| 1 | Representative Murman offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove everything after the enacting clause and insert: |
| 5 | Section 1. Section 400.0712, Florida Statutes, is created |
| 6 | to read: |
| 7 | 400.0712 Application for inactive license.-- |
| 8 | (1) As specified in this section, the agency may issue an |
| 9 | inactive license to a nursing home facility for all or a portion |
| 10 | of its beds. Any request by a licensee that a nursing home or |
| 11 | portion of a nursing home become inactive must be submitted to |
| 12 | the agency in the approved format. The facility may not initiate |
| 13 | any suspension of services, notify residents, or initiate |
| 14 | facility closure before receiving approval from the agency; and |
| 15 | a facility that violates this provision shall not be issued an |
| 16 | inactive license. Upon agency approval of an inactive license, |
| 17 | the nursing home shall notify residents of any necessary |
| 18 | discharge or transfer as provided in s. 400.0255. |
| 19 | (2) The agency may issue an inactive license to a nursing |
| 20 | home that chooses to use an unoccupied contiguous portion of the |
| 21 | facility for an alternative use to meet the needs of elderly |
| 22 | persons through the use of less restrictive, less institutional |
| 23 | services. |
| 24 | (a) An inactive license issued under this subsection may |
| 25 | be granted for a period not to exceed 12 months but may be |
| 26 | renewed annually by the agency for 12 months. |
| 27 | (b) A request to extend the inactive license must be |
| 28 | submitted to the agency in the approved format and approved by |
| 29 | the agency in writing. |
| 30 | (c) Nursing homes that receive an inactive license to |
| 31 | provide alternative services shall not receive preference for |
| 32 | participation in the Assisted Living for the Elderly Medicaid |
| 33 | waiver. |
| 34 | (3) The agency may issue an inactive license to a nursing |
| 35 | home that will be temporarily unable to provide services but is |
| 36 | reasonably expected to resume services. |
| 37 | (a) An inactive license issued under this subsection may |
| 38 | be issued for a period not to exceed 12 months and may be |
| 39 | renewed by the agency for an additional 6 months upon |
| 40 | demonstration of progress toward reopening. |
| 41 | (b) All licensure fees must be current and paid in full, |
| 42 | and may be prorated as provided by agency rule, before the |
| 43 | inactive license is issued. |
| 44 | (c) Reactivation of an inactive license requires that the |
| 45 | applicant pay all licensure fees and be inspected by the agency |
| 46 | to confirm that all of the requirements of this part and |
| 47 | applicable rules are met. |
| 48 | (4) The agency shall adopt rules pursuant to ss. |
| 49 | 120.536(1) and 120.54 necessary to implement this section. |
| 50 | Section 2. Subsections (10), (11), and (12) of section |
| 51 | 400.071, Florida Statutes, are amended to read: |
| 52 | 400.071 Application for license.-- |
| 53 | (10) The agency may issue an inactive license to a nursing |
| 54 | home that will be temporarily unable to provide services but |
| 55 | that is reasonably expected to resume services. Such designation |
| 56 | may be made for a period not to exceed 12 months but may be |
| 57 | renewed by the agency for up to 6 additional months. Any request |
| 58 | by a licensee that a nursing home become inactive must be |
| 59 | submitted to the agency and approved by the agency prior to |
| 60 | initiating any suspension of service or notifying residents. |
| 61 | Upon agency approval, the nursing home shall notify residents of |
| 62 | any necessary discharge or transfer as provided in s. 400.0255. |
| 63 | (10)(11) As a condition of licensure, each facility must |
| 64 | establish and submit with its application a plan for quality |
| 65 | assurance and for conducting risk management. |
| 66 | (11)(12) The applicant must provide the agency with proof |
| 67 | of a legal right to occupy the property before a license may be |
| 68 | issued. Proof may include, but is not limited to, copies of |
| 69 | warranty deeds, lease or rental agreements, contracts for deeds, |
| 70 | or quitclaim deeds. |
| 71 | Section 3. Subsection (17) of section 400.021, Florida |
| 72 | Statutes, is amended to read: |
| 73 | 400.021 Definitions.--When used in this part, unless the |
| 74 | context otherwise requires, the term: |
| 75 | (17) "Resident care plan" means a written plan developed, |
| 76 | maintained, and reviewed not less than quarterly by a registered |
| 77 | nurse, with participation from other facility staff and the |
| 78 | resident or his or her designee or legal representative, which |
| 79 | includes a comprehensive assessment of the needs of an |
| 80 | individual resident; the type and frequency of services required |
| 81 | to provide the necessary care for the resident to attain or |
| 82 | maintain the highest practicable physical, mental, and |
| 83 | psychosocial well-being; a listing of services provided within |
| 84 | or outside the facility to meet those needs; and an explanation |
| 85 | of service goals. The resident care plan must be signed by the |
| 86 | director of nursing or another registered nurse employed by the |
| 87 | facility to whom institutional responsibilities have been |
| 88 | delegated and by the resident, the resident's designee, or the |
| 89 | resident's legal representative. The facility may not use an |
| 90 | agency or temporary registered nurse to satisfy the foregoing |
| 91 | requirement and must document the institutional responsibilities |
| 92 | that have been delegated to the registered nurse. |
| 93 | Section 4. Subsection (10) is added to section 400.23, |
| 94 | Florida Statutes, to read: |
| 95 | 400.23 Rules; evaluation and deficiencies; licensure |
| 96 | status.-- |
| 97 | (10) Agency records, reports, ranking systems, Internet |
| 98 | information, and publications must be promptly updated to |
| 99 | reflect the most current agency actions. |
| 100 | Section 5. Subsection (4) of section 400.211, Florida |
| 101 | Statutes, is amended to read: |
| 102 | 400.211 Persons employed as nursing assistants; |
| 103 | certification requirement.-- |
| 104 | (4) When employed by a nursing home facility for a 12- |
| 105 | month period or longer, a nursing assistant, to maintain |
| 106 | certification, shall submit to a performance review every 12 |
| 107 | months and must receive regular inservice education based on the |
| 108 | outcome of such reviews. The inservice training must: |
| 109 | (a) Be sufficient to ensure the continuing competence of |
| 110 | nursing assistants and must meet the standard specified in s. |
| 111 | 464.203(7), must be at least 18 hours per year, and may include |
| 112 | hours accrued under s. 464.203(8); |
| 113 | (b) Include, at a minimum: |
| 114 | 1. Techniques for assisting with eating and proper |
| 115 | feeding; |
| 116 | 2. Principles of adequate nutrition and hydration; |
| 117 | 3. Techniques for assisting and responding to the |
| 118 | cognitively impaired resident or the resident with difficult |
| 119 | behaviors; |
| 120 | 4. Techniques for caring for the resident at the end-of- |
| 121 | life; and |
| 122 | 5. Recognizing changes that place a resident at risk for |
| 123 | pressure ulcers and falls; and |
| 124 | (c) Address areas of weakness as determined in nursing |
| 125 | assistant performance reviews and may address the special needs |
| 126 | of residents as determined by the nursing home facility staff. |
| 127 |
|
| 128 | Costs associated with this training may not be reimbursed from |
| 129 | additional Medicaid funding through interim rate adjustments. |
| 130 | Section 6. Subsection (5) of section 400.235, Florida |
| 131 | Statutes, is amended to read: |
| 132 | 400.235 Nursing home quality and licensure status; Gold |
| 133 | Seal Program.-- |
| 134 | (5) Facilities must meet the following additional criteria |
| 135 | for recognition as a Gold Seal Program facility: |
| 136 | (a) Had no class I or class II deficiencies within the 30 |
| 137 | months preceding application for the program. |
| 138 | (b) Evidence financial soundness and stability according |
| 139 | to standards adopted by the agency in administrative rule. Such |
| 140 | standards must include, but not be limited to, criteria for the |
| 141 | use of financial statements that are prepared in accordance with |
| 142 | generally accepted accounting principles and that are reviewed |
| 143 | or audited by certified public accountants. A nursing home that |
| 144 | is part of the same corporate entity as a continuing care |
| 145 | facility licensed under chapter 651 which meets the minimum |
| 146 | liquid reserve requirements specified in s. 651.035 and is |
| 147 | accredited by a recognized accrediting organization under s. |
| 148 | 651.028 and rules of the Office of Insurance Regulation |
| 149 | satisfies this requirement as long as the accreditation is not |
| 150 | provisional. Facilities operated by a federal or state agency |
| 151 | are deemed to be financially stable for purposes of applying for |
| 152 | the Gold Seal. |
| 153 | (c) Participate in a consumer satisfaction process, and |
| 154 | demonstrate that information is elicited from residents, family |
| 155 | members, and guardians about satisfaction with the nursing |
| 156 | facility, its environment, the services and care provided, the |
| 157 | staff's skills and interactions with residents, attention to |
| 158 | resident's needs, and the facility's efforts to act on |
| 159 | information gathered from the consumer satisfaction measures. |
| 160 | (d) Evidence the involvement of families and members of |
| 161 | the community in the facility on a regular basis. |
| 162 | (e) Have a stable workforce, as described in s. 400.141, |
| 163 | as evidenced by a relatively low rate of turnover among |
| 164 | certified nursing assistants and licensed nurses within the 30 |
| 165 | months preceding application for the Gold Seal Program, and |
| 166 | demonstrate a continuing effort to maintain a stable workforce |
| 167 | and to reduce turnover of licensed nurses and certified nursing |
| 168 | assistants. |
| 169 | (f) Evidence an outstanding record regarding the number |
| 170 | and types of substantiated complaints reported to the State |
| 171 | Long-Term Care Ombudsman Council within the 30 months preceding |
| 172 | application for the program. |
| 173 | (g) Provide targeted inservice training provided to meet |
| 174 | training needs identified by internal or external quality |
| 175 | assurance efforts. |
| 176 |
|
| 177 | A facility assigned a conditional licensure status may not |
| 178 | qualify for consideration for the Gold Seal Program until after |
| 179 | it has operated for 30 months with no class I or class II |
| 180 | deficiencies and has completed a regularly scheduled relicensure |
| 181 | survey. |
| 182 | Section 7. Paragraph (a) of subsection (1) of section |
| 183 | 400.441, Florida Statutes, is amended to read: |
| 184 | 400.441 Rules establishing standards.-- |
| 185 | (1) It is the intent of the Legislature that rules |
| 186 | published and enforced pursuant to this section shall include |
| 187 | criteria by which a reasonable and consistent quality of |
| 188 | resident care and quality of life may be ensured and the results |
| 189 | of such resident care may be demonstrated. Such rules shall also |
| 190 | ensure a safe and sanitary environment that is residential and |
| 191 | noninstitutional in design or nature. It is further intended |
| 192 | that reasonable efforts be made to accommodate the needs and |
| 193 | preferences of residents to enhance the quality of life in a |
| 194 | facility. In order to provide safe and sanitary facilities and |
| 195 | the highest quality of resident care accommodating the needs and |
| 196 | preferences of residents, the department, in consultation with |
| 197 | the agency, the Department of Children and Family Services, and |
| 198 | the Department of Health, shall adopt rules, policies, and |
| 199 | procedures to administer this part, which must include |
| 200 | reasonable and fair minimum standards in relation to: |
| 201 | (a) The requirements for and maintenance of facilities, |
| 202 | not in conflict with the provisions of chapter 553, relating to |
| 203 | plumbing, heating, cooling, lighting, ventilation, living space, |
| 204 | and other housing conditions, which will ensure the health, |
| 205 | safety, and comfort of residents and protection from fire |
| 206 | hazard, including adequate provisions for fire alarm and other |
| 207 | fire protection suitable to the size of the structure. Uniform |
| 208 | firesafety standards shall be established and enforced by the |
| 209 | State Fire Marshal in cooperation with the agency, the |
| 210 | department, and the Department of Health. |
| 211 | 1. Evacuation capability determination.-- |
| 212 | a. The provisions of the National Fire Protection |
| 213 | Association, NFPA 101A, Chapter 5, 1995 edition, shall be used |
| 214 | for determining the ability of the residents, with or without |
| 215 | staff assistance, to relocate from or within a licensed facility |
| 216 | to a point of safety as provided in the fire codes adopted |
| 217 | herein. An evacuation capability evaluation for initial |
| 218 | licensure shall be conducted within 6 months after the date of |
| 219 | licensure. For existing licensed facilities that are not |
| 220 | equipped with an automatic fire sprinkler system, the |
| 221 | administrator shall evaluate the evacuation capability of |
| 222 | residents at least annually. The evacuation capability |
| 223 | evaluation for each facility not equipped with an automatic fire |
| 224 | sprinkler system shall be validated, without liability, by the |
| 225 | State Fire Marshal, by the local fire marshal, or by the local |
| 226 | authority having jurisdiction over firesafety, before the |
| 227 | license renewal date. If the State Fire Marshal, local fire |
| 228 | marshal, or local authority having jurisdiction over firesafety |
| 229 | has reason to believe that the evacuation capability of a |
| 230 | facility as reported by the administrator may have changed, it |
| 231 | may, with assistance from the facility administrator, reevaluate |
| 232 | the evacuation capability through timed exiting drills. |
| 233 | Translation of timed fire exiting drills to evacuation |
| 234 | capability may be determined: |
| 235 | (I) Three minutes or less: prompt. |
| 236 | (II) More than 3 minutes, but not more than 13 minutes: |
| 237 | slow. |
| 238 | (III) More than 13 minutes: impractical. |
| 239 | b. The Office of the State Fire Marshal shall provide or |
| 240 | cause the provision of training and education on the proper |
| 241 | application of Chapter 5, NFPA 101A, 1995 edition, to its |
| 242 | employees, to staff of the Agency for Health Care Administration |
| 243 | who are responsible for regulating facilities under this part, |
| 244 | and to local governmental inspectors. The Office of the State |
| 245 | Fire Marshal shall provide or cause the provision of this |
| 246 | training within its existing budget, but may charge a fee for |
| 247 | this training to offset its costs. The initial training must be |
| 248 | delivered within 6 months after July 1, 1995, and as needed |
| 249 | thereafter. |
| 250 | c. The Office of the State Fire Marshal, in cooperation |
| 251 | with provider associations, shall provide or cause the provision |
| 252 | of a training program designed to inform facility operators on |
| 253 | how to properly review bid documents relating to the |
| 254 | installation of automatic fire sprinklers. The Office of the |
| 255 | State Fire Marshal shall provide or cause the provision of this |
| 256 | training within its existing budget, but may charge a fee for |
| 257 | this training to offset its costs. The initial training must be |
| 258 | delivered within 6 months after July 1, 1995, and as needed |
| 259 | thereafter. |
| 260 | d. The administrator of a licensed facility shall sign an |
| 261 | affidavit verifying the number of residents occupying the |
| 262 | facility at the time of the evacuation capability evaluation. |
| 263 | 2. Firesafety requirements.-- |
| 264 | a. Except for the special applications provided herein, |
| 265 | effective January 1, 1996, the provisions of the National Fire |
| 266 | Protection Association, Life Safety Code, NFPA 101, 1994 |
| 267 | edition, Chapter 22 for new facilities and Chapter 23 for |
| 268 | existing facilities shall be the uniform fire code applied by |
| 269 | the State Fire Marshal for assisted living facilities, pursuant |
| 270 | to s. 633.022. |
| 271 | b. Any new facility, regardless of size, that applies for |
| 272 | a license on or after January 1, 1996, must be equipped with an |
| 273 | automatic fire sprinkler system. The exceptions as provided in |
| 274 | section 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein, |
| 275 | apply to any new facility housing eight or fewer residents. On |
| 276 | July 1, 1995, local governmental entities responsible for the |
| 277 | issuance of permits for construction shall inform, without |
| 278 | liability, any facility whose permit for construction is |
| 279 | obtained prior to January 1, 1996, of this automatic fire |
| 280 | sprinkler requirement. As used in this part, the term "a new |
| 281 | facility" does not mean an existing facility that has undergone |
| 282 | change of ownership. |
| 283 | c. Notwithstanding any provision of s. 633.022 or of the |
| 284 | National Fire Protection Association, NFPA 101A, Chapter 5, 1995 |
| 285 | edition, to the contrary, any existing facility housing eight or |
| 286 | fewer residents is not required to install an automatic fire |
| 287 | sprinkler system, nor to comply with any other requirement in |
| 288 | Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety |
| 289 | requirements of NFPA 101, 1988 edition, that applies to this |
| 290 | size facility, unless the facility has been classified as |
| 291 | impractical to evacuate. Any existing facility housing eight or |
| 292 | fewer residents that is classified as impractical to evacuate |
| 293 | must install an automatic fire sprinkler system within the |
| 294 | timeframes granted in this section. |
| 295 | d. Any existing facility that is required to install an |
| 296 | automatic fire sprinkler system under this paragraph need not |
| 297 | meet other firesafety requirements of Chapter 23, NFPA 101, 1994 |
| 298 | edition, which exceed the provisions of NFPA 101, 1988 edition. |
| 299 | The mandate contained in this paragraph which requires certain |
| 300 | facilities to install an automatic fire sprinkler system |
| 301 | supersedes any other requirement. |
| 302 | e. This paragraph does not supersede the exceptions |
| 303 | granted in NFPA 101, 1988 edition or 1994 edition. |
| 304 | f. This paragraph does not exempt facilities from other |
| 305 | firesafety provisions adopted under s. 633.022 and local |
| 306 | building code requirements in effect before July 1, 1995. |
| 307 | g. A local government may charge fees only in an amount |
| 308 | not to exceed the actual expenses incurred by local government |
| 309 | relating to the installation and maintenance of an automatic |
| 310 | fire sprinkler system in an existing and properly licensed |
| 311 | assisted living facility structure as of January 1, 1996. |
| 312 | h. If a licensed facility undergoes major reconstruction |
| 313 | or addition to an existing building on or after January 1, 1996, |
| 314 | the entire building must be equipped with an automatic fire |
| 315 | sprinkler system. Major reconstruction of a building means |
| 316 | repair or restoration that costs in excess of 50 percent of the |
| 317 | value of the building as reported on the tax rolls, excluding |
| 318 | land, before reconstruction. Multiple reconstruction projects |
| 319 | within a 5-year period the total costs of which exceed 50 |
| 320 | percent of the initial value of the building at the time the |
| 321 | first reconstruction project was permitted are to be considered |
| 322 | as major reconstruction. Application for a permit for an |
| 323 | automatic fire sprinkler system is required upon application for |
| 324 | a permit for a reconstruction project that creates costs that go |
| 325 | over the 50-percent threshold. |
| 326 | i. Any facility licensed before January 1, 1996, that is |
| 327 | required to install an automatic fire sprinkler system shall |
| 328 | ensure that the installation is completed within the following |
| 329 | timeframes based upon evacuation capability of the facility as |
| 330 | determined under subparagraph 1.: |
| 331 | (I) Impractical evacuation capability, 24 months. |
| 332 | (II) Slow evacuation capability, 48 months. |
| 333 | (III) Prompt evacuation capability, 60 months. |
| 334 |
|
| 335 | The beginning date from which the deadline for the automatic |
| 336 | fire sprinkler installation requirement must be calculated is |
| 337 | upon receipt of written notice from the local fire official that |
| 338 | an automatic fire sprinkler system must be installed. The local |
| 339 | fire official shall send a copy of the document indicating the |
| 340 | requirement of a fire sprinkler system to the Agency for Health |
| 341 | Care Administration. |
| 342 | j. It is recognized that the installation of an automatic |
| 343 | fire sprinkler system may create financial hardship for some |
| 344 | facilities. The appropriate local fire official shall, without |
| 345 | liability, grant two 1-year extensions to the timeframes for |
| 346 | installation established herein, if an automatic fire sprinkler |
| 347 | installation cost estimate and proof of denial from two |
| 348 | financial institutions for a construction loan to install the |
| 349 | automatic fire sprinkler system are submitted. However, for any |
| 350 | facility with a class I or class II, or a history of uncorrected |
| 351 | class III, firesafety deficiencies, an extension must not be |
| 352 | granted. The local fire official shall send a copy of the |
| 353 | document granting the time extension to the Agency for Health |
| 354 | Care Administration. |
| 355 | k. A facility owner whose facility is required to be |
| 356 | equipped with an automatic fire sprinkler system under Chapter |
| 357 | 23, NFPA 101, 1994 edition, as adopted herein, must disclose to |
| 358 | any potential buyer of the facility that an installation of an |
| 359 | automatic fire sprinkler requirement exists. The sale of the |
| 360 | facility does not alter the timeframe for the installation of |
| 361 | the automatic fire sprinkler system. |
| 362 | l. Existing facilities required to install an automatic |
| 363 | fire sprinkler system as a result of construction-type |
| 364 | restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted |
| 365 | herein, or evacuation capability requirements shall be notified |
| 366 | by the local fire official in writing of the automatic fire |
| 367 | sprinkler requirement, as well as the appropriate date for final |
| 368 | compliance as provided in this subparagraph. The local fire |
| 369 | official shall send a copy of the document to the Agency for |
| 370 | Health Care Administration. |
| 371 | m. Except in cases of life-threatening fire hazards, if an |
| 372 | existing facility experiences a change in the evacuation |
| 373 | capability, or if the local authority having jurisdiction |
| 374 | identifies a construction-type restriction, such that an |
| 375 | automatic fire sprinkler system is required, it shall be |
| 376 | afforded time for installation as provided in this subparagraph. |
| 377 |
|
| 378 | Facilities that are fully sprinkled and in compliance with other |
| 379 | firesafety standards are not required to conduct more than one |
| 380 | of the required fire drills between the hours of 11 p.m. and 7 |
| 381 | a.m., per year. In lieu of the remaining drills, staff |
| 382 | responsible for residents during such hours may be required to |
| 383 | participate in a mock drill that includes a review of evacuation |
| 384 | procedures. Such standards must be included or referenced in the |
| 385 | rules adopted by the State Fire Marshal. Pursuant to s. |
| 386 | 633.022(1)(b), the State Fire Marshal is the final |
| 387 | administrative authority for firesafety standards established |
| 388 | and enforced pursuant to this section. All licensed facilities |
| 389 | must have an annual fire inspection conducted by the local fire |
| 390 | marshal or authority having jurisdiction. |
| 391 | 3. Resident elopement requirements.--Facilities are |
| 392 | required to conduct a minimum of two resident elopement |
| 393 | prevention and response drills per year. All administrators and |
| 394 | direct care staff must participate in the drills which shall |
| 395 | include a review of procedures to address resident elopement. |
| 396 | Facilities must document the implementation of the drills and |
| 397 | ensure that the drills are conducted in a manner consistent with |
| 398 | the facility's resident elopement policies and procedures. |
| 399 | Section 8. Subsection (13) of section 400.619, Florida |
| 400 | Statutes, is amended to read: |
| 401 | 400.619 Licensure application and renewal.-- |
| 402 | (13) All moneys collected under this section must be |
| 403 | deposited into the Department of Elderly Affairs Administrative |
| 404 | Trust Fund and used to offset the expenses of departmental |
| 405 | training and education for adult family-care home providers. |
| 406 | Section 9. Subsection (5) of section 408.034, Florida |
| 407 | Statutes, is amended to read: |
| 408 | 408.034 Duties and responsibilities of agency; rules.-- |
| 409 | (5) The agency shall establish by rule a nursing-home-bed- |
| 410 | need methodology that has a goal of maintaining a subdistrict |
| 411 | average occupancy rate of 94 percent and that reduces the |
| 412 | community nursing home bed need for the areas of the state where |
| 413 | the agency establishes pilot community diversion programs |
| 414 | through the Title XIX aging waiver program. |
| 415 | Section 10. Paragraphs (g) and (h) are added to subsection |
| 416 | (2) of section 408.036, Florida Statutes, paragraph (p) of |
| 417 | subsection (3) is amended, paragraphs (u) and (v) are added to |
| 418 | subsection (3) of said section, and subsection (4) is reenacted |
| 419 | to read: |
| 420 | 408.036 Projects subject to review; exemptions.-- |
| 421 | (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt |
| 422 | pursuant to subsection (3), projects subject to an expedited |
| 423 | review shall include, but not be limited to: |
| 424 | (g) Replacement of a nursing home within the same |
| 425 | district, provided the proposed project site is located within a |
| 426 | geographic area that contains at least 65 percent of the |
| 427 | facility's current residents and is within a 30-mile radius of |
| 428 | the replaced nursing home. |
| 429 | (h) Relocation of a portion of a nursing home's licensed |
| 430 | beds to a facility within the same district, provided the |
| 431 | relocation is within a 30-mile radius of the existing facility |
| 432 | and the total number of nursing home beds in the district does |
| 433 | not increase. |
| 434 |
|
| 435 | The agency shall develop rules to implement the provisions for |
| 436 | expedited review, including time schedule, application content |
| 437 | which may be reduced from the full requirements of s. |
| 438 | 408.037(1), and application processing. |
| 439 | (3) EXEMPTIONS.--Upon request, the following projects are |
| 440 | subject to exemption from the provisions of subsection (1): |
| 441 | (p) For the addition of nursing home beds licensed under |
| 442 | chapter 400 in a number not exceeding 10 total beds or 10 |
| 443 | percent of the number of beds licensed in the facility being |
| 444 | expanded, whichever is greater, or for the addition of nursing |
| 445 | home beds licensed under chapter 400 at a facility that has been |
| 446 | designated as a Gold Seal nursing home under s. 400.235 in a |
| 447 | number not exceeding 20 total beds or 10 percent of the number |
| 448 | of beds licensed in the facility being expanded, whichever is |
| 449 | greater. |
| 450 | 1. In addition to any other documentation required by the |
| 451 | agency, a request for exemption submitted under this paragraph |
| 452 | must: |
| 453 | a. Effective until June 30, 2001, Certify that the |
| 454 | facility has not had any class I or class II deficiencies within |
| 455 | the 30 months preceding the request for addition. |
| 456 | b. Effective on July 1, 2001, certify that the facility |
| 457 | has been designated as a Gold Seal nursing home under s. |
| 458 | 400.235. |
| 459 | b.c. Certify that the prior 12-month average occupancy |
| 460 | rate for the nursing home beds at the facility meets or exceeds |
| 461 | 96 percent. |
| 462 | c.d. Certify that any beds authorized for the facility |
| 463 | under this paragraph before the date of the current request for |
| 464 | an exemption have been licensed and operational for at least 12 |
| 465 | months. |
| 466 | 2. The timeframes and monitoring process specified in s. |
| 467 | 408.040(2)(a)-(c) apply to any exemption issued under this |
| 468 | paragraph. |
| 469 | 3. The agency shall count beds authorized under this |
| 470 | paragraph as approved beds in the published inventory of nursing |
| 471 | home beds until the beds are licensed. |
| 472 | (u) For replacement of a licensed nursing home on the same |
| 473 | site, or within 3 miles of the same site, provided the number of |
| 474 | licensed beds does not increase. |
| 475 | (v) For consolidation or combination of licensed nursing |
| 476 | homes or transfer of beds between licensed nursing homes within |
| 477 | the same planning subdistrict, by providers that operate |
| 478 | multiple nursing homes within that planning subdistrict, |
| 479 | provided there is no increase in the planning subdistrict total |
| 480 | of nursing home beds and the relocation does not exceed 30 miles |
| 481 | from the original location. |
| 482 | (4) A request for exemption under subsection (3) may be |
| 483 | made at any time and is not subject to the batching requirements |
| 484 | of this section. The request shall be supported by such |
| 485 | documentation as the agency requires by rule. The agency shall |
| 486 | assess a fee of $250 for each request for exemption submitted |
| 487 | under subsection (3). |
| 488 | Section 11. Section 430.701, Florida Statutes, is amended |
| 489 | to read: |
| 490 | 430.701 Legislative findings and intent.-- |
| 491 | (1) The Legislature finds that state expenditures for |
| 492 | long-term care services continue to increase at a rapid rate and |
| 493 | that Florida faces increasing pressure in its efforts to meet |
| 494 | the long-term care needs of the public. It is the intent of the |
| 495 | Legislature that the Department of Elderly Affairs, in |
| 496 | consultation with the Agency for Health Care Administration, |
| 497 | implement long-term care community diversion pilot projects to |
| 498 | test the effectiveness of managed care and outcome-based |
| 499 | reimbursement principles when applied to long-term care. |
| 500 | (2) The agency may seek federal approval in advance of its |
| 501 | formal waiver application to limit the diversion provider |
| 502 | network by freezing enrollment of providers at current levels |
| 503 | when an area already has three or more providers or, in an |
| 504 | expansion area, when enrollment reaches a level of three |
| 505 | providers. This subsection does not prevent the department from |
| 506 | approving a provider to expand service to additional counties |
| 507 | within a planning and service area for which the provider is |
| 508 | already approved to serve. |
| 509 | Section 12. Section 52 of chapter 2001-45, Laws of |
| 510 | Florida, as amended by section 1693 of chapter 2003-261, Laws of |
| 511 | Florida, is amended to read: |
| 512 | Section 52. (1) Notwithstanding the establishment of need |
| 513 | as provided for in chapter 408, Florida Statutes, no certificate |
| 514 | of need for additional community nursing home beds shall be |
| 515 | approved by the agency until July 1, 2006. |
| 516 | (2) The Legislature finds that the continued growth in the |
| 517 | Medicaid budget for nursing home care has constrained the |
| 518 | ability of the state to meet the needs of its elderly residents |
| 519 | through the use of less restrictive and less institutional |
| 520 | methods of long-term care. It is therefore the intent of the |
| 521 | Legislature to limit the increase in Medicaid nursing home |
| 522 | expenditures in order to provide funds to invest in long-term |
| 523 | care that is community-based and provides supportive services in |
| 524 | a manner that is both more cost-effective and more in keeping |
| 525 | with the wishes of the elderly residents of this state. |
| 526 | (3) This moratorium on certificates of need shall not |
| 527 | apply to sheltered nursing home beds in a continuing care |
| 528 | retirement community certified by the former Department of |
| 529 | Insurance or by the Office of Insurance Regulation pursuant to |
| 530 | chapter 651, Florida Statutes. |
| 531 | (4)(a) The moratorium on certificates of need does not |
| 532 | apply and a certificate of need for additional community nursing |
| 533 | home beds may be approved for a county that meets the following |
| 534 | circumstances: |
| 535 | 1. The county has no community nursing home beds; and |
| 536 | 2. The lack of community nursing home beds occurs because |
| 537 | all nursing home beds in the county that were licensed on July |
| 538 | 1, 2001, have subsequently closed. |
| 539 | (b) The certificate-of-need review for such circumstances |
| 540 | shall be subject to the comparative review process consistent |
| 541 | with the provisions of s. 408.039, Florida Statutes, and the |
| 542 | number of beds may not exceed the number of beds lost by the |
| 543 | county after July 1, 2001. |
| 544 |
|
| 545 | This subsection shall be repealed upon the expiration of the |
| 546 | moratorium established in subsection (1). |
| 547 | (5) The moratorium on certificates of need does not apply |
| 548 | for the addition of nursing home beds licensed under chapter |
| 549 | 400, Florida Statutes, to a nursing home located in a county |
| 550 | having up to 50,000 residents, in a number not exceeding 10 |
| 551 | total beds or 10 percent of the number of beds licensed in the |
| 552 | facility being expanded, whichever is greater. In addition to |
| 553 | any other documentation required by the agency, a request |
| 554 | submitted under this subsection must: |
| 555 | (a) Certify that the facility has not had any class I or |
| 556 | class II deficiencies within the 30 months preceding the request |
| 557 | for addition. |
| 558 | (b) Certify that the prior 12-month average occupancy rate |
| 559 | for the nursing home beds at the facility meets or exceeds 94 |
| 560 | percent. |
| 561 | (c) For a facility that has been licensed for less than 24 |
| 562 | months, certify that the prior 6-month average occupancy rate |
| 563 | for the nursing home beds at the facility meets or exceeds 94 |
| 564 | percent and that the facility has not had any class I or class |
| 565 | II deficiencies since its initial licensure. |
| 566 |
|
| 567 | This subsection shall be repealed upon the expiration of the |
| 568 | moratorium established in subsection (1). |
| 569 | Section 13. Subsection (7) of section 651.118, Florida |
| 570 | Statutes, is amended to read: |
| 571 | 651.118 Agency for Health Care Administration; |
| 572 | certificates of need; sheltered beds; community beds.-- |
| 573 | (7) Notwithstanding the provisions of subsection (2), at |
| 574 | the discretion of the continuing care provider, sheltered |
| 575 | nursing home beds may be used for persons who are not residents |
| 576 | of the continuing care facility and who are not parties to a |
| 577 | continuing care contract for a period of up to 5 years after the |
| 578 | date of issuance of the initial nursing home license. A provider |
| 579 | whose 5-year period has expired or is expiring may request the |
| 580 | Agency for Health Care Administration for an extension, not to |
| 581 | exceed 30 percent of the total sheltered nursing home beds, if |
| 582 | the utilization by residents of the nursing home facility in the |
| 583 | sheltered beds will not generate sufficient income to cover |
| 584 | nursing home facility expenses, as evidenced by one of the |
| 585 | following: |
| 586 | (a) The nursing home facility has a net loss for the most |
| 587 | recent fiscal year as determined under generally accepted |
| 588 | accounting principles, excluding the effects of extraordinary or |
| 589 | unusual items, as demonstrated in the most recently audited |
| 590 | financial statement; or |
| 591 | (b) The nursing home facility would have had a pro forma |
| 592 | loss for the most recent fiscal year, excluding the effects of |
| 593 | extraordinary or unusual items, if revenues were reduced by the |
| 594 | amount of revenues from persons in sheltered beds who were not |
| 595 | residents, as reported on by a certified public accountant. |
| 596 |
|
| 597 | The agency shall be authorized to grant an extension to the |
| 598 | provider based on the evidence required in this subsection. The |
| 599 | agency may request a continuing care facility to use up to 25 |
| 600 | percent of the patient days generated by new admissions of |
| 601 | nonresidents during the extension period to serve Medicaid |
| 602 | recipients for those beds authorized for extended use if there |
| 603 | is a demonstrated need in the respective service area and if |
| 604 | funds are available. A provider who obtains an extension is |
| 605 | prohibited from applying for additional sheltered beds under the |
| 606 | provision of subsection (2), unless additional residential units |
| 607 | are built or the provider can demonstrate need by continuing |
| 608 | care facility residents to the Agency for Health Care |
| 609 | Administration. The 5-year limit does not apply to up to five |
| 610 | sheltered beds designated for inpatient hospice care as part of |
| 611 | a contractual arrangement with a hospice licensed under part VI |
| 612 | of chapter 400. A continuing care facility that uses such beds |
| 613 | after the 5-year period shall report such use to the Agency for |
| 614 | Health Care Administration. For purposes of this subsection, |
| 615 | "resident" means a person who, upon admission to the continuing |
| 616 | care facility, initially resides in a part of the continuing |
| 617 | care facility not licensed under part II of chapter 400. |
| 618 | Section 14. Subsections (3) and (4) of section 400.9905, |
| 619 | Florida Statutes, are renumbered as subsections (4) and (5), |
| 620 | respectively, and amended, and new subsections (3), (6), and (7) |
| 621 | are added to said section, to read: |
| 622 | 400.9905 Definitions.-- |
| 623 | (3) "Chief financial officer" means an individual who has |
| 624 | a bachelor's degree from an accredited university in accounting |
| 625 | or finance, or a related field, and who is the person |
| 626 | responsible for the preparation of a clinic's billing. |
| 627 | (4)(3) "Clinic" means an entity at which health care |
| 628 | services are provided to individuals and which tenders charges |
| 629 | for reimbursement for such services, including a mobile clinic |
| 630 | and a portable equipment provider. For purposes of this part, |
| 631 | the term does not include and the licensure requirements of this |
| 632 | part do not apply to: |
| 633 | (a) Entities licensed or registered by the state under |
| 634 | chapter 395; or entities licensed or registered by the state and |
| 635 | providing only health care services within the scope of services |
| 636 | authorized under their respective licenses granted under s. |
| 637 | 383.30-383.335, chapter 390, chapter 394, chapter 395, chapter |
| 638 | 397, this chapter except part XIII, chapter 463, chapter 465, |
| 639 | chapter 466, chapter 478, part I of chapter 483 chapter 480, |
| 640 | chapter 484, or chapter 651; end-stage renal disease providers |
| 641 | authorized under 42 C.F.R. part 405, subpart U; or providers |
| 642 | certified under 42 C.F.R. part 485, subpart B or subpart H, or |
| 643 | any entity that provides neonatal or pediatric hospital-based |
| 644 | healthcare services by licensed practitioners solely within a |
| 645 | hospital licensed under chapter 395. |
| 646 | (b) Entities that own, directly or indirectly, entities |
| 647 | licensed or registered by the state pursuant to chapter 395; or |
| 648 | entities that own, directly or indirectly, entities licensed or |
| 649 | registered by the state and providing only health care services |
| 650 | within the scope of services authorized pursuant to their |
| 651 | respective licenses granted under s. 383.30-383.335, chapter |
| 652 | 390, chapter 394, chapter 395, chapter 397, this chapter except |
| 653 | part XIII, chapter 463, chapter 465, chapter 466, chapter 478, |
| 654 | part I of chapter 483 chapter 480, chapter 484, or chapter 651, |
| 655 | end-stage renal disease providers authorized under 42 C.F.R. |
| 656 | part 405, subpart U, or providers certified under 42 C.F.R. part |
| 657 | 485, subpart B or subpart H, or any entity that provides |
| 658 | neonatal or pediatric hospital-based healthcare services by |
| 659 | licensed practitioners solely within a hospital licensed under |
| 660 | chapter 395. |
| 661 | (c) Entities that are owned, directly or indirectly, by an |
| 662 | entity licensed or registered by the state pursuant to chapter |
| 663 | 395; or entities that are owned, directly or indirectly, by an |
| 664 | entity licensed or registered by the state and providing only |
| 665 | health care services within the scope of services authorized |
| 666 | pursuant to their respective licenses granted under s. 383.30- |
| 667 | 383.335, chapter 390, chapter 394, chapter 395, chapter 397, |
| 668 | this chapter except part XIII, chapter 463, chapter 465, chapter |
| 669 | 466, chapter 478, part I of chapter 483 chapter 480, chapter |
| 670 | 484, or chapter 651; end-stage renal disease providers |
| 671 | authorized under 42 C.F.R. part 405, subpart U; or providers |
| 672 | certified under 42 C.F.R. part 485, subpart B or subpart H, or |
| 673 | any entity that provides neonatal or pediatric hospital-based |
| 674 | healthcare services by licensed practitioners solely within a |
| 675 | hospital under chapter 395. |
| 676 | (d) Entities that are under common ownership, directly or |
| 677 | indirectly, with an entity licensed or registered by the state |
| 678 | pursuant to chapter 395; or entities that are under common |
| 679 | ownership, directly or indirectly, with an entity licensed or |
| 680 | registered by the state and providing only health care services |
| 681 | within the scope of services authorized pursuant to their |
| 682 | respective licenses granted under s. 383.30-383.335, chapter |
| 683 | 390, chapter 394, chapter 395, chapter 397, this chapter except |
| 684 | part XIII, chapter 463, chapter 465, chapter 466, chapter 478, |
| 685 | part I of chapter 483 480, chapter 484, or chapter 651; end- |
| 686 | stage renal disease providers authorized under 42 C.F.R. part |
| 687 | 405, subpart U; or providers certified under 42 C.F.R. part 485, |
| 688 | subpart B or subpart H or any entity that provides neonatal or |
| 689 | pediatric hospital-based healthcare services by licensed |
| 690 | practitioners solely within a hospital licensed under chapter |
| 691 | 395. |
| 692 | (e) An entity that is exempt from federal taxation under |
| 693 | 26 U.S.C. s. 501(c)(3) or s. 501(c)(4) and any community college |
| 694 | or university clinic, and any entity owned or operated by |
| 695 | federal or state government, including agencies, subdivisions, |
| 696 | or municipalities thereof. |
| 697 | (f) A sole proprietorship, group practice, partnership, or |
| 698 | corporation that provides health care services by physicians |
| 699 | covered by s. 627.419, that is directly supervised by one or |
| 700 | more of such physicians, and that is wholly owned by one or more |
| 701 | of those physicians or by a physician and the spouse, child, or |
| 702 | sibling of that physician. |
| 703 | (g)(f) A sole proprietorship, group practice, partnership, |
| 704 | or corporation that provides health care services by licensed |
| 705 | health care practitioners under chapter 457, chapter 458, |
| 706 | chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, |
| 707 | chapter 466, chapter 467, chapter 480, chapter 484, chapter 486, |
| 708 | chapter 490, chapter 491, or part I, part III, part X, part |
| 709 | XIII, or part XIV of chapter 468, or s. 464.012, which are |
| 710 | wholly owned by one or more a licensed health care practitioners |
| 711 | practitioner, or the licensed health care practitioners set |
| 712 | forth in this paragraph practitioner and the spouse, parent, or |
| 713 | child, or sibling of a licensed health care practitioner, so |
| 714 | long as one of the owners who is a licensed health care |
| 715 | practitioner is supervising the business activities services |
| 716 | performed therein and is legally responsible for the entity's |
| 717 | compliance with all federal and state laws. However, a health |
| 718 | care practitioner may not supervise services beyond the scope of |
| 719 | the practitioner's license, except that, for the purposes of |
| 720 | this part, a clinic owned by a licensee in s. 456.053(3)(b) that |
| 721 | provides only services authorized pursuant to s. 456.053(3)(b) |
| 722 | may be supervised by a licensee specified in s. 456.053(3)(b). |
| 723 | (h)(g) Clinical facilities affiliated with an accredited |
| 724 | medical school at which training is provided for medical |
| 725 | students, residents, or fellows. |
| 726 | (i) Entities that provide only oncology or radiation |
| 727 | therapy services by physicians licensed under chapter 458 or |
| 728 | chapter 459. |
| 729 | (5)(4) "Medical director" means a physician who is |
| 730 | employed or under contract with a clinic and who maintains a |
| 731 | full and unencumbered physician license in accordance with |
| 732 | chapter 458, chapter 459, chapter 460, or chapter 461. However, |
| 733 | if the clinic does not provide services pursuant to the |
| 734 | respective physician practices acts listed in this subsection, |
| 735 | it is limited to providing health care services pursuant to |
| 736 | chapter 457, chapter 484, chapter 486, chapter 490, or chapter |
| 737 | 491 or part I, part III, part X, part XIII, or part XIV of |
| 738 | chapter 468, the clinic may appoint a Florida-licensed health |
| 739 | care practitioner who does not provide services pursuant to the |
| 740 | respective physician practices acts listed in this subsection |
| 741 | licensed under that chapter to serve as a clinic director who is |
| 742 | responsible for the clinic's activities. A health care |
| 743 | practitioner may not serve as the clinic director if the |
| 744 | services provided at the clinic are beyond the scope of that |
| 745 | practitioner's license, except that a licensee specified in s. |
| 746 | 456.053(3)(b) who provides only services authorized pursuant to |
| 747 | s. 456.053(3)(b) may serve as clinic director of an entity |
| 748 | providing services as specified in s. 456.053(3)(b). |
| 749 | (6) "Mobile clinic" means a movable or detached self- |
| 750 | contained health care unit within or from which direct health |
| 751 | care services are provided to individuals and which otherwise |
| 752 | meets the definition of a clinic in subsection (4). |
| 753 | (7) "Portable equipment provider" means an entity that |
| 754 | contracts with or employs persons to provide portable equipment |
| 755 | to multiple locations performing treatment or diagnostic testing |
| 756 | of individuals, that bills third-party payors for those |
| 757 | services, and that otherwise meets the definition of a clinic in |
| 758 | subsection (4). |
| 759 | Section 15. The creation of s. 400.9905(4)(i), Florida |
| 760 | Statutes, by this act is intended to clarify the legislative |
| 761 | intent of this provision as it existed at the time the |
| 762 | provisions initially took effect as ss. 456.0375(1)(b) and |
| 763 | 400.9905(4)(i), Florida Statutes, as created by this act, shall |
| 764 | operate retroactively to October 1, 2001. Nothing in this |
| 765 | section shall be construed as amending, modifying, limiting, or |
| 766 | otherwise affecting in any way the legislative intent, scope, |
| 767 | terms, prohibition, or requirements of s. 456.053, Florida |
| 768 | Statutes. |
| 769 | Section 16. Effective upon this act becoming a law and |
| 770 | applicable retroactively to March 1, 2004, subsections (1), (2), |
| 771 | and (3) and paragraphs (a) and (b) of subsection (7) of section |
| 772 | 400.991, Florida Statutes, are amended to read: |
| 773 | 400.991 License requirements; background screenings; |
| 774 | prohibitions.-- |
| 775 | (1)(a) Each clinic, as defined in s. 400.9905, must be |
| 776 | licensed and shall at all times maintain a valid license with |
| 777 | the agency. Each clinic location shall be licensed separately |
| 778 | regardless of whether the clinic is operated under the same |
| 779 | business name or management as another clinic. |
| 780 | (b) Each mobile clinic must obtain a separate health care |
| 781 | clinic license and clinics must provide to the agency, at least |
| 782 | quarterly, its their projected street location locations to |
| 783 | enable the agency to locate and inspect such clinic clinics. A |
| 784 | portable equipment provider must obtain a health care clinic |
| 785 | license for a single administrative office and is not required |
| 786 | to submit quarterly projected street locations. |
| 787 | (2) The initial clinic license application shall be filed |
| 788 | with the agency by all clinics, as defined in s. 400.9905, on or |
| 789 | before July March 1, 2004. A clinic license must be renewed |
| 790 | biennially. |
| 791 | (3) Applicants that submit an application on or before |
| 792 | July March 1, 2004, which meets all requirements for initial |
| 793 | licensure as specified in this section shall receive a temporary |
| 794 | license until the completion of an initial inspection verifying |
| 795 | that the applicant meets all requirements in rules authorized in |
| 796 | s. 400.9925. However, a clinic engaged in magnetic resonance |
| 797 | imaging services may not receive a temporary license unless it |
| 798 | presents evidence satisfactory to the agency that such clinic is |
| 799 | making a good faith effort and substantial progress in seeking |
| 800 | accreditation required under s. 400.9935. |
| 801 | (7) Each applicant for licensure shall comply with the |
| 802 | following requirements: |
| 803 | (a) As used in this subsection, the term "applicant" means |
| 804 | individuals owning or controlling, directly or indirectly, 5 |
| 805 | percent or more of an interest in a clinic; the medical or |
| 806 | clinic director, or a similarly titled person who is responsible |
| 807 | for the day-to-day operation of the licensed clinic; the |
| 808 | financial officer or similarly titled individual who is |
| 809 | responsible for the financial operation of the clinic; and |
| 810 | licensed health care practitioners medical providers at the |
| 811 | clinic. |
| 812 | (b) Upon receipt of a completed, signed, and dated |
| 813 | application, the agency shall require background screening of |
| 814 | the applicant, in accordance with the level 2 standards for |
| 815 | screening set forth in chapter 435. Proof of compliance with the |
| 816 | level 2 background screening requirements of chapter 435 which |
| 817 | has been submitted within the previous 5 years in compliance |
| 818 | with any other health care licensure requirements of this state |
| 819 | is acceptable in fulfillment of this paragraph. Applicants who |
| 820 | own less than 10 percent of a health care clinic are not |
| 821 | required to submit fingerprints under this section. |
| 822 | Section 17. Paragraph (g) of subsection (1), subsection |
| 823 | (9), and paragraph (b) of subsection (11) of section 400.9935, |
| 824 | Florida Statutes, are amended to read: |
| 825 | 400.9935 Clinic responsibilities.-- |
| 826 | (1) Each clinic shall appoint a medical director or clinic |
| 827 | director who shall agree in writing to accept legal |
| 828 | responsibility for the following activities on behalf of the |
| 829 | clinic. The medical director or the clinic director shall: |
| 830 | (g) Conduct systematic reviews of clinic billings to |
| 831 | ensure that the billings are not fraudulent or unlawful. Upon |
| 832 | discovery of an unlawful charge, the medical director or clinic |
| 833 | director shall take immediate corrective action. If the clinic |
| 834 | performs only the technical component of magnetic resonance |
| 835 | imaging, static radiographs, computed tomography, or positron |
| 836 | emission tomography and provides the professional interpretation |
| 837 | of such services, in a fixed facility that is accredited by the |
| 838 | Joint Commission on Accreditation of Healthcare Organizations or |
| 839 | the Accreditation Association for Ambulatory Health Care and the |
| 840 | American College of Radiology, and if, in the preceding quarter, |
| 841 | the percentage of scans performed by that clinic that were |
| 842 | billed to a personal injury protection insurance carrier was |
| 843 | less than 15 percent, the chief financial officer of the clinic |
| 844 | may, in a written acknowledgment provided to the agency, assume |
| 845 | the responsibility for the conduct of the systematic reviews of |
| 846 | clinic billings to ensure that the billings are not fraudulent |
| 847 | or unlawful. |
| 848 | (9) Any person or entity providing health care services |
| 849 | which is not a clinic, as defined under s. 400.9905, may |
| 850 | voluntarily apply for a certificate of exemption from licensure |
| 851 | under its exempt status with the agency on a form that sets |
| 852 | forth its name or names and addresses, a statement of the |
| 853 | reasons why it cannot be defined as a clinic, and other |
| 854 | information deemed necessary by the agency. An exemption is not |
| 855 | transferable. The agency may charge an applicant for a |
| 856 | certificate of exemption in an amount equal to $100 or the |
| 857 | actual cost of processing the certificate, whichever is less. |
| 858 | (11) |
| 859 | (b) The agency may deny disallow the application or revoke |
| 860 | the license of any entity formed for the purpose of avoiding |
| 861 | compliance with the accreditation provisions of this subsection |
| 862 | and whose principals were previously principals of an entity |
| 863 | that was unable to meet the accreditation requirements within |
| 864 | the specified timeframes. The agency may adopt rules as to the |
| 865 | accreditation of magnetic resonance imaging clinics. |
| 866 | Section 18. Subsections (1) and (3) of section 400.995, |
| 867 | Florida Statutes, are amended, and a new subsection (10) is |
| 868 | added to said section, to read: |
| 869 | 400.995 Agency administrative penalties.-- |
| 870 | (1) The agency may deny the application for a license |
| 871 | renewal, revoke or suspend the license, and impose |
| 872 | administrative fines penalties against clinics of up to $5,000 |
| 873 | per violation for violations of the requirements of this part or |
| 874 | rules of the agency. In determining if a penalty is to be |
| 875 | imposed and in fixing the amount of the fine, the agency shall |
| 876 | consider the following factors: |
| 877 | (a) The gravity of the violation, including the |
| 878 | probability that death or serious physical or emotional harm to |
| 879 | a patient will result or has resulted, the severity of the |
| 880 | action or potential harm, and the extent to which the provisions |
| 881 | of the applicable laws or rules were violated. |
| 882 | (b) Actions taken by the owner, medical director, or |
| 883 | clinic director to correct violations. |
| 884 | (c) Any previous violations. |
| 885 | (d) The financial benefit to the clinic of committing or |
| 886 | continuing the violation. |
| 887 | (3) Any action taken to correct a violation shall be |
| 888 | documented in writing by the owner, medical director, or clinic |
| 889 | director of the clinic and verified through followup visits by |
| 890 | agency personnel. The agency may impose a fine and, in the case |
| 891 | of an owner-operated clinic, revoke or deny a clinic's license |
| 892 | when a clinic medical director or clinic director knowingly |
| 893 | fraudulently misrepresents actions taken to correct a violation. |
| 894 | (10) If the agency issues a notice of intent to deny a |
| 895 | license application after a temporary license has been issued |
| 896 | pursuant to s. 400.991(3), the temporary license shall expire on |
| 897 | the date of the notice and may not be extended during any |
| 898 | proceeding for administrative or judicial review pursuant to |
| 899 | chapter 120. |
| 900 | Section 19. The Agency for Health Care Administration is |
| 901 | directed to make refunds to applicants that submitted their |
| 902 | health care clinic licensure fees and applications but were |
| 903 | subsequently exempted from licensure by this act as follows: |
| 904 | (1) Seventy-five percent of the application fee if the |
| 905 | temporary license has not been issued; |
| 906 | (2) Fifty percent of the application fee if the temporary |
| 907 | license has been issued but the inspection has not been |
| 908 | completed; or |
| 909 | (3) No refund if the inspection has been completed. |
| 910 | Section 20. Any person or entity defined as a clinic under |
| 911 | s. 400.9905, Florida Statutes, shall not be in violation of part |
| 912 | XIII of chapter 400, Florida Statutes, due to failure to apply |
| 913 | for a clinic license by March 1, 2004, as previously required by |
| 914 | s. 400.991, Florida Statutes. Payment to any such person or |
| 915 | entity by an insurer or other person liable for payment to such |
| 916 | person or entity may not be denied on the grounds that the |
| 917 | person or entity failed to apply for or obtain a clinic license |
| 918 | before March 1, 2004. |
| 919 | Section 21. This act shall take effect upon becoming a |
| 920 | law. |
| 921 |
|
| 922 | ================= T I T L E A M E N D M E N T ================= |
| 923 | Remove the entire title and insert: |
| 924 | A bill to be entitled |
| 925 | An act relating to health care facilities; creating s. 400.0712, |
| 926 | F.S.; authorizing the Agency for Health Care Administration to |
| 927 | issue inactive licenses to nursing homes for all or a portion of |
| 928 | their beds under certain circumstances; providing requirements |
| 929 | for application for and issuance of such licenses; providing |
| 930 | rulemaking authority; amending s. 400.071, F.S.; deleting a |
| 931 | provision relating to issuance of inactive licenses, to conform; |
| 932 | amending s. 400.021, F.S.; redefining the term "resident care |
| 933 | plan," as used in part II of ch. 400, F.S.; amending s. 400.23, |
| 934 | F.S.; providing that certain information from the agency must be |
| 935 | promptly updated to reflect the most current agency actions; |
| 936 | amending s. 400.211, F.S.; revising inservice training |
| 937 | requirements for persons employed as nursing assistants in a |
| 938 | nursing home facility; amending s. 400.235, F.S.; providing for |
| 939 | financial stability for Gold Seal for certain nursing |
| 940 | facilities; amending s. 400.441, F.S.; requiring facilities to |
| 941 | conduct resident elopement prevention and response drills; |
| 942 | providing documentation thereof; amending s. 400.619, F.S.; |
| 943 | removing the requirement that certain moneys deposited into the |
| 944 | Department of Elderly Affairs Administrative Trust Fund be used |
| 945 | to offset the expenses of departmental training and education |
| 946 | for adult family-care home providers; amending s. 408.034, F.S.; |
| 947 | requiring the nursing-home-bed-need methodology established by |
| 948 | the agency by rule to include a goal of maintaining a specified |
| 949 | subdistrict average occupancy rate; amending s. 408.036, F.S., |
| 950 | relating to health-care-related projects subject to review for a |
| 951 | certificate of need; subjecting certain projects relating to |
| 952 | replacement of a nursing home and relocation of nursing home |
| 953 | beds to expedited review; revising requirements for certain |
| 954 | projects relating to the addition of nursing home beds which are |
| 955 | exempt from review; exempting from review certain projects |
| 956 | relating to replacement of a licensed nursing home bed on the |
| 957 | same site or nearby and consolidation or combination of licensed |
| 958 | nursing homes or transfer of beds between licensed nursing homes |
| 959 | within the same planning subdistrict; providing rulemaking |
| 960 | authority; providing for assessment of exemption-request fees; |
| 961 | amending s. 430.701, F.S.; authorizing the agency to seek |
| 962 | federal approval prior to seeking a certain waiver relating to |
| 963 | the long-term care diversion provider network; amending s. 52, |
| 964 | ch. 2001-45, Laws of Florida; specifying nonapplication of a |
| 965 | moratorium on certificates of need and authorizing approval of |
| 966 | certain certificates of need for certain counties; specifying |
| 967 | nonapplication of the moratorium for the addition of nursing |
| 968 | home beds in certain counties; providing requirements and |
| 969 | limitations; providing for repeal upon expiration of the |
| 970 | moratorium; amending s. 651.118, F.S.; revising provisions |
| 971 | relating to use of sheltered nursing home beds at a continuing |
| 972 | care facility by persons who are not residents of the continuing |
| 973 | care facility; amending s. 400.9905, F.S.; revising and |
| 974 | providing definitions; amending s. 400.991, F.S.; revising |
| 975 | health care clinic licensing requirements; requiring separate |
| 976 | licenses for each mobile clinic; providing licensing |
| 977 | requirements for portable equipment providers; providing for |
| 978 | retroactive effect; amending s. 400.9935, F.S.; providing that a |
| 979 | chief financial officer may assume responsibility for clinic |
| 980 | billings under certain circumstances; providing that an |
| 981 | exemption is not transferable; authorizing a fee for a |
| 982 | certificate of exemption; allowing the agency to deny or revoke |
| 983 | a license; amending s. 400.995, F.S.; allowing the agency to |
| 984 | deny the renewal of a license or to revoke or suspend a license; |
| 985 | prohibiting extension of a temporary license under certain |
| 986 | circumstances; requiring the Agency for Health Care |
| 987 | Administration to refund certain application fees; providing |
| 988 | exceptions for certain late filed applications; providing an |
| 989 | effective date. |