House Bill 1971

CODING: Words stricken are deletions; words underlined are additions.







    Florida House of Representatives - 1999                HB 1971

        By the Committee on Elder Affairs & Long-Term Care and
    Representatives Argenziano, Crist, Fiorentino, Sobel, Kosmas,
    Levine, Reddick, Bilirakis, Littlefield, Russell, Jacobs,
    Bitner, Murman and Fasano



  1                      A bill to be entitled

  2         An act relating to nursing home facilities;

  3         creating s. 400.0078, F.S.; requiring the

  4         Office of State Long-Term Care Ombudsman to

  5         establish a statewide toll-free telephone

  6         number; amending s. 400.022, F.S.; providing

  7         immediate access to residents for

  8         representatives of the Office of the Attorney

  9         General; creating s. 400.0225, F.S.; directing

10         the Agency for Health Care Administration to

11         contract for consumer satisfaction surveys for

12         nursing home residents; providing procedures

13         and requirements for use of such surveys;

14         amending s. 400.0255, F.S.; defining terms

15         relating to facility decisions to transfer or

16         discharge a resident; providing procedures,

17         requirements, and limitations; requiring notice

18         to the agency under certain circumstances;

19         providing for review of a notice of discharge

20         or transfer by the district long-term care

21         ombudsman, upon request; specifying timeframes;

22         amending s. 400.071, F.S.; providing additional

23         requirements for licensure and renewal;

24         providing a certificate-of-need preference for

25         Gold Seal licensees; creating s. 400.118, F.S.;

26         directing the agency to establish a quality

27         assurance early warning system; providing for

28         quality-of-care monitoring; providing duties of

29         monitors; excluding certain information from

30         discovery or introduction in evidence in civil

31         or administrative actions; providing for rapid

                                  1

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         response teams; amending s. 400.121, F.S.;

  2         authorizing the agency to require certain

  3         facilities to increase staffing; authorizing

  4         such facilities to request an expedited interim

  5         rate increase; providing a penalty; amending s.

  6         400.141, F.S.; providing requirements for

  7         appointment of a medical director; providing

  8         for resident use of a community pharmacy and

  9         for certain repackaging of prescription

10         medication; providing for immunity from

11         liability in the administration of repackaged

12         medication; revising conditions for encouraging

13         facilities to provide other needed services;

14         requiring public display of certain assistance

15         information; authorizing Gold Seal facilities

16         to develop programs to provide certified

17         nursing assistant training; amending s.

18         400.162, F.S.; revising procedures and policies

19         regarding the safekeeping of residents'

20         property; amending s. 400.19, F.S., relating to

21         the agency's right of entry and inspection;

22         providing a time period for investigation of

23         certain complaints; amending s. 400.191, F.S.;

24         revising requirements for provision of

25         information to the public by the agency;

26         amending s. 400.215, F.S.; specifying

27         conditions for probationary employment of

28         applicants, pending results of an abuse

29         registry screening; requiring the agency to

30         provide a direct-access screening system;

31         amending s. 400.23, F.S.; abolishing the

                                  2

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         Nursing Home Advisory Committee; revising the

  2         system for evaluating facility compliance with

  3         licensure requirements; eliminating ratings and

  4         providing for standard or conditional licensure

  5         status; directing the agency to adopt rules to

  6         provide minimum staffing requirements for

  7         nursing homes and to allow certain staff to

  8         assist residents with eating; increasing the

  9         maximum penalties for deficiencies in facility

10         operations; creating s. 400.235, F.S.;

11         providing for development of a Gold Seal

12         Program for recognition of facilities

13         demonstrating excellence in long-term care;

14         establishing a Panel on Excellence in Long-Term

15         Care under the Executive Office of the

16         Governor; providing membership; providing

17         program criteria; providing for duties of the

18         panel and the Governor; providing for agency

19         rules; providing for biennial relicensure of

20         Gold Seal Program facilities, under certain

21         conditions; amending s. 400.241, F.S.;

22         prohibiting willful interference with an

23         unannounced inspection; providing a penalty;

24         amending s. 408.035, F.S.; providing

25         certificate-of-need review criteria for Gold

26         Seal facilities; creating s. 430.80, F.S.;

27         requiring that the Agency for Health Care

28         Administration implement a pilot project for

29         establishing teaching nursing homes; specifying

30         requirements for a nursing home facility to be

31         designated as a teaching nursing home;

                                  3

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         requiring that the agency develop additional

  2         criteria; authorizing a teaching nursing home

  3         to be affiliated with a medical school within

  4         the State University System; providing for

  5         annual appropriations to a teaching nursing

  6         home; providing certain limitations on the

  7         expenditure of funds by a teaching nursing

  8         home; amending s. 468.1755, F.S.; providing for

  9         disciplinary action against a nursing home

10         administrator who authorizes discharge or

11         transfer of a resident for a reason other than

12         provided by law; amending ss. 394.4625,

13         400.063, and 468.1756, F.S.; correcting cross

14         references; reenacting ss. 468.1695(3) and

15         468.1735, F.S.; incorporating the amendment to

16         s. 468.1755, F.S., in references thereto;

17         providing for funding for recruitment of

18         qualified nursing facility staff; creating a

19         panel on Medicaid reimbursement; providing

20         membership and duties; requiring reports;

21         providing for expiration; requiring a study of

22         factors affecting recruitment, training,

23         employment, and retention of qualified

24         certified nursing assistants; requiring a

25         report; repealing s. 400.29, F.S., relating to

26         an agency annual report of nursing home

27         facilities; providing appropriations; providing

28         effective dates.

29

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

31

                                  4

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         Section 1.  Section 400.0078, Florida Statutes, is

  2  created to read:

  3         400.0078  Statewide toll-free telephone number.--The

  4  Office of State Long-Term Care Ombudsman shall establish a

  5  statewide toll-free telephone number for receiving complaints

  6  concerning nursing facilities.

  7         Section 2.  Paragraph (c) of subsection (1) of section

  8  400.022, Florida Statutes, is amended to read:

  9         400.022  Residents' rights.--

10         (1)  All licensees of nursing home facilities shall

11  adopt and make public a statement of the rights and

12  responsibilities of the residents of such facilities and shall

13  treat such residents in accordance with the provisions of that

14  statement.  The statement shall assure each resident the

15  following:

16         (c)  Any entity or individual that provides health,

17  social, legal, or other services to a resident has the right

18  to have reasonable access to the resident.  The resident has

19  the right to deny or withdraw consent to access at any time by

20  any entity or individual. Notwithstanding the visiting policy

21  of the facility, the following individuals must be permitted

22  immediate access to the resident:

23         1.  Any representative of the federal or state

24  government, including, but not limited to, representatives of

25  the Department of Children and Family Health and

26  Rehabilitative Services, the Department of Health, the Agency

27  for Health Care Administration, the Office of the Attorney

28  General, and the Department of Elderly Affairs; any law

29  enforcement officer; members of the state or district

30  ombudsman council; and the resident's individual physician.

31

                                  5

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         2.  Subject to the resident's right to deny or withdraw

  2  consent, immediate family or other relatives of the resident.

  3

  4  The facility must allow representatives of the State Nursing

  5  Home and Long-Term Care Facility Ombudsman Council to examine

  6  a resident's clinical records with the permission of the

  7  resident or the resident's legal representative and consistent

  8  with state law.

  9         Section 3.  Section 400.0225, Florida Statutes, is

10  created to read:

11         400.0225  Consumer satisfaction surveys.--The agency,

12  or its contractor, in consultation with the nursing home

13  industry and consumer representatives, shall develop an

14  easy-to-use consumer satisfaction survey, shall ensure that

15  every nursing facility licensed pursuant to this part

16  participates in assessing consumer satisfaction, and shall

17  establish procedures to ensure that, at least annually, a

18  representative sample of residents of each facility is

19  selected to participate in the survey. The sample shall be of

20  sufficient size to allow comparisons between and among

21  facilities. Family members, guardians, or other resident

22  designees may assist the resident in completing the survey.

23  Employees and volunteers of the nursing facility or of a

24  corporation or business entity with an ownership interest in

25  the facility are prohibited from assisting a resident with or

26  attempting to influence a resident's responses to the consumer

27  satisfaction survey. The agency, or its contractor, shall

28  survey family members, guardians, or other resident designees

29  when the resident is mentally incapable of responding to the

30  survey. The agency, or its contractor, shall specify the

31  protocol for conducting and reporting the consumer

                                  6

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  satisfaction surveys. Reports of consumer satisfaction surveys

  2  shall protect the identity of individual respondents. The

  3  agency shall contract for consumer satisfaction surveys and

  4  report the results of those surveys in the consumer

  5  information materials prepared and distributed by the agency.

  6         Section 4.  Section 400.0231, Florida Statutes, is

  7  renumbered as section 400.1415, Florida Statutes.

  8         Section 5.  Section 400.0255, Florida Statutes, is

  9  amended to read:

10         400.0255  Resident hearings of facility decisions to

11  transfer or discharge; requirements and procedures;

12  hearings.--

13         (1)  As used in this section, the term:

14         (a)  "Discharge" means to move a resident to a

15  noninstitutional setting when the releasing facility ceases to

16  be responsible for the resident's care.

17         (b)  "Transfer" means to move a resident from the

18  facility to another legally responsible institutional setting.

19  "discharge" or "transfer" means the movement of a resident to

20  a bed outside the certified facility. "Discharge" or

21  "transfer" does not refer to the movement of a resident to a

22  bed within the same certified facility.

23         (2)  Each facility licensed under this part must comply

24  with subsection (10) and s. 400.022(1)(p) when deciding to

25  discharge or transfer a resident.

26         (3)  When a resident is to be discharged or

27  transferred, the nursing home administrator employed by the

28  nursing home that is discharging or transferring the resident,

29  or an individual employed by the nursing home who is

30  designated by the nursing home administrator to act on behalf

31  of the administrator, must sign the notice of discharge or

                                  7

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  transfer. Any notice indicating a medical reason for transfer

  2  or discharge must be signed by the resident's attending

  3  physician or the medical director of the facility.

  4         (4)(a)  Each facility must notify the agency of any

  5  proposed discharge or transfer of a resident when such

  6  discharge or transfer is necessitated by changes in the

  7  physical plant of the facility that make the facility unsafe

  8  for the resident.

  9         (b)  Upon receipt of such a notice, the agency shall

10  conduct an onsite inspection of the facility to verify the

11  necessity of the discharge or transfer.

12         (5)(2)  A resident of any Medicaid or Medicare

13  certified facility may challenge a decision by the facility to

14  discharge or transfer the resident.

15         (6)  The facility may not cite a lack of

16  Medicaid-certified beds as a reason for a transfer or

17  discharge unless the facility has been denied permission by

18  the agency to add a vacant bed to the number of

19  Medicaid-certified beds.

20         (7)  A facility that has been reimbursed for reserving

21  a bed and, for reasons other than those permitted under this

22  section, refuses to readmit a resident within the prescribed

23  timeframe shall refund the bed reservation payment.

24         (8)(3)  At least 30 days prior to any proposed transfer

25  or discharge, a facility must provide advance notice of the

26  proposed transfer or discharge to the resident and, if known,

27  to a family member or the resident's legal guardian or

28  representative, except, in the following circumstances, the

29  facility shall give notice as soon as practicable before the

30  transfer or discharge:

31

                                  8

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (a)  The transfer or discharge is necessary for the

  2  resident's welfare and the resident's needs cannot be met in

  3  the facility, and the circumstances are documented in the

  4  resident's medical records by the resident's physician; or

  5         (b)  The health or safety of other residents or

  6  facility employees would be endangered, and the circumstances

  7  are documented in the resident's medical records by the

  8  resident's physician or the medical director if the resident's

  9  physician is not available.

10         (9)(4)  The notice required by subsection (8)(3) must

11  be in writing and must contain all information required by

12  state and federal law, rules, or regulations applicable to

13  Medicaid or Medicare cases. The agency shall develop a

14  standard document to be used by all facilities licensed under

15  this part for purposes of notifying residents of a discharge

16  or transfer. Such document must include a means for a resident

17  to request the district long-term care ombudsman council to

18  review the notice and request information about or assistance

19  with initiating a fair hearing with the department's Office of

20  Appeals Hearings. In addition to any other pertinent

21  information included, the form shall specify the reason

22  allowed under federal or state law that the resident is being

23  discharged or transferred, with an explanation to support this

24  action. Further, the form shall state the effective date of

25  the discharge or transfer and the location to which the

26  resident is being discharged or transferred. The form shall

27  clearly describe the resident's appeal rights and the

28  procedures for filing an appeal, including the right to

29  request the district ombudsman council to review the notice of

30  discharge or transfer. A copy of the notice must be placed in

31  the resident's clinical record, and a copy must be transmitted

                                  9

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  to the resident's legal guardian or representative and to the

  2  local district ombudsman council.

  3         (10)  A resident may request that the district

  4  ombudsman council review any notice of discharge or transfer

  5  given to the resident. When requested by a resident to review

  6  a notice of discharge or transfer, the district ombudsman

  7  council shall do so within 7 days after receipt of the

  8  request. The nursing home administrator, or the

  9  administrator's designee, must forward the request for review

10  contained in the notice to the district ombudsman council

11  within 24 hours after such request is submitted. Failure to

12  forward the request within 24 hours after the request is

13  submitted shall toll the running of the 30-day advance notice

14  period until the request has been forwarded.

15         (11)(5)(a)  A resident is entitled to a fair hearing to

16  challenge a facility's proposed transfer or discharge.  The

17  resident, or the resident's legal representative or designee,

18  may request a hearing at any time within 90 days after of the

19  resident's receipt of the facility's notice of the proposed

20  discharge or transfer.

21         (b)  If a resident requests a hearing within 10 days

22  after of receiving the notice from the facility, the request

23  shall stay the proposed transfer or discharge pending a

24  hearing decision.  The facility may not take action, and the

25  resident may remain in the facility, until the outcome of the

26  initial fair hearing, which must be completed within 90 days

27  after of receipt of a request for a fair hearing.

28         (c)  If the resident fails to request a hearing within

29  10 days after of receipt of the facility notice of the

30  proposed discharge or transfer, the facility may transfer or

31

                                  10

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  discharge the resident after 30 days from the date the

  2  resident received the notice.

  3         (12)(6)  Notwithstanding paragraph (11)(b) (5)(b), an

  4  emergency discharge or transfer may be implemented as

  5  necessary pursuant to state or federal law during the period

  6  of time after the notice is given and before the time a

  7  hearing decision is rendered. Notice of an emergency discharge

  8  or transfer to the resident, the resident's legal guardian or

  9  representative, and the district ombudsman council if

10  requested pursuant to subsection (10) must be by telephone or

11  in person. This notice shall be given before the transfer, if

12  possible, or as soon thereafter as practicable. A district

13  ombudsman council conducting a review under this subsection

14  shall do so within 24 hours after receipt of the request. The

15  resident's file must be documented to show who was contacted,

16  whether the contact was by telephone or in person, and the

17  date and time of the contact. If the notice is not given in

18  writing, written notice meeting the requirements of subsection

19  (9) (4) must be given the next working day.

20         (13)  After receipt of any notice required under this

21  section, the district ombudsman council may request a private

22  informal conversation with a resident to whom the notice is

23  directed, and, if known, a family member or the resident's

24  legal guardian or designee, to ensure that the facility is

25  proceeding with the discharge or transfer in accordance with

26  the requirements of this section. If requested, the district

27  ombudsman council shall assist the resident with filing an

28  appeal of the proposed discharge or transfer.

29         (14)(7)  The following persons must be present at all

30  hearings proceedings authorized under this section:

31

                                  11

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (a)  The resident, or the resident's legal

  2  representative or designee.

  3         (b)  The facility administrator, or the facility's

  4  legal representative or designee.

  5

  6  A representative of the district long-term care ombudsman

  7  council may be present at all hearings proceedings authorized

  8  by this section.

  9         (15)(8)  In any hearing proceeding under this section,

10  the following information concerning the parties shall be

11  confidential and exempt from the provisions of s. 119.07(1):

12         (a)  Names and addresses.

13         (b)  Medical services provided.

14         (c)  Social and economic conditions or circumstances.

15         (d)  Evaluation of personal information.

16         (e)  Medical data, including diagnosis and past history

17  of disease or disability.

18         (f)  Any information received verifying income

19  eligibility and amount of medical assistance payments.  Income

20  information received from the Social Security Administration

21  or the Internal Revenue Service must be safeguarded according

22  to the requirements of the agency that furnished the data.

23

24  The exemption created by this subsection does not prohibit

25  access to such information by a district long-term care

26  ombudsman council upon request, by a reviewing court if such

27  information is required to be part of the record upon

28  subsequent review, or as specified in s. 24(a), Art. I of the

29  State Constitution.

30

31

                                  12

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (16)(9)(a)  The department's Office of Appeals Hearings

  2  shall conduct hearings under this section.  The office shall

  3  notify the facility of a resident's request for a hearing.

  4         (b)  The department shall, by rule, establish

  5  procedures to be used for fair hearings requested by

  6  residents. These procedures shall be equivalent to the

  7  procedures used for fair hearings for other Medicaid cases,

  8  chapter 10-2, part VI, Florida Administrative Code.  The

  9  burden of proof must be clear and convincing evidence. A

10  hearing decision must be rendered within 90 days after of

11  receipt of the request for hearing.

12         (c)(10)  If the hearing decision is favorable to the

13  resident who has been transferred or discharged, the resident

14  must be readmitted to the facility's first available bed.

15         (d)(11)  The decision of the hearing officer shall be

16  final.  Any aggrieved party may appeal the decision to the

17  district court of appeal in the appellate district where the

18  facility is located.  Review procedures shall be conducted in

19  accordance with the Florida Rules of Appellate Procedure.

20         (17)(12)  The department may adopt rules necessary to

21  administer implement the provisions of this section.

22         Section 6.  Paragraph (g) is added to subsection (2) of

23  section 400.071, Florida Statutes, 1998 Supplement, present

24  subsections (8) and (9) are amended and renumbered as

25  subsections (9) and (10), respectively, and a new subsection

26  (8) is added to said section, to read:

27         400.071  Application for license.--

28         (2)  The application shall be under oath and shall

29  contain the following:

30         (g)  Copies of any civil verdict or judgment involving

31  the applicant rendered within the 10 years preceding the

                                  13

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  application, relating to medical negligence, violation of

  2  residents' rights, or wrongful death.  As a condition of

  3  licensure, the licensee agrees to provide to the agency copies

  4  of any new verdict or judgment involving the applicant,

  5  relating to such matters, within 30 days after filing with the

  6  clerk of the court.  The information required in this

  7  paragraph shall be maintained in the facility's licensure file

  8  and in an agency database which is available as a public

  9  record.

10         (8)  As a condition of licensure, each facility must

11  agree to participate in a consumer satisfaction measurement

12  process as prescribed by the agency.

13         (9)(8)  The agency may not issue a license to a nursing

14  home that fails to receive a certificate of need under the

15  provisions of ss. 408.031-408.045. It is the intent of the

16  Legislature that, in reviewing a certificate-of-need

17  application to add beds to an existing nursing home facility,

18  preference be given to the application of a licensee who has

19  been awarded a Gold Seal as provided for in s. 400.235, if the

20  applicant otherwise meets the review criteria specified in s.

21  408.035.

22         (10)(9)  The agency may develop an abbreviated survey

23  for licensure renewal applicable to a licensee that has

24  continuously operated as a nursing facility since 1991 or

25  earlier, and has operated under the same management for at

26  least the preceding 30 months, and has had during the

27  preceding 30 months no class I or class II deficiencies

28  maintained a superior rating during that period.

29         Section 7.  Section 400.118, Florida Statutes, is

30  created to read:

31

                                  14

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         400.118  Quality assurance; early warning system;

  2  monitoring; rapid response teams.--

  3         (1)  The agency shall establish an early warning system

  4  to detect conditions in nursing facilities that could be

  5  detrimental to the health, safety, and welfare of residents.

  6  The early warning system shall include, but not be limited to,

  7  analysis of financial and quality-of-care indicators that

  8  would predict the need for the agency to take action pursuant

  9  to the authority set forth in this part.

10         (2)(a)  The agency shall establish within each district

11  office one or more quality-of-care monitors, based on the

12  number of nursing facilities in the district, to monitor all

13  nursing facilities in the district on a regular, unannounced,

14  aperiodic basis, including nights, evenings, weekends, and

15  holidays. Priority for monitoring visits shall be given to

16  nursing facilities with a history of patient care

17  deficiencies. Quality-of-care monitors shall be registered

18  nurses who are trained and experienced in nursing facility

19  regulation, standards of practice in long-term care, and

20  evaluation of patient care. Individuals in these positions

21  shall not be deployed by the agency as a part of the district

22  survey team in the conduct of routine, scheduled surveys, but

23  shall function solely and independently as quality-of-care

24  monitors. Quality-of-care monitors shall assess the overall

25  quality of life in the nursing facility and shall assess

26  specific conditions in the facility directly related to

27  patient care. The quality-of-care monitor shall include in an

28  assessment visit observation of the care and services rendered

29  to residents and formal and informal interviews with

30  residents, family members, facility staff, resident guests,

31  volunteers, other regulatory staff, and representatives of a

                                  15

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  long-term care ombudsman council or human rights advocacy

  2  committee.

  3         (b)  Findings of a monitoring visit, both positive and

  4  negative, shall be provided orally and in writing to the

  5  facility administrator or, in the absence of the facility

  6  administrator, to the administrator on duty or the director of

  7  nursing. The quality-of-care monitor may recommend to the

  8  facility administrator procedural and policy changes and staff

  9  training, as needed, to improve the care or quality of life of

10  facility residents. Conditions observed by the quality-of-care

11  monitor which threaten the health or safety of a resident

12  shall be reported immediately to the agency area office

13  supervisor for appropriate regulatory action and, as

14  appropriate or as required by law, to law enforcement, adult

15  protective services, or other responsible agencies.

16         (c)  Any record, whether written or oral, or any

17  written or oral communication generated pursuant to paragraph

18  (a) or paragraph (b) shall not be subject to discovery or

19  introduction into evidence in any civil or administrative

20  action against a nursing facility arising out of matters which

21  are the subject of quality-of-care monitoring, and a person

22  who was in attendance at a monitoring visit or evaluation may

23  not be permitted or required to testify in any such civil or

24  administrative action as to any evidence or other matters

25  produced or presented during the monitoring visits or

26  evaluations. However, information, documents, or records

27  otherwise available from original sources are not to be

28  construed as immune from discovery or use in any such civil or

29  administrative action merely because they were presented

30  during monitoring visits or evaluations, and any person who

31  participates in such activities may not be prevented from

                                  16

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  testifying as to matters within his or her knowledge, but such

  2  witness may not be asked about his or her participation in

  3  such activities. The exclusion from the discovery or

  4  introduction of evidence in any civil or administrative action

  5  provided for herein shall not apply when the quality-of-care

  6  monitor makes a report to the appropriate authorities

  7  regarding a threat to the health or safety of a resident.

  8         (3)  The agency shall also create teams of experts that

  9  can function as rapid response teams to visit nursing

10  facilities identified through the agency's early warning

11  system. Rapid response teams may visit facilities that request

12  the agency's assistance. The rapid response teams shall not be

13  deployed for the purpose of helping a facility prepare for a

14  regular survey.

15         Section 8.  Subsection (6) is added to section 400.121,

16  Florida Statutes, 1998 Supplement, to read:

17         400.121  Denial, suspension, revocation of license;

18  moratorium on admissions; administrative fines; procedure.--

19         (6)  The agency is authorized to require a facility to

20  increase staffing beyond the minimum required by law, if the

21  agency has taken administrative action against the facility

22  for care-related deficiencies directly attributable to

23  insufficient staff. Under such circumstances, the facility may

24  request an expedited interim rate increase. The agency shall

25  process the request within 10 days after receipt of all

26  required documentation from the facility. A facility that

27  fails to maintain the required increased staffing is subject

28  to a fine of $500 per day for each day the staffing is below

29  the level required by the agency.

30         Section 9.  Section 400.141, Florida Statutes, is

31  amended to read:

                                  17

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         400.141  Administration and management of nursing home

  2  facilities.--Every licensed facility shall comply with all

  3  applicable standards and rules of the agency and shall:

  4         (1)  Be under the administrative direction and charge

  5  of a licensed administrator.

  6         (2)  Appoint a medical director licensed pursuant to

  7  chapter 458 or chapter 459. The agency may establish by rule

  8  more specific criteria for the appointment of a medical

  9  director.

10         (3)(2)  Have available the regular, consultative, and

11  emergency services of physicians licensed by the state.

12         (4)(3)  Provide for the access of the facility

13  residents to dental and other health-related services,

14  recreational services, rehabilitative services, and social

15  work services appropriate to their needs and conditions and

16  not directly furnished by the licensee.  When a geriatric

17  outpatient nurse clinic is conducted in accordance with rules

18  adopted by the agency, outpatients attending such clinic shall

19  not be counted as part of the general resident population of

20  the nursing home facility, nor shall the nursing staff of the

21  geriatric outpatient clinic be counted as part of the nursing

22  staff of the facility, until the outpatient clinic load

23  exceeds 15 a day.

24         (5)  Provide for resident use of a community pharmacy

25  as specified in s. 400.022(1)(q). Any other law to the

26  contrary notwithstanding, a registered pharmacist licensed in

27  Florida may repackage a nursing facility resident's bulk

28  prescription medication which has been packaged by another

29  pharmacist licensed in any state in the United States into a

30  unit dose system compatible with the system used by the

31  nursing facility, if such resident has bulk prescription

                                  18

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  medication benefits covered under a qualified pension plan as

  2  specified in s. 4972 of the Internal Revenue Code, a federal

  3  retirement program as specified under 5 C.F.R. s. 831, or a

  4  long-term care policy as defined in s. 627.9404(1). A

  5  pharmacist who correctly repackages and relabels the

  6  medication and the nursing facility which correctly

  7  administers such repackaged medication under the provisions of

  8  this subsection shall not be held liable in any civil or

  9  administrative action arising from the repackaging. In order

10  to be eligible for the repackaging, a nursing facility

11  resident for whom the medication is to be repackaged shall

12  sign an informed consent form provided by the facility which

13  includes an explanation of the repackaging process and which

14  notifies the resident of the immunities from liability

15  provided herein.

16         (6)(4)  Be allowed and encouraged by the agency to

17  provide other needed services under certain conditions. If the

18  facility has a standard licensure status, and has had no class

19  I or class II deficiencies during the past 2 years or has been

20  awarded a Gold Seal under the program established in s.

21  400.235, it may is rated superior or standard, be encouraged

22  by the agency to provide services, including, but not limited

23  to, respite and adult day services, which enable individuals

24  to move in and out of the facility.  A facility is not subject

25  to any additional licensure requirements for providing these

26  services. Respite care may be offered to persons in need of

27  short-term or temporary nursing home services. Respite care

28  must be provided in accordance with this part and rules

29  adopted by the agency. However, the agency shall, by rule,

30  adopt modified requirements for resident assessment, resident

31  care plans, resident contracts, physician orders, and other

                                  19

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  provisions, as appropriate, for short-term or temporary

  2  nursing home services.  The agency shall allow for shared

  3  programming and staff in a facility which meets minimum

  4  standards and offers services pursuant to this subsection,

  5  but, if the facility is cited for deficiencies in patient

  6  care, may require additional staff and programs appropriate to

  7  the needs of service recipients. A person who receives respite

  8  care may not be counted as a resident of the facility for

  9  purposes of the facility's licensed capacity unless that

10  person receives 24-hour respite care. A person receiving

11  either respite care for 24 hours or longer or adult day

12  services must be included when calculating minimum staffing

13  for the facility. Any costs and revenues generated by a

14  nursing home facility from nonresidential programs or services

15  shall be excluded from the calculations of Medicaid per diems

16  for nursing home institutional care reimbursement.

17         (7)(5)  If the facility has a standard licensure status

18  or is a Gold Seal facility is rated superior or standard,

19  exceeds minimum staffing standards, and is part of a

20  retirement community that offers other services pursuant to

21  part III, part IV, or part V, be allowed to share programming

22  and staff.  At the time of relicensure, a retirement community

23  that uses this option must demonstrate through staffing

24  records that minimum staffing requirements for the facility

25  were exceeded.

26         (8)(6)  Maintain the facility premises and equipment

27  and conduct its operations in a safe and sanitary manner.

28         (9)(7)  If the licensee furnishes food service, provide

29  a wholesome and nourishing diet sufficient to meet generally

30  accepted standards of proper nutrition for its residents and

31  provide such therapeutic diets as may be prescribed by

                                  20

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  attending physicians.  In making rules to implement this

  2  subsection, the agency shall be guided by standards

  3  recommended by nationally recognized professional groups and

  4  associations with knowledge of dietetics.

  5         (10)(8)  Keep full records of resident admissions and

  6  discharges; medical and general health status, including

  7  medical records, personal and social history, and identity and

  8  address of next of kin or other persons who may have

  9  responsibility for the affairs of the residents; and

10  individual resident care plans including, but not limited to,

11  prescribed services, service frequency and duration, and

12  service goals.  The records shall be open to inspection by the

13  agency.

14         (11)(9)  Keep such fiscal records of its operations and

15  conditions as may be necessary to provide information pursuant

16  to this part.

17         (12)(10)  Furnish copies of personnel records for

18  employees affiliated with such facility, to any other facility

19  licensed by this state requesting this information pursuant to

20  this part.  Such information contained in the records may

21  include, but is not limited to, disciplinary matters and any

22  reason for termination. Any facility releasing such records

23  pursuant to this part shall be considered to be acting in good

24  faith and may not be held liable for information contained in

25  such records, absent a showing that the facility maliciously

26  falsified such records.

27         (13)  Publicly display a poster provided by the agency

28  containing the names, addresses, and telephone numbers for the

29  state's abuse hotline, the State Long-Term Care Ombudsman, the

30  Agency for Health Care Administration consumer hotline, the

31  Advocacy Center for Persons with Disabilities, the Statewide

                                  21

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  Human Rights Advocacy Committee, and the Medicaid Fraud

  2  Control Unit, with a clear description of the assistance to be

  3  expected from each.

  4

  5  Facilities that have been awarded a Gold Seal under the

  6  program established in s. 400.235 may develop a plan to

  7  provide certified nursing assistant training as prescribed by

  8  federal regulations and state rules and may apply to the

  9  agency for approval of its program.

10         Section 10.  Subsection (3) of section 400.162, Florida

11  Statutes, is amended to read:

12         400.162  Property and personal affairs of residents.--

13         (3)  A licensee shall provide for the safekeeping of

14  personal effects, funds, and other property of the resident in

15  the facility.  Whenever necessary for the protection of

16  valuables, or in order to avoid unreasonable responsibility

17  therefor, the licensee may require that such valuables be

18  excluded or removed from the facility and kept at some place

19  not subject to the control of the licensee. At the request of

20  a resident, the facility shall mark the resident's personal

21  property with the resident's name or another type of

22  identification, without defacing the property. Any theft or

23  loss of a resident's personal property shall be documented by

24  the facility. The facility shall develop policies and

25  procedures to minimize the risk of theft or loss of the

26  personal property of residents. A copy of the policy shall be

27  provided to every employee and to each resident at admission.

28  Facility policies must include provisions related to reporting

29  theft or loss of a resident's property to law enforcement and

30  any facility waiver of liability for loss or theft. The

31

                                  22

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  facility shall post notice of these policies and procedures,

  2  and any revision thereof, in places accessible to residents.

  3         Section 11.  Subsections (1) and (4) of section 400.19,

  4  Florida Statutes, are amended to read:

  5         400.19  Right of entry and inspection.--

  6         (1)  The agency and any duly designated officer or

  7  employee thereof or a member of the State Long-Term Care

  8  Ombudsman Council or the district long-term care ombudsman

  9  council shall have the right to enter upon and into the

10  premises of any facility licensed pursuant to this part, or

11  any distinct nursing home unit of a hospital licensed under

12  chapter 395 or any freestanding facility licensed under

13  chapter 395 that provides extended care or other long-term

14  care services, at any reasonable time in order to determine

15  the state of compliance with the provisions of this part and

16  rules in force pursuant thereto.  The right of entry and

17  inspection shall also extend to any premises which the agency

18  has reason to believe is being operated or maintained as a

19  facility without a license, but no such entry or inspection of

20  any premises shall be made without the permission of the owner

21  or person in charge thereof, unless a warrant is first

22  obtained from the circuit court authorizing same.  Any

23  application for a facility license or renewal thereof, made

24  pursuant to this part, shall constitute permission for and

25  complete acquiescence in any entry or inspection of the

26  premises for which the license is sought, in order to

27  facilitate verification of the information submitted on or in

28  connection with the application; to discover, investigate, and

29  determine the existence of abuse or neglect; or to elicit,

30  receive, respond to, and resolve complaints. The agency shall,

31  within 60 days after receipt of a complaint made by a resident

                                  23

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  or resident's representative, complete its investigation and

  2  provide to the complainant its findings and resolution.

  3         (4)  The agency shall conduct unannounced onsite

  4  facility reviews following written verification of licensee

  5  noncompliance in instances in which a long-term care ombudsman

  6  council, pursuant to ss. 400.0071 and 400.0075, has received a

  7  complaint and has documented deficiencies in resident care or

  8  in the physical plant of the facility that threaten the

  9  health, safety, or security of residents, or when the agency

10  documents through inspection that conditions in a facility

11  present a direct or indirect threat to the health, safety, or

12  security of residents. However, the agency shall conduct four

13  or more unannounced onsite reviews within a 12-month period of

14  each facility which has a conditional licensure status rating.

15  Deficiencies related to physical plant do not require followup

16  reviews after the agency has determined that correction of the

17  deficiency has been accomplished and that the correction is of

18  the nature that continued compliance can be reasonably

19  expected.

20         Section 12.  Section 400.191, Florida Statutes, is

21  amended to read:

22         400.191  Availability, distribution, and posting of

23  reports and records.--

24         (1)  The agency shall provide information to the public

25  about all of the licensed nursing home facilities operating in

26  the state. The agency shall, within 60 days after from the

27  date of an annual inspection visit or within 30 days after

28  from the date of any interim visit to a facility, send copies

29  of the inspection reports to the district long-term care

30  ombudsman council, the agency's local office, and a public

31  library or the county seat for the county in which the

                                  24

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  facility is located., forward the results of all inspections

  2  of nursing home facilities to:

  3         (a)  The district ombudsman council in whose district

  4  the inspected facility is located.

  5         (b)  At least one public library or, in the absence of

  6  a public library, the county seat in the county in which the

  7  inspected facility is located.

  8         (c)  The area office supervisor of the agency in whose

  9  district the inspected facility is located.

10         (2)  The agency shall provide additional information in

11  consumer-friendly printed and electronic formats to assist

12  consumers and their families in comparing and evaluating

13  nursing home facilities.

14         (a)  The agency shall provide an Internet site which

15  shall include at least the following information:

16         1.  A list by name and address of all nursing home

17  facilities in this state.

18         2.  Whether such nursing home facilities are

19  proprietary or nonproprietary.

20         3.  The licensure status of each facility.

21         4.  The ownership history of each facility.

22         5.  The name of the owner or owners of each facility

23  and whether the facility is a part of a corporation owning or

24  operating more than one nursing facility in this state.

25         6.  Performance, regulatory, and enforcement

26  information about the corporation, as well as the facility.

27         7.  The total number of beds in each facility.

28         8.  The number of private and semiprivate rooms in each

29  facility.

30         9.  The religious affiliation, if any, of each

31  facility.

                                  25

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         10.  The languages spoken by the administrator and

  2  staff of each facility.

  3         11.  Whether or not each facility accepts Medicare or

  4  Medicaid recipients.

  5         12.  Recreational and other programs available at each

  6  facility.

  7         13.  For nursing homes certified for Medicare or

  8  Medicaid, information from the Minimum Data Set system of the

  9  federal Health Care Financing Administration about the

10  clinical performance of each facility, including information

11  related to the nursing home quality indicators.

12         14.  Information about the licensure status and

13  regulatory history of each facility.

14         15.  Special care units or programs offered at each

15  facility.

16         16.  Whether the facility is a part of a retirement

17  community that offers other services pursuant to part III,

18  part IV, or part V.

19         17.  The results of consumer and family satisfaction

20  surveys for each facility.

21         18.  The licensure status and rating history for the

22  past 5 years for each facility.

23         19.  Survey and deficiency information contained on the

24  Online Survey Certification and Reporting (OSCAR) system of

25  the federal Health Care Financing Administration, including

26  annual survey, revisit, and complaint survey information, for

27  each facility for the past 3 years.  For noncertified nursing

28  homes, state survey and deficiency information, including

29  annual survey, revisit, and complaint survey information for

30  the past 3 years shall be provided.

31

                                  26

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (b)  The agency shall provide the following information

  2  in printed form:

  3         1.  A list by name and address of all nursing home

  4  facilities in this state.

  5         2.  Whether such nursing home facilities are

  6  proprietary or nonproprietary and their current ownership.

  7         3.  The licensure status of each facility.

  8         4.  The total number of beds, and of private and

  9  semiprivate rooms, in each facility.

10         5.  The religious affiliation, if any, of each

11  facility.

12         6.  The languages spoken by the administrator and staff

13  of each facility.

14         7.  Whether or not each facility accepts Medicare or

15  Medicaid recipients.

16         8.  Recreational programs, special care units, and

17  other programs available at each facility.

18         9.  A summary of information from the Minimum Data Set

19  system of the federal Health Care Financing Administration

20  about the clinical performance of each facility.

21         10.  Information about the licensure status and

22  regulatory history of each facility.

23         11.  The results of consumer and family satisfaction

24  surveys for each facility.

25         12.  The Internet address for the site where more

26  detailed information can be seen.

27         13.  A statement advising consumers that each facility

28  will have its own policies and procedures related to

29  protecting resident property.

30         (3)(2)  Each nursing home facility licensee shall

31  maintain as public information, available upon request,

                                  27

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  records of all cost and inspection reports pertaining to that

  2  facility that have been filed with, or issued by, any

  3  governmental agency. Copies of such reports shall be retained

  4  in such records for not less than 5 years from the date the

  5  reports are filed or issued.

  6         (4)(3)  Any records of a nursing home facility

  7  determined by the agency to be necessary and essential to

  8  establish lawful compliance with any rules or standards shall

  9  be made available to the agency on the premises of the

10  facility.

11         (5)(4)  Every nursing home facility licensee shall:

12         (a)  Post, in a sufficient number of prominent

13  positions in the nursing home so as to be accessible to all

14  residents and to the general public, a concise summary of the

15  last inspection report pertaining to the nursing home and

16  issued by the agency, with references to the page numbers of

17  the full reports, noting any deficiencies found by the agency

18  and the actions taken by the licensee to rectify such

19  deficiencies and indicating in such summaries where the full

20  reports may be inspected in the nursing home.

21         (b)  Upon request, provide to any person who has

22  completed a written application with an intent to be admitted

23  to, or to any resident of, such nursing home, or to any

24  relative, spouse, or guardian of such person, a copy of the

25  last inspection report pertaining to the nursing home and

26  issued by the agency, provided the person requesting the

27  report agrees to pay a reasonable charge to cover copying

28  costs.

29         Section 13.  Effective upon this act becoming a law,

30  paragraph (a) of subsection (2) of section 400.215, Florida

31

                                  28

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  Statutes, 1998 Supplement, is amended, and paragraph (e) is

  2  added to said subsection, to read:

  3         400.215  Personnel screening requirement.--

  4         (2)  Employers and employees shall comply with the

  5  requirements of s. 435.05.

  6         (a)  Notwithstanding the provisions of s. 435.05(1),

  7  facilities must have in their possession evidence that level 1

  8  screening has been completed before allowing an employee to

  9  begin working with patients as provided in subsection (1). All

10  information necessary for conducting background screening

11  using level 1 standards as specified in s. 435.03(1) and for

12  conducting a search of the central abuse registry and tracking

13  system as specified in s. 435.03(3)(a) shall be submitted by

14  the nursing facility to the agency. Results of the background

15  screening and the abuse registry check shall be provided by

16  the agency to the requesting nursing facility. An applicant

17  who has been qualified under a level 1 criminal screening and

18  who, under penalty of perjury, attests to not having been

19  classified in the central abuse registry and tracking system

20  as a perpetrator in a confirmed report of abuse, neglect, or

21  exploitation may be allowed to work on a probationary status

22  in the nursing facility, under supervision, for a period not

23  to exceed 30 days, pending the results of an abuse registry

24  screening.

25         (e)  Notwithstanding the confidentiality provisions of

26  s. 415.107, the agency shall provide no later than 45 days

27  after the effective date of this paragraph, a direct-access

28  electronic screening capability to all enrolled facilities or

29  agencies required by law to restrict employment to only an

30  applicant who does not have a disqualifying report in the

31  central abuse registry and tracking system. The agency shall,

                                  29

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  upon request, provide to such facility or agency a user code

  2  by which the facility or agency may query the listing of all

  3  persons disqualified because of a confirmed classification.

  4  The direct-access screening system shall allow for the

  5  electronic matching of an applicant's identifying information,

  6  including name, date of birth, race, sex, and social security

  7  number, against the listing of disqualified persons. The

  8  agency may charge a fee for issuing the user code sufficient

  9  to cover the cost of establishing and maintaining the

10  direct-access screening system. The direct-access screening

11  system shall provide immediately to the user only the

12  electronic notification of applicant clearance or

13  disqualification. The system shall also maintain for

14  appropriate entry into the agency screening database an

15  electronic record of the inquiry on behalf of the applicant.

16         Section 14.  Section 400.23, Florida Statutes, 1998

17  Supplement, is amended, and subsections (11) and (12) of said

18  section are renumbered as subsections (1) and (2) of section

19  400.232, Florida Statutes, to read:

20         400.23  Rules; criteria; Nursing Home Advisory

21  Committee; evaluation and deficiencies; licensure status

22  rating system; fee for review of plans.--

23         (1)  It is the intent of the Legislature that rules

24  published and enforced pursuant to this part shall include

25  criteria by which a reasonable and consistent quality of

26  resident care may be ensured and the results of such resident

27  care can be demonstrated and by which safe and sanitary

28  nursing homes can be provided.  It is further intended that

29  reasonable efforts be made to accommodate the needs and

30  preferences of residents to enhance the quality of life in a

31  nursing home.  In addition, efforts shall be made to minimize

                                  30

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  the paperwork associated with the reporting and documentation

  2  requirements of these rules.

  3         (2)  Pursuant to the intention of the Legislature, the

  4  agency, in consultation with the Department of Health and

  5  Rehabilitative Services and the Department of Elderly Affairs,

  6  shall adopt and enforce rules to implement this part, which

  7  shall include reasonable and fair criteria in relation to:

  8         (a)  The location and construction of the facility;

  9  including fire and life safety, plumbing, heating, lighting,

10  ventilation, and other housing conditions which will ensure

11  the health, safety, and comfort of residents, including an

12  adequate call system.  The agency shall establish standards

13  for facilities and equipment to increase the extent to which

14  new facilities and a new wing or floor added to an existing

15  facility after July 1, 1999, are structurally capable of

16  serving as shelters only for residents, staff, and families of

17  residents and staff, and equipped to be self-supporting during

18  and immediately following disasters.  The agency for Health

19  Care Administration shall work with facilities licensed under

20  this part and report to the Governor and Legislature by April

21  1, 1999, its recommendations for cost-effective renovation

22  standards to be applied to existing facilities. In making such

23  rules, the agency shall be guided by criteria recommended by

24  nationally recognized reputable professional groups and

25  associations with knowledge of such subject matters. The

26  agency shall update or revise such criteria as the need

27  arises. All nursing homes must comply with those lifesafety

28  code requirements and building code standards applicable at

29  the time of approval of their construction plans. The agency

30  may require alterations to a building if it determines that an

31  existing condition constitutes a distinct hazard to life,

                                  31

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  health, or safety. The agency shall adopt fair and reasonable

  2  rules setting forth conditions under which existing facilities

  3  undergoing additions, alterations, conversions, renovations,

  4  or repairs shall be required to comply with the most recent

  5  updated or revised standards.

  6         (b)  The number and qualifications of all personnel,

  7  including management, medical, nursing, and other professional

  8  personnel, and nursing assistants, orderlies, and support

  9  personnel, having responsibility for any part of the care

10  given residents.

11         (c)  All sanitary conditions within the facility and

12  its surroundings, including water supply, sewage disposal,

13  food handling, and general hygiene which will ensure the

14  health and comfort of residents.

15         (d)  The equipment essential to the health and welfare

16  of the residents.

17         (e)  A uniform accounting system.

18         (f)  The care, treatment, and maintenance of residents

19  and measurement of the quality and adequacy thereof, based on

20  rules developed under this chapter and the Omnibus Budget

21  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,

22  1987), Title IV (Medicare, Medicaid, and Other Health-Related

23  Programs), Subtitle C (Nursing Home Reform), as amended.

24         (g)  The preparation and annual update of a

25  comprehensive emergency management plan.  The agency shall

26  adopt rules establishing minimum criteria for the plan after

27  consultation with the Department of Community Affairs.  At a

28  minimum, the rules must provide for plan components that

29  address emergency evacuation transportation; adequate

30  sheltering arrangements; postdisaster activities, including

31  emergency power, food, and water; postdisaster transportation;

                                  32

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  supplies; staffing; emergency equipment; individual

  2  identification of residents and transfer of records; and

  3  responding to family inquiries.  The comprehensive emergency

  4  management plan is subject to review and approval by the local

  5  emergency management agency.  During its review, the local

  6  emergency management agency shall ensure that the following

  7  agencies, at a minimum, are given the opportunity to review

  8  the plan:  the Department of Elderly Affairs, the Department

  9  of Health and Rehabilitative Services, the Agency for Health

10  Care Administration, and the Department of Community Affairs.

11  Also, appropriate volunteer organizations must be given the

12  opportunity to review the plan.  The local emergency

13  management agency shall complete its review within 60 days and

14  either approve the plan or advise the facility of necessary

15  revisions.

16         (3)(a)  The agency shall adopt rules providing for the

17  minimum staffing requirements for nursing homes. These

18  requirements shall include, for each nursing home facility, a

19  minimum certified nursing assistant staffing and a minimum

20  licensed nursing staffing per resident per day, including

21  evening and night shifts and weekends. Agency rules shall

22  specify requirements for documentation of compliance with

23  staffing standards, sanctions for violation of such standards,

24  and requirements for daily posting of the names of staff on

25  duty for the benefit of facility residents and the public. The

26  agency shall recognize the use of licensed nurses for

27  compliance with minimum staffing requirements for certified

28  nursing assistants, provided that the facility otherwise meets

29  the minimum staffing requirements for licensed nurses and that

30  the licensed nurses so recognized are performing the duties of

31  a certified nursing assistant.

                                  33

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (b)  The agency shall adopt rules to allow properly

  2  trained staff of a nursing facility, in addition to certified

  3  nursing assistants and licensed nurses, to assist residents

  4  with eating. The rules shall specify the minimum training

  5  requirements and shall specify the physiological conditions or

  6  disorders of residents which would necessitate that the eating

  7  assistance be provided by nursing personnel of the facility.

  8         (4)(3)  Rules developed pursuant to this section shall

  9  not restrict the use of shared staffing and shared programming

10  in facilities which are part of retirement communities that

11  provide multiple levels of care and otherwise meet the

12  requirement of law or rule.

13         (5)(4)  The agency, in collaboration with the Division

14  of Children's Medical Services Program Office of the

15  Department of Health and Rehabilitative Services, must, no

16  later than December 31, 1993, adopt rules for minimum

17  standards of care for persons under 21 years of age who reside

18  in nursing home facilities.  The rules must include a

19  methodology for reviewing a nursing home facility under ss.

20  408.031-408.045 which serves only persons under 21 years of

21  age.

22         (6)(5)  Prior to conducting a survey of the facility,

23  the survey team shall obtain a copy of the district nursing

24  home and long-term care facility ombudsman council report on

25  the facility. Problems noted in the report shall be

26  incorporated into and followed up through the agency's

27  inspection process. This procedure does not preclude the

28  district nursing home and long-term care facility ombudsman

29  council from requesting the agency to conduct a followup visit

30  to the facility.

31

                                  34

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (6)  There is created the Nursing Home Advisory

  2  Committee, which shall consist of 15 members who are to be

  3  appointed by and report directly to the director of the

  4  agency. The membership is to include:

  5         (a)  One researcher from a university center on aging.

  6         (b)  Two representatives from the Florida Health Care

  7  Association.

  8         (c)  Two representatives from the Florida Association

  9  of Homes for the Aging.

10         (d)  One representative from the Department of Elderly

11  Affairs.

12         (e)  Five consumer representatives, at least two of

13  whom serve on or are staff members of the state or a district

14  nursing home and long-term care facility ombudsman council.

15         (f)  One representative from the Florida American

16  Medical Directors Association.

17         (g)  One representative from the Florida Association of

18  Directors of Nursing Administrators.

19         (h)  One representative from the Agency for Health Care

20  Administration.

21         (i)  One representative from the nursing home industry

22  at large who owns or operates a licensed nursing home facility

23  in the state and is not a member of any state nursing home

24  association.

25

26  At least one member shall be over 60 years of age.

27         (7)  The committee shall perform the following duties

28  to assist the agency in ensuring compliance with the intent of

29  the Legislature specified in subsection (1):

30         (a)  Assist in developing a nursing home rating system

31  based on the requirements of rules developed under this

                                  35

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  chapter and the Omnibus Budget Reconciliation Act of 1987

  2  (Pub. L. No. 100-203) (December 22, 1987), Title IV (Medicare,

  3  Medicaid, and Other Health-Related Programs), Subtitle C

  4  (Nursing Home Reform), as amended.

  5         (b)  Assist in developing surveyor guidelines and

  6  training to ensure the equitable application of the nursing

  7  home rating system.

  8         (c)  Assist in developing guidelines to determine the

  9  scope and severity of noncompliance.

10         (d)  Identify burdensome paperwork that is not

11  specifically related to resident care.

12         (e)  Advise the agency of proposed changes in statutes

13  and rules necessary to ensure adequate care and services and

14  the promotion and protection of residents' rights in long-term

15  care facilities.

16         (7)(8)  The agency shall, at least every 15 months,

17  evaluate all nursing home facilities and make a determination

18  as to the degree of compliance by each licensee with the

19  established rules adopted under this part as a basis for

20  assigning a licensure status rating to that facility.  The

21  agency shall base its evaluation on the most recent inspection

22  report, taking into consideration findings from other official

23  reports, surveys, interviews, investigations, and inspections.

24  The agency shall assign a licensure status of standard or

25  conditional one of the following ratings to each nursing home:

26  standard, conditional, or superior.

27         (a)  A standard licensure status rating means that a

28  facility has no class I or class II deficiencies, has

29  corrected all class III deficiencies within the time

30  established by the agency, and is in substantial compliance at

31  the time of the survey with criteria established under this

                                  36

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  part, with rules adopted by the agency, and, if applicable,

  2  with rules adopted under the Omnibus Budget Reconciliation Act

  3  of 1987 (Pub. L. No. 100-203) (December 22, 1987), Title IV

  4  (Medicare, Medicaid, and Other Health-Related Programs),

  5  Subtitle C (Nursing Home Reform), as amended.

  6         (b)  A conditional licensure status rating means that a

  7  facility, due to the presence of one or more class I or class

  8  II deficiencies, or class III deficiencies not corrected

  9  within the time established by the agency, is not in

10  substantial compliance at the time of the survey with criteria

11  established under this part, with rules adopted by the agency,

12  or, if applicable, with rules adopted under the Omnibus Budget

13  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,

14  1987), Title IV (Medicare, Medicaid, and Other Health-Related

15  Programs), Subtitle C (Nursing Home Reform), as amended.  If

16  the facility comes into substantial compliance at the time of

17  the followup survey, a standard licensure status rating may be

18  assigned issued.  A facility assigned a conditional rating at

19  the time of the relicensure survey may not qualify for

20  consideration for a superior rating until the time of the next

21  subsequent relicensure survey.

22         (c)  A superior rating means that a facility has no

23  class I or class II deficiencies and has corrected all class

24  III deficiencies within the time established by the agency and

25  is in substantial compliance with the criteria established

26  under this part and the rules adopted by the agency and, if

27  applicable, with rules adopted pursuant to the Omnibus Budget

28  Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,

29  1987), Title IV (Medicare, Medicaid, and Other Health-Related

30  Programs), Subtitle C (Nursing Home Reform), as amended; and

31

                                  37

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  the facility exceeds the criteria for a standard rating

  2  through enhanced programs and services in the following areas:

  3         1.  Nursing service.

  4         2.  Dietary or nutritional services.

  5         3.  Physical environment.

  6         4.  Housekeeping and maintenance.

  7         5.  Restorative therapies and self-help activities.

  8         6.  Social services.

  9         7.  Activities and recreational therapy.

10         (d)  In order to facilitate the development of special

11  programs or facilitywide initiatives and promote creativity

12  based on the needs and preferences of residents, the areas

13  listed in paragraph (c) may be grouped or addressed

14  individually by the licensee.  However, a facility may not

15  qualify for a superior rating if fewer than three programs or

16  initiatives are developed to encompass the required areas.

17         (c)(e)  In determining the rating and evaluating the

18  overall quality of care and services and determining whether

19  the facility will receive a conditional or standard license,

20  the agency shall consider the needs and limitations of

21  residents in the facility and the results of interviews and

22  surveys of a representative sampling of residents, families of

23  residents, ombudsman council members in the district in which

24  the facility is located, guardians of residents, and staff of

25  the nursing home facility.

26         (d)(f)  The current licensure status rating of each

27  facility must be indicated in bold print on the face of the

28  license.  A list of the deficiencies of the facility shall be

29  posted in a prominent place that is in clear and unobstructed

30  public view at or near the place where residents are being

31  admitted to that facility. Licensees receiving a conditional

                                  38

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  licensure status rating for a facility shall prepare, within

  2  10 working days after receiving notice of deficiencies, a plan

  3  for correction of all deficiencies and shall submit the plan

  4  to the agency for approval. Correction of all deficiencies,

  5  within the period approved by the agency, shall result in

  6  termination of the conditional licensure status rating.

  7  Failure to correct the deficiencies within a reasonable period

  8  approved by the agency shall be grounds for the imposition of

  9  sanctions pursuant to this part.

10         (e)(g)  Each licensee shall post its license in a

11  prominent place that is in clear and unobstructed public view

12  at or near the place where residents are being admitted to the

13  facility.  A licensee with a superior rating may advertise its

14  rating in any nonpermanent medium and in accordance with rules

15  adopted by the agency.  A list of the facilities receiving a

16  superior rating shall be distributed to the state and district

17  ombudsman councils.

18         (f)(h)  Not later than January 1, 1994, the agency

19  shall adopt rules that:

20         1.  Establish uniform procedures for the evaluation of

21  facilities.

22         2.  Provide criteria in the areas referenced in

23  paragraph (c).

24         3.  Address other areas necessary for carrying out the

25  intent of this section.

26         (i)  A license rated superior shall continue until it

27  is replaced by a rating based on a later survey.  A superior

28  rating may be revoked at any time for failure to maintain

29  substantial compliance with criteria established under this

30  part, with rules adopted by the agency, or, if applicable,

31  with rules adopted under the Omnibus Budget Reconciliation Act

                                  39

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  of 1987 (Pub. L. No. 100-203) (December 22, 1987), Title IV

  2  (Medicare, Medicaid, and Other Health-Related Programs),

  3  Subtitle C (Nursing Home Reform), as amended, or for failure

  4  to exceed the criteria specified for any area as listed in

  5  paragraph (c).

  6         (j)  A superior rating is not transferable to another

  7  license, except when an existing facility is being relicensed

  8  in the name of an entity related to the current licenseholder

  9  by common ownership or control and there will be no change in

10  the management, operation, or programs at the facility as a

11  result of the relicensure.

12         (8)(9)  The agency shall adopt rules to provide that,

13  when the criteria established under subsection (2) are not

14  met, such deficiencies shall be classified according to the

15  nature of the deficiency.  The agency shall indicate the

16  classification on the face of the notice of deficiencies as

17  follows:

18         (a)  Class I deficiencies are those which the agency

19  determines present an imminent danger to the residents or

20  guests of the nursing home facility or a substantial

21  probability that death or serious physical harm would result

22  therefrom.  The condition or practice constituting a class I

23  violation shall be abated or eliminated immediately, unless a

24  fixed period of time, as determined by the agency, is required

25  for correction. Notwithstanding s. 400.121(2), a class I

26  deficiency is subject to a civil penalty in an amount not less

27  than $5,000 and not exceeding $25,000 $10,000 for each and

28  every deficiency. A fine may be levied notwithstanding the

29  correction of the deficiency.

30         (b)  Class II deficiencies are those which the agency

31  determines have a direct or immediate relationship to the

                                  40

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  health, safety, or security of the nursing home facility

  2  residents, other than class I deficiencies.  A class II

  3  deficiency is subject to a civil penalty in an amount not less

  4  than $1,000 and not exceeding $10,000 $5,000 for each and

  5  every deficiency.  A citation for a class II deficiency shall

  6  specify the time within which the deficiency is required to be

  7  corrected.  If a class II deficiency is corrected within the

  8  time specified, no civil penalty shall be imposed, unless it

  9  is a repeated offense.

10         (c)  Class III deficiencies are those which the agency

11  determines to have an indirect or potential relationship to

12  the health, safety, or security of the nursing home facility

13  residents, other than class I or class II deficiencies.  A

14  class III deficiency shall be subject to a civil penalty of

15  not less than $500 and not exceeding $2,500 $1,000 for each

16  and every deficiency.  A citation for a class III deficiency

17  shall specify the time within which the deficiency is required

18  to be corrected.  If a class III deficiency is corrected

19  within the time specified, no civil penalty shall be imposed,

20  unless it is a repeated offense.

21         (9)(10)  Civil penalties paid by any licensee under

22  subsection (8) (9) shall be deposited in the Health Care Trust

23  Fund and expended as provided in s. 400.063.

24         (13)  This section may not be used to increase the

25  total Medicaid funding paid as incentives for facilities

26  receiving a superior or standard rating.

27         400.232  Review and approval of plans; fees and

28  costs.--

29         (1)(11)  The agency shall approve or disapprove the

30  plans and specifications within 60 days after receipt of the

31  final plans and specifications.  The agency may be granted one

                                  41

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  15-day extension for the review period, if the director of the

  2  agency so approves. If the agency fails to act within the

  3  specified time, it shall be deemed to have approved the plans

  4  and specifications. When the agency disapproves plans and

  5  specifications, it shall set forth in writing the reasons for

  6  disapproval.  Conferences and consultations may be provided as

  7  necessary.

  8         (2)(12)  The agency is authorized to charge an initial

  9  fee of $2,000 for review of plans and construction on all

10  projects, no part of which is refundable.  The agency may also

11  collect a fee, not to exceed 1 percent of the estimated

12  construction cost or the actual cost of review, whichever is

13  less, for the portion of the review which encompasses initial

14  review through the initial revised construction document

15  review.  The agency is further authorized to collect its

16  actual costs on all subsequent portions of the review and

17  construction inspections.  Initial fee payment shall accompany

18  the initial submission of plans and specifications.  Any

19  subsequent payment that is due is payable upon receipt of the

20  invoice from the agency. Notwithstanding any other provisions

21  of law to the contrary, all money received by the agency

22  pursuant to the provisions of this section shall be deemed to

23  be trust funds, to be held and applied solely for the

24  operations required under this section.

25         Section 15.  Section 400.235, Florida Statutes, is

26  created to read:

27         400.235  Nursing home quality and licensure status;

28  Gold Seal Program.--

29         (1)  To protect the health and welfare of persons

30  receiving care in nursing facilities, it is the intent of the

31  Legislature to develop a regulatory framework that promotes

                                  42

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  the stability of the industry and facilitates the physical,

  2  social, and emotional well-being of nursing facility

  3  residents.

  4         (2)  The Legislature intends to develop an award and

  5  recognition program for nursing facilities that demonstrate

  6  excellence in long-term care over a sustained period.  This

  7  program shall be known as the Gold Seal Program.

  8         (3)(a)  The Gold Seal Program shall be developed and

  9  implemented by the Governor's Panel on Excellence in Long-Term

10  Care which shall operate under the authority of the Executive

11  Office of the Governor. The panel shall be composed of three

12  persons appointed by the Governor, to include a consumer

13  advocate for senior citizens and two persons with expertise in

14  the fields of quality management, service delivery excellence,

15  or public sector accountability; three persons appointed by

16  the Secretary of Elderly Affairs, to include an active member

17  of a nursing facility family and resident care council and a

18  member of the University Consortium on Aging; the State

19  Long-Term Care Ombudsman; one person appointed by the Florida

20  Life Care Residents Association; one person appointed by the

21  Secretary of Health; two persons appointed by the Director of

22  Health Care Administration, to include the Deputy Director for

23  State Health Purchasing; one person appointed by the Florida

24  Association of Homes for the Aging; and one person appointed

25  by the Florida Health Care Association. All members of the

26  panel shall be appointed by October 1, 1999, and the panel

27  shall hold its organizational meeting no later than December

28  10, 1999. Vacancies on the panel shall be filled in the same

29  manner as the original appointments. No member shall serve for

30  more than 4 consecutive years from the date of appointment.

31

                                  43

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (b)  Members of the Governor's Panel on Excellence in

  2  Long-Term Care shall be prohibited from having any ownership

  3  interest in a nursing facility. Any member of the panel who is

  4  employed by a nursing facility in any capacity shall be

  5  prohibited from participating in reviewing or voting on

  6  recommendations involving the facility by which the member is

  7  employed or any facility under common ownership with that

  8  facility.

  9         (c)  Recommendations to the panel for designation of a

10  nursing facility as a Gold Seal facility may be received by

11  the panel after January 1, 2000.  The activities of the panel

12  shall be supported by staff of the Department of Elderly

13  Affairs and the Agency for Health Care Administration.

14         (4)  The panel shall consider at least the following

15  resident-based quality indicator domains when evaluating a

16  facility for the Gold Seal Program:

17         (a)  Accidents.

18         (b)  Behavioral/emotional patterns.

19         (c)  Clinical management.

20         (d)  Cognitive patterns.

21         (e)  Elimination/continence.

22         (f)  Infection control.

23         (g)  Nutrition and eating.

24         (h)  Physical functioning.

25         (i)  Psychotropic drug use.

26         (j)  Quality of life.

27         (k)  Sensory functioning and communication.

28         (l)  Skin care.

29         (5)  Facilities must meet the following additional

30  criteria for recognition as a Gold Seal Program facility:

31

                                  44

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (a)  Had no class I or class II deficiencies within the

  2  30 months preceding application for the program.

  3         (b)  Evidence financial soundness and stability

  4  according to standards adopted by the agency in administrative

  5  rule.

  6         (c)  Participate consistently in the required consumer

  7  satisfaction process as prescribed by the agency, and

  8  demonstrate that information is elicited from residents,

  9  family members, and guardians about satisfaction with the

10  nursing facility, its environment, the services and care

11  provided, the staff's skills and interactions with residents,

12  attention to resident's needs, and the facility's efforts to

13  act on information gathered from the consumer satisfaction

14  measures.

15         (d)  Evidence the involvement of families and members

16  of the community in the facility on a regular basis.

17         (e)  Have a stable workforce, as evidenced by a

18  relatively low rate of turnover among certified nursing

19  assistants and registered nurses within the 30 months

20  preceding application for the Gold Seal Program, and

21  demonstrate a continuing effort to maintain a stable workforce

22  and to reduce turnover of licensed nurses and certified

23  nursing assistants.

24         (f)  Evidence an outstanding record regarding the

25  number and types of substantiated complaints reported to the

26  State Long-Term Care Ombudsman Council within the 30 months

27  preceding application for the program.

28         (g)  Provide targeted inservice training provided to

29  meet training needs identified by internal or external quality

30  assurance efforts.

31

                                  45

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (h)  Evidence superior levels of clinical outcomes as

  2  measured in the Minimum Data Set system of the federal Health

  3  Care Financing Administration.  Facilities that are not

  4  certified for Medicare or Medicaid are not required to

  5  complete the Minimum Data Set in order to qualify for the Gold

  6  Seal Program.  Such facilities may demonstrate superior levels

  7  of performance with an alternate assessment as approved by the

  8  panel.

  9

10  A facility assigned a conditional licensure status may not

11  qualify for consideration for the Gold Seal Program until

12  after it has operated for 30 months with no class I or class

13  II deficiencies and has completed a regularly scheduled

14  relicensure survey.

15         (6)  The agency, nursing facility industry

16  organizations, consumers, State Long-Term Care Ombudsman

17  Council, and members of the community may recommend to the

18  Governor facilities that meet the established criteria for

19  consideration for and award of the Gold Seal.  The panel shall

20  review nominees and make a recommendation to the Governor for

21  final approval and award.  The decision of the Governor is

22  final and is not subject to appeal.

23         (7)  A facility must be licensed and operating for 30

24  months before it is eligible to apply for the Gold Seal

25  Program. The agency shall establish by rule the frequency of

26  review for designation as a Gold Seal Program facility and

27  under what circumstances a facility may be denied the

28  privilege of using this designation.  The designation of a

29  facility as a Gold Seal Program facility is not transferable

30  to another license, except when an existing facility is being

31  relicensed in the name of an entity related to the current

                                  46

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  licenseholder by common ownership or control, and there will

  2  be no change in the management, operation, or programs at the

  3  facility as a result of the relicensure.

  4         (8)(a)  Facilities awarded the Gold Seal may use the

  5  designation in their advertising and marketing.

  6         (b)  Upon approval by the United States Department of

  7  Health and Human Services, the agency shall adopt a revised

  8  schedule of survey and relicensure visits for Gold Seal

  9  Program facilities.  Gold Seal Program facilities may be

10  surveyed for certification and relicensure every 2 years, so

11  long as they maintain the standards associated with retaining

12  the Gold Seal.

13         Section 16.  Subsection (3) of section 400.241, Florida

14  Statutes, is renumbered as subsection (4), and a new

15  subsection (3) is added to said section, to read:

16         400.241  Prohibited acts; penalties for violations.--

17         (3)  It is unlawful for any person, long-term care

18  facility, or other entity to willfully interfere with the

19  unannounced inspections mandated by s. 400.19(3). Alerting or

20  advising a facility of the actual or approximate date of such

21  inspection shall be a per se violation of this subsection.

22         (4)(3)  A violation of any provision of this part or of

23  any minimum standard, rule, or regulation adopted pursuant

24  thereto constitutes a misdemeanor of the second degree,

25  punishable as provided in s. 775.082 or s. 775.083.  Each day

26  of a continuing violation shall be considered a separate

27  offense.

28         Section 17.  Paragraph (p) is added to subsection (1)

29  of section 408.035, Florida Statutes, to read:

30         408.035  Review criteria.--

31

                                  47

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (1)  The agency shall determine the reviewability of

  2  applications and shall review applications for

  3  certificate-of-need determinations for health care facilities

  4  and health services in context with the following criteria:

  5         (p)  The applicant's designation as a Gold Seal Program

  6  nursing facility pursuant to s. 400.235, when the applicant is

  7  requesting additional nursing home beds at that facility.

  8         Section 18.  Subsection (1) of section 468.1755,

  9  Florida Statutes, 1998 Supplement, is amended to read:

10         468.1755  Disciplinary proceedings.--

11         (1)  The following acts shall constitute grounds for

12  which the disciplinary actions in subsection (2) may be taken:

13         (a)  Violation of any provision of s. 455.624(1) or s.

14  468.1745(1).

15         (b)  Attempting to procure a license to practice

16  nursing home administration by bribery, by fraudulent

17  misrepresentation, or through an error of the department or

18  the board.

19         (c)  Having a license to practice nursing home

20  administration revoked, suspended, or otherwise acted against,

21  including the denial of licensure, by the licensing authority

22  of another state, territory, or country.

23         (d)  Being convicted or found guilty, regardless of

24  adjudication, of a crime in any jurisdiction which relates to

25  the practice of nursing home administration or the ability to

26  practice nursing home administration.  Any plea of nolo

27  contendere shall be considered a conviction for purposes of

28  this part.

29         (e)  Making or filing a report or record which the

30  licensee knows to be false, intentionally failing to file a

31  report or record required by state or federal law, willfully

                                  48

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  impeding or obstructing such filing, or inducing another

  2  person to impede or obstruct such filing.  Such reports or

  3  records shall include only those which are signed in the

  4  capacity of a licensed nursing home administrator.

  5         (f)  Authorizing the discharge or transfer of a

  6  resident for a reason other than those provided in ss. 400.022

  7  and 400.0255.

  8         (g)(f)  Advertising goods or services in a manner which

  9  is fraudulent, false, deceptive, or misleading in form or

10  content.

11         (h)(g)  Fraud or deceit, negligence, incompetence, or

12  misconduct in the practice of nursing home administration.

13         (i)(h)  A violation or repeated violations of this

14  part, part II of chapter 455, or any rules promulgated

15  pursuant thereto.

16         (j)(i)  Violation of a lawful order of the board or

17  department previously entered in a disciplinary hearing or

18  failing to comply with a lawfully issued subpoena of the board

19  or department.

20         (k)(j)  Practicing with a revoked, suspended, inactive,

21  or delinquent license.

22         (l)(k)  Repeatedly acting in a manner inconsistent with

23  the health, safety, or welfare of the patients of the facility

24  in which he or she is the administrator.

25         (m)(l)  Being unable to practice nursing home

26  administration with reasonable skill and safety to patients by

27  reason of illness, drunkenness, use of drugs, narcotics,

28  chemicals, or any other material or substance or as a result

29  of any mental or physical condition.  In enforcing this

30  paragraph, upon a finding of the secretary or his or her

31  designee that probable cause exists to believe that the

                                  49

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  licensee is unable to serve as a nursing home administrator

  2  due to the reasons stated in this paragraph, the department

  3  shall have the authority to issue an order to compel the

  4  licensee to submit to a mental or physical examination by a

  5  physician designated by the department. If the licensee

  6  refuses to comply with such order, the department's order

  7  directing such examination may be enforced by filing a

  8  petition for enforcement in the circuit court where the

  9  licensee resides or serves as a nursing home administrator.

10  The licensee against whom the petition is filed shall not be

11  named or identified by initials in any public court records or

12  documents and the proceedings shall be closed to the public.

13  The department shall be entitled to the summary procedure

14  provided in s. 51.011.  A licensee affected under this

15  paragraph shall have the opportunity, at reasonable intervals,

16  to demonstrate that he or she can resume the competent

17  practice of nursing home administration with reasonable skill

18  and safety to patients.

19         (n)(m)  Has Willfully or repeatedly violating violated

20  any of the provisions of the law, code or rules of the

21  licensing or supervising authority or agency of the state or

22  political subdivision thereof having jurisdiction of the

23  operation and licensing of nursing homes.

24         (o)(n)  Paying, giving, causing Has paid, given, caused

25  to be paid or given, or offering offered to pay or to give to

26  any person a commission or other valuable consideration for

27  the solicitation or procurement, either directly or

28  indirectly, of nursing home usage.

29         (p)(o)  Has Willfully permitting permitted unauthorized

30  disclosure of information relating to a patient or his or her

31  records.

                                  50

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (q)(p)  Discriminating with Has discriminated in

  2  respect to patients, employees, or staff on account of race,

  3  religion, color, sex, or national origin.

  4         Section 19.  Paragraph (b) of subsection (1) of section

  5  394.4625, Florida Statutes, is amended to read:

  6         394.4625  Voluntary admissions.--

  7         (1)  AUTHORITY TO RECEIVE PATIENTS.--

  8         (b)  A mental health overlay program or a mobile crisis

  9  response service or a licensed professional who is authorized

10  to initiate an involuntary examination pursuant to s. 394.463

11  and is employed by a community mental health center or clinic

12  must, pursuant to district procedure approved by the

13  respective district administrator, conduct an initial

14  assessment of the ability of the following persons to give

15  express and informed consent to treatment before such persons

16  may be admitted voluntarily:

17         1.  A person 60 years of age or older for whom transfer

18  is being sought from a nursing home, assisted living facility,

19  adult day care center, or adult family-care home, when such

20  person has been diagnosed as suffering from dementia.

21         2.  A person 60 years of age or older for whom transfer

22  is being sought from a nursing home pursuant to s.

23  400.0255(12) s. 400.0255(6).

24         3.  A person for whom all decisions concerning medical

25  treatment are currently being lawfully made by the health care

26  surrogate or proxy designated under chapter 765.

27         Section 20.  Subsection (1) of section 400.063, Florida

28  Statutes, is amended to read:

29         400.063  Resident Protection Trust Fund.--

30         (1)  A Resident Protection Trust Fund shall be

31  established for the purpose of collecting and disbursing funds

                                  51

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  generated from the license fees and administrative fines as

  2  provided for in ss. 393.0673(2), 400.062(3)(b), 400.111(1),

  3  400.121(2), and 400.23(8)(9).  Such funds shall be for the

  4  sole purpose of paying for the appropriate alternate

  5  placement, care, and treatment of residents who are removed

  6  from a facility licensed under this part or a facility

  7  specified in s. 393.0678(1) in which the agency determines

  8  that existing conditions or practices constitute an immediate

  9  danger to the health, safety, or security of the residents.

10  If the agency determines that it is in the best interest of

11  the health, safety, or security of the residents to provide

12  for an orderly removal of the residents from the facility, the

13  agency may utilize such funds to maintain and care for the

14  residents in the facility pending removal and alternative

15  placement.  The maintenance and care of the residents shall be

16  under the direction and control of a receiver appointed

17  pursuant to s. 393.0678(1) or s. 400.126(1).  However, funds

18  may be expended in an emergency upon a filing of a petition

19  for a receiver, upon the declaration of a state of local

20  emergency pursuant to s. 252.38(3)(a)5., or upon a duly

21  authorized local order of evacuation of a facility by

22  emergency personnel to protect the health and safety of the

23  residents.

24         Section 21.  Section 430.80, Florida Statutes, is

25  created to read:

26         430.80  Implementation of a teaching nursing home pilot

27  project.--

28         (1)  As used in this section, the term "teaching

29  nursing home" means a nursing home facility licensed under

30  chapter 400 which contains a minimum of 400 licensed nursing

31  home beds; has access to a resident senior population of

                                  52

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  sufficient size to support education, training, and research

  2  relating to geriatric care; and has a contractual relationship

  3  with a federally funded accredited geriatric research center

  4  in this state.

  5         (2)(a)  The Agency for Health Care Administration shall

  6  implement a comprehensive multidisciplinary program of

  7  geriatric education and research as a pilot project in a

  8  nursing home facility designated by the agency as a teaching

  9  nursing home. The program shall be established as a pilot

10  project and shall be administered at the nursing home facility

11  and other appropriate settings.

12         (b)  The agency shall develop criteria for designating

13  teaching nursing homes in consultation with advocates of the

14  elderly, advocates of persons with disabilities,

15  representatives of the nursing home industry, and

16  representatives of the State University System.

17         (3)  To be designated as a teaching nursing home, a

18  nursing home licensee must, at a minimum:

19         (a)  Provide a comprehensive program of integrated

20  senior services that include institutional services and

21  community-based services;

22         (b)  Participate in a nationally recognized

23  accreditation program and hold a valid accreditation, such as

24  the accreditation awarded by the Joint Commission on

25  Accreditation of Healthcare Organizations;

26         (c)  Have been in business in this state for a minimum

27  of 10 consecutive years;

28         (d)  Demonstrate an active program in multidisciplinary

29  education and research that relates to gerontology;

30

31

                                  53

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (e)  Have a formalized contractual relationship with at

  2  least one accredited health profession education program

  3  located in this state;

  4         (f)  Have a formalized contractual relationship with an

  5  accredited hospital that is designated by law as a teaching

  6  hospital; and

  7         (g)  Have senior staff members who hold formal faculty

  8  appointments at universities, which must include at least one

  9  accredited health profession education program.

10         (4)  A teaching nursing home may be affiliated with a

11  medical school within the state and a federally funded center

12  of excellence in geriatric research and education. The purpose

13  of such affiliations is to foster the development of methods

14  for improving and expanding the capability of health care

15  facilities to respond to the medical, psychological, and

16  social needs of frail and elderly persons by providing the

17  most effective and appropriate services. A teaching nursing

18  home shall serve as a resource for research and for training

19  health care professionals in providing health care services in

20  institutional settings to frail and older persons.

21         (5)  The Legislature may provide an annual

22  appropriation to the nursing home facility designated as a

23  teaching nursing home.

24         (6)  In order for a nursing home to qualify as a

25  teaching nursing home under this section and to be entitled to

26  the benefits provided under this section, the nursing home

27  must:

28         (a)  Be primarily operated and established to offer,

29  afford, and render a comprehensive multidisciplinary program

30  of geriatric education and research to residents of the state;

31  and

                                  54

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (b)  Certify to the Agency for Health Care

  2  Administration each school year the name, address, and

  3  educational history of each trainee approved and accepted for

  4  enrollment in the institution.

  5         (7)  A teaching nursing home may not expend any of the

  6  funds received under this section for any purpose other than

  7  operating and maintaining a teaching nursing home and

  8  conducting geriatric research. In addition, a teaching nursing

  9  home may not expend any funds received under this section for

10  constructing any building of any kind, nature, or description

11  or for maintaining or operating, in any form or manner, a

12  nursing home or health care facility.

13         Section 22.  For purposes of incorporating the

14  amendment to section 468.1755, Florida Statutes, in references

15  thereto, subsection (3) of section 468.1695, Florida Statutes,

16  and section 468.1735, Florida Statutes, are reenacted to read:

17         468.1695  Licensure by examination.--

18         (3)  The department shall issue a license to practice

19  nursing home administration to any applicant who successfully

20  completes the examination in accordance with this section and

21  otherwise meets the requirements of this part.  The department

22  shall not issue a license to any applicant who is under

23  investigation in this state or another jurisdiction for an

24  offense which would constitute a violation of s. 468.1745 or

25  s. 468.1755. Upon completion of the investigation, the

26  provisions of s. 468.1755 shall apply.

27         468.1735  Provisional license.--The board may establish

28  by rule requirements for issuance of a provisional license.  A

29  provisional license shall be issued only to fill a position of

30  nursing home administrator that unexpectedly becomes vacant

31  due to illness, sudden death of the administrator, or

                                  55

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  abandonment of position and shall be issued for one single

  2  period as provided by rule not to exceed 6 months.  The

  3  department shall not issue a provisional license to any

  4  applicant who is under investigation in this state or another

  5  jurisdiction for an offense which would constitute a violation

  6  of s. 468.1745 or s. 468.1755. Upon completion of the

  7  investigation, the provisions of s. 468.1755 shall apply.  The

  8  provisional license may be issued to a person who does not

  9  meet all of the licensing requirements established by this

10  part, but the board shall by rule establish minimal

11  requirements to ensure protection of the public health,

12  safety, and welfare.  The provisional license shall be issued

13  to the person who is designated as the responsible person next

14  in command in the event of the administrator's departure.  The

15  board may set an application fee not to exceed $500 for a

16  provisional license.

17         Section 23.  Section 468.1756, Florida Statutes, 1998

18  Supplement, is amended to read:

19         468.1756  Statute of limitations.--An administrative

20  complaint may only be filed pursuant to s. 455.621 for an act

21  listed in s. 468.1755(1)(c)-(q) paragraphs (1)(c)-(p) of s.

22  468.1755 within 4 years from the time of the incident giving

23  rise to the complaint, or within 4 years from the time the

24  incident is discovered or should have been discovered.

25         Section 24.  Panel on Medicaid reimbursement.--

26         (1)  There is created a panel on Medicaid reimbursement

27  to study the state's Medicaid reimbursement plan for nursing

28  home facilities and recommend changes to accomplish the

29  following goals:

30         (a)  Increase the rate of employee retention in

31  individual nursing home facilities and in the field of

                                  56

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  long-term care, and ensure salary enhancements for staff who

  2  achieve targets of longevity with a nursing home facility.

  3         (b)  Create incentives for facilities to renovate and

  4  update existing physical plants, when practicable, instead of

  5  building new facilities or selling to another entity.

  6         (c)  Create incentives for facilities to provide more

  7  direct-care staff and nurses.

  8         (2)  The panel shall be administratively attached to

  9  and supported by the Agency for Health Care Administration and

10  shall be composed of the following members: the Director for

11  Medicaid of the Agency for Health Care Administration and two

12  agency staff persons competent in the technical and policy

13  aspects of Medicaid reimbursement; one representative from the

14  Governor's Office of Planning and Budgeting; one

15  representative from the Florida Association of Homes for the

16  Aging; one representative from the Florida Health Care

17  Association; one representative from the Department of Elderly

18  Affairs, and one consumer representative appointed by the

19  secretary of that department; and a consumer's advocate for

20  senior citizens and two persons with expertise in the field of

21  quality management, financing, or public sector

22  accountability, appointed by the Governor.

23         (3)  The panel shall hold its first meeting by August

24  1, 1999, and shall report its preliminary findings and

25  recommendations to the Legislature no later than December 31,

26  1999, by submitting a copy of its report to the President of

27  the Senate, the Speaker of the House of Representatives, and

28  the majority and minority offices of each chamber. The panel

29  shall report its final findings and recommendations to those

30  persons and offices no later than December 8, 2000. The panel

31

                                  57

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  shall cease to exist and its operation shall terminate on

  2  January 1, 2001.

  3         Section 25.  Study of certified nursing assistant

  4  training, employment, and retention.--The Department of

  5  Elderly Affairs, in consultation with the nursing home

  6  industry, consumer advocates, the Department of Health, the

  7  Agency for Health Care Administration, the Department of Labor

  8  and Employment Security, and the Department of Education,

  9  shall conduct, or contract for, a study of the major factors

10  affecting the recruitment, training, employment, and retention

11  of qualified certified nursing assistants within the nursing

12  home industry. The Department of Elderly Affairs shall, by

13  January 15, 2000, provide to the Speaker of the House of

14  Representatives and the President of the Senate the results of

15  the study, along with recommendations to improve the quality

16  and availability of certified nursing assistants employed by

17  nursing facilities. The study shall include a one-time review

18  of the performance of certified nursing assistant training

19  programs and shall compare the types of training programs as

20  to admission criteria, program requirements, graduation rates,

21  job placement, and job retention in nursing homes relative to

22  job retention in other health care environments and other job

23  classifications for which certified nursing assistants may

24  qualify. The study shall identify factors likely to improve

25  the rates of employment and retention of certified nursing

26  assistants in nursing homes. The study shall also include an

27  assessment of the extent and impact of certified nursing

28  assistant shortages within the major regional job markets of

29  the state. The study shall include an assessment of the

30  following factors:

31

                                  58

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1         (1)  The extent and characteristics of the shortage

  2  within the various regions of the state.

  3         (2)  The causes of the shortage, including, but not

  4  restricted to, salary and benefits, working conditions, career

  5  development, and the availability of certified nursing

  6  assistant training programs.

  7         (3)  The impact of labor shortages on the ability of

  8  nursing homes to hire sufficient staff to meet both the

  9  minimum staffing standards required by agency rule and the

10  facility-specific staffing standards based on the needs of

11  residents.

12         (4)  The impact of the labor shortage on the increased

13  use of temporary nursing pool agencies by nursing homes; the

14  influences of this trend on the quality and cost of services

15  provided; and the benefits of additional regulation of such

16  nursing pool agencies in light of the shortage.

17         (5)  Comparisons of the extent and effect of the

18  shortage of certified nursing assistants in Florida to the

19  experiences of other states and with respect to national

20  trends.

21         (6)  The need for and feasibility of various measures

22  to enhance the image of certified nursing assistants,

23  including enhanced recruitment efforts directed towards

24  students at the junior high school and senior high school

25  levels, local education outreach, and job placement programs.

26         (7)  The implications of the shortage as it relates to

27  the supply of and need for related paraprofessionals and other

28  health care workers, such as licensed practical nurses.

29         (8)  The feasibility of allocating loans, grants, and

30  scholarships for the purpose of providing greater incentive

31

                                  59

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1  for and access to certified nursing assistant education, and

  2  the probable effects of such efforts.

  3         (9)  The desirability of demonstration projects to test

  4  innovative models and methods for the purpose of addressing

  5  the need for more and better-qualified certified nursing

  6  assistants in nursing homes.

  7         Section 26.  Section 400.29, Florida Statutes, is

  8  repealed.

  9         Section 27.  There is hereby appropriated, unless

10  otherwise provided for in the General Appropriations Act, the

11  sum of $18,422,000 from the General Revenue Fund and the sum

12  of $23,275,600 from the Medical Care Trust Fund to the Agency

13  for Health Care Administration in order to allow nursing

14  facilities the ability to recruit and retain qualified staff

15  and to provide appropriate care. The Agency for Health Care

16  Administration shall adjust target limitations in the patient

17  care component of the per diem rate to allow these additional

18  funds to be reimbursed through the per diem rate, effective

19  July 1, 1999.

20         Section 28.  The sum of $100,000 is hereby appropriated

21  from the Health Care Trust Fund to the Department of Elderly

22  Affairs for fiscal year 1999-2000 to fund the responsibilities

23  of the Office of State Long-Term Care Ombudsman and establish

24  a statewide toll-free telephone number pursuant to s.

25  400.0078, Florida Statutes, as created by this act.

26         Section 29.  Except as otherwise provided herein, this

27  act shall take effect July 1, 1999.

28

29

30

31

                                  60

CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1999                HB 1971

    173-960C-99






  1            *****************************************

  2                          HOUSE SUMMARY

  3
      Revises various provisions of part II of chapter 400,
  4    F.S., relating to nursing home facilities.

  5

  6

  7

  8

  9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

                                  61