Senate Bill sb1062e1
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1 A bill to be entitled
2 An act relating to health care facilities;
3 creating s. 400.0712, F.S.; authorizing the
4 Agency for Health Care Administration to issue
5 inactive licenses to nursing homes for all or a
6 portion of their beds under certain
7 circumstances; providing requirements for
8 application for and issuance of such licenses;
9 providing rulemaking authority; amending s.
10 400.071, F.S.; deleting a provision relating to
11 issuance of inactive licenses, to conform;
12 amending s. 400.021, F.S.; redefining the term
13 "resident care plan," as used in part II of ch.
14 400, F.S.; amending s. 400.23, F.S.; providing
15 that certain information from the agency must
16 be promptly updated to reflect the most current
17 agency actions; amending s. 400.211, F.S.;
18 revising inservice training requirements for
19 persons employed as nursing assistants in a
20 nursing home facility; amending s. 400.9905,
21 F.S.; providing that certain entities providing
22 oncology or radiation therapy services are
23 exempt from the licensure requirements of part
24 XIII of ch. 400, F.S.; providing legislative
25 intent with respect to such exemption;
26 providing for retroactive application; amending
27 s. 400.441, F.S.; requiring facilities to
28 conduct a minimum number of resident elopement
29 prevention and response drills annually;
30 amending s. 408.034, F.S.; requiring the
31 nursing-home-bed-need methodology established
1
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1 by the agency by rule to include a goal of
2 maintaining a specified subdistrict average
3 occupancy rate; amending s. 408.036, F.S.,
4 relating to health-care-related projects
5 subject to review for a certificate of need;
6 subjecting certain projects relating to
7 replacement of a nursing home and relocation of
8 nursing home beds to expedited review; revising
9 requirements for certain projects relating to
10 the addition of nursing home beds which are
11 exempt from review; exempting from review
12 certain projects relating to replacement of a
13 licensed nursing home bed on the same site or
14 nearby and consolidation or combination of
15 licensed nursing homes or transfer of beds
16 between licensed nursing homes within the same
17 planning subdistrict; providing rulemaking
18 authority; providing for assessment of
19 exemption-request fees; amending s. 52, ch.
20 2001-45, Laws of Florida; specifying
21 nonapplication of a moratorium on certificates
22 of need and authorizing approval of certain
23 certificates of need for certain counties under
24 certain circumstances; providing review
25 requirements and bed limitations; amending s.
26 651.118, F.S.; revising provisions relating to
27 use of sheltered nursing home beds at a
28 continuing care facility by persons who are not
29 residents of the continuing care facility;
30 amending s. 395.003, F.S.; requiring a report
31 by the Agency for Health Care Administration
2
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1 regarding the licensure of emergency
2 departments located off the premises of
3 hospitals; prohibiting the issuance of licenses
4 for such departments before July 1, 2005;
5 amending s. 430.701, F.S.; providing
6 legislative intent relating to the Department
7 of Elderly Affairs approving service providers;
8 amending s. 400.601, F.S.; redefining the term
9 "hospice" as used in part VI of ch. 400, F.S.;
10 amending s. 400.9935, F.S.; providing for
11 posting of signs in health care facilities
12 relating to rewards for information concerning
13 certain crimes; providing for inspections by an
14 employee of the Division of Insurance Fraud;
15 amending s. 400.9905, F.S.; redefining the term
16 "clinic"; amending s. 400.991, F.S.; changing
17 the date by which an initial application for a
18 health care clinic license must be filed with
19 the Agency for Health Care Administration;
20 making conforming changes to the requirement
21 that qualified applicants receive a temporary
22 license; providing for retroactive application;
23 providing an effective date.
24
25 Be It Enacted by the Legislature of the State of Florida:
26
27 Section 1. Section 400.0712, Florida Statutes, is
28 created to read:
29 400.0712 Application for inactive license.--
30 (1) As specified in this section, the agency may issue
31 an inactive license to a nursing home facility for all or a
3
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1 portion of its beds. Any request by a licensee that a nursing
2 home or portion of a nursing home become inactive must be
3 submitted to the agency in the format specified by the agency.
4 The facility may not initiate any suspension of services,
5 notify residents, or initiate facility closure before
6 receiving approval from the agency; and a facility that
7 violates this provision shall not be issued an inactive
8 license. Upon agency approval of an inactive license, the
9 nursing home shall notify residents of any necessary discharge
10 or transfer as provided in s. 400.0255.
11 (2) The agency may issue an inactive license to a
12 nursing home that chooses to use an unoccupied contiguous
13 portion of the facility for an alternative use to meet the
14 needs of elderly persons through the use of less restrictive,
15 less institutional services.
16 (a) An inactive license issued under this subsection
17 may be granted for a period not to exceed 12 months but may be
18 renewed annually by the agency for 12 months.
19 (b) A request to extend the inactive license must be
20 submitted to the agency in the format specified by the agency
21 and is not effective unless approved by the agency in writing.
22 (c) Nursing homes that receive an inactive license to
23 provide alternative services shall not receive preference for
24 participation in the Assisted Living for the Elderly Medicaid
25 waiver.
26 (3) The agency may issue an inactive license to a
27 nursing home that will be temporarily unable to provide
28 services but is reasonably expected to resume services.
29 (a) An inactive license issued under this subsection
30 may be issued for a period not to exceed 12 months and may be
31
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1 renewed by the agency for an additional 6 months upon
2 demonstration of progress toward reopening.
3 (b) All licensure fees must be current and paid in
4 full, and may be prorated as provided by agency rule, before
5 the inactive license is issued.
6 (c) Reactivation of an inactive license requires that
7 the applicant pay all licensure fees and the facility be
8 inspected by the agency to confirm compliance with this part
9 and applicable rules.
10 (4) The agency shall adopt rules pursuant to ss.
11 120.536(1) and 120.54 as necessary to implement this section.
12 Section 2. Subsections (10), (11), and (12) of section
13 400.071, Florida Statutes, are amended to read:
14 400.071 Application for license.--
15 (10) The agency may issue an inactive license to a
16 nursing home that will be temporarily unable to provide
17 services but that is reasonably expected to resume services.
18 Such designation may be made for a period not to exceed 12
19 months but may be renewed by the agency for up to 6 additional
20 months. Any request by a licensee that a nursing home become
21 inactive must be submitted to the agency and approved by the
22 agency prior to initiating any suspension of service or
23 notifying residents. Upon agency approval, the nursing home
24 shall notify residents of any necessary discharge or transfer
25 as provided in s. 400.0255.
26 (10)(11) As a condition of licensure, each facility
27 must establish and submit with its application a plan for
28 quality assurance and for conducting risk management.
29 (11)(12) The applicant must provide the agency with
30 proof of a legal right to occupy the property before a license
31 may be issued. Proof may include, but is not limited to,
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1 copies of warranty deeds, lease or rental agreements,
2 contracts for deeds, or quitclaim deeds.
3 Section 3. Subsection (17) of section 400.021, Florida
4 Statutes, is amended to read:
5 400.021 Definitions.--When used in this part, unless
6 the context otherwise requires, the term:
7 (17) "Resident care plan" means a written plan
8 developed, maintained, and reviewed not less than quarterly by
9 a registered nurse, with participation from other facility
10 staff and the resident or his or her designee or legal
11 representative, which includes a comprehensive assessment of
12 the needs of an individual resident; the type and frequency of
13 services required to provide the necessary care for the
14 resident to attain or maintain the highest practicable
15 physical, mental, and psychosocial well-being; a listing of
16 services provided within or outside the facility to meet those
17 needs; and an explanation of service goals. The resident care
18 plan must be signed by the director of nursing or another
19 registered nurse employed by the facility to whom
20 institutional responsibilities have been delegated and by the
21 resident, the resident's designee, or the resident's legal
22 representative. The facility may not use an agency or
23 temporary registered nurse to satisfy the foregoing
24 requirement and must document the institutional
25 responsibilities that have been delegated to the registered
26 nurse.
27 Section 4. Subsection (10) is added to section 400.23,
28 Florida Statutes, to read:
29 400.23 Rules; evaluation and deficiencies; licensure
30 status.--
31
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1 (10) Agency records, reports, ranking systems,
2 Internet information, and publications must be promptly
3 updated to reflect the most current agency actions.
4 Section 5. Subsection (4) of section 400.211, Florida
5 Statutes, is amended to read:
6 400.211 Persons employed as nursing assistants;
7 certification requirement.--
8 (4) When employed by a nursing home facility for a
9 12-month period or longer, a nursing assistant, to maintain
10 certification, shall submit to a performance review every 12
11 months and must receive regular inservice education based on
12 the outcome of such reviews. The inservice training must:
13 (a) Be sufficient to ensure the continuing competence
14 of nursing assistants and must meet the standard specified in
15 s. 464.203(7), must be at least 18 hours per year, and may
16 include hours accrued under s. 464.203(8);
17 (b) Include, at a minimum:
18 1. Techniques for assisting with eating and proper
19 feeding;
20 2. Principles of adequate nutrition and hydration;
21 3. Techniques for assisting and responding to the
22 cognitively impaired resident or the resident with difficult
23 behaviors;
24 4. Techniques for caring for the resident at the
25 end-of-life; and
26 5. Recognizing changes that place a resident at risk
27 for pressure ulcers and falls; and
28 (c) Address areas of weakness as determined in nursing
29 assistant performance reviews and may address the special
30 needs of residents as determined by the nursing home facility
31 staff.
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1
2 Costs associated with this training may not be reimbursed from
3 additional Medicaid funding through interim rate adjustments.
4 Section 6. Paragraph (h) is added to subsection (3) of
5 section 400.9905, Florida Statutes, to read:
6 400.9905 Definitions.--
7 (3) "Clinic" means an entity at which health care
8 services are provided to individuals and which tenders charges
9 for reimbursement for such services. For purposes of this
10 part, the term does not include and the licensure requirements
11 of this part do not apply to:
12 (h) Entities that provide oncology or radiation
13 therapy services by physicians licensed under chapter 458 or
14 459.
15 Section 7. The amendment made by this act to section
16 400.9905(3), Florida Statutes, is intended to clarify the
17 legislative intent of this provision as it existed at the time
18 the provision initially took effect as section 456.0375(1)(b),
19 Florida Statutes, and section 400.9905(3)(h), Florida
20 Statutes, as created by this act, shall operate retroactively
21 to October 1, 2001.
22 Section 8. Paragraph (a) of subsection (1) of section
23 400.441, Florida Statutes, is amended to read:
24 400.441 Rules establishing standards.--
25 (1) It is the intent of the Legislature that rules
26 published and enforced pursuant to this section shall include
27 criteria by which a reasonable and consistent quality of
28 resident care and quality of life may be ensured and the
29 results of such resident care may be demonstrated. Such rules
30 shall also ensure a safe and sanitary environment that is
31 residential and noninstitutional in design or nature. It is
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1 further intended that reasonable efforts be made to
2 accommodate the needs and preferences of residents to enhance
3 the quality of life in a facility. In order to provide safe
4 and sanitary facilities and the highest quality of resident
5 care accommodating the needs and preferences of residents, the
6 department, in consultation with the agency, the Department of
7 Children and Family Services, and the Department of Health,
8 shall adopt rules, policies, and procedures to administer this
9 part, which must include reasonable and fair minimum standards
10 in relation to:
11 (a) The requirements for and maintenance of
12 facilities, not in conflict with the provisions of chapter
13 553, relating to plumbing, heating, cooling, lighting,
14 ventilation, living space, and other housing conditions, which
15 will ensure the health, safety, and comfort of residents and
16 protection from fire hazard, including adequate provisions for
17 fire alarm and other fire protection suitable to the size of
18 the structure. Uniform firesafety standards shall be
19 established and enforced by the State Fire Marshal in
20 cooperation with the agency, the department, and the
21 Department of Health.
22 1. Evacuation capability determination.--
23 a. The provisions of the National Fire Protection
24 Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
25 for determining the ability of the residents, with or without
26 staff assistance, to relocate from or within a licensed
27 facility to a point of safety as provided in the fire codes
28 adopted herein. An evacuation capability evaluation for
29 initial licensure shall be conducted within 6 months after the
30 date of licensure. For existing licensed facilities that are
31 not equipped with an automatic fire sprinkler system, the
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1 administrator shall evaluate the evacuation capability of
2 residents at least annually. The evacuation capability
3 evaluation for each facility not equipped with an automatic
4 fire sprinkler system shall be validated, without liability,
5 by the State Fire Marshal, by the local fire marshal, or by
6 the local authority having jurisdiction over firesafety,
7 before the license renewal date. If the State Fire Marshal,
8 local fire marshal, or local authority having jurisdiction
9 over firesafety has reason to believe that the evacuation
10 capability of a facility as reported by the administrator may
11 have changed, it may, with assistance from the facility
12 administrator, reevaluate the evacuation capability through
13 timed exiting drills. Translation of timed fire exiting drills
14 to evacuation capability may be determined:
15 (I) Three minutes or less: prompt.
16 (II) More than 3 minutes, but not more than 13
17 minutes: slow.
18 (III) More than 13 minutes: impractical.
19 b. The Office of the State Fire Marshal shall provide
20 or cause the provision of training and education on the proper
21 application of Chapter 5, NFPA 101A, 1995 edition, to its
22 employees, to staff of the Agency for Health Care
23 Administration who are responsible for regulating facilities
24 under this part, and to local governmental inspectors. The
25 Office of the State Fire Marshal shall provide or cause the
26 provision of this training within its existing budget, but may
27 charge a fee for this training to offset its costs. The
28 initial training must be delivered within 6 months after July
29 1, 1995, and as needed thereafter.
30 c. The Office of the State Fire Marshal, in
31 cooperation with provider associations, shall provide or cause
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1 the provision of a training program designed to inform
2 facility operators on how to properly review bid documents
3 relating to the installation of automatic fire sprinklers.
4 The Office of the State Fire Marshal shall provide or cause
5 the provision of this training within its existing budget, but
6 may charge a fee for this training to offset its costs. The
7 initial training must be delivered within 6 months after July
8 1, 1995, and as needed thereafter.
9 d. The administrator of a licensed facility shall sign
10 an affidavit verifying the number of residents occupying the
11 facility at the time of the evacuation capability evaluation.
12 2. Firesafety requirements.--
13 a. Except for the special applications provided
14 herein, effective January 1, 1996, the provisions of the
15 National Fire Protection Association, Life Safety Code, NFPA
16 101, 1994 edition, Chapter 22 for new facilities and Chapter
17 23 for existing facilities shall be the uniform fire code
18 applied by the State Fire Marshal for assisted living
19 facilities, pursuant to s. 633.022.
20 b. Any new facility, regardless of size, that applies
21 for a license on or after January 1, 1996, must be equipped
22 with an automatic fire sprinkler system. The exceptions as
23 provided in section 22-2.3.5.1, NFPA 101, 1994 edition, as
24 adopted herein, apply to any new facility housing eight or
25 fewer residents. On July 1, 1995, local governmental entities
26 responsible for the issuance of permits for construction shall
27 inform, without liability, any facility whose permit for
28 construction is obtained prior to January 1, 1996, of this
29 automatic fire sprinkler requirement. As used in this part,
30 the term "a new facility" does not mean an existing facility
31 that has undergone change of ownership.
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1 c. Notwithstanding any provision of s. 633.022 or of
2 the National Fire Protection Association, NFPA 101A, Chapter
3 5, 1995 edition, to the contrary, any existing facility
4 housing eight or fewer residents is not required to install an
5 automatic fire sprinkler system, nor to comply with any other
6 requirement in Chapter 23, NFPA 101, 1994 edition, that
7 exceeds the firesafety requirements of NFPA 101, 1988 edition,
8 that applies to this size facility, unless the facility has
9 been classified as impractical to evacuate. Any existing
10 facility housing eight or fewer residents that is classified
11 as impractical to evacuate must install an automatic fire
12 sprinkler system within the timeframes granted in this
13 section.
14 d. Any existing facility that is required to install
15 an automatic fire sprinkler system under this paragraph need
16 not meet other firesafety requirements of Chapter 23, NFPA
17 101, 1994 edition, which exceed the provisions of NFPA 101,
18 1988 edition. The mandate contained in this paragraph which
19 requires certain facilities to install an automatic fire
20 sprinkler system supersedes any other requirement.
21 e. This paragraph does not supersede the exceptions
22 granted in NFPA 101, 1988 edition or 1994 edition.
23 f. This paragraph does not exempt facilities from
24 other firesafety provisions adopted under s. 633.022 and local
25 building code requirements in effect before July 1, 1995.
26 g. A local government may charge fees only in an
27 amount not to exceed the actual expenses incurred by local
28 government relating to the installation and maintenance of an
29 automatic fire sprinkler system in an existing and properly
30 licensed assisted living facility structure as of January 1,
31 1996.
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1 h. If a licensed facility undergoes major
2 reconstruction or addition to an existing building on or after
3 January 1, 1996, the entire building must be equipped with an
4 automatic fire sprinkler system. Major reconstruction of a
5 building means repair or restoration that costs in excess of
6 50 percent of the value of the building as reported on the tax
7 rolls, excluding land, before reconstruction. Multiple
8 reconstruction projects within a 5-year period the total costs
9 of which exceed 50 percent of the initial value of the
10 building at the time the first reconstruction project was
11 permitted are to be considered as major reconstruction.
12 Application for a permit for an automatic fire sprinkler
13 system is required upon application for a permit for a
14 reconstruction project that creates costs that go over the
15 50-percent threshold.
16 i. Any facility licensed before January 1, 1996, that
17 is required to install an automatic fire sprinkler system
18 shall ensure that the installation is completed within the
19 following timeframes based upon evacuation capability of the
20 facility as determined under subparagraph 1.:
21 (I) Impractical evacuation capability, 24 months.
22 (II) Slow evacuation capability, 48 months.
23 (III) Prompt evacuation capability, 60 months.
24
25 The beginning date from which the deadline for the automatic
26 fire sprinkler installation requirement must be calculated is
27 upon receipt of written notice from the local fire official
28 that an automatic fire sprinkler system must be installed. The
29 local fire official shall send a copy of the document
30 indicating the requirement of a fire sprinkler system to the
31 Agency for Health Care Administration.
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1 j. It is recognized that the installation of an
2 automatic fire sprinkler system may create financial hardship
3 for some facilities. The appropriate local fire official
4 shall, without liability, grant two 1-year extensions to the
5 timeframes for installation established herein, if an
6 automatic fire sprinkler installation cost estimate and proof
7 of denial from two financial institutions for a construction
8 loan to install the automatic fire sprinkler system are
9 submitted. However, for any facility with a class I or class
10 II, or a history of uncorrected class III, firesafety
11 deficiencies, an extension must not be granted. The local
12 fire official shall send a copy of the document granting the
13 time extension to the Agency for Health Care Administration.
14 k. A facility owner whose facility is required to be
15 equipped with an automatic fire sprinkler system under Chapter
16 23, NFPA 101, 1994 edition, as adopted herein, must disclose
17 to any potential buyer of the facility that an installation of
18 an automatic fire sprinkler requirement exists. The sale of
19 the facility does not alter the timeframe for the installation
20 of the automatic fire sprinkler system.
21 l. Existing facilities required to install an
22 automatic fire sprinkler system as a result of
23 construction-type restrictions in Chapter 23, NFPA 101, 1994
24 edition, as adopted herein, or evacuation capability
25 requirements shall be notified by the local fire official in
26 writing of the automatic fire sprinkler requirement, as well
27 as the appropriate date for final compliance as provided in
28 this subparagraph. The local fire official shall send a copy
29 of the document to the Agency for Health Care Administration.
30 m. Except in cases of life-threatening fire hazards,
31 if an existing facility experiences a change in the evacuation
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1 capability, or if the local authority having jurisdiction
2 identifies a construction-type restriction, such that an
3 automatic fire sprinkler system is required, it shall be
4 afforded time for installation as provided in this
5 subparagraph.
6 3. Resident elopement requirements.--Facilities are
7 required to conduct a minimum of two resident elopement
8 prevention and response drills per year. All administrators
9 and direct care staff must participate in the drills that
10 shall include a review of procedures to address resident
11 elopement. Facilities shall document the implementation of the
12 drills and ensure that the drills are conducted in a manner
13 consistent with the facility's resident elopement policies and
14 procedures.
15
16 Facilities that are fully sprinkled and in compliance with
17 other firesafety standards are not required to conduct more
18 than one of the required fire drills between the hours of 11
19 p.m. and 7 a.m., per year. In lieu of the remaining drills,
20 staff responsible for residents during such hours may be
21 required to participate in a mock drill that includes a review
22 of evacuation procedures. Such standards must be included or
23 referenced in the rules adopted by the State Fire Marshal.
24 Pursuant to s. 633.022(1)(b), the State Fire Marshal is the
25 final administrative authority for firesafety standards
26 established and enforced pursuant to this section. All
27 licensed facilities must have an annual fire inspection
28 conducted by the local fire marshal or authority having
29 jurisdiction.
30 Section 9. Subsection (5) of section 408.034, Florida
31 Statutes, is amended to read:
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1 408.034 Duties and responsibilities of agency;
2 rules.--
3 (5) The agency shall establish by rule a
4 nursing-home-bed-need methodology that has a goal of
5 maintaining a subdistrict average occupancy rate of 94 percent
6 and that reduces the community nursing home bed need for the
7 areas of the state where the agency establishes pilot
8 community diversion programs through the Title XIX aging
9 waiver program.
10 Section 10. Paragraphs (g) and (h) are added to
11 subsection (2) of section 408.036, Florida Statutes, paragraph
12 (p) of subsection (3) is amended, paragraphs (u) and (v) are
13 added to subsection (3) of that section, and subsection (4) of
14 that section is reenacted to read:
15 408.036 Projects subject to review; exemptions.--
16 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless
17 exempt pursuant to subsection (3), projects subject to an
18 expedited review shall include, but not be limited to:
19 (g) Replacement of a nursing home within the same
20 district, provided the proposed project site is located within
21 a geographic area that contains at least 65 percent of the
22 facility's current residents and is within a 30-mile radius of
23 the replaced nursing home.
24 (h) Relocation of a portion of a nursing home's
25 licensed beds to a facility within the same district, provided
26 the relocation is within a 30-mile radius of the existing
27 facility and the total number of nursing home beds in the
28 district does not increase.
29
30 The agency shall develop rules to implement the provisions for
31 expedited review, including time schedule, application content
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1 which may be reduced from the full requirements of s.
2 408.037(1), and application processing.
3 (3) EXEMPTIONS.--Upon request, the following projects
4 are subject to exemption from the provisions of subsection
5 (1):
6 (p) For the addition of nursing home beds licensed
7 under chapter 400 in a number not exceeding 10 total beds or
8 10 percent of the number of beds licensed in the facility
9 being expanded, whichever is greater, or for the addition of
10 nursing home beds licensed under chapter 400 at a facility
11 that has been designated as a Gold Seal nursing home under s.
12 400.235 in a number not exceeding 20 total beds or 10 percent
13 of the number of beds licensed in the facility being expanded,
14 whichever is greater.
15 1. In addition to any other documentation required by
16 the agency, a request for exemption submitted under this
17 paragraph must:
18 a. Effective until June 30, 2001, Certify that the
19 facility has not had any class I or class II deficiencies
20 within the 30 months preceding the request for addition.
21 b. Effective on July 1, 2001, certify that the
22 facility has been designated as a Gold Seal nursing home under
23 s. 400.235.
24 b.c. Certify that the prior 12-month average occupancy
25 rate for the nursing home beds at the facility meets or
26 exceeds 96 percent.
27 c.d. Certify that any beds authorized for the facility
28 under this paragraph before the date of the current request
29 for an exemption have been licensed and operational for at
30 least 12 months.
31
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1 2. The timeframes and monitoring process specified in
2 s. 408.040(2)(a)-(c) apply to any exemption issued under this
3 paragraph.
4 3. The agency shall count beds authorized under this
5 paragraph as approved beds in the published inventory of
6 nursing home beds until the beds are licensed.
7 (u) For replacement of a licensed nursing home on the
8 same site, or within 3 miles of the same site, provided the
9 number of licensed beds does not increase.
10 (v) For consolidation or combination of licensed
11 nursing homes or transfer of beds between licensed nursing
12 homes within the same planning subdistrict, by providers that
13 operate multiple nursing homes within that planning
14 subdistrict, provided there is no increase in the planning
15 subdistrict total of nursing home beds and the relocation does
16 not exceed 30 miles from the original location.
17 (4) A request for exemption under subsection (3) may
18 be made at any time and is not subject to the batching
19 requirements of this section. The request shall be supported
20 by such documentation as the agency requires by rule. The
21 agency shall assess a fee of $250 for each request for
22 exemption submitted under subsection (3).
23 Section 11. Section 52 of chapter 2001-45, Laws of
24 Florida, as amended by section 1693 of chapter 2003-261, Laws
25 of Florida, is amended to read:
26 Section 52. (1) Notwithstanding the establishment of
27 need as provided for in chapter 408, Florida Statutes, no
28 certificate of need for additional community nursing home beds
29 shall be approved by the agency until July 1, 2006.
30 (2) The Legislature finds that the continued growth in
31 the Medicaid budget for nursing home care has constrained the
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1 ability of the state to meet the needs of its elderly
2 residents through the use of less restrictive and less
3 institutional methods of long-term care. It is therefore the
4 intent of the Legislature to limit the increase in Medicaid
5 nursing home expenditures in order to provide funds to invest
6 in long-term care that is community-based and provides
7 supportive services in a manner that is both more
8 cost-effective and more in keeping with the wishes of the
9 elderly residents of this state.
10 (3) This moratorium on certificates of need shall not
11 apply to sheltered nursing home beds in a continuing care
12 retirement community certified by the former Department of
13 Insurance or by the Office of Insurance Regulation pursuant to
14 chapter 651, Florida Statutes.
15 (4)(a) The moratorium on certificates of need does not
16 apply and a certificate of need for additional community
17 nursing home beds may be approved for a county that meets the
18 following circumstances:
19 1. The county has no community nursing home beds; and
20 2. The lack of community nursing home beds occurs
21 because all nursing home beds in the county which were
22 licensed on July 1, 2001, have subsequently closed.
23 (b) The certificate-of-need review for such
24 circumstances shall be subject to the comparative review
25 process consistent with the provisions of section 408.039,
26 Florida Statutes, and the number of beds may not exceed the
27 number of beds lost by the county after July 1, 2001.
28
29 This subsection shall be repealed upon the expiration of the
30 moratorium established in subsection (1).
31
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1 (5) The moratorium on certificates of need does not
2 apply for the addition of nursing home beds licensed under
3 chapter 400, Florida Statutes, to a nursing home located in a
4 county having up to 50,000 residents, in a number not
5 exceeding 10 total beds or 10 percent of the number of beds
6 licensed in the facility being expanded, whichever is greater.
7 In addition to any other documentation required by the agency,
8 a request submitted under this subsection must:
9 (a) Certify that the facility has not had any class I
10 or class II deficiencies within the 30 months preceding the
11 request for addition.
12 (b) Certify that the prior 12-month average occupancy
13 rate for the nursing home beds at the facility meets or
14 exceeds 94 percent and the facility has not had any class I or
15 class II deficiencies since its initial licensure.
16 (c) For a facility that has been licensed for less
17 than 24 months, certify that the prior 6-month average
18 occupancy rate for the nursing home beds at the facility meets
19 or exceeds 94 percent and that the facility has not had any
20 class I or class II deficiencies since its initial licensure.
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22 This subsection shall be repealed upon the expiration of the
23 moratorium established in subsection (1).
24 Section 12. Subsection (7) of section 651.118, Florida
25 Statutes, is amended to read:
26 651.118 Agency for Health Care Administration;
27 certificates of need; sheltered beds; community beds.--
28 (7) Notwithstanding the provisions of subsection (2),
29 at the discretion of the continuing care provider, sheltered
30 nursing home beds may be used for persons who are not
31 residents of the continuing care facility and who are not
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1 parties to a continuing care contract for a period of up to 5
2 years after the date of issuance of the initial nursing home
3 license. A provider whose 5-year period has expired or is
4 expiring may request the Agency for Health Care Administration
5 for an extension, not to exceed 30 percent of the total
6 sheltered nursing home beds, if the utilization by residents
7 of the nursing home facility in the sheltered beds will not
8 generate sufficient income to cover nursing home facility
9 expenses, as evidenced by one of the following:
10 (a) The nursing home facility has a net loss for the
11 most recent fiscal year as determined under generally accepted
12 accounting principles, excluding the effects of extraordinary
13 or unusual items, as demonstrated in the most recently audited
14 financial statement; or
15 (b) The nursing home facility would have had a pro
16 forma loss for the most recent fiscal year, excluding the
17 effects of extraordinary or unusual items, if revenues were
18 reduced by the amount of revenues from persons in sheltered
19 beds who were not residents, as reported on by a certified
20 public accountant.
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22 The agency shall be authorized to grant an extension to the
23 provider based on the evidence required in this subsection.
24 The agency may request a continuing care facility to use up to
25 25 percent of the patient days generated by new admissions of
26 nonresidents during the extension period to serve Medicaid
27 recipients for those beds authorized for extended use if there
28 is a demonstrated need in the respective service area and if
29 funds are available. A provider who obtains an extension is
30 prohibited from applying for additional sheltered beds under
31 the provision of subsection (2), unless additional residential
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1 units are built or the provider can demonstrate need by
2 continuing care facility residents to the Agency for Health
3 Care Administration. The 5-year limit does not apply to up to
4 five sheltered beds designated for inpatient hospice care as
5 part of a contractual arrangement with a hospice licensed
6 under part VI of chapter 400. A continuing care facility that
7 uses such beds after the 5-year period shall report such use
8 to the Agency for Health Care Administration. For purposes of
9 this subsection, "resident" means a person who, upon admission
10 to the continuing care facility, initially resides in a part
11 of the continuing care facility not licensed under part II of
12 chapter 400.
13 Section 13. Subsection (1) of section 395.003, Florida
14 Statutes, is amended to read:
15 395.003 Licensure; issuance, renewal, denial,
16 modification, suspension, and revocation.--
17 (1)(a) A No person may not shall establish, conduct,
18 or maintain a hospital, ambulatory surgical center, or mobile
19 surgical facility in this state without first obtaining a
20 license under this part.
21 (b)1. It is unlawful for a any person to use or
22 advertise to the public, in any way or by any medium
23 whatsoever, any facility as a "hospital," "ambulatory surgical
24 center," or "mobile surgical facility" unless such facility
25 has first secured a license under the provisions of this part.
26 2. Nothing in This part does not apply applies to
27 veterinary hospitals or to commercial business establishments
28 using the word "hospital," "ambulatory surgical center," or
29 "mobile surgical facility" as a part of a trade name if no
30 treatment of human beings is performed on the premises of such
31 establishments.
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1 3. By December 31, 2004, the agency shall submit a
2 report to the President of the Senate and the Speaker of the
3 House of Representatives recommending whether it is in the
4 public interest to allow a hospital to license or operate an
5 emergency department located off the premises of the hospital.
6 If the agency finds it to be in the public interest, the
7 report shall also recommend licensure criteria for such
8 medical facilities, including criteria related to quality of
9 care and, if deemed necessary, the elimination of the
10 possibility of confusion related to the service capabilities
11 of such facility in comparison to the service capabilities of
12 an emergency department located on the premises of the
13 hospital. Until July 1, 2005, additional emergency departments
14 located off the premises of licensed hospitals may not be
15 authorized by the agency.
16 Section 14. Section 430.701, Florida Statutes, is
17 amended to read:
18 430.701 Legislative findings and intent.--
19 (1) The Legislature finds that state expenditures for
20 long-term care services continue to increase at a rapid rate
21 and that Florida faces increasing pressure in its efforts to
22 meet the long-term care needs of the public. It is the intent
23 of the Legislature that the Department of Elderly Affairs, in
24 consultation with the Agency for Health Care Administration,
25 implement long-term care community diversion pilot projects to
26 test the effectiveness of managed care and outcome-based
27 reimbursement principles when applied to long-term care.
28 (2) Until such time as the agency receives a federal
29 waiver placing a cap on the number of providers in each
30 geographic area, the Legislature intends that the department
31 not approve any additional providers in planning and service
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1 areas that are currently served by three or more providers,
2 and not approve more than three providers in areas that are
3 currently not served by any providers or are served by fewer
4 than 3 providers. These restrictions do not prevent the
5 department from approving a provider to expand service to
6 additional counties within a planning and service area for
7 which the provider is already approved to serve.
8 Section 15. Subsection (3) of section 400.601, Florida
9 Statutes, is amended to read:
10 400.601 Definitions.--As used in this part, the term:
11 (3) "Hospice" means a centrally administered
12 corporation not for profit, as defined in chapter 617, and
13 qualified as an exempt corporation under s. 501(c)(3) of the
14 Internal Revenue Code, providing a continuum of palliative and
15 supportive care for the terminally ill patient and his or her
16 family.
17 Section 16. Subsection (13) is added to section
18 400.9935, Florida Statutes, to read:
19 400.9935 Clinic responsibilities.--
20 (13) The clinic, including hospitals and walk-in
21 clinics, shall display a sign in a conspicuous location within
22 the clinic readily visible to all patients indicating that
23 pursuant to s. 626.9892, the Department of Financial Services
24 may pay rewards of up to $25,000 to persons providing
25 information leading to the arrest and conviction of persons
26 committing crimes investigated by the Division of Insurance
27 Fraud arising from violations of s. 440.105, s. 624.15, s.
28 626.9541, s. 626.989, or s. 817.234. An authorized employee of
29 the Division of Insurance Fraud may make unannounced
30 inspections of clinics licensed pursuant to this part as are
31 necessary to determine that the clinic is in compliance with
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1 this subsection. A licensed clinic shall allow full and
2 complete access to the premises to such authorized employee of
3 the division who makes an inspection to determine compliance
4 with this subsection.
5 Section 17. Present paragraphs (f) and (g) of
6 subsection (3) of section 400.9905, Florida Statutes, are
7 redesignated as paragraphs (g) and (h) respectively, and a new
8 paragraph (f) is added to that subsection, to read:
9 400.9905 Definitions.--
10 (3) "Clinic" means an entity at which health care
11 services are provided to individuals and which tenders charges
12 for reimbursement for such services. For purposes of this
13 part, the term does not include and the licensure requirements
14 of this part do not apply to:
15 (f) A sole proprietorship, group practice,
16 partnership, or corporation that provides health care services
17 by physicians covered by s. 627.419, that is directly
18 supervised by one or more of such physicians, and that is
19 wholly owned by one or more of those physicians or by a
20 physician and the spouse, parent, child, or sibling of that
21 physician.
22 Section 18. Subsections (2) and (3) of section
23 400.991,Florida Statutes, are amended to read:
24 400.991 License requirements; background screenings;
25 prohibitions.--
26 (2) The initial clinic license application shall be
27 filed with the agency by all clinics, as defined in s.
28 400.9905, on or before July 1 March 1, 2004. A clinic license
29 must be renewed biennially.
30 (3) Applicants that submit an application on or before
31 July 1 March 1, 2004, which meets all requirements for initial
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1 licensure as specified in this section shall receive a
2 temporary license until the completion of an initial
3 inspection verifying that the applicant meets all requirements
4 in rules authorized by s. 400.9925. However, a clinic engaged
5 in magnetic resonance imaging services may not receive a
6 temporary license unless it presents evidence satisfactory to
7 the agency that such clinic is making a good faith effort and
8 substantial progress in seeking accreditation required under
9 s. 400.9935.
10 Section 19. This act shall take effect upon becoming a
11 law and section 18 shall apply retroactively to March 1, 2004.
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