 1003         under contract with the Department of Children and
 1004         Families are responsible for mental health residents
 1005         who are not enrolled with a Medicaid managed care
 1006         plan; deleting a provision to conform to changes made
 1007         by the act; requiring that the community living
 1008         support plan be completed and provided to the
 1009         administrator of a facility after the mental health
 1010         resident’s admission; requiring the community living
 1011         support plan to be updated when there is a significant
 1012         change to the mental health resident’s behavioral
 1013         health; requiring the case manager assigned to a
 1014         mental health resident of an assisted living facility
 1015         that holds a limited mental health license to keep a
 1016         record of the date and time of face-to-face
 1017         interactions with the resident and to make the record
 1018         available to the responsible entity for inspection;
 1019         requiring that the record be maintained for a
 1020         specified time; requiring the responsible entity to
 1021         ensure that there is adequate and consistent
 1022         monitoring and enforcement of community living support
 1023         plans and cooperative agreements and that concerns are
 1024         reported to the appropriate regulatory oversight
 1025         organization under certain circumstances; amending s.
 1026         400.0074, F.S.; requiring that an administrative
 1027         assessment conducted by a local council be
 1028         comprehensive in nature and focus on factors affecting
 1029         the rights, health, safety, and welfare of residents
 1030         in the facilities; requiring a local council to
 1031         conduct an exit consultation with the facility
 1032         administrator or administrator designee to discuss
 1033         issues and concerns in areas affecting the rights,
 1034         health, safety, and welfare of residents and make
 1035         recommendations for improvement; amending s. 400.0078,
 1036         F.S.; requiring that a resident or a representative of
 1037         a resident of a long-term care facility be informed
 1038         that retaliatory action cannot be taken against a
 1039         resident for presenting grievances or for exercising
 1040         any other resident right; amending s. 429.02, F.S.;
 1041         revising the definition of the term “limited nursing
 1042         services”; amending s. 429.07, F.S.; revising the
 1043         requirement that an extended congregate care license
 1044         be issued to certain facilities that have been
 1045         licensed as assisted living facilities under certain
 1046         circumstances and authorizing the issuance of such
 1047         license if a specified condition is met; providing the
 1048         purpose of an extended congregate care license;
 1049         providing that the initial extended congregate care
 1050         license of an assisted living facility is provisional
 1051         under certain circumstances; requiring a licensee to
 1052         notify the Agency for Health Care Administration if it
 1053         accepts a resident who qualifies for extended
 1054         congregate care services; requiring the agency to
 1055         inspect the facility for compliance with the
 1056         requirements of an extended congregate care license;
 1057         requiring the issuance of an extended congregate care
 1058         license under certain circumstances; requiring the
 1059         licensee to immediately suspend extended congregate
 1060         care services under certain circumstances; requiring a
 1061         registered nurse representing the agency to visit the
 1062         facility at least twice a year, rather than quarterly,
 1063         to monitor residents who are receiving extended
 1064         congregate care services; authorizing the agency to
 1065         waive one of the required yearly monitoring visits
 1066         under certain circumstances; authorizing the agency to
 1067         deny or revoke a facility’s extended congregate care
 1068         license; requiring a registered nurse representing the
 1069         agency to visit the facility at least annually, rather
 1070         than twice a year, to monitor residents who are
 1071         receiving limited nursing services; providing that
 1072         such monitoring visits may be conducted in conjunction
 1073         with other inspections by the agency; authorizing the
 1074         agency to waive the required yearly monitoring visit
 1075         for a facility that is licensed to provide limited
 1076         nursing services under certain circumstances; amending
 1077         s. 429.075, F.S.; requiring an assisted living
 1078         facility that serves one or more mental health
 1079         residents to obtain a limited mental health license;
 1080         revising the methods employed by a limited mental
 1081         health facility relating to placement requirements to
 1082         include providing written evidence that a request for
 1083         a community living support plan, a cooperative
 1084         agreement, and assessment documentation was sent to
 1085         the Department of Children and Families within 72
 1086         hours after admission; amending s. 429.14, F.S.;
 1087         revising the circumstances under which the agency may
 1088         deny, revoke, or suspend the license of an assisted
 1089         living facility and impose an administrative fine;
 1090         requiring the agency to deny or revoke the license of
 1091         an assisted living facility under certain
 1092         circumstances; requiring the agency to impose an
 1093         immediate moratorium on the license of an assisted
 1094         living facility under certain circumstances; deleting
 1095         a provision requiring the agency to provide a list of
 1096         facilities with denied, suspended, or revoked licenses
 1097         to the Department of Business and Professional
 1098         Regulation; exempting a facility from the 45-day
 1099         notice requirement if it is required to relocate some
 1100         or all of its residents; amending s. 429.178, F.S.;
 1101         conforming cross-references; amending s. 429.19, F.S.;
 1102         revising the amounts and uses of administrative fines;
 1103         requiring the agency to levy a fine for violations
 1104         that are corrected before an inspection if
 1105         noncompliance occurred within a specified period of
 1106         time; deleting factors that the agency is required to
 1107         consider in determining penalties and fines; amending
 1108         s. 429.256, F.S.; revising the term “assistance with
 1109         self-administration of medication” as it relates to
 1110         the Assisted Living Facilities Act; amending s.
 1111         429.28, F.S.; providing notice requirements to inform
 1112         facility residents that the identity of the resident
 1113         and complainant in any complaint made to the State
 1114         Long-Term Care Ombudsman Program or a local long-term
 1115         care ombudsman council is confidential and that
 1116         retaliatory action may not be taken against a resident
 1117         for presenting grievances or for exercising any other
 1118         resident right; requiring that a facility that
 1119         terminates an individual’s residency after the filing
 1120         of a complaint be fined if good cause is not shown for
 1121         the termination; amending s. 429.34, F.S.; requiring
 1122         certain persons to report elder abuse in assisted
 1123         living facilities; requiring the agency to regularly
 1124         inspect every licensed assisted living facility;
 1125         requiring the agency to conduct more frequent
 1126         inspections under certain circumstances; requiring the
 1127         licensee to pay a fee for the cost of additional
 1128         inspections; requiring the agency to annually adjust
 1129         the fee; amending s. 429.41, F.S.; providing that
 1130         certain staffing requirements apply only to residents
 1131         in continuing care facilities who are receiving
 1132         relevant services; amending s. 429.52, F.S.; requiring
 1133         each newly hired employee of an assisted living
 1134         facility to attend a preservice orientation provided
 1135         by the assisted living facility; requiring the
 1136         employee and administrator to sign a statement that
 1137         the employee completed the required preservice
 1138         orientation and keep the signed statement in the
 1139         employee’s personnel record; requiring 2 additional
 1140         hours of training for assistance with medication;
 1141         conforming a cross-reference; requiring the Office of
 1142         Program Policy Analysis and Government Accountability
 1143         to study the reliability of facility surveys and
 1144         submit to the Governor and the Legislature its
 1145         findings and recommendations; creating s. 429.55,
 1146         F.S.; requiring the Agency for Health Care
 1147         Administration to implement a rating system of
 1148         assisted living facilities by a specified date;
 1149         authorizing the agency to adopt rules; requiring the
 1150         Agency for Health Care Administration to provide
 1151         specified data on assisted living facilities by a
 1152         certain date; requiring the agency to include all
 1153         content in its possession on a specified date on the
 1154         website; providing minimum requirements for the data;
 1155         authorizing the agency to create a comment webpage
 1156         regarding assisted living facilities; providing
 1157         minimum requirements; authorizing the agency to
 1158         provide links to certain third-party websites;
 1159         providing appropriations and authorizing positions;