House Bill 0705

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    Florida House of Representatives - 1999                 HB 705

        By Representative Ogles






  1                      A bill to be entitled

  2         An act relating to emergency management

  3         planning; amending s. 252.355, F.S.; revising

  4         provisions relating to registration of persons

  5         requiring special needs assistance in

  6         emergencies; creating s. 381.0303, F.S.;

  7         providing for recruitment of health care

  8         practitioners for special needs shelters;

  9         providing for reimbursement; providing duties

10         of the Department of Health, the county health

11         departments, and the local emergency management

12         agencies; authorizing use of a health care

13         practitioner registry; authorizing

14         establishment of a special needs shelter

15         interagency committee; providing membership and

16         responsibilities; providing for rules; creating

17         s. 400.492, F.S.; requiring home health

18         agencies to prepare a comprehensive emergency

19         management plan; specifying plan requirements;

20         amending ss. 400.497 and 400.610, F.S.;

21         providing minimum requirements for home health

22         agency and hospice comprehensive emergency

23         management plans; providing for rules;

24         providing for plan review and approval;

25         amending s. 400.506, F.S.; requiring nurse

26         registries to assist at-risk clients with

27         special needs registration and to prepare a

28         comprehensive emergency management plan;

29         specifying plan requirements; creating s.

30         401.273, F.S.; providing for establishment of a

31         registry of emergency medical technicians and

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    Florida House of Representatives - 1999                 HB 705

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  1         paramedics for disasters and emergencies;

  2         amending s. 408.15, F.S.; authorizing the

  3         Agency for Health Care Administration to

  4         establish uniform standards of care for special

  5         needs shelters; creating s. 455.276, F.S.;

  6         providing for establishment of a health

  7         practitioner registry for disasters and

  8         emergencies; requiring emergency and disaster

  9         planning provisions in certain state agency

10         provider contracts; specifying minimum contract

11         requirements; providing appropriations;

12         providing an effective date.

13

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

15

16         Section 1.  Subsections (1) and (3) of section 252.355,

17  Florida Statutes, are amended to read:

18         252.355  Registry of disabled persons with special

19  needs; notice.--

20         (1)  In order to meet the special needs of persons who

21  would need assistance during evacuations and sheltering

22  because of physical, mental, or sensory disabilities or mental

23  handicaps, each local emergency management agency in the state

24  shall maintain a registry of disabled persons with special

25  needs located within the jurisdiction of the local agency.

26  The registration shall identify those persons in need of

27  assistance and plan for resource allocation to meet those

28  identified needs. To assist the local emergency management

29  agency in identifying such persons, the Department of Children

30  and Family Services, Department of Health, Department of Labor

31  and Employment Security, and Department of Elderly Affairs

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    Florida House of Representatives - 1999                 HB 705

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  1  Health and Rehabilitative Services shall provide registration

  2  information to all of their its special needs clients and to

  3  all incoming clients as a part of the intake process.  The

  4  registry shall be updated annually.  The registration program

  5  shall give disabled persons with special needs the option of

  6  preauthorizing emergency response personnel to enter their

  7  homes during search and rescue operations if necessary to

  8  assure their safety and welfare following disasters.

  9         (3)  All records, data, information, correspondence,

10  and communications relating to the registration of disabled

11  persons with special needs as provided in subsection (1) are

12  confidential and exempt from the provisions of s. 119.07(1),

13  except that such information shall be available to other

14  emergency response agencies, as determined by the local

15  emergency management director.

16         Section 2.  Section 381.0303, Florida Statutes, is

17  created to read:

18         381.0303  Health practitioner recruitment for special

19  needs shelters.--

20         (1)  PURPOSE.--The purpose of this section is to

21  designate the Department of Health, through its county health

22  departments, as the lead agency for coordination of the

23  recruitment of health care practitioners to staff special

24  needs shelters in times of emergency or disaster and to

25  provide resources to the department to carry out this

26  responsibility. However, nothing in this section prohibits a

27  county health department from entering into an agreement with

28  a local emergency management agency to assume the lead

29  responsibility for recruiting health care practitioners.

30         (2)  SPECIAL NEEDS SHELTER PLAN AND STAFFING.--Provided

31  funds have been appropriated to support medical services

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  1  disaster coordinator positions in county health departments,

  2  the department shall assume lead responsibility for the local

  3  coordination of local medical and health care providers, the

  4  American Red Cross, and other interested parties in developing

  5  a plan for the staffing and medical management of special

  6  needs shelters. The plan shall be in conformance with the

  7  local comprehensive emergency management plan.

  8         (a)  County health departments shall, in conjunction

  9  with the local emergency management agencies, have the lead

10  responsibility for coordination of the recruitment of health

11  care practitioners to staff local special needs shelters.

12  County health departments shall have the option of assigning

13  their employees to work in special needs shelters.

14         (b)  The appropriate county health department and local

15  emergency management agency shall jointly determine who has

16  responsibility for medical supervision in a special needs

17  shelter.

18         (c)  Local emergency management agencies shall be

19  responsible for the designation and operation of special needs

20  shelters during times of emergency or disaster. County health

21  departments shall assist the local emergency management agency

22  with regard to the management of medical services in special

23  needs shelters.

24         (3)  REIMBURSEMENT TO HEALTH CARE PRACTITIONERS.--The

25  Department of Health shall reimburse, subject to the

26  availability of funds for this purpose, health care

27  practitioners as defined in s. 455.501, provided the

28  practitioner is not providing care to a patient under an

29  existing contract, and emergency medical technicians and

30  paramedics licensed pursuant to chapter 401 for medical care

31  provided at the request of the department in special needs

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  1  shelters or at other locations during times of emergency or

  2  major disaster. Reimbursement for health care practitioners,

  3  except for physicians, shall be based on the average hourly

  4  rate that such practitioners were paid according to the most

  5  recent survey of Florida hospitals conducted by the Florida

  6  Hospital Association. Reimbursement shall be requested on

  7  forms prepared by the Department of Health. If a Presidential

  8  Disaster Declaration has been made, and the Federal Government

  9  makes funds available, the department shall use such funds for

10  reimbursement of eligible expenditures. In other situations,

11  or if federal funds do not fully compensate the department for

12  reimbursement made pursuant to this section, the department

13  shall submit to the Cabinet or Legislature, as appropriate, a

14  budget amendment requesting reimbursement.

15         (4)  HEALTH CARE PRACTITIONER REGISTRY.--The department

16  may use the registries established in ss. 401.273 and 455.276

17  when health care practitioners are needed to staff special

18  needs shelters or to staff disaster medical assistance teams.

19         (5)  SPECIAL NEEDS SHELTER INTERAGENCY COMMITTEE.--The

20  Department of Health may establish a special needs shelter

21  interagency committee, to be chaired and staffed by the

22  department. The committee shall resolve problems related to

23  special needs shelters not addressed in the state

24  comprehensive emergency medical plan and shall serve as an

25  oversight committee to monitor the planning and operation of

26  special needs shelters.

27         (a)  The committee may:

28         1.  On or before January 1, 2000, resolve questions

29  concerning the roles and responsibilities of state agencies

30  and other organizations that are necessary to implement the

31  program.

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  1         2.  On or before January 1, 2000, identify any issues

  2  requiring additional legislation and funding.

  3         3.  Develop and negotiate any necessary interagency

  4  agreements.

  5         4.  Undertake other such activities as the department

  6  deems necessary to facilitate the implementation of this

  7  section.

  8         5.  Submit recommendations to the Legislature as

  9  necessary.

10         (b)  The special needs shelter interagency committee

11  shall be composed of representatives of emergency management,

12  health, medical, and social services organizations. Membership

13  shall include, but shall not be limited to, the Departments of

14  Community Affairs, Children and Family Services, Elderly

15  Affairs, Labor and Employment Security, and Education; the

16  Agency for Health Care Administration; the Florida Medical

17  Association; Associated Home Health Industries of Florida,

18  Inc.; the Florida Nurses Association; the Florida Health Care

19  Association; the Florida Hospital Association; the Florida

20  Statutory Teaching Hospital Council; the Florida Association

21  of Homes for the Aging; the Florida Emergency Preparedness

22  Association; the American Red Cross; Florida Hospices, Inc.;

23  the Association of Community Hospitals and Health Systems; the

24  Florida Association of Health Maintenance Organizations; the

25  Florida League of Health Systems; and the Salvation Army.

26         (c)  Meetings of the committee shall be held in

27  Tallahassee and members of the committee shall serve at the

28  expense of the agencies or organizations they represent.

29         (6)  RULES.--The department may adopt rules necessary

30  to implement this section.

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  1         Section 3.  Section 400.492, Florida Statutes, is

  2  created to read:

  3         400.492  Provision of services during an

  4  emergency.--Each home health agency shall prepare and maintain

  5  a comprehensive emergency management plan that is consistent

  6  with the standards adopted by national accreditation

  7  organizations and consistent with the local special needs

  8  plan. The plan shall be updated annually and shall provide for

  9  continuing home health services during an emergency that

10  interrupts patient care or services in the patient's home. The

11  plan shall describe how the home health agency establishes and

12  maintains an effective response to emergencies and disasters,

13  including: notifying staff when emergency response measures

14  are initiated; providing for communication between staff

15  members, county health departments, and local emergency

16  management agencies, including a backup system; identifying

17  resources necessary to continue essential care or services or

18  referrals to other organizations subject to written agreement;

19  and prioritizing and contacting patients who need continued

20  care or services.

21         (1)  Each patient record for patients who are listed in

22  the registry established pursuant to s. 252.355 shall include

23  a description of how care or services will be continued in the

24  event of an emergency or disaster. The home health agency

25  shall discuss the emergency provisions with the patient and

26  the patient's caregivers, including where and how the patient

27  is to evacuate, procedures for notifying the home health

28  agency in the event that the patient evacuates to a location

29  other than the shelter identified in the patient record, and a

30  list of medications and equipment which must either accompany

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    Florida House of Representatives - 1999                 HB 705

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  1  the patient or will be needed by the patient in the event of

  2  an evacuation.

  3         (2)  Each home health agency shall maintain a current

  4  prioritized list of patients who need continued services

  5  during an emergency. The list shall indicate how services

  6  shall be continued in the event of an emergency or disaster

  7  for each patient and if the patient is to be transported to a

  8  special needs shelter, and shall indicate if the patient is

  9  receiving skilled nursing services and the patient's

10  medication and equipment needs. The list shall be furnished to

11  county health departments and to local emergency management

12  agencies, upon request.

13         (3)  Home health agencies shall not be required to

14  continue to provide care to patients in emergency situations

15  that are beyond their control and that make it impossible to

16  provide services, such as when roads are impassable or when

17  patients do not go to the location specified in their patient

18  records.

19         (4)  Notwithstanding the provisions of s. 400.464(2) or

20  any other provision of law to the contrary, a home health

21  agency may provide services in a special needs shelter located

22  in any county.

23         Section 4.  Subsection (1) of section 400.497, Florida

24  Statutes, is amended, and subsection (11) is added to said

25  section, to read:

26         400.497  Rules establishing minimum standards.--The

27  Agency for Health Care Administration shall adopt, publish,

28  and enforce rules to implement this part, including, as

29  applicable, ss. 400.506 and 400.509, which must provide

30  reasonable and fair minimum standards relating to:

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  1         (1)  Scope of home health services to be provided,

  2  which shall include services to be provided during emergency

  3  evacuation and sheltering.

  4         (11)  Preparation of a comprehensive emergency

  5  management plan pursuant to s. 400.492.

  6         (a)  The Agency for Health Care Administration shall

  7  adopt rules establishing minimum criteria for the plan and

  8  plan updates, with the concurrence of the Department of Health

  9  and in consultation with the Department of Community Affairs.

10         (b)  The rules must address the requirements in s.

11  400.487(7). In addition, the rules shall provide for the

12  maintenance of patient-specific medication lists that can

13  accompany patients who are transported from their homes.

14         (c)  The plan is subject to review and approval by the

15  county health department. During its review, the county health

16  department shall ensure that the following agencies, at a

17  minimum, are given the opportunity to review the plan:

18         1.  The local emergency management agency.

19         2.  The Agency for Health Care Administration.

20         3.  The local chapter of the American Red Cross or

21  other lead sheltering agency.

22         4.  The district office of the Department of Children

23  and Family Services.

24

25  The county health department shall complete its review within

26  60 days after receipt of the plan and shall either approve the

27  plan or advise the home health agency of necessary revisions.

28         Section 5.  Subsections (15), (16), and (17) of section

29  400.506, Florida Statutes, 1998 Supplement, are renumbered as

30  subsections (17), (18), and (19), respectively, and new

31  subsections (15) and (16) are added to said section to read:

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  1         400.506  Licensure of nurse registries; requirements;

  2  penalties.--

  3         (15)  Nurse registries shall assist at-risk clients

  4  with special needs registration with the appropriate local

  5  emergency management agency pursuant to s. 252.355.

  6         (16)  Each nurse registry shall prepare and maintain a

  7  comprehensive emergency management plan that is consistent

  8  with national standards adopted by accreditation organizations

  9  and consistent with local special needs plans. The plan shall

10  be updated annually and provide for continuing nursing

11  services during an emergency that interrupts patient care or

12  services in the patient's home. Continuing services are to be

13  delivered by the nurse registry or by other health care

14  providers pursuant to a written agreement for such care. The

15  plan shall describe how the nurse registry establishes and

16  maintains an effective response to emergencies and disasters,

17  including: notifying staff members, county health departments,

18  and local emergency management agencies, including a backup

19  system; identifying resources necessary to continue essential

20  care or services or referrals to other organizations subject

21  to a written agreement; and prioritizing and contacting

22  patients who need continued care or services. The plan shall

23  include identifying special needs shelters and shall contain

24  provisions for ensuring continuing care to nurse registry

25  patients who go to special needs shelters.

26         (a)  Each patient record for patients who are listed on

27  the registry established pursuant to s. 252.355 shall include

28  a description of how care or services will be continued in the

29  event of an emergency or disaster. The nurse registry shall

30  discuss the emergency provisions with the patient and the

31  patient's caregivers, including where and how the patient is

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  1  to evacuate, procedures for notifying the nurse registry in

  2  the event that the patient evacuates to a location other than

  3  the shelter identified in the patient record, and a list of

  4  medications and equipment which must either accompany the

  5  patient or will be needed by the patient in the event of an

  6  evacuation.

  7         (b)  Each nurse registry shall maintain a current

  8  prioritized list of patients who need continued services

  9  during an emergency. The list shall indicate how services

10  shall be continued in the event of an emergency or disaster

11  for each patient and if the patient is to be transported to a

12  special needs shelter, and shall indicate if the patient is

13  receiving skilled nursing services and the patient's

14  medication and equipment needs. The list shall be furnished to

15  county health departments and to local emergency management

16  agencies, upon request.

17         (c)  Nurse registries shall not be required to continue

18  to provide care to patients in emergency situations that are

19  beyond their control and that make it impossible to provide

20  services, such as when roads are impassable or when patients

21  do not go to the location specified in their patient records.

22         Section 6.  Paragraph (b) of subsection (1) of section

23  400.610, Florida Statutes, is amended to read:

24         400.610  Administration and management of a hospice.--

25         (1)  A hospice shall have a clearly defined organized

26  governing body, consisting of a minimum of seven persons who

27  are representative of the general population of the community

28  served. The governing body shall have autonomous authority and

29  responsibility for the operation of the hospice and shall meet

30  at least quarterly.  The governing body shall:

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  1         (b)  Prepare and maintain a comprehensive emergency

  2  management plan that provides for continuing hospice services

  3  in the event of an emergency that is consistent with local

  4  special needs plans. The plan shall include provisions for

  5  ensuring continuing care to hospice patients who go to special

  6  needs shelters. The plan is subject to review and approval by

  7  the county health department. During its review, the county

  8  health department shall ensure that the department, the

  9  agency, and the local chapter of the American Red Cross or

10  other lead sheltering agency have an opportunity to review and

11  comment on the plan. The county health department shall

12  complete its review within 60 days after receipt of the plan

13  and shall either approve the plan or advise the hospice of

14  necessary revisions. Prepare a disaster preparedness plan.

15         Section 7.  Section 401.273, Florida Statutes, is

16  created to read:

17         401.273  Emergency medical technician and paramedic

18  registry for disasters and emergencies.--The department shall

19  include on its forms for the certification or recertification

20  of emergency medical technicians and paramedics who could

21  assist the department in the event of a disaster a question

22  asking if the practitioner would be available to provide

23  health care services in special needs shelters or to help

24  staff disaster medical assistance teams during times of

25  emergency or major disaster. The names of the emergency

26  medical technicians and paramedics who answer affirmatively

27  shall be maintained by the department as a registry for

28  disasters and emergencies.

29         Section 8.  Subsection (12) is added to section 408.15,

30  Florida Statutes, 1998 Supplement, to read:

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  1         408.15  Powers of the agency.--In addition to the

  2  powers granted to the agency elsewhere in this chapter, the

  3  agency is authorized to:

  4         (12)  Establish, in coordination with the Department of

  5  Health, uniform standards of care to be provided in special

  6  needs units or shelters during times of emergency or major

  7  disaster.

  8         Section 9.  Section 455.276, Florida Statutes, is

  9  created to read:

10         455.276  Health care practitioner registry for

11  disasters and emergencies.--The Department of Health shall

12  include on its forms for the licensure or certification of

13  physicians, physician assistants, certified nursing

14  assistants, licensed practical nurses, registered nurses,

15  nurse practitioners, respiratory therapists, and other health

16  care practitioners who could assist the department in the

17  event of a disaster a question asking if the practitioner

18  would be available to provide health care services in special

19  needs shelters or to help staff disaster medical assistance

20  teams during times of emergency or major disaster. The names

21  of practitioners who answer affirmatively shall be maintained

22  by the department as a health care practitioner registry for

23  disasters and emergencies.

24         Section 10.  State agencies that contract with

25  providers for the care of persons with disabilities or

26  limitations that make such persons dependent upon the care of

27  others shall include emergency and disaster planning

28  provisions in such contracts at the time the contracts are

29  initiated or upon renewal. These provisions shall include, but

30  shall not be limited to:

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  1         (1)  The designation of an emergency coordinating

  2  officer.

  3         (2)  A procedure to contact all at-risk provider

  4  clients, on a priority basis, prior to and immediately

  5  following an emergency or disaster.

  6         (3)  A procedure to help at-risk clients register with

  7  the special needs registry of the local emergency management

  8  agency.

  9         (4)  A procedure to dispatch the emergency coordinating

10  officer or other staff members to special needs shelters to

11  assist clients with special needs, if necessary.

12         (5)  A procedure for providing the essential services

13  the organization currently provides to special needs clients

14  in preparation for, and during and following, a disaster.

15         Section 11.  There is hereby appropriated from the

16  General Revenue Fund, to fund the implementation of this act:

17         (1)  To the Department of Health the sum of $3,798,932

18  and 2 full-time-equivalent positions.

19         (2)  To the Department of Children and Family Services

20  the sum of $58,898 and 1 full-time-equivalent position.

21         (3)  To the Department of Elderly Affairs the sum of

22  $58,898 and 1 full-time-equivalent position.

23         (4)  To the Agency for Health Care Administration the

24  sum of $58,898 and 1 full-time-equivalent position.

25         (5)  To the Department of Community Affairs the sum of

26  $58,898 and 1 full-time-equivalent position.

27         Section 12.  This act shall take effect October 1,

28  1999.

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

  2                          HOUSE SUMMARY

  3
      Revises provisions relating to registration of persons
  4    requiring special needs assistance during an emergency or
      disaster. Provides for recruitment of health care
  5    practitioners to staff special needs shelters during
      emergencies or disasters, through the county health
  6    departments and the practitioner licensure process.
      Authorizes the Department of Health to maintain
  7    practitioner registries and provide certain compensation
      for care provided at special needs shelters. Provides for
  8    establishment of a special needs shelter interagency
      committee.
  9

10    Specifies minimum requirements for home health agency and
      hospice comprehensive emergency management plans, and
11    provides for plan review and approval. Requires nurse
      registries to assist at-risk clients with special needs
12    registration and to prepare a comprehensive emergency
      management plan. Provides for annual update of such
13    plans.

14
      Authorizes the Agency for Health Care Administration to
15    establish uniform standards of care for special needs
      shelters. Requires emergency and disaster planning
16    provisions in certain state agency contracts, and
      specifies minimum requirements. Provides appropriations
17    to implement the act. See bill for details.

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