Senate Bill sb1062e3

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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. 400.235,

21         F.S.; providing for financial stability for

22         Gold Seal for certain nursing facilities;

23         amending s. 400.441, F.S.; requiring facilities

24         to conduct resident elopement prevention and

25         response drills; providing documentation

26         thereof; amending s. 400.619, F.S.; removing

27         the requirement that certain moneys deposited

28         into the Department of Elderly Affairs

29         Administrative Trust Fund be used to offset the

30         expenses of departmental training and education

31         for adult family-care home providers; amending


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    CS for SB 1062                                 Third Engrossed



 1         s. 408.034, F.S.; requiring the

 2         nursing-home-bed-need methodology established

 3         by the agency by rule to include a goal of

 4         maintaining a specified subdistrict average

 5         occupancy rate; amending s. 408.036, F.S.,

 6         relating to health-care-related projects

 7         subject to review for a certificate of need;

 8         subjecting certain projects relating to

 9         replacement of a nursing home and relocation of

10         nursing home beds to expedited review; revising

11         requirements for certain projects relating to

12         the addition of nursing home beds which are

13         exempt from review; exempting from review

14         certain projects relating to replacement of a

15         licensed nursing home bed on the same site or

16         nearby and consolidation or combination of

17         licensed nursing homes or transfer of beds

18         between licensed nursing homes within the same

19         planning subdistrict; providing rulemaking

20         authority; providing for assessment of

21         exemption-request fees; amending s. 430.701,

22         F.S.; authorizing the agency to seek federal

23         approval prior to seeking a certain waiver

24         relating to the long-term care diversion

25         provider network; amending s. 52, ch. 2001-45,

26         Laws of Florida; specifying nonapplication of a

27         moratorium on certificates of need and

28         authorizing approval of certain certificates of

29         need for certain counties; specifying

30         nonapplication of the moratorium for the

31         addition of nursing home beds in certain


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    CS for SB 1062                                 Third Engrossed



 1         counties; providing requirements and

 2         limitations; providing for repeal upon

 3         expiration of the moratorium; amending s.

 4         651.118, F.S.; revising provisions relating to

 5         use of sheltered nursing home beds at a

 6         continuing care facility by persons who are not

 7         residents of the continuing care facility;

 8         amending s. 400.9905, F.S.; revising and

 9         providing definitions; amending s. 400.991,

10         F.S.; revising health care clinic licensing

11         requirements; requiring separate licenses for

12         each mobile clinic; providing licensing

13         requirements for portable equipment providers;

14         providing for retroactive effect; amending s.

15         400.9935, F.S.; providing that a chief

16         financial officer may assume responsibility for

17         clinic billings under certain circumstances;

18         providing that an exemption is not

19         transferable; authorizing a fee for a

20         certificate of exemption; allowing the agency

21         to deny or revoke a license; amending s.

22         400.995, F.S.; allowing the agency to deny the

23         renewal of a license or to revoke or suspend a

24         license; prohibiting extension of a temporary

25         license under certain circumstances; requiring

26         the Agency for Health Care Administration to

27         refund certain application fees; providing

28         exceptions for certain late filed applications;

29         providing an effective date.

30  

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


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    CS for SB 1062                                 Third Engrossed



 1         Section 1.  Section 400.0712, Florida Statutes, is

 2  created to read:

 3         400.0712  Application for inactive license.--

 4         (1)  As specified in this section, the agency may issue

 5  an inactive license to a nursing home facility for all or a

 6  portion of its beds. Any request by a licensee that a nursing

 7  home or portion of a nursing home become inactive must be

 8  submitted to the agency in the approved format. The facility

 9  may not initiate any suspension of services, notify residents,

10  or initiate facility closure before receiving approval from

11  the agency; and a facility that violates this provision shall

12  not be issued an inactive license. Upon agency approval of an

13  inactive license, the nursing home shall notify residents of

14  any necessary discharge or transfer as provided in s.

15  400.0255.

16         (2)  The agency may issue an inactive license to a

17  nursing home that chooses to use an unoccupied contiguous

18  portion of the facility for an alternative use to meet the

19  needs of elderly persons through the use of less restrictive,

20  less institutional services.

21         (a)  An inactive license issued under this subsection

22  may be granted for a period not to exceed 12 months but may be

23  renewed annually by the agency for 12 months.

24         (b)  A request to extend the inactive license must be

25  submitted to the agency in the approved format and approved by

26  the agency in writing.

27         (c)  Nursing homes that receive an inactive license to

28  provide alternative services shall not receive preference for

29  participation in the Assisted Living for the Elderly Medicaid

30  waiver.

31  


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 1         (3)  The agency may issue an inactive license to a

 2  nursing home that will be temporarily unable to provide

 3  services but is reasonably expected to resume services.

 4         (a)  An inactive license issued under this subsection

 5  may be issued for a period not to exceed 12 months and may be

 6  renewed by the agency for an additional 6 months upon

 7  demonstration of progress toward reopening.

 8         (b)  All licensure fees must be current and paid in

 9  full, and may be prorated as provided by agency rule, before

10  the inactive license is issued.

11         (c)  Reactivation of an inactive license requires that

12  the applicant pay all licensure fees and be inspected by the

13  agency to confirm that all of the requirements of this part

14  and applicable rules are met.

15         (4)  The agency shall adopt rules pursuant to ss.

16  120.536(1) and 120.54 necessary to implement this section.

17         Section 2.  Subsections (10), (11), and (12) of section

18  400.071, Florida Statutes, are amended to read:

19         400.071  Application for license.--

20         (10)  The agency may issue an inactive license to a

21  nursing home that will be temporarily unable to provide

22  services but that is reasonably expected to resume services.

23  Such designation may be made for a period not to exceed 12

24  months but may be renewed by the agency for up to 6 additional

25  months. Any request by a licensee that a nursing home become

26  inactive must be submitted to the agency and approved by the

27  agency prior to initiating any suspension of service or

28  notifying residents. Upon agency approval, the nursing home

29  shall notify residents of any necessary discharge or transfer

30  as provided in s. 400.0255.

31  


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 1         (10)(11)  As a condition of licensure, each facility

 2  must establish and submit with its application a plan for

 3  quality assurance and for conducting risk management.

 4         (11)(12)  The applicant must provide the agency with

 5  proof of a legal right to occupy the property before a license

 6  may be issued. Proof may include, but is not limited to,

 7  copies of warranty deeds, lease or rental agreements,

 8  contracts for deeds, or quitclaim deeds.

 9         Section 3.  Subsection (17) of section 400.021, Florida

10  Statutes, is amended to read:

11         400.021  Definitions.--When used in this part, unless

12  the context otherwise requires, the term:

13         (17)  "Resident care plan" means a written plan

14  developed, maintained, and reviewed not less than quarterly by

15  a registered nurse, with participation from other facility

16  staff and the resident or his or her designee or legal

17  representative, which includes a comprehensive assessment of

18  the needs of an individual resident; the type and frequency of

19  services required to provide the necessary care for the

20  resident to attain or maintain the highest practicable

21  physical, mental, and psychosocial well-being; a listing of

22  services provided within or outside the facility to meet those

23  needs; and an explanation of service goals. The resident care

24  plan must be signed by the director of nursing or another

25  registered nurse employed by the facility to whom

26  institutional responsibilities have been delegated and by the

27  resident, the resident's designee, or the resident's legal

28  representative. The facility may not use an agency or

29  temporary registered nurse to satisfy the foregoing

30  requirement and must document the institutional

31  


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    CS for SB 1062                                 Third Engrossed



 1  responsibilities that have been delegated to the registered

 2  nurse.

 3         Section 4.  Subsection (10) is added to section 400.23,

 4  Florida Statutes, to read:

 5         400.23  Rules; evaluation and deficiencies; licensure

 6  status.--

 7         (10)  Agency records, reports, ranking systems,

 8  Internet information, and publications must be promptly

 9  updated to reflect the most current agency actions.

10         Section 5.  Subsection (4) of section 400.211, Florida

11  Statutes, is amended to read:

12         400.211  Persons employed as nursing assistants;

13  certification requirement.--

14         (4)  When employed by a nursing home facility for a

15  12-month period or longer, a nursing assistant, to maintain

16  certification, shall submit to a performance review every 12

17  months and must receive regular inservice education based on

18  the outcome of such reviews. The inservice training must:

19         (a)  Be sufficient to ensure the continuing competence

20  of nursing assistants and must meet the standard specified in

21  s. 464.203(7), must be at least 18 hours per year, and may

22  include hours accrued under s. 464.203(8);

23         (b)  Include, at a minimum:

24         1.  Techniques for assisting with eating and proper

25  feeding;

26         2.  Principles of adequate nutrition and hydration;

27         3.  Techniques for assisting and responding to the

28  cognitively impaired resident or the resident with difficult

29  behaviors;

30         4.  Techniques for caring for the resident at the

31  end-of-life; and


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    CS for SB 1062                                 Third Engrossed



 1         5.  Recognizing changes that place a resident at risk

 2  for pressure ulcers and falls; and

 3         (c)  Address areas of weakness as determined in nursing

 4  assistant performance reviews and may address the special

 5  needs of residents as determined by the nursing home facility

 6  staff.

 7  

 8  Costs associated with this training may not be reimbursed from

 9  additional Medicaid funding through interim rate adjustments.

10         Section 6.  Subsection (5) of section 400.235, Florida

11  Statutes, is amended to read:

12         400.235  Nursing home quality and licensure status;

13  Gold Seal Program.--

14         (5)  Facilities must meet the following additional

15  criteria for recognition as a Gold Seal Program facility:

16         (a)  Had no class I or class II deficiencies within the

17  30 months preceding application for the program.

18         (b)  Evidence financial soundness and stability

19  according to standards adopted by the agency in administrative

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

21  criteria for the use of financial statements that are prepared

22  in accordance with generally accepted accounting principles

23  and that are reviewed or audited by certified public

24  accountants. A nursing home that is part of the same corporate

25  entity as a continuing care facility licensed under chapter

26  651 which meets the minimum liquid reserve requirements

27  specified in s. 651.035 and is accredited by a recognized

28  accrediting organization under s. 651.028 and rules of the

29  Office of Insurance Regulation satisfies this requirement as

30  long as the accreditation is not provisional. Facilities

31  


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    CS for SB 1062                                 Third Engrossed



 1  operated by a federal or state agency are deemed to be

 2  financially stable for purposes of applying for the Gold Seal.

 3         (c)  Participate in a consumer satisfaction process,

 4  and demonstrate that information is elicited from residents,

 5  family members, and guardians about satisfaction with the

 6  nursing facility, its environment, the services and care

 7  provided, the staff's skills and interactions with residents,

 8  attention to resident's needs, and the facility's efforts to

 9  act on information gathered from the consumer satisfaction

10  measures.

11         (d)  Evidence the involvement of families and members

12  of the community in the facility on a regular basis.

13         (e)  Have a stable workforce, as described in s.

14  400.141, as evidenced by a relatively low rate of turnover

15  among certified nursing assistants and licensed nurses within

16  the 30 months preceding application for the Gold Seal Program,

17  and demonstrate a continuing effort to maintain a stable

18  workforce and to reduce turnover of licensed nurses and

19  certified nursing assistants.

20         (f)  Evidence an outstanding record regarding the

21  number and types of substantiated complaints reported to the

22  State Long-Term Care Ombudsman Council within the 30 months

23  preceding application for the program.

24         (g)  Provide targeted inservice training provided to

25  meet training needs identified by internal or external quality

26  assurance efforts.

27  

28  A facility assigned a conditional licensure status may not

29  qualify for consideration for the Gold Seal Program until

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

31  


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    CS for SB 1062                                 Third Engrossed



 1  II deficiencies and has completed a regularly scheduled

 2  relicensure survey.

 3         Section 7.  Paragraph (a) of subsection (1) of section

 4  400.441, Florida Statutes, is amended to read:

 5         400.441  Rules establishing standards.--

 6         (1)  It is the intent of the Legislature that rules

 7  published and enforced pursuant to this section shall include

 8  criteria by which a reasonable and consistent quality of

 9  resident care and quality of life may be ensured and the

10  results of such resident care may be demonstrated. Such rules

11  shall also ensure a safe and sanitary environment that is

12  residential and noninstitutional in design or nature. It is

13  further intended that reasonable efforts be made to

14  accommodate the needs and preferences of residents to enhance

15  the quality of life in a facility. In order to provide safe

16  and sanitary facilities and the highest quality of resident

17  care accommodating the needs and preferences of residents, the

18  department, in consultation with the agency, the Department of

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

20  shall adopt rules, policies, and procedures to administer this

21  part, which must include reasonable and fair minimum standards

22  in relation to:

23         (a)  The requirements for and maintenance of

24  facilities, not in conflict with the provisions of chapter

25  553, relating to plumbing, heating, cooling, lighting,

26  ventilation, living space, and other housing conditions, which

27  will ensure the health, safety, and comfort of residents and

28  protection from fire hazard, including adequate provisions for

29  fire alarm and other fire protection suitable to the size of

30  the structure. Uniform firesafety standards shall be

31  established and enforced by the State Fire Marshal in


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    CS for SB 1062                                 Third Engrossed



 1  cooperation with the agency, the department, and the

 2  Department of Health.

 3         1.  Evacuation capability determination.--

 4         a.  The provisions of the National Fire Protection

 5  Association, NFPA 101A, Chapter 5, 1995 edition, shall be used

 6  for determining the ability of the residents, with or without

 7  staff assistance, to relocate from or within a licensed

 8  facility to a point of safety as provided in the fire codes

 9  adopted herein. An evacuation capability evaluation for

10  initial licensure shall be conducted within 6 months after the

11  date of licensure. For existing licensed facilities that are

12  not equipped with an automatic fire sprinkler system, the

13  administrator shall evaluate the evacuation capability of

14  residents at least annually. The evacuation capability

15  evaluation for each facility not equipped with an automatic

16  fire sprinkler system shall be validated, without liability,

17  by the State Fire Marshal, by the local fire marshal, or by

18  the local authority having jurisdiction over firesafety,

19  before the license renewal date. If the State Fire Marshal,

20  local fire marshal, or local authority having jurisdiction

21  over firesafety has reason to believe that the evacuation

22  capability of a facility as reported by the administrator may

23  have changed, it may, with assistance from the facility

24  administrator, reevaluate the evacuation capability through

25  timed exiting drills. Translation of timed fire exiting drills

26  to evacuation capability may be determined:

27         (I)  Three minutes or less: prompt.

28         (II)  More than 3 minutes, but not more than 13

29  minutes: slow.

30         (III)  More than 13 minutes: impractical.

31  


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    CS for SB 1062                                 Third Engrossed



 1         b.  The Office of the State Fire Marshal shall provide

 2  or cause the provision of training and education on the proper

 3  application of Chapter 5, NFPA 101A, 1995 edition, to its

 4  employees, to staff of the Agency for Health Care

 5  Administration who are responsible for regulating facilities

 6  under this part, and to local governmental inspectors. The

 7  Office of the State Fire Marshal shall provide or cause the

 8  provision of this training within its existing budget, but may

 9  charge a fee for this training to offset its costs. The

10  initial training must be delivered within 6 months after July

11  1, 1995, and as needed thereafter.

12         c.  The Office of the State Fire Marshal, in

13  cooperation with provider associations, shall provide or cause

14  the provision of a training program designed to inform

15  facility operators on how to properly review bid documents

16  relating to the installation of automatic fire sprinklers. The

17  Office of the State Fire Marshal shall provide or cause the

18  provision of this training within its existing budget, but may

19  charge a fee for this training to offset its costs. The

20  initial training must be delivered within 6 months after July

21  1, 1995, and as needed thereafter.

22         d.  The administrator of a licensed facility shall sign

23  an affidavit verifying the number of residents occupying the

24  facility at the time of the evacuation capability evaluation.

25         2.  Firesafety requirements.--

26         a.  Except for the special applications provided

27  herein, effective January 1, 1996, the provisions of the

28  National Fire Protection Association, Life Safety Code, NFPA

29  101, 1994 edition, Chapter 22 for new facilities and Chapter

30  23 for existing facilities shall be the uniform fire code

31  


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    CS for SB 1062                                 Third Engrossed



 1  applied by the State Fire Marshal for assisted living

 2  facilities, pursuant to s. 633.022.

 3         b.  Any new facility, regardless of size, that applies

 4  for a license on or after January 1, 1996, must be equipped

 5  with an automatic fire sprinkler system. The exceptions as

 6  provided in section 22-2.3.5.1, NFPA 101, 1994 edition, as

 7  adopted herein, apply to any new facility housing eight or

 8  fewer residents. On July 1, 1995, local governmental entities

 9  responsible for the issuance of permits for construction shall

10  inform, without liability, any facility whose permit for

11  construction is obtained prior to January 1, 1996, of this

12  automatic fire sprinkler requirement. As used in this part,

13  the term "a new facility" does not mean an existing facility

14  that has undergone change of ownership.

15         c.  Notwithstanding any provision of s. 633.022 or of

16  the National Fire Protection Association, NFPA 101A, Chapter

17  5, 1995 edition, to the contrary, any existing facility

18  housing eight or fewer residents is not required to install an

19  automatic fire sprinkler system, nor to comply with any other

20  requirement in Chapter 23, NFPA 101, 1994 edition, that

21  exceeds the firesafety requirements of NFPA 101, 1988 edition,

22  that applies to this size facility, unless the facility has

23  been classified as impractical to evacuate. Any existing

24  facility housing eight or fewer residents that is classified

25  as impractical to evacuate must install an automatic fire

26  sprinkler system within the timeframes granted in this

27  section.

28         d.  Any existing facility that is required to install

29  an automatic fire sprinkler system under this paragraph need

30  not meet other firesafety requirements of Chapter 23, NFPA

31  101, 1994 edition, which exceed the provisions of NFPA 101,


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    CS for SB 1062                                 Third Engrossed



 1  1988 edition. The mandate contained in this paragraph which

 2  requires certain facilities to install an automatic fire

 3  sprinkler system supersedes any other requirement.

 4         e.  This paragraph does not supersede the exceptions

 5  granted in NFPA 101, 1988 edition or 1994 edition.

 6         f.  This paragraph does not exempt facilities from

 7  other firesafety provisions adopted under s. 633.022 and local

 8  building code requirements in effect before July 1, 1995.

 9         g.  A local government may charge fees only in an

10  amount not to exceed the actual expenses incurred by local

11  government relating to the installation and maintenance of an

12  automatic fire sprinkler system in an existing and properly

13  licensed assisted living facility structure as of January 1,

14  1996.

15         h.  If a licensed facility undergoes major

16  reconstruction or addition to an existing building on or after

17  January 1, 1996, the entire building must be equipped with an

18  automatic fire sprinkler system. Major reconstruction of a

19  building means repair or restoration that costs in excess of

20  50 percent of the value of the building as reported on the tax

21  rolls, excluding land, before reconstruction. Multiple

22  reconstruction projects within a 5-year period the total costs

23  of which exceed 50 percent of the initial value of the

24  building at the time the first reconstruction project was

25  permitted are to be considered as major reconstruction.

26  Application for a permit for an automatic fire sprinkler

27  system is required upon application for a permit for a

28  reconstruction project that creates costs that go over the

29  50-percent threshold.

30         i.  Any facility licensed before January 1, 1996, that

31  is required to install an automatic fire sprinkler system


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    CS for SB 1062                                 Third Engrossed



 1  shall ensure that the installation is completed within the

 2  following timeframes based upon evacuation capability of the

 3  facility as determined under subparagraph 1.:

 4         (I)  Impractical evacuation capability, 24 months.

 5         (II)  Slow evacuation capability, 48 months.

 6         (III)  Prompt evacuation capability, 60 months.

 7  

 8  The beginning date from which the deadline for the automatic

 9  fire sprinkler installation requirement must be calculated is

10  upon receipt of written notice from the local fire official

11  that an automatic fire sprinkler system must be installed. The

12  local fire official shall send a copy of the document

13  indicating the requirement of a fire sprinkler system to the

14  Agency for Health Care Administration.

15         j.  It is recognized that the installation of an

16  automatic fire sprinkler system may create financial hardship

17  for some facilities. The appropriate local fire official

18  shall, without liability, grant two 1-year extensions to the

19  timeframes for installation established herein, if an

20  automatic fire sprinkler installation cost estimate and proof

21  of denial from two financial institutions for a construction

22  loan to install the automatic fire sprinkler system are

23  submitted. However, for any facility with a class I or class

24  II, or a history of uncorrected class III, firesafety

25  deficiencies, an extension must not be granted. The local fire

26  official shall send a copy of the document granting the time

27  extension to the Agency for Health Care Administration.

28         k.  A facility owner whose facility is required to be

29  equipped with an automatic fire sprinkler system under Chapter

30  23, NFPA 101, 1994 edition, as adopted herein, must disclose

31  to any potential buyer of the facility that an installation of


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    CS for SB 1062                                 Third Engrossed



 1  an automatic fire sprinkler requirement exists. The sale of

 2  the facility does not alter the timeframe for the installation

 3  of the automatic fire sprinkler system.

 4         l.  Existing facilities required to install an

 5  automatic fire sprinkler system as a result of

 6  construction-type restrictions in Chapter 23, NFPA 101, 1994

 7  edition, as adopted herein, or evacuation capability

 8  requirements shall be notified by the local fire official in

 9  writing of the automatic fire sprinkler requirement, as well

10  as the appropriate date for final compliance as provided in

11  this subparagraph. The local fire official shall send a copy

12  of the document to the Agency for Health Care Administration.

13         m.  Except in cases of life-threatening fire hazards,

14  if an existing facility experiences a change in the evacuation

15  capability, or if the local authority having jurisdiction

16  identifies a construction-type restriction, such that an

17  automatic fire sprinkler system is required, it shall be

18  afforded time for installation as provided in this

19  subparagraph.

20  

21  Facilities that are fully sprinkled and in compliance with

22  other firesafety standards are not required to conduct more

23  than one of the required fire drills between the hours of 11

24  p.m. and 7 a.m., per year. In lieu of the remaining drills,

25  staff responsible for residents during such hours may be

26  required to participate in a mock drill that includes a review

27  of evacuation procedures. Such standards must be included or

28  referenced in the rules adopted by the State Fire Marshal.

29  Pursuant to s. 633.022(1)(b), the State Fire Marshal is the

30  final administrative authority for firesafety standards

31  established and enforced pursuant to this section. All


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    CS for SB 1062                                 Third Engrossed



 1  licensed facilities must have an annual fire inspection

 2  conducted by the local fire marshal or authority having

 3  jurisdiction.

 4         3.  Resident elopement requirements.--Facilities are

 5  required to conduct a minimum of two resident elopement

 6  prevention and response drills per year. All administrators

 7  and direct care staff must participate in the drills which

 8  shall include a review of procedures to address resident

 9  elopement. Facilities must document the implementation of the

10  drills and ensure that the drills are conducted in a manner

11  consistent with the facility's resident elopement policies and

12  procedures.

13         Section 8.  Subsection (13) of section 400.619, Florida

14  Statutes, is amended to read:

15         400.619  Licensure application and renewal.--

16         (13)  All moneys collected under this section must be

17  deposited into the Department of Elderly Affairs

18  Administrative Trust Fund and used to offset the expenses of

19  departmental training and education for adult family-care home

20  providers.

21         Section 9.  Subsection (5) of section 408.034, Florida

22  Statutes, is amended to read:

23         408.034  Duties and responsibilities of agency;

24  rules.--

25         (5)  The agency shall establish by rule a

26  nursing-home-bed-need methodology that has a goal of

27  maintaining a subdistrict average occupancy rate of 94 percent

28  and that reduces the community nursing home bed need for the

29  areas of the state where the agency establishes pilot

30  community diversion programs through the Title XIX aging

31  waiver program.


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    CS for SB 1062                                 Third Engrossed



 1         Section 10.  Paragraphs (g) and (h) are added to

 2  subsection (2) of section 408.036, Florida Statutes, paragraph

 3  (p) of subsection (3) is amended, paragraphs (u) and (v) are

 4  added to subsection (3) of said section, and subsection (4) is

 5  reenacted to read:

 6         408.036  Projects subject to review; exemptions.--

 7         (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless

 8  exempt pursuant to subsection (3), projects subject to an

 9  expedited review shall include, but not be limited to:

10         (g)  Replacement of a nursing home within the same

11  district, provided the proposed project site is located within

12  a geographic area that contains at least 65 percent of the

13  facility's current residents and is within a 30-mile radius of

14  the replaced nursing home.

15         (h)  Relocation of a portion of a nursing home's

16  licensed beds to a facility within the same district, provided

17  the relocation is within a 30-mile radius of the existing

18  facility and the total number of nursing home beds in the

19  district does not increase.

20  

21  The agency shall develop rules to implement the provisions for

22  expedited review, including time schedule, application content

23  which may be reduced from the full requirements of s.

24  408.037(1), and application processing.

25         (3)  EXEMPTIONS.--Upon request, the following projects

26  are subject to exemption from the provisions of subsection

27  (1):

28         (p)  For the addition of nursing home beds licensed

29  under chapter 400 in a number not exceeding 10 total beds or

30  10 percent of the number of beds licensed in the facility

31  being expanded, whichever is greater, or for the addition of


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 1  nursing home beds licensed under chapter 400 at a facility

 2  that has been designated as a Gold Seal nursing home under s.

 3  400.235 in a number not exceeding 20 total beds or 10 percent

 4  of the number of beds licensed in the facility being expanded,

 5  whichever is greater.

 6         1.  In addition to any other documentation required by

 7  the agency, a request for exemption submitted under this

 8  paragraph must:

 9         a.  Effective until June 30, 2001, Certify that the

10  facility has not had any class I or class II deficiencies

11  within the 30 months preceding the request for addition.

12         b.  Effective on July 1, 2001, certify that the

13  facility has been designated as a Gold Seal nursing home under

14  s. 400.235.

15         b.c.  Certify that the prior 12-month average occupancy

16  rate for the nursing home beds at the facility meets or

17  exceeds 96 percent.

18         c.d.  Certify that any beds authorized for the facility

19  under this paragraph before the date of the current request

20  for an exemption have been licensed and operational for at

21  least 12 months.

22         2.  The timeframes and monitoring process specified in

23  s. 408.040(2)(a)-(c) apply to any exemption issued under this

24  paragraph.

25         3.  The agency shall count beds authorized under this

26  paragraph as approved beds in the published inventory of

27  nursing home beds until the beds are licensed.

28         (u)  For replacement of a licensed nursing home on the

29  same site, or within 3 miles of the same site, provided the

30  number of licensed beds does not increase.

31  


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    CS for SB 1062                                 Third Engrossed



 1         (v)  For consolidation or combination of licensed

 2  nursing homes or transfer of beds between licensed nursing

 3  homes within the same planning subdistrict, by providers that

 4  operate multiple nursing homes within that planning

 5  subdistrict, provided there is no increase in the planning

 6  subdistrict total of nursing home beds and the relocation does

 7  not exceed 30 miles from the original location.

 8         (4)  A request for exemption under subsection (3) may

 9  be made at any time and is not subject to the batching

10  requirements of this section. The request shall be supported

11  by such documentation as the agency requires by rule. The

12  agency shall assess a fee of $250 for each request for

13  exemption submitted under subsection (3).

14         Section 11.  Section 430.701, Florida Statutes, is

15  amended to read:

16         430.701  Legislative findings and intent.--

17         (1)  The Legislature finds that state expenditures for

18  long-term care services continue to increase at a rapid rate

19  and that Florida faces increasing pressure in its efforts to

20  meet the long-term care needs of the public. It is the intent

21  of the Legislature that the Department of Elderly Affairs, in

22  consultation with the Agency for Health Care Administration,

23  implement long-term care community diversion pilot projects to

24  test the effectiveness of managed care and outcome-based

25  reimbursement principles when applied to long-term care.

26         (2)  The agency may seek federal approval in advance of

27  its formal waiver application to limit the diversion provider

28  network by freezing enrollment of providers at current levels

29  when an area already has three or more providers or, in an

30  expansion area, when enrollment reaches a level of three

31  providers. This subsection does not prevent the department


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    CS for SB 1062                                 Third Engrossed



 1  from approving a provider to expand service to additional

 2  counties within a planning and service area for which the

 3  provider is already approved to serve.

 4         Section 12.  Section 52 of chapter 2001-45, Laws of

 5  Florida, as amended by section 1693 of chapter 2003-261, Laws

 6  of Florida, is amended to read:

 7         Section 52.  (1)  Notwithstanding the establishment of

 8  need as provided for in chapter 408, Florida Statutes, no

 9  certificate of need for additional community nursing home beds

10  shall be approved by the agency until July 1, 2006.

11         (2)  The Legislature finds that the continued growth in

12  the Medicaid budget for nursing home care has constrained the

13  ability of the state to meet the needs of its elderly

14  residents through the use of less restrictive and less

15  institutional methods of long-term care. It is therefore the

16  intent of the Legislature to limit the increase in Medicaid

17  nursing home expenditures in order to provide funds to invest

18  in long-term care that is community-based and provides

19  supportive services in a manner that is both more

20  cost-effective and more in keeping with the wishes of the

21  elderly residents of this state.

22         (3)  This moratorium on certificates of need shall not

23  apply to sheltered nursing home beds in a continuing care

24  retirement community certified by the former Department of

25  Insurance or by the Office of Insurance Regulation pursuant to

26  chapter 651, Florida Statutes.

27         (4)(a)  The moratorium on certificates of need does not

28  apply and a certificate of need for additional community

29  nursing home beds may be approved for a county that meets the

30  following circumstances:

31         1.  The county has no community nursing home beds; and


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    CS for SB 1062                                 Third Engrossed



 1         2.  The lack of community nursing home beds occurs

 2  because all nursing home beds in the county that were licensed

 3  on July 1, 2001, have subsequently closed.

 4         (b)  The certificate-of-need review for such

 5  circumstances shall be subject to the comparative review

 6  process consistent with the provisions of section 408.039,

 7  Florida Statutes, and the number of beds may not exceed the

 8  number of beds lost by the county after July 1, 2001.

 9  

10  This subsection shall be repealed upon the expiration of the

11  moratorium established in subsection (1).

12         (5)  The moratorium on certificates of need does not

13  apply for the addition of nursing home beds licensed under

14  chapter 400, Florida Statutes, to a nursing home located in a

15  county having up to 50,000 residents, in a number not

16  exceeding 10 total beds or 10 percent of the number of beds

17  licensed in the facility being expanded, whichever is greater.

18  In addition to any other documentation required by the agency,

19  a request submitted under this subsection must:

20         (a)  Certify that the facility has not had any class I

21  or class II deficiencies within the 30 months preceding the

22  request for addition.

23         (b)  Certify that the prior 12-month average occupancy

24  rate for the nursing home beds at the facility meets or

25  exceeds 94 percent.

26         (c)  For a facility that has been licensed for less

27  than 24 months, certify that the prior 6-month average

28  occupancy rate for the nursing home beds at the facility meets

29  or exceeds 94 percent and that the facility has not had any

30  class I or class II deficiencies since its initial licensure.

31  


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 1  This subsection shall be repealed upon the expiration of the

 2  moratorium established in subsection (1).

 3         Section 13.  Subsection (7) of section 651.118, Florida

 4  Statutes, is amended to read:

 5         651.118  Agency for Health Care Administration;

 6  certificates of need; sheltered beds; community beds.--

 7         (7)  Notwithstanding the provisions of subsection (2),

 8  at the discretion of the continuing care provider, sheltered

 9  nursing home beds may be used for persons who are not

10  residents of the continuing care facility and who are not

11  parties to a continuing care contract for a period of up to 5

12  years after the date of issuance of the initial nursing home

13  license. A provider whose 5-year period has expired or is

14  expiring may request the Agency for Health Care Administration

15  for an extension, not to exceed 30 percent of the total

16  sheltered nursing home beds, if the utilization by residents

17  of the nursing home facility in the sheltered beds will not

18  generate sufficient income to cover nursing home facility

19  expenses, as evidenced by one of the following:

20         (a)  The nursing home facility has a net loss for the

21  most recent fiscal year as determined under generally accepted

22  accounting principles, excluding the effects of extraordinary

23  or unusual items, as demonstrated in the most recently audited

24  financial statement; or

25         (b)  The nursing home facility would have had a pro

26  forma loss for the most recent fiscal year, excluding the

27  effects of extraordinary or unusual items, if revenues were

28  reduced by the amount of revenues from persons in sheltered

29  beds who were not residents, as reported on by a certified

30  public accountant.

31  


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    CS for SB 1062                                 Third Engrossed



 1  The agency shall be authorized to grant an extension to the

 2  provider based on the evidence required in this subsection.

 3  The agency may request a continuing care facility to use up to

 4  25 percent of the patient days generated by new admissions of

 5  nonresidents during the extension period to serve Medicaid

 6  recipients for those beds authorized for extended use if there

 7  is a demonstrated need in the respective service area and if

 8  funds are available. A provider who obtains an extension is

 9  prohibited from applying for additional sheltered beds under

10  the provision of subsection (2), unless additional residential

11  units are built or the provider can demonstrate need by

12  continuing care facility residents to the Agency for Health

13  Care Administration. The 5-year limit does not apply to up to

14  five sheltered beds designated for inpatient hospice care as

15  part of a contractual arrangement with a hospice licensed

16  under part VI of chapter 400. A continuing care facility that

17  uses such beds after the 5-year period shall report such use

18  to the Agency for Health Care Administration. For purposes of

19  this subsection, "resident" means a person who, upon admission

20  to the continuing care facility, initially resides in a part

21  of the continuing care facility not licensed under part II of

22  chapter 400.

23         Section 14.  Subsections (3) and (4) of section

24  400.9905, Florida Statutes, are renumbered as subsections (4)

25  and (5), respectively, and amended, and new subsections (3),

26  (6), and (7) are added to said section, to read:

27         400.9905  Definitions.--

28         (3)  "Chief financial officer" means an individual who

29  has a bachelor's degree from an accredited university in

30  accounting or finance, or a related field, and who is the

31  person responsible for the preparation of a clinic's billing.


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    CS for SB 1062                                 Third Engrossed



 1         (4)(3)  "Clinic" means an entity at which health care

 2  services are provided to individuals and which tenders charges

 3  for reimbursement for such services, including a mobile clinic

 4  and a portable equipment provider. For purposes of this part,

 5  the term does not include and the licensure requirements of

 6  this part do not apply to:

 7         (a)  Entities licensed or registered by the state under

 8  chapter 395; or entities licensed or registered by the state

 9  and providing only health care services within the scope of

10  services authorized under their respective licenses granted

11  under s. 383.30-383.335, chapter 390, chapter 394, chapter

12  395, chapter 397, this chapter except part XIII, chapter 463,

13  chapter 465, chapter 466, chapter 478, part I of chapter 483

14  chapter 480, chapter 484, or chapter 651; end-stage renal

15  disease providers authorized under 42 C.F.R. part 405, subpart

16  U; or providers certified under 42 C.F.R. part 485, subpart B

17  or subpart H, or any entity that provides neonatal or

18  pediatric hospital-based healthcare services by licensed

19  practitioners solely within a hospital licensed under chapter

20  395.

21         (b)  Entities that own, directly or indirectly,

22  entities licensed or registered by the state pursuant to

23  chapter 395; or entities that own, directly or indirectly,

24  entities licensed or registered by the state and providing

25  only health care services within the scope of services

26  authorized pursuant to their respective licenses granted under

27  s. 383.30-383.335, chapter 390, chapter 394, chapter 395,

28  chapter 397, this chapter except part XIII, chapter 463,

29  chapter 465, chapter 466, chapter 478, part I of chapter 483

30  chapter 480, chapter 484, or chapter 651, end-stage renal

31  disease providers authorized under 42 C.F.R. part 405, subpart


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    CS for SB 1062                                 Third Engrossed



 1  U, or providers certified under 42 C.F.R. part 485, subpart B

 2  or subpart H, or any entity that provides neonatal or

 3  pediatric hospital-based healthcare services by licensed

 4  practitioners solely within a hospital licensed under chapter

 5  395.

 6         (c)  Entities that are owned, directly or indirectly,

 7  by an entity licensed or registered by the state pursuant to

 8  chapter 395; or entities that are owned, directly or

 9  indirectly, by an entity licensed or registered by the state

10  and providing only health care services within the scope of

11  services authorized pursuant to their respective licenses

12  granted under s. 383.30-383.335, chapter 390, chapter 394,

13  chapter 395, chapter 397, this chapter except part XIII ,

14  chapter 463, chapter 465, chapter 466, chapter 478, part I of

15  chapter 483 chapter 480, chapter 484, or chapter 651;

16  end-stage renal disease providers authorized under 42 C.F.R.

17  part 405, subpart U; or providers certified under 42 C.F.R.

18  part 485, subpart B or subpart H, or any entity that provides

19  neonatal or pediatric hospital-based healthcare services by

20  licensed practitioners solely within a hospital under chapter

21  395.

22         (d)  Entities that are under common ownership, directly

23  or indirectly, with an entity licensed or registered by the

24  state pursuant to chapter 395; or entities that are under

25  common ownership, directly or indirectly, with an entity

26  licensed or registered by the state and providing only health

27  care services within the scope of services authorized pursuant

28  to their respective licenses granted under s. 383.30-383.335,

29  chapter 390, chapter 394, chapter 395, chapter 397, this

30  chapter except part XIII, chapter 463, chapter 465, chapter

31  466, chapter 478, part I of chapter 483 480, chapter 484, or


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    CS for SB 1062                                 Third Engrossed



 1  chapter 651; end-stage renal disease providers authorized

 2  under 42 C.F.R. part 405, subpart U; or providers certified

 3  under 42 C.F.R. part 485, subpart B or subpart H or any entity

 4  that provides neonatal or pediatric hospital-based healthcare

 5  services by licensed practitioners solely within a hospital

 6  licensed under chapter 395.

 7         (e)  An entity that is exempt from federal taxation

 8  under 26 U.S.C. s. 501(c)(3) or s. 501(c)(4) and any community

 9  college or university clinic, and any entity owned or operated

10  by federal or state government, including agencies,

11  subdivisions, or municipalities thereof.

12         (f)  A sole proprietorship, group practice,

13  partnership, or corporation that provides health care services

14  by physicians covered by s. 627.419, that is directly

15  supervised by one or more of such physicians, and that is

16  wholly owned by one or more of those physicians or by a

17  physician and the spouse, child, or sibling of that physician.

18         (g)(f)  A sole proprietorship, group practice,

19  partnership, or corporation that provides health care services

20  by licensed health care practitioners under chapter 457,

21  chapter 458, chapter 459, chapter 460, chapter 461, chapter

22  462, chapter 463, chapter 466, chapter 467, chapter 480,

23  chapter 484, chapter 486, chapter 490, chapter 491, or part I,

24  part III, part X, part XIII, or part XIV of chapter 468, or s.

25  464.012, which are wholly owned by one or more a licensed

26  health care practitioners practitioner, or the licensed health

27  care practitioners set forth in this paragraph practitioner

28  and the spouse, parent, or child, or sibling of a licensed

29  health care practitioner, so long as one of the owners who is

30  a licensed health care practitioner is supervising the

31  business activities services performed therein and is legally


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    CS for SB 1062                                 Third Engrossed



 1  responsible for the entity's compliance with all federal and

 2  state laws. However, a health care practitioner may not

 3  supervise services beyond the scope of the practitioner's

 4  license, except that, for the purposes of this part, a clinic

 5  owned by a licensee in s. 456.053(3)(b) that provides only

 6  services authorized pursuant to s. 456.053(3)(b) may be

 7  supervised by a licensee specified in s. 456.053(3)(b).

 8         (h)(g)  Clinical facilities affiliated with an

 9  accredited medical school at which training is provided for

10  medical students, residents, or fellows.

11         (i)  Entities that provide only oncology or radiation

12  therapy services by physicians licensed under chapter 458 or

13  chapter 459.

14         (5)(4)  "Medical director" means a physician who is

15  employed or under contract with a clinic and who maintains a

16  full and unencumbered physician license in accordance with

17  chapter 458, chapter 459, chapter 460, or chapter 461.

18  However, if the clinic does not provide services pursuant to

19  the respective physician practices acts listed in this

20  subsection, it is limited to providing health care services

21  pursuant to chapter 457, chapter 484, chapter 486, chapter

22  490, or chapter 491 or part I, part III, part X, part XIII, or

23  part XIV of chapter 468, the clinic may appoint a

24  Florida-licensed health care practitioner who does not provide

25  services pursuant to the respective physician practices acts

26  listed in this subsection licensed under that chapter to serve

27  as a clinic director who is responsible for the clinic's

28  activities. A health care practitioner may not serve as the

29  clinic director if the services provided at the clinic are

30  beyond the scope of that practitioner's license, except that a

31  licensee specified in s. 456.053(3)(b) who provides only


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    CS for SB 1062                                 Third Engrossed



 1  services authorized pursuant to s. 456.053(3)(b) may serve as

 2  clinic director of an entity providing services as specified

 3  in s. 456.053(3)(b).

 4         (6)  "Mobile clinic" means a movable or detached

 5  self-contained health care unit within or from which direct

 6  health care services are provided to individuals and which

 7  otherwise meets the definition of a clinic in subsection (4).

 8         (7)  "Portable equipment provider" means an entity that

 9  contracts with or employs persons to provide portable

10  equipment to multiple locations performing treatment or

11  diagnostic testing of individuals, that bills third-party

12  payors for those services, and that otherwise meets the

13  definition of a clinic in subsection (4).

14         Section 15.  The creation of section 400.9905(4)(i),

15  Florida Statutes, by this act is intended to clarify the

16  legislative intent of this provision as it existed at the time

17  the provisions initially took effect as sections

18  456.0375(1)(b) and 400.9905(4)(i), Florida Statutes, as

19  created by this act, shall operate retroactively to October 1,

20  2001. Nothing in this section shall be construed as amending,

21  modifying, limiting, or otherwise affecting in any way the

22  legislative intent, scope, terms, prohibition, or requirements

23  of section 456.053, Florida Statutes.

24         Section 16.  Effective upon this act becoming a law and

25  applicable retroactively to March 1, 2004, subsections (1),

26  (2), and (3) and paragraphs (a) and (b) of subsection (7) of

27  section 400.991, Florida Statutes, are amended to read:

28         400.991  License requirements; background screenings;

29  prohibitions.--

30         (1)(a)  Each clinic, as defined in s. 400.9905, must be

31  licensed and shall at all times maintain a valid license with


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    CS for SB 1062                                 Third Engrossed



 1  the agency. Each clinic location shall be licensed separately

 2  regardless of whether the clinic is operated under the same

 3  business name or management as another clinic.

 4         (b)  Each mobile clinic must obtain a separate health

 5  care clinic license and clinics must provide to the agency, at

 6  least quarterly, its their projected street location locations

 7  to enable the agency to locate and inspect such clinic

 8  clinics. A portable equipment provider must obtain a health

 9  care clinic license for a single administrative office and is

10  not required to submit quarterly projected street locations.

11         (2)  The initial clinic license application shall be

12  filed with the agency by all clinics, as defined in s.

13  400.9905, on or before July March 1, 2004. A clinic license

14  must be renewed biennially.

15         (3)  Applicants that submit an application on or before

16  July March 1, 2004, which meets all requirements for initial

17  licensure as specified in this section shall receive a

18  temporary license until the completion of an initial

19  inspection verifying that the applicant meets all requirements

20  in rules authorized in s. 400.9925. However, a clinic engaged

21  in magnetic resonance imaging services may not receive a

22  temporary license unless it presents evidence satisfactory to

23  the agency that such clinic is making a good faith effort and

24  substantial progress in seeking accreditation required under

25  s. 400.9935.

26         (7)  Each applicant for licensure shall comply with the

27  following requirements:

28         (a)  As used in this subsection, the term "applicant"

29  means individuals owning or controlling, directly or

30  indirectly, 5 percent or more of an interest in a clinic; the

31  medical or clinic director, or a similarly titled person who


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    CS for SB 1062                                 Third Engrossed



 1  is responsible for the day-to-day operation of the licensed

 2  clinic; the financial officer or similarly titled individual

 3  who is responsible for the financial operation of the clinic;

 4  and licensed health care practitioners medical providers at

 5  the clinic.

 6         (b)  Upon receipt of a completed, signed, and dated

 7  application, the agency shall require background screening of

 8  the applicant, in accordance with the level 2 standards for

 9  screening set forth in chapter 435. Proof of compliance with

10  the level 2 background screening requirements of chapter 435

11  which has been submitted within the previous 5 years in

12  compliance with any other health care licensure requirements

13  of this state is acceptable in fulfillment of this paragraph.

14  Applicants who own less than 10 percent of a health care

15  clinic are not required to submit fingerprints under this

16  section.

17         Section 17.  Paragraph (g) of subsection (1),

18  subsection (9), and paragraph (b) of subsection (11) of

19  section 400.9935, Florida Statutes, are amended to read:

20         400.9935  Clinic responsibilities.--

21         (1)  Each clinic shall appoint a medical director or

22  clinic director who shall agree in writing to accept legal

23  responsibility for the following activities on behalf of the

24  clinic. The medical director or the clinic director shall:

25         (g)  Conduct systematic reviews of clinic billings to

26  ensure that the billings are not fraudulent or unlawful. Upon

27  discovery of an unlawful charge, the medical director or

28  clinic director shall take immediate corrective action. If the

29  clinic performs only the technical component of magnetic

30  resonance imaging, static radiographs, computed tomography, or

31  positron emission tomography and provides the professional


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    CS for SB 1062                                 Third Engrossed



 1  interpretation of such services, in a fixed facility that is

 2  accredited by the Joint Commission on Accreditation of

 3  Healthcare Organizations or the Accreditation Association for

 4  Ambulatory Health Care and the American College of Radiology,

 5  and if, in the preceding quarter, the percentage of scans

 6  performed by that clinic that were billed to a personal injury

 7  protection insurance carrier was less than 15 percent, the

 8  chief financial officer of the clinic may, in a written

 9  acknowledgment provided to the agency, assume the

10  responsibility for the conduct of the systematic reviews of

11  clinic billings to ensure that the billings are not fraudulent

12  or unlawful.

13         (9)  Any person or entity providing health care

14  services which is not a clinic, as defined under s. 400.9905,

15  may voluntarily apply for a certificate of exemption from

16  licensure under its exempt status with the agency on a form

17  that sets forth its name or names and addresses, a statement

18  of the reasons why it cannot be defined as a clinic, and other

19  information deemed necessary by the agency. An exemption is

20  not transferable. The agency may charge an applicant for a

21  certificate of exemption in an amount equal to $100 or the

22  actual cost of processing the certificate, whichever is less.

23         (11)

24         (b)  The agency may deny disallow the application or

25  revoke the license of any entity formed for the purpose of

26  avoiding compliance with the accreditation provisions of this

27  subsection and whose principals were previously principals of

28  an entity that was unable to meet the accreditation

29  requirements within the specified timeframes. The agency may

30  adopt rules as to the accreditation of magnetic resonance

31  imaging clinics.


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    CS for SB 1062                                 Third Engrossed



 1         Section 18.  Subsections (1) and (3) of section

 2  400.995, Florida Statutes, are amended, and a new subsection

 3  (10) is added to said section, to read:

 4         400.995  Agency administrative penalties.--

 5         (1)  The agency may deny the application for a license

 6  renewal, revoke or suspend the license, and impose

 7  administrative fines penalties against clinics of up to $5,000

 8  per violation for violations of the requirements of this part

 9  or rules of the agency. In determining if a penalty is to be

10  imposed and in fixing the amount of the fine, the agency shall

11  consider the following factors:

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

13  probability that death or serious physical or emotional harm

14  to a patient will result or has resulted, the severity of the

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

16  provisions of the applicable laws or rules were violated.

17         (b)  Actions taken by the owner, medical director, or

18  clinic director to correct violations.

19         (c)  Any previous violations.

20         (d)  The financial benefit to the clinic of committing

21  or continuing the violation.

22         (3)  Any action taken to correct a violation shall be

23  documented in writing by the owner, medical director, or

24  clinic director of the clinic and verified through followup

25  visits by agency personnel. The agency may impose a fine and,

26  in the case of an owner-operated clinic, revoke or deny a

27  clinic's license when a clinic medical director or clinic

28  director knowingly fraudulently misrepresents actions taken to

29  correct a violation.

30         (10)  If the agency issues a notice of intent to deny a

31  license application after a temporary license has been issued


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    CS for SB 1062                                 Third Engrossed



 1  pursuant to s. 400.991(3), the temporary license shall expire

 2  on the date of the notice and may not be extended during any

 3  proceeding for administrative or judicial review pursuant to

 4  chapter 120.

 5         Section 19.  The Agency for Health Care Administration

 6  is directed to make refunds to applicants that submitted their

 7  health care clinic licensure fees and applications but were

 8  subsequently exempted from licensure by this act as follows:

 9         (1)  Seventy-five percent of the application fee if the

10  temporary license has not been issued;

11         (2)  Fifty percent of the application fee if the

12  temporary license has been issued but the inspection has not

13  been completed; or

14         (3)  No refund if the inspection has been completed.

15         Section 20.  Any person or entity defined as a clinic

16  under section 400.9905, Florida Statutes, shall not be in

17  violation of part XIII of chapter 400, Florida Statutes, due

18  to failure to apply for a clinic license by March 1, 2004, as

19  previously required by section 400.991, Florida Statutes.

20  Payment to any such person or entity by an insurer or other

21  person liable for payment to such person or entity may not be

22  denied on the grounds that the person or entity failed to

23  apply for or obtain a clinic license before March 1, 2004.

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

25  law.

26  

27  

28  

29  

30  

31  


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CODING: Words stricken are deletions; words underlined are additions.