House Bill 3565c1

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    Florida House of Representatives - 1998             CS/HB 3565

        By the Committee on Health Care Standards & Regulatory
    Reform and Representative Hill





  1                      A bill to be entitled

  2         An act relating to health quality assurance;

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

  4         Drug-Free Workplace Act; requiring background

  5         screening for an applicant for licensure of

  6         certain laboratories; authorizing the use of

  7         certain body hair for drug testing; creating s.

  8         381.60225, F.S.; requiring background screening

  9         for an applicant for certification to operate

10         an organ procurement organization, a tissue

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

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

13         centers; revising definitions to reflect the

14         transfer of regulatory authority from the

15         Department of Health and Rehabilitative

16         Services to the Agency for Health Care

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

18         requiring background screening for an applicant

19         for licensure of a birth center; amending ss.

20         383.308, 383.309, 383.31, 383.312, 383.313,

21         383.318, 383.32, 383.324, 383.325, 383.327,

22         383.33, and 383.331, F.S., relating to the

23         regulation of birth centers; conforming

24         provisions to reflect the transfer of

25         regulatory authority to the Agency for Health

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

27         requiring background screening for an applicant

28         for licensure of an abortion clinic; amending

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

30         screening for an applicant for licensure to

31         operate a pediatric extended care center;

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

  2         developmental disabilities; providing a

  3         definition; correcting cross references;

  4         amending s. 393.067, F.S.; requiring background

  5         screening for an applicant for licensure to

  6         operate an intermediate care facility for the

  7         developmentally disabled; amending ss.

  8         394.4787, 395.602, 395.701, and 397.405, F.S.;

  9         conforming cross references to changes made by

10         the act; amending s. 394.67, F.S., relating to

11         community alcohol, drug abuse, and mental

12         health services; revising definitions; amending

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

14         screening for an applicant for licensure of a

15         crisis stabilization unit or residential

16         treatment facility; amending ss. 394.876,

17         394.877, 394.878, 394.879, 394.90, 394.902,

18         394.903, 394.904, and 394.907, F.S., relating

19         to the regulation of mental health facilities;

20         conforming provisions to reflect the transfer

21         of regulatory authority to the Agency for

22         Health Care Administration; amending s.

23         395.002, F.S., relating to hospital licensing

24         and regulation; providing definitions; creating

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

26         screening for an applicant for licensure of a

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

28         s. 395.0199, F.S.; requiring background

29         screening for an applicant for registration as

30         a utilization review agent; amending s.

31         400.051, F.S.; conforming a cross reference;

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  1         amending s. 400.071, F.S.; requiring background

  2         screening for an applicant for licensure of a

  3         nursing home; amending s. 400.411, F.S.;

  4         requiring background screening for an applicant

  5         for licensure of an assisted living facility;

  6         amending ss. 400.414, 400.417, 400.4174, and

  7         400.4176, F.S., relating to the regulation of

  8         assisted living facilities; providing

  9         additional grounds for denial, revocation, or

10         suspension of a license; requiring background

11         screening for employees hired on or after a

12         specified date; amending ss. 400.461 and

13         400.462, F.S., relating to the regulation of

14         home health agencies; conforming a cross

15         reference; revising definitions; amending s.

16         400.464, F.S.; revising licensure requirements

17         for home health agencies; specifying services

18         and persons that are exempt from the licensure

19         requirements; amending s. 400.471, F.S.;

20         requiring background screening for an applicant

21         for licensure of a home health agency; revising

22         requirements for license renewal; amending s.

23         400.474, F.S.; providing penalties for

24         operating a home health agency without a

25         license; amending s. 400.484, F.S.; providing a

26         schedule for the agency to use in imposing

27         fines for various classes of violations;

28         amending s. 400.487, F.S.; revising

29         requirements for patient assessment and

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

31         requirements for maintaining patient records;

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

  2         requirements for the agency in establishing

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

  4         revising licensure and referral requirements

  5         for nurse registries; requiring background

  6         screening for an applicant for licensure as a

  7         nurse registry; amending s. 400.509, F.S.;

  8         requiring background screening for an applicant

  9         for registration as a service provider who is

10         exempt from licensure; amending s. 400.512,

11         F.S.; revising screening requirements for home

12         health agency personnel; amending s. 400.555,

13         F.S.; requiring background screening for an

14         applicant for licensure of an adult day care

15         center; amending s. 400.556, F.S., relating to

16         disciplinary actions against adult day care

17         center licensees; making noncompliance with

18         background screening requirements a basis for

19         disciplinary action; amending s. 400.557, F.S.,

20         relating to renewal of an adult day care center

21         license; requiring an affidavit of compliance

22         with background screening requirements when a

23         license is renewed; creating s. 400.5572, F.S.;

24         requiring background screening for employees of

25         an adult day care center hired on or after a

26         specified date; amending s. 400.606, F.S.;

27         requiring background screening for an applicant

28         for licensure of a hospice; creating s.

29         400.6065, F.S.; providing requirements for

30         background screening of hospice employees;

31         amending s. 400.607, F.S., relating to

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  1         disciplinary actions against a hospice license;

  2         making noncompliance with background screening

  3         requirements a basis for disciplinary action;

  4         amending s. 400.619, F.S.; revising background

  5         screening requirements for an applicant for

  6         licensure of an adult family care home;

  7         providing screening requirements for designated

  8         relief persons; deleting agency authority to

  9         take disciplinary action against an adult

10         family-care home license; revising rulemaking

11         authority; creating s. 400.6194, F.S.;

12         providing for disciplinary action against an

13         adult family-care home license; making

14         noncompliance with screening requirements a

15         basis for disciplinary action; amending s.

16         400.801, F.S.; requiring background screening

17         for an applicant for licensure of a home for

18         special services; amending s. 400.805, F.S.;

19         requiring background screening for an applicant

20         for licensure of a transitional living

21         facility; amending ss. 408.032, 408.072,

22         409.905, 419.001, and 440.13, F.S.; conforming

23         cross references to changes made by the act;

24         amending s. 430.04, F.S.; providing duties and

25         responsibilities of the Department of Elderly

26         Affairs; requiring the department to take

27         disciplinary action against an area agency on

28         aging for failure to implement and maintain a

29         department-approved grievance resolution

30         procedure; amending s. 455.654, F.S., relating

31         to referring health care providers; conforming

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  1         cross references to changes made by the act;

  2         amending s. 468.505, F.S., relating to

  3         disciplinary action against certain medical

  4         professionals and activities exempt from

  5         regulation; updating provisions and conforming

  6         cross references; amending s. 483.101, F.S.;

  7         requiring background screening for an applicant

  8         for licensure of a clinical laboratory;

  9         amending s. 483.106, F.S., relating to a

10         certificate of exemption; correcting

11         terminology; amending s. 483.30, F.S.;

12         requiring background screening for an applicant

13         for licensure of a multiphasic health testing

14         center; amending ss. 92.53, 914.16, 914.17,

15         918.16, 943.0585, and 943.059, F.S.; conforming

16         cross references to changes made by the act;

17         repealing s. 455.661, F.S., relating to

18         requirements for licensure of designated health

19         care services; providing appropriations and

20         authorizing positions; providing for

21         applicability of background screening

22         requirements; providing an effective date.

23

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

25

26         Section 1.  Subsection (12) and paragraph (b) of

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

28  amended to read:

29         112.0455  Drug-Free Workplace Act.--

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

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  1         (a)  A laboratory may analyze initial or confirmation

  2  drug specimens only if:

  3         1.  The laboratory is licensed and approved by the

  4  Agency for Health Care Administration using criteria

  5  established by the United States Department of Health and

  6  Human Services as general guidelines for modeling the state

  7  drug testing program. Each applicant for licensure must comply

  8  with the 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 managing employee, or other similarly

13  titled individual responsible for the daily operation of the

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

15  titled individual who is responsible for the financial

16  operation of the laboratory, including billings for services.

17  The applicant must comply with the procedures for level 2

18  background screening as set forth in chapter 435, as well as

19  the requirements of s. 435.03(3).

20         b.  The agency may require background screening of any

21  other individual who is an applicant if the agency has

22  probable cause to believe that he or she has been convicted of

23  an offense prohibited under the level 2 standards for

24  screening set forth in chapter 435.

25         c.  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 screening requirements.

30         d.  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 license

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

  9  report of the results of the Federal Bureau of Investigation

10  background screening for each individual required by this

11  section to undergo background screening which confirms that

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

13  disqualification exemption by the agency as set forth in

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

15  2 background screening may serve in his or her capacity

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

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

18  to serve if the report indicates any violation of background

19  screening standards and a disqualification exemption has not

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

21  chapter 435.

22         e.  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  the requirements for disclosure of ownership and controlling

27  interests under the Medicaid or Medicare programs shall be

28  accepted in lieu of this submission.

29         f.  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 does 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 sub-subparagraph.

16         g.  A license may not be granted to any 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         h.  The agency may deny or revoke licensure if the

24  applicant:

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

26  application required by sub-subparagraph e. or

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

28  application required by sub-subparagraph e. or

29  sub-subparagraph f.; or

30

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

  2  under the Medicaid or Medicare programs as set forth in

  3  sub-subparagraph e.

  4         i.  An application for license renewal must contain the

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

  6         2.  The laboratory has written procedures to ensure

  7  chain of custody.

  8         3.  The laboratory follows proper quality control

  9  procedures, including, but not limited to:

10         a.  The use of internal quality controls including the

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

12  the performance and calibration of testing equipment, and

13  periodic use of blind samples for overall accuracy.

14         b.  An internal review and certification process for

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

16  that function in the testing laboratory.

17         c.  Security measures implemented by the testing

18  laboratory to preclude adulteration of specimens and drug test

19  results.

20         d.  Other necessary and proper actions taken to ensure

21  reliable and accurate drug test results.

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

23  written test result report within 7 working days after receipt

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

25  shall, at a minimum, state:

26         1.  The name and address of the laboratory which

27  performed the test and the positive identification of the

28  person tested.

29         2.  Positive results on confirmation tests only, or

30  negative results, as applicable.

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

  2  were conducted.

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

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

  5         5.  Any correlation between medication reported by the

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

  7  and a positive confirmed drug test result.

  8

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

10  other than a specific drug and its metabolites listed pursuant

11  to this section.

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

13  Health Care Administration a monthly report with statistical

14  information regarding the testing of employees and job

15  applicants.  The reports shall include information on the

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

17  number of positive and negative results for both initial and

18  confirmation tests, and any other information deemed

19  appropriate by the Agency for Health Care Administration. No

20  monthly report shall identify specific employees or job

21  applicants.

22         (d)  Laboratories shall provide technical assistance to

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

24  interpreting any positive confirmed test results which could

25  have been caused by prescription or nonprescription medication

26  taken by the employee or job applicant.

27         (13)  RULES.--

28         (b)  The following standards and procedures are

29  established related to hair testing:

30         1.  Hair cutoff levels for initial drug-screening

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

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  1  screening hair specimens to determine whether they are

  2  negative for these drugs or their metabolites:

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

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

  5         c.  Opiate/synthetic narcotics and metabolites:  5

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

  7  metabolites include the following:

  8         (I)  Codeine;

  9         (II)  Heroin, monoacetylmorphine monoacitylmorphine

10  (heroin metabolites);

11         (III)  Morphine;

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

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

14  of this section, amphetamines include the following:

15         (I)  Amphetamines;

16         (II)  Methamphetamine;

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

18         a.  All specimens identified as positive on the initial

19  test must be confirmed using gas chromatography/mass

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

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

22  their metabolites. All confirmations must be by quantitative

23  analysis.

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

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

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

27  Cocaine metabolites if present will be recorded at the

28  following minimum levels:

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

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

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

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

  3  following:

  4         (A)  Codeine;

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

  6         (C)  Morphine.

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

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

  9  purpose of this section, amphetamines include the following:

10         (A)  Amphetamines; and

11         (B)  Methamphetamines.

12         b.  All hair specimens undergoing confirmation must be

13  decontaminated using a wash procedure which has been published

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

15  initial 15-minute organic solvent wash followed by multiple

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

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

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

19  or by multiple solvent extractions. The resulting digest or

20  pooled solvent extracts are then screened and confirmed by

21  approved methods.

22         d.  All confirmation analysis methods must eliminate

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

24  nondigestion method is used, the laboratory must present

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

26  population study which indicates that the method of extraction

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

28         e.  Additional hair samples may be collected to

29  reconfirm the initial report. The recollected sample shall be

30  retested as specified; however, the confirmation analysis must

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

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

  2  digest by confirmation methods exceeds the limit of

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

  4  must be offered to anyone disputing a positive hair test

  5  result.

  6         3.  Hair specimen collection procedures.--

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

  8  program shall have one or more designated collection sites

  9  which have all necessary personnel, materials, equipment,

10  facilities, and supervision to provide for the collection,

11  security, temporary storage, and shipping or transportation of

12  hair specimens to a licensed drug-testing facility.

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

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

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

16         c.  Chain of custody.--Chain-of-custody standardized

17  forms shall be properly executed by authorized collection site

18  personnel upon receipt of specimens. Handling and

19  transportation of hair specimens from one authorized

20  individual or place to another shall always be accomplished

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

22  made to minimize the number of persons handling specimens.

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

24  collection site need be off limits to unauthorized personnel

25  only during the actual collection of specimens.

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

27  performed on one individual at a time to prevent substitutions

28  or interference with the collection of reliable samples.

29  Procedures must ensure that the hair collection does not

30  infringe on the individual's privacy.

31

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

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

  3  is indicated for the laboratory which performs the testing.

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

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

  6  time window. The following minimum precautions must be taken

  7  when collecting a hair specimen to ensure that specimens are

  8  obtained and correctly identified:

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

10  the collection site personnel shall request the individual to

11  present photo identification. If the individual does not have

12  proper photo identification, the collection site personnel

13  shall contact the supervisor of the individual, the

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

15  official who can positively identify the individual. If the

16  individual's identity cannot be established, the collection

17  site personnel shall not proceed with the collection.

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

19  time, the collection site personnel shall contact the

20  appropriate authority to obtain guidance on the action to be

21  taken.

22         (III)  The collection site personnel shall note any

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

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

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

26  specimen from the individual, the collection site personnel

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

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

29         (V)  Both the individual being tested and the

30  collection site personnel shall keep the specimen in view at

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

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

  2  specimen number and other required information.

  3         (VI)  The collection site personnel shall label the

  4  container which contains the hair with the date, the

  5  individual's specimen number, and any other identifying

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

  7         (VII)  The individual shall initial the container for

  8  the purpose of certifying that it is the specimen collected

  9  from the individual.

10         (VIII)  The collection site personnel shall indicate on

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

12  specimen. The collection site personnel shall sign the

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

14  the chain of custody on the specimen container.

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

16  statement certifying that the specimen identified as having

17  been collected from the individual is in fact that specimen

18  the individual provided.

19         (X)  The collection site personnel shall complete the

20  chain-of-custody form.

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

22  possible, collection site personnel shall keep the

23  individual's specimen container within sight both before and

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

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

26  must be used for maintaining control and accountability of

27  each specimen from the point of collection to final

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

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

30  specimen is handled or transferred and every individual in the

31

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

  2  minimize the number of persons handling specimens.

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

  4  site personnel shall arrange to transport the collected

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

  6  placed in containers which shall be securely sealed to

  7  eliminate the possibility of undetected tampering. The

  8  collection site personnel shall ensure that the

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

10  specimen and placed inside the container sealed for transfer

11  to the drug-testing facility.

12         4.  Quality assurance and quality control.--

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

14  quality assurance program which encompasses all aspects of the

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

16  acquisition, chain of custody, security and reporting of

17  results, initial and confirmatory testing, and validation of

18  analytical procedures. Quality assurance procedures shall be

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

20  each step of the process of testing for drugs.

21         b.  Quality control.--

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

23  shall include:

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

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

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

27  or near the threshold (cutoff).

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

29  sufficient number of standards shall be included to ensure and

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

31  concentration area of the cutoff. After acceptable values are

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

  2  calculate sample data. Implementation of procedures to ensure

  3  that carryover does not contaminate the testing of an

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

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

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

  7  fortified hair samples of determined concentration, must be

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

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

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

11  testing facility's own quality control samples.

12         5.a.  Proficiency testing.--

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

14  demonstrate satisfactory performance in a proficiency-testing

15  program established by an independent group.

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

17  which document the handling, processing, and examination of

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

19  the date of testing.

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

21  proficiency-testing samples are analyzed at least three times

22  each year using the same techniques as those employed for

23  unknown specimens.

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

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

26  as unknown samples by the individuals responsible for testing

27  unknown specimens.

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

29  discussions or communications concerning proficiency-testing

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

31

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  1  proficiency-testing samples or portions of the samples to

  2  another drug-testing facility for analysis.

  3         b.  Satisfactory performance.--

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

  5  overall testing-event score equivalent to passing proficiency

  6  scores for other drug-testing matrices.

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

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

  9  event.

10         c.  Unsuccessful performance.--Failure to achieve

11  satisfactory performance in two consecutive testing events, or

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

13  be unsuccessful performance.

14

15  This section shall not be construed to eliminate the

16  bargainable rights as provided in the collective bargaining

17  process where applicable.

18         Section 2.  Section 381.60225, Florida Statutes, is

19  created to read:

20         381.60225  Background screening.--

21         (1)  Each applicant for certification must comply with

22  the following requirements:

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

24  application, the Agency for Health Care Administration shall

25  require background screening, in accordance with the level 2

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

27  managing employee, or other similarly titled individual who is

28  responsible for the daily operation of the organization,

29  agency, or entity, and of the financial officer, or other

30  similarly titled individual who is responsible for the

31  financial operation of the organization, agency, or entity,

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  1  including billings for services.  The applicant must comply

  2  with the procedures for level 2 background screening as set

  3  forth in chapter 435, as well as the requirements of s.

  4  435.03(3).

  5         (b)  The Agency for Health Care Administration may

  6  require background screening of any other individual who is an

  7  applicant if the Agency for Health Care Administration has

  8  probable cause to believe that he or she has been convicted of

  9  a crime or has committed any other offense prohibited under

10  the level 2 standards for screening set forth in chapter 435.

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

12  screening requirements of chapter 435 which has been submitted

13  within the previous 5 years in compliance with any other

14  health care licensure requirements of this state is acceptable

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

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

17  organization, agency, or entity when each individual required

18  by this section to undergo background screening has met the

19  standards for the abuse registry background check and the

20  Department of Law Enforcement background check, but the agency

21  has not yet received background screening results from the

22  Federal Bureau of Investigation, or a request for a

23  disqualification exemption has been submitted to the agency as

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

25  issued. A standard certification may be granted to the

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

27  report of the results of the Federal Bureau of Investigation

28  background screening for each individual required by this

29  section to undergo background screening which confirms that

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

31  disqualification exemption by the agency as set forth in

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

  2  2 background screening may serve in his or her capacity

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

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

  5  to serve if the report indicates any violation of background

  6  screening standards and a disqualification exemption has not

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

  8  chapter 435.

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

10  application, a description and explanation of any exclusions,

11  permanent suspensions, or terminations of the applicant from

12  the Medicare or Medicaid programs. Proof of compliance with

13  the requirements for disclosure of ownership and controlling

14  interests under the Medicaid or Medicare programs shall be

15  accepted in lieu of this submission.

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

17  description and explanation of any conviction of an offense

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

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

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

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

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

23  serves solely in a voluntary capacity for the corporation or

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

25  operational decisions of the corporation or organization,

26  receives no remuneration for his or her services on the

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

28  financial interest and has no family members with a financial

29  interest in the corporation or organization, provided that the

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

31  include in the application a statement affirming that the

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  1  director's relationship to the corporation satisfies the

  2  requirements of this paragraph.

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

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

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

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

  7  prohibited under the level 2 standards for screening set forth

  8  in chapter 435, unless an exemption from disqualification has

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

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

11  organization, agency, or entity if the applicant:

12         1.  Has falsely represented a material fact in the

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

14  omitted any material fact from the application required by

15  paragraph (e) or paragraph (f); or

16         2.  Has had prior action taken against the applicant

17  under the Medicaid or Medicare programs as set forth in

18  paragraph (e).

19         (i)  An application for renewal of certification must

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

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

22  eye bank certified by the Agency for Health Care

23  Administration in accordance with ss. 381.6021 and 381.6022 is

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

25  has no direct patient care responsibilities and does not bill

26  patients or insurers directly for services under the Medicare

27  or Medicaid programs or for privately insured services.

28         Section 3.  Section 383.302, Florida Statutes, is

29  amended to read:

30

31

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  1         383.302  Definitions of terms used in ss.

  2  383.30-383.335.--As used in ss. 383.30-383.335, unless the

  3  context otherwise requires, the term:

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

  5  Administration.

  6         (2)(1)  "Birth center" means any facility, institution,

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

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

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

10  normal, uncomplicated, low-risk pregnancy.

11         (3)(2)  "Clinical staff" means individuals employed

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

13  certified to provide care at childbirth.

14         (4)(3)  "Consultant" means a physician licensed

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

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

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

18  American Board of Obstetrics and Gynecology, or

19         (b)  Has hospital obstetrical privileges.

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

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

22  corporation, or institution which is responsible for the

23  overall operation and maintenance of a birth center.

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

25  municipality, or other political subdivision or any

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

27  foregoing.

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

29  accordance with s. 383.305.

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

31  expected to result in an uncomplicated birth, as determined

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

  2  which is accompanied by adequate prenatal care.

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

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

  5  association and means any legal successor of any of the

  6  foregoing.

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

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

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

10  maternity care located in such reasonable proximity to the

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

12  under the dominion and control of the licensee.

13         Section 4.  Section 383.305, Florida Statutes, is

14  amended to read:

15         383.305  Licensure; issuance, renewal, denial,

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

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

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

19  license if the applicant and facility have received all

20  approvals required by law and meet the requirements

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

22  hereunder.

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

24  center that is in substantial compliance with ss.

25  383.30-383.335 and with the rules of the agency department.  A

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

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

28  agency department, shall expire automatically at the end of

29  its term, and may not be renewed.

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

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

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  1  renewable upon application for renewal and payment of the fee

  2  prescribed, provided the applicant and the birth center meet

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

  4  rules promulgated hereunder.  A complete application for

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

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

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

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

  9  it and shall contain such information as the agency department

10  reasonably requires, which may include affirmative evidence of

11  ability to comply with applicable laws and rules.

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

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

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

15  fees are payable to the agency department and shall be

16  deposited in a trust fund administered by the agency

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

18  the provisions of ss. 383.30-383.335.

19         (b)  The fees established pursuant to ss.

20  383.30-383.335 shall be based on actual costs incurred by the

21  agency department in the administration of its duties under

22  such sections.

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

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

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

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

27  those for which it was originally issued.

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

29  place on the licensed premises.

30         (6)  Whenever the agency department finds that there

31  has been a substantial failure to comply with the requirements

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

  2  those sections promulgated hereunder, it is authorized to

  3  deny, suspend, or revoke a license.

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

  5  following requirements:

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

  7  application, the agency shall require background screening, in

  8  accordance with the level 2 standards for screening set forth

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

10  titled individual who is responsible for the daily operation

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

12  similarly titled individual who is responsible for the

13  financial operation of the center, including billings for

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

15  procedures for level 2 background screening as set forth in

16  chapter 435 as well as the requirements of s. 435.03(3).

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

18  other individual who is an applicant if the agency has

19  probable cause to believe that he or she has been convicted of

20  a crime or has committed any other offense prohibited under

21  the level 2 standards for screening set forth in chapter 435.

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

23  screening requirements of chapter 435 which has been submitted

24  within the previous 5 years in compliance with any other

25  health care licensure requirements of this state is acceptable

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

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

28  applicant when each individual required by this section to

29  undergo background screening has met the standards for the

30  abuse registry background check and the Department of Law

31  Enforcement background check, but the agency has not yet

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  1  received background screening results from the Federal Bureau

  2  of Investigation, or a request for a disqualification

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

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

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

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

  7  Investigation background screening for each individual

  8  required by this section to undergo background screening which

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

10  granting of a disqualification exemption by the agency as set

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

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

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

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

15  continue to serve if the report indicates any violation of

16  background screening standards and a disqualification

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

18  as set forth in chapter 435.

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

20  application, a description and explanation of any exclusions,

21  permanent suspensions, or terminations of the applicant from

22  the Medicare or Medicaid programs. Proof of compliance with

23  the requirements for disclosure of ownership and controlling

24  interests under the Medicaid or Medicare programs shall be

25  accepted in lieu of this submission.

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

27  description and explanation of any conviction of an offense

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

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

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

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

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

  2  serves solely in a voluntary capacity for the corporation or

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

  4  operational decisions of the corporation or organization,

  5  receives no remuneration for his or her services on the

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

  7  financial interest and has no family members with a financial

  8  interest in the corporation or organization, provided that the

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

10  include in the application a statement affirming that the

11  director's relationship to the corporation satisfies the

12  requirements of this paragraph.

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

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

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

16  contendere or guilty to, any offense prohibited under the

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

18  unless an exemption from disqualification has been granted by

19  the agency as set forth in chapter 435.

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

21  applicant:

22         1.  Has falsely represented a material fact in the

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

24  omitted any material fact from the application required by

25  paragraph (e) or paragraph (f); or

26         2.  Has had prior action taken against the applicant

27  under the Medicaid or Medicare programs as set forth in

28  paragraph (e).

29         (i)  An application for license renewal must contain

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

31

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  1         Section 5.  Paragraph (a) of subsection (2) of section

  2  383.308, Florida Statutes, is amended to read:

  3         383.308  Birth center facility and equipment;

  4  requirements.--

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

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

  7  available equipment to initiate emergency procedures in

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

  9  of the agency department.

10         Section 6.  Section 383.309, Florida Statutes, is

11  amended to read:

12         383.309  Minimum standards for birth centers; rules and

13  enforcement.--

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

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

16  implement the provisions of this act, which rules shall

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

18  standards for ensuring that:

19         (a)  Sufficient numbers and qualified types of

20  personnel and occupational disciplines are available at all

21  times to provide necessary and adequate patient care and

22  safety.

23         (b)  Infection control, housekeeping, sanitary

24  conditions, disaster plan, and medical record procedures that

25  will adequately protect patient care and provide safety are

26  established and implemented.

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

28  of licensed facilities are governed by rules of the agency

29  department which use utilize the most recently adopted,

30  nationally recognized codes wherever feasible.  Facilities

31  licensed under s. 383.305 are exempt from local construction

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  1  standards to the extent that those standards are in conflict

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

  3         (d)  Licensed facilities are established, organized,

  4  and operated consistent with established programmatic

  5  standards.

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

  7  at the time of adoption promulgation of any applicable rule

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

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

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

11  comply with such rule.

12         Section 7.  Paragraph (b) of subsection (1) and

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

14  Statutes, are amended to read:

15         383.31  Selection of clients; informed consent.--

16         (1)

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

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

19  agency department.

20         (2)

21         (b)  The agency department shall develop a client

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

23  client of the benefits and risks related to childbirth outside

24  a hospital.

25         Section 8.  Subsection (1) of section 383.312, Florida

26  Statutes, is amended to read:

27         383.312  Prenatal care of birth center clients.--

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

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

30  and shall ensure that serological tests are administered as

31  required by this chapter.

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  1         Section 9.  Subsection (1) of section 383.313, Florida

  2  Statutes, is amended to read:

  3         383.313  Performance of laboratory and surgical

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

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

  6  specimens for those tests that are requested under protocol.

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

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

  9  requirements of chapter 483, provided no more than five

10  physicians are employed by the birth center and testing is

11  conducted exclusively in connection with the diagnosis and

12  treatment of clients of the birth center.

13         Section 10.  Subsection (1) of section 383.318, Florida

14  Statutes, is amended to read:

15         383.318  Postpartum care for birth center clients and

16  infants.--

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

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

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

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

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

22  report shall be filed with the agency department within 48

23  hours of the birth describing the circumstances and the

24  reasons for the decision.

25         Section 11.  Subsection (3) of section 383.32, Florida

26  Statutes, is amended to read:

27         383.32  Clinical records.--

28         (3)  Clinical records shall be kept confidential in

29  accordance with s. 455.667 455.241 and exempt from the

30  provisions of s. 119.07(1). A client's clinical records shall

31  be open to inspection only under the following conditions:

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

  2  by the client; or

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

  4  licensure survey or complaint investigation.

  5         Section 12.  Section 383.324, Florida Statutes, is

  6  amended to read:

  7         383.324  Inspections and investigations; inspection

  8  fees.--

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

10  made such inspections and investigations as it deems

11  necessary.

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

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

14  inspection fee established by rule of the agency department.

15         (3)  The agency department shall coordinate all

16  periodic inspections for licensure made by the agency

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

18  inspections and the disruption of services by such inspections

19  is minimized.

20         Section 13.  Subsection (3) of section 383.325, Florida

21  Statutes, is amended to read:

22         383.325  Inspection reports.--

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

24  person who has completed a written application with intent to

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

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

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

28  inspection report issued by the agency department or an

29  accrediting organization, whichever is most recent, pertaining

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

31

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  1  provided the person requesting such report agrees to pay a

  2  reasonable charge to cover copying costs.

  3         Section 14.  Subsection (4) of section 383.327, Florida

  4  Statutes, is amended to read:

  5         383.327  Birth and death records; reports.--

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

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

  8  rule of the agency department.

  9         Section 15.  Section 383.33, Florida Statutes, is

10  amended to read:

11         383.33  Administrative penalties; emergency orders;

12  moratorium on admissions.--

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

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

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

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

17  383.30-383.335 promulgated hereunder.  Each day of violation

18  constitutes a separate violation and is subject to a separate

19  fine.

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

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

22  factors shall be considered:

23         1.  The severity of the violation, including the

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

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

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

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

28         2.  Actions taken by the licensee to correct the

29  violations or to remedy complaints.

30         3.  Any previous violations by the licensee.

31

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  1         (c)  All amounts collected pursuant to this section

  2  shall be deposited into a trust fund administered by the

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

  4  out the provisions of ss. 383.30-383.335.

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

  6  immediately suspending or revoking a license when it

  7  determines that any condition in the licensed facility

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

  9  safety.

10         (3)  The agency department may impose an immediate

11  moratorium on elective admissions to any licensed facility,

12  building or portion thereof, or service when the agency

13  department determines that any condition in the facility

14  presents a threat to the public health or safety.

15         Section 16.  Section 383.331, Florida Statutes, is

16  amended to read:

17         383.331  Injunctive relief.--Notwithstanding the

18  existence or pursuit of any other remedy, the agency

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

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

21  383.30-383.335 and the rules adopted promulgated under such

22  sections.

23         Section 17.  Subsection (3) is added to section

24  390.015, Florida Statutes, to read:

25         390.015  Application for license.--

26         (3)  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 clinic, and of the financial officer, or other

  3  similarly titled individual who is responsible for the

  4  financial operation of the clinic, 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, as well as the requirements of s. 435.03(3).

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

  9  other individual who is an applicant if the agency has

10  probable cause to believe that he or she has been convicted of

11  a crime or has committed any other offense prohibited under

12  the level 2 standards 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 licensure requirements of this state is acceptable

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

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

19  applicant when each individual required by this section to

20  undergo background screening has met the standards for the

21  abuse registry background check and the Department of Law

22  Enforcement background check, but the agency has not yet

23  received background screening results from the Federal Bureau

24  of Investigation, or a request for a disqualification

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

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

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

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

29  Investigation background screening for each individual

30  required by this section to undergo background screening which

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

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  1  granting of a disqualification exemption by the agency as set

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

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

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

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

  6  continue to serve if the report indicates any violation of

  7  background screening standards and a disqualification

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

  9  as set forth in chapter 435.

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

11  application, a description and explanation of any exclusions,

12  permanent suspensions, or terminations of the applicant from

13  the Medicare or Medicaid programs. Proof of compliance with

14  the requirements for disclosure of ownership and controlling

15  interests under the Medicaid or Medicare programs shall be

16  accepted in lieu of this submission.

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

18  description and explanation of any conviction of an offense

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

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

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

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

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

24  serves solely in a voluntary capacity for the corporation or

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

26  operational decisions of the corporation or organization,

27  receives no remuneration for his or her services on the

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

29  financial interest and has no family members with a financial

30  interest in the corporation or organization, provided that the

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

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  1  include in the application a statement affirming that the

  2  director's relationship to the corporation satisfies the

  3  requirements of this paragraph.

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

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

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

  7  contendere or guilty to, any offense prohibited under the

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

  9  unless an exemption from disqualification has been granted by

10  the agency as set forth in chapter 435.

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

12  applicant:

13         1.  Has falsely represented a material fact in the

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

15  omitted any material fact from the application required by

16  paragraph (e) or paragraph (f); or

17         2.  Has had prior action taken against the applicant

18  under the Medicaid or Medicare programs as set forth in

19  paragraph (e).

20         (i)  An application for license renewal must contain

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

22         Section 18.  Subsection (5) is added to section

23  391.206, Florida Statutes, to read:

24         391.206  Initial application for license.--

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

26  following requirements:

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

28  application, the agency shall require background screening, in

29  accordance with the level 2 standards for screening set forth

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

31  or other similarly titled individual who is responsible for

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  1  the financial operation of the center, including billings for

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

  3  procedures for level 2 background screening as set forth in

  4  chapter 435, as well as the requirements of s. 435.03(3).

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

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

  7  reasonable basis for believing that he or she has been

  8  convicted of a crime or has committed any other offense

  9  prohibited under the level 2 standards for screening set forth

10  in chapter 435.

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

12  screening requirements of chapter 435 which has been submitted

13  within the previous 5 years in compliance with any other

14  health care licensure requirements of this state is acceptable

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

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

17  applicant when each individual required by this section to

18  undergo background screening has met the standards for the

19  abuse registry background check and the Department of Law

20  Enforcement background check, but the agency has not yet

21  received background screening results from the Federal Bureau

22  of Investigation, or a request for a disqualification

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

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

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

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

27  Investigation background screening for each individual

28  required by this section to undergo background screening which

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

30  granting of a disqualification exemption by the agency as set

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

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

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

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

  4  continue to serve if the report indicates any violation of

  5  background screening standards and a disqualification

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

  7  as set forth in chapter 435.

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

  9  application, a description and explanation of any exclusions,

10  permanent suspensions, or terminations of the applicant from

11  the Medicare or Medicaid programs. Proof of compliance with

12  the requirements for disclosure of ownership and controlling

13  interests under the Medicaid or Medicare programs shall be

14  accepted in lieu of this submission.

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

16  description and explanation of any conviction of an offense

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

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

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

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

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

22  serves solely in a voluntary capacity for the corporation or

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

24  operational decisions of the corporation or organization,

25  receives no remuneration for his or her services on the

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

27  financial interest and has no family members with a financial

28  interest in the corporation or organization, provided that the

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

30  include in the application a statement affirming that the

31

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  1  director's relationship to the corporation satisfies the

  2  requirements of this paragraph.

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

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

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

  6  contendere or guilty to, any offense prohibited under the

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

  8  unless an exemption from disqualification has been granted by

  9  the agency as set forth in chapter 435.

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

11  applicant:

12         1.  Has falsely represented a material fact in the

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

14  omitted any material fact from the application required by

15  paragraph (e) or paragraph (f); or

16         2.  Has had prior action taken against the applicant

17  under the Medicaid or Medicare programs as set forth in

18  paragraph (e).

19         (i)  An application for license renewal must contain

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

21         Section 19.  Subsections (2) through (53) of section

22  393.063, Florida Statutes, are renumbered as subsections (3)

23  through (54), respectively, the introductory paragraph of

24  present subsection (7) is amended, and a new subsection (2) is

25  added to that section, to read:

26         393.063  Definitions.--For the purposes of this

27  chapter:

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

29  Administration.

30         (8)(7)  "Comprehensive transitional education program"

31  means a group of jointly operating centers or units, the

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  1  collective purpose of which is to provide a sequential series

  2  of educational care, training, treatment, habilitation, and

  3  rehabilitation services to persons who have developmental

  4  disabilities, as defined in subsection (12) (11), and who have

  5  severe or moderate maladaptive behaviors.  However, nothing in

  6  this subsection shall require comprehensive transitional

  7  education programs to provide services only to persons with

  8  developmental disabilities, as defined in subsection (12)

  9  (11).  All such services shall be temporary in nature and

10  delivered in a structured residential setting with the primary

11  goal of incorporating the normalization principle to establish

12  permanent residence for persons with maladaptive behaviors in

13  facilities not associated with the comprehensive transitional

14  education program.  The staff shall include psychologists and

15  teachers, and such staff personnel shall be available to

16  provide services in each component center or unit of the

17  program.  The psychologists shall be individuals who are

18  licensed in this state and certified as behavior analysts in

19  this state, or individuals who meet the professional

20  requirements established by the department for district

21  behavior analysts and are certified as behavior analysts in

22  this state.

23         Section 20.  Subsections (6) through (18) of section

24  393.067, Florida Statutes, are renumbered as subsections (7)

25  through (19), respectively, present subsection (11) is

26  amended, and a new subsection (6) is added to that section, to

27  read:

28         393.067  Licensure of residential facilities and

29  comprehensive transitional education programs.--

30

31

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  1         (6)  Each applicant for licensure as an intermediate

  2  care facility for the developmentally disabled must comply

  3  with the following requirements:

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

  5  application, the agency shall require background screening, in

  6  accordance with the level 2 standards for screening set forth

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

  8  titled individual who is responsible for the daily operation

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

10  similarly titled individual who is responsible for the

11  financial operation of the facility, including billings for

12  resident care and services.  The applicant must comply with

13  the procedures for level 2 background screening as set forth

14  in chapter 435, as well as the requirements of s. 435.03(3).

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

16  other individual who is an applicant if the agency has

17  probable cause to believe that he or she has been convicted of

18  a crime or has committed any other offense prohibited under

19  the level 2 standards for screening set forth in chapter 435.

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

21  screening requirements of chapter 435 which has been submitted

22  within the previous 5 years in compliance with any other

23  health care licensure requirements of this state is acceptable

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

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, or a request for a disqualification

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

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

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

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

  5  Investigation background screening for each individual

  6  required by this section to undergo background screening which

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

  8  granting of a disqualification exemption by the agency as set

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

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

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

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

13  continue to serve if the report indicates any violation of

14  background screening standards and a disqualification

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

16  as set forth in chapter 435.

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

18  application, a description and explanation of any exclusions,

19  permanent suspensions, or terminations of the applicant from

20  the Medicare or Medicaid programs. Proof of compliance with

21  the requirements for disclosure of ownership and controlling

22  interests under the Medicaid or Medicare programs shall be

23  accepted in lieu of this submission.

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

25  description and explanation of any conviction of an offense

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

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

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

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

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

31  serves solely in a voluntary capacity for the corporation or

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

  2  operational decisions of the corporation or organization,

  3  receives no remuneration for his or her services on the

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

  5  financial interest and has no family members with a financial

  6  interest in the corporation or organization, provided that the

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

  8  include in the application a statement affirming that the

  9  director's relationship to the corporation satisfies the

10  requirements of this paragraph.

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

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

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

14  contendere or guilty to, any offense prohibited under the

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

16  unless an exemption from disqualification has been granted by

17  the agency as set forth in chapter 435.

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

19  applicant:

20         1.  Has falsely represented a material fact in the

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

22  omitted any material fact from the application required by

23  paragraph (e) or paragraph (f); or

24         2.  Has had prior action taken against the applicant

25  under the Medicaid or Medicare programs as set forth in

26  paragraph (e).

27         (i)  An application for license renewal must contain

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

29         (12)(11)  An alternative living center and an

30  independent living education center, as defined in s.

31  393.063(8)(7), shall be subject to the provisions of s.

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  1  419.001, except that such centers shall be exempt from the

  2  1,000-foot-radius requirement of s. 419.001(2) if:

  3         (a)  Such centers are located on a site zoned in a

  4  manner so that all the component centers of a comprehensive

  5  transition education center may be located thereon; or

  6         (b)  There are no more than three such centers within

  7  said radius of 1,000 feet.

  8         Section 21.  Subsection (7) of section 394.4787,

  9  Florida Statutes, is amended to read:

10         394.4787  Definitions.--As used in this section and ss.

11  394.4786, 394.4788, and 394.4789:

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

13  licensed by the agency pursuant to s. 395.002(30) s.

14  395.002(27) as a specialty psychiatric hospital.

15         Section 22.  Section 394.67, Florida Statutes, is

16  amended to read:

17         394.67  Definitions.--As When used in this part, unless

18  the context clearly requires otherwise, the term:

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

20  council.

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

22  Administration.

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

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

25  Health and Rehabilitative Services district or subdistrict

26  established in accordance with the provisions of this part for

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

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

29  those needs.

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

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

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  1  person, or any partner or shareholder having an ownership

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

  3  corporation, partnership, or other business entity.

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

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

  6  program, or service, which facility, program, or service is

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

  8  department or regulated by the agency.

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

10  provides an alternative to inpatient hospitalization and that

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

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

13  disturbed state.

14         (6)(3)  "Department" means the Department of Children

15  and Family Health and Rehabilitative Services.

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

17  of directors reported in the organization's annual corporate

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

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

20  directors. The term excludes members of separate, restricted

21  boards that serve only in an advisory capacity to the

22  operating board.

23         (8)(4)  "District administrator" means the person

24  appointed by the Secretary of Children and Family Health and

25  Rehabilitative Services for the purpose of administering a

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

27         (9)(5)  "District plan" or "plan" means the combined

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

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

30  and approved by the district administrator and governing

31  bodies in accordance with this part.

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  1         (10)(6)  "Federal funds" means funds from federal

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

  3  and programs, exclusive of federal funds that are deemed

  4  eligible by the Federal Government, and are eligible through

  5  state regulation, for matching purposes.

  6         (11)(7)  "Governing body" means the chief legislative

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

  8  of county commissioners in counties acting jointly, or their

  9  counterparts in a charter government.

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

11  accordance with this chapter.

12         (13)(8)  "Local matching funds" means funds received

13  from governing bodies of local government, including city

14  commissions, county commissions, district school boards,

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

16  both individual and corporate, and bequests and funds received

17  from community drives or any other sources.

18         (14)  "Managing employee" means the administrator, or

19  other similarly titled individual who is responsible for the

20  daily operation of the facility.

21         (15)(9)  "Patient fees" means compensation received by

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

23  services rendered to clients from any source of funds,

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

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

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

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

28  acute or residential care which are located in such reasonable

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

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

31  licensee.

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  1         (17)(10)  "Program office" means the Alcohol, Drug

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

  3  Children and Family Health and Rehabilitative Services.

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

  5  providing residential care and treatment to individuals

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

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

  8  respite care, or long-term community placement.

  9         (19)(11)  "Service district" means a community service

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

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

12  mental health services.

13         (20)(12)  "Service provider" means any agency in which

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

15  394.675 are carried out.

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

17  providing an alternative to inpatient hospitalization and

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

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

20  acutely disturbed state.

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

22  providing residential care and treatment to individuals

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

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

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

26  facility shall also include short-term residential treatment

27  facilities for treatment of mental illness.

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

29  accordance with this chapter.

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

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

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

  2  acute or residential care located in such reasonable proximity

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

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

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

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

  7  program, or service, which facility, program, or service is

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

  9  Rehabilitative Services.

10         Section 23.  Section 394.875, Florida Statutes, is

11  amended to read:

12         394.875  Crisis stabilization units and residential

13  treatment facilities; authorized services; license required;

14  penalties.--

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

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

17  least restrictive community setting available, consistent with

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

19  assess, and admit for stabilization persons who present

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

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

22  observation, medication prescribed by a physician or

23  psychiatrist, and other appropriate services.  Crisis

24  stabilization units shall provide services regardless of the

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

26  maximum of 30 beds.

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

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

29  ill individuals in a community-based residential setting.

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

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

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  1  residential treatment facility, or to act as a crisis

  2  stabilization unit or a residential treatment facility, unless

  3  it is licensed by the agency department pursuant to this

  4  chapter.

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

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

  7  in s. 775.082 or s. 775.083.

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

  9  circuit court to enjoin the unlawful operation of a crisis

10  stabilization unit or a residential treatment facility if the

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

12  its intention to maintain such action and if the violator

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

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

15         (a)  Homes for special services licensed under chapter

16  400;

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

18         (c)  Residential child caring facilities licensed under

19  s. 409.175.

20         (6)  The department, in consultation with the agency,

21  may establish multiple license classifications for residential

22  treatment facilities.

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

24  license to a crisis stabilization unit unless the unit

25  receives state mental health funds and is affiliated with a

26  designated public receiving facility.

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

28  crisis stabilization unit or short-term residential treatment

29  facility, certifying the number of authorized beds for such

30  facility as indicated by existing need and available

31  appropriations.  The agency department may disapprove an

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  1  application for such a license if it determines that a

  2  facility should not be licensed pursuant to the provisions of

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

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

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

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

  7  issued pursuant to chapter 395 for the excess beds.

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

  9  not exceed 20 licensed beds and which provides separate

10  facilities or a distinct part of a facility, separate

11  staffing, and treatment exclusively for minors may be located

12  on the same premises as a crisis stabilization unit serving

13  adults.  The department, in consultation with the agency,

14  shall adopt promulgate rules governing facility construction,

15  staffing and licensure requirements, and the operation of such

16  units for minors.

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

18  crisis stabilization units may not exceed their licensed

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

20  licensed capacity for more than 3 consecutive working days or

21  for more than 7 days in 1 month.

22         (11)  Notwithstanding the other provisions of this

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

24  detoxification, residential level I care, and outpatient

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

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

27  residential treatment facility pursuant to this section, if

28  all of the following conditions are met:

29         (a)  The licensure application is received by the

30  department prior to January 1, 1993.

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

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

  3  residential level I care, and outpatient treatment of

  4  substance abuse.

  5         (c)  The facility restricted its practice to the

  6  treatment of law enforcement personnel for a period of at

  7  least 12 months beginning after January 1, 1992.

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

  9  394 is equal to or less than the number of beds licensed under

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

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

12  placed upon the license that the facility will limit its

13  treatment exclusively to law enforcement personnel and their

14  immediate families who are seeking admission on a voluntary

15  basis and who are exhibiting symptoms of posttraumatic stress

16  disorder or other mental health problems, including drug or

17  alcohol abuse, which are directly related to law enforcement

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

19  licensee agrees to coordinate the provision of appropriate

20  postresidential care for discharged individuals; and the

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

22  condition specified in this paragraph shall constitute grounds

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

24  treatment facility.

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

26  all licensure requirements for a residential treatment

27  facility, including minimum standards for compliance with

28  lifesafety requirements, except those licensure requirements

29  which are in express conflict with the conditions and other

30  provisions specified in this subsection.

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

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

  3  acquiring the facility by any means.

  4

  5  Any facility licensed under this subsection is not required to

  6  provide any services to any persons except those included in

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

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

  9  of stay imposed on community-based residential treatment

10  facilities otherwise licensed under this chapter.

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

12  following requirements:

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

14  application, the agency shall require background screening, in

15  accordance with the level 2 standards for screening set forth

16  in chapter 435, of the managing employee and financial

17  officer, or other similarly titled individual who is

18  responsible for the financial operation of the facility,

19  including billings for client care and services. The applicant

20  must comply with the procedures for level 2 background

21  screening as set forth in chapter 435, as well as the

22  requirements of s. 435.03(3).

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

24  other individual who is an applicant if the agency has

25  probable cause to believe that he or she has been convicted of

26  a crime or has committed any other offense prohibited under

27  the level 2 standards for screening set forth in chapter 435.

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

29  screening requirements of chapter 435 which has been submitted

30  within the previous 5 years in compliance with any other

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  1  health care licensure requirements of this state is acceptable

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

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

  4  applicant when each individual required by this section to

  5  undergo background screening has met the standards for the

  6  abuse registry background check and the Department of Law

  7  Enforcement background check, but the agency has not yet

  8  received background screening results from the Federal Bureau

  9  of Investigation, or a request for a disqualification

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

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

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

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

14  Investigation background screening for each individual

15  required by this section to undergo background screening which

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

17  granting of a disqualification exemption by the agency as set

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

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

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

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

22  continue to serve if the report indicates any violation of

23  background screening standards and a disqualification

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

25  as set forth in chapter 435.

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

27  application, a description and explanation of any exclusions,

28  permanent suspensions, or terminations of the applicant from

29  the Medicare or Medicaid programs. Proof of compliance with

30  the requirements for disclosure of ownership and controlling

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  1  interests under the Medicaid or Medicare programs shall be

  2  accepted in lieu of 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 does 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)  A license may not be granted to an applicant if

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

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

24  contendere or guilty to, any offense prohibited under the

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

26  unless an exemption from disqualification has been granted by

27  the agency as set forth in chapter 435.

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

29  applicant:

30         1.  Has falsely represented a material fact in the

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

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  1  omitted any material fact from the application required by

  2  paragraph (e) or paragraph (f); or

  3         2.  Has had prior action taken against the applicant

  4  under the Medicaid or Medicare programs as set forth in

  5  paragraph (e).

  6         (i)  An application for license renewal must contain

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

  8         Section 24.  Section 394.876, Florida Statutes, is

  9  amended to read:

10         394.876  Applications.--

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

12  chapter shall apply to the agency department on forms provided

13  by the agency department.  The application shall contain the

14  following:

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

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

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

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

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

20  the entity.

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

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

23  of each person holding at least 5 10 percent ownership

24  interest in the corporation.

25         (c)  Such information as the department determines to

26  be necessary to establish the character and competency of the

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

28  the unit or facility.

29         (c)(d)  Such information as the department and the

30  agency find determines necessary to determine the ability of

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  1  the applicant to carry out its responsibilities under this

  2  chapter.

  3         (2)  The applicant shall furnish proof satisfactory to

  4  the agency department of its financial ability to operate the

  5  unit or facility in accordance with this chapter.  An

  6  applicant for an original license shall submit a balance sheet

  7  and a statement projecting revenues, expenses, taxes,

  8  extraordinary items, and other credits and charges for the

  9  first 6 months of operation.

10         (3)  The applicant shall provide proof of liability

11  insurance coverage in amounts set by the department and the

12  agency by rule.

13         (4)  The agency department shall accept proof of

14  accreditation by the Joint Commission on Accreditation of

15  Hospitals in lieu of the information required by subsection

16  (1).

17         Section 25.  Section 394.877, Florida Statutes, is

18  amended to read:

19         394.877  Fees.--

20         (1)  Each application for licensure or renewal must

21  shall be accompanied by a fee set by the department, in

22  consultation with the agency, by rule.  Such fees shall be

23  reasonably calculated to cover only the cost of regulation

24  under this chapter.

25         (2)  All fees collected under this section shall be

26  deposited in the Mental Health Care Facility Licensing Trust

27  Fund.

28         Section 26.  Subsections (1), (2), (5), and (6) of

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

30         394.878  Issuance and renewal of licenses.--

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

  2  receipt of appropriate fees, the agency department shall issue

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

  4  requirements of this chapter.

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

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

  7  department no later than 90 days before expiration of the

  8  current license.

  9         (5)  The agency department may issue a probationary

10  license to an applicant that has completed the application

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

12  application, developed an operational crisis stabilization

13  unit or residential treatment facility.  The probationary

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

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

16  may cancel a probationary license at any time.

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

18  to an applicant that has substantially completed all

19  application requirements and has initiated action to fully

20  meet such requirements.  The interim license shall expire 90

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

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

23         Section 27.  Section 394.879, Florida Statutes, is

24  amended to read:

25         394.879  Rules; enforcement.--

26         (1)  The department, in consultation with the agency,

27  shall adopt reasonable rules to implement this chapter,

28  including, at a minimum, rules providing standards to ensure

29  that:

30

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  1         (a)  Sufficient numbers and types of qualified

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

  3  necessary and adequate client safety and care.

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

  5  licensed facility.

  6         (c)  Licensed facilities are limited to an appropriate

  7  number of beds.

  8         (d)  Each licensee establishes and implements adequate

  9  infection control, housekeeping, sanitation, disaster

10  planning, and medical recordkeeping.

11         (e)  Licensed facilities are established, organized,

12  and operated in accordance with programmatic standards of the

13  department.

14         (2)  Minimum firesafety standards shall be established

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

16  department.  Such standards shall be included in the rule

17  adopted by the department after consultation with the State

18  Fire Marshal.

19         (3)  The department, in consultation with the agency,

20  shall allow any licensed facility in operation at the time of

21  adoption of any rule a reasonable period, not to exceed 1

22  year, to bring itself into compliance with such rule.

23         (4)  The agency department may impose an administrative

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

25  violates any rule adopted pursuant to this section and may

26  suspend or revoke the license or deny the renewal application

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

28  department shall consider the severity of the violation,

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

30  previous violations by the licensee. Fines collected under

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  1  this subsection shall be deposited in the Mental Health Care

  2  Facility Licensing Trust Fund.

  3         Section 28.  Section 394.90, Florida Statutes, is

  4  amended to read:

  5         394.90  Inspection; right of entry; records.--

  6         (1)(a)  The department and the agency may enter and

  7  inspect at any time a licensed facility to determine whether

  8  the facility is in compliance with this chapter and the rules

  9  of the department.

10         (b)  The department and the agency may enter and

11  inspect any premises that it has probable cause to suspect may

12  be operating as an unlicensed crisis stabilization unit or

13  residential treatment facility; however, such entry and

14  inspection shall be made only with the permission of the

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

16         (c)  Any application for licensure under this chapter

17  constitutes full permission for the department and the agency

18  to enter and inspect the premises of the applicant or licensee

19  at any time.

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

21  department and the Agency for Health Care Administration shall

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

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

24  to the contrary notwithstanding.

25         (3)  The agency department shall schedule periodic

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

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

28  subsection shall not be construed to limit the authority of

29  the department and the agency to inspect the facilities of a

30  licensee at any time.

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  1         (4)  Each licensee shall maintain as public

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

  3  all reports of inspections of the licensee filed with or

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

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

  6  inspection report of the agency department to any person upon

  7  payment of a reasonable charge for copying.

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

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

10  an accrediting organization, if the provider is accredited and

11  the agency department receives the report of the accrediting

12  organization. The department, in consultation with the agency,

13  shall develop, and adopt by rule, specific criteria for

14  assuring that the accrediting organization has specific

15  standards and experience related to the program area being

16  licensed, specific criteria for accepting the standards and

17  survey methodologies of an accrediting organization,

18  delineations of the obligations of accrediting organizations

19  to assure adherence to those standards, criteria for

20  receiving, accepting and maintaining the confidentiality of

21  the survey and corrective action reports, and allowance for

22  the agency's department's participation in surveys.

23         (b)  The agency department shall conduct compliance

24  investigations and sample validation inspections to evaluate

25  the inspection process of accrediting organizations to ensure

26  minimum standards are maintained as provided in Florida

27  statute and rule. The agency department may conduct a

28  lifesafety inspection in calendar years in which an

29  accrediting organization survey is not conducted and shall

30  conduct a full state inspection, including a lifesafety

31  inspection, if an accrediting organization survey has not been

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  1  conducted within the previous 36 months.  The agency

  2  department, by accepting the survey or inspection of an

  3  accrediting organization, does not forfeit its right to

  4  perform inspections.

  5         Section 29.  Section 394.902, Florida Statutes, is

  6  amended to read:

  7         394.902  Denial, suspension, and revocation; other

  8  remedies.--

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

10  suspending or revoking a license if the agency department

11  determines that the continued operation of the licensed

12  facility presents a clear and present danger to the public

13  health or safety.

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

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

16  a licensed facility if the agency department determines that

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

18  health or safety.

19         (3)  If the agency department determines that an

20  applicant or licensee is not in compliance with this chapter

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

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

23  suspend, revoke, or impose reasonable restrictions on any

24  portion of the license.  If a license is revoked, the licensee

25  is barred from submitting any application for licensure to the

26  agency department for a period of 6 months following

27  revocation.

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

29  circuit court to enjoin the operation of any licensed or

30  unlicensed facility in violation of this chapter or the rules

31  adopted under this chapter.

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  1         (5)  License denial, suspension, or revocation

  2  procedures shall be in accordance with chapter 120.

  3         Section 30.  Subsections (1), (2), and (11) of section

  4  394.903, Florida Statutes, are amended to read:

  5         394.903  Receivership proceedings.--

  6         (1)  The agency, independently or in conjunction with

  7  the department, may petition a court of competent jurisdiction

  8  for the appointment of a receiver for a crisis stabilization

  9  unit or a residential treatment facility when any of the

10  following conditions exist:

11         (a)  Any person is operating a unit or facility without

12  a license and refuses to make application for a license as

13  required by this part.

14         (b)  The licensee is closing the unit or facility or

15  has informed the agency department that it intends to close

16  and adequate arrangements have not been made for relocation of

17  the residents within 7 days, exclusive of weekends and

18  holidays, of the closing of the unit or facility.

19         (c)  The agency department determines that conditions

20  exist in the unit or facility which present an imminent danger

21  to the health, safety, or welfare of the residents of the unit

22  or facility or a substantial probability that death or serious

23  physical harm would result therefrom.  The agency department

24  shall, whenever possible, facilitate the continued operation

25  of the program.

26         (d)  The licensee cannot meet its financial obligations

27  for providing food, shelter, care, and utilities.  Issuance of

28  bad checks or accumulation of delinquent bills for such items

29  as personnel salaries, food, drugs, or utilities constitutes

30  shall constitute prima facie evidence that the ownership of

31  the unit or facility lacks the financial ability to operate

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  1  the unit or facility in accordance with the requirements of

  2  this chapter and all rules adopted under this chapter

  3  hereunder.

  4         (2)  Petitions for receivership shall take precedence

  5  over other court business unless the court determines that

  6  some other pending proceeding, having similar statutory

  7  precedence, shall have priority.  A hearing shall be conducted

  8  within 5 days after of the filing of the petition, at which

  9  time all interested parties shall have the opportunity to

10  present evidence pertaining to the petition.  The agency

11  department shall notify the owner or operator of the unit or

12  facility named in the petition of its filing and the dates for

13  the hearing.  The court shall grant the petition only upon

14  finding that the health, safety, and welfare of residents of

15  the unit or facility would be threatened if a condition

16  existing at the time the petition was filed is permitted to

17  continue.  A receiver shall not be appointed ex parte unless

18  the court determines that one or more of the conditions of

19  subsection (1) exist and that the owner or operator cannot be

20  found, that all reasonable means of locating the owner or

21  operator and notifying him or her of the petition and hearing

22  have been exhausted, or that the owner or operator after

23  notification of the hearing chooses not to attend.  After such

24  findings, the court may appoint any person qualified by

25  education, training, or experience to carry out the

26  responsibilities of receiver pursuant to this section, except

27  that it shall not appoint any owner or affiliate of the unit

28  or facility which is in receivership.  Prior to the

29  appointment as receiver of a person who is the operator,

30  manager, or supervisor of another unit or facility, the court

31  shall determine that the person can reasonably operate,

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  1  manage, or supervise more than one unit or facility.  The

  2  receiver may be appointed for up to 90 days, with the option

  3  of petitioning the court for 30-day extensions.  The receiver

  4  may be selected from a list of persons qualified to act as

  5  receivers developed by the agency department and presented to

  6  the court with each petition for receivership.  Under no

  7  circumstances shall The agency or department, or a designated

  8  departmental employee of either, may not be appointed as a

  9  receiver for more than 60 days; however, such the departmental

10  receiver may petition the court for 30-day extensions.  The

11  agency department may petition the court to appoint a

12  substitute receiver. The court shall grant the extension upon

13  a showing of good cause. During the first 60 days of the

14  receivership, the agency may department shall not take action

15  to decertify or revoke the license of a unit or facility

16  unless conditions causing imminent danger to the health and

17  welfare of the residents exist and a receiver has been unable

18  to remove those conditions.  After the first 60 days of

19  receivership, and every 60 days thereafter until the

20  receivership is terminated, the agency department shall submit

21  to the court the results of an assessment of the unit's or

22  facility's ability to assure the safety and care of the

23  residents.  If the conditions at the unit or facility or the

24  intentions of the owner indicate that the purpose of the

25  receivership is to close the unit or facility rather than to

26  facilitate its continued operations, the department, in

27  consultation with the agency, shall place the residents in

28  appropriate alternative residential settings as quickly as

29  possible.  If, in the opinion of the court, the agency

30  department has not been diligent in its efforts to make

31  adequate placement arrangements, the court may find the agency

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  1  department to be in contempt and shall order the agency

  2  department to submit its plans for moving the residents.

  3         (11)  Nothing in this section shall be construed to

  4  relieve any owner, operator, or employee of a unit or facility

  5  placed in receivership of any civil or criminal liability

  6  incurred, or any duty imposed by law, by reason of acts or

  7  omissions of the owner, operator, or employee prior to the

  8  appointment of a receiver; nor shall anything contained in

  9  this section be construed to suspend during the receivership

10  any obligation of the owner, operator, or employee for payment

11  of taxes or other operating and maintenance expenses of the

12  unit or facility or of the owner, operator, or employee or any

13  other person for the payment of mortgages or liens.  The owner

14  shall retain the right to sell or mortgage any unit or

15  facility under receivership, subject to approval of the court

16  which ordered the receivership.  Receivership imposed under

17  the provisions of this chapter shall be subject to the Mental

18  Health Care Facility Licensing Trust Fund pursuant to s.

19  394.904.  The owner of a facility placed in receivership by

20  the court shall be liable for all expenses and costs incurred

21  by the Mental Health Care Facility Licensing Trust Fund which

22  occur as a result of the receivership.

23         Section 31.  Section 394.904, Florida Statutes, is

24  amended to read:

25         394.904  Mental Health Care Facility Licensing Trust

26  Fund.--There is created in the State Treasury the Mental

27  Health Care Facility Licensing Trust Fund.  All moneys

28  collected by the agency department pursuant to this chapter

29  shall be deposited in the trust fund.  Moneys in the trust

30  fund shall be appropriated to the agency department for the

31  purpose of covering the cost of regulation of facilities

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  1  licensed under this chapter and any other purpose related to

  2  enforcement of this chapter.

  3         Section 32.  Subsections (1), (2), (3), (7), (8), and

  4  (9) of section 394.907, Florida Statutes, are amended to read:

  5         394.907  Community mental health centers; quality

  6  assurance programs.--

  7         (1)  As used in this section, the term "community

  8  mental health center" means a publicly funded, not-for-profit

  9  center that which contracts with the department for the

10  provision of inpatient, outpatient, day treatment, or

11  emergency services.

12         (2)  Effective April 1, 1989, Any community mental

13  health center and any facility licensed pursuant to s. 394.875

14  shall have an ongoing quality assurance program. The purpose

15  of the quality assurance program shall be to objectively and

16  systematically monitor and evaluate the appropriateness and

17  quality of client care, to ensure that services are rendered

18  consistent with reasonable, prevailing professional standards

19  and to resolve identified problems.

20         (3)  Each facility shall develop a written plan that

21  which addresses the minimum guidelines for the quality

22  assurance program. Such guidelines shall include, but are not

23  limited to:

24         (a)  Standards for the provision of client care and

25  treatment practices;

26         (b)  Procedures for the maintenance of client records;

27         (c)  Policies and procedures for staff development;

28         (d)  Standards for facility safety and maintenance;

29         (e)  Procedures for peer review and resource

30  utilization;

31

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  1         (f)  Policies and procedures for adverse incident

  2  reporting to include verification of corrective action to

  3  remediate or minimize incidents and for reporting such

  4  incidents to the department by a timeframe as prescribed by

  5  rule.

  6

  7  Such plan shall be submitted to the governing board for

  8  approval and a copy provided to the department.

  9         (7)  The department shall have access to all records

10  necessary to determine agency compliance with the provisions

11  of this section. The records of quality assurance programs

12  which relate solely to actions taken in carrying out the

13  provisions of this section, and records obtained by the

14  department to determine agency compliance with the provisions

15  of this section, are confidential and exempt from the

16  provisions of s. 119.07(1). Such records are not admissible in

17  any civil or administrative action, except in disciplinary

18  proceedings by the Department of Business and Professional

19  Regulation and the appropriate regulatory board, nor shall

20  such records be available to the public as part of the record

21  of investigation for, and prosecution in disciplinary

22  proceedings made available to the public by the Department of

23  Business and Professional Regulation or the appropriate

24  regulatory board. Meetings or portions of meetings of quality

25  assurance program committees that relate solely to actions

26  taken pursuant to this section are exempt from the provisions

27  of s. 286.011.

28         (8)  The department, in consultation with the agency,

29  shall adopt promulgate rules to carry out the provisions of

30  this section.

31

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  1         (9)  The provisions of This section does shall not

  2  apply to hospitals licensed pursuant to chapter 395 or

  3  programs operated within such hospitals.

  4         Section 33.  Section 395.002, Florida Statutes, is

  5  amended to read:

  6         395.002  Definitions.--As used in this chapter:

  7         (1)  "Accrediting organizations" means the Joint

  8  Commission on Accreditation of Healthcare Organizations, the

  9  American Osteopathic Association, the Commission on

10  Accreditation of Rehabilitation Facilities, and the

11  Accreditation Association for Ambulatory Health Care, Inc.

12         (2)  "Adverse or untoward incident," for purposes of

13  reporting to the agency, means an event over which health care

14  personnel could exercise control, which is probably associated

15  in whole or in part with medical intervention rather than the

16  condition for which such intervention occurred, and which

17  causes injury to a patient, and which:

18         (a)  Is not consistent with or expected to be a

19  consequence of such medical intervention;

20         (b)  Occurs as a result of medical intervention to

21  which the patient has not given his or her informed consent;

22         (c)  Occurs as the result of any other action or lack

23  of any other action on the part of the hospital or personnel

24  of the hospital;

25         (d)  Results in a surgical procedure being performed on

26  the wrong patient; or

27         (e)  Results in a surgical procedure being performed

28  that is unrelated to the patient's diagnosis or medical needs.

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

30  Administration.

31

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  1         (4)  "Ambulatory surgical center" means a facility the

  2  primary purpose of which is to provide elective surgical care,

  3  in which the patient is admitted to and discharged from such

  4  facility within the same working day and is not permitted to

  5  stay overnight, and which is not part of a hospital. However,

  6  a facility existing for the primary purpose of performing

  7  terminations of pregnancy, an office maintained by a physician

  8  for the practice of medicine, or an office maintained for the

  9  practice of dentistry shall not be construed to be an

10  ambulatory surgical center, provided that any facility or

11  office which is certified or seeks certification as a Medicare

12  ambulatory surgical center shall be licensed as an ambulatory

13  surgical center pursuant to s. 395.003.

14         (5)  "Applicant" means an individual applicant, or any

15  officer, director, or agent, or any partner or shareholder

16  having an ownership interest equal to a 5-percent or greater

17  interest in the corporation, partnership, or other business

18  entity.

19         (6)(5)  "Biomedical waste" means any solid or liquid

20  waste as defined in s. 381.0098(2)(a).

21         (7)(6)  "Clinical privileges" means the privileges

22  granted to a physician or other licensed health care

23  practitioner to render patient care services in a hospital,

24  but does not include the privilege of admitting patients.

25         (8)(7)  "Department" means the Department of Health and

26  Rehabilitative Services.

27         (9)  "Director" means any member of the official board

28  of directors as reported in the organization's annual

29  corporate report to the Florida Department of State, or, if no

30  such report is made, any member of the operating board of

31  directors. The term excludes members of separate, restricted

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  1  boards that serve only in an advisory capacity to the

  2  operating board.

  3         (10)(8)  "Emergency medical condition" means:

  4         (a)  A medical condition manifesting itself by acute

  5  symptoms of sufficient severity, which may include severe

  6  pain, such that the absence of immediate medical attention

  7  could reasonably be expected to result in any of the

  8  following:

  9         1.  Serious jeopardy to patient health, including a

10  pregnant woman or a fetus.

11         2.  Serious impairment to bodily functions.

12         3.  Serious dysfunction of any bodily organ or part.

13         (b)  With respect to a pregnant woman:

14         1.  That there is inadequate time to effect safe

15  transfer to another hospital prior to delivery;

16         2.  That a transfer may pose a threat to the health and

17  safety of the patient or fetus; or

18         3.  That there is evidence of the onset and persistence

19  of uterine contractions or rupture of the membranes.

20         (11)(9)  "Emergency services and care" means medical

21  screening, examination, and evaluation by a physician, or, to

22  the extent permitted by applicable law, by other appropriate

23  personnel under the supervision of a physician, to determine

24  if an emergency medical condition exists and, if it does, the

25  care, treatment, or surgery by a physician necessary to

26  relieve or eliminate the emergency medical condition, within

27  the service capability of the facility.

28         (12)(10)  "General hospital" means any facility which

29  meets the provisions of subsection (14)(12) and which

30  regularly makes its facilities and services available to the

31  general population.

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  1         (13)(11)  "Governmental unit" means the state or any

  2  county, municipality, or other political subdivision, or any

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

  4  foregoing.

  5         (14)(12)  "Hospital" means any establishment that:

  6         (a)  Offers services more intensive than those required

  7  for room, board, personal services, and general nursing care,

  8  and offers facilities and beds for use beyond 24 hours by

  9  individuals requiring diagnosis, treatment, or care for

10  illness, injury, deformity, infirmity, abnormality, disease,

11  or pregnancy; and

12         (b)  Regularly makes available at least clinical

13  laboratory services, diagnostic X-ray services, and treatment

14  facilities for surgery or obstetrical care, or other

15  definitive medical treatment of similar extent.

16

17  However, the provisions of this chapter do not apply to any

18  institution conducted by or for the adherents of any

19  well-recognized church or religious denomination that depends

20  exclusively upon prayer or spiritual means to heal, care for,

21  or treat any person.  For purposes of local zoning matters,

22  the term "hospital" includes a medical office building located

23  on the same premises as a hospital facility, provided the land

24  on which the medical office building is constructed is zoned

25  for use as a hospital; provided the premises were zoned for

26  hospital purposes on January 1, 1992.

27         (15)(13)  "Hospital bed" means a hospital accommodation

28  which is ready for immediate occupancy, or is capable of being

29  made ready for occupancy within 48 hours, excluding provision

30  of staffing, and which conforms to minimum space, equipment,

31  and furnishings standards as specified by rule of the

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  1  department for the provision of services specified in this

  2  section to a single patient.

  3         (16)(14)  "Initial denial determination" means a

  4  determination by a private review agent that the health care

  5  services furnished or proposed to be furnished to a patient

  6  are inappropriate, not medically necessary, or not reasonable.

  7         (17)(15)  "Injury," for purposes of reporting to the

  8  agency, means any of the following outcomes if caused by an

  9  adverse or untoward incident:

10         (a)  Death;

11         (b)  Brain damage;

12         (c)  Spinal damage;

13         (d)  Permanent disfigurement;

14         (e)  Fracture or dislocation of bones or joints;

15         (f)  Any condition requiring definitive or specialized

16  medical attention which is not consistent with the routine

17  management of the patient's case or patient's preexisting

18  physical condition;

19         (g)  Any condition requiring surgical intervention to

20  correct or control;

21         (h)  Any condition resulting in transfer of the

22  patient, within or outside the facility, to a unit providing a

23  more acute level of care;

24         (i)  Any condition that extends the patient's length of

25  stay; or

26         (j)  Any condition that results in a limitation of

27  neurological, physical, or sensory function which continues

28  after discharge from the facility.

29         (18)(16)  "Intensive residential treatment programs for

30  children and adolescents" means a specialty hospital

31  accredited by the Joint Commission on Accreditation of

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  1  Healthcare Organizations which provides 24-hour care and which

  2  has the primary functions of diagnosis and treatment of

  3  patients under the age of 18 having psychiatric disorders in

  4  order to restore such patients to an optimal level of

  5  functioning.

  6         (19)(17)  "Licensed facility" means a hospital or

  7  ambulatory surgical center licensed in accordance with this

  8  chapter.

  9         (20)(18)  "Lifesafety" means the control and prevention

10  of fire and other life-threatening conditions on a premises

11  for the purpose of preserving human life.

12         (21)  "Managing employee" means the administrator or

13  other similarly titled individual who is responsible for the

14  daily operation of the facility.

15         (22)(19)  "Medical staff" means physicians licensed

16  under chapter 458 or chapter 459 with privileges in a licensed

17  facility, as well as other licensed health care practitioners

18  with clinical privileges as approved by a licensed facility's

19  governing board.

20         (23)(20)  "Medically necessary transfer" means a

21  transfer made necessary because the patient is in immediate

22  need of treatment for an emergency medical condition for which

23  the facility lacks service capability or is at service

24  capacity.

25         (24)(21)  "Person" means any individual, partnership,

26  corporation, association, or governmental unit.

27         (25)(22)  "Premises" means those buildings, beds, and

28  equipment located at the address of the licensed facility and

29  all other buildings, beds, and equipment for the provision of

30  hospital or ambulatory surgical care located in such

31  reasonable proximity to the address of the licensed facility

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  1  as to appear to the public to be under the dominion and

  2  control of the licensee.

  3         (26)(23)  "Private review agent" means any person or

  4  entity which performs utilization review services for

  5  third-party payors on a contractual basis for outpatient or

  6  inpatient services. However, the term shall not include

  7  full-time employees, personnel, or staff of health insurers,

  8  health maintenance organizations, or hospitals, or wholly

  9  owned subsidiaries thereof or affiliates under common

10  ownership, when performing utilization review for their

11  respective hospitals, health maintenance organizations, or

12  insureds of the same insurance group.  For this purpose,

13  health insurers, health maintenance organizations, and

14  hospitals, or wholly owned subsidiaries thereof or affiliates

15  under common ownership, include such entities engaged as

16  administrators of self-insurance as defined in s. 624.031.

17         (27)(24)  "Service capability" means all services

18  offered by the facility where identification of services

19  offered is evidenced by the appearance of the service in a

20  patient's medical record or itemized bill.

21         (28)(25)  "At service capacity" means the temporary

22  inability of a hospital to provide a service which is within

23  the service capability of the hospital, due to maximum use of

24  the service at the time of the request for the service.

25         (29)(26)  "Specialty bed" means a bed, other than a

26  general bed, designated on the face of the hospital license

27  for a dedicated use.

28         (30)(27)  "Specialty hospital" means any facility which

29  meets the provisions of subsection (14)(12), and which

30  regularly makes available either:

31

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  1         (a)  The range of medical services offered by general

  2  hospitals, but restricted to a defined age or gender group of

  3  the population;

  4         (b)  A restricted range of services appropriate to the

  5  diagnosis, care, and treatment of patients with specific

  6  categories of medical or psychiatric illnesses or disorders;

  7  or

  8         (c)  Intensive residential treatment programs for

  9  children and adolescents as defined in subsection (18) (16).

10         (31)(28)  "Stabilized" means, with respect to an

11  emergency medical condition, that no material deterioration of

12  the condition is likely, within reasonable medical

13  probability, to result from the transfer of the patient from a

14  hospital.

15         (32)(29)  "Utilization review" means a system for

16  reviewing the medical necessity or appropriateness in the

17  allocation of health care resources of hospital services given

18  or proposed to be given to a patient or group of patients.

19         (33)(30)  "Utilization review plan" means a description

20  of the policies and procedures governing utilization review

21  activities performed by a private review agent.

22         (34)(31)  "Validation inspection" means an inspection

23  of the premises of a licensed facility by the agency to assess

24  whether a review by an accrediting organization has adequately

25  evaluated the licensed facility according to minimum state

26  standards.

27         Section 34.  Section 395.0055, Florida Statutes, is

28  created to read:

29         395.0055  Background screening.--Each applicant for

30  licensure must comply with the following requirements:

31

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

  2  application, the agency shall require background screening of

  3  the managing employee in accordance with the level 2 standards

  4  for screening set forth in chapter 435, as well as the

  5  requirements of s. 435.03(3).

  6         (2)  The agency may require background screening for a

  7  member of the board of directors of the licensee, or an

  8  officer or an individual owning 5 percent or more of the

  9  licensee, if the agency has probable cause to believe that

10  such individual has been convicted of an offense prohibited

11  under the level 2 standards for screening set forth in chapter

12  435.

13         (3)  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 licensure requirements of this state is acceptable

17  in fulfillment of the requirements of subsection (1).

18         (4)  A provisional license may be granted to an

19  applicant when each individual required by this section to

20  undergo background screening has met the standards for the

21  abuse registry background check and the Department of Law

22  Enforcement background check, but the agency has not yet

23  received background screening results from the Federal Bureau

24  of Investigation, or a request for a disqualification

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

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

27  standard license may be granted to the applicant upon the

28  agency's receipt of a report of the results of the Federal

29  Bureau of Investigation background screening for each

30  individual required by this section to undergo background

31  screening which confirms that all standards have been met, or

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  1  upon the granting of a disqualification exemption by the

  2  agency as set forth in chapter 435.  Any other person who is

  3  required to undergo level 2 background screening may serve in

  4  his or her capacity pending the agency's receipt of the report

  5  from the Federal Bureau of Investigation. However, the person

  6  may not continue to serve if the report indicates any

  7  violation of background screening standards and a

  8  disqualification exemption has not been requested of and

  9  granted by the agency as set forth in chapter 435.

10         (5)  Each applicant must submit to the agency, with its

11  application, a description and explanation of any exclusions,

12  permanent suspensions, or terminations of the applicant from

13  the Medicare or Medicaid programs. Proof of compliance with

14  requirements for disclosure of ownership and controlling

15  interests under the Medicaid or Medicare programs shall be

16  accepted in lieu of this submission.

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

18  description and explanation of any conviction of an offense

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

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

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

22  applicant.

23         (7)  This section 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 subsection.

  5         (8)  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         (9)  The agency may deny or revoke licensure if the

13  applicant:

14         (a)  Has falsely represented a material fact in the

15  application required by subsection (5) or subsection (6), or

16  has omitted any material fact from the application required by

17  subsection (5) or subsection (6); or

18         (b)  Has had prior action taken against the applicant

19  under the Medicaid or Medicare programs as set forth in

20  subsection (5).

21         (10)  An application for license renewal must contain

22  the information required under subsections (5) and (6).

23         Section 35.  Present subsections (4) through (9) of

24  section 395.0199, Florida Statutes, are renumbered as

25  subsections (5) through (10), respectively, and a new

26  subsection (4) is added to that section to read:

27         395.0199  Private utilization review.--

28         (4)  Each applicant for registration must comply with

29  the following requirements:

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

31  application, the agency shall require background screening, in

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  1  accordance with the level 2 standards for screening set forth

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

  3  titled individual who is responsible for the operation of the

  4  entity. The applicant must comply with the procedures for

  5  level 2 background screening as set forth in chapter 435, as

  6  well as the requirements of s. 435.03(3).

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

  8  other individual who is an applicant, if the agency has

  9  probable cause to believe that he or she has been convicted of

10  a crime or has committed any other offense prohibited under

11  the level 2 standards for screening set forth in chapter 435.

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

13  screening requirements of chapter 435 which has been submitted

14  within the previous 5 years in compliance with any other

15  health care licensure requirements of this state is acceptable

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

17         (d)  A provisional registration may be granted to an

18  applicant when each individual required by this section to

19  undergo background screening has met the standards for the

20  abuse registry background check and the Department of Law

21  Enforcement background check, but the agency has not yet

22  received background screening results from the Federal Bureau

23  of Investigation, or a request for a disqualification

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

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

26  registration may be granted to the applicant upon the agency's

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

28  Investigation background screening for each individual

29  required by this section to undergo background screening which

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

31  granting of a disqualification exemption by the agency as set

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

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

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

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

  5  continue to serve if the report indicates any violation of

  6  background screening standards and a disqualification

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

  8  as set forth in chapter 435.

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

10  application, a description and explanation of any exclusions,

11  permanent suspensions, or terminations of the applicant from

12  the Medicare or Medicaid programs. Proof of compliance with

13  the requirements for disclosure of ownership and controlling

14  interests under the Medicaid or Medicare programs shall be

15  accepted in lieu of this submission.

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

17  description and explanation of any conviction of an offense

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

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

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

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

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

23  serves solely in a voluntary capacity for the corporation or

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

25  operational decisions of the corporation or organization,

26  receives no remuneration for his or her services on the

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

28  financial interest and has no family members with a financial

29  interest in the corporation or organization, provided that the

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

31  include in the application a statement affirming that the

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  1  director's relationship to the corporation satisfies the

  2  requirements of this paragraph.

  3         (g)  A registration may not be granted to an applicant

  4  if the applicant or managing employee has been found guilty

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

  6  contendere or guilty to, any offense prohibited under the

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

  8  unless an exemption from disqualification has been granted by

  9  the agency as set forth in chapter 435.

10         (h)  The agency may deny or revoke the registration if

11  any applicant:

12         1.  Has falsely represented a material fact in the

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

14  omitted any material fact from the application required by

15  paragraph (e) or paragraph (f); or

16         2.  Has had prior action taken against the applicant

17  under the Medicaid or Medicare programs as set forth in

18  paragraph (e).

19         (i)  An application for registration renewal must

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

21         Section 36.  Paragraph (c) of subsection (2) of section

22  395.602, Florida Statutes, is amended to read:

23         395.602  Rural hospitals.--

24         (2)  DEFINITIONS.--As used in this part:

25         (c)  "Inactive rural hospital bed" means a licensed

26  acute care hospital bed, as defined in s. 395.002(15)(13),

27  that is inactive in that it cannot be occupied by acute care

28  inpatients.

29         Section 37.  Paragraph (c) of subsection (1) of section

30  395.701, Florida Statutes, is amended to read:

31

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  1         395.701  Annual assessments on net operating revenues

  2  to fund public medical assistance; administrative fines for

  3  failure to pay assessments when due.--

  4         (1)  For the purposes of this section, the term:

  5         (c)  "Hospital" means a health care institution as

  6  defined in s. 395.002(14)(12), but does not include any

  7  hospital operated by the agency or the Department of

  8  Corrections.

  9         Section 38.  Subsection (9) of section 397.405, Florida

10  Statutes, is amended to read:

11         397.405  Exemptions from licensure.--The following are

12  exempt from the licensing provisions of this chapter:

13         (9)  Facilities licensed under s. 393.063(8)(7) that,

14  in addition to providing services to persons who are

15  developmentally disabled as defined therein, also provide

16  services to persons developmentally at risk as a consequence

17  of exposure to alcohol or other legal or illegal drugs while

18  in utero.

19

20  The exemptions from licensure in this section do not apply to

21  any facility or entity which receives an appropriation, grant,

22  or contract from the state to operate as a service provider as

23  defined in this chapter or to any substance abuse program

24  regulated pursuant to s. 397.406.  No provision of this

25  chapter shall be construed to limit the practice of a

26  physician licensed under chapter 458 or chapter 459, a

27  psychologist licensed under chapter 490, or a psychotherapist

28  licensed under chapter 491, providing outpatient or inpatient

29  substance abuse treatment to a voluntary patient, so long as

30  the physician, psychologist, or psychotherapist does not

31  represent to the public that he or she is a licensed service

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  1  provider under this act. Failure to comply with any

  2  requirement necessary to maintain an exempt status under this

  3  section is a misdemeanor of the first degree, punishable as

  4  provided in s. 775.082 or s. 775.083.

  5         Section 39.  Paragraph (b) of subsection (1) of section

  6  400.051, Florida Statutes, is amended to read:

  7         400.051  Homes or institutions exempt from the

  8  provisions of this part.--

  9         (1)  The following shall be exempt from the provisions

10  of this part:

11         (b)  Any hospital, as defined in s. 395.002(12) s.

12  395.002(10), that is licensed under chapter 395.

13         Section 40.  Paragraph (a) of subsection (2) of section

14  400.071, Florida Statutes, is amended, subsections (4) through

15  (8) are renumbered as subsections (5) through (9),

16  respectively, and a new subsection (4) is added to that

17  section, to read:

18         400.071  Application for license.--

19         (2)  The application shall be under oath and shall

20  contain the following:

21         (a)  The name, address, and social security number of

22  the applicant if an individual; if the applicant is a firm,

23  partnership, or association, its name, address, and employer

24  identification number (EIN), and the name and address of every

25  member; if the applicant is a corporation, its name, address,

26  and employer identification number (EIN), and the name and

27  address of its director and officers and of each person having

28  at least a 5-percent 10-percent interest in the corporation;

29  and the name by which the facility is to be known.

30         (4)  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 has probable cause to belive that such individual

15  has been convicted of an offense prohibited under the level 2

16  standards 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 the requirements of

22  paragraph (a).  Proof of compliance with background screening

23  which has been submitted within the previous 5 years to

24  fulfill the requirements of the Department of Insurance

25  pursuant to chapter 651 as part of an application for a

26  certificate of authority to operate a continuing care

27  retirement community is acceptable in fulfillment of the

28  Department of Law Enforcement and Federal Bureau of

29  Investigation background check.

30         (d)  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 license

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

  9  report of the results of the Federal Bureau of Investigation

10  background screening for each individual required by this

11  section to undergo background screening which confirms that

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

13  disqualification exemption by the agency as set forth in

14  chapter 435.  Any other person who is required to undergo

15  level 2 background screening may serve in his or her capacity

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

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

18  to serve if the report indicates any violation of background

19  screening standards and a disqualification exemption has not

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

21  chapter 435.

22         (e)  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  requirements for disclosure of ownership and controlling

27  interests under the Medicaid or Medicare programs shall be

28  accepted in lieu of this submission.

29         (f)  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 paragraph.

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

17  the applicant has been found guilty of, regardless of

18  adjudication, or has entered a plea of nolo contendere or

19  guilty to, any offense prohibited under the level 2 standards

20  for screening set forth in chapter 435, unless an exemption

21  from disqualification has been granted by the agency as set

22  forth in chapter 435.

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

24  applicant:

25         1.  Has falsely represented a material fact in the

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

27  omitted any material fact from the application required by

28  paragraph (e) or paragraph (f); or

29         2.  Has had prior action taken against the applicant

30  under the Medicaid or Medicare programs as set forth in

31  paragraph (e).

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  1         (i)  An application for license renewal must contain

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

  3         Section 41.  Section 400.411, Florida Statutes, is

  4  amended to read:

  5         400.411  Initial application for license; provisional

  6  license.--

  7         (1)  Application for a license shall be made to the

  8  agency on forms furnished by it and shall be accompanied by

  9  the appropriate license fee.  The application shall contain

10  sufficient information, as required by rules of the

11  department, to establish that the applicant can provide

12  adequate care.

13         (2)  The applicant may be an individual owner, a

14  corporation, a partnership, a firm, an association, or a

15  governmental entity.

16         (3)(2)  The application must shall be signed by the

17  applicant under oath and must shall contain the following:

18         (a)  The name, address, date of birth, and social

19  security number of the applicant and the name by which the

20  facility is to be known. Pursuant thereto:

21         1.  If the applicant is a firm, partnership, or

22  association, the application shall contain the name, address,

23  date of birth, and social security number of every member

24  thereof.

25         2.  If the applicant is a corporation, the application

26  shall contain the corporation's its name and address;, the

27  name, address, date of birth, and social security number of

28  each of its directors and officers;, and the name and address

29  of each person having at least a 5-percent ownership

30  10-percent interest in the corporation.

31

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  1         (b)  The name and address of any professional service,

  2  firm, association, partnership, or corporation that is to

  3  provide goods, leases, or services to the facility for which

  4  the application is made, if a 5-percent 10-percent or greater

  5  ownership interest in the service, firm, association,

  6  partnership, or corporation is owned by a person whose name

  7  must be listed on the application under paragraph (a).

  8         (c)  Information that provides a source to establish

  9  the suitable character, financial stability, and competency of

10  the applicant and of each person specified in the application

11  under subparagraph (a)1. or subparagraph (a)2. who has at

12  least a 10-percent interest in the firm, partnership,

13  association, or corporation and, if applicable, of the

14  administrator, including The name and address of any long-term

15  care facility with which the applicant, or administrator, or

16  financial officer has been affiliated through ownership or

17  employment within 5 years of the date of this license the

18  application for a license; and a signed affidavit disclosing

19  any financial or ownership interest that the applicant, or any

20  person listed in paragraph (a) principal, partner, or

21  shareholder thereof, holds or has held within the last 5 years

22  in any other facility licensed under this part, or in any

23  other entity licensed by this the state or another state to

24  provide health or residential care, which facility or entity

25  closed or ceased to operate as a result of financial problems.

26         (d)  A description and explanation of any exclusions,

27  permanent suspensions, or terminations of the applicant from

28  the Medicare or Medicaid programs. Proof of compliance with

29  requirements for disclosure of ownership and controlling

30  interests under the Medicaid or Medicare programs shall be

31  accepted in lieu of this submission.

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  1         (e)(d)  The names and addresses of other persons of

  2  whom the agency may inquire as to the character, and

  3  reputation, and financial responsibility of the owner

  4  applicant and, if different from the applicant, applicable, of

  5  the administrator and financial officer.

  6         (e)  The names and addresses of other persons of whom

  7  the agency may inquire as to the financial responsibility of

  8  the applicant.

  9         (f)  Identification of all other homes or facilities,

10  including the addresses and the license or licenses under

11  which they operate, if applicable, which are currently

12  operated by the applicant or administrator and which provide

13  housing, meals, and personal services to residents adults.

14         (g)  Such other reasonable information as may be

15  required by the agency to evaluate the ability of the

16  applicant to meet the responsibilities entailed under this

17  part.

18         (g)(h)  The location of the facility for which a

19  license is sought and documentation, signed by the appropriate

20  local government official, which states that the applicant has

21  met local zoning requirements.

22         (h)(i)  The name, address, date of birth, social

23  security number, education, and experience of the

24  administrator, if different from the applicant.

25         (4)(3)  The applicant shall furnish satisfactory proof

26  of financial ability to operate and conduct the facility in

27  accordance with the requirements of this part.  An applicant

28  applying for an initial license shall submit a balance sheet

29  setting forth the assets and liabilities of the owner and a

30  statement projecting revenues, expenses, taxes, extraordinary

31

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  1  items, and other credits or charges for the first 12 months of

  2  operation of the facility.

  3         (5)(4)  If the applicant is a continuing care facility

  4  certified under offers continuing care agreements, as defined

  5  in chapter 651, a copy of the facility's proof shall be

  6  furnished that the applicant has obtained a certificate of

  7  authority must be provided as required for operation under

  8  that chapter.

  9         (6)(5)  The applicant shall provide proof of liability

10  insurance as defined in s. 624.605.

11         (7)(6)  If the applicant is a community residential

12  home, the applicant must provide proof that it has met the

13  requirements specified in chapter 419 shall apply to community

14  residential homes zoned single-family or multifamily.

15         (8)(7)  The applicant must provide the agency with

16  proof of legal right to occupy the property.  This proof may

17  include, but is not limited to, copies of recorded warranty

18  deeds, or copies of lease or rental agreements, contracts for

19  deeds, quitclaim deeds, or other such documentation.

20         (9)(8)  The applicant must furnish proof that the

21  facility has received a satisfactory firesafety inspection.

22  The local fire marshal or other authority having jurisdiction

23  or the State Fire Marshal must conduct the inspection within

24  30 days after the written request by the applicant. If an

25  authority having jurisdiction does not have a certified

26  firesafety inspector, the State Fire Marshal shall conduct the

27  inspection.

28         (10)  The applicant must furnish proof of compliance

29  with level 2 background screening as required under s.

30  400.4174.

31

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  1         (11)(9)  A provisional license may be issued to an

  2  applicant making initial application for licensure or making

  3  application for a change of ownership.  A provisional license

  4  shall be limited in duration to a specific period of time not

  5  to exceed 6 months, as determined by the agency.

  6         (12)(10)  A No county or municipality may not shall

  7  issue an occupational license that which is being obtained for

  8  the purpose of operating a facility regulated under this part

  9  without first ascertaining that the applicant has been

10  licensed to operate such facility at the specified location or

11  locations by the agency.  The agency shall furnish to local

12  agencies responsible for issuing occupational licenses

13  sufficient instruction for making such the above-required

14  determinations.

15         (13)  The department may by rule establish application

16  procedures, identify forms, and specify documentation

17  necessary to administer this section.

18         Section 42.  Section 400.414, Florida Statutes, is

19  amended to read:

20         400.414  Denial, revocation, or suspension of license;

21  imposition of administrative fine; grounds.--

22         (1)  The agency may deny, revoke, or suspend any a

23  license issued under this part, or impose an administrative

24  fine in the manner provided in chapter 120, for. At the

25  chapter 120 hearing, the agency shall prove by a preponderance

26  of the evidence that its actions are warranted.

27         (2)  any of the following actions by an assisted living

28  a facility, any person subject to level 2 background screening

29  under s. 400.4174, or any facility or its employee shall be

30  grounds for action by the agency against a licensee:

31

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  1         (a)  An intentional or negligent act seriously

  2  affecting the health, safety, or welfare of a resident of the

  3  facility.

  4         (b)  The determination by the agency that the facility

  5  owner or administrator is not of suitable character or

  6  competency, or that the owner lacks the financial ability, to

  7  provide continuing adequate care to residents, pursuant to the

  8  information obtained through s. 400.411, s. 400.417, or s.

  9  400.434.

10         (c)  Misappropriation or conversion of the property of

11  a resident of the facility.

12         (d)  Failure to follow the criteria and procedures

13  provided under part I of chapter 394 relating to the

14  transportation, voluntary admission, and involuntary

15  examination of a facility resident.

16         (e)  Five or more repeated or recurring identical or

17  similar class III violations that are similar or identical to

18  violations of this part which were identified by the agency

19  during the previous survey last biennial inspection,

20  monitoring visit, or complaint investigation and which, in the

21  aggregate, affect the health, safety, or welfare of the

22  facility residents.

23         (f)  A determination that a person subject to level 2

24  background screening under s. 400.4174(1) does not meet the

25  screening standards of s. 435.04 or that the facility is

26  retaining an employee subject to level 1 background screening

27  standards under s. 400.4174(2) who does not meet the screening

28  standards of s. 435.03 and for whom exemptions from

29  disqualification have not been provided by the agency.

30         (g)(f)  A confirmed report of adult abuse, neglect, or

31  exploitation, as defined in s. 415.102, which has been upheld

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  1  following a chapter 120 hearing or a waiver of such

  2  proceedings where the perpetrator is an employee, volunteer,

  3  administrator, or owner, or otherwise has access to the

  4  residents of a facility, and the owner or administrator has

  5  not taken action to remove the perpetrator. Exemptions from

  6  disqualification may be granted as set forth in s. 435.07. No

  7  administrative action may be taken against the facility if the

  8  perpetrator is granted an exemption.

  9         (h)(g)  Violation of a moratorium.

10         (i)(h)  Failure of the license applicant, the licensee

11  during relicensure, or failure of a licensee that holds a

12  provisional an initial or change of ownership license, to meet

13  minimum license standards or the requirements of rules adopted

14  under this part.

15         (j)(i)  A fraudulent statement or omission of any

16  material fact on an application for a license or any other

17  document required by the agency, including the submission of a

18  license application that conceals the fact that any board

19  member, officer, or person owning 5 percent or more of the

20  facility may not meet the background screening requirements of

21  s. 400.4174, or that the applicant has been excluded,

22  permanently suspended, or terminated from the Medicaid or

23  Medicare programs that is signed and notarized.

24         (k)(j)  An intentional or negligent life-threatening

25  act in violation of the uniform firesafety standards for

26  assisted living facilities or other firesafety standards

27  established by the State Fire Marshal, that threatens the

28  health, safety, or welfare of a resident of a facility, as

29  communicated to the agency by the State Fire Marshal, a local

30  fire marshal, or other authority having jurisdiction or the

31  State Fire Marshal.

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  1         (l)  Exclusion, permanent suspension, or termination

  2  from the Medicare or Medicaid programs.

  3

  4  (3)  Proceedings brought under paragraphs (2)(a), (c), (e),

  5  and (k) (j) shall not be subject to de novo review.

  6         (2)(4)  Upon notification by the State Fire Marshal,

  7  local fire marshal, or other authority having jurisdiction or

  8  by the State Fire Marshal, the agency may deny or revoke the

  9  license of an assisted living a facility that fails to correct

10  cited fire code violations issued by the State Fire Marshal, a

11  local fire marshal, or other authority having jurisdiction,

12  that affect or threaten the health, safety, or welfare of a

13  resident of a facility.

14         (3)(5)  The agency may deny a license to an applicant

15  who owns or owned 25 percent or more of, or operates or

16  operated, an assisted living a facility which, during the 5

17  years prior to the application for a license, has had a

18  license denied, suspended, or revoked pursuant to subsection

19  (2), or, during the 2 years prior to the application for a

20  license, has had a moratorium imposed on admissions, has had

21  an injunctive proceeding initiated against it, has had a

22  receiver appointed, was closed due to financial inability to

23  operate, or has an outstanding fine assessed under this part.

24         (4)(6)  An action taken by the agency to suspend, deny,

25  or revoke a facility's license under this part, in which the

26  agency claims that the facility owner or an employee of the

27  facility has threatened the health, safety, or welfare of a

28  resident of the facility, shall, upon receipt of the

29  facility's request for a hearing, be heard by the Division of

30  Administrative Hearings of the Department of Management

31  Services within 120 days after the request for a hearing,

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  1  unless that time period is waived by both parties.  The

  2  administrative law judge must render a decision within 30 days

  3  after the hearing.

  4         (5)(7)  The agency shall provide to the Division of

  5  Hotels and Restaurants of the Department of Business and

  6  Professional Regulation, on a monthly basis, a list of those

  7  assisted living facilities that which have had their licenses

  8  denied, suspended, or revoked or that which are involved in an

  9  appellate proceeding pursuant to s. 120.60 related to the

10  denial, suspension, or revocation of a license.

11         Section 43.  Subsection (1) of section 400.417, Florida

12  Statutes, is amended to read:

13         400.417  Expiration of license; renewal; conditional

14  license.--

15         (1)  Biennial licenses issued for the operation of a

16  facility, unless sooner suspended or revoked, shall expire

17  automatically 2 years from the date of issuance.  The agency

18  shall notify the facility by certified mail at least 120 days

19  prior to the expiration of the license that a renewal license

20  relicensure is necessary to continue operation.  Ninety days

21  prior to the expiration date, an application for renewal shall

22  be submitted to the agency.  A license shall be renewed upon

23  the filing of an application on forms furnished by the agency

24  if the applicant has first met the requirements established

25  under this part and all rules adopted promulgated under this

26  part.  The failure to file a timely renewal application shall

27  result in a late fee charged to the facility in an amount

28  equal to 50 percent of the current fee in effect on the last

29  preceding regular renewal date.  Late fees shall be deposited

30  into the Health Care Trust Fund as provided in s. 400.418.

31  The facility shall file with the application satisfactory

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  1  proof of ability to operate and conduct the facility in

  2  accordance with the requirements of this part.  An applicant

  3  for renewal of a license must furnish proof that the facility

  4  has received a satisfactory firesafety inspection, conducted

  5  by the local fire marshal or other authority having

  6  jurisdiction or the State Fire Marshal, within the preceding

  7  12 months and an affidavit of compliance with the background

  8  screening requirements of s. 400.4174. An applicant for

  9  renewal of a license who has complied on the initial license

10  application with the provisions of s. 400.411 with respect to

11  proof of financial ability to operate shall not be required to

12  provide further proof of financial ability on renewal

13  applications unless the facility or any other facility owned

14  or operated in whole or in part by the same person or business

15  entity has demonstrated financial instability as evidenced by

16  bad checks, delinquent accounts, or nonpayment of withholding

17  taxes, utility expenses, or other essential services or unless

18  the agency suspects that the facility is not financially

19  stable as a result of the annual survey or complaints from the

20  public or a report from the State Long-Term Care Ombudsman

21  Council established under s. 400.0067.  Each facility shall

22  report to the agency any adverse court action concerning the

23  facility's financial viability, within 7 days after its

24  occurrence.  The agency shall have access to books, records,

25  and any other financial documents maintained by the facility

26  to the extent necessary to determine the facility's financial

27  stability carry out the purpose of this section.  The agency

28  may not renew a license for the operation of a facility shall

29  not be renewed if the licensee has any outstanding fines

30  assessed pursuant to this part which are in final order

31  status.

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  1         Section 44.  Section 400.4174, Florida Statutes, is

  2  amended to read:

  3         400.4174  Background screening; exemptions; reports of

  4  abuse in facilities.--

  5         (1)(a)  Level 2 background screening must be conducted

  6  on each of the following persons, who shall be considered

  7  employees for the purposes of conducting screening under

  8  chapter 435:

  9         1.  The facility owner if an individual; the

10  administrator; and the financial officer.

11         2.  An officer or board member if the facility owner is

12  a firm, corporation, partnership, or association, or any

13  person owning 5 percent or more of the facility if the agency

14  has probable cause to believe that such person has been

15  convicted of any offense prohibited by s. 435.04. For each

16  officer, board member, or person owning 5 percent or more who

17  has been convicted of any such offense, the facility shall

18  submit to the agency a description and explanation of the

19  conviction at the time of license application. This

20  subparagraph does not apply to a board member of a

21  not-for-profit corporation or organization if the board member

22  serves solely in a voluntary capacity, does not regularly take

23  part in the day-to-day operational decisions of the

24  corporation or organization, receives no remuneration for his

25  or her services, and has no financial interest and has no

26  family members with a financial interest in the corporation or

27  organization, provided that the board member and facility

28  submit a statement affirming that the board member's

29  relationship to the facility satisfies the requirements of

30  this subparagraph.

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  1         (b)  Proof of compliance with level 2 screening

  2  standards which has been submitted within the previous 5 years

  3  to meet any facility or professional licensure requirements of

  4  the agency or the Department of Health satisfies the

  5  requirements of this subsection, provided that such proof is

  6  accompanied, under penalty of perjury, by an affidavit of

  7  compliance with the provisions of chapter 435. Proof of

  8  compliance with the background screening requirements of the

  9  Department of Insurance for applicants for a certificate of

10  authority to operate a continuing care retirement community

11  under chapter 651, submitted within the last 5 years,

12  satisfies the Department of Law Enforcement and Federal Bureau

13  of Investigation portions of a level 2 background check.

14         (c)  The agency may grant a provisional license to a

15  facility applying for an initial license when each individual

16  required by this subsection to undergo screening has completed

17  the abuse registry and Department of Law Enforcement

18  background checks, but has not yet received results from the

19  Federal Bureau of Investigation, or when a request for an

20  exemption from disqualification has been submitted to the

21  agency pursuant to s. 435.07, but a response has not been

22  issued.

23         (2)  The owner or administrator of an assisted living

24  facility must conduct level 1 background screening, as set

25  forth in chapter 435, on all employees hired on or after

26  October 1, 1998, who perform personal services as defined in

27  s. 400.402(18). The agency may exempt an individual from

28  employment disqualification as set forth in chapter 435. Such

29  persons shall be considered as having met this requirement if:

30         (a)  Proof of compliance with level 1 screening

31  requirements obtained to meet any professional license

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  1  requirements in this state is provided and accompanied, under

  2  penalty of perjury, by a copy of the person's current

  3  professional license and an affidavit of current compliance

  4  with the background screening requirements.

  5         (b)  The person required to be screened has been

  6  continuously employed in the same type of occupation for which

  7  the person is seeking employment without a breach in service

  8  which exceeds 180 days, and proof of compliance with the level

  9  1 screening requirement which is no more than 2 years old is

10  provided. Proof of compliance shall be provided directly from

11  one employer or contractor to another, and not from the person

12  screened. Upon request, a copy of screening results shall be

13  provided by the employer retaining documentation of the

14  screening to the person screened.

15         (c)  The person required to be screened is employed by

16  a corporation or business entity or related corporation or

17  business entity that owns, operates, or manages more than one

18  facility or agency licensed under chapter 400, and for whom a

19  level 1 screening was conducted by the corporation or business

20  entity as a condition of initial or continued employment.

21         (3)  When an employee, volunteer, administrator, or

22  owner of a facility is the subject of has a confirmed report

23  of adult abuse, neglect, or exploitation, as defined in s.

24  415.102, or child abuse or neglect, as defined in s. 415.503,

25  and the protective investigator knows that the individual is

26  an employee, volunteer, administrator, or owner of a facility,

27  the agency shall be notified of the confirmed report.

28         Section 45.  Section 400.4176, Florida Statutes, is

29  amended to read:

30         400.4176  Notice of change of administrator.--If,

31  during the period for which a license is issued, the owner

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  1  changes administrators, the owner must notify the agency of

  2  the change within 45 days thereof and must provide

  3  documentation that the new administrator has completed the

  4  applicable core educational requirements under s. 400.452.

  5  Background screening shall be completed on any new

  6  administrator to establish that the individual is of suitable

  7  character as specified in s. 400.4174 ss. 400.411(2)(c) and

  8  400.456.

  9         Section 46.  Section 400.461, Florida Statutes, is

10  amended to read:

11         400.461  Short title; purpose.--

12         (1)  This part, consisting of ss. 400.461-400.518 ss.

13  400.461-400.515, may be cited as the "Home Health Services

14  Act."

15         (2)  The purpose of this part is to provide for the

16  licensure of every home health agency and to provide for the

17  development, establishment, and enforcement of basic standards

18  that will ensure the safe and adequate care of persons

19  receiving health services in their own homes.

20         Section 47.  Section 400.462, Florida Statutes, is

21  amended to read:

22         400.462  Definitions.--As used in this part, the term:

23         (1)  "Administrator" means a direct employee to whom

24  the governing body has delegated the responsibility for the

25  day-to-day administration of a home health agency. The

26  administrator must be a licensed physician, physician

27  assistant, or registered nurse licensed to practice in this

28  state, or an individual who has at least 1 year of supervisory

29  or administrative experience in home health care or in a

30  facility licensed under part II, part III, or part IV of this

31  chapter or under chapter 395. An employee of the governing

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  1  body may administer a maximum of five licensed home health

  2  agencies operated by a related business entity and located

  3  within one agency service district or within an immediately

  4  contiguous county. An administrator shall designate, in

  5  writing for each licensed entity, a qualified alternate

  6  administrator to serve during the administrator's absence. If

  7  the home health agency is licensed under this chapter and is

  8  part of a retirement community that provides multiple levels

  9  of care, an employee of the retirement community may

10  administer the home health agency and up to a maximum of four

11  entities licensed under this chapter which are located on the

12  same campus and owned, operated, or managed by the same

13  corporate entity.

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

15  Administration.

16         (3)(1)  "Certified nursing assistant" means any person

17  who has been issued a certificate under after fulfilling the

18  requirements of s. 400.211. A licensed home health agency or a

19  licensed nurse registry shall validate that any certified

20  nursing assistant is adequately trained to perform the tasks

21  of a home health aide in the home setting.

22         (4)  "Client" means an elderly, handicapped, or

23  convalescent individual who receives personal care services,

24  companion services, or homemaker services in the individual's

25  home or place of residence.

26         (5)(2)  "Companion" or "sitter" means a person who

27  cares for an elderly, handicapped, or convalescent individual

28  and accompanies such individual on trips and outings and may

29  prepare and serve meals to such individual. A companion may

30  not provide hands-on personal care to the client.

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  1         (6)(3)  "Department" means the Department of Children

  2  and Family Health and Rehabilitative Services.

  3         (7)  "Director of nursing" means a registered nurse,

  4  and direct employee of the home health agency, who is a

  5  graduate of an approved school of nursing and is licensed in

  6  this state; who has at least 1 year of supervisory experience

  7  as a registered nurse and experience in a licensed home health

  8  agency, a facility licensed under chapter 395, or a facility

  9  licensed under part II, part III, or part VI of this chapter;

10  and who is responsible for overseeing the professional nursing

11  and home health aid delivery of services of the agency. An

12  employee may be the director of nursing of a maximum of five

13  licensed home health agencies operated by a related business

14  entity. If a home health agency is licensed under this chapter

15  and is part of a retirement community that provides multiple

16  levels of care, an employee of the retirement community may

17  serve as the director of nursing for the home health agency

18  and up to four additional entities licensed under this chapter

19  if the entities are located on the same campus and are owned,

20  operated, or managed by the same corporate entity. A director

21  of nursing shall designate, in writing for each home health

22  agency, a qualified alternate registered nurse to serve during

23  the absence of the director of nursing.

24         (8)(4)  "Home health agency" means an organization that

25  provides home health services and staffing services for health

26  care facilities.

27         (9)(5)  "Home health agency personnel" means persons

28  who are employed by or under contract with a home health

29  agency and enter the home or place of residence of patients at

30  any time in the course of their employment or contract.

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  1         (10)  "Home health aide" means a person who provides

  2  hands-on personal care, performs simple procedures as an

  3  extension of therapy or nursing services, assists in

  4  ambulation or exercises, or supervises the self-administration

  5  of medications, for which the person has received training

  6  established by the agency pursuant to s. 400.497(1).

  7         (11)(6)  "Home health services" means health and

  8  medical services and medical supplies furnished by an

  9  organization to an individual by home health agency personnel

10  or by others under arrangements with the agency, on a visiting

11  basis, in the individual's home or place of residence.  The

12  term includes organizations that provide one or more of, but

13  is not limited to, the following:

14         (a)  Nursing care.

15         (b)  Physical, occupational, respiratory, or speech

16  therapy.

17         (c)  Home health aide services.

18         (d)  Dietetics and nutrition practice and nutrition

19  counseling Nutritional guidance.

20         (e)  Medical supplies, restricted to drugs and

21  biologicals prescribed by a physician.

22         (12)  "Home infusion therapy" means the administration

23  of intravenous pharmacological or nutritional products to a

24  patient in the patient's home.

25         (13)  "Home infusion therapy provider" means an

26  organization that employs, contracts with, or refers a

27  licensed professional who has received advanced training and

28  experience in intravenous infusion therapy and who administers

29  infusion therapy to a patient in the patient's home or place

30  of residence.

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  1         (14)(7)  "Homemaker" means a person who performs

  2  household chores that include housekeeping, meal planning and

  3  preparation, shopping assistance, and routine household

  4  activities for an elderly, handicapped, or convalescent

  5  individual. A homemaker may not provide hands-on personal care

  6  to a client.

  7         (15)(8)  "Nurse registry" means any person that

  8  procures, offers, promises, or attempts to secure

  9  health-care-related contracts for registered nurses, licensed

10  practical nurses, certified nursing assistants, home health

11  aides sitters, companions, or homemakers, who are compensated

12  by fees as independent contractors, including, but not limited

13  to, contracts for the provision of services to patients and

14  contracts to provide private duty or staffing services to

15  health care facilities licensed under chapter 395 or this

16  chapter or to other business entities.

17         (16)  "Organization" means a corporation, government or

18  governmental subdivision or agency, partnership or

19  association, two or more persons having a joint or common

20  interest, or any other legal or commercial entity. The term

21  does not include an entity that provides services using only

22  volunteers.

23         (17)(9)  "Patient" means any person who receives home

24  health services in his or her home or place of residence.

25         (18)  "Personal care" includes, but is not limited to,

26  assisting a patient in the activities of daily living, such as

27  dressing, grooming, bathing, eating, or personal hygiene;

28  assisting in physical transfer and ambulation; and supervising

29  the self-administration of medications.

30         (19)  "Physician" means a person licensed under chapter

31  458, chapter 459, chapter 460, or chapter 461.

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  1         (20)(10)  "Screening" means the assessment of the

  2  background of home health agency personnel, nurse registry

  3  personnel, and persons registered under s. 400.509 and

  4  includes employment history checks, records checks of the

  5  department's central abuse hotline under chapter 415 relating

  6  to vulnerable adults, and statewide criminal records

  7  correspondence checks through the Department of Law

  8  Enforcement.

  9         (21)  "Skilled care" means nursing services or

10  therapeutic services delivered by a health care professional

11  who is licensed under chapter 464; part I, part III, or part V

12  of chapter 468; or chapter 486, and who is employed by or

13  under contract with a licensed home health agency or is

14  referred by a licensed nurse registry.

15         (22)(11)  "Staffing services" means services provided

16  to a health care facility or other business entity on a

17  temporary basis by licensed health care personnel, including

18  certified nursing assistants and home health aides who are

19  employed by or work under the auspices of a licensed home

20  health agency or who are registered with a licensed nurse

21  registry.

22         Section 48.  Section 400.464, Florida Statutes, is

23  amended to read:

24         400.464  Home health agencies to be licensed;

25  expiration of license; exemptions; unlawful acts; penalties.--

26         (1)  Any home health agency must be licensed by the

27  agency for Health Care Administration to operate in this

28  state.  A license issued to a home health agency, unless

29  sooner suspended or revoked, expires 1 year after its date of

30  issuance.  However, any home health agency that is operated by

31  the Federal Government is exempt from this part.

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  1         (2)  If the licensed home health agency operates

  2  related offices, each related office outside the county where

  3  the main office is located must be separately licensed.  The

  4  counties where the related offices are operating must be

  5  specified on the license in the main office.

  6         (3)  An entity that receives a certificate-of-need

  7  exemption under s. 408.036 may request one home health agency

  8  license to provide Medicare and non-Medicare home health

  9  services to residents of the facility and non-Medicare home

10  health services to persons in one or more counties within the

11  agency service district where the main office of the home

12  health agency is located.

13         (3)  The furnishing of only home dialysis services,

14  supplies, or equipment, or personal care services as provided

15  by a community-care-for-the-elderly lead agency under s.

16  430.205, or personal care services provided through a

17  community-care-for-disabled-adults program under s. 410.604,

18  is exempt from this part.  The personal care services

19  exemptions apply only to community-care-for-the-elderly lead

20  agencies and community-care-for-disabled-adults programs that

21  directly provide only personal care services to their clients

22  and do not provide other home health services.

23         (4)  Any program offered through a county health

24  department that makes home visits for the purpose of providing

25  only environmental assessments, case management, health

26  education, or personal care services is exempt from this part.

27         (5)(a)  It is unlawful for any person to offer or

28  advertise home health services to the public unless he or she

29  has a valid license under this part. It is unlawful for any

30  holder of a license issued under this part to advertise or

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  1  indicate to the public that it holds a home health agency

  2  license other than the one it has been issued.

  3         (b)  A person who violates paragraph (a) is subject to

  4  an injunctive proceeding under s. 400.515.  A violation of

  5  paragraph (a) is a deceptive and unfair trade practice and

  6  constitutes a violation of the Florida Deceptive and Unfair

  7  Trade Practices Act.

  8         (c)  A person who violates paragraph (a) commits a

  9  misdemeanor of the second degree, punishable as provided in s.

10  775.082 or s. 775.083.  A person who commits a second or

11  subsequent violation commits a misdemeanor of the first

12  degree, punishable as provided in s. 775.082 or s. 775.083.

13

14  Each day of continuing violation constitutes a separate

15  offense.

16         (4)(6)  Any home infusion therapy provider shall be

17  licensed as a home health agency or nurse registry.  Any home

18  infusion therapy provider currently authorized to receive

19  Medicare reimbursement under a DME - Part B Provider number

20  for the provision of infusion therapy shall be licensed as a

21  noncertified home health agency. Such a provider shall

22  continue to receive that specified Medicare reimbursement

23  without being certified so long as the reimbursement is

24  limited to those items authorized pursuant to the DME - Part B

25  Provider Agreement and the home health agency is licensed in

26  compliance with the other provisions of this part.

27         (5)(a)  An organization may not provide, offer, or

28  advertise home health services to the public unless the

29  organization has a valid license or is specifically exempt

30  under this part. An organization that offers or advertises to

31  the public any service for which licensure or registration is

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  1  required under this part must include in the advertisement the

  2  license number or registration number issued to the

  3  organization by the agency. The agency shall assess a fine of

  4  not less than $100 to any licensee or registrant who fails to

  5  include the license or registration number when submitting an

  6  advertisement for publication, broadcast, or printing. The

  7  holder of a license issued under this part may not advertise

  8  or indicate to the public that it holds a home health agency

  9  license or a nurse registry license other than the one it has

10  been issued.

11         (b)  A person who violates the provisions of paragraph

12  (a) is subject to an injunctive proceeding under s. 400.515. A

13  violation of paragraph (a) is a deceptive and unfair trade

14  practice and constitutes a violation of the Florida Unfair and

15  Deceptive Trade Practices Act.

16         (c)  A person who violates the provisions of paragraph

17  (a) commits a misdemeanor of the second degree, punishable as

18  provided in s. 775.082 or s. 775.083. A person who commits a

19  second or subsequent violation commits a misdemeanor of the

20  first degree, punishable as provided in s. 775.082 or s.

21  775.083. Each day of continuing violation constitutes a

22  separate offense.

23         (6)  The following are exempt from the licensure

24  requirements of this part:

25         (a)  A home health agency operated by the Federal

26  Government.

27         (b)  The following home health services provided by a

28  state agency, either directly or through a contract:

29         1.  Pursuant to s. 430.04(2)(f), services provided

30  through a program or contract of the Department of Elderly

31  Affairs and services provided through a program of community

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  1  care for disabled adults under s. 410.604. This exemption does

  2  not entitle an individual to perform home health services

  3  without the required professional license.

  4         2.  Any program offered through the Department of

  5  Health, a community health center, or a rural health network

  6  which furnishes home visits for the purpose of providing

  7  environmental assessments, case management, health education,

  8  personal care services, family planning, or followup treatment

  9  or for the purpose of monitoring and tracking disease.

10         3.  Services provided to persons who have developmental

11  disabilities, as defined in s. 393.063(12).

12         (c)  A health care professional, whether or not

13  incorporated, who is licensed under chapter 458, chapter 459,

14  chapter 464, chapter 467, part I, part III, part V, or part X

15  of chapter 468, chapter 480, chapter 486, chapter 490, or

16  chapter 491, and who is acting alone within the scope of his

17  or her professional license to provide care to patients in

18  their homes.

19         (d)  A home health aide, or certified nursing

20  assistant, who acts in his or her individual capacity within

21  the definitions and standards of his or her respective

22  occupation, and who provides hands-on care to patients in

23  their homes.

24         (e)  Natural persons providing personal care services

25  to individuals or families in their place of residence. This

26  exemption allows each natural person to serve no more than 12

27  individuals or families in any calendar year without a home

28  health agency license. A natural person who provides personal

29  care services under this paragraph may not engage in paid

30  advertisement to the public as providing the services covered

31  under this exemption.

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  1         (f)  The delivery of instructional services in home

  2  dialysis and home dialysis supplies or equipment.

  3         (g)  The delivery of nursing home services, for which

  4  the nursing home is licensed under part II, to serve its

  5  residents in its facility.

  6         (h)  The delivery of assisted living facility services,

  7  for which the assisted living facility is licensed under part

  8  III, to serve its residents in its facility.

  9         (i)  The delivery of hospice services, for which the

10  hospice is licensed under part VI, to serve hospice patients

11  admitted to its service.

12         (j)  A hospital that provides services for which it is

13  licensed under chapter 395 and birth centers under chapter

14  383.

15         (k)  The delivery of community residential services,

16  for which the community residential home is licensed under

17  chapter 419, to serve the residents in its facility.

18         (l)  A not-for-profit, community-based agency that

19  provides early intervention services to infants and toddlers.

20         (m)  Certified rehabilitation agencies and

21  comprehensive outpatient rehabilitation facilities that are

22  certified under Title 18 of the Social Security Act.

23         (n)  The delivery of adult family-care home services,

24  for which the adult family-care home is licensed under part

25  VII, to serve the residents in its facility.

26         Section 49.  Section 400.471, Florida Statutes, is

27  amended to read:

28         400.471  Application for license; fee; provisional

29  license; temporary permit.--

30         (1)  Application for an initial license or for renewal

31  of an existing license must be made under oath to the agency

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  1  for Health Care Administration on forms furnished by it and

  2  must be accompanied by the appropriate license fee as provided

  3  in subsection (8) (7).  The agency must take final action on

  4  an initial licensure application within 90 60 days after

  5  receipt of all required documentation.

  6         (2)  The applicant must file with the application

  7  satisfactory proof that the home health agency is in

  8  compliance with this part and applicable rules, including:

  9         (a)  A listing of services to be provided, either

10  directly by the applicant or through contractual arrangements

11  with existing providers;

12         (b)  The number and discipline of professional staff to

13  be employed; and

14         (c)  Proof of financial ability to operate. If the

15  applicant has applied for a certificate of need under ss.

16  408.031-408.045 within the preceding 12 months, the applicant

17  may submit the proof submitted during the certificate-of-need

18  process along with an attestation that there has been no

19  substantial change in the facts and circumstances underlying

20  the original submission.

21         (3)  An applicant for initial licensure must

22  demonstrate financial ability to operate by submitting a

23  balance sheet and income and expense statement for the first 2

24  years of operation which provide evidence of having sufficient

25  assets, credit, and projected revenues to cover liabilities

26  and expenses. The applicant shall have demonstrated financial

27  ability to operate if the applicant's assets, credit, and

28  projected revenues meet or exceed projected liabilities and

29  expenses.  All documents required under this subsection must

30  be prepared in accordance with generally accepted accounting

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  1  principles and the financial statement must be signed by a

  2  certified public accountant.

  3         (4)  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 administrator, or a

10  similarly titled person who is responsible for the day-to-day

11  operation of the licensed home health agency, and the

12  financial officer, or similarly titled individual who is

13  responsible for the financial operation of the licensed home

14  health agency.

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 the requirements of

26  paragraph (a). Proof of compliance with background screening

27  which has been submitted within the previous 5 years to

28  fulfill the requirements of the Department of Insurance

29  pursuant to chapter 651 as part of an application for a

30  certificate of authority to operate a continuing care

31  retirement community is acceptable in fulfillment of the

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  1  Department of Law Enforcement and Federal Bureau of

  2  Investigation background check.

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

  4  applicant when each individual required by this section to

  5  undergo background screening has met the standards for the

  6  abuse registry background check and the Department of Law

  7  Enforcement background check, but the agency has not yet

  8  received background screening results from the Federal Bureau

  9  of Investigation. A standard license may be granted to the

10  licensee upon the agency's receipt of a report of the results

11  of the Federal Bureau of Investigation background screening

12  for each individual required by this section to undergo

13  background screening which confirms that all standards have

14  been met, or upon the granting of a disqualification exemption

15  by the agency as set forth in chapter 435. Any other person

16  who is required to undergo level 2 background screening may

17  serve in his or her capacity pending the agency's receipt of

18  the report from the Federal Bureau of Investigation. However,

19  the person may not continue to serve if the report indicates

20  any violation of background screening standards and a

21  disqualification exemption has not been requested of and

22  granted by the agency as set forth in chapter 435.

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

24  application, a description and explanation of any exclusions,

25  permanent suspensions, or terminations of the licensee or

26  potential licensee from the Medicare or Medicaid programs.

27  Proof of compliance with the requirements for disclosure of

28  ownership and controlling interests under the Medicaid or

29  Medicare programs shall be accepted in lieu of this

30  submission.

31

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

  2  description and explanation of any conviction of an offense

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

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

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

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

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

  8  serves solely in a voluntary capacity for the corporation or

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

10  operational decisions of the corporation or organization,

11  receives no remuneration for his or her services on the

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

13  financial interest and has no family members with a financial

14  interest in the corporation or organization, provided that the

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

16  include in the application a statement affirming that the

17  director's relationship to the corporation satisfies the

18  requirements of this paragraph.

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

20  the applicant, administrator, or financial officer has been

21  found guilty of, regardless of adjudication, or has entered a

22  plea of nolo contendere or guilty to, any offense prohibited

23  under the level 2 standards for screening set forth in chapter

24  435, unless an exemption from disqualification has been

25  granted by the agency as set forth in chapter 435.

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

27  applicant:

28         1.  Has falsely represented a material fact in the

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

30  omitted any material fact from the application required by

31  paragraph (e) or paragraph (f); or

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  1         2.  Has been or is currently excluded, suspended,

  2  terminated from or has involuntarily withdrawn from

  3  participation in this state's Medicaid program, or the

  4  Medicaid program of any other state, or from participation in

  5  the Medicare program or any other governmental or private

  6  health care or health insurance program.

  7         (i)  An application for license renewal must contain

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

  9         (j)  A provisional license may be issued for a period

10  not to exceed one year to any new home health agency or a home

11  health agency that is in substantial compliance with this part

12  and rules adopted thereunder.

13         (5)(4)  The home health agency must also obtain and

14  maintain the following liability insurance coverages, in an.

15  Proof of liability insurance, as defined in s. 624.605, must

16  be submitted with the application.  The Agency for Health Care

17  Administration shall set the required amounts of liability

18  insurance by rule, but the required amount of must not be less

19  than $250,000 per claim, and the home health agency must

20  submit proof of coverage with an initial application for

21  licensure and with each annual application for license

22  renewal:

23         (a)  Malpractice insurance, as defined in s.

24  624.605(1)(k); and

25         (b)  Liability insurance, as defined in s.

26  624.605(1)(b).

27         (6)(5)  Ninety Sixty days before the expiration date,

28  an application for renewal must be submitted to the agency for

29  Health Care Administration under oath on forms furnished by

30  it, and a license must be renewed if the applicant has met the

31  requirements established under this part and applicable rules.

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  1  The home health agency must file with the application

  2  satisfactory proof that it is in compliance with this part and

  3  applicable rules.  If there is evidence of financial

  4  instability, the home health agency must submit satisfactory

  5  proof of its financial ability to comply with the requirements

  6  of this part.

  7         (7)(6)  When transferring the ownership of a home

  8  health agency, the transferee must submit an application for a

  9  license at least 60 days before the effective date of the

10  transfer.  If the home health agency is being leased, a copy

11  of the lease agreement must be filed with the application. A

12  transfer to an immediate family member or member of the

13  transferor's household following a conviction, assessment, or

14  exclusion from Medicare or Medicaid may not be approved.

15         (8)(7)  The license fee and annual renewal fee required

16  of a home health agency are is nonrefundable.  The agency for

17  Health Care Administration shall set the fees in an amount

18  that is sufficient to cover its costs in carrying out its

19  responsibilities under this part, but not to exceed $1,000.

20  However, state, county, or municipal governments applying for

21  licenses under this part are exempt from the payment of

22  license fees.  All fees collected under this part must be

23  deposited in the Health Care Trust Fund for the administration

24  of this part.

25         (9)(8)  The license must be displayed in a conspicuous

26  place in the administrative office of the home health agency

27  and is valid only while in the possession of the agency person

28  to which it is issued.  The license may not be sold, assigned,

29  or otherwise transferred, voluntarily or involuntarily, and is

30  valid only for the home health agency and location for which

31  originally issued.

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  1         (10)(9)  A home health agency against whom a revocation

  2  or suspension proceeding is pending at the time of license

  3  renewal may be issued a provisional license effective until

  4  final disposition by the agency for Health Care Administration

  5  of such proceedings. If judicial relief is sought from the

  6  final disposition, the court that has jurisdiction may issue a

  7  temporary permit for the duration of the judicial proceeding.

  8         (11)(10)  The agency may department shall not issue a

  9  license designated as certified to a home health agency that

10  which fails to receive a certificate of need under the

11  provisions of ss. 408.031-408.045 and that fails to satisfy

12  the requirements of a Medicare certification survey from the

13  agency.

14         (12)  The agency may not issue a license to a home

15  health agency that has any unpaid fines assessed under this

16  part.

17         Section 50.  Section 400.474, Florida Statutes, is

18  amended to read:

19         400.474  Denial, suspension, revocation of license;

20  injunction; grounds.--

21         (1)  The agency for Health Care Administration may

22  deny, revoke, or suspend a license, or impose an

23  administrative fine in the manner provided in chapter 120, or

24  initiate injunctive proceedings under s. 400.515.

25         (2)  Any of the following actions by a home health

26  agency or its employee is grounds for disciplinary action by

27  the agency for Health Care Administration:

28         (a)  Violation of this part or of applicable rules.

29         (b)  An intentional, reckless, or negligent act that

30  materially affects the health or safety of a patient.

31

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  1         (3)  The agency may impose the following penalties for

  2  operating without a license upon an owner who has in the past

  3  operated, or who currently operates, a licensed home health

  4  agency:

  5         (a)  If a home health agency that is found to be

  6  operating without a license wishes to apply for a license, the

  7  home health agency may submit an application only after the

  8  agency has verified that the home health agency no longer

  9  operates an unlicensed agency.

10         (b)  Any person, partnership, or corporation that

11  violates paragraph (a) and that previously operated a licensed

12  home health agency or concurrently operates both a licensed

13  home health agency and an unlicensed home health agency

14  commits a felony of the third degree, punishable as provided

15  in s. 775.082, s. 775.083, or s. 775.084. If an owner has an

16  interest in more than one home health agency and fails to

17  license any one of those agencies, the agency shall issue a

18  cease and desist order for the activities of the unlicensed

19  home health agency and impose a moratorium on any or all of

20  the licensed agencies until the unlicensed home health agency

21  is licensed.

22         (c)  If any home health agency meets the criteria in

23  paragraph (a) or paragraph (b) and that home health agency has

24  received any government reimbursement for services provided by

25  an unlicensed home health agency, the agency shall make a

26  fraud referral to the appropriate government reimbursement

27  program.

28         (4)  The agency may deny, revoke, or suspend the

29  license of a home health agency, or may impose on a home

30  health agency administrative fines not to exceed the aggregate

31  sum of $5,000, if:

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  1         (a)  A home health agency fails to provide at least one

  2  of the services listed in s. 400.462(11) directly to patients

  3  for a period of 6 consecutive months.

  4         (b)  The agency is unable to obtain entry to the home

  5  health agency to conduct a licensure survey, complaint

  6  investigation, surveillance visit, or monitoring visit.

  7         (c)  An applicant or a licensed home health agency has

  8  falsely represented a material fact in the application, or has

  9  omitted from the application any material fact, including, but

10  not limited to, the fact that the controlling or ownership

11  interest is held by any officer, director, agent, manager,

12  employee, affiliated person, partner, or shareholder who may

13  not be eligible to participate.

14         (d)  An applicant, owner, or person who has a 5 percent

15  or greater interest in a licensed entity:

16         1.  Has been previously found by any licensing,

17  certifying, or professional standards board or agency to have

18  violated standards or conditions that relate to

19  home-health-related licensure or certification, or to the

20  quality of home-health-related services provided.

21         2.  Has been or is currently excluded, suspended, or

22  terminated from, or has involuntarily withdrawn from,

23  participation in the Medicaid program of this state or any

24  other state, the Medicare program, or any other governmental

25  health care or health insurance program.

26         Section 51.  Section 400.484, Florida Statutes, is

27  amended to read:

28         400.484  Right of inspection.--

29         (1)  Any duly authorized officer or employee of the

30  agency for Health Care Administration may make such

31  inspections and investigations as are necessary in order to

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  1  determine the state of compliance with this part and with

  2  applicable rules.  The right of inspection extends to any

  3  business that the agency for Health Care Administration has

  4  reason to believe is being operated as a home health agency

  5  without a license, but such inspection of any such business

  6  may not be made without the permission of the owner or person

  7  in charge unless a warrant is first obtained from a circuit

  8  court. Any application for a license issued under this part or

  9  for license renewal constitutes permission for an appropriate

10  inspection to verify the information submitted on or in

11  connection with the application.

12         (2)  The agency shall impose fines for various classes

13  of deficiencies in accordance with the following schedule:

14         (a)  A class I deficiency is any act, omission, or

15  practice that results in a patient's death, disablement, or

16  permanent injury, or places a patient at imminent risk of

17  death, disablement, or permanent injury. Upon finding a class

18  I deficiency, the agency may impose an administrative fine in

19  the amount of $5,000 for each occurrence and each day that the

20  deficiency exists. In addition, the agency may immediately

21  revoke the license, or impose a moratorium on the admission of

22  new patients, until the factors causing the deficiency have

23  been corrected.

24         (b)  A class II deficiency is any act, omission, or

25  practice that has a direct adverse effect on the health,

26  safety, or security of a patient. Upon finding a class II

27  deficiency, the agency may impose an administrative fine in

28  the amount of $1,000 for each occurrence and each day that the

29  deficiency exists. In addition, the agency may suspend the

30  license, or impose a moratorium on the admission of new

31

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  1  patients, until the factors causing the deficiency have been

  2  corrected.

  3         (c)  A class III deficiency is any act, omission, or

  4  practice that has an indirect adverse effect on the health,

  5  safety, or security of a patient. Upon finding an uncorrected

  6  or repeated class III deficiency, the agency may impose an

  7  administrative fine not to exceed $500 for each occurrence and

  8  each day that the uncorrected or repeated deficiency exists.

  9         (d)  A class IV deficiency is any act, omission, or

10  practice related to a required report, form, or document which

11  does not have the potential to negatively affect a patient. A

12  class IV deficiency is a deficiency that the agency determines

13  does not threaten the health, safety, or security of a

14  patient. Upon finding an uncorrected or repeated class IV

15  deficiency, the agency may impose an administrative fine not

16  to exceed $200 for each occurrence and each day that the

17  uncorrected or repeated deficiency exists.

18         Section 52.  Section 400.487, Florida Statutes, is

19  amended to read:

20         400.487  Patient assessment; establishment and review

21  of plan of care; provision of services.--

22         (1)  The home health agency providing skilled care and

23  treatment must make an assessment of the patient's needs

24  within 48 hours after the start of services.

25         (2)  The attending physician for a patient who is to

26  receive skilled receiving care or treatment provided by a

27  licensed nurse or by a physical, occupational, or speech

28  therapist must establish treatment orders a plan of care for

29  the patient on behalf of the home health agency that provides

30  services to the patient.  The original plan of treatment

31  orders must be signed by the physician within 21 days after

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  1  the start of care and reviewed, at least every 62 days or more

  2  frequently if the patient's illness requires, by the physician

  3  in consultation with home health agency personnel that provide

  4  services to the patient. Based on the assessment and the

  5  treatment orders, the home health agency shall prepare a plan

  6  of care that describes the services to be provided, the

  7  frequency of service provision, and any other information

  8  required by rule. The treatment orders and plan of care may be

  9  incorporated into one document.

10         (3)  If a client is accepted for home health aide

11  services, homemaker services, or companion services and such

12  services do not require a physician's order, the home health

13  agency shall establish a plan for the provision of services

14  and maintain a record of the services provided.

15         (4)(3)  Each patient or client has the right to be

16  informed of and to participate in the planning of his or her

17  care.  Each patient must be provided, upon request, a copy of

18  the plan of care or plan for the provision of services

19  established and maintained for that patient or client by the

20  home health agency.

21         (4)  Home health services that are provided to a

22  patient must be evaluated in the patient's home by a physician

23  licensed under chapter 458, chapter 459, chapter 460, or

24  chapter 461 or by a registered nurse licensed under chapter

25  464 as frequently as necessary to assure safe and adequate

26  care, but not less frequently than once every 62 days.

27         (5)  In the case of nursing services delivered by a

28  home health agency to a patient, the home health agency to

29  which a patient has been admitted for care must provide the

30  initial admission visit, all service evaluation visits, and

31  the discharge visit by qualified personnel who are on the

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  1  payroll of, and to whom an Internal Revenue Service W-2 form

  2  will be issued by, the home health agency at least one home

  3  health service to patients for whom it has agreed to provide

  4  care.  Services provided by others under contractual

  5  arrangements to a home health agency agency's patients must be

  6  monitored and managed controlled by the admitting home health

  7  agency. The home health agency is fully responsible for

  8  ensuring that all care provided through its employees or

  9  contract staff is delivered in accordance with this part and

10  applicable rules.

11         (6)  The skilled care services provided by a home

12  health agency, directly or under contract, must be supervised

13  and coordinated in accordance with the plan of care.

14         Section 53.  Section 400.491, Florida Statutes, is

15  amended to read:

16         400.491  Clinical records.--

17         (1)  The home health agency must maintain for each

18  patient who receives skilled care a clinical record that

19  includes the services the home health agency provides directly

20  and those provided through arrangement with another health

21  care provider, except for those services provided by persons

22  referred under s. 400.509.  Such records must contain

23  pertinent past and current medical, nursing, social and other

24  therapeutic information, the plan of treatment, and other such

25  information as is necessary for the safe and adequate care of

26  the patient.  When home health services are terminated, the

27  record must show the date and reason for termination.  Such

28  records are considered patient records under s. 455.667

29  400.241, and must be maintained by the home health agency for

30  5 years following termination of services.  If a patient

31  transfers to another home health agency, a copy of his or her

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  1  record must be provided to the other home health agency upon

  2  request.

  3         (2)  The home health agency must maintain a plan for

  4  service provision for each client who receives nonskilled

  5  care. Records of the client's plan must be maintained by the

  6  home health agency for 1 year following termination of the

  7  services.

  8         Section 54.  Section 400.497, Florida Statutes, is

  9  amended to read:

10         400.497  Rules establishing minimum standards.--The

11  agency for Health Care Administration shall adopt, publish,

12  and enforce rules to implement this part, including, as

13  applicable, ss. 400.506 and 400.509, which must provide

14  reasonable and fair minimum standards relating to:

15         (1)  Scope of home health services to be provided.

16         (1)(2)  The qualifications, and minimum training

17  requirements, and supervision requirements of all home health

18  agency personnel, including aides. The agency shall allow

19  shared staffing if the home health agency is part of a

20  retirement community that provides multiple levels of care, is

21  located on one campus, is licensed under this chapter, and

22  otherwise meets the requirements of law and rule.

23         (2)(3)  Requirements for prospective employees

24  Procedures for maintaining a record of the employment history

25  of all home health agency personnel.  A home health agency

26  must require its personnel to submit an employment history to

27  the home health agency, and verification of it must verify the

28  employment history unless through diligent efforts such

29  verification is not possible.  The agency for Health Care

30  Administration shall prescribe by rule the minimum

31  requirements for establishing that diligent efforts have been

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  1  made.  The administrator of a home health agency must review

  2  the employment history and references of home health agency

  3  personnel and applicants for employment.  The Agency for

  4  Health Care Administration must review the employment history

  5  and references of each administrator of a home health agency.

  6  There is no monetary liability on the part of, and no cause of

  7  action for damages arises against, a former employer of a

  8  prospective employee of or prospective independent contractor

  9  with a licensed home health agency who reasonably and in good

10  faith communicates his or her honest opinions about the former

11  employee's job performance. This subsection does not affect

12  the official immunity of an officer or employee of a public

13  corporation.

14         (3)(4)  Licensure application and renewal.

15         (4)(5)  The administration of the home health agency,

16  including requirements for onsite and electronic accessibility

17  of supervisory personnel.

18         (5)(6)  Procedures for administering drugs and

19  biologicals.

20         (6)(7)  Procedures for maintaining patients' patient

21  records.

22         (7)(8)  Provision of Ensuring that the home health

23  services provided by a home health agency are in accordance

24  with the plan of care treatment established for each patient

25  for whom a plan of care is required.

26         (8)(9)  Geographic service areas.

27         (9)(10)  Standards for contractual arrangements for the

28  provision of home health services by providers not employed by

29  the home health agency providing for the patient's care and

30  treatment.

31

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  1         Section 55.  Subsection (1) and present subsections (9)

  2  and (12) of section 400.506, Florida Statutes, are amended,

  3  subsections (2) through (16) are renumbered as subsections (3)

  4  through (17), respectively, and a new subsection (2) is added

  5  to that section, to read:

  6         400.506  Licensure of nurse registries; requirements;

  7  penalties.--

  8         (1)  A nurse registry is exempt from the licensing

  9  requirements of a home health agency, but must be licensed as

10  a nurse registry. Each operational site of a nurse registry

11  must be licensed unless the nurse registry operates more than

12  one site within a county. If the nurse registry operates more

13  than one site within a county, only one license is required

14  for the sites within that county.

15         (2)  Each applicant for licensure must comply with the

16  following requirements:

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

18  application, the agency shall require background screening, in

19  accordance with the level 2 standards for screening set forth

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

21  titled individual who is responsible for the daily operation

22  of the nurse registry, and of the financial officer, or other

23  similarly titled individual who is responsible for the

24  financial operation of the registry, including billings for

25  patient care and services.  The applicant shall comply with

26  the procedures for level 2 background screening as set forth

27  in chapter 435.

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

29  other individual who is an applicant if the agency has

30  probable cause to believe that he or she has been convicted of

31

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  1  a crime or has committed any other offense prohibited under

  2  the level 2 standards for screening set forth 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 or assisted living licensure requirements of this

  7  state is acceptable in fulfillment of the requirements of

  8  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. A standard license may be granted to the

16  applicant upon the agency's receipt of a report of the results

17  of the Federal Bureau of Investigation background screening

18  for each individual required by this section to undergo

19  background screening which confirms that all standards have

20  been met, or upon the granting of a disqualification exemption

21  by the agency as set forth in chapter 435. Any other person

22  who is required to undergo level 2 background screening may

23  serve in his or her capacity pending the agency's receipt of

24  the report from the Federal Bureau of Investigation. However,

25  the person may not continue to serve if the report indicates

26  any violation of background screening standards and a

27  disqualification exemption has not been requested of and

28  granted by the agency 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 controlling

  3  interests under the Medicaid or Medicare programs may 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 license may not be granted to an applicant if

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

25  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 license if any

31  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 programs as set forth in

  7  paragraph (e).

  8         (i)  An application for license renewal must contain

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

10         (10)(9)(a)  A nurse registry may refer for contract in

11  private residences registered nurses and licensed practical

12  nurses registered and licensed under chapter 464, certified

13  nursing assistants certified under s. 400.211, home health

14  aides who present documented proof of successful completion of

15  the training required by rule of the agency, and sitters,

16  companions, or homemakers for the purposes of providing those

17  services authorized under s. 400.509(1). A person referred by

18  a nurse registry must provide current documentation that he or

19  she is free from any communicable disease.

20         (b)  A certified nursing assistant or home health aide

21  may be referred for a contract to provide care to a patient in

22  his or her home only if that patient is under a physician's

23  care.  A certified nursing assistant or home health aide

24  referred for contract in a private residence shall be limited

25  to assisting a patient with bathing, dressing, toileting,

26  grooming, eating, physical transfer, and those normal daily

27  routines the patient could perform for himself or herself were

28  he or she physically capable.  A certified nursing assistant

29  or home health aide may not provide medical or other health

30  care services that require specialized training and that may

31  be performed only by licensed health care professionals.  The

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  1  nurse registry shall obtain the name and address of the

  2  attending physician and send written notification to the

  3  physician within 48 hours after a contract is concluded that a

  4  certified nursing assistant or home health aide will be

  5  providing care for that patient.

  6         (c)  A registered nurse shall make monthly visits to

  7  the patient's home to assess the patient's condition and

  8  quality of care being provided by the certified nursing

  9  assistant or home health aide.  Any condition which in the

10  professional judgment of the nurse requires further medical

11  attention shall be reported to the attending physician and the

12  nurse registry.  The assessment shall become a part of the

13  patient's file with the nurse registry and may be reviewed by

14  the Agency for Health Care Administration during their survey

15  procedure.

16         (d)  In order to refer for contract in private

17  residences a certified nursing assistant or any person

18  specified in s. 400.509(1), the nurse registry and such person

19  registered with the nurse registry must also be registered

20  under s. 400.509.  Any person registered as an independent

21  contractor with a nurse registry for the purpose of providing

22  services authorized under s. 400.509(1) on or before October

23  1, 1990, is exempt from registration under s. 400.509 so long

24  as such person remains continuously registered with that nurse

25  registry.

26         (13)(12)  Each nurse registry must comply with the

27  procedures set forth in s. 400.497(2)(3) for maintaining

28  records of the employment history of all persons referred for

29  contract and is subject to the standards and conditions set

30  forth in s. 400.512. However, an initial screening may not be

31

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  1  required for persons who have been continuously registered

  2  with the nurse registry since September 30, 1990.

  3         Section 56.  Subsections (1) and (2) and present

  4  subsections (4) and (5) of section 400.509, Florida Statutes,

  5  are amended, subsections (3) through (13) are renumbered as

  6  subsections (4) through (14), respectively, and a new

  7  subsection (3) is added to that section, to read:

  8         400.509  Registration of particular service providers

  9  exempt from licensure; certificate of registration; regulation

10  of registrants.--

11         (1)  Any person who that provides domestic maid

12  services, sitter services, companion services, or homemaker

13  services and does not provide a home health service to a

14  person is exempt from licensure under this part. However, any

15  person who that provides sitter services for adults, companion

16  services, or homemaker services must register with the Agency

17  for Health Care Administration. This section does not apply to

18  an individual who provides services under a contract with the

19  Department of Children and Family Services and who has

20  undergone screening under s. 393.0655.

21         (2)  Registration consists of annually filing with the

22  agency for Health Care Administration, under oath, on forms

23  provided by it, the following information:

24         (a)  The name, address, date of birth, and social

25  security number of the individual, or the name and address of

26  the person, providing the service.

27         (b)  If the registrant is a firm or partnership, the

28  name, address, date of birth, and social security number of

29  every member.

30         (c)  If the registrant is a corporation or association,

31  its name and address, the name, address, date of birth, and

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  1  social security number of each of its directors and officers,

  2  and the name and address of each person having at least a

  3  5-percent 10-percent interest in the corporation or

  4  association.

  5         (d)  The name, address, date of birth, and social

  6  security number of each person employed or under contract.

  7         (3)  Each applicant for registration must comply with

  8  the 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 1 standards for screening set forth

12  in chapter 435, of the individual providing the service. If

13  the applicant is a firm or partnership, the agency shall

14  require background screening of the managing employee, or

15  other similarly titled individual who is responsible for the

16  operation of the entity, and of the financial officer, or

17  other similarly titled individual who is responsible for the

18  financial operation of the entity, including billings for

19  client services, in accordance with level 2 standards for

20  background screening as set forth in chapter 435.

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

22  other individual who is an applicant if the agency has

23  probable cause to believe that he or she has been convicted of

24  a crime or has committed any other offense prohibited under

25  the level 2 standards for screening set forth in chapter 435.

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

27  screening requirements of chapter 435 which has been submitted

28  within the previous 5 years in compliance with any other

29  healthcare or assisted living licensure requirements of this

30  state is acceptable in fulfillment of the requirements of

31  paragraph (a).

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  1         (d)  A provisional registration may be granted to an

  2  applicant when each individual required by this section to

  3  undergo background screening has met the standards for the

  4  abuse registry background check and the Department of Law

  5  Enforcement background check but the agency has not yet

  6  received background screening results from the Federal Bureau

  7  of Investigation. A standard registration may be granted to

  8  the applicant upon the agency's receipt of a report of the

  9  results of the Federal Bureau of Investigation background

10  screening for each individual required by this section to

11  undergo background screening which confirms that all standards

12  have been met, or upon the granting of a disqualification

13  exemption by the agency as set forth in chapter 435. Any other

14  person who is required to undergo level 2 background screening

15  may serve in his or her capacity pending the agency's receipt

16  of the report from the Federal Bureau of Investigation.

17  However, the person may not continue to serve if the report

18  indicates any violation of background screening standards and

19  a disqualification exemption has not been requested of and

20  granted by the agency 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  the requirements for disclosure of ownership and controlling

26  interests under the Medicaid or Medicare programs shall 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 registration may not be granted to an applicant

16  if the applicant or managing employee has been found guilty

17  of, 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 the registration if

23  any 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 programs as set forth in

30  paragraph (e).

31

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  1         (i)  An application for registration renewal must

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

  3         (5)(4)  Each registrant must establish the employment

  4  history of persons employed or under contract having contact

  5  at any time with clients patients in their homes by:

  6         (a)  Requiring persons employed or under contract to

  7  submit an employment history to the registrant; and

  8         (b)  Verifying the employment history, unless through

  9  diligent efforts such verification is not possible.  The

10  agency for Health Care Administration shall prescribe by rule

11  the minimum requirements for establishing that diligent

12  efforts have been made.

13

14  There is no monetary liability on the part of, and no cause of

15  action for damages arises against, a former employer of a

16  prospective employee of or prospective independent contractor

17  with a registrant who reasonably and in good faith

18  communicates his or her honest opinions about the former

19  employee's job performance.  This subsection does not affect

20  the official immunity of an officer or employee of a public

21  corporation.

22         (6)(5)  On or before the first day on which services

23  are provided to a client patient, any registrant under this

24  part must inform the client patient and his or her immediate

25  family, if appropriate, of the right to report abusive,

26  neglectful, or exploitative practices.  The statewide

27  toll-free telephone number for the central abuse registry must

28  be provided to patients in a manner that is clearly legible

29  and must include the words: "To report abuse, neglect, or

30  exploitation, please call toll-free ...(phone number)...."

31

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  1  Registrants must establish appropriate policies and procedures

  2  for providing such notice to clients patients.

  3         Section 57.  Section 400.512, Florida Statutes, is

  4  amended to read:

  5         400.512  Screening of home health agency personnel;

  6  nurse registry personnel; and sitters, companions, and

  7  homemakers.--The agency for Health Care Administration shall

  8  require employment, or contractor, screening as provided in

  9  chapter 435, using the level 1 standards for screening set

10  forth in that chapter, for home health agency personnel;

11  persons referred for contract employment by nurse registries;

12  and persons employed or referred by sitter, companion, or

13  homemaker services registered under s. 400.509.

14         (1)  The agency for Health Care Administration may

15  grant exemptions from disqualification from employment under

16  this section as provided in s. 435.07.

17         (2)  The administrator of each home health agency,

18  nurse registry, or sitter, companion, or homemaker service

19  registered under s. 400.509 must sign an affidavit annually,

20  under penalty of perjury, stating that all personnel hired, or

21  registered, on or after October 1, 1994 1989, who enter the

22  home of a patient or client in the capacity of their service

23  capacity employment have been screened and that its remaining

24  personnel have worked for the home health agency or

25  registrant, or have been registered with the nurse registry,

26  continuously since before October 1, 1994 1989.

27         (3)  As a prerequisite to operating as a home health

28  agency, or sitter, companion, or homemaker service under s.

29  400.509, the administrator must submit to the agency his or

30  her for Health Care Administration their name and any other

31  information necessary to conduct a complete screening

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  1  according to this section.  The agency for Health Care

  2  Administration shall submit the information to the Department

  3  of Law Enforcement and the department's abuse hotline for

  4  state processing.  The agency for Health Care Administration

  5  shall review the record of the administrator with respect to

  6  the offenses specified in this section and shall notify the

  7  owner of its findings.  If disposition information is missing

  8  on a criminal record, the administrator, upon request of the

  9  agency for Health Care Administration, must obtain and supply

10  within 30 days the missing disposition information to the

11  agency for Health Care Administration.  Failure to supply

12  missing information within 30 days or to show reasonable

13  efforts to obtain such information will result in automatic

14  disqualification.

15         (4)  Proof of compliance with the screening

16  requirements of chapter 435 shall be accepted in lieu of the

17  requirements of this section if the provided that such person

18  has been continuously employed, or registered, without a

19  breach in service that exceeds 180 days, the proof of

20  compliance is not more than 2 years old, and the person has

21  been screened through the central abuse registry and tracking

22  system of the department and by the Department of Law

23  Enforcement. An employer or registry shall directly provide

24  proof of compliance to another home health agency or registry,

25  and a potential home health agency or registry may not accept

26  any proof of compliance directly from the person who requires

27  screening. Proof of compliance with the screening requirements

28  of this section shall be provided upon request to the person

29  screened by the home health agencies; nurse registries; or

30  sitter, companion, or homemaker services registered under s.

31  400.509.

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  1         (5)  There is no monetary liability on the part of, and

  2  no cause of action for damages arises against, a licensed home

  3  health agency, licensed nurse registry, or sitter, companion,

  4  or homemaker service registered under s. 400.509, that, upon

  5  notice of a confirmed report of adult abuse, neglect, or

  6  exploitation under paragraph (2)(b), terminates the employee,

  7  or removes from the licensed nurse registry the person,

  8  against whom the report was issued, whether or not the

  9  employee or contractor has filed for an exemption with the

10  agency in accordance with chapter 435 for Health Care

11  Administration under subparagraph (3)(a)5. and whether or not

12  the time for filing has expired.

13         (6)  The costs of processing the statewide

14  correspondence criminal records checks and the search of the

15  department's central abuse hotline must be borne by the home

16  health agency; the nurse registry; or the sitter, companion,

17  or homemaker service registered under s. 400.509, or by the

18  person being screened, at the discretion of the home health

19  agency, nurse registry, or s. 400.509 registrant.

20         (7)  The Agency for Health Care Administration; the

21  home health agency; nurse registry; or sitter, companion, or

22  homemaker service registered under s. 400.509 may not use the

23  criminal records, juvenile records, or central abuse hotline

24  information of a person for any purpose other than determining

25  whether that person meets minimum standards of good moral

26  character for home health agency personnel.  The criminal

27  records, juvenile records, or central abuse hotline

28  information obtained by the Agency for Health Care

29  Administration; home health agency; nurse registry; or sitter,

30  companion, or homemaker service for determining the moral

31  character of such personnel are confidential and exempt from

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  1  the provisions of s. 119.07(1) and s. 24(a), Art. I of the

  2  State Constitution.

  3         (8)(a)  It is a misdemeanor of the first degree,

  4  punishable under s. 775.082 or s. 775.083, for any person

  5  willfully, knowingly, or intentionally to:

  6         1.  Fail, by false statement, misrepresentation,

  7  impersonation, or other fraudulent means, to disclose in any

  8  application for voluntary or paid employment a material fact

  9  used in making a determination as to such person's

10  qualifications to be an employee under this section;

11         2.  Operate or attempt to operate an entity licensed or

12  registered under this part with persons who do not meet the

13  minimum standards for good moral character as contained in

14  this section; or

15         3.  Use information from the criminal records or

16  central abuse hotline obtained under this section for any

17  purpose other than screening that person for employment as

18  specified in this section or release such information to any

19  other person for any purpose other than screening for

20  employment under this section.

21         (b)  It is a felony of the third degree, punishable

22  under s. 775.082, s. 775.083, or s. 775.084, for any person

23  willfully, knowingly, or intentionally to use information from

24  the juvenile records of a person obtained under this section

25  for any purpose other than screening for employment under this

26  section.

27         Section 58.  Subsection (2) of section 400.555, Florida

28  Statutes, is amended to read:

29         400.555  Application for license.--

30         (2)  The applicant for licensure must furnish:

31

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  1         (a)  A description of the physical and mental

  2  capabilities and needs of the participants to be served and

  3  the availability, frequency, and intensity of basic services

  4  and of supportive and optional services to be provided;

  5         (b)  Satisfactory proof of financial ability to operate

  6  and conduct the center in accordance with the requirements of

  7  this part, which must include, in the case of an initial

  8  application, a 1-year operating plan and proof of a 3-month

  9  operating reserve fund; and

10         (c)  Proof of adequate liability insurance coverage.

11         (d)  Proof of compliance with level 2 background

12  screening as required under s. 400.5572.

13         (e)  A description and explanation of any exclusions,

14  permanent suspensions, or terminations of the application from

15  the Medicare or Medicaid programs. Proof of compliance with

16  requirements for disclosure of ownership and controlling

17  interests under the Medicare or Medicaid programs shall be

18  accepted in lieu of this submission.

19         Section 59.  Subsection (2) of section 400.556, Florida

20  Statutes, is amended to read:

21         400.556  Denial, suspension, revocation of license;

22  administrative fines; investigations and inspections.--

23         (2)  Each of the following actions by the owner of an

24  adult day care center or by its operator or employee is a

25  ground for action by the agency against the owner of the

26  center or its operator or employee:

27         (a)  An intentional or negligent act materially

28  affecting the health or safety of center participants.

29         (b)  A violation of this part or of any standard or

30  rule under this part.

31

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  1         (c)  A failure of persons subject to level 2 background

  2  screening under s. 400.4174(1) to meet the screening standards

  3  of s. 435.04, or the retention by the center of an employee

  4  subject to level 1 background screening standards under s.

  5  400.4174(2) who does not meet the screening standards of s.

  6  435.03 and for whom exemptions from disqualification have not

  7  been provided by the agency. A confirmed report of adult

  8  abuse, neglect, or exploitation, as defined in s. 415.102, or

  9  of child abuse or neglect, as defined in s. 415.503, which

10  report has been upheld following a hearing held pursuant to

11  chapter 120 or a waiver of such hearing.

12         (d)  Failure to follow the criteria and procedures

13  provided under part I of chapter 394 relating to the

14  transportation, voluntary admission, and involuntary

15  examination of center participants.

16         (e)  Multiple or repeated violations of this part or of

17  any standard or rule adopted under this part.

18         (f)  Exclusion, permanent suspension, or termination of

19  the owner, if an individual, officer, or board member of the

20  adult day care center, or if the owner is a firm, corporation,

21  partnership, or association, or of any person owning 5 percent

22  or more of the center, from the Medicare or Medicaid program.

23         Section 60.  Subsection (1) of section 400.557, Florida

24  Statutes, is amended to read:

25         400.557  Expiration of license; renewal; conditional

26  license or permit.--

27         (1)  A license issued for the operation of an adult day

28  care center, unless sooner suspended or revoked, expires 2

29  years after the date of issuance.  The agency shall notify a

30  licensee by certified mail, return receipt requested, at least

31  120 days before the expiration date that license renewal is

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  1  required to continue operation.  At least 90 days prior to the

  2  expiration date, an application for renewal must be submitted

  3  to the agency.  A license shall be renewed, upon the filing of

  4  an application on forms furnished by the agency, if the

  5  applicant has first met the requirements of this part and of

  6  the rules adopted under this part. The applicant must file

  7  with the application satisfactory proof of financial ability

  8  to operate the center in accordance with the requirements of

  9  this part and in accordance with the needs of the participants

10  to be served and an affidavit of compliance with the

11  background screening requirements of s. 400.5572.

12         Section 61.  Section 400.5572, Florida Statutes, is

13  created to read:

14         400.5572  Background screening.--

15         (1)(a)  Level 2 background screening must be conducted

16  on each of the following persons, who shall be considered

17  employees for the purposes of conducting screening under

18  chapter 435:

19         1.  The adult day care center owner if an individual,

20  the operator, and the financial officer.

21         2.  An officer or board member if the owner of the

22  adult day care center is a firm, corporation, partnership, or

23  association, or any person owning 5 percent or more of the

24  facility, if the agency has probable cause to believe that

25  such person has been convicted of any offense prohibited by s.

26  435.04. For each officer, board member, or person owning 5

27  percent or more who has been convicted of any such offense,

28  the facility shall submit to the agency a description and

29  explanation of the conviction at the time of license

30  application. This subparagraph does not apply to a board

31  member of a not-for-profit corporation or organization if the

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  1  board member serves solely in a voluntary capacity, does not

  2  regularly take part in the day-to-day operational decisions of

  3  the corporation or organization, receives no remuneration for

  4  his or her services, and has no financial interest and has no

  5  family members with a financial interest in the corporation or

  6  organization, provided that the board member and facility

  7  submit a statement affirming that the board member's

  8  relationship to the facility satisfies the requirements of

  9  this subparagraph.

10         (b)  Proof of compliance with level 2 screening

11  standards which has been submitted within the previous 5 years

12  to meet any facility or professional licensure requirements of

13  the agency or the Department of Health satisfies the

14  requirements of this subsection.

15         (c)  The agency may grant a provisional license to an

16  adult day care center applying for an initial license when

17  each individual required by this subsection to undergo

18  screening has completed the abuse registry and Department of

19  Law Enforcement background checks, but has not yet received

20  results from the Federal Bureau of Investigation, or when a

21  request for an exemption from disqualification has been

22  submitted to the agency pursuant to s. 435.07, but a response

23  has not been issued.

24         (2)  The owner or administrator of an adult day care

25  center must conduct level 1 background screening as set forth

26  in chapter 435 on all employees hired on or after October 1,

27  1998, who provide basic services or supportive and optional

28  services to the participants. Such persons satisfy this

29  requirement if:

30         (a)  Proof of compliance with level 1 screening

31  requirements obtained to meet any professional license

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  1  requirements in this state is provided and accompanied, under

  2  penalty of perjury, by a copy of the person's current

  3  professional license and an affidavit of current compliance

  4  with the background screening requirements.

  5         (b)  The person required to be screened has been

  6  continuously employed, without a breach in service that

  7  exceeds 180 days, in the same type of occupation for which the

  8  person is seeking employment and provides proof of compliance

  9  with the level 1 screening requirement which is no more than 2

10  years old. Proof of compliance must be provided directly from

11  one employer or contractor to another, and not from the person

12  screened. Upon request, a copy of screening results shall be

13  provided to the person screened by the employer retaining

14  documentation of the screening.

15         (c)  The person required to be screened is employed by

16  a corporation or business entity or related corporation or

17  business entity that owns, operates, or manages more than one

18  facility or agency licensed under chapter 400, and for whom a

19  level 1 screening was conducted by the corporation or business

20  entity as a condition of initial or continued employment.

21         (3)  When an employee, volunteer, operator, or owner of

22  an adult day care center is the subject of a confirmed report

23  of adult abuse, neglect, or exploitation, as defined in s.

24  415.102, and the protective investigator knows that the

25  individual is an employee, volunteer, operator, or owner of a

26  center, the agency shall be notified of the confirmed report.

27         Section 62.  Section 400.606, Florida Statutes, is

28  amended to read:

29         400.606  License; application; renewal; conditional

30  license or permit; certificate of need.--

31

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  1         (1)  A license application must be filed on a form

  2  provided by the agency and must be accompanied by the

  3  appropriate license fee as well as satisfactory proof that the

  4  hospice is in compliance with this part and any rules adopted

  5  by the department and proof of financial ability to operate

  6  and conduct the hospice in accordance with the requirements of

  7  this part.  The initial application must be accompanied by a

  8  plan for the delivery of home, residential, and homelike

  9  inpatient hospice services to terminally ill persons and their

10  families.  Such plan must contain, but need not be limited to:

11         (a)  The estimated average number of terminally ill

12  persons to be served monthly.

13         (b)  The geographic area in which hospice services will

14  be available.

15         (c)  A listing of services which are or will be

16  provided, either directly by the applicant or through

17  contractual arrangements with existing providers.

18         (d)  Provisions for the implementation of hospice home

19  care within 3 months after licensure.

20         (e)  Provisions for the implementation of hospice

21  homelike inpatient care within 12 months after licensure.

22         (f)  The number and disciplines of professional staff

23  to be employed.

24         (g)  The name and qualifications of any existing or

25  potential contractee.

26         (h)  A plan for attracting and training volunteers.

27         (i)  The projected annual operating cost of the

28  hospice.

29         (j)  A statement of financial resources and personnel

30  available to the applicant to deliver hospice care.

31

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  1  If the applicant is an existing health care provider, the

  2  application must be accompanied by a copy of the most recent

  3  profit-loss statement and, if applicable, the most recent

  4  licensure inspection report.

  5         (2)  Each applicant must submit to the agency with its

  6  application a description and explanation of any exclusions,

  7  permanent suspensions, or terminations from the Medicaid or

  8  Medicare programs of the owner, if an individual, of any

  9  officer or board member of the hospice, if the owner is a

10  firm, corporation, partnership, or association, or of any

11  person owning 5 percent or more of the hospice. Proof of

12  compliance with requirements for disclosure of ownership and

13  controlling interests under the Medicaid or Medicare programs

14  shall be accepted in lieu of this submission.

15         (3)(2)  A license issued for the operation of a

16  hospice, unless sooner suspended or revoked, shall expire

17  automatically 1 year from the date of issuance.  Sixty days

18  prior to the expiration date, a hospice wishing to renew its

19  license shall submit an application for renewal to the agency

20  on forms furnished by the agency.  The agency shall renew the

21  license if the applicant has first met the requirements

22  established under this part and all applicable rules and has

23  provided the information described under this section in

24  subsection (1) in addition to the application.  However, the

25  application for license renewal shall be accompanied by an

26  update of the plan for delivery of hospice care only if

27  information contained in the plan submitted pursuant to

28  subsection (1) is no longer applicable.

29         (4)(3)  A hospice against which a revocation or

30  suspension proceeding is pending at the time of license

31  renewal may be issued a conditional license by the agency

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  1  effective until final disposition of such proceeding.  If

  2  judicial relief is sought from the final agency action, the

  3  court having jurisdiction may issue a conditional permit for

  4  the duration of the judicial proceeding.

  5         (5)(4)  The agency shall not issue a license to a

  6  hospice that fails to receive a certificate of need under the

  7  provisions of ss. 408.031-408.045. A licensed hospice is a

  8  health care facility as that term is used in s. 408.039(5) and

  9  is entitled to initiate or intervene in an administrative

10  hearing.

11         (6)(5)  A freestanding hospice facility that is

12  primarily engaged in providing inpatient and related services

13  and that is not otherwise licensed as a health care facility

14  shall be required to obtain a certificate of need. However, a

15  freestanding hospice facility with six or fewer beds shall not

16  be required to comply with institutional standards such as,

17  but not limited to, standards requiring sprinkler systems,

18  emergency electrical systems, or special lavatory devices.

19         Section 63.  Section 400.6065, Florida Statutes, is

20  created to read:

21         400.6065  Background screening.--

22         (1)  Upon receipt of a completed application under s.

23  400.606, the agency shall require level 2 background screening

24  on each of the following persons, who shall be considered

25  employees for the purposes of conducting screening under

26  chapter 435:

27         (a)  The hospice administrator and financial officer.

28         (b)  An officer or board member if the hospice is a

29  firm, corporation, partnership, or association, or any person

30  owning 5 percent or more of the hospice if the agency has

31  probable cause to believe that such officer, board member, or

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  1  owner has been convicted of any offense prohibited by s.

  2  435.04. For each officer, board member, or person owning 5

  3  percent or more who has been convicted of any such offense,

  4  the hospice shall submit to the agency a description and

  5  explanation of the conviction at the time of license

  6  application. This paragraph does not apply to a board member

  7  of a not-for-profit corporation or organization if the board

  8  member serves solely in a voluntary capacity, does not

  9  regularly take part in the day-to-day operational decisions of

10  the corporation or organization, receives no remuneration for

11  his or her services, and has no financial interest and has no

12  family members with a financial interest in the corporation or

13  organization, provided that the board member and the

14  corporation or organization submit a statement affirming that

15  the board member's relationship to the corporation or

16  organization satisfies the requirements of this paragraph.

17         (2)  Proof of compliance with level 2 screening

18  standards which has been submitted within the previous 5 years

19  to meet any facility or professional licensure requirements of

20  the agency or the Department of Health satisfies the

21  requirements of this section.

22         (3)  The agency may grant a provisional license to a

23  hospice applying for an initial license when each individual

24  required by this section to undergo screening has completed

25  the abuse registry and Department of Law Enforcement

26  background checks but has not yet received results from the

27  Federal Bureau of Investigation.

28         Section 64.  Subsections (3), (4), (5), and (6) of

29  section 400.607, Florida Statutes, are renumbered as

30  subsections (4), (5), (6), and (7), respectively, and a new

31  subsection (3) is added to that section to read:

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  1         400.607  Denial, suspension, or revocation of license;

  2  imposition of administrative fine; grounds; injunctions.--

  3         (3)  The agency may deny or revoke a license upon a

  4  determination that:

  5         (a)  Persons subject to level 2 background screening

  6  under s. 400.6065 do not meet the screening standards of s.

  7  435.04, and exemptions from disqualification have not been

  8  provided by the agency.

  9         (b)  An officer, board member, or person owning 5

10  percent or more of the hospice has been excluded, permanently

11  suspended, or terminated from the Medicare or Medicaid

12  programs.

13         Section 65.  Section 400.619, Florida Statutes, is

14  amended to read:

15         400.619  Licensure application and renewal

16  requirements.--

17         (1)  Each person who intends to be a provider of an

18  adult family-care home provider must obtain a license from the

19  agency before caring for a disabled adult or an aged person in

20  the adult family-care home.  Such application must be made at

21  least 90 days before the applicant intends to operate the

22  adult family-care home.

23         (2)  A person who intends to be a provider of an adult

24  family-care home provider must own or rent and live in the

25  adult family-care home that is to be licensed.

26         (3)  Application for a license or annual license

27  renewal to operate an adult family-care home must be made on a

28  form provided by the agency, signed by the provider and

29  notarized, and must be accompanied by a licensing fee of $100

30  per year to offset the cost of training and education programs

31  by the Department of Elderly Affairs for providers.

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  1         (4)  Upon receipt of an initial a license application

  2  or license renewal application, and the fee, the agency shall

  3  initiate level 1 background screening as provided under

  4  chapter 435 on must check with the abuse registry and the

  5  Department of Law Enforcement concerning the adult family-care

  6  home provider, each designated relief person applicant, all

  7  adult household members, and all staff members. The agency

  8  shall also conduct an onsite visit to the home that is to be

  9  licensed.

10         (a)  Proof of compliance with level 1 screening

11  standards which has been submitted within the previous 5 years

12  to meet any facility or professional licensure requirements of

13  the agency or the Department of Health satisfies the

14  requirements of this subsection. Such proof must be

15  accompanied, under penalty of perjury, by a copy of the

16  person's current professional license and an affidavit of

17  current compliance with the background screening requirements.

18         (b)  The person required to be screened must have been

19  continuously employed in the same type of occupation for which

20  the person is seeking employment without a breach in service

21  that exceeds 180 days, and proof of compliance with the level

22  1 screening requirement which is no more than 2 years old must

23  be provided. Proof of compliance shall be provided directly

24  from one employer or contractor to another, and not from the

25  person screened. Upon request, a copy of screening results

26  shall be provided to the person screened by the employer

27  retaining documentation of the screening.

28         (5)  The application must be accompanied by a

29  description and explanation of any exclusions, permanent

30  suspensions, or terminations of the applicant from

31

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  1  participation in the Medicaid or Medicare programs or any

  2  other governmental health care or health insurance program.

  3         (6)  Unless the adult family-care home is a community

  4  residential home subject to chapter 419, the applicant must

  5  provide documentation, signed by the appropriate governmental

  6  official, that the home has met local zoning requirements for

  7  the location for which the license is sought.

  8         (7)(5)  Access to a licensed adult family-care home

  9  must be provided at reasonable times for the appropriate

10  officials of the department, the Department of Health, the

11  Department of Children and Family Services and Rehabilitative

12  Services, the agency, and the State Fire Marshal, who are

13  responsible for the development and maintenance of fire,

14  health, sanitary, and safety standards, to inspect the

15  facility to assure compliance with these standards.  In

16  addition, access to a licensed adult family-care home must be

17  provided at reasonable times for the long-term care ombudsman

18  council.

19         (8)(6)  A license is effective for 1 year after the

20  date of issuance unless revoked sooner.  Each license must

21  state the name of the provider, the address of the home to

22  which the license applies, and the maximum number of residents

23  of the home.  A license may be issued with or without

24  restrictions governing the residents or care offered in the

25  adult family-care home.

26         (9)(7)  A license is not transferable or applicable to

27  any location or person other than the location and or person

28  indicated on the license application for licensure.

29         (10)(8)  The licensed maximum capacity of each adult

30  family-care home is based on the service needs of the

31  residents and the capability of the provider to meet the needs

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  1  of the residents. Any relative who lives in the adult

  2  family-care home and who is an aged person or a disabled adult

  3  must be included in that limitation.

  4         (11)(9)  Each adult family-care home must designate at

  5  least one licensed space for a resident receiving optional

  6  state supplementation as defined in s. 409.212.  The

  7  Department of Children and Family Health and Rehabilitative

  8  Services shall specify by rule the procedures to be followed

  9  for referring residents who receive optional state

10  supplementation to adult family-care homes.  Those homes

11  licensed as adult foster homes or assisted living facilities

12  prior to January 1, 1994, that convert to adult family-care

13  homes, are exempt from this the requirement of designating one

14  space for a resident receiving optional state supplementation.

15         (12)(10)  The agency may issue a conditional license to

16  a provider for the purpose of bringing the adult family-care

17  home into compliance with licensure requirements.  A

18  conditional license must be limited to a specific period, not

19  exceeding 6 months, as determined by the department, in

20  consultation with the agency.  The department shall, by rule,

21  establish criteria for issuing conditional licenses.

22         (11)  The agency may deny, suspend, or revoke a license

23  for any of the following reasons:

24         (a)  A confirmed report, obtained under s. 415.1075, of

25  abuse, neglect, or exploitation, or conviction of a crime

26  related to abuse, neglect, or exploitation.

27         (b)  A proposed confirmed report that remains unserved

28  and is maintained in the central abuse registry and tracking

29  system pursuant to s. 415.1065(2)(c).

30

31

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  1         (c)  An intentional or negligent act materially

  2  affecting the health, safety, or welfare of the adult

  3  family-care home residents.

  4         (d)  A violation of ss. 400.616-400.629 or rules

  5  adopted under ss. 400.616-400.629, including the failure to

  6  comply with any restrictions specified in the license.

  7         (e)  Submission of fraudulent or inaccurate information

  8  to the agency.

  9         (f)  Conviction of a felony involving violence to a

10  person.

11         (g)  Failure to pay a civil penalty assessed under this

12  part.

13         (13)(12)  All moneys collected under this section must

14  be deposited into the Department of Elderly Affairs

15  Administrative Trust Fund and must be used to offset the

16  expenses of departmental training and education for adult

17  family-care home providers.

18         (14)(13)  The department may shall adopt rules to

19  establish procedures, identify forms, specify documentation,

20  and clarify licensure requirements, as necessary to administer

21  implement this section.

22         Section 66.  Section 400.6194, Florida Statutes, is

23  created to read:

24         400.6194  Denial, revocation, or suspension of a

25  license.--The agency may deny, suspend, or revoke a license

26  for any of the following reasons:

27         (1)  Failure of any of the persons required to undergo

28  background screening under s. 400.619 to meet the level 1

29  screening standards of s. 435.03, unless an exemption from

30  disqualification has been provided by the agency.

31

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  1         (2)  An intentional or negligent act materially

  2  affecting the health, safety, or welfare of the adult

  3  family-care home residents.

  4         (3)  Failure to comply with any restrictions specified

  5  in the license.

  6         (4)  Submission of fraudulent information or omission

  7  of any material fact on a license application or any other

  8  document required by the agency.

  9         (5)  Failure to pay an administrative fine assessed

10  under this part.

11         (6)  A violation of this part or adopted rules which

12  results in conditions or practices that directly threaten the

13  physical or emotional health, safety, or welfare of residents.

14         (7)  Failure to correct cited fire code violations that

15  threaten the health, safety, or welfare of residents.

16         (8)  Failure to submit a completed initial license

17  application or to complete an application for license renewal

18  within the specified timeframes.

19         (9)  Exclusion, permanent suspension, or termination of

20  the provider from the Medicare or Medicaid programs.

21         Section 67.  Section 400.801, Florida Statutes, is

22  amended to read:

23         400.801  Homes for special services.--

24         (1)  As used in this section, the term:

25         (a)  "Agency" means the "Agency for Health Care

26  Administration."

27         (b)  "Home for special services" means a site where

28  specialized health care services are provided, including

29  personal and custodial care, but not continuous nursing

30  services.

31

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  1         (2)  A person must obtain a license from the agency to

  2  operate a home for special services.  A license is valid for 1

  3  year.

  4         (3)  The application for a license under this section

  5  must be made on a form provided by the agency.  A

  6  nonrefundable license fee of not more than $1,000 must be

  7  submitted with the license application.

  8         (4)  Each applicant for licensure must comply with the

  9  following requirements:

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

11  application, the agency shall require background screening, in

12  accordance with the level 2 standards for screening set forth

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

14  titled individual who is responsible for the daily operation

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

16  similarly titled individual who is responsible for the

17  financial operation of the facility, including billings for

18  client care and services, in accordance with the level 2

19  standards for screening set forth in chapter 435.  The

20  applicant must comply with the procedures for level 2

21  background screening as set forth in chapter 435.

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

23  other individual who is an applicant if the agency has

24  probable cause to believe that he or she has been convicted of

25  a crime or has committed any other offense prohibited under

26  the level 2 standards for screening set forth in chapter 435.

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

28  screening requirements of chapter 435 which has been submitted

29  within the previous 5 years in compliance with any other

30  health care or assisted living licensure requirements of this

31

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  1  state is acceptable in fulfillment of the requirements of

  2  paragraph (a).

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

  4  applicant when each individual required by this section to

  5  undergo background screening has met the standards for the

  6  abuse registry background check and the Department of Law

  7  Enforcement background check but the agency has not yet

  8  received background screening results from the Federal Bureau

  9  of Investigation, or a request for a disqualification

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

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

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

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

14  Investigation background screening for each individual

15  required by this section to undergo background screening which

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

17  granting of a disqualification exemption by the agency as set

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

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

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

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

22  continue to serve if the report indicates any violation of

23  background screening standards and a disqualification

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

25  as set forth in chapter 435.

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

27  application, a description and explanation of any exclusions,

28  permanent suspensions, or terminations of the applicant from

29  the Medicare or Medicaid programs. Proof of compliance with

30  the requirements for disclosure of ownership and controlling

31

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  1  interests under the Medicaid or Medicare programs shall be

  2  accepted in lieu of 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 does 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)  A license may not be granted to an applicant if

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

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

24  contendere or guilty to, any offense prohibited under the

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

26  unless an exemption from disqualification has been granted by

27  the agency as set forth in chapter 435.

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

29  applicant:

30         1.  Has falsely represented a material fact in the

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

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  1  omitted any material fact from the application required by

  2  paragraph (e) or paragraph (f); or

  3         2.  Has had prior action taken against the applicant

  4  under the Medicaid or Medicare programs as set forth in

  5  paragraph (e).

  6         (i)  An application for license renewal must contain

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

  8         (5)(4)  Application for license renewal must be

  9  submitted 90 days before the expiration of the license.

10         (6)(5)  A change of ownership or control of a home for

11  special services must be reported to the agency in writing at

12  least 60 days before the change is scheduled to take effect.

13         (7)(6)  The agency shall adopt rules for implementing

14  and enforcing this section.

15         (8)(7)(a)  It is unlawful for any person to establish,

16  conduct, manage, or operate a home for special services

17  without obtaining a license from the agency.

18         (b)  It is unlawful for any person to offer or

19  advertise to the public, in any medium whatever, specialized

20  health care services without obtaining a license from the

21  agency.

22         (c)  It is unlawful for a holder of a license issued

23  under this section to advertise or represent to the public

24  that it holds a license for a type of facility other than the

25  facility for which its license is issued.

26         (9)(8)(a)  A violation of any provision of this section

27  or rules adopted by the agency for implementing this section

28  is punishable by payment of an administrative fine not to

29  exceed $5,000.

30         (b)  A violation of subsection (8) (7) or rules adopted

31  under that subsection is a misdemeanor of the first degree,

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  1  punishable as provided in s. 775.082 or s. 775.083.  Each day

  2  of continuing violation is a separate offense.

  3         Section 68.  Paragraph (c) of subsection (2) and

  4  present subsections (3) and (7) of section 400.805, Florida

  5  Statutes, are amended, subsections (3) through (7) are

  6  renumbered as subsections (4) through (8), respectively, and a

  7  new subsection (3) is added to that section, to read:

  8         400.805  Transitional living facilities.--

  9         (2)

10         (c)  The agency may not issue a license to an applicant

11  until the agency receives notice from the division as provided

12  in paragraph (6)(5)(b).

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, in

17  accordance with the level 2 standards for screening set forth

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

19  titled individual who is responsible for the daily operation

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

21  similarly titled individual who is responsible for the

22  financial operation of the facility, including billings for

23  client care and services. The applicant must comply with the

24  procedures for level 2 background screening as set forth in

25  chapter 435.

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

27  other individual who is an applicant if the agency has

28  probable cause to believe that he or she has been convicted of

29  a crime or has committed any other offense prohibited under

30  the level 2 standards 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  health care 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 standard

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

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

18  Investigation background screening for each individual

19  required by this section to undergo background screening which

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

21  granting of a disqualification exemption by the agency as set

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

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

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

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

26  continue to serve if the report indicates any violation of

27  background screening standards and a disqualification

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

29  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  the requirements for disclosure of ownership and controlling

  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)  A license may not be granted to an applicant if

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

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

27  contendere or guilty to, any offense prohibited under the

28  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 programs 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         (4)(3)  An application for renewal of license must be

13  submitted 90 days before the expiration of the license.  Upon

14  renewal of licensure, each applicant must submit to the

15  agency, under penalty of perjury, an affidavit as set forth in

16  paragraph (3)(e).

17         (8)(7)(a)  A violation of any provision of this section

18  or rules adopted by the agency or division under this section

19  is punishable by payment of an administrative or a civil

20  penalty fine not to exceed $5,000.

21         (b)  A violation of subsection (7) (6) or rules adopted

22  under that subsection is a misdemeanor of the first degree,

23  punishable as provided in s. 775.082 or s. 775.083.  Each day

24  of a continuing violation is a separate offense.

25         Section 69.  Subsection (9) of section 408.032, Florida

26  Statutes, is amended to read:

27         408.032  Definitions.--As used in ss. 408.031-408.045,

28  the term:

29         (9)  "Home health agency" means an organization, as

30  defined in s. 400.462(8)(4), that is certified or seeks

31  certification as a Medicare home health service provider.

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  1         Section 70.  Paragraph (a) of subsection (11) of

  2  section 408.072, Florida Statutes, is amended to read:

  3         408.072  Review of hospital budgets.--

  4         (11)  Notwithstanding any other provisions of this

  5  chapter:

  6         (a)  Any hospital operated by the Department of

  7  Children and Family Health and Rehabilitative Services or the

  8  Department of Corrections; any rural hospital as defined in s.

  9  408.07; and any intensive residential treatment program for

10  children and adolescents as defined in s. 395.002(18)(16)

11  which received a certificate of need on or before January 1,

12  1991, and is licensed under chapter 395 for less than 33 beds,

13  which is not part of a multifacility organization and which is

14  part of a community mental health system, shall be exempt from

15  filing a budget, and shall be exempt from budget review and

16  approval for exceeding the maximum allowable rate of increase

17  and from any penalties arising therefrom.  However, each such

18  hospital shall be required to submit to the board its audited

19  actual experience, as required by s. 408.061(4)(a).

20         Section 71.  Subsection (8) of section 409.905, Florida

21  Statutes, is amended to read:

22         409.905  Mandatory Medicaid services.--The agency may

23  make payments for the following services, which are required

24  of the state by Title XIX of the Social Security Act,

25  furnished by Medicaid providers to recipients who are

26  determined to be eligible on the dates on which the services

27  were provided.  Any service under this section shall be

28  provided only when medically necessary and in accordance with

29  state and federal law. Nothing in this section shall be

30  construed to prevent or limit the agency from adjusting fees,

31  reimbursement rates, lengths of stay, number of visits, number

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  1  of services, or any other adjustments necessary to comply with

  2  the availability of moneys and any limitations or directions

  3  provided for in the General Appropriations Act or chapter 216.

  4         (8)  NURSING FACILITY SERVICES.--The agency shall pay

  5  for 24-hour-a-day nursing and rehabilitative services for a

  6  recipient in a nursing facility licensed under part II of

  7  chapter 400 or in a rural hospital, as defined in s. 395.602,

  8  or in a Medicare certified skilled nursing facility operated

  9  by a hospital, as defined by s. 395.002(12)(10), that is

10  licensed under part I of chapter 395, and in accordance with

11  provisions set forth in s. 409.908(2)(a), which services are

12  ordered by and provided under the direction of a licensed

13  physician.  However, if a nursing facility has been destroyed

14  or otherwise made uninhabitable by natural disaster or other

15  emergency and another nursing facility is not available, the

16  agency must pay for similar services temporarily in a hospital

17  licensed under part I of chapter 395 provided federal funding

18  is approved and available.

19         Section 72.  Paragraph (d) of subsection (1) of section

20  419.001, Florida Statutes, is amended to read:

21         419.001  Site selection of community residential

22  homes.--

23         (1)  For the purposes of this section, the following

24  definitions shall apply:

25         (d)  "Resident" means any of the following:  an aged

26  person as defined in s. 400.618(3); a physically disabled or

27  handicapped person as defined in s. 760.22(7)(a); a

28  developmentally disabled person as defined in s.

29  393.063(12)(11); a nondangerous mentally ill person as defined

30  in s. 394.455(18)(16); or a child as defined in s. 39.01(12)

31  and (14).

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  1         Section 73.  Subsection (2) of section 430.04, Florida

  2  Statutes, is amended to read:

  3         430.04  Duties and responsibilities of the Department

  4  of Elderly Affairs.--The Department of Elderly Affairs shall:

  5         (2)  Be responsible for ensuring that each area agency

  6  on aging operates in a manner to ensure that the elderly of

  7  this state receive the best services possible.  The department

  8  shall rescind designation of an area agency on aging or take

  9  intermediate measures against the agency, including corrective

10  action, unannounced special monitoring, temporary assumption

11  of operation of one or more programs by the department,

12  placement on probationary status, imposing a moratorium on

13  agency action, imposing financial penalties for

14  nonperformance, or other administrative action pursuant to

15  chapter 120, if the department finds that:

16         (a)  An intentional or negligent act of the agency has

17  materially affected the health, welfare, or safety of clients,

18  or substantially and negatively affected the operation of an

19  aging services program.

20         (b)  The agency lacks financial stability sufficient to

21  meet contractual obligations or that contractual funds have

22  been misappropriated.

23         (c)  The agency has committed multiple or repeated

24  violations of legal and regulatory requirements or department

25  standards.

26         (d)  The agency has failed to continue the provision or

27  expansion of services after the declaration of a state of

28  emergency.

29         (e)  The agency has failed to adhere to the terms of

30  its contract with the department.

31

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  1         (f)  The agency has failed to implement and maintain a

  2  department-approved client grievance resolution procedure.

  3         Section 74.  Paragraph (g) of subsection (1) of section

  4  440.13, Florida Statutes, is amended to read:

  5         440.13  Medical services and supplies; penalty for

  6  violations; limitations.--

  7         (1)  DEFINITIONS.--As used in this section, the term:

  8         (g)  "Emergency services and care" means emergency

  9  services and care as defined in s. 395.002(9).

10         Section 75.  Paragraphs (i) and (k) of subsection (3)

11  of section 455.654, Florida Statutes, are amended to read:

12         455.654  Financial arrangements between referring

13  health care providers and providers of health care services.--

14         (3)  DEFINITIONS.--For the purpose of this section, the

15  word, phrase, or term:

16         (i)  "Investment interest" means an equity or debt

17  security issued by an entity, including, without limitation,

18  shares of stock in a corporation, units or other interests in

19  a partnership, bonds, debentures, notes, or other equity

20  interests or debt instruments.  Except for purposes of s.

21  455.661, The following investment interests shall be excepted

22  from this definition:

23         1.  An investment interest in an entity that is the

24  sole provider of designated health services in a rural area;

25         2.  An investment interest in notes, bonds, debentures,

26  or other debt instruments issued by an entity which provides

27  designated health services, as an integral part of a plan by

28  such entity to acquire such investor's equity investment

29  interest in the entity, provided that the interest rate is

30  consistent with fair market value, and that the maturity date

31  of the notes, bonds, debentures, or other debt instruments

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  1  issued by the entity to the investor is not later than October

  2  1, 1996.

  3         3.  An investment interest in real property resulting

  4  in a landlord-tenant relationship between the health care

  5  provider and the entity in which the equity interest is held,

  6  unless the rent is determined, in whole or in part, by the

  7  business volume or profitability of the tenant or exceeds fair

  8  market value; or

  9         4.  An investment interest in an entity which owns or

10  leases and operates a hospital licensed under chapter 395 or a

11  nursing home facility licensed under chapter 400.

12         (k)  "Referral" means any referral of a patient by a

13  health care provider for health care services, including,

14  without limitation:

15         1.  The forwarding of a patient by a health care

16  provider to another health care provider or to an entity which

17  provides or supplies designated health services or any other

18  health care item or service; or

19         2.  The request or establishment of a plan of care by a

20  health care provider, which includes the provision of

21  designated health services or other health care item or

22  service.

23         3.  Except for the purposes of s. 455.661, The

24  following orders, recommendations, or plans of care shall not

25  constitute a referral by a health care provider:

26         a.  By a radiologist for diagnostic-imaging services.

27         b.  By a physician specializing in the provision of

28  radiation therapy services for such services.

29         c.  By a medical oncologist for drugs and solutions to

30  be prepared and administered intravenously to such

31  oncologist's patient, as well as for the supplies and

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  1  equipment used in connection therewith to treat such patient

  2  for cancer and the complications thereof.

  3         d.  By a cardiologist for cardiac catheterization

  4  services.

  5         e.  By a pathologist for diagnostic clinical laboratory

  6  tests and pathological examination services, if furnished by

  7  or under the supervision of such pathologist pursuant to a

  8  consultation requested by another physician.

  9         f.  By a health care provider who is the sole provider

10  or member of a group practice for designated health services

11  or other health care items or services that are prescribed or

12  provided solely for such referring health care provider's or

13  group practice's own patients, and that are provided or

14  performed by or under the direct supervision of such referring

15  health care provider or group practice.

16         g.  By a health care provider for services provided by

17  an ambulatory surgical center licensed under chapter 395.

18         h.  By a health care provider for diagnostic clinical

19  laboratory services where such services are directly related

20  to renal dialysis.

21         i.  By a urologist for lithotripsy services.

22         j.  By a dentist for dental services performed by an

23  employee of or health care provider who is an independent

24  contractor with the dentist or group practice of which the

25  dentist is a member.

26         k.  By a physician for infusion therapy services to a

27  patient of that physician or a member of that physician's

28  group practice.

29         l.  By a nephrologist for renal dialysis services and

30  supplies.

31

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  1         Section 76.  Subsection (1) of section 468.505, Florida

  2  Statutes, is amended to read:

  3         468.505  Exemptions; exceptions.--

  4         (1)  Nothing in this part may be construed as

  5  prohibiting or restricting the practice, services, or

  6  activities of:

  7         (a)  A person licensed in this state under chapter 457,

  8  chapter 458, chapter 459, chapter 460, chapter 461, chapter

  9  462, chapter 463, chapter 464, chapter 465, chapter 466,

10  chapter 480, chapter 490, or chapter 491, when engaging in the

11  profession or occupation for which he or she is licensed, or

12  of any person employed by and under the supervision of the

13  licensee when rendering services within the scope of the

14  profession or occupation of the licensee.;

15         (b)  A person employed as a dietitian by the government

16  of the United States, if the person engages in dietetics

17  solely under direction or control of the organization by which

18  the person is employed.;

19         (c)  A person employed as a cooperative extension home

20  economist.;

21         (d)  A person pursuing a course of study leading to a

22  degree in dietetics and nutrition from a program or school

23  accredited pursuant to s. 468.509(2), if the activities and

24  services constitute a part of a supervised course of study and

25  if the person is designated by a title that clearly indicates

26  the person's status as a student or trainee.;

27         (e)  A person fulfilling the supervised experience

28  component of s. 468.509, if the activities and services

29  constitute a part of the experience necessary to meet the

30  requirements of s. 468.509.;

31

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  1         (f)  Any dietitian or nutritionist from another state

  2  practicing dietetics or nutrition incidental to a course of

  3  study when taking or giving a postgraduate course or other

  4  course of study in this state, provided such dietitian or

  5  nutritionist is licensed in another jurisdiction or is a

  6  registered dietitian or holds an appointment on the faculty of

  7  a school accredited pursuant to s. 468.509(2).;

  8         (g)  A person who markets or distributes food, food

  9  materials, or dietary supplements, or any person who engages

10  in the explanation of the use and benefits of those products

11  or the preparation of those products, if that person does not

12  engage for a fee in dietetics and nutrition practice or

13  nutrition counseling.;

14         (h)  A person who markets or distributes food, food

15  materials, or dietary supplements, or any person who engages

16  in the explanation of the use of those products or the

17  preparation of those products, as an employee of an

18  establishment permitted pursuant to chapter 465.;

19         (i)  An educator who is in the employ of a nonprofit

20  organization approved by the council; a federal, state,

21  county, or municipal agency, or other political subdivision;

22  an elementary or secondary school; or an accredited

23  institution of higher education the definition of which, as

24  provided in s. 468.509(2), applies to other sections of this

25  part, insofar as the activities and services of the educator

26  are part of such employment.;

27         (j)  Any person who provides weight control services or

28  related weight control products, provided the program has been

29  reviewed by, consultation is available from, and no program

30  change can be initiated without prior approval by a licensed

31  dietitian/nutritionist, a dietitian or nutritionist licensed

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  1  in another state that has licensure requirements considered by

  2  the council to be at least as stringent as the requirements

  3  for licensure under this part, or a registered dietitian.;

  4         (k)  A person employed by a hospital licensed under

  5  chapter 395, or by a nursing home or assisted living facility

  6  licensed under part II or part III of chapter 400, or by a

  7  continuing care facility certified under chapter 651, if the

  8  person is employed in compliance with the laws and rules

  9  adopted thereunder regarding the operation of its dietetic

10  department.;

11         (l)  A person employed by a nursing facility exempt

12  from licensing under s. 395.002(14) s. 395.002(12), or a

13  person exempt from licensing under s. 464.022.; or

14         (m)  A person employed as a dietetic technician.

15         Section 77.  Section 483.101, Florida Statutes, is

16  amended to read:

17         483.101  Application for clinical laboratory license.--

18         (1)  An application for a clinical laboratory license

19  must be made under oath by the owner or director operator of

20  the clinical laboratory or by the public official responsible

21  for operating a state, municipal, or county clinical

22  laboratory or institution that contains a clinical laboratory,

23  upon forms provided by the agency.

24         (2)  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 director or other similarly

30  titled individual who is responsible for the daily operation

31  of the laboratory 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 laboratory, including billings for

  3  patient services. The applicant must comply with the

  4  procedures for level 2 background screening as set forth in

  5  chapter 435, as well as the requirements of s. 435.03(3).

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

  7  other individual who is an applicant if the agency has

  8  probable cause to believe that he or she has been convicted of

  9  a crime or has committed any other offense prohibited under

10  the level 2 standards for screening set forth in chapter 435.

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

12  screening requirements of chapter 435 which has been submitted

13  within the previous 5 years in compliance with any other

14  health care licensure requirements of this state is acceptable

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

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

17  applicant when each individual required by this section to

18  undergo background screening has met the standards for the

19  abuse registry background check and the Department of Law

20  Enforcement background check but the agency has not yet

21  received background screening results from the Federal Bureau

22  of Investigation, or a request for a disqualification

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

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

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

26  report of the results of the Federal Bureau of Investigation

27  background screening for each individual required by this

28  section to undergo background screening which confirms that

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

30  disqualification exemption by the agency as set forth in

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

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  1  2 background screening may serve in his or her capacity

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

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

  4  to serve if the report indicates any violation of background

  5  screening standards and a disqualification exemption has not

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

  7  chapter 435.

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

  9  application, a description and explanation of any exclusions,

10  permanent suspensions, or terminations of the applicant from

11  the Medicare or Medicaid programs. Proof of compliance with

12  the requirements for disclosure of ownership and controlling

13  interests under the Medicaid or Medicare programs shall be

14  accepted in lieu of this submission.

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

16  description and explanation of any conviction of an offense

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

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

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

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

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

22  serves solely in a voluntary capacity for the corporation or

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

24  operational decisions of the corporation or organization,

25  receives no remuneration for his or her services on the

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

27  financial interest and has no family members with a financial

28  interest in the corporation or organization, provided that the

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

30  include in the application a statement affirming that the

31

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  1  director's relationship to the corporation satisfies the

  2  requirements of this paragraph.

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

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

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

  6  contendere or guilty to, any offense prohibited under the

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

  8  unless an exemption from disqualification has been granted by

  9  the agency as set forth in chapter 435.

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

11  applicant:

12         1.  Has falsely represented a material fact in the

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

14  omitted any material fact from the application required by

15  paragraph (e) or paragraph (f); or

16         2.  Has had prior action taken against the applicant

17  under the Medicaid or Medicare programs as set forth in

18  paragraph (e).

19         (i)  An application for license renewal must contain

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

21         (3)  A license must be issued authorizing the

22  performance of one or more clinical laboratory procedures or

23  one or more tests on each specialty or subspecialty.  A

24  separate license is required of all laboratories maintained on

25  separate premises even if the laboratories are operated under

26  the same management.  Upon receipt of a request for an

27  application for a clinical laboratory license, the agency

28  shall provide to the applicant a copy of the rules relating to

29  licensure and operations applicable to the laboratory for

30  which licensure is sought.

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  1         Section 78.  Section 483.106, Florida Statutes, is

  2  amended to read:

  3         483.106  Application for a certificate of

  4  exemption.--An application for a certificate of exemption must

  5  be made under oath by the owner or director operator of a

  6  clinical laboratory that performs only waived tests as defined

  7  in s. 483.041.  A certificate of exemption authorizes a

  8  clinical laboratory to perform waived tests.  Laboratories

  9  maintained on separate premises and operated under the same

10  management may apply for a single certificate of exemption or

11  multiple certificates of exemption. The agency shall, by rule,

12  specify the process for biennially issuing certificates of

13  exemption.  Sections 483.011, 483.021, 483.031, 483.041,

14  483.172, 483.23, and 483.25 apply to a clinical laboratory

15  that obtains a certificate of exemption under this section.

16         Section 79.  Section 483.30, Florida Statutes, is

17  amended to read:

18         483.30  Licensing of centers.--

19         (1)  A person may not conduct, maintain, or operate a

20  multiphasic health testing center in this state without

21  obtaining a multiphasic health testing center license from the

22  agency.  The license is valid only for the person or persons

23  to whom it is issued and may not be sold, assigned, or

24  transferred, voluntarily or involuntarily.  A license is not

25  valid for any premises other than the center for which it is

26  issued.  However, a new license may be secured for the new

27  location for a fixed center before the actual change, if the

28  contemplated change is in compliance with this part and the

29  rules adopted under this part.  A center must be relicensed if

30  a change of ownership occurs.  Application for relicensure

31  must be made 60 days before the change of ownership.

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  1         (2)  Each applicant for licensure must comply with the

  2  following requirements:

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

  4  application, the agency shall require background screening, in

  5  accordance with the level 2 standards for screening set forth

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

  7  titled individual who is responsible for the daily operation

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

  9  similarly titled individual who is responsible for the

10  financial operation of the center, including billings for

11  patient services.  The applicant must comply with the

12  procedures for level 2 background screening as set forth in

13  chapter 435, as well as the requirements of s. 435.03(3).

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

15  other individual who is an applicant if the agency has

16  probable cause to believe that he or she has been convicted of

17  a crime or has committed any other offense prohibited under

18  the level 2 standards for screening set forth in chapter 435.

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

20  screening requirements of chapter 435 which has been submitted

21  within the previous 5 years in compliance with any other

22  health care licensure requirements of this state is acceptable

23  in fulfillment of the requirements of 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, or a request for a disqualification

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

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

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

  3  report of the results of the Federal Bureau of Investigation

  4  background screening for each individual required by this

  5  section to undergo background screening which confirms that

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

  7  disqualification exemption by the agency as set forth in

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

  9  2 background screening may serve in his or her capacity

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

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

12  to serve if the report indicates any violation of background

13  screening standards and a disqualification exemption has not

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

15  chapter 435.

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

17  application, a description and explanation of any exclusions,

18  permanent suspensions, or terminations of the applicant from

19  the Medicare or Medicaid programs. Proof of compliance with

20  the requirements for disclosure of ownership and controlling

21  interests under the Medicaid or Medicare programs shall be

22  accepted in lieu of this submission.

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

24  description and explanation of any conviction of an offense

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

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

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

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

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

30  serves solely in a voluntary capacity for the corporation or

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

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  1  operational decisions of the corporation or organization,

  2  receives no remuneration for his or her services on the

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

  4  financial interest and has no family members with a financial

  5  interest in the corporation or organization, provided that the

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

  7  include in the application a statement affirming that the

  8  director's relationship to the corporation satisfies the

  9  requirements of this paragraph.

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

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

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

13  contendere or guilty to, any offense prohibited under the

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

15  unless an exemption from disqualification has been granted by

16  the agency as set forth in chapter 435.

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

18  applicant:

19         1.  Has falsely represented a material fact in the

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

21  omitted any material fact from the application required by

22  paragraph (e) or paragraph (f); or

23         2.  Has had prior action taken against the applicant

24  under the Medicaid or Medicare programs as set forth in

25  paragraph (e).

26         (i)  An application for license renewal must contain

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

28         Section 80.  Subsection (1) of section 92.53, Florida

29  Statutes, is amended to read:

30         92.53  Videotaping of testimony of victim or witness

31  under age 16 or person with mental retardation.--

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  1         (1)  On motion and hearing in camera and a finding that

  2  there is a substantial likelihood that a victim or witness who

  3  is under the age of 16 or who is a person with mental

  4  retardation as defined in s. 393.063(44)(41) would suffer at

  5  least moderate emotional or mental harm due to the presence of

  6  the defendant if the child or person with mental retardation

  7  is required to testify in open court, or that such victim or

  8  witness is otherwise unavailable as defined in s. 90.804(1),

  9  the trial court may order the videotaping of the testimony of

10  the victim or witness in a case, whether civil or criminal in

11  nature, in which videotaped testimony is to be utilized at

12  trial in lieu of trial testimony in open court.

13         Section 81.  Section 914.16, Florida Statutes, is

14  amended to read:

15         914.16  Child abuse and sexual abuse of victims under

16  age 16 or persons with mental retardation; limits on

17  interviews.--The chief judge of each judicial circuit, after

18  consultation with the state attorney and the public defender

19  for the judicial circuit, the appropriate chief law

20  enforcement officer, and any other person deemed appropriate

21  by the chief judge, shall provide by order reasonable limits

22  on the number of interviews that a victim of a violation of s.

23  794.011, s. 800.04, or s. 827.03 who is under 16 years of age

24  or a victim of a violation of s. 794.011, s. 800.02, s.

25  800.03, or s. 825.102 who is a person with mental retardation

26  as defined in s. 393.063(44)(41) must submit to for law

27  enforcement or discovery purposes.  The order shall, to the

28  extent possible, protect the victim from the psychological

29  damage of repeated interrogations while preserving the rights

30  of the public, the victim, and the person charged with the

31  violation.

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  1         Section 82.  The introductory paragraph of subsection

  2  (2) of section 914.17, Florida Statutes, is amended to read:

  3         914.17  Appointment of advocate for victims or

  4  witnesses who are minors or persons with mental retardation.--

  5         (2)  An advocate shall be appointed by the court to

  6  represent a person with mental retardation as defined in s.

  7  393.063(44)(41) in any criminal proceeding if the person with

  8  mental retardation is a victim of or witness to abuse or

  9  neglect, or if the person with mental retardation is a victim

10  of a sexual offense or a witness to a sexual offense committed

11  against a minor or person with mental retardation. The court

12  may appoint an advocate in any other criminal proceeding in

13  which a person with mental retardation is involved as either a

14  victim or a witness. The advocate shall have full access to

15  all evidence and reports introduced during the proceedings,

16  may interview witnesses, may make recommendations to the

17  court, shall be noticed and have the right to appear on behalf

18  of the person with mental retardation at all proceedings, and

19  may request additional examinations by medical doctors,

20  psychiatrists, or psychologists. It is the duty of the

21  advocate to perform the following services:

22         Section 83.  Section 918.16, Florida Statutes, is

23  amended to read:

24         918.16  Sex offenses; testimony of person under age 16

25  or person with mental retardation; courtroom cleared;

26  exceptions.--In the trial of any case, civil or criminal, when

27  any person under the age of 16 or any person with mental

28  retardation as defined in s. 393.063(44)(41) is testifying

29  concerning any sex offense, the court shall clear the

30  courtroom of all persons except parties to the cause and their

31  immediate families or guardians, attorneys and their

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  1  secretaries, officers of the court, jurors, newspaper

  2  reporters or broadcasters, court reporters, and at the request

  3  of the victim, victim or witness advocates designated by the

  4  state attorney's office.

  5         Section 84.  Paragraph (a) of subsection (4) of section

  6  943.0585, Florida Statutes, is amended to read:

  7         943.0585  Court-ordered expunction of criminal history

  8  records.--The courts of this state have jurisdiction over

  9  their own procedures, including the maintenance, expunction,

10  and correction of judicial records containing criminal history

11  information to the extent such procedures are not inconsistent

12  with the conditions, responsibilities, and duties established

13  by this section.  Any court of competent jurisdiction may

14  order a criminal justice agency to expunge the criminal

15  history record of a minor or an adult who complies with the

16  requirements of this section.  The court shall not order a

17  criminal justice agency to expunge a criminal history record

18  until the person seeking to expunge a criminal history record

19  has applied for and received a certificate of eligibility for

20  expunction pursuant to subsection (2).  A criminal history

21  record that relates to a violation of chapter 794, s. 800.04,

22  s. 817.034, s. 827.071, chapter 839, s. 893.135, or a

23  violation enumerated in s. 907.041 may not be expunged,

24  without regard to whether adjudication was withheld, if the

25  defendant was found guilty of or pled guilty or nolo

26  contendere to the offense, or if the defendant, as a minor,

27  was found to have committed, or pled guilty or nolo contendere

28  to committing, the offense as a delinquent act. The court may

29  only order expunction of a criminal history record pertaining

30  to one arrest or one incident of alleged criminal activity,

31  except as provided in this section. The court may, at its sole

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  1  discretion, order the expunction of a criminal history record

  2  pertaining to more than one arrest if the additional arrests

  3  directly relate to the original arrest. If the court intends

  4  to order the expunction of records pertaining to such

  5  additional arrests, such intent must be specified in the

  6  order. A criminal justice agency may not expunge any record

  7  pertaining to such additional arrests if the order to expunge

  8  does not articulate the intention of the court to expunge a

  9  record pertaining to more than one arrest. This section does

10  not prevent the court from ordering the expunction of only a

11  portion of a criminal history record pertaining to one arrest

12  or one incident of alleged criminal activity.  Notwithstanding

13  any law to the contrary, a criminal justice agency may comply

14  with laws, court orders, and official requests of other

15  jurisdictions relating to expunction, correction, or

16  confidential handling of criminal history records or

17  information derived therefrom.  This section does not confer

18  any right to the expunction of any criminal history record,

19  and any request for expunction of a criminal history record

20  may be denied at the sole discretion of the court.

21         (4)  EFFECT OF CRIMINAL HISTORY RECORD EXPUNCTION.--Any

22  criminal history record of a minor or an adult which is

23  ordered expunged by a court of competent jurisdiction pursuant

24  to this section must be physically destroyed or obliterated by

25  any criminal justice agency having custody of such record;

26  except that any criminal history record in the custody of the

27  department must be retained in all cases. A criminal history

28  record ordered expunged that is retained by the department is

29  confidential and exempt from the provisions of s. 119.07(1)

30  and s. 24(a), Art. I of the State Constitution and not

31  available to any person or entity except upon order of a court

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  1  of competent jurisdiction. A criminal justice agency may

  2  retain a notation indicating compliance with an order to

  3  expunge.

  4         (a)  The person who is the subject of a criminal

  5  history record that is expunged under this section or under

  6  other provisions of law, including former s. 893.14, former s.

  7  901.33, and former s. 943.058, may lawfully deny or fail to

  8  acknowledge the arrests covered by the expunged record, except

  9  when the subject of the record:

10         1.  Is a candidate for employment with a criminal

11  justice agency;

12         2.  Is a defendant in a criminal prosecution;

13         3.  Concurrently or subsequently petitions for relief

14  under this section or s. 943.059;

15         4.  Is a candidate for admission to The Florida Bar;

16         5.  Is seeking to be employed or licensed by or to

17  contract with the Department of Children and Family Health and

18  Rehabilitative Services or to be employed or used by such

19  contractor or licensee in a sensitive position having direct

20  contact with children, the developmentally disabled, the aged,

21  or the elderly as provided in  s. 39.076, s. 110.1127(3), s.

22  393.063(15)(14), s. 394.4572(1), s. 397.451, s. 402.302(8), s.

23  402.313(3), s. 409.175(2)(i), s. 415.102(4), s. 415.1075(4),

24  s. 985.407, or chapter 400; or

25         6.  Is seeking to be employed or licensed by the Office

26  of Teacher Education, Certification, Staff Development, and

27  Professional Practices of the Department of Education, any

28  district school board, or any local governmental entity that

29  licenses child care facilities.

30         Section 85.  Paragraph (a) of subsection (4) of section

31  943.059, Florida Statutes, is amended to read:

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  1         943.059  Court-ordered sealing of criminal history

  2  records.--The courts of this state shall continue to have

  3  jurisdiction over their own procedures, including the

  4  maintenance, sealing, and correction of judicial records

  5  containing criminal history information to the extent such

  6  procedures are not inconsistent with the conditions,

  7  responsibilities, and duties established by this section.  Any

  8  court of competent jurisdiction may order a criminal justice

  9  agency to seal the criminal history record of a minor or an

10  adult who complies with the requirements of this section.  The

11  court shall not order a criminal justice agency to seal a

12  criminal history record until the person seeking to seal a

13  criminal history record has applied for and received a

14  certificate of eligibility for sealing pursuant to subsection

15  (2).  A criminal history record that relates to a violation of

16  chapter 794, s. 800.04, s. 817.034, s. 827.071, chapter 839,

17  s. 893.135, or a violation enumerated in s. 907.041 may not be

18  sealed, without regard to whether adjudication was withheld,

19  if the defendant was found guilty of or pled guilty or nolo

20  contendere to the offense, or if the defendant, as a minor,

21  was found to have committed or pled guilty or nolo contendere

22  to committing the offense as a delinquent act.  The court may

23  only order sealing of a criminal history record pertaining to

24  one arrest or one incident of alleged criminal activity,

25  except as provided in this section. The court may, at its sole

26  discretion, order the sealing of a criminal history record

27  pertaining to more than one arrest if the additional arrests

28  directly relate to the original arrest.  If the court intends

29  to order the sealing of records pertaining to such additional

30  arrests, such intent must be specified in the order.  A

31  criminal justice agency may not seal any record pertaining to

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  1  such additional arrests if the order to seal does not

  2  articulate the intention of the court to seal records

  3  pertaining to more than one arrest.  This section does not

  4  prevent the court from ordering the sealing of only a portion

  5  of a criminal history record pertaining to one arrest or one

  6  incident of alleged criminal activity. Notwithstanding any law

  7  to the contrary, a criminal justice agency may comply with

  8  laws, court orders, and official requests of other

  9  jurisdictions relating to sealing, correction, or confidential

10  handling of criminal history records or information derived

11  therefrom.  This section does not confer any right to the

12  sealing of any criminal history record, and any request for

13  sealing a criminal history record may be denied at the sole

14  discretion of the court.

15         (4)  EFFECT OF CRIMINAL HISTORY RECORD SEALING.--A

16  criminal history record of a minor or an adult which is

17  ordered sealed by a court of competent jurisdiction pursuant

18  to this section is confidential and exempt from the provisions

19  of s. 119.07(1) and s. 24(a), Art. I of the State Constitution

20  and is available only to the person who is the subject of the

21  record, to the subject's attorney, to criminal justice

22  agencies for their respective criminal justice purposes, or to

23  those entities set forth in subparagraphs (a)1., 4., 5., and

24  6. for their respective licensing and employment purposes.

25         (a)  The subject of a criminal history record sealed

26  under this section or under other provisions of law, including

27  former s. 893.14, former s. 901.33, and former s. 943.058, may

28  lawfully deny or fail to acknowledge the arrests covered by

29  the sealed record, except when the subject of the record:

30         1.  Is a candidate for employment with a criminal

31  justice agency;

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  1         2.  Is a defendant in a criminal prosecution;

  2         3.  Concurrently or subsequently petitions for relief

  3  under this section or s. 943.0585;

  4         4.  Is a candidate for admission to The Florida Bar;

  5         5.  Is seeking to be employed or licensed by or to

  6  contract with the Department of Children and Family Health and

  7  Rehabilitative Services or the Department of Juvenile Justice

  8  or to be employed or used by such contractor or licensee in a

  9  sensitive position having direct contact with children, the

10  developmentally disabled, the aged, or the elderly as provided

11  in s. 39.076, s. 110.1127(3), s. 393.063(15)(14), s.

12  394.4572(1), s. 397.451, s. 402.302(8), s. 402.313(3), s.

13  409.175(2)(i), s. 415.102(4), s. 415.103, s. 985.407, or

14  chapter 400; or

15         6.  Is seeking to be employed or licensed by the Office

16  of Teacher Education, Certification, Staff Development, and

17  Professional Practices of the Department of Education, any

18  district school board, or any local governmental entity which

19  licenses child care facilities.

20         Section 86.  Section 455.661, Florida Statutes, is

21  repealed.

22         Section 87.  Two full-time positions are allocated to

23  the Agency for Health Care Administration to implement and

24  administer a background screening exemption program pursuant

25  to section 400.4174, Florida Statutes, as amended by this act,

26  section 400.5572, Florida Statutes, as created by this act,

27  and chapter 435, Florida Statutes, and the sum of $127,609 is

28  appropriated from the Health Care Trust Fund for this purpose.

29         Section 88.  The provisions of this act which require

30  an applicant for licensure, certification, or registration to

31  undergo background screening shall apply to any individual or

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  1  entity that applies, on or after July 1, 1998, for renewal of

  2  a license, certificate, or registration that is subject to the

  3  background screening required by this act.

  4         Section 89.  This act shall take effect July 1 of the

  5  year in which enacted.

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