HB 1083 2003
1	A bill to be entitled
2	An act relating to nursing homes; amending s. 400.021,
3	F.S.; amending the definition of the term "resident care
4	plan" as used in pt. II of ch. 400, F.S.; amending s.
5	400.111, F.S.; requiring the Agency for Health Care
6	Administration to give notice, as specified, of the
7	necessity to renew a license; amending s. 400.141, F.S.;
8	amending prerequisites to shared staffing; amending
9	provisions that specify deficiencies in staffing which
10	trigger an admissions moratorium; amending s. 400.23,
11	F.S.; amending provisions relating to minimum staffing
12	requirements; providing exceptions for a state of
13	emergency declared by the Governor or his or her designee;
14	amending s. 400.235, F.S.; amending provisions describing
15	the financial soundness and stability that constitutes a
16	prerequisite to recognition as a Gold Seal Program
17	facility; providing an effective date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1. Subsection (17) of section 400.021, Florida
22	Statutes, is amended to read:
23	400.021 Definitions.--When used in this part, unless the
24	context otherwise requires, the term:
25	(17) "Resident care plan" means a written plan developed,
26	maintained, and reviewed not less than quarterly by a registered
27	nurse, with participation from other facility staff and the
28	resident or his or her designee or legal representative, which
29	includes a comprehensive assessment of the needs of an
30	individual resident; the type and frequency of services required
31	to provide the necessary care for the resident to attain or
32	maintain the highest practicable physical, mental, and
33	psychosocial well-being; a listing of services provided within
34	or outside the facility to meet those needs; and an explanation
35	of service goals. The resident care plan must be signed by the
36	director of nursing, another nurse to whom institutional
37	responsibilities have been delegated, or the registered nurse
38	who is responsible for the resident's care, and bythe resident,
39	the resident's designee, or the resident's legal representative.
40	Section 2. Subsection (1) of section 400.111, Florida
41	Statutes, is amended to read:
42	400.111 Expiration of license; renewal.--
43	(1) A license issued for the operation of a facility,
44	unless sooner suspended or revoked, shall expire on the date set
45	forth by the agency on the face of the license or 1 year from
46	the date of issuance, whichever occurs first. The agency shall
47	notify the facility by certified mail at least 120 days before
48	the license expires that a renewal license is necessary to
49	continue operating.Ninety days prior to the expiration date, an
50	application for renewal shall be submitted to the agency. A
51	license shall be renewed upon the filing of an application on
52	forms furnished by the agency if the applicant has first met the
53	requirements established under this part and all rules adopted
54	under this part. The failure to file an application within the
55	period established in this subsection shall result in a late fee
56	charged to the licensee by the agency in an amount equal to 50
57	percent of the fee in effect on the last preceding regular
58	renewal date. A late fee shall be levied for each and every day
59	the filing of the license application is delayed, but in no
60	event shall such fine aggregate more than $5,000. If an
61	application is received after the required filing date and
62	exhibits a hand-canceled postmark obtained from a United States
63	Post Office dated on or before the required filing date, no fine
64	will be levied.
65	Section 3. Subsection (7) and paragraph (d) of subsection
66	(15) of section 400.141, Florida Statutes, are amended to read:
67	400.141 Administration and management of nursing home
68	facilities.--Every licensed facility shall comply with all
69	applicable standards and rules of the agency and shall:
70	(7) If the facility has a standard licenselicensure
71	status or is a Gold Seal facility, exceeds the minimum required
72	hours of licensed nursing and certified nursing assistant direct
73	care per resident per daystaffing standards, and is part of a
74	continuing care facility licensed under chapter 651 ora
75	retirement community that offers other services pursuant to part
76	III, part IV, or part V on a single campus, be allowed to share
77	programming and staff. At the time of relicensure, a continuing
78	care facility orretirement community that uses this option must
79	demonstrate through staffing records that minimum staffing
80	requirements for the facility were exceeded. Licensed nurses and
81	certified nursing assistants may be used to provide services
82	elsewhere on campus if the facility exceeds the minimum number
83	of direct care hours required per resident per day and the
84	number of residents served on campus by a licensed nurse or a
85	certified nursing assistant never drops below the staffing
86	ratios required in s. 400.23(3)(a). If the facility receives a
87	conditional license, it may not share staff until the
88	conditional license status ends. This subsection does not
89	restrict the agency's authority under federal or state law to
90	require additional staff if a facility is cited for deficiencies
91	in care which are caused by an insufficient number of certified
92	nurses or licensed nurses.
93	(15) Submit semiannually to the agency, or more frequently
94	if requested by the agency, information regarding facility
95	staff-to-resident ratios, staff turnover, and staff stability,
96	including information regarding certified nursing assistants,
97	licensed nurses, the director of nursing, and the facility
98	administrator. For purposes of this reporting:
99	(d) A nursing facility that has failed to comply with
100	state minimum staffing requirements of s. 400.23(3)(a)1.b. or s.
101	400.23(3)(a)1.d.for 2 consecutive days is prohibited from
102	accepting new admissions until the facility has achieved the
103	minimum staffing requirements of s. 400.23(3)(a)1.b. and 1.d.
104	for a period of 6 consecutive days. For the purposes of this
105	paragraph, any person who was a resident of the facility and was
106	absent from the facility for the purpose of receiving medical
107	care at a separate location or was on a leave of absence is not
108	considered a new admission. Failure to impose such an admissions
109	moratorium constitutes a class II deficiency.
110
111	Facilities that have been awarded a Gold Seal under the program
112	established in s. 400.235 may develop a plan to provide
113	certified nursing assistant training as prescribed by federal
114	regulations and state rules and may apply to the agency for
115	approval of their program.
116	Section 4. Paragraph (a) of subsection (3) of section
117	400.23, Florida Statutes, is amended to read:
118	400.23 Rules; evaluation and deficiencies; licensure
119	status.--
120	(3)(a)1.The agency shall adopt rules providing for the
121	minimum staffing requirements for nursing homes. These
122	requirements shall include, for each nursing home facility:,
123	a. A biweekly averageminimumcertified nursing assistant
124	staffing of 2.3 hours of direct care per resident per day
125	beginning January 1, 2002, increasing to 2.6 hours of direct
126	care per resident per day beginning January 1, 2003, and
127	increasing to 2.9 hours of direct care per resident per day
128	beginning January 1, 2004.
129	b. A daily average certified nursing assistant staffing
130	that is at least 95 percent of the required biweekly average
131	under sub-subparagraph a., and at least 0.4 hours of the
132	required certified nursing assistant direct care per resident
133	must be maintained during the hours between the hours of 11 p.m.
134	and 7 a.m., but at least one certified nursing assistant must be
135	on duty at all times.
136	c. Beginning January 1, 2002, a biweekly averageno
137	facility shall staff below one certified nursing assistant per
138	20 residents, and a minimumlicensed nursing staffing of 1.0
139	hour of direct resident care per resident per day but never
140	below one licensed nurse per 40 residents.
141	d. A daily average licensed nursing staffing that is at
142	least 95 percent of the required biweekly average under sub-
143	subparagraph c., and at least 0.2 hours of required licensed
144	nursing direct care per resident must be maintained during the
145	hours between the hours of 11 p.m. and 7 a.m., but at least one
146	licensed nurse must be on duty at all times.
147	2.Nursing assistants employed under s. 400.211(2) may be
148	included in computing the staffing ratio for certified nursing
149	assistants only if they provide nursing assistance services to
150	residents on a full-time basis.
151	3.Each nursing home must document compliance with
152	staffing standards as required under this paragraph and post
153	daily the names of staff on duty for the benefit of facility
154	residents and the public.
155	4. If the Governor or his or her designee declares a state
156	of emergency pursuant to s. 252.36, the agency may not cite
157	affected nursing home facilities for noncompliance with the
158	minimum staffing requirements until the state of emergency is
159	lifted.
160	5.The agency shall recognize the use of licensed nurses
161	for compliance with minimum staffing requirements for certified
162	nursing assistants, provided that the facility otherwise meets
163	the minimum staffing requirements for licensed nurses and that
164	the licensed nurses so recognized are performing the duties of a
165	certified nursing assistant. Unless otherwise approved by the
166	agency, licensed nurses counted towards the minimum staffing
167	requirements for certified nursing assistants must exclusively
168	perform the duties of a certified nursing assistant for the
169	entire shift and shall not also be counted towards the minimum
170	staffing requirements for licensed nurses. If a nursing home
171	facility usesthe agency approved a facility's request to usea
172	licensed nurse to perform both licensed nursing and certified
173	nursing assistant duties, the facility must allocate the amount
174	of staff time specifically spent on certified nursing assistant
175	duties for the purpose of documenting compliance with minimum
176	staffing requirements for certified and licensed nursing staff.
177	In no event may The hours of a licensed nurse may notwith dual
178	job responsibilitiesbe counted twice.
179	Section 5. Paragraph (b) of subsection (5) of section
180	400.235, Florida Statutes, is amended to read:
181	400.235 Nursing home quality and licensure status; Gold
182	Seal Program.--
183	(5) Facilities must meet the following additional criteria
184	for recognition as a Gold Seal Program facility:
185	(b) Evidence financial soundness and stability according
186	to standards adopted by the agency in administrative rule. A
187	nursing home that is part of the same corporate entity as a
188	continuing care facility licensed under chapter 651, meets the
189	minimum liquid reserve requirements specified in s. 651.035, and
190	is accredited by a recognized accrediting organization under s.
191	651.028 and rules of the Office of Insurance Regulation
192	satisfies this requirement as long as the accreditation is not
193	provisional.
194	Section 6. This act shall take effect upon becoming a law.