HB 1871 2003
1	CHAMBER ACTION
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6	The Committee on Appropriations recommends the following:
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8	Committee Substitute
9	Remove the entire bill and insert:
10	A bill to be entitled
11	An act relating to long-term care services; providing that
12	certain prior offenses shall be considered in conducting
13	employment screening, notwithstanding the provisions of
14	section 64 of ch. 95-228, Laws of Florida; amending s.
15	400.071, F.S.; requiring applicants for licensure as a
16	nursing home to provide proof of a legal right to occupy
17	the property; amending s. 400.414, F.S.; delineating the
18	types and number of deficiencies justifying denial,
19	revocation, or suspension of a license as an assisted
20	living facility; amending s. 400.417, F.S.; providing an
21	alternative method of providing notice to an assisted
22	living facility that a license must be renewed; amending
23	s. 400.419, F.S.; providing that administrative fines for
24	assisted living facilities or its personnel shall be
25	imposed by the Agency for Health Care Administration in
26	the manner provided in ch. 120, F.S.; amending s.
27	400.0239, F.S.; providing for deposit of civil monetary
28	fines in the Quality of Long-Term Care Facility
29	Improvement Trust Fund; providing for additional purposes
30	for which funds from such trust fund may be expended;
31	amending s. 400.141, F.S.; providing for enforcement of
32	minimum-staffing standards for nursing facilities within a
33	range; amending s. 400.235, F.S.; allowing reviewed
34	financial statements to be submitted for the Gold Seal
35	Program; amending s. 400.452, F.S.; revising training and
36	education requirements of the Department of Elderly
37	Affairs for assisted living facilities; deleting a
38	requirement that fees for training and education programs
39	be based on the percentage of residents receiving monthly
40	optional supplementation payments; amending s. 430.502,
41	F.S.; requiring the Agency for Health Care Administration
42	and the Department of Health to seek and implement a
43	Medicaid home and community-based waiver for persons with
44	Alzheimer's disease; requiring the development of waiver
45	program standards; providing for consultation with the
46	presiding officers of the Legislature; providing for a
47	contingent future repeal of such waiver program; amending
48	s. 400.557, F.S.; providing an alternative method of
49	providing notice to an adult day care center that a
50	license must be renewed; amending s. 400.619, F.S.;
51	requiring that the Agency for Health Care Administration
52	provide advance notice to an adult family-care home that a
53	license must be renewed; reenacting and amending s.
54	400.980, F.S.; providing that the provisions governing
55	background screening of persons involved with health care
56	services pools shall not stand repealed; amending s.
57	408.061, F.S.; exempting nursing homes and continuing care
58	facilities from certain financial reporting requirements;
59	amending s. 408.062, F.S.; providing that the Agency for
60	Health Care Administration is not required to evaluate
61	financial reports of nursing homes; amending s. 408.831,
62	F.S.; requiring that licensees of the Agency for Health
63	Care Administration pay or arrange for payment of amounts
64	owed to the agency by the licensee prior to transfer of
65	the license or issuance of a license to a transferee;
66	amending s. 409.9116, F.S.; correcting a cross reference;
67	providing an effective date.
68
69	Be It Enacted by the Legislature of the State of Florida:
70
71	Section 1. Notwithstanding the provisions of section 64 of
72	chapter 95-228, Laws of Florida, the provisions of chapter 435,
73	Florida Statutes, as created therein and as subsequently
74	amended, and any reference thereto, shall apply to all offenses
75	regardless of the date on which offenses referenced in chapter
76	435, Florida Statutes, were committed, unless specifically
77	provided otherwise in a provision other than section 64 of
78	chapter 95-228, Laws of Florida.
79	Section 2. Subsection (12) is added to section 400.071,
80	Florida Statutes, to read:
81	400.071 Application for license.--
82	(12) The applicant must provide the agency with proof of a
83	legal right to occupy the property before a license may be
84	issued. Proof may include, but is not limited to, copies of
85	warranty deeds, lease or rental agreements, contracts for deeds,
86	or quitclaim deeds.
87	Section 3. Subsection (1) of section 400.414, Florida
88	Statutes, is amended to read:
89	400.414 Denial, revocation, or suspension of license;
90	imposition of administrative fine; grounds.--
91	(1) The agency may deny, revoke, or suspend any license
92	issued under this part, or impose an administrative fine in the
93	manner provided in chapter 120, for any of the following actions
94	by an assisted living facility, for the actions ofany person
95	subject to level 2 background screening under s. 400.4174, or
96	for the actions ofany facility employee:
97	(a) An intentional or negligent act seriously affecting
98	the health, safety, or welfare of a resident of the facility.
99	(b) The determination by the agency that the owner lacks
100	the financial ability to provide continuing adequate care to
101	residents.
102	(c) Misappropriation or conversion of the property of a
103	resident of the facility.
104	(d) Failure to follow the criteria and procedures provided
105	under part I of chapter 394 relating to the transportation,
106	voluntary admission, and involuntary examination of a facility
107	resident.
108	(e) A citation of any of the following deficiencies as
109	defined in s. 400.419:
110	1. One or more cited class I deficiencies.
111	2. Three or more cited class II deficiencies.
112	3. Five or more cited class III deficiencies that have
113	been cited on a single survey and have not been corrected within
114	the times specifiedOne or more class I, three or more class II,
115	or five or more repeated or recurring identical or similar class
116	III violations that are similar or identical to violations which
117	were identified by the agency within the last 2 years.
118	(f) A determination that a person subject to level 2
119	background screening under s. 400.4174(1) does not meet the
120	screening standards of s. 435.04 or that the facility is
121	retaining an employee subject to level 1 background screening
122	standards under s. 400.4174(2) who does not meet the screening
123	standards of s. 435.03 and for whom exemptions from
124	disqualification have not been provided by the agency.
125	(g) A determination that an employee, volunteer,
126	administrator, or owner, or person who otherwise has access to
127	the residents of a facility does not meet the criteria specified
128	in s. 435.03(2), and the owner or administrator has not taken
129	action to remove the person. Exemptions from disqualification
130	may be granted as set forth in s. 435.07. No administrative
131	action may be taken against the facility if the person is
132	granted an exemption.
133	(h) Violation of a moratorium.
134	(i) Failure of the license applicant, the licensee during
135	relicensure, or a licensee that holds a provisional license to
136	meet the minimum license requirements of this part, or related
137	rules, at the time of license application or renewal.
138	(j) A fraudulent statement or omission of any material
139	fact on an application for a license or any other document
140	required by the agency, including the submission of a license
141	application that conceals the fact that any board member,
142	officer, or person owning 5 percent or more of the facility may
143	not meet the background screening requirements of s. 400.4174,
144	or that the applicant has been excluded, permanently suspended,
145	or terminated from the Medicaid or Medicare programs.
146	(k) An intentional or negligent life-threatening act in
147	violation of the uniform firesafety standards for assisted
148	living facilities or other firesafety standards that threatens
149	the health, safety, or welfare of a resident of a facility, as
150	communicated to the agency by the local authority having
151	jurisdiction or the State Fire Marshal.
152	(l) Exclusion, permanent suspension, or termination from
153	the Medicare or Medicaid programs.
154	(m) Knowingly operating any unlicensed facility or
155	providing without a license any service that must be licensed
156	under this chapter.
157	(n) Any act constituting a ground upon which application
158	for a license may be denied.
159
160	Administrative proceedings challenging agency action under this
161	subsection shall be reviewed on the basis of the facts and
162	conditions that resulted in the agency action.
163	Section 4. Subsection (1) of section 400.417, Florida
164	Statutes, is amended to read:
165	400.417 Expiration of license; renewal; conditional
166	license.--
167	(1) Biennial licenses, unless sooner suspended or revoked,
168	shall expire 2 years from the date of issuance. Limited nursing,
169	extended congregate care, and limited mental health licenses
170	shall expire at the same time as the facility's standard
171	license, regardless of when issued. The agency shall notify the
172	facility by certified mailat least 120 days prior to expiration
173	that a renewal license is necessary to continue operation. The
174	notification must be provided electronically or by mail
175	delivery.Ninety days prior to the expiration date, an
176	application for renewal shall be submitted to the agency. Fees
177	must be prorated. The failure to file a timely renewal
178	application shall result in a late fee charged to the facility
179	in an amount equal to 50 percent of the current fee.
180	Section 5. Section 400.419, Florida Statutes, is amended
181	to read:
182	400.419 Violations; imposition of administrative fines;
183	grounds.--
184	(1) The agency shall impose an administrative fine in the
185	manner provided in chapter 120 for any of the actions or
186	violations as set forth within this section by an assisted
187	living facility, for the actions of any person subject to level
188	2 background screening under s. 400.4174, for the actions of any
189	facility employee, or for an intentional or negligent act
190	seriously affecting the health, safety, or welfare of a resident
191	of the facility.
192	(2)(1)Each violation of this part and adopted rules shall
193	be classified according to the nature of the violation and the
194	gravity of its probable effect on facility residents. The agency
195	shall indicate the classification on the written notice of the
196	violation as follows:
197	(a) Class "I" violations are those conditions or
198	occurrences related to the operation and maintenance of a
199	facility or to the personal care of residents which the agency
200	determines present an imminent danger to the residents or guests
201	of the facility or a substantial probability that death or
202	serious physical or emotional harm would result therefrom. The
203	condition or practice constituting a class I violation shall be
204	abated or eliminated within 24 hours, unless a fixed period, as
205	determined by the agency, is required for correction. The agency
206	shall impose an administrative fine for a citedclass I
207	violation is subject to an administrative finein an amount not
208	less than $5,000 and not exceeding $10,000 for each violation. A
209	fine may be levied notwithstanding the correction of the
210	violation.
211	(b) Class "II" violations are those conditions or
212	occurrences related to the operation and maintenance of a
213	facility or to the personal care of residents which the agency
214	determines directly threaten the physical or emotional health,
215	safety, or security of the facility residents, other than class
216	I violations. The agency shall impose an administrative fine for
217	a cited class II violation is subject to an administrative fine
218	in an amount not less than $1,000 and not exceeding $5,000 for
219	each violation. A fine shall be levied notwithstanding the
220	correction of the violationA citation for a class II violation
221	must specify the time within which the violation is required to
222	be corrected.
223	(c) Class "III" violations are those conditions or
224	occurrences related to the operation and maintenance of a
225	facility or to the personal care of residents which the agency
226	determines indirectly or potentially threaten the physical or
227	emotional health, safety, or security of facility residents,
228	other than class I or class II violations. The agency shall
229	impose an administrative fine for a cited class III violation in
230	an amountis subject to an administrative fine ofnot less than
231	$500 and not exceeding $1,000 for each violation. A citation for
232	a class III violation must specify the time within which the
233	violation is required to be corrected. If a class III violation
234	is corrected within the time specified, no fine may be imposed,
235	unless it is a repeated offense.
236	(d) Class "IV" violations are those conditions or
237	occurrences related to the operation and maintenance of a
238	building or to required reports, forms, or documents that do not
239	have the potential of negatively affecting residents. These
240	violations are of a type that the agency determines do not
241	threaten the health, safety, or security of residents of the
242	facility. The agency shall impose an administrative fine for a
243	cited class IV violation in an amountA facility that does not
244	correct a class IV violation within the time specified in the
245	agency-approved corrective action plan is subject to an
246	administrative fine of not less than $100 and not exceedingnor
247	more than $200 for each violation. A citation for a class IV
248	violation must specify the time within which the violation is
249	required to be corrected. If a class IV violation is corrected
250	within the time specified, no fine shall be imposed.Any class
251	IV violation that is corrected during the time an agency survey
252	is being conducted will be identified as an agency finding and
253	not as a violation.
254	(3)(2)In determining if a penalty is to be imposed and in
255	fixing the amount of the fine, the agency shall consider the
256	following factors:
257	(a) The gravity of the violation, including the
258	probability that death or serious physical or emotional harm to
259	a resident will result or has resulted, the severity of the
260	action or potential harm, and the extent to which the provisions
261	of the applicable laws or rules were violated.
262	(b) Actions taken by the owner or administrator to correct
263	violations.
264	(c) Any previous violations.
265	(d) The financial benefit to the facility of committing or
266	continuing the violation.
267	(e) The licensed capacity of the facility.
268	(4)(3)Each day of continuing violation after the date
269	fixed for termination of the violation, as ordered by the
270	agency, constitutes an additional, separate, and distinct
271	violation.
272	(5)(4)Any action taken to correct a violation shall be
273	documented in writing by the owner or administrator of the
274	facility and verified through followup visits by agency
275	personnel. The agency may impose a fine and, in the case of an
276	owner-operated facility, revoke or deny a facility's license
277	when a facility administrator fraudulently misrepresents action
278	taken to correct a violation.
279	(6)(5)For fines that are upheld following administrative
280	or judicial review, the violator shall pay the fine, plus
281	interest at the rate as specified in s. 55.03, for each day
282	beyond the date set by the agency for payment of the fine.
283	(7)(6)Any unlicensed facility that continues to operate
284	after agency notification is subject to a $1,000 fine per day.
285	(8)(7)Any licensed facility whose owner or administrator
286	concurrently operates an unlicensed facility shall be subject to
287	an administrative fine of $5,000 per day.
288	(9)(8)Any facility whose owner fails to apply for a
289	change-of-ownership license in accordance with s. 400.412 and
290	operates the facility under the new ownership is subject to a
291	fine of $5,000.
292	(10)(9)In addition to any administrative fines imposed,
293	the agency may assess a survey fee, equal to the lesser of one
294	half of the facility's biennial license and bed fee or $500, to
295	cover the cost of conducting initial complaint investigations
296	that result in the finding of a violation that was the subject
297	of the complaint or monitoring visits conducted under s.
298	400.428(3)(c) to verify the correction of the violations.
299	(11)(10)The agency, as an alternative to or in
300	conjunction with an administrative action against a facility for
301	violations of this part and adopted rules, shall make a
302	reasonable attempt to discuss each violation and recommended
303	corrective action with the owner or administrator of the
304	facility, prior to written notification. The agency, instead of
305	fixing a period within which the facility shall enter into
306	compliance with standards, may request a plan of corrective
307	action from the facility which demonstrates a good faith effort
308	to remedy each violation by a specific date, subject to the
309	approval of the agency.
310	(12)(11)Administrative fines paid by any facility under
311	this section shall be deposited into the Health Care Trust Fund
312	and expended as provided in s. 400.418.
313	(13)(12)The agency shall develop and disseminate an
314	annual list of all facilities sanctioned or fined $5,000 or more
315	for violations of state standards, the number and class of
316	violations involved, the penalties imposed, and the current
317	status of cases. The list shall be disseminated, at no charge,
318	to the Department of Elderly Affairs, the Department of Health,
319	the Department of Children and Family Services, the area
320	agencies on aging, the Florida Statewide Advocacy Council, and
321	the state and local ombudsman councils. The Department of
322	Children and Family Services shall disseminate the list to
323	service providers under contract to the department who are
324	responsible for referring persons to a facility for residency.
325	The agency may charge a fee commensurate with the cost of
326	printing and postage to other interested parties requesting a
327	copy of this list.
328	Section 6. Subsections (1) and (2) of section 400.0239,
329	Florida Statutes, are amended to read:
330	400.0239 Quality of Long-Term Care Facility Improvement
331	Trust Fund.--
332	(1) There is created within the Agency for Health Care
333	Administration a Quality of Long-Term Care Facility Improvement
334	Trust Fund to support activities and programs directly related
335	to improvement of the care of nursing home and assisted living
336	facility residents. The trust fund shall be funded through
337	proceeds generated pursuant to ss. 400.0238 and 400.4298,
338	through funds specifically appropriated by the Legislature, and
339	through gifts, endowments, and other charitable contributions
340	allowed under federal and state law, and through federal nursing
341	home civil monetary penalties collected by the Centers for
342	Medicare and Medicaid Services and returned to the state. These
343	funds must be utilized in accordance with federal requirements.
344	(2) Expenditures from the trust fund shall be allowable
345	for direct support of the following:
346	(a) Development and operation of a mentoring program, in
347	consultation with the Department of Health and the Department of
348	Elderly Affairs, for increasing the competence, professionalism,
349	and career preparation of long-term care facility direct care
350	staff, including nurses, nursing assistants, and social service
351	and dietary personnel.
352	(b) Development and implementation of specialized training
353	programs for long-term care facility personnel who provide
354	direct care for residents with Alzheimer's disease and other
355	dementias, residents at risk of developing pressure sores, and
356	residents with special nutrition and hydration needs.
357	(c) Addressing areas of deficient practice identified
358	through regulation or state monitoring.
359	(d)(c)Provision of economic and other incentives to
360	enhance the stability and career development of the nursing home
361	direct care workforce, including paid sabbaticals for exemplary
362	direct care career staff to visit facilities throughout the
363	state to train and motivate younger workers to commit to careers
364	in long-term care.
365	(e)(d)Promotion and support for the formation and active
366	involvement of resident and family councils in the improvement
367	of nursing home care.
368	(f) Evaluation of special residents' needs in long-term
369	care facilities, including challenges in meeting special
370	residents' needs, appropriateness of placement and setting, and
371	cited deficiencies related to caring for special needs.
372	(g) Other initiatives authorized by the Centers for
373	Medicare and Medicaid Services for the use of federal civil
374	monetary penalties, including projects recommended through the
375	Medicaid "Up-or-Out" Quality of Care Contract Management Program
376	pursuant to s. 400.148.
377	Section 7. Paragraph (d) of subsection (15) of section
378	400.141, Florida Statutes, is amended, and a new paragraph (e)
379	is added to said subsection, to read:
380	400.141 Administration and management of nursing home
381	facilities.--Every licensed facility shall comply with all
382	applicable standards and rules of the agency and shall:
383	(15) Submit semiannually to the agency, or more frequently
384	if requested by the agency, information regarding facility
385	staff-to-resident ratios, staff turnover, and staff stability,
386	including information regarding certified nursing assistants,
387	licensed nurses, the director of nursing, and the facility
388	administrator. For purposes of this reporting:
389	(d) A nursing facility that has failed to maintain
390	certified nursing assistant staffing of at least 95 percent of
391	thecomply with state minimum-staffing requirements on any day
392	or has certified nursing assistant staffing that is below the
393	minimum requirements provided in s. 400.23(3)(a)for 2
394	consecutive days is prohibited from accepting new admissions
395	until the facility has achieved the minimum-staffing
396	requirements for a period of 6 consecutive days. For the
397	purposes of this paragraph, any person who was a resident of the
398	facility and was absent from the facility for the purpose of
399	receiving medical care at a separate location or was on a leave
400	of absence is not considered a new admission. Failure to impose
401	such an admissions moratorium constitutes a class II deficiency.
402	(e) A nursing facility may be cited for failure to comply
403	with the standards for certified nursing assistants in s.
404	400.23(3)(a) only if it has failed to meet those standards on 2
405	consecutive days or if it has failed to meet at least 95 percent
406	of those standards on any one day. Nothing in this section shall
407	limit the agency’s ability to impose a deficiency or take other
408	actions if a facility does not have enough staff to meet the
409	residents’ needs.
410
411	Facilities that have been awarded a Gold Seal under the program
412	established in s. 400.235 may develop a plan to provide
413	certified nursing assistant training as prescribed by federal
414	regulations and state rules and may apply to the agency for
415	approval of their program.
416	Section 8. Paragraph (b) of subsection (5) of section
417	400.235, Florida Statutes, is amended to read:
418	400.235 Nursing home quality and licensure status; Gold
419	Seal Program.--
420	(5) Facilities must meet the following additional criteria
421	for recognition as a Gold Seal Program facility:
422	(b) Evidence financial soundness and stability according
423	to standards adopted by the agency in administrative rule. Such
424	standards must include, but not be limited to, criteria for the
425	use of financial statements that are prepared in accordance with
426	generally accepted accounting principles and that are reviewed
427	or audited by certified public accountants.
428
429	A facility assigned a conditional licensure status may not
430	qualify for consideration for the Gold Seal Program until after
431	it has operated for 30 months with no class I or class II
432	deficiencies and has completed a regularly scheduled relicensure
433	survey.
434	Section 9. Subsections (1), (2), (7), (8), and (9) of
435	section 400.452, Florida Statutes, are amended to read:
436	400.452 Staff training and educational programs; core
437	educational requirement.--
438	(1) The department shall ensure thatprovide, or cause to
439	be provided, training and educational programs forthe
440	administrators and other assisted living facility staff have met
441	training and education requirements thatto betterenable them
442	to appropriately respond to the needs of residents, to maintain
443	resident care and facility standards, and to meet licensure
444	requirements.
445	(2) The department shall alsoestablish a core educational
446	requirement to be used in these programs. Successful completion
447	of the core educational requirement must include successful
448	completion of a competency test. Programs must be provided by
449	the department or by a provider approved by the department at
450	least quarterly.The core educational requirement must cover at
451	least the following topics:
452	(a) State law and rules relating to assisted living
453	facilities.
454	(b) Resident rights and identifying and reporting abuse,
455	neglect, and exploitation.
456	(c) Special needs of elderly persons, persons with mental
457	illness, and persons with developmental disabilities and how to
458	meet those needs.
459	(d) Nutrition and food service, including acceptable
460	sanitation practices for preparing, storing, and serving food.
461	(e) Medication management, recordkeeping, and proper
462	techniques for assisting residents with self-administered
463	medication.
464	(f) Firesafety requirements, including fire evacuation
465	drill procedures and other emergency procedures.
466	(g) Care of persons with Alzheimer's disease and related
467	disorders.
468	(7) A facility that does not have any residents who
469	receive monthly optional supplementation payments must pay a
470	reasonable fee for such training and education programs. A
471	facility that has one or more such residents shall pay a reduced
472	fee that is proportional to the percentage of such residents in
473	the facility. Any facility more than 90 percent of whose
474	residents receive monthly optional state supplementation
475	payments is not required to pay for the training and continuing
476	education programs required under this section.
477	(7)(8)If the department or the agency determines that
478	there are problems in a facility that could be reduced through
479	specific staff training or education beyond that already
480	required under this section, the department or the agency may
481	require, and provide, or cause to be provided, the training or
482	education of any personal care staff in the facility.
483	(8)(9)The department shall adopt rules to establish
484	training programs, standards and curriculum for training, staff
485	training requirements, procedures for approving training
486	programs, and training fees.
487	Section 10. Subsections (7), (8), and (9) are added to
488	section 430.502, Florida Statutes, to read:
489	430.502 Alzheimer's disease; memory disorder clinics and
490	day care and respite care programs.--
491	(7) The Agency for Health Care Administration and the
492	department shall seek a federal waiver to implement a Medicaid
493	home and community-based waiver targeted to persons with
494	Alzheimer's disease to test the effectiveness of Alzheimer’s
495	specific interventions to delay or to avoid institutional
496	placement.
497	(8) The department will implement the waiver program
498	specified in subsection (7). The agency and the department shall
499	ensure that providers are selected that have a history of
500	successfully serving persons with Alzheimer's disease. The
501	department and the agency shall develop specialized standards
502	for providers and services tailored to persons in the early,
503	middle, and late stages of Alzheimer's disease and designate a
504	level of care determination process and standard that is most
505	appropriate to this population. The department and the agency
506	shall include in the waiver services designed to assist the
507	caregiver in continuing to provide in-home care. The department
508	shall implement this waiver program subject to a specific
509	appropriation or as provided in the General Appropriations Act.
510	The department and the agency shall submit their program design
511	to the President of the Senate and the Speaker of the House of
512	Representatives for consultation during the development process.
513	(9) Authority to continue the waiver program specified in
514	subsection (7) shall be automatically eliminated at the close of
515	the 2008 Regular Session of the Legislature unless further
516	legislative action is taken to continue it prior to such time.
517	Section 11. Subsection (1) of section 400.557, Florida
518	Statutes, is amended to read:
519	400.557 Expiration of license; renewal; conditional
520	license or permit.--
521	(1) A license issued for the operation of an adult day
522	care center, unless sooner suspended or revoked, expires 2 years
523	after the date of issuance. The agency shall notify a licensee
524	by certified mail, return receipt requested,at least 120 days
525	before the expiration date that license renewal is required to
526	continue operation. The notification must be provided
527	electronically or by mail delivery.At least 90 days prior to
528	the expiration date, an application for renewal must be
529	submitted to the agency. A license shall be renewed, upon the
530	filing of an application on forms furnished by the agency, if
531	the applicant has first met the requirements of this part and of
532	the rules adopted under this part. The applicant must file with
533	the application satisfactory proof of financial ability to
534	operate the center in accordance with the requirements of this
535	part and in accordance with the needs of the participants to be
536	served and an affidavit of compliance with the background
537	screening requirements of s. 400.5572.
538	Section 12. Subsection (3) of section 400.619, Florida
539	Statutes, is amended to read:
540	400.619 Licensure application and renewal.--
541	(3) The agency shall notify a licensee at least 120 days
542	before the expiration date that license renewal is required to
543	continue operation. The notification must be provided
544	electronically or by mail delivery.Application for a license or
545	annual license renewal must be made on a form provided by the
546	agency, signed under oath, and must be accompanied by a
547	licensing fee of $100 per year.
548	Section 13. Subsection (4) of section 400.980, Florida
549	Statutes, is reenacted and amended to read:
550	400.980 Health care services pools.--
551	(4) Each applicant for registration must comply with the
552	following requirements:
553	(a) Upon receipt of a completed, signed, and dated
554	application, the agency shall require background screening, in
555	accordance with the level 1 standards for screening set forth in
556	chapter 435, of every individual who will have contact with
557	patients. The agency shall require background screening of the
558	managing employee or other similarly titled individual who is
559	responsible for the operation of the entity, and of the
560	financial officer or other similarly titled individual who is
561	responsible for the financial operation of the entity, including
562	billings for services in accordance with the level 2 standards
563	for background screening as set forth in chapter 435.
564	(b) The agency may require background screening of any
565	other individual who is affiliated with the applicant if the
566	agency has a reasonable basis for believing that he or she has
567	been convicted of a crime or has committed any other offense
568	prohibited under the level 2 standards for screening set forth
569	in chapter 435.
570	(c) Proof of compliance with the level 2 background
571	screening requirements of chapter 435 which has been submitted
572	within the previous 5 years in compliance with any other health
573	care or assisted living licensure requirements of this state is
574	acceptable in fulfillment of paragraph (a).
575	(d) A provisional registration may be granted to an
576	applicant when each individual required by this section to
577	undergo background screening has met the standards for the
578	Department of Law Enforcement background check but the agency
579	has not yet received background screening results from the
580	Federal Bureau of Investigation. A standard registration may be
581	granted to the applicant upon the agency's receipt of a report
582	of the results of the Federal Bureau of Investigation background
583	screening for each individual required by this section to
584	undergo background screening which confirms that all standards
585	have been met, or upon the granting of a disqualification
586	exemption by the agency as set forth in chapter 435. Any other
587	person who is required to undergo level 2 background screening
588	may serve in his or her capacity pending the agency's receipt of
589	the report from the Federal Bureau of Investigation. However,
590	the person may not continue to serve if the report indicates any
591	violation of background screening standards and if a
592	disqualification exemption has not been requested of and granted
593	by the agency as set forth in chapter 435.
594	(e) Each applicant must submit to the agency, with its
595	application, a description and explanation of any exclusions,
596	permanent suspensions, or terminations of the applicant from the
597	Medicare or Medicaid programs. Proof of compliance with the
598	requirements for disclosure of ownership and controlling
599	interests under the Medicaid or Medicare programs may be
600	accepted in lieu of this submission.
601	(f) Each applicant must submit to the agency a description
602	and explanation of any conviction of an offense prohibited under
603	the level 2 standards of chapter 435 which was committed by a
604	member of the board of directors of the applicant, its officers,
605	or any individual owning 5 percent or more of the applicant.
606	This requirement does not apply to a director of a not-for-
607	profit corporation or organization who serves solely in a
608	voluntary capacity for the corporation or organization, does not
609	regularly take part in the day-to-day operational decisions of
610	the corporation or organization, receives no remuneration for
611	his or her services on the corporation's or organization's board
612	of directors, and has no financial interest and no family
613	members having a financial interest in the corporation or
614	organization, if the director and the not-for-profit corporation
615	or organization include in the application a statement affirming
616	that the director's relationship to the corporation satisfies
617	the requirements of this paragraph.
618	(g) A registration may not be granted to an applicant if
619	the applicant or managing employee has been found guilty of,
620	regardless of adjudication, or has entered a plea of nolo
621	contendere or guilty to, any offense prohibited under the level
622	2 standards for screening set forth in chapter 435, unless an
623	exemption from disqualification has been granted by the agency
624	as set forth in chapter 435.
625	(h) The provisions of this section which require an
626	applicant for registration to undergo background screening shall
627	stand repealed on June 30, 2001, unless reviewed and saved from
628	repeal through reenactment by the Legislature.
629	(h)(i)Failure to provide all required documentation
630	within 30 days after a written request from the agency will
631	result in denial of the application for registration.
632	(i)(j)The agency must take final action on an application
633	for registration within 60 days after receipt of all required
634	documentation.
635	(j)(k)The agency may deny, revoke, or suspend the
636	registration of any applicant or registrant who:
637	1. Has falsely represented a material fact in the
638	application required by paragraph (e) or paragraph (f), or has
639	omitted any material fact from the application required by
640	paragraph (e) or paragraph (f); or
641	2. Has had prior action taken against the applicant under
642	the Medicaid or Medicare program as set forth in paragraph (e).
643	3. Fails to comply with this section or applicable rules.
644	4. Commits an intentional, reckless, or negligent act that
645	materially affects the health or safety of a person receiving
646	services.
647	Section 14. Section 408.061, Florida Statutes, is amended
648	to read:
649	408.061 Data collection; uniform systems of financial
650	reporting; information relating to physician charges;
651	confidential information; immunity.--
652	(1) The agency may require the submission by health care
653	facilities, health care providers, and health insurers of data
654	necessary to carry out the agency's duties. Specifications for
655	data to be collected under this section shall be developed by
656	the agency with the assistance of technical advisory panels
657	including representatives of affected entities, consumers,
658	purchasers, and such other interested parties as may be
659	determined by the agency.
660	(a) Data to be submitted by health care facilities may
661	include, but are not limited to: case-mix data, patient
662	admission or discharge data with patient and provider-specific
663	identifiers included, actual charge data by diagnostic groups,
664	financial data, accounting data, operating expenses, expenses
665	incurred for rendering services to patients who cannot or do not
666	pay, interest charges, depreciation expenses based on the
667	expected useful life of the property and equipment involved, and
668	demographic data. Data may be obtained from documents such as,
669	but not limited to: leases, contracts, debt instruments,
670	itemized patient bills, medical record abstracts, and related
671	diagnostic information.
672	(b) Data to be submitted by health care providers may
673	include, but are not limited to: Medicare and Medicaid
674	participation, types of services offered to patients, amount of
675	revenue and expenses of the health care provider, and such other
676	data which are reasonably necessary to study utilization
677	patterns.
678	(c) Data to be submitted by health insurers may include,
679	but are not limited to: claims, premium, administration, and
680	financial information.
681	(d) Data required to be submitted by health care
682	facilities, health care providers, or health insurers shall not
683	include specific provider contract reimbursement information.
684	However, such specific provider reimbursement data shall be
685	reasonably available for onsite inspection by the agency as is
686	necessary to carry out the agency's regulatory duties. Any such
687	data obtained by the agency as a result of onsite inspections
688	may not be used by the state for purposes of direct provider
689	contracting and are confidential and exempt from the provisions
690	of s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
691	(e) A requirement to submit data shall be adopted by rule
692	if the submission of data is being required of all members of
693	any type of health care facility, health care provider, or
694	health insurer. Rules are not required, however, for the
695	submission of data for a special study mandated by the
696	Legislature or when information is being requested for a single
697	health care facility, health care provider, or health insurer.
698	(2) The agency shall, by rule, after consulting with
699	appropriate professional and governmental advisory bodies and
700	holding public hearings and considering existing and proposed
701	systems of accounting and reporting utilized by health care
702	facilities, specify a uniform system of financial reporting for
703	each type of facility based on a uniform chart of accounts
704	developed after considering any chart of accounts developed by
705	the national association for such facilities and generally
706	accepted accounting principles. Such systems shall, to the
707	extent feasible, use existing accounting systems and shall
708	minimize the paperwork required of facilities. This provision
709	shall not be construed to authorize the agency to require health
710	care facilities to adopt a uniform accounting system. As a part
711	of such uniform system of financial reporting, the agency may
712	require the filing of any information relating to the cost to
713	the provider and the charge to the consumer of any service
714	provided in such facility, except the cost of a physician's
715	services which is billed independently of the facility.
716	(3) When more than one licensed facility is operated by
717	the reporting organization, the information required by this
718	section shall be reported for each facility separately.
719	(4)(a)Within 120 days after the end of its fiscal year,
720	each health care facility, excluding continuing care facilities
721	and nursing homes as defined in s. 408.07(14) and (36),shall
722	file with the agency, on forms adopted by the agency and based
723	on the uniform system of financial reporting, its actual
724	financial experience for that fiscal year, including
725	expenditures, revenues, and statistical measures. Such data may
726	be based on internal financial reports which are certified to be
727	complete and accurate by the provider. However, hospitals'
728	actual financial experience shall be their audited actual
729	experience. Nursing homes that do not participate in the
730	Medicare or Medicaid programs shall also submit audited actual
731	experience.Every nursing home shall submit to the agency, in a
732	format designated by the agency, a statistical profile of the
733	nursing home residents. The agency, in conjunction with the
734	Department of Elderly Affairs and the Department of Health,
735	shall review these statistical profiles and develop
736	recommendations for the types of residents who might more
737	appropriately be placed in their homes or other noninstitutional
738	settings.
739	(b) Each nursing home shall also submit a schedule of the
740	charges in effect at the beginning of the fiscal year and any
741	changes that were made during the fiscal year. A nursing home
742	which is certified under Title XIX of the Social Security Act
743	and files annual Medicaid cost reports may substitute copies of
744	such reports and any Medicaid audits to the agency in lieu of a
745	report and audit required under this subsection. For such
746	facilities, the agency may require only information in
747	compliance with this chapter that is not contained in the
748	Medicaid cost report. Facilities that are certified under Title
749	XVIII, but not Title XIX, of the Social Security Act must submit
750	a report as developed by the agency. This report shall be
751	substantially the same as the Medicaid cost report and shall not
752	require any more information than is contained in the Medicare
753	cost report unless that information is required of all nursing
754	homes. The audit under Title XVIII shall satisfy the audit
755	requirement under this subsection.
756	(5) In addition to information submitted in accordance
757	with subsection (4), each nursing home shall track and file with
758	the agency, on a form adopted by the agency, data related to
759	each resident's admission, discharge, or conversion to Medicaid;
760	health and functional status; plan of care; and other
761	information pertinent to the resident's placement in a nursing
762	home.
763	(6) Any nursing home which assesses residents a separate
764	charge for personal laundry services shall submit to the agency
765	data on the monthly charge for such services, excluding
766	drycleaning. For facilities that charge based on the amount of
767	laundry, the most recent schedule of charges and the average
768	monthly charge shall be submitted to the agency.
769	(6)(7)The agency may require other reports based on the
770	uniform system of financial reporting necessary to accomplish
771	the purposes of this chapter.
772	(7)(8)Portions of patient records obtained or generated
773	by the agency containing the name, residence or business
774	address, telephone number, social security or other identifying
775	number, or photograph of any person or the spouse, relative, or
776	guardian of such person, or any other identifying information
777	which is patient-specific or otherwise identifies the patient,
778	either directly or indirectly, are confidential and exempt from
779	the provisions of s. 119.07(1) and s. 24(a), Art. I of the State
780	Constitution.
781	(8)(9)The identity of any health care provider, health
782	care facility, or health insurer who submits any data which is
783	proprietary business information to the agency pursuant to the
784	provisions of this section shall remain confidential and exempt
785	from the provisions of s. 119.07(1) and s. 24(a), Art. I of the
786	State Constitution. As used in this section, "proprietary
787	business information" shall include, but not be limited to,
788	information relating to specific provider contract reimbursement
789	information; information relating to security measures, systems,
790	or procedures; and information concerning bids or other
791	contractual data, the disclosure of which would impair efforts
792	to contract for goods or services on favorable terms or would
793	injure the affected entity's ability to compete in the
794	marketplace. Notwithstanding the provisions of this subsection,
795	any information obtained or generated pursuant to the provisions
796	of former s. 407.61, either by the former Health Care Cost
797	Containment Board or by the Agency for Health Care
798	Administration upon transfer to that agency of the duties and
799	functions of the former Health Care Cost Containment Board, is
800	not confidential and exempt from the provisions of s. 119.07(1)
801	and s. 24(a), Art. I of the State Constitution. Such proprietary
802	business information may be used in published analyses and
803	reports or otherwise made available for public disclosure in
804	such manner as to preserve the confidentiality of the identity
805	of the provider. This exemption shall not limit the use of any
806	information used in conjunction with investigation or
807	enforcement purposes under the provisions of s. 456.073.
808	(9)(10)No health care facility, health care provider,
809	health insurer, or other reporting entity or its employees or
810	agents shall be held liable for civil damages or subject to
811	criminal penalties either for the reporting of patient data to
812	the agency or for the release of such data by the agency as
813	authorized by this chapter.
814	(10)(11)The agency shall be the primary source for
815	collection and dissemination of health care data. No other
816	agency of state government may gather data from a health care
817	provider licensed or regulated under this chapter without first
818	determining if the data is currently being collected by the
819	agency and affirmatively demonstrating that it would be more
820	cost-effective for an agency of state government other than the
821	agency to gather the health care data. The director shall ensure
822	that health care data collected by the divisions within the
823	agency is coordinated. It is the express intent of the
824	Legislature that all health care data be collected by a single
825	source within the agency and that other divisions within the
826	agency, and all other agencies of state government, obtain data
827	for analysis, regulation, and public dissemination purposes from
828	that single source. Confidential information may be released to
829	other governmental entities or to parties contracting with the
830	agency to perform agency duties or functions as needed in
831	connection with the performance of the duties of the receiving
832	entity. The receiving entity or party shall retain the
833	confidentiality of such information as provided for herein.
834	(11)(12)The agency shall cooperate with local health
835	councils and the state health planning agency with regard to
836	health care data collection and dissemination and shall
837	cooperate with state agencies in any efforts to establish an
838	integrated health care database.
839	(12)(13)It is the policy of this state that philanthropic
840	support for health care should be encouraged and expanded,
841	especially in support of experimental and innovative efforts to
842	improve the health care delivery system.
843	(13)(14)For purposes of determining reasonable costs of
844	services furnished by health care facilities, unrestricted
845	grants, gifts, and income from endowments shall not be deducted
846	from any operating costs of such health care facilities, and, in
847	addition, the following items shall not be deducted from any
848	operating costs of such health care facilities:
849	(a) An unrestricted grant or gift, or income from such a
850	grant or gift, which is not available for use as operating funds
851	because of its designation by the health care facility's
852	governing board.
853	(b) A grant or similar payment which is made by a
854	governmental entity and which is not available, under the terms
855	of the grant or payment, for use as operating funds.
856	(c) The sale or mortgage of any real estate or other
857	capital assets of the health care facility which the health care
858	facility acquired through a gift or grant and which is not
859	available for use as operating funds under the terms of the gift
860	or grant or because of its designation by the health care
861	facility's governing board, except for recovery of the
862	appropriate share of gains and losses realized from the disposal
863	of depreciable assets.
864	Section 15. Section 408.062, Florida Statutes, is amended
865	to read:
866	408.062 Research, analyses, studies, and reports.--
867	(1) The agency shall have the authority to conduct
868	research, analyses, and studies relating to health care costs
869	and access to and quality of health care services as access and
870	quality are affected by changes in health care costs. Such
871	research, analyses, and studies shall include, but not be
872	limited to, research and analysis relating to:
873	(a) The financial status of any health care facility or
874	facilities subject to the provisions of this chapter.
875	(b) The impact of uncompensated charity care on health
876	care facilities and health care providers.
877	(c) The state's role in assisting to fund indigent care.
878	(d) The availability and affordability of health insurance
879	for small businesses.
880	(e) Total health care expenditures in the state according
881	to the sources of payment and the type of expenditure.
882	(f) The quality of health services, using techniques such
883	as small area analysis, severity adjustments, and risk-adjusted
884	mortality rates.
885	(g) The development of physician payment systems which are
886	capable of taking into account the amount of resources consumed
887	and the outcomes produced in the delivery of care.
888	(h) The impact of subacute admissions on hospital revenues
889	and expenses for purposes of calculating adjusted admissions as
890	defined in s. 408.07.
891	(2) The agency shall evaluate data from nursing home
892	financial reports and shall document and monitor:
893	(a) Total revenues, annual change in revenues, and
894	revenues by source and classification, including contributions
895	for a resident's care from the resident's resources and from the
896	family and contributions not directed toward any specific
897	resident's care.
898	(b) Average resident charges by geographic region, payor,
899	and type of facility ownership.
900	(c) Profit margins by geographic region and type of
901	facility ownership.
902	(d) Amount of charity care provided by geographic region
903	and type of facility ownership.
904	(e) Resident days by payor category.
905	(f) Experience related to Medicaid conversion as reported
906	under s. 408.061.
907	(g) Other information pertaining to nursing home revenues
908	and expenditures.
909
910	The findings of the agency shall be included in an annual report
911	to the Governor and Legislature by January 1 each year.
912	(2)(3)The agency may assess annually the caesarean
913	section rate in Florida hospitals using the analysis methodology
914	that the agency determines most appropriate. To assist the
915	agency in determining the impact of this chapter on Florida
916	hospitals' caesarean section rates, each provider hospital, as
917	defined in s. 383.336, shall notify the agency of the date of
918	implementation of the practice parameters and the date of the
919	first meeting of the hospital peer review board created pursuant
920	to this chapter. The agency shall use these dates in monitoring
921	any change in provider hospital caesarean section rates. An
922	annual report based on this monitoring and assessment shall be
923	submitted to the Governor, the Speaker of the House of
924	Representatives, and the President of the Senate by the agency,
925	with the first annual report due January 1, 1993.
926	(3)(4)The agency may also prepare such summaries and
927	compilations or other supplementary reports based on the
928	information analyzed by the agency under this section, as will
929	advance the purposes of this chapter.
930	(4)(5)(a) The agency may conduct data-based studies and
931	evaluations and make recommendations to the Legislature and the
932	Governor concerning exemptions, the effectiveness of limitations
933	of referrals, restrictions on investment interests and
934	compensation arrangements, and the effectiveness of public
935	disclosure. Such analysis may include, but need not be limited
936	to, utilization of services, cost of care, quality of care, and
937	access to care. The agency may require the submission of data
938	necessary to carry out this duty, which may include, but need
939	not be limited to, data concerning ownership, Medicare and
940	Medicaid, charity care, types of services offered to patients,
941	revenues and expenses, patient-encounter data, and other data
942	reasonably necessary to study utilization patterns and the
943	impact of health care provider ownership interests in health-
944	care-related entities on the cost, quality, and accessibility of
945	health care.
946	(b) The agency may collect such data from any health
947	facility as a special study.
948	Section 16. Subsection (2) of section 408.831, Florida
949	Statutes, is renumbered as subsection (3) and a new subsection
950	(2) is added to said section to read:
951	408.831 Denial, suspension, or revocation of a license,
952	registration, certificate, or application.--
953	(2) In reviewing any application requesting a change of
954	ownership or change of the licensee, registrant, or certificate
955	holder, the transferor shall, prior to agency approval of the
956	change, repay or make arrangements to repay any amounts owed to
957	the agency. Should the transferor fail to repay or make
958	arrangements to repay the amounts owed to the agency, the
959	issuance of a license, registration, or certificate to the
960	transferee shall be delayed until repayment or until
961	arrangements for repayment are made.
962	Section 17. Subsection (1) of section 409.9116, Florida
963	Statutes, is amended to read:
964	409.9116 Disproportionate share/financial assistance
965	program for rural hospitals.--In addition to the payments made
966	under s. 409.911, the Agency for Health Care Administration
967	shall administer a federally matched disproportionate share
968	program and a state-funded financial assistance program for
969	statutory rural hospitals. The agency shall make
970	disproportionate share payments to statutory rural hospitals
971	that qualify for such payments and financial assistance payments
972	to statutory rural hospitals that do not qualify for
973	disproportionate share payments. The disproportionate share
974	program payments shall be limited by and conform with federal
975	requirements. Funds shall be distributed quarterly in each
976	fiscal year for which an appropriation is made. Notwithstanding
977	the provisions of s. 409.915, counties are exempt from
978	contributing toward the cost of this special reimbursement for
979	hospitals serving a disproportionate share of low-income
980	patients.
981	(1) The following formula shall be used by the agency to
982	calculate the total amount earned for hospitals that participate
983	in the rural hospital disproportionate share program or the
984	financial assistance program:
985
986	TAERH = (CCD + MDD)/TPD
987
988	Where:
989	CCD = total charity care-other, plus charity care-Hill-
990	Burton, minus 50 percent of unrestricted tax revenue from local
991	governments, and restricted funds for indigent care, divided by
992	gross revenue per adjusted patient day; however, if CCD is less
993	than zero, then zero shall be used for CCD.
994	MDD = Medicaid inpatient days plus Medicaid HMO inpatient
995	days.
996	TPD = total inpatient days.
997	TAERH = total amount earned by each rural hospital.
998
999	In computing the total amount earned by each rural hospital, the
1000	agency must use the most recent actual data reported in
1001	accordance with s. 408.061(4)(a).
1002	Section 18. This act shall take effect upon becoming a
1003	law.