CODING: Words stricken are deletions; words underlined are additions.House Bill 1891
Florida House of Representatives - 1997 HB 1891
By Representative Fischer
1 A bill to be entitled
2 An act relating to assisted living facilities;
3 amending s. 400.407, F.S.; modifying the number
4 of monitoring visits that must be made by the
5 Agency for Health Care Administration to an
6 assisted living facility licensed to provide
7 extended congregate care services; changing the
8 requirements for admission to an assisted
9 living facility licensed to provide extended
10 congregate care services; amending s. 400.408,
11 F.S.; requiring certain individuals with
12 knowledge of unlicensed assisted living
13 facility activity to be subject to disciplinary
14 action; amending s. 400.426, F.S.; authorizing
15 use of a certain assessment to fulfill medical
16 examination requirements; providing an
17 effective date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Subsection (3) of section 400.407, Florida
22 Statutes, is amended to read:
23 400.407 License required; fee, display.--
24 (3) Any license granted by the agency shall state the
25 maximum resident capacity of the facility, the type of care
26 for which the license is granted, the date the license is
27 issued, the expiration date of the license, and any other
28 information deemed necessary by the agency. Licenses shall be
29 issued for one or more of the following categories of care:
30 standard, extended congregate care, limited nursing services,
31 or limited mental health services.
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1 (a) A standard license shall be issued to facilities
2 providing one or more of the services identified in s.
3 400.402(16). Such facilities may also employ or contract with
4 a person licensed under chapter 464 to administer medications
5 and perform other tasks as specified in s. 400.4255.
6 (b) An extended congregate care license shall be
7 issued to facilities providing, directly or through contract,
8 services beyond those authorized in paragraph (a), including
9 acts performed pursuant to chapter 464 by persons licensed
10 thereunder, and supportive services which may be defined by
11 rule to persons who otherwise would be disqualified from
12 continued residence in a facility licensed under this part.
13 1. In order for extended congregate care services to
14 be provided in a facility licensed under this part, the agency
15 must first determine that all requirements established in law
16 and rule are met and must specifically designate, on the
17 facility's license, that such services may be provided and
18 whether the designation applies to all or part of a facility.
19 Such designation may be made at the time of initial licensure
20 or biennial relicensure, or upon request in writing by a
21 licensee under this part. Notification of approval or denial
22 of such request shall be made within 90 days after receipt of
23 such request and all necessary documentation. Existing
24 facilities qualifying to provide extended congregate care
25 services shall have maintained a standard license and shall
26 not have been subject to administrative sanctions during the
27 previous 2 years, or since initial licensure if the facility
28 has been licensed for less than 2 years, for any of the
29 following reasons:
30 a. A class I or class II violation;
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1 b. Three or more repeat or recurring class III
2 violations of identical or similar resident care standards as
3 specified in rule from which a pattern of noncompliance is
4 found by the agency;
5 c. Three or more class III violations which were not
6 corrected in accordance with the corrective action plan
7 approved by the agency;
8 d. Violation of resident care standards resulting in a
9 requirement to employ the services of a consultant pharmacist
10 or consultant dietitian;
11 e. Denial, suspension, or revocation of a license for
12 another facility under this part in which the applicant for an
13 extended congregate care license has at least 25 percent
14 ownership interest; or
15 f. Imposition of a moratorium on admissions or
16 initiation of injunctive proceedings.
17 2. Facilities that which are licensed to provide
18 extended congregate care services shall maintain a written
19 progress report on each person who receives such services,
20 which report describes the type, amount, duration, scope, and
21 outcome of services that are rendered and the general status
22 of the resident's health. A registered nurse, or appropriate
23 designee, representing the agency shall visit such facilities
24 at least two three times a year to monitor residents who are
25 receiving extended congregate care services and to determine
26 if the facility is in compliance with applicable provisions of
27 this part and with related rules relating to extended
28 congregate care. One of the visits may be in conjunction with
29 the regular biennial survey. The monitoring visits may be
30 provided through contractual arrangements with appropriate
31 community agencies. A registered nurse shall serve as part of
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1 the team that biennially inspects such facility. The agency
2 may waive one of the required yearly monitoring visits for a
3 facility that has been licensed for at least 24 months to
4 provide extended congregate care services, if, during the
5 biennial inspection, the registered nurse determines that
6 extended congregate care services are being provided
7 appropriately, and if the facility has no class I or class II
8 violations and no uncorrected class III violations. Before
9 such decision is made, the agency shall consult with the
10 long-term care ombudsman council for the area in which the
11 facility is located to determine if any complaints have been
12 made and substantiated about the quality of services or care.
13 The agency shall not waive one of the required yearly
14 monitoring visits if complaints have been made and
15 substantiated.
16 3. Facilities that which are licensed to provide
17 extended congregate care services shall:
18 a. Demonstrate the capability to meet unanticipated
19 resident service needs.
20 b. Offer a physical environment which promotes a
21 homelike setting, provides for resident privacy, promotes
22 resident independence, and allows sufficient congregate space
23 as defined by rule.
24 c. Have sufficient staff available, taking into
25 account the physical plant and firesafety features of the
26 building, to assist with the evacuation of residents in an
27 emergency, as necessary.
28 d. Adopt and follow policies and procedures which
29 maximize resident independence, dignity, choice, and
30 decisionmaking to permit residents to age in place to the
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1 extent possible, so that moves due to changes in functional
2 status are minimized or avoided.
3 e. Allow residents or, if applicable, a resident's
4 representative, designee, surrogate, guardian, or attorney in
5 fact to make a variety of personal choices, participate in
6 developing service plans, and share responsibility in
7 decisionmaking.
8 f. Implement the concept of managed risk.
9 g. Provide, either directly or through contract, the
10 services of a person licensed pursuant to chapter 464.
11 h. In addition to the training mandated in s. 400.452,
12 provide specialized training as defined by rule for facility
13 staff.
14 4. Facilities licensed to provide extended congregate
15 care services shall be exempt from the criteria for continued
16 residency as set forth in rule pursuant to s. 400.441(1)(h).
17 Facilities so licensed shall adopt their own requirements
18 within guidelines for continued residency set forth by the
19 department in rule. However, such facilities shall not serve
20 residents who require 24-hour nursing supervision. Facilities
21 licensed to provide extended congregate care services shall
22 provide each resident with a written copy of facility policies
23 governing admission and retention.
24 5. The primary purpose of extended congregate care
25 services is to allow residents, as they become more impaired,
26 the option of remaining in a familiar setting from which they
27 would otherwise be disqualified for continued residency. A
28 facility licensed to provide extended congregate care services
29 may also admit an individual who exceeds the admission
30 criteria for a facility with a standard license, if the
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1 individual is determined appropriate for admission to the
2 extended congregate care facility. and either:
3 a. Transfers from a facility with a standard license;
4 or
5 b. Transfers from another facility licensed to provide
6 extended congregate care services.
7 6. Before admission of an individual to a facility
8 licensed to provide extended congregate care services, the
9 individual must undergo a medical examination as provided in
10 s. 400.426(4) and the facility must develop a preliminary
11 service plan for the individual.
12 7. When a facility can no longer provide or arrange
13 for services in accordance with the resident's service plan
14 and needs and the facility's policy, the facility shall make
15 arrangements for relocating the person in accordance with s.
16 400.428(1)(k).
17 8. Failure to provide extended congregate care
18 services may result in denial of extended congregate care
19 license renewal.
20 9. No later than January 1 of each year, the
21 department, in consultation with the agency, shall prepare and
22 submit to the Governor, the President of the Senate, the
23 Speaker of the House of Representatives, and the chairmen of
24 appropriate legislative committees, a report on the status of,
25 and recommendations related to, extended congregate care
26 services. The status report must include, but need not be
27 limited to, the following information:
28 a. A description of the facilities licensed to provide
29 such services, including total number of beds licensed under
30 this part.
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1 b. The number and characteristics of residents
2 receiving such services.
3 c. The types of services rendered that could not be
4 provided through a standard license.
5 d. An analysis of deficiencies cited during biennial
6 inspections.
7 e. The number of residents who required extended
8 congregate care services at admission and the source of
9 admission.
10 f. Recommendations for statutory or regulatory
11 changes.
12 g. The availability of extended congregate care to
13 state clients residing in facilities licensed under this part
14 and in need of additional services, and recommendations for
15 appropriations to subsidize extended congregate care services
16 for such persons.
17 h. Such other information as the department considers
18 appropriate.
19 (c) A limited nursing services license shall be issued
20 to a facility which provides services beyond those authorized
21 in paragraph (a) and as specified in this paragraph.
22 1. In order for limited nursing services to be
23 provided in a facility licensed under this part, the agency
24 must first determine that all requirements established in law
25 and rule are met and must specifically designate, on the
26 facility's license, that such services may be provided. Such
27 designation may be made at the time of initial licensure or
28 biennial relicensure, or upon request in writing by a licensee
29 under this part. Notification of approval or denial of such
30 request shall be made within 90 days after receipt of such
31 request and all necessary documentation. Existing facilities
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1 qualifying to provide limited nursing services shall have
2 maintained a standard license and shall not have been subject
3 to administrative sanctions which affect the health, safety,
4 and welfare of residents for the previous 2 years or since
5 initial licensure if the facility has been licensed for less
6 than 2 years.
7 2. Facilities which are licensed to provide limited
8 nursing services shall maintain a written progress report on
9 each person who receives such nursing services, which report
10 describes the type, amount, duration, scope, and outcome of
11 services that are rendered and the general status of the
12 resident's health. A registered nurse representing the agency
13 shall visit such facilities at least once a year to monitor
14 residents who are receiving limited nursing services and to
15 determine if the facility is in compliance with applicable
16 provisions of this part and with related rules. The
17 monitoring visits may be provided through contractual
18 arrangements with appropriate community agencies. A
19 registered nurse shall also serve as part of the team that
20 biennially inspects such facility.
21 3. A person who receives limited nursing services
22 under this part must meet the admission criteria established
23 by the agency for assisted living facilities. When a resident
24 no longer meets the admission criteria for a facility licensed
25 under this part, arrangements for relocating the person shall
26 be made in accordance with s. 400.428(1)(k), unless the
27 facility is licensed to provide extended congregate care
28 services.
29 Section 2. Subsection (1) of section 400.408, Florida
30 Statutes, is amended to read:
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1 400.408 Referral of person for residency to unlicensed
2 facility; penalty; verification of licensure status.--
3 (1) It is unlawful to knowingly refer a person for
4 residency to an unlicensed facility that provides services
5 that may only be provided by an assisted living facility; to
6 an assisted living facility the license of which is under
7 denial or has been suspended or revoked; or to a facility that
8 has a moratorium on admissions. Any person who violates this
9 subsection is guilty of a noncriminal violation, punishable by
10 a fine not exceeding $500 as provided in s. 775.083.
11 (a) Any employee of the agency or department, or the
12 Department of Health and Rehabilitative Services, who
13 knowingly refers a person for residency to an unlicensed
14 facility; to a facility the license of which is under denial
15 or has been suspended or revoked; or to a facility that has a
16 moratorium on admissions is subject to disciplinary action by
17 the agency or department, or the Department of Health and
18 Rehabilitative Services.
19 (b) The employer of any person who is under contract
20 with the agency or department, or the Department of Health and
21 Rehabilitative Services, and who knowingly refers a person for
22 residency to an unlicensed facility; to a facility the license
23 of which is under denial or has been suspended or revoked; or
24 to a facility that has a moratorium on admissions shall be
25 fined and required to prepare a corrective action plan
26 designed to prevent such referrals.
27 (c) Unreported knowledge of any unlicensed assisted
28 living facility activity by any licensed health care
29 professional, or by the owner or employee of any facility
30 licensed by the Agency for Health Care Administration or the
31 Department of Business and Professional Regulation, subjects
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1 the licensed professional or the licensed facility to
2 disciplinary action by the appropriate board, agency, or
3 department.
4 Section 3. Subsection (4) of section 400.426, Florida
5 Statutes, 1996 Supplement, is amended to read:
6 400.426 Appropriateness of placements; examinations of
7 residents.--
8 (4) Where possible, each resident shall have been
9 examined by a licensed physician or a licensed nurse
10 practitioner within 60 days before admission to the facility.
11 The signed and completed medical examination report shall be
12 submitted to the owner or administrator of the facility who
13 shall utilize the information contained therein to assist in
14 the determination of the appropriateness of the resident's
15 admission and continued stay in the facility. The medical
16 examination report shall become a permanent part of the record
17 of the resident at the facility and shall be made available to
18 the agency during inspection or upon request. An assessment
19 conducted by the Comprehensive Assessment and Review for
20 Long-term Care Program (CARES) fulfills the medical
21 examination requirement of this subsection and s.
22 400.407(3)(b)6.
23 Section 4. This act shall take effect upon becoming a
24 law.
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26 *****************************************
27 SENATE SUMMARY
28 Modifies the number of monitoring visits that must be
made to an assisted living facility licensed to provide
29 extended congregate care services by the Agency for
Health Care Administration. Changes admission
30 requirements to an assisted living facility. Authorizes a
specific type of assessment to fulfill medical
31 examination requirements.
10