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





                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    

                            CHAMBER ACTION
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10                                                                

11  Senator Silver moved the following amendment:

12

13         Senate Amendment (with title amendment) 

14         On page 12, between lines 24 and 25,

15

16  insert:

17         Section 6.  Sections 468.821 through 468.829, Florida

18  Statutes, are renumbered as sections 464.201 through 464.209,

19  respectively, designated as part II of chapter 464, Florida

20  Statutes, and amended to read:

21         464.201 468.821  Definitions.--As used in this part,

22  the term:

23         (1)  "Approved training program" means:

24         (a)  A course of training conducted by a public sector

25  or private sector educational center licensed by the

26  Department of Education to implement the basic curriculum for

27  nursing assistants which is approved by the Department of

28  Education. Beginning October 1, 2000, the board shall assume

29  responsibility for approval of training programs under this

30  paragraph.

31         (b)  A training program operated under s. 400.141.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (2)  "Board" means the Board of Nursing.

 2         (3)(2)  "Certified nursing assistant" means a person

 3  who meets the qualifications specified in this part and who is

 4  certified by the board department as a certified nursing

 5  assistant.

 6         (4)(3)  "Department" means the Department of Health.

 7         (5)(4)  "Registry" means the listing of certified

 8  nursing assistants maintained by the board department.

 9         464.202 468.822  Duties and powers of the board

10  department.--The board department shall maintain, or contract

11  with or approve another entity to maintain, a state registry

12  of certified nursing assistants. The registry must consist of

13  the name of each certified nursing assistant in this state;

14  other identifying information defined by board department

15  rule; certification status; the effective date of

16  certification; other information required by state or federal

17  law; information regarding any crime or any abuse, neglect, or

18  exploitation as provided under chapter 435; and any

19  disciplinary action taken against the certified nursing

20  assistant. The registry shall be accessible to the public, the

21  certificateholder, employers, and other state agencies. The

22  board department shall adopt by rule testing procedures for

23  use in certifying nursing assistants and shall adopt rules

24  regulating the practice of certified nursing assistants to

25  enforce this part. The board department may contract with or

26  approve another entity or organization to provide the

27  examination services, including the development and

28  administration of examinations. The board shall require that

29  the contract provider offer certified nursing assistant

30  applications via the Internet, and may require the contract

31  provider to accept certified nursing assistant applications

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                                                  SENATE AMENDMENT

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 1  for processing via the Internet.  The board shall require the

 2  contract provider to provide the preliminary results of the

 3  certified nursing examination on the date the test is

 4  administered. The provider shall pay all reasonable costs and

 5  expenses incurred by the board department in evaluating the

 6  provider's application and performance during the delivery of

 7  services, including examination services and procedures for

 8  maintaining the certified nursing assistant registry.

 9         464.203 468.823  Certified nursing assistants;

10  certification requirement.--

11         (1)  The board department shall issue a certificate to

12  practice as a certified nursing assistant to any person who

13  demonstrates a minimum competency to read and write and

14  successfully passes the required Level I or Level II screening

15  pursuant to s. 400.215 and meets one of the following

16  requirements:

17         (a)  Has successfully completed an approved training

18  program and achieved a minimum score, established by rule of

19  the board department, on the nursing assistant competency

20  examination, which consists of a written portion and

21  skills-demonstration portion approved by the board department

22  and administered at a site and by personnel approved by the

23  department.

24         (b)  Has achieved a minimum score, established by rule

25  of the board department, on the nursing assistant competency

26  examination, which consists of a written portion and

27  skills-demonstration portion, approved by the board department

28  and administered at a site and by personnel approved by the

29  department and:

30         1.  Has a high school diploma, or its equivalent; or

31         2.  Is at least 18 years of age.

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                                                  SENATE AMENDMENT

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 1         (c)  Is currently certified in another state; is listed

 2  on that state's certified nursing assistant registry; and has

 3  not been found to have committed abuse, neglect, or

 4  exploitation in that state; and has successfully completed a

 5  national nursing assistant evaluation in order to receive

 6  certification in that state.

 7         (d)  Has completed the curriculum developed under the

 8  Enterprise Florida Jobs and Education Partnership Grant and

 9  achieved a minimum score, established by rule of the board, on

10  the nursing assistant competency examination, which consists

11  of a written portion and skills-demonstration portion,

12  approved by the board and administered at a site and by

13  personnel approved by the department.

14         (2)  If an applicant fails to pass the nursing

15  assistant competency examination in three attempts, the

16  applicant is not eligible for reexamination unless the

17  applicant completes an approved training program.

18         (3)  An oral examination shall be administered as a

19  substitute for the written portion of the examination upon

20  request. The oral examination shall be administered at a site

21  and by personnel approved by the department.

22         (4)  The board department shall adopt rules to provide

23  for the initial certification of certified nursing assistants.

24         (5)  A certified nursing assistant shall maintain a

25  current address with the board department in accordance with

26  s. 455.717.

27         464.204 468.824  Denial, suspension, or revocation of

28  certification; disciplinary actions.--

29         (1)  The following acts constitute grounds for which

30  the board department may impose disciplinary sanctions as

31  specified in subsection (2):

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                                                  SENATE AMENDMENT

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 1         (a)  Obtaining or attempting to obtain certification or

 2  an exemption, or possessing or attempting to possess

 3  certification or a letter of exemption, by bribery,

 4  misrepresentation, deceit, or through an error of the board

 5  department.

 6         (b)  Intentionally violating any provision of this

 7  chapter, chapter 455, or the rules adopted by the board

 8  department.

 9         (2)  When the board department finds any person guilty

10  of any of the grounds set forth in subsection (1), it may

11  enter an order imposing one or more of the following

12  penalties:

13         (a)  Denial, suspension, or revocation of

14  certification.

15         (b)  Imposition of an administrative fine not to exceed

16  $150 for each count or separate offense.

17         (c)  Imposition of probation or restriction of

18  certification, including conditions such as corrective actions

19  as retraining or compliance with an approved treatment program

20  for impaired practitioners.

21         (3)  The board department may, upon the request of a

22  certificateholder, exempt the certificateholder from

23  disqualification of certification or disqualification of

24  employment in accordance with chapter 435 and issue a letter

25  of exemption. After January 1, 2000, The board department must

26  notify an applicant seeking an exemption from disqualification

27  from certification or employment of its decision to approve or

28  deny the request within 30 days after the date the board

29  department receives all required documentation.

30         464.205 468.825  Availability of disciplinary records

31  and proceedings.--Pursuant to s. 455.621, any complaint or

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                                                  SENATE AMENDMENT

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 1  record maintained by the department of Health pursuant to the

 2  discipline of a certified nursing assistant and any proceeding

 3  held by the board department to discipline a certified nursing

 4  assistant shall remain open and available to the public.

 5         464.206 468.826  Exemption from liability.--If an

 6  employer terminates or denies employment to a certified

 7  nursing assistant whose certification is inactive as shown on

 8  the certified nursing assistant registry or whose name appears

 9  on the central abuse registry and tracking system of the

10  Department of Children and Family Services or on a criminal

11  screening report of the Department of Law Enforcement, the

12  employer is not civilly liable for such termination and a

13  cause of action may not be brought against the employer for

14  damages, regardless of whether the employee has filed for an

15  exemption from the board department under s. 464.204(3)

16  468.824(1). There may not be any monetary liability on the

17  part of, and a cause of action for damages may not arise

18  against, any licensed facility, its governing board or members

19  thereof, medical staff, disciplinary board, agents,

20  investigators, witnesses, employees, or any other person for

21  any action taken in good faith without intentional fraud in

22  carrying out this section.

23         464.207 468.827  Penalties.--It is a misdemeanor of the

24  first degree, punishable as provided under s. 775.082 or s.

25  775.083, for any person, knowingly or intentionally, to fail

26  to disclose, by false statement, misrepresentation,

27  impersonation, or other fraudulent means, in any application

28  for voluntary or paid employment or certification licensure

29  regulated under this part, a material fact used in making a

30  determination as to such person's qualifications to be an

31  employee or certificateholder licensee.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         464.208 468.828  Background screening information;

 2  rulemaking authority.--

 3         (1)  The Agency for Health Care Administration shall

 4  allow the board department to electronically access its

 5  background screening database and records, and the Department

 6  of Children and Family Services shall allow the board

 7  department to electronically access its central abuse registry

 8  and tracking system under chapter 415.

 9         (2)  An employer, or an agent thereof, may not use

10  criminal records, juvenile records, or information obtained

11  from the central abuse hotline under chapter 415 relating to

12  vulnerable adults for any purpose other than determining if

13  the person meets the requirements of this part. Such records

14  and information obtained by the board department shall remain

15  confidential and exempt from s. 119.07(1).

16         (3)  If the requirements of the Omnibus Budget

17  Reconciliation Act of 1987, as amended, for the certification

18  of nursing assistants are in conflict with this part, the

19  federal requirements shall prevail for those facilities

20  certified to provide care under Title XVIII (Medicare) or

21  Title XIX (Medicaid) of the Social Security Act.

22         (4)  The board department shall adopt rules to

23  administer this part.

24         464.209 468.829  Certified nursing assistant

25  registry.--

26         (1)  By October 1, 1999, and by October 1 of every year

27  thereafter, each employer of certified nursing assistants

28  shall submit to the board Department of Health a list of the

29  names and social security numbers of each person employed by

30  the employer as a certified nursing assistant in a

31  nursing-related occupation for a minimum of 8 hours for

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                                                  SENATE AMENDMENT

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 1  monetary compensation during the preceding 24 months.

 2  Employers may submit such information electronically through

 3  the department's Internet site.

 4         (2)  The board department shall update the certified

 5  nursing assistant registry upon receipt of the lists of

 6  certified nursing assistants, and shall complete the first of

 7  such updates by December 31, 1999.

 8         (3)  Each certified nursing assistant whose name is not

 9  reported to the board department under subsection (1) on

10  October 1, 1999, shall be assigned an inactive certification

11  on January 1, 2000. A certified nursing assistant may remove

12  such an inactive certification by submitting documentation to

13  the board department that he or she was employed for a minimum

14  of 8 hours for monetary compensation as a certified nursing

15  assistant in a nursing-related occupation during the preceding

16  24 months.

17         (4)  This section is repealed October 2, 2001.

18         Section 7.  Section 464.2085, Florida Statutes, is

19  created to read:

20         464.2085  Council on Certified Nursing Assistants.--The

21  Council on Certified Nursing Assistants is created within the

22  department, under the Board of Nursing.

23         (1)  The council shall consist of five members

24  appointed as follows:

25         (a)  The chairperson of the Board of Nursing shall

26  appoint two members who are registered nurses. One of the

27  members must currently supervise a certified nursing assistant

28  in a licensed nursing home.

29         (b)  The chairperson of the Board of Nursing shall

30  appoint one member who is a licensed practical nurse who is

31  currently working in a licensed nursing home.

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                                                  SENATE AMENDMENT

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 1         (c)  The secretary of the department or his or her

 2  designee shall appoint two certified nursing assistants

 3  currently certified under this chapter, at least one of whom

 4  is currently working in a licensed nursing home.

 5         (2)  The council shall:

 6         (a)  Recommend to the department policies and

 7  procedures for the certification of nursing assistants.

 8         (b)  Develop all rules regulating the education,

 9  training, and certification process for nursing assistants

10  certified under this chapter. The Board of Nursing shall

11  consider adopting a proposed rule developed by the council at

12  the regularly scheduled meeting immediately following the

13  submission of the proposed rule by the council.

14         (c)  Make recommendations to the board regarding all

15  matters relating to the certification of nursing assistants.

16         (d)  Address concerns and problems of certified nursing

17  assistants in order to improve safety in the practice of

18  certified nursing assistants.

19         Section 8.  Paragraph (g) of subsection (3) of section

20  20.43, Florida Statutes, is amended to read:

21         20.43  Department of Health.--There is created a

22  Department of Health.

23         (3)  The following divisions of the Department of

24  Health are established:

25         (g)  Division of Medical Quality Assurance, which is

26  responsible for the following boards and professions

27  established within the division:

28         1.  Nursing assistants, as provided under s. 400.211.

29         1.2.  Health care services pools, as provided under s.

30  402.48.

31         2.3.  The Board of Acupuncture, created under chapter

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 1  457.

 2         3.4.  The Board of Medicine, created under chapter 458.

 3         4.5.  The Board of Osteopathic Medicine, created under

 4  chapter 459.

 5         5.6.  The Board of Chiropractic Medicine, created under

 6  chapter 460.

 7         6.7.  The Board of Podiatric Medicine, created under

 8  chapter 461.

 9         7.8.  Naturopathy, as provided under chapter 462.

10         8.9.  The Board of Optometry, created under chapter

11  463.

12         9.10.  The Board of Nursing, created under part I of

13  chapter 464.

14         10.  Nursing assistants, as provided under part II of

15  chapter 464.

16         11.  The Board of Pharmacy, created under chapter 465.

17         12.  The Board of Dentistry, created under chapter 466.

18         13.  Midwifery, as provided under chapter 467.

19         14.  The Board of Speech-Language Pathology and

20  Audiology, created under part I of chapter 468.

21         15.  The Board of Nursing Home Administrators, created

22  under part II of chapter 468.

23         16.  The Board of Occupational Therapy, created under

24  part III of chapter 468.

25         17.  Respiratory therapy, as provided under part V of

26  chapter 468.

27         18.  Dietetics and nutrition practice, as provided

28  under part X of chapter 468.

29         19.  The Board of Athletic Training, created under part

30  XIII of chapter 468.

31         20.  The Board of Orthotists and Prosthetists, created

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 1  under part XIV of chapter 468.

 2         21.  Electrolysis, as provided under chapter 478.

 3         22.  The Board of Massage Therapy, created under

 4  chapter 480.

 5         23.  The Board of Clinical Laboratory Personnel,

 6  created under part III of chapter 483.

 7         24.  Medical physicists, as provided under part IV of

 8  chapter 483.

 9         25.  The Board of Opticianry, created under part I of

10  chapter 484.

11         26.  The Board of Hearing Aid Specialists, created

12  under part II of chapter 484.

13         27.  The Board of Physical Therapy Practice, created

14  under chapter 486.

15         28.  The Board of Psychology, created under chapter

16  490.

17         29.  School psychologists, as provided under chapter

18  490.

19         30.  The Board of Clinical Social Work, Marriage and

20  Family Therapy, and Mental Health Counseling, created under

21  chapter 491.

22

23  The department may contract with the Agency for Health Care

24  Administration who shall provide consumer complaint,

25  investigative, and prosecutorial services required by the

26  Division of Medical Quality Assurance, councils, or boards, as

27  appropriate.

28         Section 9.  Subsection (38) of section 39.01, Florida

29  Statutes, is amended to read:

30         39.01  Definitions.--When used in this chapter, unless

31  the context otherwise requires:

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                                                  SENATE AMENDMENT

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 1         (38)  "Licensed health care professional" means a

 2  physician licensed under chapter 458, an osteopathic physician

 3  licensed under chapter 459, a nurse licensed under part I of

 4  chapter 464, a physician assistant licensed under chapter 458

 5  or chapter 459, or a dentist licensed under chapter 466.

 6         Section 10.  Paragraph (b) of subsection (1) of section

 7  39.304, Florida Statutes, is amended to read:

 8         39.304  Photographs, medical examinations, X rays, and

 9  medical treatment of abused, abandoned, or neglected child.--

10         (1)

11         (b)  If the areas of trauma visible on a child indicate

12  a need for a medical examination, or if the child verbally

13  complains or otherwise exhibits distress as a result of injury

14  through suspected child abuse, abandonment, or neglect, or is

15  alleged to have been sexually abused, the person required to

16  investigate may cause the child to be referred for diagnosis

17  to a licensed physician or an emergency department in a

18  hospital without the consent of the child's parents or legal

19  custodian. Such examination may be performed by any licensed

20  physician or an advanced registered nurse practitioner

21  licensed pursuant to part I of chapter 464. Any licensed

22  physician, or advanced registered nurse practitioner licensed

23  pursuant to part I of chapter 464, who has reasonable cause to

24  suspect that an injury was the result of child abuse,

25  abandonment, or neglect may authorize a radiological

26  examination to be performed on the child without the consent

27  of the child's parent or legal custodian.

28         Section 11.  Paragraph (c) of subsection (6) of section

29  110.131, Florida Statutes, is amended to read:

30         110.131  Other-personal-services temporary

31  employment.--

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1         (6)

 2         (c)  Notwithstanding the provisions of this section,

 3  the agency head or his or her designee may extend the

 4  other-personal-services employment of a health care

 5  practitioner licensed pursuant to chapter 458, chapter 459,

 6  chapter 460, chapter 461, chapter 463, part I of chapter 464,

 7  chapter 466, chapter 468, chapter 483, chapter 486, or chapter

 8  490 beyond 2,080 hours and may employ such practitioner on an

 9  hourly or other basis.

10         Section 12.  Subsection (1) of section 232.46, Florida

11  Statutes, is amended to read:

12         232.46  Administration of medication by school district

13  personnel.--

14         (1)  Notwithstanding the provisions of the Nurse

15  Practice Act, part I of chapter 464, school district personnel

16  shall be authorized to assist students in the administration

17  of prescription medication when the following conditions have

18  been met:

19         (a)  Each district school board shall include in its

20  approved school health services plan a procedure to provide

21  training, by a registered nurse, a licensed practical nurse, a

22  physician licensed pursuant to chapter 458 or chapter 459, or

23  a physician assistant licensed pursuant to chapter 458 or

24  chapter 459, to the school personnel designated by the

25  principal to assist students in the administration of

26  prescribed medication.  Such training may be provided in

27  collaboration with other school districts, through contract

28  with an education consortium, or by any other arrangement

29  consistent with the intent of this section.

30         (b)  Each district school board shall adopt policies

31  and procedures governing the administration of prescription

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 1  medication by school district personnel.  The policies and

 2  procedures shall include, but not be limited to, the following

 3  provisions:

 4         1.  For each prescribed medication, the student's

 5  parent or guardian shall provide to the school principal a

 6  written statement which shall grant to the principal or the

 7  principal's designee permission to assist in the

 8  administration of such medication and which shall explain the

 9  necessity for such medication to be provided during the school

10  day, including any occasion when the student is away from

11  school property on official school business. The school

12  principal or the principal's trained designee shall assist the

13  student in the administration of such medication.

14         2.  Each prescribed medication to be administered by

15  school district personnel shall be received, counted, and

16  stored in its original container. When the medication is not

17  in use, it shall be stored in its original container in a

18  secure fashion under lock and key in a location designated by

19  the principal.

20         Section 13.  Subsection (6) of section 240.4075,

21  Florida Statutes, is amended to read:

22         240.4075  Nursing Student Loan Forgiveness Program.--

23         (6)  In addition to licensing fees imposed under part I

24  of chapter 464, there is hereby levied and imposed an

25  additional fee of $5, which fee shall be paid upon licensure

26  or renewal of nursing licensure. Revenues collected from the

27  fee imposed in this subsection shall be deposited in the

28  Nursing Student Loan Forgiveness Trust Fund of the Department

29  of Education and will be used solely for the purpose of

30  carrying out the provisions of this section and s. 240.4076.

31  Up to 50 percent of the revenues appropriated to implement

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 1  this subsection may be used for the nursing scholarship

 2  program established pursuant to s. 240.4076.

 3         Section 14.  Paragraph (b) of subsection (1) of section

 4  246.081, Florida Statutes, is amended to read:

 5         246.081  License, certificate of exemption, or

 6  authorization required; exceptions.--

 7         (1)  The following colleges are not under the

 8  jurisdiction of the board and are not required to obtain a

 9  license, a certificate of exemption, permission to operate, or

10  an authorization from the board:

11         (b)  Any college, school, or course licensed or

12  approved for establishment and operation under part I of

13  chapter 464, chapter 466, or chapter 475, or any other chapter

14  of the Florida Statutes, requiring licensing or approval as

15  defined in ss. 246.011-246.151.

16         Section 15.  Subsection (2) of section 310.102, Florida

17  Statutes, is amended to read:

18         310.102  Treatment programs for impaired pilots and

19  deputy pilots.--

20         (2)  The department shall retain one or more impaired

21  practitioner consultants as recommended by the committee. A

22  consultant shall be a licensee under the jurisdiction of the

23  Division of Medical Quality Assurance within the Department of

24  Health, and at least one consultant must be a practitioner

25  licensed under chapter 458, chapter 459, or part I of chapter

26  464. The consultant shall assist the probable cause panel and

27  department in carrying out the responsibilities of this

28  section. This shall include working with department

29  investigators to determine whether a pilot or deputy pilot is,

30  in fact, impaired.

31         Section 16.  Subsection (7) of section 381.0302,

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 1  Florida Statutes, is amended to read:

 2         381.0302  Florida Health Services Corps.--

 3         (7)  The financial penalty for noncompliance with

 4  participation requirements for persons who have received

 5  financial payments under subsection (5) or subsection (6)

 6  shall be determined in the same manner as in the National

 7  Health Services Corps scholarship program.  In addition,

 8  noncompliance with participation requirements shall also

 9  result in ineligibility for professional licensure or renewal

10  of licensure under chapter 458, chapter 459, chapter 460, part

11  I of chapter 464, chapter 465, or chapter 466.  For a

12  participant who is unable to participate for reasons of

13  disability, the penalty is the actual amount of financial

14  assistance provided to the participant.  Financial penalties

15  shall be deposited in the Florida Health Services Corps Trust

16  Fund and shall be used to provide additional scholarship and

17  financial assistance.

18         Section 17.  Subsection (1) of section 384.30, Florida

19  Statutes, is amended to read:

20         384.30  Minors' consent to treatment.--

21         (1)  The department and its authorized representatives,

22  each physician licensed to practice medicine under the

23  provisions of chapter 458 or chapter 459, each health care

24  professional licensed under the provisions of part I of

25  chapter 464 who is acting pursuant to the scope of his or her

26  license, and each public or private hospital, clinic, or other

27  health facility may examine and provide treatment for sexually

28  transmissible diseases to any minor, if the physician, health

29  care professional, or facility is qualified to provide such

30  treatment.  The consent of the parents or guardians of a minor

31  is not a prerequisite for an examination or treatment.

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 1         Section 18.  Section 384.31, Florida Statutes, is

 2  amended to read:

 3         384.31  Serological testing of pregnant women; duty of

 4  the attendant.--

 5         (1)  Every person, including every physician licensed

 6  under chapter 458 or chapter 459 or midwife licensed under

 7  part I of chapter 464 or chapter 467, attending a pregnant

 8  woman for conditions relating to pregnancy during the period

 9  of gestation and delivery shall take or cause to be taken a

10  sample of venous blood at a time or times specified by the

11  department.  Each sample of blood shall be tested by a

12  laboratory approved for such purposes under part I of chapter

13  483 for sexually transmissible diseases as required by rule of

14  the department.

15         (2)  At the time the venous blood sample is taken,

16  testing for human immunodeficiency virus (HIV) infection shall

17  be offered to each pregnant woman. The prevailing professional

18  standard of care in this state requires each health care

19  provider and midwife who attends a pregnant woman to counsel

20  the woman to be tested for human immunodeficiency virus (HIV).

21  Counseling shall include a discussion of the availability of

22  treatment if the pregnant woman tests HIV positive. If a

23  pregnant woman objects to HIV testing, reasonable steps shall

24  be taken to obtain a written statement of such objection,

25  signed by the patient, which shall be placed in the patient's

26  medical record. Every person, including every physician

27  licensed under chapter 458 or chapter 459 or midwife licensed

28  under part I of chapter 464 or chapter 467, who attends a

29  pregnant woman who has been offered and objects to HIV testing

30  shall be immune from liability arising out of or related to

31  the contracting of HIV infection or acquired immune deficiency

                                  17
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  syndrome (AIDS) by the child from the mother.

 2         Section 19.  Subsection (23) of section 394.455,

 3  Florida Statutes, is amended to read:

 4         394.455  Definitions.--As used in this part, unless the

 5  context clearly requires otherwise, the term:

 6         (23)  "Psychiatric nurse" means a registered nurse

 7  licensed under part I of chapter 464 who has a master's degree

 8  or a doctorate in psychiatric nursing and 2 years of

 9  post-master's clinical experience under the supervision of a

10  physician.

11         Section 20.  Paragraphs (a) and (b) of subsection (2)

12  and subsection (4) of section 395.0191, Florida Statutes, are

13  amended to read:

14         395.0191  Staff membership and clinical privileges.--

15         (2)(a)  Each licensed facility shall establish rules

16  and procedures for consideration of an application for

17  clinical privileges submitted by an advanced registered nurse

18  practitioner licensed and certified under part I of chapter

19  464, in accordance with the provisions of this section.  No

20  licensed facility shall deny such application solely because

21  the applicant is licensed under part I of chapter 464 or

22  because the applicant is not a participant in the Florida

23  Birth-Related Neurological Injury Compensation Plan.

24         (b)  An advanced registered nurse practitioner who is

25  certified as a registered nurse anesthetist licensed under

26  part I of chapter 464 shall administer anesthesia under the

27  onsite medical direction of a professional licensed under

28  chapter 458, chapter 459, or chapter 466, and in accordance

29  with an established protocol approved by the medical staff.

30  The medical direction shall specifically address the needs of

31  the individual patient.

                                  18
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (4)  Nothing herein shall restrict in any way the

 2  authority of the medical staff of a licensed facility to

 3  review for approval or disapproval all applications for

 4  appointment and reappointment to all categories of staff and

 5  to make recommendations on each applicant to the governing

 6  board, including the delineation of privileges to be granted

 7  in each case.  In making such recommendations and in the

 8  delineation of privileges, each applicant shall be considered

 9  individually pursuant to criteria for a doctor licensed under

10  chapter 458, chapter 459, chapter 461, or chapter 466, or for

11  an advanced registered nurse practitioner licensed and

12  certified under part I of chapter 464, or for a psychologist

13  licensed under chapter 490, as applicable.  The applicant's

14  eligibility for staff membership or clinical privileges shall

15  be determined by the applicant's background, experience,

16  health, training, and demonstrated competency; the applicant's

17  adherence to applicable professional ethics; the applicant's

18  reputation; and the applicant's ability to work with others

19  and by such other elements as determined by the governing

20  board, consistent with this part.

21         Section 21.  Subsection (11) of section 400.021,

22  Florida Statutes, is amended to read:

23         400.021  Definitions.--When used in this part, unless

24  the context otherwise requires, the term:

25         (11)  "Nursing home facility" means any facility which

26  provides nursing services as defined in part I of chapter 464

27  and which is licensed according to this part.

28         Section 22.  Section 400.211, Florida Statutes, is

29  amended to read:

30         400.211  Persons employed as nursing assistants;

31  certification requirement.--

                                  19
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (1)  To serve as a nursing assistant in any nursing

 2  home, a person must be certified as a nursing assistant under

 3  part II XV of chapter 464 468, unless the person is except a

 4  registered nurse or practical nurse licensed in accordance

 5  with part I of chapter 464 or an applicant for such licensure

 6  who is permitted to practice nursing in accordance with rules

 7  adopted by the Board of Nursing pursuant to part I of chapter

 8  464, to serve as a nursing assistant in any nursing home.

 9         (2)  The following categories of persons who are not

10  certified as nursing assistants under this part II of chapter

11  464 may be employed by a nursing facility for a period of 4

12  months:

13         (a)  Persons who are enrolled in, or have completed, a

14  state-approved nursing assistant program; or

15         (b)  Persons who have been positively verified by a

16  state approved test site as actively certified and on the

17  registry in another state with no findings of abuse, but who

18  have not completed the written examination required under this

19  section.;or

20         (c)  Persons who have preliminarily passed the state's

21  certification exam.

22

23  The certification requirement must be met within 4 months

24  after of initial employment as a nursing assistant in a

25  licensed nursing facility.

26         (3)  Nursing homes shall require persons seeking

27  employment as a certified nursing assistant to submit an

28  employment history to the facility. The facility shall verify

29  the employment history unless, through diligent efforts, such

30  verification is not possible.  There shall be no monetary

31  liability on the part of, and no cause of action for damages

                                  20
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  shall arise against, a former employer who reasonably and in

 2  good faith communicates his or her honest opinion about a

 3  former employee's job performance.

 4         Section 23.  Paragraph (b) of subsection (4) of section

 5  400.215, Florida Statutes, is amended to read:

 6         400.215  Personnel screening requirement.--

 7         (4)

 8         (b)  As provided in s. 435.07, the appropriate

 9  regulatory board within the Department of Health, or that

10  department itself when there is no board, may grant an

11  exemption from disqualification to an employee or prospective

12  employee who is subject to this section and who has received a

13  professional license or certification from the Department of

14  Health or a regulatory board within that department.

15         Section 24.  Paragraph (c) is added to subsection (3)

16  of section 400.23, Florida Statutes, to read:

17         400.23  Rules; evaluation and deficiencies; licensure

18  status.--

19         (3)

20         (c)  Licensed practical nurses licensed under chapter

21  464 who are providing nursing services in nursing home

22  facilities under this part may supervise the activities of

23  other licensed practical nurses, certified nursing assistants,

24  and other unlicensed personnel providing services in such

25  facilities in accordance with rules adopted by the Board of

26  Nursing.

27         Section 25.  Subsections (12) and (14) of section

28  400.402, Florida Statutes, are amended to read:

29         400.402  Definitions.--When used in this part, the

30  term:

31         (12)  "Extended congregate care" means acts beyond

                                  21
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  those authorized in subsection (17) that may be performed

 2  pursuant to part I of chapter 464 by persons licensed

 3  thereunder while carrying out their professional duties, and

 4  other supportive services which may be specified by rule.  The

 5  purpose of such services is to enable residents to age in

 6  place in a residential environment despite mental or physical

 7  limitations that might otherwise disqualify them from

 8  residency in a facility licensed under this part.

 9         (14)  "Limited nursing services" means acts that may be

10  performed pursuant to part I of chapter 464 by persons

11  licensed thereunder while carrying out their professional

12  duties but limited to those acts which the department

13  specifies by rule.  Acts which may be specified by rule as

14  allowable limited nursing services shall be for persons who

15  meet the admission criteria established by the department for

16  assisted living facilities and shall not be complex enough to

17  require 24-hour nursing supervision and may include such

18  services as the application and care of routine dressings, and

19  care of casts, braces, and splints.

20         Section 26.  Paragraphs (a) and (b) of subsection (3)

21  of section 400.407, Florida Statutes, are amended to read:

22         400.407  License required; fee, display.--

23         (3)  Any license granted by the agency must state the

24  maximum resident capacity of the facility, the type of care

25  for which the license is granted, the date the license is

26  issued, the expiration date of the license, and any other

27  information deemed necessary by the agency. Licenses shall be

28  issued for one or more of the following categories of care:

29  standard, extended congregate care, limited nursing services,

30  or limited mental health.

31         (a)  A standard license shall be issued to facilities

                                  22
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  providing one or more of the services identified in s.

 2  400.402. Such facilities may also employ or contract with a

 3  person licensed under part I of chapter 464 to administer

 4  medications and perform other tasks as specified in s.

 5  400.4255.

 6         (b)  An extended congregate care license shall be

 7  issued to facilities providing, directly or through contract,

 8  services beyond those authorized in paragraph (a), including

 9  acts performed pursuant to part I of chapter 464 by persons

10  licensed thereunder, and supportive services defined by rule

11  to persons who otherwise would be disqualified from continued

12  residence in a facility licensed under this part.

13         1.  In order for extended congregate care services to

14  be provided in a facility licensed under this part, the agency

15  must first determine that all requirements established in law

16  and rule are met and must specifically designate, on the

17  facility's license, that such services may be provided and

18  whether the designation applies to all or part of a facility.

19  Such designation may be made at the time of initial licensure

20  or biennial relicensure, or upon request in writing by a

21  licensee under this part. Notification of approval or denial

22  of such request shall be made within 90 days after receipt of

23  such request and all necessary documentation. Existing

24  facilities qualifying to provide extended congregate care

25  services must have maintained a standard license and may not

26  have been subject to administrative sanctions during the

27  previous 2 years, or since initial licensure if the facility

28  has been licensed for less than 2 years, for any of the

29  following reasons:

30         a.  A class I or class II violation;

31         b.  Three or more repeat or recurring class III

                                  23
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  violations of identical or similar resident care standards as

 2  specified in rule from which a pattern of noncompliance is

 3  found by the agency;

 4         c.  Three or more class III violations that were not

 5  corrected in accordance with the corrective action plan

 6  approved by the agency;

 7         d.  Violation of resident care standards resulting in a

 8  requirement to employ the services of a consultant pharmacist

 9  or consultant dietitian;

10         e.  Denial, suspension, or revocation of a license for

11  another facility under this part in which the applicant for an

12  extended congregate care license has at least 25 percent

13  ownership interest; or

14         f.  Imposition of a moratorium on admissions or

15  initiation of injunctive proceedings.

16         2.  Facilities that are licensed to provide extended

17  congregate care services shall maintain a written progress

18  report on each person who receives such services, which report

19  describes the type, amount, duration, scope, and outcome of

20  services that are rendered and the general status of the

21  resident's health.  A registered nurse, or appropriate

22  designee, representing the agency shall visit such facilities

23  at least two times a year to monitor residents who are

24  receiving extended congregate care services and to determine

25  if the facility is in compliance with this part and with rules

26  that relate to extended congregate care. One of these visits

27  may be in conjunction with the regular biennial survey.  The

28  monitoring visits may be provided through contractual

29  arrangements with appropriate community agencies.  A

30  registered nurse shall serve as part of the team that

31  biennially inspects such facility. The agency may waive one of

                                  24
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  the required yearly monitoring visits for a facility that has

 2  been licensed for at least 24 months to provide extended

 3  congregate care services, if, during the biennial inspection,

 4  the registered nurse determines that extended congregate care

 5  services are being provided appropriately, and if the facility

 6  has no class I or class II violations and no uncorrected class

 7  III violations. Before such decision is made, the agency shall

 8  consult with the long-term care ombudsman council for the area

 9  in which the facility is located to determine if any

10  complaints have been made and substantiated about the quality

11  of services or care.  The agency may not waive one of the

12  required yearly monitoring visits if complaints have been made

13  and substantiated.

14         3.  Facilities that are licensed to provide extended

15  congregate care services shall:

16         a.  Demonstrate the capability to meet unanticipated

17  resident service needs.

18         b.  Offer a physical environment that promotes a

19  homelike setting, provides for resident privacy, promotes

20  resident independence, and allows sufficient congregate space

21  as defined by rule.

22         c.  Have sufficient staff available, taking into

23  account the physical plant and firesafety features of the

24  building, to assist with the evacuation of residents in an

25  emergency, as necessary.

26         d.  Adopt and follow policies and procedures that

27  maximize resident independence, dignity, choice, and

28  decisionmaking to permit residents to age in place to the

29  extent possible, so that moves due to changes in functional

30  status are minimized or avoided.

31         e.  Allow residents or, if applicable, a resident's

                                  25
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  representative, designee, surrogate, guardian, or attorney in

 2  fact to make a variety of personal choices, participate in

 3  developing service plans, and share responsibility in

 4  decisionmaking.

 5         f.  Implement the concept of managed risk.

 6         g.  Provide, either directly or through contract, the

 7  services of a person licensed pursuant to part I of chapter

 8  464.

 9         h.  In addition to the training mandated in s. 400.452,

10  provide specialized training as defined by rule for facility

11  staff.

12         4.  Facilities licensed to provide extended congregate

13  care services are exempt from the criteria for continued

14  residency as set forth in rules adopted under s. 400.441.

15  Facilities so licensed shall adopt their own requirements

16  within guidelines for continued residency set forth by the

17  department in rule.  However, such facilities may not serve

18  residents who require 24-hour nursing supervision. Facilities

19  licensed to provide extended congregate care services shall

20  provide each resident with a written copy of facility policies

21  governing admission and retention.

22         5.  The primary purpose of extended congregate care

23  services is to allow residents, as they become more impaired,

24  the option of remaining in a familiar setting from which they

25  would otherwise be disqualified for continued residency.  A

26  facility licensed to provide extended congregate care services

27  may also admit an individual who exceeds the admission

28  criteria for a facility with a standard license, if the

29  individual is determined appropriate for admission to the

30  extended congregate care facility.

31         6.  Before admission of an individual to a facility

                                  26
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  licensed to provide extended congregate care services, the

 2  individual must undergo a medical examination as provided in

 3  s. 400.426(4) and the facility must develop a preliminary

 4  service plan for the individual.

 5         7.  When a facility can no longer provide or arrange

 6  for services in accordance with the resident's service plan

 7  and needs and the facility's policy, the facility shall make

 8  arrangements for relocating the person in accordance with s.

 9  400.428(1)(k).

10         8.  Failure to provide extended congregate care

11  services may result in denial of extended congregate care

12  license renewal.

13         9.  No later than January 1 of each year, the

14  department, in consultation with the agency, shall prepare and

15  submit to the Governor, the President of the Senate, the

16  Speaker of the House of Representatives, and the chairs of

17  appropriate legislative committees, a report on the status of,

18  and recommendations related to, extended congregate care

19  services. The status report must include, but need not be

20  limited to, the following information:

21         a.  A description of the facilities licensed to provide

22  such services, including total number of beds licensed under

23  this part.

24         b.  The number and characteristics of residents

25  receiving such services.

26         c.  The types of services rendered that could not be

27  provided through a standard license.

28         d.  An analysis of deficiencies cited during biennial

29  inspections.

30         e.  The number of residents who required extended

31  congregate care services at admission and the source of

                                  27
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  admission.

 2         f.  Recommendations for statutory or regulatory

 3  changes.

 4         g.  The availability of extended congregate care to

 5  state clients residing in facilities licensed under this part

 6  and in need of additional services, and recommendations for

 7  appropriations to subsidize extended congregate care services

 8  for such persons.

 9         h.  Such other information as the department considers

10  appropriate.

11         Section 27.  Paragraphs (a) and (c) of subsection (1)

12  and subsection (2) of section 400.4255, Florida Statutes, are

13  amended to read:

14         400.4255  Use of personnel; emergency care.--

15         (1)(a)  Persons under contract to the facility,

16  facility staff, or volunteers, who are licensed according to

17  part I of chapter 464, or those persons exempt under s.

18  464.022(1), and others as defined by rule, may administer

19  medications to residents, take residents' vital signs, manage

20  individual weekly pill organizers for residents who

21  self-administer medication, give prepackaged enemas ordered by

22  a physician, observe residents, document observations on the

23  appropriate resident's record, report observations to the

24  resident's physician, and contract or allow residents or a

25  resident's representative, designee, surrogate, guardian, or

26  attorney in fact to contract with a third party, provided

27  residents meet the criteria for appropriate placement as

28  defined in s. 400.426.  Nursing assistants certified pursuant

29  to part II of chapter 464 s. 400.211 may take residents' vital

30  signs as directed by a licensed nurse or physician.

31         (c)  In an emergency situation, licensed personnel may

                                  28
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  carry out their professional duties pursuant to part I of

 2  chapter 464 until emergency medical personnel assume

 3  responsibility for care.

 4         (2)  In facilities licensed to provide extended

 5  congregate care, persons under contract to the facility,

 6  facility staff, or volunteers, who are licensed according to

 7  part I of chapter 464, or those persons exempt under s.

 8  464.022(1), or those persons certified as nursing assistants

 9  pursuant to part II of chapter 464 s. 400.211, may also

10  perform all duties within the scope of their license or

11  certification, as approved by the facility administrator and

12  pursuant to this part.

13         Section 28.  Subsection (3) of section 400.426, Florida

14  Statutes, is amended to read:

15         400.426  Appropriateness of placements; examinations of

16  residents.--

17         (3)  Persons licensed under part I of chapter 464 who

18  are employed by or under contract with a facility shall, on a

19  routine basis or at least monthly, perform a nursing

20  assessment of the residents for whom they are providing

21  nursing services ordered by a physician, except administration

22  of medication, and shall document such assessment, including

23  any substantial changes in a resident's status which may

24  necessitate relocation to a nursing home, hospital, or

25  specialized health care facility.  Such records shall be

26  maintained in the facility for inspection by the agency and

27  shall be forwarded to the resident's case manager, if

28  applicable.

29         Section 29.  Subsections (3) and (21) of section

30  400.462, Florida Statutes, are amended to read:

31         400.462  Definitions.--As used in this part, the term:

                                  29
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (3)  "Certified nursing assistant" means any person who

 2  has been issued a certificate under part II of chapter 464 s.

 3  400.211. The licensed home health agency or licensed nurse

 4  registry shall ensure that the certified nursing assistant

 5  employed by or under contract with the home health agency or

 6  licensed nurse registry is adequately trained to perform the

 7  tasks of a home health aide in the home setting.

 8         (21)  "Skilled care" means nursing services or

 9  therapeutic services delivered by a health care professional

10  who is licensed under part I of chapter 464; part I, part III,

11  or part V of chapter 468; or chapter 486 and who is employed

12  by or under contract with a licensed home health agency or is

13  referred by a licensed nurse registry.

14         Section 30.  Paragraph (c) of subsection (6) of section

15  400.464, Florida Statutes, is amended to read:

16         400.464  Home health agencies to be licensed;

17  expiration of license; exemptions; unlawful acts; penalties.--

18         (6)  The following are exempt from the licensure

19  requirements of this part:

20         (c)  A health care professional, whether or not

21  incorporated, who is licensed under chapter 457; chapter 458;

22  chapter 459; part I of chapter 464; chapter 467; part I, part

23  III, part V, or part X of chapter 468; chapter 480; chapter

24  486; chapter 490; or chapter 491; and who is acting alone

25  within the scope of his or her professional license to provide

26  care to patients in their homes.

27         Section 31.  Paragraph (a) of subsection (10),

28  subsection (11), and paragraph (a) of subsection (15) of

29  section 400.506, Florida Statutes, are amended to read:

30         400.506  Licensure of nurse registries; requirements;

31  penalties.--

                                  30
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (10)(a)  A nurse registry may refer for contract in

 2  private residences registered nurses and licensed practical

 3  nurses registered and licensed under part I of chapter 464,

 4  certified nursing assistants certified under part II of

 5  chapter 464 s. 400.211, home health aides who present

 6  documented proof of successful completion of the training

 7  required by rule of the agency, and companions or homemakers

 8  for the purposes of providing those services authorized under

 9  s. 400.509(1). Each person referred by a nurse registry must

10  provide current documentation that he or she is free from

11  communicable diseases.

12         (11)  A person who is referred by a nurse registry for

13  contract in private residences and who is not a nurse licensed

14  under part I of chapter 464 may perform only those services or

15  care to clients that the person has been certified to perform

16  or trained to perform as required by law or rules of the

17  Agency for Health Care Administration or the Department of

18  Business and Professional Regulation. Providing services

19  beyond the scope authorized under this subsection constitutes

20  the unauthorized practice of medicine or a violation of the

21  Nurse Practice Act and is punishable as provided under chapter

22  458, chapter 459, or part I of chapter 464.

23         (15)  All persons referred for contract in private

24  residences by a nurse registry must comply with the following

25  requirements for a plan of treatment:

26         (a)  When, in accordance with the privileges and

27  restrictions imposed upon a nurse under part I of chapter 464,

28  the delivery of care to a patient is under the direction or

29  supervision of a physician or when a physician is responsible

30  for the medical care of the patient, a medical plan of

31  treatment must be established for each patient receiving care

                                  31
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  or treatment provided by a licensed nurse in the home.  The

 2  original medical plan of treatment must be timely signed by

 3  the physician and reviewed by him or her in consultation with

 4  the licensed nurse at least every 2 months.  Any additional

 5  order or change in orders must be obtained from the physician

 6  and reduced to writing and timely signed by the physician.

 7  The delivery of care under a medical plan of treatment must be

 8  substantiated by the appropriate nursing notes or

 9  documentation made by the nurse in compliance with nursing

10  practices established under part I of chapter 464.

11         Section 32.  Subsection (1) of section 400.512, Florida

12  Statutes, is amended to read:

13         400.512  Screening of home health agency personnel;

14  nurse registry personnel; and companions and homemakers.--The

15  agency shall require employment or contractor screening as

16  provided in chapter 435, using the level 1 standards for

17  screening set forth in that chapter, for home health agency

18  personnel; persons referred for employment by nurse

19  registries; and persons employed by companion or homemaker

20  services registered under s. 400.509.

21         (1)(a)  The Agency for Health Care Administration may,

22  upon request, grant exemptions from disqualification from

23  employment or contracting under this section as provided in s.

24  435.07, except for health care practitioners licensed by the

25  Department of Health or a regulatory board within that

26  department.

27         (b)  The appropriate regulatory board within the

28  Department of Health, or that department itself when there is

29  no board, may, upon request of the licensed health care

30  practitioner, grant exemptions from disqualification from

31  employment or contracting under this section as provided in s.

                                  32
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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  435.07.

 2         Section 33.  Subsections (2) and (3) of section

 3  400.6105, Florida Statutes, are amended to read:

 4         400.6105  Staffing and personnel.--

 5         (2)  Each hospice shall employ a full-time registered

 6  nurse licensed pursuant to part I of chapter 464 who shall

 7  coordinate the implementation of the plan of care for each

 8  patient.

 9         (3)  A hospice shall employ a hospice care team or

10  teams who shall participate in the establishment and ongoing

11  review of the patient's plan of care, and be responsible for

12  and supervise the delivery of hospice care and services to the

13  patient. The team shall, at a minimum, consist of a physician

14  licensed pursuant to chapter 458 or chapter 459, a nurse

15  licensed pursuant to part I of chapter 464, a social worker,

16  and a pastoral or other counselor. The composition of the team

17  may vary for each patient and, over time, for the same patient

18  to ensure that all the patient's needs and preferences are

19  met.

20         Section 34.  Subsection (20) of section 401.23, Florida

21  Statutes, is amended to read:

22         401.23  Definitions.--As used in this part, the term:

23         (20)  "Registered nurse" means a practitioner who is

24  licensed to practice professional nursing pursuant to part I

25  of chapter 464.

26         Section 35.  Paragraph (c) of subsection (1) of section

27  401.252, Florida Statutes, is amended to read:

28         401.252  Interfacility transfer.--

29         (1)  A licensed basic or advanced life support

30  ambulance service may conduct interfacility transfers in a

31  permitted ambulance, using a registered nurse in place of an

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  emergency medical technician or paramedic, if:

 2         (c)  The registered nurse operates within the scope of

 3  part I of chapter 464.

 4         Section 36.  Subsection (11) of section 408.706,

 5  Florida Statutes, is amended to read:

 6         408.706  Community health purchasing alliances;

 7  accountable health partnerships.--

 8         (11)  The ability to recruit and retain alliance

 9  district health care providers in its provider network. For

10  provider networks initially formed in an alliance district

11  after July 1, 1993, an accountable health partnership shall

12  make offers as to provider participation in its provider

13  network to relevant alliance district health care providers

14  for at least 60 percent of the available provider positions. A

15  provider who is made an offer may participate in an

16  accountable health partnership as long as the provider abides

17  by the terms and conditions of the provider network contract,

18  provides services at a rate or price equal to the rate or

19  price negotiated by the accountable health partnership, and

20  meets all of the accountable health partnership's

21  qualifications for participation in its provider networks

22  including, but not limited to, network adequacy criteria. For

23  purposes of this subsection, "alliance district health care

24  provider" means a health care provider who is licensed under

25  chapter 458, chapter 459, chapter 460, chapter 461, part I of

26  chapter 464, or chapter 465 who has practiced in Florida for

27  more than 1 year within the alliance district served by the

28  accountable health partnership.

29         Section 37.  Paragraph (d) of subsection (12) of

30  section 409.908, Florida Statutes, is amended to read:

31         409.908  Reimbursement of Medicaid providers.--Subject

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  to specific appropriations, the agency shall reimburse

 2  Medicaid providers, in accordance with state and federal law,

 3  according to methodologies set forth in the rules of the

 4  agency and in policy manuals and handbooks incorporated by

 5  reference therein.  These methodologies may include fee

 6  schedules, reimbursement methods based on cost reporting,

 7  negotiated fees, competitive bidding pursuant to s. 287.057,

 8  and other mechanisms the agency considers efficient and

 9  effective for purchasing services or goods on behalf of

10  recipients.  Payment for Medicaid compensable services made on

11  behalf of Medicaid eligible persons is subject to the

12  availability of moneys and any limitations or directions

13  provided for in the General Appropriations Act or chapter 216.

14  Further, nothing in this section shall be construed to prevent

15  or limit the agency from adjusting fees, reimbursement rates,

16  lengths of stay, number of visits, or number of services, or

17  making any other adjustments necessary to comply with the

18  availability of moneys and any limitations or directions

19  provided for in the General Appropriations Act, provided the

20  adjustment is consistent with legislative intent.

21         (12)

22         (d)  Notwithstanding paragraph (b), reimbursement fees

23  to physicians for providing total obstetrical services to

24  Medicaid recipients, which include prenatal, delivery, and

25  postpartum care, shall be at least $1,500 per delivery for a

26  pregnant woman with low medical risk and at least $2,000 per

27  delivery for a pregnant woman with high medical risk. However,

28  reimbursement to physicians working in Regional Perinatal

29  Intensive Care Centers designated pursuant to chapter 383, for

30  services to certain pregnant Medicaid recipients with a high

31  medical risk, may be made according to obstetrical care and

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  neonatal care groupings and rates established by the agency.

 2  Nurse midwives licensed under part I of chapter 464 or

 3  midwives licensed under chapter 467 shall be reimbursed at no

 4  less than 80 percent of the low medical risk fee. The agency

 5  shall by rule determine, for the purpose of this paragraph,

 6  what constitutes a high or low medical risk pregnant woman and

 7  shall not pay more based solely on the fact that a caesarean

 8  section was performed, rather than a vaginal delivery. The

 9  agency shall by rule determine a prorated payment for

10  obstetrical services in cases where only part of the total

11  prenatal, delivery, or postpartum care was performed. The

12  Department of Health shall adopt rules for appropriate

13  insurance coverage for midwives licensed under chapter 467.

14  Prior to the issuance and renewal of an active license, or

15  reactivation of an inactive license for midwives licensed

16  under chapter 467, such licensees shall submit proof of

17  coverage with each application.

18         Section 38.  Subsection (1) of section 415.1085,

19  Florida Statutes, is amended to read:

20         415.1085  Photographs, medical examinations, and X rays

21  of abused or neglected aged persons or disabled adults.--

22         (1)  Any person authorized by law to investigate cases

23  of alleged abuse or neglect of an aged person or disabled

24  adult may take or cause to be taken photographs of the areas

25  of trauma visible on the aged person or disabled adult who is

26  the subject of a report, and photographs of the surrounding

27  environment, with the consent of the subject or guardian or

28  guardians.  If the areas of trauma visible on the aged person

29  or disabled adult indicate a need for medical examination, or

30  if the aged person or disabled adult verbally complains or

31  otherwise exhibits distress as a result of injury through

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  suspected adult abuse, neglect, or exploitation, or is alleged

 2  to have been sexually abused, the department may, with the

 3  consent of the subject or guardian or guardians, cause the

 4  aged person or disabled adult to be referred to a licensed

 5  physician or any emergency department in a hospital or health

 6  care facility for medical examinations and X rays, if deemed

 7  necessary by the examining physician.  Such examinations may

 8  be performed by an advanced registered nurse practitioner

 9  licensed pursuant to part I of chapter 464.  Medical

10  examinations performed and X rays taken pursuant to this

11  section shall be paid for by third-party reimbursement, if

12  available, or by the subject or his or her guardian, if they

13  are determined to be financially able to pay; or, if neither

14  is available, the department shall pay the costs within

15  available emergency services funds.

16         Section 39.  Paragraph (a) of subsection (1) of section

17  455.597 Florida Statutes, is amended to read:

18         455.597  Requirement for instruction on domestic

19  violence.--

20         (1)(a)  The appropriate board shall require each person

21  licensed or certified under chapter 458, chapter 459, part I

22  of chapter 464, chapter 466, chapter 467, chapter 490, or

23  chapter 491 to complete a 1-hour continuing education course,

24  approved by the board, on domestic violence, as defined in s.

25  741.28, as part of biennial relicensure or recertification.

26  The course shall consist of information on the number of

27  patients in that professional's practice who are likely to be

28  victims of domestic violence and the number who are likely to

29  be perpetrators of domestic violence, screening procedures for

30  determining whether a patient has any history of being either

31  a victim or a perpetrator of domestic violence, and

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  instruction on how to provide such patients with information

 2  on, or how to refer such patients to, resources in the local

 3  community, such as domestic violence centers and other

 4  advocacy groups, that provide legal aid, shelter, victim

 5  counseling, batterer counseling, or child protection services.

 6         Section 40.  Subsection (1) of section 455.604, Florida

 7  Statutes, is amended to read:

 8         455.604  Requirement for instruction for certain

 9  licensees on human immunodeficiency virus and acquired immune

10  deficiency syndrome.--

11         (1)  The appropriate board shall require each person

12  licensed or certified under chapter 457; chapter 458; chapter

13  459; chapter 460; chapter 461; chapter 463; part I of chapter

14  464; chapter 465; chapter 466; part II, part III, part V, or

15  part X of chapter 468; or chapter 486 to complete a continuing

16  educational course, approved by the board, on human

17  immunodeficiency virus and acquired immune deficiency syndrome

18  as part of biennial relicensure or recertification. The course

19  shall consist of education on the modes of transmission,

20  infection control procedures, clinical management, and

21  prevention of human immunodeficiency virus and acquired immune

22  deficiency syndrome. Such course shall include information on

23  current Florida law on acquired immune deficiency syndrome and

24  its impact on testing, confidentiality of test results,

25  treatment of patients, and any protocols and procedures

26  applicable to human immunodeficiency virus counseling and

27  testing, reporting, the offering of HIV testing to pregnant

28  women, and partner notification issues pursuant to ss. 381.004

29  and 384.25.

30         Section 41.  Paragraph (a) of subsection (2) of section

31  455.667, Florida Statutes, is amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         455.667  Ownership and control of patient records;

 2  report or copies of records to be furnished.--

 3         (2)  As used in this section, the terms "records

 4  owner," "health care practitioner," and "health care

 5  practitioner's employer" do not include any of the following

 6  persons or entities; furthermore, the following persons or

 7  entities are not authorized to acquire or own medical records,

 8  but are authorized under the confidentiality and disclosure

 9  requirements of this section to maintain those documents

10  required by the part or chapter under which they are licensed

11  or regulated:

12         (a)  Certified nursing assistants regulated under part

13  II of chapter 464 s. 400.211.

14         Section 42.  Section 455.677, Florida Statutes, is

15  amended to read:

16         455.677  Disposition of records of deceased

17  practitioners or practitioners relocating or terminating

18  practice.--Each board created under the provisions of chapter

19  457, chapter 458, chapter 459, chapter 460, chapter 461,

20  chapter 463, part I of chapter 464, chapter 465, chapter 466,

21  part I of chapter 484, chapter 486, chapter 490, or chapter

22  491, and the department under the provisions of chapter 462,

23  shall provide by rule for the disposition, under that chapter,

24  of the medical records or records of a psychological nature of

25  practitioners which are in existence at the time the

26  practitioner dies, terminates practice, or relocates and is no

27  longer available to patients and which records pertain to the

28  practitioner's patients.  The rules shall provide that the

29  records be retained for at least 2 years after the

30  practitioner's death, termination of practice, or relocation.

31  In the case of the death of the practitioner, the rules shall

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  provide for the disposition of such records by the estate of

 2  the practitioner.

 3         Section 43.  Paragraph (b) of subsection (2) of section

 4  455.694, Florida Statutes, is amended to read:

 5         455.694  Financial responsibility requirements for

 6  certain health care practitioners.--

 7         (2)  The board or department may grant exemptions upon

 8  application by practitioners meeting any of the following

 9  criteria:

10         (b)  Any person whose license or certification has

11  become inactive under chapter 457, chapter 460, chapter 461,

12  part I of chapter 464, chapter 466, or chapter 467 and who is

13  not practicing in this state.  Any person applying for

14  reactivation of a license must show either that such licensee

15  maintained tail insurance coverage which provided liability

16  coverage for incidents that occurred on or after October 1,

17  1993, or the initial date of licensure in this state,

18  whichever is later, and incidents that occurred before the

19  date on which the license became inactive; or such licensee

20  must submit an affidavit stating that such licensee has no

21  unsatisfied medical malpractice judgments or settlements at

22  the time of application for reactivation.

23         Section 44.  Subsection (2) of section 455.707, Florida

24  Statutes, is amended to read:

25         455.707  Treatment programs for impaired

26  practitioners.--

27         (2)  The department shall retain one or more impaired

28  practitioner consultants as recommended by the committee.  A

29  consultant shall be a licensee or recovered licensee under the

30  jurisdiction of the Division of Medical Quality Assurance

31  within the department, and at least one consultant must be a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  practitioner or recovered practitioner licensed under chapter

 2  458, chapter 459, or part I of chapter 464.  The consultant

 3  shall assist the probable cause panel and department in

 4  carrying out the responsibilities of this section.  This shall

 5  include working with department investigators to determine

 6  whether a practitioner is, in fact, impaired.

 7         Section 45.  Subsection (2) of section 458.348, Florida

 8  Statutes, is amended to read:

 9         458.348  Formal supervisory relationships, standing

10  orders, and established protocols; notice; standards.--

11         (2)  ESTABLISHMENT OF STANDARDS BY JOINT

12  COMMITTEE.--The joint committee created by s. 464.003(3)(c)

13  shall determine minimum standards for the content of

14  established protocols pursuant to which an advanced registered

15  nurse practitioner may perform medical acts identified and

16  approved by the joint committee pursuant to s. 464.003(3)(c)

17  or acts set forth in s. 464.012(3) and (4) and shall determine

18  minimum standards for supervision of such acts by the

19  physician, unless the joint committee determines that any act

20  set forth in s. 464.012(3) or (4) is not a medical act.  Such

21  standards shall be based on risk to the patient and acceptable

22  standards of medical care and shall take into account the

23  special problems of medically underserved areas. The standards

24  developed by the joint committee shall be adopted as rules by

25  the Board of Nursing and the Board of Medicine for purposes of

26  carrying out their responsibilities pursuant to part I of

27  chapter 464 and this chapter, respectively, but neither board

28  shall have disciplinary powers over the licensees of the other

29  board.

30         Section 46.  Section 464.001, Florida Statutes, is

31  amended to read:

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         464.001  Short title.--This part may be cited chapter

 2  shall be known as the "Nurse Practice Act."

 3         Section 47.  Section 464.002, Florida Statutes, is

 4  amended to read:

 5         464.002  Purpose.--The sole legislative purpose in

 6  enacting this part chapter is to ensure that every nurse

 7  practicing in this state meets minimum requirements for safe

 8  practice.  It is the legislative intent that nurses who fall

 9  below minimum competency or who otherwise present a danger to

10  the public shall be prohibited from practicing in this state.

11         Section 48.  Section 464.003, Florida Statutes, is

12  amended to read:

13         464.003  Definitions.--As used in this part chapter:

14         (1)  "Department" means the Department of Health.

15         (2)  "Board" means the Board of Nursing as created in

16  this chapter.

17         (3)(a)  "Practice of professional nursing" means the

18  performance of those acts requiring substantial specialized

19  knowledge, judgment, and nursing skill based upon applied

20  principles of psychological, biological, physical, and social

21  sciences which shall include, but not be limited to:

22         1.  The observation, assessment, nursing diagnosis,

23  planning, intervention, and evaluation of care; health

24  teaching and counseling of the ill, injured, or infirm; and

25  the promotion of wellness, maintenance of health, and

26  prevention of illness of others.

27         2.  The administration of medications and treatments as

28  prescribed or authorized by a duly licensed practitioner

29  authorized by the laws of this state to prescribe such

30  medications and treatments.

31         3.  The supervision and teaching of other personnel in

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  the theory and performance of any of the above acts.

 2         (b)  "Practice of practical nursing" means the

 3  performance of selected acts, including the administration of

 4  treatments and medications, in the care of the ill, injured,

 5  or infirm and the promotion of wellness, maintenance of

 6  health, and prevention of illness of others under the

 7  direction of a registered nurse, a licensed physician, a

 8  licensed osteopathic physician, a licensed podiatric

 9  physician, or a licensed dentist.

10

11  The professional nurse and the practical nurse shall be

12  responsible and accountable for making decisions that are

13  based upon the individual's educational preparation and

14  experience in nursing.

15         (c)  "Advanced or specialized nursing practice" means,

16  in addition to the practice of professional nursing, the

17  performance of advanced-level nursing acts approved by the

18  board which, by virtue of postbasic specialized education,

19  training, and experience, are proper to be performed by an

20  advanced registered nurse practitioner.  Within the context of

21  advanced or specialized nursing practice, the advanced

22  registered nurse practitioner may perform acts of nursing

23  diagnosis and nursing treatment of alterations of the health

24  status.  The advanced registered nurse practitioner may also

25  perform acts of medical diagnosis and treatment, prescription,

26  and operation which are identified and approved by a joint

27  committee composed of three members appointed by the Board of

28  Nursing, two of whom shall be advanced registered nurse

29  practitioners; three members appointed by the Board of

30  Medicine, two of whom shall have had work experience with

31  advanced registered nurse practitioners; and the secretary of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  the department or the secretary's designee. Each committee

 2  member appointed by a board shall be appointed to a term of 4

 3  years unless a shorter term is required to establish or

 4  maintain staggered terms. The Board of Nursing shall adopt

 5  rules authorizing the performance of any such acts approved by

 6  the joint committee. Unless otherwise specified by the joint

 7  committee, such acts shall be performed under the general

 8  supervision of a practitioner licensed under chapter 458,

 9  chapter 459, or chapter 466 within the framework of standing

10  protocols which identify the medical acts to be performed and

11  the conditions for their performance.  The department may, by

12  rule, require that a copy of the protocol be filed with the

13  department along with the notice required by s. 458.348.

14         (d)  "Nursing diagnosis" means the observation and

15  evaluation of physical or mental conditions, behaviors, signs

16  and symptoms of illness, and reactions to treatment and the

17  determination as to whether such conditions, signs, symptoms,

18  and reactions represent a deviation from normal.

19         (e)  "Nursing treatment" means the establishment and

20  implementation of a nursing regimen for the care and comfort

21  of individuals, the prevention of illness, and the education,

22  restoration, and maintenance of health.

23         (4)  "Registered nurse" means any person licensed in

24  this state to practice professional nursing.

25         (5)  "Licensed practical nurse" means any person

26  licensed in this state to practice practical nursing.

27         (6)  "Advanced registered nurse practitioner" means any

28  person licensed in this state to practice professional nursing

29  and certified in advanced or specialized nursing practice.

30         (7)  "Approved program" means a nursing program

31  conducted in a school, college, or university which is

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  approved by the board pursuant to s. 464.019 for the education

 2  of nurses.

 3         Section 49.  Section 464.006, Florida Statutes, is

 4  amended to read:

 5         464.006  Authority to make rules.--The board of Nursing

 6  has authority to adopt rules pursuant to ss. 120.536(1) and

 7  120.54 to implement the provisions of this part chapter

 8  conferring duties upon it.

 9         Section 50.  Subsection (3) of section 464.009, Florida

10  Statutes, is amended to read:

11         464.009  Licensure by endorsement.--

12         (3)  The department shall not issue a license by

13  endorsement to any applicant who is under investigation in

14  another state for an act which would constitute a violation of

15  this part chapter until such time as the investigation is

16  complete, at which time the provisions of s. 464.018 shall

17  apply.

18         Section 51.  Paragraphs (a) and (d) of subsection (1)

19  and paragraph (b) of subsection (2) of section 464.016,

20  Florida Statutes, are amended to read:

21         464.016  Violations and penalties.--

22         (1)  Each of the following acts constitutes a felony of

23  the third degree, punishable as provided in s. 775.082, s.

24  775.083, or s. 775.084:

25         (a)  Practicing advanced or specialized, professional

26  or practical nursing, as defined in this part chapter, unless

27  holding an active license or certificate to do so.

28         (d)  Obtaining or attempting to obtain a license or

29  certificate under this part chapter by misleading statements

30  or knowing misrepresentation.

31         (2)  Each of the following acts constitutes a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  misdemeanor of the first degree, punishable as provided in s.

 2  775.082 or s. 775.083:

 3         (b)  Knowingly concealing information relating to

 4  violations of this part chapter.

 5         Section 52.  Paragraphs (i), (k), and (l) of subsection

 6  (1) and subsection (4) of section 464.018, Florida Statutes,

 7  are amended to read:

 8         464.018  Disciplinary actions.--

 9         (1)  The following acts shall be grounds for

10  disciplinary action set forth in this section:

11         (i)  Engaging or attempting to engage in the

12  possession, sale, or distribution of controlled substances as

13  set forth in chapter 893, for any other than legitimate

14  purposes authorized by this part chapter.

15         (k)  Failing to report to the department any person who

16  the licensee knows is in violation of this part chapter or of

17  the rules of the department or the board; however, if the

18  licensee verifies that such person is actively participating

19  in a board-approved program for the treatment of a physical or

20  mental condition, the licensee is required to report such

21  person only to an impaired professionals consultant.

22         (l)  Knowingly violating any provision of this part

23  chapter, a rule of the board or the department, or a lawful

24  order of the board or department previously entered in a

25  disciplinary proceeding or failing to comply with a lawfully

26  issued subpoena of the department.

27         (4)  The board shall not reinstate the license of a

28  nurse who has been found guilty by the board on three separate

29  occasions of violations of this part chapter relating to the

30  use of drugs or narcotics, which offenses involved the

31  diversion of drugs or narcotics from patients to personal use

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  or sale.

 2         Section 53.  Subsections (1), (2), and (3) of section

 3  464.019, Florida Statutes, are amended to read:

 4         464.019  Approval of nursing programs.--

 5         (1)  An institution desiring to conduct an approved

 6  program for the education of professional or practical nurses

 7  shall apply to the department and submit such evidence as may

 8  be required to show that it complies with the provisions of

 9  this part chapter and with the rules of the board. The

10  application shall include a program review fee, as set by the

11  board, not to exceed $1,000.

12         (2)  The board shall adopt rules regarding educational

13  objectives, faculty qualifications, curriculum guidelines,

14  administrative procedures, and clinical training as are

15  necessary to ensure that approved programs graduate nurses

16  capable of competent practice under this part act.

17         (3)  The department shall survey each institution

18  applying for approval and submit its findings to the board.

19  If the board is satisfied that the program meets the

20  requirements of this part chapter and rules pursuant thereto,

21  it shall certify the program for approval and the department

22  shall approve the program.

23         Section 54.  Section 464.022, Florida Statutes, is

24  amended to read:

25         464.022  Exceptions.--No provision of this part chapter

26  shall be construed to prohibit:

27         (1)  The care of the sick by friends or members of the

28  family without compensation, the incidental care of the sick

29  by domestic servants, or the incidental care of

30  noninstitutionalized persons by a surrogate family.

31         (2)  Assistance by anyone in the case of an emergency.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (3)  The practice of nursing by students enrolled in

 2  approved schools of nursing.

 3         (4)  The practice of nursing by graduates of approved

 4  programs or the equivalent, pending the result of the first

 5  licensing examination for which they are eligible following

 6  graduation, provided they practice under direct supervision of

 7  a registered professional nurse.  The board shall by rule

 8  define what constitutes direct supervision.

 9         (5)  The rendering of services by nursing assistants

10  acting under the direct supervision of a registered

11  professional nurse.

12         (6)  Any nurse practicing in accordance with the

13  practices and principles of the body known as the Church of

14  Christ Scientist; nor shall any rule of the board apply to any

15  sanitarium, nursing home, or rest home operated in accordance

16  with the practices and principles of the body known as the

17  Church of Christ Scientist.

18         (7)  The practice of any legally qualified nurse or

19  licensed attendant of another state who is employed by the

20  United States Government, or any bureau, division, or agency

21  thereof, while in the discharge of official duties.

22         (8)  Any nurse currently licensed in another state from

23  performing nursing services in this state for a period of 60

24  days after furnishing to the employer satisfactory evidence of

25  current licensure in another state and having submitted proper

26  application and fees to the board for licensure prior to

27  employment.  The board may extend this time for administrative

28  purposes when necessary.

29         (9)  The rendering of nursing services on a

30  fee-for-service basis, or the reimbursement for nursing

31  services directly to a nurse rendering such services by any

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 1  government program, commercial insurance company, hospital or

 2  medical services plan, or any other third-party payor.

 3         (10)  The establishment of an independent practice by

 4  one or more nurses for the purpose of rendering to patients

 5  nursing services within the scope of the nursing license.

 6         (11)  The furnishing of hemodialysis treatments in a

 7  patient's home, using an assistant chosen by the patient,

 8  provided that the assistant is properly trained, as defined by

 9  the board by rule, and has immediate telephonic access to a

10  registered nurse who is licensed pursuant to this part chapter

11  and who has dialysis training and experience.

12         (12)  The practice of nursing by any legally qualified

13  nurse of another state whose employment requires the nurse to

14  accompany and care for a patient temporarily residing in this

15  state for not more than 30 consecutive days, provided the

16  patient is not in an inpatient setting, the board is notified

17  prior to arrival of the patient and nurse, the nurse has the

18  standing physician orders and current medical status of the

19  patient available, and prearrangements with the appropriate

20  licensed health care providers in this state have been made in

21  case the patient needs placement in an inpatient setting.

22         (13)  The practice of nursing by individuals enrolled

23  in board-approved remedial courses.

24         Section 55.  Section 464.023, Florida Statutes, is

25  amended to read:

26         464.023  Saving clauses.--

27         (1)  No judicial or administrative proceeding pending

28  on July 1, 1979, shall be abated as a result of the repeal and

29  reenactment of this part chapter.

30         (2)  Each licensee or holder of a certificate who was

31  duly licensed or certified on June 30, 1979, shall be entitled

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 1  to hold such license or certificate.  Henceforth, such license

 2  or certificate shall be renewed in accordance with the

 3  provisions of this part act.

 4         Section 56.  Subsection (3) of section 464.027, Florida

 5  Statutes, is amended to read:

 6         464.027  Registered nurse first assistant.--

 7         (3)  QUALIFICATIONS.--A registered nurse first

 8  assistant is any person who:

 9         (a)  Is licensed as a registered nurse under this part

10  chapter;

11         (b)  Is certified in perioperative nursing; and

12         (c)  Holds a certificate from, and has successfully

13  completed, a recognized program.

14         Section 57.  Subsection (6) of section 466.003, Florida

15  Statutes, is amended to read:

16         466.003  Definitions.--As used in this chapter:

17         (6)  "Dental assistant" means a person, other than a

18  dental hygienist, who, under the supervision and authorization

19  of a dentist, provides dental care services directly to a

20  patient. This term shall not include a certified registered

21  nurse anesthetist licensed under part I of chapter 464.

22         Section 58.  Subsection (2) of section 467.003, Florida

23  Statutes, is amended to read:

24         467.003  Definitions.--As used in this chapter, unless

25  the context otherwise requires:

26         (2)  "Certified nurse midwife" means a person who is

27  licensed as an advanced registered nurse practitioner under

28  part I of chapter 464 and who is certified to practice

29  midwifery by the American College of Nurse Midwives.

30         Section 59.  Paragraph (a) of subsection (2) of section

31  467.0125, Florida Statutes, is amended to read:

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                                                  SENATE AMENDMENT

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 1         467.0125  Licensure by endorsement.--

 2         (2)  The department may issue a temporary certificate

 3  to practice in areas of critical need to any midwife who is

 4  qualifying for licensure by endorsement under subsection (1),

 5  with the following restrictions:

 6         (a)  The Department of Health shall determine the areas

 7  of critical need, and the midwife so certified shall practice

 8  only in those specific areas, under the auspices of a

 9  physician licensed pursuant to chapter 458 or chapter 459, a

10  certified nurse midwife licensed pursuant to part I of chapter

11  464, or a midwife licensed under this chapter, who has a

12  minimum of 3 years' professional experience. Such areas shall

13  include, but not be limited to, health professional shortage

14  areas designated by the United States Department of Health and

15  Human Services.

16         Section 60.  Paragraph (e) of subsection (2) of section

17  467.203, Florida Statutes, is amended to read:

18         467.203  Disciplinary actions; penalties.--

19         (2)  When the department finds any person guilty of any

20  of the grounds set forth in subsection (1), it may enter an

21  order imposing one or more of the following penalties:

22         (e)  Placement of the midwife on probation for such

23  period of time and subject to such conditions as the

24  department may specify, including requiring the midwife to

25  submit to treatment; undertake further relevant education or

26  training; take an examination; or work under the supervision

27  of another licensed midwife, a physician, or a nurse midwife

28  licensed under part I of chapter 464.

29         Section 61.  Paragraph (a) of subsection (1) of section

30  468.505, Florida Statutes, is amended to read:

31         468.505  Exemptions; exceptions.--

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 1         (1)  Nothing in this part may be construed as

 2  prohibiting or restricting the practice, services, or

 3  activities of:

 4         (a)  A person licensed in this state under chapter 457,

 5  chapter 458, chapter 459, chapter 460, chapter 461, chapter

 6  462, chapter 463, part I of chapter 464, chapter 465, chapter

 7  466, chapter 480, chapter 490, or chapter 491, when engaging

 8  in the profession or occupation for which he or she is

 9  licensed, or of any person employed by and under the

10  supervision of the licensee when rendering services within the

11  scope of the profession or occupation of the licensee.

12         Section 62.  Subsection (7) of section 483.041, Florida

13  Statutes, is amended to read:

14         483.041  Definitions.--As used in this part, the term:

15         (7)  "Licensed practitioner" means a physician licensed

16  under chapter 458, chapter 459, chapter 460, or chapter 461; a

17  dentist licensed under chapter 466; a person licensed under

18  chapter 462; or an advanced registered nurse practitioner

19  licensed under part I of chapter 464; or a duly licensed

20  practitioner from another state licensed under similar

21  statutes who orders examinations on materials or specimens for

22  nonresidents of the State of Florida, but who reside in the

23  same state as the requesting licensed practitioner.

24         Section 63.  Subsection (5) of section 483.801, Florida

25  Statutes, is amended to read:

26         483.801  Exemptions.--This part applies to all clinical

27  laboratories and clinical laboratory personnel within this

28  state, except:

29         (5)  Advanced registered nurse practitioners licensed

30  under part I of chapter 464 who perform provider-performed

31  microscopy procedures (PPMP) in an exclusive-use laboratory

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1  setting.

 2         Section 64.  Paragraph (a) of subsection (4) of section

 3  491.0112, Florida Statutes, is amended to read:

 4         491.0112  Sexual misconduct by a psychotherapist;

 5  penalties.--

 6         (4)  For the purposes of this section:

 7         (a)  The term "psychotherapist" means any person

 8  licensed pursuant to chapter 458, chapter 459, part I of

 9  chapter 464, chapter 490, or chapter 491, or any other person

10  who provides or purports to provide treatment, diagnosis,

11  assessment, evaluation, or counseling of mental or emotional

12  illness, symptom, or condition.

13         Section 65.  Subsection (5) of section 550.24055,

14  Florida Statutes, is amended to read:

15         550.24055  Use of controlled substances or alcohol

16  prohibited; testing of certain occupational licensees;

17  penalty; evidence of test or action taken and admissibility

18  for criminal prosecution limited.--

19         (5)  This section does not apply to the possession and

20  use of controlled or chemical substances that are prescribed

21  as part of the care and treatment of a disease or injury by a

22  practitioner licensed under chapter 458, chapter 459, part I

23  of chapter 464, or chapter 466.

24         Section 66.  Paragraph (h) of subsection (4) of section

25  627.351, Florida Statutes, is amended to read:

26         627.351  Insurance risk apportionment plans.--

27         (4)  MEDICAL MALPRACTICE RISK APPORTIONMENT.--

28         (h)  As used in this subsection:

29         1.  "Health care provider" means hospitals licensed

30  under chapter 395; physicians licensed under chapter 458;

31  osteopathic physicians licensed under chapter 459; podiatric

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1  physicians licensed under chapter 461; dentists licensed under

 2  chapter 466; chiropractic physicians licensed under chapter

 3  460; naturopaths licensed under chapter 462; nurses licensed

 4  under part I of chapter 464; midwives licensed under chapter

 5  467; clinical laboratories registered under chapter 483;

 6  physician assistants licensed under chapter 458 or chapter

 7  459; physical therapists and physical therapist assistants

 8  licensed under chapter 486; health maintenance organizations

 9  certificated under part I of chapter 641; ambulatory surgical

10  centers licensed under chapter 395; other medical facilities

11  as defined in subparagraph 2.; blood banks, plasma centers,

12  industrial clinics, and renal dialysis facilities; or

13  professional associations, partnerships, corporations, joint

14  ventures, or other associations for professional activity by

15  health care providers.

16         2.  "Other medical facility" means a facility the

17  primary purpose of which is to provide human medical

18  diagnostic services or a facility providing nonsurgical human

19  medical treatment, to which facility the patient is admitted

20  and from which facility the patient is discharged within the

21  same working day, and which facility is not part of a

22  hospital.  However, a facility existing for the primary

23  purpose of performing terminations of pregnancy or an office

24  maintained by a physician or dentist for the practice of

25  medicine shall not be construed to be an "other medical

26  facility."

27         3.  "Health care facility" means any hospital licensed

28  under chapter 395, health maintenance organization

29  certificated under part I of chapter 641, ambulatory surgical

30  center licensed under chapter 395, or other medical facility

31  as defined in subparagraph 2.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1         Section 67.  Paragraph (b) of subsection (1) of section

 2  627.357, Florida Statutes, is amended to read:

 3         627.357  Medical malpractice self-insurance.--

 4         (1)  DEFINITIONS.--As used in this section, the term:

 5         (b)  "Health care provider" means any:

 6         1.  Hospital licensed under chapter 395.

 7         2.  Physician licensed, or physician assistant

 8  licensed, under chapter 458.

 9         3.  Osteopathic physician or physician assistant

10  licensed under chapter 459.

11         4.  Podiatric physician licensed under chapter 461.

12         5.  Health maintenance organization certificated under

13  part I of chapter 641.

14         6.  Ambulatory surgical center licensed under chapter

15  395.

16         7.  Chiropractic physician licensed under chapter 460.

17         8.  Psychologist licensed under chapter 490.

18         9.  Optometrist licensed under chapter 463.

19         10.  Dentist licensed under chapter 466.

20         11.  Pharmacist licensed under chapter 465.

21         12.  Registered nurse, licensed practical nurse, or

22  advanced registered nurse practitioner licensed or registered

23  under part I of chapter 464.

24         13.  Other medical facility.

25         14.  Professional association, partnership,

26  corporation, joint venture, or other association established

27  by the individuals set forth in subparagraphs 2., 3., 4., 7.,

28  8., 9., 10., 11., and 12. for professional activity.

29         Section 68.  Subsection (6) of section 627.9404,

30  Florida Statutes, is amended to read:

31         627.9404  Definitions.--For the purposes of this part:

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                                                  SENATE AMENDMENT

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 1         (6)  "Licensed health care practitioner" means any

 2  physician, nurse licensed under part I of chapter 464, or

 3  psychotherapist licensed under chapter 490 or chapter 491, or

 4  any individual who meets any requirements prescribed by rule

 5  by the department.

 6         Section 69.  Subsection (21) of section 641.31, Florida

 7  Statutes, is amended to read:

 8         641.31  Health maintenance contracts.--

 9         (21)  Notwithstanding any other provision of law,

10  health maintenance policies or contracts which provide

11  anesthesia coverage, benefits, or services shall offer to the

12  subscriber, if requested and available, the services of a

13  certified registered nurse anesthetist licensed pursuant to

14  part I of chapter 464.

15         Section 70.  Subsection (8) of section 766.101, Florida

16  Statutes, is amended to read:

17         766.101  Medical review committee, immunity from

18  liability.--

19         (8)  No cause of action of any nature by a person

20  licensed pursuant to chapter 458, chapter 459, chapter 461,

21  chapter 463, part I of chapter 464, chapter 465, or chapter

22  466 shall arise against another person licensed pursuant to

23  chapter 458, chapter 459, chapter 461, chapter 463, part I of

24  chapter 464, chapter 465, or chapter 466 for furnishing

25  information to a duly appointed medical review committee, to

26  an internal risk management program established under s.

27  395.0197, to the Department of Business and Professional

28  Regulation, or to the appropriate regulatory board if the

29  information furnished concerns patient care at a facility

30  licensed pursuant to part I of chapter 395 where both persons

31  provide health care services, if the information is not

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                                                  SENATE AMENDMENT

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 1  intentionally fraudulent, and if the information is within the

 2  scope of the functions of the committee, department, or board.

 3  However, if such information is otherwise available from

 4  original sources, it is not immune from discovery or use in a

 5  civil action merely because it was presented during a

 6  proceeding of the committee, department, or board.

 7         Section 71.  Subsection (2) of section 766.110, Florida

 8  Statutes, is amended to read:

 9         766.110  Liability of health care facilities.--

10         (2)  Every hospital licensed under chapter 395 may

11  carry liability insurance or adequately insure itself in an

12  amount of not less than $1.5 million per claim, $5 million

13  annual aggregate to cover all medical injuries to patients

14  resulting from negligent acts or omissions on the part of

15  those members of its medical staff who are covered thereby in

16  furtherance of the requirements of ss. 458.320 and 459.0085.

17  Self-insurance coverage extended hereunder to a member of a

18  hospital's medical staff meets the financial responsibility

19  requirements of ss. 458.320 and 459.0085 if the physician's

20  coverage limits are not less than the minimum limits

21  established in ss. 458.320 and 459.0085 and the hospital is a

22  verified trauma center as of July 1, 1990, that has extended

23  self-insurance coverage continuously to members of its medical

24  staff for activities both inside and outside of the hospital

25  since January 1, 1987.  Any insurer authorized to write

26  casualty insurance may make available, but shall not be

27  required to write, such coverage.  The hospital may assess on

28  an equitable and pro rata basis the following professional

29  health care providers for a portion of the total hospital

30  insurance cost for this coverage:  physicians licensed under

31  chapter 458, osteopathic physicians licensed under chapter

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1  459, podiatric physicians licensed under chapter 461, dentists

 2  licensed under chapter 466, and nurses licensed under part I

 3  of chapter 464. The hospital may provide for a deductible

 4  amount to be applied against any individual health care

 5  provider found liable in a law suit in tort or for breach of

 6  contract.  The legislative intent in providing for the

 7  deductible to be applied to individual health care providers

 8  found negligent or in breach of contract is to instill in each

 9  individual health care provider the incentive to avoid the

10  risk of injury to the fullest extent and ensure that the

11  citizens of this state receive the highest quality health care

12  obtainable.

13         Section 72.  Paragraph (d) of subsection (3) of section

14  766.1115, Florida Statutes, is amended to read:

15         766.1115  Health care providers; creation of agency

16  relationship with governmental contractors.--

17         (3)  DEFINITIONS.--As used in this section, the term:

18         (d)  "Health care provider" or "provider" means:

19         1.  A birth center licensed under chapter 383.

20         2.  An ambulatory surgical center licensed under

21  chapter 395.

22         3.  A hospital licensed under chapter 395.

23         4.  A physician or physician assistant licensed under

24  chapter 458.

25         5.  An osteopathic physician or osteopathic physician

26  assistant licensed under chapter 459.

27         6.  A chiropractic physician licensed under chapter

28  460.

29         7.  A podiatric physician licensed under chapter 461.

30         8.  A registered nurse, nurse midwife, licensed

31  practical nurse, or advanced registered nurse practitioner

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 1  licensed or registered under part I of chapter 464 or any

 2  facility which employs nurses licensed or registered under

 3  part I of chapter 464 to supply all or part of the care

 4  delivered under this section.

 5         9.  A midwife licensed under chapter 467.

 6         10.  A health maintenance organization certificated

 7  under part I of chapter 641.

 8         11.  A health care professional association and its

 9  employees or a corporate medical group and its employees.

10         12.  Any other medical facility the primary purpose of

11  which is to deliver human medical diagnostic services or which

12  delivers nonsurgical human medical treatment, and which

13  includes an office maintained by a provider.

14         13.  A dentist or dental hygienist licensed under

15  chapter 466.

16         14.  Any other health care professional, practitioner,

17  provider, or facility under contract with a governmental

18  contractor.

19

20  The term includes any nonprofit corporation qualified as

21  exempt from federal income taxation under s. 501(c) of the

22  Internal Revenue Code which delivers health care services

23  provided by licensed professionals listed in this paragraph,

24  any federally funded community health center, and any

25  volunteer corporation or volunteer health care provider that

26  delivers health care services.

27         Section 73.  Subsection (1) of section 877.111, Florida

28  Statutes, is amended to read:

29         877.111  Inhalation, ingestion, possession, sale,

30  purchase, or transfer of harmful chemical substances;

31  penalties.--

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 1         (1)  It is unlawful for any person to inhale or ingest,

 2  or to possess with intent to breathe, inhale, or drink, any

 3  compound, liquid, or chemical containing toluol, hexane,

 4  trichloroethylene, acetone, toluene, ethyl acetate, methyl

 5  ethyl ketone, trichloroethane, isopropanol, methyl isobutyl

 6  ketone, ethylene glycol monomethyl ether acetate,

 7  cyclohexanone, nitrous oxide, diethyl ether, alkyl nitrites

 8  (butyl nitrite), or any similar substance for the purpose of

 9  inducing a condition of intoxication or which distorts or

10  disturbs the auditory, visual, or mental processes.  This

11  section does not apply to the possession and use of these

12  substances as part of the care or treatment of a disease or

13  injury by a practitioner licensed under chapter 458, chapter

14  459, part I of chapter 464, or chapter 466 or to beverages

15  controlled by the provisions of chapter 561, chapter 562,

16  chapter 563, chapter 564, or chapter 565.

17         Section 74.  Subsection (6) of section 945.602, Florida

18  Statutes, is amended to read:

19         945.602  State of Florida Correctional Medical

20  Authority; creation; members.--

21         (6)  At least one member of the authority must be a

22  nurse licensed under part I of chapter 464 and have at least 5

23  years' experience in the practice of nursing.

24         Section 75.  Subsection (2) of section 960.28, Florida

25  Statutes, is amended to read:

26         960.28  Payment for victims' initial forensic physical

27  examinations.--

28         (2)  The Crime Victims' Services Office of the

29  department shall pay for medical expenses connected with an

30  initial forensic physical examination of a victim who reports

31  a violation of chapter 794 or chapter 800 to a law enforcement

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 1  officer.  Such payment shall be made regardless of whether or

 2  not the victim is covered by health or disability insurance.

 3  The payment shall be made only out of moneys allocated to the

 4  Crime Victims' Services Office for the purposes of this

 5  section, and the payment may not exceed $250 with respect to

 6  any violation. Payment may not be made for an initial forensic

 7  physical examination unless the law enforcement officer

 8  certifies in writing that the initial forensic physical

 9  examination is needed to aid in the investigation of an

10  alleged sexual offense and that the claimant is the alleged

11  victim of the offense. The department shall develop and

12  maintain separate protocols for the initial forensic physical

13  examination of adults and children. Payment under this section

14  is limited to medical expenses connected with the initial

15  forensic physical examination, and payment may be made to a

16  medical provider using an examiner qualified under part I of

17  chapter 464, excluding s. 464.003(5); chapter 458; or chapter

18  459. Payment made to the medical provider by the department

19  shall be considered by the provider as payment in full for the

20  initial forensic physical examination associated with the

21  collection of evidence. The victim may not be required to pay,

22  directly or indirectly, the cost of an initial forensic

23  physical examination performed in accordance with this

24  section.

25         Section 76.  Subsection (36) of section 984.03, Florida

26  Statutes, is amended to read:

27         984.03  Definitions.--When used in this chapter, the

28  term:

29         (36)  "Licensed health care professional" means a

30  physician licensed under chapter 458, an osteopathic physician

31  licensed under chapter 459, a nurse licensed under part I of

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

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 1  chapter 464, a physician assistant licensed under chapter 458

 2  or chapter 459, or a dentist licensed under chapter 466.

 3         Section 77.  Subsection (37) of section 985.03, Florida

 4  Statutes, is amended to read:

 5         985.03  Definitions.--When used in this chapter, the

 6  term:

 7         (37)  "Licensed health care professional" means a

 8  physician licensed under chapter 458, an osteopathic physician

 9  licensed under chapter 459, a nurse licensed under part I of

10  chapter 464, a physician assistant licensed under chapter 458

11  or chapter 459, or a dentist licensed under chapter 466.

12         Section 78.  Section 455.557, Florida Statutes, is

13  amended to read:

14         455.557  Standardized credentialing for health care

15  practitioners.--

16         (1)  INTENT.--The Legislature recognizes that an

17  efficient and effective health care practitioner credentialing

18  program helps to ensure access to quality health care and also

19  recognizes that health care practitioner credentialing

20  activities have increased significantly as a result of health

21  care reform and recent changes in health care delivery and

22  reimbursement systems. Moreover, the resulting duplication of

23  health care practitioner credentialing activities is

24  unnecessarily costly and cumbersome for both the practitioner

25  and the entity granting practice privileges. Therefore, it is

26  the intent of this section that a credentials collection

27  program be established which provides that, once a health care

28  practitioner's core credentials data are collected, they need

29  not be collected again, except for corrections, updates, and

30  modifications thereto. Participation under this section shall

31  initially include those individuals licensed under chapter

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 1  458, chapter 459, chapter 460, or chapter 461, or s. 464.012.

 2  However, the department shall, with the approval of the

 3  applicable board, include other professions under the

 4  jurisdiction of the Division of Medical Quality Assurance in

 5  this program, provided they meet the requirements of s.

 6  455.565 or s. 455.56503.

 7         (2)  DEFINITIONS.--As used in this section, the term:

 8         (a)  "Advisory council" or "council" means the

 9  Credentials Advisory Council.

10         (a)(b)  "Certified" or "accredited," as applicable,

11  means approved by a quality assessment program, from the

12  National Committee for Quality Assurance, the Joint Commission

13  on Accreditation of Healthcare Organizations, the American

14  Accreditation HealthCare Commission/URAC, or any such other

15  nationally recognized and accepted organization authorized by

16  the department, used to assess and certify any credentials

17  verification program, entity, or organization that verifies

18  the credentials of any health care practitioner.

19         (b)(c)  "Core credentials data" means the following

20  data: current name, any former name, and any alias, any

21  professional education, professional training, licensure,

22  current Drug Enforcement Administration certification, social

23  security number, specialty board certification, Educational

24  Commission for Foreign Medical Graduates certification,

25  hospital or other institutional affiliations, evidence of

26  professional liability coverage or evidence of financial

27  responsibility as required by s. 458.320, or s. 459.0085, or

28  s. 455.694, history of claims, suits, judgments, or

29  settlements, final disciplinary action reported pursuant to s.

30  455.565(1)(a)8. or s. 455.56503(1)(a)8., and Medicare or

31  Medicaid sanctions.

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 1         (c)(d)  "Credential" or "credentialing" means the

 2  process of assessing and verifying the qualifications of a

 3  licensed health care practitioner or applicant for licensure

 4  as a health care practitioner.

 5         (d)(e)  "Credentials verification organization" means

 6  any organization certified or accredited as a credentials

 7  verification organization.

 8         (e)(f)  "Department" means the Department of Health,

 9  Division of Medical Quality Assurance.

10         (f)(g)  "Designated credentials verification

11  organization" means the credentials verification organization

12  which is selected by the health care practitioner, if the

13  health care practitioner chooses to make such a designation.

14         (g)(h)  "Drug Enforcement Administration certification"

15  means certification issued by the Drug Enforcement

16  Administration for purposes of administration or prescription

17  of controlled substances. Submission of such certification

18  under this section must include evidence that the

19  certification is current and must also include all current

20  addresses to which the certificate is issued.

21         (h)(i)  "Health care entity" means:

22         1.  Any health care facility or other health care

23  organization licensed or certified to provide approved medical

24  and allied health services in this state;

25         2.  Any entity licensed by the Department of Insurance

26  as a prepaid health care plan or health maintenance

27  organization or as an insurer to provide coverage for health

28  care services through a network of providers; or

29         3.  Any accredited medical school in this state.

30         (i)(j)  "Health care practitioner" means any person

31  licensed, or, for credentialing purposes only, any person

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  applying for licensure, under chapter 458, chapter 459,

 2  chapter 460, or chapter 461, or s. 464.012 or any person

 3  licensed or applying for licensure under a chapter

 4  subsequently made subject to this section by the department

 5  with the approval of the applicable board, except a person

 6  registered or applying for registration pursuant to s. 458.345

 7  or s. 459.021.

 8         (j)(k)  "Hospital or other institutional affiliations"

 9  means each hospital or other institution for which the health

10  care practitioner or applicant has provided medical services.

11  Submission of such information under this section must

12  include, for each hospital or other institution, the name and

13  address of the hospital or institution, the staff status of

14  the health care practitioner or applicant at that hospital or

15  institution, and the dates of affiliation with that hospital

16  or institution.

17         (k)(l)  "National accrediting organization" means an

18  organization that awards accreditation or certification to

19  hospitals, managed care organizations, credentials

20  verification organizations, or other health care

21  organizations, including, but not limited to, the Joint

22  Commission on Accreditation of Healthcare Organizations, the

23  American Accreditation HealthCare Commission/URAC, and the

24  National Committee for Quality Assurance.

25         (l)(m)  "Professional training" means any internship,

26  residency, or fellowship relating to the profession for which

27  the health care practitioner is licensed or seeking licensure.

28         (m)(n)  "Specialty board certification" means

29  certification in a specialty issued by a specialty board

30  recognized by the board in this state that regulates the

31  profession for which the health care practitioner is licensed

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  or seeking licensure.

 2         (3)  STANDARDIZED CREDENTIALS VERIFICATION PROGRAM.--

 3         (a)  Every health care practitioner shall:

 4         1.  Report all core credentials data to the department

 5  which is not already on file with the department, either by

 6  designating a credentials verification organization to submit

 7  the data or by submitting the data directly.

 8         2.  Notify the department within 45 days of any

 9  corrections, updates, or modifications to the core credentials

10  data either through his or her designated credentials

11  verification organization or by submitting the data directly.

12  Corrections, updates, and modifications to the core

13  credentials data provided the department under this section

14  shall comply with the updating requirements of s. 455.565(3)

15  or s. 455.56503(3) related to profiling.

16         (b)  The department shall:

17         1.  Maintain a complete, current file of core

18  credentials data on each health care practitioner, which shall

19  include all updates provided in accordance with subparagraph

20  (a)2.

21         2.  Release the core credentials data that is otherwise

22  confidential or exempt from the provisions of chapter 119 and

23  s. 24(a), Art. I of the State Constitution and any

24  corrections, updates, and modifications thereto, if authorized

25  by the health care practitioner.

26         3.  Charge a fee to access the core credentials data,

27  which may not exceed the actual cost, including prorated setup

28  and operating costs, pursuant to the requirements of chapter

29  119. The actual cost shall be set in consultation with the

30  advisory council.

31         4.  Develop, in consultation with the advisory council,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  standardized forms to be used by the health care practitioner

 2  or designated credentials verification organization for the

 3  initial reporting of core credentials data, for the health

 4  care practitioner to authorize the release of core credentials

 5  data, and for the subsequent reporting of corrections,

 6  updates, and modifications thereto.

 7         5.  Establish a Credentials Advisory Council,

 8  consisting of 13 members, to assist the department as provided

 9  in this section. The secretary, or his or her designee, shall

10  serve as one member and chair of the council and shall appoint

11  the remaining 12 members. Except for any initial lesser term

12  required to achieve staggering, such appointments shall be for

13  4-year staggered terms, with one 4-year reappointment, as

14  applicable. Three members shall represent hospitals, and two

15  members shall represent health maintenance organizations. One

16  member shall represent health insurance entities. One member

17  shall represent the credentials verification industry. Two

18  members shall represent physicians licensed under chapter 458.

19  One member shall represent osteopathic physicians licensed

20  under chapter 459. One member shall represent chiropractic

21  physicians licensed under chapter 460. One member shall

22  represent podiatric physicians licensed under chapter 461.

23         (c)  A registered credentials verification organization

24  may be designated by a health care practitioner to assist the

25  health care practitioner to comply with the requirements of

26  subparagraph (a)2. A designated credentials verification

27  organization shall:

28         1.  Timely comply with the requirements of subparagraph

29  (a)2., pursuant to rules adopted by the department.

30         2.  Not provide the health care practitioner's core

31  data, including all corrections, updates, and modifications,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  without the authorization of the practitioner.

 2         (d)  This section shall not be construed to restrict in

 3  any way the authority of the health care entity to credential

 4  and to approve or deny an application for hospital staff

 5  membership, clinical privileges, or managed care network

 6  participation.

 7         (4)  DUPLICATION OF DATA PROHIBITED.--

 8         (a)  A health care entity or credentials verification

 9  organization is prohibited from collecting or attempting to

10  collect duplicate core credentials data from any health care

11  practitioner if the information is available from the

12  department. This section shall not be construed to restrict

13  the right of any health care entity or credentials

14  verification organization to collect additional information

15  from the health care practitioner which is not included in the

16  core credentials data file. This section shall not be

17  construed to prohibit a health care entity or credentials

18  verification organization from obtaining all necessary

19  attestation and release form signatures and dates.

20         (b)  Effective July 1, 2002, a state agency in this

21  state which credentials health care practitioners may not

22  collect or attempt to collect duplicate core credentials data

23  from any individual health care practitioner if the

24  information is already available from the department. This

25  section shall not be construed to restrict the right of any

26  such state agency to request additional information not

27  included in the core credential data file, but which is deemed

28  necessary for the agency's specific credentialing purposes.

29         (5)  STANDARDS AND REGISTRATION.--Any credentials

30  verification organization that does business in this state

31  must be fully accredited or certified as a credentials

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  verification organization by a national accrediting

 2  organization as specified in paragraph (2)(a)(b) and must

 3  register with the department. The department may charge a

 4  reasonable registration fee, set in consultation with the

 5  advisory council, not to exceed an amount sufficient to cover

 6  its actual expenses in providing and enforcing such

 7  registration. The department shall establish by rule for

 8  biennial renewal of such registration. Failure by a registered

 9  credentials verification organization to maintain full

10  accreditation or certification, to provide data as authorized

11  by the health care practitioner, to report to the department

12  changes, updates, and modifications to a health care

13  practitioner's records within the time period specified in

14  subparagraph (3)(a)2., or to comply with the prohibition

15  against collection of duplicate core credentials data from a

16  practitioner may result in denial of an application for

17  renewal of registration or in revocation or suspension of a

18  registration.

19         (6)  LIABILITY.--No civil, criminal, or administrative

20  action may be instituted, and there shall be no liability,

21  against any registered credentials verification organization

22  or health care entity on account of its reliance on any data

23  obtained directly from the department.

24         (7)  LIABILITY INSURANCE REQUIREMENTS.--Each

25  credentials verification organization doing business in this

26  state shall maintain liability insurance appropriate to meet

27  the certification or accreditation requirements established in

28  this section.

29         (8)  RULES.--The department, in consultation with the

30  advisory council, shall adopt rules necessary to develop and

31  implement the standardized core credentials data collection

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  program established by this section.

 2         (9)  COUNCIL ABOLISHED; DEPARTMENT AUTHORITY.--The

 3  council shall be abolished October 1, 1999. After the council

 4  is abolished, all duties of the department required under this

 5  section to be in consultation with the council may be carried

 6  out by the department on its own.

 7         Section 79.  Section 455.56503, Florida Statutes, is

 8  created to read:

 9         455.56503  Advanced registered nurse practitioners;

10  information required for certification.--

11         (1)(a)  Each person who applies for initial

12  certification under s. 464.012 must, at the time of

13  application, and each person certified under s. 464.012 who

14  applies for certification renewal must, in conjunction with

15  the renewal of such certification and under procedures adopted

16  by the Department of Health, and in addition to any other

17  information that may be required from the applicant, furnish

18  the following information to the Department of Health:

19         1.  The name of each school or training program that

20  the applicant has attended, with the months and years of

21  attendance and the month and year of graduation, and a

22  description of all graduate professional education completed

23  by the applicant, excluding any coursework taken to satisfy

24  continuing education requirements.

25         2.  The name of each location at which the applicant

26  practices.

27         3.  The address at which the applicant will primarily

28  conduct his or her practice.

29         4.  Any certification or designation that the applicant

30  has received from a specialty or certification board that is

31  recognized or approved by the regulatory board or department

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  to which the applicant is applying.

 2         5.  The year that the applicant received initial

 3  certification and began practicing the profession in any

 4  jurisdiction and the year that the applicant received initial

 5  certification in this state.

 6         6.  Any appointment which the applicant currently holds

 7  to the faculty of a school related to the profession and an

 8  indication as to whether the applicant has had the

 9  responsibility for graduate education within the most recent

10  10 years.

11         7.  A description of any criminal offense of which the

12  applicant has been found guilty, regardless of whether

13  adjudication of guilt was withheld, or to which the applicant

14  has pled guilty or nolo contendere. A criminal offense

15  committed in another jurisdiction which would have been a

16  felony or misdemeanor if committed in this state must be

17  reported. If the applicant indicates that a criminal offense

18  is under appeal and submits a copy of the notice for appeal of

19  that criminal offense, the department must state that the

20  criminal offense is under appeal if the criminal offense is

21  reported in the applicant's profile. If the applicant

22  indicates to the department that a criminal offense is under

23  appeal, the applicant must, within 15 days after the

24  disposition of the appeal, submit to the department a copy of

25  the final written order of disposition.

26         8.  A description of any final disciplinary action

27  taken within the previous 10 years against the applicant by a

28  licensing or regulatory body in any jurisdiction, by a

29  specialty board that is recognized by the board or department,

30  or by a licensed hospital, health maintenance organization,

31  prepaid health clinic, ambulatory surgical center, or nursing

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  home. Disciplinary action includes resignation from or

 2  nonrenewal of staff membership or the restriction of

 3  privileges at a licensed hospital, health maintenance

 4  organization, prepaid health clinic, ambulatory surgical

 5  center, or nursing home taken in lieu of or in settlement of a

 6  pending disciplinary case related to competence or character.

 7  If the applicant indicates that the disciplinary action is

 8  under appeal and submits a copy of the document initiating an

 9  appeal of the disciplinary action, the department must state

10  that the disciplinary action is under appeal if the

11  disciplinary action is reported in the applicant's profile.

12         (b)  In addition to the information required under

13  paragraph (a), each applicant for initial certification or

14  certification renewal must provide the information required of

15  licensees pursuant to s. 455.697.

16         (2)  The Department of Health shall send a notice to

17  each person certified under s. 464.012 at the

18  certificateholder's last known address of record regarding the

19  requirements for information to be submitted by advanced

20  registered nurse practitioners pursuant to this section in

21  conjunction with the renewal of such certificate.

22         (3)  Each person certified under s. 464.012 who has

23  submitted information pursuant to subsection (1) must update

24  that information in writing by notifying the Department of

25  Health within 45 days after the occurrence of an event or the

26  attainment of a status that is required to be reported by

27  subsection (1). Failure to comply with the requirements of

28  this subsection to update and submit information constitutes a

29  ground for disciplinary action under chapter 464 and s.

30  455.624(1)(k). For failure to comply with the requirements of

31  this subsection to update and submit information, the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  department or board, as appropriate, may:

 2         (a)  Refuse to issue a certificate to any person

 3  applying for initial certification who fails to submit and

 4  update the required information.

 5         (b)  Issue a citation to any certificateholder who

 6  fails to submit and update the required information and may

 7  fine the certificateholder up to $50 for each day that the

 8  certificateholder is not in compliance with this subsection.

 9  The citation must clearly state that the certificateholder may

10  choose, in lieu of accepting the citation, to follow the

11  procedure under s. 455.621. If the certificateholder disputes

12  the matter in the citation, the procedures set forth in s.

13  455.621 must be followed. However, if the certificateholder

14  does not dispute the matter in the citation with the

15  department within 30 days after the citation is served, the

16  citation becomes a final order and constitutes discipline.

17  Service of a citation may be made by personal service or

18  certified mail, restricted delivery, to the subject at the

19  certificateholder's last known address.

20         (4)(a)  An applicant for initial certification under s.

21  464.012 must submit a set of fingerprints to the Department of

22  Health on a form and under procedures specified by the

23  department, along with payment in an amount equal to the costs

24  incurred by the Department of Health for a national criminal

25  history check of the applicant.

26         (b)  An applicant for renewed certification who has not

27  previously submitted a set of fingerprints to the Department

28  of Health for purposes of certification must submit a set of

29  fingerprints to the department as a condition of the initial

30  renewal of his or her certificate after the effective date of

31  this section. The applicant must submit the fingerprints on a

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  form and under procedures specified by the department, along

 2  with payment in an amount equal to the costs incurred by the

 3  Department of Health for a national criminal history check.

 4  For subsequent renewals, the applicant for renewed

 5  certification must only submit information necessary to

 6  conduct a statewide criminal history check, along with payment

 7  in an amount equal to the costs incurred by the Department of

 8  Health for a statewide criminal history check.

 9         (c)1.  The Department of Health shall submit the

10  fingerprints provided by an applicant for initial

11  certification to the Florida Department of Law Enforcement for

12  a statewide criminal history check, and the Florida Department

13  of Law Enforcement shall forward the fingerprints to the

14  Federal Bureau of Investigation for a national criminal

15  history check of the applicant.

16         2.  The department shall submit the fingerprints

17  provided by an applicant for the initial renewal of

18  certification to the Florida Department of Law Enforcement for

19  a statewide criminal history check, and the Florida Department

20  of Law Enforcement shall forward the fingerprints to the

21  Federal Bureau of Investigation for a national criminal

22  history check for the initial renewal of the applicant's

23  certificate after the effective date of this section.

24         3.  For any subsequent renewal of the applicant's

25  certificate, the department shall submit the required

26  information for a statewide criminal history check of the

27  applicant to the Florida Department of Law Enforcement.

28         (d)  Any applicant for initial certification or renewal

29  of certification as an advanced registered nurse practitioner

30  who submits to the Department of Health a set of fingerprints

31  and information required for the criminal history check

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  required under this section shall not be required to provide a

 2  subsequent set of fingerprints or other duplicate information

 3  required for a criminal history check to the Agency for Health

 4  Care Administration, the Department of Juvenile Justice, or

 5  the Department of Children and Family Services for employment

 6  or licensure with such agency or department, if the applicant

 7  has undergone a criminal history check as a condition of

 8  initial certification or renewal of certification as an

 9  advanced registered nurse practitioner with the Department of

10  Health, notwithstanding any other provision of law to the

11  contrary. In lieu of such duplicate submission, the Agency for

12  Health Care Administration, the Department of Juvenile

13  Justice, and the Department of Children and Family Services

14  shall obtain criminal history information for employment or

15  licensure of persons certified under s. 464.012 by such agency

16  or department from the Department of Health's health care

17  practitioner credentialing system.

18         (5)  Each person who is required to submit information

19  pursuant to this section may submit additional information to

20  the Department of Health. Such information may include, but is

21  not limited to:

22         (a)  Information regarding publications in

23  peer-reviewed professional literature within the previous 10

24  years.

25         (b)  Information regarding professional or community

26  service activities or awards.

27         (c)  Languages, other than English, used by the

28  applicant to communicate with patients or clients and

29  identification of any translating service that may be

30  available at the place where the applicant primarily conducts

31  his or her practice.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (d)  An indication of whether the person participates

 2  in the Medicaid program.

 3         Section 80.  Section 455.5651, Florida Statutes, is

 4  amended to read:

 5         455.5651  Practitioner profile; creation.--

 6         (1)  Beginning July 1, 1999, the Department of Health

 7  shall compile the information submitted pursuant to s. 455.565

 8  into a practitioner profile of the applicant submitting the

 9  information, except that the Department of Health may develop

10  a format to compile uniformly any information submitted under

11  s. 455.565(4)(b). Beginning July 1, 2001, the Department of

12  Health may compile the information submitted pursuant to s.

13  455.56503 into a practitioner profile of the applicant

14  submitting the information.

15         (2)  On the profile published required under subsection

16  (1), the department shall indicate if the information provided

17  under s. 455.565(1)(a)7. or s. 455.56503(1)(a)7. is not

18  corroborated by a criminal history check conducted according

19  to this subsection. If the information provided under s.

20  455.565(1)(a)7. or s. 455.56503(1)(a)7. is corroborated by the

21  criminal history check, the fact that the criminal history

22  check was performed need not be indicated on the profile. The

23  department, or the board having regulatory authority over the

24  practitioner acting on behalf of the department, shall

25  investigate any information received by the department or the

26  board when it has reasonable grounds to believe that the

27  practitioner has violated any law that relates to the

28  practitioner's practice.

29         (3)  The Department of Health may include in each

30  practitioner's practitioner profile that criminal information

31  that directly relates to the practitioner's ability to

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  competently practice his or her profession.  The department

 2  must include in each practitioner's practitioner profile the

 3  following statement:  "The criminal history information, if

 4  any exists, may be incomplete; federal criminal history

 5  information is not available to the public."

 6         (4)  The Department of Health shall include, with

 7  respect to a practitioner licensed under chapter 458 or

 8  chapter 459, a statement of how the practitioner has elected

 9  to comply with the financial responsibility requirements of s.

10  458.320 or s. 459.0085. The department shall include, with

11  respect to practitioners subject to s. 455.694, a statement of

12  how the practitioner has elected to comply with the financial

13  responsibility requirements of that section. The department

14  shall include, with respect to practitioners licensed under

15  chapter 458, chapter 459, or chapter 461, information relating

16  to liability actions which has been reported under s. 455.697

17  or s. 627.912 within the previous 10 years for any paid claim

18  that exceeds $5,000. Such claims information shall be reported

19  in the context of comparing an individual practitioner's

20  claims to the experience of other practitioners physicians

21  within the same specialty, or profession if the practitioner

22  is not a specialist, to the extent such information is

23  available to the Department of Health. If information relating

24  to a liability action is included in a practitioner's

25  practitioner profile, the profile must also include the

26  following statement:  "Settlement of a claim may occur for a

27  variety of reasons that do not necessarily reflect negatively

28  on the professional competence or conduct of the practitioner

29  physician.  A payment in settlement of a medical malpractice

30  action or claim should not be construed as creating a

31  presumption that medical malpractice has occurred."

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (5)  The Department of Health may not include

 2  disciplinary action taken by a licensed hospital or an

 3  ambulatory surgical center in the practitioner profile.

 4         (6)  The Department of Health may include in the

 5  practitioner's practitioner profile any other information that

 6  is a public record of any governmental entity and that relates

 7  to a practitioner's ability to competently practice his or her

 8  profession.  However, the department must consult with the

 9  board having regulatory authority over the practitioner before

10  such information is included in his or her profile.

11         (7)  Upon the completion of a practitioner profile

12  under this section, the Department of Health shall furnish the

13  practitioner who is the subject of the profile a copy of it.

14  The practitioner has a period of 30 days in which to review

15  the profile and to correct any factual inaccuracies in it. The

16  Department of Health shall make the profile available to the

17  public at the end of the 30-day period. The department shall

18  make the profiles available to the public through the World

19  Wide Web and other commonly used means of distribution.

20         (8)  Making a practitioner profile available to the

21  public under this section does not constitute agency action

22  for which a hearing under s. 120.57 may be sought.

23         Section 81.  Section 455.5653, Florida Statutes, is

24  amended to read:

25         455.5653  Practitioner profiles; data

26  storage.--Effective upon this act becoming a law, the

27  Department of Health must develop or contract for a computer

28  system to accommodate the new data collection and storage

29  requirements under this act pending the development and

30  operation of a computer system by the Department of Health for

31  handling the collection, input, revision, and update of data

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  submitted by physicians as a part of their initial licensure

 2  or renewal to be compiled into individual practitioner

 3  profiles. The Department of Health must incorporate any data

 4  required by this act into the computer system used in

 5  conjunction with the regulation of health care professions

 6  under its jurisdiction. The department must develop, by the

 7  year 2000, a schedule and procedures for each practitioner

 8  within a health care profession regulated within the Division

 9  of Medical Quality Assurance to submit relevant information to

10  be compiled into a profile to be made available to the public.

11  The Department of Health is authorized to contract with and

12  negotiate any interagency agreement necessary to develop and

13  implement the practitioner profiles. The Department of Health

14  shall have access to any information or record maintained by

15  the Agency for Health Care Administration, including any

16  information or record that is otherwise confidential and

17  exempt from the provisions of chapter 119 and s. 24(a), Art. I

18  of the State Constitution, so that the Department of Health

19  may corroborate any information that practitioners physicians

20  are required to report under s. 455.565 or s. 455.56503.

21         Section 82.  Section 455.5654, Florida Statutes, is

22  amended to read:

23         455.5654  Practitioner profiles; rules;

24  workshops.--Effective upon this act becoming a law, the

25  Department of Health shall adopt rules for the form of a

26  practitioner profile that the agency is required to prepare.

27  The Department of Health, pursuant to chapter 120, must hold

28  public workshops for purposes of rule development to implement

29  this section. An agency to which information is to be

30  submitted under this act may adopt by rule a form for the

31  submission of the information required under s. 455.565 or s.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  455.56503.

 2         Section 83.  Subsection (20) of section 400.462,

 3  Florida Statutes, is repealed.

 4         Section 84.  Paragraph (d) of subsection (4) of section

 5  400.471, Florida Statutes, is amended to read:

 6         400.471  Application for license; fee; provisional

 7  license; temporary permit.--

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

 9  following requirements:

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

11  applicant when each individual required by this section to

12  undergo background screening has met the standards for the

13  abuse registry background check through the agency and the

14  Department of Law Enforcement background check, but the agency

15  has not yet received background screening results from the

16  Federal Bureau of Investigation. A standard license may be

17  granted to the licensee upon the agency's receipt of a report

18  of the results of the Federal Bureau of Investigation

19  background screening for each individual required by this

20  section to undergo background screening which confirms that

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

22  disqualification exemption by the agency as set forth in

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

24  2 background screening may serve in his or her capacity

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

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

27  to serve if the report indicates any violation of background

28  screening standards and a disqualification exemption has not

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

30  chapter 435.

31         Section 85.  Subsection (3) is added to section

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  400.484, Florida Statutes, to read:

 2         400.484  Right of inspection; deficiencies; fines.--

 3         (3)  In addition to any other penalties imposed

 4  pursuant to this section or part, the agency may assess costs

 5  related to an investigation that results in a successful

 6  prosecution, excluding costs associated with an attorney's

 7  time.

 8         Section 86.  Section 400.487, Florida Statutes, is

 9  amended to read:

10         400.487  Home health service agreements; physician's

11  treatment orders; patient assessment; establishment and review

12  of plan of care; provision of services; orders not to

13  resuscitate.--

14         (1)  Services provided by a home health agency must be

15  covered by an agreement between the home health agency and the

16  patient or the patient's legal representative specifying the

17  home health services to be provided, the rates or charges for

18  services paid with private funds, and the method of payment. A

19  The home health agency providing skilled care must make an

20  assessment of the patient's needs within 48 hours after the

21  start of services.

22         (2)  When required by the provisions of chapter 464,

23  part I, part III, or part V of chapter 468, or chapter 486,

24  the attending physician for a patient who is to receive

25  skilled care must establish treatment orders. The treatment

26  orders must be signed by the physician within 30 24 days after

27  the start of care and must be reviewed, as at least every 62

28  days or more frequently as if the patient's illness requires,

29  by the physician in consultation with home health agency

30  personnel that provide services to the patient.

31         (3)  A home health agency shall arrange for supervisory

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  visits by a registered nurse to the home of a patient

 2  receiving home health aide services in accordance with the

 3  patient's direction and approval. If a client is accepted for

 4  home health aide services or homemaker or companion services

 5  and such services do not require a physician's order, the home

 6  health agency shall establish a service provision plan and

 7  maintain a record of the services provided.

 8         (4)  Each patient or client has the right to be

 9  informed of and to participate in the planning of his or her

10  care. Each patient must be provided, upon request, a copy of

11  the plan of care or service provision plan established and

12  maintained for that patient or client by the home health

13  agency.

14         (5)  When nursing services are ordered, the home health

15  agency to which a patient has been admitted for care must

16  provide the initial admission visit, all service evaluation

17  visits, and the discharge visit by qualified personnel who are

18  on the payroll of, and to whom an IRS payroll form W-2 will be

19  issued by, the home health agency. Services provided by others

20  under contractual arrangements to a home health agency must be

21  monitored and managed by the admitting home health agency. The

22  admitting home health agency is fully responsible for ensuring

23  that all care provided through its employees or contract staff

24  is delivered in accordance with this part and applicable

25  rules.

26         (6)  The skilled care services provided by a home

27  health agency, directly or under contract, must be supervised

28  and coordinated in accordance with the plan of care.

29         (7)  Home health agency personnel may withhold or

30  withdraw cardiopulmonary resuscitation if presented with an

31  order not to resuscitate executed pursuant to s. 401.45. The

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  agency shall adopt rules providing for the implementation of

 2  such orders. Home health personnel and agencies shall not be

 3  subject to criminal prosecution or civil liability, nor be

 4  considered to have engaged in negligent or unprofessional

 5  conduct, for withholding or withdrawing cardiopulmonary

 6  resuscitation pursuant to such an order and rules adopted by

 7  the agency.

 8         Section 87.  Section 400.497, Florida Statutes, is

 9  amended to read:

10         400.497  Rules establishing minimum standards.--The

11  agency shall adopt, publish, and enforce rules to implement

12  this part, including, as applicable, ss. 400.506 and 400.509,

13  which must provide reasonable and fair minimum standards

14  relating to:

15         (1)  The home health aide competency test and home

16  health aide training. The qualifications, minimum training

17  requirements, and supervision requirements of all home health

18  agency personnel. The agency shall create the home health aide

19  competency test and establish the curriculum and instructor

20  qualifications for home health aide training. Licensed home

21  health agencies may provide this training and shall furnish

22  documentation of such training to other licensed home health

23  agencies upon request. Successful passage of the competency

24  test by home health aides may be substituted for the training

25  required under this section and any rule adopted pursuant

26  thereto.

27         (2)  Shared staffing. The agency shall allow shared

28  staffing if the home health agency is part of a retirement

29  community that provides multiple levels of care, is located on

30  one campus, is licensed under this chapter, and otherwise

31  meets the requirements of law and rule.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         (2)  Requirements for prospective employees.  A home

 2  health agency must require prospective employees and

 3  contractors to submit an employment or contractual history,

 4  and it must verify the employment or contractual history

 5  unless through diligent efforts such verification is not

 6  possible.  The agency shall prescribe by rule the minimum

 7  requirements for establishing that diligent efforts have been

 8  made. There is no monetary liability on the part of, and no

 9  cause of action for damages arising against, a former employer

10  of a prospective employee of or prospective independent

11  contractor with a licensed home health agency who reasonably

12  and in good faith communicates his or her honest opinions

13  about the former employee's job performance. This subsection

14  does not affect the official immunity of an officer or

15  employee of a public corporation.

16         (3)  The criteria for the frequency of onsite licensure

17  surveys.

18         (4)(3)  Licensure application and renewal.

19         (5)(4)  The administration of the home health agency,

20  including requirements for onsite and electronic accessibility

21  of supervisory personnel of home health agencies.

22         (5)  Procedures for administering drugs and

23  biologicals.

24         (6)  Information to be included in Procedures for

25  maintaining patients' records.

26         (7)  Ensuring that home health services are provided in

27  accordance with the treatment orders established for each

28  patient for whom physician orders are required.

29         (7)(8)  Geographic service areas.

30         (9)  Standards for contractual arrangements for the

31  provision of home health services by providers not employed by

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  the home health agency to whom the patient has been admitted.

 2         Section 88.  Paragraph (d) of subsection (2) and

 3  subsection (13) of section 400.506, Florida Statutes, are

 4  amended, subsection (17) is renumbered as subsection (18), and

 5  a new subsection (17) is added to said section, to read:

 6         400.506  Licensure of nurse registries; requirements;

 7  penalties.--

 8         (2)  Each applicant for licensure must comply with the

 9  following requirements:

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

11  applicant when each individual required by this section to

12  undergo background screening has met the standards for the

13  abuse registry background check through the agency and the

14  Department of Law Enforcement background check, but the agency

15  has not yet received background screening results from the

16  Federal Bureau of Investigation. A standard license may be

17  granted to the applicant upon the agency's receipt of a report

18  of the results of the Federal Bureau of Investigation

19  background screening for each individual required by this

20  section to undergo background screening which confirms that

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

22  disqualification exemption by the agency as set forth in

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

24  2 background screening may serve in his or her capacity

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

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

27  to serve if the report indicates any violation of background

28  screening standards and a disqualification exemption has not

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

30  chapter 435.

31         (13)  Each nurse registry must comply with the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  procedures set forth in s. 400.512 400.497(3) for maintaining

 2  records of the employment history of all persons referred for

 3  contract and is subject to the standards and conditions set

 4  forth in that section s. 400.512. However, an initial

 5  screening may not be required for persons who have been

 6  continuously registered with the nurse registry since

 7  September 30, 1990.

 8         (17)  In addition to any other penalties imposed

 9  pursuant to this section or part, the agency may assess costs

10  related to an investigation that results in a successful

11  prosecution, excluding costs associated with an attorney's

12  time. If the agency imposes such an assessment and the

13  assessment is not paid, and if challenged is not the subject

14  of a pending appeal, prior to the renewal of the license, the

15  license shall not be issued until the assessment is paid or

16  arrangements for payment of the assessment are made.

17         Section 89.  Paragraph (d) of subsection (4) of section

18  400.509, Florida Statutes, is amended, subsection (14) is

19  renumbered as subsection (15), and a new subsection (14) is

20  added to said section, to read:

21         400.509  Registration of particular service providers

22  exempt from licensure; certificate of registration; regulation

23  of registrants.--

24         (4)  Each applicant for registration must comply with

25  the following requirements:

26         (d)  A provisional registration may be granted to an

27  applicant when each individual required by this section to

28  undergo background screening has met the standards for the

29  abuse-registry background check through the agency and the

30  Department of Law Enforcement background check, but the agency

31  has not yet received background screening results from the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  Federal Bureau of Investigation.  A standard registration may

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

 3  report of the results of the Federal Bureau of Investigation

 4  background screening for each individual required by this

 5  section to undergo background screening which confirms that

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

 7  disqualification exemption by the agency as set forth in

 8  chapter 435.  Any other person who is required to undergo

 9  level 2 background screening may serve in his or her capacity

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

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

12  to serve if the report indicates any violation of background

13  screening standards and if a disqualification exemption has

14  not been requested of and granted by the agency as set forth

15  in chapter 435.

16         (14)  In addition to any other penalties imposed

17  pursuant to this section or part, the agency may assess costs

18  related to an investigation that results in a successful

19  prosecution, excluding costs associated with an attorney's

20  time. If the agency imposes such an assessment and the

21  assessment is not paid, and if challenged is not the subject

22  of a pending appeal, prior to the renewal of the registration,

23  the registration shall not be issued until the assessment is

24  paid or arrangements for payment of the assessment are made.

25         Section 90.  Section 400.512, Florida Statutes, is

26  amended to read:

27         400.512  Screening of home health agency personnel;

28  nurse registry personnel; and companions and homemakers.--The

29  agency shall require employment or contractor screening as

30  provided in chapter 435, using the level 1 standards for

31  screening set forth in that chapter, for home health agency

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  personnel; persons referred for employment by nurse

 2  registries; and persons employed by companion or homemaker

 3  services registered under s. 400.509.

 4         (1)  The agency may grant exemptions from

 5  disqualification from employment or contracting under this

 6  section as provided in s. 435.07.

 7         (2)  The administrator of each home health agency, the

 8  managing employee of each nurse registry, and the managing

 9  employee of each companion or homemaker service registered

10  under s. 400.509 must sign an affidavit annually, under

11  penalty of perjury, stating that all personnel hired,

12  contracted with, or registered on or after October 1, 1994,

13  who enter the home of a patient or client in their service

14  capacity have been screened and that its remaining personnel

15  have worked for the home health agency or registrant

16  continuously since before October 1, 1994.

17         (3)  As a prerequisite to operating as a home health

18  agency, nurse registry, or companion or homemaker service

19  under s. 400.509, the administrator or managing employee,

20  respectively, must submit to the agency his or her name and

21  any other information necessary to conduct a complete

22  screening according to this section.  The agency shall submit

23  the information to the Department of Law Enforcement and shall

24  conduct a search for any report of confirmed abuse the

25  department's abuse hotline for state processing.  The agency

26  shall review the record of the administrator or manager with

27  respect to the offenses specified in this section and shall

28  notify the owner of its findings.  If disposition information

29  is missing on a criminal record, the administrator or manager,

30  upon request of the agency, must obtain and supply within 30

31  days the missing disposition information to the agency.

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  Failure to supply missing information within 30 days or to

 2  show reasonable efforts to obtain such information will result

 3  in automatic disqualification.

 4         (4)  Proof of compliance with the screening

 5  requirements of chapter 435 shall be accepted in lieu of the

 6  requirements of this section if the person has been

 7  continuously employed or registered without a breach in

 8  service that exceeds 180 days, the proof of compliance is not

 9  more than 2 years old, and the person has been screened

10  through the agency for any reports of confirmed abuse central

11  abuse registry and tracking system of the department and for

12  any criminal record from by the Department of Law Enforcement.

13  A home health agency, nurse registry, or companion or

14  homemaker service registered under s. 400.509 shall directly

15  provide proof of compliance to another home health agency,

16  nurse registry, or companion or homemaker service registered

17  under s. 400.509. The recipient home health agency, nurse

18  registry, or companion or homemaker service registered under

19  s. 400.509 may not accept any proof of compliance directly

20  from the person who requires screening. Proof of compliance

21  with the screening requirements of this section shall be

22  provided upon request to the person screened by the home

23  health agencies; nurse registries; or companion or homemaker

24  services registered under s. 400.509.

25         (5)(a)  There is no monetary liability on the part of,

26  and no cause of action for damages arises against, a licensed

27  home health agency, licensed nurse registry, or companion or

28  homemaker service registered under s. 400.509, that, upon

29  notice of a confirmed report of adult abuse, neglect, or

30  exploitation through the agency, terminates the employee or

31  contractor against whom the report was issued, whether or not

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  the employee or contractor has filed for an exemption with the

 2  agency in accordance with chapter 435 and whether or not the

 3  time for filing has expired.

 4         (b)  If a home health agency is asked about a person

 5  who was employed by or contracted with that agency, there is

 6  no monetary liability on the part of, and no cause of action

 7  for damages arising against, a former employer of the person

 8  for that agency, who reasonably and in good faith communicates

 9  his or her honest opinions about the former caregiver's job

10  performance. This paragraph does not affect the official

11  immunity of an officer or employee of a public corporation.

12         (6)  The costs of processing the statewide

13  correspondence criminal records checks and the search of the

14  department's central abuse hotline must be borne by the home

15  health agency; the nurse registry; or the companion or

16  homemaker service registered under s. 400.509, or by the

17  person being screened, at the discretion of the home health

18  agency, nurse registry, or s. 400.509 registrant.

19         (7)(a)  It is a misdemeanor of the first degree,

20  punishable under s. 775.082 or s. 775.083, for any person

21  willfully, knowingly, or intentionally to:

22         1.  Fail, by false statement, misrepresentation,

23  impersonation, or other fraudulent means, to disclose in any

24  application for voluntary or paid employment a material fact

25  used in making a determination as to such person's

26  qualifications to be an employee under this section;

27         2.  Operate or attempt to operate an entity licensed or

28  registered under this part with persons who do not meet the

29  minimum standards for good moral character as contained in

30  this section; or

31         3.  Use information from the criminal records or the

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  agency's reports of confirmed abuse central abuse hotline

 2  obtained under this section for any purpose other than

 3  screening that person for employment as specified in this

 4  section or release such information to any other person for

 5  any purpose other than screening for employment under this

 6  section.

 7         (b)  It is a felony of the third degree, punishable

 8  under s. 775.082, s. 775.083, or s. 775.084, for any person

 9  willfully, knowingly, or intentionally to use information from

10  the juvenile records of a person obtained under this section

11  for any purpose other than screening for employment under this

12  section.

13         Section 91.  Subsection (5) of section 455.587, Florida

14  Statutes, is amended to read:

15         455.587  Fees; receipts; disposition.--

16         (5)  All moneys collected by the department from fees

17  or fines or from costs awarded to the agency by a court shall

18  be paid into a trust fund used by the department to implement

19  this part. The Legislature shall appropriate funds from this

20  trust fund sufficient to carry out this part and the

21  provisions of law with respect to professions regulated by the

22  Division of Medical Quality Assurance within the department

23  and the boards.  The department may contract with public and

24  private entities to receive and deposit revenue pursuant to

25  this section.  The department shall maintain separate accounts

26  in the trust fund used by the department to implement this

27  part for every profession within the department.  To the

28  maximum extent possible, the department shall directly charge

29  all expenses to the account of each regulated profession.  For

30  the purpose of this subsection, direct charge expenses

31  include, but are not limited to, costs for investigations,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  examinations, and legal services.  For expenses that cannot be

 2  charged directly, the department shall provide for the

 3  proportionate allocation among the accounts of expenses

 4  incurred by the department in the performance of its duties

 5  with respect to each regulated profession. The regulation by

 6  the department of professions, as defined in this part, shall

 7  be financed solely from revenue collected by it from fees and

 8  other charges and deposited in the Medical Quality Assurance

 9  Trust Fund, and all such revenue is hereby appropriated to the

10  department. However, it is legislative intent that each

11  profession shall operate within its anticipated fees. The

12  department may not expend funds from the account of a

13  profession to pay for the expenses incurred on behalf of

14  another profession, except that the Board of Nursing must pay

15  for any costs incurred in the regulation of certified nursing

16  assistants. The department shall maintain adequate records to

17  support its allocation of agency expenses.  The department

18  shall provide any board with reasonable access to these

19  records upon request.  The department shall provide each board

20  an annual report of revenue and direct and allocated expenses

21  related to the operation of that profession. The board shall

22  use these reports and the department's adopted long-range plan

23  to determine the amount of license fees.  A condensed version

24  of this information, with the department's recommendations,

25  shall be included in the annual report to the Legislature

26  prepared under s. 455.644.

27         Section 92.  There is appropriated from the Medical

28  Quality Assurance Trust Fund to the Department of Health the

29  sum of $280,000 to implement the provisions of this act.

30

31  (Redesignate subsequent sections.)

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1  ================ T I T L E   A M E N D M E N T ===============

 2  And the title is amended as follows:

 3         On page 2, line 1, after the semicolon,

 4

 5  insert:

 6         amending part XV of chapter 468, F.S., relating

 7         to certified nursing assistants, and

 8         transferring that part to chapter 464, F.S.,

 9         relating to nursing, to transfer from the

10         Department of Health to the Board of Nursing

11         responsibility and rulemaking authority for

12         regulation of certified nursing assistants;

13         changing requirements for nursing assistants;

14         transferring from the Department of Education

15         to the board responsibility for approval of

16         training programs; revising grounds for which

17         the board may impose certain penalties;

18         creating s. 464.2085, F.S.; creating and

19         providing requirements for a Council on

20         Certified Nursing Assistants; amending ss.

21         20.43, 39.01, 39.304, 110.131, 232.46,

22         240.4075, 246.081, 310.102, 381.0302, 384.30,

23         384.31, 394.455, 395.0191, 400.021, 400.211,

24         400.402, 400.407, 400.4255, 400.426, 400.462,

25         400.464, 400.506, 400.6105, 401.23, 401.252,

26         408.706, 409.908, 415.1085, 455.597, 455.604,

27         455.667, 455.677, 455.694, 455.707, 458.348,

28         464.001, 464.002, 464.003, 464.006, 464.009,

29         464.016, 464.018, 464.019, 464.022, 464.023,

30         464.027, 466.003, 467.003, 467.0125, 467.203,

31         468.505, 483.041, 483.801, 491.0112, 550.24055,

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         627.351, 627.357, 627.9404, 641.31, 766.101,

 2         766.110, 766.1115, 877.111, 945.602, 960.28,

 3         984.03, 985.03, F.S.; conforming references;

 4         revising application procedures for certified

 5         nursing assistants; revising registration

 6         requirements for certified nursing assistants;

 7         amending ss. 400.215, 400.512, F.S.; revising

 8         provisions relating to the granting of

 9         exemptions from disqualification for employment

10         in nursing homes or home health agencies;

11         amending s. 400.23, F.S.; authorizing licensed

12         practical nurses in nursing home facilities to

13         supervise the activities of other licensed

14         practical nurses, certified nursing assistants,

15         and other unlicensed personnel working in such

16         facilities in accordance with rules adopted by

17         the Board of Nursing; amending s. 455.557,

18         F.S.; including advanced registered nurse

19         practitioners under the credentialing program;

20         creating s. 455.56503, F.S.; requiring advanced

21         registered nurse practitioners to submit

22         information and fingerprints for profiling

23         purposes; amending s. 455.5651, F.S.;

24         authorizing the department to publish certain

25         information in practitioner profiles; amending

26         s. 455.5653, F.S.; deleting obsolete provisions

27         relating to scheduling and development of

28         practitioner profiles for additional health

29         care practitioners; providing access to

30         information on advanced registered nurse

31         practitioners maintained by the Agency for

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         Health Care Administration for corroboration

 2         purposes; amending s. 455.5654, F.S.; providing

 3         for adoption by rule of a form for submission

 4         of profiling information; repealing s.

 5         400.462(20), F.S., to delete the definition of

 6         "screening" under the Home Health Services Act;

 7         amending s. 400.471, F.S.; providing for an

 8         abuse registry background check through the

 9         Agency for Health Care Administration; amending

10         s. 400.484, F.S.; providing for assessment of

11         certain costs of an investigation that results

12         in a successful prosecution; amending s.

13         400.487, F.S.; requiring home health service

14         agreements; revising requirements for

15         physician's treatment orders; providing for

16         supervisory visits by a registered nurse under

17         certain circumstances; deleting provisions

18         relating to service provision plans; amending

19         s. 400.497, F.S.; providing for a home health

20         aide competency test, criteria for the

21         frequency of onsite licensure surveys, and

22         information to be included in patients'

23         records; amending s. 400.506, F.S.; providing

24         for an abuse registry background check through

25         the Agency for Health Care Administration;

26         authorizing assessment of certain costs of an

27         investigation that results in a successful

28         prosecution; revising a cross reference; making

29         renewal of license contingent on payment or

30         arrangement for payment of any unpaid

31         assessment; amending s. 400.509, F.S.;

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                                                  SENATE AMENDMENT

    Bill No. CS for SB 2456

    Amendment No.    





 1         providing for an abuse registry background

 2         check through the Agency for Health Care

 3         Administration; authorizing assessment of

 4         certain costs of an investigation that results

 5         in a successful prosecution; making renewal of

 6         registration contingent on payment or

 7         arrangement for payment of any unpaid

 8         assessment; amending s. 400.512, F.S.; revising

 9         provisions relating to the screening of home

10         health agency, nurse registry, and companion

11         and homemaker service personnel; requiring the

12         Agency for Health Care Administration to

13         conduct the search for reports of confirmed

14         abuse; providing an exemption from liability

15         under certain conditions for providing opinions

16         on the job performance of former employees and

17         contract workers; providing conforming changes;

18         amending s. 455.587, F.S.; providing

19         requirements for funding regulation of

20         professions by the Department of Health;

21         providing an appropriation;

22

23

24

25

26

27

28

29

30

31

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