Senate Bill sb0596c2

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    Florida Senate - 2002                     CS for CS for SB 596

    By the Committees on Appropriations; and Health, Aging and
    Long-Term Care




    309-2073-02

  1                      A bill to be entitled

  2         An act relating to long-term care; providing

  3         legislative findings and intent with respect to

  4         the needs of the state's elderly population;

  5         requiring the Agency for Health Care

  6         Administration and the Department of Elderly

  7         Affairs to submit a plan to the Governor and

  8         Legislature for reducing nursing-home-bed days

  9         funded under the Medicaid program; amending s.

10         408.034, F.S.; providing additional

11         requirements for the Agency for Health Care

12         Administration in determining the need for

13         additional nursing-facility beds; amending s.

14         409.912; requiring the Agency for Health Care

15         Administration to establish a nursing facility

16         preadmission screening program; authorizing the

17         agency to operate the program by contract;

18         requiring an annual report to the Legislature

19         and the Office of Long-Term-Care Policy;

20         creating s. 430.041, F.S.; establishing the

21         Office of Long-Term-Care Policy within the

22         Department of Elderly Affairs; requiring the

23         office to make recommendations for coordinating

24         the services provided by state agencies;

25         providing for the appointment of an advisory

26         board to the Office of Long-Term-Care Policy;

27         specifying membership in the advisory board;

28         providing for reimbursement of per diem and

29         travel expenses for members of the advisory

30         board; requiring that the office submit an

31         annual report to the Governor and Legislature;

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  1         requiring assistance to the office by state

  2         agencies and universities; amending s. 430.204,

  3         F.S.; providing certain restrictions on

  4         community-care-for-the-elderly services;

  5         creating s. 430.7031, F.S.; requiring the

  6         Department of Elderly Affairs and the Agency

  7         for Health Care Administration to implement a

  8         nursing home transition program; providing

  9         requirements for the program; amending ss.

10         409.908, 430.708, 641.386, F.S., relating to

11         reimbursement of Medicaid providers,

12         certificates of need, and agent licensing and

13         appointment; conforming cross-references to

14         changes made by the act; amending s. 400.0069,

15         F.S.; increasing the maximum membership of the

16         local long-term care ombudsman councils;

17         amending s. 400.0089, F.S.; requiring the State

18         Long-Term Care Ombudsman Council to publish

19         complaint information quarterly; amending s.

20         400.0091, F.S.; specifying training

21         requirements for employees of the Office of the

22         State Long-Term Care Ombudsman and its

23         volunteers; providing an effective date.

24

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

26

27         Section 1.  The Legislature finds that the State of

28  Florida does not have a comprehensive and effective strategy

29  for economically and efficiently meeting the long-term-care

30  needs of an increasingly elderly population; that multiple

31  state agencies have responsibilities for oversight, planning,

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  1  and operation of long-term-care programs; that long-term care

  2  is provided by a complex array of public and private entities

  3  delivering services; that there has not been a focus on

  4  evaluation of innovative and pilot projects and expansion of

  5  pilot projects that are successful; that the provision of

  6  long-term-care services has not been approached holistically;

  7  and that the state does not have a mechanism for ensuring that

  8  long-term-care programs are effectively and efficiently

  9  operated and coordinated to comply with the policies set out

10  in Florida Statutes. It is therefore the intent of the

11  Legislature to increase the rate of diversion of elderly

12  persons in need of long-term care to noninstitutional

13  alternatives; to increase coordination, evaluation, and

14  planning for the state's long-term-care system; to expand

15  successful pilot programs; and to establish a nursing facility

16  preadmission screening program.

17         Section 2.  (1)  Prior to December 1, 2002, the Agency

18  for Health Care Administration in consultation with the

19  Department of Elderly Affairs shall submit to the Governor,

20  the President of the Senate, and the Speaker of the House of

21  Representatives a plan to reduce the number of

22  nursing-home-bed days purchased by the state Medicaid program

23  and to replace such nursing home care with care provided in

24  less costly alternative settings.

25         (2)  The plan must include specific goals for reducing

26  Medicaid-funded bed days and recommend specific statutory and

27  operational changes necessary to achieve such reduction.

28         (3)  The plan must include an evaluation of the

29  cost-effectiveness and the relative strengths and weaknesses

30  of programs that serve as alternatives to nursing homes.

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  1         Section 3.  Section 408.034, Florida Statutes, is

  2  amended to read:

  3         408.034  Duties and responsibilities of agency;

  4  rules.--

  5         (1)  The agency is designated as the single state

  6  agency to issue, revoke, or deny certificates of need and to

  7  issue, revoke, or deny exemptions from certificate-of-need

  8  review in accordance with the district plans and present and

  9  future federal and state statutes.  The agency is designated

10  as the state health planning agency for purposes of federal

11  law.

12         (2)  In the exercise of its authority to issue licenses

13  to health care facilities and health service providers, as

14  provided under chapters 393, 395, and parts II and VI of

15  chapter 400, the agency may not issue a license to any health

16  care facility, health service provider, hospice, or part of a

17  health care facility which fails to receive a certificate of

18  need or an exemption for the licensed facility or service.

19         (3)  The agency shall establish, by rule, uniform need

20  methodologies for health services and health facilities. In

21  developing uniform need methodologies, the agency shall, at a

22  minimum, consider the demographic characteristics of the

23  population, the health status of the population, service use

24  patterns, standards and trends, geographic accessibility, and

25  market economics.

26         (4)  Prior to determining that there is a need for

27  additional community nursing-facility beds in any area of the

28  state, the agency shall determine that the need cannot be met

29  through the provision, enhancement, or expansion of home and

30  community-based services. In determining such need, the agency

31  shall examine nursing-home-placement patterns and demographic

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  1  patterns of persons entering nursing homes and the

  2  availability of and effectiveness of existing home-based and

  3  community-based service delivery systems at meeting the

  4  long-term-care needs of the population. The agency shall

  5  recommend to the Office of Long-Term-Care Policy changes that

  6  could be made to existing home-based and community-based

  7  delivery systems to lessen the need for additional

  8  nursing-facility beds.

  9         (5)(4)  The agency shall establish by rule a

10  nursing-home-bed-need methodology that reduces the community

11  nursing home bed need for the areas of the state where the

12  agency establishes pilot community diversion programs through

13  the Title XIX aging waiver program.

14         (6)(5)  The agency may adopt rules necessary to

15  implement ss. 408.031-408.045.

16         Section 4.  Present subsections (13) through (39) of

17  section 409.912, Florida Statutes, are redesignated as

18  subsections (14) through (40) and a new subsection (13) is

19  added to that section to read:

20         409.912  Cost-effective purchasing of health care.--The

21  agency shall purchase goods and services for Medicaid

22  recipients in the most cost-effective manner consistent with

23  the delivery of quality medical care.  The agency shall

24  maximize the use of prepaid per capita and prepaid aggregate

25  fixed-sum basis services when appropriate and other

26  alternative service delivery and reimbursement methodologies,

27  including competitive bidding pursuant to s. 287.057, designed

28  to facilitate the cost-effective purchase of a case-managed

29  continuum of care. The agency shall also require providers to

30  minimize the exposure of recipients to the need for acute

31  inpatient, custodial, and other institutional care and the

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  1  inappropriate or unnecessary use of high-cost services. The

  2  agency may establish prior authorization requirements for

  3  certain populations of Medicaid beneficiaries, certain drug

  4  classes, or particular drugs to prevent fraud, abuse, overuse,

  5  and possible dangerous drug interactions. The Pharmaceutical

  6  and Therapeutics Committee shall make recommendations to the

  7  agency on drugs for which prior authorization is required. The

  8  agency shall inform the Pharmaceutical and Therapeutics

  9  Committee of its decisions regarding drugs subject to prior

10  authorization.

11         (13)(a)  The agency shall operate the Comprehensive

12  Assessment and Review (CARES) nursing facility preadmission

13  screening program to ensure that Medicaid payment for nursing

14  facility care is made only for individuals whose conditions

15  require such care and to ensure that long-term-care services

16  are provided in the setting most appropriate to the needs of

17  the person and in the most economical manner possible. The

18  CARES program shall also ensure that individuals participating

19  in Medicaid home and community-based waiver programs meet

20  criteria for those programs, consistent with approved federal

21  waivers.

22         (b)  The agency may operate the CARES program using its

23  own staff or may contract with another state agency or other

24  provider. If the agency contracts for the operation of the

25  program, the agency must maintain policy control of all

26  operations of the program, including the criteria applied and

27  forms used, and perform regular monitoring to assure effective

28  and efficient operation of the program and ensure that the

29  operation of the program is consistent with state and federal

30  law and rules.

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  1         (c)  The agency shall develop performance standards for

  2  the CARES program.

  3         (d)  Prior to making payment for nursing facility

  4  services for a Medicaid recipient, the agency must verify that

  5  the nursing facility preadmission screening program has

  6  determined that the individual requires nursing facility care

  7  and that the individual cannot be safely served in

  8  community-based programs. The nursing facility preadmission

  9  screening program shall refer a Medicaid recipient to a

10  community-based program if the individual could be safely

11  served at a lower cost and the recipient chooses to

12  participate in such program.

13         (e)  By January 1 of each year, the agency shall submit

14  a report to the Legislature and the Office of Long-Term-Care

15  Policy describing the operations of the CARES program. The

16  report must describe:

17         1.  Rate of diversion to community alternative

18  programs;

19         2.  CARES program staffing needs to achieve additional

20  diversions;

21         3.  Reasons the program is unable to place individuals

22  in less restrictive settings when such individuals desired

23  such services and could have been served in such settings;

24         4.  Barriers to appropriate placement, including

25  barriers due to policies or operations of other agencies or

26  state-funded programs; and

27         5.  Statutory changes necessary to ensure that

28  individuals in need of long-term-care services receive care in

29  the least-restrictive environment.

30         Section 5.  Section 430.041, Florida Statutes, is

31  created to read:

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  1         430.041  Office of Long-Term-Care Policy.--

  2         (1)  There is established in the Department of Elderly

  3  Affairs the Office of Long-Term-Care Policy to evaluate the

  4  state's long-term-care service delivery system and make

  5  recommendations to increase the availability and the use of

  6  noninstitutional settings to provide care to the elderly and

  7  ensure coordination among the agencies responsible for the

  8  long-term-care continuum.

  9         (2)  The purpose of the Office of Long-Term-Care Policy

10  is to:

11         (a)  Ensure close communication and coordination among

12  state agencies involved in developing and administering a more

13  efficient and coordinated long-term-care service delivery

14  system in this state;

15         (b)  Identify duplication and unnecessary service

16  provision in the long-term-care system and make

17  recommendations to decrease inappropriate service provision;

18         (c)  Review current programs providing long-term-care

19  services to determine whether the programs are cost effective,

20  of high quality, and operating efficiently and make

21  recommendations to increase consistency and effectiveness in

22  the state's long-term-care programs;

23         (d)  Develop strategies for promoting and implementing

24  cost-effective home and community-based services as an

25  alternative to institutional care which coordinate and

26  integrate the continuum of care needs of the elderly; and

27         (e)  Assist the Office of Long-Term-Care Policy

28  Advisory Council as necessary to help implement this section.

29         (3)  The Director of the Office of Long-Term-Care

30  Policy shall be appointed by, and serve at the pleasure of,

31  the Governor. The director shall report to, and be under the

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  1  general supervision of, the Secretary of Elderly Affairs and

  2  shall not be subject to supervision by any other employee of

  3  the department.

  4         (4)  The Office of Long-Term-Care Policy shall have an

  5  advisory council, whose chair shall be the Director of the

  6  Office of Long-Term-Care Policy. The purposes of the advisory

  7  council are to provide assistance and direction to the office

  8  and to ensure that the appropriate state agencies are properly

  9  implementing recommendations from the office.

10         (a)  The advisory council shall consist of:

11         1.  A member of the Senate, appointed by the President

12  of the Senate;

13         2.  A member of the House of Representatives, appointed

14  by the Speaker of the House of Representatives;

15         3.  The Director of the Office of Long-Term-Care

16  Policy;

17         4.  The Secretary of Health Care Administration;

18         5.  The Secretary of Elderly Affairs;

19         6.  The Secretary of Children and Family Services;

20         7.  The Secretary of Health;

21         8.  The Executive Director of the Department of

22  Veterans' Affairs;

23         9.  A representative of the Florida Association of Area

24  Agencies on Aging, appointed by the Governor;

25         10.  A representative of the Florida Association of

26  Aging Service Providers, appointed by the Governor;

27         11.  A representative of the Florida Association of

28  Homes for the Aging, appointed by the Governor; and

29         12.  Two representatives of people using long-term-care

30  services, appointed by the Governor from groups representing

31  elderly persons.

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  1         (b)  Members shall serve without compensation, but are

  2  entitled to receive reimbursement for travel and per diem as

  3  provided in s. 112.061.

  4         (c)  The advisory council shall meet at the call of its

  5  chair or at the request of a majority of its members. During

  6  its first year of existence, the advisory council shall meet

  7  at least monthly.

  8         (d)  Members of the advisory council appointed by the

  9  Governor shall serve at the pleasure of the Governor and shall

10  be appointed to 4-year staggered terms in accordance with s.

11  20.052.

12         (5)(a)  The Department of Elderly Affairs shall provide

13  administrative support and services to the Office of

14  Long-Term-Care Policy.

15         (b)  The office shall call upon appropriate agencies of

16  state government, including the centers on aging in the State

17  University System, for assistance needed in discharging its

18  duties.

19         (c)  Each state agency represented on the Office of

20  Long-Term-Care Policy Advisory Council shall make at least one

21  employee available to work with the Office of Long-Term-Care

22  Policy. All state agencies and universities shall assist the

23  office in carrying out its responsibilities prescribed by this

24  section.

25         (d)  Each state agency shall pay from its own funds any

26  expenses related to its support of the Office of

27  Long-Term-Care Policy and its participation on the advisory

28  council. The Department of Elderly Affairs shall be

29  responsible for expenses related to participation on the

30  advisory council by members appointed by the Governor.

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  1         (6)(a)  By December 1, 2002, the office shall submit to

  2  the advisory council a preliminary report of its findings and

  3  recommendations on improving the long-term-care continuum in

  4  this state. The report shall contain recommendations and

  5  implementation proposals for policy changes, as well as

  6  legislative and funding recommendations that will make the

  7  system more effective and efficient. The report shall contain

  8  a specific plan for accomplishing the recommendations and

  9  proposals. Thereafter, the office shall revise and update the

10  report annually and resubmit it to the advisory council for

11  review and comments by November 1 of each year.

12         (b)  The advisory council shall review and recommend

13  any suggested changes to the preliminary report, and each

14  subsequent annual update of the report, within 30 days after

15  the receipt of the preliminary report. Suggested revisions,

16  additions, or deletions shall be made to the Director of the

17  Office of Long-Term-Care Policy.

18         (c)  The office shall submit its final report, and each

19  subsequent annual update of the report, to the Governor and

20  the Legislature within 30 days after the receipt of any

21  revisions, additions, or deletions suggested by the advisory

22  council, or after the time such comments are due to the

23  office.

24         Section 6.  Present subsections (7), (8), and (9) of

25  section 430.204, Florida Statutes, are renumbered as

26  subsections (8), (9), and (10), respectively, and a new

27  subsection (7) is added to that section, to read:

28         430.204  Community-care-for-the-elderly core services;

29  departmental powers and duties.--

30         (7)  In no case shall community-care-for-the-elderly

31  services be provided for longer than 60 days if the individual

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  1  does not complete the process for establishing eligibility

  2  under the Florida Medicaid program.

  3         Section 7.  Section 430.7031, Florida Statutes, is

  4  created to read:

  5         430.7031  Nursing home transition program.--The

  6  department and the Agency for Health Care Administration:

  7         (1)  Shall implement a system of care designed to

  8  assist individuals residing in nursing homes to regain

  9  independence and to move to less-costly settings.

10         (2)  Shall collaboratively work to identify long-stay

11  nursing home residents who are able to move to community

12  placements, and to provide case management and supportive

13  services to such individuals while they are in nursing homes

14  to assist such individuals in moving to less-expensive and

15  less-restrictive settings.

16         (3)  Shall modify existing service delivery systems or

17  develop new service delivery systems to economically and

18  efficiently meet such individuals' care needs.

19         (4)  Shall offer such individuals priority placement

20  and services in all home-based and community-based care

21  programs, and shall ensure that funds are available to provide

22  services to individuals to whom services are offered.

23         (5)  May seek federal waivers necessary to administer

24  this section.

25         Section 8.  Subsection (4) of section 409.908, Florida

26  Statutes, is amended to read:

27         409.908  Reimbursement of Medicaid providers.--Subject

28  to specific appropriations, the agency shall reimburse

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

30  according to methodologies set forth in the rules of the

31  agency and in policy manuals and handbooks incorporated by

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  1  reference therein.  These methodologies may include fee

  2  schedules, reimbursement methods based on cost reporting,

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

  4  and other mechanisms the agency considers efficient and

  5  effective for purchasing services or goods on behalf of

  6  recipients.  Payment for Medicaid compensable services made on

  7  behalf of Medicaid eligible persons is subject to the

  8  availability of moneys and any limitations or directions

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

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

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

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

13  making any other adjustments necessary to comply with the

14  availability of moneys and any limitations or directions

15  provided for in the General Appropriations Act, provided the

16  adjustment is consistent with legislative intent.

17         (4)  Subject to any limitations or directions provided

18  for in the General Appropriations Act, alternative health

19  plans, health maintenance organizations, and prepaid health

20  plans shall be reimbursed a fixed, prepaid amount negotiated,

21  or competitively bid pursuant to s. 287.057, by the agency and

22  prospectively paid to the provider monthly for each Medicaid

23  recipient enrolled.  The amount may not exceed the average

24  amount the agency determines it would have paid, based on

25  claims experience, for recipients in the same or similar

26  category of eligibility.  The agency shall calculate

27  capitation rates on a regional basis and, beginning September

28  1, 1995, shall include age-band differentials in such

29  calculations. Effective July 1, 2001, the cost of exempting

30  statutory teaching hospitals, specialty hospitals, and

31  community hospital education program hospitals from

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  1  reimbursement ceilings and the cost of special Medicaid

  2  payments shall not be included in premiums paid to health

  3  maintenance organizations or prepaid health care plans. Each

  4  rate semester, the agency shall calculate and publish a

  5  Medicaid hospital rate schedule that does not reflect either

  6  special Medicaid payments or the elimination of rate

  7  reimbursement ceilings, to be used by hospitals and Medicaid

  8  health maintenance organizations, in order to determine the

  9  Medicaid rate referred to in ss. 409.912(17) 409.912(16),

10  409.9128(5), and 641.513(6).

11         Section 9.  Section 430.708, Florida Statutes, is

12  amended to read:

13         430.708  Certificate of need.--To ensure that Medicaid

14  community diversion pilot projects result in a reduction in

15  the projected average monthly nursing home caseload, the

16  agency shall, in accordance with the provisions of s.

17  408.034(5) s. 408.034(4):

18         (1)  Reduce the projected nursing home bed need in each

19  certificate-of-need batching cycle in the community diversion

20  pilot project areas.

21         (2)  Reduce the conditions imposed on existing nursing

22  homes or those to be constructed, in accordance with the

23  number of projected community diversion slots.

24         (3)  Adopt rules to reduce the number of beds in

25  Medicaid-participating nursing homes eligible for Medicaid,

26  through a Medicaid-selective contracting process or some other

27  appropriate method.

28         (4)  Determine the feasibility of increasing the

29  nursing home occupancy threshold used in determining nursing

30  home bed needs under the certificate-of-need process.

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  1         Section 10.  Subsection (4) of section 641.386, Florida

  2  Statutes, is amended to read:

  3         641.386  Agent licensing and appointment required;

  4  exceptions.--

  5         (4)  All agents and health maintenance organizations

  6  shall comply with and be subject to the applicable provisions

  7  of ss. 641.309 and 409.912(19) 409.912(18), and all companies

  8  and entities appointing agents shall comply with s. 626.451,

  9  when marketing for any health maintenance organization

10  licensed pursuant to this part, including those organizations

11  under contract with the Agency for Health Care Administration

12  to provide health care services to Medicaid recipients or any

13  private entity providing health care services to Medicaid

14  recipients pursuant to a prepaid health plan contract with the

15  Agency for Health Care Administration.

16         Section 11.  Subsection (4) of section 400.0069,

17  Florida Statutes, is amended to read:

18         400.0069  Local long-term care ombudsman councils;

19  duties; membership.--

20         (4)  Each local ombudsman council shall be composed of

21  no less than 15 members and no more than 40 30 members from

22  the local planning and service area, to include the following:

23  one medical or osteopathic physician whose practice includes

24  or has included a substantial number of geriatric patients and

25  who may have limited practice in a long-term care facility;

26  one registered nurse who has geriatric experience, if

27  possible; one licensed pharmacist; one registered dietitian;

28  at least six nursing home residents or representative consumer

29  advocates for nursing home residents; at least three residents

30  of assisted living facilities or adult family-care homes or

31  three representative consumer advocates for long-term care

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  1  facility residents; one attorney; and one professional social

  2  worker.  In no case shall the medical director of a long-term

  3  care facility or an employee of the Agency for Health Care

  4  Administration, the Department of Children and Family

  5  Services, or the Department of Elderly Affairs serve as a

  6  member or as an ex officio member of a council.  Each member

  7  of the council shall certify that neither the council member

  8  nor any member of the council member's immediate family has

  9  any conflict of interest pursuant to subsection (10).  Local

10  ombudsman councils are encouraged to recruit council members

11  who are 60 years of age or older.

12         Section 12.  Section 400.0089, Florida Statutes, is

13  amended to read:

14         400.0089  Agency reports.--The State Long-Term Care

15  Ombudsman Council, shall, in cooperation with the Department

16  of Elderly Affairs, maintain a statewide uniform reporting

17  system to collect and analyze data relating to complaints and

18  conditions in long-term care facilities and to residents, for

19  the purpose of identifying and resolving significant problems.

20  The council shall submit such data as part of its annual

21  report required pursuant to s. 400.0067(2)(g) to the Agency

22  for Health Care Administration, the Department of Children and

23  Family Services, the Florida Statewide Advocacy Council, the

24  Advocacy Center for Persons with Disabilities, the

25  Commissioner for the United States Administration on Aging,

26  the National Ombudsman Resource Center, and any other state or

27  federal entities that the ombudsman determines appropriate.

28  The State Long-Term Care Ombudsman Council shall publish

29  quarterly and make readily available information pertaining to

30  the number and types of complaints received by the long-term

31  care ombudsman program.

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  1         Section 13.  Section 400.0091, Florida Statutes, is

  2  amended to read:

  3         400.0091  Training.--The ombudsman shall provide

  4  appropriate training to all employees of the Office of State

  5  Long-Term Care Ombudsman and to the state and local long-term

  6  care ombudsman councils, including all unpaid volunteers. All

  7  volunteers and appropriate employees of the Office of the

  8  State Long-Term Care Ombudsman must be given a minimum of 20

  9  hours of training upon employment or enrollment as a volunteer

10  and 10 hours of continuing education annually thereafter.

11  Training must cover, at a minimum, guardianships and powers of

12  attorney, medication administration, care and medication of

13  residents with dementia and Alzheimer's disease, accounting

14  for residents' funds, discharge rights and responsibilities,

15  and cultural sensitivity. No employee, officer, or

16  representative of the office or of the state or local

17  long-term care ombudsman councils, other than the ombudsman,

18  may carry out any authorized ombudsman duty or responsibility

19  unless the person has received the training required by this

20  section and has been approved by the ombudsman as qualified to

21  carry out ombudsman activities on behalf of the office or the

22  state or local long-term care ombudsman councils.

23         Section 14.  This act shall take effect July 1, 2002.

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    Florida Senate - 2002                     CS for CS for SB 596
    309-2073-02




  1          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
  2                            CS/SB 596

  3

  4  Revises the Office of Long-Term-Care Policy in the Department
    of Elderly Affairs and consolidates some of the original
  5  duties.

  6  Increases membership on the advisory council from 9 members to
    13 members.
  7
    Requires that the Office of Long-Term-Care Policy submit a
  8  preliminary report of its findings and recommendations to the
    advisory council by December 1, 2002, and annual updates
  9  thereafter by November 1.

10  Limits community-care-for-the-elderly services to no longer
    than 60 days if the individual does not complete the process
11  for establishing Medicaid eligibility.

12  Increases the local ombudsman council membership from 30 to
    40; requires publication of quarterly reports of complaints;
13  and requires 20 hours of training upon employment and 10 hours
    of continuing education thereafter.
14
    Removes language that revised the purpose and duties of the
15  Department of Elderly Affairs.

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