Senate Bill sb2568er

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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



  1                                 

  2         An act relating to the protection and delivery

  3         of services to persons who are disabled,

  4         vulnerable, or elderly; creating s. 393.506,

  5         F.S.; allowing administration of medication by

  6         certain unlicensed staff for persons with

  7         developmental disabilities; providing

  8         requirements for such administration; creating

  9         s. 400.9685, F.S.; allowing administration of

10         medication by certain unlicensed staff in

11         nursing homes and related health care

12         facilities for persons with developmental

13         disabilities; providing requirements for such

14         administration; amending s. 394.74, F.S.;

15         providing for alternative payment methods for

16         contracts for provision of local substance

17         abuse and mental health programs; amending s.

18         415.102, F.S.; clarifying definitions; amending

19         s. 765.401, F.S.; providing additional persons

20         which may be given a proxy for the making of

21         health care decisions; amending s. 744.102,

22         F.S.; providing that a public guardian shall be

23         considered a professional guardian for certain

24         purposes; amending s. 744.108, F.S.; providing

25         that certain costs relating to determination of

26         certain fees shall be payable from the

27         guardianship estate; amending s. 744.1083,

28         F.S.; deleting obsolete language; increasing

29         the maximum annual fee for registration as a

30         professional guardian; requiring additional

31         information for registration; transferring


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         certain rule adoption authority and

 2         registration responsibilities from the

 3         Statewide Public Guardianship Office to the

 4         Department of Elderly Affairs; authorizing the

 5         Department of Elderly Affairs to contract with

 6         a not-for-profit entity to register

 7         professional guardians; providing that certain

 8         educational institutions may act as

 9         professional guardians without registering;

10         amending s. 744.1085, F.S.; providing for

11         additional regulation of professional

12         guardians; providing for a professional

13         examination as a condition of registration;

14         providing additional requirements for

15         registration as a professional guardian;

16         providing that certain financial institutions

17         are exempt from the regulations governing

18         professional guardians; amending s. 744.3135,

19         F.S.; limiting certain requirements to

20         professional guardians; authorizing the court

21         to require guardians to submit to credit

22         history investigations and background

23         screening; amending s. 744.3145, F.S.;

24         providing training requirements for parents

25         appointed as guardians of the property of their

26         minor children; amending s. 744.444, F.S.;

27         allowing guardians to employ care managers and

28         disclose confidential information to an

29         ombudsman without court approval; providing

30         that such information shall remain

31         confidential; authorizing the payment of


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         certain costs; amending ss. 744.534 and

 2         744.7021, F.S.; providing that the executive

 3         director of the Statewide Public Guardianship

 4         Office shall be appointed by the Secretary of

 5         Elderly Affairs, rather than by the Governor;

 6         transferring certain responsibilities from the

 7         Statewide Public Guardianship Office to the

 8         Department of Elderly Affairs; amending s.

 9         744.704, F.S.; removing a limitation on what

10         wards a public guardian may serve; creating the

11         Guardianship Task Force to examine and make

12         recommendations regarding guardianship in this

13         state; providing for membership; providing for

14         appointment; providing for term of existence;

15         providing that certain prior offenses shall be

16         considered in conducting employment screening,

17         notwithstanding the provisions of section 64 of

18         ch. 95-228, Laws of Florida; amending s.

19         400.071, F.S.; requiring applicants for

20         licensure as a nursing home to provide proof of

21         a legal right to occupy the property; amending

22         s. 400.414, F.S.; delineating the types and

23         number of deficiencies justifying denial,

24         revocation, or suspension of a license as an

25         assisted living facility; amending s. 400.417,

26         F.S.; providing an alternative method of

27         providing notice to an assisted living facility

28         that a license must be renewed; amending s.

29         400.419, F.S.; providing that administrative

30         fines for assisted living facilities or its

31         personnel shall be imposed by the Agency for


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         Health Care Administration in the manner

 2         provided in ch. 120, F.S.; amending s.

 3         400.0239, F.S.; providing for deposit of civil

 4         monetary fines in the Quality of Long-Term Care

 5         Facility Improvement Trust Fund; providing for

 6         additional purposes for which funds from such

 7         trust fund may be expended; amending s.

 8         400.141, F.S; providing for enforcement of

 9         minimum staffing standards for a nursing

10         facility within a range; amending s. 400.235,

11         F.S.; allowing reviewed financial statements to

12         be submitted for the Gold Seal program;

13         amending s. 400.452, F.S.; revising training

14         and education requirements of the Department of

15         Elderly Affairs for assisted living facilities;

16         deleting a requirement that fees for training

17         and education programs be based on the

18         percentage of residents receiving monthly

19         optional supplementation payments; amending s.

20         430.502, F.S.; requiring the Agency for Health

21         Care Administration and the Department of

22         Health to seek and implement a Medicaid home

23         and community-based waiver for persons with

24         Alzheimer's disease; requiring the development

25         of waiver program standards; providing for

26         consultation with the presiding officers of the

27         Legislature; providing for a contingent future

28         repeal of such waiver program; amending s.

29         400.557, F.S.; providing an alternative method

30         of providing notice to an adult day care center

31         that a license must be renewed; amending s.


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         400.619, F.S.; requiring that the Agency for

 2         Health Care Administration provide advance

 3         notice to an adult family-care home that a

 4         license must be renewed; reenacting and

 5         amending s. 400.980, F.S.; providing that the

 6         provisions governing background screening of

 7         persons involved with health care services

 8         pools shall not stand repealed; amending s.

 9         408.061, F.S.; exempting nursing homes and

10         continuing care facilities from certain

11         financial reporting requirements; amending s.

12         408.062, F.S.; providing that the Agency for

13         Health Care Administration is not required to

14         evaluate financial reports of nursing homes;

15         amending s. 408.831, F.S.; requiring that

16         licensees of the Agency for Health Care

17         Administration pay or arrange for payment of

18         amounts owed to the agency by the licensee

19         prior to transfer of the license or issuance of

20         a license to a transferee; amending s.

21         409.9116, F.S.; correcting a cross-reference;

22         providing an effective date.

23  

24  Be It Enacted by the Legislature of the State of Florida:

25  

26         Section 1.  Section 393.506, Florida Statutes, is

27  created to read:

28         393.506  Administration of medication.--

29         (1)  Notwithstanding the provisions of part I of

30  chapter 464, the Nurse Practice Act, unlicensed direct care

31  service staff providing services to persons with developmental


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  disabilities may administer oral, transdermal, inhaled, or

 2  topical prescription medications as provided in this section.

 3         (a)  For day programs, as defined in s. 393.063, the

 4  director of the facility or program shall designate in writing

 5  unlicensed direct care services staff who are eligible to be

 6  trained to assist in the administration of or to administer

 7  medication.

 8         (b)  For intermediate care facilities for the

 9  developmentally disabled licensed pursuant to part XI of

10  chapter 400, unlicensed staff designated by the director may

11  provide medication assistance under the general supervision of

12  a registered nurse licensed pursuant to chapter 464.

13         (2)  Each facility, institution, or program must

14  include in its policies and procedures a plan for training

15  designated staff to ensure the safe handling, storage, and

16  administration of prescription medication. These policies and

17  procedures must be approved by the department before

18  unlicensed direct care services staff assist with medication.

19         (3)  The policies and procedures must include, at a

20  minimum, the following provisions:

21         (a)  An expressed and informed consent for each client.

22         (b)  The director of the facility, program, or provider

23  must maintain a copy of the written prescription, and that

24  prescription must include the name of the medication, the

25  dosage and administration schedule, the reason for the

26  prescription, and the termination date.

27         (c)  Each prescribed medication shall be kept in its

28  original container and in a secure location.

29         (4)  The training required in this section shall be

30  conducted by a registered nurse or a physician licensed

31  pursuant to chapter 458 or chapter 459.


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         Section 2.  Section 400.9685, Florida Statutes, is

 2  created to read:

 3         400.9685  Administration of medication.--

 4         (1)  Notwithstanding the provisions of the Nurse

 5  Practice Act, part I of chapter 464, unlicensed direct care

 6  services staff who are providing services to clients in

 7  Intermediate Care Facilities for the Developmentally Disabled,

 8  licensed pursuant to this part, may administer prescribed,

 9  prepackaged, pre-measured medications under the general

10  supervision of a registered nurse as provided in this section

11  and applicable rules. Training required by this section and

12  applicable rules must be conducted by a registered nurse

13  licensed pursuant to chapter 464, or a physician licensed

14  pursuant to chapter 458 or chapter 459.

15         (2)  Each facility that allows unlicensed direct care

16  service staff to administer medications pursuant to this

17  section must:

18         (a)  Develop and implement policies and procedures that

19  include a plan to ensure the safe handling, storage, and

20  administration of prescription medication.

21         (b)  Maintain written evidence of the expressed and

22  informed consent for each client.

23         (c)  Maintain a copy of the written prescription

24  including the name of the medication, the dosage, and

25  administration schedule.

26         (d)  Maintain documentation regarding the prescription

27  including the name, dosage, and administration schedule,

28  reason for prescription, and the termination date.

29         (e)  Maintain documentation of compliance with required

30  training.

31  


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (3)  Agency rules shall specify the following as it

 2  relates to the administration of medications by unlicensed

 3  staff:

 4         (a)  Medications authorized and packaging required.

 5         (b)  Acceptable methods of administration.

 6         (c)  A definition of "general supervision".

 7         (d)  Minimum educational requirements of staff.

 8         (e)  Criteria of required training and competency that

 9  must be demonstrated prior to the administration of

10  medications by unlicensed staff including in-service training.

11         (f)  Requirements for safe handling, storage, and

12  administration of medications.

13         Section 3.  Subsection (2) of section 394.74, Florida

14  Statutes, is amended, and subsection (6) is added to said

15  section, to read:

16         394.74  Contracts for provision of local substance

17  abuse and mental health programs.--

18         (2)(a)  Contracts for service shall be consistent with

19  the approved district plan.

20         (b)  Notwithstanding s. 394.76(3)(a) and (c), the

21  department may use unit cost methods of payment in contracts

22  for purchasing mental health and substance abuse services. The

23  unit cost contracting system must account for those patient

24  fees that are paid on behalf of a specific client and those

25  that are earned and used by the provider for those services

26  funded in whole or in part by the department. The department

27  may also use a fee-for-service arrangement, case rates, or a

28  capitation arrangement in order to account for those services.

29         (c)  The department may reimburse actual expenditures

30  for startup contracts and fixed capital outlay contracts in

31  accordance with contract specifications.


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (6)  The department may use a fee-for-service

 2  arrangement, case rates, or capitation in order to account for

 3  mental health and substance abuse services.

 4         Section 4.  Subsections (1) and (26) of section

 5  415.102, Florida Statutes, are amended to read:

 6         415.102  Definitions of terms used in ss.

 7  415.101-415.113.--As used in ss. 415.101-415.113, the term:

 8         (1)  "Abuse" means any willful act or threatened act by

 9  a caregiver that causes or is likely to cause significant

10  impairment to a vulnerable adult's physical, mental, or

11  emotional health. Abuse includes acts and omissions.

12         (26)  "Vulnerable adult" means a person 18 years of age

13  or older whose ability to perform the normal activities of

14  daily living or to provide for his or her own care or

15  protection is impaired due to a mental, emotional, long-term

16  physical, or developmental disability or dysfunctioning, or

17  brain damage, or the infirmities of aging.

18         Section 5.  Paragraph (h) is added to subsection (1) of

19  section 765.401, Florida Statutes, to read:

20         765.401  The proxy.--

21         (1)  If an incapacitated or developmentally disabled

22  patient has not executed an advance directive, or designated a

23  surrogate to execute an advance directive, or the designated

24  or alternate surrogate is no longer available to make health

25  care decisions, health care decisions may be made for the

26  patient by any of the following individuals, in the following

27  order of priority, if no individual in a prior class is

28  reasonably available, willing, or competent to act:

29         (h)  A clinical social worker licensed pursuant to

30  chapter 491, or who is a graduate of a court-approved

31  guardianship program. Such a proxy must be selected by the


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  provider's bioethics committee and must not be employed by the

 2  provider. If the provider does not have a bioethics committee,

 3  then such a proxy may be chosen through an arrangement with

 4  the bioethics committee of another provider. The proxy will be

 5  notified that upon request, the provider shall make available

 6  a second physician, not involved in the patient's care to

 7  assist the proxy in evaluating treatment. Decisions to

 8  withhold or withdraw life-prolonging procedures will be

 9  reviewed by the facility's bioethics committee. Documentation

10  of efforts to locate proxies from prior classes must be

11  recorded in the patient record.

12         Section 6.  Subsection (15) of section 744.102, Florida

13  Statutes, is amended to read:

14         744.102  Definitions.--As used in this chapter, the

15  term:

16         (15)  "Professional guardian" means any guardian who

17  receives or has at any time received compensation for services

18  rendered to more than two wards as their guardian. A person

19  serving as a guardian for two or more relatives as defined in

20  s. 744.309(2) is not considered a professional guardian. A

21  public guardian shall be considered a professional guardian

22  for purposes of regulation, education, and registration.

23         Section 7.  Subsection (8) is added to section 744.108,

24  Florida Statutes, to read:

25         744.108  Guardian's and attorney's fees and expenses.--

26         (8)  When court proceedings are instituted to review or

27  determine a guardian's or an attorney's fees under subsection

28  (2), such proceedings are part of the guardianship

29  administration process and the costs, including fees for the

30  guardian's attorney, shall be determined by the court and paid

31  from the assets of the guardianship estate unless the court


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  finds the requested compensation under subsection (2) to be

 2  substantially unreasonable.

 3         Section 8.  Section 744.1083, Florida Statutes, is

 4  amended to read:

 5         744.1083  Professional guardian registration.--

 6         (1)  Effective January 1, 2003, A professional guardian

 7  must register with the Statewide Public Guardianship Office

 8  established in part IX of this chapter. The Statewide Public

 9  Guardianship Office may contract with the clerk of the court

10  in each county to perform the administrative functions

11  associated with registering professional guardians.

12         (2)  Annual registration shall be made on forms

13  furnished by the Statewide Public Guardianship Office and

14  accompanied by the applicable registration fee as determined

15  by rule. Such fee shall not exceed $100 $25.

16         (3)  Registration must include the following:

17         (a)  If the professional guardian is a natural person,

18  the name, address, date of birth, and employer identification

19  or social security number of the professional guardian.

20         (b)  If the professional guardian is a partnership or

21  association, the name, address, and date of birth of every

22  member, and the employer identification number of the

23  partnership or association.

24         (c)  If the professional guardian is a corporation, the

25  name, address, and employer identification number of the

26  corporation; the name, address, and date of birth of each of

27  its directors and officers; the name of its resident agent;

28  and the name, address, and date of birth of each person having

29  at least a 10-percent interest in the corporation.

30         (d)  The name, address, date of birth, and employer

31  identification number, if applicable, of each person providing


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  guardian-delegated financial or personal guardianship services

 2  for wards.

 3         (e)  Documentation that the bonding and educational

 4  requirements of s. 744.1085 have been met, and that background

 5  screening has been conducted pursuant to s. 744.3135.

 6  Compliance with this section shall constitute compliance with

 7  the attestation requirement of s. 435.04(5).

 8         (f)  Sufficient information to distinguish a guardian

 9  providing guardianship services as a public guardian,

10  individually, through partnership, corporation, or any other

11  business organization.

12         (4)  The Department of Elderly Affairs Statewide Public

13  Guardianship Office may adopt rules necessary to administer

14  this section.

15         (5)  A trust company, a state banking corporation or

16  state savings association authorized and qualified to exercise

17  fiduciary powers in this state, or a national banking

18  association or federal savings and loan association authorized

19  and qualified to exercise fiduciary powers in this state, may,

20  but shall not be required to, register as a professional

21  guardian under this section. If a trust company, state banking

22  corporation, state savings association, national banking

23  association, or federal savings and loan association described

24  in this subsection elects to register as a professional

25  guardian under this subsection, the requirements of subsection

26  (3) shall not apply and the registration shall include only

27  the name, address, and employer identification number of the

28  registrant, the name and address of its registered agent, if

29  any, and the documentation described in paragraph (3)(e).

30  

31  


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (6)  The Department of Elderly Affairs may contract

 2  with the Florida Guardianship Foundation or other

 3  not-for-profit entity to register professional guardians.

 4         (7)  The department or its contractor shall ensure that

 5  the clerks of the court and the Chief Judge of each judicial

 6  circuit receive information about each registered professional

 7  guardian.

 8         (8)  A state college or university or an independent

 9  college or university as described pursuant to s.

10  1009.98(3)(a), may, but shall not be required to, register as

11  a professional guardian under this section. If a state college

12  or university or independent college or university elects to

13  register as a professional guardian under this subsection, the

14  requirements of subsection (3) shall not apply and the

15  registration shall include only the name, address, and

16  employer identification number of the registrant.

17         Section 9.  Subsection (3) of section 744.1085, Florida

18  Statutes, is amended and subsections (4) through (10) are

19  added to said section to read:

20         744.1085  Regulation of professional guardians;

21  application; bond required; educational requirements.--

22         (3)  Each professional guardian defined in s.

23  744.102(15) and public guardian, on October 1, 1997, must

24  receive a minimum of 40 hours of instruction and training by

25  October 1, 1998, or within 1 year after becoming a

26  professional guardian, whichever occurs later. Each

27  professional guardian must receive a minimum of 16 hours of

28  continuing education every 2 calendar years after the year in

29  which the initial 40-hour educational requirement is met. The

30  instruction and education must be completed through a course

31  approved or offered by the Statewide Public Guardianship


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  Office. The expenses incurred to satisfy the educational

 2  requirements prescribed in this section may not be paid with

 3  the assets of any ward. This subsection does not apply to any

 4  attorney who is licensed to practice law in this state.

 5         (4)  Each professional guardian must allow, at the

 6  guardian's expense, an investigation of the guardian's credit

 7  history, and the credit history of employees of the guardian,

 8  in a manner prescribed by the Department of Elderly Affairs.

 9         (5)  As required in s. 744.3135, each professional

10  guardian shall allow a level 2 background screening of the

11  guardian and employees of the guardian in accordance with the

12  provisions of s. 435.04.

13         (6)  After July 1, 2005, each professional guardian

14  shall be required to demonstrate competency to act as a

15  professional guardian by taking an examination approved by the

16  Department of Elderly Affairs.

17         (a)  The Department of Elderly Affairs shall determine

18  the minimum examination score necessary for passage of

19  guardianship examinations.

20         (b)  The Department of Elderly Affairs shall determine

21  the procedure for administration of the examination.

22         (c)  The Department of Elderly Affairs or its

23  contractor shall charge an examination fee for the actual

24  costs of the development and the administration of the

25  examination, not to exceed $500.

26         (d)  The Department of Elderly Affairs may recognize

27  passage of a national guardianship examination in lieu of all

28  or part of the examination approved by the Department of

29  Elderly Affairs, except that all professional guardians must

30  take and pass an approved examination section related to

31  Florida law and procedure.


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (7)  The Department of Elderly Affairs shall set the

 2  minimum score necessary to demonstrate professional

 3  guardianship competency.

 4         (8)  The Department of Elderly Affairs shall waive the

 5  examination requirement in paragraph (6) if a professional

 6  guardian can provide:

 7         (a)  Proof that the guardian has actively acted as a

 8  professional guardian for 5 years or more; and

 9         (b)  A letter from a circuit judge before whom the

10  professional guardian practiced at least 1 year which states

11  that the professional guardian had demonstrated to the court

12  competency as a professional guardian.

13         (9)  After July 1, 2004, the court shall not appoint

14  any professional guardian who has not met the requirements of

15  this section and s. 744.1083.

16         (10)  This section does not apply to a professional

17  guardian or the employees of that professional guardian when

18  that guardian is a trust company, a state banking corporation,

19  state savings association authorized and qualified to exercise

20  fiduciary powers in this state, or a national banking

21  association or federal savings and loan association authorized

22  and qualified to exercise fiduciary powers in this state.

23         Section 10.  Section 744.3135, Florida Statutes, is

24  amended to read:

25         744.3135  Credit and criminal investigation.--The court

26  may require a nonprofessional guardian and shall require a

27  professional or public guardian, and all employees of a

28  professional guardian who have a fiduciary responsibility to a

29  ward, to submit, at their own expense, to an investigation of

30  the guardian's credit history and to undergo level 2

31  background screening as required under s. 435.04. The clerk of


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  the court shall obtain fingerprint cards from the Federal

 2  Bureau of Investigation and make them available to guardians.

 3  Any guardian who is so required shall have his or her

 4  fingerprints taken and forward the proper fingerprint card

 5  along with the necessary fee to the Florida Department of Law

 6  Enforcement for processing. The professional guardian shall

 7  pay to the clerk of the court a fee of $5 for handling and

 8  processing professional guardian files. The results of the

 9  fingerprint checks shall be forwarded to the clerk of court

10  who shall maintain the results in a guardian file and shall

11  make the results available to the court. If credit or criminal

12  investigations are required, the court must consider the

13  results of the investigations in appointing a guardian.

14  Professional guardians and all employees of a professional

15  guardian who have a fiduciary responsibility to a ward, so

16  appointed, must resubmit, at their own expense, to an

17  investigation of credit history, and undergo level 1

18  background screening as required under s. 435.03, at least

19  every 2 years after the date of their appointment. At any

20  time, the court may require guardians or their employees to

21  submit to an investigation of credit history and undergo level

22  1 background screening as required under s. 435.03. The court

23  must consider the results of these investigations in

24  reappointing a guardian. This section shall not apply to a

25  professional guardian, or to the employees of a professional

26  guardian, that is a trust company, a state banking corporation

27  or state savings association authorized and qualified to

28  exercise fiduciary powers in this state, or a national banking

29  association or federal savings and loan association authorized

30  and qualified to exercise fiduciary powers in this state.

31  


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         Section 11.  Section 744.3145, Florida Statutes, is

 2  amended to read:

 3         744.3145  Guardian education requirements.--

 4         (1)  Each ward is entitled to a guardian competent to

 5  perform the duties of a guardian necessary to protect the

 6  interests of the ward.

 7         (2)  Each person appointed by the court to be a

 8  guardian, other than a parent who is the guardian of the

 9  property of a minor child, must receive a minimum of 8 hours

10  of instruction and training which covers:

11         (a)  The legal duties and responsibilities of the

12  guardian;

13         (b)  The rights of the ward;

14         (c)  The availability of local resources to aid the

15  ward; and

16         (d)  The preparation of habilitation plans and annual

17  guardianship reports, including financial accounting for the

18  ward's property.

19         (3)  Each person appointed by the court to be the

20  guardian of the property of his or her minor child must

21  receive a minimum of 4 hours of instruction and training that

22  covers:

23         (a)  The legal duties and responsibilities of the

24  guardian of the property;

25         (b)  The preparation of the initial inventory and

26  annual guardianship accountings for the ward's property; and

27         (c)  Use of guardianship assets.

28         (4)(3)  Each person appointed by the court to be a

29  guardian must complete the required number of 8 hours of

30  instruction and education within 1 year after his or her

31  appointment as guardian. The instruction and education must be


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  completed through a course approved by the chief judge of the

 2  circuit court and taught by a court-approved organization.

 3  Court-approved organizations may include, but are not limited

 4  to, community or junior colleges, guardianship organizations,

 5  and the local bar association or The Florida Bar.

 6         (5)(4)  Expenses incurred by the guardian to satisfy

 7  the education requirement may be paid from the ward's estate,

 8  unless the court directs that such expenses be paid by the

 9  guardian individually.

10         (6)(5)  The court may, in its discretion, waive some or

11  all of the requirements of this section or impose additional

12  requirements. The court shall make its decision on a

13  case-by-case basis and, in making its decision, shall consider

14  the experience and education of the guardian, the duties

15  assigned to the guardian, and the needs of the ward.

16         (7)(6)  The provisions of this section do not apply to

17  professional guardians.

18         Section 12.  Subsection (13) of section 744.444,

19  Florida Statutes, is amended, and subsections (16) and (17)

20  are added to said section to read:

21         744.444  Power of guardian without court

22  approval.--Without obtaining court approval, a plenary

23  guardian of the property, or a limited guardian of the

24  property within the powers granted by the order appointing the

25  guardian or an approved annual or amended guardianship report,

26  may:

27         (13)  When reasonably necessary, employ persons,

28  including attorneys, auditors, investment advisers, care

29  managers, or agents, even if they are associated with the

30  guardian, to advise or assist the guardian in the performance

31  of his or her duties.


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 1         (16)  Pay or reimburse costs incurred and reasonable

 2  fees or compensation to persons, including attorneys, employed

 3  by the guardian pursuant to subsection (13) from the assets of

 4  the guardianship estate, subject to obtaining court approval

 5  of the annual accounting.

 6         (17)  Provide confidential information about a ward

 7  that is related to an investigation arising under part I of

 8  chapter 400 to a local or state ombudsman council member

 9  conducting such an investigation. Any such ombudsman shall

10  have a duty to maintain the confidentiality of such

11  information.

12         Section 13.  Paragraph (c) of subsection (2) of section

13  744.534, Florida Statutes, is amended to read:

14         744.534  Disposition of unclaimed funds held by

15  guardian.--

16         (2)

17         (c)  Within 5 years from the date of deposit with the

18  State Treasurer, on written petition to the court that

19  directed the deposit of the funds and informal notice to the

20  Department of Legal Affairs, and after proof of his or her

21  right to them, any person entitled to the funds, before or

22  after payment to the State Treasurer and deposit as provided

23  for in paragraph (a), may obtain a court order directing the

24  payment of the funds to him or her. All funds deposited with

25  the State Treasurer and not claimed within 5 years from the

26  date of deposit shall escheat to the state to be deposited in

27  the Department of Elderly Affairs Administrative Trust Fund to

28  be used solely for the benefit of public guardianship as

29  determined by the Secretary of Elderly Affairs Statewide

30  Public Guardianship Office established in part IX of this

31  chapter.


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         Section 14.  Section 744.7021, Florida Statutes, is

 2  amended to read:

 3         744.7021  Statewide Public Guardianship Office.--There

 4  is hereby created the Statewide Public Guardianship Office

 5  within the Department of Elderly Affairs. The Department of

 6  Elderly Affairs shall provide administrative support and

 7  service to the office to the extent requested by the executive

 8  director within the available resources of the department. The

 9  Statewide Public Guardianship Office may request the

10  assistance of the Inspector General of the Department of

11  Elderly Affairs in providing auditing services, and the Office

12  of General Counsel of the department may provide assistance in

13  rulemaking and other matters as needed to assist the Statewide

14  Public Guardianship Office. The Statewide Public Guardianship

15  Office shall not be subject to control, supervision, or

16  direction by the Department of Elderly Affairs in the

17  performance of its duties.

18         (1)  The Secretary of Elderly Affairs shall appoint the

19  executive director, who shall be the head of the Statewide

20  Public Guardianship Office is the executive director, who

21  shall be appointed by the Governor. The executive director

22  must be a member of The Florida Bar, knowledgeable of licensed

23  attorney with a background in guardianship law and knowledge

24  of the social services available to meet the needs of

25  incapacitated persons, shall serve on a full-time basis, and

26  shall personally, or through representatives of the office,

27  carry out the purposes and functions of the Statewide Public

28  Guardianship Office in accordance with state and federal law.

29  The executive director shall serve at the pleasure of and

30  report to the Secretary Governor .

31  


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (2)  The executive director Statewide Public

 2  Guardianship Office shall, within available resources, have

 3  oversight responsibilities for all public guardians.

 4         (a)  The executive director office shall review the

 5  current public guardian programs in Florida and other states.

 6         (b)  The executive director office, in consultation

 7  with local guardianship offices, shall develop statewide

 8  performance measures and standards.

 9         (c)  The executive director office shall review the

10  various methods of funding guardianship programs, the kinds of

11  services being provided by such programs, and the demographics

12  of the wards. In addition, the executive director office shall

13  review and make recommendations regarding the feasibility of

14  recovering a portion or all of the costs of providing public

15  guardianship services from the assets or income of the wards.

16         (d)  No later than October 1, 2000, the office shall

17  submit to the Governor, the President of the Senate, the

18  Speaker of the House of Representatives, and the Chief Justice

19  of the Supreme Court an interim report describing the progress

20  of the office in meeting the goals as described in this

21  section. No later than October 1, 2001, the office shall

22  submit to the Governor, the President of the Senate, the

23  Speaker of the House of Representatives, and the Chief Justice

24  of the Supreme Court a proposed public guardianship plan

25  including alternatives for meeting the state's guardianship

26  needs. This plan may include recommendations for less than the

27  entire state, may include a phase-in system, and shall include

28  estimates of the cost of each of the alternatives. By January

29  1, 2004, and by January 1 of each year thereafter, the

30  executive director office shall provide a status report and

31  


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    ENROLLED

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 1  provide further recommendations to the Secretary that address

 2  the need for public guardianship services and related issues.

 3         (e)  The executive director office may provide

 4  assistance to local governments or entities in pursuing grant

 5  opportunities. The executive director office shall review and

 6  make recommendations in the annual report on the availability

 7  and efficacy of seeking Medicaid matching funds. The executive

 8  director office shall diligently seek ways to use existing

 9  programs and services to meet the needs of public wards.

10         (f)  The executive director, in consultation with the

11  Florida Guardianship Foundation, office shall develop a

12  guardianship training program curriculum that. The training

13  program may be offered to all guardians whether public or

14  private. The office shall establish a curriculum committee to

15  develop the training program specified in this part. The

16  curriculum committee shall include, but not be limited to,

17  probate judges. A fee may be charged to private guardians in

18  order to defray the cost of providing the training. In

19  addition, a fee may be charged to any training provider for up

20  to the actual cost of the review and approval of their

21  curriculum. Any fees collected pursuant to this paragraph

22  shall be deposited in the Department of Elderly Affairs

23  Administrative Trust Fund to be used for the guardianship

24  training program.

25         (3)  The executive director office may conduct or

26  contract for demonstration projects authorized by the

27  Department of Elderly Affairs, within funds appropriated or

28  through gifts, grants, or contributions for such purposes, to

29  determine the feasibility or desirability of new concepts of

30  organization, administration, financing, or service delivery

31  designed to preserve the civil and constitutional rights of


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  persons of marginal or diminished capacity. Any gifts, grants,

 2  or contributions for such purposes shall be deposited in the

 3  Department of Elderly Affairs Administrative Trust Fund.

 4         (4)  The Department of Elderly Affairs office has

 5  authority to adopt rules pursuant to ss. 120.536(1) and 120.54

 6  to carry out the provisions of this section.

 7         Section 15.  Subsections (1) and (3) of section

 8  744.704, Florida Statutes, are amended to read:

 9         744.704  Powers and duties.--

10         (1)  A public guardian may serve as a guardian of a

11  person adjudicated incapacitated under this chapter:

12         (a)  if there is no family member or friend, other

13  person, bank, or corporation willing and qualified to serve as

14  guardian; and

15         (b)  If the assets of the ward do not exceed the asset

16  level for Medicaid eligibility, exclusive of homestead and

17  exempt property as defined in s. 4, Art. X of the State

18  Constitution, and the ward's income, from all sources, is less

19  than $4,000 per year. Income from public welfare programs,

20  supplemental security income, optional state supplement, a

21  disability pension, or a social security pension shall be

22  excluded in such computation. However, a ward whose total

23  income, counting excludable income, exceeds $30,000 a year may

24  not be served.

25         (3)  The public guardian shall primarily serve

26  incapacitated persons who are of limited financial means, as

27  defined by contract or rule of the Department of Elderly

28  Affairs. The public guardian may serve incapacitated persons

29  of greater financial means to the extent the Department of

30  Elderly Affairs determines to be appropriate If the public

31  guardian finds that the assets or the income of the ward


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  exceeds the amounts set forth in paragraph (1)(b), the public

 2  guardian shall submit a resignation and petition the court for

 3  appointment of a successor guardian. The public guardian shall

 4  not be dismissed until such time that a private guardian is

 5  appointed. If a qualified successor guardian is not available,

 6  the public guardian may remain as guardian, provided the

 7  guardian makes reasonable efforts to find a successor and

 8  reports to the court every 6 months on efforts to obtain a

 9  successor.

10         Section 16.  (1)  There is created within the

11  Department of Elderly Affairs a Guardianship Task Force for

12  the purpose of examining guardianship and incapacity and

13  making recommendations to the Governor and the Legislature for

14  the improvement of processes and procedures related to

15  guardianship and incapacity. The department shall staff the

16  task force, and the Secretary of Elderly Affairs shall appoint

17  the chair from among the task force membership. The members of

18  the task force shall serve without compensation. Unless

19  specified otherwise, task force members shall be appointed by

20  the organizations they represent, and the cost of members'

21  participation shall be borne by their appointing organization.

22  Any member who is a public employee is entitled to

23  reimbursement for per diem and travel expenses by the

24  appointing department.

25         (2)  The Guardianship Task Force shall identify the

26  characteristics of Florida guardianship practice. It shall

27  also identify best practices and recommend specific statutory

28  and other changes for achieving such best practices and for

29  achieving citizen access to quality guardianship services. The

30  task force shall make a preliminary report to the Secretary of

31  Elderly Affairs no later than January 1, 2004, and its final


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  report to the secretary shall be made no later than January 1,

 2  2005.

 3         (3)  The Guardianship Task Force shall consist of ten

 4  members, including a judge with experience in guardianship

 5  proceedings who is appointed by the Florida Conference of

 6  Circuit Judges, a representative of the Association of Clerks

 7  of Court, a professor of law with experience in elder issues

 8  appointed by the Secretary of Elderly Affairs, a

 9  representative of the Florida State Guardianship Association,

10  a representative of the Florida Guardianship Foundation, a

11  representative of the Real Property and Probate Section of The

12  Florida Bar, a representative of the Elder Law Section of The

13  Florida Bar, a professional as provided in section 744.331(3),

14  Florida Statutes, with experience performing examinations and

15  determining incapacity, a representative of the Florida

16  Banker's Association, and a citizen or consumer appointed by

17  the Executive Director of the Florida office of the American

18  Association of Retired Persons.

19         (4)  The Guardianship Task Force may appoint ex officio

20  members who possess needed expertise to assist the task force

21  in its work. The task force will cease to exist May 6, 2005.

22         Section 17.  Notwithstanding the provisions of section

23  64 of chapter 95-228, Laws of Florida, the provisions of

24  chapter 435, Florida Statutes, as created therein and as

25  subsequently amended, and any reference thereto, shall apply

26  to all offenses regardless of the date on which offenses

27  referenced in chapter 435, Florida Statutes, were committed,

28  unless specifically provided otherwise in a provision other

29  than section 64 of chapter 95-228, Laws of Florida.

30         Section 18.  Subsection (12) is added to section

31  400.071, Florida Statutes, to read:


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    ENROLLED

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 1         400.071  Application for license.--

 2         (12)  The applicant must provide the agency with proof

 3  of a legal right to occupy the property before a license may

 4  be issued. Proof may include, but is not limited to, copies of

 5  warranty deeds, lease or rental agreements, contracts for

 6  deeds, or quitclaim deeds.

 7         Section 19.  Subsection (1) of section 400.414, Florida

 8  Statutes, is amended to read:

 9         400.414  Denial, revocation, or suspension of license;

10  imposition of administrative fine; grounds.--

11         (1)  The agency may deny, revoke, or suspend any

12  license issued under this part, or impose an administrative

13  fine in the manner provided in chapter 120, for any of the

14  following actions by an assisted living facility, for the

15  actions of any person subject to level 2 background screening

16  under s. 400.4174, or for the actions of any facility

17  employee:

18         (a)  An intentional or negligent act seriously

19  affecting the health, safety, or welfare of a resident of the

20  facility.

21         (b)  The determination by the agency that the owner

22  lacks the financial ability to provide continuing adequate

23  care to residents.

24         (c)  Misappropriation or conversion of the property of

25  a resident of the facility.

26         (d)  Failure to follow the criteria and procedures

27  provided under part I of chapter 394 relating to the

28  transportation, voluntary admission, and involuntary

29  examination of a facility resident.

30         (e)  A citation of any of the following deficiencies as

31  defined in s. 400.419:


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 1         1.  One or more cited class I deficiencies.

 2         2.  Three or more cited class II deficiencies.

 3         3.  Five or more cited class III deficiencies that have

 4  been cited on a single survey and have not been corrected

 5  within the times specified One or more class I, three or more

 6  class II, or five or more repeated or recurring identical or

 7  similar class III violations that are similar or identical to

 8  violations which were identified by the agency within the last

 9  2 years.

10         (f)  A determination that a person subject to level 2

11  background screening under s. 400.4174(1) does not meet the

12  screening standards of s. 435.04 or that the facility is

13  retaining an employee subject to level 1 background screening

14  standards under s. 400.4174(2) who does not meet the screening

15  standards of s. 435.03 and for whom exemptions from

16  disqualification have not been provided by the agency.

17         (g)  A determination that an employee, volunteer,

18  administrator, or owner, or person who otherwise has access to

19  the residents of a facility does not meet the criteria

20  specified in s. 435.03(2), and the owner or administrator has

21  not taken action to remove the person. Exemptions from

22  disqualification may be granted as set forth in s. 435.07. No

23  administrative action may be taken against the facility if the

24  person is granted an exemption.

25         (h)  Violation of a moratorium.

26         (i)  Failure of the license applicant, the licensee

27  during relicensure, or a licensee that holds a provisional

28  license to meet the minimum license requirements of this part,

29  or related rules, at the time of license application or

30  renewal.

31  


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 1         (j)  A fraudulent statement or omission of any material

 2  fact on an application for a license or any other document

 3  required by the agency, including the submission of a license

 4  application that conceals the fact that any board member,

 5  officer, or person owning 5 percent or more of the facility

 6  may not meet the background screening requirements of s.

 7  400.4174, or that the applicant has been excluded, permanently

 8  suspended, or terminated from the Medicaid or Medicare

 9  programs.

10         (k)  An intentional or negligent life-threatening act

11  in violation of the uniform firesafety standards for assisted

12  living facilities or other firesafety standards that threatens

13  the health, safety, or welfare of a resident of a facility, as

14  communicated to the agency by the local authority having

15  jurisdiction or the State Fire Marshal.

16         (l)  Exclusion, permanent suspension, or termination

17  from the Medicare or Medicaid programs.

18         (m)  Knowingly operating any unlicensed facility or

19  providing without a license any service that must be licensed

20  under this chapter.

21         (n)  Any act constituting a ground upon which

22  application for a license may be denied.

23  

24  Administrative proceedings challenging agency action under

25  this subsection shall be reviewed on the basis of the facts

26  and conditions that resulted in the agency action.

27         Section 20.  Subsection (1) of section 400.417, Florida

28  Statutes, is amended to read:

29         400.417  Expiration of license; renewal; conditional

30  license.--

31  


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (1)  Biennial licenses, unless sooner suspended or

 2  revoked, shall expire 2 years from the date of issuance.

 3  Limited nursing, extended congregate care, and limited mental

 4  health licenses shall expire at the same time as the

 5  facility's standard license, regardless of when issued. The

 6  agency shall notify the facility by certified mail at least

 7  120 days prior to expiration that a renewal license is

 8  necessary to continue operation. The notification must be

 9  provided electronically or by mail delivery. Ninety days prior

10  to the expiration date, an application for renewal shall be

11  submitted to the agency. Fees must be prorated. The failure to

12  file a timely renewal application shall result in a late fee

13  charged to the facility in an amount equal to 50 percent of

14  the current fee.

15         Section 21.  Section 400.419, Florida Statutes, is

16  amended to read:

17         400.419  Violations; imposition of administrative

18  fines; grounds.--

19         (1)  The agency shall impose an administrative fine in

20  the manner provided in chapter 120 for any of the actions or

21  violations as set forth within this section by an assisted

22  living facility, for the actions of any person subject to

23  level 2 background screening under s. 400.4174, for the

24  actions of any facility employee, or for an intentional or

25  negligent act seriously affecting the health, safety, or

26  welfare of a resident of the facility.

27         (2)(1)  Each violation of this part and adopted rules

28  shall be classified according to the nature of the violation

29  and the gravity of its probable effect on facility residents.

30  The agency shall indicate the classification on the written

31  notice of the violation as follows:


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 1         (a)  Class "I" violations are those conditions or

 2  occurrences related to the operation and maintenance of a

 3  facility or to the personal care of residents which the agency

 4  determines present an imminent danger to the residents or

 5  guests of the facility or a substantial probability that death

 6  or serious physical or emotional harm would result therefrom.

 7  The condition or practice constituting a class I violation

 8  shall be abated or eliminated within 24 hours, unless a fixed

 9  period, as determined by the agency, is required for

10  correction. The agency shall impose an administrative fine for

11  a cited class I violation is subject to an administrative fine

12  in an amount not less than $5,000 and not exceeding $10,000

13  for each violation. A fine may be levied notwithstanding the

14  correction of the violation.

15         (b)  Class "II" violations are those conditions or

16  occurrences related to the operation and maintenance of a

17  facility or to the personal care of residents which the agency

18  determines directly threaten the physical or emotional health,

19  safety, or security of the facility residents, other than

20  class I violations. The agency shall impose an administrative

21  fine for a cited class II violation is subject to an

22  administrative fine in an amount not less than $1,000 and not

23  exceeding $5,000 for each violation. A fine shall be levied

24  notwithstanding the correction of the violation A citation for

25  a class II violation must specify the time within which the

26  violation is required to be corrected.

27         (c)  Class "III" violations are those conditions or

28  occurrences related to the operation and maintenance of a

29  facility or to the personal care of residents which the agency

30  determines indirectly or potentially threaten the physical or

31  emotional health, safety, or security of facility residents,


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  other than class I or class II violations. The agency shall

 2  impose an administrative fine for a cited class III violation

 3  in an amount is subject to an administrative fine of not less

 4  than $500 and not exceeding $1,000 for each violation. A

 5  citation for a class III violation must specify the time

 6  within which the violation is required to be corrected. If a

 7  class III violation is corrected within the time specified, no

 8  fine may be imposed, unless it is a repeated offense.

 9         (d)  Class "IV" violations are those conditions or

10  occurrences related to the operation and maintenance of a

11  building or to required reports, forms, or documents that do

12  not have the potential of negatively affecting residents.

13  These violations are of a type that the agency determines do

14  not threaten the health, safety, or security of residents of

15  the facility. The agency shall impose an administrative fine

16  for a cited class IV violation in an amount A facility that

17  does not correct a class IV violation within the time

18  specified in the agency-approved corrective action plan is

19  subject to an administrative fine of not less than $100 and

20  not exceeding nor more than $200 for each violation. A

21  citation for a class IV violation must specify the time within

22  which the violation is required to be corrected. If a class IV

23  violation is corrected within the time specified, no fine

24  shall be imposed. Any class IV violation that is corrected

25  during the time an agency survey is being conducted will be

26  identified as an agency finding and not as a violation.

27         (3)(2)  In determining if a penalty is to be imposed

28  and in fixing the amount of the fine, the agency shall

29  consider the following factors:

30         (a)  The gravity of the violation, including the

31  probability that death or serious physical or emotional harm


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  to a resident will result or has resulted, the severity of the

 2  action or potential harm, and the extent to which the

 3  provisions of the applicable laws or rules were violated.

 4         (b)  Actions taken by the owner or administrator to

 5  correct violations.

 6         (c)  Any previous violations.

 7         (d)  The financial benefit to the facility of

 8  committing or continuing the violation.

 9         (e)  The licensed capacity of the facility.

10         (4)(3)  Each day of continuing violation after the date

11  fixed for termination of the violation, as ordered by the

12  agency, constitutes an additional, separate, and distinct

13  violation.

14         (5)(4)  Any action taken to correct a violation shall

15  be documented in writing by the owner or administrator of the

16  facility and verified through followup visits by agency

17  personnel. The agency may impose a fine and, in the case of an

18  owner-operated facility, revoke or deny a facility's license

19  when a facility administrator fraudulently misrepresents

20  action taken to correct a violation.

21         (6)(5)  For fines that are upheld following

22  administrative or judicial review, the violator shall pay the

23  fine, plus interest at the rate as specified in s. 55.03, for

24  each day beyond the date set by the agency for payment of the

25  fine.

26         (7)(6)  Any unlicensed facility that continues to

27  operate after agency notification is subject to a $1,000 fine

28  per day.

29         (8)(7)  Any licensed facility whose owner or

30  administrator concurrently operates an unlicensed facility

31  shall be subject to an administrative fine of $5,000 per day.


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    ENROLLED

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 1         (9)(8)  Any facility whose owner fails to apply for a

 2  change-of-ownership license in accordance with s. 400.412 and

 3  operates the facility under the new ownership is subject to a

 4  fine of $5,000.

 5         (10)(9)  In addition to any administrative fines

 6  imposed, the agency may assess a survey fee, equal to the

 7  lesser of one half of the facility's biennial license and bed

 8  fee or $500, to cover the cost of conducting initial complaint

 9  investigations that result in the finding of a violation that

10  was the subject of the complaint or monitoring visits

11  conducted under s. 400.428(3)(c) to verify the correction of

12  the violations.

13         (11)(10)  The agency, as an alternative to or in

14  conjunction with an administrative action against a facility

15  for violations of this part and adopted rules, shall make a

16  reasonable attempt to discuss each violation and recommended

17  corrective action with the owner or administrator of the

18  facility, prior to written notification. The agency, instead

19  of fixing a period within which the facility shall enter into

20  compliance with standards, may request a plan of corrective

21  action from the facility which demonstrates a good faith

22  effort to remedy each violation by a specific date, subject to

23  the approval of the agency.

24         (12)(11)  Administrative fines paid by any facility

25  under this section shall be deposited into the Health Care

26  Trust Fund and expended as provided in s. 400.418.

27         (13)(12)  The agency shall develop and disseminate an

28  annual list of all facilities sanctioned or fined $5,000 or

29  more for violations of state standards, the number and class

30  of violations involved, the penalties imposed, and the current

31  status of cases. The list shall be disseminated, at no charge,


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 1  to the Department of Elderly Affairs, the Department of

 2  Health, the Department of Children and Family Services, the

 3  area agencies on aging, the Florida Statewide Advocacy

 4  Council, and the state and local ombudsman councils. The

 5  Department of Children and Family Services shall disseminate

 6  the list to service providers under contract to the department

 7  who are responsible for referring persons to a facility for

 8  residency. The agency may charge a fee commensurate with the

 9  cost of printing and postage to other interested parties

10  requesting a copy of this list.

11         Section 22.  Subsections (1) and (2) of section

12  400.0239, Florida Statutes, are amended to read:

13         400.0239  Quality of Long-Term Care Facility

14  Improvement Trust Fund.--

15         (1)  There is created within the Agency for Health Care

16  Administration a Quality of Long-Term Care Facility

17  Improvement Trust Fund to support activities and programs

18  directly related to improvement of the care of nursing home

19  and assisted living facility residents. The trust fund shall

20  be funded through proceeds generated pursuant to ss. 400.0238

21  and 400.4298, through funds specifically appropriated by the

22  Legislature, and through gifts, endowments, and other

23  charitable contributions allowed under federal and state law,

24  and through federal nursing home civil monetary penalties

25  collected by the Centers for Medicare and Medicaid Services

26  and returned to the state. These funds must be utilized in

27  accordance with federal requirements.

28         (2)  Expenditures from the trust fund shall be

29  allowable for direct support of the following:

30         (a)  Development and operation of a mentoring program,

31  in consultation with the Department of Health and the


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 1  Department of Elderly Affairs, for increasing the competence,

 2  professionalism, and career preparation of long-term care

 3  facility direct care staff, including nurses, nursing

 4  assistants, and social service and dietary personnel.

 5         (b)  Development and implementation of specialized

 6  training programs for long-term care facility personnel who

 7  provide direct care for residents with Alzheimer's disease and

 8  other dementias, residents at risk of developing pressure

 9  sores, and residents with special nutrition and hydration

10  needs.

11         (c)  Addressing areas of deficient practice identified

12  through regulation or state monitoring.

13         (d)(c)  Provision of economic and other incentives to

14  enhance the stability and career development of the nursing

15  home direct care workforce, including paid sabbaticals for

16  exemplary direct care career staff to visit facilities

17  throughout the state to train and motivate younger workers to

18  commit to careers in long-term care.

19         (e)(d)  Promotion and support for the formation and

20  active involvement of resident and family councils in the

21  improvement of nursing home care.

22         (f)  Evaluation of special residents' needs in

23  long-term care facilities, including challenges in meeting

24  special residents' needs, appropriateness of placement and

25  setting, and cited deficiencies related to caring for special

26  needs.

27         (g)  Other initiatives authorized by the Centers for

28  Medicare and Medicaid Services for the use of federal civil

29  monetary penalties, including projects recommended through the

30  Medicaid "Up-or-Out" Quality of Care Contract Management

31  Program pursuant to s. 400.148.


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 1         Section 23.  Subsection (15) of section 400.141,

 2  Florida Statutes, is amended to read:

 3         400.141  Administration and management of nursing home

 4  facilities.--Every licensed facility shall comply with all

 5  applicable standards and rules of the agency and shall:

 6         (15)  Submit semiannually to the agency, or more

 7  frequently if requested by the agency, information regarding

 8  facility staff-to-resident ratios, staff turnover, and staff

 9  stability, including information regarding certified nursing

10  assistants, licensed nurses, the director of nursing, and the

11  facility administrator. For purposes of this reporting:

12         (a)  Staff-to-resident ratios must be reported in the

13  categories specified in s. 400.23(3)(a) and applicable rules.

14  The ratio must be reported as an average for the most recent

15  calendar quarter.

16         (b)  Staff turnover must be reported for the most

17  recent 12-month period ending on the last workday of the most

18  recent calendar quarter prior to the date the information is

19  submitted. The turnover rate must be computed quarterly, with

20  the annual rate being the cumulative sum of the quarterly

21  rates. The turnover rate is the total number of terminations

22  or separations experienced during the quarter, excluding any

23  employee terminated during a probationary period of 3 months

24  or less, divided by the total number of staff employed at the

25  end of the period for which the rate is computed, and

26  expressed as a percentage.

27         (c)  The formula for determining staff stability is the

28  total number of employees that have been employed for more

29  than 12 months, divided by the total number of employees

30  employed at the end of the most recent calendar quarter, and

31  expressed as a percentage.


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 1         (d)  A nursing facility that has failed to comply with

 2  state minimum-staffing requirements for 2 consecutive days is

 3  prohibited from accepting new admissions until the facility

 4  has achieved the minimum-staffing requirements for a period of

 5  6 consecutive days. For the purposes of this paragraph, any

 6  person who was a resident of the facility and was absent from

 7  the facility for the purpose of receiving medical care at a

 8  separate location or was on a leave of absence is not

 9  considered a new admission. Failure to impose such an

10  admissions moratorium constitutes a class II deficiency.

11         (e)  A nursing facility which does not have a

12  conditional license may be cited for failure to comply with

13  the standards in s. 400.23(3)(a) only if it has failed to meet

14  those standards on 2 consecutive days or if it has failed to

15  meet at least 97 percent of those standards on any one day.  

16         (f)  A facility which has a conditional license must be

17  in compliance with the standards in s. 400.23(3)(a) at all

18  times.

19  

20  Nothing in this section shall limit the agency's ability to

21  impose a deficiency or take other actions if a facility does

22  not have enough staff to meet the residents' needs.

23  

24  Facilities that have been awarded a Gold Seal under the

25  program established in s. 400.235 may develop a plan to

26  provide certified nursing assistant training as prescribed by

27  federal regulations and state rules and may apply to the

28  agency for approval of their program.

29         Section 24.  Paragraph (b) of subsection (5) of section

30  400.235, Florida Statutes, is amended to read:

31  


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 1         400.235  Nursing home quality and licensure status;

 2  Gold Seal Program.--

 3         (5)  Facilities must meet the following additional

 4  criteria for recognition as a Gold Seal Program facility:

 5         (b)  Evidence financial soundness and stability

 6  according to standards adopted by the agency in administrative

 7  rule. Such standards must include, but not be limited to,

 8  criteria for the use of financial statements that are prepared

 9  in accordance with generally accepted accounting principles

10  and that are reviewed or audited by certified public

11  accountants.

12  

13  A facility assigned a conditional licensure status may not

14  qualify for consideration for the Gold Seal Program until

15  after it has operated for 30 months with no class I or class

16  II deficiencies and has completed a regularly scheduled

17  relicensure survey.

18         Section 25.  Subsections (1), (2), (7), (8), and (9) of

19  section 400.452, Florida Statutes, are amended to read:

20         400.452  Staff training and educational programs; core

21  educational requirement.--

22         (1)  The department shall ensure that provide, or cause

23  to be provided, training and educational programs for the

24  administrators and other assisted living facility staff have

25  met training and education requirements that to better enable

26  them to appropriately respond to the needs of residents, to

27  maintain resident care and facility standards, and to meet

28  licensure requirements.

29         (2)  The department shall also establish a core

30  educational requirement to be used in these programs.

31  Successful completion of the core educational requirement must


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 1  include successful completion of a competency test. Programs

 2  must be provided by the department or by a provider approved

 3  by the department at least quarterly. The core educational

 4  requirement must cover at least the following topics:

 5         (a)  State law and rules relating to assisted living

 6  facilities.

 7         (b)  Resident rights and identifying and reporting

 8  abuse, neglect, and exploitation.

 9         (c)  Special needs of elderly persons, persons with

10  mental illness, and persons with developmental disabilities

11  and how to meet those needs.

12         (d)  Nutrition and food service, including acceptable

13  sanitation practices for preparing, storing, and serving food.

14         (e)  Medication management, recordkeeping, and proper

15  techniques for assisting residents with self-administered

16  medication.

17         (f)  Firesafety requirements, including fire evacuation

18  drill procedures and other emergency procedures.

19         (g)  Care of persons with Alzheimer's disease and

20  related disorders.

21         (7)  A facility that does not have any residents who

22  receive monthly optional supplementation payments must pay a

23  reasonable fee for such training and education programs. A

24  facility that has one or more such residents shall pay a

25  reduced fee that is proportional to the percentage of such

26  residents in the facility. Any facility more than 90 percent

27  of whose residents receive monthly optional state

28  supplementation payments is not required to pay for the

29  training and continuing education programs required under this

30  section.

31  


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 1         (7)(8)  If the department or the agency determines that

 2  there are problems in a facility that could be reduced through

 3  specific staff training or education beyond that already

 4  required under this section, the department or the agency may

 5  require, and provide, or cause to be provided, the training or

 6  education of any personal care staff in the facility.

 7         (8)(9)  The department shall adopt rules to establish

 8  training programs, standards and curriculum for training,

 9  staff training requirements, procedures for approving training

10  programs, and training fees.

11         Section 26.  Subsections (7), (8), and (9) are added to

12  section 430.502, Florida Statutes, to read:

13         430.502  Alzheimer's disease; memory disorder clinics

14  and day care and respite care programs.--

15         (7)  The Agency for Health Care Administration and the

16  department shall seek a federal waiver to implement a Medicaid

17  home and community-based waiver targeted to persons with

18  Alzheimer's disease to test the effectiveness of Alzheimer's

19  specific interventions to delay or to avoid institutional

20  placement.

21         (8)  The department will implement the waiver program

22  specified in subsection (7). The agency and the department

23  shall ensure that providers are selected that have a history

24  of successfully serving persons with Alzheimer's disease. The

25  department and the agency shall develop specialized standards

26  for providers and services tailored to persons in the early,

27  middle, and late stages of Alzheimer's disease and designate a

28  level of care determination process and standard that is most

29  appropriate to this population. The department and the agency

30  shall include in the waiver services designed to assist the

31  caregiver in continuing to provide in-home care. The


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 1  department shall implement this waiver program subject to a

 2  specific appropriation or as provided in the General

 3  Appropriations Act. The department and the agency shall submit

 4  their program design to the President of the Senate and the

 5  Speaker of the House of Representatives for consultation

 6  during the development process.

 7         (9)  Authority to continue the waiver program specified

 8  in subsection (7) shall be automatically eliminated at the

 9  close of the 2008 Regular Session of the Legislature unless

10  further legislative action is taken to continue it prior to

11  such time.

12         Section 27.  Subsection (1) of section 400.557, Florida

13  Statutes, is amended to read:

14         400.557  Expiration of license; renewal; conditional

15  license or permit.--

16         (1)  A license issued for the operation of an adult day

17  care center, unless sooner suspended or revoked, expires 2

18  years after the date of issuance. The agency shall notify a

19  licensee by certified mail, return receipt requested, at least

20  120 days before the expiration date that license renewal is

21  required to continue operation. The notification must be

22  provided electronically or by mail delivery. At least 90 days

23  prior to the expiration date, an application for renewal must

24  be submitted to the agency. A license shall be renewed, upon

25  the filing of an application on forms furnished by the agency,

26  if the applicant has first met the requirements of this part

27  and of the rules adopted under this part. The applicant must

28  file with the application satisfactory proof of financial

29  ability to operate the center in accordance with the

30  requirements of this part and in accordance with the needs of

31  


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 1  the participants to be served and an affidavit of compliance

 2  with the background screening requirements of s. 400.5572.

 3         Section 28.  Subsection (3) of section 400.619, Florida

 4  Statutes, is amended to read:

 5         400.619  Licensure application and renewal.--

 6         (3)  The agency shall notify a licensee at least 120

 7  days before the expiration date that license renewal is

 8  required to continue operation. The notification must be

 9  provided electronically or by mail delivery. Application for a

10  license or annual license renewal must be made on a form

11  provided by the agency, signed under oath, and must be

12  accompanied by a licensing fee of $100 per year.

13         Section 29.  Subsection (4) of section 400.980, Florida

14  Statutes, is reenacted and amended to read:

15         400.980  Health care services pools.--

16         (4)  Each applicant for registration must comply with

17  the following requirements:

18         (a)  Upon receipt of a completed, signed, and dated

19  application, the agency shall require background screening, in

20  accordance with the level 1 standards for screening set forth

21  in chapter 435, of every individual who will have contact with

22  patients. The agency shall require background screening of the

23  managing employee or other similarly titled individual who is

24  responsible for the operation of the entity, and of the

25  financial officer or other similarly titled individual who is

26  responsible for the financial operation of the entity,

27  including billings for services in accordance with the level 2

28  standards for background screening as set forth in chapter

29  435.

30         (b)  The agency may require background screening of any

31  other individual who is affiliated with the applicant if the


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 1  agency has a reasonable basis for believing that he or she has

 2  been convicted of a crime or has committed any other offense

 3  prohibited under the level 2 standards for screening set forth

 4  in chapter 435.

 5         (c)  Proof of compliance with the level 2 background

 6  screening requirements of chapter 435 which has been submitted

 7  within the previous 5 years in compliance with any other

 8  health care or assisted living licensure requirements of this

 9  state is acceptable in fulfillment of paragraph (a).

10         (d)  A provisional registration may be granted to an

11  applicant when each individual required by this section to

12  undergo background screening has met the standards for the

13  Department of Law Enforcement background check but the agency

14  has not yet received background screening results from the

15  Federal Bureau of Investigation. A standard registration may

16  be granted to the applicant upon the agency's receipt of a

17  report of the results of the Federal Bureau of Investigation

18  background screening for each individual required by this

19  section to undergo background screening which confirms that

20  all standards have been met, or upon the granting of a

21  disqualification exemption by the agency as set forth in

22  chapter 435. Any other person who is required to undergo level

23  2 background screening may serve in his or her capacity

24  pending the agency's receipt of the report from the Federal

25  Bureau of Investigation. However, the person may not continue

26  to serve if the report indicates any violation of background

27  screening standards and if a disqualification exemption has

28  not been requested of and granted by the agency as set forth

29  in chapter 435.

30         (e)  Each applicant must submit to the agency, with its

31  application, a description and explanation of any exclusions,


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 1  permanent suspensions, or terminations of the applicant from

 2  the Medicare or Medicaid programs. Proof of compliance with

 3  the requirements for disclosure of ownership and controlling

 4  interests under the Medicaid or Medicare programs may be

 5  accepted in lieu of this submission.

 6         (f)  Each applicant must submit to the agency a

 7  description and explanation of any conviction of an offense

 8  prohibited under the level 2 standards of chapter 435 which

 9  was committed by a member of the board of directors of the

10  applicant, its officers, or any individual owning 5 percent or

11  more of the applicant. This requirement does not apply to a

12  director of a not-for-profit corporation or organization who

13  serves solely in a voluntary capacity for the corporation or

14  organization, does not regularly take part in the day-to-day

15  operational decisions of the corporation or organization,

16  receives no remuneration for his or her services on the

17  corporation's or organization's board of directors, and has no

18  financial interest and no family members having a financial

19  interest in the corporation or organization, if the director

20  and the not-for-profit corporation or organization include in

21  the application a statement affirming that the director's

22  relationship to the corporation satisfies the requirements of

23  this paragraph.

24         (g)  A registration may not be granted to an applicant

25  if the applicant or managing employee has been found guilty

26  of, regardless of adjudication, or has entered a plea of nolo

27  contendere or guilty to, any offense prohibited under the

28  level 2 standards for screening set forth in chapter 435,

29  unless an exemption from disqualification has been granted by

30  the agency as set forth in chapter 435.

31  


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 1         (h)  The provisions of this section which require an

 2  applicant for registration to undergo background screening

 3  shall stand repealed on June 30, 2001, unless reviewed and

 4  saved from repeal through reenactment by the Legislature.

 5         (h)(i)  Failure to provide all required documentation

 6  within 30 days after a written request from the agency will

 7  result in denial of the application for registration.

 8         (i)(j)  The agency must take final action on an

 9  application for registration within 60 days after receipt of

10  all required documentation.

11         (j)(k)  The agency may deny, revoke, or suspend the

12  registration of any applicant or registrant who:

13         1.  Has falsely represented a material fact in the

14  application required by paragraph (e) or paragraph (f), or has

15  omitted any material fact from the application required by

16  paragraph (e) or paragraph (f); or

17         2.  Has had prior action taken against the applicant

18  under the Medicaid or Medicare program as set forth in

19  paragraph (e).

20         3.  Fails to comply with this section or applicable

21  rules.

22         4.  Commits an intentional, reckless, or negligent act

23  that materially affects the health or safety of a person

24  receiving services.

25         Section 30.  Section 408.061, Florida Statutes, is

26  amended to read:

27         408.061  Data collection; uniform systems of financial

28  reporting; information relating to physician charges;

29  confidential information; immunity.--

30         (1)  The agency may require the submission by health

31  care facilities, health care providers, and health insurers of


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 1  data necessary to carry out the agency's duties.

 2  Specifications for data to be collected under this section

 3  shall be developed by the agency with the assistance of

 4  technical advisory panels including representatives of

 5  affected entities, consumers, purchasers, and such other

 6  interested parties as may be determined by the agency.

 7         (a)  Data to be submitted by health care facilities may

 8  include, but are not limited to: case-mix data, patient

 9  admission or discharge data with patient and provider-specific

10  identifiers included, actual charge data by diagnostic groups,

11  financial data, accounting data, operating expenses, expenses

12  incurred for rendering services to patients who cannot or do

13  not pay, interest charges, depreciation expenses based on the

14  expected useful life of the property and equipment involved,

15  and demographic data. Data may be obtained from documents such

16  as, but not limited to: leases, contracts, debt instruments,

17  itemized patient bills, medical record abstracts, and related

18  diagnostic information.

19         (b)  Data to be submitted by health care providers may

20  include, but are not limited to: Medicare and Medicaid

21  participation, types of services offered to patients, amount

22  of revenue and expenses of the health care provider, and such

23  other data which are reasonably necessary to study utilization

24  patterns.

25         (c)  Data to be submitted by health insurers may

26  include, but are not limited to: claims, premium,

27  administration, and financial information.

28         (d)  Data required to be submitted by health care

29  facilities, health care providers, or health insurers shall

30  not include specific provider contract reimbursement

31  information. However, such specific provider reimbursement


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 1  data shall be reasonably available for onsite inspection by

 2  the agency as is necessary to carry out the agency's

 3  regulatory duties. Any such data obtained by the agency as a

 4  result of onsite inspections may not be used by the state for

 5  purposes of direct provider contracting and are confidential

 6  and exempt from the provisions of s. 119.07(1) and s. 24(a),

 7  Art. I of the State Constitution.

 8         (e)  A requirement to submit data shall be adopted by

 9  rule if the submission of data is being required of all

10  members of any type of health care facility, health care

11  provider, or health insurer. Rules are not required, however,

12  for the submission of data for a special study mandated by the

13  Legislature or when information is being requested for a

14  single health care facility, health care provider, or health

15  insurer.

16         (2)  The agency shall, by rule, after consulting with

17  appropriate professional and governmental advisory bodies and

18  holding public hearings and considering existing and proposed

19  systems of accounting and reporting utilized by health care

20  facilities, specify a uniform system of financial reporting

21  for each type of facility based on a uniform chart of accounts

22  developed after considering any chart of accounts developed by

23  the national association for such facilities and generally

24  accepted accounting principles. Such systems shall, to the

25  extent feasible, use existing accounting systems and shall

26  minimize the paperwork required of facilities. This provision

27  shall not be construed to authorize the agency to require

28  health care facilities to adopt a uniform accounting system.

29  As a part of such uniform system of financial reporting, the

30  agency may require the filing of any information relating to

31  the cost to the provider and the charge to the consumer of any


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 1  service provided in such facility, except the cost of a

 2  physician's services which is billed independently of the

 3  facility.

 4         (3)  When more than one licensed facility is operated

 5  by the reporting organization, the information required by

 6  this section shall be reported for each facility separately.

 7         (4)(a)  Within 120 days after the end of its fiscal

 8  year, each health care facility, excluding continuing care

 9  facilities and nursing homes as defined in s. 408.07(14) and

10  (36), shall file with the agency, on forms adopted by the

11  agency and based on the uniform system of financial reporting,

12  its actual financial experience for that fiscal year,

13  including expenditures, revenues, and statistical measures.

14  Such data may be based on internal financial reports which are

15  certified to be complete and accurate by the provider.

16  However, hospitals' actual financial experience shall be their

17  audited actual experience. Nursing homes that do not

18  participate in the Medicare or Medicaid programs shall also

19  submit audited actual experience. Every nursing home shall

20  submit to the agency, in a format designated by the agency, a

21  statistical profile of the nursing home residents. The agency,

22  in conjunction with the Department of Elderly Affairs and the

23  Department of Health, shall review these statistical profiles

24  and develop recommendations for the types of residents who

25  might more appropriately be placed in their homes or other

26  noninstitutional settings.

27         (b)  Each nursing home shall also submit a schedule of

28  the charges in effect at the beginning of the fiscal year and

29  any changes that were made during the fiscal year. A nursing

30  home which is certified under Title XIX of the Social Security

31  Act and files annual Medicaid cost reports may substitute


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 1  copies of such reports and any Medicaid audits to the agency

 2  in lieu of a report and audit required under this subsection.

 3  For such facilities, the agency may require only information

 4  in compliance with this chapter that is not contained in the

 5  Medicaid cost report. Facilities that are certified under

 6  Title XVIII, but not Title XIX, of the Social Security Act

 7  must submit a report as developed by the agency. This report

 8  shall be substantially the same as the Medicaid cost report

 9  and shall not require any more information than is contained

10  in the Medicare cost report unless that information is

11  required of all nursing homes. The audit under Title XVIII

12  shall satisfy the audit requirement under this subsection.

13         (5)  In addition to information submitted in accordance

14  with subsection (4), each nursing home shall track and file

15  with the agency, on a form adopted by the agency, data related

16  to each resident's admission, discharge, or conversion to

17  Medicaid; health and functional status; plan of care; and

18  other information pertinent to the resident's placement in a

19  nursing home.

20         (6)  Any nursing home which assesses residents a

21  separate charge for personal laundry services shall submit to

22  the agency data on the monthly charge for such services,

23  excluding drycleaning. For facilities that charge based on the

24  amount of laundry, the most recent schedule of charges and the

25  average monthly charge shall be submitted to the agency.

26         (6)(7)  The agency may require other reports based on

27  the uniform system of financial reporting necessary to

28  accomplish the purposes of this chapter.

29         (7)(8)  Portions of patient records obtained or

30  generated by the agency containing the name, residence or

31  business address, telephone number, social security or other


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 1  identifying number, or photograph of any person or the spouse,

 2  relative, or guardian of such person, or any other identifying

 3  information which is patient-specific or otherwise identifies

 4  the patient, either directly or indirectly, are confidential

 5  and exempt from the provisions of s. 119.07(1) and s. 24(a),

 6  Art. I of the State Constitution.

 7         (8)(9)  The identity of any health care provider,

 8  health care facility, or health insurer who submits any data

 9  which is proprietary business information to the agency

10  pursuant to the provisions of this section shall remain

11  confidential and exempt from the provisions of s. 119.07(1)

12  and s. 24(a), Art. I of the State Constitution. As used in

13  this section, "proprietary business information" shall

14  include, but not be limited to, information relating to

15  specific provider contract reimbursement information;

16  information relating to security measures, systems, or

17  procedures; and information concerning bids or other

18  contractual data, the disclosure of which would impair efforts

19  to contract for goods or services on favorable terms or would

20  injure the affected entity's ability to compete in the

21  marketplace. Notwithstanding the provisions of this

22  subsection, any information obtained or generated pursuant to

23  the provisions of former s. 407.61, either by the former

24  Health Care Cost Containment Board or by the Agency for Health

25  Care Administration upon transfer to that agency of the duties

26  and functions of the former Health Care Cost Containment

27  Board, is not confidential and exempt from the provisions of

28  s. 119.07(1) and s. 24(a), Art. I of the State Constitution.

29  Such proprietary business information may be used in published

30  analyses and reports or otherwise made available for public

31  disclosure in such manner as to preserve the confidentiality


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  of the identity of the provider. This exemption shall not

 2  limit the use of any information used in conjunction with

 3  investigation or enforcement purposes under the provisions of

 4  s. 456.073.

 5         (9)(10)  No health care facility, health care provider,

 6  health insurer, or other reporting entity or its employees or

 7  agents shall be held liable for civil damages or subject to

 8  criminal penalties either for the reporting of patient data to

 9  the agency or for the release of such data by the agency as

10  authorized by this chapter.

11         (10)(11)  The agency shall be the primary source for

12  collection and dissemination of health care data. No other

13  agency of state government may gather data from a health care

14  provider licensed or regulated under this chapter without

15  first determining if the data is currently being collected by

16  the agency and affirmatively demonstrating that it would be

17  more cost-effective for an agency of state government other

18  than the agency to gather the health care data. The director

19  shall ensure that health care data collected by the divisions

20  within the agency is coordinated. It is the express intent of

21  the Legislature that all health care data be collected by a

22  single source within the agency and that other divisions

23  within the agency, and all other agencies of state government,

24  obtain data for analysis, regulation, and public dissemination

25  purposes from that single source. Confidential information may

26  be released to other governmental entities or to parties

27  contracting with the agency to perform agency duties or

28  functions as needed in connection with the performance of the

29  duties of the receiving entity. The receiving entity or party

30  shall retain the confidentiality of such information as

31  provided for herein.


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 1         (11)(12)  The agency shall cooperate with local health

 2  councils and the state health planning agency with regard to

 3  health care data collection and dissemination and shall

 4  cooperate with state agencies in any efforts to establish an

 5  integrated health care database.

 6         (12)(13)  It is the policy of this state that

 7  philanthropic support for health care should be encouraged and

 8  expanded, especially in support of experimental and innovative

 9  efforts to improve the health care delivery system.

10         (13)(14)  For purposes of determining reasonable costs

11  of services furnished by health care facilities, unrestricted

12  grants, gifts, and income from endowments shall not be

13  deducted from any operating costs of such health care

14  facilities, and, in addition, the following items shall not be

15  deducted from any operating costs of such health care

16  facilities:

17         (a)  An unrestricted grant or gift, or income from such

18  a grant or gift, which is not available for use as operating

19  funds because of its designation by the health care facility's

20  governing board.

21         (b)  A grant or similar payment which is made by a

22  governmental entity and which is not available, under the

23  terms of the grant or payment, for use as operating funds.

24         (c)  The sale or mortgage of any real estate or other

25  capital assets of the health care facility which the health

26  care facility acquired through a gift or grant and which is

27  not available for use as operating funds under the terms of

28  the gift or grant or because of its designation by the health

29  care facility's governing board, except for recovery of the

30  appropriate share of gains and losses realized from the

31  disposal of depreciable assets.


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         Section 31.  Section 408.062, Florida Statutes, is

 2  amended to read:

 3         408.062  Research, analyses, studies, and reports.--

 4         (1)  The agency shall have the authority to conduct

 5  research, analyses, and studies relating to health care costs

 6  and access to and quality of health care services as access

 7  and quality are affected by changes in health care costs. Such

 8  research, analyses, and studies shall include, but not be

 9  limited to, research and analysis relating to:

10         (a)  The financial status of any health care facility

11  or facilities subject to the provisions of this chapter.

12         (b)  The impact of uncompensated charity care on health

13  care facilities and health care providers.

14         (c)  The state's role in assisting to fund indigent

15  care.

16         (d)  The availability and affordability of health

17  insurance for small businesses.

18         (e)  Total health care expenditures in the state

19  according to the sources of payment and the type of

20  expenditure.

21         (f)  The quality of health services, using techniques

22  such as small area analysis, severity adjustments, and

23  risk-adjusted mortality rates.

24         (g)  The development of physician payment systems which

25  are capable of taking into account the amount of resources

26  consumed and the outcomes produced in the delivery of care.

27         (h)  The impact of subacute admissions on hospital

28  revenues and expenses for purposes of calculating adjusted

29  admissions as defined in s. 408.07.

30         (2)  The agency shall evaluate data from nursing home

31  financial reports and shall document and monitor:


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (a)  Total revenues, annual change in revenues, and

 2  revenues by source and classification, including contributions

 3  for a resident's care from the resident's resources and from

 4  the family and contributions not directed toward any specific

 5  resident's care.

 6         (b)  Average resident charges by geographic region,

 7  payor, and type of facility ownership.

 8         (c)  Profit margins by geographic region and type of

 9  facility ownership.

10         (d)  Amount of charity care provided by geographic

11  region and type of facility ownership.

12         (e)  Resident days by payor category.

13         (f)  Experience related to Medicaid conversion as

14  reported under s. 408.061.

15         (g)  Other information pertaining to nursing home

16  revenues and expenditures.

17  

18  The findings of the agency shall be included in an annual

19  report to the Governor and Legislature by January 1 each year.

20         (2)(3)  The agency may assess annually the caesarean

21  section rate in Florida hospitals using the analysis

22  methodology that the agency determines most appropriate. To

23  assist the agency in determining the impact of this chapter on

24  Florida hospitals' caesarean section rates, each provider

25  hospital, as defined in s. 383.336, shall notify the agency of

26  the date of implementation of the practice parameters and the

27  date of the first meeting of the hospital peer review board

28  created pursuant to this chapter. The agency shall use these

29  dates in monitoring any change in provider hospital caesarean

30  section rates. An annual report based on this monitoring and

31  assessment shall be submitted to the Governor, the Speaker of


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    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1  the House of Representatives, and the President of the Senate

 2  by the agency, with the first annual report due January 1,

 3  1993.

 4         (3)(4)  The agency may also prepare such summaries and

 5  compilations or other supplementary reports based on the

 6  information analyzed by the agency under this section, as will

 7  advance the purposes of this chapter.

 8         (4)(5)(a)  The agency may conduct data-based studies

 9  and evaluations and make recommendations to the Legislature

10  and the Governor concerning exemptions, the effectiveness of

11  limitations of referrals, restrictions on investment interests

12  and compensation arrangements, and the effectiveness of public

13  disclosure. Such analysis may include, but need not be limited

14  to, utilization of services, cost of care, quality of care,

15  and access to care. The agency may require the submission of

16  data necessary to carry out this duty, which may include, but

17  need not be limited to, data concerning ownership, Medicare

18  and Medicaid, charity care, types of services offered to

19  patients, revenues and expenses, patient-encounter data, and

20  other data reasonably necessary to study utilization patterns

21  and the impact of health care provider ownership interests in

22  health-care-related entities on the cost, quality, and

23  accessibility of health care.

24         (b)  The agency may collect such data from any health

25  facility as a special study.

26         Section 32.  Subsection (2) of section 408.831, Florida

27  Statutes, is renumbered as subsection (3) and a new subsection

28  (2) is added to said section to read:

29         408.831  Denial, suspension, or revocation of a

30  license, registration, certificate, or application.--

31  


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    ENROLLED

    2003 Legislature                 CS for SB 2568, 3rd Engrossed



 1         (2)  In reviewing any application requesting a change

 2  of ownership or change of the licensee, registrant, or

 3  certificate holder, the transferor shall, prior to agency

 4  approval of the change, repay or make arrangements to repay

 5  any amounts owed to the agency. Should the transferor fail to

 6  repay or make arrangements to repay the amounts owed to the

 7  agency, the issuance of a license, registration, or

 8  certificate to the transferee shall be delayed until repayment

 9  or until arrangements for repayment are made.

10         Section 33.  Subsection (1) of section 409.9116,

11  Florida Statutes, is amended to read:

12         409.9116  Disproportionate share/financial assistance

13  program for rural hospitals.--In addition to the payments made

14  under s. 409.911, the Agency for Health Care Administration

15  shall administer a federally matched disproportionate share

16  program and a state-funded financial assistance program for

17  statutory rural hospitals. The agency shall make

18  disproportionate share payments to statutory rural hospitals

19  that qualify for such payments and financial assistance

20  payments to statutory rural hospitals that do not qualify for

21  disproportionate share payments. The disproportionate share

22  program payments shall be limited by and conform with federal

23  requirements. Funds shall be distributed quarterly in each

24  fiscal year for which an appropriation is made.

25  Notwithstanding the provisions of s. 409.915, counties are

26  exempt from contributing toward the cost of this special

27  reimbursement for hospitals serving a disproportionate share

28  of low-income patients.

29         (1)  The following formula shall be used by the agency

30  to calculate the total amount earned for hospitals that

31  


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 1  participate in the rural hospital disproportionate share

 2  program or the financial assistance program:

 3  

 4         TAERH = (CCD + MDD)/TPD

 5  

 6         Where:

 7         CCD = total charity care-other, plus charity

 8  care-Hill-Burton, minus 50 percent of unrestricted tax revenue

 9  from local governments, and restricted funds for indigent

10  care, divided by gross revenue per adjusted patient day;

11  however, if CCD is less than zero, then zero shall be used for

12  CCD.

13         MDD = Medicaid inpatient days plus Medicaid HMO

14  inpatient days.

15         TPD = total inpatient days.

16         TAERH = total amount earned by each rural hospital.

17  

18  In computing the total amount earned by each rural hospital,

19  the agency must use the most recent actual data reported in

20  accordance with s. 408.061(4)(a).

21         Section 34.  This act shall take effect upon becoming a

22  law.

23  

24  

25  

26  

27  

28  

29  

30  

31  


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