HOUSE AMENDMENT Bill No. HB 1891 CS
1	CHAMBER ACTION
2	Senate House
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12	Representative Fiorentino offered the following:
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14	Amendment (with title amendment)
15	Remove line(s) 1028-1066, and insert:
16	Section 23. Section 400.141, Florida Statutes, is amended
17	to read:
18	400.141 Administration and management of nursing home
19	facilities.--Every licensed facility shall comply with all
20	applicable standards and rules of the agency and shall:
21	(1) Be under the administrative direction and charge of a
22	licensed administrator.
23	(2) Appoint a medical director licensed pursuant to
24	chapter 458 or chapter 459. The agency may establish by rule
25	more specific criteria for the appointment of a medical
26	director.
27	(3) Have available the regular, consultative, and
28	emergency services of physicians licensed by the state.
29	(4) Provide for resident use of a community pharmacy as
30	specified in s. 400.022(1)(q). Any other law to the contrary
31	notwithstanding, a registered pharmacist licensed in Florida,
32	that is under contract with a facility licensed under this
33	chapter, shall repackage a nursing facility resident's bulk
34	prescription medication which has been packaged by another
35	pharmacist licensed in any state in the United States into a
36	unit dose system compatible with the system used by the nursing
37	facility, if the pharmacist is requested to offer such service.
38	In order to be eligible for the repackaging, a resident or the
39	resident's spouse must receive prescription medication benefits
40	provided through a former employer as part of his or her
41	retirement benefits, a qualified pension plan as specified in s.
42	4972 of the Internal Revenue Code, a federal retirement program
43	as specified under 5 C.F.R. s. 831, or a long-term care policy
44	as defined in s. 627.9404(1). A pharmacist who correctly
45	repackages and relabels the medication and the nursing facility
46	which correctly administers such repackaged medication under the
47	provisions of this subsection shall not be held liable in any
48	civil or administrative action arising from the repackaging. In
49	order to be eligible for the repackaging, a nursing facility
50	resident for whom the medication is to be repackaged shall sign
51	an informed consent form provided by the facility which includes
52	an explanation of the repackaging process and which notifies the
53	resident of the immunities from liability provided herein. A
54	pharmacist who repackages and relabels prescription medications,
55	as authorized under this subsection, may charge a reasonable fee
56	for costs resulting from the implementation of this provision.
57	(5) Provide for the access of the facility residents to
58	dental and other health-related services, recreational services,
59	rehabilitative services, and social work services appropriate to
60	their needs and conditions and not directly furnished by the
61	licensee. When a geriatric outpatient nurse clinic is conducted
62	in accordance with rules adopted by the agency, outpatients
63	attending such clinic shall not be counted as part of the
64	general resident population of the nursing home facility, nor
65	shall the nursing staff of the geriatric outpatient clinic be
66	counted as part of the nursing staff of the facility, until the
67	outpatient clinic load exceeds 15 a day.
68	(6) Be allowed and encouraged by the agency to provide
69	other needed services under certain conditions. If the facility
70	has a standard licensure status, and has had no class I or class
71	II deficiencies during the past 2 years or has been awarded a
72	Gold Seal under the program established in s. 400.235, it may be
73	encouraged by the agency to provide services, including, but not
74	limited to, respite and adult day services, which enable
75	individuals to move in and out of the facility. A facility is
76	not subject to any additional licensure requirements for
77	providing these services. Respite care may be offered to persons
78	in need of short-term or temporary nursing home services.
79	Respite care must be provided in accordance with this part and
80	rules adopted by the agency. However, the agency shall, by rule,
81	adopt modified requirements for resident assessment, resident
82	care plans, resident contracts, physician orders, and other
83	provisions, as appropriate, for short-term or temporary nursing
84	home services. The agency shall allow for shared programming and
85	staff in a facility which meets minimum standards and offers
86	services pursuant to this subsection, but, if the facility is
87	cited for deficiencies in patient care, may require additional
88	staff and programs appropriate to the needs of service
89	recipients. A person who receives respite care may not be
90	counted as a resident of the facility for purposes of the
91	facility's licensed capacity unless that person receives 24-hour
92	respite care. A person receiving either respite care for 24
93	hours or longer or adult day services must be included when
94	calculating minimum staffing for the facility. Any costs and
95	revenues generated by a nursing home facility from
96	nonresidential programs or services shall be excluded from the
97	calculations of Medicaid per diems for nursing home
98	institutional care reimbursement.
99	(7) If the facility has a standard licensure status or is
100	a Gold Seal facility, exceeds minimum staffing standards, and is
101	part of a retirement community that offers other services
102	pursuant to part III, part IV, or part V, be allowed to share
103	programming and staff. At the time of relicensure, a retirement
104	community that uses this option must demonstrate through
105	staffing records that minimum staffing requirements for the
106	facility were exceeded.
107	(8) Maintain the facility premises and equipment and
108	conduct its operations in a safe and sanitary manner.
109	(9) If the licensee furnishes food service, provide a
110	wholesome and nourishing diet sufficient to meet generally
111	accepted standards of proper nutrition for its residents and
112	provide such therapeutic diets as may be prescribed by attending
113	physicians. In making rules to implement this subsection, the
114	agency shall be guided by standards recommended by nationally
115	recognized professional groups and associations with knowledge
116	of dietetics.
117	(10) Keep full records of resident admissions and
118	discharges; medical and general health status, including medical
119	records, personal and social history, and identity and address
120	of next of kin or other persons who may have responsibility for
121	the affairs of the residents; and individual resident care plans
122	including, but not limited to, prescribed services, service
123	frequency and duration, and service goals. The records shall be
124	open to inspection by the agency.
125	(11) Keep such fiscal records of its operations and
126	conditions as may be necessary to provide information pursuant
127	to this part.
128	(12) Furnish copies of personnel records for employees
129	affiliated with such facility, to any other facility licensed by
130	this state requesting this information pursuant to this part.
131	Such information contained in the records may include, but is
132	not limited to, disciplinary matters and any reason for
133	termination. Any facility releasing such records pursuant to
134	this part shall be considered to be acting in good faith and may
135	not be held liable for information contained in such records,
136	absent a showing that the facility maliciously falsified such
137	records.
138	(13) Publicly display a poster provided by the agency
139	containing the names, addresses, and telephone numbers for the
140	state's abuse hotline, the State Long-Term Care Ombudsman, the
141	Agency for Health Care Administration consumer hotline, the
142	Advocacy Center for Persons with Disabilities, the Florida
143	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
144	with a clear description of the assistance to be expected from
145	each.
146	(14) Submit to the agency the information specified in s.
147	400.071(2)(e) for a management company within 30 days after the
148	effective date of the management agreement.
149	(15) Submit semiannually to the agency, or more frequently
150	if requested by the agency, information regarding facility
151	staff-to-resident ratios, staff turnover, and staff stability,
152	including information regarding certified nursing assistants,
153	licensed nurses, the director of nursing, and the facility
154	administrator. For purposes of this reporting:
155	(a) Staff-to-resident ratios must be reported in the
156	categories specified in s. 400.23(3)(a) and applicable rules.
157	The ratio must be reported as an average for the most recent
158	calendar quarter.
159	(b) Staff turnover must be reported for the most recent
160	12-month period ending on the last workday of the most recent
161	calendar quarter prior to the date the information is submitted.
162	The turnover rate must be computed quarterly, with the annual
163	rate being the cumulative sum of the quarterly rates. The
164	turnover rate is the total number of terminations or separations
165	experienced during the quarter, excluding any employee
166	terminated during a probationary period of 3 months or less,
167	divided by the total number of staff employed at the end of the
168	period for which the rate is computed, and expressed as a
169	percentage.
170	(c) The formula for determining staff stability is the
171	total number of employees that have been employed for more than
172	12 months, divided by the total number of employees employed at
173	the end of the most recent calendar quarter, and expressed as a
174	percentage.
175	(d) A nursing facility that has failed to comply with
176	state minimum-staffing requirements for 2 consecutive days is
177	prohibited from accepting new admissions until the facility has
178	achieved the minimum-staffing requirements for a period of 6
179	consecutive days. For the purposes of this paragraph, any person
180	who was a resident of the facility and was absent from the
181	facility for the purpose of receiving medical care at a separate
182	location or was on a leave of absence is not considered a new
183	admission. Failure to impose such an admissions moratorium
184	constitutes a class II deficiency.
185	(e) A nursing facility which is not on the watch list may
186	be cited for failure to comply with the standards in s.
187	400.23(3)(a) only if it has failed to meet those standards on 2
188	consecutive days or if it has failed to meet at least 97 percent
189	of those standards on any one day.
190	(f) A facility which is on the watch list must be in
191	compliance with the standards in s. 400.23(3)(a) at all times.
192	(16) Report monthly the number of vacant beds in the
193	facility which are available for resident occupancy on the day
194	the information is reported.
195	(17) Notify a licensed physician when a resident exhibits
196	signs of dementia or cognitive impairment or has a change of
197	condition in order to rule out the presence of an underlying
198	physiological condition that may be contributing to such
199	dementia or impairment. The notification must occur within 30
200	days after the acknowledgment of such signs by facility staff.
201	If an underlying condition is determined to exist, the facility
202	shall arrange, with the appropriate health care provider, the
203	necessary care and services to treat the condition.
204	(18) If the facility implements a dining and hospitality
205	attendant program, ensure that the program is developed and
206	implemented under the supervision of the facility director of
207	nursing. A licensed nurse, licensed speech or occupational
208	therapist, or a registered dietitian must conduct training of
209	dining and hospitality attendants. A person employed by a
210	facility as a dining and hospitality attendant must perform
211	tasks under the direct supervision of a licensed nurse.
212	(19) Report to the agency any filing for bankruptcy
213	protection by the facility or its parent corporation,
214	divestiture or spin-off of its assets, or corporate
215	reorganization within 30 days after the completion of such
216	activity.
217	(20) Maintain general and professional liability insurance
218	coverage that is in force at all times. In lieu of general and
219	professional liability insurance coverage, a state-designated
220	teaching nursing home and its affiliated assisted living
221	facilities created under s. 430.80 may demonstrate proof of
222	financial responsibility as provided in s. 430.80(3)(h); the
223	exception provided in this paragraph shall expire July 1, 2005.
224	(21) Maintain in the medical record for each resident a
225	daily chart of certified nursing assistant services provided to
226	the resident. The certified nursing assistant who is caring for
227	the resident must complete this record by the end of his or her
228	shift. This record must indicate assistance with activities of
229	daily living, assistance with eating, and assistance with
230	drinking, and must record each offering of nutrition and
231	hydration for those residents whose plan of care or assessment
232	indicates a risk for malnutrition or dehydration.
233	(22) Before November 30 of each year, subject to the
234	availability of an adequate supply of the necessary vaccine,
235	provide for immunizations against influenza viruses to all its
236	consenting residents in accordance with the recommendations of
237	the United States Centers for Disease Control and Prevention,
238	subject to exemptions for medical contraindications and
239	religious or personal beliefs. Subject to these exemptions, any
240	consenting person who becomes a resident of the facility after
241	November 30 but before March 31 of the following year must be
242	immunized within 5 working days after becoming a resident.
243	Immunization shall not be provided to any resident who provides
244	documentation that he or she has been immunized as required by
245	this subsection. This subsection does not prohibit a resident
246	from receiving the immunization from his or her personal
247	physician if he or she so chooses. A resident who chooses to
248	receive the immunization from his or her personal physician
249	shall provide proof of immunization to the facility. The agency
250	may adopt and enforce any rules necessary to comply with or
251	implement this subsection.
252	(23) Assess all residents for eligibility for pneumococcal
253	polysaccharide vaccination (PPV) and vaccinate residents when
254	indicated within 60 days after the effective date of this act in
255	accordance with the recommendations of the United States Centers
256	for Disease Control and Prevention, subject to exemptions for
257	medical contraindications and religious or personal beliefs.
258	Residents admitted after the effective date of this act shall be
259	assessed within 5 working days of admission and, when indicated,
260	vaccinated within 60 days in accordance with the recommendations
261	of the United States Centers for Disease Control and Prevention,
262	subject to exemptions for medical contraindications and
263	religious or personal beliefs. Immunization shall not be
264	provided to any resident who provides documentation that he or
265	she has been immunized as required by this subsection. This
266	subsection does not prohibit a resident from receiving the
267	immunization from his or her personal physician if he or she so
268	chooses. A resident who chooses to receive the immunization from
269	his or her personal physician shall provide proof of
270	immunization to the facility. The agency may adopt and enforce
271	any rules necessary to comply with or implement this subsection.
272	(24) Annually encourage and promote to its employees the
273	benefits associated with immunizations against influenza viruses
274	in accordance with the recommendations of the United States
275	Centers for Disease Control and Prevention. The agency may adopt
276	and enforce any rules necessary to comply with or implement this
277	subsection.
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279	Nothing in this section shall limit the agency’s ability to
280	impose a deficiency or take other actions if a facility does not
281	have enough staff to meet the residents’ needs.Facilities that
282	have been awarded a Gold Seal under the program established in
283	s. 400.235 may develop a plan to provide certified nursing
284	assistant training as prescribed by federal regulations and
285	state rules and may apply to the agency for approval of their
286	program.
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288	================= T I T L E A M E N D M E N T =================
289	Remove line(s) 91, and insert:
290	minimum staffing standards for certain nursing facilities
291	within a