House Bill 3565

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    Florida House of Representatives - 1998                HB 3565

        By Representative Hill






  1                      A bill to be entitled

  2         An act relating to health quality assurance;

  3         amending s. 20.42, F.S.; deleting the

  4         responsibility of the Division of Health Policy

  5         and Cost Control within the Agency for Health

  6         Care Administration for reviewing hospital

  7         budgets; abolishing the Health Care Board;

  8         amending s. 112.0455, F.S., relating to the

  9         Drug-Free Workplace Act; requiring background

10         screening for an applicant for licensure of

11         certain laboratories; authorizing the use of

12         certain body hair for drug testing; amending s.

13         154.304, F.S., relating to health care for

14         indigent persons; revising definitions;

15         amending s. 381.026, F.S.; requiring that a

16         patient's bill of rights be made available by a

17         facility that provides emergency services or

18         outpatient services; amending s. 381.0261,

19         F.S.; requiring that a patient's bill of rights

20         includes additional information; creating s.

21         381.60225, F.S.; requiring background screening

22         for an applicant for certification to operate

23         an organ procurement organization, a tissue

24         bank, or an eye bank; amending s. 383.302,

25         F.S., relating to the regulation of birth

26         centers; revising definitions to reflect the

27         transfer of regulatory authority from the

28         Department of Health and Rehabilitative

29         Services to the Agency for Health Care

30         Administration; amending s. 383.305, F.S.;

31         requiring background screening for an applicant

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  1         for licensure of a birth center; amending ss.

  2         383.308, 383.309, 383.31, 383.312, 383.313,

  3         383.318, 383.32, 383.324, 383.325, 383.327,

  4         383.33, 383.331, F.S., relating to the

  5         regulation of birth centers; conforming

  6         provisions to reflect the transfer of

  7         regulatory authority to the Agency for Health

  8         Care Administration; amending s. 390.015, F.S.;

  9         requiring background screening for an applicant

10         for licensure of an abortion clinic; amending

11         s. 391.206, F.S.; requiring background

12         screening for an applicant for licensure to

13         operate a pediatric extended care center;

14         amending s. 393.063, F.S., relating to

15         developmental disabilities; providing a

16         definition; amending s. 393.067, F.S.;

17         requiring background screening for an applicant

18         for licensure to operate an intermediate care

19         facility for the developmentally disabled;

20         amending s. 394.4787, F.S., relating to the

21         regulation of mental health facilities;

22         conforming a cross-reference to changes made by

23         the act; amending s. 394.4788, F.S., relating

24         to mental health services; updating provisions

25         relating to duties of the agency formerly

26         performed by the Health Care Cost Containment

27         Board; amending s. 394.67, F.S., relating to

28         community alcohol, drug abuse, and mental

29         health services; revising definitions; amending

30         s. 394.875, F.S.; requiring background

31         screening for an applicant for licensure of a

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  1         crisis stabilization unit or residential

  2         treatment facility; amending ss. 394.876,

  3         394.877, 394.878, 394.879, 394.90, 394.902,

  4         394.903, 394.904, 394.907, F.S., relating to

  5         the regulation of mental health facilities;

  6         conforming provisions to reflect the transfer

  7         of regulatory authority to the Agency for

  8         Health Care Administration; amending s.

  9         395.002, F.S., relating to hospital licensing

10         and regulation; providing definitions; creating

11         s. 395.0055, F.S.; requiring background

12         screening for an applicant for licensure of a

13         facility operated under ch. 395, F.S.; amending

14         s. 395.0163, F.S.; requiring that the agency

15         review plans and specifications for certain

16         outpatient facilities; amending s. 395.0193,

17         F.S.; revising certain requirements for peer

18         review of physicians; providing requirements

19         for reporting disciplinary actions to the

20         agency; authorizing the agency to levy

21         administrative fines; amending s. 395.0197,

22         F.S.; revising provisions relating to internal

23         risk management; defining the term "adverse

24         incident"; requiring certain reports to the

25         agency; including minors in provisions relating

26         to notification of sexual misconduct or abuse;

27         requiring facility corrective action plans;

28         providing penalties; amending s. 395.0199,

29         F.S.; requiring background screening for an

30         applicant for registration as a utilization

31         review agent; amending s. 395.1055, F.S.;

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  1         requiring the Agency for Health Care

  2         Administration to adopt rules to assure that,

  3         following a disaster, licensed hospital

  4         facilities are capable of serving as shelters

  5         only for patients, staff, and the families of

  6         staff; providing for applicability; providing

  7         for a report by the agency to the Governor and

  8         Legislature; transferring, renumbering, and

  9         amending ss. 626.941, 626.942, 626.943,

10         626.944, 626.945, F.S., relating to the

11         regulation of health care risk managers;

12         conforming provisions to reflect the transfer

13         of regulatory authority from the Department of

14         Insurance to the Agency for Health Care

15         Administration; providing for the Health Care

16         Risk Manager Advisory Council to be appointed

17         by the Director of Health Care Administration;

18         amending s. 395.401, F.S.; providing for

19         certain reports relating to charity care and

20         formerly made to the Health Care Board to be

21         made to the agency; amending s. 395.602, F.S.,

22         relating to rural hospitals; conforming a

23         cross-reference to changes made by the act;

24         amending s. 395.701, F.S., relating to the

25         Public Medical Assistance Trust Fund; revising

26         definitions; amending s. 400.051, F.S.;

27         conforming a cross-reference; amending s.

28         400.071, F.S.; requiring background screening

29         for an applicant for licensure of a nursing

30         home; amending s. 400.411, F.S.; requiring

31         background screening for an applicant for

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  1         licensure of an assisted living facility;

  2         amending ss. 400.414, 400.417, 400.4174,

  3         400.4176, F.S., relating to the regulation of

  4         assisted living facilities; providing

  5         additional grounds for denial, revocation, or

  6         suspension of a license; requiring background

  7         screening for employees hired on or after a

  8         specified date; amending ss. 400.461, 400.462,

  9         F.S., relating to the regulation of home health

10         agencies; conforming a cross-reference;

11         revising definitions; amending s. 400.464,

12         F.S.; revising licensure requirements for home

13         health agencies; specifying services that are

14         exempt from the licensure requirements;

15         amending s. 400.471, F.S.; requiring background

16         screening for an applicant for licensure of a

17         home health agency; revising requirements for

18         license renewal; amending s. 400.474, F.S.;

19         providing penalties for operating a home health

20         agency without a license; amending s. 400.484,

21         F.S.; providing a schedule for the agency to

22         use in imposing fines for various classes of

23         violations; amending s. 400.487, F.S.; revising

24         requirements for patient assessment and

25         services; amending s. 400.491, F.S.; revising

26         requirements for maintaining patient records;

27         amending s. 400.497, F.S.; revising

28         requirements for the agency in establishing

29         minimum standards; amending s. 400.506, F.S.;

30         requiring background screening for an applicant

31         for licensure of a nurse registry; amending s.

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  1         400.509, F.S.; requiring background screening

  2         for an applicant for registration as a service

  3         provider who is exempt from licensure; amending

  4         s. 400.512, F.S.; revising screening

  5         requirements for home health agency personnel;

  6         amending s. 400.555, F.S.; requiring background

  7         screening for an applicant for licensure of an

  8         adult day care center; creating s. 400.5572,

  9         F.S.; requiring background screening for

10         employees of an adult day care center hired on

11         or after a specified date; amending s. 400.606,

12         F.S.; requiring background screening for an

13         applicant for licensure of a hospice; amending

14         s. 400.619, F.S.; revising background screening

15         requirements for an applicant for licensure of

16         an adult family care home; providing screening

17         requirements for designated relief persons;

18         amending s. 400.702, F.S.; deleting a

19         requirement that certain intermediate-level

20         care facilities accept only certain low-income

21         residents who receive subsidized housing

22         vouchers; amending s. 400.801, F.S.; requiring

23         background screening for an applicant for

24         licensure of a home for special services;

25         amending s. 400.805, F.S.; requiring background

26         screening for an applicant for licensure of a

27         transitional living facility; amending ss.

28         408.05, 408.061, 408.062, 408.063, F.S.,

29         relating to the State Center for Health

30         Statistics and the collection and dissemination

31         of health care information; updating provisions

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  1         to reflect the assumption by the Agency for

  2         Health Care Administration of duties formerly

  3         performed by the Health Care Board and the

  4         former Department of Health and Rehabilitative

  5         Services; authorizing the agency to conduct

  6         data-based studies and make recommendations;

  7         deleting obsolete provisions; amending s.

  8         408.07, F.S.; deleting definitions made

  9         obsolete by the repeal of requirements with

10         respect to hospital budget reviews; amending s.

11         408.08, F.S.; deleting provisions requiring the

12         Health Care Board to review the budgets of

13         certain hospitals; deleting requirements that a

14         hospital file budget letters; deleting certain

15         administrative penalties; amending s. 408.40,

16         F.S.; removing a reference to the duties of the

17         Public Counsel with respect to hospital budget

18         review proceedings; amending ss. 409.2673,

19         409.9113, F.S., relating to health care

20         programs for low-income persons and the

21         disproportionate share program for teaching

22         hospitals; updating provisions to reflect the

23         abolishment of the Health Care Cost Containment

24         Board and the assumption of its duties by the

25         agency; amending ss. 409.905, 440.13, 455.654,

26         F.S., relating to mandatory Medicaid services,

27         medical services and supplies, and referring

28         health care providers; conforming

29         cross-references to changes made by the act;

30         amending ss. 458.331, 459.015, 461.013,

31         468.505, F.S., relating to disciplinary action

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  1         against certain medical professionals and

  2         activities exempt from regulation; updating

  3         provisions and conforming cross-references;

  4         amending s. 483.101, F.S.; requiring background

  5         screening for an applicant for licensure of a

  6         clinical laboratory; amending s. 483.106, F.S.,

  7         relating to a certificate of exemption;

  8         correcting terminology; amending s. 483.30,

  9         F.S.; requiring background screening for an

10         applicant for licensure of a multiphasic health

11         testing center; amending ss. 641.55, 766.1115,

12         F.S., relating to internal risk management

13         programs and contracts with governmental

14         contractors; updating provisions and conforming

15         cross-references to changes made by the act;

16         repealing ss. 395.403(9), 407.61, 408.003,

17         408.072, 408.085, 455.661, F.S., relating to

18         reimbursement of state-sponsored trauma

19         centers, studies by the Health Care Board,

20         appointment of members to the Health Care

21         Board, review of hospital budgets, budget

22         reviews of comprehensive inpatient

23         rehabilitation hospitals, and designated health

24         care services; providing for retroactive

25         application of provisions of the act relating

26         to repeal of review of hospital budgets;

27         transferring the internal risk manager

28         licensure program from the Department of

29         Insurance to the Agency for Health Care

30         Administration; providing appropriations and

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  1         authorizing positions; providing effective

  2         dates.

  3

  4  Be It Enacted by the Legislature of the State of Florida:

  5

  6         Section 1.  Paragraphs (b), (d), and (e) of subsection

  7  (2) and subsections (6) and (7) of section 20.42, Florida

  8  Statutes, are amended to read:

  9         20.42  Agency for Health Care Administration.--There is

10  created the Agency for Health Care Administration within the

11  Department of Business and Professional Regulation. The agency

12  shall be a separate budget entity, and the director of the

13  agency shall be the agency head for all purposes. The agency

14  shall not be subject to control, supervision, or direction by

15  the Department of Business and Professional Regulation in any

16  manner, including, but not limited to, personnel, purchasing,

17  transactions involving real or personal property, and

18  budgetary matters.

19         (2)  ORGANIZATION OF THE AGENCY.--The agency shall be

20  organized as follows:

21         (b)  The Division of Health Policy and Cost Control,

22  which shall be responsible for health policy, the State Center

23  for Health Statistics, the development of The Florida Health

24  Plan, certificate of need, hospital budget review, state and

25  local health planning under s. 408.033, and research and

26  analysis.

27         (d)  The Health Care Board, which shall be responsible

28  for hospital budget review, nursing home financial analysis,

29  and special studies as assigned by the secretary or the

30  Legislature.

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  1         (d)(e)  The Division of Administrative Services, which

  2  shall be responsible for revenue management, budget,

  3  personnel, and general services.

  4         (6)  HEALTH CARE BOARD.--The Health Care Board shall be

  5  composed of 11 members appointed by the Governor, subject to

  6  confirmation by the Senate. The members of the board shall

  7  biennially elect a chairperson and a vice chairperson from its

  8  membership. The board shall be responsible for hospital budget

  9  review, nursing home financial review and analysis, and

10  special studies requested by the Governor, the Legislature, or

11  the director.

12         (6)(7)  DEPUTY DIRECTOR OF ADMINISTRATIVE

13  SERVICES.--The director shall appoint a Deputy Director of

14  Administrative Services who shall serve at the pleasure of,

15  and be directly responsible to, the director. The deputy

16  director shall be responsible for the Division of

17  Administrative Services.

18         Section 2.  Subsection (12) and paragraph (b) of

19  subsection (13) of section 112.0455, Florida Statutes, are

20  amended to read:

21         112.0455  Drug-Free Workplace Act.--

22         (12)  DRUG-TESTING STANDARDS; LABORATORIES.--

23         (a)  A laboratory may analyze initial or confirmation

24  drug specimens only if:

25         1.  The laboratory is licensed and approved by the

26  Agency for Health Care Administration using criteria

27  established by the United States Department of Health and

28  Human Services as general guidelines for modeling the state

29  drug testing program. Each applicant for licensure must comply

30  with the following requirements:

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  1         a.  Upon receipt of a completed, signed, and dated

  2  application, the agency shall require background screening, in

  3  accordance with the level 2 standards for screening set forth

  4  in chapter 435, of the managing employee, or other similarly

  5  titled individual responsible for the daily operation of the

  6  laboratory, and of the financial officer, or other similarly

  7  titled individual who is responsible for the financial

  8  operation of the laboratory, including billings for services.

  9  The applicant must comply with the procedures for level 2

10  background screening as set forth in chapter 435.

11         b.  The agency may require background screening of any

12  other individual who is an applicant if the agency has a

13  reasonable basis for believing that he or she has been

14  convicted of an offense prohibited under the level 2 standards

15  for screening set forth in chapter 435.

16         c.  Proof of compliance with the level 2 background

17  screening requirements of chapter 435 which has been submitted

18  within the previous 5 years in compliance with any other

19  health care licensure requirements of this state is acceptable

20  in fulfillment of screening requirements.

21         d.  A provisional license may be granted to an

22  applicant when each individual required by this section to

23  undergo background screening has met the standards for the

24  abuse registry background check and the Department of Law

25  Enforcement background check, but the agency has not yet

26  received background screening results from the Federal Bureau

27  of Investigation, or a request for a disqualification

28  exemption has been submitted to the agency as set forth in

29  chapter 435 but a response has not yet been issued. A license

30  may be granted to the applicant upon the agency's receipt of a

31  report of the results of the Federal Bureau of Investigation

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  1  background screening for each individual required by this

  2  section to undergo background screening which confirms that

  3  all standards have been met, or upon the granting of a

  4  disqualification exemption by the agency as set forth in

  5  chapter 435. Any other person who is required to undergo level

  6  2 background screening may serve in his or her capacity

  7  pending the agency's receipt of the report from the Federal

  8  Bureau of Investigation. However, the person may not continue

  9  to serve if the report indicates any violation of background

10  screening standards and a disqualification exemption has not

11  been requested of and granted by the agency as set forth in

12  chapter 435.

13         e.  Each applicant must submit to the agency, with its

14  application, a description and explanation of any exclusions,

15  permanent suspensions, or terminations of the applicant from

16  the Medicare or Medicaid programs. Proof of compliance with

17  the requirements for disclosure of ownership and control

18  interests under the Medicaid or Medicare programs shall be

19  accepted in lieu of this submission.

20         f.  Each applicant must submit to the agency a

21  description and explanation of any conviction of an offense

22  prohibited under the level 2 standards of chapter 435 by a

23  member of the board of directors of the applicant, its

24  officers, or any individual owning 5 percent or more of the

25  applicant. This requirement does not apply to a director of a

26  not-for-profit corporation or organization if the director

27  serves solely in a voluntary capacity for the corporation or

28  organization, does not regularly take part in the day-to-day

29  operational decisions of the corporation or organization,

30  receives no remuneration for his or her services on the

31  corporation or organization's board of directors, and has no

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  1  financial interest and has no family members with a financial

  2  interest in the corporation or organization, provided that the

  3  director and the not-for-profit corporation or organization

  4  include in the application a statement affirming that the

  5  director's relationship to the corporation satisfies the

  6  requirements of this sub-subparagraph.

  7         g.  A license may not be granted to any applicant if

  8  the applicant or managing employee has been found guilty of,

  9  regardless of adjudication, or has entered a plea of nolo

10  contendere or guilty to, any offense prohibited under the

11  level 2 standards for screening set forth in chapter 435,

12  unless an exemption from disqualification has been granted by

13  the agency as set forth in chapter 435.

14         h.  The agency may deny or revoke licensure if the

15  applicant:

16         (I)  Has falsely represented a material fact in the

17  application required by sub-subparagraph e. or

18  sub-subparagraph f., or has omitted any material fact from the

19  application required by sub-subparagraph e. or

20  sub-subparagraph f.; or

21         (II)  Has had prior action taken against the applicant

22  under the Medicaid or Medicare program as set forth in

23  sub-subparagraph e.

24         i.  An application for license renewal must contain the

25  information required under sub-subparagraphs e. and f.

26         2.  The laboratory has written procedures to ensure

27  chain of custody.

28         3.  The laboratory follows proper quality control

29  procedures, including, but not limited to:

30         a.  The use of internal quality controls including the

31  use of samples of known concentrations which are used to check

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  1  the performance and calibration of testing equipment, and

  2  periodic use of blind samples for overall accuracy.

  3         b.  An internal review and certification process for

  4  drug test results, conducted by a person qualified to perform

  5  that function in the testing laboratory.

  6         c.  Security measures implemented by the testing

  7  laboratory to preclude adulteration of specimens and drug test

  8  results.

  9         d.  Other necessary and proper actions taken to ensure

10  reliable and accurate drug test results.

11         (b)  A laboratory shall disclose to the employer a

12  written test result report within 7 working days after receipt

13  of the sample.  All laboratory reports of a drug test result

14  shall, at a minimum, state:

15         1.  The name and address of the laboratory which

16  performed the test and the positive identification of the

17  person tested.

18         2.  Positive results on confirmation tests only, or

19  negative results, as applicable.

20         3.  A list of the drugs for which the drug analyses

21  were conducted.

22         4.  The type of tests conducted for both initial and

23  confirmation tests and the minimum cutoff levels of the tests.

24         5.  Any correlation between medication reported by the

25  employee or job applicant pursuant to subparagraph (8)(b)2.

26  and a positive confirmed drug test result.

27

28  No report shall disclose the presence or absence of any drug

29  other than a specific drug and its metabolites listed pursuant

30  to this section.

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  1         (c)  The laboratory shall submit to the Agency for

  2  Health Care Administration a monthly report with statistical

  3  information regarding the testing of employees and job

  4  applicants.  The reports shall include information on the

  5  methods of analyses conducted, the drugs tested for, the

  6  number of positive and negative results for both initial and

  7  confirmation tests, and any other information deemed

  8  appropriate by the Agency for Health Care Administration. No

  9  monthly report shall identify specific employees or job

10  applicants.

11         (d)  Laboratories shall provide technical assistance to

12  the employer, employee, or job applicant for the purpose of

13  interpreting any positive confirmed test results which could

14  have been caused by prescription or nonprescription medication

15  taken by the employee or job applicant.

16         (13)  RULES.--

17         (b)  The following standards and procedures are

18  established related to hair testing:

19         1.  Hair cutoff levels for initial drug-screening

20  tests.--The following initial cutoff levels must be used when

21  screening hair specimens to determine whether they are

22  negative for these drugs or their metabolites:

23         a.  Marijuana:  10 pg/10 mg of hair;

24         b.  Cocaine:  5 ng/10 mg of hair; and

25         c.  Opiate/synthetic narcotics and metabolites:  5

26  ng/10 mg of hair. For the purpose of this section, opiate and

27  metabolites include the following:

28         (I)  Codeine;

29         (II)  Heroin, monoacetylmorphine monoacitylmorphine

30  (heroin metabolites);

31         (III)  Morphine;

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  1         d.  Phencyclidine:  3 ng/10 mg of hair; and

  2         e.  Amphetamines:  5 ng/10 mg of hair.  For the purpose

  3  of this section, amphetamines include the following:

  4         (I)  Amphetamines;

  5         (II)  Methamphetamine;

  6         2.  Hair cutoff levels for drug confirmation testing.--

  7         a.  All specimens identified as positive on the initial

  8  test must be confirmed using gas chromatography/mass

  9  spectrometry (GC/MS), mass spectrometry/mass spectrometry

10  (MS/MS) at the following cutoff levels for these drugs on

11  their metabolites. All confirmations must be by quantitative

12  analysis.

13         (I)  Marijuana metabolites:  1 pg/10 mg of hair

14  (Delta-9-tetrahydrocannabinol-0-carboxylic acid).

15         (II)  Cocaine:  must be at or above 5 ng/10 mg of hair.

16  Cocaine metabolites if present will be recorded at the

17  following minimum levels:

18         (A)  Benzoylecgonine at 1 ng/10 mg of hair; and

19         (B)  Cocaethlyene at 1 ng/10 mg of hair.

20         (III)  Opiate/synthetic narcotics and metabolites:  5

21  ng/10 mg of hair; opiate and metabolites include the

22  following:

23         (A)  Codeine;

24         (B)  6-Monoacetylmorphine (heroin metabolite); and

25         (C)  Morphine.

26         (IV)  Phencyclidine:  3 ng/10 mg of hair.

27         (V)  Amphetamines:  5 ng/10 mg of hair.  For the

28  purpose of this section, amphetamines include the following:

29         (A)  Amphetamines; and

30         (B)  Methamphetamines.

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  1         b.  All hair specimens undergoing confirmation must be

  2  decontaminated using a wash procedure which has been published

  3  in the peer-reviewed literature which, as a minimum, has an

  4  initial 15-minute organic solvent wash followed by multiple

  5  (minimum of three) 30-minute aqueous washes.

  6         c.  After hair is washed, the drug entrapped in the

  7  hair is released either by digestion (chemical or enzymatic)

  8  or by multiple solvent extractions. The resulting digest or

  9  pooled solvent extracts are then screened and confirmed by

10  approved methods.

11         d.  All confirmation analysis methods must eliminate

12  the melanin fraction of the hair before analysis. If a

13  nondigestion method is used, the laboratory must present

14  published data in the peer-reviewed literature from a large

15  population study which indicates that the method of extraction

16  does not possess a statistically significant hair-color bias.

17         e.  Additional hair samples may be collected to

18  reconfirm the initial report. The recollected sample shall be

19  retested as specified; however, the confirmation analysis must

20  be performed even if the screening test is negative. A second

21  positive report must be made if the drug concentration in the

22  digest by confirmation methods exceeds the limit of

23  quantitation of the testing laboratory's method. A second test

24  must be offered to anyone disputing a positive hair test

25  result.

26         3.  Hair specimen collection procedures.--

27         a.  Designation of collection site.--Each drug-testing

28  program shall have one or more designated collection sites

29  which have all necessary personnel, materials, equipment,

30  facilities, and supervision to provide for the collection,

31

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  1  security, temporary storage, and shipping or transportation of

  2  hair specimens to a licensed drug-testing facility.

  3         b.  Security.--While security is important with any

  4  collection, in the case of hair, only the temporary storage

  5  area in the designated collection site needs to be secure.

  6         c.  Chain of custody.--Chain-of-custody standardized

  7  forms shall be properly executed by authorized collection site

  8  personnel upon receipt of specimens. Handling and

  9  transportation of hair specimens from one authorized

10  individual or place to another shall always be accomplished

11  through chain-of-custody procedures. Every effort shall be

12  made to minimize the number of persons handling specimens.

13         d.  Access to authorized personnel only.--The hair

14  collection site need be off limits to unauthorized personnel

15  only during the actual collection of specimens.

16         e.  Privacy.--Procedures for collecting hair should be

17  performed on one individual at a time to prevent substitutions

18  or interference with the collection of reliable samples.

19  Procedures must ensure that the hair collection does not

20  infringe on the individual's privacy.

21         f.  Integrity and identity of specimen.--Precautions

22  must be taken to ensure that the root end of a hair specimen

23  is indicated for the laboratory which performs the testing.

24  The maximum length of hair that shall be tested is 3.9 cm

25  distal from the head, which on average represents a 3-month

26  time window. The following minimum precautions must be taken

27  when collecting a hair specimen to ensure that specimens are

28  obtained and correctly identified:

29         (I)  When an individual arrives at the collection site,

30  the collection site personnel shall request the individual to

31  present photo identification. If the individual does not have

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  1  proper photo identification, the collection site personnel

  2  shall contact the supervisor of the individual, the

  3  coordinator of the drug testing program, or any other employer

  4  official who can positively identify the individual. If the

  5  individual's identity cannot be established, the collection

  6  site personnel shall not proceed with the collection.

  7         (II)  If the individual fails to arrive at the assigned

  8  time, the collection site personnel shall contact the

  9  appropriate authority to obtain guidance on the action to be

10  taken.

11         (III)  The collection site personnel shall note any

12  unusual behavior or appearance on the chain-of-custody form.

13         (IV)  Hair shall be cut as close to the scalp or body,

14  excluding the pubic area, as possible. Upon taking the

15  specimen from the individual, the collection site personnel

16  shall determine that it contains approximately  1/2 -inch of

17  hair when fanned out on a ruler (about 40 mg of hair).

18         (V)  Both the individual being tested and the

19  collection site personnel shall keep the specimen in view at

20  all times prior to the specimen container being sealed with a

21  tamper-resistant seal and labeled with the individual's

22  specimen number and other required information.

23         (VI)  The collection site personnel shall label the

24  container which contains the hair with the date, the

25  individual's specimen number, and any other identifying

26  information provided or required by the drug-testing program.

27         (VII)  The individual shall initial the container for

28  the purpose of certifying that it is the specimen collected

29  from the individual.

30         (VIII)  The collection site personnel shall indicate on

31  the chain-of-custody form all information identifying the

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  1  specimen. The collection site personnel shall sign the

  2  chain-of-custody form next to the identifying information or

  3  the chain of custody on the specimen container.

  4         (IX)  The individual must be asked to read and sign a

  5  statement certifying that the specimen identified as having

  6  been collected from the individual is in fact that specimen

  7  the individual provided.

  8         (X)  The collection site personnel shall complete the

  9  chain-of-custody form.

10         g.  Collection control.--To the maximum extent

11  possible, collection site personnel shall keep the

12  individual's specimen container within sight both before and

13  after collection. After the specimen is collected, it must be

14  properly sealed and labeled. An approved chain-of-custody form

15  must be used for maintaining control and accountability of

16  each specimen from the point of collection to final

17  disposition of the specimen. The date and purpose must be

18  documented on an approved chain-of-custody form each time a

19  specimen is handled or transferred and every individual in the

20  chain must be identified. Every effort must be made to

21  minimize the number of persons handling specimens.

22         h.  Transportation to the testing facility.--Collection

23  site personnel shall arrange to transport the collected

24  specimens to the drug-testing facility. The specimens shall be

25  placed in containers which shall be securely sealed to

26  eliminate the possibility of undetected tampering. The

27  collection site personnel shall ensure that the

28  chain-of-custody documentation is sealed separately from the

29  specimen and placed inside the container sealed for transfer

30  to the drug-testing facility.

31         4.  Quality assurance and quality control.--

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  1         a.  Quality assurance.--Testing facilities shall have a

  2  quality assurance program which encompasses all aspects of the

  3  testing process, including, but not limited to, specimen

  4  acquisition, chain of custody, security and reporting of

  5  results, initial and confirmatory testing, and validation of

  6  analytical procedures. Quality assurance procedures shall be

  7  designed, implemented, and reviewed to monitor the conduct of

  8  each step of the process of testing for drugs.

  9         b.  Quality control.--

10         (I)  Each analytical run of specimens to be screened

11  shall include:

12         (A)  Hair specimens certified to contain no drug;

13         (B)  Hair specimens fortified with known standards; and

14         (C)  Positive controls with the drug or metabolite at

15  or near the threshold (cutoff).

16         (II)  In addition, with each batch of samples, a

17  sufficient number of standards shall be included to ensure and

18  document the linearity of the assay method over time in the

19  concentration area of the cutoff. After acceptable values are

20  obtained for the known standards, those values must be used to

21  calculate sample data. Implementation of procedures to ensure

22  that carryover does not contaminate the testing of an

23  individual's specimen must be documented. A minimum of 5

24  percent of all test samples must be quality control specimens.

25  The testing facility's quality control samples, prepared from

26  fortified hair samples of determined concentration, must be

27  included in the run and must appear as normal samples to

28  drug-screen testing facility analysis. One percent of each

29  run, with a minimum of at least one sample, must be the

30  testing facility's own quality control samples.

31         5.a.  Proficiency testing.--

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  1         (I)  Each hair drug-testing facility shall enroll and

  2  demonstrate satisfactory performance in a proficiency-testing

  3  program established by an independent group.

  4         (II)  The drug-testing facility shall maintain records

  5  which document the handling, processing, and examination of

  6  all proficiency-testing samples for a minimum of 2 years from

  7  the date of testing.

  8         (III)  The drug-testing facility shall ensure that

  9  proficiency-testing samples are analyzed at least three times

10  each year using the same techniques as those employed for

11  unknown specimens.

12         (IV)  The proficiency-testing samples must be included

13  with the routine sample run and tested with the same frequency

14  as unknown samples by the individuals responsible for testing

15  unknown specimens.

16         (V)  The drug-testing facility may not engage in

17  discussions or communications concerning proficiency-testing

18  results with other drug-testing facilities, nor may they send

19  proficiency-testing samples or portions of the samples to

20  another drug-testing facility for analysis.

21         b.  Satisfactory performance.--

22         (I)  The drug-testing facility shall maintain an

23  overall testing-event score equivalent to passing proficiency

24  scores for other drug-testing matrices.

25         (II)  Failure to participate in a proficiency-testing

26  event shall result in a score of 0 percent for that testing

27  event.

28         c.  Unsuccessful performance.--Failure to achieve

29  satisfactory performance in two consecutive testing events, or

30  two out of three consecutive testing events, is determined to

31  be unsuccessful performance.

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  1

  2  This section shall not be construed to eliminate the

  3  bargainable rights as provided in the collective bargaining

  4  process where applicable.

  5         Section 3.  Subsections (1) and (8) of section 154.304,

  6  Florida Statutes, are amended to read:

  7         154.304  Definitions.--For the purpose of this act:

  8         (1)  "Agency" means the Agency for Health Care

  9  Administration "Board" means the Health Care Board as

10  established in chapter 408.

11         (8)  "Participating hospital" means a hospital which is

12  eligible to receive reimbursement under the provisions of this

13  act because it has been certified by the agency board as

14  having met its charity care obligation and has either:

15         (a)  A formal signed agreement with a county or

16  counties to treat such county's indigent patients; or

17         (b)  Demonstrated to the agency board that at least 2.5

18  percent of its uncompensated charity care, as reported to the

19  board, is generated by out-of-county residents.

20         Section 4.  Subsection (6) of section 381.026, Florida

21  Statutes, is amended to read:

22         381.026  Florida Patient's Bill of Rights and

23  Responsibilities.--

24         (6)  SUMMARY OF RIGHTS AND RESPONSIBILITIES.--Any

25  health care provider who treats a patient in an office or any

26  health care facility licensed under chapter 395 that provides

27  emergency services and care or outpatient services and care to

28  a patient, or admits and treats a patient, shall adopt and

29  make available to the patient public, in writing, a statement

30  of the rights and responsibilities of patients, including:

31

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  1              SUMMARY OF THE FLORIDA PATIENT'S BILL

  2                  OF RIGHTS AND RESPONSIBILITIES

  3

  4         Florida law requires that your health care provider or

  5  health care facility recognize your rights while you are

  6  receiving medical care and that you respect the health care

  7  provider's or health care facility's right to expect certain

  8  behavior on the part of patients.  You may request a copy of

  9  the full text of this law from your health care provider or

10  health care facility.  A summary of your rights and

11  responsibilities follows:

12         A patient has the right to be treated with courtesy and

13  respect, with appreciation of his or her individual dignity,

14  and with protection of his or her need for privacy.

15         A patient has the right to a prompt and reasonable

16  response to questions and requests.

17         A patient has the right to know who is providing

18  medical services and who is responsible for his or her care.

19         A patient has the right to know what patient support

20  services are available, including whether an interpreter is

21  available if he or she does not speak English.

22         A patient has the right to know what rules and

23  regulations apply to his or her conduct.

24         A patient has the right to be given by the health care

25  provider information concerning diagnosis, planned course of

26  treatment, alternatives, risks, and prognosis.

27         A patient has the right to refuse any treatment, except

28  as otherwise provided by law.

29         A patient has the right to be given, upon request, full

30  information and necessary counseling on the availability of

31  known financial resources for his or her care.

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  1         A patient who is eligible for Medicare has the right to

  2  know, upon request and in advance of treatment, whether the

  3  health care provider or health care facility accepts the

  4  Medicare assignment rate.

  5         A patient has the right to receive, upon request, prior

  6  to treatment, a reasonable estimate of charges for medical

  7  care.

  8         A patient has the right to receive a copy of a

  9  reasonably clear and understandable, itemized bill and, upon

10  request, to have the charges explained.

11         A patient has the right to impartial access to medical

12  treatment or accommodations, regardless of race, national

13  origin, religion, physical handicap, or source of payment.

14         A patient has the right to treatment for any emergency

15  medical condition that will deteriorate from failure to

16  provide treatment.

17         A patient has the right to know if medical treatment is

18  for purposes of experimental research and to give his or her

19  consent or refusal to participate in such experimental

20  research.

21         A patient has the right to express grievances regarding

22  any violation of his or her rights, as stated in Florida law,

23  through the grievance procedure of the health care provider or

24  health care facility which served him or her and to the

25  appropriate state licensing agency.

26         A patient is responsible for providing to the health

27  care provider, to the best of his or her knowledge, accurate

28  and complete information about present complaints, past

29  illnesses, hospitalizations, medications, and other matters

30  relating to his or her health.

31

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  1         A patient is responsible for reporting unexpected

  2  changes in his or her condition to the health care provider.

  3         A patient is responsible for reporting to the health

  4  care provider whether he or she comprehends a contemplated

  5  course of action and what is expected of him or her.

  6         A patient is responsible for following the treatment

  7  plan recommended by the health care provider.

  8         A patient is responsible for keeping appointments and,

  9  when he or she is unable to do so for any reason, for

10  notifying the health care provider or health care facility.

11         A patient is responsible for his or her actions if he

12  or she refuses treatment or does not follow the health care

13  provider's instructions.

14         A patient is responsible for assuring that the

15  financial obligations of his or her health care are fulfilled

16  as promptly as possible.

17         A patient is responsible for following health care

18  facility rules and regulations affecting patient care and

19  conduct.

20         Section 5.  Section 381.0261, Florida Statutes, is

21  amended to read:

22         381.0261  Distribution of Summary of patient's bill of

23  rights; distribution; penalty.--

24         (1)  The Agency for Health Care Administration

25  Department of Health and Rehabilitative Services shall have

26  printed and made continuously available to health care

27  facilities licensed under chapter 395, physicians licensed

28  under chapter 458, osteopathic physicians licensed under

29  chapter 459, and podiatrists licensed under chapter 461 a

30  summary of the Florida Patient's Bill of Rights and

31  Responsibilities.  In adopting and making available to

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  1  patients public the summary of the Florida Patient's Bill of

  2  Rights and Responsibilities, health care providers and health

  3  care facilities are not limited to the format in which the

  4  Agency for Health Care Administration Department of Health and

  5  Rehabilitative Services prints and distributes the summary.

  6         (2)  Health care providers and health care facilities,

  7  if requested, shall inform patients of the address and

  8  telephone number of each state agency responsible for

  9  responding to patient complaints about a health care provider

10  or health care facility's alleged noncompliance with state

11  licensing requirements established pursuant to law.

12         (3)  Health care facilities shall adopt policies and

13  procedures to ensure that inpatients are provided the

14  opportunity during the course of admission to receive

15  information regarding their rights and how to file complaints

16  with the facility and appropriate state agencies.

17         (4)  An administrative fine may be imposed by the

18  agency when any health care provider or health care facility

19  fails to make available to patients a summary of their rights,

20  pursuant to s. 381.026 and this section.  Initial nonwillful

21  violations are subject to corrective action and are not

22  subject to an administrative fine. The agency may levy a fine

23  of up to $5,000 for repeated nonwillful violations, and up to

24  $25,000 for intentional and willful violations. Each

25  intentional and willful violation constitutes a separate

26  violation and is subject to a separate fine.

27         (5)  In determining the amount of fine to be levied for

28  a violation, as provided in subsection (4), the following

29  factors shall be considered:

30         (a)  The scope and severity of the violation, including

31  the number of patients found to have not received notice of

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  1  patient rights, and whether the failure to provide notice to

  2  patients was willful.

  3         (b)  Actions taken by the health care provider or

  4  health care facility to correct the violations or to remedy

  5  complaints.

  6         (c)  Any previous violations of this section by the

  7  health care provider or health care facility.

  8         Section 6.  Section 381.60225, Florida Statutes, is

  9  created to read:

10         381.60225  Background screening.--

11         (1)  Each applicant for certification must comply with

12  the following requirements:

13         (a)  Upon receipt of a completed, signed, and dated

14  application, the Agency for Health Care Administration shall

15  require background screening, in accordance with the level 2

16  standards for screening set forth in chapter 435, of the

17  managing employee, or other similarly titled individual

18  responsible for the daily operation of the organization,

19  agency, or entity, and financial officer, or other similarly

20  titled individual who is responsible for the financial

21  operation of the organization, agency, or entity, including

22  billings for services.  The applicant must comply with the

23  procedures for level 2 background screening as set forth in

24  chapter 435.

25         (b)  The Agency for Health Care Administration may

26  require background screening of any other individual who is an

27  applicant if the Agency for Health Care Administration has a

28  reasonable basis for believing that he or she has been

29  convicted of a crime or has committed any other offense

30  prohibited under the level 2 standards for screening set forth

31  in chapter 435.

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  1         (c)  Proof of compliance with the level 2 background

  2  screening requirements of chapter 435 which has been submitted

  3  within the previous 5 years in compliance with any other

  4  health care licensure requirements of this state is acceptable

  5  in fulfillment of the requirements of paragraph (a).

  6         (d)  A provisional certification may be granted to the

  7  organization, agency, or entity when each individual required

  8  by this section to undergo background screening has met the

  9  standards for the abuse registry background check and the

10  Department of Law Enforcement background check, but the agency

11  has not yet received background screening results from the

12  Federal Bureau of Investigation, or a request for a

13  disqualification exemption has been submitted to the agency as

14  set forth in chapter 435 but a response has not yet been

15  issued. A standard certification may be granted to the

16  organization, agency, or entity upon the agency's receipt of a

17  report of the results of the Federal Bureau of Investigation

18  background screening for each individual required by this

19  section to undergo background screening which confirms that

20  all standards have been met, or upon the granting of a

21  disqualification exemption by the agency as set forth in

22  chapter 435. Any other person who is required to undergo level

23  2 background screening may serve in his or her capacity

24  pending the agency's receipt of the report from the Federal

25  Bureau of Investigation. However, the person may not continue

26  to serve if the report indicates any violation of background

27  screening standards and a disqualification exemption has not

28  been requested of and granted by the agency as set forth in

29  chapter 435.

30         (e)  Each applicant must submit to the agency, with its

31  application, a description and explanation of any exclusions,

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  1  permanent suspensions, or terminations of the applicant from

  2  the Medicare or Medicaid programs. Proof of compliance with

  3  the requirements for disclosure of ownership and control

  4  interests under the Medicaid or Medicare programs shall be

  5  accepted in lieu of this submission.

  6         (f)  Each applicant must submit to the agency a

  7  description and explanation of any conviction of an offense

  8  prohibited under the level 2 standards of chapter 435 by a

  9  member of the board of directors of the applicant, its

10  officers, or any individual owning 5 percent or more of the

11  applicant. This requirement does not apply to a director of a

12  not-for-profit corporation or organization if the director

13  serves solely in a voluntary capacity for the corporation or

14  organization, does not regularly take part in the day-to-day

15  operational decisions of the corporation or organization,

16  receives no remuneration for his or her services on the

17  corporation or organization's board of directors, and has no

18  financial interest and has no family members with a financial

19  interest in the corporation or organization, provided that the

20  director and the not-for-profit corporation or organization

21  include in the application a statement affirming that the

22  director's relationship to the corporation satisfies the

23  requirements of this paragraph.

24         (g)  The agency may not certify any organization,

25  agency, or entity if any applicant or managing employee has

26  been found guilty of, regardless of adjudication, or has

27  entered a plea of nolo contendere or guilty to, any offense

28  prohibited under the level 2 standards for screening set forth

29  in chapter 435, unless an exemption from disqualification has

30  been granted by the agency as set forth in chapter 435.

31

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  1         (h)  The agency may deny or revoke certification of any

  2  organization, agency, or entity if the applicant:

  3         1.  Has falsely represented a material fact in the

  4  application required by paragraph (e) or paragraph (f), or has

  5  omitted any material fact from the application required by

  6  paragraph (e) or paragraph (f); or

  7         2.  Has had prior action taken against the applicant

  8  under the Medicaid or Medicare program as set forth in

  9  paragraph (e).

10         (i)  An application for renewal of certification must

11  contain the information required under paragraphs (e) and (f).

12         (2)  An organ procurement organization, tissue bank, or

13  eye bank certified by the Agency for Health Care

14  Administration in accordance with ss. 381.6021 and 381.6022 is

15  not subject to the requirements of this section if the entity

16  has no direct patient-care responsibilities and does not bill

17  patients or insurers directly for services under the Medicare

18  or Medicaid programs, or for privately insured services.

19         Section 7.  Section 383.302, Florida Statutes, is

20  amended to read:

21         383.302  Definitions of terms used in ss.

22  383.30-383.335.--As used in ss. 383.30-383.335, unless the

23  context otherwise requires, the term:

24         (1)  "Agency" means the Agency for Health Care

25  Administration.

26         (2)(1)  "Birth center" means any facility, institution,

27  or place, which is not an ambulatory surgical center or a

28  hospital or in a hospital, in which births are planned to

29  occur away from the mother's usual residence following a

30  normal, uncomplicated, low-risk pregnancy.

31

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  1         (3)(2)  "Clinical staff" means individuals employed

  2  full time or part time by a birth center who are licensed or

  3  certified to provide care at childbirth.

  4         (4)(3)  "Consultant" means a physician licensed

  5  pursuant to chapter 458 or chapter 459 who agrees to provide

  6  advice and services to a birth center and who either:

  7         (a)  Is certified or eligible for certification by the

  8  American Board of Obstetrics and Gynecology, or

  9         (b)  Has hospital obstetrical privileges.

10         (4)  "Department" means the Department of Health.

11         (5)  "Governing body" means any individual, group,

12  corporation, or institution which is responsible for the

13  overall operation and maintenance of a birth center.

14         (6)  "Governmental unit" means the state or any county,

15  municipality, or other political subdivision or any

16  department, division, board, or other agency of any of the

17  foregoing.

18         (7)  "Licensed facility" means a facility licensed in

19  accordance with s. 383.305.

20         (8)  "Low-risk pregnancy" means a pregnancy which is

21  expected to result in an uncomplicated birth, as determined

22  through risk criteria developed by rule of the department, and

23  which is accompanied by adequate prenatal care.

24         (9)  "Person" means any individual, firm, partnership,

25  corporation, company, association, institution, or joint stock

26  association and means any legal successor of any of the

27  foregoing.

28         (10)  "Premises" means those buildings, beds, and

29  facilities located at the main address of the licensee and all

30  other buildings, beds, and facilities for the provision of

31  maternity care located in such reasonable proximity to the

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  1  main address of the licensee as to appear to the public to be

  2  under the dominion and control of the licensee.

  3         Section 8.  Section 383.305, Florida Statutes, is

  4  amended to read:

  5         383.305  Licensure; issuance, renewal, denial,

  6  suspension, revocation; fees; background screening.--

  7         (1)(a)  Upon receipt of an application for a license

  8  and the license fee, the agency department shall issue a

  9  license if the applicant and facility have received all

10  approvals required by law and meet the requirements

11  established under ss. 383.30-383.335 and by rules promulgated

12  hereunder.

13         (b)  A provisional license may be issued to any birth

14  center that is in substantial compliance with ss.

15  383.30-383.335 and with the rules of the agency department.  A

16  provisional license may be granted for a period of no more

17  than 1 year from the effective date of rules adopted by the

18  agency department, shall expire automatically at the end of

19  its term, and may not be renewed.

20         (c)  A license, unless sooner suspended or revoked,

21  automatically expires 1 year from its date of issuance and is

22  renewable upon application for renewal and payment of the fee

23  prescribed, provided the applicant and the birth center meet

24  the requirements established under ss. 383.30-383.335 and by

25  rules promulgated hereunder.  A complete application for

26  renewal of a license shall be made 90 days prior to expiration

27  of the license on forms provided by the agency department.

28         (2)  An application for a license, or renewal thereof,

29  shall be made to the agency department upon forms provided by

30  it and shall contain such information as the agency department

31

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  1  reasonably requires, which may include affirmative evidence of

  2  ability to comply with applicable laws and rules.

  3         (3)(a)  Each application for a birth center license, or

  4  renewal thereof, shall be accompanied by a license fee.  Fees

  5  shall be established by rule of the agency department.  Such

  6  fees are payable to the agency department and shall be

  7  deposited in a trust fund administered by the agency

  8  department, to be used for the sole purpose of carrying out

  9  the provisions of ss. 383.30-383.335.

10         (b)  The fees established pursuant to ss.

11  383.30-383.335 shall be based on actual costs incurred by the

12  agency department in the administration of its duties under

13  such sections.

14         (4)  Each license is valid only for the person or

15  governmental unit to whom or which it is issued; is not

16  subject to sale, assignment, or other transfer, voluntary or

17  involuntary; and is not valid for any premises other than

18  those for which it was originally issued.

19         (5)  Each license shall be posted in a conspicuous

20  place on the licensed premises.

21         (6)  Whenever the agency department finds that there

22  has been a substantial failure to comply with the requirements

23  established under ss. 383.30-383.335 or in rules adopted under

24  those sections promulgated hereunder, it is authorized to

25  deny, suspend, or revoke a license.

26         (7)  Each applicant for licensure must comply with the

27  following requirements:

28         (a)  Upon receipt of a completed, signed, and dated

29  application, the agency shall require background screening, in

30  accordance with the level 2 standards for screening set forth

31  in chapter 435, of the managing employee, or other similarly

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  1  titled individual who is responsible for the daily operation

  2  of the center, and of the financial officer, or other

  3  similarly titled individual who is responsible for the

  4  financial operation of the center, including billings for

  5  patient care and services.  The applicant must comply with the

  6  procedures for level 2 background screening as set forth in

  7  chapter 435.

  8         (b)  The agency may require background screening of any

  9  other individual who is an applicant if the agency has a

10  reasonable basis for believing that he or she has been

11  convicted of a crime or has committed any other offense

12  prohibited under the level 2 standards for screening set forth

13  in chapter 435.

14         (c)  Proof of compliance with the level 2 background

15  screening requirements of chapter 435 which has been submitted

16  within the previous 5 years in compliance with any other

17  health care licensure requirements of this state is acceptable

18  in fulfillment of the requirements of paragraph (a).

19         (d)  A provisional license may be granted to an

20  applicant when each individual required by this section to

21  undergo background screening has met the standards for the

22  abuse registry background check and the Department of Law

23  Enforcement background check, but the agency has not yet

24  received background screening results from the Federal Bureau

25  of Investigation, or a request for a disqualification

26  exemption has been submitted to the agency as set forth in

27  chapter 435 but a response has not yet been issued. A standard

28  license may be granted to the applicant upon the agency's

29  receipt of a report of the results of the Federal Bureau of

30  Investigation background screening for each individual

31  required by this section to undergo background screening which

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  1  confirms that all standards have been met, or upon the

  2  granting of a disqualification exemption by the agency as set

  3  forth in chapter 435. Any other person who is required to

  4  undergo level 2 background screening may serve in his or her

  5  capacity pending the agency's receipt of the report from the

  6  Federal Bureau of Investigation. However, the person may not

  7  continue to serve if the report indicates any violation of

  8  background screening standards and a disqualification

  9  exemption has not been requested of and granted by the agency

10  as set forth in chapter 435.

11         (e)  Each applicant must submit to the agency, with its

12  application, a description and explanation of any exclusions,

13  permanent suspensions, or terminations of the applicant from

14  the Medicare or Medicaid programs. Proof of compliance with

15  the requirements for disclosure of ownership and control

16  interests under the Medicaid or Medicare programs shall be

17  accepted in lieu of this submission.

18         (f)  Each applicant must submit to the agency a

19  description and explanation of any conviction of an offense

20  prohibited under the level 2 standards of chapter 435 by a

21  member of the board of directors of the applicant, its

22  officers, or any individual owning 5 percent or more of the

23  applicant. This requirement does not apply to a director of a

24  not-for-profit corporation or organization if the director

25  serves solely in a voluntary capacity for the corporation or

26  organization, does not regularly take part in the day-to-day

27  operational decisions of the corporation or organization,

28  receives no remuneration for his or her services on the

29  corporation or organization's board of directors, and has no

30  financial interest and has no family members with a financial

31  interest in the corporation or organization, provided that the

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  1  director and the not-for-profit corporation or organization

  2  include in the application a statement affirming that the

  3  director's relationship to the corporation satisfies the

  4  requirements of this paragraph.

  5         (g)  A license may not be granted to an applicant if

  6  the applicant or managing employee has been found guilty of,

  7  regardless of adjudication, or has entered a plea of nolo

  8  contendere or guilty to, any offense prohibited under the

  9  level 2 standards for screening set forth in chapter 435,

10  unless an exemption from disqualification has been granted by

11  the agency as set forth in chapter 435.

12         (h)  The agency may deny or revoke licensure if the

13  applicant:

14         1.  Has falsely represented a material fact in the

15  application required by paragraph (e) or paragraph (f), or has

16  omitted any material fact from the application required by

17  paragraph (e) or paragraph (f); or

18         2.  Has had prior action taken against the applicant

19  under the Medicaid or Medicare program as set forth in

20  paragraph (e).

21         (i)  An application for license renewal must contain

22  the information required under paragraphs (e) and (f).

23         Section 9.  Paragraph (a) of subsection (2) of section

24  383.308, Florida Statutes, is amended to read:

25         383.308  Birth center facility and equipment;

26  requirements.--

27         (2)(a)  A birth center shall be equipped with those

28  items needed to provide low-risk maternity care and readily

29  available equipment to initiate emergency procedures in

30  life-threatening events to mother and baby, as defined by rule

31  of the agency department.

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  1         Section 10.  Section 383.309, Florida Statutes, is

  2  amended to read:

  3         383.309  Minimum standards for birth centers; rules and

  4  enforcement.--

  5         (1)  The agency department shall adopt, amend,

  6  promulgate, and enforce rules to administer ss. 383.30-383.335

  7  implement the provisions of this act, which rules shall

  8  include, but are not limited to, reasonable and fair minimum

  9  standards for ensuring that:

10         (a)  Sufficient numbers and qualified types of

11  personnel and occupational disciplines are available at all

12  times to provide necessary and adequate patient care and

13  safety.

14         (b)  Infection control, housekeeping, sanitary

15  conditions, disaster plan, and medical record procedures that

16  will adequately protect patient care and provide safety are

17  established and implemented.

18         (c)  Construction, maintenance, repair, and renovation

19  of licensed facilities are governed by rules of the agency

20  department which use utilize the most recently adopted,

21  nationally recognized codes wherever feasible.  Facilities

22  licensed under s. 383.305 are exempt from local construction

23  standards to the extent that those standards are in conflict

24  with the standards adopted by rule of the agency department.

25         (d)  Licensed facilities are established, organized,

26  and operated consistent with established programmatic

27  standards.

28         (2)  Any licensed facility that which is in operation

29  at the time of adoption promulgation of any applicable rule

30  under ss. 383.30-383.335 shall be given a reasonable time

31  under the particular circumstances, not to exceed 1 year after

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  1  from the date of such adoption promulgation, within which to

  2  comply with such rule.

  3         Section 11.  Paragraph (b) of subsection (1) and

  4  paragraph (b) of subsection (2) of section 383.31, Florida

  5  Statutes, are amended to read:

  6         383.31  Selection of clients; informed consent.--

  7         (1)

  8         (b)  The criteria for the selection of clients and the

  9  establishment of risk status shall be defined by rule of the

10  agency department.

11         (2)

12         (b)  The agency department shall develop a client

13  informed-consent form to be used by the center to inform the

14  client of the benefits and risks related to childbirth outside

15  a hospital.

16         Section 12.  Subsection (1) of section 383.312, Florida

17  Statutes, is amended to read:

18         383.312  Prenatal care of birth center clients.--

19         (1)  A birth center shall ensure that its clients have

20  adequate prenatal care, as defined by the agency department,

21  and shall ensure that serological tests are administered as

22  required by this chapter.

23         Section 13.  Subsection (1) of section 383.313, Florida

24  Statutes, is amended to read:

25         383.313  Performance of laboratory and surgical

26  services; use of anesthetic and chemical agents.--

27         (1)  LABORATORY SERVICES.--A birth center may collect

28  specimens for those tests that are requested under protocol.

29  A birth center may perform simple laboratory tests, as defined

30  by rule of the agency department, and is exempt from the

31  requirements of chapter 483, provided no more than five

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  1  physicians are employed by the birth center and testing is

  2  conducted exclusively in connection with the diagnosis and

  3  treatment of clients of the birth center.

  4         Section 14.  Subsection (1) of section 383.318, Florida

  5  Statutes, is amended to read:

  6         383.318  Postpartum care for birth center clients and

  7  infants.--

  8         (1)  A mother and her infant shall be dismissed from

  9  the birth center within 24 hours after the birth of the

10  infant, except in unusual circumstances as defined by rule of

11  the agency department.  If a mother or infant is retained at

12  the birth center for more than 24 hours after the birth, a

13  report shall be filed with the agency department within 48

14  hours of the birth describing the circumstances and the

15  reasons for the decision.

16         Section 15.  Subsection (3) of section 383.32, Florida

17  Statutes, is amended to read:

18         383.32  Clinical records.--

19         (3)  Clinical records shall be kept confidential in

20  accordance with s. 455.241 and exempt from the provisions of

21  s. 119.07(1). A client's clinical records shall be open to

22  inspection only under the following conditions:

23         (a)  A consent to release information has been signed

24  by the client; or

25         (b)  The review is made by the agency department for a

26  licensure survey or complaint investigation.

27         Section 16.  Section 383.324, Florida Statutes, is

28  amended to read:

29         383.324  Inspections and investigations; inspection

30  fees.--

31

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  1         (1)  The agency department shall make or cause to be

  2  made such inspections and investigations as it deems

  3  necessary.

  4         (2)  Each facility licensed under s. 383.305 shall pay

  5  to the agency department, at the time of inspection, an

  6  inspection fee established by rule of the agency department.

  7         (3)  The agency department shall coordinate all

  8  periodic inspections for licensure made by the agency

  9  department to ensure that the cost to the facility of such

10  inspections and the disruption of services by such inspections

11  is minimized.

12         Section 17.  Subsection (3) of section 383.325, Florida

13  Statutes, is amended to read:

14         383.325  Inspection reports.--

15         (3)  A licensed facility shall, upon the request of any

16  person who has completed a written application with intent to

17  be admitted to such facility or any person who is a patient of

18  such facility, or any relative, spouse, or guardian of any

19  such person, furnish to the requester a copy of the last

20  inspection report issued by the agency department or an

21  accrediting organization, whichever is most recent, pertaining

22  to the licensed facility, as provided in subsection (1),

23  provided the person requesting such report agrees to pay a

24  reasonable charge to cover copying costs.

25         Section 18.  Subsection (4) of section 383.327, Florida

26  Statutes, is amended to read:

27         383.327  Birth and death records; reports.--

28         (4)  A report shall be submitted annually to the agency

29  department.  The contents of the report shall be prescribed by

30  rule of the agency department.

31

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  1         Section 19.  Section 383.33, Florida Statutes, is

  2  amended to read:

  3         383.33  Administrative penalties; emergency orders;

  4  moratorium on admissions.--

  5         (1)(a)  The agency department may deny, revoke, or

  6  suspend a license, or impose an administrative fine not to

  7  exceed $500 per violation per day, for the violation of any

  8  provision of ss. 383.30-383.335 or any rule adopted under ss.

  9  383.30-383.335 promulgated hereunder.  Each day of violation

10  constitutes a separate violation and is subject to a separate

11  fine.

12         (b)  In determining the amount of the fine to be levied

13  for a violation, as provided in paragraph (a), the following

14  factors shall be considered:

15         1.  The severity of the violation, including the

16  probability that death or serious harm to the health or safety

17  of any person will result or has resulted; the severity of the

18  actual or potential harm; and the extent to which the

19  provisions of ss. 383.30-383.335 this act were violated.

20         2.  Actions taken by the licensee to correct the

21  violations or to remedy complaints.

22         3.  Any previous violations by the licensee.

23         (c)  All amounts collected pursuant to this section

24  shall be deposited into a trust fund administered by the

25  agency department to be used for the sole purpose of carrying

26  out the provisions of ss. 383.30-383.335.

27         (2)  The agency department may issue an emergency order

28  immediately suspending or revoking a license when it

29  determines that any condition in the licensed facility

30  presents a clear and present danger to the public health and

31  safety.

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  1         (3)  The agency department may impose an immediate

  2  moratorium on elective admissions to any licensed facility,

  3  building or portion thereof, or service when the agency

  4  department determines that any condition in the facility

  5  presents a threat to the public health or safety.

  6         Section 20.  Section 383.331, Florida Statutes, is

  7  amended to read:

  8         383.331  Injunctive relief.--Notwithstanding the

  9  existence or pursuit of any other remedy, the agency

10  department may maintain an action in the name of the state for

11  injunction or other process to enforce the provisions of ss.

12  383.30-383.335 and the rules adopted promulgated under such

13  sections.

14         Section 21.  Subsection (3) is added to section

15  390.015, Florida Statutes, to read:

16         390.015  Application for license.--

17         (3)  Each applicant for licensure must comply with the

18  following requirements:

19         (a)  Upon receipt of a completed, signed, and dated

20  application, the agency shall require background screening, in

21  accordance with the level 2 standards for screening set forth

22  in chapter 435, of the managing employee, or other similarly

23  titled individual who is responsible for the daily operation

24  of the clinic, and financial officer, or other similarly

25  titled individual who is responsible for the financial

26  operation of the clinic, including billings for patient care

27  and services. The applicant must comply with the procedures

28  for level 2 background screening as set forth in chapter 435.

29         (b)  The agency may require background screening of any

30  other individual who is an applicant if the agency has a

31  reasonable basis for believing that he or she has been

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  1  convicted of a crime or has committed any other offense

  2  prohibited under the level 2 standards for screening set forth

  3  in chapter 435.

  4         (c)  Proof of compliance with the level 2 background

  5  screening requirements of chapter 435 which has been submitted

  6  within the previous 5 years in compliance with any other

  7  health care licensure requirements of this state is acceptable

  8  in fulfillment of the requirements of paragraph (a).

  9         (d)  A provisional license may be granted to an

10  applicant when each individual required by this section to

11  undergo background screening has met the standards for the

12  abuse registry background check and the Department of Law

13  Enforcement background check, but the agency has not yet

14  received background screening results from the Federal Bureau

15  of Investigation, or a request for a disqualification

16  exemption has been submitted to the agency as set forth in

17  chapter 435 but a response has not yet been issued. A standard

18  license may be granted to the applicant upon the agency's

19  receipt of a report of the results of the Federal Bureau of

20  Investigation background screening for each individual

21  required by this section to undergo background screening which

22  confirms that all standards have been met, or upon the

23  granting of a disqualification exemption by the agency as set

24  forth in chapter 435. Any other person who is required to

25  undergo level 2 background screening may serve in his or her

26  capacity pending the agency's receipt of the report from the

27  Federal Bureau of Investigation. However, the person may not

28  continue to serve if the report indicates any violation of

29  background screening standards and a disqualification

30  exemption has not been requested of and granted by the agency

31  as set forth in chapter 435.

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  1         (e)  Each applicant must submit to the agency, with its

  2  application, a description and explanation of any exclusions,

  3  permanent suspensions, or terminations of the applicant from

  4  the Medicare or Medicaid programs. Proof of compliance with

  5  the requirements for disclosure of ownership and control

  6  interests under the Medicaid or Medicare programs shall be

  7  accepted in lieu of this submission.

  8         (f)  Each applicant must submit to the agency a

  9  description and explanation of any conviction of an offense

10  prohibited under the level 2 standards of chapter 435 by a

11  member of the board of directors of the applicant, its

12  officers, or any individual owning 5 percent or more of the

13  applicant. This requirement does not apply to a director of a

14  not-for-profit corporation or organization if the director

15  serves solely in a voluntary capacity for the corporation or

16  organization, does not regularly take part in the day-to-day

17  operational decisions of the corporation or organization,

18  receives no remuneration for his or her services on the

19  corporation or organization's board of directors, and has no

20  financial interest and has no family members with a financial

21  interest in the corporation or organization, provided that the

22  director and the not-for-profit corporation or organization

23  include in the application a statement affirming that the

24  director's relationship to the corporation satisfies the

25  requirements of this paragraph.

26         (g)  A license may not be granted to an applicant if

27  the applicant or managing employee has been found guilty of,

28  regardless of adjudication, or has entered a plea of nolo

29  contendere or guilty to, any offense prohibited under the

30  level 2 standards for screening set forth in chapter 435,

31

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  1  unless an exemption from disqualification has been granted by

  2  the agency as set forth in chapter 435.

  3         (h)  The agency may deny or revoke licensure if the

  4  applicant:

  5         1.  Has falsely represented a material fact in the

  6  application required by paragraph (e) or paragraph (f), or has

  7  omitted any material fact from the application required by

  8  paragraph (e) or paragraph (f); or

  9         2.  Has had prior action taken against the applicant

10  under the Medicaid or Medicare program as set forth in

11  paragraph (e).

12         (i)  An application for license renewal must contain

13  the information required under paragraphs (e) and (f).

14         Section 22.  Subsection (5) is added to section

15  391.206, Florida Statutes, to read:

16         391.206  Initial application for license.--

17         (5)  Each applicant for licensure must comply with the

18  following requirements:

19         (a)  Upon receipt of a completed, signed, and dated

20  application, the agency shall require background screening, in

21  accordance with the level 2 standards for screening set forth

22  in chapter 435, of the operator, and of the financial officer,

23  or other similarly titled individual who is responsible for

24  the financial operation of the center, including billings for

25  patient care and services.  The applicant must comply with the

26  procedures for level 2 background screening as set forth in

27  chapter 435.

28         (b)  The agency may require background screening of any

29  other individual who is an applicant if the agency has a

30  reasonable basis for believing that he or she has been

31  convicted of a crime or has committed any other offense

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  1  prohibited under the level 2 standards for screening set forth

  2  in chapter 435.

  3         (c)  Proof of compliance with the level 2 background

  4  screening requirements of chapter 435 which has been submitted

  5  within the previous 5 years in compliance with any other

  6  health care licensure requirements of this state is acceptable

  7  in fulfillment of the requirements of paragraph (a).

  8         (d)  A provisional license may be granted to an

  9  applicant when each individual required by this section to

10  undergo background screening has met the standards for the

11  abuse registry background check and the Department of Law

12  Enforcement background check, but the agency has not yet

13  received background screening results from the Federal Bureau

14  of Investigation, or a request for a disqualification

15  exemption has been submitted to the agency as set forth in

16  chapter 435 but a response has not yet been issued. A standard

17  license may be granted to the applicant upon the agency's

18  receipt of a report of the results of the Federal Bureau of

19  Investigation background screening for each individual

20  required by this section to undergo background screening which

21  confirms that all standards have been met, or upon the

22  granting of a disqualification exemption by the agency as set

23  forth in chapter 435. Any other person who is required to

24  undergo level 2 background screening may serve in his or her

25  capacity pending the agency's receipt of the report from the

26  Federal Bureau of Investigation. However, the person may not

27  continue to serve if the report indicates any violation of

28  background screening standards and a disqualification

29  exemption has not been requested of and granted by the agency

30  as set forth in chapter 435.

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  1         (e)  Each applicant must submit to the agency, with its

  2  application, a description and explanation of any exclusions,

  3  permanent suspensions, or terminations of the applicant from

  4  the Medicare or Medicaid programs. Proof of compliance with

  5  the requirements for disclosure of ownership and control

  6  interests under the Medicaid or Medicare programs shall be

  7  accepted in lieu of this submission.

  8         (f)  Each applicant must submit to the agency a

  9  description and explanation of any conviction of an offense

10  prohibited under the level 2 standards of chapter 435 by a

11  member of the board of directors of the applicant, its

12  officers, or any individual owning 5 percent or more of the

13  applicant. This requirement does not apply to a director of a

14  not-for-profit corporation or organization if the director

15  serves solely in a voluntary capacity for the corporation or

16  organization, does not regularly take part in the day-to-day

17  operational decisions of the corporation or organization,

18  receives no remuneration for his or her services on the

19  corporation or organization's board of directors, and has no

20  financial interest and has no family members with a financial

21  interest in the corporation or organization, provided that the

22  director and the not-for-profit corporation or organization

23  include in the application a statement affirming that the

24  director's relationship to the corporation satisfies the

25  requirements of this paragraph.

26         (g)  A license may not be granted to an applicant if

27  the applicant or managing employee has been found guilty of,

28  regardless of adjudication, or has entered a plea of nolo

29  contendere or guilty to, any offense prohibited under the

30  level 2 standards for screening set forth in chapter 435,

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  1  unless an exemption from disqualification has been granted by

  2  the agency as set forth in chapter 435.

  3         (h)  The agency may deny or revoke licensure if the

  4  applicant:

  5         1.  Has falsely represented a material fact in the

  6  application required by paragraph (e) or paragraph (f), or has

  7  omitted any material fact from the application required by

  8  paragraph (e) or paragraph (f); or

  9         2.  Has had prior action taken against the applicant

10  under the Medicaid or Medicare program as set forth in

11  paragraph (e).

12         (i)  An application for license renewal must contain

13  the information required under paragraphs (e) and (f).

14         Section 23.  Present subsections (2) through (53) of

15  section 393.063, Florida Statutes, are renumbered as

16  subsections (3) through (54), respectively, and a new

17  subsection (2) is added to that section, to read:

18         393.063  Definitions.--For the purposes of this

19  chapter:

20         (2)  "Agency" means the Agency for Health Care

21  Administration.

22         Section 24.  Present subsections (6) through (18) of

23  section 393.067, Florida Statutes, are renumbered as

24  subsections (7) through (19), respectively, and a new

25  subsection (6) is added to that section, to read:

26         393.067  Licensure of residential facilities and

27  comprehensive transitional education programs.--

28         (6)  Each applicant for licensure as an intermediate

29  care facility for the developmentally disabled must comply

30  with the following requirements:

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  1         (a)  Upon receipt of a completed, signed, and dated

  2  application, the agency shall require background screening, in

  3  accordance with the level 2 standards for screening set forth

  4  in chapter 435, of the managing employee, or other similarly

  5  titled individual who is responsible for the daily operation

  6  of the facility, and of the financial officer, or other

  7  similarly titled individual who is responsible for the

  8  financial operation of the center, including billings for

  9  resident care and services.  The applicant must comply with

10  the procedures for level 2 background screening as set forth

11  in chapter 435.

12         (b)  The agency may require background screening of any

13  other individual who is an applicant if the agency has a

14  reasonable basis for believing that he or she has been

15  convicted of a crime or has committed any other offense

16  prohibited under the level 2 standards for screening set forth

17  in chapter 435.

18         (c)  Proof of compliance with the level 2 background

19  screening requirements of chapter 435 which has been submitted

20  within the previous 5 years in compliance with any other

21  health care licensure requirements of this state is acceptable

22  in fulfillment of the requirements of paragraph (a).

23         (d)  A provisional license may be granted to an

24  applicant when each individual required by this section to

25  undergo background screening has met the standards for the

26  abuse registry background check and the Department of Law

27  Enforcement background check, but the agency has not yet

28  received background screening results from the Federal Bureau

29  of Investigation, or a request for a disqualification

30  exemption has been submitted to the agency as set forth in

31  chapter 435 but a response has not yet been issued. A standard

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  1  license may be granted to the applicant upon the agency's

  2  receipt of a report of the results of the Federal Bureau of

  3  Investigation background screening for each individual

  4  required by this section to undergo background screening which

  5  confirms that all standards have been met, or upon the

  6  granting of a disqualification exemption by the agency as set

  7  forth in chapter 435. Any other person who is required to

  8  undergo level 2 background screening may serve in his or her

  9  capacity pending the agency's receipt of the report from the

10  Federal Bureau of Investigation. However, the person may not

11  continue to serve if the report indicates any violation of

12  background screening standards and a disqualification

13  exemption has not been requested of and granted by the agency

14  as set forth in chapter 435.

15         (e)  Each applicant must submit to the agency, with its

16  application, a description and explanation of any exclusions,

17  permanent suspensions, or terminations of the applicant from

18  the Medicare or Medicaid programs. Proof of compliance with

19  the requirements for disclosure of ownership and control

20  interests under the Medicaid or Medicare programs shall be

21  accepted in lieu of this submission.

22         (f)  Each applicant must submit to the agency a

23  description and explanation of any conviction of an offense

24  prohibited under the level 2 standards of chapter 435 by a

25  member of the board of directors of the applicant, its

26  officers, or any individual owning 5 percent or more of the

27  applicant. This requirement does not apply to a director of a

28  not-for-profit corporation or organization if the director

29  serves solely in a voluntary capacity for the corporation or

30  organization, does not regularly take part in the day-to-day

31  operational decisions of the corporation or organization,

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  1  receives no remuneration for his or her services on the

  2  corporation or organization's board of directors, and has no

  3  financial interest and has no family members with a financial

  4  interest in the corporation or organization, provided that the

  5  director and the not-for-profit corporation or organization

  6  include in the application a statement affirming that the

  7  director's relationship to the corporation satisfies the

  8  requirements of this paragraph.

  9         (g)  A license may not be granted to an applicant if

10  the applicant or managing employee has been found guilty of,

11  regardless of adjudication, or has entered a plea of nolo

12  contendere or guilty to, any offense prohibited under the

13  level 2 standards for screening set forth in chapter 435,

14  unless an exemption from disqualification has been granted by

15  the agency as set forth in chapter 435.

16         (h)  The agency may deny or revoke licensure if the

17  applicant:

18         1.  Has falsely represented a material fact in the

19  application required by paragraph (e) or paragraph (f), or has

20  omitted any material fact from the application required by

21  paragraph (e) or paragraph (f); or

22         2.  Has had prior action taken against the applicant

23  under the Medicaid or Medicare program as set forth in

24  paragraph (e).

25         (i)  An application for license renewal must contain

26  the information required under paragraphs (e) and (f).

27         Section 25.  Subsection (7) of section 394.4787,

28  Florida Statutes, is amended to read:

29         394.4787  Definitions.--As used in this section and ss.

30  394.4786, 394.4788, and 394.4789:

31

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  1         (7)  "Specialty psychiatric hospital" means a hospital

  2  licensed by the agency pursuant to s. 395.002(28) s.

  3  395.002(27) as a specialty psychiatric hospital.

  4         Section 26.  Subsections (2) and (3) of section

  5  394.4788, Florida Statutes, are amended to read:

  6         394.4788  Use of certain PMATF funds for the purchase

  7  of acute care mental health services.--

  8         (2)  By October 1, 1989, and annually thereafter, The

  9  agency shall annually calculate a per diem reimbursement rate

10  for each specialty psychiatric hospital to be paid to the

11  specialty psychiatric hospitals for the provision of acute

12  mental health services provided to indigent mentally ill

13  patients who meet the criteria in subsection (1).  After the

14  first rate period, providers shall be notified of new

15  reimbursement rates for each new state fiscal year by June 1.

16  The new reimbursement rates shall commence July 1.

17         (3)  Reimbursement rates shall be calculated using the

18  most recent audited actual costs received by the agency.  Cost

19  data received as of August 15, 1989, and each April 15

20  thereafter shall be used in the calculation of the rates.

21  Historic costs shall be inflated from the midpoint of a

22  hospital's fiscal year to the midpoint of the state fiscal

23  year.  The inflation adjustment shall be made utilizing the

24  latest available projections as of March 31 for the Data

25  Resources Incorporated National and Regional Hospital Input

26  Price Indices as calculated by the Medicaid program office.

27         Section 27.  Section 394.67, Florida Statutes, is

28  amended to read:

29         394.67  Definitions.--As When used in this part, unless

30  the context clearly requires otherwise, the term:

31

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  1         (1)  "Advisory council" means a district advisory

  2  council.

  3         (2)  "Agency" means the Agency for Health Care

  4  Administration.

  5         (2)  "Alcohol, drug abuse, and mental health planning

  6  council" or "council" means the council within a Department of

  7  Health and Rehabilitative Services district or subdistrict

  8  established in accordance with the provisions of this part for

  9  the purpose of assessing the alcohol, drug abuse, and mental

10  health needs of the community and developing a plan to address

11  those needs.

12         (3)  "Applicant" means an individual applicant, or any

13  officer, director, agent, managing employee, or affiliated

14  person, or any partner or shareholder having an ownership

15  interest equal to a 5-percent or greater interest in the

16  corporation, partnership, or other business entity.

17         (4)  "Client" means any individual receiving services

18  in any alcohol, drug abuse, or mental health facility,

19  program, or service, which facility, program, or service is

20  operated, funded, or regulated by the agency and the

21  department or regulated by the agency.

22         (5)  "Crisis stabilization unit" means a program that

23  provides an alternative to inpatient hospitalization and that

24  provides brief, intensive services 24 hours a day, 7 days a

25  week, for mentally ill individuals who are in an acutely

26  disturbed state.

27         (6)(3)  "Department" means the Department of Children

28  and Family Health and Rehabilitative Services.

29         (7)  "Director" means any member of the official board

30  of directors reported in the organization's annual corporate

31  report to the Florida Department of State, or, if no such

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  1  report is made, any member of the operating board of

  2  directors. The term excludes members of separate, restricted

  3  boards that serve only in an advisory capacity to the

  4  operating board.

  5         (8)(4)  "District administrator" means the person

  6  appointed by the Secretary of Children and Family Health and

  7  Rehabilitative Services for the purpose of administering a

  8  department service district as set forth in s. 20.19.

  9         (9)(5)  "District plan" or "plan" means the combined

10  district alcohol, drug abuse, and mental health plan prepared

11  by the alcohol, drug abuse, and mental health planning council

12  and approved by the district administrator and governing

13  bodies in accordance with this part.

14         (10)(6)  "Federal funds" means funds from federal

15  sources for alcohol, drug abuse, or mental health facilities

16  and programs, exclusive of federal funds that are deemed

17  eligible by the Federal Government, and are eligible through

18  state regulation, for matching purposes.

19         (11)(7)  "Governing body" means the chief legislative

20  body of a county, a board of county commissioners, or boards

21  of county commissioners in counties acting jointly, or their

22  counterparts in a charter government.

23         (12)  "Licensed facility" means a facility licensed in

24  accordance with this chapter.

25         (13)(8)  "Local matching funds" means funds received

26  from governing bodies of local government, including city

27  commissions, county commissions, district school boards,

28  special tax districts, private hospital funds, private gifts,

29  both individual and corporate, and bequests and funds received

30  from community drives or any other sources.

31

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  1         (14)  "Managing employee" means the administrator or

  2  other similarly titled individual who is responsible for the

  3  daily operation of the facility.

  4         (15)(9)  "Patient fees" means compensation received by

  5  a community alcohol, drug abuse, or mental health facility for

  6  services rendered to clients from any source of funds,

  7  including city, county, state, federal, and private sources.

  8         (16)  "Premises" means those buildings, beds, and

  9  facilities located at the main address of the licensee and all

10  other buildings, beds, and facilities for the provision of

11  acute or residential care which are located in such reasonable

12  proximity to the main address of the licensee as to appear to

13  the public to be under the dominion and control of the

14  licensee.

15         (17)(10)  "Program office" means the Alcohol, Drug

16  Abuse, and Mental Health Program Office of the Department of

17  Children and Family Health and Rehabilitative Services.

18         (18)  "Residential treatment facility" means a facility

19  providing residential care and treatment to individuals

20  exhibiting symptoms of mental illness who are in need of a

21  24-hour-per-day, 7-day-a-week structured living environment,

22  respite care, or long-term community placement.  The term also

23  includes short-term residential treatment facilities for

24  treatment of mental illness.

25         (19)(11)  "Service district" means a community service

26  district as established by the department under s. 20.19 for

27  the purpose of providing community alcohol, drug abuse, and

28  mental health services.

29         (20)(12)  "Service provider" means any agency in which

30  all or any portion of the programs or services set forth in s.

31  394.675 are carried out.

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  1         (13)  "Crisis stabilization unit" means a program

  2  providing an alternative to inpatient hospitalization and

  3  which provides brief, intensive services 24 hours a day, 7

  4  days a week, for mentally ill individuals who are in an

  5  acutely disturbed state.

  6         (14)  "Residential treatment facility" means a facility

  7  providing residential care and treatment to individuals

  8  exhibiting symptoms of mental illness who are in need of a

  9  24-hour, 7-day-a-week structured living environment, respite

10  care, or long-term community placement.  Residential treatment

11  facility shall also include short-term residential treatment

12  facilities for treatment of mental illness.

13         (15)  "Licensed facility" means a facility licensed in

14  accordance with this chapter.

15         (16)  "Premises" means those buildings, beds, and

16  facilities located at the main address of the licensee and all

17  other buildings, beds, and facilities for the provision of

18  acute or residential care located in such reasonable proximity

19  to the main address of the licensee as to appear to the public

20  to be under the dominion and control of the licensee.

21         (17)  "Client" means any individual receiving services

22  in any alcohol, drug abuse, or mental health facility,

23  program, or service, which facility, program, or service is

24  operated, funded, or regulated by the Department of Health and

25  Rehabilitative Services.

26         Section 28.  Section 394.875, Florida Statutes, is

27  amended to read:

28         394.875  Crisis stabilization units and residential

29  treatment facilities; authorized services; license required;

30  penalties.--

31

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  1         (1)(a)  The purpose of a crisis stabilization unit is

  2  to stabilize and redirect a client to the most appropriate and

  3  least restrictive community setting available, consistent with

  4  the client's needs.  Crisis stabilization units may screen,

  5  assess, and admit for stabilization persons who present

  6  themselves to the unit and persons who are brought to the unit

  7  under s. 394.463.  Clients may be provided 24-hour

  8  observation, medication prescribed by a physician or

  9  psychiatrist, and other appropriate services.  Crisis

10  stabilization units shall provide services regardless of the

11  client's ability to pay and shall be limited in size to a

12  maximum of 30 beds.

13         (b)  The purpose of a residential treatment facility is

14  to be a part of a comprehensive treatment program for mentally

15  ill individuals in a community-based residential setting.

16         (2)  After July 1, 1986, It is unlawful for any entity

17  to hold itself out as a crisis stabilization unit or a

18  residential treatment facility, or to act as a crisis

19  stabilization unit or a residential treatment facility, unless

20  it is licensed by the agency department pursuant to this

21  chapter.

22         (3)  Any person who violates subsection (2) is guilty

23  of a misdemeanor of the first degree, punishable as provided

24  in s. 775.082 or s. 775.083.

25         (4)  The agency department may maintain an action in

26  circuit court to enjoin the unlawful operation of a crisis

27  stabilization unit or a residential treatment facility if the

28  agency department first gives the violator 14 days' notice of

29  its intention to maintain such action and if the violator

30  fails to apply for licensure within such 14-day period.

31         (5)  Subsection (2) does not apply to:

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  1         (a)  Homes for special services licensed under chapter

  2  400;

  3         (b)  Nursing homes licensed under chapter 400; or

  4         (c)  Residential child caring facilities licensed under

  5  s. 409.175.

  6         (6)  The agency department may establish multiple

  7  license classifications for residential treatment facilities.

  8         (7)  The agency may department shall not issue a

  9  license to a crisis stabilization unit unless the unit

10  receives state mental health funds and is affiliated with a

11  designated public receiving facility.

12         (8)  The agency department may issue a license for a

13  crisis stabilization unit or short-term residential treatment

14  facility, certifying the number of authorized beds for such

15  facility as indicated by existing need and available

16  appropriations.  The agency department may disapprove an

17  application for such a license if it determines that a

18  facility should not be licensed pursuant to the provisions of

19  this chapter.  Any facility operating beds in excess of those

20  authorized by the agency department shall, upon demand of the

21  agency department, reduce the number of beds to the authorized

22  number, forfeit its license, or provide evidence of a license

23  issued pursuant to chapter 395 for the excess beds.

24         (9)  A children's crisis stabilization unit which does

25  not exceed 20 licensed beds and which provides separate

26  facilities or a distinct part of a facility, separate

27  staffing, and treatment exclusively for minors may be located

28  on the same premises as a crisis stabilization unit serving

29  adults.  The agency department shall adopt promulgate rules

30  governing facility construction, staffing and licensure

31  requirements, and the operation of such units for minors.

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  1         (10)  Notwithstanding the provisions of subsection (8),

  2  crisis stabilization units may not exceed their licensed

  3  capacity by more than 10 percent, nor may they exceed their

  4  licensed capacity for more than 3 consecutive working days or

  5  for more than 7 days in 1 month.

  6         (11)  Notwithstanding the other provisions of this

  7  section, any facility licensed under chapters 396 and 397 for

  8  detoxification, residential level I care, and outpatient

  9  treatment may elect to license concurrently all of the beds at

10  such facility both for that purpose and as a long-term

11  residential treatment facility pursuant to this section, if

12  all of the following conditions are met:

13         (a)  The licensure application is received by the

14  department prior to January 1, 1993.

15         (b)  On January 1, 1993, the facility was licensed

16  under chapters 396 and 397 as a facility for detoxification,

17  residential level I care, and outpatient treatment of

18  substance abuse.

19         (c)  The facility restricted its practice to the

20  treatment of law enforcement personnel for a period of at

21  least 12 months beginning after January 1, 1992.

22         (d)  The number of beds to be licensed under chapter

23  394 is equal to or less than the number of beds licensed under

24  chapters 396 and 397 as of January 1, 1993.

25         (e)  The licensee agrees in writing to a condition

26  placed upon the license that the facility will limit its

27  treatment exclusively to law enforcement personnel and their

28  immediate families who are seeking admission on a voluntary

29  basis and who are exhibiting symptoms of posttraumatic stress

30  disorder or other mental health problems, including drug or

31  alcohol abuse, which are directly related to law enforcement

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  1  work and which are amenable to verbal treatment therapies; the

  2  licensee agrees to coordinate the provision of appropriate

  3  postresidential care for discharged individuals; and the

  4  licensee further agrees in writing that a failure to meet any

  5  condition specified in this paragraph shall constitute grounds

  6  for a revocation of the facility's license as a residential

  7  treatment facility.

  8         (f)  The licensee agrees that the facility will meet

  9  all licensure requirements for a residential treatment

10  facility, including minimum standards for compliance with

11  lifesafety requirements, except those licensure requirements

12  which are in express conflict with the conditions and other

13  provisions specified in this subsection.

14         (g)  The licensee agrees that the conditions stated in

15  this subsection must be agreed to in writing by any person

16  acquiring the facility by any means.

17

18  Any facility licensed under this subsection is not required to

19  provide any services to any persons except those included in

20  the specified conditions of licensure, and is exempt from any

21  requirements related to the 60-day or greater average length

22  of stay imposed on community-based residential treatment

23  facilities otherwise licensed under this chapter.

24         (12)  Each applicant for licensure must comply with the

25  following requirements:

26         (a)  Upon receipt of a completed, signed, and dated

27  application, the agency shall require background screening, in

28  accordance with the level 2 standards for screening set forth

29  in chapter 435,  of the managing employee and financial

30  officer, or other similarly titled individual who is

31  responsible for the financial operation of the facility,

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  1  including billings for client care and services. The applicant

  2  must comply with the procedures for level 2 background

  3  screening as set forth in chapter 435.

  4         (b)  The agency may require background screening of any

  5  other individual who is an applicant if the agency has a

  6  reasonable basis for believing that he or she has been

  7  convicted of a crime or has committed any other offense

  8  prohibited under the level 2 standards for screening set forth

  9  in chapter 435.

10         (c)  Proof of compliance with the level 2 background

11  screening requirements of chapter 435 which has been submitted

12  within the previous 5 years in compliance with any other

13  healthcare licensure requirements of this state is acceptable

14  in fulfillment of the requirements of paragraph (a).

15         (d)  A provisional license may be granted to an

16  applicant when each individual required by this section to

17  undergo background screening has met the standards for the

18  abuse registry background check and the Department of Law

19  Enforcement background check, but the agency has not yet

20  received background screening results from the Federal Bureau

21  of Investigation, or a request for a disqualification

22  exemption has been submitted to the agency as set forth in

23  chapter 435 but a response has not yet been issued. A standard

24  license may be granted to the applicant upon the agency's

25  receipt of a report of the results of the Federal Bureau of

26  Investigation background screening for each individual

27  required by this section to undergo background screening which

28  confirms that all standards have been met, or upon the

29  granting of a disqualification exemption by the agency as set

30  forth in chapter 435. Any other person who is required to

31  undergo level 2 background screening may serve in his or her

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  1  capacity pending the agency's receipt of the report from the

  2  Federal Bureau of Investigation. However, the person may not

  3  continue to serve if the report indicates any violation of

  4  background screening standards and a disqualification

  5  exemption has not been requested of and granted by the agency

  6  as set forth in chapter 435.

  7         (e)  Each applicant must submit to the agency, with its

  8  application, a description and explanation of any exclusions,

  9  permanent suspensions, or terminations of the applicant from

10  the Medicare or Medicaid programs. Proof of compliance with

11  the requirements for disclosure of ownership and control

12  interests under the Medicaid or Medicare programs shall be

13  accepted in lieu of this submission.

14         (f)  Each applicant must submit to the agency a

15  description and explanation of any conviction of an offense

16  prohibited under the level 2 standards of chapter 435 by a

17  member of the board of directors of the applicant, its

18  officers, or any individual owning 5 percent or more of the

19  applicant. This requirement does not apply to a director of a

20  not-for-profit corporation or organization if the director

21  serves solely in a voluntary capacity for the corporation or

22  organization, does not regularly take part in the day-to-day

23  operational decisions of the corporation or organization,

24  receives no remuneration for his or her services on the

25  corporation or organization's board of directors, and has no

26  financial interest and has no family members with a financial

27  interest in the corporation or organization, provided that the

28  director and the not-for-profit corporation or organization

29  include in the application a statement affirming that the

30  director's relationship to the corporation satisfies the

31  requirements of this paragraph.

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  1         (g)  A license may not be granted to an applicant if

  2  the applicant or managing employee has been found guilty of,

  3  regardless of adjudication, or has entered a plea of nolo

  4  contendere or guilty to, any offense prohibited under the

  5  level 2 standards for screening set forth in chapter 435,

  6  unless an exemption from disqualification has been granted by

  7  the agency as set forth in chapter 435.

  8         (h)  The agency may deny or revoke licensure if the

  9  applicant:

10         1.  Has falsely represented a material fact in the

11  application required by paragraph (e) or paragraph (f), or has

12  omitted any material fact from the application required by

13  paragraph (e) or paragraph (f); or

14         2.  Has had prior action taken against the applicant

15  under the Medicaid or Medicare program as set forth in

16  paragraph (e).

17         (i)  An application for license renewal must contain

18  the information required under paragraphs (e) and (f).

19         Section 29.  Section 394.876, Florida Statutes, is

20  amended to read:

21         394.876  Applications.--

22         (1)  Any person desiring to be licensed under this

23  chapter shall apply to the agency department on forms provided

24  by the agency department.  The application shall contain the

25  following:

26         (a)  The name and address of the applicant, the name of

27  the unit or facility, and the address of the unit or facility.

28         (b)1.  If the applicant is a partnership, association,

29  or other form of entity other than an individual or a

30  corporation, the name and address of each member or owner of

31  the entity.

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  1         2.  If the applicant is a corporation, the name and

  2  address of each director or officer and the name and address

  3  of each person holding at least 5 10 percent ownership

  4  interest in the corporation.

  5         (c)  Such information as the department determines to

  6  be necessary to establish the character and competency of the

  7  applicant and of the person who is or will be administrator of

  8  the unit or facility.

  9         (c)(d)  Such information as the agency department

10  determines necessary to determine the ability of the applicant

11  to carry out its responsibilities under this chapter.

12         (2)  The applicant shall furnish proof satisfactory to

13  the agency department of its financial ability to operate the

14  unit or facility in accordance with this chapter.  An

15  applicant for an original license shall submit a balance sheet

16  and a statement projecting revenues, expenses, taxes,

17  extraordinary items, and other credits and charges for the

18  first 6 months of operation.

19         (3)  The applicant shall provide proof of liability

20  insurance coverage in amounts set by the agency department by

21  rule.

22         (4)  The agency department shall accept proof of

23  accreditation by the Joint Commission on Accreditation of

24  Hospitals in lieu of the information required by subsection

25  (1).

26         Section 30.  Subsection (1) of section 394.877, Florida

27  Statutes, is amended to read:

28         394.877  Fees.--

29         (1)  Each application for licensure or renewal shall be

30  accompanied by a fee set by the agency department by rule.

31

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  1  Such fees shall be reasonably calculated to cover only the

  2  cost of regulation under this chapter.

  3         Section 31.  Subsections (1), (2), (5), and (6) of

  4  section 394.878, Florida Statutes, are amended to read:

  5         394.878  Issuance and renewal of licenses.--

  6         (1)  Upon review of the application for licensure and

  7  receipt of appropriate fees, the agency department shall issue

  8  an original or renewal license to any applicant that meets the

  9  requirements of this chapter.

10         (2)  A license is valid for a period of 1 year.  An

11  applicant for renewal of a license shall apply to the agency

12  department no later than 90 days before expiration of the

13  current license.

14         (5)  The agency department may issue a probationary

15  license to an applicant that has completed the application

16  requirements of this chapter but has not, at the time of the

17  application, developed an operational crisis stabilization

18  unit or residential treatment facility.  The probationary

19  license shall expire 90 days after issuance and may once be

20  renewed for an additional 90-day period. The agency department

21  may cancel a probationary license at any time.

22         (6)  The agency department may issue an interim license

23  to an applicant that has substantially completed all

24  application requirements and has initiated action to fully

25  meet such requirements.  The interim license shall expire 90

26  days after issuance and, in cases of extreme hardship, may

27  once be renewed for an additional 90-day period.

28         Section 32.  Section 394.879, Florida Statutes, is

29  amended to read:

30         394.879  Rules; enforcement.--

31

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  1         (1)  The agency department shall adopt reasonable rules

  2  to implement this chapter, including, at a minimum, rules

  3  providing standards to ensure that:

  4         (a)  Sufficient numbers and types of qualified

  5  personnel are on duty and available at all times to provide

  6  necessary and adequate client safety and care.

  7         (b)  Adequate space is provided each client of a

  8  licensed facility.

  9         (c)  Licensed facilities are limited to an appropriate

10  number of beds.

11         (d)  Each licensee establishes and implements adequate

12  infection control, housekeeping, sanitation, disaster

13  planning, and medical recordkeeping.

14         (e)  Licensed facilities are established, organized,

15  and operated in accordance with programmatic standards of the

16  agency department.

17         (2)  Minimum firesafety standards shall be established

18  and enforced by the State Fire Marshal in cooperation with the

19  agency department.  Such standards shall be included in the

20  rule adopted by the agency department after consultation with

21  the State Fire Marshal.

22         (3)  The agency department shall allow any licensed

23  facility in operation at the time of adoption of any rule a

24  reasonable period, not to exceed 1 year, to bring itself into

25  compliance with such rule.

26         (4)  The agency department may impose an administrative

27  penalty of no more than $500 per day against any licensee that

28  violates any rule adopted pursuant to this section and may

29  suspend or revoke the license or deny the renewal application

30  of such licensee.  In imposing such penalty, the agency

31  department shall consider the severity of the violation,

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  1  actions taken by the licensee to correct the violation, and

  2  previous violations by the licensee. Fines collected under

  3  this subsection shall be deposited in the Mental Health

  4  Facility Licensing Trust Fund.

  5         Section 33.  Section 394.90, Florida Statutes, is

  6  amended to read:

  7         394.90  Inspection; right of entry; records.--

  8         (1)(a)  The agency department may enter and inspect at

  9  any time a licensed facility to determine whether the facility

10  is in compliance with this chapter and the rules of the agency

11  department.

12         (b)  The agency department may enter and inspect any

13  premises that it has probable cause to suspect may be

14  operating as an unlicensed crisis stabilization unit or

15  residential treatment facility; however, such entry and

16  inspection shall be made only with the permission of the

17  person in charge of such premises or pursuant to warrant.

18         (c)  Any application for licensure under this chapter

19  constitutes full permission for the agency department to enter

20  and inspect the premises of the applicant or licensee at any

21  time.

22         (2)  For purposes of monitoring and investigation, the

23  department and the Agency for Health Care Administration shall

24  have access to the clinical records of any client of a

25  licensee or designated facility, the provisions of s. 394.4615

26  to the contrary notwithstanding.

27         (3)  The agency department shall schedule periodic

28  inspections of licensees so as to minimize the cost to the

29  licensees and the disruption of the licensees' programs.  This

30  subsection shall not be construed to limit the authority of

31

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  1  the agency department to inspect the facilities of a licensee

  2  at any time.

  3         (4)  Each licensee shall maintain as public

  4  information, available to any person upon request, copies of

  5  all reports of inspections of the licensee filed with or

  6  issued by any governmental agency during the preceding 5-year

  7  period.  The licensee shall furnish a copy of the most recent

  8  inspection report of the agency department to any person upon

  9  payment of a reasonable charge for copying.

10         (5)(a)  The agency department may accept, in lieu of

11  its own inspections for licensure, the survey or inspection of

12  an accrediting organization, if the provider is accredited and

13  the agency department receives the report of the accrediting

14  organization. The agency department shall develop, and adopt

15  by rule, specific criteria for assuring that the accrediting

16  organization has specific standards and experience related to

17  the program area being licensed, specific criteria for

18  accepting the standards and survey methodologies of an

19  accrediting organization, delineations of the obligations of

20  accrediting organizations to assure adherence to those

21  standards, criteria for receiving, accepting and maintaining

22  the confidentiality of the survey and corrective action

23  reports, and allowance for the agency's department's

24  participation in surveys.

25         (b)  The agency department shall conduct compliance

26  investigations and sample validation inspections to evaluate

27  the inspection process of accrediting organizations to ensure

28  minimum standards are maintained as provided in Florida

29  statute and rule. The agency department may conduct a

30  lifesafety inspection in calendar years in which an

31  accrediting organization survey is not conducted and shall

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  1  conduct a full state inspection, including a lifesafety

  2  inspection, if an accrediting organization survey has not been

  3  conducted within the previous 36 months.  The agency

  4  department, by accepting the survey or inspection of an

  5  accrediting organization, does not forfeit its right to

  6  perform inspections.

  7         Section 34.  Section 394.902, Florida Statutes, is

  8  amended to read:

  9         394.902  Denial, suspension, and revocation; other

10  remedies.--

11         (1)  The agency department may issue an emergency order

12  suspending or revoking a license if the agency department

13  determines that the continued operation of the licensed

14  facility presents a clear and present danger to the public

15  health or safety.

16         (2)  The agency department may impose a moratorium on

17  elective admissions to a licensee or any program or portion of

18  a licensed facility if the agency department determines that

19  any condition in the facility presents a threat to the public

20  health or safety.

21         (3)  If the agency department determines that an

22  applicant or licensee is not in compliance with this chapter

23  or the rules adopted under this chapter, the agency department

24  may deny, suspend, or revoke the license or application or may

25  suspend, revoke, or impose reasonable restrictions on any

26  portion of the license.  If a license is revoked, the licensee

27  is barred from submitting any application for licensure to the

28  agency department for a period of 6 months following

29  revocation.

30         (4)  The agency department may maintain an action in

31  circuit court to enjoin the operation of any licensed or

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  1  unlicensed facility in violation of this chapter or the rules

  2  adopted under this chapter.

  3         (5)  License denial, suspension, or revocation

  4  procedures shall be in accordance with chapter 120.

  5         Section 35.  Subsections (1) and (2) of section

  6  394.903, Florida Statutes, are amended to read:

  7         394.903  Receivership proceedings.--

  8         (1)  The agency department may petition a court of

  9  competent jurisdiction for the appointment of a receiver for a

10  crisis stabilization unit or a residential treatment facility

11  when any of the following conditions exist:

12         (a)  Any person is operating a unit or facility without

13  a license and refuses to make application for a license as

14  required by this part.

15         (b)  The licensee is closing the unit or facility or

16  has informed the agency department that it intends to close

17  and adequate arrangements have not been made for relocation of

18  the residents within 7 days, exclusive of weekends and

19  holidays, of the closing of the unit or facility.

20         (c)  The agency department determines that conditions

21  exist in the unit or facility which present an imminent danger

22  to the health, safety, or welfare of the residents of the unit

23  or facility or a substantial probability that death or serious

24  physical harm would result therefrom.  The agency department

25  shall, whenever possible, facilitate the continued operation

26  of the program.

27         (d)  The licensee cannot meet its financial obligations

28  for providing food, shelter, care, and utilities.  Issuance of

29  bad checks or accumulation of delinquent bills for such items

30  as personnel salaries, food, drugs, or utilities constitutes

31  shall constitute prima facie evidence that the ownership of

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  1  the unit or facility lacks the financial ability to operate

  2  the unit or facility in accordance with the requirements of

  3  this chapter and all rules adopted under this chapter

  4  hereunder.

  5         (2)  Petitions for receivership shall take precedence

  6  over other court business unless the court determines that

  7  some other pending proceeding, having similar statutory

  8  precedence, shall have priority.  A hearing shall be conducted

  9  within 5 days after of the filing of the petition, at which

10  time all interested parties shall have the opportunity to

11  present evidence pertaining to the petition.  The agency

12  department shall notify the owner or operator of the unit or

13  facility named in the petition of its filing and the dates for

14  the hearing.  The court shall grant the petition only upon

15  finding that the health, safety, and welfare of residents of

16  the unit or facility would be threatened if a condition

17  existing at the time the petition was filed is permitted to

18  continue.  A receiver shall not be appointed ex parte unless

19  the court determines that one or more of the conditions of

20  subsection (1) exist and that the owner or operator cannot be

21  found, that all reasonable means of locating the owner or

22  operator and notifying him or her of the petition and hearing

23  have been exhausted, or that the owner or operator after

24  notification of the hearing chooses not to attend.  After such

25  findings, the court may appoint any person qualified by

26  education, training, or experience to carry out the

27  responsibilities of receiver pursuant to this section, except

28  that it shall not appoint any owner or affiliate of the unit

29  or facility which is in receivership.  Prior to the

30  appointment as receiver of a person who is the operator,

31  manager, or supervisor of another unit or facility, the court

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  1  shall determine that the person can reasonably operate,

  2  manage, or supervise more than one unit or facility.  The

  3  receiver may be appointed for up to 90 days, with the option

  4  of petitioning the court for 30-day extensions.  The receiver

  5  may be selected from a list of persons qualified to act as

  6  receivers developed by the agency department and presented to

  7  the court with each petition for receivership.  Under no

  8  circumstances shall The agency, department or a designated

  9  departmental employee of the agency, may not be appointed as a

10  receiver for more than 60 days; however, such the departmental

11  receiver may petition the court for 30-day extensions.  The

12  agency department may petition the court to appoint a

13  substitute receiver. The court shall grant the extension upon

14  a showing of good cause. During the first 60 days of the

15  receivership, the agency may department shall not take action

16  to decertify or revoke the license of a unit or facility

17  unless conditions causing imminent danger to the health and

18  welfare of the residents exist and a receiver has been unable

19  to remove those conditions.  After the first 60 days of

20  receivership, and every 60 days thereafter until the

21  receivership is terminated, the agency department shall submit

22  to the court the results of an assessment of the unit's or

23  facility's ability to assure the safety and care of the

24  residents.  If the conditions at the unit or facility or the

25  intentions of the owner indicate that the purpose of the

26  receivership is to close the unit or facility rather than to

27  facilitate its continued operations, the agency department

28  shall place the residents in appropriate alternative

29  residential settings as quickly as possible.  If, in the

30  opinion of the court, the agency department has not been

31  diligent in its efforts to make adequate placement

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  1  arrangements, the court may find the agency department to be

  2  in contempt and shall order the agency department to submit

  3  its plans for moving the residents.

  4         Section 36.  Section 394.904, Florida Statutes, is

  5  amended to read:

  6         394.904  Mental Health Facility Licensing Trust

  7  Fund.--There is created in the State Treasury the Mental

  8  Health Facility Licensing Trust Fund.  All moneys collected by

  9  the agency department pursuant to this chapter shall be

10  deposited in the trust fund.  Moneys in the trust fund shall

11  be appropriated to the agency department for the purpose of

12  covering the cost of regulation of facilities licensed under

13  this chapter and any other purpose related to enforcement of

14  this chapter.

15         Section 37.  Subsections (1), (2), (3), (7), (8), and

16  (9) of section 394.907, Florida Statutes, are amended to read:

17         394.907  Community mental health centers; quality

18  assurance programs.--

19         (1)  As used in this section, the term "community

20  mental health center" means a publicly funded, not-for-profit

21  center that which contracts with the agency department for the

22  provision of inpatient, outpatient, day treatment, or

23  emergency services.

24         (2)  Effective April 1, 1989, Any community mental

25  health center and any facility licensed pursuant to s. 394.875

26  shall have an ongoing quality assurance program. The purpose

27  of the quality assurance program shall be to objectively and

28  systematically monitor and evaluate the appropriateness and

29  quality of client care, to ensure that services are rendered

30  consistent with reasonable, prevailing professional standards

31  and to resolve identified problems.

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  1         (3)  Each facility shall develop a written plan that

  2  which addresses the minimum guidelines for the quality

  3  assurance program. Such guidelines shall include, but are not

  4  limited to:

  5         (a)  Standards for the provision of client care and

  6  treatment practices;

  7         (b)  Procedures for the maintenance of client records;

  8         (c)  Policies and procedures for staff development;

  9         (d)  Standards for facility safety and maintenance;

10         (e)  Procedures for peer review and resource

11  utilization;

12         (f)  Policies and procedures for adverse incident

13  reporting to include verification of corrective action to

14  remediate or minimize incidents and for reporting such

15  incidents to the agency department by a timeframe as

16  prescribed by rule.

17

18  Such plan shall be submitted to the governing board for

19  approval and a copy provided to the agency department.

20         (7)  The agency department shall have access to all

21  records necessary to determine agency compliance with the

22  provisions of this section. The records of quality assurance

23  programs which relate solely to actions taken in carrying out

24  the provisions of this section, and records obtained by the

25  agency department to determine agency compliance with the

26  provisions of this section, are confidential and exempt from

27  the provisions of s. 119.07(1). Such records are not

28  admissible in any civil or administrative action, except in

29  disciplinary proceedings by the Department of Business and

30  Professional Regulation and the appropriate regulatory board,

31  nor shall such records be available to the public as part of

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  1  the record of investigation for, and prosecution in

  2  disciplinary proceedings made available to the public by the

  3  Department of Business and Professional Regulation or the

  4  appropriate regulatory board. Meetings or portions of meetings

  5  of quality assurance program committees that relate solely to

  6  actions taken pursuant to this section are exempt from the

  7  provisions of s. 286.011.

  8         (8)  The agency department shall adopt promulgate rules

  9  to carry out the provisions of this section.

10         (9)  The provisions of This section does shall not

11  apply to hospitals licensed pursuant to chapter 395 or

12  programs operated within such hospitals.

13         Section 38.  Section 395.002, Florida Statutes, is

14  amended to read:

15         395.002  Definitions.--As used in this chapter:

16         (1)  "Accrediting organizations" means the Joint

17  Commission on Accreditation of Healthcare Organizations, the

18  American Osteopathic Association, the Commission on

19  Accreditation of Rehabilitation Facilities, and the

20  Accreditation Association for Ambulatory Health Care, Inc.

21         (2)  "Adverse or untoward incident," for purposes of

22  reporting to the agency, means an event over which health care

23  personnel could exercise control, which is probably associated

24  in whole or in part with medical intervention rather than the

25  condition for which such intervention occurred, and which

26  causes injury to a patient, and which:

27         (a)  Is not consistent with or expected to be a

28  consequence of such medical intervention;

29         (b)  Occurs as a result of medical intervention to

30  which the patient has not given his or her informed consent;

31

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  1         (c)  Occurs as the result of any other action or lack

  2  of any other action on the part of the hospital or personnel

  3  of the hospital;

  4         (d)  Results in a surgical procedure being performed on

  5  the wrong patient; or

  6         (e)  Results in a surgical procedure being performed

  7  that is unrelated to the patient's diagnosis or medical needs.

  8         (2)(3)  "Agency" means the Agency for Health Care

  9  Administration.

10         (3)(4)  "Ambulatory surgical center" means a facility

11  the primary purpose of which is to provide elective surgical

12  care, in which the patient is admitted to and discharged from

13  such facility within the same working day and is not permitted

14  to stay overnight, and which is not part of a hospital.

15  However, a facility existing for the primary purpose of

16  performing terminations of pregnancy, an office maintained by

17  a physician for the practice of medicine, or an office

18  maintained for the practice of dentistry shall not be

19  construed to be an ambulatory surgical center, provided that

20  any facility or office which is certified or seeks

21  certification as a Medicare ambulatory surgical center shall

22  be licensed as an ambulatory surgical center pursuant to s.

23  395.003.

24         (4)  "Applicant" means an individual applicant, or any

25  officer, director, or agent, or any partner or shareholder

26  having an ownership interest equal to a 5-percent or greater

27  interest in the corporation, partnership, or other business

28  entity.

29         (5)  "Biomedical waste" means any solid or liquid waste

30  as defined in s. 381.0098(2)(a).

31

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  1         (6)  "Clinical privileges" means the privileges granted

  2  to a physician or other licensed health care practitioner to

  3  render patient care services in a hospital, but does not

  4  include the privilege of admitting patients.

  5         (7)  "Department" means the Department of Health and

  6  Rehabilitative Services.

  7         (8)  "Director" means any member of the official board

  8  of directors as reported in the organization's annual

  9  corporate report to the Florida Department of State, or, if no

10  such report is made, any member of the operating board of

11  directors. The term excludes members of separate, restricted

12  boards that serve only in an advisory capacity to the

13  operating board.

14         (9)(8)  "Emergency medical condition" means:

15         (a)  A medical condition manifesting itself by acute

16  symptoms of sufficient severity, which may include severe

17  pain, such that the absence of immediate medical attention

18  could reasonably be expected to result in any of the

19  following:

20         1.  Serious jeopardy to patient health, including a

21  pregnant woman or fetus.

22         2.  Serious impairment to bodily functions.

23         3.  Serious dysfunction of any bodily organ or part.

24         (b)  With respect to a pregnant woman:

25         1.  That there is inadequate time to effect safe

26  transfer to another hospital prior to delivery;

27         2.  That a transfer may pose a threat to the health and

28  safety of the patient or fetus; or

29         3.  That there is evidence of the onset and persistence

30  of uterine contractions or rupture of the membranes.

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  1         (10)(9)  "Emergency services and care" means medical

  2  screening, examination, and evaluation by a physician, or, to

  3  the extent permitted by applicable law, by other appropriate

  4  personnel under the supervision of a physician, to determine

  5  if an emergency medical condition exists and, if it does, the

  6  care, treatment, or surgery by a physician necessary to

  7  relieve or eliminate the emergency medical condition, within

  8  the service capability of the facility.

  9         (11)(10)  "General hospital" means any facility which

10  meets the provisions of subsection (13)(12) and which

11  regularly makes its facilities and services available to the

12  general population.

13         (12)(11)  "Governmental unit" means the state or any

14  county, municipality, or other political subdivision, or any

15  department, division, board, or other agency of any of the

16  foregoing.

17         (13)(12)  "Hospital" means any establishment that:

18         (a)  Offers services more intensive than those required

19  for room, board, personal services, and general nursing care,

20  and offers facilities and beds for use beyond 24 hours by

21  individuals requiring diagnosis, treatment, or care for

22  illness, injury, deformity, infirmity, abnormality, disease,

23  or pregnancy; and

24         (b)  Regularly makes available at least clinical

25  laboratory services, diagnostic X-ray services, and treatment

26  facilities for surgery or obstetrical care, or other

27  definitive medical treatment of similar extent.

28

29  However, the provisions of this chapter do not apply to any

30  institution conducted by or for the adherents of any

31  well-recognized church or religious denomination that depends

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  1  exclusively upon prayer or spiritual means to heal, care for,

  2  or treat any person.  For purposes of local zoning matters,

  3  the term "hospital" includes a medical office building located

  4  on the same premises as a hospital facility, provided the land

  5  on which the medical office building is constructed is zoned

  6  for use as a hospital; provided the premises were zoned for

  7  hospital purposes on January 1, 1992.

  8         (14)(13)  "Hospital bed" means a hospital accommodation

  9  which is ready for immediate occupancy, or is capable of being

10  made ready for occupancy within 48 hours, excluding provision

11  of staffing, and which conforms to minimum space, equipment,

12  and furnishings standards as specified by rule of the

13  department for the provision of services specified in this

14  section to a single patient.

15         (15)(14)  "Initial denial determination" means a

16  determination by a private review agent that the health care

17  services furnished or proposed to be furnished to a patient

18  are inappropriate, not medically necessary, or not reasonable.

19         (15)  "Injury," for purposes of reporting to the

20  agency, means any of the following outcomes if caused by an

21  adverse or untoward incident:

22         (a)  Death;

23         (b)  Brain damage;

24         (c)  Spinal damage;

25         (d)  Permanent disfigurement;

26         (e)  Fracture or dislocation of bones or joints;

27         (f)  Any condition requiring definitive or specialized

28  medical attention which is not consistent with the routine

29  management of the patient's case or patient's preexisting

30  physical condition;

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  1         (g)  Any condition requiring surgical intervention to

  2  correct or control;

  3         (h)  Any condition resulting in transfer of the

  4  patient, within or outside the facility, to a unit providing a

  5  more acute level of care;

  6         (i)  Any condition that extends the patient's length of

  7  stay; or

  8         (j)  Any condition that results in a limitation of

  9  neurological, physical, or sensory function which continues

10  after discharge from the facility.

11         (16)  "Intensive residential treatment programs for

12  children and adolescents" means a specialty hospital

13  accredited by the Joint Commission on Accreditation of

14  Healthcare Organizations which provides 24-hour care and which

15  has the primary functions of diagnosis and treatment of

16  patients under the age of 18 having psychiatric disorders in

17  order to restore such patients to an optimal level of

18  functioning.

19         (17)  "Licensed facility" means a hospital or

20  ambulatory surgical center licensed in accordance with this

21  chapter.

22         (18)  "Lifesafety" means the control and prevention of

23  fire and other life-threatening conditions on a premises for

24  the purpose of preserving human life.

25         (19)  "Managing employee" means the administrator or

26  other similarly titled individual who is responsible for the

27  daily operation of the facility.

28         (20)(19)  "Medical staff" means physicians licensed

29  under chapter 458 or chapter 459 with privileges in a licensed

30  facility, as well as other licensed health care practitioners

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  1  with clinical privileges as approved by a licensed facility's

  2  governing board.

  3         (21)(20)  "Medically necessary transfer" means a

  4  transfer made necessary because the patient is in immediate

  5  need of treatment for an emergency medical condition for which

  6  the facility lacks service capability or is at service

  7  capacity.

  8         (22)(21)  "Person" means any individual, partnership,

  9  corporation, association, or governmental unit.

10         (23)(22)  "Premises" means those buildings, beds, and

11  equipment located at the address of the licensed facility and

12  all other buildings, beds, and equipment for the provision of

13  hospital or ambulatory surgical care located in such

14  reasonable proximity to the address of the licensed facility

15  as to appear to the public to be under the dominion and

16  control of the licensee.

17         (24)(23)  "Private review agent" means any person or

18  entity which performs utilization review services for

19  third-party payors on a contractual basis for outpatient or

20  inpatient services. However, the term shall not include

21  full-time employees, personnel, or staff of health insurers,

22  health maintenance organizations, or hospitals, or wholly

23  owned subsidiaries thereof or affiliates under common

24  ownership, when performing utilization review for their

25  respective hospitals, health maintenance organizations, or

26  insureds of the same insurance group.  For this purpose,

27  health insurers, health maintenance organizations, and

28  hospitals, or wholly owned subsidiaries thereof or affiliates

29  under common ownership, include such entities engaged as

30  administrators of self-insurance as defined in s. 624.031.

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  1         (25)(24)  "Service capability" means all services

  2  offered by the facility where identification of services

  3  offered is evidenced by the appearance of the service in a

  4  patient's medical record or itemized bill.

  5         (26)(25)  "At service capacity" means the temporary

  6  inability of a hospital to provide a service which is within

  7  the service capability of the hospital, due to maximum use of

  8  the service at the time of the request for the service.

  9         (27)(26)  "Specialty bed" means a bed, other than a

10  general bed, designated on the face of the hospital license

11  for a dedicated use.

12         (28)(27)  "Specialty hospital" means any facility which

13  meets the provisions of subsection (13)(12), and which

14  regularly makes available either:

15         (a)  The range of medical services offered by general

16  hospitals, but restricted to a defined age or gender group of

17  the population;

18         (b)  A restricted range of services appropriate to the

19  diagnosis, care, and treatment of patients with specific

20  categories of medical or psychiatric illnesses or disorders;

21  or

22         (c)  Intensive residential treatment programs for

23  children and adolescents as defined in subsection (16).

24         (29)(28)  "Stabilized" means, with respect to an

25  emergency medical condition, that no material deterioration of

26  the condition is likely, within reasonable medical

27  probability, to result from the transfer of the patient from a

28  hospital.

29         (30)(29)  "Utilization review" means a system for

30  reviewing the medical necessity or appropriateness in the

31

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  1  allocation of health care resources of hospital services given

  2  or proposed to be given to a patient or group of patients.

  3         (31)(30)  "Utilization review plan" means a description

  4  of the policies and procedures governing utilization review

  5  activities performed by a private review agent.

  6         (32)(31)  "Validation inspection" means an inspection

  7  of the premises of a licensed facility by the agency to assess

  8  whether a review by an accrediting organization has adequately

  9  evaluated the licensed facility according to minimum state

10  standards.

11         Section 39.  Section 395.0055, Florida Statutes, is

12  created to read:

13         395.0055  Background screening.--Each applicant for

14  licensure must comply with the following requirements:

15         (1)  Upon receipt of a completed, signed, and dated

16  application, the agency shall require background screening of

17  the managing employee in accordance with the level 2 standards

18  for screening set forth in chapter 435.

19         (2)  The agency may require background screening for a

20  member of the board of directors of the licensee, or an

21  officer or an individual owning 5 percent or more of the

22  licensee, if the agency reasonably suspects that such

23  individual has been convicted of an offense prohibited under

24  the level 2 standards for screening set forth in chapter 435.

25         (3)  Proof of compliance with the level 2 background

26  screening requirements of chapter 435 which has been submitted

27  within the previous 5 years in compliance with any other

28  health care licensure requirements of this state is acceptable

29  in fulfillment of subsection (1).

30         (4)  A provisional license may be granted to an

31  applicant when each individual required by this section to

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  1  undergo background screening has met the standards for the

  2  abuse registry background check and the Department of Law

  3  Enforcement background check, but the agency has not yet

  4  received background screening results from the Federal Bureau

  5  of Investigation, or a request for a disqualification

  6  exemption has been submitted to the agency as set forth in

  7  chapter 435 but a response has not yet been issued.  A

  8  standard license may be granted to the applicant upon the

  9  agency's receipt of a report of the results of the Federal

10  Bureau of Investigation background screening for each

11  individual required by this section to undergo background

12  screening which confirms that all standards have been met, or

13  upon the granting of a disqualification exemption by the

14  agency as set forth in chapter 435.  Any other person who is

15  required to undergo level 2 background screening may serve in

16  his or her capacity pending the agency's receipt of the report

17  from the Federal Bureau of Investigation; however, the person

18  may not continue to serve if the report indicates any

19  violation of background screening standards and a

20  disqualification exemption has not been requested of and

21  granted by the agency as set forth in chapter 435.

22         (5)  Each applicant must submit to the agency, with its

23  application, a description and explanation of any exclusions,

24  permanent suspensions, or terminations of the applicant from

25  the Medicare or Medicaid programs. Proof of compliance with

26  disclosure of ownership and control interest requirements of

27  the Medicaid or Medicare programs shall be accepted in lieu of

28  this submission.

29         (6)  Each applicant must submit to the agency a

30  description and explanation of any conviction of an offense

31  prohibited under the level 2 standards of chapter 435 by a

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  1  member of the board of directors of the applicant, its

  2  officers, or any individual owning 5 percent or more of the

  3  applicant. This requirement shall not apply to a director of a

  4  not-for-profit corporation or organization if the director

  5  serves solely in a voluntary capacity for the corporation or

  6  organization, does not regularly take part in the day-to-day

  7  operational decisions of the corporation or organization,

  8  receives no remuneration for his or her services on the

  9  corporation or organization's board of directors, and has no

10  financial interest and has no family members with a financial

11  interest in the corporation or organization, provided that the

12  director and the not-for-profit corporation or organization

13  include in the application a statement affirming that the

14  director's relationship to the corporation satisfies the

15  requirements of this subsection.

16         (7)  A license may not be granted to an applicant if

17  the applicant or managing employee has been found guilty of,

18  regardless of adjudication, or has entered a plea of nolo

19  contendere or guilty to, any offense prohibited under the

20  level 2 standards for screening set forth in chapter 435,

21  unless an exemption from disqualification has been granted by

22  the agency as set forth in chapter 435.

23         (8)  The agency may deny or revoke licensure if the

24  applicant:

25         (a)  Has falsely represented a material fact in the

26  application required by subsection (5) or subsection (6), or

27  has omitted any material fact from the application required by

28  subsection (5) or subsection (6); or

29         (b)  Has had prior Medicaid or Medicare action taken

30  against the applicant as set forth in subsection (5).

31

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  1         (9)  An application for license renewal must contain

  2  the information required under subsections (5) and (6).

  3         Section 40.  Subsection (1) of section 395.0163,

  4  Florida Statutes, is amended to read:

  5         395.0163  Construction inspections; plan submission and

  6  approval; fees.--

  7         (1)(a)  The agency shall make, or cause to be made,

  8  such construction inspections and investigations as it deems

  9  necessary. The agency may prescribe by rule that any licensee

10  or applicant desiring to make specified types of alterations

11  or additions to its facilities or to construct new facilities

12  shall, before commencing such alteration, addition, or new

13  construction, submit plans and specifications therefor to the

14  agency for preliminary inspection and approval or

15  recommendation with respect to compliance with agency rules

16  and standards.  The agency shall approve or disapprove the

17  plans and specifications within 60 days after receipt of the

18  fee for review of plans as required in subsection (2).  The

19  agency may be granted one 15-day extension for the review

20  period if the director of the agency approves the extension.

21  If the agency fails to act within the specified time, it shall

22  be deemed to have approved the plans and specifications.  When

23  the agency disapproves plans and specifications, it shall set

24  forth in writing the reasons for its disapproval.  Conferences

25  and consultations may be provided as necessary.

26         (b)  All outpatient facilities that provide surgical

27  treatments requiring general anesthesia or IV conscious

28  sedation, that provide cardiac catheterization services, or

29  that are to be licensed as ambulatory surgical centers shall

30  submit plans and specifications to the agency for review under

31  this section.  All other outpatient facilities must be

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  1  reviewed under this section, except that those that are

  2  physically detached from, and have no utility connections

  3  with, the hospital and that do not block emergency egress from

  4  or create a fire hazard to the hospital are exempt from review

  5  under this section. This section applies to applications for

  6  which review is pending on or after July 1, 1998.

  7         Section 41.  Section 395.0193, Florida Statutes, is

  8  amended to read:

  9         395.0193  Licensed facilities; peer review;

10  disciplinary powers; agency or partnership with physicians.--

11         (1)  It is the intent of the Legislature that good

12  faith participants in the process of investigating and

13  disciplining physicians pursuant to the state-mandated peer

14  review process shall, in addition to receiving immunity from

15  retaliatory tort suits pursuant to s. 455.225(12), be

16  protected from federal antitrust suits filed under the Sherman

17  Anti-Trust Act, 15 U.S.C.A. ss. 1 et seq.  Such intent is

18  within the public policy of the state to secure the provision

19  of quality medical services to the public.

20         (2)  Each licensed facility, as a condition of

21  licensure, shall provide for peer review of physicians who

22  deliver health care services at the facility.  Each licensed

23  facility shall develop written, binding procedures by which

24  such peer review shall be conducted.  Such procedures must

25  shall include:

26         (a)  A mechanism for choosing the membership of the

27  body or bodies that conduct peer review.

28         (b)  Adoption of rules of order for the peer review

29  process.

30         (c)  Fair review of the case with the physician

31  involved.

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  1         (d)  A mechanism to identify and avoid any conflict of

  2  interest on the part of the peer review panel members.

  3         (e)  Recording of agendas and minutes that which do not

  4  contain confidential material, for review by the Division of

  5  Health Quality Assurance of the agency.

  6         (f)  Review, at least annually, of the peer review

  7  procedures by the governing board of the licensed facility.

  8         (g)  Focus of the peer review process on review of

  9  professional practices at the facility to reduce morbidity and

10  mortality and to improve patient care.

11         (3)  If reasonable belief exists that conduct by a

12  staff member or physician who delivers health care services at

13  the licensed facility may constitute one or more grounds for

14  discipline as provided in this subsection, a peer review panel

15  shall investigate and determine whether grounds for discipline

16  exist with respect to such staff member or physician.  The

17  governing board of any licensed facility, after considering

18  the recommendations of its peer review panel, shall suspend,

19  deny, revoke, or curtail the privileges, or reprimand,

20  counsel, or require education, of any such staff member or

21  physician after a final determination has been made that one

22  or more of the following grounds exist:

23         (a)  Incompetence.

24         (b)  Being found to be a habitual user of intoxicants

25  or drugs to the extent that he or she is deemed dangerous to

26  himself, herself, or others.

27         (c)  Mental or physical impairment that could which may

28  adversely affect patient care.

29         (d)  Being found liable by a court of competent

30  jurisdiction for medical negligence or malpractice involving

31  negligent conduct.

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  1         (e)  One or more settlements exceeding $10,000 for

  2  medical negligence or malpractice involving negligent conduct

  3  by the staff member.

  4         (f)  Medical negligence other than as specified in

  5  paragraph (d) or paragraph (e).

  6         (g)  Failure to comply with the policies, procedures,

  7  or directives of the risk management program or any quality

  8  assurance committees of any licensed facility.

  9

10  However, the grounds specified in paragraphs (a)-(g) are not

11  the only grounds for discipline of a practitioner. procedures

12  for such actions shall comply with the standards outlined by

13  the Joint Commission on Accreditation of Healthcare

14  Organizations, the American Osteopathic Association, the

15  Commission on Accreditation of Rehabilitation Facilities, the

16  Accreditation Association for Ambulatory Health Care, Inc.,

17  and the "Medicare/Medicaid Conditions of Participation," and

18  rules of the agency and the department.  The procedures shall

19  be adopted pursuant to hospital bylaws.

20         (4)  Pursuant to ss. 458.337 and 459.016, any

21  disciplinary action taken under subsection (3) shall be

22  reported in writing to the Division of Health Quality

23  Assurance of the agency within 30 working days after its

24  initial occurrence, regardless of the pendency of appeals to

25  the governing board of the hospital. The notification shall

26  identify the disciplined practitioner, the action taken, and

27  the reason for such action. All final disciplinary actions

28  taken under subsection (3), if different from those that were

29  reported to the agency within 30 days after the initial

30  occurrence, must shall be reported within 10 working days to

31  the Division of Health Quality Assurance of the agency in

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  1  writing and must shall specify the disciplinary action taken

  2  and the specific grounds therefor.  The division shall review

  3  each report and determine whether it potentially involved

  4  conduct by the licensee that is subject to disciplinary

  5  action, in which case s. 455.225 shall apply. These reports

  6  are The report shall not be subject to inspection under s.

  7  119.07(1) even if the division's investigation results in a

  8  finding of probable cause.

  9         (5)  There is shall be no monetary liability on the

10  part of, and no cause of action for damages against, any

11  licensed facility, its governing board or governing board

12  members, peer review panel, medical staff, or disciplinary

13  body, or its agents, investigators, witnesses, or employees; a

14  committee of a hospital, a physician-hospital organization, or

15  an integrated delivery system;, or any other person, for any

16  action taken without intentional fraud in carrying out the

17  provisions of this section.

18         (6)  For a single incident or series of isolated

19  incidents that are nonwillful violations of the reporting

20  requirements of this section, the agency shall first seek to

21  obtain corrective action by the facility. If correction is not

22  demonstrated within the timeframe established by the agency or

23  if there is a pattern of nonwillful violations of this

24  section, the agency may impose an administrative fine, not to

25  exceed $5,000, for any violation of the reporting requirements

26  of this section. The administrative fine for repeated

27  nonwillful violations may not exceed $10,000 for any

28  violation. The administrative fine for each intentional and

29  willful violation may not exceed $25,000 per violation, per

30  day. A fine for an intentional and willful violation of this

31  section may not exceed $250,000. In determining the amount of

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  1  fine to be levied, the agency shall be guided by s.

  2  395.1065(2)(b).

  3         (7)(6)  The proceedings and records of peer review

  4  panels, committees, and governing boards or agent thereof

  5  which relate solely to actions taken in carrying out this

  6  section are not subject to inspection under s. 119.07(1); and

  7  meetings held pursuant to achieving the objectives of such

  8  panels, committees, and governing boards are not open to the

  9  public under the provisions of chapter 286.

10         (8)(7)  The investigations, proceedings, and records of

11  the peer review panel, a committee of a hospital, a

12  physician-hospital organization, an integrated delivery

13  system, a disciplinary board, or a governing board, or agent

14  thereof with whom there is a specific written contract for

15  that purpose, as described in this section are shall not be

16  subject to discovery or introduction into evidence in any

17  civil or administrative action against a provider of

18  professional health services arising out of the matters that

19  which are the subject of evaluation and review by such a group

20  or its agent, and a person who was in attendance at a meeting

21  of such group or its agent may not be permitted or required to

22  testify in any such civil or administrative action as to any

23  evidence or other matters produced or presented during the

24  proceedings of such a group or its agent or as to any

25  findings, recommendations, evaluations, opinions, or other

26  actions of such a group or its agent or any members thereof.

27  However, information, documents, or records otherwise

28  available from original sources are not to be construed as

29  immune from discovery or use in any such civil or

30  administrative action merely because they were presented

31  during proceedings of such group, and any person who testifies

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  1  before such group or who is a member of such group may not be

  2  prevented from testifying as to matters within his or her

  3  knowledge, but such a witness may not be asked about his or

  4  her testimony before such a group or about opinions that he or

  5  she formed by him or her as a result of those such group

  6  hearings.

  7         (9)(8)(a)  If the defendant prevails in an action

  8  brought by a staff member or physician who delivers health

  9  care services at the licensed facility against any person or

10  entity that initiated, participated in, was a witness in, or

11  conducted any review as authorized by this section, the court

12  must shall award reasonable attorney's fees and costs to the

13  defendant.

14         (b)  As a condition of any staff member or physician

15  bringing any action against any person or entity that

16  initiated, participated in, was a witness in, or conducted any

17  review as authorized by this section and before any responsive

18  pleading is due, the staff member or physician must shall post

19  a bond or other security, as set by the court having

20  jurisdiction of the action, in an amount sufficient to pay the

21  costs and attorney's fees.

22         (10)(9)(a)  A hospital's compliance with the

23  requirements of this chapter or s. 766.110(1) may not be the

24  sole basis to establish an agency or partnership relationship

25  between the hospital and physicians who provide services

26  within the hospital.

27         (b)  A hospital may create an agency relationship with

28  a physician by written contract signed by the hospital and:

29         1.  The physician;

30         2.  A health care professional association; or

31         3.  A corporate medical group and its employees.

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  1

  2  A written contract is not the exclusive means to establish an

  3  agency or partnership relationship between a hospital and any

  4  other person described in this paragraph.

  5         Section 42.  Section 395.0197, Florida Statutes, is

  6  amended to read:

  7         395.0197  Internal risk management program.--

  8         (1)  Every licensed facility shall, as a part of its

  9  administrative functions, establish an internal risk

10  management program that includes all of the following

11  components:

12         (a)  The investigation and analysis of the frequency

13  and causes of general categories and specific types of adverse

14  incidents causing injury to patients.

15         (b)  The development of appropriate measures to

16  minimize the risk of injuries and adverse incidents to

17  patients, including, but not limited to:

18         1.  Risk management and risk prevention education and

19  training of all nonphysician personnel as follows:

20         a.  Such education and training of all nonphysician

21  personnel as part of their initial orientation; and

22         b.  At least 1 hour of such education and training

23  annually for all nonphysician personnel of the licensed

24  facility working in clinical areas and providing patient care.

25         2.  A prohibition, except when emergency circumstances

26  require otherwise, against a staff member of the licensed

27  facility attending a patient in the recovery room, unless the

28  staff member is authorized to attend the patient in the

29  recovery room and is in the company of at least one other

30  person.  However, a licensed facility hospital is exempt from

31  the two-person requirement if it has:

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  1         a.  Live visual observation;

  2         b.  Electronic observation; or

  3         c.  Any other reasonable measure taken to ensure

  4  patient protection and privacy.

  5         (c)  The analysis of patient grievances that relate to

  6  patient care and the quality of medical services.

  7         (d)  The development and implementation of an incident

  8  reporting system based upon the affirmative duty of all health

  9  care providers and all agents and employees of the licensed

10  health care facility to report an adverse incident incidents

11  to the risk manager, or to his or her designee, within 3

12  business days after its occurrence.

13         (2)  The internal risk management program is the

14  responsibility of the governing board of the health care

15  facility. Each licensed facility shall hire a risk manager,

16  licensed under part IX of chapter 626, who is responsible for

17  implementation and oversight of such facility's internal risk

18  management program as required by this section.  A risk

19  manager must not be made responsible for more than four

20  internal risk management programs in separate licensed

21  facilities, unless the facilities are under one corporate

22  ownership or the risk management programs are in rural

23  hospitals.

24         (3)  In addition to the programs mandated by this

25  section, other innovative approaches intended to reduce the

26  frequency and severity of medical malpractice and patient

27  injury claims must shall be encouraged and their

28  implementation and operation facilitated. Such additional

29  approaches may include extending internal risk management

30  programs to health care providers' offices and the assuming of

31

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  1  provider liability by a licensed health care facility for acts

  2  or omissions occurring within the licensed facility.

  3         (4)  The agency shall, after consulting with the

  4  Department of Insurance, adopt rules governing the

  5  establishment of internal risk management programs to meet the

  6  needs of individual licensed facilities.  Each internal risk

  7  management program must shall include the use of incident

  8  reports to be filed with an individual of responsibility who

  9  is competent in risk management techniques in the employ of

10  each licensed facility, such as an insurance coordinator, or

11  who is retained by the licensed facility as a consultant.  The

12  individual responsible for the risk management program shall

13  have free access to all medical records of the licensed

14  facility.  The incident reports are part of the workpapers of

15  the attorney defending the licensed facility in litigation

16  relating to the licensed facility and are subject to

17  discovery, but are not admissible as evidence in court.  A

18  person filing an incident report is not subject to civil suit

19  by virtue of such incident report.  As a part of each internal

20  risk management program, the incident reports must shall be

21  used to develop categories of incidents which identify problem

22  areas.  Once problem areas are identified, procedures must

23  shall be adjusted to correct the problem areas.

24         (5)  For purposes of reporting to the agency pursuant

25  to subsections (6), (7), and (8), the term "adverse incident"

26  means an event over which health care personnel could exercise

27  control and which is associated in whole or in part with

28  medical intervention, rather than the condition for which such

29  intervention occurred, and which:

30         (a)  Results in one of the following injuries:

31         1.  Death;

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  1         2.  Brain or spinal damage;

  2         3.  Permanent disfigurement;

  3         4.  Fracture or dislocation of bones or joints;

  4         5.  A resulting limitation of neurological, physical,

  5  or sensory function which exists upon discharge from the

  6  facility;

  7         6.  Any condition that required specialized medical

  8  attention or surgical intervention resulting from nonemergency

  9  medical intervention, other than an emergency medical

10  condition, to which the patient had not given his or her

11  informed consent; or

12         7.  Any condition that required the transfer of the

13  patient, within or outside the facility, to a unit providing a

14  more acute level of care due to the adverse incident rather

15  than to the patient's condition prior to the adverse incident;

16         (b)  Was the performance of a surgical procedure on the

17  wrong patient; a wrong surgical procedure; a wrong-site

18  surgical procedure; or a surgical procedure otherwise

19  unrelated to the patient's diagnosis or medical condition;

20         (c)  Required the surgical repair of damage resulting

21  to a patient from a planned surgical procedure, where the

22  damage was not a recognized specific risk as disclosed to the

23  patient on the informed consent form; or

24         (d)  Was a procedure to remove foreign objects

25  unintentionally left inside the patient during a surgical

26  procedure.

27         (6)(5)(a)  Each licensed facility subject to this

28  section shall submit an annual report to the agency

29  summarizing the incident reports that have been filed in the

30  facility for that year.  The report shall include:

31

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  1         1.  The total number of adverse incidents causing

  2  injury to patients.

  3         2.  A listing, by category, of the types of operations,

  4  diagnostic or treatment procedures, or other actions causing

  5  the injuries, and the number of incidents occurring within

  6  each category.

  7         3.  A listing, by category, of the types of injuries

  8  caused and the number of incidents occurring within each

  9  category.

10         4.  A code number using the health care professional's

11  licensure number and a separate code number identifying all

12  other individuals directly involved in adverse incidents

13  causing injury to patients, the relationship of the individual

14  to the licensed facility, and the number of incidents in which

15  each individual has been directly involved.  Each licensed

16  facility shall maintain names of the health care professionals

17  and individuals identified by code numbers for purposes of

18  this section.

19         5.  A description of all malpractice claims filed

20  against the licensed facility, including the total number of

21  pending and closed claims and the nature of the incident that

22  which led to, the persons involved in, and the status and

23  disposition of each claim. Each report must shall update

24  status and disposition for all prior reports.

25         6.  A report of all disciplinary actions pertaining to

26  patient care taken against any medical staff member, including

27  the nature and cause of the action.

28         (b)  The information reported to the agency pursuant to

29  paragraph (a) which relates to persons licensed under chapter

30  458, chapter 459, chapter 461, or chapter 466 must shall be

31  reviewed by the agency.  The agency shall determine whether

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  1  any of the incidents potentially involved conduct by a health

  2  care professional who is subject to disciplinary action, in

  3  which case the provisions of s. 455.225 applies shall apply.

  4         (c)  The report submitted to the agency must shall also

  5  contain the name and license number of the risk manager of the

  6  licensed facility, a copy of its policy and procedures which

  7  govern the measures taken by the facility and its risk manager

  8  to reduce the risk of injuries and adverse or untoward

  9  incidents, and the results of such measures.  The annual

10  report is confidential and is not available to the public

11  pursuant to s. 119.07(1) or any other law providing access to

12  public records. The annual report is not discoverable or

13  admissible in any civil or administrative action, except in

14  disciplinary proceedings by the agency or the appropriate

15  regulatory board.  The annual report is not available to the

16  public as part of the record of investigation for and

17  prosecution in disciplinary proceedings made available to the

18  public by the agency or the appropriate regulatory board.

19  However, the agency or the appropriate regulatory board shall

20  make available, upon written request by a health care

21  professional against whom probable cause has been found, any

22  such records which form the basis of the determination of

23  probable cause.

24         (7)  The licensed facility shall notify the agency no

25  later than 1 business day after the risk manager or his or her

26  designee has received a report pursuant to paragraph (1)(d)

27  and is able to determine within 1 business day that any of the

28  following adverse incidents has occurred, whether occurring in

29  the licensed facility or arising from health care prior to

30  admission in the licensed facility. Notification is not

31

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  1  required if the risk manager is unable to determine within 1

  2  business day that any of the following incidents occurred:

  3         (a)  The death of a patient;

  4         (b)  Brain or spinal damage to a patient;

  5         (c)  The performance of a surgical procedure on the

  6  wrong patient;

  7         (d)  The performance of a wrong-site surgical

  8  procedure; or

  9         (e)  The performance of a wrong surgical procedure.

10

11  The notification must be made in writing and be provided by

12  facsimile device or overnight mail delivery. The notification

13  must include information regarding the identity of the

14  affected patient, the type of adverse incident, the initiation

15  of an investigation by the facility, and whether the events

16  causing or resulting in the adverse incident represent a

17  potential risk to other patients.

18         (8)(6)  Any of the following adverse incidents, whether

19  occurring in the licensed facility or arising from health care

20  prior to admission in the licensed facility, shall be reported

21  by the facility to the agency within 15 calendar days after

22  its occurrence If an adverse or untoward incident, whether

23  occurring in the licensed facility or arising from health care

24  prior to admission in the licensed facility, results in:

25         (a)  The death of a patient;

26         (b)  Brain or spinal damage to a patient;

27         (c)  The performance of a surgical procedure on the

28  wrong patient; or

29         (d)  The performance of a wrong-site surgical

30  procedure;

31         (e)  The performance of a wrong surgical procedure;

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  1         (f)  The performance of a surgical procedure that is

  2  medically unnecessary or otherwise unrelated to the patient's

  3  diagnosis or medical condition;

  4         (g)  The surgical repair of damage resulting to a

  5  patient from a planned surgical procedure, where the damage is

  6  not a recognized specific risk as disclosed to the patient on

  7  the informed consent form; or

  8         (h)  The performance of procedures to remove foreign

  9  objects remaining from a surgical procedure.

10         (d)  A surgical procedure unrelated to the patient's

11  diagnosis or medical needs being performed on any patient,

12  including the surgical repair of injuries or damage resulting

13  from the planned surgical procedure, wrong site or wrong

14  procedure surgeries, and procedures to remove foreign objects

15  remaining from surgical procedures,

16

17  The agency may grant extensions to this reporting requirement

18  for more than 15 days upon justification submitted in writing

19  by the facility administrator to the agency. the licensed

20  facility shall report this incident to the agency within 15

21  calendar days after its occurrence. The agency may require an

22  additional, final report.  These reports shall not be

23  available to the public pursuant to s. 119.07(1) or any other

24  law providing access to public records, nor be discoverable or

25  admissible in any civil or administrative action, except in

26  disciplinary proceedings by the agency or the appropriate

27  regulatory board, nor shall they be available to the public as

28  part of the record of investigation for and prosecution in

29  disciplinary proceedings made available to the public by the

30  agency or the appropriate regulatory board. However, the

31  agency or the appropriate regulatory board shall make

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  1  available, upon written request by a health care professional

  2  against whom probable cause has been found, any such records

  3  which form the basis of the determination of probable cause.

  4  The agency may investigate, as it deems appropriate, any such

  5  incident and prescribe measures that must or may be taken in

  6  response to the incident. The agency shall review each

  7  incident and determine whether it potentially involved conduct

  8  by the health care professional who is subject to disciplinary

  9  action, in which case the provisions of s. 455.225 shall

10  apply.

11         (9)(7)  The internal risk manager of each licensed

12  facility shall:

13         (a)  Notify the family or guardian of the victim, if a

14  minor, that an allegation of sexual misconduct has been made

15  and that an investigation is being conducted;

16         (a)(b)  Investigate every allegation of sexual

17  misconduct which is made against a member of the facility's

18  personnel who has direct patient contact, when the allegation

19  is that the sexual misconduct occurred at the facility or on

20  the grounds of the facility; and

21         (b)(c)  Report every allegation of sexual misconduct to

22  the administrator of the licensed facility; and.

23         (c)  Notify the family or guardian of the victim, if a

24  minor, that an allegation of sexual misconduct has been made

25  and that an investigation is being conducted.

26         (10)(8)  Any witness who witnessed or who possesses

27  actual knowledge of the act that is the basis of an allegation

28  of sexual abuse shall:

29         (a)  Notify the local police; and

30         (b)  Notify the hospital risk manager and the

31  administrator.

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  1

  2  For purposes of this subsection, the term "sexual abuse" means

  3  acts of a sexual nature committed for the sexual gratification

  4  of anyone upon, or in the presence of, a vulnerable adult,

  5  without the vulnerable adult's informed consent, or a minor.

  6  "Sexual abuse" includes, but is not limited to, the acts

  7  defined in s. 794.011(1)(h), fondling, exposure of a

  8  vulnerable adult's or minor's sexual organs, or the use of the

  9  vulnerable adult or minor to solicit for or engage in

10  prostitution or sexual performance. "Sexual abuse" does not

11  include any act intended for a valid medical purpose or any

12  act which may reasonably be construed to be a normal

13  caregiving action.

14         (11)(9)  A person who, with malice or with intent to

15  discredit or harm a licensed facility or any person, makes a

16  false allegation of sexual misconduct against a member of a

17  licensed facility's personnel is guilty of a misdemeanor of

18  the second degree, punishable as provided in s. 775.082 or s.

19  775.083.

20         (12)(10)  In addition to any penalty imposed pursuant

21  to this section, the agency shall require a written plan of

22  correction from the facility may impose an administrative

23  fine, not to exceed $5,000, for any violation of the reporting

24  requirements of this section. For a single incident or series

25  of isolated incidents that are nonwillful violations of the

26  reporting requirements of this section, the agency shall first

27  seek to obtain corrective action by the facility.  If the

28  correction is not demonstrated within the timeframe

29  established by the agency or if there is a pattern of

30  nonwillful violations of this section, the agency may impose

31  an administrative fine, not to exceed $5,000, for any

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  1  violation of the reporting requirements of this section.  The

  2  administrative fine for repeated nonwillful violations may not

  3  exceed $10,000 for any violation. The administrative fine for

  4  each intentional and willful violation may not exceed $25,000

  5  per violation, per day. A fine for an intentional and willful

  6  violation of this section may not exceed $250,000. In

  7  determining the amount of fine to be levied, the agency shall

  8  be guided by s. 395.1065(2)(b).

  9         (13)(11)  The agency shall have access to all licensed

10  facility records necessary to carry out the provisions of this

11  section.  The records obtained are not available to the public

12  under s. 119.07(1), nor shall they be discoverable or

13  admissible in any civil or administrative action, except in

14  disciplinary proceedings by the agency or the appropriate

15  regulatory board, nor shall records obtained pursuant to s.

16  455.223 be available to the public as part of the record of

17  investigation for and prosecution in disciplinary proceedings

18  made available to the public by the agency or the appropriate

19  regulatory board. However, the agency or the appropriate

20  regulatory board shall make available, upon written request by

21  a health care professional against whom probable cause has

22  been found, any such records which form the basis of the

23  determination of probable cause, except that, with respect to

24  medical review committee records, s. 766.101 controls.

25         (14)(12)  The meetings of the committees and governing

26  board of a licensed facility held solely for the purpose of

27  achieving the objectives of risk management as provided by

28  this section shall not be open to the public under the

29  provisions of chapter 286. The records of such meetings are

30  confidential and exempt from s. 119.07(1), except as provided

31  in subsection (13)(11).

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  1         (15)(13)  The agency shall review, as part of its

  2  licensure inspection process, the internal risk management

  3  program at each licensed facility regulated by this section to

  4  determine whether the program meets standards established in

  5  statutes and rules, whether the program is being conducted in

  6  a manner designed to reduce adverse incidents, and whether the

  7  program is appropriately reporting incidents under subsections

  8  (5), and (6), (7), and (8).

  9         (16)(14)  There shall be no monetary liability on the

10  part of, and no cause of action for damages shall arise

11  against, any risk manager, licensed under part IX of chapter

12  626, for the implementation and oversight of the internal risk

13  management program in a facility licensed under this chapter

14  or chapter 390 as required by this section, for any act or

15  proceeding undertaken or performed within the scope of the

16  functions of such internal risk management program if the risk

17  manager acts without intentional fraud.

18         (17)(15)  If the agency, through its receipt of the

19  annual reports prescribed in subsection (6) (5) or through any

20  investigation, has a reasonable belief that conduct by a staff

21  member or employee of a licensed facility is grounds for

22  disciplinary action by the appropriate regulatory board, the

23  agency shall report this fact to such regulatory board.

24         (18)(16)  The agency shall annually publish a report

25  summarizing the information contained in the annual incident

26  reports submitted by licensed facilities under subsection (6),

27  and any serious incident reports submitted by licensed

28  facilities under subsection (7), and disciplinary actions

29  reported to the agency under s. 395.0193. The report must, at

30  a minimum, summarize:

31

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  1         (a)  Adverse and serious incidents, by service district

  2  of the department as defined in s. 20.19, by category of

  3  reported incident, and by type of professional involved.

  4         (b)  Types of malpractice claims filed, by service

  5  district of the department as defined in s. 20.19, and by type

  6  of professional involved.

  7         (c)  Disciplinary actions taken against professionals,

  8  by service district of the department as defined in s. 20.19,

  9  and by type of professional involved.

10         Section 43.  Present subsections (4), (5), (6), (7),

11  (8), and (9) of section 395.0199, Florida Statutes, are

12  renumbered as subsections (5), (6), (7), (8), (9), and (10),

13  respectively, and a new subsection (4) is added to that

14  section, to read:

15         395.0199  Private utilization review.--

16         (4)  Each applicant for registration must comply with

17  the following requirements:

18         (a)  Upon receipt of a completed, signed, and dated

19  application, the agency shall require background screening, in

20  accordance with the level 2 standards for screening set forth

21  in chapter 435, of the managing employee or other similarly

22  titled individual who is responsible for the operation of the

23  entity. The applicant must comply with the procedures for

24  level 2 background screening as set forth in chapter 435.

25         (b)  The agency may require background screening of any

26  other individual who is an applicant, if the agency has a

27  reasonable basis for believing that he or she has been

28  convicted of a crime or has committed any other offense

29  prohibited under the level 2 standards for screening set forth

30  in chapter 435.

31

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  1         (c)  Proof of compliance with the level 2 background

  2  screening requirements of chapter 435 which has been submitted

  3  within the previous 5 years in compliance with any other

  4  health care licensure requirements of this state is acceptable

  5  in fulfillment of the requirements of paragraph (a).

  6         (d)  A provisional registration may be granted to an

  7  applicant when each individual required by this section to

  8  undergo background screening has met the standards for the

  9  abuse registry background check and the Department of Law

10  Enforcement background check, but the agency has not yet

11  received background screening results from the Federal Bureau

12  of Investigation, or a request for a disqualification

13  exemption has been submitted to the agency as set forth in

14  chapter 435 but a response has not yet been issued. A standard

15  registration may be granted to the applicant upon the agency's

16  receipt of a report of the results of the Federal Bureau of

17  Investigation background screening for each individual

18  required by this section to undergo background screening which

19  confirms that all standards have been met, or upon the

20  granting of a disqualification exemption by the agency as set

21  forth in chapter 435. Any other person who is required to

22  undergo level 2 background screening may serve in his or her

23  capacity pending the agency's receipt of the report from the

24  Federal Bureau of Investigation. However, the person may not

25  continue to serve if the report indicates any violation of

26  background screening standards and a disqualification

27  exemption has not been requested of and granted by the agency

28  as set forth in chapter 435.

29         (e)  Each applicant must submit to the agency, with its

30  application, a description and explanation of any exclusions,

31  permanent suspensions, or terminations of the applicant from

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  1  the Medicare or Medicaid programs. Proof of compliance with

  2  the requirements for disclosure of ownership and control

  3  interests under the Medicaid or Medicare programs shall be

  4  accepted in lieu of this submission.

  5         (f)  Each applicant must submit to the agency a

  6  description and explanation of any conviction of an offense

  7  prohibited under the level 2 standards of chapter 435 by a

  8  member of the board of directors of the applicant, its

  9  officers, or any individual owning 5 percent or more of the

10  applicant. This requirement does not apply to a director of a

11  not-for-profit corporation or organization if the director

12  serves solely in a voluntary capacity for the corporation or

13  organization, does not regularly take part in the day-to-day

14  operational decisions of the corporation or organization,

15  receives no remuneration for his or her services on the

16  corporation or organization's board of directors, and has no

17  financial interest and has no family members with a financial

18  interest in the corporation or organization, provided that the

19  director and the not-for-profit corporation or organization

20  include in the application a statement affirming that the

21  director's relationship to the corporation satisfies the

22  requirements of this paragraph.

23         (g)  A registration may not be granted to an applicant

24  if the applicant or managing employee has been found guilty

25  of, regardless of adjudication, or has entered a plea of nolo

26  contendere or guilty to, any offense prohibited under the

27  level 2 standards for screening set forth in chapter 435,

28  unless an exemption from disqualification has been granted by

29  the agency as set forth in chapter 435.

30         (h)  The agency may deny or revoke the registration if

31  any applicant:

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  1         1.  Has falsely represented a material fact in the

  2  application required by paragraph (e) or paragraph (f), or has

  3  omitted any material fact from the application required by

  4  paragraph (e) or paragraph (f); or

  5         2.  Has had prior action taken against the applicant

  6  under the Medicaid or Medicare program as set forth in

  7  paragraph (e).

  8         (i)  An application for registration renewal must

  9  contain the information required under paragraphs (e) and (f).

10         Section 44.  Paragraph (d) of subsection (1) of section

11  395.1055, Florida Statutes, is amended to read:

12         395.1055  Rules and enforcement.--

13         (1)  The agency shall adopt, amend, promulgate, and

14  enforce rules to implement the provisions of this part, which

15  shall include reasonable and fair minimum standards for

16  ensuring that:

17         (d)  New facilities and a new wing or floor added to an

18  existing facility after July 1, 1999, are structurally capable

19  of serving as shelters only for patients, staff, and families

20  of staff, and equipped to be self-supporting during and

21  immediately following disasters.

22         Section 45.  The Agency for Health Care Administration

23  shall work with persons affected by section 44 of this act and

24  report to the Governor and Legislature by March 1, 1999, its

25  recommendations for cost-effective renovation standards to be

26  applied to existing facilities.

27         Section 46.  Effective January 1, 1999, section

28  626.941, Florida Statutes, is transferred, renumbered as

29  section 395.10971, Florida Statutes, and amended to read:

30         395.10971 626.941  Purpose.--The Legislature finds that

31  control and prevention of medical accidents and injuries are

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  1  is a significant public health and safety concern.  An

  2  essential method of controlling medical injuries is a

  3  comprehensive program of risk management, as required by s.

  4  395.0197.  The key to such a program is a competent and

  5  qualified health care risk manager.  It is the intent of the

  6  Legislature to establish certain minimum standards for health

  7  care risk managers to ensure the public welfare.

  8         Section 47.  Effective January 1, 1999, section

  9  626.942, Florida Statutes, is transferred, renumbered as

10  section 395.10972, Florida Statutes, and amended to read:

11         395.10972 626.942  Health Care Risk Manager Advisory

12  Council.--The Director of Health Care Administration Insurance

13  Commissioner may appoint a five-member advisory council to

14  advise the agency department on matters pertaining to health

15  care risk managers.  The members of the council shall serve at

16  the pleasure of the director Insurance Commissioner. The

17  council shall designate a chair.  The council shall meet at

18  the call of the director Insurance Commissioner or at those

19  times that are as may be required by rule of the agency

20  department.  The members of the advisory council shall receive

21  no compensation for their services, but shall be reimbursed

22  for travel expenses as provided in s. 112.061. The council

23  must shall consist of individuals who represent representing

24  the following areas:

25         (1)  Two members must shall be active health care risk

26  managers.

27         (2)  One member must shall be an active hospital

28  administrator.

29         (3)  One member must shall be an employee of an insurer

30  or self-insurer of medical malpractice coverage.

31

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  1         (4)  One member must shall be a representative of the

  2  health-care-consuming public.

  3         Section 48.  Effective January 1, 1999, section

  4  626.943, Florida Statutes, is transferred, renumbered as

  5  section 395.10973, Florida Statutes, and amended to read:

  6         395.10973 626.943  Powers and duties of the agency

  7  department.--It is the function of the agency department to:

  8         (1)  Adopt Promulgate rules necessary to carry out the

  9  duties conferred upon it under this part to protect the public

10  health, safety, and welfare.

11         (2)  Develop, impose, and enforce specific standards

12  within the scope of the general qualifications established by

13  this part which must be met by individuals in order to receive

14  licenses as health care risk managers.  These standards shall

15  be designed to ensure that health care risk managers are

16  individuals of good character and otherwise suitable and, by

17  training or experience in the field of health care risk

18  management, qualified in accordance with the provisions of

19  this part to serve as health care risk managers, within

20  statutory requirements.

21         (3)  Develop a method for determining whether an

22  individual meets the standards set forth in s. 395.10974 s.

23  626.944.

24         (4)  Issue licenses, beginning on June 1, 1986, to

25  qualified individuals who meet meeting the standards set forth

26  in s. 395.10974 s. 626.944.

27         (5)  Receive, investigate, and take appropriate action

28  with respect to any charge or complaint filed with the agency

29  department to the effect that a certified health care risk

30  manager has failed to comply with the requirements or

31

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  1  standards adopted by rule by the agency department or to

  2  comply with the provisions of this part.

  3         (6)  Establish procedures for providing the Department

  4  of Health and Rehabilitative Services with periodic reports on

  5  persons certified or disciplined by the agency department

  6  under this part.

  7         (7)  Develop a model risk management program for health

  8  care facilities which will satisfy the requirements of s.

  9  395.0197.

10         Section 49.  Effective January 1, 1999, section

11  626.944, Florida Statutes, is transferred, renumbered as

12  section 395.10974, Florida Statutes, and amended to read:

13         395.10974 626.944  Qualifications for health care risk

14  managers.--

15         (1)  Any person desiring to be licensed as a health

16  care risk manager shall submit an application on a form

17  provided by the agency department.  In order to qualify, the

18  applicant must shall submit evidence satisfactory to the

19  agency department which demonstrates the applicant's

20  competence, by education or experience, in the following

21  areas:

22         (a)  Applicable standards of health care risk

23  management.

24         (b)  Applicable federal, state, and local health and

25  safety laws and rules.

26         (c)  General risk management administration.

27         (d)  Patient care.

28         (e)  Medical care.

29         (f)  Personal and social care.

30         (g)  Accident prevention.

31         (h)  Departmental organization and management.

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  1         (i)  Community interrelationships.

  2         (j)  Medical terminology.

  3

  4  The agency department may require such additional information,

  5  from the applicant or any other person, as is may be

  6  reasonably required to verify the information contained in the

  7  application.

  8         (2)  The agency may department shall not grant or issue

  9  a license as a health care risk manager to any individual

10  unless from the application it affirmatively appears that the

11  applicant:

12         (a)  Is 18 years of age or over;

13         (b)  Is a high school graduate or equivalent; and

14         (c)1.  Has fulfilled the requirements of a 1-year

15  program or its equivalent in health care risk management

16  training which may be developed or approved by the agency

17  department;

18         2.  Has completed 2 years of college-level studies

19  which would prepare the applicant for health care risk

20  management, to be further defined by rule; or

21         3.  Has obtained 1 year of practical experience in

22  health care risk management.

23         (3)  The agency department shall issue a license,

24  beginning on June 1, 1986, to practice health care risk

25  management to any applicant who qualifies under this section

26  and submits an application fee of not more than $75, a

27  fingerprinting fee of not more than $75, and a license fee of

28  not more than $100.  The agency shall by rule establish fees

29  and procedures for the issuance and cancellation of licenses

30  the license fee as set forth in s. 624.501.  Licenses shall be

31

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  1  issued and canceled in the same manner as provided in part I

  2  of this chapter.

  3         (4)  The agency department shall renew a health care

  4  risk manager license upon receipt of a biennial renewal

  5  application and fees in accordance with procedures prescribed

  6  in s. 626.381 for agents in general. The agency shall, by

  7  rule, establish a procedure for the biennial renewal of

  8  licenses.

  9         Section 50.  Effective January 1, 1999, section

10  626.945, Florida Statutes, is transferred, renumbered as

11  section 395.10975, Florida Statutes, and amended to read:

12         395.10975 626.945  Grounds for denial, suspension, or

13  revocation of a health care risk manager's license;

14  administrative fine.--

15         (1)  The agency department may, in its discretion,

16  deny, suspend, revoke, or refuse to renew or continue the

17  license of any health care risk manager or applicant, if it

18  finds that as to such applicant or licensee any one or more of

19  the following grounds exist:

20         (a)  Any cause for which issuance of the license could

21  have been refused had it then existed and been known to the

22  agency department.

23         (b)  Giving false or forged evidence to the agency

24  department for the purpose of obtaining a license.

25         (c)  Having been found guilty of, or having pleaded

26  guilty or nolo contendere to, a crime in this state or any

27  other state relating to the practice of risk management or the

28  ability to practice risk management, whether or not a judgment

29  or conviction has been entered.

30         (d)  Having been found guilty of, or having pleaded

31  guilty or nolo contendere to, a felony, or a crime involving

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  1  moral turpitude punishable by imprisonment of 1 year or more

  2  under the law of the United States, under the law of any

  3  state, or under the law of any other country, without regard

  4  to whether a judgment of conviction has been entered by the

  5  court having jurisdiction of such cases.

  6         (e)  Making or filing a report or record which the

  7  licensee knows to be false; or intentionally failing to file a

  8  report or record required by state or federal law; or

  9  willfully impeding or obstructing, or inducing another person

10  to impede or obstruct, the filing of a report or record

11  required by state or federal law. Such reports or records

12  shall include only those which are signed in the capacity of a

13  licensed health care risk manager.

14         (f)  Fraud or deceit, negligence, incompetence, or

15  misconduct in the practice of health care risk management.

16         (g)  Violation of any provision of this part or any

17  other law applicable to the business of health care risk

18  management.

19         (h)  Violation of any lawful order or rule of the

20  agency department or failure to comply with a lawful subpoena

21  issued by the agency department.

22         (i)  Practicing with a revoked or suspended health care

23  risk manager license.

24         (j)  Repeatedly acting in a manner inconsistent with

25  the health and safety of the patients of the licensed facility

26  in which the licensee is the health care risk manager.

27         (k)  Being unable to practice health care risk

28  management with reasonable skill and safety to patients by

29  reason of illness; drunkenness; or use of drugs, narcotics,

30  chemicals, or any other material or substance or as a result

31  of any mental or physical condition.  Any person affected

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  1  under this paragraph shall have the opportunity, at reasonable

  2  intervals, to demonstrate that he or she can resume the

  3  competent practices of health care risk manager with

  4  reasonable skill and safety to patients.

  5         (l)  Willfully permitting unauthorized disclosure of

  6  information relating to a patient or a patient's records.

  7         (m)  Discriminating in respect to patients, employees,

  8  or staff on account of race, religion, color, sex, or national

  9  origin.

10         (2)  If the agency department finds that one or more of

11  the grounds set forth in subsection (1) exist, it may, in lieu

12  of or in addition to suspension or revocation, enter an order

13  imposing one or more of the following penalties:

14         (a)  Imposition of an administrative fine not to exceed

15  $2,500 for each count or separate offense.

16         (b)  Issuance of a reprimand.

17         (c)  Placement of the licensee on probation for a

18  period of time and subject to such conditions as the agency

19  specifies department may specify, including requiring the

20  licensee to attend continuing education courses or to work

21  under the supervision of another licensee.

22         (3)  The agency department may reissue the license of a

23  disciplined licensee in accordance with the provisions of this

24  part.

25         Section 51.  Paragraphs (a) and (b) of subsection (1)

26  of section 395.401, Florida Statutes, are amended to read:

27         395.401  Trauma services system plans; verification of

28  trauma centers and pediatric trauma referral centers;

29  procedures; renewal.--

30         (1)  As used in this part, the term:

31

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  1         (a)  "Agency" means the Agency for Health Care

  2  Administration "Board" means the Health Care Board.

  3         (b)  "Charity care" or "uncompensated charity care"

  4  means that portion of hospital charges reported to the agency

  5  board for which there is no compensation for care provided to

  6  a patient whose family income for the 12 months preceding the

  7  determination is less than or equal to 150 percent of the

  8  federal poverty level, unless the amount of hospital charges

  9  due from the patient exceeds 25 percent of the annual family

10  income.  However, in no case shall the hospital charges for a

11  patient whose family income exceeds 4 times the federal

12  poverty level for a family of four be considered charity.

13         Section 52.  Paragraph (c) of subsection (2) of section

14  395.602, Florida Statutes, is amended to read:

15         395.602  Rural hospitals.--

16         (2)  DEFINITIONS.--As used in this part:

17         (c)  "Inactive rural hospital bed" means a licensed

18  acute care hospital bed, as defined in s. 395.002(14) s.

19  395.002(13), that is inactive in that it cannot be occupied by

20  acute care inpatients.

21         Section 53.  Subsections (1), (2), (3), and (4) of

22  section 395.701, Florida Statutes, are amended to read:

23         395.701  Annual assessments on net operating revenues

24  to fund public medical assistance; administrative fines for

25  failure to pay assessments when due.--

26         (1)  For the purposes of this section, the term:

27         (a)  "Agency" means the Agency for Health Care

28  Administration.

29         (b)(a)  "Gross operating revenue" or "gross revenue"

30  means the sum of daily hospital service charges, ambulatory

31

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  1  service charges, ancillary service charges, and other

  2  operating revenue.

  3         (b)  "Health Care Board" or "board" means the Health

  4  Care Board created by s. 20.42.

  5         (c)  "Hospital" means a health care institution as

  6  defined in s. 395.002(13) s. 395.002(12), but does not include

  7  any hospital operated by the agency or the Department of

  8  Corrections.

  9         (d)  "Net operating revenue" or "net revenue" means

10  gross revenue less deductions from revenue.

11         (e)  "Total deductions from gross revenue" or

12  "deductions from revenue" means reductions from gross revenue

13  resulting from inability to collect payment of charges.  Such

14  reductions include bad debts; contractual adjustments;

15  uncompensated care; administrative, courtesy, and policy

16  discounts and adjustments; and other such revenue deductions,

17  but also includes the offset of restricted donations and

18  grants for indigent care.

19         (2)  There is hereby imposed upon each hospital an

20  assessment in an amount equal to 1.5 percent of the annual net

21  operating revenue for each hospital, such revenue to be

22  determined by the agency department, based on the actual

23  experience of the hospital as reported to the agency

24  department.  Within 6 months after the end of each hospital

25  fiscal year, the agency department shall certify the amount of

26  the assessment for each hospital.  The assessment shall be

27  payable to and collected by the agency department in equal

28  quarterly amounts, on or before the first day of each calendar

29  quarter, beginning with the first full calendar quarter that

30  occurs after the agency department certifies the amount of the

31  assessment for each hospital. All moneys collected pursuant to

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  1  this subsection shall be deposited into the Public Medical

  2  Assistance Trust Fund.

  3         (3)  The agency department shall impose an

  4  administrative fine, not to exceed $500 per day, for failure

  5  of any hospital to pay its assessment by the first day of the

  6  calendar quarter on which it is due.  The failure of a

  7  hospital to pay its assessment within 30 days after the

  8  assessment is due is ground for the agency department to

  9  impose an administrative fine not to exceed $5,000 per day.

10         (4)  The purchaser, successor, or assignee of a

11  facility subject to the agency's board's jurisdiction shall

12  assume full liability for any assessments, fines, or penalties

13  of the facility or its employees, regardless of when

14  identified.  Such assessments, fines, or penalties shall be

15  paid by the employee, owner, or licensee who incurred them,

16  within 15 days of the sale, transfer, or assignment.  However,

17  the purchaser, successor, or assignee of the facility may

18  withhold such assessments, fines, or penalties from purchase

19  moneys or payment due to the seller, transferor, or employee,

20  and shall make such payment on behalf of the seller,

21  transferor, or employee.  Any employer, purchaser, successor,

22  or assignee who fails to withhold sufficient funds to pay

23  assessments, fines, or penalties arising under the provisions

24  of chapter 408 shall make such payments within 15 days of the

25  date of the transfer, purchase, or assignment.  Failure by the

26  transferee to make payments as provided in this subsection

27  shall subject such transferee to the penalties and assessments

28  provided in chapter 408.  Further, in the event of sale,

29  transfer, or assignment of any facility under the agency's

30  board's jurisdiction, future assessments shall be based upon

31  the most recently available prior year report or audited

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  1  actual experience for the facility.  It shall be the

  2  responsibility of the new owner or licensee to require the

  3  production of the audited financial data for the period of

  4  operation of the prior owner.  If the transferee fails to

  5  obtain current audited financial data from the previous owner

  6  or licensee, the new owner shall be assessed based upon the

  7  most recent year of operation for which 12 months of audited

  8  actual experience are available or upon a reasonable estimate

  9  of 12 months of full operation as calculated by the agency

10  board.

11         Section 54.  Paragraph (b) of subsection (1) of section

12  400.051, Florida Statutes, is amended to read:

13         400.051  Homes or institutions exempt from the

14  provisions of this part.--

15         (1)  The following shall be exempt from the provisions

16  of this part:

17         (b)  Any hospital, as defined in s. 395.002(11) s.

18  395.002(10), that is licensed under chapter 395.

19         Section 55.  Paragraph (a) of subsection (2) of section

20  400.071, Florida Statutes, is amended, present subsections

21  (4), (5), (6), (7), and (8) of that section are redesignated

22  as subsections (5), (6), (7), (8), and (9), respectively, and

23  a new subsection (4) is added to that section, to read:

24         400.071  Application for license.--

25         (2)  The application shall be under oath and shall

26  contain the following:

27         (a)  The name, address, and social security number of

28  the applicant if an individual; if the applicant is a firm,

29  partnership, or association, its name, address, and employer

30  identification number (EIN), and the name and address of every

31  member; if the applicant is a corporation, its name, address,

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  1  and employer identification number (EIN), and the name and

  2  address of its director and officers and of each person having

  3  at least a 5-percent 10-percent interest in the corporation;

  4  and the name by which the facility is to be known.

  5         (4)  Each applicant for licensure must comply with the

  6  following requirements:

  7         (a)  Upon receipt of a completed, signed, and dated

  8  application, the agency shall require background screening of

  9  the applicant, in accordance with the level 2 standards for

10  screening set forth in chapter 435. As used in this

11  subsection, the term "applicant" means the facility

12  administrator, or similarly titled individual who is

13  responsible for the day-to-day operation of the licensed

14  facility, and the facility financial officer, or similarly

15  titled individual who is responsible for the financial

16  operation of the licensed facility.

17         (b)  The agency may require background screening for a

18  member of the board of directors of the licensee or an officer

19  or an individual owning 5 percent or more of the licensee if

20  the agency reasonably suspects that such individual has been

21  convicted of an offense prohibited under the level 2 standards

22  for screening set forth in chapter 435.

23         (c)  Proof of compliance with the level 2 background

24  screening requirements of chapter 435 which has been submitted

25  within the previous 5 years in compliance with any other

26  health care or assisted living licensure requirements of this

27  state is acceptable in fulfillment of paragraph (a).  Proof of

28  compliance with background screening which has been submitted

29  within the previous 5 years to fulfill the requirements of the

30  Department of Insurance pursuant to chapter 651 as part of an

31  application for a certificate of authority to operate a

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  1  continuing care retirement community is acceptable in

  2  fulfillment of the Department of Law Enforcement and Federal

  3  Bureau of Investigation background check.

  4         (d)  A provisional license may be granted to an

  5  applicant when each individual required by this section to

  6  undergo background screening has met the standards for the

  7  abuse registry background check and the Department of Law

  8  Enforcement background check, but the agency has not yet

  9  received background screening results from the Federal Bureau

10  of Investigation, or a request for a disqualification

11  exemption has been submitted to the agency as set forth in

12  chapter 435 but a response has not yet been issued.  A license

13  may be granted to the applicant upon the agency's receipt of a

14  report of the results of the Federal Bureau of Investigation

15  background screening for each individual required by this

16  section to undergo background screening which confirms that

17  all standards have been met, or upon the granting of a

18  disqualification exemption by the agency as set forth in

19  chapter 435.  Any other person who is required to undergo

20  level 2 background screening may serve in his or her capacity

21  pending the agency's receipt of the report from the Federal

22  Bureau of Investigation; however, the person may not continue

23  to serve if the report indicates any violation of background

24  screening standards and a disqualification exemption has not

25  been requested of and granted by the agency as set forth in

26  chapter 435.

27         (e)  Each applicant must submit to the agency, with its

28  application, a description and explanation of any exclusions,

29  permanent suspensions, or terminations of the applicant from

30  the Medicare or Medicaid programs. Proof of compliance with

31  disclosure of ownership and control interest requirements of

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  1  the Medicaid or Medicare programs shall be accepted in lieu of

  2  this submission.

  3         (f)  Each applicant must submit to the agency a

  4  description and explanation of any conviction of an offense

  5  prohibited under the level 2 standards of chapter 435 by a

  6  member of the board of directors of the applicant, its

  7  officers, or any individual owning 5 percent or more of the

  8  applicant. This requirement shall not apply to a director of a

  9  not-for-profit corporation or organization if the director

10  serves solely in a voluntary capacity for the corporation or

11  organization, does not regularly take part in the day-to-day

12  operational decisions of the corporation or organization,

13  receives no remuneration for his or her services on the

14  corporation or organization's board of directors, and has no

15  financial interest and has no family members with a financial

16  interest in the corporation or organization, provided that the

17  director and the not-for-profit corporation or organization

18  include in the application a statement affirming that the

19  director's relationship to the corporation satisfies the

20  requirements of this paragraph.

21         (g)  An application for license renewal must contain

22  the information required under paragraphs (e) and (f).

23         Section 56.  Present subsections (3), (4), (5), (6),

24  (7), (8), (9), and (10) of section 400.411, Florida Statutes,

25  are redesignated as subsections (4), (5), (6), (7), (8), (9),

26  (10), and (11), respectively, and a new subsection (3) is

27  added to that section, to read:

28         400.411  Initial application for license; provisional

29  license.--

30         (3)  Each applicant for licensure must comply with the

31  following requirements:

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  1         (a)  Upon receipt of a completed, signed, and dated

  2  application, the agency shall require background screening of

  3  the applicant, in accordance with the level 2 standards for

  4  screening set forth in chapter 435. As used in this

  5  subsection, the term "applicant" means the facility

  6  administrator, or similarly titled individual who is

  7  responsible for the day-to-day operation of the licensed

  8  facility, and the facility financial officer, or similarly

  9  titled individual who is responsible for the financial

10  operation of the licensed facility.

11         (b)  The agency may require background screening for a

12  member of the board of directors of the licensee or an officer

13  or an individual owning 5 percent or more of the licensee if

14  the agency reasonably suspects that such individual has been

15  convicted of an offense prohibited under the level 2 standards

16  for screening set forth in chapter 435.

17         (c)  Proof of compliance with the level 2 background

18  screening requirements of chapter 435 which has been submitted

19  within the previous 5 years in compliance with any other

20  health care or assisted living licensure requirements of this

21  state is acceptable in fulfillment of paragraph (a).  Proof of

22  compliance with background screening which has been submitted

23  within the previous 5 years to fulfill the requirements of the

24  Department of Insurance pursuant to chapter 651 as part of an

25  application for a certificate of authority to operate a

26  continuing care retirement community is acceptable in

27  fulfillment of the Department of Law Enforcement and Federal

28  Bureau of Investigation background check.

29         (d)  A provisional license may be granted to an

30  applicant when each individual required by this section to

31  undergo background screening has met the standards for the

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  1  abuse registry background check and the Department of Law

  2  Enforcement background check, but the agency has not yet

  3  received background screening results from the Federal Bureau

  4  of Investigation, or a request for a disqualification

  5  exemption has been submitted to the agency as set forth in

  6  chapter 435 but a response has not yet been issued. A standard

  7  license may be granted to the applicant upon the agency's

  8  receipt of a report of the results of the Federal Bureau of

  9  Investigation background screening for each individual

10  required by this section to undergo background screening which

11  confirms that all standards have been met, or upon the

12  granting of a disqualification exemption by the agency as set

13  forth in chapter 435.  Any other person who is required to

14  undergo level 2 background screening may serve in his or her

15  capacity pending the agency's receipt of the report from the

16  Federal Bureau of Investigation; however, the person may not

17  continue to serve if the report indicates any violation of

18  background screening standards and a disqualification

19  exemption has not been requested of and granted by the agency

20  as set forth in chapter 435.

21         (e)  Each applicant must submit to the agency, with its

22  application, a description and explanation of any exclusions,

23  permanent suspensions, or terminations of the applicant from

24  the Medicare or Medicaid programs. Proof of compliance with

25  disclosure of ownership and control interest requirements of

26  the Medicaid or Medicare programs shall be accepted in lieu of

27  this submission.

28         (f)  Each applicant must submit to the agency a

29  description and explanation of any conviction of an offense

30  prohibited under the level 2 standards of chapter 435 by a

31  member of the board of directors of the applicant, its

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  1  officers, or any individual owning 5 percent or more of the

  2  applicant. This requirement shall not apply to a director of a

  3  not-for-profit corporation or organization if the director

  4  serves solely in a voluntary capacity for the corporation or

  5  organization, does not regularly take part in the day-to-day

  6  operational decisions of the corporation or organization,

  7  receives no remuneration for his or her services on the

  8  corporation or organization's board of directors, and has no

  9  financial interest and has no family members with a financial

10  interest in the corporation or organization, provided that the

11  director and the not-for-profit corporation or organization

12  include in the application a statement affirming that the

13  director's relationship to the corporation satisfies the

14  requirements of this paragraph.

15         (g)  A license may not be granted to an applicant if

16  the applicant, administrator, or financial officer has been

17  found guilty of, regardless of adjudication, or has entered a

18  plea of nolo contendere or guilty to, any offense prohibited

19  under the level 2 standards for screening set forth in chapter

20  435, unless an exemption from disqualification has been

21  granted by the agency as set forth in chapter 435.

22         (h)  The agency may deny or revoke licensure if the

23  applicant:

24         1.  Has falsely represented a material fact in the

25  application required by paragraph (e) or paragraph (f), or has

26  omitted any material fact from the application required by

27  paragraph (e) or paragraph (f); or

28         2.  Has had prior Medicaid or Medicare action taken

29  against the applicant as set forth in paragraph (e).

30         (i)  An application for license renewal must contain

31  the information required under paragraphs (e) and (f).

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  1         Section 57.  Paragraph (b) of subsection (2) of section

  2  400.414, Florida Statutes, is amended, and paragraph (j) is

  3  added to that subsection, to read:

  4         400.414  Denial, revocation, or suspension of license;

  5  imposition of administrative fine; grounds.--

  6         (2)  Any of the following actions by a facility or its

  7  employee shall be grounds for action by the agency against a

  8  licensee:

  9         (b)  The determination by the agency that any person

10  specified in s. 400.411(3) the facility owner or administrator

11  is not of suitable character or competency in accordance with

12  level 2 standards for screening set forth in chapter 435, or

13  that the owner lacks the financial ability, to provide

14  continuing adequate care to residents, pursuant to the

15  information obtained through s. 400.411, s. 400.417, or s.

16  400.434.

17         (j)  A facility owner's or administrator's retention of

18  an employee who performs personal care or nursing care and who

19  is not of suitable character or competency in accordance with

20  level 1 standards for screening set forth in chapter 435, as

21  indicated by the results of the employee's criminal-history

22  background screening.

23         Section 58.  Present subsections (2) and (3) of section

24  400.417, Florida Statutes, are renumbered as subsections (3)

25  and (4), respectively, and a new subsection (2) is added to

26  that section, to read:

27         400.417  Expiration of license; renewal; conditional

28  license.--

29         (2)  An applicant for renewal who has not completed the

30  initial background screening requirements specified in s.

31  400.411 must complete the required screening. After the

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  1  initial background screening is completed, each applicant for

  2  renewal must submit to the agency, under penalty of perjury, a

  3  notarized affidavit of compliance with the background

  4  screening provisions.

  5         Section 59.  Section 400.4174, Florida Statutes, is

  6  amended to read:

  7         400.4174  Background screening; reports of abuse in

  8  facilities.--

  9         (1)  The facility owner or administrator shall conduct

10  level 1 background screening, as set forth in chapter 435, on

11  all employees hired on or after October 1, 1998, who perform

12  personal services as defined in s. 400.402(16).  The agency

13  may exempt an individual from employment disqualification as

14  set forth in chapter 435.

15         (2)  Proof of compliance with the level 1 background

16  screening requirements of chapter 435 may be satisfied as

17  follows:

18         (a)  The employee or applicant for employment has had a

19  level 1 background screening to qualify for a professional

20  license in this state.  Proof of compliance with the level 1

21  screening requirement must be accompanied, under penalty of

22  perjury, by a copy of the applicant's current professional

23  license and an affidavit of compliance with the level 1

24  screening requirement.

25         (b)  The employee or applicant for employment has been

26  continuously employed in the same type of occupation for which

27  the person is seeking employment without a breach in service

28  that exceeds 180 days and proof of compliance with the level 1

29  screening requirement is no more than 2 years old.  Proof of

30  compliance shall be provided directly from one employer or

31  contractor to another, and no potential employer or contractor

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  1  shall accept any proof of compliance directly from the person

  2  who was screened.  Upon request, proof of completion of the

  3  level 1 screening requirement of this section shall be

  4  provided by the employer retaining documentation of the

  5  screening to the person who was screened.

  6         (c)  The employee or applicant seeking employment is

  7  employed by a corporation or business entity or related

  8  corporation or business entity that owns, operates, or manages

  9  more than one facility or agency licensed under chapter 400

10  for whom a level 1 screening was conducted by the corporation

11  or business entity as a condition of initial employment or

12  continued employment.

13         (3)  When an employee, volunteer, administrator, or

14  owner of a facility has a confirmed report of adult abuse,

15  neglect, or exploitation, as defined in s. 415.102, or child

16  abuse or neglect, as defined in s. 415.503, and the protective

17  investigator knows that the individual is an employee,

18  volunteer, administrator, or owner of a facility, the agency

19  shall be notified of the confirmed report.

20         Section 60.  Section 400.4176, Florida Statutes, is

21  amended to read:

22         400.4176  Notice of change of administrator.--If,

23  during the period for which a license is issued, the owner

24  changes administrators, the owner must notify the agency of

25  the change within 45 days thereof and must provide

26  documentation that the new administrator has completed the

27  applicable core educational requirements under s. 400.452.

28  Background screening shall be completed on any new

29  administrator to establish that the individual is of suitable

30  character as specified in s. 400.411(2)(c) and (3) ss.

31  400.411(2)(c) and 400.456.

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  1         Section 61.  Section 400.461, Florida Statutes, is

  2  amended to read:

  3         400.461  Short title; purpose.--

  4         (1)  This part, consisting of ss. 400.461-400.518 ss.

  5  400.461-400.515, may be cited as the "Home Health Services

  6  Act."

  7         (2)  The purpose of this part is to provide for the

  8  licensure of every home health agency and to provide for the

  9  development, establishment, and enforcement of basic standards

10  that will ensure the safe and adequate care of persons

11  receiving health services in their own homes.

12         Section 62.  Section 400.462, Florida Statutes, is

13  amended to read:

14         400.462  Definitions.--As used in this part, the term:

15         (1)  "Administrator" means a direct employee to whom

16  the governing body has delegated the responsibility for the

17  day-to-day administration of a home health agency or nurse

18  registry. The administrator must be a licensed physician,

19  physician assistant, or registered nurse licensed to practice

20  in this state, or an individual who has at least 1 year of

21  supervisory or administrative experience in home health care

22  or in a facility licensed under part II, part III, or part IV

23  of chapter 400 or chapter 395. An employee of the governing

24  body may administer a maximum of five licensed home health

25  agencies or nurse registries operated by a related business

26  entity and located within one agency service district or

27  within an immediately contiguous county. An administrator

28  shall designate, in writing for each licensed entity, a

29  qualified alternate administrator to serve during the

30  administrator's absence. If the home health agency is licensed

31  under this chapter and is part of a retirement community that

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  1  provides multiple levels of care, an employee of the

  2  retirement community may administer the home health agency and

  3  up to a maximum of four entities licensed under this chapter

  4  which are located on the same campus and owned, operated, or

  5  managed by the same corporate entity.

  6         (2)  "Agency" means the Agency for Health Care

  7  Administration.

  8         (3)(1)  "Certified nursing assistant" means any person

  9  who has been issued a certificate under after fulfilling the

10  requirements of s. 400.211. A licensed home health agency or

11  licensed nurse registry shall ensure that any certified

12  nursing assistant employed by or under contract with the home

13  health agency or licensed nurse registry is adequately trained

14  to perform the tasks of a home health aide in the home

15  setting.

16         (4)  "Client" means an elderly, handicapped, or

17  convalescent individual who receives personal care services,

18  companion services, or homemaker services in the individual's

19  home or place of residence.

20         (5)(2)  "Companion" or "sitter" means a person who

21  cares for an elderly, handicapped, or convalescent individual

22  and accompanies such individual on trips and outings and may

23  prepare and serve meals to such individual. A companion may

24  not provide hands-on personal care to the client.

25         (6)(3)  "Department" means the Department of Children

26  and Family Health and Rehabilitative Services.

27         (7)  "Director of nursing" means a registered nurse,

28  and direct employee of the agency, who is a graduate of an

29  approved school of nursing and is licensed in this state; who

30  has at least 1 year of supervisory experience as a registered

31  nurse and experience in a licensed home health agency, a

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  1  facility licensed under chapter 395, or a facility licensed

  2  under part II, part III, or part VI of chapter 400; and who is

  3  responsible for overseeing the professional nursing and home

  4  health aid delivery of services of the agency. An employee may

  5  be the director of nursing of a maximum of five licensed home

  6  health agencies operated by a related business entity. If a

  7  home health agency is licensed under this chapter and is part

  8  of a retirement community that provides multiple levels of

  9  care, an employee of the retirement community may serve as the

10  director of nursing for the home health agency and up to four

11  additional entities licensed under chapter 400 if the entities

12  are located on the same campus and are owned, operated, or

13  managed by the same corporate entity. A director of nursing

14  shall designate, in writing for each agency, a qualified

15  alternate registered nurse to serve during the absence of the

16  director of nursing.

17         (8)(4)  "Home health agency" means an organization that

18  provides home health services and staffing services for health

19  care facilities.

20         (9)(5)  "Home health agency personnel" means persons

21  who are employed by or under contract with a home health

22  agency and enter the home or place of residence of patients at

23  any time in the course of their employment or contract.

24         (10)(6)  "Home health services" means health and

25  medical services and medical supplies furnished by an

26  organization to an individual by home health agency personnel

27  or by others under arrangements with the agency, on a visiting

28  basis, in the individual's home or place of residence.  The

29  term includes organizations that provide one or more of, but

30  is not limited to, the following:

31         (a)  Nursing care.

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  1         (b)  Physical, occupational, respiratory, or speech

  2  therapy.

  3         (c)  Home health aide services.

  4         (d)  Dietetics and nutrition practice and nutrition

  5  counseling Nutritional guidance.

  6         (e)  Medical supplies, restricted to drugs and

  7  biologicals prescribed by a physician.

  8         (11)  "Home health aide" means a person who provides

  9  hands-on personal care, performs simple procedures as an

10  extension of therapy or nursing services, assists in

11  ambulation or exercises, or supervises the self-administration

12  of medications, and for which the person has received training

13  established by the agency pursuant to s. 400.497(1).

14         (12)(7)  "Homemaker" means a person who performs

15  household chores that include housekeeping, meal planning and

16  preparation, shopping assistance, and routine household

17  activities for an elderly, handicapped, or convalescent

18  individual. A homemaker may not provide hands-on personal care

19  to a client.

20         (13)  "Home infusion therapy provider" means an

21  organization that employs, contracts with, or refers a

22  licensed professional who has received advanced training and

23  experience in intravenous infusion therapy and who administers

24  infusion therapy to a patient in the patient's home or place

25  of residence.

26         (14)  "Home infusion therapy" means the administration

27  of intravenous pharmacological or nutritional products to a

28  patient in the patient's home.

29         (15)(8)  "Nurse registry" means any person that

30  procures, offers, promises, or attempts to secure

31  health-care-related contracts for registered nurses, licensed

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  1  practical nurses, certified nursing assistants, home health

  2  aides sitters, companions, or homemakers, who are compensated

  3  by fees as independent contractors, including, but not limited

  4  to, contracts for the provision of services to patients and

  5  contracts to provide private duty or staffing services to

  6  health care facilities licensed under chapter 395 or this

  7  chapter or to other business entities.

  8         (16)  "Organization" means a corporation, government or

  9  governmental subdivision or agency, partnership or

10  association, two or more persons having a joint or common

11  interest, or any other legal or commercial entity. The term

12  does not include an entity that provides services using only

13  volunteers.

14         (17)(9)  "Patient" means any person who receives home

15  health services in his or her home or place of residence.

16         (18)  "Personal care" includes, but is not limited to,

17  assisting a patient in the activities of daily living, such as

18  dressing, grooming, bathing, eating, or personal hygiene;

19  assisting in physical transfer and ambulation; and supervising

20  the self-administration of medications.

21         (19)  "Physician" means a person licensed under chapter

22  458, chapter 459, chapter 460, or chapter 461.

23         (20)(10)  "Screening" means the assessment of the

24  background of home health agency personnel, nurse registry

25  personnel, and persons registered under s. 400.509 and

26  includes employment history checks, records checks of the

27  department's central abuse hotline under chapter 415 relating

28  to vulnerable adults, and statewide criminal records

29  correspondence checks through the Department of Law

30  Enforcement.

31

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  1         (21)  "Skilled care" means nursing services or

  2  therapeutic services delivered by a health care professional

  3  who is licensed under chapter 464; parts I, III, or V of

  4  chapter 468; or chapter 486, and who is employed by or under

  5  contract with a licensed home health agency or is referred by

  6  a licensed nurse registry.

  7         (22)(11)  "Staffing services" means services provided

  8  to a health care facility or other business entity on a

  9  temporary basis by licensed health care personnel, including

10  certified nursing assistants and home health aides who are

11  employed by or work under the auspices of a licensed home

12  health agency or who are registered with a licensed nurse

13  registry.

14         Section 63.  Section 400.464, Florida Statutes, is

15  amended to read:

16         400.464  Home health agencies to be licensed;

17  expiration of license; exemptions; unlawful acts; penalties.--

18         (1)  Any home health agency must be licensed by the

19  agency for Health Care Administration to operate in this

20  state.  A license issued to a home health agency, unless

21  sooner suspended or revoked, expires 1 year after its date of

22  issuance.  However, any home health agency that is operated by

23  the Federal Government is exempt from this part.

24         (2)  If the licensed home health agency operates

25  related offices, each related office outside the county where

26  the main office is located must be separately licensed.  The

27  counties where the related offices are operating must be

28  specified on the license in the main office.

29         (3)  An entity that receives a certificate-of-need

30  exemption under s. 408.0366 may request one home health agency

31  license to provide Medicare and non-Medicare home health

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  1  services to residents of the facility and non-Medicare home

  2  health services to persons in one or more counties within the

  3  agency service district where the main office of the home

  4  health agency is located.

  5         (3)  The furnishing of only home dialysis services,

  6  supplies, or equipment, or personal care services as provided

  7  by a community-care-for-the-elderly lead agency under s.

  8  430.205, or personal care services provided through a

  9  community-care-for-disabled-adults program under s. 410.604,

10  is exempt from this part.  The personal care services

11  exemptions apply only to community-care-for-the-elderly lead

12  agencies and community-care-for-disabled-adults programs that

13  directly provide only personal care services to their clients

14  and do not provide other home health services.

15         (4)  Any program offered through a county health

16  department that makes home visits for the purpose of providing

17  only environmental assessments, case management, health

18  education, or personal care services is exempt from this part.

19         (5)(a)  It is unlawful for any person to offer or

20  advertise home health services to the public unless he or she

21  has a valid license under this part. It is unlawful for any

22  holder of a license issued under this part to advertise or

23  indicate to the public that it holds a home health agency

24  license other than the one it has been issued.

25         (b)  A person who violates paragraph (a) is subject to

26  an injunctive proceeding under s. 400.515.  A violation of

27  paragraph (a) is a deceptive and unfair trade practice and

28  constitutes a violation of the Florida Deceptive and Unfair

29  Trade Practices Act.

30         (c)  A person who violates paragraph (a) commits a

31  misdemeanor of the second degree, punishable as provided in s.

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  1  775.082 or s. 775.083.  Any person who commits a second or

  2  subsequent violation commits a misdemeanor of the first

  3  degree, punishable as provided in s. 775.082 or s. 775.083.

  4

  5  Each day of continuing violation constitutes a separate

  6  offense.

  7         (4)(6)  Any home infusion therapy provider shall be

  8  licensed as a home health agency or nurse registry.  Any home

  9  infusion therapy provider currently authorized to receive

10  Medicare reimbursement under a DME - Part B Provider number

11  for the provision of infusion therapy shall be licensed as a

12  noncertified home health agency. Such a provider shall

13  continue to receive that specified Medicare reimbursement

14  without being certified so long as the reimbursement is

15  limited to those items authorized pursuant to the DME - Part B

16  Provider Agreement and the agency is licensed in compliance

17  with the other provisions of this part.

18         (5)(a)  An organization may not provide, offer, or

19  advertise home health services to the public unless the

20  organization has a valid license or is specifically exempt

21  under this part. An organization that offers or advertises to

22  the public any service for which licensure or registration is

23  required under this part must include in the advertisement the

24  license number or registration number issued to the

25  organization by the agency. The agency shall assess a fine of

26  not less than $100 to any licensee or registrant who fails to

27  include the license or registration number when submitting an

28  advertisement for publication, broadcast, or printing. The

29  holder of a license issued under this part may not advertise

30  or indicate to the public that it holds a home health agency

31

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  1  license or a nurse registry license other than the one it has

  2  been issued.

  3         (b)  A person who violates the provisions of paragraph

  4  (a) is subject to an injunctive proceeding under s. 400.515. A

  5  violation of paragraph (a) is a deceptive and unfair trade

  6  practice and constitutes a violation of the Florida Unfair and

  7  Deceptive Trade Practices Act.

  8         (c)  A person who violates the provisions of paragraph

  9  (a) commits a misdemeanor of the second degree, punishable as

10  provided in s. 775.082 or s. 775.083. Any person who commits a

11  second or subsequent violation commits a misdemeanor of the

12  first degree, punishable as provided in s. 775.082 or s.

13  775.083. Each day of continuing violation constitutes a

14  separate offense.

15         (6)  The following are exempt from the licensure

16  requirements of this part:

17         (a)  A home health agency operated by the Federal

18  Government.

19         (b)  The following home health services provided by a

20  state agency, either directly or through a contract:

21         1.  Personal care services provided through a program

22  or contract of the Department of Elderly Affairs and personal

23  care services provided through a program of community care for

24  disabled adults under s. 410.604. The exemptions provided in

25  this subparagraph apply only to programs or contracts that do

26  not provide home health services other than directly provided

27  personal care services.

28         2.  Any program offered through the Department of

29  Health, a community health center, or a rural health network

30  which furnishes home visits for the purpose of providing

31  environmental assessments, case management, health education,

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  1  personal care services, family planning, or follow-up

  2  treatment or for the purpose of monitoring and tracking

  3  disease.

  4         3.  Services provided to persons who have developmental

  5  disabilities, as defined in s. 393.063(11).

  6         (c)  A health care professional, whether or not

  7  incorporated, who is licensed under chapter 458, chapter 459,

  8  chapter 464, parts I, III, V, or X of chapter 468, chapter

  9  486, chapter 490, or chapter 491, and who is acting alone

10  within the scope of his or her professional license to provide

11  care to patients in their homes.

12         (d)  A home health aide, or certified nursing

13  assistant, who acts in his or her individual capacity within

14  the definitions and standards of his or her respective

15  occupation, and who provides hands-on care to patients in

16  their homes.

17         (e)  An individual who acts alone, in his or her

18  individual capacity, and who is not employed by, or affiliated

19  with, a licensed home health agency or registered with a

20  licensed nurse registry. This exemption does not entitle an

21  individual to perform home health services without the

22  required professional license.

23         (f)  The delivery of instructional services in home

24  dialysis and home dialysis supplies or equipment.

25         (g)  The delivery of nursing home services, for which

26  the nursing home is licensed under part II of this chapter, to

27  serve its residents in its facility.

28         (h)  The delivery of assisted living facility services,

29  for which the assisted living facility is licensed under part

30  III of this chapter, to serve its residents in its facility.

31

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  1         (i)  The delivery of hospice services, for which the

  2  hospice is licensed under part VI of this chapter, to serve

  3  hospice patients admitted to its service.

  4         (j)  A hospital that provides services for which it is

  5  licensed under chapter 395.

  6         (k)  The delivery of community residential services,

  7  for which the community residential home is licensed under

  8  chapter 419, to serve the residents in its facility.

  9         (l)  A not-for-profit, community-based agency that

10  provides early intervention services to infants and toddlers.

11         (m)  Certified rehabilitation agencies and

12  comprehensive outpatient rehabilitation facilities that are

13  certified under Title 18 of the Social Security Act.

14         (n)  The delivery of adult family-care home services,

15  for which the adult family-care home is licensed under part

16  VII of this chapter, to serve the residents in its facility.

17         Section 64.  Section 400.471, Florida Statutes, is

18  amended to read:

19         400.471  Application for license; fee; provisional

20  license; temporary permit.--

21         (1)  Application for an initial license or for renewal

22  of an existing license must be made under oath to the agency

23  for Health Care Administration on forms furnished by it and

24  must be accompanied by the appropriate license fee as provided

25  in subsection (8) subsection (7).  The agency must take final

26  action on an initial licensure application within 90 60 days

27  after receipt of all required documentation.

28         (2)  The applicant must file with the application

29  satisfactory proof that the home health agency is in

30  compliance with this part and applicable rules, including:

31

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  1         (a)  A listing of services to be provided, either

  2  directly by the applicant or through contractual arrangements

  3  with existing providers;

  4         (b)  The number and discipline of professional staff to

  5  be employed; and

  6         (c)  Proof of financial ability to operate.

  7

  8  If the applicant has applied for a certificate of need under

  9  ss. 408.0331-408.045 within the preceding 12 months, the

10  applicant may submit the proof submitted during the

11  certificate-of-need process along with an attestation that

12  there has been no substantial change in the facts and

13  circumstances underlying the original submission.

14         (3)  An applicant for initial licensure must

15  demonstrate financial ability to operate by submitting a

16  balance sheet and income and expense statement for the first 2

17  years of operation which provide evidence of having sufficient

18  assets, credit, and projected revenues to cover liabilities

19  and expenses. The applicant shall have demonstrated financial

20  ability to operate if the applicant's assets, credit, and

21  projected revenues meet or exceed projected liabilities and

22  expenses.  All documents required under this subsection must

23  be prepared in accordance with generally accepted accounting

24  principles and the financial statement must be signed by a

25  certified public accountant.

26         (4)  Each applicant for licensure must comply with the

27  following requirements:

28         (a)  Upon receipt of a completed, signed, and dated

29  application, the agency shall require background screening of

30  the applicant, in accordance with the level 2 standards for

31  screening set forth in chapter 435. As used in this

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  1  subsection, the term "applicant" means the administrator, or a

  2  similarly titled person who is responsible for the day-to-day

  3  operation of the licensed home health agency, and the

  4  financial officer, or similarly titled individual who is

  5  responsible for the financial operation of the licensed home

  6  health agency.

  7         (b)  The agency may require background screening for a

  8  member of the board of directors of the licensee or an officer

  9  or an individual owning 5 percent or more of the licensee if

10  the agency reasonably suspects that such individual has been

11  convicted of an offense prohibited under the level 2 standards

12  for screening set forth in chapter 435.

13         (c)  Proof of compliance with the level 2 background

14  screening requirements of chapter 435 which has been submitted

15  within the previous 5 years in compliance with any other

16  health care or assisted living licensure requirements of this

17  state is acceptable in fulfillment of paragraph (a). Proof of

18  compliance with background screening which has been submitted

19  within the previous 5 years to fulfill the requirements of the

20  Department of Insurance pursuant to chapter 651 as part of an

21  application for a certificate of authority to operate a

22  continuing care retirement community is acceptable in

23  fulfillment of the Department of Law Enforcement and Federal

24  Bureau of Investigation background check.

25         (d)  A provisional license may be granted to an

26  applicant when each individual required by this section to

27  undergo background screening has met the standards for the

28  abuse registry background check and the Department of Law

29  Enforcement background check, but the agency has not yet

30  received background screening results from the Federal Bureau

31  of Investigation. A standard license may be granted to the

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  1  licensee upon the agency's receipt of a report of the results

  2  of the Federal Bureau of Investigation background screening

  3  for each individual required by this section to undergo

  4  background screening which confirms that all standards have

  5  been met, or upon the granting of a disqualification exemption

  6  by the agency as set forth in chapter 435. Any other person

  7  who is required to undergo level 2 background screening may

  8  serve in his or her capacity pending the agency's receipt of

  9  the report from the Federal Bureau of Investigation. However,

10  the person may not continue to serve if the report indicates

11  any violation of background screening standards and a

12  disqualification exemption has not been requested of and

13  granted by the agency as set forth in chapter 435.

14         (e)  Each applicant must submit to the agency, with its

15  application, a description and explanation of any exclusions,

16  permanent suspensions, or terminations of the licensee or

17  potential licensee from the Medicare or Medicaid programs.

18  Proof of compliance with the requirements for disclosure of

19  ownership and control interest under the Medicaid or Medicare

20  programs may be accepted in lieu of this submission.

21         (f)  Each applicant must submit to the agency a

22  description and explanation of any conviction of an offense

23  prohibited under the level 2 standards of chapter 435 by a

24  member of the board of directors of the applicant, its

25  officers, or any individual owning 5 percent or more of the

26  applicant. This requirement does not apply to a director of a

27  not-for-profit corporation or organization if the director

28  serves solely in a voluntary capacity for the corporation or

29  organization, does not regularly take part in the day-to-day

30  operational decisions of the corporation or organization,

31  receives no remuneration for his or her services on the

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  1  corporation or organization's board of directors, and has no

  2  financial interest and has no family members with a financial

  3  interest in the corporation or organization, provided that the

  4  director and the not-for-profit corporation or organization

  5  include in the application a statement affirming that the

  6  director's relationship to the corporation satisfies the

  7  requirements of this paragraph.

  8         (g)  A license may not be granted to an applicant if

  9  the applicant, administrator, or financial officer has been

10  found guilty of, regardless of adjudication, or has entered a

11  plea of nolo contendere or guilty to, any offense prohibited

12  under the level 2 standards for screening set forth in chapter

13  435, unless an exemption from disqualification has been

14  granted by the agency as set forth in chapter 435.

15         (h)  The agency may deny or revoke licensure if the

16  applicant:

17         1.  Has falsely represented a material fact in the

18  application required by paragraph (e) or paragraph (f), or has

19  omitted any material fact from the application required by

20  paragraph (e) or paragraph (f); or

21         2.  Has been or is currently excluded, suspended,

22  terminated from, or has involuntarily withdrawn from

23  participation in this state's Medicaid program, or the

24  Medicaid program of any other state, or from participation in

25  the Medicare program or any other governmental or private

26  health care or health insurance program.

27         (i)  An application for license renewal must contain

28  the information required under paragraphs (e) and (f).

29         (5)(4)  The home health agency must also obtain and

30  maintain the following liability insurance coverages, in an.

31  Proof of liability insurance, as defined in s. 624.605, must

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  1  be submitted with the application.  The Agency for Health Care

  2  Administration shall set the required amounts of liability

  3  insurance by rule, but the required amount of must not be less

  4  than $250,000 per claim, and the home health agency must

  5  submit proof of coverage with an initial application for

  6  licensure and with each annual application for license

  7  renewal:.

  8         (a)  Malpractice insurance, as defined in s.

  9  624.605(1)(k); and

10         (b)  Liability insurance, as defined in s.

11  624.605(1)(b).

12         (6)(5)  Ninety Sixty days before the expiration date,

13  an application for renewal must be submitted to the agency for

14  Health Care Administration under oath on forms furnished by

15  it, and a license must be renewed if the applicant has met the

16  requirements established under this part and applicable rules.

17  The home health agency must file with the application

18  satisfactory proof that it is in compliance with this part and

19  applicable rules.  If there is evidence of financial

20  instability, the home health agency must submit satisfactory

21  proof of its financial ability to comply with the requirements

22  of this part.

23         (7)(6)  When transferring the ownership of a home

24  health agency, the transferee must submit an application for a

25  license at least 60 days before the effective date of the

26  transfer.  If the home health agency is being leased, a copy

27  of the lease agreement must be filed with the application.

28         (8)(7)  The license fee and annual renewal fee required

29  of a home health agency are is nonrefundable.  The agency for

30  Health Care Administration shall set the fees in an amount

31  that is sufficient to cover its costs in carrying out its

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  1  responsibilities under this part, but not to exceed $1,000.

  2  However, state, county, or municipal governments applying for

  3  licenses under this part are exempt from the payment of

  4  license fees.  All fees collected under this part must be

  5  deposited in the Health Care Trust Fund for the administration

  6  of this part.

  7         (9)(8)  The license must be displayed in a conspicuous

  8  place in the administrative office of the home health agency

  9  and is valid only while in the possession of the person to

10  which it is issued.  The license may not be sold, assigned, or

11  otherwise transferred, voluntarily or involuntarily, and is

12  valid only for the home health agency and location for which

13  originally issued.

14         (10)(9)  A home health agency against whom a revocation

15  or suspension proceeding is pending at the time of license

16  renewal may be issued a provisional license effective until

17  final disposition by the agency for Health Care Administration

18  of such proceedings. If judicial relief is sought from the

19  final disposition, the court that has jurisdiction may issue a

20  temporary permit for the duration of the judicial proceeding.

21         (11)(10)  The agency may department shall not issue a

22  license designated as certified to a home health agency that

23  which fails to receive a certificate of need under the

24  provisions of ss. 408.031-408.045 and that fails to satisfy

25  the requirements of a Medicare-certification survey from the

26  agency.

27         (12)  The agency may not issue a license to an agency

28  that has any unpaid fines assessed under this part.

29         Section 65.  Section 400.474, Florida Statutes, is

30  amended to read:

31

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  1         400.474  Denial, suspension, revocation of license;

  2  injunction; grounds.--

  3         (1)  The agency for Health Care Administration may

  4  deny, revoke, or suspend a license, or impose an

  5  administrative fine in the manner provided in chapter 120, or

  6  initiate injunctive proceedings under s. 400.515.

  7         (2)  Any of the following actions by a home health

  8  agency or its employee is grounds for disciplinary action by

  9  the agency for Health Care Administration:

10         (a)  Violation of this part or of applicable rules.

11         (b)  An intentional, reckless, or negligent act that

12  materially affects the health or safety of a patient.

13         (3)  The agency may impose the following penalties for

14  operating without a license upon an owner who has in the past

15  operated, or who currently operates, a licensed home health

16  agency:

17         (a)  If a home health agency that is found to be

18  operating without a license wishes to apply for a license, the

19  home health agency may submit an application only after the

20  agency has verified that the home health agency no longer

21  operates an unlicensed agency.

22         (b)  Any person, partnership, or corporation that

23  violates paragraph (a) and that previously operated a licensed

24  home health agency or concurrently operates both a licensed

25  home health agency and an unlicensed home health agency

26  commits a felony of the third degree, punishable as provided

27  in s. 775.082, s. 775.083, or s. 775.084. If an owner has an

28  interest in more than one home health agency and fails to

29  license any one of those agencies, the agency shall issue a

30  cease and desist order for the activities of the unlicensed

31  home health agency and impose a moratorium on any or all of

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  1  the licensed agencies until the unlicensed home health agency

  2  is licensed.

  3         (c)  If any home health agency meets the criteria in

  4  paragraph (a) or paragraph (b) and that home health agency has

  5  received any government reimbursement for services provided by

  6  an unlicensed home health agency, the agency shall make a

  7  fraud referral to the appropriate government reimbursement

  8  program.

  9         (4)  The agency may deny, revoke, or suspend the

10  license of a home health agency, or may impose on a home

11  health agency administrative fines not to exceed the aggregate

12  sum of $5,000, if:

13         (a)  A home health agency fails to provide at least one

14  of the services listed in s. 400.462(10) directly to patients

15  for a period of 6 consecutive months.

16         (b)  The agency is unable to obtain entry to the home

17  health agency to conduct a licensure survey, complaint

18  investigation, surveillance visit, or monitoring visit.

19         (c)  An applicant or a licensed home health agency has

20  falsely represented a material fact in the application, or has

21  omitted from the application any material fact, including, but

22  not limited to, the fact that the controlling or ownership

23  interest is held by any officer, director, agent, manager,

24  employee, affiliated person, partner, or shareholder who may

25  not be eligible to participate.

26         (d)  An applicant, owner, or person who has a 5 percent

27  or greater interest in a licensed entity:

28         1.  Has been previously found by any licensing,

29  certifying, or professional standards board or agency to have

30  violated standards or conditions that relate to home

31

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  1  health-related licensure or certification, or to the quality

  2  of home health-related services provided.

  3         2.  Has been or is currently excluded, suspended, or

  4  terminated from, or has involuntarily withdrawn from,

  5  participation in the Medicaid program of this state or any

  6  other state, the Medicare program, or any other governmental

  7  health care or health insurance program.

  8         Section 66.  Section 400.484, Florida Statutes, is

  9  amended to read:

10         400.484  Right of inspection.--

11         (1)  Any duly authorized officer or employee of the

12  agency for Health Care Administration may make such

13  inspections and investigations as are necessary in order to

14  determine the state of compliance with this part and with

15  applicable rules.  The right of inspection extends to any

16  business that the agency for Health Care Administration has

17  reason to believe is being operated as a home health agency

18  without a license, but such inspection of any such business

19  may not be made without the permission of the owner or person

20  in charge unless a warrant is first obtained from a circuit

21  court. Any application for a license issued under this part or

22  for license renewal constitutes permission for an appropriate

23  inspection to verify the information submitted on or in

24  connection with the application.

25         (2)  The agency shall impose fines for various classes

26  of deficiencies in accordance with the following schedule:

27         (a)  A class I deficiency is any act, omission, or

28  practice that results in a patient's death, disablement, or

29  permanent injury, or places a patient at imminent risk of

30  death, disablement, or permanent injury. Upon finding a class

31  I deficiency, the agency must impose an administrative fine in

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  1  the amount of $5,000 for each occurrence and each day that the

  2  deficiency exists. In addition, the agency may immediately

  3  revoke the license, or impose a moratorium on the admission of

  4  new patients, until the factors causing the deficiency have

  5  been corrected.

  6         (b)  A class II deficiency is any act, omission, or

  7  practice that has a direct adverse effect on the health,

  8  safety, or security of a patient. Upon finding a class II

  9  deficiency, the agency must impose an administrative fine in

10  the amount of $1,000 for each occurrence and each day that the

11  deficiency exists. In addition, the agency may suspend the

12  license, or impose a moratorium on the admission of new

13  patients, until the factors causing the deficiency have been

14  corrected.

15         (c)  A class III deficiency is any act, omission, or

16  practice that has an indirect adverse effect on the health,

17  safety, or security of a patient. Upon finding an uncorrected

18  or repeated class III deficiency, the agency may impose an

19  administrative fine not to exceed $500 for each occurrence and

20  each day that the uncorrected or repeated deficiency exists.

21         (d)  A class IV deficiency is any act, omission, or

22  practice related to a required report, form, or document which

23  does not have the potential to negatively affect a patient. A

24  class IV deficiency is a deficiency that the agency determines

25  does not threaten the health, safety, or security of a

26  patient. Upon finding an uncorrected or repeated class IV

27  deficiency, the agency may impose an administrative fine not

28  to exceed $200 for each occurrence and each day that the

29  uncorrected or repeated deficiency exists.

30         Section 67.  Section 400.487, Florida Statutes, is

31  amended to read:

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  1         400.487  Patient assessment; establishment and review

  2  of plan of care; provision of services.--

  3         (1)  The home health agency providing skilled care and

  4  treatment must make an assessment of the patient's needs

  5  within 48 hours after the start of services.

  6         (2)  The attending physician for a patient who is to

  7  receive skilled receiving care or treatment provided by a

  8  licensed nurse or by a physical, occupational, or speech

  9  therapist must establish treatment orders a plan of care for

10  the patient on behalf of the home health agency that provides

11  services to the patient.  The original plan of treatment

12  orders must be signed by the physician within 21 days after

13  the start of care and reviewed, at least every 62 days or more

14  frequently if the patient's illness requires, by the physician

15  in consultation with home health agency personnel that provide

16  services to the patient. Based on the assessment and the

17  treatment orders, the home health agency shall prepare a plan

18  of care that describes the services to be provided, the

19  frequency of service provision, and any other information

20  required by rule. The treatment orders and plan of care may be

21  incorporated into one document.

22         (3)  If a client is accepted for home health aide

23  services, homemaker services, or companion services and such

24  services do not require a physician's order, the home health

25  agency shall establish a service-provision plan and maintain a

26  record of the services provided.

27         (4)(3)  Each patient or client has the right to be

28  informed of and to participate in the planning of his or her

29  care.  Each patient must be provided, upon request, a copy of

30  the plan of care or service-provision plan established and

31

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  1  maintained for that patient or client by the home health

  2  agency.

  3         (4)  Home health services that are provided to a

  4  patient must be evaluated in the patient's home by a physician

  5  licensed under chapter 458, chapter 459, chapter 460, or

  6  chapter 461 or by a registered nurse licensed under chapter

  7  464 as frequently as necessary to assure safe and adequate

  8  care, but not less frequently than once every 62 days.

  9         (5)  In the case of nursing services delivered by a

10  home health agency to a patient, the home health agency to

11  which a patient has been admitted for care must provide the

12  initial admission visit, all service evaluation visits, and

13  the discharge visit by qualified personnel who are on the

14  payroll of, and to whom an IRS payroll form W-2 will be issued

15  by, the home health agency at least one home health service to

16  patients for whom it has agreed to provide care.  Services

17  provided by others under contractual arrangements to a home

18  health agency agency's patients must be monitored and managed

19  controlled by the admitting home health agency. The home

20  health agency is fully responsible for ensuring that all care

21  provided through its employees or contract staff is delivered

22  in accordance with this part and applicable rules.

23         (6)  The skilled care services provided by a home

24  health agency, directly or under contract, must be supervised

25  and coordinated in accordance with the plan of care.

26         Section 68.  Section 400.491, Florida Statutes, is

27  amended to read:

28         400.491  Clinical records.--

29         (1)  The home health agency must maintain for each

30  patient who receives skilled care a clinical record that

31  includes the services the home health agency provides directly

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  1  and those provided through arrangement with another health

  2  care provider, except for those services provided by persons

  3  referred under s. 400.509.  Such records must contain

  4  pertinent past and current medical, nursing, social and other

  5  therapeutic information, the plan of treatment, and other such

  6  information as is necessary for the safe and adequate care of

  7  the patient.  When home health services are terminated, the

  8  record must show the date and reason for termination.  Such

  9  records are considered patient records under s. 455.241 s.

10  400.241, and must be maintained by the home health agency for

11  5 years following termination of services.  If a patient

12  transfers to another home health agency, a copy of his or her

13  record must be provided to the other home health agency upon

14  request.

15         (2)  The home health agency must maintain for each

16  client who receives nonskilled care a service-provision plan.

17  Such records must be maintained by the home health agency for

18  1 year following termination of services.

19         Section 69.  Section 400.497, Florida Statutes, is

20  amended to read:

21         400.497  Rules establishing minimum standards.--The

22  agency for Health Care Administration shall adopt, publish,

23  and enforce rules to implement this part, including, as

24  applicable, ss. 400.506 and 400.509, which must provide

25  reasonable and fair minimum standards relating to:

26         (1)  Scope of home health services to be provided.

27         (1)(2)  The qualifications, and minimum training

28  requirements, and supervision requirements of all home health

29  agency personnel, including aides. The agency shall allow

30  shared staffing if the home health agency is part of a

31  retirement community that provides multiple levels of care, is

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  1  located on one campus, is licensed under this chapter, and

  2  otherwise meets the requirements of law and rule.

  3         (2)(3)  Requirements for prospective employees

  4  Procedures for maintaining a record of the employment history

  5  of all home health agency personnel.  A home health agency

  6  must require its personnel to submit an employment history to

  7  the home health agency, and verification of it must verify the

  8  employment history unless through diligent efforts such

  9  verification is not possible.  The agency for Health Care

10  Administration shall prescribe by rule the minimum

11  requirements for establishing that diligent efforts have been

12  made.  The administrator of a home health agency must review

13  the employment history and references of home health agency

14  personnel and applicants for employment.  The Agency for

15  Health Care Administration must review the employment history

16  and references of each administrator of a home health agency.

17  There is no monetary liability on the part of, and no cause of

18  action for damages arises against, a former employer of a

19  prospective employee of or prospective independent contractor

20  with a licensed home health agency who reasonably and in good

21  faith communicates his or her honest opinions about the former

22  employee's job performance. This subsection does not affect

23  the official immunity of an officer or employee of a public

24  corporation.

25         (3)(4)  Licensure application and renewal.

26         (4)(5)  The administration of the home health agency,

27  including requirements for onsite and electronic accessibility

28  of supervisory personnel.

29         (5)(6)  Procedures for administering drugs and

30  biologicals.

31

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  1         (6)(7)  Procedures for maintaining patients' patient

  2  records.

  3         (7)(8)  Provision of Ensuring that the home health

  4  services provided by a home health agency are in accordance

  5  with the plan of care treatment established for each patient

  6  for whom a plan of care is required.

  7         (8)(9)  Geographic service areas.

  8         (9)(10)  Standards for contractual arrangements for the

  9  provision of home health services by providers not employed by

10  the home health agency providing for the patient's care and

11  treatment.

12         Section 70.  Subsection (1) of section 400.506, Florida

13  Statutes, is amended, present subsections (2), (3), (4), (5),

14  (6), (7), (8), (10), (11), (12), (13), (14), (15), and (16) of

15  that section are redesignated as subsections (3), (4), (5),

16  (6), (7), (8), (9), (11), (12), (13), (14), (15), (16), and

17  (17), respectively, present subsection (9) of that section is

18  redesignated as subsection (10) and amended, and a new

19  subsection (2) is added to that section, to read:

20         400.506  Licensure of nurse registries; requirements;

21  penalties.--

22         (1)  A nurse registry is exempt from the licensing

23  requirements of a home health agency, but must be licensed as

24  a nurse registry. Each operational site of a nurse registry

25  must be licensed unless the nurse registry operates more than

26  one site within a county. If the nurse registry operates more

27  than one site within a county, only one license is required

28  for the sites within that county and each operational site

29  shall be listed on the license.

30         (2)  Each applicant for licensure must comply with the

31  following requirements:

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  1         (a)  Upon receipt of a completed, signed, and dated

  2  application, the agency shall require background screening, in

  3  accordance with the level 2 standards for screening set forth

  4  in chapter 435, of the managing employee, or other similarly

  5  titled individual who is responsible for the daily operation

  6  of the nurse registry, and of the financial officer, or other

  7  similarly titled individual who is responsible for the

  8  financial operation of the registry, including billings for

  9  patient care and services.  The applicant shall comply with

10  the procedures for level 2 background screening as set forth

11  in chapter 435.

12         (b)  The agency may require background screening of any

13  other individual who is an applicant if the agency has a

14  reasonable basis for believing that he or she has been

15  convicted of a crime or has committed any other offense

16  prohibited under the level 2 standards for screening set forth

17  in chapter 435.

18         (c)  Proof of compliance with the level 2 background

19  screening requirements of chapter 435 which has been submitted

20  within the previous 5 years in compliance with any other

21  health care or assisted living licensure requirements of this

22  state is acceptable in fulfillment of the requirements of

23  paragraph (a).

24         (d)  A provisional license may be granted to an

25  applicant when each individual required by this section to

26  undergo background screening has met the standards for the

27  abuse registry background check and the Department of Law

28  Enforcement background check but the agency has not yet

29  received background screening results from the Federal Bureau

30  of Investigation. A standard license may be granted to the

31  applicant upon the agency's receipt of a report of the results

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  1  of the Federal Bureau of Investigation background screening

  2  for each individual required by this section to undergo

  3  background screening which confirms that all standards have

  4  been met, or upon the granting of a disqualification exemption

  5  by the agency as set forth in chapter 435. Any other person

  6  who is required to undergo level 2 background screening may

  7  serve in his or her capacity pending the agency's receipt of

  8  the report from the Federal Bureau of Investigation. However,

  9  the person may not continue to serve if the report indicates

10  any violation of background screening standards and a

11  disqualification exemption has not been requested of and

12  granted by the agency as set forth in chapter 435.

13         (e)  Each applicant must submit to the agency, with its

14  application, a description and explanation of any exclusions,

15  permanent suspensions, or terminations of the applicant from

16  the Medicare or Medicaid programs. Proof of compliance with

17  the requirements for disclosure of ownership and control

18  interests under the Medicaid or Medicare programs may be

19  accepted in lieu of this submission.

20         (f)  Each applicant must submit to the agency a

21  description and explanation of any conviction of an offense

22  prohibited under the level 2 standards of chapter 435 by a

23  member of the board of directors of the applicant, its

24  officers, or any individual owning 5 percent or more of the

25  applicant. This requirement does not apply to a director of a

26  not-for-profit corporation or organization if the director

27  serves solely in a voluntary capacity for the corporation or

28  organization, does not regularly take part in the day-to-day

29  operational decisions of the corporation or organization,

30  receives no remuneration for his or her services on the

31  corporation or organization's board of directors, and has no

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  1  financial interest and has no family members with a financial

  2  interest in the corporation or organization, provided that the

  3  director and the not-for-profit corporation or organization

  4  include in the application a statement affirming that the

  5  director's relationship to the corporation satisfies the

  6  requirements of this paragraph.

  7         (g)  A license may not be granted to an applicant if

  8  the applicant or managing employee has been found guilty of,

  9  regardless of adjudication, or has entered a plea of nolo

10  contendere or guilty to, any offense prohibited under the

11  level 2 standards for screening set forth in chapter 435,

12  unless an exemption from disqualification has been granted by

13  the agency as set forth in chapter 435.

14         (h)  The agency may deny or revoke the license if any

15  applicant:

16         1.  Has falsely represented a material fact in the

17  application required by paragraph (e) or paragraph (f), or has

18  omitted any material fact from the application required by

19  paragraph (e) or paragraph (f); or

20         2.  Has had prior action taken against the applicant

21  under the Medicaid or Medicare program as set forth in

22  paragraph (e).

23         (i)  An application for license renewal must contain

24  the information required under paragraphs (e) and (f).

25         (10)(9)(a)  A nurse registry may refer for contract in

26  private residences registered nurses and licensed practical

27  nurses registered and licensed under chapter 464, certified

28  nursing assistants certified under s. 400.211, home health

29  aides who present documented proof of successful completion of

30  the training required by rule of the agency, and sitters,

31  companions, or homemakers for the purposes of providing those

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  1  services authorized under s. 400.509(1). A person referred by

  2  a nurse registry must provide current documentation that he or

  3  she is free from any communicable disease.

  4         (b)  A certified nursing assistant or home health aide

  5  may be referred for a contract to provide care to a patient in

  6  his or her home only if that patient is under a physician's

  7  care.  A certified nursing assistant, or home health aide,

  8  referred for contract in a private residence shall be limited

  9  to assisting a patient with bathing, dressing, toileting,

10  grooming, eating, physical transfer, and those normal daily

11  routines the patient could perform for himself or herself were

12  he or she physically capable.  A certified nursing assistant

13  or home health aide may not provide medical or other health

14  care services that require specialized training and that may

15  be performed only by licensed health care professionals.  The

16  nurse registry shall obtain the name and address of the

17  attending physician and send written notification to the

18  physician within 48 hours after a contract is concluded that a

19  certified nursing assistant or home health aide will be

20  providing care for that patient.

21         (c)  A registered nurse shall make monthly visits to

22  the patient's home to assess the patient's condition and

23  quality of care being provided by the certified nursing

24  assistant or home health aide.  Any condition which in the

25  professional judgment of the nurse requires further medical

26  attention shall be reported to the attending physician and the

27  nurse registry.  The assessment shall become a part of the

28  patient's file with the nurse registry and may be reviewed by

29  the Agency for Health Care Administration during their survey

30  procedure.

31

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  1         (d)  In order to refer for contract in private

  2  residences a certified nursing assistant or any person

  3  specified in s. 400.509(1), the nurse registry and such person

  4  registered with the nurse registry must also be registered

  5  under s. 400.509.  Any person registered as an independent

  6  contractor with a nurse registry for the purpose of providing

  7  services authorized under s. 400.509(1) on or before October

  8  1, 1990, is exempt from registration under s. 400.509 so long

  9  as such person remains continuously registered with that nurse

10  registry.

11         Section 71.  Subsections (1) and (2) of section

12  400.509, Florida Statutes, are amended, present subsections

13  (3), (6), (7), (8), (9), (10), (11), (12), and (13) of that

14  section are redesignated as subsections (4), (7), (8), (9),

15  (10), (11), (12), (13), and (14), respectively, subsections

16  (4) and (5) of that section are redesignated as subsections

17  (5) and (6), respectively, and amended, and a new subsection

18  (3) is added to that section, to read:

19         400.509  Registration of particular service providers

20  exempt from licensure; certificate of registration; regulation

21  of registrants.--

22         (1)  Any person who that provides domestic maid

23  services, sitter services, companion services, or homemaker

24  services and does not provide a home health service to a

25  person is exempt from licensure under this part. However, any

26  person who that provides sitter services for adults, companion

27  services, or homemaker services must register with the Agency

28  for Health Care Administration. This section does not apply to

29  an individual who provides services under a contract with the

30  Department of Children and Family Services and who has

31  undergone screening under s. 393.0655.

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  1         (2)  Registration consists of annually filing with the

  2  agency for Health Care Administration, under oath, on forms

  3  provided by it, the following information:

  4         (a)  The name, address, date of birth, and social

  5  security number of the individual, or the name and address of

  6  the person, providing the service.

  7         (b)  If the registrant is a firm or partnership, the

  8  name, address, date of birth, and social security number of

  9  every member.

10         (c)  If the registrant is a corporation or association,

11  its name and address, the name, address, date of birth, and

12  social security number of each of its directors and officers,

13  and the name and address of each person having at least a

14  5-percent 10-percent interest in the corporation or

15  association.

16         (d)  The name, address, date of birth, and social

17  security number of each person employed or under contract.

18         (3)  Each applicant for registration must comply with

19  the following requirements:

20         (a)  Upon receipt of a completed, signed, and dated

21  application, the agency shall require background screening, in

22  accordance with the level 1 standards for screening set forth

23  in chapter 435, of the individual providing the service. If

24  the applicant is a firm or partnership, the agency shall

25  require background screening of the managing employee, or

26  other similarly titled individual who is responsible for the

27  operation of the entity, and of the financial officer, or

28  other similarly titled individual who is responsible for the

29  financial operation of the entity, including billings for

30  client services, in accordance with level 2 standards for

31  background screening as set forth in chapter 435.

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  1         (b)  The agency may require background screening of any

  2  other individual who is an applicant if the agency has a

  3  reasonable basis for believing that he or she has been

  4  convicted of a crime or has committed any other offense

  5  prohibited under the level 2 standards for screening set forth

  6  in chapter 435.

  7         (c)  Proof of compliance with the level 2 background

  8  screening requirements of chapter 435 which has been submitted

  9  within the previous 5 years in compliance with any other

10  healthcare or assisted living licensure requirements of this

11  state is acceptable in fulfillment of the requirements of

12  paragraph (a).

13         (d)  A provisional registration may be granted to an

14  applicant when each individual required by this section to

15  undergo background screening has met the standards for the

16  abuse registry background check and the Department of Law

17  Enforcement background check but the agency has not yet

18  received background screening results from the Federal Bureau

19  of Investigation. A standard registration may be granted to

20  the applicant upon the agency's receipt of a report of the

21  results of the Federal Bureau of Investigation background

22  screening for each individual required by this section to

23  undergo background screening which confirms that all standards

24  have been met, or upon the granting of a disqualification

25  exemption by the agency as set forth in chapter 435. Any other

26  person who is required to undergo level 2 background screening

27  may serve in his or her capacity pending the agency's receipt

28  of the report from the Federal Bureau of Investigation.

29  However, the person may not continue to serve if the report

30  indicates any violation of background screening standards and

31

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  1  a disqualification exemption has not been requested of and

  2  granted by the agency as set forth in chapter 435.

  3         (e)  Each applicant must submit to the agency, with its

  4  application, a description and explanation of any exclusions,

  5  permanent suspensions, or terminations of the applicant from

  6  the Medicare or Medicaid programs. Proof of compliance with

  7  the requirements for disclosure of ownership and control

  8  interests under the Medicaid or Medicare programs may be

  9  accepted in lieu of this submission.

10         (f)  Each applicant must submit to the agency a

11  description and explanation of any conviction of an offense

12  prohibited under the level 2 standards of chapter 435 by a

13  member of the board of directors of the applicant, its

14  officers, or any individual owning 5 percent or more of the

15  applicant. This requirement does not apply to a director of a

16  not-for-profit corporation or organization if the director

17  serves solely in a voluntary capacity for the corporation or

18  organization, does not regularly take part in the day-to-day

19  operational decisions of the corporation or organization,

20  receives no remuneration for his or her services on the

21  corporation or organization's board of directors, and has no

22  financial interest and has no family members with a financial

23  interest in the corporation or organization, provided that the

24  director and the not-for-profit corporation or organization

25  include in the application a statement affirming that the

26  director's relationship to the corporation satisfies the

27  requirements of this paragraph.

28         (g)  A registration may not be granted to an applicant

29  if the applicant or managing employee has been found guilty

30  of, regardless of adjudication, or has entered a plea of nolo

31  contendere or guilty to, any offense prohibited under the

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  1  level 2 standards for screening set forth in chapter 435,

  2  unless an exemption from disqualification has been granted by

  3  the agency as set forth in chapter 435.

  4         (h)  The agency may deny or revoke the registration if

  5  any applicant:

  6         1.  Has falsely represented a material fact in the

  7  application required by paragraph (e) or paragraph (f), or has

  8  omitted any material fact from the application required by

  9  paragraph (e) or paragraph (f); or

10         2.  Has had prior action taken against the applicant

11  under the Medicaid or Medicare program as set forth in

12  paragraph (e).

13         (i)  An application for registration renewal must

14  contain the information required under paragraphs (e) and (f).

15         (5)(4)  Each registrant must establish the employment

16  history of persons employed or under contract having contact

17  at any time with clients patients in their homes by:

18         (a)  Requiring persons employed or under contract to

19  submit an employment history to the registrant; and

20         (b)  Verifying the employment history, unless through

21  diligent efforts such verification is not possible.  The

22  agency for Health Care Administration shall prescribe by rule

23  the minimum requirements for establishing that diligent

24  efforts have been made.

25

26  There is no monetary liability on the part of, and no cause of

27  action for damages arises against, a former employer of a

28  prospective employee of or prospective independent contractor

29  with a registrant who reasonably and in good faith

30  communicates his or her honest opinions about the former

31  employee's job performance.  This subsection does not affect

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  1  the official immunity of an officer or employee of a public

  2  corporation.

  3         (6)(5)  On or before the first day on which services

  4  are provided to a client patient, any registrant under this

  5  part must inform the client patient and his or her immediate

  6  family, if appropriate, of the right to report abusive,

  7  neglectful, or exploitative practices.  The statewide

  8  toll-free telephone number for the central abuse registry must

  9  be provided to patients in a manner that is clearly legible

10  and must include the words: "To report abuse, neglect, or

11  exploitation, please call toll-free ...(phone number)...."

12  Registrants must establish appropriate policies and procedures

13  for providing such notice to clients patients.

14         Section 72.  Section 400.512, Florida Statutes, is

15  amended to read:

16         400.512  Screening of home health agency personnel;

17  nurse registry personnel; and sitters, companions, and

18  homemakers.--The agency for Health Care Administration shall

19  require employment, or contractor, screening as provided in

20  chapter 435, using the level 1 standards for screening set

21  forth in that chapter, for home health agency personnel;

22  persons referred for contract employment by nurse registries;

23  and persons employed or referred by sitter, companion, or

24  homemaker services registered under s. 400.509.

25         (1)  The agency for Health Care Administration may

26  grant exemptions from disqualification from employment under

27  this section as provided in s. 435.07.

28         (2)  The administrator of each home health agency,

29  nurse registry, or sitter, companion, or homemaker service

30  registered under s. 400.509 must sign an affidavit annually,

31  under penalty of perjury, stating that all personnel hired, or

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  1  registered, on or after October 1, 1994 1989, who enter the

  2  home of a patient or client in the capacity of their service

  3  capacity employment have been screened and that its remaining

  4  personnel have worked for the home health agency or

  5  registrant, or have been registered with the nurse registry,

  6  continuously since before October 1, 1994 1989.

  7         (3)  As a prerequisite to operating as a home health

  8  agency, or sitter, companion, or homemaker service under s.

  9  400.509, the administrator must submit to the agency his or

10  her for Health Care Administration their name and any other

11  information necessary to conduct a complete screening

12  according to this section.  The agency for Health Care

13  Administration shall submit the information to the Department

14  of Law Enforcement and the department's abuse hotline for

15  state processing.  The agency for Health Care Administration

16  shall review the record of the administrator with respect to

17  the offenses specified in this section and shall notify the

18  owner of its findings.  If disposition information is missing

19  on a criminal record, the administrator, upon request of the

20  agency for Health Care Administration, must obtain and supply

21  within 30 days the missing disposition information to the

22  agency for Health Care Administration.  Failure to supply

23  missing information within 30 days or to show reasonable

24  efforts to obtain such information will result in automatic

25  disqualification.

26         (4)  Proof of compliance with the screening

27  requirements of chapter 435 shall be accepted in lieu of the

28  requirements of this section if the provided that such person

29  has been continuously employed, or registered, without a

30  breach in service that exceeds 180 days, the proof of

31  compliance is not more than 2 years old, and the person has

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  1  been screened through the central abuse registry and tracking

  2  system of the department and by the Department of Law

  3  Enforcement. An employer or registry shall directly provide

  4  proof of compliance to another home health agency or registry,

  5  and a potential home health agency or registry may not accept

  6  any proof of compliance directly from the person who requires

  7  screening. Proof of compliance with the screening requirements

  8  of this section shall be provided upon request to the person

  9  screened by the home health agencies; nurse registries; or

10  sitter, companion, or homemaker services registered under s.

11  400.509.

12         (5)  There is no monetary liability on the part of, and

13  no cause of action for damages arises against, a licensed home

14  health agency, licensed nurse registry, or sitter, companion,

15  or homemaker service registered under s. 400.509, that, upon

16  notice of a confirmed report of adult abuse, neglect, or

17  exploitation under paragraph (2)(b), terminates the employee,

18  or removes from the licensed nurse registry the person,

19  against whom the report was issued, whether or not the

20  employee or contractor has filed for an exemption with the

21  agency in accordance with chapter 435 for Health Care

22  Administration under subparagraph (3)(a)5. and whether or not

23  the time for filing has expired.

24         (6)  The costs of processing the statewide

25  correspondence criminal records checks and the search of the

26  department's central abuse hotline must be borne by the home

27  health agency; the nurse registry; or the sitter, companion,

28  or homemaker service registered under s. 400.509, or by the

29  person being screened, at the discretion of the home health

30  agency, nurse registry, or s. 400.509 registrant.

31

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  1         (7)  The Agency for Health Care Administration; the

  2  home health agency; nurse registry; or sitter, companion, or

  3  homemaker service registered under s. 400.509 may not use the

  4  criminal records, juvenile records, or central abuse hotline

  5  information of a person for any purpose other than determining

  6  whether that person meets minimum standards of good moral

  7  character for home health agency personnel.  The criminal

  8  records, juvenile records, or central abuse hotline

  9  information obtained by the Agency for Health Care

10  Administration; home health agency; nurse registry; or sitter,

11  companion, or homemaker service for determining the moral

12  character of such personnel are confidential and exempt from

13  the provisions of s. 119.07(1) and s. 24(a), Art. I of the

14  State Constitution.

15         (8)(a)  It is a misdemeanor of the first degree,

16  punishable under s. 775.082 or s. 775.083, for any person

17  willfully, knowingly, or intentionally to:

18         1.  Fail, by false statement, misrepresentation,

19  impersonation, or other fraudulent means, to disclose in any

20  application for voluntary or paid employment a material fact

21  used in making a determination as to such person's

22  qualifications to be an employee under this section;

23         2.  Operate or attempt to operate an entity licensed or

24  registered under this part with persons who do not meet the

25  minimum standards for good moral character as contained in

26  this section; or

27         3.  Use information from the criminal records or

28  central abuse hotline obtained under this section for any

29  purpose other than screening that person for employment as

30  specified in this section or release such information to any

31

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  1  other person for any purpose other than screening for

  2  employment under this section.

  3         (b)  It is a felony of the third degree, punishable

  4  under s. 775.082, s. 775.083, or s. 775.084, for any person

  5  willfully, knowingly, or intentionally to use information from

  6  the juvenile records of a person obtained under this section

  7  for any purpose other than screening for employment under this

  8  section.

  9         Section 73.  Subsections (3), (4), (5), (6), (7), (8),

10  (9), (10), and (11) are added to section 400.555, Florida

11  Statutes, to read:

12         400.555  Application for licensure.--

13         (3)  Each applicant for licensure must comply with the

14  following requirements:

15         (a)  Upon receipt of a completed, signed, and dated

16  application, the agency shall require background screening of

17  the applicant, in accordance with the level 2 standards for

18  screening set forth in chapter 435. As used in this

19  subsection, the term "applicant" means the facility

20  administrator or similarly titled individual who is

21  responsible for the day-to-day operation of the licensed

22  facility and the facility financial officer or similarly

23  titled individual who is responsible for the financial

24  operation of the licensed facility.

25         (b)  The agency may require background screening for a

26  member of the board of directors of the licensee or an officer

27  or an individual owning 5 percent or more of the licensee if

28  the agency reasonably suspects that such individual has been

29  convicted of an offense prohibited under the level 2 standards

30  for screening set forth in chapter 435.

31

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  1         (c)  Proof of compliance with the level 2 background

  2  screening requirements of chapter 435 which has been submitted

  3  within the previous 5 years in compliance with any other

  4  healthcare or assisted living licensure requirements of this

  5  state is acceptable in fulfillment of the requirements of

  6  paragraph (a).

  7         (d)  A provisional license may be granted to an

  8  applicant when each individual required by this section to

  9  undergo background screening has met the standards for the

10  abuse registry background check and the Department of Law

11  Enforcement background check but the agency has not yet

12  received background screening results from the Federal Bureau

13  of Investigation, or a request for a disqualification

14  exemption has been submitted to the agency as set forth in

15  chapter 435 but a response has not yet been issued.  A

16  standard license may be granted to the applicant upon the

17  agency's receipt of a report of the results of the Federal

18  Bureau of Investigation background screening for each

19  individual required by this section to undergo background

20  screening which confirms that all standards have been met, or

21  upon the granting of a disqualification exemption by the

22  agency as set forth in chapter 435.  Any other person who is

23  required to undergo level 2 background screening may serve in

24  his or her capacity pending the agency's receipt of the report

25  from the Federal Bureau of Investigation. However, the person

26  may not continue to serve if the report indicates any

27  violation of background screening standards and a

28  disqualification exemption has not been requested of and

29  granted by the agency as set forth in chapter 435.

30         (e)  Each applicant must submit to the agency, with its

31  application, a description and explanation of any exclusions,

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  1  permanent suspensions, or terminations of the applicant from

  2  the Medicare or Medicaid programs. Proof of compliance with

  3  disclosure of ownership and control interest requirements of

  4  the Medicaid or Medicare programs may be accepted in lieu of

  5  this submission.

  6         (f)  Each applicant must submit to the agency a

  7  description and explanation of any conviction of an offense

  8  prohibited under the level 2 standards of chapter 435 by a

  9  member of the board of directors of the applicant, its

10  officers, or any individual owning 5 percent or more of the

11  applicant. This requirement shall not apply to a director of a

12  not-for-profit corporation or organization if the director

13  serves solely in a voluntary capacity for the corporation or

14  organization, does not regularly take part in the day-to-day

15  operational decisions of the corporation or organization,

16  receives no remuneration for his or her services on the

17  corporation or organization's board of directors, and has no

18  financial interest and has no family members with a financial

19  interest in the corporation or organization, provided that the

20  director and the not-for-profit corporation or organization

21  include in the application a statement affirming that the

22  director's relationship to the corporation satisfies the

23  requirements of this paragraph.

24         (g)  A license may not be granted to an applicant if

25  the applicant, operator, or financial officer has been found

26  guilty of, regardless of adjudication, or has entered a plea

27  of nolo contendere or guilty to, any offense prohibited under

28  the level 2 standards for screening set forth in chapter 435,

29  unless an exemption from disqualification has been granted by

30  the agency as set forth in chapter 435.

31

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  1         (h)  The agency may deny or revoke licensure if the

  2  applicant:

  3         1.  Has falsely represented a material fact in the

  4  application required by paragraph (e) or paragraph (f), or has

  5  omitted any material fact from the application required by

  6  paragraph (e) or paragraph (f); or

  7         2.  Has had prior action taken against the applicant

  8  under the Medicaid or Medicare program as set forth in

  9  paragraph (e).

10         (i)  An application for license renewal must contain

11  the information required under paragraphs (e) and (f).

12         Section 74.  Section 400.5572, Florida Statutes, is

13  created to read:

14         400.5572  Background screening.--

15         (1)  The center owner or operator shall conduct level 1

16  background screening, as set forth in chapter 435, on all

17  employees hired on or after October 1, 1998, who perform basic

18  or supportive and optional services defined in s. 400.551.

19  The agency may exempt an individual from employment

20  disqualification as set forth in chapter 435.

21         (2)  Proof of compliance with the level 1 background

22  screening requirements of chapter 435 may be satisfied as

23  follows:

24         (a)  The employee or applicant for employment has had a

25  level 1 background screening to qualify for a professional

26  license in this state.  Proof of compliance with the level 1

27  screening requirements must be accompanied, under penalty of

28  perjury, by a copy of the applicant's current professional

29  license and an affidavit of compliance with the level 1

30  screening requirements.

31

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  1         (b)  The employee or applicant for employment has been

  2  continuously employed in the same type of occupation for which

  3  the person is seeking employment without a breach in service

  4  that exceeds 180 days, and proof of compliance with the level

  5  1 screening requirement is no more than 2 years old. Proof of

  6  compliance shall be provided directly from one employer or

  7  contractor to another, and a potential employer or contractor

  8  may not accept any proof of compliance directly from the

  9  person who was screened.  Upon request, proof of completion of

10  the level 1 screening requirements of this section shall be

11  provided by the employer retaining documentation of the

12  screening to the person who was screened.

13         (c)  The employee or applicant seeking employment is

14  employed by a corporation or business entity or related

15  corporation or business entity that owns, operates, or manages

16  more than one facility or agency licensed under chapter 400

17  for whom a level 1 screening was conducted by the corporation

18  or business entity as a condition of initial employment or

19  continued employment.

20         (3)  When an employee, volunteer, operator, or owner of

21  a facility has a confirmed report of adult abuse, neglect, or

22  exploitation, as defined in s. 415.102, and the protective

23  investigator knows that the individual is an employee,

24  volunteer, operator, or owner of a center, the agency must be

25  notified of the confirmed report.

26         Section 75.  Section 400.606, Florida Statutes, is

27  amended to read:

28         400.606  License; application; provisional license

29  renewal; conditional license or permit; certificate of need.--

30         (1)  A license application must be filed on a form

31  provided by the agency and must be accompanied by the

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  1  appropriate license fee as well as satisfactory proof that the

  2  hospice is in compliance with this part and any rules adopted

  3  by the department and proof of financial ability to operate

  4  and conduct the hospice in accordance with the requirements of

  5  this part.  The initial application must be accompanied by a

  6  plan for the delivery of home, residential, and homelike

  7  inpatient hospice services to terminally ill persons and their

  8  families.  Such plan must contain, but need not be limited to:

  9         (a)  The estimated average number of terminally ill

10  persons to be served monthly.

11         (b)  The geographic area in which hospice services will

12  be available.

13         (c)  A listing of services which are or will be

14  provided, either directly by the applicant or through

15  contractual arrangements with existing providers.

16         (d)  Provisions for the implementation of hospice home

17  care within 3 months after licensure.

18         (e)  Provisions for the implementation of hospice

19  homelike inpatient care within 12 months after licensure.

20         (f)  The number and disciplines of professional staff

21  to be employed.

22         (g)  The name and qualifications of any existing or

23  potential contractee.

24         (h)  A plan for attracting and training volunteers.

25         (i)  The projected annual operating cost of the

26  hospice.

27         (j)  A statement of financial resources and personnel

28  available to the applicant to deliver hospice care.

29

30  If the applicant is an existing health care provider, the

31  application must be accompanied by a copy of the most recent

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  1  profit-loss statement and, if applicable, the most recent

  2  licensure inspection report.

  3         (2)  Each applicant for licensure must comply with the

  4  following requirements:

  5         (a)  Upon receipt of a completed, signed, and dated

  6  application, the agency shall require background screening of

  7  the applicant, in accordance with the level 2 standards for

  8  screening set forth in chapter 435. As used in this

  9  subsection, the term "applicant" means the facility

10  administrator or similarly titled individual who is

11  responsible for the day-to-day operation of the licensed

12  facility and the facility financial officer or similarly

13  titled individual who is responsible for the financial

14  operation of the licensed facility.

15         (b)  The agency may require background screening for a

16  member of the board of directors of the licensee or an officer

17  or an individual owning 5 percent or more of the licensee if

18  the agency reasonably suspects that such individual has been

19  convicted of an offense prohibited under the level 2 standards

20  for screening set forth in chapter 435.

21         (c)  Proof of compliance with the level 2 background

22  screening requirements of chapter 435 which has been submitted

23  within the previous 5 years in compliance with any other

24  health care or assisted living licensure requirements of this

25  state is acceptable in fulfillment of paragraph (a).

26         (d)  A provisional license may be granted to an

27  applicant when each individual required by this section to

28  undergo background screening has met the standards for the

29  abuse registry background check and the Department of Law

30  Enforcement background check but the agency has not yet

31  received background screening results from the Federal Bureau

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  1  of Investigation.  A standard license may be granted to the

  2  applicant upon the agency's receipt of a report of the results

  3  of the Federal Bureau of Investigation background screening

  4  for each individual required by this section to undergo

  5  background screening which confirms that all standards have

  6  been met, or upon the granting of a disqualification exemption

  7  by the agency as set forth in chapter 435.  Any other person

  8  who is required to undergo level 2 background screening may

  9  serve in his or her capacity pending the agency's receipt of

10  the report from the Federal Bureau of Investigation. However,

11  the person may not continue to serve if the report indicates

12  any violation of background screening standards and a

13  disqualification exemption has not been requested of and

14  granted by the agency as set forth in chapter 435.

15         (e)  Each applicant must submit to the agency, with its

16  application, a description and explanation of any exclusions,

17  permanent suspensions, or terminations of the applicant from

18  the Medicare or Medicaid programs. Proof of compliance with

19  disclosure of ownership and control interest requirements of

20  the Medicaid or Medicare programs may be accepted in lieu of

21  this submission.

22         (f)  Each applicant must submit to the agency a

23  description and explanation of any conviction of an offense

24  prohibited under the level 2 standards of chapter 435 by a

25  member of the board of directors of the applicant, its

26  officers, or any individual owning 5 percent or more of the

27  applicant. This requirement does not apply to a director of a

28  not-for-profit corporation or organization if the director

29  serves solely in a voluntary capacity for the corporation or

30  organization, does not regularly take part in the day-to-day

31  operational decisions of the corporation or organization,

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  1  receives no remuneration for his or her services on the

  2  corporation or organization's board of directors, and has no

  3  financial interest and has no family members with a financial

  4  interest in the corporation or organization, provided that the

  5  director and the not-for-profit corporation or organization

  6  include in the application a statement affirming that the

  7  director's relationship to the corporation satisfies the

  8  requirements of this paragraph.

  9         (g)  A license may not be granted to an applicant if

10  the applicant, managing employee, or financial officer has

11  been found guilty of, regardless of adjudication, or has

12  entered a plea of nolo contendere or guilty to, any offense

13  prohibited under the level 2 standards for screening set forth

14  in chapter 435, unless an exemption from disqualification has

15  been granted by the agency as set forth in chapter 435.

16         (h)  The agency may deny or revoke licensure if the

17  applicant:

18         1.  Has falsely represented a material fact in the

19  application required by paragraph (e) or paragraph (f), or has

20  omitted any material fact from the application required by

21  paragraph (e) or paragraph (f); or

22         2.  Has had prior action taken against the applicant

23  under the Medicaid or Medicare program as set forth in

24  paragraph (e).

25         (i)  An application for license renewal must contain

26  the information required under paragraphs (e) and (f).

27         (3)(2)  A license issued for the operation of a

28  hospice, unless sooner suspended or revoked, shall expire

29  automatically 1 year from the date of issuance.  Sixty days

30  prior to the expiration date, a hospice wishing to renew its

31  license shall submit an application for renewal to the agency

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  1  on forms furnished by the agency.  The agency shall renew the

  2  license if the applicant has first met the requirements

  3  established under this part and all applicable rules and has

  4  provided the information described in subsection (1) in

  5  addition to the application.  However, the application for

  6  license renewal shall be accompanied by an update of the plan

  7  for delivery of hospice care only if information contained in

  8  the plan submitted pursuant to subsection (1) is no longer

  9  applicable.

10         (4)(3)  A hospice against which a revocation or

11  suspension proceeding is pending at the time of license

12  renewal may be issued a conditional license by the agency

13  effective until final disposition of such proceeding.  If

14  judicial relief is sought from the final agency action, the

15  court having jurisdiction may issue a conditional permit for

16  the duration of the judicial proceeding.

17         (5)(4)  The agency shall not issue a license to a

18  hospice that fails to receive a certificate of need under the

19  provisions of ss. 408.031-408.045. A licensed hospice is a

20  health care facility as that term is used in s. 408.039(5) and

21  is entitled to initiate or intervene in an administrative

22  hearing.

23         (6)(5)  A freestanding hospice facility that is

24  primarily engaged in providing inpatient and related services

25  and that is not otherwise licensed as a health care facility

26  shall be required to obtain a certificate of need. However, a

27  freestanding hospice facility with six or fewer beds shall not

28  be required to comply with institutional standards such as,

29  but not limited to, standards requiring sprinkler systems,

30  emergency electrical systems, or special lavatory devices.

31

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  1         Section 76.  Subsection (4) of section 400.619, Florida

  2  Statutes, is amended, present subsections (5), (6), (7), (8),

  3  (9), (10), (12), and (13) of that section are redesignated as

  4  subsections (11), (12), (13), (14), (15), (16), (18) and (19),

  5  respectively, present subsection (11) is redesignated as

  6  subsection (17) and amended, and new subsections (5), (6),

  7  (7), (8), (9), and (10), are added to that section, to read:

  8         400.619  Licensure requirements.--

  9         (4)  Upon receipt of a completed, signed, and dated

10  license application and the fee, the agency must initiate

11  background screening using the level 1 standards for screening

12  which are set forth in chapter 435 for check with the abuse

13  registry and the Department of Law Enforcement concerning the

14  adult family-care home applicant, designated relief persons,

15  all adult household members, and all staff members. The

16  applicant must comply with the procedures for background

17  screening as set forth in chapter 435. The agency shall also

18  conduct an onsite visit to the home that is to be licensed.

19         (5)  Proof of compliance with the level 1 background

20  screening requirements of chapter 435 which has been submitted

21  within the previous 5 years in compliance with any other

22  healthcare or assisted living licensure requirements of this

23  state is acceptable in fulfillment of the required level 1

24  background screening of the applicant.

25         (6)  Proof of compliance with the level 1 background

26  screening requirements of chapter 435 may be satisfied as

27  follows:

28         (a)  The applicant, adult household member, staff

29  person, or designated relief person has had a level 1

30  background screening to qualify for a professional license in

31  this state.  Proof of compliance with the level 1 screening

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  1  requirement must be accompanied, under penalty of perjury, by

  2  a copy of the applicant's current professional license and an

  3  affidavit of compliance with the level 1 screening

  4  requirement.

  5         (b)  The applicant, adult household member, staff

  6  person, or designated relief person has been continuously

  7  employed in the same type of occupation for which the person

  8  is seeking employment without a breach in service that exceeds

  9  180 days, and proof of compliance with the level 1 screening

10  requirement is no more than 2 years old.  Proof of compliance

11  shall be provided directly from one employer or contractor to

12  another, and a potential employer or contractor may not accept

13  any proof of compliance directly from the person who was

14  screened.  Upon request, proof of completion of the level 1

15  screening requirement of this section shall be provided by the

16  employer retaining documentation of the screening to the

17  person who was screened.

18         (7)  The application must be accompanied by an

19  affidavit, under penalty of perjury, providing the following

20  information regarding the applicant:

21         (a)  A description and explanation of any exclusions,

22  permanent suspensions, or terminations of the applicant from

23  participation in the Medicaid or Medicare programs or any

24  other governmental healthcare or governmental health insurance

25  program.

26         (b)  Proof of compliance by the applicant with the

27  level 1 background screening standards as set forth in chapter

28  435, and by all adult household members, all staff, and all

29  relief persons with the level 1 background screening standards

30  set forth in chapter 435.

31

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  1         (8)  A license may not be granted to any applicant if

  2  the applicant, adult household member, staff member, or

  3  designated relief person has been found guilty of, regardless

  4  of adjudication, or has entered a plea of nolo contendere or

  5  guilty to, any offense prohibited under the level 1 standards

  6  for screening set forth in chapter 435, unless an exemption

  7  from disqualification has been granted by the agency as set

  8  forth in chapter 435.

  9         (17)(11)  The agency may deny, suspend, or revoke a

10  license for any of the following reasons:

11         (a)  A confirmed report, obtained under s. 415.1075, of

12  abuse, neglect, or exploitation, or conviction of a crime

13  related to abuse, neglect, or exploitation.

14         (b)  A proposed confirmed report that remains unserved

15  and is maintained in the central abuse registry and tracking

16  system pursuant to s. 415.1065(2)(c).

17         (c)  An intentional or negligent act materially

18  affecting the health, safety, or welfare of the adult

19  family-care home residents.

20         (d)  A violation of ss. 400.616-400.629 or rules

21  adopted under ss. 400.616-400.629, including the failure to

22  comply with any restrictions specified in the license.

23         (e)  Submission of fraudulent or inaccurate information

24  to the agency.

25         (f)  Conviction of a felony involving violence to a

26  person.

27         (g)  Failure to pay a civil penalty assessed under this

28  part.

29         (h)  Has had prior Medicaid or Medicare action taken

30  against the applicant as set forth in subsection (8).

31

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  1         Section 77.  Subsection (1) of section 400.702, Florida

  2  Statutes, is amended to read:

  3         400.702  Development of intermediate care facilities.--

  4         (1)  The Department of Health and Rehabilitative

  5  Services is directed to issue a request for proposals,

  6  pursuant to the provisions of chapter 287, for a pilot program

  7  of intermediate-level care facilities.  The development of

  8  intermediate-level care facilities under this pilot program

  9  shall be limited to four projects in geographic locations

10  distributed in the south, north, and central part of the state

11  and shall not exceed a total of 120 beds in each location.

12  None of the projects may accept residents prior to July 1,

13  1990.  The intermediate-level care facilities shall:

14         (a)  Provide care to residents whose condition requires

15  intermediate care services, including 24-hour observation and

16  care and the constant availability of medical and nursing

17  treatment and care, but not to the degree of care and

18  treatment provided in a hospital or that which meets the

19  criteria for skilled nursing services.

20         (b)  Accept only low-income residents who receive

21  subsidized housing vouchers through the United States

22  Department of Housing and Urban Development or other

23  subsidized housing programs.

24         (b)(c)  Accept only low-income residents who are

25  Medicaid recipients or Medicaid-eligible recipients.

26         (c)(d)  Be exempt from all requirements to obtain a

27  certificate of need pursuant to ss. 408.031-408.045; however,

28  the beds so utilized will be counted in the total bed supply

29  for determination of nursing home bed needs.

30         (d)(e)  Be licensed as a nursing home pursuant to part

31  II and ss. 408.061, 408.08, and 408.20, except that the

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  1  department is given the authority to waive any requirement

  2  that unnecessarily restricts the development of intermediate

  3  care facilities, provided such waiver does not contravene

  4  federal or state law. The department shall, however, ensure

  5  that the health and safety of residents of intermediate care

  6  facilities are adequately protected.

  7         Section 78.  Section 400.801, Florida Statutes, is

  8  amended to read:

  9         400.801  Homes for special services.--

10         (1)  As used in this section, the term:

11         (a)  "Agency" means the "Agency for Health Care

12  Administration."

13         (b)  "Home for special services" means a site where

14  specialized health care services are provided, including

15  personal and custodial care, but not continuous nursing

16  services.

17         (2)  A person must obtain a license from the agency to

18  operate a home for special services.  A license is valid for 1

19  year.

20         (3)  The application for a license under this section

21  must be made on a form provided by the agency.  A

22  nonrefundable license fee of not more than $1,000 must be

23  submitted with the license application.

24         (4)  Each applicant for licensure must comply with the

25  following requirements:

26         (a)  Upon receipt of a completed, signed, and dated

27  application, the agency shall require background screening, in

28  accordance with the level 2 standards for screening set forth

29  in chapter 435, of the managing employee, or other similarly

30  titled individual who is responsible for the daily operation

31  of the facility, and of the financial officer, or other

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  1  similarly titled individual who is responsible for the

  2  financial operation of the facility, including billings for

  3  client care and services, in accordance with the level 2

  4  standards for screening set forth in chapter 435.  The

  5  applicant must comply with the procedures for level 2

  6  background screening as set forth in chapter 435.

  7         (b)  The agency may require background screening of any

  8  other individual who is an applicant if the agency has a

  9  reasonable basis for believing that he or she has been

10  convicted of a crime or has committed any other offense

11  prohibited under the level 2 standards for screening set forth

12  in chapter 435.

13         (c)  Proof of compliance with the level 2 background

14  screening requirements of chapter 435 which has been submitted

15  within the previous 5 years in compliance with any other

16  health care or assisted living licensure requirements of this

17  state is acceptable in fulfillment of the requirements of

18  paragraph (a).

19         (d)  A provisional license may be granted to an

20  applicant when each individual required by this section to

21  undergo background screening has met the standards for the

22  abuse registry background check and the Department of Law

23  Enforcement background check but the agency has not yet

24  received background screening results from the Federal Bureau

25  of Investigation, or a request for a disqualification

26  exemption has been submitted to the agency as set forth in

27  chapter 435 but a response has not yet been issued. A standard

28  license may be granted to the applicant upon the agency's

29  receipt of a report of the results of the Federal Bureau of

30  Investigation background screening for each individual

31  required by this section to undergo background screening which

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  1  confirms that all standards have been met, or upon the

  2  granting of a disqualification exemption by the agency as set

  3  forth in chapter 435. Any other person who is required to

  4  undergo level 2 background screening may serve in his or her

  5  capacity pending the agency's receipt of the report from the

  6  Federal Bureau of Investigation. However, the person may not

  7  continue to serve if the report indicates any violation of

  8  background screening standards and a disqualification

  9  exemption has not been requested of and granted by the agency

10  as set forth in chapter 435.

11         (e)  Each applicant must submit to the agency, with its

12  application, a description and explanation of any exclusions,

13  permanent suspensions, or terminations of the applicant from

14  the Medicare or Medicaid programs. Proof of compliance with

15  the requirements for disclosure of ownership and control

16  interests under the Medicaid or Medicare programs may be

17  accepted in lieu of this submission.

18         (f)  Each applicant must submit to the agency a

19  description and explanation of any conviction of an offense

20  prohibited under the level 2 standards of chapter 435 by a

21  member of the board of directors of the applicant, its

22  officers, or any individual owning 5 percent or more of the

23  applicant. This requirement does not apply to a director of a

24  not-for-profit corporation or organization if the director

25  serves solely in a voluntary capacity for the corporation or

26  organization, does not regularly take part in the day-to-day

27  operational decisions of the corporation or organization,

28  receives no remuneration for his or her services on the

29  corporation or organization's board of directors, and has no

30  financial interest and has no family members with a financial

31  interest in the corporation or organization, provided that the

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  1  director and the not-for-profit corporation or organization

  2  include in the application a statement affirming that the

  3  director's relationship to the corporation satisfies the

  4  requirements of this paragraph.

  5         (g)  A license may not be granted to an applicant if

  6  the applicant or managing employee has been found guilty of,

  7  regardless of adjudication, or has entered a plea of nolo

  8  contendere or guilty to, any offense prohibited under the

  9  level 2 standards for screening set forth in chapter 435,

10  unless an exemption from disqualification has been granted by

11  the agency as set forth in chapter 435.

12         (h)  The agency may deny or revoke licensure if the

13  applicant:

14         1.  Has falsely represented a material fact in the

15  application required by paragraph (e) or paragraph (f), or has

16  omitted any material fact from the application required by

17  paragraph (e) or paragraph (f); or

18         2.  Has had prior action taken against the applicant

19  under the Medicaid or Medicare program as set forth in

20  paragraph (e).

21         (i)  An application for license renewal must contain

22  the information required under paragraphs (e) and (f).

23         (5)(4)  Application for license renewal must be

24  submitted 90 days before the expiration of the license.

25         (6)(5)  A change of ownership or control of a home for

26  special services must be reported to the agency in writing at

27  least 60 days before the change is scheduled to take effect.

28         (7)(6)  The agency shall adopt rules for implementing

29  and enforcing this section.

30

31

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  1         (8)(7)(a)  It is unlawful for any person to establish,

  2  conduct, manage, or operate a home for special services

  3  without obtaining a license from the agency.

  4         (b)  It is unlawful for any person to offer or

  5  advertise to the public, in any medium whatever, specialized

  6  health care services without obtaining a license from the

  7  agency.

  8         (c)  It is unlawful for a holder of a license issued

  9  under this section to advertise or represent to the public

10  that it holds a license for a type of facility other than the

11  facility for which its license is issued.

12         (9)(8)(a)  A violation of any provision of this section

13  or rules adopted by the agency for implementing this section

14  is punishable by payment of an administrative fine not to

15  exceed $5,000.

16         (b)  A violation of subsection (8)(7) or rules adopted

17  under that subsection is a misdemeanor of the first degree,

18  punishable as provided in s. 775.082 or s. 775.083.  Each day

19  of continuing violation is a separate offense.

20         Section 79.  Present subsections (4), (5), and (6) of

21  section 400.805, Florida Statutes, are redesignated as

22  subsections (5), (6), and (7), respectively, present

23  subsections (3) and (7) of that section are redesignated as

24  subsections (4) and (8), respectively, and amended, and a new

25  subsection (3) is added to that section, to read:

26         400.805  Transitional living facilities.--

27         (3)  Each applicant for licensure must comply with the

28  following requirements:

29         (a)  Upon receipt of a completed, signed, and dated

30  application, the agency shall require background screening, in

31  accordance with the level 2 standards for screening set forth

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  1  in chapter 435, of the managing employee, or other similarly

  2  titled individual who is responsible for the daily operation

  3  of the facility, and of the financial officer, or other

  4  similarly titled individual who is responsible for the

  5  financial operation of the facility, including billings for

  6  client care and services. The applicant must comply with the

  7  procedures for level 2 background screening as set forth in

  8  chapter 435.

  9         (b)  The agency may require background screening of any

10  other individual who is an applicant if the agency has a

11  reasonable basis for believing that he or she has been

12  convicted of a crime or has committed any other offense

13  prohibited under the level 2 standards for screening set forth

14  in chapter 435.

15         (c)  Proof of compliance with the level 2 background

16  screening requirements of chapter 435 which has been submitted

17  within the previous 5 years in compliance with any other

18  health care or assisted living licensure requirements of this

19  state is acceptable in fulfillment of the requirements of

20  paragraph (a).

21         (d)  A provisional license may be granted to an

22  applicant when each individual required by this section to

23  undergo background screening has met the standards for the

24  abuse registry background check and the Department of Law

25  Enforcement background check, but the agency has not yet

26  received background screening results from the Federal Bureau

27  of Investigation, or a request for a disqualification

28  exemption has been submitted to the agency as set forth in

29  chapter 435 but a response has not yet been issued. A standard

30  license may be granted to the applicant upon the agency's

31  receipt of a report of the results of the Federal Bureau of

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  1  Investigation background screening for each individual

  2  required by this section to undergo background screening which

  3  confirms that all standards have been met, or upon the

  4  granting of a disqualification exemption by the agency as set

  5  forth in chapter 435. Any other person who is required to

  6  undergo level 2 background screening may serve in his or her

  7  capacity pending the agency's receipt of the report from the

  8  Federal Bureau of Investigation. However, the person may not

  9  continue to serve if the report indicates any violation of

10  background screening standards and a disqualification

11  exemption has not been requested of and granted by the agency

12  as set forth in chapter 435.

13         (e)  Each applicant must submit to the agency, with its

14  application, a description and explanation of any exclusions,

15  permanent suspensions, or terminations of the applicant from

16  the Medicare or Medicaid programs. Proof of compliance with

17  the requirements for disclosure of ownership and control

18  interests under the Medicaid or Medicare programs may be

19  accepted in lieu of this submission.

20         (f)  Each applicant must submit to the agency a

21  description and explanation of any conviction of an offense

22  prohibited under the level 2 standards of chapter 435 by a

23  member of the board of directors of the applicant, its

24  officers, or any individual owning 5 percent or more of the

25  applicant. This requirement does not apply to a director of a

26  not-for-profit corporation or organization if the director

27  serves solely in a voluntary capacity for the corporation or

28  organization, does not regularly take part in the day-to-day

29  operational decisions of the corporation or organization,

30  receives no remuneration for his or her services on the

31  corporation or organization's board of directors, and has no

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  1  financial interest and has no family members with a financial

  2  interest in the corporation or organization, provided that the

  3  director and the not-for-profit corporation or organization

  4  include in the application a statement affirming that the

  5  director's relationship to the corporation satisfies the

  6  requirements of this paragraph.

  7         (g)  A license may not be granted to an applicant if

  8  the applicant or managing employee has been found guilty of,

  9  regardless of adjudication, or has entered a plea of nolo

10  contendere or guilty to, any offense prohibited under the

11  level 2 standards for screening set forth in chapter 435,

12  unless an exemption from disqualification has been granted by

13  the agency as set forth in chapter 435.

14         (h)  The agency may deny or revoke licensure if the

15  applicant:

16         1.  Has falsely represented a material fact in the

17  application required by paragraph (e) or paragraph (f), or has

18  omitted any material fact from the application required by

19  paragraph (e) or paragraph (f); or

20         2.  Has had prior action taken against the applicant

21  under the Medicaid or Medicare program as set forth in

22  paragraph (e).

23         (i)  An application for license renewal must contain

24  the information required under paragraphs (e) and (f).

25         (4)(3)  An application for renewal of license must be

26  submitted 90 days before the expiration of the license.  Upon

27  renewal of licensure, each applicant must submit to the

28  agency, under penalty of perjury, an affidavit as set forth in

29  s. 400.805(3)(d).

30         (8)(7)(a)  A violation of any provision of this section

31  or rules adopted by the agency or division under this section

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  1  is punishable by payment of an administrative or a civil

  2  penalty fine not to exceed $5,000.

  3         (b)  A violation of subsection (7)(6) or rules adopted

  4  under that subsection is a misdemeanor of the first degree,

  5  punishable as provided in s. 775.082 or s. 775.083.  Each day

  6  of a continuing violation is a separate offense.

  7         Section 80.  Subsection (1), paragraphs (e) and (f) of

  8  subsection (3), subsection (6), and paragraphs (c) and (d) of

  9  subsection (7) of section 408.05, Florida Statutes, are

10  amended to read:

11         408.05  State Center for Health Statistics.--

12         (1)  ESTABLISHMENT.--The agency department shall

13  establish a State Center for Health Statistics.  The center

14  shall establish a comprehensive health information system to

15  provide for the collection, compilation, coordination,

16  analysis, indexing, dissemination, and utilization of both

17  purposefully collected and extant health-related data and

18  statistics.  The center shall be staffed with public health

19  experts, biostatisticians, information system analysts, health

20  policy experts, economists, and other staff necessary to carry

21  out its functions.

22         (3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.--In order

23  to produce comparable and uniform health information and

24  statistics, the agency shall perform the following functions:

25         (e)  The agency department shall establish by rule the

26  types of data collected, compiled, processed, used, or shared.

27  Decisions regarding center data sets should be made based on

28  consultation with the Comprehensive Health Information System

29  Advisory Council and other public and private users regarding

30  the types of data which should be collected and their uses.

31

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  1         (f)  The center shall establish standardized means for

  2  collecting health information and statistics under laws and

  3  rules administered by the agency department.

  4         (6)  PROVIDER DATA REPORTING.--This section does not

  5  confer on the agency department the power to demand or require

  6  that a health care provider or professional furnish

  7  information, records of interviews, written reports,

  8  statements, notes, memoranda, or data other than as expressly

  9  required by law.

10         (7)  BUDGET; FEES; TRUST FUND.--

11         (c)  The center may charge such reasonable fees for

12  services as the agency department prescribes by rule.  The

13  established fees may shall not exceed the reasonable cost for

14  such services.  Fees collected may not be used to offset

15  annual appropriations from the General Revenue Fund.

16         (d)  The agency department shall establish a

17  Comprehensive Health Information System Trust Fund as the

18  repository of all funds appropriated to, and fees and grants

19  collected for, services of the State Center for Health

20  Statistics. Any funds, other than funds appropriated to the

21  center from the General Revenue Fund, which are raised or

22  collected by the agency department for the operation of the

23  center and which are not needed to meet the expenses of the

24  center for its current fiscal year shall be available to the

25  agency board in succeeding years.

26         Section 81.  Subsections (10) and (11) of section

27  408.061, Florida Statutes, are amended to read:

28         408.061  Data collection; uniform systems of financial

29  reporting; information relating to physician charges;

30  confidentiality of patient records; immunity.--

31

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  1         (10)  No health care facility, health care provider,

  2  health insurer, or other reporting entity or its employees or

  3  agents shall be held liable for civil damages or subject to

  4  criminal penalties either for the reporting of patient data to

  5  the agency board or for the release of such data by the agency

  6  board as authorized by this chapter.

  7         (11)  The agency shall be the primary source for

  8  collection and dissemination of health care data.  No other

  9  agency of state government may gather data from a health care

10  provider licensed or regulated under this chapter without

11  first determining if the data is currently being collected by

12  the agency and affirmatively demonstrating that it would be

13  more cost-effective for an agency of state government other

14  than the agency to gather the health care data.  The director

15  secretary shall ensure that health care data collected by the

16  divisions within the agency is coordinated. It is the express

17  intent of the Legislature that all health care data be

18  collected by a single source within the agency and that other

19  divisions within the agency, and all other agencies of state

20  government, obtain data for analysis, regulation, and public

21  dissemination purposes from that single source. Confidential

22  information may be released to other governmental entities or

23  to parties contracting with the agency to perform agency

24  duties or functions as needed in connection with the

25  performance of the duties of the receiving entity.  The

26  receiving entity or party shall retain the confidentiality of

27  such information as provided for herein.

28         Section 82.  Subsections (2) and (5) of section

29  408.062, Florida Statutes, are amended to read:

30         408.062  Research, analyses, studies, and reports.--

31

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  1         (2)  The agency board shall evaluate data from nursing

  2  home financial reports and shall document and monitor:

  3         (a)  Total revenues, annual change in revenues, and

  4  revenues by source and classification, including contributions

  5  for a resident's care from the resident's resources and from

  6  the family and contributions not directed toward any specific

  7  resident's care.

  8         (b)  Average resident charges by geographic region,

  9  payor, and type of facility ownership.

10         (c)  Profit margins by geographic region and type of

11  facility ownership.

12         (d)  Amount of charity care provided by geographic

13  region and type of facility ownership.

14         (e)  Resident days by payor category.

15         (f)  Experience related to Medicaid conversion as

16  reported under s. 408.061.

17         (g)  Other information pertaining to nursing home

18  revenues and expenditures.

19

20  The findings of the agency board shall be included in an

21  annual report to the Governor and Legislature by January 1

22  each year.

23         (5)(a)  The agency may conduct data-based studies and

24  evaluations and make recommendations to the Legislature and

25  the Governor concerning exemptions, the effectiveness of

26  limitations of referrals, restrictions on investment interests

27  and compensation arrangements, and the effectiveness of public

28  disclosure.  Such analysis may include, but need not be

29  limited to, utilization of services, cost of care, quality of

30  care, and access to care. The agency may require the

31  submission of data necessary to carry out such investigations,

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  1  which may include, but need not be limited to, data concerning

  2  ownership, Medicare and Medicaid, charity care, types of

  3  services offered to patients, revenues and expenses,

  4  patient-encounter data, and other data reasonably necessary to

  5  study utilization patterns and the impact of health care

  6  provider ownership interests in health-care-related entities

  7  on the cost, quality, and accessibility of health care.

  8         (b)  The agency may collect such data from any health

  9  facility as a special study. The board is directed to research

10  hospital financial and nonfinancial data in order to determine

11  the need for establishing a category of inpatient hospital

12  patients defined as medically indigent.  For purposes of this

13  section, a medically indigent patient is an individual who is

14  admitted as an inpatient to a hospital, who is not classified

15  as a Medicare beneficiary, a Medicaid recipient, or a charity

16  care patient, but who has insufficient financial resources to

17  pay for needed medical care. In its determination of the need

18  for establishing a category of medically indigent patients,

19  the board shall consider the creation of income and asset

20  levels that would establish a person as medically indigent.

21  The board shall submit a report and recommendations to the

22  Governor and the Legislature on the establishment of a

23  category of medically indigent inpatient hospital patients on

24  or before January 1, 1994.  If the board recommends the

25  establishment of a category of medically indigent patients, it

26  shall provide a specific recommendation for the eligibility

27  determination process to be used in classifying a patient as

28  medically indigent.

29         Section 83.  Subsection (1) of section 408.063, Florida

30  Statutes, is amended to read:

31         408.063  Dissemination of health care information.--

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  1         (1)  The agency, relying on data collected pursuant to

  2  this chapter, shall establish a reliable, timely, and

  3  consistent information system which distributes information

  4  and serves as the basis for the agency's board's public

  5  education programs.  The agency shall seek advice from

  6  consumers, health care purchasers, health care providers,

  7  health care facilities, health insurers, and local health

  8  councils in the development and implementation of its

  9  information system. Whenever appropriate, the agency shall use

10  the local health councils for the dissemination of information

11  and education of the public.

12         Section 84.  Section 408.07, Florida Statutes, is

13  amended to read:

14         408.07  Definitions.--As used in this chapter, with the

15  exception of ss. 408.031-408.045, the term:

16         (1)  "Accepted" means that the agency board has found

17  that a report or data submitted by a health care facility or a

18  health care provider contains all schedules and data required

19  by the agency board and has been prepared in the format

20  specified by the agency board, and otherwise conforms to

21  applicable rule or Florida Hospital Uniform Reporting System

22  manual requirements regarding reports in effect at the time

23  such report was submitted, and the data are mathematically

24  reasonable and accurate.

25         (2)  "Adjusted admission" means the sum of acute and

26  intensive care admissions divided by the ratio of inpatient

27  revenues generated from acute, intensive, ambulatory, and

28  ancillary patient services to gross revenues.  If a hospital

29  reports only subacute admissions, then "adjusted admission"

30  means the sum of subacute admissions divided by the ratio of

31  total inpatient revenues to gross revenues.

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  1         (3)  "Agency" means the Agency for Health Care

  2  Administration.

  3         (4)  "Alcohol or chemical dependency treatment center"

  4  means an organization licensed under chapter 397.

  5         (5)  "Ambulatory care center" means an organization

  6  which employs or contracts with licensed health care

  7  professionals to provide diagnosis or treatment services

  8  predominantly on a walk-in basis and the organization holds

  9  itself out as providing care on a walk-in basis.  Such an

10  organization is not an ambulatory care center if it is wholly

11  owned and operated by five or fewer health care providers.

12         (6)  "Ambulatory surgical center" means a facility

13  licensed as an ambulatory surgical center under chapter 395.

14         (7)  "Applicable rate of increase" means the maximum

15  allowable rate of increase (MARI) when applied to gross

16  revenue per adjusted admission, unless the board has approved

17  a different rate of increase, in which case the board-approved

18  rate of increase shall apply.

19         (7)(8)  "Audited actual data" means information

20  contained within financial statements examined by an

21  independent, Florida-licensed, certified public accountant in

22  accordance with generally accepted auditing standards, but

23  does not include data within a financial statement about which

24  the certified public accountant does not express an opinion or

25  issues a disclaimer.

26         (9)  "Banked points" means the percentage points earned

27  by a hospital when the actual rate of increase in gross

28  revenue per adjusted admission (GRAA) is less than the maximum

29  allowable rate of increase (MARI) or the actual rate of

30  increase in the net revenue per adjusted admission (NRAA) is

31  less than the market basket index.

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  1         (8)(10)  "Birth center" means an organization licensed

  2  under s. 383.305.

  3         (11)  "Board" means the Health Care Board established

  4  under s. 408.003.

  5         (12)  "Budget" means the projections by the hospital,

  6  for a specified future time period, of expenditures and

  7  revenues, with supporting statistical indicators, or a budget

  8  letter verified by the board pursuant to s. 408.072(3)(a).

  9         (9)(13)  "Cardiac catheterization laboratory" means a

10  freestanding facility that which employs or contracts with

11  licensed health care professionals to provide diagnostic or

12  therapeutic services for cardiac conditions such as cardiac

13  catheterization or balloon angioplasty.

14         (10)(14)  "Case mix" means a calculated index for each

15  health care facility or health care provider, based on patient

16  data, reflecting the relative costliness of the mix of cases

17  to that facility or provider compared to a state or national

18  mix of cases.

19         (11)(15)  "Clinical laboratory" means a facility

20  licensed under s. 483.091, excluding:  any hospital laboratory

21  defined under s. 483.041(5); any clinical laboratory operated

22  by the state or a political subdivision of the state; any

23  blood or tissue bank where the majority of revenues are

24  received from the sale of blood or tissue and where blood,

25  plasma, or tissue is procured from volunteer donors and

26  donated, processed, stored, or distributed on a nonprofit

27  basis; and any clinical laboratory which is wholly owned and

28  operated by physicians who are licensed pursuant to chapter

29  458 or chapter 459 and who practice in the same group

30  practice, and at which no clinical laboratory work is

31

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  1  performed for patients referred by any health care provider

  2  who is not a member of that same group practice.

  3         (12)(16)  "Comprehensive rehabilitative hospital" or

  4  "rehabilitative hospital" means a hospital licensed by the

  5  agency for Health Care Administration as a specialty hospital

  6  as defined in s. 395.002; provided that the hospital provides

  7  a program of comprehensive medical rehabilitative services and

  8  is designed, equipped, organized, and operated solely to

  9  deliver comprehensive medical rehabilitative services, and

10  further provided that all licensed beds in the hospital are

11  classified as "comprehensive rehabilitative beds" pursuant to

12  s. 395.003(4), and are not classified as "general beds."

13         (13)(17)  "Consumer" means any person other than a

14  person who administers health activities, is a member of the

15  governing body of a health care facility, provides health

16  services, has a fiduciary interest in a health facility or

17  other health agency or its affiliated entities, or has a

18  material financial interest in the rendering of health

19  services.

20         (14)(18)  "Continuing care facility" means a facility

21  licensed under chapter 651.

22         (15)(19)  "Cross-subsidization" means that the revenues

23  from one type of hospital service are sufficiently higher than

24  the costs of providing such service as to offset some of the

25  costs of providing another type of service in the hospital.

26  Cross-subsidization results from the lack of a direct

27  relationship between charges and the costs of providing a

28  particular hospital service or type of service.

29         (16)(20)  "Deductions from gross revenue" or

30  "deductions from revenue" means reductions from gross revenue

31  resulting from inability to collect payment of charges.  For

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  1  hospitals, such reductions include contractual adjustments;

  2  uncompensated care; administrative, courtesy, and policy

  3  discounts and adjustments; and other such revenue deductions,

  4  but also includes the offset of restricted donations and

  5  grants for indigent care.

  6         (17)(21)  "Diagnostic-imaging center" means a

  7  freestanding outpatient facility that provides specialized

  8  services for the diagnosis of a disease by examination and

  9  also provides radiological services.  Such a facility is not a

10  diagnostic-imaging center if it is wholly owned and operated

11  by physicians who are licensed pursuant to chapter 458 or

12  chapter 459 and who practice in the same group practice and no

13  diagnostic-imaging work is performed at such facility for

14  patients referred by any health care provider who is not a

15  member of that same group practice.

16         (18)(22)  "FHURS" means the Florida Hospital Uniform

17  Reporting System developed by the agency board.

18         (19)(23)  "Freestanding" means that a health facility

19  bills and receives revenue which is not directly subject to

20  the hospital assessment for the Public Medical Assistance

21  Trust Fund as described in s. 395.701.

22         (20)(24)  "Freestanding radiation therapy center" means

23  a facility where treatment is provided through the use of

24  radiation therapy machines that are registered under s. 404.22

25  and the provisions of the Florida Administrative Code

26  implementing s. 404.22.  Such a facility is not a freestanding

27  radiation therapy center if it is wholly owned and operated by

28  physicians licensed pursuant to chapter 458 or chapter 459 who

29  practice within the specialty of diagnostic or therapeutic

30  radiology.

31

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  1         (21)(25)  "GRAA" means gross revenue per adjusted

  2  admission.

  3         (22)(26)  "Gross revenue" means the sum of daily

  4  hospital service charges, ambulatory service charges,

  5  ancillary service charges, and other operating revenue.  Gross

  6  revenues do not include contributions, donations, legacies, or

  7  bequests made to a hospital without restriction by the donors.

  8         (23)(27)  "Health care facility" means an ambulatory

  9  surgical center, a hospice, a nursing home, a hospital, a

10  diagnostic-imaging center, a freestanding or hospital-based

11  therapy center, a clinical laboratory, a home health agency, a

12  cardiac catheterization laboratory, a medical equipment

13  supplier, an alcohol or chemical dependency treatment center,

14  a physical rehabilitation center, a lithotripsy center, an

15  ambulatory care center, a birth center, or a nursing home

16  component licensed under chapter 400 within a continuing care

17  facility licensed under chapter 651.

18         (24)(28)  "Health care provider" means a health care

19  professional licensed under chapter 458, chapter 459, chapter

20  460, chapter 461, chapter 463, chapter 464, chapter 465,

21  chapter 466, part I, part III, part IV, part V, or part X of

22  chapter 468, chapter 483, chapter 484, chapter 486, chapter

23  490, or chapter 491.

24         (25)(29)  "Health care purchaser" means an employer in

25  the state, other than a health care facility, health insurer,

26  or health care provider, who provides health care coverage for

27  her or his employees.

28         (26)(30)  "Health insurer" means any insurance company

29  authorized to transact health insurance in the state, any

30  insurance company authorized to transact health insurance or

31  casualty insurance in the state that is offering a minimum

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  1  premium plan or stop-loss coverage for any person or entity

  2  providing health care benefits, any self-insurance plan as

  3  defined in s. 624.031, any health maintenance organization

  4  authorized to transact business in the state pursuant to part

  5  I of chapter 641, any prepaid health clinic authorized to

  6  transact business in the state pursuant to part II of chapter

  7  641, any multiple-employer welfare arrangement authorized to

  8  transact business in the state pursuant to ss. 624.436-624.45,

  9  or any fraternal benefit society providing health benefits to

10  its members as authorized pursuant to chapter 632.

11         (27)(31)  "Home health agency" means an organization

12  licensed under part IV of chapter 400.

13         (28)(32)  "Hospice" means an organization licensed

14  under part VI of chapter 400.

15         (29)(33)  "Hospital" means a health care institution

16  licensed by the Agency for Health Care Administration as a

17  hospital under chapter 395.

18         (30)(34)  "Lithotripsy center" means a freestanding

19  facility that which employs or contracts with licensed health

20  care professionals to provide diagnosis or treatment services

21  using electro-hydraulic shock waves.

22         (31)(35)  "Local health council" means the agency

23  defined in s. 408.033.

24         (32)(36)  "Market basket index" means the Florida

25  hospital input price index (FHIPI), which is a statewide

26  market basket index used to measure inflation in hospital

27  input prices weighted for the Florida-specific experience

28  which uses multistate regional and state-specific price

29  measures, when available.  The index shall be constructed in

30  the same manner as the index employed by the Secretary of the

31  United States Department of Health and Human Services for

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  1  determining the inflation in hospital input prices for

  2  purposes of Medicare reimbursement.

  3         (37)  "Maximum allowable rate of increase" or "MARI"

  4  means the maximum rate at which a hospital is normally

  5  expected to increase its average gross revenues per adjusted

  6  admission for a given period.  The board, using the most

  7  recent audited actual data for each hospital, shall calculate

  8  the MARI for each hospital as follows:  The projected rate of

  9  increase in the market basket index shall be divided by a

10  number which is determined by subtracting the sum of one-half

11  of the proportion of Medicare days plus one-half of the

12  proportion of CHAMPUS days plus the proportion of Medicaid

13  days plus 1.5 times the proportion of charity care days from

14  the number one. The formula to be employed by the board to

15  calculate the MARI shall take the following form:

16

17                             FHIPI

18  MARI =    (....................................)

19  1-[(Me x 0.5) + (Cp x 0.5) + Md + (Cc x 1.5)]

20

21  where:

22         MARI = maximum allowable rate of increase applied to

23  gross revenue.

24         FHIPI = Florida hospital input price index, which shall

25  be the projected rate of change in the market basket index.

26         Me = proportion of Medicare days, including when

27  available and reported to the board Medicare HMO days, to

28  total days.

29         Cp = proportion of Civilian Health and Medical Program

30  of the Uniformed Services (CHAMPUS) days to total days.

31

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  1         Md = proportion of Medicaid days, including when

  2  available and reported to the board Medicaid HMO days, to

  3  total days.

  4         Cc = proportion of charity care days to total days with

  5  a 50-percent offset for restricted grants for charity care and

  6  unrestricted grants from local governments.

  7         (33)(38)  "Medical equipment supplier" means an

  8  organization that which provides medical equipment and

  9  supplies used by health care providers and health care

10  facilities in the diagnosis or treatment of disease.

11         (34)(39)  "Net revenue" means gross revenue minus

12  deductions from revenue.

13         (35)(40)  "New hospital" means a hospital in its

14  initial year of operation as a licensed hospital and does not

15  include any facility which has been in existence as a licensed

16  hospital, regardless of changes in ownership, for over 1

17  calendar year.

18         (36)(41)  "Nursing home" means a facility licensed

19  under s. 400.062 or, for resident level and financial data

20  collection purposes only, any institution licensed under

21  chapter 395 and which has a Medicare or Medicaid certified

22  distinct part used for skilled nursing home care, but does not

23  include a facility licensed under chapter 651.

24         (37)(42)  "Operating expenses" means total expenses

25  excluding income taxes.

26         (38)(43)  "Other operating revenue" means all revenue

27  generated from hospital operations other than revenue directly

28  associated with patient care.

29         (39)(44)  "Physical rehabilitation center" means an

30  organization that which employs or contracts with health care

31  professionals licensed under part I or part III of chapter 468

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  1  or chapter 486 to provide speech, occupational, or physical

  2  therapy services on an outpatient or ambulatory basis.

  3         (40)(45)  "Prospective payment arrangement" means a

  4  financial agreement negotiated between a hospital and an

  5  insurer, health maintenance organization, preferred provider

  6  organization, or other third-party payor which contains, at a

  7  minimum, the elements provided for in s. 408.50.

  8         (41)(46)  "Rate of return" means the financial

  9  indicators used to determine or demonstrate reasonableness of

10  the financial requirements of a hospital.  Such indicators

11  shall include, but not be limited to:  return on assets,

12  return on equity, total margin, and debt service coverage.

13         (42)(47)  "Rural hospital" means an acute care hospital

14  licensed under chapter 395, with 85 licensed beds or fewer,

15  which has an emergency room and is located in an area defined

16  as rural by the United States Census, and which is:

17         (a)  The sole provider within a county with a

18  population density of no greater than 100 persons per square

19  mile;

20         (b)  An acute care hospital, in a county with a

21  population density of no greater than 100 persons per square

22  mile, which is at least 30 minutes of travel time, on normally

23  traveled roads under normal traffic conditions, from another

24  acute care hospital within the same county; or

25         (c)  A hospital supported by a tax district or

26  subdistrict whose boundaries encompass a population of 100

27  persons or less per square mile.

28         (43)(48)  "Special study" means a nonrecurring

29  data-gathering and analysis effort designed to aid the agency

30  for Health Care Administration in meeting its responsibilities

31  pursuant to this chapter.

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  1         (44)(49)  "Teaching hospital" means any hospital

  2  formally affiliated with an accredited medical school which

  3  that exhibits activity in the area of medical education as

  4  reflected by at least seven different resident physician

  5  specialties and the presence of 100 or more resident

  6  physicians.

  7         Section 85.  Section 408.08, Florida Statutes, is

  8  amended to read:

  9         408.08  Inspections and audits; violations; penalties;

10  fines; enforcement.--

11         (1)  The agency may inspect and audit books and records

12  of individual or corporate ownership, including books and

13  records of related organizations with which a health care

14  provider or a health care facility had transactions, for

15  compliance with this chapter.  Upon presentation of a written

16  request for inspection to a health care provider or a health

17  care facility by the agency or its staff, the health care

18  provider or the health care facility shall make available to

19  the agency or its staff for inspection, copying, and review

20  all books and records relevant to the determination of whether

21  the health care provider or the health care facility has

22  complied with this chapter.

23         (2)  The board shall annually compare the audited

24  actual experience of each hospital to the audited actual

25  experience of that hospital for the previous year.

26         (a)  For a hospital submitting a budget letter, if the

27  board determines that the audited actual experience of the

28  hospital exceeded its previous year's audited actual

29  experience by more than the maximum allowable rate of increase

30  as certified in the budget letter plus any banked points

31  utilized in the budget letter, the amount of such excess shall

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  1  be determined by the board and a penalty shall be levied

  2  against such hospital pursuant to subsection (3).

  3         (b)  For a hospital subject to budget review, if the

  4  board determines that the audited actual experience of the

  5  hospital exceeded its previous year's audited actual

  6  experience by more than the most recent approved budget or the

  7  most recent approved budget as amended, the amount of such

  8  excess shall be determined by the board, and a penalty shall

  9  be levied against such hospital pursuant to subsection (3).

10         (c)  For a hospital submitting a budget letter and for

11  a hospital subject to budget review, the board shall annually

12  compare each hospital's audited actual experience for net

13  revenues per adjusted admission to the hospital's audited

14  actual experience for net revenues per adjusted admission for

15  the previous year.  If the rate of increase in net revenues

16  per adjusted admission between the previous year and the

17  current year was less than the market basket index, the

18  hospital may carry forward the difference and earn up to a

19  cumulative maximum of 3 banked net revenue percentage points.

20  Such banked net revenue percentage points shall be available

21  to the hospital to offset, in any future year, penalties for

22  exceeding the approved budget or the maximum allowable rate of

23  increase as set forth in subsection (3). Nothing in this

24  paragraph shall be used by a hospital to justify the approval

25  of a budget or a budget amendment by the board in excess of

26  the maximum allowable rate of increase pursuant to s. 408.072.

27         (3)  Penalties shall be assessed as follows:

28         (a)  For the first occurrence within a 5-year period,

29  the board shall prospectively reduce the current budget of the

30  hospital by the amount of the excess up to 5 percent; and, if

31  such excess is greater than 5 percent over the maximum

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  1  allowable rate of increase, any amount in excess of 5 percent

  2  shall be levied by the board as a fine against such hospital

  3  to be deposited in the Public Medical Assistance Trust Fund.

  4         (b)  For the second occurrence with the 5-year period

  5  following the first occurrence as set forth in paragraph (a),

  6  the board shall prospectively reduce the current budget of the

  7  hospital by the amount of the excess up to 2 percent; and, if

  8  such excess is greater than 2 percent over the maximum

  9  allowable rate of increase, any amount in excess of 2 percent

10  shall be levied by the board as a fine against such hospital

11  to be deposited in the Public Medical Assistance Trust Fund.

12         (c)  For the third occurrence within the 5-year period

13  following the first occurrence as set forth in paragraph (a),

14  the board shall:

15         1.  Levy a fine against the hospital in the total

16  amount of the excess, to be deposited in the Public Medical

17  Assistance Trust Fund.

18         2.  Notify the agency of the violation, whereupon the

19  agency shall not accept any application for a certificate of

20  need pursuant to ss. 408.031-408.045 from or on behalf of such

21  hospital until such time as the hospital has demonstrated to

22  the satisfaction of the board that, following the date the

23  penalty was imposed under subparagraph 1., the hospital has

24  stayed within its projected or amended budget or its

25  applicable maximum allowable rate of increase for a period of

26  at least 1 year.  However, this provision does not apply with

27  respect to a certificate-of-need application filed to satisfy

28  a life or safety code violation.

29         3.  Upon a determination that the hospital knowingly

30  and willfully generated such excess, notify the agency,

31  whereupon the agency shall initiate disciplinary proceedings

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  1  to deny, modify, suspend, or revoke the license of such

  2  hospital or impose an administrative fine on such hospital not

  3  to exceed $20,000.

  4

  5  The determination of the amount of any such excess shall be

  6  based upon net revenues per adjusted admission, excluding

  7  funds distributed to the hospital from the Public Medical

  8  Assistance Trust Fund.  However, in making such determination,

  9  the board shall appropriately reduce the amount of the excess

10  by the total amount of the assessment paid by such hospital

11  pursuant to s. 395.701 minus the amount of revenues received

12  by the hospital through the Public Medical Assistance Trust

13  Fund.  It is the responsibility of the hospital to demonstrate

14  to the satisfaction of the board its entitlement to such

15  reduction.  It is the intent of the Legislature that the

16  Health Care Board, in levying any penalty imposed against a

17  hospital for exceeding its maximum allowable rate of increase

18  or its approved budget pursuant to this subsection, consider

19  the effect of changes in the case mix of the hospital and in

20  the hospital's intensity and severity of illness as measured

21  by changes in the hospital's actual proportion of outlier

22  cases to total cases and dollar increases in outlier cases'

23  average charge per case.  It is the responsibility of the

24  hospital to demonstrate to the satisfaction of the board any

25  change in its case mix and in its intensity and severity of

26  illness.  For psychiatric hospitals and other hospitals not

27  reimbursed under a prospective payment system by the Federal

28  Government, until a proxy for case mix is available, the board

29  shall also reduce the amount of excess by the change in a

30  hospital's audited actual average length of stay without any

31  thresholds or limitations.

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  1         (4)  The following factors may be used by the board to

  2  reduce the amount of excess of the hospital as determined

  3  pursuant to this section:

  4         (a)  Unforeseen and unforeseeable events which affect

  5  the net revenue per adjusted admission and which are beyond

  6  the control of the hospital, such as prior year Medicare cost

  7  report settlements, retroactive changes in Medicare

  8  reimbursement methodology, and increases in malpractice

  9  insurance premiums, which occurred in the last 3 months of the

10  hospital fiscal year during which the hospital generated the

11  excess; or

12         (b)  Imposition of the penalty would have a severe

13  adverse effect which would jeopardize the continued existence

14  of an otherwise economically viable hospital.

15         (5)  The board shall reduce the amount of the excess

16  for hospitals submitting budget letters pursuant to s.

17  408.072(3)(a) by the amount of any documented costs from

18  financial assistance provided to expand or supplement the

19  curriculum of a community college, university, or vocational

20  training school for the purpose of training nurses or other

21  health professionals, not including physicians.  Financial

22  assistance would include, but not be limited to, the direct

23  costs for faculty salaries and expenses, books, equipment,

24  recruiting efforts, tuition assistance, and hospital

25  internships.  The reduction would be based on actual

26  documented expenses increased by the gross revenues necessary

27  to generate net revenues sufficient to cover the expenses.

28         (6)  If the board finds that any hospital chief

29  executive officer or any person who is in charge of hospital

30  administration or operations has knowingly and willfully

31  allowed or authorized actual operating revenues or

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  1  expenditures that are in excess of projected operating

  2  revenues or expenditures in the hospital's approved budget,

  3  the board shall order such officer or person to pay an

  4  administrative fine not to exceed $5,000.

  5         (7)  For hospitals filing budget letters, the board

  6  shall annually compare the audited actual experience of each

  7  hospital for the year under review to the audited actual

  8  experience of that hospital for the previous year.  For

  9  hospitals which submitted detailed budgets or budget

10  amendments, the board shall compare the audited actual

11  experience of each hospital for the year under review to its

12  approved gross revenue per adjusted admission for the year

13  under review, for purposes of levying an administrative fine.

14         (a)  For a hospital submitting a budget letter pursuant

15  to s. 408.072(3)(a), if the board determines that the audited

16  actual experience for the year under review exceeded the

17  hospital's previous year's audited actual experience by more

18  than the maximum allowable rate of increase as certified in

19  the budget letter plus any banked points utilized in the

20  budget letter, the amount of the excess shall be determined

21  and an administrative fine shall be levied against such

22  hospital pursuant to subsection (8).

23         (b)  For a hospital which submitted a budget pursuant

24  to s. 408.072(1), or a budget amendment pursuant to s.

25  408.072(6), if the board determines that the gross revenue per

26  adjusted admission contained in the hospital's audited actual

27  experience exceeded its board-approved gross revenue per

28  adjusted admission, the amount of the excess shall be

29  determined and an administrative fine shall be levied against

30  such hospital pursuant to subsection (8).

31

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  1         (8)  If the board determines that an excess exists

  2  pursuant to subsection (7), the board shall multiply the

  3  excess by the number of actual adjusted admissions contained

  4  in the year at issue to determine the amount of the base fine.

  5  The base fine shall be multiplied by the applicable occurrence

  6  factor to determine the amount of the administrative fine

  7  levied against the hospital.

  8         (a)  For the first occurrence within a 5-year period,

  9  the applicable occurrence factor shall be 0.25.  For the

10  second occurrence within a 5-year period, the applicable

11  occurrence factor shall be 0.55.  For the third occurrence

12  within a 5-year period, the applicable occurrence factor shall

13  be 1.0.

14         (b)  In no event shall any administrative fine levied

15  pursuant to this subsection exceed $365,000.

16         (9)  In levying any administrative fine against a

17  hospital pursuant to subsection (8), the board shall consider

18  the effect of any changes in the hospital's case mix, and in

19  the hospital's intensity and severity of illness as measured

20  by changes in the hospital's actual proportion of outlier

21  cases to total cases and dollar increases in outlier cases'

22  average charge per case.  The board shall adjust the amount of

23  any excess by the changes in the hospital's case mix and in

24  its intensity and severity of illness, based upon certified

25  hospital patient discharge data provided to the board pursuant

26  to s. 408.061.  For psychiatric hospitals and other hospitals

27  not reimbursed under a prospective payment system by the

28  Federal Government, until a proxy for case mix is available,

29  the board shall adjust the amount of any excess by the change

30  in a hospital's audited actual average length of stay without

31  any thresholds or limitation.

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  1         (10)  In levying any administrative fine against a

  2  hospital pursuant to subsection (8), it is the intent of the

  3  Legislature that if a hospital can demonstrate to the

  4  satisfaction of the board that it operated within its approved

  5  gross revenue per adjusted admission for the first 8 months of

  6  its fiscal year and did not increase its prices, except for

  7  exceptions determined by the board during the last 5 months of

  8  its fiscal year, it shall not be subject to any administrative

  9  fine levied pursuant to subsection (8).

10         (11)  It is the further intent of the Legislature that

11  if a hospital can demonstrate to the satisfaction of the board

12  that it did not increase its prices on average in excess of

13  the MARI for the prior year, it shall not be subject to any

14  administrative fine levied pursuant to subsection (8).

15         (12)  If the board finds that any hospital chief

16  executive officer or any person who is in charge of hospital

17  administration or operations has knowingly and willfully

18  allowed or authorized gross revenue per adjusted admission,

19  net revenue per adjusted admission, or rates of increase that

20  are in excess of gross or net revenue per adjusted admission,

21  or rates of increase in the hospital's approved budget, budget

22  amendment, or budget letter, the agency shall order such

23  officer or person to pay an administrative fine not to exceed

24  $5,000.

25         (2)(13)  Any health care facility that refuses to file

26  a report, fails to timely file a report, files a false report,

27  or files an incomplete report and upon notification fails to

28  timely file a complete report required under this section and

29  s. 408.061; that violates any provision of this section, s.

30  408.061, or s. 408.20, or rule adopted thereunder; or that

31  fails to provide documents or records requested by the agency

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  1  under the provisions of this chapter shall be punished by a

  2  fine not exceeding $1,000 per day for each day in violation,

  3  to be imposed and collected by the agency.

  4         (3)(14)  Any health care provider that refuses to file

  5  a report, fails to timely file a report, files a false report,

  6  or files an incomplete report and upon notification fails to

  7  timely file a complete report required under this section and

  8  s. 408.061; that violates any provision of this section, s.

  9  408.061, or s. 408.20, or rule adopted thereunder; or that

10  fails to provide documents or records requested by the agency

11  under the provisions of this chapter shall be referred to the

12  appropriate licensing board which shall take appropriate

13  action against the health care provider.

14         (4)(15)  If In the event that a health insurer does not

15  comply with the requirements of s. 408.061, the agency shall

16  report a health insurer's failure to comply to the Department

17  of Insurance, which shall take into account the failure by the

18  health insurer to comply in conjunction with its approval

19  authority under s. 627.410.  The agency shall adopt any rules

20  necessary to carry out its responsibilities required by this

21  subsection.

22         (5)(16)  Refusal to file, failure to timely file, or

23  filing false or incomplete reports or other information

24  required to be filed under the provisions of this chapter,

25  failure to pay or failure to timely pay any assessment

26  authorized to be collected by the agency, or violation of any

27  other provision of this chapter or lawfully entered order of

28  the agency or rule adopted under this chapter, shall be

29  punished by a fine not exceeding $1,000 a day for each day in

30  violation, to be fixed, imposed, and collected by the agency.

31  Each day in violation shall be considered a separate offense.

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  1         (6)(17)  Notwithstanding any other provisions of this

  2  chapter, when a hospital alleges that a factual determination

  3  made by the agency board is incorrect, the burden of proof

  4  shall be on the hospital to demonstrate that such

  5  determination is, in light of the total record, not supported

  6  by a preponderance of the evidence. The burden of proof

  7  remains with the hospital in all cases involving

  8  administrative agency action.

  9         Section 86.  Section 408.40, Florida Statutes, 1996

10  Supplement, is amended to read:

11         408.40  Budget review proceedings; duty of Public

12  Counsel.--

13         (1)  Notwithstanding any other provisions of this

14  chapter, it shall be the duty of the Public Counsel shall to

15  represent the general public of the state in any proceeding

16  before the agency or its advisory panels in any administrative

17  hearing conducted pursuant to the provisions of chapter 120 or

18  before any other state and federal agencies and courts in any

19  issue before the agency, any court, or any agency. With

20  respect to any such proceeding, the Public Counsel is subject

21  to the provisions of and may use utilize the powers granted to

22  him or her by ss. 350.061-350.0614.

23         (2)  The Public Counsel shall:

24         (a)  Recommend to the agency, by petition, the

25  commencement of any proceeding or action or to appear, in the

26  name of the state or its citizens, in any proceeding or action

27  before the agency and urge therein any position that which he

28  or she deems to be in the public interest, whether consistent

29  or inconsistent with positions previously adopted by the

30  agency, and use utilize therein all forms of discovery

31  available to attorneys in civil actions generally, subject to

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  1  protective orders of the agency, which shall be reviewable by

  2  summary procedure in the circuit courts of this state.

  3         (b)  Have access to and use of all files, records, and

  4  data of the agency available to any other attorney

  5  representing parties in a proceeding before the agency.

  6         (c)  In any proceeding in which he or she has

  7  participated as a party, seek review of any determination,

  8  finding, or order of the agency, or of any administrative law

  9  judge, or any hearing officer or hearing examiner designated

10  by the agency, in the name of the state or its citizens.

11         (d)  Prepare and issue reports, recommendations, and

12  proposed orders to the agency, the Governor, and the

13  Legislature on any matter or subject within the jurisdiction

14  of the agency, and to make such recommendations as he or she

15  deems appropriate for legislation relative to agency

16  procedures, rules, jurisdiction, personnel, and functions.

17         (e)  Appear before other state agencies, federal

18  agencies, and state and federal courts in connection with

19  matters under the jurisdiction of the agency, in the name of

20  the state or its citizens.

21         Section 87.  Paragraph (e) of subsection (10) and

22  subsection (14) of section 409.2673, Florida Statutes, are

23  amended to read:

24         409.2673  Shared county and state health care program

25  for low-income persons; trust fund.--

26         (10)  Under the shared county and state program,

27  reimbursement to a hospital for services for an eligible

28  person must:

29         (e)  Be conditioned, for tax district hospitals that

30  deliver services as part of this program, on the delivery of

31  charity care, as defined in the rules of the Agency for Health

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  1  Care Administration Health Care Cost Containment Board, which

  2  equals a minimum of 2.5 percent of the tax district hospital's

  3  net revenues; however, those tax district hospitals which by

  4  virtue of the population within the geographic boundaries of

  5  the tax district can not feasibly provide this level of

  6  charity care shall assure an "open door" policy to those

  7  residents of the geographic boundaries of the tax district who

  8  would otherwise be considered charity cases.

  9         (14)  Any dispute among a county, the Agency for Health

10  Care Administration Health Care Cost Containment Board, the

11  department, or a participating hospital shall be resolved by

12  order as provided in chapter 120.  Hearings held under this

13  subsection shall be conducted in the same manner as provided

14  in ss. 120.569 and 120.57, except that the administrative law

15  judge's or hearing officer's order constitutes final agency

16  action. Cases filed under chapter 120 may combine all relevant

17  disputes between parties.

18         Section 88.  Subsection (8) of section 409.905, Florida

19  Statutes, is amended to read:

20         409.905  Mandatory Medicaid services.--The agency may

21  make payments for the following services, which are required

22  of the state by Title XIX of the Social Security Act,

23  furnished by Medicaid providers to recipients who are

24  determined to be eligible on the dates on which the services

25  were provided.  Any service under this section shall be

26  provided only when medically necessary and in accordance with

27  state and federal law. Nothing in this section shall be

28  construed to prevent or limit the agency from adjusting fees,

29  reimbursement rates, lengths of stay, number of visits, number

30  of services, or any other adjustments necessary to comply with

31

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  1  the availability of moneys and any limitations or directions

  2  provided for in the General Appropriations Act or chapter 216.

  3         (8)  NURSING FACILITY SERVICES.--The agency shall pay

  4  for 24-hour-a-day nursing and rehabilitative services for a

  5  recipient in a nursing facility licensed under part II of

  6  chapter 400 or in a rural hospital, as defined in s. 395.602,

  7  or in a Medicare certified skilled nursing facility operated

  8  by a hospital, as defined by s. 395.002(13) s. 395.002(10),

  9  that is licensed under part I of chapter 395, and in

10  accordance with provisions set forth in s. 409.908(2)(a),

11  which services are ordered by and provided under the direction

12  of a licensed physician.  However, if a nursing facility has

13  been destroyed or otherwise made uninhabitable by natural

14  disaster or other emergency and another nursing facility is

15  not available, the agency must pay for similar services

16  temporarily in a hospital licensed under part I of chapter 395

17  provided federal funding is approved and available.

18         Section 89.  Section 409.9113, Florida Statutes, is

19  amended to read:

20         409.9113  Disproportionate share program for teaching

21  hospitals.--In addition to the payments made under ss. 409.911

22  and 409.9112, the Agency for Health Care Administration

23  Department of Health and Rehabilitative Services shall make

24  disproportionate share payments to statutorily defined

25  teaching hospitals for their increased costs associated with

26  medical education programs and for tertiary health care

27  services provided to the indigent.  This system of payments

28  shall conform with federal requirements and shall distribute

29  funds in each fiscal year for which an appropriation is made

30  by making quarterly Medicaid payments.  Notwithstanding the

31  provisions of s. 409.915, counties are exempt from

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  1  contributing toward the cost of this special reimbursement for

  2  hospitals serving a disproportionate share of low-income

  3  patients.

  4         (1)  On or before September 15 of each year, the Agency

  5  for Health Care Administration shall calculate an allocation

  6  fraction to be used for distributing funds to state statutory

  7  teaching hospitals. Subsequent to the end of each quarter of

  8  the state fiscal year, the agency department shall distribute

  9  to each statutory teaching hospital, as defined in s. 408.07,

10  an amount determined by multiplying one-fourth of the funds

11  appropriated for this purpose by the Legislature times such

12  hospital's allocation fraction.  The allocation fraction for

13  each such hospital shall be determined by the sum of three

14  primary factors, divided by three. The primary factors are:

15         (a)  The number of nationally accredited graduate

16  medical education programs offered by the hospital, including

17  programs accredited by the Accreditation Council for Graduate

18  Medical Education and the combined Internal Medicine and

19  Pediatrics programs acceptable to both the American Board of

20  Internal Medicine and the American Board of Pediatrics at the

21  beginning of the state fiscal year preceding the date on which

22  the allocation fraction is calculated.  The numerical value of

23  this factor is the fraction that the hospital represents of

24  the total number of programs, where the total is computed for

25  all state statutory teaching hospitals.

26         (b)  The number of full-time equivalent trainees in the

27  hospital, which comprises two components:

28         1.  The number of trainees enrolled in nationally

29  accredited graduate medical education programs, as defined in

30  paragraph (a).  Full-time equivalents are computed using the

31  fraction of the year during which each trainee is primarily

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  1  assigned to the given institution, over the state fiscal year

  2  preceding the date on which the allocation fraction is

  3  calculated. The numerical value of this factor is the fraction

  4  that the hospital represents of the total number of full-time

  5  equivalent trainees enrolled in accredited graduate programs,

  6  where the total is computed for all state statutory teaching

  7  hospitals.

  8         2.  The number of medical students enrolled in

  9  accredited colleges of medicine and engaged in clinical

10  activities, including required clinical clerkships and

11  clinical electives.  Full-time equivalents are computed using

12  the fraction of the year during which each trainee is

13  primarily assigned to the given institution, over the course

14  of the state fiscal year preceding the date on which the

15  allocation fraction is calculated. The numerical value of this

16  factor is the fraction that the given hospital represents of

17  the total number of full-time equivalent students enrolled in

18  accredited colleges of medicine, where the total is computed

19  for all state statutory teaching hospitals.

20

21  The primary factor for full-time equivalent trainees is

22  computed as the sum of these two components, divided by two.

23         (c)  A service index that which comprises three

24  components:

25         1.  The Agency for Health Care Administration Health

26  Care Cost Containment Board Service Index, computed by

27  applying the standard Service Inventory Scores established by

28  the Agency for Health Care Administration Health Care Cost

29  Containment Board to services offered by the given hospital,

30  as reported on the Health Care Cost Containment Board

31  Worksheet A-2 for the last fiscal year reported to the agency

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  1  board before the date on which the allocation fraction is

  2  calculated.  The numerical value of this factor is the

  3  fraction that the given hospital represents of the total

  4  Agency for Health Care Administration Health Care Cost

  5  Containment Board Service Index values, where the total is

  6  computed for all state statutory teaching hospitals.

  7         2.  A volume-weighted service index, computed by

  8  applying the standard Service Inventory Scores established by

  9  the Agency for Health Care Administration Health Care Cost

10  Containment Board to the volume of each service, expressed in

11  terms of the standard units of measure reported on the Health

12  Care Cost Containment Board Worksheet A-2 for the last fiscal

13  year reported to the agency board before the date on which the

14  allocation factor is calculated.  The numerical value of this

15  factor is the fraction that the given hospital represents of

16  the total volume-weighted service index values, where the

17  total is computed for all state statutory teaching hospitals.

18         3.  Total Medicaid payments to each hospital for direct

19  inpatient and outpatient services during the fiscal year

20  preceding the date on which the allocation factor is

21  calculated.  This includes payments made to each hospital for

22  such services by Medicaid prepaid health plans, whether the

23  plan was administered by the hospital or not.  The numerical

24  value of this factor is the fraction that each hospital

25  represents of the total of such Medicaid payments, where the

26  total is computed for all state statutory teaching hospitals.

27

28  The primary factor for the service index is computed as the

29  sum of these three components, divided by three.

30         (2)  By October 1 of each year, the agency shall use

31  the following formula shall be utilized by the department to

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  1  calculate the maximum additional disproportionate share

  2  payment for statutorily defined teaching hospitals:

  3

  4                          TAP = THAF x A

  5

  6  Where:

  7         TAP = total additional payment.

  8         THAF = teaching hospital allocation factor.

  9         A = amount appropriated for a teaching hospital

10  disproportionate share program.

11

12         (3)  The Health Care Cost Containment Board shall

13  report to the department the statutory teaching hospital

14  allocation fraction prior to October 1 of each year.

15         Section 90.  Paragraph (g) of subsection (1) of section

16  440.13, Florida Statutes, is amended to read:

17         440.13  Medical services and supplies; penalty for

18  violations; limitations.--

19         (1)  DEFINITIONS.--As used in this section, the term:

20         (g)  "Emergency services and care" means emergency

21  services and care as defined in s. 395.002(10) s. 395.002(9).

22         Section 91.  Paragraphs (i) and (k) of subsection (3)

23  of section 455.654, Florida Statutes, are amended to read:

24         455.654  Financial arrangements between referring

25  health care providers and providers of health care services.--

26         (3)  DEFINITIONS.--For the purpose of this section, the

27  word, phrase, or term:

28         (i)  "Investment interest" means an equity or debt

29  security issued by an entity, including, without limitation,

30  shares of stock in a corporation, units or other interests in

31  a partnership, bonds, debentures, notes, or other equity

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  1  interests or debt instruments.  Except for purposes of s.

  2  455.661, The following investment interests shall be excepted

  3  from this definition:

  4         1.  An investment interest in an entity that is the

  5  sole provider of designated health services in a rural area;

  6         2.  An investment interest in notes, bonds, debentures,

  7  or other debt instruments issued by an entity which provides

  8  designated health services, as an integral part of a plan by

  9  such entity to acquire such investor's equity investment

10  interest in the entity, provided that the interest rate is

11  consistent with fair market value, and that the maturity date

12  of the notes, bonds, debentures, or other debt instruments

13  issued by the entity to the investor is not later than October

14  1, 1996.

15         3.  An investment interest in real property resulting

16  in a landlord-tenant relationship between the health care

17  provider and the entity in which the equity interest is held,

18  unless the rent is determined, in whole or in part, by the

19  business volume or profitability of the tenant or exceeds fair

20  market value; or

21         4.  An investment interest in an entity which owns or

22  leases and operates a hospital licensed under chapter 395 or a

23  nursing home facility licensed under chapter 400.

24         (k)  "Referral" means any referral of a patient by a

25  health care provider for health care services, including,

26  without limitation:

27         1.  The forwarding of a patient by a health care

28  provider to another health care provider or to an entity which

29  provides or supplies designated health services or any other

30  health care item or service; or

31

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  1         2.  The request or establishment of a plan of care by a

  2  health care provider, which includes the provision of

  3  designated health services or other health care item or

  4  service.

  5         3.  Except for the purposes of s. 455.661, The

  6  following orders, recommendations, or plans of care shall not

  7  constitute a referral by a health care provider:

  8         a.  By a radiologist for diagnostic-imaging services.

  9         b.  By a physician specializing in the provision of

10  radiation therapy services for such services.

11         c.  By a medical oncologist for drugs and solutions to

12  be prepared and administered intravenously to such

13  oncologist's patient, as well as for the supplies and

14  equipment used in connection therewith to treat such patient

15  for cancer and the complications thereof.

16         d.  By a cardiologist for cardiac catheterization

17  services.

18         e.  By a pathologist for diagnostic clinical laboratory

19  tests and pathological examination services, if furnished by

20  or under the supervision of such pathologist pursuant to a

21  consultation requested by another physician.

22         f.  By a health care provider who is the sole provider

23  or member of a group practice for designated health services

24  or other health care items or services that are prescribed or

25  provided solely for such referring health care provider's or

26  group practice's own patients, and that are provided or

27  performed by or under the direct supervision of such referring

28  health care provider or group practice.

29         g.  By a health care provider for services provided by

30  an ambulatory surgical center licensed under chapter 395.

31

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  1         h.  By a health care provider for diagnostic clinical

  2  laboratory services where such services are directly related

  3  to renal dialysis.

  4         i.  By a urologist for lithotripsy services.

  5         j.  By a dentist for dental services performed by an

  6  employee of or health care provider who is an independent

  7  contractor with the dentist or group practice of which the

  8  dentist is a member.

  9         k.  By a physician for infusion therapy services to a

10  patient of that physician or a member of that physician's

11  group practice.

12         l.  By a nephrologist for renal dialysis services and

13  supplies.

14         Section 92.  Subsections (7) and (9) of section

15  458.331, Florida Statutes, are amended to read:

16         458.331  Grounds for disciplinary action; action by the

17  board and department.--

18         (7)  Upon the department's receipt from the Agency for

19  Health Care Administration Department of Health and

20  Rehabilitative Services pursuant to s. 395.0197 of the name of

21  a physician whose conduct may constitute grounds for

22  disciplinary action by the department, the department shall

23  investigate the occurrences upon which the report was based

24  and determine if action by the department against the

25  physician is warranted.

26         (9)  When an investigation of a physician is

27  undertaken, the department shall promptly furnish to the

28  physician or the physician's attorney a copy of the complaint

29  or document that which resulted in the initiation of the

30  investigation.  For purposes of this subsection, such

31  documents include, but are not limited to:  the pertinent

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  1  portions of an annual report submitted to the department

  2  pursuant to s. 395.0197(6) s. 395.0197(5)(b); a report of an

  3  adverse or untoward incident which is provided to the

  4  department pursuant to the provisions of s. 395.0197(8) s.

  5  395.0197(6); a report of peer review disciplinary action

  6  submitted to the department pursuant to the provisions of s.

  7  395.0193(4) or s. 458.337, providing that the investigations,

  8  proceedings, and records relating to such peer review

  9  disciplinary action shall continue to retain their privileged

10  status even as to the licensee who is the subject of the

11  investigation, as provided by ss. 395.0193(8) ss. 395.0193(7)

12  and 458.337(3); a report of a closed claim submitted pursuant

13  to s. 627.912; a presuit notice submitted pursuant to s.

14  766.106(2); and a petition brought under the Florida

15  Birth-Related Neurological Injury Compensation Plan, pursuant

16  to s. 766.305(2).  The physician may submit a written response

17  to the information contained in the complaint or document

18  which resulted in the initiation of the investigation within

19  45 days after service to the physician of the complaint or

20  document. The physician's written response shall be considered

21  by the probable cause panel.

22         Section 93.  Subsections (7) and (9) of section

23  459.015, Florida Statutes, are amended to read:

24         459.015  Grounds for disciplinary action by the

25  board.--

26         (7)  Upon the department's receipt from the Agency for

27  Health Care Administration Department of Health and

28  Rehabilitative Services pursuant to s. 395.0197 of the name of

29  an osteopathic physician whose conduct may constitute grounds

30  for disciplinary action by the department, the department

31  shall investigate the occurrences upon which the report was

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  1  based and determine if action by the department against the

  2  osteopathic physician is warranted.

  3         (9)  When an investigation of an osteopathic physician

  4  is undertaken, the department shall promptly furnish to the

  5  osteopathic physician or his or her attorney a copy of the

  6  complaint or document that which resulted in the initiation of

  7  the investigation. For purposes of this subsection, such

  8  documents include, but are not limited to:  the pertinent

  9  portions of an annual report submitted to the department

10  pursuant to s. 395.0197(6) s. 395.0197(5)(b); a report of an

11  adverse or untoward incident which is provided to the

12  department pursuant to the provisions of s. 395.0197(8) s.

13  395.0197(6); a report of peer review disciplinary action

14  submitted to the department pursuant to the provisions of s.

15  395.0193(4) or s. 459.016, provided that the investigations,

16  proceedings, and records relating to such peer review

17  disciplinary action shall continue to retain their privileged

18  status even as to the licensee who is the subject of the

19  investigation, as provided by ss. 395.0193(8) ss. 395.0193(7)

20  and 459.016(3); a report of a closed claim submitted pursuant

21  to s. 627.912; a presuit notice submitted pursuant to s.

22  766.106(2); and a petition brought under the Florida

23  Birth-Related Neurological Injury Compensation Plan, pursuant

24  to s. 766.305(2).  The osteopathic physician may submit a

25  written response to the information contained in the complaint

26  or document which resulted in the initiation of the

27  investigation within 45 days after service to the osteopathic

28  physician of the complaint or document. The osteopathic

29  physician's written response shall be considered by the

30  probable cause panel.

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  1         Section 94.  Paragraph (b) of subsection (5) of section

  2  461.013, Florida Statutes, is amended to read:

  3         461.013  Grounds for disciplinary action; action by the

  4  board; investigations by department.--

  5         (5)

  6         (b)  Upon the department's receipt from the Agency for

  7  Health Care Administration Department of Health and

  8  Rehabilitative Services pursuant to s. 395.0197 of the name of

  9  the podiatrist whose conduct may constitute grounds for

10  disciplinary action by the department, the department shall

11  investigate the occurrences upon which the report was based

12  and determine if action by the department against the

13  podiatrist is warranted.

14         Section 95.  Subsection (1) of section 468.505, Florida

15  Statutes, is amended to read:

16         468.505  Exemptions; exceptions.--

17         (1)  Nothing in this part may be construed as

18  prohibiting or restricting the practice, services, or

19  activities of:

20         (a)  A person licensed in this state under chapter 457,

21  chapter 458, chapter 459, chapter 460, chapter 461, chapter

22  462, chapter 463, chapter 464, chapter 465, chapter 466,

23  chapter 480, chapter 490, or chapter 491, when engaging in the

24  profession or occupation for which he or she is licensed, or

25  of any person employed by and under the supervision of the

26  licensee when rendering services within the scope of the

27  profession or occupation of the licensee.;

28         (b)  A person employed as a dietitian by the government

29  of the United States, if the person engages in dietetics

30  solely under direction or control of the organization by which

31  the person is employed.;

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  1         (c)  A person employed as a cooperative extension home

  2  economist.;

  3         (d)  A person pursuing a course of study leading to a

  4  degree in dietetics and nutrition from a program or school

  5  accredited pursuant to s. 468.509(2), if the activities and

  6  services constitute a part of a supervised course of study and

  7  if the person is designated by a title that clearly indicates

  8  the person's status as a student or trainee.;

  9         (e)  A person fulfilling the supervised experience

10  component of s. 468.509, if the activities and services

11  constitute a part of the experience necessary to meet the

12  requirements of s. 468.509.;

13         (f)  Any dietitian or nutritionist from another state

14  practicing dietetics or nutrition incidental to a course of

15  study when taking or giving a postgraduate course or other

16  course of study in this state, provided such dietitian or

17  nutritionist is licensed in another jurisdiction or is a

18  registered dietitian or holds an appointment on the faculty of

19  a school accredited pursuant to s. 468.509(2).;

20         (g)  A person who markets or distributes food, food

21  materials, or dietary supplements, or any person who engages

22  in the explanation of the use and benefits of those products

23  or the preparation of those products, if that person does not

24  engage for a fee in dietetics and nutrition practice or

25  nutrition counseling.;

26         (h)  A person who markets or distributes food, food

27  materials, or dietary supplements, or any person who engages

28  in the explanation of the use of those products or the

29  preparation of those products, as an employee of an

30  establishment permitted pursuant to chapter 465.;

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  1         (i)  An educator who is in the employ of a nonprofit

  2  organization approved by the council; a federal, state,

  3  county, or municipal agency, or other political subdivision;

  4  an elementary or secondary school; or an accredited

  5  institution of higher education the definition of which, as

  6  provided in s. 468.509(2), applies to other sections of this

  7  part, insofar as the activities and services of the educator

  8  are part of such employment.;

  9         (j)  Any person who provides weight control services or

10  related weight control products, provided the program has been

11  reviewed by, consultation is available from, and no program

12  change can be initiated without prior approval by a licensed

13  dietitian/nutritionist, a dietitian or nutritionist licensed

14  in another state that has licensure requirements considered by

15  the council to be at least as stringent as the requirements

16  for licensure under this part, or a registered dietitian.;

17         (k)  A person employed by a hospital licensed under

18  chapter 395, or by a nursing home or assisted living facility

19  licensed under part II or part III of chapter 400, or by a

20  continuing care facility certified under chapter 651, if the

21  person is employed in compliance with the laws and rules

22  adopted thereunder regarding the operation of its dietetic

23  department.;

24         (l)  A person employed by a nursing facility exempt

25  from licensing under s. 395.002(13) s. 395.002(12), or a

26  person exempt from licensing under s. 464.022.; or

27         (m)  A person employed as a dietetic technician.

28         Section 96.  Section 483.101, Florida Statutes, is

29  amended to read:

30         483.101  Application for clinical laboratory license.--

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  1         (1)  An application for a clinical laboratory license

  2  must be made under oath by the owner or director operator of

  3  the clinical laboratory or by the public official responsible

  4  for operating a state, municipal, or county clinical

  5  laboratory or institution that contains a clinical laboratory,

  6  upon forms provided by the agency.

  7         (2)  Each applicant for licensure must comply with the

  8  following requirements:

  9         (a)  Upon receipt of a completed, signed, and dated

10  application, the agency shall require background screening, in

11  accordance with the level 2 standards for screening set forth

12  in chapter 435, of the director and of the financial officer,

13  or other similarly titled individual who is responsible for

14  the financial operation of the laboratory, including billings

15  for patient services. The applicant must comply with the

16  procedures for level 2 background screening as set forth in

17  chapter 435.

18         (b)  The agency may require background screening of any

19  other individual who is an applicant if the agency has a

20  reasonable basis for believing that he or she has been

21  convicted of a crime or has committed any other offense

22  prohibited under the level 2 standards for screening set forth

23  in chapter 435.

24         (c)  Proof of compliance with the level 2 background

25  screening requirements of chapter 435 which has been submitted

26  within the previous 5 years in compliance with any other

27  health care licensure requirements of this state is acceptable

28  in fulfillment of the requirements of paragraph (a).

29         (d)  A provisional license may be granted to an

30  applicant when each individual required by this section to

31  undergo background screening has met the standards for the

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  1  abuse registry background check and the Department of Law

  2  Enforcement background check but the agency has not yet

  3  received background screening results from the Federal Bureau

  4  of Investigation, or a request for a disqualification

  5  exemption has been submitted to the agency as set forth in

  6  chapter 435 but a response has not yet been issued. A license

  7  may be granted to the applicant upon the agency's receipt of a

  8  report of the results of the Federal Bureau of Investigation

  9  background screening for each individual required by this

10  section to undergo background screening which confirms that

11  all standards have been met, or upon the granting of a

12  disqualification exemption by the agency as set forth in

13  chapter 435. Any other person who is required to undergo level

14  2 background screening may serve in his or her capacity

15  pending the agency's receipt of the report from the Federal

16  Bureau of Investigation. However, the person may not continue

17  to serve if the report indicates any violation of background

18  screening standards and a disqualification exemption has not

19  been requested of and granted by the agency as set forth in

20  chapter 435.

21         (e)  Each applicant must submit to the agency, with its

22  application, a description and explanation of any exclusions,

23  permanent suspensions, or terminations of the applicant from

24  the Medicare or Medicaid programs. Proof of compliance with

25  the requirements for disclosure of ownership and control

26  interests under the Medicaid or Medicare programs may be

27  accepted in lieu of this submission.

28         (f)  Each applicant must submit to the agency a

29  description and explanation of any conviction of an offense

30  prohibited under the level 2 standards of chapter 435 by a

31  member of the board of directors of the applicant, its

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  1  officers, or any individual owning 5 percent or more of the

  2  applicant. This requirement does not apply to a director of a

  3  not-for-profit corporation or organization if the director

  4  serves solely in a voluntary capacity for the corporation or

  5  organization, does not regularly take part in the day-to-day

  6  operational decisions of the corporation or organization,

  7  receives no remuneration for his or her services on the

  8  corporation or organization's board of directors, and has no

  9  financial interest and has no family members with a financial

10  interest in the corporation or organization, provided that the

11  director and the not-for-profit corporation or organization

12  include in the application a statement affirming that the

13  director's relationship to the corporation satisfies the

14  requirements of this paragraph.

15         (g)  A license may not be granted to an applicant if

16  the applicant or managing employee has been found guilty of,

17  regardless of adjudication, or has entered a plea of nolo

18  contendere or guilty to, any offense prohibited under the

19  level 2 standards for screening set forth in chapter 435,

20  unless an exemption from disqualification has been granted by

21  the agency as set forth in chapter 435.

22         (h)  The agency may deny or revoke licensure if the

23  applicant:

24         1.  Has falsely represented a material fact in the

25  application required by paragraph (e) or paragraph (f), or has

26  omitted any material fact from the application required by

27  paragraph (e) or paragraph (f); or

28         2.  Has had prior action taken against the applicant

29  under the Medicaid or Medicare program as set forth in

30  paragraph (e).

31

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  1         (i)  An application for license renewal must contain

  2  the information required under paragraphs (e) and (f).

  3         (3)  A license must be issued authorizing the

  4  performance of one or more clinical laboratory procedures or

  5  one or more tests on each specialty or subspecialty.  A

  6  separate license is required of all laboratories maintained on

  7  separate premises even if the laboratories are operated under

  8  the same management.  Upon receipt of a request for an

  9  application for a clinical laboratory license, the agency

10  shall provide to the applicant a copy of the rules relating to

11  licensure and operations applicable to the laboratory for

12  which licensure is sought.

13         Section 97.  Section 483.106, Florida Statutes, is

14  amended to read:

15         483.106  Application for a certificate of

16  exemption.--An application for a certificate of exemption must

17  be made under oath by the owner or director operator of a

18  clinical laboratory that performs only waived tests as defined

19  in s. 483.041.  A certificate of exemption authorizes a

20  clinical laboratory to perform waived tests.  Laboratories

21  maintained on separate premises and operated under the same

22  management may apply for a single certificate of exemption or

23  multiple certificates of exemption. The agency shall, by rule,

24  specify the process for biennially issuing certificates of

25  exemption.  Sections 483.011, 483.021, 483.031, 483.041,

26  483.172, 483.23, and 483.25 apply to a clinical laboratory

27  that obtains a certificate of exemption under this section.

28         Section 98.  Section 483.30, Florida Statutes, is

29  amended to read:

30         483.30  Licensing of centers.--

31

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  1         (1)  A person may not conduct, maintain, or operate a

  2  multiphasic health testing center in this state without

  3  obtaining a multiphasic health testing center license from the

  4  agency.  The license is valid only for the person or persons

  5  to whom it is issued and may not be sold, assigned, or

  6  transferred, voluntarily or involuntarily.  A license is not

  7  valid for any premises other than the center for which it is

  8  issued.  However, a new license may be secured for the new

  9  location for a fixed center before the actual change, if the

10  contemplated change is in compliance with this part and the

11  rules adopted under this part.  A center must be relicensed if

12  a change of ownership occurs.  Application for relicensure

13  must be made 60 days before the change of ownership.

14         (2)  Each applicant for licensure must comply with the

15  following requirements:

16         (a)  Upon receipt of a completed, signed, and dated

17  application, the agency shall require background screening, in

18  accordance with the level 2 standards for screening set forth

19  in chapter 435, of the managing employee, or other similarly

20  titled individual who is responsible for the daily operation

21  of the center, and of the financial officer, or other

22  similarly titled individual who is responsible for the

23  financial operation of the center, including billings for

24  patient services.  The applicant must comply with the

25  procedures for level 2 background screening as set forth in

26  chapter 435.

27         (b)  The agency may require background screening of any

28  other individual who is an applicant if the agency has a

29  reasonable basis for believing that he or she has been

30  convicted of a crime or has committed any other offense

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  1  prohibited under the level 2 standards for screening set forth

  2  in chapter 435.

  3         (c)  Proof of compliance with the level 2 background

  4  screening requirements of chapter 435 which has been submitted

  5  within the previous 5 years in compliance with any other

  6  health care licensure requirements of this state is acceptable

  7  in fulfillment of the requirements of paragraph (a).

  8         (d)  A provisional license may be granted to an

  9  applicant when each individual required by this section to

10  undergo background screening has met the standards for the

11  abuse registry background check and the Department of Law

12  Enforcement background check, but the agency has not yet

13  received background screening results from the Federal Bureau

14  of Investigation, or a request for a disqualification

15  exemption has been submitted to the agency as set forth in

16  chapter 435 but a response has not yet been issued. A license

17  may be granted to the applicant upon the agency's receipt of a

18  report of the results of the Federal Bureau of Investigation

19  background screening for each individual required by this

20  section to undergo background screening which confirms that

21  all standards have been met, or upon the granting of a

22  disqualification exemption by the agency as set forth in

23  chapter 435. Any other person who is required to undergo level

24  2 background screening may serve in his or her capacity

25  pending the agency's receipt of the report from the Federal

26  Bureau of Investigation. However, the person may not continue

27  to serve if the report indicates any violation of background

28  screening standards and a disqualification exemption has not

29  been requested of and granted by the agency as set forth in

30  chapter 435.

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  1         (e)  Each applicant must submit to the agency, with its

  2  application, a description and explanation of any exclusions,

  3  permanent suspensions, or terminations of the applicant from

  4  the Medicare or Medicaid programs. Proof of compliance with

  5  the requirements for disclosure of ownership and control

  6  interests under the Medicaid or Medicare programs may be

  7  accepted in lieu of this submission.

  8         (f)  Each applicant must submit to the agency a

  9  description and explanation of any conviction of an offense

10  prohibited under the level 2 standards of chapter 435 by a

11  member of the board of directors of the applicant, its

12  officers, or any individual owning 5 percent or more of the

13  applicant. This requirement does not apply to a director of a

14  not-for-profit corporation or organization if the director

15  serves solely in a voluntary capacity for the corporation or

16  organization, does not regularly take part in the day-to-day

17  operational decisions of the corporation or organization,

18  receives no remuneration for his or her services on the

19  corporation or organization's board of directors, and has no

20  financial interest and has no family members with a financial

21  interest in the corporation or organization, provided that the

22  director and the not-for-profit corporation or organization

23  include in the application a statement affirming that the

24  director's relationship to the corporation satisfies the

25  requirements of this paragraph.

26         (g)  A license may not be granted to an applicant if

27  the applicant or managing employee has been found guilty of,

28  regardless of adjudication, or has entered a plea of nolo

29  contendere or guilty to, any offense prohibited under the

30  level 2 standards for screening set forth in chapter 435,

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  1  unless an exemption from disqualification has been granted by

  2  the agency as set forth in chapter 435.

  3         (h)  The agency may deny or revoke licensure if the

  4  applicant:

  5         1.  Has falsely represented a material fact in the

  6  application required by paragraph (e) or paragraph (f), or has

  7  omitted any material fact from the application required by

  8  paragraph (e) or paragraph (f); or

  9         2.  Has had prior action taken against the applicant

10  under the Medicaid or Medicare program as set forth in

11  paragraph (e).

12         (i)  An application for license renewal must contain

13  the information required under paragraphs (e) and (f).

14         Section 99.  Effective January 1, 1999, subsection (2)

15  of section 641.55, Florida Statutes, is amended to read:

16         641.55  Internal risk management program.--

17         (2)  The risk management program shall be the

18  responsibility of the governing authority or board of the

19  organization. Every organization which has an annual premium

20  volume of $10 million or more and which directly provides

21  health care in a building owned or leased by the organization

22  shall hire a risk manager, certified under ss.

23  395.10971-395.10975 ss. 626.941-626.945, who shall be

24  responsible for implementation of the organization's risk

25  management program required by this section.  A part-time risk

26  manager shall not be responsible for risk management programs

27  in more than four organizations or facilities. Every

28  organization which does not directly provide health care in a

29  building owned or leased by the organization and every

30  organization with an annual premium volume of less than $10

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  1  million shall designate an officer or employee of the

  2  organization to serve as the risk manager.

  3

  4  The gross data compiled under this section or s. 395.0197

  5  shall be furnished by the agency upon request to organizations

  6  to be utilized for risk management purposes.  The agency shall

  7  adopt rules necessary to carry out the provisions of this

  8  section.

  9         Section 100.  Paragraph (c) of subsection (4) of

10  section 766.1115, Florida Statutes, is amended to read:

11         766.1115  Health care providers; creation of agency

12  relationship with governmental contractors.--

13         (4)  CONTRACT REQUIREMENTS.--A health care provider

14  that executes a contract with a governmental contractor to

15  deliver health care services on or after April 17, 1992, as an

16  agent of the governmental contractor is an agent for purposes

17  of s. 768.28(9), while acting within the scope of duties

18  pursuant to the contract, if the contract complies with the

19  requirements of this section.  A health care provider under

20  contract with the state may not be named as a defendant in any

21  action arising out of the medical care or treatment provided

22  on or after April 17, 1992, pursuant to contracts entered into

23  under this section.  The contract must provide that:

24         (c)  Adverse incidents and information on treatment

25  outcomes must be reported by any health care provider to the

26  governmental contractor if such incidents and information

27  pertain to a patient treated pursuant to the contract. The

28  health care provider shall annually submit an adverse incident

29  report that includes all information required by s.

30  395.0197(6) s. 395.0197(5)(a), unless the adverse incident

31  involves a result described by s. 395.0197(8) s. 395.0197(6),

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  1  in which case it shall be reported within 15 days of the

  2  occurrence of such incident. If an incident involves a

  3  professional licensed by the Department of Health Business and

  4  Professional Regulation or a facility licensed by the Agency

  5  for Health Care Administration Department of Health and

  6  Rehabilitative Services, the governmental contractor shall

  7  submit such incident reports to the appropriate department or

  8  agency, which shall review each incident and determine whether

  9  it involves conduct by the licensee that is subject to

10  disciplinary action. All patient medical records and any

11  identifying information contained in adverse incident reports

12  and treatment outcomes which are obtained by governmental

13  entities pursuant to this paragraph are confidential and

14  exempt from the provisions of s. 119.07(1) and s. 24(a), Art.

15  I of the State Constitution.

16

17  A governmental contractor that is also a health care provider

18  is not required to enter into a contract under this section

19  with respect to the health care services delivered by its

20  employees.

21         Section 101.  Subsection (9) of section 395.403,

22  Florida Statutes, and sections 407.61, 408.003, 408.072,

23  408.085, and 455.661, Florida Statutes, are repealed.

24         Section 102.  The repeal of laws governing the review

25  of hospital budgets and related penalties contained in this

26  act operates retroactively and applies to any hospital budget

27  prepared for a fiscal year that ended during the 1995 calendar

28  year.

29         Section 103.  Effective January 1, 1999, all powers,

30  duties, and functions and all rules, records, personnel,

31  property, and unexpended balances of appropriations,

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  1  allocations, or other funds of the Department of Insurance

  2  related to the health care risk manager licensure program, as

  3  established in part IX of chapter 626, Florida Statutes, are

  4  transferred by a type two transfer, as defined in section

  5  20.06(2), Florida Statutes, from the Department of Insurance

  6  to the Agency for Health Care Administration.

  7         Section 104.  There is appropriated $143,510 from the

  8  Health Care Trust Fund to the Agency for Health Care

  9  Administration for the purpose of funding two full-time

10  positions to administer the health care risk manager licensure

11  program.

12         Section 105.  Two full-time positions are allocated to

13  the Agency for Health Care Administration to implement and

14  administer a background screening exemption program pursuant

15  to section 400.4174, Florida Statutes, as amended by this act,

16  section 400.5572, Florida Statutes, as created by this act,

17  and chapter 435, Florida Statutes, and the sum of $127,350 is

18  appropriated from the Health Care Trust Fund for this purpose.

19         Section 106.  The provisions of this act which require

20  an applicant for licensure, certification, or registration to

21  undergo background screening shall apply to any individual or

22  entity that applies, on or after July 1, 1998, for renewal of

23  a license, certificate, or registration that is subject to the

24  background screening required by this act.

25         Section 107.  Except as otherwise expressly provided in

26  this act, this act shall take effect July 1, 1998.

27

28

29

30

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  1            *****************************************

  2                          SENATE SUMMARY

  3    Provides for health care quality assurance by requiring
      background screening of specified personnel associated
  4    with certain entities that provide health care services.
      Specifies standards for such screening. Transfers duties
  5    pertaining to health care risk management from the
      Insurance Commissioner to the Director for Health Care
  6    Administration. Removes and repeals provisions relating
      to the Health Care Board and review of hospital budgets.
  7    Revises, updates, and conforms various provisions to
      reflect the assumption by the Agency for Health Care
  8    Administration of the duties of the Health Care Board and
      the former Health Care Cost Containment Board and duties
  9    of the former Department of Health and Rehabilitative
      Services relating to indigent medical care and the State
10    Center for Health Statistics. Requires licensed hospital
      facilities to be capable of serving as disaster shelters
11    for patients, staff, and families of staff only, limits
      applicability of the requirement to new facilities and
12    new wings or floors of existing facilities, and requires
      the agency to recommend to the Governor and Legislature
13    cost-effective renovation standards for existing hospital
      facilities. Authorizes the agency to conduct data-based
14    studies and evaluations and make certain recommendations
      to the Governor and Legislature. (See bill for details.)
15

16

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