Florida Senate - 2022                        COMMITTEE AMENDMENT
       Bill No. CS for SB 804
       
       
       
       
       
       
                                Ì627240wÎ627240                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                   Comm: OO            .                                
                  03/01/2022           .                                
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       The Committee on Rules (Gibson) recommended the following:
       
    1         Senate Amendment 
    2  
    3         Delete lines 119 - 313
    4  and insert:
    5         b. A minimum certified nursing assistant staffing of 2.5
    6  hours of direct care by a certified nursing assistant per
    7  resident per day. A facility may not staff below a ratio of one
    8  certified nursing assistant per 20 residents.
    9         c. A minimum licensed nursing staffing of 1.0 hour of
   10  direct care by a licensed nurse per resident per day. A facility
   11  may not staff below a ratio of one licensed nurse per 40
   12  residents.
   13         2. Nursing assistants employed under s. 400.211(2) may be
   14  included in computing the hours of direct care provided by
   15  certified nursing assistants and may be included in computing
   16  the staffing ratio for certified nursing assistants if their job
   17  responsibilities include only nursing-assistant-related duties.
   18         3. Each nursing home facility must document compliance with
   19  staffing standards as required under this paragraph and post
   20  daily the names of licensed nurses and certified nursing
   21  assistants staff on duty for the benefit of facility residents
   22  and the public. Facilities must maintain the records documenting
   23  compliance with minimum staffing standards for a period of 5
   24  years and must report staffing in accordance with 42 C.F.R. s.
   25  483.70(q).
   26         4. The agency must shall recognize the use of licensed
   27  nurses for compliance with minimum staffing requirements for
   28  certified nursing assistants if the nursing home facility
   29  otherwise meets the minimum staffing requirements for licensed
   30  nurses and the licensed nurses are performing the duties of a
   31  certified nursing assistant. Unless otherwise approved by the
   32  agency, licensed nurses counted toward the minimum staffing
   33  requirements for certified nursing assistants must exclusively
   34  perform the duties of a certified nursing assistant for the
   35  entire shift and not also be counted toward the minimum staffing
   36  requirements for licensed nurses. If the agency approved a
   37  facility’s request to use a licensed nurse to perform both
   38  licensed nursing and certified nursing assistant duties, the
   39  facility must allocate the amount of staff time specifically
   40  spent on certified nursing assistant duties for the purpose of
   41  documenting compliance with minimum staffing requirements for
   42  certified and licensed nursing staff. The hours of a licensed
   43  nurse with dual job responsibilities may not be counted twice.
   44         5.The nurse staffing requirements imposed in this
   45  paragraph are minimum nurse staffing requirements for nursing
   46  home facilities. Evidence that a facility complied with the
   47  minimum direct care staffing requirements under subparagraph 1.
   48  is not admissible as evidence of compliance with the nursing
   49  services requirements under 42 C.F.R. s. 483.35 or 42 C.F.R. s.
   50  483.70.
   51         (c)(b) Paid feeding assistants and direct care staff, other
   52  than certified nursing assistants, who have successfully
   53  completed the feeding assistant training program under s.
   54  400.141(1)(v) and who provide nonnursing staff providing eating
   55  assistance to residents shall not count toward compliance with
   56  overall direct care minimum staffing hours but not the hours of
   57  direct care required for certified nursing assistants or
   58  licensed nurses standards.
   59         (d)(c) Licensed practical nurses licensed under chapter 464
   60  who provide are providing nursing services in nursing home
   61  facilities under this part may supervise the activities of other
   62  licensed practical nurses, certified nursing assistants, and
   63  other unlicensed personnel providing services in such facilities
   64  in accordance with rules adopted by the Board of Nursing.
   65         (e)The agency may adopt rules to implement this
   66  subsection.
   67         Section 3. Present subsection (2) of section 400.0234,
   68  Florida Statutes, is redesignated as subsection (3), and a new
   69  subsection (2) is added to that section, to read:
   70         400.0234 Availability of facility records for investigation
   71  of resident’s rights violations and defenses; penalty.—
   72         (2) Forms filed with the agency pursuant to s. 408.061(5)
   73  and (6) are not confidential or exempt from the provisions of s.
   74  119.07(1) and s. 24(a), Art. I of the State Constitution and may
   75  be discoverable and admissible in a civil action under this part
   76  or an administrative action under this part or part II of
   77  chapter 408.
   78         Section 4. Subsection (4) of section 400.024, Florida
   79  Statutes, is amended to read:
   80         400.024 Failure to satisfy a judgment or settlement
   81  agreement.—
   82         (4) If, After the agency is placed on notice pursuant to
   83  subsection (2), the following applies and:
   84         (a) If the license is subject to renewal, the agency may
   85  deny the license renewal unless compliance with this section is
   86  achieved.; and
   87         (b) If a change of ownership application for the facility
   88  at issue is filed submitted by the licensee, by a person or
   89  entity identified as having a controlling interest in the
   90  licensee, or by a related party, the unsatisfied or undischarged
   91  adverse final judgment under subsection (1) becomes the
   92  responsibility and liability of the transferee, and the agency
   93  shall deny the change of ownership application unless compliance
   94  with this section is achieved.
   95         (c)If a change of ownership application for the facility
   96  at issue is filed by the licensee, by a person or entity
   97  identified as having a controlling interest in the licensee, or
   98  by a related party, then:
   99         1.The licensee or transferor must provide written notice
  100  of the filing of the application to each pending claimant or the
  101  claimant’s attorney of record, if applicable, within 14 days
  102  after the date the application is filed with the agency.
  103         2.The written notice must be provided by certified mail,
  104  return receipt requested, or other method that provides
  105  verification of receipt.
  106         3.A claimant has 30 days after the date of receipt of the
  107  written notice to object to the application if the claimant has
  108  reason to believe that the approval of the application would
  109  facilitate a fraudulent transfer or allow the transferor to
  110  avoid financial responsibility for the claimant’s pending claim.
  111         4.The agency must consider any objection brought pursuant
  112  to this subsection in its decision to approve or deny an
  113  application for change of ownership under this part and part II
  114  of chapter 408.
  115         5.If a claim is pending in arbitration at the time that
  116  the application for change of ownership is filed, the claimant
  117  may file a petition to enjoin the transfer in circuit court.
  118         6.As used in this paragraph, “claimant” means a resident
  119  or the resident’s family or personal representative who has
  120  notified the licensee or facility of a potential claim by notice
  121  of intent letter or who has initiated an action, claim, or
  122  arbitration proceeding against the licensee or facility.
  123         Section 5. Paragraphs (g), (n), and (r) of subsection (1)
  124  of section 400.141, Florida Statutes, are amended to read:
  125         400.141 Administration and management of nursing home
  126  facilities.—
  127         (1) Every licensed facility shall comply with all
  128  applicable standards and rules of the agency and shall:
  129         (g) If the facility has a standard license, exceeds the
  130  minimum required hours of direct care provided by licensed
  131  nurses nursing and certified nursing assistants assistant direct
  132  care per resident per day, and is part of a continuing care
  133  facility licensed under chapter 651 or is a retirement community
  134  that offers other services pursuant to part III of this chapter
  135  or part I or part III of chapter 429 on a single campus, be
  136  allowed to share programming and staff. At the time of
  137  inspection, a continuing care facility or retirement community
  138  that uses this option must demonstrate through staffing records
  139  that minimum staffing requirements for the facility were met.
  140  Licensed nurses and certified nursing assistants who work in the
  141  facility may be used to provide services elsewhere on campus if
  142  the facility exceeds the minimum number of direct care hours
  143  required per resident per day and the total number of residents
  144  receiving direct care services from a licensed nurse or a
  145  certified nursing assistant does not cause the facility to
  146  violate the staffing ratios required under s. 400.23(3)(b) s.
  147  400.23(3)(a). Compliance with the minimum staffing ratios must
  148  be based on the total number of residents receiving direct care
  149  services, regardless of where they reside on campus. If the
  150  facility receives a conditional license, it may not share staff
  151  until the conditional license status ends. This paragraph does
  152  not restrict the agency’s authority under federal or state law
  153  to require additional staff if a facility is cited for
  154  deficiencies in care which are caused by an insufficient number
  155  of certified nursing assistants or licensed nurses. The agency
  156  may adopt rules for the documentation necessary to determine
  157  compliance with this provision.
  158         (n) Comply with state minimum-staffing requirements:
  159         1. The agency shall impose a moratorium on new admissions
  160  for a facility that has failed for 48 consecutive hours to
  161  comply with the minimum hours of direct care required to be
  162  provided by a licensed nurse or certified nursing assistant. The
  163  moratorium must be imposed until the facility is able to
  164  document compliance with the minimum direct care hours required
  165  per resident per day for licensed nurses and certified nursing
  166  assistants state minimum-staffing requirements for 2 consecutive
  167  days is prohibited from accepting new admissions until the
  168  facility has achieved the minimum-staffing requirements for 6
  169  consecutive days. For the purposes of this subparagraph, any
  170  person who was a resident of the facility and was absent from
  171  the facility for the purpose of receiving medical care at a
  172  separate location or was on a leave of absence is not considered
  173  a new admission. Failure by the facility to impose such an
  174  admissions moratorium is subject to a $1,000 fine.
  175         2. A facility that has a standard does not have a
  176  conditional license may be cited for failure to comply with the
  177  standards in s. 400.23(3)(b)1.b. and c. s. 400.23(3)(a)1.b. and
  178  c. only if it has failed to meet those standards on 2
  179  consecutive days or if it has failed to meet at least 97 percent
  180  of those standards on any one day.
  181         3. A facility that has a conditional license must be in
  182  compliance with the standards in s. 400.23(3)(b) s. 400.23(3)(a)
  183  at all times.
  184         (r) Maintain in the medical record for each resident a
  185  daily chart of direct care certified nursing assistant services
  186  provided to the resident. The direct care staff certified
  187  nursing assistant who is caring for the resident must complete
  188  this record by the end of his or her shift. This record must
  189  indicate assistance with activities of daily living, assistance
  190  with eating, and assistance with drinking, and must record each
  191  offering of nutrition and hydration for those residents whose
  192  plan of care or assessment indicates a risk for malnutrition or
  193  dehydration.
  194         Section 6. Nursing Home Sustainability Task Force.—There is
  195  created the Nursing Home Sustainability Task Force. The task
  196  force shall review, analyze, and make recommendations specific
  197  to the sustainability of the state’s model of providing quality
  198  nursing home care. The task force shall consist of
  199  representatives of nursing home providers, nurses, certified
  200  nursing assistants, and aging advocates and other interested