Senate Bill 0430c1
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Florida Senate - 2000 CS for SB 430
By the Committee on Comprehensive Planning, Local and Military
Affairs; and Senator Carlton
316-844-00
1 A bill to be entitled
2 An act relating to emergency management
3 planning; amending s. 252.355, F.S.; revising
4 provisions relating to registration of persons
5 requiring special needs assistance in
6 emergencies; creating s. 381.0303, F.S.;
7 providing for recruitment of health care
8 practitioners for special needs shelters;
9 providing for reimbursement and funding;
10 providing duties of the Department of Health,
11 the county health departments, and the local
12 emergency management agencies; authorizing use
13 of a health care practitioner registry;
14 authorizing establishment of a special needs
15 shelter interagency committee; providing
16 membership and responsibilities; providing for
17 rules; creating s. 400.492, F.S.; requiring
18 home health agencies to prepare a comprehensive
19 emergency management plan; specifying plan
20 requirements; amending ss. 400.497 and 400.610,
21 F.S.; providing minimum requirements for home
22 health agency and hospice comprehensive
23 emergency management plans; providing for
24 rules; providing for plan review and approval;
25 providing for plan review and approval for home
26 health agencies and hospices operating in more
27 than one county; providing an exception to
28 comprehensive emergency management plan
29 requirements; amending s. 400.506, F.S.;
30 requiring nurse registries to assist at-risk
31 clients with special needs registration and to
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1 prepare a comprehensive emergency management
2 plan; specifying plan requirements; providing
3 for plan review; amending s. 400.605, F.S.;
4 requiring the Department of Elderly Affairs to
5 include components for comprehensive emergency
6 management plan in its rules establishing
7 minimum standards for a hospice; amending s.
8 400.6095, F.S.; requiring that certain
9 emergency care and service information be
10 included in hospice patients' medical records;
11 creating s. 401.273, F.S.; providing for
12 establishment of a registry of emergency
13 medical technicians and paramedics for
14 disasters and emergencies; clarifying the
15 functions of emergency medical technicians and
16 paramedics; amending s. 408.15, F.S.;
17 authorizing the Agency for Health Care
18 Administration to establish uniform standards
19 of care for special needs shelters; creating s.
20 455.718, F.S.; providing for establishment of a
21 health practitioner registry for disasters and
22 emergencies; requiring emergency and disaster
23 planning provisions in certain state agency
24 provider contracts; specifying minimum contract
25 requirements; providing appropriations;
26 providing an effective date.
27
28 Be It Enacted by the Legislature of the State of Florida:
29
30 Section 1. Subsections (1), (3), and (4) of section
31 252.355, Florida Statutes, are amended to read:
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1 252.355 Registry of disabled persons with special
2 needs; notice.--
3 (1) In order to meet the special needs of persons who
4 would need assistance during evacuations and sheltering
5 because of physical, mental, or sensory disabilities or mental
6 handicaps, each local emergency management agency in the state
7 shall maintain a registry of disabled persons with special
8 needs located within the jurisdiction of the local agency.
9 The registration shall identify those persons in need of
10 assistance and plan for resource allocation to meet those
11 identified needs. To assist the local emergency management
12 agency in identifying such persons, the Department of Children
13 and Family Services, Department of Health, Agency for Health
14 Care Administration, Department of Labor and Employment
15 Security, and Department of Elderly Affairs shall provide
16 registration information to all of their special needs clients
17 and to all incoming clients as a part of the intake process.
18 The registry shall be updated annually. The registration
19 program shall give disabled persons with special needs the
20 option of preauthorizing emergency response personnel to enter
21 their homes during search and rescue operations if necessary
22 to assure their safety and welfare following disasters.
23 (3) All records, data, information, correspondence,
24 and communications relating to the registration of disabled
25 persons with special needs as provided in subsection (1) are
26 confidential and exempt from the provisions of s. 119.07(1),
27 except that such information shall be available to other
28 emergency response agencies, as determined by the local
29 emergency management director.
30 (4) All appropriate agencies and community-based
31 service providers, including home health care providers, shall
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1 assist emergency management agencies by collecting
2 registration information for persons people with special needs
3 as part of program intake processes, establishing programs to
4 increase the awareness of the registration process, and
5 educating clients about the procedures that may be necessary
6 for their safety during disasters. Clients of state or
7 federally funded service programs with physical, mental, or
8 sensory disabilities or mental handicaps who need assistance
9 in evacuating, or when in shelters, must register as persons
10 people with special needs.
11 Section 2. Section 381.0303, Florida Statutes, is
12 created to read:
13 381.0303 Health practitioner recruitment for special
14 needs shelters.--
15 (1) PURPOSE.--The purpose of this section is to
16 designate the Department of Health, through its county health
17 departments, as the lead agency for coordination of the
18 recruitment of health care practitioners, as defined in s.
19 455.501(4), to staff special needs shelters in times of
20 emergency or disaster and to provide resources to the
21 department to carry out this responsibility. However, nothing
22 in this section prohibits a county health department from
23 entering into an agreement with a local emergency management
24 agency to assume the lead responsibility for recruiting health
25 care practitioners.
26 (2) SPECIAL NEEDS SHELTER PLAN AND STAFFING.--Provided
27 funds have been appropriated to support medical services
28 disaster coordinator positions in county health departments,
29 the department shall assume lead responsibility for the local
30 coordination of local medical and health care providers, the
31 American Red Cross, and other interested parties in developing
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1 a plan for the staffing and medical management of special
2 needs shelters. The plan shall be in conformance with the
3 local comprehensive emergency management plan.
4 (a) County health departments shall, in conjunction
5 with the local emergency management agencies, have the lead
6 responsibility for coordination of the recruitment of health
7 care practitioners to staff local special needs shelters.
8 County health departments shall assign their employees to work
9 in special needs shelters when needed to protect the health of
10 patients.
11 (b) The appropriate county health department and local
12 emergency management agency shall jointly determine who has
13 responsibility for medical supervision in a special needs
14 shelter.
15 (c) Local emergency management agencies shall be
16 responsible for the designation and operation of special needs
17 shelters during times of emergency or disaster. County health
18 departments shall assist the local emergency management agency
19 with regard to the management of medical services in special
20 needs shelters.
21 (3) REIMBURSEMENT TO HEALTH CARE PRACTITIONERS.--The
22 Department of Health shall reimburse, subject to the
23 availability of funds for this purpose, health care
24 practitioners, as defined in s. 455.501, provided the
25 practitioner is not providing care to a patient under an
26 existing contract, and emergency medical technicians and
27 paramedics licensed pursuant to chapter 401 for medical care
28 provided at the request of the department in special needs
29 shelters or at other locations during times of emergency or
30 major disaster. Reimbursement for health care practitioners,
31 except for physicians licensed pursuant to chapter 458 or
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1 chapter 459, shall be based on the average hourly rate that
2 such practitioners were paid according to the most recent
3 survey of Florida hospitals conducted by the Florida Hospital
4 Association. Reimbursement shall be requested on forms
5 prepared by the Department of Health. If a Presidential
6 Disaster Declaration has been made, and the Federal Government
7 makes funds available, the department shall use such funds for
8 reimbursement of eligible expenditures. In other situations,
9 or if federal funds do not fully compensate the department for
10 reimbursement made pursuant to this section, the department
11 shall submit to the Cabinet or Legislature, as appropriate, a
12 budget amendment to obtain reimbursement from the working
13 capital fund. Travel expense and per diem costs shall be
14 reimbursed pursuant to s. 112.061.
15 (4) HEALTH CARE PRACTITIONER REGISTRY.--The department
16 may use the registries established in ss. 401.273 and 455.718
17 when health care practitioners are needed to staff special
18 needs shelters or to staff disaster medical assistance teams.
19 (5) SPECIAL NEEDS SHELTER INTERAGENCY COMMITTEE.--The
20 Department of Health may establish a special needs shelter
21 interagency committee, to be chaired and staffed by the
22 department. The committee shall resolve problems related to
23 special needs shelters not addressed in the state
24 comprehensive emergency medical plan and shall serve as an
25 oversight committee to monitor the planning and operation of
26 special needs shelters.
27 (a) The committee may:
28 1. On or before January 1, 2001, resolve questions
29 concerning the roles and responsibilities of state agencies
30 and other organizations that are necessary to implement the
31 program.
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1 2. On or before January 1, 2001, identify any issues
2 requiring additional legislation and funding.
3 3. Develop and negotiate any necessary interagency
4 agreements.
5 4. Undertake other such activities as the department
6 deems necessary to facilitate the implementation of this
7 section.
8 5. Submit recommendations to the Legislature as
9 necessary.
10 (b) The special needs shelter interagency committee
11 shall be composed of representatives of emergency management,
12 health, medical, and social services organizations. Membership
13 shall include, but shall not be limited to, the Departments of
14 Community Affairs, Children and Family Services, Elderly
15 Affairs, Labor and Employment Security, and Education; the
16 Agency for Health Care Administration; the Florida Medical
17 Association; the Florida Osteopathic Medical Association;
18 Associated Home Health Industries of Florida, Inc.; the
19 Florida Nurses Association; the Florida Health Care
20 Association; the Florida Hospital Association; the Florida
21 Statutory Teaching Hospital Council; the Florida Association
22 of Homes for the Aging; the Florida Emergency Preparedness
23 Association; the American Red Cross; Florida Hospices, Inc.;
24 the Association of Community Hospitals and Health Systems; the
25 Florida Association of Health Maintenance Organizations; the
26 Florida League of Health Systems; Private Care Association;
27 and the Salvation Army.
28 (c) Meetings of the committee shall be held in
29 Tallahassee and members of the committee shall serve at the
30 expense of the agencies or organizations they represent.
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1 (6) RULES.--The department has the authority to adopt
2 rules necessary to implement this section. Rules may include a
3 definition of a special needs patient, specify physician
4 reimbursement, and designate which county health departments
5 will have responsibility for implementation of subsections (2)
6 and (3).
7 Section 3. Section 400.492, Florida Statutes, is
8 created to read:
9 400.492 Provision of services during an
10 emergency.--Each home health agency shall prepare and maintain
11 a comprehensive emergency management plan that is consistent
12 with the standards adopted by national accreditation
13 organizations and consistent with the local special needs
14 plan. The plan shall be updated annually and shall provide for
15 continuing home health services during an emergency that
16 interrupts patient care or services in the patient's home. The
17 plan shall describe how the home health agency establishes and
18 maintains an effective response to emergencies and disasters,
19 including: notifying staff when emergency response measures
20 are initiated; providing for communication between staff
21 members, county health departments, and local emergency
22 management agencies, including a backup system; identifying
23 resources necessary to continue essential care or services or
24 referrals to other organizations subject to written agreement;
25 and prioritizing and contacting patients who need continued
26 care or services.
27 (1) Each patient record for patients who are listed in
28 the registry established pursuant to s. 252.355 shall include
29 a description of how care or services will be continued in the
30 event of an emergency or disaster. The home health agency
31 shall discuss the emergency provisions with the patient and
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1 the patient's caregivers, including where and how the patient
2 is to evacuate, procedures for notifying the home health
3 agency in the event that the patient evacuates to a location
4 other than the shelter identified in the patient record, and a
5 list of medications and equipment which must either accompany
6 the patient or will be needed by the patient in the event of
7 an evacuation.
8 (2) Each home health agency shall maintain a current
9 prioritized list of patients who need continued services
10 during an emergency. The list shall indicate how services
11 shall be continued in the event of an emergency or disaster
12 for each patient and if the patient is to be transported to a
13 special needs shelter, and shall indicate if the patient is
14 receiving skilled nursing services and the patient's
15 medication and equipment needs. The list shall be furnished to
16 county health departments and to local emergency management
17 agencies, upon request.
18 (3) Home health agencies shall not be required to
19 continue to provide care to patients in emergency situations
20 that are beyond their control and that make it impossible to
21 provide services, such as when roads are impassable or when
22 patients do not go to the location specified in their patient
23 records.
24 (4) Notwithstanding the provisions of s. 400.464(2) or
25 any other provision of law to the contrary, a home health
26 agency may provide services in a special needs shelter located
27 in any county.
28 Section 4. Subsection (1) of section 400.497, Florida
29 Statutes, is amended, and subsection (11) is added to said
30 section, to read:
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1 400.497 Rules establishing minimum standards.--The
2 Agency for Health Care Administration shall adopt, publish,
3 and enforce rules to implement this part, including, as
4 applicable, ss. 400.506 and 400.509, which must provide
5 reasonable and fair minimum standards relating to:
6 (1) Scope of home health services to be provided,
7 which shall include services to be provided during emergency
8 evacuation and sheltering.
9 (11) Preparation of a comprehensive emergency
10 management plan pursuant to s. 400.492.
11 (a) The Agency for Health Care Administration shall
12 adopt rules establishing minimum criteria for the plan and
13 plan updates, with the concurrence of the Department of Health
14 and in consultation with the Department of Community Affairs.
15 (b) The rules must address the requirements in s.
16 400.492. In addition, the rules shall provide for the
17 maintenance of patient-specific medication lists that can
18 accompany patients who are transported from their homes.
19 (c) The plan is subject to review and approval by the
20 county health department. During its review, the county health
21 department shall ensure that the following agencies, at a
22 minimum, are given the opportunity to review the plan:
23 1. The local emergency management agency.
24 2. The Agency for Health Care Administration.
25 3. The local chapter of the American Red Cross or
26 other lead sheltering agency.
27 4. The district office of the Department of Children
28 and Family Services.
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1 The county health department shall complete its review within
2 60 days after receipt of the plan and shall either approve the
3 plan or advise the home health agency of necessary revisions.
4 (d) For any home health agency that operates in more
5 than one county, the Department of Health shall review the
6 plan, after consulting with all of the county health
7 departments, the agency, and all the local chapters of the
8 American Red Cross or other lead sheltering agencies in the
9 areas of operation for that particular home health agency. The
10 Department of Health shall complete its review within 90 days
11 after receipt of the plan and shall either approve the plan or
12 advise the home health agency of necessary revisions. The
13 Department of Health shall make every effort to avoid imposing
14 differing requirements based on differences between counties
15 on the home health agency.
16 (e) The requirements in this subsection do not apply
17 to:
18 1. A facility that is certified under chapter 651 and
19 has a licensed home health agency used exclusively by
20 residents of the facility; or
21 2. A retirement community that consists of residential
22 units for independent living and either a licensed nursing
23 home or an assisted living facility, and has a licensed home
24 health agency used exclusively by the residents of the
25 retirement community, provided the comprehensive emergency
26 management plan for the facility or retirement community
27 provides for continuous care of all residents with special
28 needs during an emergency.
29 Section 5. Subsections (15), (16), and (17) of section
30 400.506, Florida Statutes, are renumbered as subsections (17),
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1 (18), and (19), respectively, and new subsections (15) and
2 (16) are added to said section to read:
3 400.506 Licensure of nurse registries; requirements;
4 penalties.--
5 (15) Nurse registries shall assist at-risk clients
6 with special needs registration with the appropriate local
7 emergency management agency pursuant to s. 252.355.
8 (16) Each nurse registry shall prepare and maintain a
9 comprehensive emergency management plan that is consistent
10 with the criteria in this subsection and with the local
11 special needs plan. The plan shall be updated annually. The
12 plan shall specify how the nurse registry shall facilitate the
13 provision of continuous care by persons referred for contract
14 to persons who are registered pursuant to s. 252.355 during an
15 emergency that interrupts the provision of care or services in
16 private residencies.
17 (a) All persons referred for contract who care for
18 persons registered pursuant to s. 252.355 must include in the
19 patient record a description of how care will be continued
20 during a disaster or emergency that interrupts the provision
21 of care in the patient's home. It shall be the responsibility
22 of the person referred for contract to ensure that continuous
23 care is provided.
24 (b) Each nurse registry shall maintain a current
25 prioritized list of patients in private residences who are
26 registered pursuant to s. 252.355 and are under the care of
27 persons referred for contract and who need continued services
28 during an emergency. This list shall indicate, for each
29 patient, if the client is to be transported to a special needs
30 shelter and if the patient is receiving skilled nursing
31 services. Nurse registries shall make this list available to
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1 county health departments and to local emergency management
2 agencies upon request.
3 (c) Each person referred for contract who is caring
4 for a patient who is registered pursuant to s. 252.355 shall
5 provide a list of the patient's medication and equipment needs
6 to the nurse registry. Each person referred for contract shall
7 make this information available to county health departments
8 and to local emergency management agencies upon request.
9 (d) Each person referred for contract shall not be
10 required to continue to provide care to patients in emergency
11 situations that are beyond the person's control and that make
12 it impossible to provide services, such as when roads are
13 impassable or when patients do not go to the location
14 specified in their patient records.
15 (e) The comprehensive emergency management plan
16 required by this subsection is subject to review and approval
17 by the county health department. During its review, the county
18 health department shall ensure that, at a minimum, the local
19 emergency management agency, the Agency for Health Care
20 Administration, and the local chapter of the American Red
21 Cross or other lead sheltering agency are given the
22 opportunity to review the plan. The county health department
23 shall complete its review within 60 days after receipt of the
24 plan and shall either approve the plan or advise the nurse
25 registry of necessary revisions.
26 (f) The Agency for Health Care Administration shall
27 adopt rules establishing minimum criteria for the
28 comprehensive emergency management plan and plan updates
29 required by this subsection, with the concurrence of the
30 Department of Health and in consultation with the Department
31 of Community Affairs.
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1 Section 6. Paragraph (j) of subsection (1) of section
2 400.605, Florida Statutes, is amended to read:
3 400.605 Administration; forms; fees; rules;
4 inspections; fines.--
5 (1) The department, in consultation with the agency,
6 shall by rule establish minimum standards and procedures for a
7 hospice. The rules must include:
8 (j) Components of a comprehensive emergency management
9 plan, developed in consultation with the Department of Health,
10 the Department of Elderly Affairs, and the Department of
11 Community Affairs Component of a disaster preparedness plan.
12 Section 7. Paragraph (f) is added to subsection (5) of
13 section 400.6095, Florida Statutes, to read:
14 400.6095 Patient admission; assessment; plan of care;
15 discharge; death.--
16 (5) Each hospice, in collaboration with the patient
17 and the patient's primary or attending physician, shall
18 prepare and maintain a plan of care for each patient, and the
19 care provided to a patient must be in accordance with the plan
20 of care. The plan of care shall be made a part of the
21 patient's medical record and shall include, at a minimum:
22 (f) A description of how needed care and services will
23 be provided in the event of an emergency.
24 Section 8. Paragraph (b) of subsection (1) of section
25 400.610, Florida Statutes, is amended to read:
26 400.610 Administration and management of a hospice.--
27 (1) A hospice shall have a clearly defined organized
28 governing body, consisting of a minimum of seven persons who
29 are representative of the general population of the community
30 served. The governing body shall have autonomous authority and
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1 responsibility for the operation of the hospice and shall meet
2 at least quarterly. The governing body shall:
3 (b)1. Prepare and maintain a comprehensive emergency
4 management plan that provides for continuing hospice services
5 in the event of an emergency that is consistent with local
6 special needs plans. The plan shall include provisions for
7 ensuring continuing care to hospice patients who go to special
8 needs shelters. The plan is subject to review and approval by
9 the county health department, except as provided in
10 subparagraph 2. During its review, the county health
11 department shall ensure that the department, the agency, and
12 the local chapter of the American Red Cross or other lead
13 sheltering agency have an opportunity to review and comment on
14 the plan. The county health department shall complete its
15 review within 60 days after receipt of the plan and shall
16 either approve the plan or advise the hospice of necessary
17 revisions Prepare a disaster preparedness plan.
18 2. For any hospice that operates in more than one
19 county, the Department of Health shall review the plan, after
20 consulting with all of the county health departments, the
21 agency, and all the local chapters of the American Red Cross
22 or other lead sheltering agency in the areas of operation for
23 that particular hospice. The Department of Health shall
24 complete its review within 90 days after receipt of the plan
25 and shall either approve the plan or advise the hospice of
26 necessary revisions. The Department of Health shall make every
27 effort to avoid imposing on the hospice differing requirements
28 based on differences between counties.
29 Section 9. Section 401.273, Florida Statutes, is
30 created to read:
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1 401.273 Emergency medical technician and paramedic
2 registry for disasters and emergencies.--
3 (1) The department shall include on its forms for the
4 certification or recertification of emergency medical
5 technicians and paramedics who could assist the department in
6 the event of a disaster a question asking if the practitioner
7 would be available to provide health care services in special
8 needs shelters or to help staff disaster medical assistance
9 teams during times of emergency or major disaster. The names
10 of the emergency medical technicians and paramedics who answer
11 affirmatively shall be maintained by the department as a
12 registry for disasters and emergencies.
13 (2) A certificateholder may perform the functions of
14 an emergency medical technician or paramedic in a special
15 needs shelter or as a member of a disaster medical assistance
16 team, provided that such functions are performed only under
17 the medical direction of a physician who is licensed under
18 chapter 458 or chapter 459 and who has complied with the
19 formal supervision requirements of s. 458.348.
20 Section 10. Subsection (12) is added to section
21 408.15, Florida Statutes, to read:
22 408.15 Powers of the agency.--In addition to the
23 powers granted to the agency elsewhere in this chapter, the
24 agency is authorized to:
25 (12) Establish, in coordination with the Department of
26 Health, uniform standards of care to be provided in special
27 needs units or shelters during times of emergency or major
28 disaster.
29 Section 11. Section 455.718, Florida Statutes, is
30 created to read:
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1 455.718 Health care practitioner registry for
2 disasters and emergencies.--The Department of Health may
3 include on its forms for the licensure or certification of
4 health care practitioners, as defined in s. 455.501, who could
5 assist the department in the event of a disaster a question
6 asking if the practitioner would be available to provide
7 health care services in special needs shelters or to help
8 staff disaster medical assistance teams during times of
9 emergency or major disaster. The names of practitioners who
10 answer affirmatively shall be maintained by the department as
11 a health care practitioner registry for disasters and
12 emergencies.
13 Section 12. State agencies that contract with
14 providers for the care of persons with disabilities or
15 limitations that make such persons dependent upon the care of
16 others shall include emergency and disaster planning
17 provisions in such contracts at the time the contracts are
18 initiated or upon renewal. These provisions shall include, but
19 shall not be limited to:
20 (1) The designation of an emergency coordinating
21 officer.
22 (2) A procedure to contact all at-risk provider
23 clients, on a priority basis, prior to and immediately
24 following an emergency or disaster.
25 (3) A procedure to help at-risk clients register with
26 the special needs registry of the local emergency management
27 agency.
28 (4) A procedure to dispatch the emergency coordinating
29 officer or other staff members to special needs shelters to
30 assist clients with special needs, if necessary.
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1 (5) A procedure for providing the essential services
2 the organization currently provides to special needs clients
3 in preparation for, and during and following, a disaster.
4 Section 13. There is hereby appropriated from the
5 General Revenue Fund, to fund the implementation of this act:
6 (1) To the Department of Health the sum of $3,798,932
7 and 2 full-time-equivalent positions.
8 (2) To the Department of Children and Family Services
9 the sum of $58,898 and 1 full-time-equivalent position.
10 (3) To the Department of Elderly Affairs the sum of
11 $58,898 and 1 full-time-equivalent position.
12 (4) To the Agency for Health Care Administration the
13 sum of $58,898 and 1 full-time-equivalent position.
14 (5) To the Department of Community Affairs the sum of
15 $58,898 and 1 full-time-equivalent position.
16 Section 14. This act shall take effect October 1,
17 2000.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 SB 430
3
4 The CS differs fron the bill in the following ways:
5 In Section 2, provides a statutory reference to the definition
of "health care practitioner"; clarifies that physicians
6 licensed under chapters 458 and 459, F.S., are exempt from
being reimbursed on an hourly basis; and adds the Florida
7 Osteopathic Medical Association to the special needs shelter
interagency committee.
8
In Section 4, strikes the word "hospice" and inserts "home
9 health agency."
10 In Section 6, adds the Department of Elderly Affairs to a list
of agencies required to collaborate to develop a comprehensive
11 emergency management plan for hospices.
12 In Section 11, renumbers a section to place it in part II of
chapter 455, F.S., which is the part regulating medical
13 professions; and strikes references to specific health care
practitioners and inserts the cross reference to the
14 definition of "health care practitioner."
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