CODING: Words stricken are deletions; words underlined are additions.
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The Committee on Elder Affairs & Long Term Care offered the
following:
HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 The Committee on Elder Affairs & Long Term Care offered the
12 following:
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14 Amendment
15 remove from the bill: Everything after the enacting clause
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17 and insert in lieu thereof:
18 Section 1. Subsection (2) of section 400.404, Florida
19 Statutes, is amended to read:
20 400.404 Facilities to be licensed; exemptions.--
21 (2) The following are exempt from this part:
22 (a) Any facility, institution, or other place operated
23 by the Federal Government or any agency of the Federal
24 Government.
25 (b) Any facility or part of a facility licensed under
26 chapter 393 or chapter 394.
27 (c) Any home or facility approved by the United States
28 Department of Veterans Affairs as a residential care home
29 wherein care is provided exclusively to three or fewer
30 veterans.
31 (d) Any facility that has been incorporated in this
1
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 state for 50 years or more on or before July 1, 1983, and the
2 board of directors of which is nominated or elected by the
3 residents, until the facility is sold or its ownership is
4 transferred; or any facility, with improvements or additions
5 thereto, which has existed and operated continuously in this
6 state for 60 years or more on or before July 1, 1989, is
7 directly or indirectly owned and operated by a nationally
8 recognized fraternal organization, is not open to the public,
9 and accepts only its own members and their spouses as
10 residents.
11 (e) Any facility certified under chapter 651, or a
12 retirement community, may provide services authorized under
13 this part or part IV of this chapter to its residents who live
14 in single-family homes, duplexes, quadruplexes, or apartments
15 located on the campus without obtaining a license to operate
16 an assisted living facility if residential units within such
17 buildings are used by residents who do not require staff
18 supervision for that portion of the day when personal services
19 are not being delivered and the owner obtains a home health
20 license to provide such services. However, any building or
21 distinct part of a building on the campus that is designated
22 for persons who receive personal services and require
23 supervision beyond that which is available while such services
24 are being rendered must be licensed in accordance with this
25 part. If a facility provides personal services to residents
26 who do not otherwise require supervision and the owner is not
27 licensed as a home health agency, the buildings or distinct
28 parts of buildings where such services are rendered must be
29 licensed under this part. A resident of a facility that
30 obtains a home health license may contract with a home health
31 agency of his or her choice, provided that the home health
2
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 agency provides liability insurance and workers' compensation
2 coverage for its employees. Facilities covered by this
3 exemption may establish policies that give residents the
4 option of contracting for services and care beyond that which
5 is provided by the facility to enable them to age in place.
6 For purposes of this section, a retirement community consists
7 of a facility licensed under this part or under part II, and
8 apartments designed for independent living located on the same
9 campus.
10 (f) Any residential unit for independent living which
11 is located within a facility certified under chapter 651, or
12 any residential unit which is colocated with a nursing home
13 licensed under part II or colocated with a facility licensed
14 under this part in which services are provided through an
15 outpatient clinic or a nursing home on an outpatient basis.
16 Section 2. Subsections (1), (2), (3), and (5) of
17 section 400.424, Florida Statutes, are amended, and subsection
18 (8) is added to that section, to read:
19 400.424 Contracts.--
20 (1) The presence of each resident in a facility shall
21 be covered by a contract, executed at the time of admission or
22 prior thereto, between the licensee and the resident or his or
23 her designee or legal representative. Each party to the
24 contract shall be provided with a duplicate original thereof,
25 and the licensee shall keep on file in the facility all such
26 contracts. The licensee may shall not destroy or otherwise
27 dispose of any such contract until 5 years after its
28 expiration or such longer period as may be provided in the
29 rules of the department.
30 (2) Each contract must shall contain express
31 provisions specifically setting forth the services and
3
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 accommodations to be provided by the facility; the rates or
2 charges; provision for at least 30 days' written notice of a
3 rate increase; the rights, duties, and obligations of the
4 residents, other than those specified in s. 400.428; and other
5 matters that which the parties deem appropriate. Whenever
6 money is deposited or advanced by a resident in a contract as
7 security for performance of the contract agreement or as
8 advance rent for other than the next immediate rental period:
9 (a) Such funds shall be deposited held in a banking
10 institution in this state that is. Funds held shall be kept
11 separate from the funds and property of the facility; shall be
12 deposited in a bank savings association, trust company, or
13 credit union located in this state and, if possible, located,
14 if possible, in the same community district in which the
15 facility is located; shall be kept separate from the funds and
16 property of the facility; may not be represented as part of
17 the assets of the facility on financial statements; and shall
18 be used, or otherwise expended, only for the account of the
19 resident.
20 (b) The licensee shall, within 30 days of receipt of
21 advance rent or a security deposit, notify the resident or
22 residents in writing of the manner in which the licensee is
23 holding the advance rent or security deposit and state the
24 name and address of the depository where the moneys are being
25 held. The licensee shall notify residents of the facility's
26 policy on advance deposits.
27 (3)(a) The contract shall include a refund policy to
28 be implemented at the time of a resident's transfer,
29 discharge, or death. The refund policy shall provide that the
30 resident or responsible party is entitled to a prorated refund
31 based on the daily rate for any unused portion of payment
4
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 beyond the termination date after all charges, including the
2 cost of damages to the residential unit resulting from
3 circumstances other than normal use, have been paid to the
4 licensee. For the purpose of this paragraph, the termination
5 date shall be the date the unit is vacated by the resident and
6 cleared of all personal belongings. If the amount of
7 belongings does not preclude renting the unit, the facility
8 may clear the unit and charge the resident or his or her
9 estate for moving and storing the items at a rate equal to the
10 actual cost to the facility, not to exceed 20 percent of the
11 regular rate for the unit, provided that 14 days' advance
12 written notification is given. If the resident's possessions
13 are not claimed within 45 days after notification, the
14 facility may dispose of them. The contract shall also specify
15 any other conditions under which claims will be made against
16 the refund due the resident. Except in the case of death or a
17 discharge due to medical reasons, the refunds shall be
18 computed in accordance with the notice of relocation
19 requirements specified in the contract. However, a resident
20 may not be required to provide the licensee with more than 30
21 days' notice of termination. If after a contract is
22 terminated, the facility intends to make a claim against a
23 refund due the resident, the facility shall notify the
24 resident or responsible party in writing of the claim and
25 shall provide said party with a reasonable time period of no
26 less than 14 calendar days to respond. The facility shall
27 provide a refund to the resident or responsible party within
28 45 days after the transfer, discharge, or death of the
29 resident. The agency shall impose a fine upon a facility that
30 fails to comply with the refund provisions of the paragraph,
31 which fine shall be equal to three times the amount due to the
5
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 resident. One-half of the fine shall be remitted to the
2 resident or his or her estate, and the other half to the
3 Health Care Trust Fund to be used for the purpose specified in
4 s. 400.418.
5 (b) If a licensee agrees to reserve a bed for a
6 resident who is admitted to a medical facility, including, but
7 not limited to, a nursing home, health care facility, or
8 psychiatric facility, the resident or his or her responsible
9 party shall notify the licensee of any change in status that
10 would prevent the resident from returning to the facility.
11 Until such notice is received, the agreed upon daily rate may
12 be charged by the licensee.
13 (c) The purpose of any advance payment and a refund
14 policy for such payment, including any advance payment for
15 housing, meals, lodging, or personal services, shall be
16 covered in the contract.
17 (5) Neither the No contract nor, or any provision
18 thereof relieves, shall be construed to relieve any licensee
19 of any requirement or obligation imposed upon it by this part
20 or rules adopted under this part act or by standards or rules
21 in force pursuant thereto.
22 (8) The department may by rule clarify terms,
23 establish procedures, clarify refund policies and contract
24 provisions, and specify documentation as necessary to
25 administer this section.
26 Section 3. Subsections (2), (3), and (7) of section
27 400.427, Florida Statutes, are amended, and subsection (8) is
28 added to that section, to read:
29 400.427 Property and personal affairs of residents.--
30 (2) A facility, or an owner, administrator, employee,
31 or representative thereof, may not act as the guardian,
6
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 trustee, or conservator for any resident of the assisted
2 living facility or any of such resident's property. An owner,
3 administrator, or staff member, or representative thereof, may
4 not act as a competent resident's payee for social security,
5 veteran's, or railroad benefits without the consent of the
6 resident. Any facility whose owner, administrator, or staff,
7 or representative thereof, serves as representative payee for
8 any resident of the facility shall file a surety bond with the
9 agency in an amount equal to twice the average monthly
10 aggregate income or personal funds due to residents, or
11 expendable for their account, which are received by a
12 facility. Any facility whose owner, administrator, or staff,
13 or a representative thereof, is granted power of attorney for
14 any resident of the facility shall file a surety bond with the
15 agency for each resident for whom such power of attorney is
16 granted. The surety bond shall be in an amount equal to twice
17 the average monthly income of the resident, plus the value of
18 any resident's other property of the resident, which income
19 and property are under the control of the attorney in fact.
20 The bond shall be executed by the facility as principal and a
21 licensed surety company authorized and licensed to do business
22 in the state as surety. The bond shall be conditioned upon
23 the faithful compliance of the facility with this section and
24 shall run to the agency for the benefit of any resident who
25 suffers a financial loss as a result of the misuse or
26 misappropriation by a facility of funds held pursuant to this
27 subsection. Any surety company that which cancels or does not
28 renew the bond of any licensee shall notify the agency in
29 writing not less than 30 days in advance of such action,
30 giving the reason for the cancellation or nonrenewal. The
31 agency, in cooperation with insurance companies, associations,
7
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 and organizations representing facilities licensed under this
2 part, and the Department of Insurance shall develop procedures
3 to implement the bonding requirements of this subsection. Any
4 facility owner, administrator, or staff, or representative
5 thereof, who is granted power of attorney for any resident of
6 the facility shall, on a monthly basis, be required to provide
7 the resident a written statement of any transaction made on
8 behalf of the resident pursuant to this subsection, and a copy
9 of such statement given to the resident shall be retained in
10 the facility in each resident's file and available for agency
11 inspection.
12 (3) A facility, upon mutual consent with the resident,
13 shall provide for the safekeeping in the facility of personal
14 effects not in excess of $500 and funds of the resident not in
15 excess of $200 cash, and. A facility shall keep complete and
16 accurate records of all such funds and personal effects
17 received for safekeeping. If When a resident is absent from a
18 facility for 24 hours or more, the facility may provide for
19 the safekeeping of the resident's personal effects in excess
20 of $500.
21 (7) In the event of the death of a resident, a
22 licensee shall return all refunds, funds, and property held in
23 trust to the resident's personal representative, if one has
24 been appointed at the time the facility disburses such funds,
25 and, if not, to the resident's spouse or adult next of kin
26 named in a beneficiary designation form provided by the
27 facility to the resident. If In the event the resident has no
28 spouse or adult next of kin or such person cannot be located,
29 funds due the resident shall be placed in an interest-bearing
30 account, and all property held in trust by the facility shall
31 be safeguarded until such time as the funds and property are
8
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 disbursed pursuant to the Florida Probate Code. Such funds
2 shall be kept separate from the funds and property of the
3 facility and other residents of the facility. If In the event
4 the funds of the deceased resident are not disbursed pursuant
5 to the provisions of the Florida Probate Code within 2 years
6 after of the resident's death, the funds shall be deposited in
7 the Health Care Trust Fund administered by the agency as
8 provided in s. 400.418.
9 (8) The department may by rule clarify terms and
10 specify procedures and documentation necessary to administer
11 the provisions of this section relating to the proper
12 management of residents' funds and personal property and the
13 execution of surety bonds.
14 Section 4. Section 400.4275, Florida Statutes, is
15 created to read:
16 400.4275 Business practice; personnel records;
17 liability insurance.--The assisted living facility shall be
18 administered on a sound financial basis that is consistent
19 with good business practices.
20 (1) The administrator or owner of a facility shall
21 maintain accurate business records that identify, summarize,
22 and classify funds received and expenses disbursed and shall
23 use written accounting procedures and a recognized accounting
24 system.
25 (2) The administrator or owner of a facility shall
26 maintain personnel records for each staff member which
27 contain, at a minimum, documentation of background screening,
28 if applicable, documentation of compliance with all training
29 requirements of this part or applicable rule, and a copy of
30 all licenses or certification held by each staff who performs
31 services for which licensure or certification is required
9
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 under this part or rule.
2 (3) The administrator or owner of a facility shall
3 maintain liability insurance coverage that is in force at all
4 times.
5 (4) The department may by rule clarify terms,
6 establish requirements for financial records, accounting
7 procedures, personnel procedures, insurance coverage, and
8 reporting procedures, and specify documentation as necessary
9 to implement the requirements of this section.
10 Section 5. Subsections (1) and (3) of section 400.441,
11 Florida Statutes, are amended to read:
12 400.441 Rules establishing standards.--
13 (1) It is the intent of the Legislature that rules
14 published and enforced pursuant to this section shall include
15 criteria by which a reasonable and consistent quality of
16 resident care and quality of life may be ensured and the
17 results of such resident care may be demonstrated. Such rules
18 shall also ensure a safe and sanitary environment that is
19 residential and noninstitutional in design or nature. It is
20 further intended that reasonable efforts be made to
21 accommodate the needs and preferences of residents to enhance
22 the quality of life in a facility. In order to provide safe
23 and sanitary facilities and the highest quality of resident
24 care accommodating the needs and preferences of residents, the
25 department, in consultation with the agency, the Department of
26 Children and Family Services, and the Department of Health and
27 Rehabilitative Services, shall adopt rules, policies, and
28 procedures to administer this part, which must include
29 reasonable and fair minimum standards in relation to:
30 (a) The requirements for and maintenance of
31 facilities, not in conflict with the provisions of chapter
10
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 553, relating to plumbing, heating, lighting, ventilation,
2 living space, and other housing conditions, which will ensure
3 the health, safety, and comfort of residents and protection
4 from fire hazard, including adequate provisions for fire alarm
5 and other fire protection suitable to the size of the
6 structure. Uniform firesafety standards shall be established
7 and enforced by the State Fire Marshal in cooperation with the
8 agency, the department, and the Department of Health and
9 Rehabilitative Services.
10 1. Evacuation capability determination.--
11 a. The provisions of the National Fire Protection
12 Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
13 for determining the ability of the residents, with or without
14 staff assistance, to relocate from or within a licensed
15 facility to a point of safety as provided in the fire codes
16 adopted herein. An evacuation capability evaluation for
17 initial licensure shall be conducted within 6 months after the
18 date of licensure. For existing licensed facilities that are
19 not equipped with an automatic fire sprinkler system, the
20 administrator shall evaluate the evacuation capability of
21 residents at least annually. The evacuation capability
22 evaluation for each facility not equipped with an automatic
23 fire sprinkler system shall be validated, without liability,
24 by the State Fire Marshal, by the local fire marshal, or by
25 the local authority having jurisdiction over firesafety,
26 before the license renewal date. If the State Fire Marshal,
27 local fire marshal, or local authority having jurisdiction
28 over firesafety has reason to believe that the evacuation
29 capability of a facility as reported by the administrator may
30 have changed, it may, with assistance from the facility
31 administrator, reevaluate the evacuation capability through
11
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 timed exiting drills. Translation of timed fire exiting drills
2 to evacuation capability may be determined:
3 (I) Three minutes or less: prompt.
4 (II) More than 3 minutes, but not more than 13
5 minutes: slow.
6 (III) More than 13 minutes: impractical.
7 b. The Office of the State Fire Marshal shall provide
8 or cause the provision of training and education on the proper
9 application of Chapter 5, NFPA 101A, 1995 edition, to its
10 employees, to staff of the Agency for Health Care
11 Administration who are responsible for regulating facilities
12 under this part, and to local governmental inspectors. The
13 Office of the State Fire Marshal shall provide or cause the
14 provision of this training within its existing budget, but may
15 charge a fee for this training to offset its costs. The
16 initial training must be delivered within 6 months after July
17 1, 1995, and as needed thereafter.
18 c. The Office of the State Fire Marshal, in
19 cooperation with provider associations, shall provide or cause
20 the provision of a training program designed to inform
21 facility operators on how to properly review bid documents
22 relating to the installation of automatic fire sprinklers.
23 The Office of the State Fire Marshal shall provide or cause
24 the provision of this training within its existing budget, but
25 may charge a fee for this training to offset its costs. The
26 initial training must be delivered within 6 months after July
27 1, 1995, and as needed thereafter.
28 d. The administrator of a licensed facility shall sign
29 an affidavit verifying the number of residents occupying the
30 facility at the time of the evacuation capability evaluation.
31 2. Firesafety requirements.--
12
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 a. Except for the special applications provided
2 herein, effective January 1, 1996, the provisions of the
3 National Fire Protection Association, Life Safety Code, NFPA
4 101, 1994 edition, Chapter 22 for new facilities and Chapter
5 23 for existing facilities shall be the uniform fire code
6 applied by the State Fire Marshal for assisted living
7 facilities, pursuant to s. 633.022.
8 b. Any new facility, regardless of size, that applies
9 for a license on or after January 1, 1996, must be equipped
10 with an automatic fire sprinkler system. The exceptions as
11 provided in section 22-2.3.5.1, NFPA 101, 1994 edition, as
12 adopted herein, apply to any new facility housing eight or
13 fewer residents. On July 1, 1995, local governmental entities
14 responsible for the issuance of permits for construction shall
15 inform, without liability, any facility whose permit for
16 construction is obtained prior to January 1, 1996, of this
17 automatic fire sprinkler requirement. As used in this part,
18 the term "a new facility" does not mean an existing facility
19 that has undergone change of ownership.
20 c. Notwithstanding any provision of s. 633.022 or of
21 the National Fire Protection Association, NFPA 101A, Chapter
22 5, 1995 edition, to the contrary, any existing facility
23 housing eight or fewer residents is not required to install an
24 automatic fire sprinkler system, nor to comply with any other
25 requirement in Chapter 23 of NFPA 101, 1994 edition, that
26 exceeds the firesafety requirements of NFPA 101, 1988 edition,
27 that applies to this size facility, unless the facility has
28 been classified as impractical to evacuate. Any existing
29 facility housing eight or fewer residents that is classified
30 as impractical to evacuate must install an automatic fire
31 sprinkler system within the timeframes granted in this
13
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 section.
2 d. Any existing facility that is required to install
3 an automatic fire sprinkler system under this paragraph need
4 not meet other firesafety requirements of Chapter 23, NFPA
5 101, 1994 edition, which exceed the provisions of NFPA 101,
6 1988 edition. The mandate contained in this paragraph which
7 requires certain facilities to install an automatic fire
8 sprinkler system supersedes any other requirement.
9 e. This paragraph does not supersede the exceptions
10 granted in NFPA 101, 1988 edition or 1994 edition.
11 f. This paragraph does not exempt facilities from
12 other firesafety provisions adopted under s. 633.022 and local
13 building code requirements in effect before July 1, 1995.
14 g. A local government may charge fees only in an
15 amount not to exceed the actual expenses incurred by local
16 government relating to the installation and maintenance of an
17 automatic fire sprinkler system in an existing and properly
18 licensed assisted living facility structure as of January 1,
19 1996.
20 h. If a licensed facility undergoes major
21 reconstruction or addition to an existing building on or after
22 January 1, 1996, the entire building must be equipped with an
23 automatic fire sprinkler system. Major reconstruction of a
24 building means repair or restoration that costs in excess of
25 50 percent of the value of the building as reported on the tax
26 rolls, excluding land, before reconstruction. Multiple
27 reconstruction projects within a 5-year period the total costs
28 of which exceed 50 percent of the initial value of the
29 building at the time the first reconstruction project was
30 permitted are to be considered as major reconstruction.
31 Application for a permit for an automatic fire sprinkler
14
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 system is required upon application for a permit for a
2 reconstruction project that creates costs that go over the
3 50-percent threshold.
4 i. Any facility licensed before January 1, 1996, that
5 is required to install an automatic fire sprinkler system
6 shall ensure that the installation is completed within the
7 following timeframes based upon evacuation capability of the
8 facility as determined under subparagraph 1.:
9 (I) Impractical evacuation capability, 24 months.
10 (II) Slow evacuation capability, 48 months.
11 (III) Prompt evacuation capability, 60 months.
12
13 The beginning date from which the deadline for the automatic
14 fire sprinkler installation requirement must be calculated is
15 upon receipt of written notice from the local fire official
16 that an automatic fire sprinkler system must be installed. The
17 local fire official shall send a copy of the document
18 indicating the requirement of a fire sprinkler system to the
19 Agency for Health Care Administration.
20 j. It is recognized that the installation of an
21 automatic fire sprinkler system may create financial hardship
22 for some facilities. The appropriate local fire official
23 shall, without liability, grant two 1-year extensions to the
24 timeframes for installation established herein, if an
25 automatic fire sprinkler installation cost estimate and proof
26 of denial from two financial institutions for a construction
27 loan to install the automatic fire sprinkler system are
28 submitted. However, for any facility with a class I or class
29 II, or a history of uncorrected class III, firesafety
30 deficiencies, an extension must not be granted. The local
31 fire official shall send a copy of the document granting the
15
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 time extension to the Agency for Health Care Administration.
2 k. A facility owner whose facility is required to be
3 equipped with an automatic fire sprinkler system under Chapter
4 23, NFPA 101, 1994 edition, as adopted herein, must disclose
5 to any potential buyer of the facility that an installation of
6 an automatic fire sprinkler requirement exists. The sale of
7 the facility does not alter the timeframe for the installation
8 of the automatic fire sprinkler system.
9 l. Existing facilities required to install an
10 automatic fire sprinkler system as a result of
11 construction-type restrictions in Chapter 23, NFPA 101, 1994
12 edition, as adopted herein, or evacuation capability
13 requirements shall be notified by the local fire official in
14 writing of the automatic fire sprinkler requirement, as well
15 as the appropriate date for final compliance as provided in
16 this subparagraph. The local fire official shall send a copy
17 of the document to the Agency for Health Care Administration.
18 m. Except in cases of life-threatening fire hazards,
19 if an existing facility experiences a change in the evacuation
20 capability, or if the local authority having jurisdiction
21 identifies a construction-type restriction, such that an
22 automatic fire sprinkler system is required, it shall be
23 afforded time for installation as provided in this
24 subparagraph.
25 n. There is created a study-work group consisting of
26 representatives of the Office of the State Fire Marshal,
27 Florida Fire Chiefs' Association, Florida Fire Marshals'
28 Association, Florida Assisted Living Association, Florida
29 Association of Homes for the Aging, Florida Health Care
30 Association, Florida League of Cities, Florida Association of
31 Counties, Florida State Firemen's Association, Building
16
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 Officials' Association of Florida, the Aging and Adult
2 Services Program Office of the Department of Health and
3 Rehabilitative Services, and the Agency for Health Care
4 Administration. Each entity involved shall select its
5 representative to the study-work group. The Florida Fire
6 Chiefs' Association shall coordinate study-work group
7 activities. The study-work group shall examine the National
8 Fire Protection Association, NFPA 101, Chapter 23, 1994
9 edition, and shall report to the Legislature by December 31,
10 1995, its recommendations for firesafety standards that will
11 provide a reasonable level of firesafety for the protection of
12 assisted living facility residents without imposing
13 unnecessary economic impact on facilities regulated under this
14 part. Expenses incurred while participating in this study-work
15 group activity shall be borne by the participants.
16
17 Facilities that are fully sprinkled and in compliance with
18 other firesafety standards are not required to conduct more
19 than one of the required fire drills between the hours of 11
20 p.m. and 7 a.m., per year. In lieu of the remaining drills,
21 staff responsible for residents during such hours may be
22 required to participate in a mock drill that includes a review
23 of evacuation procedures. Such standards must be included or
24 referenced in the rules adopted by the department after
25 consultation with the State Fire Marshal. Pursuant to s.
26 633.022(1)(b), the State Fire Marshal is the final
27 administrative authority for firesafety standards established
28 and enforced pursuant to this section. All licensed facilities
29 must have an annual fire inspection conducted by the local
30 fire marshal or authority having jurisdiction.
31 (b) The preparation and annual update of a
17
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 comprehensive emergency management plan. Such standards must
2 be included in the rules adopted by the department after
3 consultation with the Department of Community Affairs. At a
4 minimum, the rules must provide for plan components that
5 address emergency evacuation transportation; adequate
6 sheltering arrangements; postdisaster activities, including
7 provision of emergency power, food, and water; postdisaster
8 transportation; supplies; staffing; emergency equipment;
9 individual identification of residents and transfer of
10 records; communication with families; and responses to family
11 inquiries. The comprehensive emergency management plan is
12 subject to review and approval by the local emergency
13 management agency. During its review, the local emergency
14 management agency shall ensure that the following agencies, at
15 a minimum, are given the opportunity to review the plan: the
16 Department of Elderly Affairs, the Department of Health and
17 Rehabilitative Services, the Agency for Health Care
18 Administration, and the Department of Community Affairs.
19 Also, appropriate volunteer organizations must be given the
20 opportunity to review the plan. The local emergency
21 management agency shall complete its review within 60 days and
22 either approve the plan or advise the facility of necessary
23 revisions.
24 (c) The number, training, and qualifications of all
25 personnel having responsibility for the care of residents.
26 The rules must require adequate staff to provide for the
27 safety of all residents. Facilities licensed for 17 or more
28 residents are required to maintain an alert staff for 24 hours
29 per day.
30 (d) All sanitary conditions within the facility and
31 its surroundings, including water supply, sewage disposal,
18
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 food handling, and general hygiene, and maintenance thereof,
2 which will ensure the health and comfort of residents. The
3 rules must clearly delineate the responsibilities of the
4 agency's licensure and survey staff, and the responsibilities
5 of the county health departments, and the local authority
6 having jurisdiction over fire safety and ensure that
7 inspections are not duplicative. The agency may collect fees
8 for food service inspections conducted by the county health
9 departments and transfer such fees to the Department of Health
10 and Rehabilitative Services.
11 (e) License application and license renewal, transfer
12 of ownership, proper management of resident funds and personal
13 property, surety bonds, resident contracts, refund policies,
14 financial ability to operate, and facility and staff records.
15 (f)(e) Inspections, complaint investigations,
16 moratoriums, classification of deficiencies,
17 The levying and enforcement of penalties, and use of
18 income from fees and fines.
19 (g)(f) The enforcement of the resident bill of rights
20 specified in s. 400.428.
21 (h)(g) The care and maintenance of residents, which
22 must include, but is not limited to:
23 1. The supervision of residents;
24 2.1. The provision of personal services;
25 3.2. The provision of, or arrangement for, social and
26 leisure activities;
27 4.3. The arrangement for appointments and
28 transportation to appropriate medical, dental, nursing, or
29 mental health services, as needed by residents;
30 4. The provision of limited nursing services;
31 5. The management of medication; The provision of
19
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 extended congregate care services; and
2 6. The nutritional needs of residents; and The
3 provision of limited mental health services.
4 7. Resident records.
5 (i) Facilities holding a limited nursing, extended
6 congregate care, or limited mental health license.
7 (j)(h) The establishment of specific criteria to
8 define appropriateness of resident admission and continued
9 residency in a facility holding a standard, limited nursing,
10 extended congregate care, and limited mental health license.
11 (k)(i) The definition and use of physical or chemical
12 restraints. The use of physical restraints is limited to
13 half-bed rails as prescribed and documented by the resident's
14 physician with the consent of the resident or, if applicable,
15 the resident's representative or designee or the resident's
16 surrogate, guardian, or attorney in fact. The use of chemical
17 restraints is limited to prescribed dosages of medications
18 authorized by the resident's physician and must be consistent
19 with the resident's diagnosis. Residents who are receiving
20 medications that can serve as chemical restraints must be
21 evaluated by their physician at least annually to assess:
22 1. The continued need for the medication.
23 2. The level of the medication in the resident's
24 blood.
25 3. The need for adjustments in the prescription.
26 (3) The department shall submit a copy of proposed
27 rules to the Speaker of the House of Representatives, the
28 President of the Senate, and appropriate committees of
29 substance for review and comment prior to the promulgation
30 thereof.
31 (a) Rules promulgated by the department shall
20
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 encourage the development of homelike facilities which promote
2 the dignity, individuality, personal strengths, and
3 decisionmaking ability of residents.
4 (b) The agency, in consultation with the department,
5 may waive rules promulgated pursuant to this part in order to
6 demonstrate and evaluate innovative or cost-effective
7 congregate care alternatives which enable individuals to age
8 in place. Such waivers may be granted only in instances where
9 there is reasonable assurance that the health, safety, or
10 welfare of residents will not be endangered. To apply for a
11 waiver, the licensee shall submit to the agency a written
12 description of the concept to be demonstrated, including
13 goals, objectives, and anticipated benefits; the number and
14 types of residents who will be affected, if applicable; a
15 brief description of how the demonstration will be evaluated;
16 and any other information deemed appropriate by the agency.
17 Any facility granted a waiver shall submit a report of
18 findings to the agency and the department within 12 months.
19 At such time, the agency may renew or revoke the waiver or
20 pursue any regulatory or statutory changes necessary to allow
21 other facilities to adopt the same practices. The department
22 may by rule clarify terms and establish waiver application
23 procedures, criteria for reviewing waiver proposals, and
24 procedures for reporting findings, as necessary to implement
25 this subsection.
26 Section 6. Subsection (3) is added to section 400.442,
27 Florida Statutes, to read:
28 400.442 Pharmacy and dietary services.--
29 (3) The department may by rule establish procedures
30 and specify documentation as necessary to implement this
31 section.
21
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 Section 7. Subsection (3) is added to section 400.444,
2 Florida Statutes, to read:
3 400.444 Construction and renovation; requirements.--
4 (3) The department may adopt rules to establish
5 procedures and specify the documentation necessary to
6 implement this section.
7 Section 8. Subsections (3), (4), and (13) of section
8 400.619, Florida Statutes, are amended to read:
9 400.619 Licensure requirements.--
10 (3) Application for a license or annual license
11 renewal to operate an adult family-care home must be made on a
12 form provided by the agency, signed under oath, and must be
13 accompanied by a licensing fee of $100 per year to offset the
14 cost of training and education programs by the Department of
15 Elderly Affairs for providers.
16 (4) Upon receipt of a completed license application or
17 license renewal, and the fee, the agency shall conduct a level
18 1 background screening as provided under chapter 435 on must
19 check with the abuse registry and the Department of Law
20 Enforcement concerning the adult family-care home provider
21 applicant, the designated relief person, all adult household
22 members, and all staff members. The agency shall also conduct
23 an onsite visit to the home that is to be licensed.
24 (13) The department may shall adopt rules to establish
25 procedures, identify forms, specify documentation, and clarify
26 terms, as necessary, to administer implement this section.
27 Section 9. Section 400.6196, Florida Statutes, is
28 amended to read:
29 400.6196 Violations; penalties.--
30 (1) In addition to any other liability or penalty
31 provided by law, the agency may impose a civil penalty on a
22
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 provider according to the following classification person for:
2 (a) Class I violations are those conditions or
3 practices related to the operation and maintenance of an adult
4 family-care home or to the care of residents which the agency
5 determines present an imminent danger to the residents or
6 guests of the facility or a substantial probability that death
7 or serious physical or emotional harm would result therefrom.
8 The condition or practice that constitutes a class I violation
9 must be abated or eliminated within 24 hours, unless a fixed
10 period, as determined by the agency, is required for
11 correction. A class I deficiency is subject to an
12 administrative fine in an amount not less that $500 and not
13 exceeding $1,000 for each violation. A fine may be levied
14 notwithstanding the correction of the deficiency.
15 (b) Class II violations are those conditions or
16 practices related to the operation and maintenance of an adult
17 family-care home or to the care of residents which the agency
18 determines directly threaten the physical or emotional health,
19 safety, or security of the residents, other than class I
20 violations. A class II violation is subject to an
21 administrative fine in an amount not less that $250 and not
22 exceeding $500 for each violation. A citation for a class II
23 violation must specify the time within which the violation is
24 required to be corrected. If a class II violation is corrected
25 within the time specified, no civil penalty shall be imposed,
26 unless it is a repeated offense.
27 (c) Class III violations are those conditions or
28 practices related to the operation and maintenance of an adult
29 family-care home or to the care of residents which the agency
30 determines indirectly or potentially threaten the physical or
31 emotional health, safety, or security of residents, other than
23
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 class I or class II violations. A class III violation is
2 subject to an administrative fine in an amount not less than
3 $100 and not exceeding $250 for each violation. A citation for
4 a class III violation shall specify the time within which the
5 violation is required to be corrected. If a class III
6 violation is corrected within the time specified, no civil
7 penalty shall be imposed, unless it is a repeated offense.
8 (d) Class IV violations are those conditions or
9 occurrences related to the operation and maintenance of an
10 adult family-care home, or related to the required reports,
11 forms, or documents, which do not have the potential of
12 negatively affecting the residents. A provider that does not
13 correct a class IV violation within the time limit specified
14 by the agency is subject to an administrative fine in an
15 amount not less that $50 and not exceeding $100 for each
16 violation. Any class IV violation that is corrected during the
17 time the agency survey is conducted will be identified as an
18 agency finding and not as a violation.
19 (2) The agency may impose an administrative fine for
20 violations which do not qualify as class I, class II, class
21 III, or class IV violations. The amount of the fine shall not
22 exceed $250 for each violation or $2,000 in the aggregate.
23 Unclassified violations include:
24 (a) Violating any term or condition of a license.; or
25 (b) Violating any rule adopted under this part ss.
26 400.616-400.629.
27 (c) Failure to follow the criteria and procedures
28 provided under part I of chapter 394 relating to the
29 transportation, voluntary admission, and involuntary
30 examination of adult family-care home residents.
31 (d) Exceeding licensed capacity.
24
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 (e) Providing services beyond the scope of the
2 license.
3 (f) Violating a moratorium.
4 (3)(2) Each day during which a violation occurs
5 constitutes a separate offense violation.
6 (4)(3) In determining whether a penalty is to be
7 imposed, and in fixing the amount of any penalty to be
8 imposed, the agency must consider:
9 (a) The gravity of the violation.
10 (b) Actions taken by the provider to correct a
11 violation.
12 (c) Any previous violation by the provider.
13 (d) The financial benefit to the provider of
14 committing or continuing the violation.
15 (5)(4) As an alternative to or in conjunction with an
16 administrative action against a provider, the agency may
17 request a plan of corrective action that demonstrates a good
18 faith effort to remedy each violation by a specific date,
19 subject to the approval of the agency department.
20 (6)(5) The department shall set forth, by rule, notice
21 requirements and procedures for correction of deficiencies
22 classifications of violations and civil penalties to be
23 levied.
24 (7)(6) Civil penalties paid by a provider must be
25 deposited into the Department of Elderly Affairs
26 Administrative Trust Fund and used to offset the expenses of
27 departmental training and education for adult family-care home
28 providers.
29 (8)(7) The agency may impose an immediate moratorium
30 on admissions to any adult family-care home if the agency
31 finds that a condition in the home presents a threat to the
25
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 health, safety, or welfare of its residents. The department
2 may by rule establish facility conditions that constitute
3 grounds for imposing a moratorium and establish procedures for
4 imposing and lifting a moratorium.
5 Section 10. Section 400.621, Florida Statutes, is
6 amended to read:
7 400.621 Rules and standards relating to adult
8 family-care homes.--
9 (1) The department shall, in consultation with the
10 Department of Health, the Department of Children and Family
11 Services, and Rehabilitative Services and the agency shall, by
12 rule, establish minimum standards to ensure and licensure
13 procedures for adult family-care homes. The rules must, at a
14 minimum:
15 (a) Provide for the health, safety, and well-being of
16 each resident in the adult family-care home. The rules must
17 address:
18 (a) Requirements for the physical site of the facility
19 and facility maintenance.
20 (b) Services that must be provided to all residents of
21 an adult family-care home and standards for such services,
22 which must include, but need not be limited to:
23 1. Room and board.
24 2. Assistance necessary to perform the activities of
25 daily living.
26 3. Assistance necessary to administer medication.
27 4. Supervision of residents.
28 5. Health monitoring.
29 6. Social and leisure activities.
30 (c)(b) Standards and Provide procedures for license
31 application and annual license renewal, advertising prevention
26
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 of abuse, proper management of each resident's funds and
2 personal property and personal affairs, financial ability to
3 operate, medication management, inspections, complaint
4 investigations, and facility, staff, and resident and records
5 and reports.
6 (d) Qualifications, training, standards, and
7 responsibilities for providers and staff.
8 (c) Promote the growth of adult family-care homes as a
9 component of a long-term care system.
10 (d) Promote the goal of aging in place.
11 (e) Mandate Compliance with chapter 419, relating to
12 community residential homes.
13 (f) Criteria and procedures for determining the
14 appropriateness of a resident's placement and continued
15 residency in Assure that an adult family-care home is the
16 appropriate living arrangement for each resident. A resident
17 who requires 24-hour nursing supervision may not be retained
18 in an adult family-care home. A person who would not be an
19 appropriate resident in any assisted living facility under s.
20 400.426 would not be an appropriate resident in an adult
21 family-care home.
22 (g) Procedures for providing notice and assuring
23 Assure the least possible disruption of residents' lives when
24 residents are relocated, an adult family-care home is closed,
25 or the ownership of an adult family-care home is transferred.
26 (h) Provide Procedures to protect the residents'
27 rights as provided in s. 400.628.
28 (i) Procedures to promote the growth of adult
29 family-care homes as a component of a long-term-care system.
30 (j) Procedures to promote the goal of aging in place
31 for residents of adult family-care homes.
27
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 (2) The department shall by rule provide minimum
2 standards and procedures for emergencies. Minimum firesafety
3 standards shall be established and enforced by the State Fire
4 Marshal in cooperation with the department and the agency.
5 Such standards must be included in the rules adopted by the
6 department after consultation with the State Fire Marshal and
7 the agency.
8 (3) The department shall by rule establish standards
9 for the adequate supervision of adult family-care residents.
10 (3)(4) The provider of any adult family-care home that
11 is in operation at the time any rules are adopted or amended
12 under this part ss. 400.616-400.629 may be given a reasonable
13 time, not exceeding 6 months, within which to comply with the
14 those new or revised rules and standards.
15 Section 11. Section 400.6211, Florida Statutes, is
16 amended to read:
17 400.6211 Training and education programs.--
18 (1) The department of Elderly Affairs must provide
19 training and education programs for all adult family-care home
20 providers.
21 (2) Training and education programs must include, but
22 are not limited to, information relating to:
23 (a) State law and rules governing adult family-care
24 homes, with emphasis on appropriateness of placement of
25 residents in an adult family-care home.
26 (b) Identifying and reporting abuse, neglect, and
27 exploitation.
28 (c) Identifying and meeting the special needs of aged
29 persons and disabled adults.
30 (d) Monitoring the health of residents, including
31 guidelines for prevention and care of pressure ulcers.
28
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 (3) Providers must complete the training and education
2 program within a reasonable time determined by the department
3 by rule. Failure to complete the training and education
4 program within the time set by the department is a violation
5 of ss. 400.616-400.629 and subjects the provider to revocation
6 or denial of the license under this part.
7 (4) If the Department of Children and Family Services
8 Health and Rehabilitative Services, the agency, or the
9 department determines that there are problems in an adult
10 family-care home which could be reduced through specific
11 training or education beyond that required under this section,
12 the department may require the provider or staff to complete
13 such training or education.
14 (5) The department shall specify by rule training and
15 education programs, training requirements and the assignment
16 of training responsibilities for staff, training procedures,
17 and training fees as necessary to administer this section.
18 Section 12. Present subsections (3) and (4) of section
19 409.212, Florida Statutes, are redesignated as subsections (4)
20 and (5), respectively, present subsection (4) is amended, and
21 a new subsection (3) is added to that section, to read:
22 409.212 Optional supplementation.--
23 (3) Assisted living facilities, adult family-care
24 homes, family placement, or any other specialized living
25 arrangement accepting residents who receive optional
26 supplementation payments must comply with the requirements of
27 42 U.S.C. s. 1382e(e).
28 (4)(3) In addition to the amount of optional
29 supplementation provided by the state, a person may receive
30 additional supplementation from third parties to contribute to
31 his or her cost of care. Additional supplementation may be
29
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HOUSE AMENDMENT
Bill No. CS for SB 1706
Amendment No. (for drafter's use only)
1 provided under the following conditions:
2 (a) Payments shall be made to the assisted living
3 facility, or to the operator of an adult family-care home,
4 family placement, or other special living arrangement, on
5 behalf of the person and not directly to the optional state
6 supplementation recipient.
7 (b) Contributions made by third parties shall be
8 entirely voluntary and shall not be a condition of providing
9 proper care to the client.
10 (c) The additional supplementation shall not exceed
11 two times the provider rate recognized under the optional
12 state supplementation program.
13 (d) Rent vouchers issued pursuant to a federal, state,
14 or local housing program may be issued directly to a recipient
15 of optional state supplementation.
16 (5)(4) When contributions are made in accordance with
17 the provisions of subsection (4)(3), the department shall not
18 count such supplements as income to the client for purposes of
19 determining eligibility for, or computing the amount of,
20 optional state supplementation benefits, nor shall the
21 department increase an optional state supplementation payment
22 to offset the reduction in Supplemental Security Income
23 benefits that will occur because of the third-party
24 contribution.
25 Section 13. This act shall take effect July 1 of the
26 year in which enacted.
27
28
29
30
31
30
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