HB 1871 2003
1	A bill to be entitled
2	An act relating to long-term care services; providing that
3	certain prior offenses shall be considered in conducting
4	employment screening, notwithstanding the provisions of
5	section 64 of ch. 95-228, Laws of Florida; amending s.
6	400.071, F.S.; requiring applicants for licensure as a
7	nursing home to provide proof of a legal right to occupy
8	the property; amending s. 400.414, F.S.; delineating the
9	types and number of deficiencies justifying denial,
10	revocation, or suspension of a license as an assisted
11	living facility; amending s. 400.417, F.S.; providing an
12	alternative method of providing notice to an assisted
13	living facility that a license must be renewed; amending
14	s. 400.419, F.S.; providing that administrative fines for
15	assisted living facilities or its personnel shall be
16	imposed by the Agency for Health Care Administration in
17	the manner provided in ch. 120, F.S.; amending s. 400.441,
18	F.S.; prohibiting the use of certain restraints for
19	discipline or convenience; providing exceptions; amending
20	s. 400.557, F.S.; providing an alternative method of
21	providing notice to an adult day care center that a
22	license must be renewed; amending s. 400.619, F.S.;
23	requiring that the Agency for Health Care Administration
24	provide advance notice to an adult family-care home that a
25	license must be renewed; reenacting and amending s.
26	400.980, F.S.; providing that the provisions governing
27	background screening of persons involved with health care
28	services pools shall not stand repealed; amending s.
29	408.061, F.S.; exempting nursing homes and continuing care
30	facilities from certain financial reporting requirements;
31	amending s. 408.062, F.S.; providing that the Agency for
32	Health Care Administration is not required to evaluate
33	financial reports of nursing homes; amending s. 408.831,
34	F.S.; requiring that licensees of the Agency for Health
35	Care Administration pay or arrange for payment of amounts
36	owed to the agency by the licensee prior to transfer of
37	the license or issuance of a license to a transferee;
38	amending s. 409.9116, F.S.; correcting a cross reference;
39	providing an effective date.
40
41	Be It Enacted by the Legislature of the State of Florida:
42
43	Section 1. Notwithstanding the provisions of section 64 of
44	chapter 95-228, Laws of Florida, the provisions of chapter 435,
45	Florida Statutes, as created therein and as subsequently
46	amended, and any reference thereto, shall apply to all offenses
47	regardless of the date on which offenses referenced in chapter
48	435, Florida Statutes, were committed, unless specifically
49	provided otherwise in a provision other than section 64 of
50	chapter 95-228, Laws of Florida.
51	Section 2. Subsection (12) is added to section 400.071,
52	Florida Statutes, to read:
53	400.071 Application for license.--
54	(12) The applicant must provide the agency with proof of a
55	legal right to occupy the property before a license may be
56	issued. Proof may include, but is not limited to, copies of
57	warranty deeds, lease or rental agreements, contracts for deeds,
58	or quitclaim deeds.
59	Section 3. Subsection (1) of section 400.414, Florida
60	Statutes, is amended to read:
61	400.414 Denial, revocation, or suspension of license;
62	imposition of administrative fine; grounds.--
63	(1) The agency may deny, revoke, or suspend any license
64	issued under this part, or impose an administrative fine in the
65	manner provided in chapter 120, for any of the following actions
66	by an assisted living facility, for the actions ofany person
67	subject to level 2 background screening under s. 400.4174, or
68	for the actions ofany facility employee:
69	(a) An intentional or negligent act seriously affecting
70	the health, safety, or welfare of a resident of the facility.
71	(b) The determination by the agency that the owner lacks
72	the financial ability to provide continuing adequate care to
73	residents.
74	(c) Misappropriation or conversion of the property of a
75	resident of the facility.
76	(d) Failure to follow the criteria and procedures provided
77	under part I of chapter 394 relating to the transportation,
78	voluntary admission, and involuntary examination of a facility
79	resident.
80	(e) A citation of any of the following deficiencies as
81	defined in s. 400.419:
82	1. One or more cited class I deficiencies.
83	2. Three or more cited class II deficiencies.
84	3. Five or more cited class III deficiencies that have
85	been cited on a single survey and have not been corrected within
86	the times specifiedOne or more class I, three or more class II,
87	or five or more repeated or recurring identical or similar class
88	III violations that are similar or identical to violations which
89	were identified by the agency within the last 2 years.
90	(f) A determination that a person subject to level 2
91	background screening under s. 400.4174(1) does not meet the
92	screening standards of s. 435.04 or that the facility is
93	retaining an employee subject to level 1 background screening
94	standards under s. 400.4174(2) who does not meet the screening
95	standards of s. 435.03 and for whom exemptions from
96	disqualification have not been provided by the agency.
97	(g) A determination that an employee, volunteer,
98	administrator, or owner, or person who otherwise has access to
99	the residents of a facility does not meet the criteria specified
100	in s. 435.03(2), and the owner or administrator has not taken
101	action to remove the person. Exemptions from disqualification
102	may be granted as set forth in s. 435.07. No administrative
103	action may be taken against the facility if the person is
104	granted an exemption.
105	(h) Violation of a moratorium.
106	(i) Failure of the license applicant, the licensee during
107	relicensure, or a licensee that holds a provisional license to
108	meet the minimum license requirements of this part, or related
109	rules, at the time of license application or renewal.
110	(j) A fraudulent statement or omission of any material
111	fact on an application for a license or any other document
112	required by the agency, including the submission of a license
113	application that conceals the fact that any board member,
114	officer, or person owning 5 percent or more of the facility may
115	not meet the background screening requirements of s. 400.4174,
116	or that the applicant has been excluded, permanently suspended,
117	or terminated from the Medicaid or Medicare programs.
118	(k) An intentional or negligent life-threatening act in
119	violation of the uniform firesafety standards for assisted
120	living facilities or other firesafety standards that threatens
121	the health, safety, or welfare of a resident of a facility, as
122	communicated to the agency by the local authority having
123	jurisdiction or the State Fire Marshal.
124	(l) Exclusion, permanent suspension, or termination from
125	the Medicare or Medicaid programs.
126	(m) Knowingly operating any unlicensed facility or
127	providing without a license any service that must be licensed
128	under this chapter.
129	(n) Any act constituting a ground upon which application
130	for a license may be denied.
131
132	Administrative proceedings challenging agency action under this
133	subsection shall be reviewed on the basis of the facts and
134	conditions that resulted in the agency action.
135	Section 4. Subsection (1) of section 400.417, Florida
136	Statutes, is amended to read:
137	400.417 Expiration of license; renewal; conditional
138	license.--
139	(1) Biennial licenses, unless sooner suspended or revoked,
140	shall expire 2 years from the date of issuance. Limited nursing,
141	extended congregate care, and limited mental health licenses
142	shall expire at the same time as the facility's standard
143	license, regardless of when issued. The agency shall notify the
144	facility by certified mailat least 120 days prior to expiration
145	that a renewal license is necessary to continue operation. The
146	notification must be provided electronically or by mail
147	delivery.Ninety days prior to the expiration date, an
148	application for renewal shall be submitted to the agency. Fees
149	must be prorated. The failure to file a timely renewal
150	application shall result in a late fee charged to the facility
151	in an amount equal to 50 percent of the current fee.
152	Section 5. Section 400.419, Florida Statutes, is amended
153	to read:
154	400.419 Violations; imposition of administrative fines;
155	grounds.--
156	(1) The agency shall impose an administrative fine in the
157	manner provided in chapter 120 for any of the actions or
158	violations as set forth within this section by an assisted
159	living facility, for the actions of any person subject to level
160	2 background screening under s. 400.4174, for the actions of any
161	facility employee, or for an intentional or negligent act
162	seriously affecting the health, safety, or welfare of a resident
163	of the facility.
164	(2)(1)Each violation of this part and adopted rules shall
165	be classified according to the nature of the violation and the
166	gravity of its probable effect on facility residents. The agency
167	shall indicate the classification on the written notice of the
168	violation as follows:
169	(a) Class "I" violations are those conditions or
170	occurrences related to the operation and maintenance of a
171	facility or to the personal care of residents which the agency
172	determines present an imminent danger to the residents or guests
173	of the facility or a substantial probability that death or
174	serious physical or emotional harm would result therefrom. The
175	condition or practice constituting a class I violation shall be
176	abated or eliminated within 24 hours, unless a fixed period, as
177	determined by the agency, is required for correction. The agency
178	shall impose an administrative fine for a citedclass I
179	violation is subject to an administrative finein an amount not
180	less than $5,000 and not exceeding $10,000 for each violation. A
181	fine may be levied notwithstanding the correction of the
182	violation.
183	(b) Class "II" violations are those conditions or
184	occurrences related to the operation and maintenance of a
185	facility or to the personal care of residents which the agency
186	determines directly threaten the physical or emotional health,
187	safety, or security of the facility residents, other than class
188	I violations. The agency shall impose an administrative fine for
189	a cited class II violation is subject to an administrative fine
190	in an amount not less than $1,000 and not exceeding $5,000 for
191	each violation. A fine shall be levied notwithstanding the
192	correction of the violationA citation for a class II violation
193	must specify the time within which the violation is required to
194	be corrected.
195	(c) Class "III" violations are those conditions or
196	occurrences related to the operation and maintenance of a
197	facility or to the personal care of residents which the agency
198	determines indirectly or potentially threaten the physical or
199	emotional health, safety, or security of facility residents,
200	other than class I or class II violations. The agency shall
201	impose an administrative fine for a cited class III violation in
202	an amountis subject to an administrative fine ofnot less than
203	$500 and not exceeding $1,000 for each violation. A citation for
204	a class III violation must specify the time within which the
205	violation is required to be corrected. If a class III violation
206	is corrected within the time specified, no fine may be imposed,
207	unless it is a repeated offense.
208	(d) Class "IV" violations are those conditions or
209	occurrences related to the operation and maintenance of a
210	building or to required reports, forms, or documents that do not
211	have the potential of negatively affecting residents. These
212	violations are of a type that the agency determines do not
213	threaten the health, safety, or security of residents of the
214	facility. The agency shall impose an administrative fine for a
215	cited class IV violation in an amountA facility that does not
216	correct a class IV violation within the time specified in the
217	agency-approved corrective action plan is subject to an
218	administrative fine of not less than $100 and not exceedingnor
219	more than $200 for each violation. A citation for a class IV
220	violation must specify the time within which the violation is
221	required to be corrected. If a class IV violation is corrected
222	within the time specified, no fine shall be imposed.Any class
223	IV violation that is corrected during the time an agency survey
224	is being conducted will be identified as an agency finding and
225	not as a violation.
226	(3)(2)In determining if a penalty is to be imposed and in
227	fixing the amount of the fine, the agency shall consider the
228	following factors:
229	(a) The gravity of the violation, including the
230	probability that death or serious physical or emotional harm to
231	a resident will result or has resulted, the severity of the
232	action or potential harm, and the extent to which the provisions
233	of the applicable laws or rules were violated.
234	(b) Actions taken by the owner or administrator to correct
235	violations.
236	(c) Any previous violations.
237	(d) The financial benefit to the facility of committing or
238	continuing the violation.
239	(e) The licensed capacity of the facility.
240	(4)(3)Each day of continuing violation after the date
241	fixed for termination of the violation, as ordered by the
242	agency, constitutes an additional, separate, and distinct
243	violation.
244	(5)(4)Any action taken to correct a violation shall be
245	documented in writing by the owner or administrator of the
246	facility and verified through followup visits by agency
247	personnel. The agency may impose a fine and, in the case of an
248	owner-operated facility, revoke or deny a facility's license
249	when a facility administrator fraudulently misrepresents action
250	taken to correct a violation.
251	(6)(5)For fines that are upheld following administrative
252	or judicial review, the violator shall pay the fine, plus
253	interest at the rate as specified in s. 55.03, for each day
254	beyond the date set by the agency for payment of the fine.
255	(7)(6)Any unlicensed facility that continues to operate
256	after agency notification is subject to a $1,000 fine per day.
257	(8)(7)Any licensed facility whose owner or administrator
258	concurrently operates an unlicensed facility shall be subject to
259	an administrative fine of $5,000 per day.
260	(9)(8)Any facility whose owner fails to apply for a
261	change-of-ownership license in accordance with s. 400.412 and
262	operates the facility under the new ownership is subject to a
263	fine of $5,000.
264	(10)(9)In addition to any administrative fines imposed,
265	the agency may assess a survey fee, equal to the lesser of one
266	half of the facility's biennial license and bed fee or $500, to
267	cover the cost of conducting initial complaint investigations
268	that result in the finding of a violation that was the subject
269	of the complaint or monitoring visits conducted under s.
270	400.428(3)(c) to verify the correction of the violations.
271	(11)(10)The agency, as an alternative to or in
272	conjunction with an administrative action against a facility for
273	violations of this part and adopted rules, shall make a
274	reasonable attempt to discuss each violation and recommended
275	corrective action with the owner or administrator of the
276	facility, prior to written notification. The agency, instead of
277	fixing a period within which the facility shall enter into
278	compliance with standards, may request a plan of corrective
279	action from the facility which demonstrates a good faith effort
280	to remedy each violation by a specific date, subject to the
281	approval of the agency.
282	(12)(11)Administrative fines paid by any facility under
283	this section shall be deposited into the Health Care Trust Fund
284	and expended as provided in s. 400.418.
285	(13)(12)The agency shall develop and disseminate an
286	annual list of all facilities sanctioned or fined $5,000 or more
287	for violations of state standards, the number and class of
288	violations involved, the penalties imposed, and the current
289	status of cases. The list shall be disseminated, at no charge,
290	to the Department of Elderly Affairs, the Department of Health,
291	the Department of Children and Family Services, the area
292	agencies on aging, the Florida Statewide Advocacy Council, and
293	the state and local ombudsman councils. The Department of
294	Children and Family Services shall disseminate the list to
295	service providers under contract to the department who are
296	responsible for referring persons to a facility for residency.
297	The agency may charge a fee commensurate with the cost of
298	printing and postage to other interested parties requesting a
299	copy of this list.
300	Section 6. Paragraph (k) of subsection (1) of section
301	400.441, Florida Statutes, is amended to read:
302	400.441 Rules establishing standards.--
303	(1) It is the intent of the Legislature that rules
304	published and enforced pursuant to this section shall include
305	criteria by which a reasonable and consistent quality of
306	resident care and quality of life may be ensured and the results
307	of such resident care may be demonstrated. Such rules shall also
308	ensure a safe and sanitary environment that is residential and
309	noninstitutional in design or nature. It is further intended
310	that reasonable efforts be made to accommodate the needs and
311	preferences of residents to enhance the quality of life in a
312	facility. In order to provide safe and sanitary facilities and
313	the highest quality of resident care accommodating the needs and
314	preferences of residents, the department, in consultation with
315	the agency, the Department of Children and Family Services, and
316	the Department of Health, shall adopt rules, policies, and
317	procedures to administer this part, which must include
318	reasonable and fair minimum standards in relation to:
319	(k) The use of physical or chemical restraints. Restraints
320	shall not be used for discipline or convenience. Assistive
321	devices that areThe use of physical restraints is limited to
322	half-bed rails as prescribed or approvedand documented by the
323	resident's physician with the consent of the resident or, if
324	applicable, the resident's representative or designee or the
325	resident's surrogate, guardian, or attorney in fact are not
326	restraints for purposes of this section. The use of chemical
327	restraints is limited to prescribed dosages of medications
328	authorized by the resident's physician and must be consistent
329	with the resident's diagnosis. Residents who are receiving
330	medications that can serve as chemical restraints must be
331	evaluated by their physician at least annually to assess:
332	1. The continued need for the medication.
333	2. The level of the medication in the resident's blood.
334	3. The need for adjustments in the prescription.
335	Section 7. Subsection (1) of section 400.557, Florida
336	Statutes, is amended to read:
337	400.557 Expiration of license; renewal; conditional
338	license or permit.--
339	(1) A license issued for the operation of an adult day
340	care center, unless sooner suspended or revoked, expires 2 years
341	after the date of issuance. The agency shall notify a licensee
342	by certified mail, return receipt requested,at least 120 days
343	before the expiration date that license renewal is required to
344	continue operation. The notification must be provided
345	electronically or by mail delivery.At least 90 days prior to
346	the expiration date, an application for renewal must be
347	submitted to the agency. A license shall be renewed, upon the
348	filing of an application on forms furnished by the agency, if
349	the applicant has first met the requirements of this part and of
350	the rules adopted under this part. The applicant must file with
351	the application satisfactory proof of financial ability to
352	operate the center in accordance with the requirements of this
353	part and in accordance with the needs of the participants to be
354	served and an affidavit of compliance with the background
355	screening requirements of s. 400.5572.
356	Section 8. Subsection (3) of section 400.619, Florida
357	Statutes, is amended to read:
358	400.619 Licensure application and renewal.--
359	(3) The agency shall notify a licensee at least 120 days
360	before the expiration date that license renewal is required to
361	continue operation. The notification must be provided
362	electronically or by mail delivery.Application for a license or
363	annual license renewal must be made on a form provided by the
364	agency, signed under oath, and must be accompanied by a
365	licensing fee of $100 per year.
366	Section 9. Subsection (4) of section 400.980, Florida
367	Statutes, is reenacted and amended to read:
368	400.980 Health care services pools.--
369	(4) Each applicant for registration must comply with the
370	following requirements:
371	(a) Upon receipt of a completed, signed, and dated
372	application, the agency shall require background screening, in
373	accordance with the level 1 standards for screening set forth in
374	chapter 435, of every individual who will have contact with
375	patients. The agency shall require background screening of the
376	managing employee or other similarly titled individual who is
377	responsible for the operation of the entity, and of the
378	financial officer or other similarly titled individual who is
379	responsible for the financial operation of the entity, including
380	billings for services in accordance with the level 2 standards
381	for background screening as set forth in chapter 435.
382	(b) The agency may require background screening of any
383	other individual who is affiliated with the applicant if the
384	agency has a reasonable basis for believing that he or she has
385	been convicted of a crime or has committed any other offense
386	prohibited under the level 2 standards for screening set forth
387	in chapter 435.
388	(c) Proof of compliance with the level 2 background
389	screening requirements of chapter 435 which has been submitted
390	within the previous 5 years in compliance with any other health
391	care or assisted living licensure requirements of this state is
392	acceptable in fulfillment of paragraph (a).
393	(d) A provisional registration may be granted to an
394	applicant when each individual required by this section to
395	undergo background screening has met the standards for the
396	Department of Law Enforcement background check but the agency
397	has not yet received background screening results from the
398	Federal Bureau of Investigation. A standard registration may be
399	granted to the applicant upon the agency's receipt of a report
400	of the results of the Federal Bureau of Investigation background
401	screening for each individual required by this section to
402	undergo background screening which confirms that all standards
403	have been met, or upon the granting of a disqualification
404	exemption by the agency as set forth in chapter 435. Any other
405	person who is required to undergo level 2 background screening
406	may serve in his or her capacity pending the agency's receipt of
407	the report from the Federal Bureau of Investigation. However,
408	the person may not continue to serve if the report indicates any
409	violation of background screening standards and if a
410	disqualification exemption has not been requested of and granted
411	by the agency as set forth in chapter 435.
412	(e) Each applicant must submit to the agency, with its
413	application, a description and explanation of any exclusions,
414	permanent suspensions, or terminations of the applicant from the
415	Medicare or Medicaid programs. Proof of compliance with the
416	requirements for disclosure of ownership and controlling
417	interests under the Medicaid or Medicare programs may be
418	accepted in lieu of this submission.
419	(f) Each applicant must submit to the agency a description
420	and explanation of any conviction of an offense prohibited under
421	the level 2 standards of chapter 435 which was committed by a
422	member of the board of directors of the applicant, its officers,
423	or any individual owning 5 percent or more of the applicant.
424	This requirement does not apply to a director of a not-for-
425	profit corporation or organization who serves solely in a
426	voluntary capacity for the corporation or organization, does not
427	regularly take part in the day-to-day operational decisions of
428	the corporation or organization, receives no remuneration for
429	his or her services on the corporation's or organization's board
430	of directors, and has no financial interest and no family
431	members having a financial interest in the corporation or
432	organization, if the director and the not-for-profit corporation
433	or organization include in the application a statement affirming
434	that the director's relationship to the corporation satisfies
435	the requirements of this paragraph.
436	(g) A registration may not be granted to an applicant if
437	the applicant or managing employee has been found guilty of,
438	regardless of adjudication, or has entered a plea of nolo
439	contendere or guilty to, any offense prohibited under the level
440	2 standards for screening set forth in chapter 435, unless an
441	exemption from disqualification has been granted by the agency
442	as set forth in chapter 435.
443	(h) The provisions of this section which require an
444	applicant for registration to undergo background screening shall
445	stand repealed on June 30, 2001, unless reviewed and saved from
446	repeal through reenactment by the Legislature.
447	(h)(i)Failure to provide all required documentation
448	within 30 days after a written request from the agency will
449	result in denial of the application for registration.
450	(i)(j)The agency must take final action on an application
451	for registration within 60 days after receipt of all required
452	documentation.
453	(j)(k)The agency may deny, revoke, or suspend the
454	registration of any applicant or registrant who:
455	1. Has falsely represented a material fact in the
456	application required by paragraph (e) or paragraph (f), or has
457	omitted any material fact from the application required by
458	paragraph (e) or paragraph (f); or
459	2. Has had prior action taken against the applicant under
460	the Medicaid or Medicare program as set forth in paragraph (e).
461	3. Fails to comply with this section or applicable rules.
462	4. Commits an intentional, reckless, or negligent act that
463	materially affects the health or safety of a person receiving
464	services.
465	Section 10. Section 408.061, Florida Statutes, is amended
466	to read:
467	408.061 Data collection; uniform systems of financial
468	reporting; information relating to physician charges;
469	confidential information; immunity.--
470	(1) The agency may require the submission by health care
471	facilities, health care providers, and health insurers of data
472	necessary to carry out the agency's duties. Specifications for
473	data to be collected under this section shall be developed by
474	the agency with the assistance of technical advisory panels
475	including representatives of affected entities, consumers,
476	purchasers, and such other interested parties as may be
477	determined by the agency.
478	(a) Data to be submitted by health care facilities may
479	include, but are not limited to: case-mix data, patient
480	admission or discharge data with patient and provider-specific
481	identifiers included, actual charge data by diagnostic groups,
482	financial data, accounting data, operating expenses, expenses
483	incurred for rendering services to patients who cannot or do not
484	pay, interest charges, depreciation expenses based on the
485	expected useful life of the property and equipment involved, and
486	demographic data. Data may be obtained from documents such as,
487	but not limited to: leases, contracts, debt instruments,
488	itemized patient bills, medical record abstracts, and related
489	diagnostic information.
490	(b) Data to be submitted by health care providers may
491	include, but are not limited to: Medicare and Medicaid
492	participation, types of services offered to patients, amount of
493	revenue and expenses of the health care provider, and such other
494	data which are reasonably necessary to study utilization
495	patterns.
496	(c) Data to be submitted by health insurers may include,
497	but are not limited to: claims, premium, administration, and
498	financial information.
499	(d) Data required to be submitted by health care
500	facilities, health care providers, or health insurers shall not
501	include specific provider contract reimbursement information.
502	However, such specific provider reimbursement data shall be
503	reasonably available for onsite inspection by the agency as is
504	necessary to carry out the agency's regulatory duties. Any such
505	data obtained by the agency as a result of onsite inspections
506	may not be used by the state for purposes of direct provider
507	contracting and are confidential and exempt from the provisions
508	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
509	(e) A requirement to submit data shall be adopted by rule
510	if the submission of data is being required of all members of
511	any type of health care facility, health care provider, or
512	health insurer. Rules are not required, however, for the
513	submission of data for a special study mandated by the
514	Legislature or when information is being requested for a single
515	health care facility, health care provider, or health insurer.
516	(2) The agency shall, by rule, after consulting with
517	appropriate professional and governmental advisory bodies and
518	holding public hearings and considering existing and proposed
519	systems of accounting and reporting utilized by health care
520	facilities, specify a uniform system of financial reporting for
521	each type of facility based on a uniform chart of accounts
522	developed after considering any chart of accounts developed by
523	the national association for such facilities and generally
524	accepted accounting principles. Such systems shall, to the
525	extent feasible, use existing accounting systems and shall
526	minimize the paperwork required of facilities. This provision
527	shall not be construed to authorize the agency to require health
528	care facilities to adopt a uniform accounting system. As a part
529	of such uniform system of financial reporting, the agency may
530	require the filing of any information relating to the cost to
531	the provider and the charge to the consumer of any service
532	provided in such facility, except the cost of a physician's
533	services which is billed independently of the facility.
534	(3) When more than one licensed facility is operated by
535	the reporting organization, the information required by this
536	section shall be reported for each facility separately.
537	(4)(a)Within 120 days after the end of its fiscal year,
538	each health care facility, excluding continuing care facilities
539	and nursing homes as defined in s. 408.07(14) and (36),shall
540	file with the agency, on forms adopted by the agency and based
541	on the uniform system of financial reporting, its actual
542	financial experience for that fiscal year, including
543	expenditures, revenues, and statistical measures. Such data may
544	be based on internal financial reports which are certified to be
545	complete and accurate by the provider. However, hospitals'
546	actual financial experience shall be their audited actual
547	experience. Nursing homes that do not participate in the
548	Medicare or Medicaid programs shall also submit audited actual
549	experience.Every nursing home shall submit to the agency, in a
550	format designated by the agency, a statistical profile of the
551	nursing home residents. The agency, in conjunction with the
552	Department of Elderly Affairs and the Department of Health,
553	shall review these statistical profiles and develop
554	recommendations for the types of residents who might more
555	appropriately be placed in their homes or other noninstitutional
556	settings.
557	(b) Each nursing home shall also submit a schedule of the
558	charges in effect at the beginning of the fiscal year and any
559	changes that were made during the fiscal year. A nursing home
560	which is certified under Title XIX of the Social Security Act
561	and files annual Medicaid cost reports may substitute copies of
562	such reports and any Medicaid audits to the agency in lieu of a
563	report and audit required under this subsection. For such
564	facilities, the agency may require only information in
565	compliance with this chapter that is not contained in the
566	Medicaid cost report. Facilities that are certified under Title
567	XVIII, but not Title XIX, of the Social Security Act must submit
568	a report as developed by the agency. This report shall be
569	substantially the same as the Medicaid cost report and shall not
570	require any more information than is contained in the Medicare
571	cost report unless that information is required of all nursing
572	homes. The audit under Title XVIII shall satisfy the audit
573	requirement under this subsection.
574	(5) In addition to information submitted in accordance
575	with subsection (4), each nursing home shall track and file with
576	the agency, on a form adopted by the agency, data related to
577	each resident's admission, discharge, or conversion to Medicaid;
578	health and functional status; plan of care; and other
579	information pertinent to the resident's placement in a nursing
580	home.
581	(6) Any nursing home which assesses residents a separate
582	charge for personal laundry services shall submit to the agency
583	data on the monthly charge for such services, excluding
584	drycleaning. For facilities that charge based on the amount of
585	laundry, the most recent schedule of charges and the average
586	monthly charge shall be submitted to the agency.
587	(6)(7)The agency may require other reports based on the
588	uniform system of financial reporting necessary to accomplish
589	the purposes of this chapter.
590	(7)(8)Portions of patient records obtained or generated
591	by the agency containing the name, residence or business
592	address, telephone number, social security or other identifying
593	number, or photograph of any person or the spouse, relative, or
594	guardian of such person, or any other identifying information
595	which is patient-specific or otherwise identifies the patient,
596	either directly or indirectly, are confidential and exempt from
597	the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
598	Constitution.
599	(8)(9)The identity of any health care provider, health
600	care facility, or health insurer who submits any data which is
601	proprietary business information to the agency pursuant to the
602	provisions of this section shall remain confidential and exempt
603	from the provisions of s. 119.07(1) and s. 24(a), Art. I of the
604	State Constitution. As used in this section, "proprietary
605	business information" shall include, but not be limited to,
606	information relating to specific provider contract reimbursement
607	information; information relating to security measures, systems,
608	or procedures; and information concerning bids or other
609	contractual data, the disclosure of which would impair efforts
610	to contract for goods or services on favorable terms or would
611	injure the affected entity's ability to compete in the
612	marketplace. Notwithstanding the provisions of this subsection,
613	any information obtained or generated pursuant to the provisions
614	of former s. 407.61, either by the former Health Care Cost
615	Containment Board or by the Agency for Health Care
616	Administration upon transfer to that agency of the duties and
617	functions of the former Health Care Cost Containment Board, is
618	not confidential and exempt from the provisions of s. 119.07(1)
619	and s. 24(a), Art. I of the State Constitution. Such proprietary
620	business information may be used in published analyses and
621	reports or otherwise made available for public disclosure in
622	such manner as to preserve the confidentiality of the identity
623	of the provider. This exemption shall not limit the use of any
624	information used in conjunction with investigation or
625	enforcement purposes under the provisions of s. 456.073.
626	(9)(10)No health care facility, health care provider,
627	health insurer, or other reporting entity or its employees or
628	agents shall be held liable for civil damages or subject to
629	criminal penalties either for the reporting of patient data to
630	the agency or for the release of such data by the agency as
631	authorized by this chapter.
632	(10)(11)The agency shall be the primary source for
633	collection and dissemination of health care data. No other
634	agency of state government may gather data from a health care
635	provider licensed or regulated under this chapter without first
636	determining if the data is currently being collected by the
637	agency and affirmatively demonstrating that it would be more
638	cost-effective for an agency of state government other than the
639	agency to gather the health care data. The director shall ensure
640	that health care data collected by the divisions within the
641	agency is coordinated. It is the express intent of the
642	Legislature that all health care data be collected by a single
643	source within the agency and that other divisions within the
644	agency, and all other agencies of state government, obtain data
645	for analysis, regulation, and public dissemination purposes from
646	that single source. Confidential information may be released to
647	other governmental entities or to parties contracting with the
648	agency to perform agency duties or functions as needed in
649	connection with the performance of the duties of the receiving
650	entity. The receiving entity or party shall retain the
651	confidentiality of such information as provided for herein.
652	(11)(12)The agency shall cooperate with local health
653	councils and the state health planning agency with regard to
654	health care data collection and dissemination and shall
655	cooperate with state agencies in any efforts to establish an
656	integrated health care database.
657	(12)(13)It is the policy of this state that philanthropic
658	support for health care should be encouraged and expanded,
659	especially in support of experimental and innovative efforts to
660	improve the health care delivery system.
661	(13)(14)For purposes of determining reasonable costs of
662	services furnished by health care facilities, unrestricted
663	grants, gifts, and income from endowments shall not be deducted
664	from any operating costs of such health care facilities, and, in
665	addition, the following items shall not be deducted from any
666	operating costs of such health care facilities:
667	(a) An unrestricted grant or gift, or income from such a
668	grant or gift, which is not available for use as operating funds
669	because of its designation by the health care facility's
670	governing board.
671	(b) A grant or similar payment which is made by a
672	governmental entity and which is not available, under the terms
673	of the grant or payment, for use as operating funds.
674	(c) The sale or mortgage of any real estate or other
675	capital assets of the health care facility which the health care
676	facility acquired through a gift or grant and which is not
677	available for use as operating funds under the terms of the gift
678	or grant or because of its designation by the health care
679	facility's governing board, except for recovery of the
680	appropriate share of gains and losses realized from the disposal
681	of depreciable assets.
682	Section 11. Section 408.062, Florida Statutes, is amended
683	to read:
684	408.062 Research, analyses, studies, and reports.--
685	(1) The agency shall have the authority to conduct
686	research, analyses, and studies relating to health care costs
687	and access to and quality of health care services as access and
688	quality are affected by changes in health care costs. Such
689	research, analyses, and studies shall include, but not be
690	limited to, research and analysis relating to:
691	(a) The financial status of any health care facility or
692	facilities subject to the provisions of this chapter.
693	(b) The impact of uncompensated charity care on health
694	care facilities and health care providers.
695	(c) The state's role in assisting to fund indigent care.
696	(d) The availability and affordability of health insurance
697	for small businesses.
698	(e) Total health care expenditures in the state according
699	to the sources of payment and the type of expenditure.
700	(f) The quality of health services, using techniques such
701	as small area analysis, severity adjustments, and risk-adjusted
702	mortality rates.
703	(g) The development of physician payment systems which are
704	capable of taking into account the amount of resources consumed
705	and the outcomes produced in the delivery of care.
706	(h) The impact of subacute admissions on hospital revenues
707	and expenses for purposes of calculating adjusted admissions as
708	defined in s. 408.07.
709	(2) The agency shall evaluate data from nursing home
710	financial reports and shall document and monitor:
711	(a) Total revenues, annual change in revenues, and
712	revenues by source and classification, including contributions
713	for a resident's care from the resident's resources and from the
714	family and contributions not directed toward any specific
715	resident's care.
716	(b) Average resident charges by geographic region, payor,
717	and type of facility ownership.
718	(c) Profit margins by geographic region and type of
719	facility ownership.
720	(d) Amount of charity care provided by geographic region
721	and type of facility ownership.
722	(e) Resident days by payor category.
723	(f) Experience related to Medicaid conversion as reported
724	under s. 408.061.
725	(g) Other information pertaining to nursing home revenues
726	and expenditures.
727
728	The findings of the agency shall be included in an annual report
729	to the Governor and Legislature by January 1 each year.
730	(2)(3)The agency may assess annually the caesarean
731	section rate in Florida hospitals using the analysis methodology
732	that the agency determines most appropriate. To assist the
733	agency in determining the impact of this chapter on Florida
734	hospitals' caesarean section rates, each provider hospital, as
735	defined in s. 383.336, shall notify the agency of the date of
736	implementation of the practice parameters and the date of the
737	first meeting of the hospital peer review board created pursuant
738	to this chapter. The agency shall use these dates in monitoring
739	any change in provider hospital caesarean section rates. An
740	annual report based on this monitoring and assessment shall be
741	submitted to the Governor, the Speaker of the House of
742	Representatives, and the President of the Senate by the agency,
743	with the first annual report due January 1, 1993.
744	(3)(4)The agency may also prepare such summaries and
745	compilations or other supplementary reports based on the
746	information analyzed by the agency under this section, as will
747	advance the purposes of this chapter.
748	(4)(5)(a) The agency may conduct data-based studies and
749	evaluations and make recommendations to the Legislature and the
750	Governor concerning exemptions, the effectiveness of limitations
751	of referrals, restrictions on investment interests and
752	compensation arrangements, and the effectiveness of public
753	disclosure. Such analysis may include, but need not be limited
754	to, utilization of services, cost of care, quality of care, and
755	access to care. The agency may require the submission of data
756	necessary to carry out this duty, which may include, but need
757	not be limited to, data concerning ownership, Medicare and
758	Medicaid, charity care, types of services offered to patients,
759	revenues and expenses, patient-encounter data, and other data
760	reasonably necessary to study utilization patterns and the
761	impact of health care provider ownership interests in health-
762	care-related entities on the cost, quality, and accessibility of
763	health care.
764	(b) The agency may collect such data from any health
765	facility as a special study.
766	Section 12. Subsection (2) of section 408.831, Florida
767	Statutes, is renumbered as subsection (3) and a new subsection
768	(2) is added to said section to read:
769	408.831 Denial, suspension, or revocation of a license,
770	registration, certificate, or application.--
771	(2) In reviewing any application requesting a change of
772	ownership or change of the licensee, registrant, or certificate
773	holder, the transferor shall, prior to agency approval of the
774	change, repay or make arrangements to repay any amounts owed to
775	the agency. Should the transferor fail to repay or make
776	arrangements to repay the amounts owed to the agency, the
777	issuance of a license, registration, or certificate to the
778	transferee shall be delayed until repayment or until
779	arrangements for repayment are made.
780	Section 13. Subsection (1) of section 409.9116, Florida
781	Statutes, is amended to read:
782	409.9116 Disproportionate share/financial assistance
783	program for rural hospitals.--In addition to the payments made
784	under s. 409.911, the Agency for Health Care Administration
785	shall administer a federally matched disproportionate share
786	program and a state-funded financial assistance program for
787	statutory rural hospitals. The agency shall make
788	disproportionate share payments to statutory rural hospitals
789	that qualify for such payments and financial assistance payments
790	to statutory rural hospitals that do not qualify for
791	disproportionate share payments. The disproportionate share
792	program payments shall be limited by and conform with federal
793	requirements. Funds shall be distributed quarterly in each
794	fiscal year for which an appropriation is made. Notwithstanding
795	the provisions of s. 409.915, counties are exempt from
796	contributing toward the cost of this special reimbursement for
797	hospitals serving a disproportionate share of low-income
798	patients.
799	(1) The following formula shall be used by the agency to
800	calculate the total amount earned for hospitals that participate
801	in the rural hospital disproportionate share program or the
802	financial assistance program:
803
804	TAERH = (CCD + MDD)/TPD
805
806	Where:
807	CCD = total charity care-other, plus charity care-Hill-
808	Burton, minus 50 percent of unrestricted tax revenue from local
809	governments, and restricted funds for indigent care, divided by
810	gross revenue per adjusted patient day; however, if CCD is less
811	than zero, then zero shall be used for CCD.
812	MDD = Medicaid inpatient days plus Medicaid HMO inpatient
813	days.
814	TPD = total inpatient days.
815	TAERH = total amount earned by each rural hospital.
816
817	In computing the total amount earned by each rural hospital, the
818	agency must use the most recent actual data reported in
819	accordance with s. 408.061(4)(a).
820	Section 14. This act shall take effect upon becoming a
821	law.