HB 1105, Engrossed 1 2003
1	A bill to be entitled
2	An act relating to health care facilities; amending s.
3	408.032, F.S.; revising the definition of "tertiary health
4	service" under the Health Facility and Services
5	Development Act; amending s. 408.033, F.S.; providing for
6	the level of funding for local health councils; amending
7	s. 408.034, F.S.; requiring the nursing-home-bed-need
8	methodology established by the Agency for Health Care
9	Administration by rule to include a goal of maintaining a
10	specified district average occupancy rate; amending s.
11	408.036, F.S., relating to health-care-related projects
12	subject to review for a certificate of need; removing
13	certain projects from and subjecting certain projects to
14	expedited review and revising requirements for other
15	projects subject to expedited review; removing the
16	exemption from review for certain projects; revising
17	requirements for certain projects that are exempt from
18	review; exempting certain projects from review; amending
19	s. 408.038, F.S.; increasing fees of the certificate-of-
20	need program; amending s. 408.039, F.S.; providing for
21	approval of recommended orders of the Division of
22	Administrative Hearings when the Agency for Health Care
23	Administration fails to take action on an application for
24	a certificate of need within a specified time period;
25	amending s. 400.021, F.S.; revising the definition of
26	"resident care plan"; amending s. 400.147, F.S.; revising
27	the definition of "adverse incident"; revising adverse
28	incident reporting requirements; amending s. 400.195,F.S.;
29	conforming a cross reference; amending s. 400.211, F.S.;
30	requiring nursing assistants to meet certain inservice
31	training requirements to maintain certification; amending
32	s. 400.23, F.S.; requiring agency records, reports,
33	ranking systems, Internet information, and publications to
34	reflect final agency actions; creating s. 400.244, F.S.;
35	allowing nursing homes to convert beds to alternative uses
36	as specified; providing restrictions on uses of funding
37	under assisted-living Medicaid waivers; providing
38	procedures; providing for the applicability of certain
39	fire and life safety codes; providing applicability of
40	certain laws; requiring a nursing home to submit to the
41	Agency for Health Care Administration a written request
42	for permission to convert beds to alternative uses;
43	providing conditions for disapproving such a request;
44	providing for periodic review; providing for retention of
45	nursing home licensure for converted beds; providing for
46	reconversion of the beds; providing applicability of
47	licensure fees; requiring a report to the agency; creating
48	the Hospital Statutory and Regulatory Reform Council;
49	providing legislative intent; providing for membership and
50	duties of the council; providing an effective date.
51
52	Be It Enacted by the Legislature of the State of Florida:
53
54	Section 1. Subsection (17) of section 408.032, Florida
55	Statutes, is amended to read:
56	408.032 Definitions relating to Health Facility and
57	Services Development Act.--As used in ss. 408.031-408.045, the
58	term:
59	(17) "Tertiary health service" means a health service
60	which, due to its high level of intensity, complexity,
61	specialized or limited applicability, and cost, should be
62	limited to, and concentrated in, a limited number of hospitals
63	to ensure the quality, availability, and cost-effectiveness of
64	such service. Examples of such service include, but are not
65	limited to, organ transplantation, adult and pediatric open
66	heart surgery,specialty burn units, neonatal intensive care
67	units, comprehensive rehabilitation, and medical or surgical
68	services which are experimental or developmental in nature to
69	the extent that the provision of such services is not yet
70	contemplated within the commonly accepted course of diagnosis or
71	treatment for the condition addressed by a given service. The
72	agency shall establish by rule a list of all tertiary health
73	services.
74	Section 2. Paragraph (g) is added to subsection (2) of
75	section 408.033, Florida Statutes, to read:
76	408.033 Local and state health planning.--
77	(2) FUNDING.--
78	(g) Effective July 1, 2003, funding for the local health
79	councils shall be at the level provided on July 1, 2002.
80	Section 3. Subsection (5) of section 408.034, Florida
81	Statutes, is amended to read:
82	408.034 Duties and responsibilities of agency; rules.--
83	(5) The agency shall establish by rule a nursing-home-bed-
84	need methodology that has a goal of maintaining a district
85	average occupancy rate of 94 percent and thatreduces the
86	community nursing home bed need for the areas of the state where
87	the agency establishes pilot community diversion programs
88	through the Title XIX aging waiver program.
89	Section 4. Section 408.036, Florida Statutes, is amended
90	to read:
91	408.036 Projects subject to review; exemptions.--
92	(1) APPLICABILITY.--Unless exempt under subsection (3),
93	all health-care-related projects, as described in paragraphs
94	(a)-(h), are subject to review and must file an application for
95	a certificate of need with the agency. The agency is exclusively
96	responsible for determining whether a health-care-related
97	project is subject to review under ss. 408.031-408.045.
98	(a) The addition of beds by new construction or
99	alteration.
100	(b) The new construction or establishment of additional
101	health care facilities, including a replacement health care
102	facility when the proposed project site is not located on the
103	same site as the existing health care facility.
104	(c) The conversion from one type of health care facility
105	to another.
106	(d) An increase in the total licensed bed capacity of a
107	health care facility.
108	(e) The establishment of a hospice or hospice inpatient
109	facility, except as provided in s. 408.043.
110	(f) The establishment of inpatient health services by a
111	health care facility, or a substantial change in such services.
112	(g) An increase in the number of beds for acute care,
113	nursing home care beds, specialty burn units, neonatal intensive
114	care units, comprehensive rehabilitation, mental health
115	services, or hospital-based distinct part skilled nursing units,
116	or at a long-term care hospital.
117	(h) The establishment of tertiary health services.
118	(2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
119	pursuant to subsection (3), projects subject to an expedited
120	review shall include, but not be limited to:
121	(a) Research, education, and training programs.
122	(b) Shared services contracts or projects.
123	(b)(c) A transfer of a certificate of need, except when an
124	existing hospital is acquired by a purchaser, in which case all
125	pending certificates of need filed by the existing hospital and
126	all approved certificates of need owned by that hospital would
127	be acquired by the purchaser.
128	(c)(d)A 50-percent increase in nursing home beds for a
129	facility incorporated and operating in this state for at least
130	60 years on or before July 1, 1988, which has a licensed nursing
131	home facility located on a campus providing a variety of
132	residential settings and supportive services. The increased
133	nursing home beds shall be for the exclusive use of the campus
134	residents. Any application on behalf of an applicant meeting
135	this requirement shall be subject to the base fee of $5,000
136	provided in s. 408.038.
137	(d)(e)Replacement of a health care facility when the
138	proposed project site is located in the same district and within
139	a 1-mile radius of the replaced health care facility.
140	(e)(f)The conversion of mental health services beds
141	licensed under chapter 395 or hospital-based distinct part
142	skilled nursing unit beds to general acute care beds; the
143	conversion of mental health services beds between or among the
144	licensed bed categories defined as beds for mental health
145	services;or the conversion of general acute care beds to beds
146	for mental health services.
147	1. Conversion under this paragraph shall not establish a
148	new licensed bed category at the hospital but shall apply only
149	to categories of beds licensed at that hospital.
150	2. Beds converted under this paragraph must be licensed
151	and operational for at least 12 months before the hospital may
152	apply for additional conversion affecting beds of the same type.
153	(f) Replacement of a nursing home within the same
154	district, provided the proposed project site is located within a
155	geographic area that contains at least 65 percent of the
156	facility's current residents and is within a 30-mile radius of
157	the replaced nursing home.
158	(g) Relocation of a portion of a nursing home's licensed
159	beds to a replacement facility within the same district,
160	provided the relocation is within a 30-mile radius of the
161	existing facility and the total number of nursing home beds in
162	the district does not increase.
163
164	The agency shall develop rules to implement the provisions for
165	expedited review, including time schedule, application content
166	which may be reduced from the full requirements of s.
167	408.037(1), and application processing.
168	(3) EXEMPTIONS.--Upon request, the following projects are
169	subject to exemption from the provisions of subsection (1):
170	(a) For replacement of a licensed health care facility on
171	the same site, provided that the number of beds in each licensed
172	bed category will not increase.
173	(b) For hospice services or for swing beds in a rural
174	hospital, as defined in s. 395.602, in a number that does not
175	exceed one-half of its licensed beds.
176	(c) For the conversion of licensed acute care hospital
177	beds to Medicare and Medicaid certified skilled nursing beds in
178	a rural hospital, as defined in s. 395.602, so long as the
179	conversion of the beds does not involve the construction of new
180	facilities. The total number of skilled nursing beds, including
181	swing beds, may not exceed one-half of the total number of
182	licensed beds in the rural hospital as of July 1, 1993.
183	Certified skilled nursing beds designated under this paragraph,
184	excluding swing beds, shall be included in the community nursing
185	home bed inventory. A rural hospital which subsequently
186	decertifies any acute care beds exempted under this paragraph
187	shall notify the agency of the decertification, and the agency
188	shall adjust the community nursing home bed inventory
189	accordingly.
190	(d) For the addition of nursing home beds at a skilled
191	nursing facility that is part of a retirement community that
192	provides a variety of residential settings and supportive
193	services and that has been incorporated and operated in this
194	state for at least 65 years on or before July 1, 1994. All
195	nursing home beds must not be available to the public but must
196	be for the exclusive use of the community residents.
197	(e) For an increase in the bed capacity of a nursing
198	facility licensed for at least 50 beds as of January 1, 1994,
199	under part II of chapter 400 which is not part of a continuing
200	care facility if, after the increase, the total licensed bed
201	capacity of that facility is not more than 60 beds and if the
202	facility has been continuously licensed since 1950 and has
203	received a superior rating on each of its two most recent
204	licensure surveys.
205	(f) For an inmate health care facility built by or for the
206	exclusive use of the Department of Corrections as provided in
207	chapter 945. This exemption expires when such facility is
208	converted to other uses.
209	(g) For the termination of an inpatient health care
210	service, upon 30 days' written notice to the agency.
211	(h) For the delicensure of beds, upon 30 days' written
212	notice to the agency. A request for exemption submitted under
213	this paragraph must identify the number, the category of beds,
214	and the name of the facility in which the beds to be delicensed
215	are located.
216	(i) For the provision of adult inpatient diagnostic
217	cardiac catheterization services in a hospital.
218	1. In addition to any other documentation otherwise
219	required by the agency, a request for an exemption submitted
220	under this paragraph must comply with the following criteria:
221	a. The applicant must certify it will not provide
222	therapeutic cardiac catheterization pursuant to the grant of the
223	exemption.
224	b. The applicant must certify it will meet and
225	continuously maintain the minimum licensure requirements adopted
226	by the agency governing such programs pursuant to subparagraph
227	2.
228	c. The applicant must certify it will provide a minimum of
229	2 percent of its services to charity and Medicaid patients.
230	2. The agency shall adopt licensure requirements by rule
231	which govern the operation of adult inpatient diagnostic cardiac
232	catheterization programs established pursuant to the exemption
233	provided in this paragraph. The rules shall ensure that such
234	programs:
235	a. Perform only adult inpatient diagnostic cardiac
236	catheterization services authorized by the exemption and will
237	not provide therapeutic cardiac catheterization or any other
238	services not authorized by the exemption.
239	b. Maintain sufficient appropriate equipment and health
240	personnel to ensure quality and safety.
241	c. Maintain appropriate times of operation and protocols
242	to ensure availability and appropriate referrals in the event of
243	emergencies.
244	d. Maintain appropriate program volumes to ensure quality
245	and safety.
246	e. Provide a minimum of 2 percent of its services to
247	charity and Medicaid patients each year.
248	3.a. The exemption provided by this paragraph shall not
249	apply unless the agency determines that the program is in
250	compliance with the requirements of subparagraph 1. and that the
251	program will, after beginning operation, continuously comply
252	with the rules adopted pursuant to subparagraph 2. The agency
253	shall monitor such programs to ensure compliance with the
254	requirements of subparagraph 2.
255	b.(I) The exemption for a program shall expire immediately
256	when the program fails to comply with the rules adopted pursuant
257	to sub-subparagraphs 2.a., b., and c.
258	(II) Beginning 18 months after a program first begins
259	treating patients, the exemption for a program shall expire when
260	the program fails to comply with the rules adopted pursuant to
261	sub-subparagraphs 2.d. and e.
262	(III) If the exemption for a program expires pursuant to
263	sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
264	agency shall not grant an exemption pursuant to this paragraph
265	for an adult inpatient diagnostic cardiac catheterization
266	program located at the same hospital until 2 years following the
267	date of the determination by the agency that the program failed
268	to comply with the rules adopted pursuant to subparagraph 2.
269	(j) For the provision of percutaneous coronary
270	intervention for patients presenting with emergency myocardial
271	infarctions in a hospital without an approved adult open heart
272	surgery program. In addition to any other documentation required
273	by the agency, a request for an exemption submitted under this
274	paragraph must comply with the following:
275	1. The applicant must certify that it will meet and
276	continuously maintain the requirements adopted by the agency for
277	the provision of these services. These licensure requirements
278	are to be adopted by rule pursuant to ss. 120.536(1) and 120.54
279	and are to be consistent with the guidelines published by the
280	American College of Cardiology and the American Heart
281	Association for the provision of percutaneous coronary
282	interventions in hospitals without adult open heart services. At
283	a minimum, the rules shall require the following:
284	a. Cardiologists must be experienced interventionalists
285	who have performed a minimum of 75 interventions within the
286	previous 12 months.
287	b. The hospital must provide a minimum of 36 emergency
288	interventions annually in order to continue to provide the
289	service.
290	c. The hospital must offer sufficient physician, nursing,
291	and laboratory staff to provide the services 24 hours a day, 7
292	days a week.
293	d. Nursing and technical staff must have demonstrated
294	experience in handling acutely ill patients requiring
295	intervention based on previous experience in dedicated
296	interventional laboratories or surgical centers.
297	e. Cardiac care nursing staff must be adept in hemodynamic
298	monitoring and Intra-aortic Balloon Pump (IABP) management.
299	f. Formalized written transfer agreements must be
300	developed with a hospital with an adult open heart surgery
301	program, and written transport protocols must be in place to
302	ensure safe and efficient transfer of a patient within 60
303	minutes. Transfer and transport agreements must be reviewed and
304	tested, with appropriate documentation maintained at least every
305	3 months.
306	g. Hospitals implementing the service must first undertake
307	a training program of 3 to 6 months which includes establishing
308	standards, testing logistics, creating quality assessment and
309	error management practices, and formalizing patient selection
310	criteria.
311	2. The applicant must certify that it will utilize at all
312	times the patient selection criteria for the performance of
313	primary angioplasty at hospitals without adult open heart
314	surgery programs issued by the American College of Cardiology
315	and the American Heart Association. At a minimum, these criteria
316	would provide for the following:
317	a. Avoidance of interventions in hemodynamically stable
318	patients presenting with identified symptoms or medical
319	histories.
320	b. Transfer of patients presenting with a history of
321	coronary disease and clinical presentation of hemodynamic
322	instability.
323	3. The applicant must agree to submit a quarterly report
324	to the agency detailing patient characteristics, treatment, and
325	outcomes for all patients receiving emergency percutaneous
326	coronary interventions pursuant to this paragraph. This report
327	must be submitted within 15 days after the close of each
328	calendar quarter.
329	4. The exemption provided by this paragraph shall not
330	apply unless the agency determines that the hospital has taken
331	all necessary steps to be in compliance with all requirements of
332	this paragraph, including the training program required pursuant
333	to sub-subparagraph 1.g.
334	5. Failure of the hospital to continuously comply with the
335	requirements of sub-subparagraphs 1.c.-f. and subparagraphs 2.
336	and 3. will result in the immediate expiration of this
337	exemption.
338	6. Failure of the hospital to meet the volume requirements
339	of sub-subparagraphs 1.a.-b. within 18 months after the program
340	begins offering the service will result in the immediate
341	expiration of the exemption.
342	7. If the exemption for this service expires pursuant to
343	subparagraph 5. or subparagraph 6., the agency shall not grant
344	another exemption for this service to the same hospital for a
345	period of 2 years and then only upon a showing that the hospital
346	will remain in compliance with the requirements of this
347	paragraph through a demonstration of corrections to the
348	deficiencies which caused expiration of the exemption.
349	Compliance with the requirements of this paragraph includes
350	compliance with the rules adopted pursuant to this paragraph.
351	(k)(j)For mobile surgical facilities and related health
352	care services provided under contract with the Department of
353	Corrections or a private correctional facility operating
354	pursuant to chapter 957.
355	(l)(k)For state veterans' nursing homes operated by or on
356	behalf of the Florida Department of Veterans' Affairs in
357	accordance with part II of chapter 296 for which at least 50
358	percent of the construction cost is federally funded and for
359	which the Federal Government pays a per diem rate not to exceed
360	one-half of the cost of the veterans' care in such state nursing
361	homes. These beds shall not be included in the nursing home bed
362	inventory.
363	(m)(l)For combination within one nursing home facility of
364	the beds or services authorized by two or more certificates of
365	need issued in the same planning subdistrict. An exemption
366	granted under this paragraph shall extend the validity period of
367	the certificates of need to be consolidated by the length of the
368	period beginning upon submission of the exemption request and
369	ending with issuance of the exemption. The longest validity
370	period among the certificates shall be applicable to each of the
371	combined certificates.
372	(n)(m)For division into two or more nursing home
373	facilities of beds or services authorized by one certificate of
374	need issued in the same planning subdistrict. An exemption
375	granted under this paragraph shall extend the validity period of
376	the certificate of need to be divided by the length of the
377	period beginning upon submission of the exemption request and
378	ending with issuance of the exemption.
379	(o)(n)For the addition of hospital beds licensed under
380	chapter 395 for acute care, mental health services,or a
381	hospital-based distinct part skilled nursing unit in a number
382	that may not exceed 3010total beds or 10 percent of the
383	licensed capacity of the bed category being expanded, whichever
384	is greater; for the addition of medical rehabilitation beds
385	licensed under chapter 395 in a number that may not exceed eight
386	total beds or 10 percent of capacity, whichever is greater; or
387	for the addition of mental health services beds licensed under
388	chapter 395 in a number that may not exceed 10 total beds or 10
389	percent of the licensed capacity of the bed category being
390	expanded, whichever is greater. Beds for specialty burn units
391	or, neonatal intensive care units, or comprehensive
392	rehabilitation, or at a long-term care hospital, may not be
393	increased under this paragraph.
394	1. In addition to any other documentation otherwise
395	required by the agency, a request for exemption submitted under
396	this paragraph must:
397	a. Certify that the prior 12-month average occupancy rate
398	for the category of licensed beds being expanded at the facility
399	meets or exceeds 7580percent or, for a hospital-based distinct
400	part skilled nursing unit, the prior 12-month average occupancy
401	rate meets or exceeds 96 percent or, for medical rehabilitation
402	beds, the prior 12-month average occupancy rate meets or exceeds
403	90 percent.
404	b. Certify that any beds of the same type authorized for
405	the facility under this paragraph before the date of the current
406	request for an exemption have been licensed and operational for
407	at least 12 months.
408	2. The timeframes and monitoring process specified in s.
409	408.040(2)(a)-(c) apply to any exemption issued under this
410	paragraph.
411	3. The agency shall count beds authorized under this
412	paragraph as approved beds in the published inventory of
413	hospital beds until the beds are licensed.
414	(p)(o)For the addition of acute care beds, as authorized
415	by rule consistent with s. 395.003(4), in a number that may not
416	exceed 3010total beds or 10 percent of licensed bed capacity,
417	whichever is greater, for temporary beds in a hospital that has
418	experienced high seasonal occupancy within the prior 12-month
419	period or in a hospital that must respond to emergency
420	circumstances.
421	(q)(p)For the addition of nursing home beds licensed
422	under chapter 400 in a number not exceeding 10 total beds or 10
423	percent of the number of beds licensed in the facility being
424	expanded, whichever is greater.
425	1. In addition to any other documentation required by the
426	agency, a request for exemption submitted under this paragraph
427	must:
428	a. Effective until June 30, 2001,Certify that the
429	facility has not had any class I or class II deficiencies within
430	the 30 months preceding the request for addition.
431	b. Effective on July 1, 2001, certify that the facility
432	has been designated as a Gold Seal nursing home under s.
433	400.235.
434	b.c.Certify that the prior 12-month average occupancy
435	rate for the nursing home beds at the facility meets or exceeds
436	96 percent.
437	c.d.Certify that any beds authorized for the facility
438	under this paragraph before the date of the current request for
439	an exemption have been licensed and operational for at least 12
440	months.
441	2. The timeframes and monitoring process specified in s.
442	408.040(2)(a)-(c) apply to any exemption issued under this
443	paragraph.
444	3. The agency shall count beds authorized under this
445	paragraph as approved beds in the published inventory of nursing
446	home beds until the beds are licensed.
447	(q) For establishment of a specialty hospital offering a
448	range of medical service restricted to a defined age or gender
449	group of the population or a restricted range of services
450	appropriate to the diagnosis, care, and treatment of patients
451	with specific categories of medical illnesses or disorders,
452	through the transfer of beds and services from an existing
453	hospital in the same county.
454	(r) For the conversion of hospital-based Medicare and
455	Medicaid certified skilled nursing beds to acute care beds, if
456	the conversion does not involve the construction of new
457	facilities.
458	(s) For the replacement of a statutory rural hospital when
459	the proposed project site is located in the same district and
460	within 10 miles of the existing facility and within the current
461	primary service area, defined as the least number of zip codes
462	comprising 75 percent of the hospital's inpatient admissions.
463	For fiscal year 2001-2002 only, for transfer by a health care
464	system of existing services and not more than 100 licensed and
465	approved beds from a hospital in district 1, subdistrict 1, to
466	another location within the same subdistrict in order to
467	establish a satellite facility that will improve access to
468	outpatient and inpatient care for residents of the district and
469	subdistrict and that will use new medical technologies,
470	including advanced diagnostics, computer assisted imaging, and
471	telemedicine to improve care. This paragraph is repealed on July
472	1, 2002.
473	(t) For the conversion of mental health services beds
474	between or among the licensed bed categories defined as beds for
475	mental health services.
476	(u) For the creation of at least a 10-bed Level II
477	neonatal intensive care unit upon demonstrating to the agency
478	that the applicant hospital had a minimum of 1,500 live births
479	during the previous 12 months.
480	(v) For the addition of Level II or Level III neonatal
481	intensive care beds in a number not to exceed six beds or 10
482	percent of licensed capacity in that category, whichever is
483	greater, provided that the hospital certifies that the prior 12-
484	month average occupancy rate for the category of licensed
485	neonatal intensive care beds meets or exceeds 75 percent.
486	(w) For replacement of a licensed nursing home on the same
487	site, or within 3 miles of the same site, provided the number of
488	licensed beds does not increase.
489	(x) For consolidation or combination of licensed nursing
490	homes or transfer of beds between licensed nursing homes within
491	the same district, by providers that operate multiple nursing
492	homes within that district, provided there is no increase in the
493	district total of nursing home beds and the relocation does not
494	exceed 30 miles from the original location.
495	(4) A request for exemption under subsection (3) may be
496	made at any time and is not subject to the batching requirements
497	of this section. The request shall be supported by such
498	documentation as the agency requires by rule. The agency shall
499	assess a fee of $250 for each request for exemption submitted
500	under subsection (3).
501	Section 5. Section 408.038, Florida Statutes, is amended
502	to read:
503	408.038 Fees.--The agency shall assess fees on
504	certificate-of-need applications. Such fees shall be for the
505	purpose of funding the functions of the local health councils
506	and the activities of the agency and shall be allocated as
507	provided in s. 408.033. The fee shall be determined as follows:
508	(1) A minimum base fee of $10,000$5,000.
509	(2) In addition to the base fee of $10,000$5,000, 0.015
510	of each dollar of proposed expenditure, except that a fee may
511	not exceed $50,000$22,000.
512	Section 6. Paragraph (e) of subsection (5) and paragraph
513	(c) of subsection (6) of section 408.039, Florida Statutes, are
514	amended to read:
515	408.039 Review process.--The review process for
516	certificates of need shall be as follows:
517	(5) ADMINISTRATIVE HEARINGS.--
518	(e) The agency shall issue its final order within 45 days
519	after receipt of the recommended order. If the agency fails to
520	take action within 45 days, the recommended order of the
521	Division of Administrative Hearings is deemed approvedsuch
522	time, or as otherwise agreed to by the applicant and the agency,
523	the applicant may take appropriate legal action to compel the
524	agency to act. When making a determination on an application for
525	a certificate of need, the agency is specifically exempt from
526	the time limitations provided in s. 120.60(1).
527	(6) JUDICIAL REVIEW.--
528	(c) The court, in its discretion, may award reasonable
529	attorney's fees and costs to the prevailing party if the court
530	finds that there was a complete absence of a justiciable issue
531	of law or fact raised by the losing party. If the losing party
532	is a hospital, the court shall order it to pay the reasonable
533	attorney's fees and costs, which shall include fees and costs
534	incurred as a result of the administrative hearing and the
535	judicial appeal, of the prevailing hospital party.
536	Section 7. Subsection (17) of section 400.021, Florida
537	Statutes, is amended to read:
538	400.021 Definitions.--When used in this part, unless the
539	context otherwise requires, the term:
540	(17) "Resident care plan" means a written plan developed,
541	maintained, and reviewed not less than quarterly by a registered
542	nurse, with participation from other facility staff and the
543	resident or his or her designee or legal representative, which
544	includes a comprehensive assessment of the needs of an
545	individual resident; the type and frequency of services required
546	to provide the necessary care for the resident to attain or
547	maintain the highest practicable physical, mental, and
548	psychosocial well-being; a listing of services provided within
549	or outside the facility to meet those needs; and an explanation
550	of service goals. The resident care plan must be signed by the
551	director of nursing or another registered nurse employed by the
552	facility to whom institutional responsibilities have been
553	delegated and bythe resident, the resident's designee, or the
554	resident's legal representative.
555	Section 8. Subsections (5) through (15) of section
556	400.147, Florida Statutes, are amended to read:
557	400.147 Internal risk management and quality assurance
558	program.--
559	(5) For purposes of reporting to the agency under this
560	section, the term "adverse incident" means:
561	(a) An event over which facility personnel could exercise
562	control and which is associated in whole or in part with the
563	facility's intervention, rather than the condition for which
564	such intervention occurred, and which results in one of the
565	following:
566	1. Death;
567	2. Brain or spinal damage;
568	3. Permanent disfigurement;
569	4. Fracture or dislocation of bones or joints;
570	5. A limitation of neurological, physical, or sensory
571	function;
572	6. Any condition that required medical attention to which
573	the resident has not given his or her informed consent,
574	including failure to honor advanced directives; or
575	7. Any condition that required the transfer of the
576	resident, within or outside the facility, to a unit providing a
577	more acute level of care due to the adverse incident, rather
578	than the resident's condition prior to the adverse incident;
579	(b) Abuse, neglect, or exploitation as defined in s.
580	415.102;
581	(c) Abuse, neglect and harm as defined in s. 39.01;
582	(d) Resident elopement; or
583	(e) An event that is reported to law enforcement for
584	investigation.
585	(6) The internal risk manager of each licensed facility
586	shall:
587	(a) Investigate every allegation of sexual misconduct
588	which is made against a member of the facility's personnel who
589	has direct patient contact when the allegation is that the
590	sexual misconduct occurred at the facility or at the grounds of
591	the facility.;
592	(b) Report every allegation of sexual misconduct to the
593	administrator of the licensed facility.; and
594	(c) Notify the resident representative or guardian of the
595	victim that an allegation of sexual misconduct has been made and
596	that an investigation is being conducted.
597	(7) The facility shall initiate an investigation and shall
598	notify the agency within 1 business day after the risk manager
599	or his or her designee has received a report pursuant to
600	paragraph (1)(d). The notification must be made in writing and
601	be provided electronically, by facsimile device or overnight
602	mail delivery. The notification must include information
603	regarding the identity of the affected resident, the type of
604	adverse incident, the initiation of an investigation by the
605	facility, and whether the events causing or resulting in the
606	adverse incident represent a potential risk to any other
607	resident. The notification is confidential as provided by law
608	and is not discoverable or admissible in any civil or
609	administrative action, except in disciplinary proceedings by the
610	agency or the appropriate regulatory board. The agency may
611	investigate, as it deems appropriate, any such incident and
612	prescribe measures that must or may be taken in response to the
613	incident. The agency shall review each incident and determine
614	whether it potentially involved conduct by the health care
615	professional who is subject to disciplinary action, in which
616	case the provisions of s. 456.073 shall apply.
617	(7)(8)(a) Each facility shall complete the investigation
618	and submit an adverse incident report to the agency for each
619	adverse incident within 15 calendar days after its occurrence.
620	If, after a complete investigation, the risk manager determines
621	that the incident was notan adverse incident as defined in
622	subsection (5), the facility shall include this information in
623	the report. The agency shall develop a form for reporting this
624	information.
625	(b) The information reported to the agency pursuant to
626	paragraph (a) which relates to persons licensed under chapter
627	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
628	by the agency. The agency shall determine whether any of the
629	incidents potentially involved conduct by a health care
630	professional who is subject to disciplinary action, in which
631	case the provisions of s. 456.073 shall apply.
632	(c) The report submitted to the agency must also contain
633	the name of the risk manager of the facility.
634	(d) The adverse incident report is confidential as
635	provided by law and is not discoverable or admissible in any
636	civil or administrative action, except in disciplinary
637	proceedings by the agency or the appropriate regulatory board.
638	(8)(9)By the 10th of each month, each facility subject to
639	this section shall report any notice received pursuant to s.
640	400.0233(2) and each initial complaint that was filed with the
641	clerk of the court and served on the facility during the
642	previous month by a resident or a resident's family member,
643	guardian, conservator, or personal legal representative. The
644	report must include the name of the resident, the resident's
645	date of birth and social security number, the Medicaid
646	identification number for Medicaid-eligible persons, the date or
647	dates of the incident leading to the claim or dates of
648	residency, if applicable, and the type of injury or violation of
649	rights alleged to have occurred. Each facility shall also submit
650	a copy of the notices received pursuant to s. 400.0233(2) and
651	complaints filed with the clerk of the court. This report is
652	confidential as provided by law and is not discoverable or
653	admissible in any civil or administrative action, except in such
654	actions brought by the agency to enforce the provisions of this
655	part.
656	(9)(10)The agency shall review, as part of its licensure
657	inspection process, the internal risk management and quality
658	assurance program at each facility regulated by this section to
659	determine whether the program meets standards established in
660	statutory laws and rules, is being conducted in a manner
661	designed to reduce adverse incidents, and is appropriately
662	reporting incidents as required by this section.
663	(10)(11)There is no monetary liability on the part of,
664	and a cause of action for damages may not arise against, any
665	risk manager for the implementation and oversight of the
666	internal risk management and quality assurance program in a
667	facility licensed under this part as required by this section,
668	or for any act or proceeding undertaken or performed within the
669	scope of the functions of such internal risk management and
670	quality assurance program if the risk manager acts without
671	intentional fraud.
672	(11)(12)If the agency, through its receipt of the adverse
673	incident reports prescribed in subsection (7),or through any
674	investigation, has a reasonable belief that conduct by a staff
675	member or employee of a facility is grounds for disciplinary
676	action by the appropriate regulatory board, the agency shall
677	report this fact to the regulatory board. The agency must use
678	the 15-day report to fulfill this reporting requirement. This
679	subsection does not require dual reporting or additional, new
680	documentation and reporting by the facility to the appropriate
681	regulatory board.
682	(12)(13)The agency may adopt rules to administer this
683	section.
684	(13)(14)The agency shall annually submit to the
685	Legislature a report on nursing home adverse incidents. The
686	report must include the following information arranged by
687	county:
688	(a) The total number of adverse incidents.
689	(b) A listing, by category, of the types of adverse
690	incidents, the number of incidents occurring within each
691	category, and the type of staff involved.
692	(c) A listing, by category, of the types of injury caused
693	and the number of injuries occurring within each category.
694	(d) Types of liability claims filed based on an adverse
695	incident or reportable injury.
696	(e) Disciplinary action taken against staff, categorized
697	by type of staff involved.
698	(14)(15)Information gathered by a credentialing
699	organization under a quality assurance program is not
700	discoverable from the credentialing organization. This
701	subsection does not limit discovery of, access to, or use of
702	facility records, including those records from which the
703	credentialing organization gathered its information.
704	Section 9. Paragraph (d) of subsection (1) of section
705	400.195, Florida Statutes, is amended to read:
706	400.195 Agency reporting requirements.--
707	(1) For the period beginning June 30, 2001, and ending
708	June 30, 2005, the Agency for Health Care Administration shall
709	provide a report to the Governor, the President of the Senate,
710	and the Speaker of the House of Representatives with respect to
711	nursing homes. The first report shall be submitted no later than
712	December 30, 2002, and subsequent reports shall be submitted
713	every 6 months thereafter. The report shall identify facilities
714	based on their ownership characteristics, size, business
715	structure, for-profit or not-for-profit status, and any other
716	characteristics the agency determines useful in analyzing the
717	varied segments of the nursing home industry and shall report:
718	(d) Information regarding deficiencies cited, including
719	information used to develop the Nursing Home Guide WATCH LIST
720	pursuant to s. 400.191, and applicable rules, a summary of data
721	generated on nursing homes by Centers for Medicare and Medicaid
722	Services Nursing Home Quality Information Project, and
723	information collected pursuant to s. 400.147(8)(9), relating to
724	litigation.
725	Section 10. Subsection (4) of section 400.211, Florida
726	Statutes, is amended to read:
727	400.211 Persons employed as nursing assistants;
728	certification requirement.--
729	(4) When employed by a nursing home facility for a 12-
730	month period or longer, a nursing assistant, to maintain
731	certification, shall submit to a performance review every 12
732	months and must receive regular inservice education based on the
733	outcome of such reviews. The inservice training must:
734	(a) Be sufficient to ensure the continuing competence of
735	nursing assistants and must meet the standard specified in s.
736	464.203(7)., must be at least 18 hours per year, and may include
737	hours accrued under s. 464.203(8);
738	(b) Include, at a minimum:
739	1. Techniques for assisting with eating and proper
740	feeding.;
741	2. Principles of adequate nutrition and hydration.;
742	3. Techniques for assisting and responding to the
743	cognitively impaired resident or the resident with difficult
744	behaviors.;
745	4. Techniques for caring for the resident at the end-of-
746	life.; and
747	5. Recognizing changes that place a resident at risk for
748	pressure ulcers and falls.; and
749	(c) Address areas of weakness as determined in nursing
750	assistant performance reviews and may address the special needs
751	of residents as determined by the nursing home facility staff.
752
753	Costs associated with thethis training required by this
754	subsectionmay not be reimbursed from additional Medicaid
755	funding through interim rate adjustments.
756	Section 11. Subsection (10) is added to section 400.23,
757	Florida Statutes, to read:
758	400.23 Rules; evaluation and deficiencies; licensure
759	status.--
760	(10) Agency records, reports, ranking systems, Internet
761	information, and publications must reflect final agency actions.
762	Section 12. Section 400.244, Florida Statutes, is created
763	to read:
764	400.244 Alternative uses of nursing home beds; funding
765	limitations; applicable codes and requirements; procedures;
766	reconversion.--
767	(1) It is the intent of the Legislature to allow nursing
768	home facilities to use licensed nursing home facility beds for
769	alternative uses other than nursing home care for extended
770	periods of time exceeding 48 hours.
771	(2) A nursing home may use a contiguous portion of the
772	nursing home facility to meet the needs of the elderly through
773	the use of less restrictive and less institutional methods of
774	long-term care, including, but not limited to, adult day care,
775	assisted living, extended congregate care, or limited nursing
776	services.
777	(3) Funding under assisted-living Medicaid waivers for
778	nursing home facility beds that are used to provide extended
779	congregate care or limited nursing services under this section
780	may be provided only for residents who have resided in the
781	nursing home facility for a minimum of 90 consecutive days.
782	(4) Nursing home facility beds that are used in providing
783	alternative services may share common areas, services, and staff
784	with beds that are designated for nursing home care. Fire codes
785	and life safety codes applicable to nursing home facilities also
786	apply to beds used for alternative purposes under this section.
787	Any alternative use must meet other requirements specified by
788	law for that use.
789	(5) In order to take beds out of service for nursing home
790	care and use them to provide alternative services under this
791	section, a nursing home must submit a written request for
792	approval to the Agency for Health Care Administration in a
793	format specified by the agency. The agency shall approve the
794	request unless it determines that such action will adversely
795	affect access to nursing home care in the geographical area in
796	which the nursing home is located. The agency shall, in its
797	review, consider a district average occupancy of 94 percent or
798	greater at the time of the application as an indicator of an
799	adverse impact. The agency shall review the request for
800	alternative use at each annual license renewal.
801	(6) A nursing home facility that converts beds to an
802	alternative use under this section retains its license for all
803	of the nursing home facility beds and may return those beds to
804	nursing home operation upon 60 days' advance notice to the
805	agency unless notice requirements are specified elsewhere in
806	law. The nursing home facility shall continue to pay all
807	licensure fees as required by s. 400.062 and applicable rules
808	but is not required to pay any other state licensure fee for the
809	alternative service.
810	(7) Within 45 days after the end of each calendar quarter,
811	each facility that has nursing facility beds licensed under this
812	chapter shall report to the agency or its designee the total
813	number of patient days which occurred in each month of the
814	quarter and the number of such days which were Medicaid patient
815	days.
816	Section 13. Hospital Statutory and Regulatory Reform
817	Council; legislative intent; creation; membership; duties.--
818	(1) It is the intent of the Legislature to provide for the
819	protection of the public health and safety in the establishment,
820	construction, maintenance, and operation of hospitals. However,
821	the Legislature further intends that the police power of the
822	state be exercised toward that purpose only to the extent
823	necessary and that regulation remain current with the ever-
824	changing standard of care and not restrict the introduction and
825	use of new medical technologies and procedures.
826	(2) In order to achieve the purposes expressed in
827	subsection (1), it is necessary that the state establish a
828	mechanism for the ongoing review and updating of laws regulating
829	hospitals. The Hospital Statutory and Regulatory Reform Council
830	is created and located, for administrative purposes only, within
831	the Agency for Health Care Administration. The council shall
832	consist of no more than 15 members, including:
833	(a) Nine members appointed by the Florida Hospital
834	Association who represent acute care, teaching, specialty,
835	rural, government-owned, for-profit, and not-for-profit
836	hospitals.
837	(b) Two members appointed by the Governor who represent
838	patients.
839	(c) Two members appointed by the President of the Senate
840	who represent private businesses that provide health insurance
841	coverage for their employees, one of whom represents small
842	private businesses and one of whom represents large private
843	businesses. As used in this paragraph, the term "private
844	business" does not include an entity licensed under chapter 627,
845	Florida Statutes, or chapter 641, Florida Statutes, or otherwise
846	licensed or authorized to provide health insurance services,
847	either directly or indirectly, in this state.
848	(d) Two members appointed by the Speaker of the House
849	of Representatives who represent physicians.
850	(3) Council members shall be appointed to serve 2-year
851	terms and may be reappointed. A member shall serve until his or
852	her successor is appointed. The council shall annually elect
853	from among its members a chair and a vice chair. The council
854	shall meet at least twice a year and shall hold additional
855	meetings as it considers necessary. Members appointed by the
856	Florida Hospital Association may not receive compensation or
857	reimbursement of expenses for their services. Members appointed
858	by the Governor, the President of the Senate, or the Speaker of
859	the House of Representatives may be reimbursed for travel
860	expenses by the agency.
861	(4) The council, as its first priority, shall review
862	chapters 395 and 408, Florida Statutes, and shall make
863	recommendations to the Legislature for the repeal of regulatory
864	provisions that are no longer necessary or that fail to promote
865	cost-efficient, high-quality medicine.
866	(5) The council, as its second priority, shall recommend
867	to the Secretary of Health and the Secretary of Health Care
868	Administration regulatory changes relating to hospital licensure
869	and regulation to assist the Department of Health and the Agency
870	for Health Care Administration in carrying out their duties and
871	to ensure that the intent of the Legislature as expressed in
872	this section is carried out.
873	(6) In determining whether a statute or rule is
874	appropriate or necessary, the council shall consider whether:
875	(a) The statute or rule is necessary to prevent
876	substantial harm, which is recognizable and not remote, to the
877	public health, safety, or welfare.
878	(b) The statute or rule restricts the use of new medical
879	technologies or encourages the implementation of more cost-
880	effective medical procedures.
881	(c) The statute or rule has an unreasonable effect on job
882	creation or job retention in the state.
883	(d) The public is or can be effectively protected by other
884	means.
885	(e) The overall cost-effectiveness and economic effect of
886	the proposed statute or rule, including the indirect costs to
887	consumers, will be favorable.
888	(f) A lower-cost regulatory alternative to the statute or
889	rule could be adopted.
890	Section 14. This act shall take effect July 1, 2003.