House Bill 1971er
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1
2 An act relating to nursing home facilities;
3 amending s. 430.502, F.S.; establishing an
4 additional memory disorder clinic; authorizing
5 the Department of Elder Affairs and the
6 Department of Children and Families to initiate
7 certain projects; creating s. 400.0078, F.S.;
8 requiring the Office of State Long-Term Care
9 Ombudsman to establish a statewide toll-free
10 telephone number; amending s. 400.022, F.S.;
11 providing immediate access to residents for
12 representatives of the Office of the Attorney
13 General; creating s. 400.0225, F.S.; directing
14 the Agency for Health Care Administration to
15 contract for consumer satisfaction surveys for
16 nursing home residents; providing procedures
17 and requirements for use of such surveys;
18 amending s. 400.0255, F.S.; defining terms
19 relating to facility decisions to transfer or
20 discharge a resident; providing procedures,
21 requirements, and limitations; requiring notice
22 to the agency under certain circumstances;
23 providing for review of a notice of discharge
24 or transfer by the district long-term care
25 ombudsman, upon request; specifying timeframes;
26 amending s. 400.071, F.S.; providing additional
27 requirements for licensure and renewal;
28 providing a certificate-of-need preference for
29 Gold Seal licensees; creating s. 400.118, F.S.;
30 directing the agency to establish a quality
31 assurance early warning system; providing for
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1 quality-of-care monitoring; providing duties of
2 monitors; excluding certain information from
3 discovery or introduction in evidence in civil
4 or administrative actions; providing for rapid
5 response teams; amending s. 400.121, F.S.;
6 authorizing the agency to require certain
7 facilities to increase staffing; authorizing
8 such facilities to request an expedited interim
9 rate increase; providing a penalty; amending s.
10 400.141, F.S.; providing requirements for
11 appointment of a medical director; providing
12 for resident use of a community pharmacy and
13 for certain repackaging of prescription
14 medication; providing for immunity from
15 liability in the administration of repackaged
16 medication; revising conditions for encouraging
17 facilities to provide other needed services;
18 requiring public display of certain assistance
19 information; authorizing Gold Seal facilities
20 to develop programs to provide certified
21 nursing assistant training; amending s.
22 400.162, F.S.; revising procedures and policies
23 regarding the safekeeping of residents'
24 property; amending s. 400.19, F.S., relating to
25 the agency's right of entry and inspection;
26 providing a time period for investigation of
27 certain complaints; amending s. 400.191, F.S.;
28 revising requirements for provision of
29 information to the public by the agency;
30 amending s. 400.215, F.S.; specifying
31 conditions for probationary employment of
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1 applicants, pending results of an abuse
2 registry screening; requiring the agency to
3 provide a direct-access screening system;
4 amending s. 400.23, F.S.; abolishing the
5 Nursing Home Advisory Committee; revising the
6 system for evaluating facility compliance with
7 licensure requirements; eliminating ratings and
8 providing for standard or conditional licensure
9 status; directing the agency to adopt rules to
10 provide minimum staffing requirements for
11 nursing homes and to allow certain staff to
12 assist residents with eating; increasing the
13 maximum penalties for deficiencies in facility
14 operations; creating s. 400.235, F.S.;
15 providing for development of a Gold Seal
16 Program for recognition of facilities
17 demonstrating excellence in long-term care;
18 establishing a Panel on Excellence in Long-Term
19 Care under the Executive Office of the
20 Governor; providing membership; providing
21 program criteria; providing for duties of the
22 panel and the Governor; providing for agency
23 rules; providing for biennial relicensure of
24 Gold Seal Program facilities, under certain
25 conditions; amending s. 400.241, F.S.;
26 prohibiting willful interference with an
27 unannounced inspection; providing a penalty;
28 amending s. 408.035, F.S.; providing
29 certificate-of-need review criteria for Gold
30 Seal facilities; creating s. 430.80, F.S.;
31 requiring that the Agency for Health Care
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1 Administration implement a pilot project for
2 establishing teaching nursing homes; specifying
3 requirements for a nursing home facility to be
4 designated as a teaching nursing home;
5 requiring that the agency develop additional
6 criteria; authorizing a teaching nursing home
7 to be affiliated with a medical school within
8 the State University System; providing for
9 annual appropriations to a teaching nursing
10 home; providing certain limitations on the
11 expenditure of funds by a teaching nursing
12 home; amending s. 468.1755, F.S.; providing for
13 disciplinary action against a nursing home
14 administrator who authorizes discharge or
15 transfer of a resident for a reason other than
16 provided by law; amending ss. 394.4625,
17 400.063, and 468.1756, F.S.; correcting cross
18 references; reenacting ss. 468.1695(3) and
19 468.1735, F.S.; incorporating the amendment to
20 s. 468.1755, F.S., in references thereto;
21 providing for funding for recruitment of
22 qualified nursing facility staff; creating a
23 panel on Medicaid reimbursement; providing
24 membership and duties; requiring reports;
25 providing for expiration; requiring a study of
26 factors affecting recruitment, training,
27 employment, and retention of qualified
28 certified nursing assistants; requiring a
29 report; repealing s. 400.29, F.S., relating to
30 an agency annual report of nursing home
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1 facilities; providing appropriations; providing
2 effective dates.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Paragraphs (i) and (j) of subsection (1) of
7 section 430.502, Florida Statutes, 1998 Supplement, are
8 amended and paragraph (k) is added to said subsection, to
9 read:
10 430.502 Alzheimer's disease; memory disorder clinics
11 and day care and respite care programs.--
12 (1) There is established:
13 (i) A memory disorder clinic at the Tallahassee
14 Memorial Regional Medical Center; and
15 (j) A memory disorder clinic at Lee Memorial Hospital
16 created by chapter 63-1552, Laws of Florida, as amended; and,
17 (k) A memory disorder clinic at Sarasota Memorial
18 Hospital in Sarasota County,
19
20 for the purpose of conducting research and training in a
21 diagnostic and therapeutic setting for persons suffering from
22 Alzheimer's disease and related memory disorders. However,
23 memory disorder clinics funded as of June 30, 1995, shall not
24 receive decreased funding due solely to subsequent additions
25 of memory disorder clinics in this subsection.
26 Section 2. The Department of Elder Affairs is
27 authorized to initiate projects to demonstrate the
28 effectiveness of comprehensive day treatment services to
29 seniors as a diversion from nursing home care thereby allowing
30 seniors to remain in their homes.
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1 Section 3. The Department of Children and Families is
2 authorized to initiate projects to demonstrate the
3 effectiveness of comprehensive day treatment service to the
4 developmentally disabled to remain in their homes and/or
5 communities.
6 Section 4. Section 400.0078, Florida Statutes, is
7 created to read:
8 400.0078 Statewide toll-free telephone number.--The
9 Office of State Long-Term Care Ombudsman shall establish a
10 statewide toll-free telephone number for receiving complaints
11 concerning nursing facilities.
12 Section 5. Paragraph (c) of subsection (1) of section
13 400.022, Florida Statutes, is amended to read:
14 400.022 Residents' rights.--
15 (1) All licensees of nursing home facilities shall
16 adopt and make public a statement of the rights and
17 responsibilities of the residents of such facilities and shall
18 treat such residents in accordance with the provisions of that
19 statement. The statement shall assure each resident the
20 following:
21 (c) Any entity or individual that provides health,
22 social, legal, or other services to a resident has the right
23 to have reasonable access to the resident. The resident has
24 the right to deny or withdraw consent to access at any time by
25 any entity or individual. Notwithstanding the visiting policy
26 of the facility, the following individuals must be permitted
27 immediate access to the resident:
28 1. Any representative of the federal or state
29 government, including, but not limited to, representatives of
30 the Department of Children and Family Health and
31 Rehabilitative Services, the Department of Health, the Agency
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1 for Health Care Administration, the Office of the Attorney
2 General, and the Department of Elderly Affairs; any law
3 enforcement officer; members of the state or district
4 ombudsman council; and the resident's individual physician.
5 2. Subject to the resident's right to deny or withdraw
6 consent, immediate family or other relatives of the resident.
7
8 The facility must allow representatives of the State Nursing
9 Home and Long-Term Care Facility Ombudsman Council to examine
10 a resident's clinical records with the permission of the
11 resident or the resident's legal representative and consistent
12 with state law.
13 Section 6. Section 400.0225, Florida Statutes, is
14 created to read:
15 400.0225 Consumer satisfaction surveys.--The agency,
16 or its contractor, in consultation with the nursing home
17 industry and consumer representatives, shall develop an
18 easy-to-use consumer satisfaction survey, shall ensure that
19 every nursing facility licensed pursuant to this part
20 participates in assessing consumer satisfaction, and shall
21 establish procedures to ensure that, at least annually, a
22 representative sample of residents of each facility is
23 selected to participate in the survey. The sample shall be of
24 sufficient size to allow comparisons between and among
25 facilities. Family members, guardians, or other resident
26 designees may assist the resident in completing the survey.
27 Employees and volunteers of the nursing facility or of a
28 corporation or business entity with an ownership interest in
29 the facility are prohibited from assisting a resident with or
30 attempting to influence a resident's responses to the consumer
31 satisfaction survey. The agency, or its contractor, shall
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1 survey family members, guardians, or other resident designees
2 when the resident is mentally incapable of responding to the
3 survey. The agency, or its contractor, shall specify the
4 protocol for conducting and reporting the consumer
5 satisfaction surveys. Reports of consumer satisfaction surveys
6 shall protect the identity of individual respondents. The
7 agency shall contract for consumer satisfaction surveys and
8 report the results of those surveys in the consumer
9 information materials prepared and distributed by the agency.
10 Section 7. Section 400.0231, Florida Statutes, is
11 renumbered as section 400.1415, Florida Statutes.
12 Section 8. Section 400.0255, Florida Statutes, is
13 amended to read:
14 400.0255 Resident hearings of facility decisions to
15 transfer or discharge; requirements and procedures;
16 hearings.--
17 (1) As used in this section, the term:
18 (a) "Discharge" means to move a resident to a
19 noninstitutional setting when the releasing facility ceases to
20 be responsible for the resident's care.
21 (b) "Transfer" means to move a resident from the
22 facility to another legally responsible institutional setting.
23 "discharge" or "transfer" means the movement of a resident to
24 a bed outside the certified facility. "Discharge" or
25 "transfer" does not refer to the movement of a resident to a
26 bed within the same certified facility.
27 (2) Each facility licensed under this part must comply
28 with subsection (10) and s. 400.022(1)(p) when deciding to
29 discharge or transfer a resident.
30 (3) When a resident is to be discharged or
31 transferred, the nursing home administrator employed by the
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1 nursing home that is discharging or transferring the resident,
2 or an individual employed by the nursing home who is
3 designated by the nursing home administrator to act on behalf
4 of the administrator, must sign the notice of discharge or
5 transfer. Any notice indicating a medical reason for transfer
6 or discharge must be signed by the resident's attending
7 physician or the medical director of the facility.
8 (4)(a) Each facility must notify the agency of any
9 proposed discharge or transfer of a resident when such
10 discharge or transfer is necessitated by changes in the
11 physical plant of the facility that make the facility unsafe
12 for the resident.
13 (b) Upon receipt of such a notice, the agency shall
14 conduct an onsite inspection of the facility to verify the
15 necessity of the discharge or transfer.
16 (5)(2) A resident of any Medicaid or Medicare
17 certified facility may challenge a decision by the facility to
18 discharge or transfer the resident.
19 (7) A facility that has been reimbursed for reserving
20 a bed and, for reasons other than those permitted under this
21 section, refuses to readmit a resident within the prescribed
22 timeframe shall refund the bed reservation payment.
23 (8)(3) At least 30 days prior to any proposed transfer
24 or discharge, a facility must provide advance notice of the
25 proposed transfer or discharge to the resident and, if known,
26 to a family member or the resident's legal guardian or
27 representative, except, in the following circumstances, the
28 facility shall give notice as soon as practicable before the
29 transfer or discharge:
30 (a) The transfer or discharge is necessary for the
31 resident's welfare and the resident's needs cannot be met in
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1 the facility, and the circumstances are documented in the
2 resident's medical records by the resident's physician; or
3 (b) The health or safety of other residents or
4 facility employees would be endangered, and the circumstances
5 are documented in the resident's medical records by the
6 resident's physician or the medical director if the resident's
7 physician is not available.
8 (9)(4) The notice required by subsection (8)(3) must
9 be in writing and must contain all information required by
10 state and federal law, rules, or regulations applicable to
11 Medicaid or Medicare cases. The agency shall develop a
12 standard document to be used by all facilities licensed under
13 this part for purposes of notifying residents of a discharge
14 or transfer. Such document must include a means for a resident
15 to request the district long-term care ombudsman council to
16 review the notice and request information about or assistance
17 with initiating a fair hearing with the department's Office of
18 Appeals Hearings. In addition to any other pertinent
19 information included, the form shall specify the reason
20 allowed under federal or state law that the resident is being
21 discharged or transferred, with an explanation to support this
22 action. Further, the form shall state the effective date of
23 the discharge or transfer and the location to which the
24 resident is being discharged or transferred. The form shall
25 clearly describe the resident's appeal rights and the
26 procedures for filing an appeal, including the right to
27 request the district ombudsman council to review the notice of
28 discharge or transfer. A copy of the notice must be placed in
29 the resident's clinical record, and a copy must be transmitted
30 to the resident's legal guardian or representative and to the
31 local district ombudsman council.
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1 (10) A resident may request that the district
2 ombudsman council review any notice of discharge or transfer
3 given to the resident. When requested by a resident to review
4 a notice of discharge or transfer, the district ombudsman
5 council shall do so within 7 days after receipt of the
6 request. The nursing home administrator, or the
7 administrator's designee, must forward the request for review
8 contained in the notice to the district ombudsman council
9 within 24 hours after such request is submitted. Failure to
10 forward the request within 24 hours after the request is
11 submitted shall toll the running of the 30-day advance notice
12 period until the request has been forwarded.
13 (11)(5)(a) A resident is entitled to a fair hearing to
14 challenge a facility's proposed transfer or discharge. The
15 resident, or the resident's legal representative or designee,
16 may request a hearing at any time within 90 days after of the
17 resident's receipt of the facility's notice of the proposed
18 discharge or transfer.
19 (b) If a resident requests a hearing within 10 days
20 after of receiving the notice from the facility, the request
21 shall stay the proposed transfer or discharge pending a
22 hearing decision. The facility may not take action, and the
23 resident may remain in the facility, until the outcome of the
24 initial fair hearing, which must be completed within 90 days
25 after of receipt of a request for a fair hearing.
26 (c) If the resident fails to request a hearing within
27 10 days after of receipt of the facility notice of the
28 proposed discharge or transfer, the facility may transfer or
29 discharge the resident after 30 days from the date the
30 resident received the notice.
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1 (12)(6) Notwithstanding paragraph (11)(b) (5)(b), an
2 emergency discharge or transfer may be implemented as
3 necessary pursuant to state or federal law during the period
4 of time after the notice is given and before the time a
5 hearing decision is rendered. Notice of an emergency discharge
6 or transfer to the resident, the resident's legal guardian or
7 representative, and the district ombudsman council if
8 requested pursuant to subsection (10) must be by telephone or
9 in person. This notice shall be given before the transfer, if
10 possible, or as soon thereafter as practicable. A district
11 ombudsman council conducting a review under this subsection
12 shall do so within 24 hours after receipt of the request. The
13 resident's file must be documented to show who was contacted,
14 whether the contact was by telephone or in person, and the
15 date and time of the contact. If the notice is not given in
16 writing, written notice meeting the requirements of subsection
17 (9) (4) must be given the next working day.
18 (13) After receipt of any notice required under this
19 section, the district ombudsman council may request a private
20 informal conversation with a resident to whom the notice is
21 directed, and, if known, a family member or the resident's
22 legal guardian or designee, to ensure that the facility is
23 proceeding with the discharge or transfer in accordance with
24 the requirements of this section. If requested, the district
25 ombudsman council shall assist the resident with filing an
26 appeal of the proposed discharge or transfer.
27 (14)(7) The following persons must be present at all
28 hearings proceedings authorized under this section:
29 (a) The resident, or the resident's legal
30 representative or designee.
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1 (b) The facility administrator, or the facility's
2 legal representative or designee.
3
4 A representative of the district long-term care ombudsman
5 council may be present at all hearings proceedings authorized
6 by this section.
7 (15)(8) In any hearing proceeding under this section,
8 the following information concerning the parties shall be
9 confidential and exempt from the provisions of s. 119.07(1):
10 (a) Names and addresses.
11 (b) Medical services provided.
12 (c) Social and economic conditions or circumstances.
13 (d) Evaluation of personal information.
14 (e) Medical data, including diagnosis and past history
15 of disease or disability.
16 (f) Any information received verifying income
17 eligibility and amount of medical assistance payments. Income
18 information received from the Social Security Administration
19 or the Internal Revenue Service must be safeguarded according
20 to the requirements of the agency that furnished the data.
21
22 The exemption created by this subsection does not prohibit
23 access to such information by a district long-term care
24 ombudsman council upon request, by a reviewing court if such
25 information is required to be part of the record upon
26 subsequent review, or as specified in s. 24(a), Art. I of the
27 State Constitution.
28 (16)(9)(a) The department's Office of Appeals Hearings
29 shall conduct hearings under this section. The office shall
30 notify the facility of a resident's request for a hearing.
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1 (b) The department shall, by rule, establish
2 procedures to be used for fair hearings requested by
3 residents. These procedures shall be equivalent to the
4 procedures used for fair hearings for other Medicaid cases,
5 chapter 10-2, part VI, Florida Administrative Code. The
6 burden of proof must be clear and convincing evidence. A
7 hearing decision must be rendered within 90 days after of
8 receipt of the request for hearing.
9 (c)(10) If the hearing decision is favorable to the
10 resident who has been transferred or discharged, the resident
11 must be readmitted to the facility's first available bed.
12 (d)(11) The decision of the hearing officer shall be
13 final. Any aggrieved party may appeal the decision to the
14 district court of appeal in the appellate district where the
15 facility is located. Review procedures shall be conducted in
16 accordance with the Florida Rules of Appellate Procedure.
17 (17)(12) The department may adopt rules necessary to
18 administer implement the provisions of this section.
19 Section 9. Paragraph (g) is added to subsection (2) of
20 section 400.071, Florida Statutes, 1998 Supplement, present
21 subsections (8) and (9) are amended and renumbered as
22 subsections (9) and (10), respectively, and a new subsection
23 (8) is added to said section, to read:
24 400.071 Application for license.--
25 (2) The application shall be under oath and shall
26 contain the following:
27 (g) Copies of any civil verdict or judgment involving
28 the applicant rendered within the 10 years preceding the
29 application, relating to medical negligence, violation of
30 residents' rights, or wrongful death. As a condition of
31 licensure, the licensee agrees to provide to the agency copies
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1 of any new verdict or judgment involving the applicant,
2 relating to such matters, within 30 days after filing with the
3 clerk of the court. The information required in this
4 paragraph shall be maintained in the facility's licensure file
5 and in an agency database which is available as a public
6 record.
7 (8) As a condition of licensure, each facility must
8 agree to participate in a consumer satisfaction measurement
9 process as prescribed by the agency.
10 (9)(8) The agency may not issue a license to a nursing
11 home that fails to receive a certificate of need under the
12 provisions of ss. 408.031-408.045. It is the intent of the
13 Legislature that, in reviewing a certificate-of-need
14 application to add beds to an existing nursing home facility,
15 preference be given to the application of a licensee who has
16 been awarded a Gold Seal as provided for in s. 400.235, if the
17 applicant otherwise meets the review criteria specified in s.
18 408.035.
19 (10)(9) The agency may develop an abbreviated survey
20 for licensure renewal applicable to a licensee that has
21 continuously operated as a nursing facility since 1991 or
22 earlier, and has operated under the same management for at
23 least the preceding 30 months, and has had during the
24 preceding 30 months no class I or class II deficiencies
25 maintained a superior rating during that period.
26 Section 10. Section 400.118, Florida Statutes, is
27 created to read:
28 400.118 Quality assurance; early warning system;
29 monitoring; rapid response teams.--
30 (1) The agency shall establish an early warning system
31 to detect conditions in nursing facilities that could be
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1 detrimental to the health, safety, and welfare of residents.
2 The early warning system shall include, but not be limited to,
3 analysis of financial and quality-of-care indicators that
4 would predict the need for the agency to take action pursuant
5 to the authority set forth in this part.
6 (2)(a) The agency shall establish within each district
7 office one or more quality-of-care monitors, based on the
8 number of nursing facilities in the district, to monitor all
9 nursing facilities in the district on a regular, unannounced,
10 aperiodic basis, including nights, evenings, weekends, and
11 holidays. Priority for monitoring visits shall be given to
12 nursing facilities with a history of patient care
13 deficiencies. Quality-of-care monitors shall be registered
14 nurses who are trained and experienced in nursing facility
15 regulation, standards of practice in long-term care, and
16 evaluation of patient care. Individuals in these positions
17 shall not be deployed by the agency as a part of the district
18 survey team in the conduct of routine, scheduled surveys, but
19 shall function solely and independently as quality-of-care
20 monitors. Quality-of-care monitors shall assess the overall
21 quality of life in the nursing facility and shall assess
22 specific conditions in the facility directly related to
23 patient care. The quality-of-care monitor shall include in an
24 assessment visit observation of the care and services rendered
25 to residents and formal and informal interviews with
26 residents, family members, facility staff, resident guests,
27 volunteers, other regulatory staff, and representatives of a
28 long-term care ombudsman council or human rights advocacy
29 committee.
30 (b) Findings of a monitoring visit, both positive and
31 negative, shall be provided orally and in writing to the
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1 facility administrator or, in the absence of the facility
2 administrator, to the administrator on duty or the director of
3 nursing. The quality-of-care monitor may recommend to the
4 facility administrator procedural and policy changes and staff
5 training, as needed, to improve the care or quality of life of
6 facility residents. Conditions observed by the quality-of-care
7 monitor which threaten the health or safety of a resident
8 shall be reported immediately to the agency area office
9 supervisor for appropriate regulatory action and, as
10 appropriate or as required by law, to law enforcement, adult
11 protective services, or other responsible agencies.
12 (c) Any record, whether written or oral, or any
13 written or oral communication generated pursuant to paragraph
14 (a) or paragraph (b) shall not be subject to discovery or
15 introduction into evidence in any civil or administrative
16 action against a nursing facility arising out of matters which
17 are the subject of quality-of-care monitoring, and a person
18 who was in attendance at a monitoring visit or evaluation may
19 not be permitted or required to testify in any such civil or
20 administrative action as to any evidence or other matters
21 produced or presented during the monitoring visits or
22 evaluations. However, information, documents, or records
23 otherwise available from original sources are not to be
24 construed as immune from discovery or use in any such civil or
25 administrative action merely because they were presented
26 during monitoring visits or evaluations, and any person who
27 participates in such activities may not be prevented from
28 testifying as to matters within his or her knowledge, but such
29 witness may not be asked about his or her participation in
30 such activities. The exclusion from the discovery or
31 introduction of evidence in any civil or administrative action
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1 provided for herein shall not apply when the quality-of-care
2 monitor makes a report to the appropriate authorities
3 regarding a threat to the health or safety of a resident.
4 (3) The agency shall also create teams of experts that
5 can function as rapid response teams to visit nursing
6 facilities identified through the agency's early warning
7 system. Rapid response teams may visit facilities that request
8 the agency's assistance. The rapid response teams shall not be
9 deployed for the purpose of helping a facility prepare for a
10 regular survey.
11 Section 11. Subsection (6) is added to section
12 400.121, Florida Statutes, 1998 Supplement, to read:
13 400.121 Denial, suspension, revocation of license;
14 moratorium on admissions; administrative fines; procedure.--
15 (6) The agency is authorized to require a facility to
16 increase staffing beyond the minimum required by law, if the
17 agency has taken administrative action against the facility
18 for care-related deficiencies directly attributable to
19 insufficient staff. Under such circumstances, the facility may
20 request an expedited interim rate increase. The agency shall
21 process the request within 10 days after receipt of all
22 required documentation from the facility. A facility that
23 fails to maintain the required increased staffing is subject
24 to a fine of $500 per day for each day the staffing is below
25 the level required by the agency.
26 Section 12. Section 400.141, Florida Statutes, is
27 amended to read:
28 400.141 Administration and management of nursing home
29 facilities.--Every licensed facility shall comply with all
30 applicable standards and rules of the agency and shall:
31
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1 (1) Be under the administrative direction and charge
2 of a licensed administrator.
3 (2) Appoint a medical director licensed pursuant to
4 chapter 458 or chapter 459. The agency may establish by rule
5 more specific criteria for the appointment of a medical
6 director.
7 (3)(2) Have available the regular, consultative, and
8 emergency services of physicians licensed by the state.
9 (4)(3) Provide for the access of the facility
10 residents to dental and other health-related services,
11 recreational services, rehabilitative services, and social
12 work services appropriate to their needs and conditions and
13 not directly furnished by the licensee. When a geriatric
14 outpatient nurse clinic is conducted in accordance with rules
15 adopted by the agency, outpatients attending such clinic shall
16 not be counted as part of the general resident population of
17 the nursing home facility, nor shall the nursing staff of the
18 geriatric outpatient clinic be counted as part of the nursing
19 staff of the facility, until the outpatient clinic load
20 exceeds 15 a day.
21 (5) Provide for resident use of a community pharmacy
22 as specified in s. 400.022(1)(q). Any other law to the
23 contrary notwithstanding, a registered pharmacist licensed in
24 Florida may repackage a nursing facility resident's bulk
25 prescription medication which has been packaged by another
26 pharmacist licensed in any state in the United States into a
27 unit dose system compatible with the system used by the
28 nursing facility, if such resident has bulk prescription
29 medication benefits covered under a qualified pension plan as
30 specified in s. 4972 of the Internal Revenue Code, a federal
31 retirement program as specified under 5 C.F.R. s. 831, or a
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1 long-term care policy as defined in s. 627.9404(1). A
2 pharmacist who correctly repackages and relabels the
3 medication and the nursing facility which correctly
4 administers such repackaged medication under the provisions of
5 this subsection shall not be held liable in any civil or
6 administrative action arising from the repackaging. In order
7 to be eligible for the repackaging, a nursing facility
8 resident for whom the medication is to be repackaged shall
9 sign an informed consent form provided by the facility which
10 includes an explanation of the repackaging process and which
11 notifies the resident of the immunities from liability
12 provided herein. A pharmacist who repackages and relabels
13 prescription medications, as authorized under this subsection,
14 may charge a reasonable fee for costs resulting from the
15 implementation of this provision.
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
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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
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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
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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 13. 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
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1 facility shall post notice of these policies and procedures,
2 and any revision thereof, in places accessible to residents.
3 Section 14. 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
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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 15. 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
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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.
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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
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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,
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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 16. Effective upon this act becoming a law,
30 paragraph (a) of subsection (2) of section 400.215, Florida
31
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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,
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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 17. 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
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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,
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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;
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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. Unless otherwise approved by
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1 the agency, licensed nurses counted towards the minimum
2 staffing requirements for certified nursing assistants must
3 exclusively perform the duties of a certified nursing
4 assistant for the entire shift and shall not also be counted
5 towards the minimum staffing requirements for licensed nurses.
6 If the agency approved a facility's request to use a licensed
7 nurse to perform both licensed nursing and certified nursing
8 assistant duties, the facility must allocate the amount of
9 staff time specifically spent on certified nursing assistant
10 duties for the purpose of documenting compliance with minimum
11 staffing requirements for certified and licensed nursing
12 staff. In no event may the hours of a licensed nurse with dual
13 job responsibilities be counted twice.
14 (b) The agency shall adopt rules to allow properly
15 trained staff of a nursing facility, in addition to certified
16 nursing assistants and licensed nurses, to assist residents
17 with eating. The rules shall specify the minimum training
18 requirements and shall specify the physiological conditions or
19 disorders of residents which would necessitate that the eating
20 assistance be provided by nursing personnel of the facility.
21 Non-nursing staff providing eating assistance to residents
22 under the provisions of this subsection shall not count
23 towards compliance with minimum staffing standards.
24 (4)(3) Rules developed pursuant to this section shall
25 not restrict the use of shared staffing and shared programming
26 in facilities which are part of retirement communities that
27 provide multiple levels of care and otherwise meet the
28 requirement of law or rule.
29 (5)(4) The agency, in collaboration with the Division
30 of Children's Medical Services Program Office of the
31 Department of Health and Rehabilitative Services, must, no
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1 later than December 31, 1993, adopt rules for minimum
2 standards of care for persons under 21 years of age who reside
3 in nursing home facilities. The rules must include a
4 methodology for reviewing a nursing home facility under ss.
5 408.031-408.045 which serves only persons under 21 years of
6 age.
7 (6)(5) Prior to conducting a survey of the facility,
8 the survey team shall obtain a copy of the district nursing
9 home and long-term care facility ombudsman council report on
10 the facility. Problems noted in the report shall be
11 incorporated into and followed up through the agency's
12 inspection process. This procedure does not preclude the
13 district nursing home and long-term care facility ombudsman
14 council from requesting the agency to conduct a followup visit
15 to the facility.
16 (6) There is created the Nursing Home Advisory
17 Committee, which shall consist of 15 members who are to be
18 appointed by and report directly to the director of the
19 agency. The membership is to include:
20 (a) One researcher from a university center on aging.
21 (b) Two representatives from the Florida Health Care
22 Association.
23 (c) Two representatives from the Florida Association
24 of Homes for the Aging.
25 (d) One representative from the Department of Elderly
26 Affairs.
27 (e) Five consumer representatives, at least two of
28 whom serve on or are staff members of the state or a district
29 nursing home and long-term care facility ombudsman council.
30 (f) One representative from the Florida American
31 Medical Directors Association.
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1 (g) One representative from the Florida Association of
2 Directors of Nursing Administrators.
3 (h) One representative from the Agency for Health Care
4 Administration.
5 (i) One representative from the nursing home industry
6 at large who owns or operates a licensed nursing home facility
7 in the state and is not a member of any state nursing home
8 association.
9
10 At least one member shall be over 60 years of age.
11 (7) The committee shall perform the following duties
12 to assist the agency in ensuring compliance with the intent of
13 the Legislature specified in subsection (1):
14 (a) Assist in developing a nursing home rating system
15 based on the requirements of rules developed under this
16 chapter and the Omnibus Budget Reconciliation Act of 1987
17 (Pub. L. No. 100-203) (December 22, 1987), Title IV (Medicare,
18 Medicaid, and Other Health-Related Programs), Subtitle C
19 (Nursing Home Reform), as amended.
20 (b) Assist in developing surveyor guidelines and
21 training to ensure the equitable application of the nursing
22 home rating system.
23 (c) Assist in developing guidelines to determine the
24 scope and severity of noncompliance.
25 (d) Identify burdensome paperwork that is not
26 specifically related to resident care.
27 (e) Advise the agency of proposed changes in statutes
28 and rules necessary to ensure adequate care and services and
29 the promotion and protection of residents' rights in long-term
30 care facilities.
31
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1 (7)(8) The agency shall, at least every 15 months,
2 evaluate all nursing home facilities and make a determination
3 as to the degree of compliance by each licensee with the
4 established rules adopted under this part as a basis for
5 assigning a licensure status rating to that facility. The
6 agency shall base its evaluation on the most recent inspection
7 report, taking into consideration findings from other official
8 reports, surveys, interviews, investigations, and inspections.
9 The agency shall assign a licensure status of standard or
10 conditional one of the following ratings to each nursing home:
11 standard, conditional, or superior.
12 (a) A standard licensure status rating means that a
13 facility has no class I or class II deficiencies, has
14 corrected all class III deficiencies within the time
15 established by the agency, and is in substantial compliance at
16 the time of the survey with criteria established under this
17 part, with rules adopted by the agency, and, if applicable,
18 with rules adopted under the Omnibus Budget Reconciliation Act
19 of 1987 (Pub. L. No. 100-203) (December 22, 1987), Title IV
20 (Medicare, Medicaid, and Other Health-Related Programs),
21 Subtitle C (Nursing Home Reform), as amended.
22 (b) A conditional licensure status rating means that a
23 facility, due to the presence of one or more class I or class
24 II deficiencies, or class III deficiencies not corrected
25 within the time established by the agency, is not in
26 substantial compliance at the time of the survey with criteria
27 established under this part, with rules adopted by the agency,
28 or, if applicable, with rules adopted under the Omnibus Budget
29 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
30 1987), Title IV (Medicare, Medicaid, and Other Health-Related
31 Programs), Subtitle C (Nursing Home Reform), as amended. If
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1 the facility comes into substantial compliance at the time of
2 the followup survey, a standard licensure status rating may be
3 assigned issued. A facility assigned a conditional rating at
4 the time of the relicensure survey may not qualify for
5 consideration for a superior rating until the time of the next
6 subsequent relicensure survey.
7 (c) A superior rating means that a facility has no
8 class I or class II deficiencies and has corrected all class
9 III deficiencies within the time established by the agency and
10 is in substantial compliance with the criteria established
11 under this part and the rules adopted by the agency and, if
12 applicable, with rules adopted pursuant to 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; and
16 the facility exceeds the criteria for a standard rating
17 through enhanced programs and services in the following areas:
18 1. Nursing service.
19 2. Dietary or nutritional services.
20 3. Physical environment.
21 4. Housekeeping and maintenance.
22 5. Restorative therapies and self-help activities.
23 6. Social services.
24 7. Activities and recreational therapy.
25 (d) In order to facilitate the development of special
26 programs or facilitywide initiatives and promote creativity
27 based on the needs and preferences of residents, the areas
28 listed in paragraph (c) may be grouped or addressed
29 individually by the licensee. However, a facility may not
30 qualify for a superior rating if fewer than three programs or
31 initiatives are developed to encompass the required areas.
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1 (c)(e) In determining the rating and evaluating the
2 overall quality of care and services and determining whether
3 the facility will receive a conditional or standard license,
4 the agency shall consider the needs and limitations of
5 residents in the facility and the results of interviews and
6 surveys of a representative sampling of residents, families of
7 residents, ombudsman council members in the district in which
8 the facility is located, guardians of residents, and staff of
9 the nursing home facility.
10 (d)(f) The current licensure status rating of each
11 facility must be indicated in bold print on the face of the
12 license. A list of the deficiencies of the facility shall be
13 posted in a prominent place that is in clear and unobstructed
14 public view at or near the place where residents are being
15 admitted to that facility. Licensees receiving a conditional
16 licensure status rating for a facility shall prepare, within
17 10 working days after receiving notice of deficiencies, a plan
18 for correction of all deficiencies and shall submit the plan
19 to the agency for approval. Correction of all deficiencies,
20 within the period approved by the agency, shall result in
21 termination of the conditional licensure status rating.
22 Failure to correct the deficiencies within a reasonable period
23 approved by the agency shall be grounds for the imposition of
24 sanctions pursuant to this part.
25 (e)(g) Each licensee shall post its license in a
26 prominent place that is in clear and unobstructed public view
27 at or near the place where residents are being admitted to the
28 facility. A licensee with a superior rating may advertise its
29 rating in any nonpermanent medium and in accordance with rules
30 adopted by the agency. A list of the facilities receiving a
31
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1 superior rating shall be distributed to the state and district
2 ombudsman councils.
3 (f)(h) Not later than January 1, 1994, the agency
4 shall adopt rules that:
5 1. Establish uniform procedures for the evaluation of
6 facilities.
7 2. Provide criteria in the areas referenced in
8 paragraph (c).
9 3. Address other areas necessary for carrying out the
10 intent of this section.
11 (i) A license rated superior shall continue until it
12 is replaced by a rating based on a later survey. A superior
13 rating may be revoked at any time for failure to maintain
14 substantial compliance with criteria established under this
15 part, with rules adopted by the agency, or, if applicable,
16 with rules adopted under the Omnibus Budget Reconciliation Act
17 of 1987 (Pub. L. No. 100-203) (December 22, 1987), Title IV
18 (Medicare, Medicaid, and Other Health-Related Programs),
19 Subtitle C (Nursing Home Reform), as amended, or for failure
20 to exceed the criteria specified for any area as listed in
21 paragraph (c).
22 (j) A superior rating is not transferable to another
23 license, except when an existing facility is being relicensed
24 in the name of an entity related to the current licenseholder
25 by common ownership or control and there will be no change in
26 the management, operation, or programs at the facility as a
27 result of the relicensure.
28 (8)(9) The agency shall adopt rules to provide that,
29 when the criteria established under subsection (2) are not
30 met, such deficiencies shall be classified according to the
31 nature of the deficiency. The agency shall indicate the
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1 classification on the face of the notice of deficiencies as
2 follows:
3 (a) Class I deficiencies are those which the agency
4 determines present an imminent danger to the residents or
5 guests of the nursing home facility or a substantial
6 probability that death or serious physical harm would result
7 therefrom. The condition or practice constituting a class I
8 violation shall be abated or eliminated immediately, unless a
9 fixed period of time, as determined by the agency, is required
10 for correction. Notwithstanding s. 400.121(2), a class I
11 deficiency is subject to a civil penalty in an amount not less
12 than $5,000 and not exceeding $25,000 $10,000 for each and
13 every deficiency. A fine may be levied notwithstanding the
14 correction of the deficiency.
15 (b) Class II deficiencies are those which the agency
16 determines have a direct or immediate relationship to the
17 health, safety, or security of the nursing home facility
18 residents, other than class I deficiencies. A class II
19 deficiency is subject to a civil penalty in an amount not less
20 than $1,000 and not exceeding $10,000 $5,000 for each and
21 every deficiency. A citation for a class II deficiency shall
22 specify the time within which the deficiency is required to be
23 corrected. If a class II deficiency is corrected within the
24 time specified, no civil penalty shall be imposed, unless it
25 is a repeated offense.
26 (c) Class III deficiencies are those which the agency
27 determines to have an indirect or potential relationship to
28 the health, safety, or security of the nursing home facility
29 residents, other than class I or class II deficiencies. A
30 class III deficiency shall be subject to a civil penalty of
31 not less than $500 and not exceeding $2,500 $1,000 for each
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1 and every deficiency. A citation for a class III deficiency
2 shall specify the time within which the deficiency is required
3 to be corrected. If a class III deficiency is corrected
4 within the time specified, no civil penalty shall be imposed,
5 unless it is a repeated offense.
6 (9)(10) Civil penalties paid by any licensee under
7 subsection (8) (9) shall be deposited in the Health Care Trust
8 Fund and expended as provided in s. 400.063.
9 (13) This section may not be used to increase the
10 total Medicaid funding paid as incentives for facilities
11 receiving a superior or standard rating.
12 400.232 Review and approval of plans; fees and
13 costs.--
14 (1)(11) The agency shall approve or disapprove the
15 plans and specifications within 60 days after receipt of the
16 final plans and specifications. The agency may be granted one
17 15-day extension for the review period, if the director of the
18 agency so approves. If the agency fails to act within the
19 specified time, it shall be deemed to have approved the plans
20 and specifications. When the agency disapproves plans and
21 specifications, it shall set forth in writing the reasons for
22 disapproval. Conferences and consultations may be provided as
23 necessary.
24 (2)(12) The agency is authorized to charge an initial
25 fee of $2,000 for review of plans and construction on all
26 projects, no part of which is refundable. The agency may also
27 collect a fee, not to exceed 1 percent of the estimated
28 construction cost or the actual cost of review, whichever is
29 less, for the portion of the review which encompasses initial
30 review through the initial revised construction document
31 review. The agency is further authorized to collect its
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1 actual costs on all subsequent portions of the review and
2 construction inspections. Initial fee payment shall accompany
3 the initial submission of plans and specifications. Any
4 subsequent payment that is due is payable upon receipt of the
5 invoice from the agency. Notwithstanding any other provisions
6 of law to the contrary, all money received by the agency
7 pursuant to the provisions of this section shall be deemed to
8 be trust funds, to be held and applied solely for the
9 operations required under this section.
10 Section 18. Section 400.235, Florida Statutes, is
11 created to read:
12 400.235 Nursing home quality and licensure status;
13 Gold Seal Program.--
14 (1) To protect the health and welfare of persons
15 receiving care in nursing facilities, it is the intent of the
16 Legislature to develop a regulatory framework that promotes
17 the stability of the industry and facilitates the physical,
18 social, and emotional well-being of nursing facility
19 residents.
20 (2) The Legislature intends to develop an award and
21 recognition program for nursing facilities that demonstrate
22 excellence in long-term care over a sustained period. This
23 program shall be known as the Gold Seal Program.
24 (3)(a) The Gold Seal Program shall be developed and
25 implemented by the Governor's Panel on Excellence in Long-Term
26 Care which shall operate under the authority of the Executive
27 Office of the Governor. The panel shall be composed of three
28 persons appointed by the Governor, to include a consumer
29 advocate for senior citizens and two persons with expertise in
30 the fields of quality management, service delivery excellence,
31 or public sector accountability; three persons appointed by
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1 the Secretary of Elderly Affairs, to include an active member
2 of a nursing facility family and resident care council and a
3 member of the University Consortium on Aging; the State
4 Long-Term Care Ombudsman; one person appointed by the Florida
5 Life Care Residents Association; one person appointed by the
6 Secretary of Health; two persons appointed by the Director of
7 Health Care Administration, to include the Deputy Director for
8 State Health Purchasing; one person appointed by the Florida
9 Association of Homes for the Aging; and one person appointed
10 by the Florida Health Care Association. All members of the
11 panel shall be appointed by October 1, 1999, and the panel
12 shall hold its organizational meeting no later than December
13 10, 1999. Vacancies on the panel shall be filled in the same
14 manner as the original appointments. No member shall serve for
15 more than 4 consecutive years from the date of appointment.
16 (b) Members of the Governor's Panel on Excellence in
17 Long-Term Care shall be prohibited from having any ownership
18 interest in a nursing facility. Any member of the panel who is
19 employed by a nursing facility in any capacity shall be
20 prohibited from participating in reviewing or voting on
21 recommendations involving the facility by which the member is
22 employed or any facility under common ownership with that
23 facility.
24 (c) Recommendations to the panel for designation of a
25 nursing facility as a Gold Seal facility may be received by
26 the panel after January 1, 2000. The activities of the panel
27 shall be supported by staff of the Department of Elderly
28 Affairs and the Agency for Health Care Administration.
29 (4) The panel shall consider at least the following
30 resident-based quality indicator domains when evaluating a
31 facility for the Gold Seal Program:
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1 (a) Accidents.
2 (b) Behavioral/emotional patterns.
3 (c) Clinical management.
4 (d) Cognitive patterns.
5 (e) Elimination/continence.
6 (f) Infection control.
7 (g) Nutrition and eating.
8 (h) Physical functioning.
9 (i) Psychotropic drug use.
10 (j) Quality of life.
11 (k) Sensory functioning and communication.
12 (l) Skin care.
13 (5) Facilities must meet the following additional
14 criteria for recognition as a Gold Seal Program facility:
15 (a) Had no class I or class II deficiencies within the
16 30 months preceding application for the program.
17 (b) Evidence financial soundness and stability
18 according to standards adopted by the agency in administrative
19 rule.
20 (c) Participate consistently in the required consumer
21 satisfaction process as prescribed by the agency, and
22 demonstrate that information is elicited from residents,
23 family members, and guardians about satisfaction with the
24 nursing facility, its environment, the services and care
25 provided, the staff's skills and interactions with residents,
26 attention to resident's needs, and the facility's efforts to
27 act on information gathered from the consumer satisfaction
28 measures.
29 (d) Evidence the involvement of families and members
30 of the community in the facility on a regular basis.
31
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1 (e) Have a stable workforce, as evidenced by a
2 relatively low rate of turnover among certified nursing
3 assistants and registered nurses within the 30 months
4 preceding application for the Gold Seal Program, and
5 demonstrate a continuing effort to maintain a stable workforce
6 and to reduce turnover of licensed nurses and certified
7 nursing assistants.
8 (f) Evidence an outstanding record regarding the
9 number and types of substantiated complaints reported to the
10 State Long-Term Care Ombudsman Council within the 30 months
11 preceding application for the program.
12 (g) Provide targeted inservice training provided to
13 meet training needs identified by internal or external quality
14 assurance efforts.
15 (h) Evidence superior levels of clinical outcomes as
16 measured in the Minimum Data Set system of the federal Health
17 Care Financing Administration. Facilities that are not
18 certified for Medicare or Medicaid are not required to
19 complete the Minimum Data Set in order to qualify for the Gold
20 Seal Program. Such facilities may demonstrate superior levels
21 of performance with an alternate assessment as approved by the
22 panel.
23
24 A facility assigned a conditional licensure status may not
25 qualify for consideration for the Gold Seal Program until
26 after it has operated for 30 months with no class I or class
27 II deficiencies and has completed a regularly scheduled
28 relicensure survey.
29 (6) The agency, nursing facility industry
30 organizations, consumers, State Long-Term Care Ombudsman
31 Council, and members of the community may recommend to the
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1 Governor facilities that meet the established criteria for
2 consideration for and award of the Gold Seal. The panel shall
3 review nominees and make a recommendation to the Governor for
4 final approval and award. The decision of the Governor is
5 final and is not subject to appeal.
6 (7) A facility must be licensed and operating for 30
7 months before it is eligible to apply for the Gold Seal
8 Program. The agency shall establish by rule the frequency of
9 review for designation as a Gold Seal Program facility and
10 under what circumstances a facility may be denied the
11 privilege of using this designation. The designation of a
12 facility as a Gold Seal Program facility is not transferable
13 to another license, except when an existing facility is being
14 relicensed in the name of an entity related to the current
15 licenseholder by common ownership or control, and there will
16 be no change in the management, operation, or programs at the
17 facility as a result of the relicensure.
18 (8)(a) Facilities awarded the Gold Seal may use the
19 designation in their advertising and marketing.
20 (b) Upon approval by the United States Department of
21 Health and Human Services, the agency shall adopt a revised
22 schedule of survey and relicensure visits for Gold Seal
23 Program facilities. Gold Seal Program facilities may be
24 surveyed for certification and relicensure every 2 years, so
25 long as they maintain the standards associated with retaining
26 the Gold Seal.
27 Section 19. Subsection (3) of section 400.241, Florida
28 Statutes, is renumbered as subsection (4), and a new
29 subsection (3) is added to said section, to read:
30 400.241 Prohibited acts; penalties for violations.--
31
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1 (3) It is unlawful for any person, long-term care
2 facility, or other entity to willfully interfere with the
3 unannounced inspections mandated by s. 400.19(3). Alerting or
4 advising a facility of the actual or approximate date of such
5 inspection shall be a per se violation of this subsection.
6 (4)(3) A violation of any provision of this part or of
7 any minimum standard, rule, or regulation adopted pursuant
8 thereto constitutes a misdemeanor of the second degree,
9 punishable as provided in s. 775.082 or s. 775.083. Each day
10 of a continuing violation shall be considered a separate
11 offense.
12 Section 20. Paragraph (p) is added to subsection (1)
13 of section 408.035, Florida Statutes, to read:
14 408.035 Review criteria.--
15 (1) The agency shall determine the reviewability of
16 applications and shall review applications for
17 certificate-of-need determinations for health care facilities
18 and health services in context with the following criteria:
19 (p) The applicant's designation as a Gold Seal Program
20 nursing facility pursuant to s. 400.235, when the applicant is
21 requesting additional nursing home beds at that facility.
22 Section 21. Subsection (1) of section 468.1755,
23 Florida Statutes, 1998 Supplement, is amended to read:
24 468.1755 Disciplinary proceedings.--
25 (1) The following acts shall constitute grounds for
26 which the disciplinary actions in subsection (2) may be taken:
27 (a) Violation of any provision of s. 455.624(1) or s.
28 468.1745(1).
29 (b) Attempting to procure a license to practice
30 nursing home administration by bribery, by fraudulent
31
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1 misrepresentation, or through an error of the department or
2 the board.
3 (c) Having a license to practice nursing home
4 administration revoked, suspended, or otherwise acted against,
5 including the denial of licensure, by the licensing authority
6 of another state, territory, or country.
7 (d) Being convicted or found guilty, regardless of
8 adjudication, of a crime in any jurisdiction which relates to
9 the practice of nursing home administration or the ability to
10 practice nursing home administration. Any plea of nolo
11 contendere shall be considered a conviction for purposes of
12 this part.
13 (e) Making or filing a report or record which the
14 licensee knows to be false, intentionally failing to file a
15 report or record required by state or federal law, willfully
16 impeding or obstructing such filing, or inducing another
17 person to impede or obstruct such filing. Such reports or
18 records shall include only those which are signed in the
19 capacity of a licensed nursing home administrator.
20 (f) Authorizing the discharge or transfer of a
21 resident for a reason other than those provided in ss. 400.022
22 and 400.0255.
23 (g)(f) Advertising goods or services in a manner which
24 is fraudulent, false, deceptive, or misleading in form or
25 content.
26 (h)(g) Fraud or deceit, negligence, incompetence, or
27 misconduct in the practice of nursing home administration.
28 (i)(h) A violation or repeated violations of this
29 part, part II of chapter 455, or any rules promulgated
30 pursuant thereto.
31
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1 (j)(i) Violation of a lawful order of the board or
2 department previously entered in a disciplinary hearing or
3 failing to comply with a lawfully issued subpoena of the board
4 or department.
5 (k)(j) Practicing with a revoked, suspended, inactive,
6 or delinquent license.
7 (l)(k) Repeatedly acting in a manner inconsistent with
8 the health, safety, or welfare of the patients of the facility
9 in which he or she is the administrator.
10 (m)(l) Being unable to practice nursing home
11 administration with reasonable skill and safety to patients by
12 reason of illness, drunkenness, use of drugs, narcotics,
13 chemicals, or any other material or substance or as a result
14 of any mental or physical condition. In enforcing this
15 paragraph, upon a finding of the secretary or his or her
16 designee that probable cause exists to believe that the
17 licensee is unable to serve as a nursing home administrator
18 due to the reasons stated in this paragraph, the department
19 shall have the authority to issue an order to compel the
20 licensee to submit to a mental or physical examination by a
21 physician designated by the department. If the licensee
22 refuses to comply with such order, the department's order
23 directing such examination may be enforced by filing a
24 petition for enforcement in the circuit court where the
25 licensee resides or serves as a nursing home administrator.
26 The licensee against whom the petition is filed shall not be
27 named or identified by initials in any public court records or
28 documents and the proceedings shall be closed to the public.
29 The department shall be entitled to the summary procedure
30 provided in s. 51.011. A licensee affected under this
31 paragraph shall have the opportunity, at reasonable intervals,
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1 to demonstrate that he or she can resume the competent
2 practice of nursing home administration with reasonable skill
3 and safety to patients.
4 (n)(m) Has Willfully or repeatedly violating violated
5 any of the provisions of the law, code or rules of the
6 licensing or supervising authority or agency of the state or
7 political subdivision thereof having jurisdiction of the
8 operation and licensing of nursing homes.
9 (o)(n) Paying, giving, causing Has paid, given, caused
10 to be paid or given, or offering offered to pay or to give to
11 any person a commission or other valuable consideration for
12 the solicitation or procurement, either directly or
13 indirectly, of nursing home usage.
14 (p)(o) Has Willfully permitting permitted unauthorized
15 disclosure of information relating to a patient or his or her
16 records.
17 (q)(p) Discriminating with Has discriminated in
18 respect to patients, employees, or staff on account of race,
19 religion, color, sex, or national origin.
20 Section 22. Paragraph (b) of subsection (1) of section
21 394.4625, Florida Statutes, is amended to read:
22 394.4625 Voluntary admissions.--
23 (1) AUTHORITY TO RECEIVE PATIENTS.--
24 (b) A mental health overlay program or a mobile crisis
25 response service or a licensed professional who is authorized
26 to initiate an involuntary examination pursuant to s. 394.463
27 and is employed by a community mental health center or clinic
28 must, pursuant to district procedure approved by the
29 respective district administrator, conduct an initial
30 assessment of the ability of the following persons to give
31
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1 express and informed consent to treatment before such persons
2 may be admitted voluntarily:
3 1. A person 60 years of age or older for whom transfer
4 is being sought from a nursing home, assisted living facility,
5 adult day care center, or adult family-care home, when such
6 person has been diagnosed as suffering from dementia.
7 2. A person 60 years of age or older for whom transfer
8 is being sought from a nursing home pursuant to s.
9 400.0255(12) s. 400.0255(6).
10 3. A person for whom all decisions concerning medical
11 treatment are currently being lawfully made by the health care
12 surrogate or proxy designated under chapter 765.
13 Section 23. Subsection (1) of section 400.063, Florida
14 Statutes, is amended to read:
15 400.063 Resident Protection Trust Fund.--
16 (1) A Resident Protection Trust Fund shall be
17 established for the purpose of collecting and disbursing funds
18 generated from the license fees and administrative fines as
19 provided for in ss. 393.0673(2), 400.062(3)(b), 400.111(1),
20 400.121(2), and 400.23(8)(9). Such funds shall be for the
21 sole purpose of paying for the appropriate alternate
22 placement, care, and treatment of residents who are removed
23 from a facility licensed under this part or a facility
24 specified in s. 393.0678(1) in which the agency determines
25 that existing conditions or practices constitute an immediate
26 danger to the health, safety, or security of the residents.
27 If the agency determines that it is in the best interest of
28 the health, safety, or security of the residents to provide
29 for an orderly removal of the residents from the facility, the
30 agency may utilize such funds to maintain and care for the
31 residents in the facility pending removal and alternative
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1 placement. The maintenance and care of the residents shall be
2 under the direction and control of a receiver appointed
3 pursuant to s. 393.0678(1) or s. 400.126(1). However, funds
4 may be expended in an emergency upon a filing of a petition
5 for a receiver, upon the declaration of a state of local
6 emergency pursuant to s. 252.38(3)(a)5., or upon a duly
7 authorized local order of evacuation of a facility by
8 emergency personnel to protect the health and safety of the
9 residents.
10 Section 24. Section 430.80, Florida Statutes, is
11 created to read:
12 430.80 Implementation of a teaching nursing home pilot
13 project.--
14 (1) As used in this section, the term "teaching
15 nursing home" means a nursing home facility licensed under
16 chapter 400 which contains a minimum of 400 licensed nursing
17 home beds; has access to a resident senior population of
18 sufficient size to support education, training, and research
19 relating to geriatric care; and has a contractual relationship
20 with a federally funded accredited geriatric research center
21 in this state.
22 (2)(a) The Agency for Health Care Administration shall
23 implement a comprehensive multidisciplinary program of
24 geriatric education and research as a pilot project in a
25 nursing home facility designated by the agency as a teaching
26 nursing home. The program shall be established as a pilot
27 project and shall be administered at the nursing home facility
28 and other appropriate settings.
29 (b) The agency shall develop criteria for designating
30 teaching nursing homes in consultation with advocates of the
31 elderly, advocates of persons with disabilities,
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1 representatives of the nursing home industry, and
2 representatives of the State University System.
3 (3) To be designated as a teaching nursing home, a
4 nursing home licensee must, at a minimum:
5 (a) Provide a comprehensive program of integrated
6 senior services that include institutional services and
7 community-based services;
8 (b) Participate in a nationally recognized
9 accreditation program and hold a valid accreditation, such as
10 the accreditation awarded by the Joint Commission on
11 Accreditation of Healthcare Organizations;
12 (c) Have been in business in this state for a minimum
13 of 10 consecutive years;
14 (d) Demonstrate an active program in multidisciplinary
15 education and research that relates to gerontology;
16 (e) Have a formalized contractual relationship with at
17 least one accredited health profession education program
18 located in this state;
19 (f) Have a formalized contractual relationship with an
20 accredited hospital that is designated by law as a teaching
21 hospital; and
22 (g) Have senior staff members who hold formal faculty
23 appointments at universities, which must include at least one
24 accredited health profession education program.
25 (4) A teaching nursing home may be affiliated with a
26 medical school within the state and a federally funded center
27 of excellence in geriatric research and education. The purpose
28 of such affiliations is to foster the development of methods
29 for improving and expanding the capability of health care
30 facilities to respond to the medical, psychological, and
31 social needs of frail and elderly persons by providing the
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1 most effective and appropriate services. A teaching nursing
2 home shall serve as a resource for research and for training
3 health care professionals in providing health care services in
4 institutional settings to frail and older persons.
5 (5) The Legislature may provide an annual
6 appropriation to the nursing home facility designated as a
7 teaching nursing home.
8 (6) In order for a nursing home to qualify as a
9 teaching nursing home under this section and to be entitled to
10 the benefits provided under this section, the nursing home
11 must:
12 (a) Be primarily operated and established to offer,
13 afford, and render a comprehensive multidisciplinary program
14 of geriatric education and research to residents of the state;
15 and
16 (b) Certify to the Agency for Health Care
17 Administration each school year the name, address, and
18 educational history of each trainee approved and accepted for
19 enrollment in the institution.
20 (7) A teaching nursing home may not expend any of the
21 funds received under this section for any purpose other than
22 operating and maintaining a teaching nursing home and
23 conducting geriatric research. In addition, a teaching nursing
24 home may not expend any funds received under this section for
25 constructing any building of any kind, nature, or description
26 or for maintaining or operating, in any form or manner, a
27 nursing home or health care facility.
28 Section 25. For purposes of incorporating the
29 amendment to section 468.1755, Florida Statutes, in references
30 thereto, subsection (3) of section 468.1695, Florida Statutes,
31 and section 468.1735, Florida Statutes, are reenacted to read:
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1 468.1695 Licensure by examination.--
2 (3) The department shall issue a license to practice
3 nursing home administration to any applicant who successfully
4 completes the examination in accordance with this section and
5 otherwise meets the requirements of this part. The department
6 shall not issue a license to any applicant who is under
7 investigation in this state or another jurisdiction for an
8 offense which would constitute a violation of s. 468.1745 or
9 s. 468.1755. Upon completion of the investigation, the
10 provisions of s. 468.1755 shall apply.
11 468.1735 Provisional license.--The board may establish
12 by rule requirements for issuance of a provisional license. A
13 provisional license shall be issued only to fill a position of
14 nursing home administrator that unexpectedly becomes vacant
15 due to illness, sudden death of the administrator, or
16 abandonment of position and shall be issued for one single
17 period as provided by rule not to exceed 6 months. The
18 department shall not issue a provisional license to any
19 applicant who is under investigation in this state or another
20 jurisdiction for an offense which would constitute a violation
21 of s. 468.1745 or s. 468.1755. Upon completion of the
22 investigation, the provisions of s. 468.1755 shall apply. The
23 provisional license may be issued to a person who does not
24 meet all of the licensing requirements established by this
25 part, but the board shall by rule establish minimal
26 requirements to ensure protection of the public health,
27 safety, and welfare. The provisional license shall be issued
28 to the person who is designated as the responsible person next
29 in command in the event of the administrator's departure. The
30 board may set an application fee not to exceed $500 for a
31 provisional license.
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1 Section 26. Section 468.1756, Florida Statutes, 1998
2 Supplement, is amended to read:
3 468.1756 Statute of limitations.--An administrative
4 complaint may only be filed pursuant to s. 455.621 for an act
5 listed in s. 468.1755(1)(c)-(q) paragraphs (1)(c)-(p) of s.
6 468.1755 within 4 years from the time of the incident giving
7 rise to the complaint, or within 4 years from the time the
8 incident is discovered or should have been discovered.
9 Section 27. Panel on Medicaid reimbursement.--
10 (1) There is created a panel on Medicaid reimbursement
11 to study the state's Medicaid reimbursement plan for nursing
12 home facilities and recommend changes to accomplish the
13 following goals:
14 (a) Increase the rate of employee retention in
15 individual nursing home facilities and in the field of
16 long-term care, and ensure salary enhancements for staff who
17 achieve targets of longevity with a nursing home facility.
18 (b) Create incentives for facilities to renovate and
19 update existing physical plants, when practicable, instead of
20 building new facilities or selling to another entity.
21 (c) Create incentives for facilities to provide more
22 direct-care staff and nurses.
23 (2) The panel shall be administratively attached to
24 and supported by the Agency for Health Care Administration and
25 shall be composed of the following members: the Director for
26 Medicaid of the Agency for Health Care Administration and two
27 agency staff persons competent in the technical and policy
28 aspects of Medicaid reimbursement; one representative from the
29 Governor's Office of Planning and Budgeting; one
30 representative from the Florida Association of Homes for the
31 Aging; one representative from the Florida Health Care
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1 Association; one representative from the Department of Elderly
2 Affairs, and one consumer representative appointed by the
3 secretary of that department; and a consumer's advocate for
4 senior citizens and two persons with expertise in the field of
5 quality management, financing, or public sector
6 accountability, appointed by the Governor.
7 (3) The panel shall hold its first meeting by August
8 1, 1999, and shall report its preliminary findings and
9 recommendations to the Legislature no later than December 31,
10 1999, by submitting a copy of its report to the President of
11 the Senate, the Speaker of the House of Representatives, and
12 the majority and minority offices of each chamber. The panel
13 shall report its final findings and recommendations to those
14 persons and offices no later than December 8, 2000. The panel
15 shall cease to exist and its operation shall terminate on
16 January 1, 2001.
17 Section 28. Study of certified nursing assistant
18 training, employment, and retention.--The Department of
19 Elderly Affairs, in consultation with the nursing home
20 industry, consumer advocates, persons employed by nursing
21 homes as licensed nurses and certified nursing assistants, the
22 Department of Health, the Agency for Health Care
23 Administration, the Department of Labor and Employment
24 Security, and the Department of Education, shall conduct, or
25 contract for, a study of the major factors affecting the
26 recruitment, training, employment, and retention of qualified
27 certified nursing assistants within the nursing home industry.
28 The Department of Elderly Affairs shall, by January 15, 2000,
29 provide to the Speaker of the House of Representatives and the
30 President of the Senate the results of the study, along with
31 recommendations to improve the quality and availability of
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1 certified nursing assistants employed by nursing facilities.
2 The study shall include a one-time review of the performance
3 of certified nursing assistant training programs and shall
4 compare the types of training programs as to admission
5 criteria, program requirements, graduation rates, job
6 placement, and job retention in nursing homes relative to job
7 retention in other health care environments and other job
8 classifications for which certified nursing assistants may
9 qualify. The study shall identify factors likely to improve
10 the rates of employment and retention of certified nursing
11 assistants in nursing homes. The study shall also include an
12 assessment of the extent and impact of certified nursing
13 assistant shortages within the major regional job markets of
14 the state. The study shall include an assessment of the
15 following factors:
16 (1) The extent and characteristics of the shortage
17 within the various regions of the state.
18 (2) The causes of the shortage, including, but not
19 restricted to, salary and benefits, working conditions, career
20 development, and the availability of certified nursing
21 assistant training programs.
22 (3) The impact of labor shortages on the ability of
23 nursing homes to hire sufficient staff to meet both the
24 minimum staffing standards required by agency rule and the
25 facility-specific staffing standards based on the needs of
26 residents.
27 (4) The impact of the labor shortage on the increased
28 use of temporary nursing pool agencies by nursing homes; the
29 influences of this trend on the quality and cost of services
30 provided; and the benefits of additional regulation of such
31 nursing pool agencies in light of the shortage.
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1 (5) Comparisons of the extent and effect of the
2 shortage of certified nursing assistants in Florida to the
3 experiences of other states and with respect to national
4 trends.
5 (6) The need for and feasibility of various measures
6 to enhance the image of certified nursing assistants,
7 including enhanced recruitment efforts directed towards
8 students at the junior high school and senior high school
9 levels, local education outreach, and job placement programs.
10 (7) The implications of the shortage as it relates to
11 the supply of and need for related paraprofessionals and other
12 health care workers, such as licensed practical nurses.
13 (8) The feasibility of allocating loans, grants, and
14 scholarships for the purpose of providing greater incentive
15 for and access to certified nursing assistant education, and
16 the probable effects of such efforts.
17 (9) The desirability of demonstration projects to test
18 innovative models and methods for the purpose of addressing
19 the need for more and better-qualified certified nursing
20 assistants in nursing homes.
21 Section 29. Section 400.29, Florida Statutes, is
22 repealed.
23 Section 30. There is hereby appropriated the sum of
24 $3,500,000 from the General Revenue Fund and the sum
25 $4,420,344 from the Medical Care Trust Fund to the Agency for
26 Health Care Administration in order to allow nursing
27 facilities the ability to recruit and retain qualified staff
28 and to provide appropriate care. The Agency for Health Care
29 Administration shall adjust limitations in the patient care
30 component of the per diem rate to allow these additional funds
31 to be reimbursed through the per diem rate, effective April 1,
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1 2000. The agency in expending the funds provided in this
2 appropriation shall establish a formula for reimbursing
3 nursing facilities for the cost of hiring additional certified
4 nursing assistants and licensed nurses or for the cost of
5 salary or benefit enhancements to retain such staff in these
6 specific classes. The formula shall provide for an increase
7 in a nursing facility's per diem rate inversely proportionate
8 to the facility's current staffing level for these staff
9 compared to the staffing standards set forth in agency rule.
10 The agency shall maintain for tracking purposes the record of
11 each facility's staffing increases or enhancements resulting
12 from these funds.
13 Section 31. The sum of $150,000 is hereby appropriated
14 from the General Revenue Fund to the Department of Elderly
15 Affairs for fiscal year 1999-2000 to fund the responsibilities
16 of the Office of State Long-Term Care Ombudsman and establish
17 a statewide toll-free telephone number pursuant to s.
18 400.0078, Florida Statutes, as created by this act. Eighteen
19 positions and the sum of $1,304,720 from recurring General
20 Revenue Funds, $72,994 from nonrecurring General Revenue Funds
21 and $452,584 from the Administrative Trust Fund is
22 appropriated to the Agency for Health Care Administration for
23 Fiscal Year 1999-2000 implement the provisions of this act.
24 The sum of $26,000 from General Revenue Fund is appropriated
25 to the Executive Office of the Governor for Fiscal Year
26 1999-2000 for the Governor's Panel on Excellence in Long Term
27 Care.
28 Section 32. Except as otherwise provided herein, this
29 act shall take effect July 1, 1999.
30
31
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