Senate Bill sb1680e2
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CS for CS for CS for SB 1680 Second Engrossed (ntc)
1 A bill to be entitled
2 An act relating to the licensure of health care
3 providers; designating parts I, II, III, and IV
4 of ch. 408, F.S., relating to health care
5 administration; creating ss. 408.801-408.819,
6 F.S.; amending ss. 400.991, 400.9915, 400.992,
7 400.9925, 400.993, 400.9935, and 400.995, F.S.,
8 and repealing ss. 400.9905(2), 400.994, and
9 400.9945, F.S., relating to health care
10 clinics; defining terms; providing licensure
11 requirements for mobile clinics; prohibiting
12 the transfer of certain exemptions; providing
13 for the expiration of certain temporary
14 licenses; providing for the refund of certain
15 fees; exempting certain persons from license
16 application deadlines; requiring health care
17 clinics to be in compliance with part II of ch.
18 408, F.S.; providing for licensure fees;
19 authorizing the agency to adopt rules;
20 providing for administrative fines; conforming
21 provisions with the requirements of part II of
22 ch. 408, F.S.; providing requirements for
23 license application; providing for late fees;
24 providing duties of the agency, including
25 requirements for inspections; authorizing the
26 electronic submission of information to the
27 agency; providing requirements for licensure
28 upon a change of ownership of a provider;
29 specifying license categories; requiring
30 background screening of a licensee,
31 administrator, financial officer, or
1
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1 controlling interest; providing minimum
2 licensure requirements; providing requirements
3 for a licensee that discontinues operation;
4 requiring that notice be provided to clients;
5 requiring a licensee to inform clients of
6 certain rights; requiring an applicant for
7 licensure to provide proof of liability
8 insurance and financial ability to operate;
9 authorizing the agency to make inspections and
10 investigations; prohibiting certain unlicensed
11 activity; providing penalties; providing for
12 administrative fines; authorizing the agency to
13 impose a moratorium under certain
14 circumstances; specifying grounds under which
15 the agency may deny or revoke a license;
16 authorizing the agency to institute proceedings
17 for an injunction against a provider; requiring
18 that fees and fines be deposited into the
19 Health Care Trust Fund and used for
20 administering the laws and rules governing
21 providers; providing rulemaking authority;
22 amending s. 112.045, F.S., relating to the
23 Drug-Free Workplace Act; requiring drug-testing
24 laboratories to be in compliance with part II
25 of ch. 408, F.S.; deleting obsolete and
26 repetitive provisions; providing for rules and
27 licensure fees; amending ss. 383.301, 383.305,
28 383.309, 383.315, 383.324, 383.33, and 383.335,
29 F.S., and repealing ss. 383.304, 383.325,
30 383.331, and 383.332, F.S., relating to the
31 Birth Center Licensure Act; requiring birth
2
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CS for CS for CS for SB 1680 Second Engrossed (ntc)
1 centers to be in compliance with part II of ch.
2 408, F.S.; providing for licensure fees;
3 authorizing the agency to adopt rules;
4 providing for administrative fines; conforming
5 provisions with the requirements of part II of
6 ch. 408, F.S.; amending ss. 390.011, 390.012,
7 390.014, and 390.018, F.S., and repealing ss.
8 390.013, 390.015, 390.016, 390.017, 390.019,
9 and 390.021, F.S., relating to the regulation
10 of abortion clinics; requiring abortion clinics
11 to be in compliance with part II of ch. 408,
12 F.S.; providing for licensure fees; authorizing
13 the agency to adopt rules; providing for
14 administrative fines; amending s. 400.9905,
15 F.S.; revising the definitions of "clinic" and
16 "medical director" and defining "mobile clinic"
17 and "portable equipment provider" for purposes
18 of the Health Care Clinic Act; providing that
19 certain entities providing oncology or
20 radiation therapy services are exempt from the
21 licensure requirements of part XIII of ch. 400,
22 F.S.; providing legislative intent with respect
23 to such exemption; providing for retroactive
24 application; amending s. 400.991, F.S.;
25 requiring each mobile clinic to obtain a health
26 care clinic license; requiring a portable
27 equipment provider to obtain a health care
28 clinic license for a single office and
29 exempting such a provider from submitting
30 certain information to the Agency for Health
31 Care Administration; revising the date by which
3
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1 an initial application for a health care clinic
2 license must be filed with the agency; revising
3 the definition of "applicant"; amending s.
4 400.9935, F.S.; providing that an exemption
5 from licensure is not transferable; providing
6 that the agency may charge a fee of applicants
7 for certificates of exemption; providing that
8 the agency may deny an application or revoke a
9 license under certain circumstances; amending
10 s. 400.995, F.S.; providing that the agency may
11 deny, revoke, or suspend specified licenses and
12 impose fines for certain violations; providing
13 that a temporary license expires after a notice
14 of intent to deny an application is issued by
15 the agency; providing that persons or entities
16 made exempt under the act and which have paid
17 the clinic licensure fee to the agency are
18 entitled to a partial refund from the agency;
19 providing that certain persons or entities are
20 not in violation of part XIII of ch. 400, F.S.,
21 due to failure to apply for a clinic license by
22 a specified date; providing that certain
23 payments may not be denied to such persons or
24 entities for failure to apply for or obtain a
25 clinic license before a specified date;
26 requiring substance abuse or mental health
27 facilities, programs, and services to be in
28 compliance with part II of ch. 408, F.S.;
29 providing for licensure fees; authorizing the
30 agency to adopt rules; providing for
31 administrative penalties; conforming provisions
4
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1 with the requirements of part II of ch. 408,
2 F.S.; amending ss. 395.003, 395.004, 395.0161,
3 395.0163, 395.0199, 395.1046, 395.1055, and
4 395.1065, F.S., and repealing ss. 395.002(4),
5 395.0055, and 395.0162, F.S., relating to
6 hospitals and other licensed facilities;
7 requiring hospitals and other licensed
8 facilities to be in compliance with part II of
9 ch. 408, F.S.; providing for licensure fees;
10 authorizing the agency to adopt rules;
11 providing for administrative fines; conforming
12 provisions with the requirements of part II of
13 ch. 408, F.S.; amending s. 395.1041, F.S.;
14 requiring a facility licensed under ch. 395,
15 F.S., to withhold or withdraw cardiopulmonary
16 resuscitation when presented with an order not
17 to resuscitate; creating s. 395.10411, F.S.;
18 providing requirements to be carried out by a
19 facility licensed under ch. 395, F.S., when a
20 patient has an advance directive, has an order
21 not to resuscitate, or is a designated organ
22 donor; amending s. 765.1105, F.S.; requiring a
23 health care provider that refuses to carry out
24 a patient's advance directive to transfer the
25 patient within a specified time to a health
26 care provider that will comply with the advance
27 directive; creating s. 765.1021, F.S., to
28 encourage physicians and patients to discuss
29 end-of-life care and to specify when an advance
30 directive be part of the patient's medical
31 record; amending s. 765.304, F.S.; requiring an
5
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1 attending physician who refuses to comply with
2 a person's living will to transfer the person
3 to a physician who will comply; amending s.
4 395.0197, F.S.; providing that a health care
5 facility must use the services of, rather than
6 hire, a risk manager; restricting the number of
7 internal risk management programs in separate
8 hospitals which may be the responsibility of a
9 risk manager; providing exceptions; amending
10 ss. 395.10973, 395.10974, and 395.10975, F.S.,
11 relating to health care risk managers;
12 requiring health care risk managers to comply
13 with part II of ch. 408, F.S.; providing for
14 fees; authorizing the agency to adopt rules;
15 providing for administrative fines; conforming
16 provisions with the requirements of part II of
17 ch. 408, F.S.; amending s. 400.21, F.S.;
18 providing that certain registered nurses may
19 sign a resident care plan; amending ss.
20 400.022, 400.051, 400.062, 400.063, 400.071,
21 400.102, 400.111, 400.1183, 400.121, 400.141,
22 400.17, 400.179, 400.18, 400.19, 400.191,
23 400.20, 400.211, and 400.23, F.S., and
24 repealing ss. 400.021(5) and (20), 400.125, and
25 400.241(1) and (2), F.S., relating to nursing
26 homes; requiring nursing homes to be in
27 compliance with part II of ch. 408, F.S.;
28 providing for licensure fees; authorizing the
29 agency to adopt rules; providing for
30 administrative fines; revising reporting
31 requirements; conforming provisions with the
6
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1 requirements of part II of ch. 408, F.S.;
2 creating s. 400.0712, F.S.; authorizing the
3 Agency for Health Care Administration to issue
4 an inactive license to a nursing home facility
5 for all or a portion of its beds; providing
6 procedures when applying for an inactive
7 license; permitting the agency to issue an
8 inactive license to a nursing home that chooses
9 to use an unoccupied contiguous portion of the
10 facility for an alternative use to meet the
11 needs of elderly persons through the use of
12 less restrictive, less institutional services;
13 providing that an inactive license issued may
14 be granted for specified periods of time;
15 directing that a nursing home that receives an
16 inactive license to provide alternative
17 services may not receive preference for
18 participation in the Assisted Living for the
19 Elderly Medicaid waiver; providing that
20 reactivation of an inactive license requires
21 the applicant to meet certain specified
22 conditions; amending ss. 400.402, 400.407,
23 400.4075, 400.408, 400.411, 400.412, 400.414,
24 400.417, 400.4174, 400.4176, 400.418, 400.419,
25 400.42, 400.424, 400.4255, 400.4256, 400.427,
26 400.4275, 400.431, 400.434, 400.441, 400.442,
27 400.444, 400.452, and 400.454, F.S., and
28 repealing ss. 400.415, 400.4178(7), 400.435(1),
29 400.447(1), (2), and (3), and 400.451, F.S.,
30 relating to assisted living facilities;
31 requiring assisted living facilities to be in
7
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1 compliance with part II of ch. 408, F.S.;
2 providing for licensure fees; requiring
3 assisted living facilities to conduct resident
4 elopement prevention and response drills;
5 authorizing the agency to adopt rules;
6 providing for administrative fines; conforming
7 provisions with the requirements of part II of
8 ch. 408, F.S.; amending s. 400.487, F.S.;
9 revising home health agency service agreements
10 and treatment orders; amending ss. 400.464,
11 400.471, 400.474, 400.484, 400.494, 400.495,
12 400.497, 400.506, 400.509, and 400.512, F.S.,
13 and repealing s. 400.515, F.S., relating to
14 home health agencies and nurse registries;
15 requiring home health agencies and nurse
16 registries to be in compliance with part II of
17 ch. 408, F.S.; providing for licensure fees;
18 authorizing the agency to adopt rules;
19 providing for administrative fines; conforming
20 provisions with the requirements of part II of
21 ch. 408, F.S.; amending ss. 400.551, 400.554,
22 400.555, 400.556, 400.5565, 400.557, 400.5572,
23 400.559, 400.56, and 400.562, F.S., and
24 repealing ss. 400.5575, 400.558, and 400.564,
25 F.S., relating to adult day care centers;
26 requiring adult day care centers to be in
27 compliance with part II of ch. 408, F.S.;
28 providing for licensure fees; authorizing the
29 agency to adopt rules; providing for
30 administrative fines; conforming provisions
31 with the requirements of part II of ch. 408,
8
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1 F.S.; amending ss. 400.602, 400.605, 400.606,
2 400.6065, 400.607, and 400.6095, F.S., relating
3 to hospices; requiring hospices to be in
4 compliance with part II of ch. 408, F.S.;
5 providing for licensure fees; authorizing the
6 agency to adopt rules; providing for
7 administrative fines; conforming provisions
8 with the requirements of part II of ch. 408,
9 F.S.; amending ss. 400.617, 400.619, 400.6194,
10 400.6196, 400.621, 400.6211, and 400.625, F.S.,
11 and repealing s. 400.622, F.S., relating to
12 adult family-care homes; requiring adult
13 family-care homes to be in compliance with part
14 II of ch. 408, F.S.; providing for licensure
15 fees; authorizing the agency to adopt rules;
16 providing for administrative fines; conforming
17 provisions with the requirements of part II of
18 ch. 408, F.S.; amending ss. 400.801 and
19 400.805, F.S., relating to homes for special
20 services and transitional living facilities;
21 requiring such homes and facilities to be in
22 compliance with part II of ch. 408, F.S.;
23 providing for licensure fees; authorizing the
24 agency to adopt rules; providing for
25 administrative fines; conforming provisions
26 with the requirements of part II of ch. 408,
27 F.S.; amending ss. 400.902, 400.903, 400.905,
28 400.907, 400.908, 400.912, 400.914, and
29 400.915, F.S., and repealing ss. 400.906,
30 400.910, 400.911, 400.913, 400.916, and
31 400.917, F.S., relating to prescribed pediatric
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1 extended care centers; requiring such centers
2 to be in compliance with part II of ch. 408,
3 F.S.; providing for licensure fees; authorizing
4 the agency to adopt rules; providing for
5 administrative fines; conforming provisions
6 with the requirements of part II of ch. 408,
7 F.S.; amending ss. 400.925, 400.93, 400.931,
8 400.932, 400.933, and 400.935, F.S., and
9 repealing ss. 400.95, 400.953(2), 400.955(4),
10 and 400.956, F.S., relating to home medical
11 equipment providers; requiring home medical
12 equipment providers to be in compliance with
13 part II of ch. 408, F.S.; providing for
14 licensure fees; authorizing the agency to adopt
15 rules; providing for administrative fines;
16 conforming provisions with the requirements of
17 part II of ch. 408, F.S.; amending ss. 400.960,
18 400.962, 400.967, 400.968, and 400.969, F.S.,
19 and repealing ss. 400.963 and 400.965, F.S.,
20 relating to intermediate care facilities for
21 the developmentally disabled; requiring such
22 facilities to be in compliance with part II of
23 ch. 408, F.S.; providing for licensure fees;
24 authorizing the agency to adopt rules;
25 providing for administrative fines; conforming
26 provisions with the requirements of part II of
27 ch. 408, F.S.; amending s. 400.908, F.S.;
28 requiring health care services pools to be in
29 compliance with part II of ch. 408, F.S.;
30 providing for licensure fees; authorizing the
31 agency to adopt rules; providing for
10
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1 administrative fines; conforming provisions
2 with the requirements of part II of ch. 408,
3 F.S.; amending ss. 400.991, 400.9915, 400.992,
4 400.9925, 400.993, 400.9935, and 400.995, F.S.,
5 and repealing ss. 400.9905(2), 400.994, and
6 400.9945, F.S., relating to health care
7 clinics; requiring health care clinics to be in
8 compliance with part II of ch. 408, F.S.;
9 providing for licensure fees; authorizing the
10 agency to adopt rules; providing for
11 administrative fines; conforming provisions
12 with the requirements of part II of ch. 408,
13 F.S.; amending s. 408.036, F.S.; revising the
14 prerequisites for allowing an exemption from
15 certificate-of-need review for adding skilled
16 nursing facility beds to a licensed skilled
17 nursing facility or for construction of a
18 skilled nursing facility; allowing such an
19 exemption only in counties having a specified
20 maximum population; amending s. 408.831, F.S.,
21 relating to the authority of the Agency for
22 Health Care Administration to impose certain
23 penalties against a regulated or licensed
24 entity; conforming provisions to changes made
25 by the act; amending s. 440.102, F.S., relating
26 to the drug-free workplace program; requiring
27 laboratories to be in compliance with the
28 requirements of part II of ch. 408, F.S.;
29 conforming provisions to changes made by the
30 act; amending s. 468.711, F.S.; deleting the
31 requirement that continuing education for
11
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1 athletic trainers include first aid; amending
2 s. 468.723, F.S.; revising exemptions from
3 licensure requirements; amending s. 1012.46,
4 F.S.; providing that a first responder for a
5 school district may not represent himself or
6 herself as an athletic trainer; amending ss.
7 483.035, 483.051, 483.061, 483.091, 483.101,
8 483.111, 483.172, 483.201, 483.221, and 483.23,
9 F.S., and repealing ss. 483.131 and 483.25,
10 F.S., relating to clinical laboratories;
11 requiring clinical laboratories to be in
12 compliance with part II of ch. 408, F.S.;
13 providing for licensure fees; authorizing the
14 agency to adopt rules; providing for
15 administrative fines; conforming provisions
16 with the requirements of part II of ch. 408,
17 F.S.; amending ss. 483.291, 483.294, 483.30,
18 483.302, and 483.32, F.S., and repealing ss.
19 483.311, 483.317(1), 483.322(1), and 483.328,
20 F.S., relating to multiphasic health testing
21 centers; requiring such centers to be in
22 compliance with part II of ch. 408, F.S.;
23 providing for licensure fees; authorizing the
24 agency to adopt rules; providing for
25 administrative fines; conforming provisions
26 with the requirements of part II of ch. 408,
27 F.S.; providing for ss. 408.801-408.819, F.S.,
28 to prevail in the case of a conflict with other
29 laws governing the licensure of health care
30 providers by the agency; authorizing the agency
31 to issue a license for less than a specified
12
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1 period and to charge a prorated fee; amending
2 s. 651.118, F.S.; revising standards for use of
3 sheltered nursing home beds by certain persons;
4 amending s. 456.025, F.S.; deleting
5 requirements for the Department of Health to
6 administer an electronic continuing education
7 tracking system for health care practitioners;
8 creating s. 456.0251, F.S.; providing for
9 enforcement of continuing education
10 requirements required for license renewal;
11 authorizing citations and fines to be imposed
12 for failure to comply with required continuing
13 education requirements; amending s. 456.072,
14 F.S.; providing for discipline of licensees who
15 fail to meet continuing education requirements
16 as a prerequisite for license renewal three or
17 more times; providing a short title; requiring
18 the Agency for Workforce Innovation to
19 establish a pilot program for delivery of
20 certified geriatric specialty nursing
21 education; specifying eligibility requirements
22 for certified nursing assistants to obtain
23 certified geriatric specialty nursing
24 education; specifying requirements for the
25 education of certified nursing assistants to
26 prepare for certification as a certified
27 geriatric specialist; creating a Certified
28 Geriatric Specialty Nursing Initiative Steering
29 Committee; providing for the composition of and
30 manner of appointment to the Certified
31 Geriatric Specialty Nursing Initiative Steering
13
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1 Committee; providing responsibilities of the
2 steering committee; providing for reimbursement
3 for per diem and travel expenses; requiring the
4 Agency for Workforce Innovation to conduct or
5 contract for an evaluation of the pilot program
6 for delivery of certified geriatric specialty
7 nursing education; requiring the evaluation to
8 include recommendations regarding the expansion
9 of the delivery of certified geriatric
10 specialty nursing education in nursing homes;
11 requiring the Agency for Workforce Innovation
12 to report to the Governor and Legislature
13 regarding the status and evaluation of the
14 pilot program; creating s. 464.0125, F.S.;
15 providing definitions; providing requirements
16 for persons to become certified geriatric
17 specialists; specifying fees; providing for
18 articulation of geriatric specialty nursing
19 coursework and practical nursing coursework;
20 providing practice standards and grounds for
21 which certified geriatric specialists may be
22 subject to discipline by the Board of Nursing;
23 creating restrictions on the use of
24 professional nursing titles; prohibiting the
25 use of certain professional titles; providing
26 penalties; authorizing approved nursing
27 programs to provide education for the
28 preparation of certified geriatric specialists
29 without further board approval; authorizing
30 certified geriatric specialists to supervise
31 the activities of others in nursing home
14
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1 facilities according to rules by the Board of
2 Nursing; revising terminology relating to
3 nursing to conform to the certification of
4 geriatric specialists; amending s. 381.00315,
5 F.S.; revising requirements for the
6 reactivation of the licenses of specified
7 health care practitioners in the event of a
8 public health emergency to include certified
9 geriatric specialists; amending s. 400.021,
10 F.S.; including services provided by a
11 certified geriatric specialist within the
12 definition of nursing service; amending s.
13 400.211, F.S.; revising requirements for
14 persons employed as nursing assistants to
15 conform to the certification of certified
16 geriatric specialists; amending s. 400.23,
17 F.S.; specifying that certified geriatric
18 specialists shall be considered licensed
19 nursing staff; authorizing licensed practical
20 nurses to supervise the activities of certified
21 geriatric specialists in nursing home
22 facilities according to rules adopted by the
23 Board of Nursing; amending s. 409.908, F.S.;
24 revising the methodology for reimbursement of
25 Medicaid program providers to include services
26 of certified geriatric specialists; amending s.
27 458.303, F.S.; revising exceptions to the
28 practice of medicine to include services
29 delegated to a certified geriatric specialist
30 under specified circumstances; amending s.
31 1009.65, F.S.; revising eligibility for the
15
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1 Medical Education Reimbursement and Loan
2 Repayment Program to include certified
3 geriatric specialists; amending s. 1009.66,
4 F.S.; revising eligibility requirements for the
5 Nursing Student Loan Forgiveness Program to
6 include certified geriatric specialists;
7 providing an appropriation; amending s.
8 464.201, F.S.; defining terms; amending s.
9 464.202, F.S.; authorizing the Board of Nursing
10 to adopt rules regarding the practice and
11 supervision of certified nursing assistants;
12 providing inapplicability to ss. 456.052 and
13 456.053, F.S.; providing effective dates.
14
15 Be It Enacted by the Legislature of the State of Florida:
16
17 Section 1. Part I of chapter 408, Florida Statutes,
18 consisting of sections 408.02, 408.031, 408.032, 408.033,
19 408.034, 408.035, 408.036, 408.0361, 408.037, 408.038,
20 408.039, 408.040, 408.041, 408.042, 408.043, 408.044, 408.045,
21 408.0455, 408.05, 408.061, 408.062, 408.063, 408.07, 408.08,
22 408.09, 408.10, 408.15, 408.16, 408.18, 408.185, 408.20,
23 408.301, 408.302, 408.40, 408.50, 408.70, 408.7056, 408.7057,
24 and 408.7071, is created and entitled "Health Facility and
25 Services Planning."
26 Section 2. Part II of chapter 408, Florida Statutes,
27 consisting of sections 408.801, 408.802, 408.803, 408.804,
28 408.805, 408.806, 408.807, 408.808, 408.809, 408.810, 408.811,
29 408.812, 408.813, 408.814, 408.815, 408.816, 408.817, 408.818,
30 408.819, and 408.831, is created and entitled "Health Care
31 Licensing: General Provisions."
16
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1 Section 3. Part III of chapter 408, Florida Statutes,
2 consisting of sections 408.90, 408.901, 408.902, 408.903,
3 408.904, 408.905, 408.906, 408.907, 408.908, and 408.909, is
4 created and entitled "Health Insurance Access."
5 Section 4. Part IV of chapter 408, Florida Statutes,
6 consisting of sections 408.911, 408.913, 408.914, 408.915,
7 408.916, 408.917, and 408.918, is created and entitled "Health
8 and Human Services Eligibility Access System."
9 Section 5. Sections 408.801 through 408.819, Florida
10 Statutes, are created to read:
11 408.801 Short title; purpose.--
12 (1) This part may be cited as the "Health Care
13 Licensing Procedures Act."
14 (2) The Legislature finds that there is unnecessary
15 duplication and variation in the requirements for licensure by
16 the Agency for Health Care Administration, brought about by
17 the historical pattern of legislative action focused
18 exclusively on a single type of regulated provider. It is the
19 intent of the Legislature to provide a streamlined and
20 consistent set of basic licensing requirements for all such
21 providers in order to minimize confusion, standardize
22 terminology, and include issues that are otherwise not
23 adequately addressed in the statutes pertaining to specific
24 providers.
25 408.802 Applicability.--The provisions of this part
26 apply to the provision of services that necessitate licensure
27 as defined in this part and to the following entities licensed
28 or registered by the Agency for Health Care Administration, as
29 further described in chapters 112, 383, 390, 394, 395, 400,
30 440, and 483:
31
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1 (1) Laboratories authorized to perform testing under
2 the Drug-Free Workplace Act, as provided under ss. 112.0455
3 and 440.102.
4 (2) Birth centers, as provided under chapter 383.
5 (3) Abortion clinics, as provided under chapter 390.
6 (4) Crisis stabilization units, as provided under
7 parts I and IV of chapter 394.
8 (5) Short-term residential treatment units, as
9 provided under parts I and IV of chapter 394.
10 (6) Residential treatment facilities, as provided
11 under part IV of chapter 394.
12 (7) Residential treatment centers for children and
13 adolescents, as provided under part IV of chapter 394.
14 (8) Hospitals, as provided under part I of chapter
15 395.
16 (9) Ambulatory surgical centers, as provided under
17 part I of chapter 395.
18 (10) Mobile surgical facilities, as provided under
19 part I of chapter 395.
20 (11) Private review agents, as provided under part I
21 of chapter 395.
22 (12) Health care risk managers, as provided under part
23 I of chapter 395.
24 (13) Nursing homes, as provided under part II of
25 chapter 400.
26 (14) Assisted living facilities, as provided under
27 part III of chapter 400.
28 (15) Home health agencies, as provided under part IV
29 of chapter 400.
30 (16) Nurse registries, as provided under part IV of
31 chapter 400.
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1 (17) Companion services or homemaker services
2 providers, as provided under part IV of chapter 400.
3 (18) Adult day care centers, as provided under part V
4 of chapter 400.
5 (19) Hospices, as provided under part VI of chapter
6 400.
7 (20) Adult family-care homes, as provided under part
8 VII of chapter 400.
9 (21) Homes for special services, as provided under
10 part VIII of chapter 400.
11 (22) Transitional living facilities, as provided under
12 part VIII of chapter 400.
13 (23) Prescribed pediatric extended care centers, as
14 provided under part IX of chapter 400.
15 (24) Home medical equipment providers, as provided
16 under part X of chapter 400.
17 (25) Intermediate care facilities for the
18 developmentally disabled, as provided under part XI of chapter
19 400.
20 (26) Health care services pools, as provided under
21 part XII of chapter 400.
22 (27) Health care clinics, as provided under part XIII
23 of chapter 400.
24 (28) Clinical laboratories, as provided under part I
25 of chapter 483.
26 (29) Multiphasic health testing centers, as provided
27 under part II of chapter 483.
28 408.803 Definitions.--As used in this part, the term:
29 (1) "Agency" means the Agency for Health Care
30 Administration, which is the licensing agency under this part.
31
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1 (2) "Applicant" means an individual, corporation,
2 partnership, firm, association, or governmental entity that
3 submits an application to the agency for a license.
4 (3) "Authorizing statute" means the statute
5 authorizing the licensed operation of a provider listed in s.
6 408.802.
7 (4) "Certification" means certification as a Medicare
8 or Medicaid provider of the services that necessitate
9 licensure or certification pursuant to the federal Clinical
10 Laboratory Improvement Amendments (CLIA).
11 (5) "Change in ownership" means an event in which the
12 licensee changes to a different legal entity or in which 45
13 percent or more of the ownership, voting shares, or
14 controlling interest in a corporation whose shares are not
15 publicly traded on a recognized stock exchange is transferred
16 or assigned, including the final transfer or assignment of
17 multiple transfers or assignments over a 2-year period which
18 cumulatively total 45 percent or greater. However, a change
19 solely in the management company is not a change of ownership.
20 (6) "Client" means any person receiving services from
21 a provider listed in s. 408.802.
22 (7) "Controlling interest" means:
23 (a) The applicant for licensure or a licensee;
24 (b) A person or entity that serves as an officer of,
25 is on the board of directors of, or has a 5 percent or greater
26 ownership interest in the applicant or licensee; or
27 (c) A person or entity that serves as an officer of,
28 is on the board of directors of, or has a 5 percent or greater
29 ownership interest in the management company or other entity,
30 related or unrelated, which the applicant or licensee may
31 contract with to operate the provider.
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1
2 The term does not include a voluntary board member.
3 (8) "License" means any permit, registration,
4 certificate, or license issued by the agency.
5 (9) "Licensee" means an individual, corporation,
6 partnership, firm, association, or governmental entity that is
7 issued a permit, registration, certificate, or license by the
8 agency. The licensee is legally responsible for all aspects of
9 the provider operation.
10 (10) "Moratorium" means a prohibition on the
11 acceptance of new clients.
12 (11) "Provider" means any activity, service, agency,
13 or facility regulated by the agency and listed in s. 408.802.
14 (12) "Services that necessitate licensure" means those
15 services, including residential services, which require a
16 valid license before those services may be provided in
17 accordance with authorizing statutes and agency rules.
18 (13) "Voluntary board member" means a board member of
19 a not-for-profit corporation or organization who serves solely
20 in a voluntary capacity for the licensee, does not receive any
21 remuneration for his or her services on the board of
22 directors, and has no financial interest in the corporation or
23 organization. The agency shall recognize a person as a
24 voluntary board member following submission of a statement to
25 the agency by the board member and the not-for-profit
26 corporation or organization which affirms that the board
27 member conforms to this definition. The statement affirming
28 the status of the board member must be submitted to the agency
29 on a form provided by the agency.
30 408.804 License required; display.--
31
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1 (1) It is unlawful to provide services that
2 necessitate licensure, or operate or maintain a provider
3 offering or providing services that necessitate licensure,
4 without first obtaining from the agency a license authorizing
5 such operation.
6 (2) A license must be displayed in a conspicuous place
7 readily visible to clients who enter at the address that
8 appears on the license and is valid only in the hands of the
9 individual, firm, partnership, association, or corporation to
10 whom it is issued and may not be sold, assigned, or otherwise
11 transferred, voluntarily or involuntarily. The license is
12 valid only for the licensee, provider, and location for which
13 the license is originally issued.
14 408.805 Fees required; adjustments.--Unless otherwise
15 limited by authorizing statutes, license fees must be
16 reasonably calculated by the agency to cover its costs in
17 carrying out its responsibilities under this part, authorizing
18 statutes, and applicable rules, including the cost of
19 licensure, inspection, and regulation of providers, and must
20 be of such amount that the total fees collected do not exceed
21 the cost of administering and enforcing compliance with this
22 part, authorizing statutes, and applicable rules.
23 (1) Licensure fees shall be adjusted for biennial
24 licensure in agency rules.
25 (2) The agency shall annually adjust licensure fees,
26 including fees paid per bed, by not more than the change in
27 the consumer price index based on the 12 months immediately
28 preceding the increase.
29 (3) The agency may, by rule, adjust licensure fees to
30 cover the cost of regulation under this part, authorizing
31 statutes, and applicable rules.
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1 (4) An inspection fee must be paid as required in
2 authorizing statutes.
3 (5) Licensure and inspection fees are nonrefundable.
4 (6) When a change is reported which requires issuance
5 of a license, a fee must be assessed. The fee must be based on
6 the actual cost of processing and issuing the license.
7 (7) A fee may be charged to a licensee requesting a
8 duplicate license. The fee may not exceed the actual cost of
9 duplication and postage.
10 (8) Total fees collected may not exceed the cost of
11 carrying out the provisions of this part, authorizing
12 statutes, or applicable rules.
13 408.806 License application process.--
14 (1) An application for licensure must be made to the
15 agency on forms furnished by the agency, submitted under oath,
16 and accompanied by the appropriate license fee in order to be
17 accepted and considered timely. The application must contain
18 information required by authorizing statutes and applicable
19 rules and must include:
20 (a) The name, address, and social security number of
21 the applicant and each controlling interest if the applicant
22 or controlling interest is an individual.
23 (b) The name, address, and federal employer
24 identification number or taxpayer identification number of the
25 applicant and each controlling interest if the applicant or
26 controlling interest is not an individual.
27 (c) The name by which the provider is to be known.
28 (d) The total number of beds or capacity requested, as
29 applicable.
30 (e) The location of the provider for which application
31 is made, a report or letter from the zoning authority
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1 indicating the location is zoned appropriately for its use,
2 and a satisfactory fire safety report from the local authority
3 having jurisdiction or the state fire marshal. If the provider
4 is a community residential home under chapter 419, the zoning
5 requirement must be satisfied by proof of compliance with
6 chapter 419.
7 (f) The name of the person or persons under whose
8 management or supervision the provider will be operated and
9 the name of the administrator if required.
10 (g) Any information that the agency finds is necessary
11 to determine the ability of the applicant to carry out its
12 responsibilities, including satisfactory inspection results,
13 under this part and authorizing statutes, as specified in
14 rule.
15 (2)(a) The applicant for a renewal license must submit
16 an application that must be received by the agency at least 60
17 days prior to the expiration of the current license.
18 (b) The applicant for initial licensure due to a
19 change of ownership must submit an application that must be
20 received by the agency at least 60 days prior to the date of
21 change of ownership.
22 (c) For any other application or request, the
23 applicant must submit an application or request that must be
24 received by the agency at least 60 days prior to the requested
25 effective date, unless otherwise specified in authorizing
26 statutes or rules.
27 (3) Upon receipt of an application for a license, the
28 agency shall examine the application and, within 30 days after
29 receipt, notify the applicant in writing of any apparent
30 errors or omissions and request any additional information
31 required.
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1 (4) Requested information omitted from an application
2 for licensure, license renewal, or change of ownership, other
3 than an inspection, must be filed with the agency within 21
4 days after the agency's request for omitted information, or
5 the application shall be deemed incomplete, and shall be
6 withdrawn from further consideration and the fees forfeited.
7 (5) Licensees subject to the provisions of this part
8 shall be issued biennial licenses unless conditions of the
9 license category specify a shorter license period. The agency
10 may not issue an initial license to a health care provider
11 subject to the certificate-of-need provisions in ss.
12 408.031-408.045 if the licensee has not been issued a
13 certificate of need or exemption, when applicable. Failure to
14 apply for the renewal of a license prior to the expiration
15 date renders the license null and void and the former licensee
16 may not be issued a new license unless the licensee reapplies
17 for an initial license and meets all current qualifications
18 for licensure, including construction standards for facilities
19 where applicable and complies with certificate-of-need
20 requirements if the applicant is subject to the provisions of
21 ss. 408.031-408.045.
22 (6) The failure to file a timely application and
23 license fee shall result in a late fee charged to the licensee
24 in an amount equal to 50 percent of the licensure fee. If a
25 renewal application is not received by the agency 60 days in
26 advance of the license expiration date, the agency shall
27 notify the licensee of this late fee within 10 days after the
28 date the renewal application was due.
29 (7) Within 60 days after the receipt of a complete
30 application, the agency shall approve or deny the application.
31
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1 (8) Each license issued shall indicate the name of the
2 licensee, the provider or service that the licensee is
3 required or authorized to operate or offer, the date the
4 license is issued, the expiration date of the license, the
5 maximum capacity of the licensed premises if applicable, and
6 any other information required by authorizing statutes or
7 deemed necessary by the agency.
8 (9)(a) An initial inspection is not required for
9 companion services or homemaker services providers, as
10 provided under part IV of chapter 400 or for health care
11 services pools, as provided under part XII of chapter 400.
12 (b) If an inspection is required by the authorizing
13 statute for a license application other than an initial
14 application, the inspection must be unannounced. This
15 paragraph does not apply to inspections required pursuant to
16 ss. 483.061(2), 395.0161(4), and 383.324(3).
17 (c) If a provider is not available when an inspection
18 is attempted, the application shall be withdrawn from further
19 consideration.
20 (10) The agency may establish procedures for the
21 electronic submission of required information, including, but
22 not limited to:
23 (a) Licensure applications and required signatures.
24 (b) Payment of fees.
25 (c) Notarization of applications.
26
27 Requirements for electronic submission of any documents
28 required by this part or authorizing statutes may be
29 established by rule.
30 408.807 Change of ownership.--Whenever a change of
31 ownership occurs:
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1 (1) The transferor shall notify the agency in writing
2 at least 60 days before the anticipated date of transfer of
3 ownership.
4 (2) The transferee shall make application to the
5 agency for a license within the timeframes required in s.
6 408.806.
7 (3) The transferor shall be responsible and liable
8 for:
9 (a) The lawful operation of the provider and the
10 welfare of the clients served until the date the transferee is
11 licensed by the agency.
12 (b) Any and all penalties imposed against the
13 transferor for violations occurring before the date of change
14 of ownership.
15 (4) Any restriction on licensure, including a
16 conditional license existing at the time of a change of
17 ownership, shall remain in effect until removed by the agency.
18 (5) The transferee shall maintain records of the
19 transferor as required in this part, authorizing statutes, and
20 applicable rules including:
21 (a) All client records.
22 (b) Inspection reports.
23 (c) All records required to be maintained pursuant to
24 409.913, if applicable.
25 408.808 License categories.--
26 (1) STANDARD LICENSE.--A standard license may be
27 issued at the time of initial licensure, license renewal, or
28 change of ownership. A standard license shall be issued when
29 the applicant is in compliance with all statutory requirements
30 and agency rules. Unless sooner revoked, a standard license
31 expires 2 years following the date of issue.
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1 (2) PROVISIONAL LICENSE.--A provisional license may be
2 issued:
3 (a) Pursuant to s. 408.809(3).
4 (b) When a denial or revocation proceeding is pending,
5 a provisional license for this purpose is effective until
6 final agency disposition of the proceeding.
7 (3) INACTIVE LICENSE.--An inactive license may be
8 issued to a health care provider subject to the
9 certificate-of-need provisions in ss. 408.031-408.045 when the
10 provider is currently licensed, does not have a provisional
11 license, and will be temporarily unable to provide services
12 but is reasonably expected to resume services within 12
13 months. Such designation may be made for a period not to
14 exceed 12 months but may be renewed by the agency for up to 6
15 additional months upon demonstration by the licensee of the
16 provider's progress toward reopening. Any request by a
17 licensee for an inactive license or to extend the previously
18 approved inactive period must be submitted to the agency,
19 accompanied by written justification for the inactive license
20 with the beginning and ending dates of inactivity, including a
21 plan for the transfer of any clients to other providers, and
22 the appropriate licensure fees. The agency may not accept a
23 request that is submitted after initiating closure, after any
24 suspension of service, or after notifying clients of closure
25 or suspension of service. Upon agency approval, the provider
26 shall notify clients of any necessary discharge or transfer as
27 required by authorizing statutes. The beginning of the
28 inactive license shall be the date the provider ceases
29 operations. The end of the inactive period shall become the
30 license expiration date and all licensure fees must be
31 current, paid in full, and may be prorated. Reactivation of an
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1 inactive license requires the approval of a renewal
2 application, including payment of licensure fees and agency
3 inspections indicating compliance with all requirements of
4 this part, authorizing statutes, and applicable rules.
5 (4) OTHER LICENSES.--Other licensure types may be
6 issued pursuant to authorizing statutes.
7 408.809 Background screening; prohibited offenses.--
8 (1) Level 2 background screening pursuant to chapter
9 435 must be conducted through the agency on each of the
10 following persons, who shall be considered an employee for the
11 purposes of conducting screening under chapter 435:
12 (a) The licensee if an individual;
13 (b) The administrator or a similarly titled person who
14 is responsible for the day-to-day operation of the provider;
15 (c) The financial officer or similarly titled
16 individual who is responsible for the financial operation of
17 the licensee or provider; and
18 (d) Any person who is a controlling interest if the
19 agency has reason to believe that such person has been
20 convicted of any offense prohibited by s. 435.04. For each
21 controlling interest who has been convicted of any such
22 offense, the licensee shall submit to the agency a description
23 and explanation of the conviction at the time of license
24 application.
25 (2) Proof of compliance with level 2 screening
26 standards submitted within the previous 5 years to meet any
27 provider or professional licensure requirements of the agency,
28 the Department of Health, or the Department of Children and
29 Family Services satisfies the requirements of this section,
30 provided that such proof is accompanied, under penalty of
31 perjury, by an affidavit of compliance with the provisions of
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1 chapter 435. Proof of compliance with the background screening
2 requirements of the Office of Insurance Regulation for an
3 applicant for a certificate of authority to operate a
4 continuing care retirement community under chapter 651,
5 submitted within the previous 5 years, satisfies the
6 Department of Law Enforcement and Federal Bureau of
7 Investigation portions of a level 2 background check.
8 (3) A provisional license may be granted to an
9 applicant when each individual required by this section to
10 undergo background screening has met the standards for the
11 Department of Law Enforcement background check, but the agency
12 has not yet received background screening results from the
13 Federal Bureau of Investigation. A standard license may be
14 granted to the licensee upon the agency's receipt of a report
15 of the results of the Federal Bureau of Investigation
16 background screening for each individual required by this
17 section to undergo background screening which confirms that
18 all standards have been met, or upon the granting of a
19 disqualification exemption by the agency as set forth in
20 chapter 435. Any other person who is required to undergo level
21 2 background screening may serve in his or her capacity
22 pending the agency's receipt of the report from the Federal
23 Bureau of Investigation. However, the person may not continue
24 to serve if the report indicates any violation of background
25 screening standards and a disqualification exemption has not
26 been requested of or granted by the agency as set forth in
27 chapter 435.
28 (4) When a change in the administrator of a provider
29 occurs, the licensee must notify the agency of the change
30 within the time period specified in the authorizing statute or
31 rules unless otherwise reported to the administrator's
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1 professional licensing board, or Department of Health if there
2 is no board, and must provide evidence of compliance with
3 background screening requirements of this section; except that
4 an administrator who has met the standards for the Department
5 of Law Enforcement background check, but for whom background
6 screening results from the Federal Bureau of Investigation
7 have not yet been received, may be employed pending a receipt
8 of the Federal Bureau of Investigation background screening
9 report. An individual may not continue to serve as
10 administrator if the Federal Bureau of Investigation
11 background screening report indicates any violation of
12 background screening standards.
13 (5) Background screening is not required to obtain a
14 certificate of exemption issued under s. 483.106.
15 408.810 Minimum licensure requirements.--In addition
16 to the licensure requirements specified in this part, chapter
17 112, chapter 383, chapter 390, chapter 394, chapter 395,
18 chapter 400, chapter 440, or chapter 483, each applicant for
19 licensure by the Agency for Health Care Administration must
20 comply with the requirements of this section in order to
21 obtain and maintain a license.
22 (1) An applicant for licensure must comply with
23 background screening requirements of s. 408.809.
24 (2) An applicant for licensure must provide a
25 description and explanation of any exclusions, suspensions, or
26 terminations of the applicant from the Medicare, Medicaid, or
27 federal Clinical Laboratory Improvement Amendments (CLIA)
28 programs.
29 (3) Unless otherwise specified in this part,
30 authorizing statutes, or applicable rules, any information
31 required to be reported to the agency must be submitted within
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1 10 calendar days after the report period or effective date of
2 the information.
3 (4) Whenever a licensee discontinues operation of a
4 provider:
5 (a) The licensee must inform the agency not less than
6 30 days prior to the discontinuance of operation and inform
7 clients of discharge as required by authorizing statutes.
8 Immediately upon discontinuance of operation of a provider,
9 the licensee shall surrender the license to the agency and the
10 license shall be canceled.
11 (b) Upon closure of a provider, the licensee shall
12 remain responsible for retaining and appropriately
13 distributing all records within the timeframes prescribed in
14 authorizing statutes and applicable rules. In addition, the
15 licensee or, in the event of death or dissolution of a
16 licensee, the estate or agent of the licensee shall:
17 1. Make arrangements to forward records for each
18 client to one of the following, based upon the client's
19 choice: the client or the client's legal representative, the
20 client's attending physician, or the health care provider
21 where the client currently receives services; or
22 2. Cause a notice to be published in the newspaper of
23 greatest general circulation in the county where the provider
24 was located which advises clients of the discontinuance of the
25 provider operation. The notice must inform clients that they
26 may obtain copies of their records and specify the name,
27 address, and telephone number of the person from whom the
28 copies of records may be obtained. The notice must appear at
29 least once a week for 4 consecutive weeks.
30
31
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1 Failure to comply with this paragraph is a misdemeanor of the
2 second degree, punishable as provided in s. 775.083.
3 (5)(a) On or before the first day services are
4 provided to a client, a licensee must inform the client and
5 his or her immediate family or representative, if appropriate,
6 of the right to report:
7 1. Complaints. The statewide toll-free telephone
8 number for reporting complaints to the agency must be provided
9 to clients in a manner that is clearly legible and must
10 include the words: "To report a complaint regarding the
11 services you receive, please call toll free (phone number)".
12 2. Abusive, neglectful, or exploitative practices. The
13 statewide toll-free telephone number for the central abuse
14 hotline must be provided to clients in a manner that is
15 clearly legible and must include the words: "To report abuse,
16 neglect, or exploitation, please call toll-free (phone
17 number)."
18
19 The agency shall publish a minimum of a 90-day advance notice
20 of a change in the toll-free telephone numbers.
21 (b) Each licensee shall establish appropriate policies
22 and procedures for providing such notice to clients.
23 (6) An applicant must provide the agency with proof of
24 the applicant's legal right to occupy the property before a
25 license may be issued. Proof may include, but need not be
26 limited to, copies of warranty deeds, lease or rental
27 agreements, contracts for deeds, quitclaim deeds, or other
28 such documentation.
29 (7) If proof of insurance is required by the
30 authorizing statute, that insurance must be in compliance with
31
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1 chapter 624, chapter 626, chapter 627, or chapter 628 and with
2 agency rules.
3 (8) Upon application for initial licensure or
4 change-of-ownership licensure, the applicant shall furnish
5 satisfactory proof of the applicant's financial ability to
6 operate in accordance with the requirements of this part,
7 authorizing statutes, and applicable rules. The agency shall
8 establish standards for this purpose, including information
9 concerning the applicant's controlling interests. The agency
10 also shall establish documentation requirements, to be
11 completed by each applicant, that show anticipated provider
12 revenues and expenditures, the basis for financing the
13 anticipated cash-flow requirements of the provider, and an
14 applicant's access to contingency financing. A current
15 certificate of authority, pursuant to chapter 651, may be
16 provided as proof of financial ability to operate. The agency
17 may require a licensee to provide proof of financial ability
18 to operate at any time if there is evidence of financial
19 instability, including, but not limited to, unpaid expenses
20 necessary for the basic operations of the provider.
21 (9) A licensee or controlling interest may not
22 withhold from the agency any evidence of financial
23 instability, including, but not limited to, checks returned
24 due to insufficient funds, delinquent accounts, nonpayment of
25 withholding taxes, unpaid utility expenses, nonpayment for
26 essential services, or adverse court action concerning the
27 financial viability of the provider or any other provider
28 licensed under this part which is under the control of the
29 licensee. Any person found guilty of violating this subsection
30 commits a misdemeanor of the second degree, punishable as
31
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1 provided in s. 775.083. Each day of continuing violation is a
2 separate offense.
3 (10) The agency may not issue a license to a health
4 care provider subject to the certificate of need provisions in
5 ss. 408.031-408.045 if the licensee has not been issued a
6 certificate of need or an exemption. Upon initial licensure of
7 any such provider, the authorization contained in the
8 certificate of need shall be considered fully implemented and
9 merged into the license, and shall have no force and effect
10 upon termination of the license for any reason.
11 408.811 Right of inspection; copies; inspection
12 reports.--
13 (1) An authorized officer or employee of the agency
14 may make or cause to be made any inspections and
15 investigations as the agency deems necessary to determine the
16 state of compliance with this part, authorizing statutes, and
17 applicable rules. The right of inspection extends to any
18 business that the agency has reason to believe is being
19 operated as a provider without a license, but inspection of
20 any business suspected of being operated without the
21 appropriate license may not be made without the permission of
22 the owner or person in charge unless a warrant is first
23 obtained from a circuit court. Any application for a license
24 issued under this part, authorizing statutes, or applicable
25 rules constitutes permission for an appropriate inspection to
26 verify the information submitted on or in connection with the
27 application.
28 (a) All inspections shall be unannounced, except as
29 specified in s. 408.806.
30
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1 (b) Inspections for relicensure shall be conducted
2 biennially unless otherwise specified by authorizing statutes
3 or applicable rules.
4 (2) Inspections conducted in conjunction with
5 certification may be accepted in lieu of a complete licensure
6 inspection. However, a licensure inspection may also be
7 conducted to review any licensure requirements that are not
8 also requirements of certification.
9 (3) The agency shall have access to and the licensee
10 shall provide copies of all provider records required during
11 an inspection at no cost to the agency.
12 (4)(a) Each licensee shall maintain as public
13 information, available upon request, records of all inspection
14 reports pertaining to that provider which have been filed
15 with, or issued by, any governmental agency unless those
16 reports are exempt from, or contain information that is exempt
17 from, s. 119.07(1), or is otherwise made confidential by law.
18 Effective July 1, 2004, copies of such reports shall be
19 retained in the records of the provider for at least 5 years
20 following the date the reports are filed and issued,
21 regardless of a change of ownership.
22 (b) A licensee shall, upon the request of any person
23 who has completed a written application with intent to be
24 admitted by such provider or any person who is a patient of
25 such provider, or any relative, spouse, or guardian of any
26 such person, furnish to the requester a copy of the last
27 inspection report pertaining to the licensed provider which
28 was issued by the agency or by an accrediting organization if
29 such report is used in lieu of a licensure inspection.
30 408.812 Unlicensed activity.--
31
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1 (1) A person may not offer or advertise to the public
2 services as defined by this part, authorizing statutes, or
3 application rules without obtaining a valid license from the
4 Agency for Health Care Administration. The holder of a license
5 may not advertise or hold out to the public that he or she
6 holds a license for other than that for which he or she
7 actually holds a license.
8 (2) The operation or maintenance of an unlicensed
9 provider or the performance of any services that necessitate
10 licensure without such licensure is a violation of this part
11 and authorizing statutes. Unlicensed activity constitutes harm
12 that materially affects the health, safety, and welfare of
13 clients. The agency, or any state attorney, may, in addition
14 to other remedies provided in this part, bring an action for
15 an injunction to restrain such violation, or to enjoin the
16 future operation or maintenance of any such provider or the
17 provision of services that necessitate licensure in violation
18 of this part and authorizing statutes, until compliance with
19 this part, authorizing statutes, and agency rules has been
20 demonstrated to the satisfaction of the agency.
21 (3) Any person who owns, operates, or maintains an
22 unlicensed provider and who, after receiving notification from
23 the agency, fails to cease operation and apply for a license
24 under this part and authorizing statutes commits a felony of
25 the third degree, punishable as provided in s. 775.082, s.
26 775.083, or s. 775.084. Each day of continued operation is a
27 separate offense.
28 (4) Any person found guilty of violating subsection
29 (3) a second or subsequent time commits a felony of the second
30 degree, punishable as provided under s. 775.082, s. 775.083,
31
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1 or s. 775.084. Each day of continued operation is a separate
2 offense.
3 (5) Any provider that fails to cease operation after
4 agency notification may be fined $1,000 for each day of
5 noncompliance.
6 (6) When a licensee has an interest in more than one
7 provider and fails to license any provider rendering services
8 that necessitate licensure, the agency may revoke all
9 licenses, impose actions under s. 408.814, or impose a fine of
10 $1,000 unless otherwise specified by authorizing statutes
11 against the licensee until such time as the licensee becomes
12 appropriately licensed.
13 (7) In addition to injunctive relief pursuant to
14 subsection (2), if the agency determines that an owner is
15 operating or maintaining a provider without obtaining a
16 license and determines that a condition exists that poses a
17 threat to the health, safety, or welfare of a client of the
18 provider, the owner is subject to the same actions and fines
19 imposed against a licensed provider as specified in this part,
20 the authorizing statute, and agency rules.
21 (8) Any person aware of the operation of an unlicensed
22 provider must report that provider and operation to the
23 agency.
24 408.813 Administrative fines.--As a penalty for any
25 violation of this part, authorizing statutes, or applicable
26 rules, the agency may impose an administrative fine. Unless
27 the amount of the fine is prescribed by authorizing statutes
28 or applicable rules, the agency may establish criteria for the
29 amount of administrative fines applicable to this part,
30 authorizing statutes, and applicable rules. Each day of
31 violation constitutes a separate violation and is subject to a
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1 separate fine. For fines imposed by final agency action, the
2 violator shall pay the fine, plus interest at the rate as
3 specified in s. 55.03 for each day beyond the date set by the
4 agency for payment of the fine.
5 408.814 Moratoriums; emergency suspensions.--
6 (1) The agency may impose an immediate moratorium or
7 emergency suspension as defined in s. 120.60 on any provider
8 if the agency determines that any condition related to the
9 provider presents a threat to the health, safety, or welfare
10 of the clients.
11 (2) A provider, the license of which is denied or
12 revoked, may be subject to immediate imposition of a
13 moratorium or emergency suspension to run concurrently with
14 licensure denial, revocation, or injunction.
15 (3) A moratorium or emergency suspension remains in
16 effect after a change of ownership, unless the agency has
17 determined that the conditions that created the moratorium,
18 emergency suspension, or denial of licensure have been
19 corrected.
20 (4) When a moratorium or emergency suspension is
21 placed on a provider, notice of the action shall be posted and
22 visible to the public at the location of the provider until
23 the action is lifted.
24 408.815 License denial; revocation.--
25 (1) In addition to grounds in authorizing statutes,
26 grounds that may be used by the agency for denying or revoking
27 a license or application include any of the following actions
28 by a controlling interest:
29 (a) False representation of a material fact in the
30 license application or omission of any material fact from the
31 application.
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1 (b) An intentional or negligent act materially
2 affecting the health or safety of clients of the provider.
3 (c) A violation of this part, authorizing statutes, or
4 applicable rules.
5 (d) A demonstrated pattern of deficient performance.
6 (e) The applicant, licensee, or controlling interest
7 has been or is currently excluded, suspended, terminated from,
8 or has involuntarily withdrawn from participation in the state
9 Medicaid program, the Medicaid program of any other state, or
10 the Medicare program.
11 (2) If a licensee lawfully continues to operate while
12 a denial or revocation is pending in litigation, the licensee
13 must continue to meet all other requirements of this part,
14 authorizing statutes, and applicable rules, and must file
15 subsequent renewal applications for licensure, including
16 licensure fees. The provisions of s. 120.60(1) shall not apply
17 to renewal applications filed during the time period the
18 litigation of the denial or revocation is pending until that
19 litigation is final.
20 (3) An action under s. 408.814, or denial of the
21 license of the transferor, may be grounds for denial of a
22 change-of-ownership application of the transferee.
23 408.816 Injunctions.--
24 (1) In addition to the other powers provided by this
25 part and authorizing statutes, the agency may institute
26 injunction proceedings in a court of competent jurisdiction
27 to:
28 (a) Restrain or prevent the establishment or operation
29 of a provider that does not have a license or is in violation
30 of any provision of this part, authorizing statutes, or
31 applicable rules. The agency may also institute injunction
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1 proceedings in a court of competent jurisdiction when a
2 violation of this part, authorizing statutes, or applicable
3 rules constitutes an emergency affecting the immediate health
4 and safety of a client.
5 (b) Enforce the provisions of this part, authorizing
6 statutes, or any minimum standard, rule, or order issued or
7 entered into pursuant thereto when the attempt by the agency
8 to correct a violation through administrative sanctions has
9 failed or when the violation materially affects the health,
10 safety, or welfare of clients or involves any operation of an
11 unlicensed provider.
12 (c) Terminate the operation of a provider when a
13 violation of any provision of this part, authorizing statutes,
14 or any standard or rule adopted pursuant thereto exist that
15 materially affect the health, safety, or welfare of clients.
16 (2) Such injunctive relief may be temporary or
17 permanent.
18 (3) If action is necessary to protect clients of
19 providers from immediate, life-threatening situations, the
20 court may allow a temporary injunction without bond upon
21 proper proof being made. If it appears by competent evidence
22 or a sworn, substantiated affidavit that a temporary
23 injunction should be issued, the court, pending the
24 determination on final hearing, shall enjoin the operation of
25 the provider.
26 408.817 Administrative proceedings.--Administrative
27 proceedings challenging agency licensure enforcement action
28 shall be reviewed on the basis of the facts and conditions
29 that resulted in the agency action.
30 408.818 Health Care Trust Fund.--Unless otherwise
31 prescribed by authorizing statutes, all fees and fines
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1 collected pursuant to this part, authorizing statutes, and
2 applicable rules shall be deposited into the Health Care Trust
3 Fund, created in s. 408.16, and used to pay the costs of the
4 agency in administering the provider program paying the fees
5 or fines.
6 408.819 Rules.--The agency is authorized to adopt
7 rules as necessary to administer this part. Any licensed
8 provider that is in operation at the time of adoption of any
9 applicable rule under this part or authorizing statutes shall
10 be given a reasonable time under the particular circumstances,
11 not to exceed 6 months after the date of such adoption, within
12 which to comply with such rule, unless otherwise specified by
13 rule.
14 Section 6. Subsection (12), paragraph (a) of
15 subsection (13), and subsection (17) of section 112.0455,
16 Florida Statutes, are amended to read:
17 112.0455 Drug-Free Workplace Act.--
18 (12) DRUG-TESTING STANDARDS; LABORATORIES.--
19 (a) The requirements of ss. 408.801-408.819 apply to
20 the provision of services that necessitate licensure pursuant
21 to this section and part II of chapter 408 and to entities
22 licensed by or applying for such licensure from the Agency for
23 Health Care Administration pursuant to this section.
24 (b)(a) A laboratory may analyze initial or
25 confirmation drug specimens only if:
26 1. The laboratory is licensed and approved by the
27 Agency for Health Care Administration using criteria
28 established by the United States Department of Health and
29 Human Services as general guidelines for modeling the state
30 drug testing program and in accordance with part II of chapter
31 408. Each applicant for licensure must comply with all
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1 requirements of part II of chapter 408, with the exception of
2 s. 408.810(5)-(10). the following requirements:
3 a. Upon receipt of a completed, signed, and dated
4 application, the agency shall require background screening, in
5 accordance with the level 2 standards for screening set forth
6 in chapter 435, of the managing employee, or other similarly
7 titled individual responsible for the daily operation of the
8 laboratory, and of the financial officer, or other similarly
9 titled individual who is responsible for the financial
10 operation of the laboratory, including billings for services.
11 The applicant must comply with the procedures for level 2
12 background screening as set forth in chapter 435, as well as
13 the requirements of s. 435.03(3).
14 b. The agency may require background screening of any
15 other individual who is an applicant if the agency has
16 probable cause to believe that he or she has been convicted of
17 an offense prohibited under the level 2 standards for
18 screening set forth in chapter 435.
19 c. Proof of compliance with the level 2 background
20 screening requirements of chapter 435 which has been submitted
21 within the previous 5 years in compliance with any other
22 health care licensure requirements of this state is acceptable
23 in fulfillment of screening requirements.
24 d. A provisional license may be granted to an
25 applicant when each individual required by this section to
26 undergo background screening has met the standards for the
27 Department of Law Enforcement background check, but the agency
28 has not yet received background screening results from the
29 Federal Bureau of Investigation, or a request for a
30 disqualification exemption has been submitted to the agency as
31 set forth in chapter 435, but a response has not yet been
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1 issued. A license may be granted to the applicant upon the
2 agency's receipt of a report of the results of the Federal
3 Bureau of Investigation background screening for each
4 individual required by this section to undergo background
5 screening which confirms that all standards have been met, or
6 upon the granting of a disqualification exemption by the
7 agency as set forth in chapter 435. Any other person who is
8 required to undergo level 2 background screening may serve in
9 his or her capacity pending the agency's receipt of the report
10 from the Federal Bureau of Investigation. However, the person
11 may not continue to serve if the report indicates any
12 violation of background screening standards and a
13 disqualification exemption has not been requested of and
14 granted by the agency as set forth in chapter 435.
15 e. Each applicant must submit to the agency, with its
16 application, a description and explanation of any exclusions,
17 permanent suspensions, or terminations of the applicant from
18 the Medicare or Medicaid programs. Proof of compliance with
19 the requirements for disclosure of ownership and control
20 interests under the Medicaid or Medicare programs shall be
21 accepted in lieu of this submission.
22 f. Each applicant must submit to the agency a
23 description and explanation of any conviction of an offense
24 prohibited under the level 2 standards of chapter 435 by a
25 member of the board of directors of the applicant, its
26 officers, or any individual owning 5 percent or more of the
27 applicant. This requirement does not apply to a director of a
28 not-for-profit corporation or organization if the director
29 serves solely in a voluntary capacity for the corporation or
30 organization, does not regularly take part in the day-to-day
31 operational decisions of the corporation or organization,
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1 receives no remuneration for his or her services on the
2 corporation or organization's board of directors, and has no
3 financial interest and has no family members with a financial
4 interest in the corporation or organization, provided that the
5 director and the not-for-profit corporation or organization
6 include in the application a statement affirming that the
7 director's relationship to the corporation satisfies the
8 requirements of this sub-subparagraph.
9 g. A license may not be granted to any applicant if
10 the applicant or managing employee has been found guilty of,
11 regardless of adjudication, or has entered a plea of nolo
12 contendere or guilty to, any offense prohibited under the
13 level 2 standards for screening set forth in chapter 435,
14 unless an exemption from disqualification has been granted by
15 the agency as set forth in chapter 435.
16 h. The agency may deny or revoke licensure if the
17 applicant:
18 (I) Has falsely represented a material fact in the
19 application required by sub-subparagraph e. or
20 sub-subparagraph f., or has omitted any material fact from the
21 application required by sub-subparagraph e. or
22 sub-subparagraph f.; or
23 (II) Has had prior action taken against the applicant
24 under the Medicaid or Medicare program as set forth in
25 sub-subparagraph e.
26 i. An application for license renewal must contain the
27 information required under sub-subparagraphs e. and f.
28 2. The laboratory has written procedures to ensure
29 chain of custody.
30 3. The laboratory follows proper quality control
31 procedures, including, but not limited to:
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1 a. The use of internal quality controls including the
2 use of samples of known concentrations which are used to check
3 the performance and calibration of testing equipment, and
4 periodic use of blind samples for overall accuracy.
5 b. An internal review and certification process for
6 drug test results, conducted by a person qualified to perform
7 that function in the testing laboratory.
8 c. Security measures implemented by the testing
9 laboratory to preclude adulteration of specimens and drug test
10 results.
11 d. Other necessary and proper actions taken to ensure
12 reliable and accurate drug test results.
13 (c)(b) A laboratory shall disclose to the employer a
14 written test result report within 7 working days after receipt
15 of the sample. All laboratory reports of a drug test result
16 shall, at a minimum, state:
17 1. The name and address of the laboratory which
18 performed the test and the positive identification of the
19 person tested.
20 2. Positive results on confirmation tests only, or
21 negative results, as applicable.
22 3. A list of the drugs for which the drug analyses
23 were conducted.
24 4. The type of tests conducted for both initial and
25 confirmation tests and the minimum cutoff levels of the tests.
26 5. Any correlation between medication reported by the
27 employee or job applicant pursuant to subparagraph (8)(b)2.
28 and a positive confirmed drug test result.
29
30
31
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1 No report shall disclose the presence or absence of any drug
2 other than a specific drug and its metabolites listed pursuant
3 to this section.
4 (d)(c) The laboratory shall submit to the Agency for
5 Health Care Administration a monthly report with statistical
6 information regarding the testing of employees and job
7 applicants. The reports shall include information on the
8 methods of analyses conducted, the drugs tested for, the
9 number of positive and negative results for both initial and
10 confirmation tests, and any other information deemed
11 appropriate by the Agency for Health Care Administration. No
12 monthly report shall identify specific employees or job
13 applicants.
14 (e)(d) Laboratories shall provide technical assistance
15 to the employer, employee, or job applicant for the purpose of
16 interpreting any positive confirmed test results which could
17 have been caused by prescription or nonprescription medication
18 taken by the employee or job applicant.
19 (13) RULES.--
20 (a) The Agency for Health Care Administration may
21 adopt additional rules to support this law and part II of
22 chapter 408, using criteria established by the United States
23 Department of Health and Human Services as general guidelines
24 for modeling drug-free workplace laboratories the state
25 drug-testing program, concerning, but not limited to:
26 1. Standards for drug-testing laboratory licensing and
27 denial, suspension, and revocation of a license.
28 2. Urine, hair, blood, and other body specimens and
29 minimum specimen amounts which are appropriate for drug
30 testing, not inconsistent with other provisions established by
31 law.
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1 3. Methods of analysis and procedures to ensure
2 reliable drug-testing results, including standards for initial
3 tests and confirmation tests, not inconsistent with other
4 provisions established by law.
5 4. Minimum cutoff detection levels for drugs or their
6 metabolites for the purposes of determining a positive test
7 result, not inconsistent with other provisions established by
8 law.
9 5. Chain-of-custody procedures to ensure proper
10 identification, labeling, and handling of specimens being
11 tested, not inconsistent with other provisions established by
12 law.
13 6. Retention, storage, and transportation procedures
14 to ensure reliable results on confirmation tests and retests.
15 7. A list of the most common medications by brand name
16 or common name, as applicable, as well as by chemical name,
17 which may alter or affect a drug test.
18 (17) LICENSE FEE.--Fees from licensure of drug-testing
19 laboratories shall be sufficient to carry out the
20 responsibilities of the Agency for Health Care Administration
21 for the regulation of drug-testing laboratories. In accordance
22 with s. 408.805, an applicant or licensee shall pay a fee for
23 each license application submitted under this part and part II
24 of chapter 408. The fee may not be less than $16,000 or more
25 than $20,000 per biennium and shall be established by rule.
26 The Agency for Health Care Administration shall collect fees
27 for all licenses issued under this part. Each nonrefundable
28 fee shall be due at the time of application and shall be
29 payable to the Agency for Health Care Administration to be
30 deposited in a trust fund administered by the Agency for
31 Health Care Administration and used only for the purposes of
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1 this section. The fee schedule is as follows: For licensure
2 as a drug-testing laboratory, an annual fee of not less than
3 $8,000 or more than $10,000 per fiscal year; for late filing
4 of an application for renewal, an additional fee of $500 per
5 day shall be charged.
6 Section 7. Section 383.301, Florida Statutes, is
7 amended to read:
8 383.301 Licensure and regulation of birth centers;
9 legislative intent.--It is the intent of the Legislature to
10 provide for the protection of public health and safety in the
11 establishment, maintenance, and operation of birth centers by
12 providing for licensure of birth centers and for the
13 development, establishment, and enforcement of minimum
14 standards with respect to birth centers. The requirements of
15 part II of chapter 408 apply to the provision of services that
16 necessitate licensure pursuant to ss. 383.30-383.335 and part
17 II of chapter 408 and to entities licensed by or applying for
18 such licensure from the Agency for Health Care Administration
19 pursuant to ss. 383.30-383.335.
20 Section 8. Section 383.304, Florida Statutes, is
21 repealed.
22 Section 9. Section 383.305, Florida Statutes, is
23 amended to read:
24 383.305 Licensure; issuance, renewal, denial,
25 suspension, revocation; fees; background screening.--
26 (1) In accordance with s. 408.805, an applicant or
27 licensee shall pay a fee for each license application
28 submitted under this part and part II of chapter 408. The
29 amount of the fee shall be established by rule.
30 (1)(a) Upon receipt of an application for a license
31 and the license fee, the agency shall issue a license if the
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1 applicant and facility have received all approvals required by
2 law and meet the requirements established under ss.
3 383.30-383.335 and by rules promulgated hereunder.
4 (b) A provisional license may be issued to any birth
5 center that is in substantial compliance with ss.
6 383.30-383.335 and with the rules of the agency. A
7 provisional license may be granted for a period of no more
8 than 1 year from the effective date of rules adopted by the
9 agency, shall expire automatically at the end of its term, and
10 may not be renewed.
11 (c) A license, unless sooner suspended or revoked,
12 automatically expires 1 year from its date of issuance and is
13 renewable upon application for renewal and payment of the fee
14 prescribed, provided the applicant and the birth center meet
15 the requirements established under ss. 383.30-383.335 and by
16 rules promulgated hereunder. A complete application for
17 renewal of a license shall be made 90 days prior to expiration
18 of the license on forms provided by the agency.
19 (2) An application for a license, or renewal thereof,
20 shall be made to the agency upon forms provided by it and
21 shall contain such information as the agency reasonably
22 requires, which may include affirmative evidence of ability to
23 comply with applicable laws and rules.
24 (3)(a) Each application for a birth center license, or
25 renewal thereof, shall be accompanied by a license fee. Fees
26 shall be established by rule of the agency. Such fees are
27 payable to the agency and shall be deposited in a trust fund
28 administered by the agency, to be used for the sole purpose of
29 carrying out the provisions of ss. 383.30-383.335.
30 (b) The fees established pursuant to ss.
31 383.30-383.335 shall be based on actual costs incurred by the
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1 agency in the administration of its duties under such
2 sections.
3 (4) Each license is valid only for the person or
4 governmental unit to whom or which it is issued; is not
5 subject to sale, assignment, or other transfer, voluntary or
6 involuntary; and is not valid for any premises other than
7 those for which it was originally issued.
8 (5) Each license shall be posted in a conspicuous
9 place on the licensed premises.
10 (6) Whenever the agency finds that there has been a
11 substantial failure to comply with the requirements
12 established under ss. 383.30-383.335 or in rules adopted under
13 those sections, it is authorized to deny, suspend, or revoke a
14 license.
15 (2)(7) Each applicant for licensure must comply with
16 the following requirements of part II of chapter 408, with the
17 exception of s. 408.810(7)-(10).:
18 (a) Upon receipt of a completed, signed, and dated
19 application, the agency shall require background screening, in
20 accordance with the level 2 standards for screening set forth
21 in chapter 435, of the managing employee, or other similarly
22 titled individual who is responsible for the daily operation
23 of the center, and of the financial officer, or other
24 similarly titled individual who is responsible for the
25 financial operation of the center, including billings for
26 patient care and services. The applicant must comply with the
27 procedures for level 2 background screening as set forth in
28 chapter 435 as well as the requirements of s. 435.03(3).
29 (b) The agency may require background screening of any
30 other individual who is an applicant if the agency has
31 probable cause to believe that he or she has been convicted of
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1 a crime or has committed any other offense prohibited under
2 the level 2 standards for screening set forth in chapter 435.
3 (c) Proof of compliance with the level 2 background
4 screening requirements of chapter 435 which has been submitted
5 within the previous 5 years in compliance with any other
6 health care licensure requirements of this state is acceptable
7 in fulfillment of the requirements of paragraph (a).
8 (d) A provisional license may be granted to an
9 applicant when each individual required by this section to
10 undergo background screening has met the standards for the
11 Department of Law Enforcement background check, but the agency
12 has not yet received background screening results from the
13 Federal Bureau of Investigation, or a request for a
14 disqualification exemption has been submitted to the agency as
15 set forth in chapter 435 but a response has not yet been
16 issued. A standard license may be granted to the applicant
17 upon the agency's receipt of a report of the results of the
18 Federal Bureau of Investigation background screening for each
19 individual required by this section to undergo background
20 screening which confirms that all standards have been met, or
21 upon the granting of a disqualification exemption by the
22 agency as set forth in chapter 435. Any other person who is
23 required to undergo level 2 background screening may serve in
24 his or her capacity pending the agency's receipt of the report
25 from the Federal Bureau of Investigation. However, the person
26 may not continue to serve if the report indicates any
27 violation of background screening standards and a
28 disqualification exemption has not been requested of and
29 granted by the agency as set forth in chapter 435.
30 (e) Each applicant must submit to the agency, with its
31 application, a description and explanation of any exclusions,
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1 permanent suspensions, or terminations of the applicant from
2 the Medicare or Medicaid programs. Proof of compliance with
3 the requirements for disclosure of ownership and control
4 interests under the Medicaid or Medicare programs shall be
5 accepted in lieu of this submission.
6 (f) Each applicant must submit to the agency a
7 description and explanation of any conviction of an offense
8 prohibited under the level 2 standards of chapter 435 by a
9 member of the board of directors of the applicant, its
10 officers, or any individual owning 5 percent or more of the
11 applicant. This requirement does not apply to a director of a
12 not-for-profit corporation or organization if the director
13 serves solely in a voluntary capacity for the corporation or
14 organization, does not regularly take part in the day-to-day
15 operational decisions of the corporation or organization,
16 receives no remuneration for his or her services on the
17 corporation or organization's board of directors, and has no
18 financial interest and has no family members with a financial
19 interest in the corporation or organization, provided that the
20 director and the not-for-profit corporation or organization
21 include in the application a statement affirming that the
22 director's relationship to the corporation satisfies the
23 requirements of this paragraph.
24 (g) A license may not be granted to an applicant if
25 the applicant or managing employee has been found guilty of,
26 regardless of adjudication, or has entered a plea of nolo
27 contendere or guilty to, any offense prohibited under the
28 level 2 standards for screening set forth in chapter 435,
29 unless an exemption from disqualification has been granted by
30 the agency as set forth in chapter 435.
31
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1 (h) The agency may deny or revoke licensure if the
2 applicant:
3 1. Has falsely represented a material fact in the
4 application required by paragraph (e) or paragraph (f), or has
5 omitted any material fact from the application required by
6 paragraph (e) or paragraph (f); or
7 2. Has had prior action taken against the applicant
8 under the Medicaid or Medicare program as set forth in
9 paragraph (e).
10 (i) An application for license renewal must contain
11 the information required under paragraphs (e) and (f).
12 Section 10. Section 383.309, Florida Statutes, is
13 amended to read:
14 383.309 Minimum standards for birth centers; rules and
15 enforcement.--
16 (1) The agency shall adopt and enforce rules to
17 administer ss. 383.30-383.335 and part II of chapter 408,
18 which rules shall include, but are not limited to, reasonable
19 and fair minimum standards for ensuring that:
20 (a) Sufficient numbers and qualified types of
21 personnel and occupational disciplines are available at all
22 times to provide necessary and adequate patient care and
23 safety.
24 (b) Infection control, housekeeping, sanitary
25 conditions, disaster plan, and medical record procedures that
26 will adequately protect patient care and provide safety are
27 established and implemented.
28 (c) Licensed facilities are established, organized,
29 and operated consistent with established programmatic
30 standards.
31
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1 (2) Any licensed facility that is in operation at the
2 time of adoption of any applicable rule under ss.
3 383.30-383.335 shall be given a reasonable time under the
4 particular circumstances, not to exceed 1 year after the date
5 of such adoption, within which to comply with such rule.
6 (2)(3) The agency may not establish any rule governing
7 the design, construction, erection, alteration, modification,
8 repair, or demolition of birth centers. It is the intent of
9 the Legislature to preempt that function to the Florida
10 Building Commission and the State Fire Marshal through
11 adoption and maintenance of the Florida Building Code and the
12 Florida Fire Prevention Code. However, the agency shall
13 provide technical assistance to the commission and the State
14 Fire Marshal in updating the construction standards of the
15 Florida Building Code and the Florida Fire Prevention Code
16 which govern birth centers. In addition, the agency may
17 enforce the special-occupancy provisions of the Florida
18 Building Code and the Florida Fire Prevention Code which apply
19 to birth centers in conducting any inspection authorized under
20 this chapter.
21 Section 11. Subsection (1) of section 383.315, Florida
22 Statutes, is amended to read:
23 383.315 Agreements with consultants for advice or
24 services; maintenance.--
25 (1) A birth center shall maintain in writing a
26 consultation agreement, signed within the current license
27 period year, with each consultant who has agreed to provide
28 advice and services to the birth center as requested.
29 Section 12. Section 383.324, Florida Statutes, is
30 amended to read:
31
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1 383.324 Inspections and investigations; Inspection
2 fees.--
3 (1) The agency shall make or cause to be made such
4 inspections and investigations as it deems necessary.
5 (2) Each facility licensed under s. 383.305 shall pay
6 to the agency, at the time of inspection, an inspection fee
7 established by rule of the agency.
8 (3) The agency shall coordinate all periodic
9 inspections for licensure made by the agency to ensure that
10 the cost to the facility of such inspections and the
11 disruption of services by such inspections is minimized.
12 Section 13. Section 383.325, Florida Statutes, is
13 repealed.
14 Section 14. Section 383.33, Florida Statutes, is
15 amended to read:
16 383.33 Administrative fines penalties; emergency
17 orders; moratorium on admissions.--
18 (1)(a) In addition to the requirements of part II of
19 chapter 408, the agency may deny, revoke, or suspend a
20 license, or impose an administrative fine, not to exceed $500
21 per violation per day, for the violation of any provision of
22 ss. 383.30-383.335, part II of chapter 408, or applicable
23 rules or any rule adopted under ss. 383.30-383.335. Each day
24 of violation constitutes a separate violation and is subject
25 to a separate fine.
26 (2)(b) In determining the amount of the fine to be
27 levied for a violation, as provided in paragraph (a), the
28 following factors shall be considered:
29 (a)1. The severity of the violation, including the
30 probability that death or serious harm to the health or safety
31 of any person will result or has resulted; the severity of the
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1 actual or potential harm; and the extent to which the
2 provisions of ss. 383.30-383.335, part II of chapter 408, or
3 applicable rules were violated.
4 (b)2. Actions taken by the licensee to correct the
5 violations or to remedy complaints.
6 (c)3. Any previous violations by the licensee.
7 (c) All amounts collected pursuant to this section
8 shall be deposited into a trust fund administered by the
9 agency to be used for the sole purpose of carrying out the
10 provisions of ss. 383.30-383.335.
11 (2) The agency may issue an emergency order
12 immediately suspending or revoking a license when it
13 determines that any condition in the licensed facility
14 presents a clear and present danger to the public health and
15 safety.
16 (3) The agency may impose an immediate moratorium on
17 elective admissions to any licensed facility, building or
18 portion thereof, or service when the agency determines that
19 any condition in the facility presents a threat to the public
20 health or safety.
21 Section 15. Sections 383.331 and 383.332, Florida
22 Statutes, are repealed.
23 Section 16. Subsection (1) of section 383.335, Florida
24 Statutes, is amended to read:
25 383.335 Partial exemptions.--
26 (1) Any facility that which was providing obstetrical
27 and gynecological surgical services and was owned and operated
28 by a board-certified obstetrician on June 15, 1984, and that
29 which is otherwise subject to licensure under ss.
30 383.30-383.335 as a birth center, is exempt from the
31 provisions of ss. 383.30-383.335 and part II of chapter 408
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1 which restrict the provision of surgical services and outlet
2 forceps delivery and the administration of anesthesia at birth
3 centers. The agency shall adopt rules specifically related to
4 the performance of such services and the administration of
5 anesthesia at such facilities.
6 Section 17. Subsection (5) of section 390.011, Florida
7 Statutes, is amended to read:
8 390.011 Definitions.--As used in this chapter, the
9 term:
10 (5) "Hospital" means a facility defined in s. 395.002
11 and licensed under chapter 395.
12 Section 18. Subsection (1) of section 390.012, Florida
13 Statutes, is amended to read:
14 390.012 Powers of agency; rules; disposal of fetal
15 remains.--
16 (1) The agency may shall have the authority to develop
17 and enforce rules under ss. 390.001-390.021 and part II of
18 chapter 408 for the health, care, and treatment of persons in
19 abortion clinics and for the safe operation of such clinics.
20 These rules shall be comparable to rules which apply to all
21 surgical procedures requiring approximately the same degree of
22 skill and care as the performance of first trimester
23 abortions. The rules shall be reasonably related to the
24 preservation of maternal health of the clients. The rules
25 shall not impose a legally significant burden on a woman's
26 freedom to decide whether to terminate her pregnancy. The
27 rules shall provide for:
28 (a) The performance of pregnancy termination
29 procedures only by a licensed physician.
30
31
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1 (b) The making, protection, and preservation of
2 patient records, which shall be treated as medical records
3 under chapter 458.
4 Section 19. Section 390.013, Florida Statutes, is
5 repealed.
6 Section 20. Section 390.014, Florida Statutes, is
7 amended to read:
8 390.014 Licenses; fees, display, etc.--
9 (1) The requirements of part II of chapter 408 apply
10 to the provision of services that necessitate licensure
11 pursuant to ss. 390.011-390.021 and part II of chapter 408 and
12 to entities licensed by or applying for such licensure from
13 the Agency for Health Care Administration pursuant to ss.
14 390.011-390.021. However, an applicant for licensure is exempt
15 from s. 408.810(7)-(10). No abortion clinic shall operate in
16 this state without a currently effective license issued by the
17 agency.
18 (2) A separate license shall be required for each
19 clinic maintained on separate premises, even though it is
20 operated by the same management as another clinic; but a
21 separate license shall not be required for separate buildings
22 on the same premises.
23 (3) In accordance with s. 408.805, an applicant or
24 licensee shall pay a fee for each license application
25 submitted under this part and part II of chapter 408. The fee
26 shall be established by rule and The annual license fee
27 required for a clinic shall be nonrefundable and shall be
28 reasonably calculated to cover the cost of regulation under
29 this chapter, but may not be less than $70 or $35 nor more
30 than $500 per biennium $250.
31
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1 (4) Counties and municipalities applying for licenses
2 under this act shall be exempt from the payment of the license
3 fees.
4 (5) The license shall be displayed in a conspicuous
5 place inside the clinic.
6 (6) A license shall be valid only for the clinic to
7 which it is issued, and it shall not be subject to sale,
8 assignment, or other transfer, voluntary or involuntary. No
9 license shall be valid for any premises other than those for
10 which it was originally issued.
11 Section 21. Sections 390.015, 390.016, and 390.017,
12 Florida Statutes, are repealed.
13 Section 22. Section 390.018, Florida Statutes, is
14 amended to read:
15 390.018 Administrative fine penalty in lieu of
16 revocation or suspension.--In addition to the requirements of
17 part II of chapter 408 If the agency finds that one or more
18 grounds exist for the revocation or suspension of a license
19 issued to an abortion clinic, the agency may, in lieu of such
20 suspension or revocation, impose a fine upon the clinic in an
21 amount not to exceed $1,000 for each violation of any
22 provision of this part, part II of chapter 408, or applicable
23 rules. The fine shall be paid to the agency within 60 days
24 from the date of entry of the administrative order. If the
25 licensee fails to pay the fine in its entirety to the agency
26 within the period allowed, the license of the licensee shall
27 stand suspended, revoked, or renewal or continuation may be
28 refused, as the case may be, upon expiration of such period
29 and without any further administrative or judicial
30 proceedings.
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1 Section 23. Sections 390.019 and 390.021, Florida
2 Statutes, are repealed.
3 Section 24. Subsection (13) of section 394.455,
4 Florida Statutes, is amended to read:
5 394.455 Definitions.--As used in this part, unless the
6 context clearly requires otherwise, the term:
7 (13) "Hospital" means a facility defined in s. 395.002
8 and licensed under chapter 395.
9 Section 25. Section 394.67, Florida Statutes, is
10 amended to read:
11 394.67 Definitions.--As used in this part, the term:
12 (1) "Agency" means the Agency for Health Care
13 Administration.
14 (2) "Applicant" means an individual applicant, or any
15 officer, director, agent, managing employee, or affiliated
16 person, or any partner or shareholder having an ownership
17 interest equal to a 5-percent or greater interest in the
18 corporation, partnership, or other business entity.
19 (2)(3) "Client" means any individual receiving
20 services in any substance abuse or mental health facility,
21 program, or service, which facility, program, or service is
22 operated, funded, or regulated by the agency and the
23 department or regulated by the agency.
24 (3)(4) "Crisis services" means short-term evaluation,
25 stabilization, and brief intervention services provided to a
26 person who is experiencing an acute mental or emotional
27 crisis, as defined in subsection (17) (18), or an acute
28 substance abuse crisis, as defined in subsection (18) (19), to
29 prevent further deterioration of the person's mental health.
30 Crisis services are provided in settings such as a crisis
31 stabilization unit, an inpatient unit, a short-term
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1 residential treatment program, a detoxification facility, or
2 an addictions receiving facility; at the site of the crisis by
3 a mobile crisis response team; or at a hospital on an
4 outpatient basis.
5 (4)(5) "Crisis stabilization unit" means a program
6 that provides an alternative to inpatient hospitalization and
7 that provides brief, intensive services 24 hours a day, 7 days
8 a week, for mentally ill individuals who are in an acutely
9 disturbed state.
10 (5)(6) "Department" means the Department of Children
11 and Family Services.
12 (6)(7) "Director" means any member of the official
13 board of directors reported in the organization's annual
14 corporate report to the Florida Department of State, or, if no
15 such report is made, any member of the operating board of
16 directors. The term excludes members of separate, restricted
17 boards that serve only in an advisory capacity to the
18 operating board.
19 (7)(8) "District administrator" means the person
20 appointed by the Secretary of Children and Family Services for
21 the purpose of administering a department service district as
22 set forth in s. 20.19.
23 (8)(9) "District plan" or "plan" means the combined
24 district substance abuse and mental health plan approved by
25 the district administrator and governing bodies in accordance
26 with this part.
27 (9)(10) "Federal funds" means funds from federal
28 sources for substance abuse or mental health facilities and
29 programs, exclusive of federal funds that are deemed eligible
30 by the Federal Government, and are eligible through state
31 regulation, for matching purposes.
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1 (10)(11) "Governing body" means the chief legislative
2 body of a county, a board of county commissioners, or boards
3 of county commissioners in counties acting jointly, or their
4 counterparts in a charter government.
5 (11)(12) "Health and human services board" or "board"
6 means the board within a district or subdistrict of the
7 department which is established in accordance with s. 20.19
8 and designated in this part for the purpose of assessing the
9 substance abuse and mental health needs of the community and
10 developing a plan to address those needs.
11 (12)(13) "Licensed facility" means a facility licensed
12 in accordance with this chapter.
13 (13)(14) "Local matching funds" means funds received
14 from governing bodies of local government, including city
15 commissions, county commissions, district school boards,
16 special tax districts, private hospital funds, private gifts,
17 both individual and corporate, and bequests and funds received
18 from community drives or any other sources.
19 (14)(15) "Managing employee" means the administrator
20 or other similarly titled individual who is responsible for
21 the daily operation of the facility.
22 (15)(16) "Mental health services" means those
23 therapeutic interventions and activities that help to
24 eliminate, reduce, or manage symptoms or distress for persons
25 who have severe emotional distress or a mental illness and to
26 effectively manage the disability that often accompanies a
27 mental illness so that the person can recover from the mental
28 illness, become appropriately self-sufficient for his or her
29 age, and live in a stable family or in the community. The term
30 also includes those preventive interventions and activities
31
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1 that reduce the risk for or delay the onset of mental
2 disorders. The term includes the following types of services:
3 (a) Treatment services, such as psychiatric
4 medications and supportive psychotherapies, which are intended
5 to reduce or ameliorate the symptoms of severe distress or
6 mental illness.
7 (b) Rehabilitative services, which are intended to
8 reduce or eliminate the disability that is associated with
9 mental illness. Rehabilitative services may include assessment
10 of personal goals and strengths, readiness preparation,
11 specific skill training, and assistance in designing
12 environments that enable individuals to maximize their
13 functioning and community participation.
14 (c) Support services, which include services that
15 assist individuals in living successfully in environments of
16 their choice. Such services may include income supports,
17 social supports, housing supports, vocational supports, or
18 accommodations related to the symptoms or disabilities
19 associated with mental illness.
20 (d) Case management services, which are intended to
21 assist individuals in obtaining the formal and informal
22 resources that they need to successfully cope with the
23 consequences of their illness. Resources may include treatment
24 or rehabilitative or supportive interventions by both formal
25 and informal providers. Case management may include an
26 assessment of client needs; intervention planning with the
27 client, his or her family, and service providers; linking the
28 client to needed services; monitoring service delivery;
29 evaluating the effect of services and supports; and advocating
30 on behalf of the client.
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1 Mental health services may be delivered in a variety of
2 settings, such as inpatient, residential, partial hospital,
3 day treatment, outpatient, club house, or a drop-in or
4 self-help center, as well as in other community settings, such
5 as the client's residence or workplace. The types and
6 intensity of services provided shall be based on the client's
7 clinical status and goals, community resources, and
8 preferences. Services such as assertive community treatment
9 involve all four types of services which are delivered by a
10 multidisciplinary treatment team that is responsible for
11 identified individuals who have a serious mental illness.
12 (16)(17) "Patient fees" means compensation received by
13 a community substance abuse or mental health facility for
14 services rendered to a specific client from any source of
15 funds, including city, county, state, federal, and private
16 sources.
17 (17)(18) "Person who is experiencing an acute mental
18 or emotional crisis" means a child, adolescent, or adult who
19 is experiencing a psychotic episode or a high level of mental
20 or emotional distress which may be precipitated by a traumatic
21 event or a perceived life problem for which the individual's
22 typical coping strategies are inadequate. The term includes an
23 individual who meets the criteria for involuntary examination
24 specified in s. 394.463(1).
25 (18)(19) "Person who is experiencing an acute
26 substance abuse crisis" means a child, adolescent, or adult
27 who is experiencing a medical or emotional crisis because of
28 the use of alcoholic beverages or any psychoactive or
29 mood-altering substance. The term includes an individual who
30 meets the criteria for involuntary admission specified in s.
31 397.675.
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1 (19)(20) "Premises" means those buildings, beds, and
2 facilities located at the main address of the licensee and all
3 other buildings, beds, and facilities for the provision of
4 acute or residential care which are located in such reasonable
5 proximity to the main address of the licensee as to appear to
6 the public to be under the dominion and control of the
7 licensee.
8 (20)(21) "Program office" means the Mental Health
9 Program Office of the Department of Children and Family
10 Services.
11 (21)(22) "Residential treatment center for children
12 and adolescents" means a 24-hour residential program,
13 including a therapeutic group home, which provides mental
14 health services to emotionally disturbed children or
15 adolescents as defined in s. 394.492(5) or (6) and which is a
16 private for-profit or not-for-profit corporation under
17 contract with the department which offers a variety of
18 treatment modalities in a more restrictive setting.
19 (22)(23) "Residential treatment facility" means a
20 facility providing residential care and treatment to
21 individuals exhibiting symptoms of mental illness who are in
22 need of a 24-hour-per-day, 7-day-a-week structured living
23 environment, respite care, or long-term community placement.
24 (23) "Short-term residential treatment facility" means
25 a program that provides an alternative to inpatient
26 hospitalization and that provides brief, intensive services 24
27 hours a day, 7 days a week, for mentally ill individuals who
28 are temporarily in need of a 24-hour-a-day structured
29 therapeutic setting in a less restrictive, but longer-stay
30 alternative to hospitalization.
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1 (24) "Sliding fee scale" means a schedule of fees for
2 identified services delivered by a service provider which are
3 based on a uniform schedule of discounts deducted from the
4 service provider's usual and customary charges. These charges
5 must be consistent with the prevailing market rates in the
6 community for comparable services.
7 (25) "Substance abuse services" means services
8 designed to prevent or remediate the consequences of substance
9 abuse, improve an individual's quality of life and
10 self-sufficiency, and support long-term recovery. The term
11 includes the following service categories:
12 (a) Prevention services, which include information
13 dissemination; education regarding the consequences of
14 substance abuse; alternative drug-free activities; problem
15 identification; referral of persons to appropriate prevention
16 programs; community-based programs that involve members of
17 local communities in prevention activities; and environmental
18 strategies to review, change, and enforce laws that control
19 the availability of controlled and illegal substances.
20 (b) Assessment services, which include the evaluation
21 of individuals and families in order to identify their
22 strengths and determine their required level of care,
23 motivation, and need for treatment and ancillary services.
24 (c) Intervention services, which include early
25 identification, short-term counseling and referral, and
26 outreach.
27 (d) Rehabilitation services, which include
28 residential, outpatient, day or night, case management,
29 in-home, psychiatric, and medical treatment, and methadone or
30 medication management.
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1 (e) Ancillary services, which include self-help and
2 other support groups and activities; aftercare provided in a
3 structured, therapeutic environment; supported housing;
4 supported employment; vocational services; and educational
5 services.
6 Section 26. Section 394.875, Florida Statutes, is
7 amended to read:
8 394.875 Crisis stabilization units, short-term
9 residential treatment facilities, residential treatment
10 facilities, and residential treatment centers for children and
11 adolescents; authorized services; license required;
12 penalties.--
13 (1)(a) The purpose of a crisis stabilization unit is
14 to stabilize and redirect a client to the most appropriate and
15 least restrictive community setting available, consistent with
16 the client's needs. Crisis stabilization units may screen,
17 assess, and admit for stabilization persons who present
18 themselves to the unit and persons who are brought to the unit
19 under s. 394.463. Clients may be provided 24-hour
20 observation, medication prescribed by a physician or
21 psychiatrist, and other appropriate services. Crisis
22 stabilization units shall provide services regardless of the
23 client's ability to pay and shall be limited in size to a
24 maximum of 30 beds.
25 (b) The purpose of a short-term residential treatment
26 unit is to provide intensive services in a 24-hour-a-day
27 structured therapeutic setting as a less restrictive, but
28 longer-stay alternative to hospitalization.
29 (c)(b) The purpose of a residential treatment facility
30 is to be a part of a comprehensive treatment program for
31
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1 mentally ill individuals in a community-based residential
2 setting.
3 (d)(c) The purpose of a residential treatment center
4 for children and adolescents is to provide mental health
5 assessment and treatment services pursuant to ss. 394.491,
6 394.495, and 394.496 to children and adolescents who meet the
7 target population criteria specified in s. 394.493(1)(a), (b),
8 or (c).
9 (2) The requirements of part II of chapter 408 apply
10 to the provision of services that necessitate licensure
11 pursuant to ss. 394.455-394.904 and part II of chapter 408 and
12 to entities licensed by or applying for such licensure from
13 the Agency for Health Care Administration pursuant to ss.
14 394.455-394.904. However, an applicant for licensure is exempt
15 from the provisions of s. 408.810(8), (9), and (10). It is
16 unlawful for any entity to hold itself out as a crisis
17 stabilization unit, a residential treatment facility, or a
18 residential treatment center for children and adolescents, or
19 to act as a crisis stabilization unit, a residential treatment
20 facility, or a residential treatment center for children and
21 adolescents, unless it is licensed by the agency pursuant to
22 this chapter.
23 (3) Any person who violates subsection (2) is guilty
24 of a misdemeanor of the first degree, punishable as provided
25 in s. 775.082 or s. 775.083.
26 (4) The agency may maintain an action in circuit court
27 to enjoin the unlawful operation of a crisis stabilization
28 unit, a residential treatment facility, or a residential
29 treatment center for children and adolescents if the agency
30 first gives the violator 14 days' notice of its intention to
31
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1 maintain such action and if the violator fails to apply for
2 licensure within such 14-day period.
3 (3)(5) The following entities are exempt from
4 licensure as required in ss. 394.455-394.904 Subsection (2)
5 does not apply to:
6 (a) Hospitals licensed under chapter 395 or programs
7 operated within such hospitals. Homes for special services
8 licensed under chapter 400; or
9 (b) Nursing homes licensed under chapter 400.
10 (c) Comprehensive transitional education programs
11 licensed under s. 393.067.
12 (4)(6) The department, in consultation with the
13 agency, may establish multiple license classifications for
14 residential treatment facilities.
15 (5)(7) The agency may not issue a license to a crisis
16 stabilization unit unless the unit receives state mental
17 health funds and is affiliated with a designated public
18 receiving facility.
19 (6)(8) The agency may issue a license for a crisis
20 stabilization unit or short-term residential treatment
21 facility, certifying the number of authorized beds for such
22 facility as indicated by existing need and available
23 appropriations. The agency may disapprove an application for
24 such a license if it determines that a facility should not be
25 licensed pursuant to the provisions of this chapter. Any
26 facility operating beds in excess of those authorized by the
27 agency shall, upon demand of the agency, reduce the number of
28 beds to the authorized number, forfeit its license, or provide
29 evidence of a license issued pursuant to chapter 395 for the
30 excess beds.
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1 (7)(9) A children's crisis stabilization unit which
2 does not exceed 20 licensed beds and which provides separate
3 facilities or a distinct part of a facility, separate
4 staffing, and treatment exclusively for minors may be located
5 on the same premises as a crisis stabilization unit serving
6 adults. The department, in consultation with the agency, shall
7 adopt rules governing facility construction, staffing and
8 licensure requirements, and the operation of such units for
9 minors.
10 (8)(10) The department, in consultation with the
11 agency, must adopt rules governing a residential treatment
12 center for children and adolescents which specify licensure
13 standards for: admission; length of stay; program and
14 staffing; discharge and discharge planning; treatment
15 planning; seclusion, restraints, and time-out; rights of
16 patients under s. 394.459; use of psychotropic medications;
17 and standards for the operation of such centers.
18 (9)(11) Notwithstanding the provisions of subsection
19 (6) (8), crisis stabilization units may not exceed their
20 licensed capacity by more than 10 percent, nor may they exceed
21 their licensed capacity for more than 3 consecutive working
22 days or for more than 7 days in 1 month.
23 (10)(12) Notwithstanding the other provisions of this
24 section, any facility licensed under former chapter 396 and
25 chapter 397 for detoxification, residential level I care, and
26 outpatient treatment may elect to license concurrently all of
27 the beds at such facility both for that purpose and as a
28 long-term residential treatment facility pursuant to this
29 section, if all of the following conditions are met:
30 (a) The licensure application is received by the
31 department prior to January 1, 1993.
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1 (b) On January 1, 1993, the facility was licensed
2 under former chapter 396 and chapter 397 as a facility for
3 detoxification, residential level I care, and outpatient
4 treatment of substance abuse.
5 (c) The facility restricted its practice to the
6 treatment of law enforcement personnel for a period of at
7 least 12 months beginning after January 1, 1992.
8 (d) The number of beds to be licensed under this
9 chapter is equal to or less than the number of beds licensed
10 under former chapter 396 and chapter 397 as of January 1,
11 1993.
12 (e) The licensee agrees in writing to a condition
13 placed upon the license that the facility will limit its
14 treatment exclusively to law enforcement personnel and their
15 immediate families who are seeking admission on a voluntary
16 basis and who are exhibiting symptoms of posttraumatic stress
17 disorder or other mental health problems, including drug or
18 alcohol abuse, which are directly related to law enforcement
19 work and which are amenable to verbal treatment therapies; the
20 licensee agrees to coordinate the provision of appropriate
21 postresidential care for discharged individuals; and the
22 licensee further agrees in writing that a failure to meet any
23 condition specified in this paragraph shall constitute grounds
24 for a revocation of the facility's license as a residential
25 treatment facility.
26 (f) The licensee agrees that the facility will meet
27 all licensure requirements for a residential treatment
28 facility, including minimum standards for compliance with
29 lifesafety requirements, except those licensure requirements
30 which are in express conflict with the conditions and other
31 provisions specified in this subsection.
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1 (g) The licensee agrees that the conditions stated in
2 this subsection must be agreed to in writing by any person
3 acquiring the facility by any means.
4
5 Any facility licensed under this subsection is not required to
6 provide any services to any persons except those included in
7 the specified conditions of licensure, and is exempt from any
8 requirements related to the 60-day or greater average length
9 of stay imposed on community-based residential treatment
10 facilities otherwise licensed under this chapter.
11 (13) Each applicant for licensure must comply with the
12 following requirements:
13 (a) Upon receipt of a completed, signed, and dated
14 application, the agency shall require background screening, in
15 accordance with the level 2 standards for screening set forth
16 in chapter 435, of the managing employee and financial
17 officer, or other similarly titled individual who is
18 responsible for the financial operation of the facility,
19 including billings for client care and services. The applicant
20 must comply with the procedures for level 2 background
21 screening as set forth in chapter 435, as well as the
22 requirements of s. 435.03(3).
23 (b) The agency may require background screening of any
24 other individual who is an applicant if the agency has
25 probable cause to believe that he or she has been convicted of
26 a crime or has committed any other offense prohibited under
27 the level 2 standards for screening set forth in chapter 435.
28 (c) Proof of compliance with the level 2 background
29 screening requirements of chapter 435 which has been submitted
30 within the previous 5 years in compliance with any other
31
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1 health care licensure requirements of this state is acceptable
2 in fulfillment of the requirements of paragraph (a).
3 (d) A provisional license may be granted to an
4 applicant when each individual required by this section to
5 undergo background screening has met the standards for the
6 Department of Law Enforcement background check, but the agency
7 has not yet received background screening results from the
8 Federal Bureau of Investigation, or a request for a
9 disqualification exemption has been submitted to the agency as
10 set forth in chapter 435, but a response has not yet been
11 issued. A standard license may be granted to the applicant
12 upon the agency's receipt of a report of the results of the
13 Federal Bureau of Investigation background screening for each
14 individual required by this section to undergo background
15 screening which confirms that all standards have been met, or
16 upon the granting of a disqualification exemption by the
17 agency as set forth in chapter 435. Any other person who is
18 required to undergo level 2 background screening may serve in
19 his or her capacity pending the agency's receipt of the report
20 from the Federal Bureau of Investigation. However, the person
21 may not continue to serve if the report indicates any
22 violation of background screening standards and a
23 disqualification exemption has not been requested of and
24 granted by the agency as set forth in chapter 435.
25 (e) Each applicant must submit to the agency, with its
26 application, a description and explanation of any exclusions,
27 permanent suspensions, or terminations of the applicant from
28 the Medicare or Medicaid programs. Proof of compliance with
29 the requirements for disclosure of ownership and control
30 interests under the Medicaid or Medicare programs shall be
31 accepted in lieu of this submission.
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1 (f) Each applicant must submit to the agency a
2 description and explanation of any conviction of an offense
3 prohibited under the level 2 standards of chapter 435 by a
4 member of the board of directors of the applicant, its
5 officers, or any individual owning 5 percent or more of the
6 applicant. This requirement does not apply to a director of a
7 not-for-profit corporation or organization if the director
8 serves solely in a voluntary capacity for the corporation or
9 organization, does not regularly take part in the day-to-day
10 operational decisions of the corporation or organization,
11 receives no remuneration for his or her services on the
12 corporation or organization's board of directors, and has no
13 financial interest and has no family members with a financial
14 interest in the corporation or organization, provided that the
15 director and the not-for-profit corporation or organization
16 include in the application a statement affirming that the
17 director's relationship to the corporation satisfies the
18 requirements of this paragraph.
19 (g) A license may not be granted to an applicant if
20 the applicant or managing employee has been found guilty of,
21 regardless of adjudication, or has entered a plea of nolo
22 contendere or guilty to, any offense prohibited under the
23 level 2 standards for screening set forth in chapter 435,
24 unless an exemption from disqualification has been granted by
25 the agency as set forth in chapter 435.
26 (h) The agency may deny or revoke licensure if the
27 applicant:
28 1. Has falsely represented a material fact in the
29 application required by paragraph (e) or paragraph (f), or has
30 omitted any material fact from the application required by
31 paragraph (e) or paragraph (f); or
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1 2. Has had prior action taken against the applicant
2 under the Medicaid or Medicare program as set forth in
3 paragraph (e).
4 (i) An application for license renewal must contain
5 the information required under paragraphs (e) and (f).
6 Section 27. Section 394.876, Florida Statutes, is
7 repealed.
8 Section 28. Section 394.877, Florida Statutes, is
9 amended to read:
10 394.877 Fees.--
11 (1) In accordance with s. 408.805, an applicant or
12 licensee shall pay a fee for each license application
13 submitted under this part and part II of chapter 408. The
14 amount of the fee shall be established by rule. Each
15 application for licensure or renewal must be accompanied by a
16 fee set by the department, in consultation with the agency, by
17 rule. Such fees shall be reasonably calculated to cover only
18 the cost of regulation under this chapter.
19 (2) All fees collected under this section shall be
20 deposited in the Health Care Trust Fund.
21 Section 29. Section 394.878, Florida Statutes, is
22 amended to read:
23 394.878 Issuance and renewal of licenses.--
24 (1) Upon review of the application for licensure and
25 receipt of appropriate fees, the agency shall issue an
26 original or renewal license to any applicant that meets the
27 requirements of this chapter.
28 (2) A license is valid for a period of 1 year. An
29 applicant for renewal of a license shall apply to the agency
30 no later than 90 days before expiration of the current
31 license.
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1 (3) A license may not be transferred from one entity
2 to another and is valid only for the premises for which it was
3 originally issued. For the purposes of this subsection,
4 "transfer" includes, but is not limited to, transfer of a
5 majority of the ownership interests in a licensee or transfer
6 of responsibilities under the license to another entity by
7 contractual arrangement.
8 (4) Each license shall state the services which the
9 licensee is required or authorized to perform and the maximum
10 residential capacity of the licensed premises.
11 (1)(5) The agency may issue a probationary license to
12 an applicant that has completed the application requirements
13 of this chapter but has not, at the time of the application,
14 developed an operational crisis stabilization unit or
15 residential treatment facility. The probationary license
16 shall expire 90 days after issuance and may once be renewed
17 for an additional 90-day period. The agency may cancel a
18 probationary license at any time.
19 (2)(6) The agency may issue an interim license to an
20 applicant that has substantially completed all application
21 requirements and has initiated action to fully meet such
22 requirements. The interim license shall expire 90 days after
23 issuance and, in cases of extreme hardship, may once be
24 renewed for an additional 90-day period.
25 (7) Any applicant which fails to file an application
26 for license renewal during the 90-day relicensure period shall
27 be considered unlicensed and subject to penalties pursuant to
28 s. 394.875.
29 Section 30. Subsections (1), (3), and (4) of section
30 394.879, Florida Statutes, are amended to read:
31 394.879 Rules; enforcement.--
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1 (1) The agency, in consultation with the department,
2 may adopt rules to administer part II of chapter 408. The
3 department, in consultation with the agency, shall adopt rules
4 pursuant to ss. 120.536(1) and 120.54 to implement the
5 provisions of this chapter, including, at a minimum, rules
6 providing standards to ensure that:
7 (a) Sufficient numbers and types of qualified
8 personnel are on duty and available at all times to provide
9 necessary and adequate client safety and care.
10 (b) Adequate space is provided each client of a
11 licensed facility.
12 (c) Licensed facilities are limited to an appropriate
13 number of beds.
14 (d) Each licensee establishes and implements adequate
15 infection control, housekeeping, sanitation, disaster
16 planning, and medical recordkeeping.
17 (e) Licensed facilities are established, organized,
18 and operated in accordance with programmatic standards of the
19 department.
20 (f) The operation and purposes of these facilities
21 assure individuals' health, safety, and welfare.
22 (3) The department, in consultation with the agency,
23 shall allow any licensed facility in operation at the time of
24 adoption of any rule a reasonable period, not to exceed 1
25 year, to bring itself into compliance with department rules
26 such rule.
27 (4) In accordance with part II of chapter 408, the
28 agency may impose an administrative penalty of no more than
29 $500 per day against any licensee that violates any rule
30 adopted pursuant to this section and may suspend or revoke the
31 license or deny the renewal application of such licensee. In
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1 imposing such penalty, the agency shall consider the severity
2 of the violation, actions taken by the licensee to correct the
3 violation, and previous violations by the licensee. Fines
4 collected under this subsection shall be deposited in the
5 Mental Health Facility Licensing Trust Fund.
6 Section 31. Paragraph (a) of subsection (1) of section
7 394.90, Florida Statutes, is amended to read:
8 394.90 Inspection; right of entry; records.--
9 (1)(a) The department and the agency, in accordance
10 with s. 408.811, may enter and inspect at any time a licensed
11 facility to determine whether the facility is in compliance
12 with this chapter and applicable the rules of the department.
13 Section 32. Section 394.902, Florida Statutes, is
14 amended to read:
15 394.902 Denial, suspension, and revocation; other
16 remedies.--
17 (1) The agency may issue an emergency order suspending
18 or revoking a license if the agency determines that the
19 continued operation of the licensed facility presents a clear
20 and present danger to the public health or safety.
21 (2) The agency may impose a moratorium on elective
22 admissions to a licensee or any program or portion of a
23 licensed facility if the agency determines that any condition
24 in the facility presents a threat to the public health or
25 safety.
26 (3) If the agency determines that an applicant or
27 licensee is not in compliance with this chapter or the rules
28 adopted under this chapter, the agency may deny, suspend, or
29 revoke the license or application or may suspend, revoke, or
30 impose reasonable restrictions on any portion of the license.
31 If a license is revoked, the licensee is barred from
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1 submitting any application for licensure to the agency for a
2 period of 6 months following revocation.
3 (4) The agency may maintain an action in circuit court
4 to enjoin the operation of any licensed or unlicensed facility
5 in violation of this chapter or the rules adopted under this
6 chapter.
7 (5) License denial, suspension, or revocation
8 procedures shall be in accordance with chapter 120.
9 Section 33. Subsection (4) of section 395.002, Florida
10 Statutes, is repealed.
11 Section 34. Section 395.003, Florida Statutes, is
12 amended to read:
13 395.003 Licensure; issuance, renewal, denial,
14 modification, suspension, and revocation.--
15 (1)(a) A No person may not shall establish, conduct,
16 or maintain a hospital, ambulatory surgical center, or mobile
17 surgical facility in this state without first obtaining a
18 license under this part.
19 (b)1. It is unlawful for a any person to use or
20 advertise to the public, in any way or by any medium
21 whatsoever, any facility as a "hospital," "ambulatory surgical
22 center," or "mobile surgical facility" unless such facility
23 has first secured a license under the provisions of this part.
24 2. Nothing in This part does not apply applies to
25 veterinary hospitals or to commercial business establishments
26 using the word "hospital," "ambulatory surgical center," or
27 "mobile surgical facility" as a part of a trade name if no
28 treatment of human beings is performed on the premises of such
29 establishments.
30 3. By December 31, 2004, the agency shall submit a
31 report to the President of the Senate and the Speaker of the
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1 House of Representatives recommending whether it is in the
2 public interest to allow a hospital to license or operate an
3 emergency department located off the premises of the hospital.
4 If the agency finds it to be in the public interest, the
5 report shall also recommend licensure criteria for such
6 medical facilities, including criteria related to quality of
7 care and, if deemed necessary, the elimination of the
8 possibility of confusion related to the service capabilities
9 of such facility in comparison to the service capabilities of
10 an emergency department located on the premises of the
11 hospital. Until July 1, 2005, additional emergency departments
12 located off the premises of licensed hospitals may not be
13 authorized by the agency.
14 (2)(a) Upon the receipt of an application for a
15 license and the license fee, the agency shall issue a license
16 if the applicant and facility have received all approvals
17 required by law and meet the requirements established under
18 this part and in rules. Such license shall include all beds
19 and services located on the premises of the facility.
20 (b) A provisional license may be issued to a new
21 facility or a facility that is in substantial compliance with
22 this part and with the rules of the agency. A provisional
23 license shall be granted for a period of no more than 1 year
24 and shall expire automatically at the end of its term. A
25 provisional license may not be renewed.
26 (c) A license, unless sooner suspended or revoked,
27 shall automatically expire 2 years from the date of issuance
28 and shall be renewable biennially upon application for renewal
29 and payment of the fee prescribed by s. 395.004(2), provided
30 the applicant and licensed facility meet the requirements
31 established under this part and in rules. An application for
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1 renewal of a license shall be made 90 days prior to expiration
2 of the license, on forms provided by the agency.
3 (3)(d) The agency shall, at the request of a licensee,
4 issue a single license to a licensee for facilities located on
5 separate premises. Such a license shall specifically state
6 the location of the facilities, the services, and the licensed
7 beds available on each separate premises. If a licensee
8 requests a single license, the licensee shall designate which
9 facility or office is responsible for receipt of information,
10 payment of fees, service of process, and all other activities
11 necessary for the agency to carry out the provisions of this
12 part.
13 (4)(e) The agency shall, at the request of a licensee
14 that is a teaching hospital as defined in s. 408.07(44), issue
15 a single license to a licensee for facilities that have been
16 previously licensed as separate premises, provided such
17 separately licensed facilities, taken together, constitute the
18 same premises as defined in s. 395.002(24). Such license for
19 the single premises shall include all of the beds, services,
20 and programs that were previously included on the licenses for
21 the separate premises. The granting of a single license under
22 this paragraph shall not in any manner reduce the number of
23 beds, services, or programs operated by the licensee.
24 (5)(f) Intensive residential treatment programs for
25 children and adolescents which have received accreditation
26 from the Joint Commission on Accreditation of Healthcare
27 Organizations and which meet the minimum standards developed
28 by rule of the agency for such programs shall be licensed by
29 the agency under this part.
30 (3)(a) Each license shall be valid only for the person
31 to whom it is issued and shall not be sold, assigned, or
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1 otherwise transferred, voluntarily or involuntarily. A
2 license is only valid for the premises for which it was
3 originally issued.
4 (b)1. An application for a new license is required if
5 ownership, a majority of the ownership, or controlling
6 interest of a licensed facility is transferred or assigned and
7 when a lessee agrees to undertake or provide services to the
8 extent that legal liability for operation of the facility
9 rests with the lessee. The application for a new license
10 showing such change shall be made at least 60 days prior to
11 the date of the sale, transfer, assignment, or lease.
12 (6)2. After a change of ownership has occurred, the
13 transferee shall be liable for any liability to the state,
14 regardless of when identified, resulting from changes to
15 allowable costs affecting provider reimbursement for Medicaid
16 participation or Public Medical Assistance Trust Fund
17 Assessments, and related administrative fines. The
18 transferee, simultaneously with the transfer of ownership,
19 shall pay or make arrangements to pay to the agency or the
20 department any amount owed to the agency or the department;
21 payment assurances may be in the form of an irrevocable credit
22 instrument or payment bond acceptable to the agency or the
23 department provided by or on behalf of the transferor. The
24 issuance of a license to the transferee shall be delayed
25 pending payment or until arrangement for payment acceptable to
26 the agency or the department is made.
27 (7)(4) The agency shall issue a license which
28 specifies the service categories and the number of hospital
29 beds in each bed category for which a license is received.
30 Such information shall be listed on the face of the license.
31 All beds which are not covered by any specialty-bed-need
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1 methodology shall be specified as general beds. A licensed
2 facility shall not operate a number of hospital beds greater
3 than the number indicated by the agency on the face of the
4 license without approval from the agency under conditions
5 established by rule.
6 (8)(5)(a) Adherence to patient rights, standards of
7 care, and examination and placement procedures provided under
8 part I of chapter 394 shall be a condition of licensure for
9 hospitals providing voluntary or involuntary medical or
10 psychiatric observation, evaluation, diagnosis, or treatment.
11 (b) Any hospital that provides psychiatric treatment
12 to persons under 18 years of age who have emotional
13 disturbances shall comply with the procedures pertaining to
14 the rights of patients prescribed in part I of chapter 394.
15 (9)(6) A No specialty hospital may not shall provide
16 any service or regularly serve any population group beyond
17 those services or groups specified in its license.
18 (7) Licenses shall be posted in a conspicuous place on
19 each of the licensed premises.
20 (10)(8) In addition to the requirements of ss.
21 408.801-408.819, whenever the agency finds that there has been
22 a substantial failure to comply with the requirements
23 established under this part or in rules, the agency is
24 authorized to deny, modify, suspend, or revoke:
25 (a) A license;
26 (b) That part of a license which is limited to a
27 separate premises, as designated on the license; or
28 (c) Licensure approval limited to a facility,
29 building, or portion thereof, or a service, within a given
30 premises.
31
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1 Section 35. Section 395.004, Florida Statutes, is
2 amended to read:
3 395.004 Application for license, Fees; expenses.--
4 (1) In accordance with s. 408.805, an applicant or
5 licensee shall pay a fee for each license application
6 submitted under this part and ss. 408.801-408.819. The amount
7 of the fee shall be established by rule An application for a
8 license or renewal thereof shall be made under oath to the
9 agency, upon forms provided by it, and shall contain such
10 information as the agency reasonably requires, which may
11 include affirmative evidence of ability to comply with
12 applicable laws and rules.
13 (2) Each application for a general hospital license,
14 specialty hospital license, ambulatory surgical center
15 license, or mobile surgical facility license, or renewal
16 thereof, shall be accompanied by a license fee, in accordance
17 with the following schedule:
18 (a) The biennial license, provisional license, and
19 license renewal fee required of a facility licensed under this
20 part shall be reasonably calculated to cover the cost of
21 regulation under this part and shall be established by rule at
22 the rate of not less than $9.50 per hospital bed, nor more
23 than $30 per hospital bed, except that the minimum license fee
24 shall be $1,500 and the total fees collected from all licensed
25 facilities may not exceed the cost of properly carrying out
26 the provisions of this part.
27 (b) Such fees shall be paid to the agency and shall be
28 deposited in the Planning and Regulation Trust Fund of the
29 agency, which is hereby created, for the sole purpose of
30 carrying out the provisions of this part.
31
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1 Section 36. Section 395.0055, Florida Statutes, is
2 repealed.
3 Section 37. Section 395.0161, Florida Statutes, is
4 amended to read:
5 395.0161 Licensure inspection.--
6 (1) In accordance with s. 408.811, the agency shall
7 make or cause to be made such inspections and investigations
8 as it deems necessary, including:
9 (a) Inspections directed by the Health Care Financing
10 Administration.
11 (b) Validation inspections.
12 (c) Lifesafety inspections.
13 (d) Licensure complaint investigations, including full
14 licensure investigations with a review of all licensure
15 standards as outlined in the administrative rules. Complaints
16 received by the agency from individuals, organizations, or
17 other sources are subject to review and investigation by the
18 agency.
19 (e) Emergency access complaint investigations.
20 (f) inspections of mobile surgical facilities at each
21 time a facility establishes a new location, prior to the
22 admission of patients. However, such inspections shall not be
23 required when a mobile surgical facility is moved temporarily
24 to a location where medical treatment will not be provided.
25 (2) The agency shall accept, in lieu of its own
26 periodic inspections for licensure, the survey or inspection
27 of an accrediting organization, provided the accreditation of
28 the licensed facility is not provisional and provided the
29 licensed facility authorizes release of, and the agency
30 receives the report of, the accrediting organization. The
31 agency shall develop, and adopt by rule, criteria for
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1 accepting survey reports of accrediting organizations in lieu
2 of conducting a state licensure inspection.
3 (3) In accordance with s. 408.805, an applicant or
4 licensee shall pay a fee for each license application
5 submitted under this part and part II of chapter 408. With the
6 exception of state-operated licensed facilities, each facility
7 licensed under this part shall pay to the agency, at the time
8 of inspection, the following fees:
9 (a) Inspection for licensure.--A fee shall be paid
10 which is not less than $8 per hospital bed, nor more than $12
11 per hospital bed, except that the minimum fee shall be $400
12 per facility.
13 (b) Inspection for lifesafety only.--A fee shall be
14 paid which is not less than 75 cents per hospital bed, nor
15 more than $1.50 per hospital bed, except that the minimum fee
16 shall be $40 per facility.
17 (4) The agency shall coordinate all periodic
18 inspections for licensure made by the agency to ensure that
19 the cost to the facility of such inspections and the
20 disruption of services by such inspections is minimized.
21 Section 38. Section 395.0162, Florida Statutes, is
22 repealed.
23 Section 39. Subsections (2) and (3) of section
24 395.0163, Florida Statutes, are amended to read:
25 395.0163 Construction inspections; plan submission and
26 approval; fees.--
27 (2)(a) The agency is authorized to charge an initial
28 fee of $2,000 for review of plans and construction on all
29 projects, no part of which is refundable. The agency may also
30 collect a fee, not to exceed 1 percent of the estimated
31 construction cost or the actual cost of review, whichever is
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1 less, for the portion of the review which encompasses initial
2 review through the initial revised construction document
3 review. The agency is further authorized to collect its
4 actual costs on all subsequent portions of the review and
5 construction inspections. The initial fee payment shall
6 accompany the initial submission of plans and specifications.
7 Any subsequent payment that is due is payable upon receipt of
8 the invoice from the agency.
9 (b) Notwithstanding any other provisions of law to the
10 contrary, all moneys received by the agency pursuant to the
11 provisions of this section shall be deposited in the Planning
12 and Regulation Trust Fund, as created by s. 395.004, to be
13 held and applied solely for the operations required under this
14 section.
15 (3) In accordance with s. 408.811, the agency shall
16 inspect a mobile surgical facility at initial licensure and at
17 each time the facility establishes a new location, prior to
18 admission of patients. However, such inspections shall not be
19 required when a mobile surgical facility is moved temporarily
20 to a location where medical treatment will not be provided.
21 Section 40. Subsection (2) of section 395.0197,
22 Florida Statutes, is amended to read:
23 395.0197 Internal risk management program.--
24 (2) The internal risk management program is the
25 responsibility of the governing board of the health care
26 facility. Each licensed facility shall use the services of
27 hire a risk manager, licensed under s. 395.10974, who is
28 responsible for implementation and oversight of such
29 facility's internal risk management program as required by
30 this section. A risk manager must not be made responsible for
31 more than four internal risk management programs in separate
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1 hospitals licensed facilities, unless the hospitals facilities
2 are under one corporate ownership or the risk management
3 programs are in rural hospitals.
4 Section 41. Section 395.0199, Florida Statutes, is
5 amended to read:
6 395.0199 Private utilization review.--
7 (1) The purpose of this section is to:
8 (a) Promote the delivery of quality health care in a
9 cost-effective manner.
10 (b) Foster greater coordination between providers and
11 health insurers performing utilization review.
12 (c) Protect patients and insurance providers by
13 ensuring that private review agents are qualified to perform
14 utilization review activities and to make informed decisions
15 on the appropriateness of medical care.
16 (d) This section does not regulate the activities of
17 private review agents, health insurers, health maintenance
18 organizations, or hospitals, except as expressly provided
19 herein, or authorize regulation or intervention as to the
20 correctness of utilization review decisions of insurers or
21 private review agents.
22 (2) The requirements of part II of chapter 408 apply
23 to the provision of services that necessitate registration or
24 licensure pursuant to this section and part II of chapter 408
25 and to persons registered by or applying for such registration
26 from the Agency for Health Care Administration pursuant to
27 this section. However, an applicant for registration is exempt
28 from the provisions of ss. 408.810(5), (6), (7), (8), (9), and
29 (10) and 408.811. A private review agent conducting
30 utilization review as to health care services performed or
31
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1 proposed to be performed in this state shall register with the
2 agency in accordance with this section.
3 (3) In accordance with s. 408.805, an applicant or
4 registrant shall pay a fee for each registration issued under
5 this part and part II of chapter 408. The amount of the fee
6 shall be established by rule, Registration shall be made
7 annually with the agency on forms furnished by the agency and
8 shall be accompanied by the appropriate registration fee as
9 set by the agency. The fee shall be sufficient to pay for the
10 administrative costs of registering the agent, but may shall
11 not exceed $250. The agency may also charge reasonable fees,
12 reflecting actual costs, to persons requesting copies of
13 registration.
14 (4) Each applicant for registration must comply with
15 the following requirements:
16 (a) Upon receipt of a completed, signed, and dated
17 application, the agency shall require background screening, in
18 accordance with the level 2 standards for screening set forth
19 in chapter 435, of the managing employee or other similarly
20 titled individual who is responsible for the operation of the
21 entity. The applicant must comply with the procedures for
22 level 2 background screening as set forth in chapter 435, as
23 well as the requirements of s. 435.03(3).
24 (b) The agency may require background screening of any
25 other individual who is an applicant, if the agency has
26 probable cause to believe that he or she has been convicted of
27 a crime or has committed any other offense prohibited under
28 the level 2 standards for screening set forth in chapter 435.
29 (c) Proof of compliance with the level 2 background
30 screening requirements of chapter 435 which has been submitted
31 within the previous 5 years in compliance with any other
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1 health care licensure requirements of this state is acceptable
2 in fulfillment of the requirements of paragraph (a).
3 (d) A provisional registration may be granted to an
4 applicant when each individual required by this section to
5 undergo background screening has met the standards for the
6 Department of Law Enforcement background check, but the agency
7 has not yet received background screening results from the
8 Federal Bureau of Investigation, or a request for a
9 disqualification exemption has been submitted to the agency as
10 set forth in chapter 435 but a response has not yet been
11 issued. A standard registration may be granted to the
12 applicant upon the agency's receipt of a report of the results
13 of the Federal Bureau of Investigation background screening
14 for each individual required by this section to undergo
15 background screening which confirms that all standards have
16 been met, or upon the granting of a disqualification exemption
17 by the agency as set forth in chapter 435. Any other person
18 who is required to undergo level 2 background screening may
19 serve in his or her capacity pending the agency's receipt of
20 the report from the Federal Bureau of Investigation. However,
21 the person may not continue to serve if the report indicates
22 any violation of background screening standards and a
23 disqualification exemption has not been requested of and
24 granted by the agency as set forth in chapter 435.
25 (e) Each applicant must submit to the agency, with its
26 application, a description and explanation of any exclusions,
27 permanent suspensions, or terminations of the applicant from
28 the Medicare or Medicaid programs. Proof of compliance with
29 the requirements for disclosure of ownership and control
30 interests under the Medicaid or Medicare programs shall be
31 accepted in lieu of this submission.
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1 (f) Each applicant must submit to the agency a
2 description and explanation of any conviction of an offense
3 prohibited under the level 2 standards of chapter 435 by a
4 member of the board of directors of the applicant, its
5 officers, or any individual owning 5 percent or more of the
6 applicant. This requirement does not apply to a director of a
7 not-for-profit corporation or organization if the director
8 serves solely in a voluntary capacity for the corporation or
9 organization, does not regularly take part in the day-to-day
10 operational decisions of the corporation or organization,
11 receives no remuneration for his or her services on the
12 corporation or organization's board of directors, and has no
13 financial interest and has no family members with a financial
14 interest in the corporation or organization, provided that the
15 director and the not-for-profit corporation or organization
16 include in the application a statement affirming that the
17 director's relationship to the corporation satisfies the
18 requirements of this paragraph.
19 (g) A registration may not be granted to an applicant
20 if the applicant or managing employee has been found guilty
21 of, regardless of adjudication, or has entered a plea of nolo
22 contendere or guilty to, any offense prohibited under the
23 level 2 standards for screening set forth in chapter 435,
24 unless an exemption from disqualification has been granted by
25 the agency as set forth in chapter 435.
26 (h) The agency may deny or revoke the registration if
27 any applicant:
28 1. Has falsely represented a material fact in the
29 application required by paragraph (e) or paragraph (f), or has
30 omitted any material fact from the application required by
31 paragraph (e) or paragraph (f); or
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1 2. Has had prior action taken against the applicant
2 under the Medicaid or Medicare program as set forth in
3 paragraph (e).
4 (i) An application for registration renewal must
5 contain the information required under paragraphs (e) and (f).
6 (4)(5) Registration shall include the following:
7 (a) A description of the review policies and
8 procedures to be used in evaluating proposed or delivered
9 hospital care.
10 (b) The name, address, and telephone number of the
11 utilization review agent performing utilization review, who
12 shall be at least:
13 1. A licensed practical nurse or licensed registered
14 nurse, or other similarly qualified medical records or health
15 care professionals, for performing initial review when
16 information is necessary from the physician or hospital to
17 determine the medical necessity or appropriateness of hospital
18 services; or
19 2. A licensed physician, or a licensed physician
20 practicing in the field of psychiatry for review of mental
21 health services, for an initial denial determination prior to
22 a final denial determination by the health insurer and which
23 shall include the written evaluation and findings of the
24 reviewing physician.
25 (c) A description of an appeal procedure for patients
26 or health care providers whose services are under review, who
27 may appeal an initial denial determination prior to a final
28 determination by the health insurer with whom the private
29 review agent has contracted. The appeal procedure shall
30 provide for review by a licensed physician, or by a licensed
31 physician practicing in the field of psychiatry for review of
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1 mental health services, and shall include the written
2 evaluation and findings of the reviewing physician.
3 (d) A designation of the times when the staff of the
4 utilization review agent will be available by toll-free
5 telephone, which shall include at least 40 hours per week
6 during the normal business hours of the agent.
7 (e) An acknowledgment and agreement that any private
8 review agent which, as a general business practice, fails to
9 adhere to the policies, procedures, and representations made
10 in its application for registration shall have its
11 registration revoked.
12 (f) Disclosure of any incentive payment provision or
13 quota provision which is contained in the agent's contract
14 with a health insurer and is based on reduction or denial of
15 services, reduction of length of stay, or selection of
16 treatment setting.
17 (g) Updates of any material changes to review policies
18 or procedures.
19 (6) The agency may impose fines or suspend or revoke
20 the registration of any private review agent in violation of
21 this section. Any private review agent failing to register or
22 update registration as required by this section shall be
23 deemed to be within the jurisdiction of the agency and subject
24 to an administrative penalty not to exceed $1,000. The agency
25 may bring actions to enjoin activities of private review
26 agents in violation of this section.
27 (5)(7) An No insurer may not shall knowingly contract
28 with or utilize a private review agent that which has failed
29 to register as required by this section or which has had a
30 registration revoked by the agency.
31
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1 (6)(8) A private review agent that which operates
2 under contract with the federal or state government for
3 utilization review of patients eligible for hospital or other
4 services under Title XVIII or Title XIX of the Social Security
5 Act is exempt from the provisions of this section for services
6 provided under such contract. A private review agent that
7 which provides utilization review services to the federal or
8 state government and a private insurer shall not be exempt for
9 services provided to nonfederally funded patients. This
10 section shall not apply to persons who perform utilization
11 review services for medically necessary hospital services
12 provided to injured workers pursuant to chapter 440 and shall
13 not apply to self-insurance funds or service companies
14 authorized pursuant to chapter 440 or part VII of chapter 626.
15 (7)(9) Facilities licensed under this chapter shall
16 promptly comply with the requests of utilization review agents
17 or insurers which are reasonably necessary to facilitate
18 prompt accomplishment of utilization review activities.
19 (8)(10) The agency shall adopt rules to implement the
20 provisions of this section.
21 Section 42. Subsection (1) of section 395.1046,
22 Florida Statutes, is amended to read:
23 395.1046 Complaint investigation procedures.--
24 (1) In accordance with s. 408.811, the agency shall
25 investigate any complaint against a hospital for any violation
26 of s. 395.1041 that the agency reasonably believes to be
27 legally sufficient. A complaint is legally sufficient if it
28 contains ultimate facts which show that a violation of this
29 chapter, or any rule adopted under this chapter by the agency,
30 has occurred. The agency may investigate, or continue to
31 investigate, and may take appropriate final action on a
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1 complaint, even though the original complainant withdraws his
2 or her complaint or otherwise indicates his or her desire not
3 to cause it to be investigated to completion. When an
4 investigation of any person or facility is undertaken, the
5 agency shall notify such person in writing of the
6 investigation and inform the person or facility in writing of
7 the substance, the facts which show that a violation has
8 occurred, and the source of any complaint filed against him or
9 her. The agency may conduct an investigation without
10 notification to any person if the act under investigation is a
11 criminal offense. The agency shall have access to all records
12 necessary for the investigation of the complaint.
13 Section 43. Subsections (1), (7), and (8) of section
14 395.1055, Florida Statutes, are amended to read:
15 395.1055 Rules and enforcement.--
16 (1) The agency shall adopt rules pursuant to ss.
17 120.536(1) and 120.54 to implement the provisions of this part
18 and part II of chapter 408, which shall include reasonable and
19 fair minimum standards for ensuring that:
20 (a) Sufficient numbers and qualified types of
21 personnel and occupational disciplines are on duty and
22 available at all times to provide necessary and adequate
23 patient care and safety.
24 (b) Infection control, housekeeping, sanitary
25 conditions, and medical record procedures that will adequately
26 protect patient care and safety are established and
27 implemented.
28 (c) A comprehensive emergency management plan is
29 prepared and updated annually. Such standards must be
30 included in the rules adopted by the agency after consulting
31 with the Department of Community Affairs. At a minimum, the
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1 rules must provide for plan components that address emergency
2 evacuation transportation; adequate sheltering arrangements;
3 postdisaster activities, including emergency power, food, and
4 water; postdisaster transportation; supplies; staffing;
5 emergency equipment; individual identification of residents
6 and transfer of records, and responding to family inquiries.
7 The comprehensive emergency management plan is subject to
8 review and approval by the local emergency management agency.
9 During its review, the local emergency management agency shall
10 ensure that the following agencies, at a minimum, are given
11 the opportunity to review the plan: the Department of Elderly
12 Affairs, the Department of Health, the Agency for Health Care
13 Administration, and the Department of Community Affairs. Also,
14 appropriate volunteer organizations must be given the
15 opportunity to review the plan. The local emergency
16 management agency shall complete its review within 60 days and
17 either approve the plan or advise the facility of necessary
18 revisions.
19 (d) Licensed facilities are established, organized,
20 and operated consistent with established standards and rules.
21 (e) Licensed facility beds conform to minimum space,
22 equipment, and furnishings standards as specified by the
23 department.
24 (f) All hospitals submit such data as necessary to
25 conduct certificate-of-need reviews required under ss.
26 408.031-408.045. Such data shall include, but shall not be
27 limited to, patient origin data, hospital utilization data,
28 type of service reporting, and facility staffing data. The
29 agency shall not collect data that identifies or could
30 disclose the identity of individual patients. The agency shall
31
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1 utilize existing uniform statewide data sources when available
2 and shall minimize reporting costs to hospitals.
3 (g) Each hospital has a quality improvement program
4 designed according to standards established by their current
5 accrediting organization. This program will enhance quality of
6 care and emphasize quality patient outcomes, corrective action
7 for problems, governing board review, and reporting to the
8 agency of standardized data elements necessary to analyze
9 quality of care outcomes. The agency shall use existing data,
10 when available, and shall not duplicate the efforts of other
11 state agencies in order to obtain such data.
12 (7) Any licensed facility which is in operation at the
13 time of promulgation of any applicable rules under this part
14 shall be given a reasonable time, under the particular
15 circumstances, but not to exceed 1 year from the date of such
16 promulgation, within which to comply with such rules.
17 (7)(8) The agency may not adopt any rule governing the
18 design, construction, erection, alteration, modification,
19 repair, or demolition of any public or private hospital,
20 intermediate residential treatment facility, or ambulatory
21 surgical center. It is the intent of the Legislature to
22 preempt that function to the Florida Building Commission and
23 the State Fire Marshal through adoption and maintenance of the
24 Florida Building Code and the Florida Fire Prevention Code.
25 However, the agency shall provide technical assistance to the
26 commission and the State Fire Marshal in updating the
27 construction standards of the Florida Building Code and the
28 Florida Fire Prevention Code which govern hospitals,
29 intermediate residential treatment facilities, and ambulatory
30 surgical centers.
31
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1 Section 44. Section 395.1065, Florida Statutes, is
2 amended to read:
3 395.1065 Criminal and administrative penalties;
4 injunctions; emergency orders; moratorium.--
5 (1) Any person establishing, conducting, managing, or
6 operating any facility without a license under this part is
7 guilty of a misdemeanor and, upon conviction, shall be fined
8 not more than $500 for the first offense and not more than
9 $1,000 for each subsequent offense, and each day of continuing
10 violation after conviction shall be considered a separate
11 offense.
12 (1)(2)(a) The agency may deny, revoke, or suspend a
13 license or impose an administrative fine, not to exceed $1,000
14 per violation, per day, for the violation of any provision of
15 this part, part II of chapter 408, or applicable rules adopted
16 under this part. Each day of violation constitutes a separate
17 violation and is subject to a separate fine.
18 (b) In determining the amount of fine to be levied for
19 a violation, as provided in paragraph (a), the following
20 factors shall be considered:
21 1. The severity of the violation, including the
22 probability that death or serious harm to the health or safety
23 of any person will result or has resulted, the severity of the
24 actual or potential harm, and the extent to which the
25 provisions of this part were violated.
26 2. Actions taken by the licensee to correct the
27 violations or to remedy complaints.
28 3. Any previous violations of the licensee.
29 (c) All amounts collected pursuant to this section
30 shall be deposited into the Planning and Regulation Trust
31 Fund, as created by s. 395.004.
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1 (c)(d) The agency may impose an administrative fine
2 for the violation of s. 641.3154 or, if sufficient claims due
3 to a provider from a health maintenance organization do not
4 exist to enable the take-back of an overpayment, as provided
5 under s. 641.3155(5), for the violation of s. 641.3155(5). The
6 administrative fine for a violation cited in this paragraph
7 shall be in the amounts specified in s. 641.52(5), and the
8 provisions of paragraph (a) do not apply.
9 (2)(3) Notwithstanding the existence or pursuit of any
10 other remedy, the agency may maintain an action in the name of
11 the state for injunction or other process to enforce the
12 provisions of this part, part II of chapter 408, and
13 applicable rules promulgated hereunder.
14 (4) The agency may issue an emergency order
15 immediately suspending or revoking a license when it
16 determines that any condition in the licensed facility
17 presents a clear and present danger to public health and
18 safety.
19 (5) The agency may impose an immediate moratorium on
20 elective admissions to any licensed facility, building, or
21 portion thereof, or service, when the agency determines that
22 any condition in the facility presents a threat to public
23 health or safety.
24 (3)(6) In seeking to impose penalties against a
25 facility as defined in s. 394.455 for a violation of part I of
26 chapter 394, the agency is authorized to rely on the
27 investigation and findings by the Department of Health in lieu
28 of conducting its own investigation.
29 Section 45. Subsection (1) of section 395.10973,
30 Florida Statutes, is amended to read:
31
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1 395.10973 Powers and duties of the agency.--It is the
2 function of the agency to:
3 (1) Adopt rules pursuant to ss. 120.536(1) and 120.54
4 to implement the provisions of this part and part II of
5 chapter 408 conferring duties upon it.
6 Section 46. Section 395.10974, Florida Statutes, is
7 amended to read:
8 395.10974 Health care risk managers; qualifications,
9 licensure, fees.--
10 (1) The requirements of part II of chapter 408 apply
11 to the provision of services that necessitate licensure
12 pursuant to ss. 395.10971-395.10976 and part II of chapter 408
13 and to entities licensed by or applying for such licensure
14 from the Agency for Health Care Administration pursuant to ss.
15 395.10971-395.10976. Any person desiring to be licensed as a
16 health care risk manager shall submit an application on a form
17 provided by the agency. In order to qualify for licensure, the
18 applicant shall submit evidence satisfactory to the agency
19 which demonstrates the applicant's competence, by education or
20 experience, in the following areas:
21 (a) Applicable standards of health care risk
22 management.
23 (b) Applicable federal, state, and local health and
24 safety laws and rules.
25 (c) General risk management administration.
26 (d) Patient care.
27 (e) Medical care.
28 (f) Personal and social care.
29 (g) Accident prevention.
30 (h) Departmental organization and management.
31 (i) Community interrelationships.
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1 (j) Medical terminology.
2
3 Each applicant for licensure must comply with all provisions
4 of part II of chapter 408, with the exception of ss. 408.809,
5 408.810, and 408.811. The agency may require such additional
6 information, from the applicant or any other person, as may be
7 reasonably required to verify the information contained in the
8 application.
9 (2) The agency shall not grant or issue a license as a
10 health care risk manager to any individual unless from the
11 application it affirmatively appears that the applicant:
12 (a) Is 18 years of age or over;
13 (b) Is a high school graduate or equivalent; and
14 (c)1. Has fulfilled the requirements of a 1-year
15 program or its equivalent in health care risk management
16 training which may be developed or approved by the agency;
17 2. Has completed 2 years of college-level studies
18 which would prepare the applicant for health care risk
19 management, to be further defined by rule; or
20 3. Has obtained 1 year of practical experience in
21 health care risk management.
22 (3) The agency shall issue a license to practice
23 health care risk management to any applicant who qualifies
24 under this section. In accordance with s. 408.805, an
25 applicant or licensee shall pay a fee for each license
26 application submitted under this part and part II of chapter
27 408. The amount of the fees shall be established by rule, as
28 follows: and submits an application fee of not more than $75,
29 a fingerprinting fee of not more than $75, and a license fee
30 of not more than $100. The agency shall by rule establish fees
31 and procedures for the issuance and cancellation of licenses.
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1 (4) The agency shall renew a health care risk manager
2 license upon receipt of a biennial renewal application and
3 fees. The agency shall by rule establish a procedure for the
4 biennial renewal of licenses.
5 Section 47. Paragraph (l) of subsection (3) of section
6 395.1041, Florida Statutes, is amended to read:
7 395.1041 Access to emergency services and care.--
8 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
9 FACILITY OR HEALTH CARE PERSONNEL.--
10 (l) Hospital personnel must may withhold or withdraw
11 cardiopulmonary resuscitation if presented with an order not
12 to resuscitate executed pursuant to s. 401.45. Facility staff
13 and facilities shall not be subject to criminal prosecution or
14 civil liability, nor be considered to have engaged in
15 negligent or unprofessional conduct, for withholding or
16 withdrawing cardiopulmonary resuscitation pursuant to such an
17 order. The absence of an order not to resuscitate executed
18 pursuant to s. 401.45 does not preclude a physician from
19 withholding or withdrawing cardiopulmonary resuscitation as
20 otherwise permitted by law.
21 Section 48. Section 395.10411, Florida Statutes, is
22 created to read:
23 395.10411 Duty of a facility to carry out the advance
24 directive of a patient.--
25 (1) When a person who has a terminal condition or an
26 end-stage condition or is in a persistent vegetative state and
27 who has an advance directive is a patient in a facility
28 licensed under this chapter which is providing health care
29 services to the person, the facility must carry out the
30 advance directive or must transfer the patient pursuant to s.
31 765.1105 to a facility that will carry out the advance
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1 directive. The cost of transferring a patient for the purpose
2 of carrying out an advance directive shall be paid by the
3 facility from which the patient is transferred, and neither
4 the patient nor the receiving facility is responsible for any
5 part of such cost. A facility that fails to carry out a
6 patient's advance directive will not receive payment of any
7 state funds for life-prolonging treatment provided to the
8 patient.
9 (2) When a person who has a terminal condition or an
10 end-stage condition or is in a persistent vegetative state and
11 who has an order not to resuscitate is a patient in a facility
12 licensed under this chapter which is providing health care
13 services to the person, the facility must carry out the order
14 not to resuscitate. A facility that fails to carry out a
15 patient's order not to resuscitate will not receive payment of
16 any state funds for life-prolonging treatment provided to the
17 patient.
18 (3) When a person who has a terminal condition or an
19 end-stage condition or is in a persistent vegetative state and
20 who has an advance directive is a designated organ donor, a
21 health care facility may keep the organs of the person viable
22 for a period not to exceed 36 hours once the decision has been
23 made to remove life support. This subsection does not
24 supersede an advance directive, and life-prolonging procedures
25 may not be used beyond a period of 36 hours.
26 Section 49. Section 765.1105, Florida Statutes, is
27 amended to read:
28 765.1105 Transfer of a patient.--
29 (1) A health care provider or facility that refuses to
30 comply with a patient's advance directive, or the treatment
31 decision of his or her surrogate, must, within 48 hours after
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1 a determination by the attending physician that the patient's
2 condition is such that the advance directive applies, shall
3 make reasonable efforts to transfer the patient to another
4 health care provider or facility that will comply with the
5 directive or treatment decision. This chapter does not require
6 a health care provider or facility to commit any act which is
7 contrary to the provider's or facility's moral or ethical
8 beliefs, if the patient:
9 (a) Is not in an emergency condition; and
10 (b) Has received written information upon admission
11 informing the patient of the policies of the health care
12 provider or facility regarding such moral or ethical beliefs.
13 (2) A health care provider or facility that is
14 unwilling to carry out the wishes of the patient or the
15 treatment decision of his or her surrogate because of moral or
16 ethical beliefs must, within 48 hours after a determination by
17 the attending physician that the patient's condition is such
18 that the advance directive applies, 7 days either:
19 (a) Transfer the patient to another health care
20 provider or facility. The health care provider or facility
21 shall pay the costs for transporting the patient to another
22 health care provider or facility; or
23 (b) If the patient has not been transferred, carry out
24 the wishes of the patient or the patient's surrogate, unless
25 the provisions of s. 765.105 apply.
26 Section 50. Section 765.1021, Florida Statutes, is
27 created to read:
28 765.1021 Advance directive as part of a patient's
29 medical record.--To encourage individuals to complete an
30 advance directive and to inform individuals about options for
31 care available to them at the end of life, the Legislature
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1 encourages primary physicians and patients to discuss advance
2 directives and end-of-life care in a physician's office
3 setting on a nonemergency basis. If a patient completes an
4 advance directive and gives a copy of it to a physician, the
5 patient's advance directive must become part of the patient's
6 medical record.
7 Section 51. Subsection (1) of section 765.304, Florida
8 Statutes, is amended to read:
9 765.304 Procedure for living will.--
10 (1) If a person has made a living will expressing his
11 or her desires concerning life-prolonging procedures, but has
12 not designated a surrogate to execute his or her wishes
13 concerning life-prolonging procedures or designated a
14 surrogate under part II, the attending physician must may
15 proceed as directed by the principal in the living will or
16 must transfer him or her to a physician who will comply with
17 the living will. In the event of a dispute or disagreement
18 concerning the attending physician's decision to withhold or
19 withdraw life-prolonging procedures, the attending physician
20 shall not withhold or withdraw life-prolonging procedures
21 pending review under s. 765.105. If a review of a disputed
22 decision is not sought within 7 days following the attending
23 physician's decision to withhold or withdraw life-prolonging
24 procedures, the attending physician must may proceed in
25 accordance with the principal's instructions.
26 Section 52. Subsection (2) of section 395.10975,
27 Florida Statutes, is amended to read:
28 395.10975 Grounds for denial, suspension, or
29 revocation of a health care risk manager's license;
30 administrative fine.--
31
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1 (2) If the agency finds that one or more of the
2 grounds set forth in subsection (1) exist, it may, in lieu of
3 or in addition to denial suspension or revocation, enter an
4 order imposing one or more of the following penalties:
5 (a) Imposition of an administrative fine not to exceed
6 $2,500 for each count or separate offense.
7 (b) Issuance of a reprimand.
8 (c) Placement of the licensee on probation for a
9 period of time and subject to such conditions as the agency
10 may specify, including requiring the licensee to attend
11 continuing education courses or to work under the supervision
12 of another licensee.
13 Section 53. Subsection (17) of section 400.021,
14 Florida Statutes, is amended to read:
15 400.021 Definitions.--When used in this part, unless
16 the context otherwise requires, the term:
17 (17) "Resident care plan" means a written plan
18 developed, maintained, and reviewed not less than quarterly by
19 a registered nurse, with participation from other facility
20 staff and the resident or his or her designee or legal
21 representative, which includes a comprehensive assessment of
22 the needs of an individual resident; the type and frequency of
23 services required to provide the necessary care for the
24 resident to attain or maintain the highest practicable
25 physical, mental, and psychosocial well-being; a listing of
26 services provided within or outside the facility to meet those
27 needs; and an explanation of service goals. The resident care
28 plan must be signed by the director of nursing or another
29 registered nurse employed by the facility to whom
30 institutional responsibilities have been delegated and by the
31 resident, the resident's designee, or the resident's legal
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1 representative. The facility may not use an agency or
2 temporary registered nurse to satisfy the foregoing
3 requirement and must document the institutional
4 responsibilities that have been delegated to the registered
5 nurse.
6 Section 54. Subsections (5) and (20) of section
7 400.021, Florida Statutes, are repealed.
8 Section 55. Subsection (3) of section 400.022, Florida
9 Statutes, is amended to read:
10 400.022 Residents' rights.--
11 (3) Any violation of the resident's rights set forth
12 in this section shall constitute grounds for action by the
13 agency under the provisions of s. 400.102, s. 400.121, or part
14 II of chapter 408. In order to determine whether the licensee
15 is adequately protecting residents' rights, the licensure
16 annual inspection of the facility shall include private
17 informal conversations with a sample of residents to discuss
18 residents' experiences within the facility with respect to
19 rights specified in this section and general compliance with
20 standards, and consultation with the ombudsman council in the
21 local planning and service area of the Department of Elderly
22 Affairs in which the nursing home is located.
23 Section 56. Paragraph (b) of subsection (1) of section
24 400.051, Florida Statutes, is amended to read:
25 400.051 Homes or institutions exempt from the
26 provisions of this part.--
27 (1) The following shall be exempt from the provisions
28 of this part:
29 (b) Any hospital, as defined in s. 395.002 s.
30 395.002(11), that is licensed under chapter 395.
31
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1 Section 57. Section 400.062, Florida Statutes, is
2 amended to read:
3 400.062 License required; fee; disposition; display;
4 transfer.--
5 (1) The requirements of part II of chapter 408 apply
6 to the provision of services that necessitate licensure
7 pursuant to this part and part II of chapter 408 and to
8 entities licensed by or applying for such licensure from the
9 Agency for Health Care Administration pursuant to this part.
10 It is unlawful to operate or maintain a facility without first
11 obtaining from the agency a license authorizing such
12 operation.
13 (2) Separate licenses shall be required for facilities
14 maintained in separate premises, even though operated under
15 the same management. However, a separate license shall not be
16 required for separate buildings on the same grounds.
17 (3) In accordance with s. 408.805, an applicant or
18 licensee shall pay a fee for each license application
19 submitted under this part and part II of chapter 408. The
20 annual license fee required for each license issued under this
21 part shall be comprised of two parts. Part I of the license
22 fee shall be the basic license fee. The rate per bed for the
23 basic license fee shall be established biennially annually and
24 shall be $100 $50 per bed unless modified by rule. The agency
25 may adjust the per bed licensure fees by the Consumer Price
26 Index based on the 12 months immediately preceding the
27 increase to cover the cost of regulation under this part. Part
28 II of the license fee shall be the resident protection fee,
29 which shall be at the rate of not less than 50 25 cents per
30 bed. The rate per bed shall be the minimum rate per bed, and
31 such rate shall remain in effect until the effective date of a
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1 rate per bed adopted by rule by the agency pursuant to this
2 part. At such time as the amount on deposit in the Resident
3 Protection Trust Fund is less than $1 million, the agency may
4 adopt rules to establish a rate which may not exceed $20 $10
5 per bed. The rate per bed shall revert back to the minimum
6 rate per bed when the amount on deposit in the Resident
7 Protection Trust Fund reaches $1 million, except that any rate
8 established by rule shall remain in effect until such time as
9 the rate has been equally required for each license issued
10 under this part. Any amount in the fund in excess of $2
11 million shall revert to the Health Care Trust Fund and may not
12 be expended without prior approval of the Legislature. The
13 agency may prorate the biennial annual license fee for those
14 licenses which it issues under this part for less than 2 years
15 1 year. Funds generated by license fees collected in
16 accordance with this section shall be deposited in the
17 following manner:
18 (a) The basic license fee collected shall be deposited
19 in the Health Care Trust Fund, established for the sole
20 purpose of carrying out this part. When the balance of the
21 account established in the Health Care Trust Fund for the
22 deposit of fees collected as authorized under this section
23 exceeds one-third of the annual cost of regulation under this
24 part, the excess shall be used to reduce the licensure fees in
25 the next year.
26 (b) The resident protection fee collected shall be
27 deposited in the Resident Protection Trust Fund for the sole
28 purpose of paying, in accordance with the provisions of s.
29 400.063, for the appropriate alternate placement, care, and
30 treatment of a resident removed from a nursing home facility
31 on a temporary, emergency basis or for the maintenance and
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1 care of residents in a nursing home facility pending removal
2 and alternate placement.
3 (4) Counties or municipalities applying for licenses
4 under this part are exempt from license fees authorized under
5 this section.
6 (5) The license shall be displayed in a conspicuous
7 place inside the facility.
8 (6) A license shall be valid only in the hands of the
9 individual, firm, partnership, association, or corporation to
10 whom it is issued and shall not be subject to sale,
11 assignment, or other transfer, voluntary or involuntary, nor
12 shall a license be valid for any premises other than those for
13 which originally issued.
14 Section 58. Subsection (1) of section 400.063, Florida
15 Statutes, is amended to read:
16 400.063 Resident Protection Trust Fund.--
17 (1) A Resident Protection Trust Fund shall be
18 established for the purpose of collecting and disbursing funds
19 generated from the license fees and administrative fines as
20 provided for in ss. 393.0673(2), 400.062(3) 400.062(3)(b),
21 400.111(1), 400.121(2), and 400.23(8). Such funds shall be
22 for the sole purpose of paying for the appropriate alternate
23 placement, care, and treatment of residents who are removed
24 from a facility licensed under this part or a facility
25 specified in s. 393.0678(1) in which the agency determines
26 that existing conditions or practices constitute an immediate
27 danger to the health, safety, or security of the residents.
28 If the agency determines that it is in the best interest of
29 the health, safety, or security of the residents to provide
30 for an orderly removal of the residents from the facility, the
31 agency may utilize such funds to maintain and care for the
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1 residents in the facility pending removal and alternative
2 placement. The maintenance and care of the residents shall be
3 under the direction and control of a receiver appointed
4 pursuant to s. 393.0678(1) or s. 400.126(1). However, funds
5 may be expended in an emergency upon a filing of a petition
6 for a receiver, upon the declaration of a state of local
7 emergency pursuant to s. 252.38(3)(a)5., or upon a duly
8 authorized local order of evacuation of a facility by
9 emergency personnel to protect the health and safety of the
10 residents.
11 Section 59. Section 400.071, Florida Statutes, is
12 amended to read:
13 400.071 Application for license.--
14 (1) An application for a license as required by s.
15 400.062 shall be made to the agency on forms furnished by it
16 and shall be accompanied by the appropriate license fee.
17 (1)(2) The application shall be under oath and shall
18 contain the following:
19 (a) The name, address, and social security number of
20 the applicant if an individual; if the applicant is a firm,
21 partnership, or association, its name, address, and employer
22 identification number (EIN), and the name and address of any
23 controlling interest; and the name by which the facility is to
24 be known.
25 (b) The name of any person whose name is required on
26 the application under the provisions of paragraph (a) and who
27 owns at least a 10-percent interest in any professional
28 service, firm, association, partnership, or corporation
29 providing goods, leases, or services to the facility for which
30 the application is made, and the name and address of the
31
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1 professional service, firm, association, partnership, or
2 corporation in which such interest is held.
3 (c) The location of the facility for which a license
4 is sought and an indication, as in the original application,
5 that such location conforms to the local zoning ordinances.
6 (d) The name of the person or persons under whose
7 management or supervision the facility will be conducted and
8 the name of the administrator.
9 (a)(e) A signed affidavit disclosing any financial or
10 ownership interest that a controlling interest, as defined in
11 s. 408.803, person or entity described in paragraph (a) or
12 paragraph (d) has held in the last 5 years in any entity
13 licensed by this state or any other state to provide health or
14 residential care which has closed voluntarily or
15 involuntarily; has filed for bankruptcy; has had a receiver
16 appointed; has had a license denied, suspended, or revoked; or
17 has had an injunction issued against it which was initiated by
18 a regulatory agency. The affidavit must disclose the reason
19 any such entity was closed, whether voluntarily or
20 involuntarily.
21 (b)(f) The total number of beds and the total number
22 of Medicare and Medicaid certified beds.
23 (c)(g) Information relating to the number, experience,
24 and training of the employees of the facility and of the moral
25 character of the applicant and employees which the agency
26 requires by rule, including the name and address of any
27 nursing home with which the applicant or employees have been
28 affiliated through ownership or employment within 5 years of
29 the date of the application for a license and the record of
30 any criminal convictions involving the applicant and any
31 criminal convictions involving an employee if known by the
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1 applicant after inquiring of the employee. The applicant must
2 demonstrate that sufficient numbers of qualified staff, by
3 training or experience, will be employed to properly care for
4 the type and number of residents who will reside in the
5 facility.
6 (d)(h) Copies of any civil verdict or judgment
7 involving the applicant rendered within the 10 years preceding
8 the application, relating to medical negligence, violation of
9 residents' rights, or wrongful death. As a condition of
10 licensure, the licensee agrees to provide to the agency copies
11 of any new verdict or judgment involving the applicant,
12 relating to such matters, within 30 days after filing with the
13 clerk of the court. The information required in this
14 paragraph shall be maintained in the facility's licensure file
15 and in an agency database which is available as a public
16 record.
17 (3) The applicant shall submit evidence which
18 establishes the good moral character of the applicant,
19 manager, supervisor, and administrator. No applicant, if the
20 applicant is an individual; no member of a board of directors
21 or officer of an applicant, if the applicant is a firm,
22 partnership, association, or corporation; and no licensed
23 nursing home administrator shall have been convicted, or found
24 guilty, regardless of adjudication, of a crime in any
25 jurisdiction which affects or may potentially affect residents
26 in the facility.
27 (4) Each applicant for licensure must comply with the
28 following requirements:
29 (a) Upon receipt of a completed, signed, and dated
30 application, the agency shall require background screening of
31 the applicant, in accordance with the level 2 standards for
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1 screening set forth in chapter 435. As used in this
2 subsection, the term "applicant" means the facility
3 administrator, or similarly titled individual who is
4 responsible for the day-to-day operation of the licensed
5 facility, and the facility financial officer, or similarly
6 titled individual who is responsible for the financial
7 operation of the licensed facility.
8 (b) The agency may require background screening for a
9 member of the board of directors of the licensee or an officer
10 or an individual owning 5 percent or more of the licensee if
11 the agency has probable cause to believe that such individual
12 has been convicted of an offense prohibited under the level 2
13 standards for screening set forth in chapter 435.
14 (c) Proof of compliance with the level 2 background
15 screening requirements of chapter 435 which has been submitted
16 within the previous 5 years in compliance with any other
17 health care or assisted living licensure requirements of this
18 state is acceptable in fulfillment of paragraph (a). Proof of
19 compliance with background screening which has been submitted
20 within the previous 5 years to fulfill the requirements of the
21 Financial Services Commission and the Office of Insurance
22 Regulation pursuant to chapter 651 as part of an application
23 for a certificate of authority to operate a continuing care
24 retirement community is acceptable in fulfillment of the
25 Department of Law Enforcement and Federal Bureau of
26 Investigation background check.
27 (d) A provisional license may be granted to an
28 applicant when each individual required by this section to
29 undergo background screening has met the standards for the
30 Department of Law Enforcement background check, but the agency
31 has not yet received background screening results from the
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1 Federal Bureau of Investigation, or a request for a
2 disqualification exemption has been submitted to the agency as
3 set forth in chapter 435, but a response has not yet been
4 issued. A license may be granted to the applicant upon the
5 agency's receipt of a report of the results of the Federal
6 Bureau of Investigation background screening for each
7 individual required by this section to undergo background
8 screening which confirms that all standards have been met, or
9 upon the granting of a disqualification exemption by the
10 agency as set forth in chapter 435. Any other person who is
11 required to undergo level 2 background screening may serve in
12 his or her capacity pending the agency's receipt of the report
13 from the Federal Bureau of Investigation; however, the person
14 may not continue to serve if the report indicates any
15 violation of background screening standards and a
16 disqualification exemption has not been requested of and
17 granted by the agency as set forth in chapter 435.
18 (e) Each applicant must submit to the agency, with its
19 application, a description and explanation of any exclusions,
20 permanent suspensions, or terminations of the applicant from
21 the Medicare or Medicaid programs. Proof of compliance with
22 disclosure of ownership and control interest requirements of
23 the Medicaid or Medicare programs shall be accepted in lieu of
24 this submission.
25 (f) Each applicant must submit to the agency a
26 description and explanation of any conviction of an offense
27 prohibited under the level 2 standards of chapter 435 by a
28 member of the board of directors of the applicant, its
29 officers, or any individual owning 5 percent or more of the
30 applicant. This requirement shall not apply to a director of a
31 not-for-profit corporation or organization if the director
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1 serves solely in a voluntary capacity for the corporation or
2 organization, does not regularly take part in the day-to-day
3 operational decisions of the corporation or organization,
4 receives no remuneration for his or her services on the
5 corporation or organization's board of directors, and has no
6 financial interest and has no family members with a financial
7 interest in the corporation or organization, provided that the
8 director and the not-for-profit corporation or organization
9 include in the application a statement affirming that the
10 director's relationship to the corporation satisfies the
11 requirements of this paragraph.
12 (g) An application for license renewal must contain
13 the information required under paragraphs (e) and (f).
14 (5) The applicant shall furnish satisfactory proof of
15 financial ability to operate and conduct the nursing home in
16 accordance with the requirements of this part and all rules
17 adopted under this part, and the agency shall establish
18 standards for this purpose, including information reported
19 under paragraph (2)(e). The agency also shall establish
20 documentation requirements, to be completed by each applicant,
21 that show anticipated facility revenues and expenditures, the
22 basis for financing the anticipated cash-flow requirements of
23 the facility, and an applicant's access to contingency
24 financing.
25 (2)(6) If the applicant offers continuing care
26 agreements as defined in chapter 651, proof shall be furnished
27 that such applicant has obtained a certificate of authority as
28 required for operation under that chapter.
29 (3)(7) As a condition of licensure, each licensee,
30 except one offering continuing care agreements as defined in
31 chapter 651, must agree to accept recipients of Title XIX of
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1 the Social Security Act on a temporary, emergency basis. The
2 persons whom the agency may require such licensees to accept
3 are those recipients of Title XIX of the Social Security Act
4 who are residing in a facility in which existing conditions
5 constitute an immediate danger to the health, safety, or
6 security of the residents of the facility.
7 (4)(8) The agency may not issue a license to a nursing
8 home that fails to receive a certificate of need under the
9 provisions of ss. 408.031-408.045. It is the intent of the
10 Legislature that, in reviewing a certificate-of-need
11 application to add beds to an existing nursing home facility,
12 preference be given to the application of a licensee who has
13 been awarded a Gold Seal as provided for in s. 400.235, if the
14 applicant otherwise meets the review criteria specified in s.
15 408.035.
16 (5)(9) The agency may develop an abbreviated survey
17 for licensure renewal applicable to a licensee that has
18 continuously operated as a nursing facility since 1991 or
19 earlier, has operated under the same management for at least
20 the preceding 30 months, and has had during the preceding 30
21 months no class I or class II deficiencies.
22 (10) The agency may issue an inactive license to a
23 nursing home that will be temporarily unable to provide
24 services but that is reasonably expected to resume services.
25 Such designation may be made for a period not to exceed 12
26 months but may be renewed by the agency for up to 6 additional
27 months. Any request by a licensee that a nursing home become
28 inactive must be submitted to the agency and approved by the
29 agency prior to initiating any suspension of service or
30 notifying residents. Upon agency approval, the nursing home
31
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1 shall notify residents of any necessary discharge or transfer
2 as provided in s. 400.0255.
3 (6)(11) As a condition of licensure, each facility
4 must establish and submit with its application a plan for
5 quality assurance and for conducting risk management.
6 (12) The applicant must provide the agency with proof
7 of a legal right to occupy the property before a license may
8 be issued. Proof may include, but is not limited to, copies of
9 warranty deeds, lease or rental agreements, contracts for
10 deeds, or quitclaim deeds.
11 Section 60. Section 400.0712, Florida Statutes, is
12 created to read:
13 400.0712 Application for inactive license.--
14 (1) As specified in this section, the agency may issue
15 an inactive license to a nursing home facility for all or a
16 portion of its beds. Any request by a licensee that a nursing
17 home or portion of a nursing home become inactive must be
18 submitted to the agency in the approved format. The facility
19 may not initiate any suspension of services, notify residents,
20 or initiate facility closure before receiving approval from
21 the agency; and a facility that violates this provision may
22 not be issued an inactive license. Upon agency approval of an
23 inactive license, the nursing home shall notify residents of
24 any necessary discharge or transfer as provided in s.
25 400.0255.
26 (2) The agency may issue an inactive license to a
27 nursing home that chooses to use an unoccupied contiguous
28 portion of the facility for an alternative use to meet the
29 needs of elderly persons through the use of less restrictive,
30 less institutional services.
31
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1 (a) An inactive license issued under this subsection
2 may be granted for a period not to exceed 12 months but may be
3 renewed annually by the agency for 12 months.
4 (b) A request to extend the inactive license must be
5 submitted to the agency in the approved format and approved by
6 the agency in writing.
7 (c) Nursing homes that receive an inactive license to
8 provide alternative services shall not receive preference for
9 participation in the Assisted Living for the Elderly Medicaid
10 waiver.
11 (3) The agency may issue an inactive license to a
12 nursing home that will be temporarily unable to provide
13 services but is reasonably expected to resume services.
14 (a) An inactive license issued under this subsection
15 may be issued for a period not to exceed 12 months and may be
16 renewed by the agency for an additional 6 months upon
17 demonstration of progress toward reopening.
18 (b) All licensure fees must be current and paid in
19 full, and may be prorated as provided by agency rule, before
20 the inactive license is issued.
21 (c) Reactivation of an inactive license requires that
22 the applicant pay all licensure fees and be inspected by the
23 agency to confirm that all of the requirements of this part
24 and applicable rules are met.
25 (4) The agency shall adopt rules necessary to
26 administer this section.
27 Section 61. Section 400.102, Florida Statutes, is
28 amended to read:
29 400.102 Action by agency against licensee; grounds.--
30
31
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1 (1) In addition to the grounds listed in part II of
2 chapter 408, any of the following conditions shall be grounds
3 for action by the agency against a licensee:
4 (a) An intentional or negligent act materially
5 affecting the health or safety of residents of the facility;
6 (1)(b) Misappropriation or conversion of the property
7 of a resident of the facility;
8 (2)(c) Failure to follow the criteria and procedures
9 provided under part I of chapter 394 relating to the
10 transportation, voluntary admission, and involuntary
11 examination of a nursing home resident or;
12 (d) Violation of provisions of this part or rules
13 adopted under this part;
14 (3)(e) Fraudulent altering, defacing, or falsifying
15 any medical or nursing home records, or causing or procuring
16 any of these offenses to be committed.; or
17 (f) Any act constituting a ground upon which
18 application for a license may be denied.
19 (2) If the agency has reasonable belief that any of
20 such conditions exist, it shall take the following action:
21 (a) In the case of an applicant for original
22 licensure, denial action as provided in s. 400.121.
23 (b) In the case of an applicant for relicensure or a
24 current licensee, administrative action as provided in s.
25 400.121 or injunctive action as authorized by s. 400.125.
26 (c) In the case of a facility operating without a
27 license, injunctive action as authorized in s. 400.125.
28 Section 62. Section 400.111, Florida Statutes, is
29 amended to read:
30 400.111 Renewal Expiration of license; renewal.--
31
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1 (1) A license issued for the operation of a facility,
2 unless sooner suspended or revoked, shall expire on the date
3 set forth by the agency on the face of the license or 1 year
4 from the date of issuance, whichever occurs first. Ninety
5 days prior to the expiration date, an application for renewal
6 shall be submitted to the agency. A license shall be renewed
7 upon the filing of an application on forms furnished by the
8 agency if the applicant has first met the requirements
9 established under this part and all rules adopted under this
10 part. The failure to file an application within the period
11 established in this subsection shall result in a late fee
12 charged to the licensee by the agency in an amount equal to 50
13 percent of the fee in effect on the last preceding regular
14 renewal date. A late fee shall be levied for each and every
15 day the filing of the license application is delayed, but in
16 no event shall such fine aggregate more than $5,000. If an
17 application is received after the required filing date and
18 exhibits a hand-canceled postmark obtained from a United
19 States Post Office dated on or before the required filing
20 date, no fine will be levied.
21 (2) A licensee against whom a revocation or suspension
22 proceeding, or any judicial proceeding instituted by the
23 agency under this part, is pending at the time of license
24 renewal may be issued a temporary license effective until
25 final disposition by the agency of such proceeding. If
26 judicial relief is sought from the aforesaid administrative
27 order, the court having jurisdiction may issue such orders
28 regarding the issuance of a temporary permit during the
29 pendency of the judicial proceeding.
30 (3) The agency may not renew a license if the
31 applicant has failed to pay any fines assessed by final order
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1 of the agency or final order of the Health Care Financing
2 Administration under requirements for federal certification.
3 The agency may renew the license of an applicant following the
4 assessment of a fine by final order if such fine has been paid
5 into an escrow account pending an appeal of a final order.
6 (4) In addition to the requirements of part II of
7 chapter 408, the licensee shall submit a signed affidavit
8 disclosing any financial or ownership interest that a
9 controlling interest licensee has held within the last 5 years
10 in any entity licensed by the state or any other state to
11 provide health or residential care which entity has closed
12 voluntarily or involuntarily; has filed for bankruptcy; has
13 had a receiver appointed; has had a license denied, suspended,
14 or revoked; or has had an injunction issued against it which
15 was initiated by a regulatory agency. The affidavit must
16 disclose the reason such entity was closed, whether
17 voluntarily or involuntarily.
18 Section 63. Subsections (2) and (5) of section
19 400.1183, Florida Statutes, are amended to read:
20 400.1183 Resident grievance procedures.--
21 (2) Each facility shall maintain records of all
22 grievances and shall report annually to the agency at the time
23 of relicensure the total number of grievances handled, a
24 categorization of the cases underlying the grievances, and the
25 final disposition of the grievances.
26 (5) The agency may impose an administrative fine, in
27 accordance with s. 400.121, against a nursing home facility
28 for noncompliance with this section.
29 Section 64. Section 400.121, Florida Statutes, is
30 amended to read:
31
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1 400.121 Denial or, suspension, revocation of license;
2 moratorium on admissions; administrative fines; procedure;
3 order to increase staffing.--
4 (1) The agency may deny an application, revoke or
5 suspend a license, or impose an administrative fine, not to
6 exceed $500 per violation per day, against any applicant or
7 licensee for the following violations by the applicant,
8 licensee, or other controlling interest:
9 (a) A violation of any provision of s. 400.102(1);
10 (b) A violation of any provision of this part, part II
11 of chapter 408, or applicable rule; or A demonstrated pattern
12 of deficient practice;
13 (c) Failure to pay any outstanding fines assessed by
14 final order of the agency or final order of the Health Care
15 Financing Administration pursuant to requirements for federal
16 certification. The agency may renew or approve the license of
17 an applicant following the assessment of a fine by final order
18 if such fine has been paid into an escrow account pending an
19 appeal of a final order;
20 (d) Exclusion from the Medicare or Medicaid program;
21 or
22 (b)(e) An adverse action by a regulatory agency
23 against any other licensed facility that has a common
24 controlling interest with the licensee or applicant against
25 whom the action under this section is being brought. If the
26 adverse action involves solely the management company, the
27 applicant or licensee shall be given 30 days to remedy before
28 final action is taken. If the adverse action is based solely
29 upon actions by a controlling interest, the applicant or
30 licensee may present factors in mitigation of any proposed
31
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1 penalty based upon a showing that such penalty is
2 inappropriate under the circumstances.
3
4 All hearings shall be held within the county in which the
5 licensee or applicant operates or applies for a license to
6 operate a facility as defined herein.
7 (2) Except as provided in s. 400.23(8), a $500 fine
8 shall be imposed for each violation. Each day a violation of
9 this part occurs constitutes a separate violation and is
10 subject to a separate fine, but in no event may any fine
11 aggregate more than $5,000. A fine may be levied pursuant to
12 this section in lieu of and notwithstanding the provisions of
13 s. 400.23. Fines paid shall be deposited in the Resident
14 Protection Trust Fund and expended as provided in s. 400.063.
15 (3) The agency shall revoke or deny a nursing home
16 license if the licensee or controlling interest operates a
17 facility in this state that:
18 (a) Has had two moratoria imposed by final order for
19 substandard quality of care, as defined by 42 C.F.R. part 483,
20 within any 30-month period;
21 (b) Is conditionally licensed for 180 or more
22 continuous days;
23 (c) Is cited for two class I deficiencies arising from
24 unrelated circumstances during the same survey or
25 investigation; or
26 (d) Is cited for two class I deficiencies arising from
27 separate surveys or investigations within a 30-month period.
28
29 The licensee may present factors in mitigation of revocation,
30 and the agency may make a determination not to revoke a
31
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1 license based upon a showing that revocation is inappropriate
2 under the circumstances.
3 (4) The agency may issue an order immediately
4 suspending or revoking a license when it determines that any
5 condition in the facility presents a danger to the health,
6 safety, or welfare of the residents in the facility.
7 (5)(a) The agency may impose an immediate moratorium
8 on admissions to any facility when the agency determines that
9 any condition in the facility presents a threat to the health,
10 safety, or welfare of the residents in the facility.
11 (4)(b) Where the agency has placed a moratorium on
12 admissions on any facility two times within a 7-year period,
13 the agency may revoke suspend the license of the nursing home
14 and the facility's management company, if any. During the
15 suspension, the agency shall take the facility into
16 receivership and shall operate the facility.
17 (5)(6) An action taken by the agency to deny, suspend,
18 or revoke a facility's license under this part shall be heard
19 by the Division of Administrative Hearings of the Department
20 of Management Services within 60 days after the assignment of
21 an administrative law judge, unless the time limitation is
22 waived by both parties. The administrative law judge must
23 render a decision within 30 days after receipt of a proposed
24 recommended order.
25 (6)(7) The agency is authorized to require a facility
26 to increase staffing beyond the minimum required by law, if
27 the agency has taken administrative action against the
28 facility for care-related deficiencies directly attributable
29 to insufficient staff. Under such circumstances, the facility
30 may request an expedited interim rate increase. The agency
31 shall process the request within 10 days after receipt of all
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1 required documentation from the facility. A facility that
2 fails to maintain the required increased staffing is subject
3 to a fine of $500 per day for each day the staffing is below
4 the level required by the agency.
5 (8) An administrative proceeding challenging an action
6 taken by the agency pursuant to this section shall be reviewed
7 on the basis of the facts and conditions that resulted in such
8 agency action.
9 (7)(9) Notwithstanding any other provision of law to
10 the contrary, agency action in an administrative proceeding
11 under this section may be overcome by the licensee upon a
12 showing by a preponderance of the evidence to the contrary.
13 (8)(10) In addition to any other sanction imposed
14 under this part, in any final order that imposes sanctions,
15 the agency may assess costs related to the investigation and
16 prosecution of the case. Payment of agency costs shall be
17 deposited into the Health Care Trust Fund.
18 Section 65. Section 400.125, Florida Statutes, is
19 repealed.
20 Section 66. Subsections (14), (15), and (16) of
21 section 400.141, Florida Statutes, are amended to read:
22 400.141 Administration and management of nursing home
23 facilities.--Every licensed facility shall comply with all
24 applicable standards and rules of the agency and shall:
25 (14) Submit to the agency the information specified in
26 s. 400.071(1)(a) s. 400.071(2)(e) for a management company
27 within 30 days after the effective date of the management
28 agreement.
29 (15)(a) At the end of each calendar quarter, submit
30 semiannually to the agency, or more frequently if requested by
31 the agency, information regarding facility staff-to-resident
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1 ratios, staff turnover, and staff stability, including
2 information regarding certified nursing assistants, licensed
3 nurses, the director of nursing, and the facility
4 administrator. For purposes of this reporting:
5 1.(a) Staff-to-resident ratios must be reported in the
6 categories specified in s. 400.23(3)(a) and applicable rules.
7 The ratio must be reported as an average for the most recent
8 calendar quarter.
9 2.(b) Staff turnover must be reported for the most
10 recent 12-month period ending on the last workday of the most
11 recent calendar quarter prior to the date the information is
12 submitted. The turnover rate must be computed quarterly, with
13 the annual rate being the cumulative sum of the quarterly
14 rates. The turnover rate is the total number of terminations
15 or separations experienced during the quarter, excluding any
16 employee terminated during a probationary period of 3 months
17 or less, divided by the total number of staff employed at the
18 end of the period for which the rate is computed, and
19 expressed as a percentage.
20 3.(c) The formula for determining staff stability is
21 the total number of employees that have been employed for more
22 than 12 months, divided by the total number of employees
23 employed at the end of the most recent calendar quarter, and
24 expressed as a percentage.
25 (b)(d) A nursing facility that has failed to comply
26 with state minimum-staffing requirements for 2 consecutive
27 days is prohibited from accepting new admissions until the
28 facility has achieved the minimum-staffing requirements for a
29 period of 6 consecutive days. For the purposes of this
30 paragraph, any person who was a resident of the facility and
31 was absent from the facility for the purpose of receiving
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1 medical care at a separate location or was on a leave of
2 absence is not considered a new admission. Failure to impose
3 such an admissions moratorium constitutes a class II
4 deficiency.
5 (c)(e) A nursing facility that which does not have a
6 conditional license may be cited for failure to comply with
7 the standards in s. 400.23(3)(a) only if it has failed to meet
8 those standards on 2 consecutive days or if it has failed to
9 meet at least 97 percent of those standards on any one day.
10 (d)(f) A facility that which has a conditional license
11 must be in compliance with the standards in s. 400.23(3)(a) at
12 all times from the effective date of the conditional license
13 until the effective date of a subsequent standard license.
14
15 Nothing in this section shall limit the agency's ability to
16 impose a deficiency or take other actions if a facility does
17 not have enough staff to meet the residents' needs.
18 (16) Report monthly the number of vacant beds in the
19 facility which are available for resident occupancy on the
20 last day of the month information is reported.
21
22 Facilities that have been awarded a Gold Seal under the
23 program established in s. 400.235 may develop a plan to
24 provide certified nursing assistant training as prescribed by
25 federal regulations and state rules and may apply to the
26 agency for approval of their program.
27 Section 67. Subsections (4) and (5) of section 400.17,
28 Florida Statutes, are amended to read:
29 400.17 Bribes, kickbacks, certain solicitations
30 prohibited.--
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1 (4) Solicitation of contributions of any kind in a
2 threatening, coercive, or unduly forceful manner by or on
3 behalf of a nursing home by any agent, employee, owner, or
4 representative of a nursing home shall be grounds for denial,
5 suspension, or revocation of the license for any nursing home
6 on behalf of which such contributions were solicited.
7 (5) The admission, maintenance, or treatment of a
8 nursing home resident whose care is supported in whole or in
9 part by state funds may not be made conditional upon the
10 receipt of any manner of contribution or donation from any
11 person. However, this may not be construed to prohibit the
12 offer or receipt of contributions or donations to a nursing
13 home which are not related to the care of a specific resident.
14 Contributions solicited or received in violation of this
15 subsection shall be grounds for denial, suspension, or
16 revocation of a license for any nursing home on behalf of
17 which such contributions were solicited.
18 Section 68. Section 400.179, Florida Statutes, is
19 amended to read:
20 400.179 Sale or transfer of ownership of a nursing
21 facility; Liability for Medicaid underpayments and
22 overpayments.--
23 (1) It is the intent of the Legislature to protect the
24 rights of nursing home residents and the security of public
25 funds when a nursing facility is sold or the ownership is
26 transferred.
27 (2) Whenever a nursing facility is sold or the
28 ownership is transferred, including leasing, the transferee
29 shall make application to the agency for a new license at
30 least 90 days prior to the date of transfer of ownership.
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1 (3) The transferor shall notify the agency in writing
2 at least 90 days prior to the date of transfer of ownership.
3 The transferor shall be responsible and liable for the lawful
4 operation of the nursing facility and the welfare of the
5 residents domiciled in the facility until the date the
6 transferee is licensed by the agency. The transferor shall be
7 liable for any and all penalties imposed against the facility
8 for violations occurring prior to the date of transfer of
9 ownership.
10 (4) The transferor shall, prior to transfer of
11 ownership, repay or make arrangements to repay to the agency
12 or the Department of Children and Family Services any amounts
13 owed to the agency or the department. Should the transferor
14 fail to repay or make arrangements to repay the amounts owed
15 to the agency or the department prior to the transfer of
16 ownership, the issuance of a license to the transferee shall
17 be delayed until repayment or until arrangements for repayment
18 are made.
19 (2)(5) Because any transfer of a nursing facility may
20 expose the fact that Medicaid may have underpaid or overpaid
21 the transferor, and because in most instances, any such
22 underpayment or overpayment can only be determined following a
23 formal field audit, the liabilities for any such underpayments
24 or overpayments shall be as follows:
25 (a) The Medicaid program shall be liable to the
26 transferor for any underpayments owed during the transferor's
27 period of operation of the facility.
28 (b) Without regard to whether the transferor had
29 leased or owned the nursing facility, the transferor shall
30 remain liable to the Medicaid program for all Medicaid
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1 overpayments received during the transferor's period of
2 operation of the facility, regardless of when determined.
3 (c) Where the facility transfer takes any form of a
4 sale of assets, in addition to the transferor's continuing
5 liability for any such overpayments, if the transferor fails
6 to meet these obligations, the transferee shall be liable for
7 all liabilities that can be readily identifiable 90 days in
8 advance of the transfer. Such liability shall continue in
9 succession until the debt is ultimately paid or otherwise
10 resolved. It shall be the burden of the transferee to
11 determine the amount of all such readily identifiable
12 overpayments from the Agency for Health Care Administration,
13 and the agency shall cooperate in every way with the
14 identification of such amounts. Readily identifiable
15 overpayments shall include overpayments that will result from,
16 but not be limited to:
17 1. Medicaid rate changes or adjustments;
18 2. Any depreciation recapture;
19 3. Any recapture of fair rental value system indexing;
20 or
21 4. Audits completed by the agency.
22
23 The transferor shall remain liable for any such Medicaid
24 overpayments that were not readily identifiable 90 days in
25 advance of the nursing facility transfer.
26 (d) Where the transfer involves a facility that has
27 been leased by the transferor:
28 1. The transferee shall, as a condition to being
29 issued a license by the agency, acquire, maintain, and provide
30 proof to the agency of a bond with a term of 30 months,
31 renewable annually, in an amount not less than the total of 3
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1 months Medicaid payments to the facility computed on the basis
2 of the preceding 12-month average Medicaid payments to the
3 facility.
4 2. A leasehold licensee may meet the requirements of
5 subparagraph 1. by payment of a nonrefundable fee, paid at
6 initial licensure, paid at the time of any subsequent change
7 of ownership, and paid at the time of any subsequent change of
8 ownership, and paid annually thereafter at the time of any
9 subsequent annual license renewal, in the amount of 2 percent
10 of the total of 3 months' Medicaid payments to the facility
11 computed on the basis of the preceding 12-month average
12 Medicaid payments to the facility. If a preceding 12-month
13 average is not available, projected Medicaid payments may be
14 used. The fee shall be deposited into the Health Care Trust
15 Fund and shall be accounted for separately as a Medicaid
16 nursing home overpayment account. These fees shall be used at
17 the sole discretion of the agency to repay nursing home
18 Medicaid overpayments. Payment of this fee shall not release
19 the licensee from any liability for any Medicaid overpayments,
20 nor shall payment bar the agency from seeking to recoup
21 overpayments from the licensee and any other liable party. As
22 a condition of exercising this lease bond alternative,
23 licensees paying this fee must maintain an existing lease bond
24 through the end of the 30-month term period of that bond. The
25 agency is herein granted specific authority to promulgate all
26 rules pertaining to the administration and management of this
27 account, including withdrawals from the account, subject to
28 federal review and approval. This provision shall take effect
29 upon becoming law and shall apply to any leasehold license
30 application.
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1 a. The financial viability of the Medicaid nursing
2 home overpayment account shall be determined by the agency
3 through annual review of the account balance and the amount of
4 total outstanding, unpaid Medicaid overpayments owing from
5 leasehold licensees to the agency as determined by final
6 agency audits.
7 b. The agency, in consultation with the Florida Health
8 Care Association and the Florida Association of Homes for the
9 Aging, shall study and make recommendations on the minimum
10 amount to be held in reserve to protect against Medicaid
11 overpayments to leasehold licensees and on the issue of
12 successor liability for Medicaid overpayments upon sale or
13 transfer of ownership of a nursing facility. The agency shall
14 submit the findings and recommendations of the study to the
15 Governor, the President of the Senate, and the Speaker of the
16 House of Representatives by January 1, 2003.
17 3. The leasehold licensee may meet the bond
18 requirement through other arrangements acceptable to the
19 agency. The agency is herein granted specific authority to
20 promulgate rules pertaining to lease bond arrangements.
21 4. All existing nursing facility licensees, operating
22 the facility as a leasehold, shall acquire, maintain, and
23 provide proof to the agency of the 30-month bond required in
24 subparagraph 1., above, on and after July 1, 1993, for each
25 license renewal.
26 5. It shall be the responsibility of all nursing
27 facility operators, operating the facility as a leasehold, to
28 renew the 30-month bond and to provide proof of such renewal
29 to the agency annually at the time of application for license
30 renewal.
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1 6. Any failure of the nursing facility licensee
2 operator to acquire, maintain, renew annually, or provide
3 proof to the agency shall be grounds for the agency to deny
4 or, cancel, revoke, or suspend the facility license to operate
5 such facility and to take any further action, including, but
6 not limited to, enjoining the facility, asserting a moratorium
7 pursuant to part II of chapter 408, or applying for a
8 receiver, deemed necessary to ensure compliance with this
9 section and to safeguard and protect the health, safety, and
10 welfare of the facility's residents. A lease agreement
11 required as a condition of bond financing or refinancing under
12 s. 154.213 by a health facilities authority or required under
13 s. 159.30 by a county or municipality is not a leasehold for
14 purposes of this paragraph and is not subject to the bond
15 requirement of this paragraph.
16 Section 69. Subsections (1) and (4) of section 400.18,
17 Florida Statutes, are amended to read:
18 400.18 Closing of nursing facility.--
19 (1) Whenever a licensee voluntarily discontinues
20 operation, and during the period when it is preparing for such
21 discontinuance, it shall inform the agency not less than 90
22 days prior to the discontinuance of operation. The licensee
23 also shall inform the resident or the next of kin, legal
24 representative, or agency acting on behalf of the resident of
25 the fact, and the proposed time, of such discontinuance of
26 operation and give at least 90 days' notice so that suitable
27 arrangements may be made for the transfer and care of the
28 resident. In the event any resident has no such person to
29 represent him or her, the licensee shall be responsible for
30 securing a suitable transfer of the resident before the
31 discontinuance of operation. The agency shall be responsible
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1 for arranging for the transfer of those residents requiring
2 transfer who are receiving assistance under the Medicaid
3 program.
4 (4) Immediately upon discontinuance of operation of a
5 facility, the licensee shall surrender the license therefor to
6 the agency, and the license shall be canceled.
7 Section 70. Subsections (1), (2), and (3) of section
8 400.19, Florida Statutes, are amended to read:
9 400.19 Right of entry and inspection.--
10 (1) In accordance with part II of chapter 408, the
11 agency and any duly designated officer or employee thereof or
12 a member of the State Long-Term Care Ombudsman Council or the
13 local long-term care ombudsman council shall have the right to
14 enter upon and into the premises of any facility licensed
15 pursuant to this part, or any distinct nursing home unit of a
16 hospital licensed under chapter 395 or any freestanding
17 facility licensed under chapter 395 that provides extended
18 care or other long-term care services, at any reasonable time
19 in order to determine the state of compliance with the
20 provisions of this part and rules in force pursuant thereto.
21 The right of entry and inspection shall also extend to any
22 premises which the agency has reason to believe is being
23 operated or maintained as a facility without a license, but no
24 such entry or inspection of any premises shall be made without
25 the permission of the owner or person in charge thereof,
26 unless a warrant is first obtained from the circuit court
27 authorizing same. Any application for a facility license or
28 renewal thereof, made pursuant to this part, shall constitute
29 permission for and complete acquiescence in any entry or
30 inspection of the premises for which the license is sought, in
31 order to facilitate verification of the information submitted
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1 on or in connection with the application; to discover,
2 investigate, and determine the existence of abuse or neglect;
3 or to elicit, receive, respond to, and resolve complaints. The
4 agency shall, within 60 days after receipt of a complaint made
5 by a resident or resident's representative, complete its
6 investigation and provide to the complainant its findings and
7 resolution.
8 (2) The agency shall coordinate nursing home facility
9 licensing activities and responsibilities of any duly
10 designated officer or employee involved in nursing home
11 facility inspection to assure necessary, equitable, and
12 consistent supervision of inspection personnel without
13 unnecessary duplication of inspections, consultation services,
14 or complaint investigations. To facilitate such coordination,
15 all rules promulgated by the agency pursuant to this part
16 shall be distributed to nursing homes licensed under s.
17 400.062 30 days prior to implementation. This requirement
18 does not apply to emergency rules.
19 (3) The agency shall every 15 months conduct at least
20 one unannounced inspection to determine compliance by the
21 licensee with statutes, and with rules promulgated under the
22 provisions of those statutes, governing minimum standards of
23 construction, quality and adequacy of care, and rights of
24 residents. The survey shall be conducted every 6 months for
25 the next 2-year period if the facility has been cited for a
26 class I deficiency, has been cited for two or more class II
27 deficiencies arising from separate surveys or investigations
28 within a 60-day period, or has had three or more substantiated
29 complaints within a 6-month period, each resulting in at least
30 one class I or class II deficiency. In addition to any other
31 fees or fines in this part, the agency shall assess a fine for
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1 each facility that is subject to the 6-month survey cycle. The
2 fine for the 2-year period shall be $6,000, one-half to be
3 paid at the completion of each survey. The agency may adjust
4 this fine by the change in the Consumer Price Index, based on
5 the 12 months immediately preceding the increase, to cover the
6 cost of the additional surveys. The agency shall verify
7 through subsequent inspection that any deficiency identified
8 during the annual inspection is corrected. However, the
9 agency may verify the correction of a class III or class IV
10 deficiency unrelated to resident rights or resident care
11 without reinspecting the facility if adequate written
12 documentation has been received from the facility, which
13 provides assurance that the deficiency has been corrected. The
14 giving or causing to be given of advance notice of such
15 unannounced inspections by an employee of the agency to any
16 unauthorized person shall constitute cause for suspension of
17 not fewer than 5 working days according to the provisions of
18 chapter 110.
19 Section 71. Section 400.191, Florida Statutes, is
20 amended to read:
21 400.191 Availability, distribution, and posting of
22 reports and records.--
23 (1) The agency shall provide information to the public
24 about all of the licensed nursing home facilities operating in
25 the state. The agency shall, within 60 days after an annual
26 inspection visit or within 30 days after any interim visit to
27 a facility, send copies of the inspection reports to the local
28 long-term care ombudsman council, the agency's local office,
29 and a public library or the county seat for the county in
30 which the facility is located. The agency may provide
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1 electronic access to inspection reports as a substitute for
2 sending copies.
3 (2) The agency shall publish the Guide to Nursing
4 Homes in Florida provide additional information in
5 consumer-friendly printed and electronic formats to assist
6 consumers and their families in comparing and evaluating
7 nursing home facilities.
8 (a) The agency shall provide an Internet site which
9 shall include at least the following information either
10 directly or indirectly through a link to another established
11 site or sites of the agency's choosing:
12 1. A list by name and address of all nursing home
13 facilities in this state, including any prior name a facility
14 was known by during the previous 12-month period.
15 2. Whether such nursing home facilities are
16 proprietary or nonproprietary.
17 3. The current owner of the facility's license and the
18 year that that entity became the owner of the license.
19 4. The name of the owner or owners of each facility
20 and whether the facility is affiliated with a company or other
21 organization owning or managing more than one nursing facility
22 in this state.
23 5. The total number of beds in each facility and the
24 most recently available occupancy levels.
25 6. The number of private and semiprivate rooms in each
26 facility.
27 7. The religious affiliation, if any, of each
28 facility.
29 8. The languages spoken by the administrator and staff
30 of each facility.
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1 9. Whether or not each facility accepts Medicare or
2 Medicaid recipients or insurance, health maintenance
3 organization, Veterans Administration, CHAMPUS program, or
4 workers' compensation coverage.
5 10. Recreational and other programs available at each
6 facility.
7 11. Special care units or programs offered at each
8 facility.
9 12. Whether the facility is a part of a retirement
10 community that offers other services pursuant to part III,
11 part IV, or part V.
12 13. Survey and deficiency information contained on the
13 Online Survey Certification and Reporting (OSCAR) system of
14 the federal Centers for Medicare and Medicaid Services Health
15 Care Financing Administration, including recertification
16 annual survey, revisit, and complaint survey information, for
17 each facility for the past 30 45 months. For noncertified
18 nursing homes, state survey and deficiency information,
19 including licensure annual survey, revisit, and complaint
20 survey information for the past 30 45 months shall be
21 provided.
22 14. A summary of the Online Survey Certification and
23 Reporting (OSCAR) data for each facility over the past 30 45
24 months. Such summary may include a score, rating, or
25 comparison ranking with respect to other facilities based on
26 the number of citations received by the facility of
27 recertification annual, revisit, and complaint surveys; the
28 severity and scope of the citations; and the number of annual
29 recertification surveys the facility has had during the past
30 30 45 months. The score, rating, or comparison ranking may be
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1 presented in either numeric or symbolic form for the intended
2 consumer audience.
3 (b) The agency shall provide the following information
4 in printed form:
5 1. A list by name and address of all nursing home
6 facilities in this state.
7 2. Whether such nursing home facilities are
8 proprietary or nonproprietary.
9 3. The current owner or owners of the facility's
10 license and the year that entity became the owner of the
11 license.
12 4. The total number of beds, and of private and
13 semiprivate rooms, in each facility.
14 5. The religious affiliation, if any, of each
15 facility.
16 6. The name of the owner of each facility and whether
17 the facility is affiliated with a company or other
18 organization owning or managing more than one nursing facility
19 in this state.
20 7. The languages spoken by the administrator and staff
21 of each facility.
22 8. Whether or not each facility accepts Medicare or
23 Medicaid recipients or insurance, health maintenance
24 organization, Veterans Administration, CHAMPUS program, or
25 workers' compensation coverage.
26 9. Recreational programs, special care units, and
27 other programs available at each facility.
28 10. The Internet address for the site where more
29 detailed information can be seen.
30
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1 11. A statement advising consumers that each facility
2 will have its own policies and procedures related to
3 protecting resident property.
4 12. A summary of the Online Survey Certification and
5 Reporting (OSCAR) data for each facility over the past 30 45
6 months. Such summary may include a score, rating, or
7 comparison ranking with respect to other facilities based on
8 the number of citations received by the facility on
9 recertification annual, revisit, and complaint surveys; the
10 severity and scope of the citations; the number of citations;
11 and the number of annual recertification surveys the facility
12 has had during the past 30 45 months. The score, rating, or
13 comparison ranking may be presented in either numeric or
14 symbolic form for the intended consumer audience.
15 (c) For purposes of this subsection, references to the
16 Online Survey Certification and Reporting (OSCAR) system shall
17 refer to any future system that the Centers for Medicare and
18 Medicaid Services Health Care Financing Administration
19 develops to replace the current OSCAR system.
20 (d) The agency may provide the following additional
21 information on an Internet site or in printed form as the
22 information becomes available:
23 1. The licensure status history of each facility.
24 2. The rating history of each facility.
25 3. The regulatory history of each facility, which may
26 include federal sanctions, state sanctions, federal fines,
27 state fines, and other actions.
28 4. Whether the facility currently possesses the Gold
29 Seal designation awarded pursuant to s. 400.235.
30 5. Internet links to the Internet sites of the
31 facilities or their affiliates.
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1 (3) Each nursing home facility licensee shall maintain
2 as public information, available upon request, records of all
3 cost and inspection reports pertaining to that facility that
4 have been filed with, or issued by, any governmental agency.
5 Copies of such reports shall be retained in such records for
6 not less than 5 years from the date the reports are filed or
7 issued.
8 (a) The agency shall quarterly publish in the Guide to
9 Nursing Homes in Florida a "Nursing Home Guide Watch List" to
10 assist consumers in evaluating the quality of nursing home
11 care in Florida. The watch list must identify each facility
12 that met the criteria for a conditional licensure status on
13 any day within the quarter covered by the list and each
14 facility that was operating under bankruptcy protection on any
15 day within the quarter. The watch list must include, but is
16 not limited to, the facility's name, address, and ownership;
17 the county in which the facility operates; the license
18 expiration date; the number of licensed beds; a description of
19 the deficiency causing the facility to be placed on the list;
20 any corrective action taken; and the cumulative number and
21 percentage of days times the facility had a conditional
22 license and was has been on a watch list in the past 30
23 months. The watch list must include a brief description
24 regarding how to choose a nursing home, the categories of
25 licensure, the agency's inspection process, an explanation of
26 terms used in the watch list, and the addresses and phone
27 numbers of the agency's managed care and health quality
28 assurance field area offices.
29 (b) Upon publication of each quarterly Guide to
30 Nursing Homes in Florida watch list, the agency must transmit
31 a copy of all pages listing the facility the watch list to
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1 each nursing home facility by mail and must make the watch
2 list available on the agency's Internet website.
3 (4) Any records of a nursing home facility determined
4 by the agency to be necessary and essential to establish
5 lawful compliance with any rules or standards shall be made
6 available to the agency on the premises of the facility and
7 submitted to the agency. Each facility must submit this
8 information electronically when electronic transmission to the
9 agency is available.
10 (5) Every nursing home facility licensee shall:
11 (a) Post, in a sufficient number of prominent
12 positions in the nursing home so as to be accessible to all
13 residents and to the general public:
14 1. A concise summary of the last inspection report
15 pertaining to the nursing home and issued by the agency, with
16 references to the page numbers of the full reports, noting any
17 deficiencies found by the agency and the actions taken by the
18 licensee to rectify such deficiencies and indicating in such
19 summaries where the full reports may be inspected in the
20 nursing home.
21 2. A copy of the most recent version of all pages
22 listing the facility in the Guide to Nursing Homes in Florida
23 the Florida Nursing Home Guide Watch List.
24 (b) Upon request, provide to any person who has
25 completed a written application with an intent to be admitted
26 to, or to any resident of, such nursing home, or to any
27 relative, spouse, or guardian of such person, a copy of the
28 last inspection report pertaining to the nursing home and
29 issued by the agency, provided the person requesting the
30 report agrees to pay a reasonable charge to cover copying
31 costs.
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1 (6) The agency may adopt rules as necessary to
2 administer this section.
3 Section 72. Section 400.20, Florida Statutes, is
4 amended to read:
5 400.20 Licensed nursing home administrator
6 required.--A No nursing home may not shall operate except
7 under the supervision of a licensed nursing home
8 administrator, and a no person may not shall be a nursing home
9 administrator unless he or she holds is the holder of a
10 current license as provided in chapter 468.
11 Section 73. Subsection (4) of section 400.211, Florida
12 Statutes, is amended to read:
13 400.211 Persons employed as nursing assistants;
14 certification requirement.--
15 (4) When employed by a nursing home facility for a
16 12-month period or longer, a nursing assistant, to maintain
17 certification, shall submit to a performance review every 12
18 months and must receive regular inservice education based on
19 the outcome of such reviews. The inservice training must:
20 (a) Be sufficient to ensure the continuing competence
21 of nursing assistants and be in accordance with s. 464.203(7),
22 must be at least 18 hours per year, and may include hours
23 accrued under s. 464.203(8);
24 (b) Include, at a minimum:
25 1. Techniques for assisting with eating and proper
26 feeding;
27 2. Principles of adequate nutrition and hydration;
28 3. Techniques for assisting and responding to the
29 cognitively impaired resident or the resident with difficult
30 behaviors;
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1 4. Techniques for caring for the resident at the
2 end-of-life; and
3 5. Recognizing changes that place a resident at risk
4 for pressure ulcers and falls; and
5 (c) Address areas of weakness as determined in nursing
6 assistant performance reviews and may address the special
7 needs of residents as determined by the nursing home facility
8 staff.
9
10 Costs associated with this training may not be reimbursed from
11 additional Medicaid funding through interim rate adjustments.
12 Section 74. Subsections (2), (7), and (8) of section
13 400.23, Florida Statutes, are amended, and subsection (10) is
14 added to that section, to read:
15 400.23 Rules; evaluation and deficiencies; licensure
16 status.--
17 (2) Pursuant to the intention of the Legislature, the
18 agency, in consultation with the Department of Health and the
19 Department of Elderly Affairs, shall adopt and enforce rules
20 to implement this part and part II of chapter 408, which shall
21 include reasonable and fair criteria in relation to:
22 (a) The location of the facility and housing
23 conditions that will ensure the health, safety, and comfort of
24 residents, including an adequate call system. In making such
25 rules, the agency shall be guided by criteria recommended by
26 nationally recognized reputable professional groups and
27 associations with knowledge of such subject matters. The
28 agency shall update or revise such criteria as the need
29 arises. The agency may require alterations to a building if it
30 determines that an existing condition constitutes a distinct
31 hazard to life, health, or safety. In performing any
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1 inspections of facilities authorized by this part, the agency
2 may enforce the special-occupancy provisions of the Florida
3 Building Code and the Florida Fire Prevention Code which apply
4 to nursing homes. The agency is directed to provide assistance
5 to the Florida Building Commission in updating the
6 construction standards of the code relative to nursing homes.
7 (b) The number and qualifications of all personnel,
8 including management, medical, nursing, and other professional
9 personnel, and nursing assistants, orderlies, and support
10 personnel, having responsibility for any part of the care
11 given residents.
12 (c) All sanitary conditions within the facility and
13 its surroundings, including water supply, sewage disposal,
14 food handling, and general hygiene which will ensure the
15 health and comfort of residents.
16 (d) The equipment essential to the health and welfare
17 of the residents.
18 (e) A uniform accounting system.
19 (f) The care, treatment, and maintenance of residents
20 and measurement of the quality and adequacy thereof, based on
21 rules developed under this chapter and the Omnibus Budget
22 Reconciliation Act of 1987 (Pub. L. No. 100-203) (December 22,
23 1987), Title IV (Medicare, Medicaid, and Other Health-Related
24 Programs), Subtitle C (Nursing Home Reform), as amended.
25 (g) The preparation and annual update of a
26 comprehensive emergency management plan. The agency shall
27 adopt rules establishing minimum criteria for the plan after
28 consultation with the Department of Community Affairs. At a
29 minimum, the rules must provide for plan components that
30 address emergency evacuation transportation; adequate
31 sheltering arrangements; postdisaster activities, including
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1 emergency power, food, and water; postdisaster transportation;
2 supplies; staffing; emergency equipment; individual
3 identification of residents and transfer of records; and
4 responding to family inquiries. The comprehensive emergency
5 management plan is subject to review and approval by the local
6 emergency management agency. During its review, the local
7 emergency management agency shall ensure that the following
8 agencies, at a minimum, are given the opportunity to review
9 the plan: the Department of Elderly Affairs, the Department
10 of Health, the Agency for Health Care Administration, and the
11 Department of Community Affairs. Also, appropriate volunteer
12 organizations must be given the opportunity to review the
13 plan. The local emergency management agency shall complete
14 its review within 60 days and either approve the plan or
15 advise the facility of necessary revisions.
16 (h) The availability, distribution, and posting of
17 reports and records pursuant to s. 400.191 and the Gold Seal
18 Program pursuant to s. 400.235.
19 (7) The agency shall, at least every 15 months,
20 evaluate all nursing home facilities and make a determination
21 as to the degree of compliance by each licensee with the
22 established rules adopted under this part as a basis for
23 assigning a licensure status to that facility. The agency
24 shall base its evaluation on the most recent inspection
25 report, taking into consideration findings from other official
26 reports, surveys, interviews, investigations, and inspections.
27 The agency shall assign a licensure status of standard or
28 conditional to each nursing home.
29 (a) A standard licensure status means that a facility
30 has no class I or class II deficiencies and has corrected all
31
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1 class III deficiencies within the time established by the
2 agency.
3 (b) A conditional licensure status means that a
4 facility, due to the presence of one or more class I or class
5 II deficiencies, or class III deficiencies not corrected
6 within the time established by the agency, is not in
7 substantial compliance at the time of the survey with criteria
8 established under this part or with rules adopted by the
9 agency. If the facility has no class I, class II, or class
10 III deficiencies at the time of the followup survey, a
11 standard licensure status may be assigned.
12 (c) In evaluating the overall quality of care and
13 services and determining whether the facility will receive a
14 conditional or standard license, the agency shall consider the
15 needs and limitations of residents in the facility and the
16 results of interviews and surveys of a representative sampling
17 of residents, families of residents, ombudsman council members
18 in the planning and service area in which the facility is
19 located, guardians of residents, and staff of the nursing home
20 facility.
21 (d) The current licensure status of each facility must
22 be indicated in bold print on the face of the license. A list
23 of the deficiencies of the facility shall be posted in a
24 prominent place that is in clear and unobstructed public view
25 at or near the place where residents are being admitted to
26 that facility. Licensees receiving a conditional licensure
27 status for a facility shall prepare, within 10 working days
28 after receiving notice of deficiencies, a plan for correction
29 of all deficiencies and shall submit the plan to the agency
30 for approval.
31
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1 (e) Each licensee shall post its license in a
2 prominent place that is in clear and unobstructed public view
3 at or near the place where residents are being admitted to the
4 facility.
5 (e)(f) The agency shall adopt rules that:
6 1. Establish uniform procedures for the evaluation of
7 facilities.
8 2. Provide criteria in the areas referenced in
9 paragraph (c).
10 3. Address other areas necessary for carrying out the
11 intent of this section.
12 (8) The agency shall adopt rules pursuant to this part
13 and part II of chapter 408 to provide that, when the criteria
14 established under subsection (2) are not met, such
15 deficiencies shall be classified according to the nature and
16 the scope of the deficiency. The scope shall be cited as
17 isolated, patterned, or widespread. An isolated deficiency is
18 a deficiency affecting one or a very limited number of
19 residents, or involving one or a very limited number of staff,
20 or a situation that occurred only occasionally or in a very
21 limited number of locations. A patterned deficiency is a
22 deficiency where more than a very limited number of residents
23 are affected, or more than a very limited number of staff are
24 involved, or the situation has occurred in several locations,
25 or the same resident or residents have been affected by
26 repeated occurrences of the same deficient practice but the
27 effect of the deficient practice is not found to be pervasive
28 throughout the facility. A widespread deficiency is a
29 deficiency in which the problems causing the deficiency are
30 pervasive in the facility or represent systemic failure that
31 has affected or has the potential to affect a large portion of
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1 the facility's residents. The agency shall indicate the
2 classification on the face of the notice of deficiencies as
3 follows:
4 (a) A class I deficiency is a deficiency that the
5 agency determines presents a situation in which immediate
6 corrective action is necessary because the facility's
7 noncompliance has caused, or is likely to cause, serious
8 injury, harm, impairment, or death to a resident receiving
9 care in a facility. The condition or practice constituting a
10 class I violation shall be abated or eliminated immediately,
11 unless a fixed period of time, as determined by the agency, is
12 required for correction. A class I deficiency is subject to a
13 civil penalty of $10,000 for an isolated deficiency, $12,500
14 for a patterned deficiency, and $15,000 for a widespread
15 deficiency. The fine amount shall be doubled for each
16 deficiency if the facility was previously cited for one or
17 more class I or class II deficiencies during the last
18 licensure annual inspection or any inspection or complaint
19 investigation since the last licensure annual inspection. A
20 fine must be levied notwithstanding the correction of the
21 deficiency.
22 (b) A class II deficiency is a deficiency that the
23 agency determines has compromised the resident's ability to
24 maintain or reach his or her highest practicable physical,
25 mental, and psychosocial well-being, as defined by an accurate
26 and comprehensive resident assessment, plan of care, and
27 provision of services. A class II deficiency is subject to a
28 civil penalty of $2,500 for an isolated deficiency, $5,000 for
29 a patterned deficiency, and $7,500 for a widespread
30 deficiency. The fine amount shall be doubled for each
31 deficiency if the facility was previously cited for one or
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1 more class I or class II deficiencies during the last
2 licensure annual inspection or any inspection or complaint
3 investigation since the last licensure annual inspection. A
4 fine shall be levied notwithstanding the correction of the
5 deficiency.
6 (c) A class III deficiency is a deficiency that the
7 agency determines will result in no more than minimal
8 physical, mental, or psychosocial discomfort to the resident
9 or has the potential to compromise the resident's ability to
10 maintain or reach his or her highest practical physical,
11 mental, or psychosocial well-being, as defined by an accurate
12 and comprehensive resident assessment, plan of care, and
13 provision of services. A class III deficiency is subject to a
14 civil penalty of $1,000 for an isolated deficiency, $2,000 for
15 a patterned deficiency, and $3,000 for a widespread
16 deficiency. The fine amount shall be doubled for each
17 deficiency if the facility was previously cited for one or
18 more class I or class II deficiencies during the last
19 licensure annual inspection or any inspection or complaint
20 investigation since the last licensure annual inspection. A
21 citation for a class III deficiency must specify the time
22 within which the deficiency is required to be corrected. If a
23 class III deficiency is corrected within the time specified,
24 no civil penalty shall be imposed.
25 (d) A class IV deficiency is a deficiency that the
26 agency determines has the potential for causing no more than a
27 minor negative impact on the resident. If the class IV
28 deficiency is isolated, no plan of correction is required.
29 (10) Agency records, reports, ranking systems,
30 Internet information, and publications must be promptly
31 updated to reflect the most current agency actions.
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1 Section 75. Subsections (1) and (2) of section
2 400.241, Florida Statutes, are repealed.
3 Section 76. Subsection (5) of section 400.402, Florida
4 Statutes, is repealed and present subsections (12), (14), and
5 (17) of that section are redesignated as subsections (11),
6 (13), and (16), respectively, and amended to read:
7 400.402 Definitions.--When used in this part, the
8 term:
9 (5) "Applicant" means an individual owner,
10 corporation, partnership, firm, association, or governmental
11 entity that applies for a license.
12 (11)(12) "Extended congregate care" means acts beyond
13 those authorized in subsection (16) (17) that may be performed
14 pursuant to part I of chapter 464 by persons licensed
15 thereunder while carrying out their professional duties, and
16 other supportive services which may be specified by rule. The
17 purpose of such services is to enable residents to age in
18 place in a residential environment despite mental or physical
19 limitations that might otherwise disqualify them from
20 residency in a facility licensed under this part.
21 (13)(14) "Limited nursing services" means acts that
22 may be performed pursuant to part I of chapter 464 by persons
23 licensed thereunder while carrying out their professional
24 duties but limited to those acts which the agency department
25 specifies by rule. Acts which may be specified by rule as
26 allowable limited nursing services shall be for persons who
27 meet the admission criteria established by the agency
28 department for assisted living facilities and shall not be
29 complex enough to require 24-hour nursing supervision and may
30 include such services as the application and care of routine
31 dressings, and care of casts, braces, and splints.
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1 (16)(17) "Personal services" means direct physical
2 assistance with or supervision of the activities of daily
3 living and the self-administration of medication and other
4 similar services which the agency department may define by
5 rule. "Personal services" shall not be construed to mean the
6 provision of medical, nursing, dental, or mental health
7 services.
8 Section 77. Section 400.407, Florida Statutes, is
9 amended to read:
10 400.407 License required; fee, display.--
11 (1) The requirements of part II of chapter 408 apply
12 to the provision of services that necessitate licensure
13 pursuant to this part and part II of chapter 408 and to
14 entities licensed by or applying for such licensure from the
15 Agency for Health Care Administration pursuant to this part.
16 However, an applicant for licensure is exempt from s.
17 408.810(10). A license issued by the agency is required for an
18 assisted living facility operating in this state.
19 (2) Separate licenses shall be required for facilities
20 maintained in separate premises, even though operated under
21 the same management. A separate license shall not be required
22 for separate buildings on the same grounds.
23 (3) In addition to the requirements of s. 408.806,
24 each any license granted by the agency must state the maximum
25 resident capacity of the facility, the type of care for which
26 the license is granted, the date the license is issued, the
27 expiration date of the license, and any other information
28 deemed necessary by the agency. Licenses shall be issued for
29 one or more of the following categories of care: standard,
30 extended congregate care, limited nursing services, or limited
31 mental health.
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1 (a) A standard license shall be issued to facilities
2 providing one or more of the personal services identified in
3 s. 400.402. Such facilities may also employ or contract with a
4 person licensed under part I of chapter 464 to administer
5 medications and perform other tasks as specified in s.
6 400.4255.
7 (b) An extended congregate care license shall be
8 issued to facilities providing, directly or through contract,
9 services beyond those authorized in paragraph (a), including
10 acts performed pursuant to part I of chapter 464 by persons
11 licensed thereunder, and supportive services defined by rule
12 to persons who otherwise would be disqualified from continued
13 residence in a facility licensed under this part.
14 1. In order for extended congregate care services to
15 be provided in a facility licensed under this part, the agency
16 must first determine that all requirements established in law
17 and rule are met and must specifically designate, on the
18 facility's license, that such services may be provided and
19 whether the designation applies to all or part of a facility.
20 Such designation may be made at the time of initial licensure
21 or relicensure, or upon request in writing by a licensee under
22 this part pursuant to s. 408.806. Notification of approval or
23 denial of such request shall be made in accordance with part
24 II of chapter 408 within 90 days after receipt of such request
25 and all necessary documentation. Existing facilities
26 qualifying to provide extended congregate care services must
27 have maintained a standard license and may not have been
28 subject to administrative sanctions during the previous 2
29 years, or since initial licensure if the facility has been
30 licensed for less than 2 years, for any of the following
31 reasons:
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1 a. A class I or class II violation;
2 b. Three or more repeat or recurring class III
3 violations of identical or similar resident care standards as
4 specified in rule from which a pattern of noncompliance is
5 found by the agency;
6 c. Three or more class III violations that were not
7 corrected in accordance with the corrective action plan
8 approved by the agency;
9 d. Violation of resident care standards resulting in a
10 requirement to employ the services of a consultant pharmacist
11 or consultant dietitian;
12 e. Denial, suspension, or revocation of a license for
13 another facility under this part in which the applicant for an
14 extended congregate care license has at least 25 percent
15 ownership interest; or
16 f. Imposition of a moratorium on admissions or
17 initiation of injunctive proceedings.
18 2. Facilities that are licensed to provide extended
19 congregate care services shall maintain a written progress
20 report on each person who receives such services, which report
21 describes the type, amount, duration, scope, and outcome of
22 services that are rendered and the general status of the
23 resident's health. A registered nurse, or appropriate
24 designee, representing the agency shall visit such facilities
25 at least quarterly to monitor residents who are receiving
26 extended congregate care services and to determine if the
27 facility is in compliance with this part, part II of chapter
28 408, and with rules that relate to extended congregate care.
29 One of these visits may be in conjunction with the regular
30 survey. The monitoring visits may be provided through
31 contractual arrangements with appropriate community agencies.
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1 A registered nurse shall serve as part of the team that
2 inspects such facility. The agency may waive one of the
3 required yearly monitoring visits for a facility that has been
4 licensed for at least 24 months to provide extended congregate
5 care services, if, during the inspection, the registered nurse
6 determines that extended congregate care services are being
7 provided appropriately, and if the facility has no class I or
8 class II violations and no uncorrected class III violations.
9 Before such decision is made, the agency shall consult with
10 the long-term care ombudsman council for the area in which the
11 facility is located to determine if any complaints have been
12 made and substantiated about the quality of services or care.
13 The agency may not waive one of the required yearly monitoring
14 visits if complaints have been made and substantiated.
15 3. Facilities that are licensed to provide extended
16 congregate care services shall:
17 a. Demonstrate the capability to meet unanticipated
18 resident service needs.
19 b. Offer a physical environment that promotes a
20 homelike setting, provides for resident privacy, promotes
21 resident independence, and allows sufficient congregate space
22 as defined by rule.
23 c. Have sufficient staff available, taking into
24 account the physical plant and firesafety features of the
25 building, to assist with the evacuation of residents in an
26 emergency, as necessary.
27 d. Adopt and follow policies and procedures that
28 maximize resident independence, dignity, choice, and
29 decisionmaking to permit residents to age in place to the
30 extent possible, so that moves due to changes in functional
31 status are minimized or avoided.
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1 e. Allow residents or, if applicable, a resident's
2 representative, designee, surrogate, guardian, or attorney in
3 fact to make a variety of personal choices, participate in
4 developing service plans, and share responsibility in
5 decisionmaking.
6 f. Implement the concept of managed risk.
7 g. Provide, either directly or through contract, the
8 services of a person licensed pursuant to part I of chapter
9 464.
10 h. In addition to the training mandated in s. 400.452,
11 provide specialized training as defined by rule for facility
12 staff.
13 4. Facilities licensed to provide extended congregate
14 care services are exempt from the criteria for continued
15 residency as set forth in rules adopted under s. 400.441.
16 Facilities so licensed shall adopt their own requirements
17 within guidelines for continued residency set forth by the
18 department in rule. However, such facilities may not serve
19 residents who require 24-hour nursing supervision. Facilities
20 licensed to provide extended congregate care services shall
21 provide each resident with a written copy of facility policies
22 governing admission and retention.
23 5. The primary purpose of extended congregate care
24 services is to allow residents, as they become more impaired,
25 the option of remaining in a familiar setting from which they
26 would otherwise be disqualified for continued residency. A
27 facility licensed to provide extended congregate care services
28 may also admit an individual who exceeds the admission
29 criteria for a facility with a standard license, if the
30 individual is determined appropriate for admission to the
31 extended congregate care facility.
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1 6. Before admission of an individual to a facility
2 licensed to provide extended congregate care services, the
3 individual must undergo a medical examination as provided in
4 s. 400.426(4) and the facility must develop a preliminary
5 service plan for the individual.
6 7. When a facility can no longer provide or arrange
7 for services in accordance with the resident's service plan
8 and needs and the facility's policy, the facility shall make
9 arrangements for relocating the person in accordance with s.
10 400.428(1)(k).
11 8. Failure to provide extended congregate care
12 services may result in denial of extended congregate care
13 license renewal.
14 9. No later than January 1 of each year, the
15 department, in consultation with the agency, shall prepare and
16 submit to the Governor, the President of the Senate, the
17 Speaker of the House of Representatives, and the chairs of
18 appropriate legislative committees, a report on the status of,
19 and recommendations related to, extended congregate care
20 services. The status report must include, but need not be
21 limited to, the following information:
22 a. A description of the facilities licensed to provide
23 such services, including total number of beds licensed under
24 this part.
25 b. The number and characteristics of residents
26 receiving such services.
27 c. The types of services rendered that could not be
28 provided through a standard license.
29 d. An analysis of deficiencies cited during licensure
30 inspections.
31
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1 e. The number of residents who required extended
2 congregate care services at admission and the source of
3 admission.
4 f. Recommendations for statutory or regulatory
5 changes.
6 g. The availability of extended congregate care to
7 state clients residing in facilities licensed under this part
8 and in need of additional services, and recommendations for
9 appropriations to subsidize extended congregate care services
10 for such persons.
11 h. Such other information as the department considers
12 appropriate.
13 (c) A limited nursing services license shall be issued
14 to a facility that provides services beyond those authorized
15 in paragraph (a) and as specified in this paragraph.
16 1. In order for limited nursing services to be
17 provided in a facility licensed under this part, the agency
18 must first determine that all requirements established in law
19 and rule are met and must specifically designate, on the
20 facility's license, that such services may be provided. Such
21 designation may be made at the time of initial licensure or
22 relicensure, or upon request in writing by a licensee under
23 this part pursuant to s. 408.806. Notification of approval or
24 denial of such request shall be made in accordance with part
25 II of chapter 408 within 90 days after receipt of such request
26 and all necessary documentation. Existing facilities
27 qualifying to provide limited nursing services shall have
28 maintained a standard license and may not have been subject to
29 administrative sanctions that affect the health, safety, and
30 welfare of residents for the previous 2 years or since initial
31
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1 licensure if the facility has been licensed for less than 2
2 years.
3 2. Facilities that are licensed to provide limited
4 nursing services shall maintain a written progress report on
5 each person who receives such nursing services, which report
6 describes the type, amount, duration, scope, and outcome of
7 services that are rendered and the general status of the
8 resident's health. A registered nurse representing the agency
9 shall visit such facilities at least twice a year to monitor
10 residents who are receiving limited nursing services and to
11 determine if the facility is in compliance with applicable
12 provisions of this part and with related rules. The monitoring
13 visits may be provided through contractual arrangements with
14 appropriate community agencies. A registered nurse shall also
15 serve as part of the team that inspects such facility.
16 3. A person who receives limited nursing services
17 under this part must meet the admission criteria established
18 by the agency for assisted living facilities. When a resident
19 no longer meets the admission criteria for a facility licensed
20 under this part, arrangements for relocating the person shall
21 be made in accordance with s. 400.428(1)(k), unless the
22 facility is licensed to provide extended congregate care
23 services.
24 (4) In accordance with s. 408.805, an applicant or
25 licensee shall pay a fee for each license application
26 submitted under this part and part II of chapter 408. The
27 amount of the fee shall be established by rule.
28 (a) The biennial license fee required of a facility is
29 $300 per license, with an additional fee of $50 per resident
30 based on the total licensed resident capacity of the facility,
31 except that no additional fee will be assessed for beds
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1 designated for recipients of optional state supplementation
2 payments provided for in s. 409.212. The total fee may not
3 exceed $10,000, no part of which shall be returned to the
4 facility. The agency shall adjust the per bed license fee and
5 the total licensure fee annually by not more than the change
6 in the consumer price index based on the 12 months immediately
7 preceding the increase.
8 (b) In addition to the total fee assessed under
9 paragraph (a), the agency shall require facilities that are
10 licensed to provide extended congregate care services under
11 this part to pay an additional fee per licensed facility. The
12 amount of the biennial fee shall be $400 per license, with an
13 additional fee of $10 per resident based on the total licensed
14 resident capacity of the facility. No part of this fee shall
15 be returned to the facility. The agency may adjust the per bed
16 license fee and the annual license fee once each year by not
17 more than the average rate of inflation for the 12 months
18 immediately preceding the increase.
19 (c) In addition to the total fee assessed under
20 paragraph (a), the agency shall require facilities that are
21 licensed to provide limited nursing services under this part
22 to pay an additional fee per licensed facility. The amount of
23 the biennial fee shall be $250 per license, with an additional
24 fee of $10 per resident based on the total licensed resident
25 capacity of the facility. No part of this fee shall be
26 returned to the facility. The agency may adjust the per bed
27 license fee and the biennial license fee once each year by not
28 more than the average rate of inflation for the 12 months
29 immediately preceding the increase.
30 (5) Counties or municipalities applying for licenses
31 under this part are exempt from the payment of license fees.
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1 (6) The license shall be displayed in a conspicuous
2 place inside the facility.
3 (7) A license shall be valid only in the possession of
4 the individual, firm, partnership, association, or corporation
5 to which it is issued and shall not be subject to sale,
6 assignment, or other transfer, voluntary or involuntary; nor
7 shall a license be valid for any premises other than that for
8 which originally issued.
9 (8) A fee may be charged to a facility requesting a
10 duplicate license. The fee shall not exceed the actual cost
11 of duplication and postage.
12 Section 78. Subsection (1) of section 400.4075,
13 Florida Statutes, is amended to read:
14 400.4075 Limited mental health license.--An assisted
15 living facility that serves three or more mental health
16 residents must obtain a limited mental health license.
17 (1) To obtain a limited mental health license, a
18 facility must hold a standard license as an assisted living
19 facility, must not have any current uncorrected deficiencies
20 or violations, and must ensure that, within 6 months after
21 receiving a limited mental health license, the facility
22 administrator and the staff of the facility who are in direct
23 contact with mental health residents must complete training of
24 no less than 6 hours related to their duties. Such designation
25 may be made at the time of initial licensure or relicensure,
26 or upon request in writing by a licensee under this part
27 pursuant to s. 408.806. Notification of approval or denial of
28 such request shall be made in accordance with part II of
29 chapter 408. The This training required by this subsection
30 shall will be provided by or approved by the Department of
31 Children and Family Services.
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1 Section 79. Section 400.408, Florida Statutes, is
2 amended to read:
3 400.408 Unlicensed facilities; referral of person for
4 residency to unlicensed facility; penalties; verification of
5 licensure status.--
6 (1)(a) It is unlawful to own, operate, or maintain an
7 assisted living facility without obtaining a license under
8 this part.
9 (b) Except as provided under paragraph (d), any person
10 who owns, operates, or maintains an unlicensed assisted living
11 facility commits a felony of the third degree, punishable as
12 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
13 continued operation is a separate offense.
14 (c) Any person found guilty of violating paragraph (a)
15 a second or subsequent time commits a felony of the second
16 degree, punishable as provided under s. 775.082, s. 775.083,
17 or s. 775.084. Each day of continued operation is a separate
18 offense.
19 (1)(d) Any person who owns, operates, or maintains an
20 unlicensed assisted living facility due to a change in this
21 part or a modification in department rule within 6 months
22 after the effective date of such change and who, within 10
23 working days after receiving notification from the agency,
24 fails to cease operation or apply for a license under this
25 part commits a felony of the third degree, punishable as
26 provided in s. 775.082, s. 775.083, or s. 775.084. Each day of
27 continued operation is a separate offense.
28 (e) Any facility that fails to cease operation after
29 agency notification may be fined for each day of noncompliance
30 pursuant to s. 400.419.
31
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1 (f) When a licensee has an interest in more than one
2 assisted living facility, and fails to license any one of
3 these facilities, the agency may revoke the license, impose a
4 moratorium, or impose a fine pursuant to s. 400.419, on any or
5 all of the licensed facilities until such time as the
6 unlicensed facility is licensed or ceases operation.
7 (g) If the agency determines that an owner is
8 operating or maintaining an assisted living facility without
9 obtaining a license and determines that a condition exists in
10 the facility that poses a threat to the health, safety, or
11 welfare of a resident of the facility, the owner is subject to
12 the same actions and fines imposed against a licensed facility
13 as specified in ss. 400.414 and 400.419.
14 (h) Any person aware of the operation of an unlicensed
15 assisted living facility must report that facility to the
16 agency. The agency shall provide to the department's elder
17 information and referral providers a list, by county, of
18 licensed assisted living facilities, to assist persons who are
19 considering an assisted living facility placement in locating
20 a licensed facility.
21 (2)(i) Each field office of the Agency for Health Care
22 Administration shall establish a local coordinating workgroup
23 which includes representatives of local law enforcement
24 agencies, state attorneys, local fire authorities, the
25 Department of Children and Family Services, the district
26 long-term care ombudsman council, and the district human
27 rights advocacy committee to assist in identifying the
28 operation of unlicensed facilities and to develop and
29 implement a plan to ensure effective enforcement of state laws
30 relating to such facilities. The workgroup shall report its
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1 findings, actions, and recommendations semiannually to the
2 Director of Health Facility Regulation of the agency.
3 (3)(2) It is unlawful to knowingly refer a person for
4 residency to an unlicensed assisted living facility; to an
5 assisted living facility the license of which is under denial
6 or has been suspended or revoked; or to an assisted living
7 facility that has a moratorium pursuant to s. 408.814 on
8 admissions. Any person who violates this subsection commits a
9 noncriminal violation, punishable by a fine not exceeding $500
10 as provided in s. 775.083.
11 (a) Any health care practitioner, as defined in s.
12 456.001, who is aware of the operation of an unlicensed
13 facility shall report that facility to the agency. Failure to
14 report a facility that the practitioner knows or has
15 reasonable cause to suspect is unlicensed shall be reported to
16 the practitioner's licensing board.
17 (b) Any hospital or community mental health center
18 licensed under chapter 395 or chapter 394 which knowingly
19 discharges a patient or client to an unlicensed facility is
20 subject to sanction by the agency.
21 (c) Any employee of the agency or department, or the
22 Department of Children and Family Services, who knowingly
23 refers a person for residency to an unlicensed facility; to a
24 facility the license of which is under denial or has been
25 suspended or revoked; or to a facility that has a moratorium
26 pursuant to s. 408.814 on admissions is subject to
27 disciplinary action by the agency or department, or the
28 Department of Children and Family Services.
29 (d) The employer of any person who is under contract
30 with the agency or department, or the Department of Children
31 and Family Services, and who knowingly refers a person for
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1 residency to an unlicensed facility; to a facility the license
2 of which is under denial or has been suspended or revoked; or
3 to a facility that has a moratorium pursuant to s. 408.814 on
4 admissions shall be fined and required to prepare a corrective
5 action plan designed to prevent such referrals.
6 (e) The agency shall provide the department and the
7 Department of Children and Family Services with a list of
8 licensed facilities within each county and shall update the
9 list at least quarterly.
10 (f) At least annually, the agency shall notify, in
11 appropriate trade publications, physicians licensed under
12 chapter 458 or chapter 459, hospitals licensed under chapter
13 395, nursing home facilities licensed under part II of this
14 chapter, and employees of the agency or the department, or the
15 Department of Children and Family Services, who are
16 responsible for referring persons for residency, that it is
17 unlawful to knowingly refer a person for residency to an
18 unlicensed assisted living facility and shall notify them of
19 the penalty for violating such prohibition. The department and
20 the Department of Children and Family Services shall, in turn,
21 notify service providers under contract to the respective
22 departments who have responsibility for resident referrals to
23 facilities. Further, the notice must direct each noticed
24 facility and individual to contact the appropriate agency
25 office in order to verify the licensure status of any facility
26 prior to referring any person for residency. Each notice must
27 include the name, telephone number, and mailing address of the
28 appropriate office to contact.
29 Section 80. Section 400.411, Florida Statutes, is
30 amended to read:
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1 400.411 Initial application for license; provisional
2 license.--
3 (1) Each applicant for licensure must comply with all
4 provisions of part II of chapter 408 and the following:
5 Application for a license shall be made to the agency on forms
6 furnished by it and shall be accompanied by the appropriate
7 license fee.
8 (2) The applicant may be an individual owner, a
9 corporation, a partnership, a firm, an association, or a
10 governmental entity.
11 (3) The application must be signed by the applicant
12 under oath and must contain the following:
13 (a) The name, address, date of birth, and social
14 security number of the applicant and the name by which the
15 facility is to be known. If the applicant is a firm,
16 partnership, or association, the application shall contain the
17 name, address, date of birth, and social security number of
18 every member thereof. If the applicant is a corporation, the
19 application shall contain the corporation's name and address;
20 the name, address, date of birth, and social security number
21 of each of its directors and officers; and the name and
22 address of each person having at least a 5-percent ownership
23 interest in the corporation.
24 (b) The name and address of any professional service,
25 firm, association, partnership, or corporation that is to
26 provide goods, leases, or services to the facility if a
27 5-percent or greater ownership interest in the service, firm,
28 association, partnership, or corporation is owned by a person
29 whose name must be listed on the application under paragraph
30 (a).
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1 (c) The name and address of any long-term care
2 facility with which the applicant, administrator, or financial
3 officer has been affiliated through ownership or employment
4 within 5 years of the date of this license application; and a
5 signed affidavit disclosing any financial or ownership
6 interest that the applicant, or any person listed in paragraph
7 (a), holds or has held within the last 5 years in any facility
8 licensed under this part, or in any other entity licensed by
9 this state or another state to provide health or residential
10 care, which facility or entity closed or ceased to operate as
11 a result of financial problems, or has had a receiver
12 appointed or a license denied, suspended or revoked, or was
13 subject to a moratorium on admissions, or has had an
14 injunctive proceeding initiated against it.
15 (d) A description and explanation of any exclusions,
16 permanent suspensions, or terminations of the applicant from
17 the Medicare or Medicaid programs. Proof of compliance with
18 disclosure of ownership and control interest requirements of
19 the Medicaid or Medicare programs shall be accepted in lieu of
20 this submission.
21 (e) The names and addresses of persons of whom the
22 agency may inquire as to the character, reputation, and
23 financial responsibility of the owner and, if different from
24 the applicant, the administrator and financial officer.
25 (a)(f) Identify Identification of all other homes or
26 facilities, including the addresses and the license or
27 licenses under which they operate, if applicable, which are
28 currently operated by the applicant or administrator and which
29 provide housing, meals, and personal services to residents.
30 (b)(g) Provide the location of the facility for which
31 a license is sought and documentation, signed by the
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1 appropriate local government official, which states that the
2 applicant has met local zoning requirements.
3 (c)(h) Provide the name, address, date of birth,
4 social security number, education, and experience of the
5 administrator, if different from the applicant.
6 (4) The applicant shall furnish satisfactory proof of
7 financial ability to operate and conduct the facility in
8 accordance with the requirements of this part. A certificate
9 of authority, pursuant to chapter 651, may be provided as
10 proof of financial ability.
11 (5) If the applicant is a continuing care facility
12 certified under chapter 651, a copy of the facility's
13 certificate of authority must be provided.
14 (2)(6) The applicant shall provide proof of liability
15 insurance as defined in s. 624.605.
16 (7) If the applicant is a community residential home,
17 the applicant must provide proof that it has met the
18 requirements specified in chapter 419.
19 (8) The applicant must provide the agency with proof
20 of legal right to occupy the property.
21 (3)(9) The applicant must furnish proof that the
22 facility has received a satisfactory firesafety inspection.
23 The local authority having jurisdiction or the State Fire
24 Marshal must conduct the inspection within 30 days after
25 written request by the applicant.
26 (4)(10) The applicant must furnish documentation of a
27 satisfactory sanitation inspection of the facility by the
28 county health department.
29 (11) The applicant must furnish proof of compliance
30 with level 2 background screening as required under s.
31 400.4174.
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1 (5)(12) A provisional license may be issued to an
2 applicant making initial application for licensure or making
3 application for a change of ownership. A provisional license
4 shall be limited in duration to a specific period of time not
5 to exceed 6 months, as determined by the agency.
6 (6)(13) A county or municipality may not issue an
7 occupational license that is being obtained for the purpose of
8 operating a facility regulated under this part without first
9 ascertaining that the applicant has been licensed to operate
10 such facility at the specified location or locations by the
11 agency. The agency shall furnish to local agencies
12 responsible for issuing occupational licenses sufficient
13 instruction for making such determinations.
14 Section 81. Section 400.412, Florida Statutes, is
15 amended to read:
16 400.412 Sale or transfer of ownership of a
17 facility.--It is the intent of the Legislature to protect the
18 rights of the residents of an assisted living facility when
19 the facility is sold or the ownership thereof is transferred.
20 Therefore, in addition to the requirements of part II of
21 chapter 408, whenever a facility is sold or the ownership
22 thereof is transferred, including leasing:
23 (1) The transferee shall make application to the
24 agency for a new license at least 60 days before the date of
25 transfer of ownership. The application must comply with the
26 provisions of s. 400.411.
27 (2)(a) The transferor shall notify the agency in
28 writing at least 60 days before the date of transfer of
29 ownership.
30
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1 (1)(b) The transferee new owner shall notify the
2 residents, in writing, of the change transfer of ownership
3 within 7 days after of his or her receipt of the new license.
4 (3) The transferor shall be responsible and liable
5 for:
6 (a) The lawful operation of the facility and the
7 welfare of the residents domiciled in the facility until the
8 date the transferee is licensed by the agency.
9 (b) Any and all penalties imposed against the facility
10 for violations occurring before the date of transfer of
11 ownership unless the penalty imposed is a moratorium on
12 admissions or denial of licensure. The moratorium on
13 admissions or denial of licensure remains in effect after the
14 transfer of ownership, unless the agency has approved the
15 transferee's corrective action plan or the conditions which
16 created the moratorium or denial have been corrected, and may
17 be grounds for denial of license to the transferee in
18 accordance with chapter 120.
19 (c) Any outstanding liability to the state, unless the
20 transferee has agreed, as a condition of sale or transfer, to
21 accept the outstanding liabilities and to guarantee payment
22 therefor; except that, if the transferee fails to meet these
23 obligations, the transferor shall remain liable for the
24 outstanding liability.
25 (2)(4) The transferor of a facility the license of
26 which is denied pending an administrative hearing shall, as a
27 part of the written change-of-ownership transfer-of-ownership
28 contract, advise the transferee that a plan of correction must
29 be submitted by the transferee and approved by the agency at
30 least 7 days before the change transfer of ownership and that
31 failure to correct the condition which resulted in the
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1 moratorium pursuant to s. 408.814 on admissions or denial of
2 licensure is grounds for denial of the transferee's license.
3 (5) The transferee must provide the agency with proof
4 of legal right to occupy the property before a license may be
5 issued. Proof may include, but is not limited to, copies of
6 warranty deeds, or copies of lease or rental agreements,
7 contracts for deeds, quitclaim deeds, or other such
8 documentation.
9 Section 82. Section 400.414, Florida Statutes, is
10 amended to read:
11 400.414 Denial or, revocation, or suspension of
12 license; moratorium; imposition of administrative fine;
13 grounds.--
14 (1) The agency may deny or, revoke, or suspend any
15 license issued under this part, impose a moratorium, or impose
16 an administrative fine in the manner provided in chapter 120,
17 for any of the following actions by an assisted living
18 facility, for the actions of any person subject to level 2
19 background screening under s. 400.4174, or for the actions of
20 any facility employee in violation of any provision of this
21 part, part II of chapter 408, or applicable rule:
22 (a) An intentional or negligent act seriously
23 affecting the health, safety, or welfare of a resident of the
24 facility.
25 (b) The determination by the agency that the owner
26 lacks the financial ability to provide continuing adequate
27 care to residents.
28 (c) Misappropriation or conversion of the property of
29 a resident of the facility.
30 (d) Failure to follow the criteria and procedures
31 provided under part I of chapter 394 relating to the
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1 transportation, voluntary admission, and involuntary
2 examination of a facility resident.
3 (e) A citation of any of the following deficiencies as
4 defined in s. 400.419:
5 1. One or more cited class I deficiencies.
6 2. Three or more cited class II deficiencies.
7 3. Five or more cited class III deficiencies that have
8 been cited on a single survey and have not been corrected
9 within the times specified.
10 (f) A determination that a person subject to level 2
11 background screening under s. 400.4174(1) does not meet the
12 screening standards of s. 435.04 or that the facility is
13 retaining an employee subject to level 1 background screening
14 standards under s. 400.4174(2) who does not meet the screening
15 standards of s. 435.03 and for whom exemptions from
16 disqualification have not been provided by the agency.
17 (g) A determination that an employee, volunteer,
18 administrator, or owner, or person who otherwise has access to
19 the residents of a facility does not meet the criteria
20 specified in s. 435.03(2), and the owner or administrator has
21 not taken action to remove the person. Exemptions from
22 disqualification may be granted as set forth in s. 435.07. No
23 administrative action may be taken against the facility if the
24 person is granted an exemption.
25 (h) Violation of a moratorium.
26 (i) Failure of the license applicant, the licensee
27 during relicensure, or a licensee that holds a provisional
28 license to meet the minimum license requirements of this part,
29 or related rules, at the time of license application or
30 renewal.
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1 (j) A fraudulent statement or omission of any material
2 fact on an application for a license or any other document
3 required by the agency, including the submission of a license
4 application that conceals the fact that any board member,
5 officer, or person owning 5 percent or more of the facility
6 may not meet the background screening requirements of s.
7 400.4174, or that the applicant has been excluded, permanently
8 suspended, or terminated from the Medicaid or Medicare
9 programs.
10 (h)(k) An intentional or negligent life-threatening
11 act in violation of the uniform firesafety standards for
12 assisted living facilities or other firesafety standards that
13 threatens the health, safety, or welfare of a resident of a
14 facility, as communicated to the agency by the local authority
15 having jurisdiction or the State Fire Marshal.
16 (l) Exclusion, permanent suspension, or termination
17 from the Medicare or Medicaid programs.
18 (i)(m) Knowingly operating any unlicensed facility or
19 providing without a license any service that must be licensed
20 under this chapter.
21 (j)(n) Any act constituting a ground upon which
22 application for a license may be denied.
23
24 Administrative proceedings challenging agency action under
25 this subsection shall be reviewed on the basis of the facts
26 and conditions that resulted in the agency action.
27 (2) Upon notification by the local authority having
28 jurisdiction or by the State Fire Marshal, the agency may deny
29 or revoke the license of an assisted living facility that
30 fails to correct cited fire code violations that affect or
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1 threaten the health, safety, or welfare of a resident of a
2 facility.
3 (3) The agency may deny a license to any applicant
4 controlling interest as defined in s. 408.803 that or to any
5 officer or board member of an applicant who is a firm,
6 corporation, partnership, or association or who owns 5 percent
7 or more of the facility, if the applicant, officer, or board
8 member has or had a 25-percent or greater financial or
9 ownership interest in any other facility licensed under this
10 part, or in any entity licensed by this state or another state
11 to provide health or residential care, which facility or
12 entity during the 5 years prior to the application for a
13 license closed due to financial inability to operate; had a
14 receiver appointed or a license denied, suspended, or revoked;
15 was subject to a moratorium pursuant to s. 408.814 on
16 admissions; had an injunctive proceeding initiated against it;
17 or has an outstanding fine assessed under this chapter.
18 (4) The agency shall deny or revoke the license of an
19 assisted living facility that has two or more class I
20 violations that are similar or identical to violations
21 identified by the agency during a survey, inspection,
22 monitoring visit, or complaint investigation occurring within
23 the previous 2 years.
24 (5) An action taken by the agency to suspend, deny, or
25 revoke a facility's license under this part, in which the
26 agency claims that the facility owner or an employee of the
27 facility has threatened the health, safety, or welfare of a
28 resident of the facility be heard by the Division of
29 Administrative Hearings of the Department of Management
30 Services within 120 days after receipt of the facility's
31 request for a hearing, unless that time limitation is waived
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1 by both parties. The administrative law judge must render a
2 decision within 30 days after receipt of a proposed
3 recommended order.
4 (6) The agency shall provide to the Division of Hotels
5 and Restaurants of the Department of Business and Professional
6 Regulation, on a monthly basis, a list of those assisted
7 living facilities that have had their licenses denied,
8 suspended, or revoked or that are involved in an appellate
9 proceeding pursuant to s. 120.60 related to the denial,
10 suspension, or revocation of a license.
11 (7) Agency notification of a license suspension or
12 revocation, or denial of a license renewal, shall be posted
13 and visible to the public at the facility.
14 (8) The agency may issue a temporary license pending
15 final disposition of a proceeding involving the suspension or
16 revocation of an assisted living facility license.
17 Section 83. Section 400.417, Florida Statutes, is
18 amended to read:
19 400.417 Expiration of license; renewal; conditional
20 license.--
21 (1) Biennial licenses, unless sooner suspended or
22 revoked, shall expire 2 years from the date of issuance.
23 Limited nursing, extended congregate care, and limited mental
24 health licenses shall expire at the same time as the
25 facility's standard license, regardless of when issued. The
26 agency shall notify the facility at least 120 days prior to
27 expiration that a renewal license is necessary to continue
28 operation. The notification must be provided electronically or
29 by mail delivery. Ninety days prior to the expiration date, an
30 application for renewal shall be submitted to the agency. Fees
31 must be prorated. The failure to file a timely renewal
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1 application shall result in a late fee charged to the facility
2 in an amount equal to 50 percent of the current fee.
3 (2) A license shall be renewed in accordance with part
4 II of chapter 408 within 90 days upon the timely filing of an
5 application on forms furnished by the agency and the provision
6 of satisfactory proof of ability to operate and conduct the
7 facility in accordance with the requirements of this part and
8 adopted rules, including proof that the facility has received
9 a satisfactory firesafety inspection, conducted by the local
10 authority having jurisdiction or the State Fire Marshal,
11 within the preceding 12 months and an affidavit of compliance
12 with the background screening requirements of s. 400.4174.
13 (3) In addition to the requirements of part II of
14 chapter 408, An applicant for renewal of a license who has
15 complied with the provisions of s. 400.411 with respect to
16 proof of financial ability to operate shall not be required to
17 provide further proof unless the facility or any other
18 facility owned or operated in whole or in part by the same
19 person has demonstrated financial instability as provided
20 under s. 400.447(2) or unless the agency suspects that the
21 facility is not financially stable as a result of the annual
22 survey or complaints from the public or a report from the
23 State Long-Term Care Ombudsman Council. each facility must
24 report to the agency any adverse court action concerning the
25 facility's financial viability, within 7 days after its
26 occurrence. The agency shall have access to books, records,
27 and any other financial documents maintained by the facility
28 to the extent necessary to determine the facility's financial
29 stability. A license for the operation of a facility shall not
30 be renewed if the licensee has any outstanding fines assessed
31 pursuant to this part which are in final order status.
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1 (4) A licensee against whom a revocation or suspension
2 proceeding is pending at the time of license renewal may be
3 issued a conditional license effective until final disposition
4 by the agency. If judicial relief is sought from the final
5 disposition, the court having jurisdiction may issue a
6 conditional license for the duration of the judicial
7 proceeding.
8 (4)(5) A conditional license may be issued to an
9 applicant for license renewal if the applicant fails to meet
10 all standards and requirements for licensure. A conditional
11 license issued under this subsection shall be limited in
12 duration to a specific period of time not to exceed 6 months,
13 as determined by the agency, and shall be accompanied by an
14 agency-approved plan of correction.
15 (5)(6) When an extended care or limited nursing
16 license is requested during a facility's biennial license
17 period, the fee shall be prorated in order to permit the
18 additional license to expire at the end of the biennial
19 license period. The fee shall be calculated as of the date the
20 additional license application is received by the agency.
21 (6)(7) The agency department may by rule establish
22 renewal procedures, identify forms, and specify documentation
23 necessary to administer this section and part II of chapter
24 408.
25 Section 84. Section 400.415, Florida Statutes, is
26 repealed.
27 Section 85. Section 400.4174, Florida Statutes, is
28 amended to read:
29 400.4174 Background screening; exemptions.--
30 (1)(a) Level 2 background screening must be conducted
31 on each of the following persons, who shall be considered
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1 employees for the purposes of conducting screening under
2 chapter 435:
3 1. The facility owner if an individual, the
4 administrator, and the financial officer.
5 2. An officer or board member if the facility owner is
6 a firm, corporation, partnership, or association, or any
7 person owning 5 percent or more of the facility if the agency
8 has probable cause to believe that such person has been
9 convicted of any offense prohibited by s. 435.04. For each
10 officer, board member, or person owning 5 percent or more who
11 has been convicted of any such offense, the facility shall
12 submit to the agency a description and explanation of the
13 conviction at the time of license application. This
14 subparagraph does not apply to a board member of a
15 not-for-profit corporation or organization if the board member
16 serves solely in a voluntary capacity, does not regularly take
17 part in the day-to-day operational decisions of the
18 corporation or organization, receives no remuneration for his
19 or her services, and has no financial interest and has no
20 family members with a financial interest in the corporation or
21 organization, provided that the board member and facility
22 submit a statement affirming that the board member's
23 relationship to the facility satisfies the requirements of
24 this subparagraph.
25 (b) Proof of compliance with level 2 screening
26 standards which has been submitted within the previous 5 years
27 to meet any facility or professional licensure requirements of
28 the agency or the Department of Health satisfies the
29 requirements of this subsection, provided that such proof is
30 accompanied, under penalty of perjury, by an affidavit of
31 compliance with the provisions of chapter 435. Proof of
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1 compliance with the background screening requirements of the
2 Financial Services Commission and the Office of Insurance
3 Regulation for applicants for a certificate of authority to
4 operate a continuing care retirement community under chapter
5 651, submitted within the last 5 years, satisfies the
6 Department of Law Enforcement and Federal Bureau of
7 Investigation portions of a level 2 background check.
8 (c) The agency may grant a provisional license to a
9 facility applying for an initial license when each individual
10 required by this subsection to undergo screening has completed
11 the Department of Law Enforcement background checks, but has
12 not yet received results from the Federal Bureau of
13 Investigation, or when a request for an exemption from
14 disqualification has been submitted to the agency pursuant to
15 s. 435.07, but a response has not been issued.
16 (2) The owner or administrator of an assisted living
17 facility must conduct level 1 background screening, as set
18 forth in chapter 435, on all employees hired on or after
19 October 1, 1998, who perform personal services as defined in
20 s. 400.402(17). The agency may exempt an individual from
21 employment disqualification as set forth in chapter 435. Such
22 persons shall be considered as having met this requirement if:
23 (1)(a) Proof of compliance with level 1 screening
24 requirements obtained to meet any professional license
25 requirements in this state is provided and accompanied, under
26 penalty of perjury, by a copy of the person's current
27 professional license and an affidavit of current compliance
28 with the background screening requirements.
29 (2)(b) The person required to be screened has been
30 continuously employed in the same type of occupation for which
31 the person is seeking employment without a breach in service
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1 which exceeds 180 days, and proof of compliance with the level
2 1 screening requirement which is no more than 2 years old is
3 provided. Proof of compliance shall be provided directly from
4 one employer or contractor to another, and not from the person
5 screened. Upon request, a copy of screening results shall be
6 provided by the employer retaining documentation of the
7 screening to the person screened.
8 (3)(c) The person required to be screened is employed
9 by a corporation or business entity or related corporation or
10 business entity that owns, operates, or manages more than one
11 facility or agency licensed under this chapter, and for whom a
12 level 1 screening was conducted by the corporation or business
13 entity as a condition of initial or continued employment.
14 Section 86. Section 400.4176, Florida Statutes, is
15 amended to read:
16 400.4176 Notice of change of administrator.--If,
17 during the period for which a license is issued, the owner
18 changes administrators, the owner must notify the agency of
19 the change within 10 days and provide documentation within 90
20 days that the new administrator has completed the applicable
21 core educational requirements under s. 400.452. Background
22 screening shall be completed on any new administrator as
23 specified in s. 400.4174.
24 Section 87. Subsection (7) of section 400.4178,
25 Florida Statutes, is repealed.
26 Section 88. Section 400.418, Florida Statutes, is
27 amended to read:
28 400.418 Disposition of fees and administrative
29 fines.--
30 (1) Income from license fees, inspection fees, late
31 fees, and administrative fines collected under this part
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1 generated pursuant to ss. 400.407, 400.408, 400.417, 400.419,
2 and 400.431 shall be deposited in the Health Care Trust Fund
3 administered by the agency. Such funds shall be directed to
4 and used by the agency for the following purposes:
5 (1)(a) Up to 50 percent of the trust funds accrued
6 each fiscal year under this part may be used to offset the
7 expenses of receivership, pursuant to s. 400.422, if the court
8 determines that the income and assets of the facility are
9 insufficient to provide for adequate management and operation.
10 (2)(b) An amount of $5,000 of the trust funds accrued
11 each year under this part shall be allocated to pay for
12 inspection-related physical and mental health examinations
13 requested by the agency pursuant to s. 400.426 for residents
14 who are either recipients of supplemental security income or
15 have monthly incomes not in excess of the maximum combined
16 federal and state cash subsidies available to supplemental
17 security income recipients, as provided for in s. 409.212.
18 Such funds shall only be used where the resident is ineligible
19 for Medicaid.
20 (3)(c) Any trust funds accrued each year under this
21 part and not used for the purposes specified in paragraphs (a)
22 and (b) shall be used to offset the costs of the licensure
23 program, including the costs of conducting background
24 investigations, verifying information submitted, defraying the
25 costs of processing the names of applicants, and conducting
26 inspections and monitoring visits pursuant to this part and
27 part II of chapter 408.
28 (2) Income from fees generated pursuant to s.
29 400.441(5) shall be deposited in the Health Care Trust Fund
30 and used to offset the costs of printing and postage.
31
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1 Section 89. Section 400.419, Florida Statutes, is
2 amended to read:
3 400.419 Violations; imposition of administrative
4 fines; grounds.--
5 (1) The agency shall impose an administrative fine in
6 the manner provided in chapter 120 for a violation of any
7 provision of this part, part II of chapter 408, or applicable
8 rule any of the actions or violations as set forth within this
9 section by an assisted living facility, for the actions of any
10 person subject to level 2 background screening under s.
11 400.4174, for the actions of any facility employee, or for an
12 intentional or negligent act seriously affecting the health,
13 safety, or welfare of a resident of the facility.
14 (2) Each violation of this part and adopted rules
15 shall be classified according to the nature of the violation
16 and the gravity of its probable effect on facility residents.
17 The agency shall indicate the classification on the written
18 notice of the violation as follows:
19 (a) Class "I" violations are those conditions or
20 occurrences related to the operation and maintenance of a
21 facility or to the personal care of residents which the agency
22 determines present an imminent danger to the residents or
23 guests of the facility or a substantial probability that death
24 or serious physical or emotional harm would result therefrom.
25 The condition or practice constituting a class I violation
26 shall be abated or eliminated within 24 hours, unless a fixed
27 period, as determined by the agency, is required for
28 correction. The agency shall impose an administrative fine for
29 a cited class I violation in an amount not less than $5,000
30 and not exceeding $10,000 for each violation. A fine may be
31 levied notwithstanding the correction of the violation.
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1 (b) Class "II" violations are those conditions or
2 occurrences related to the operation and maintenance of a
3 facility or to the personal care of residents which the agency
4 determines directly threaten the physical or emotional health,
5 safety, or security of the facility residents, other than
6 class I violations. The agency shall impose an administrative
7 fine for a cited class II violation in an amount not less than
8 $1,000 and not exceeding $5,000 for each violation. A fine
9 shall be levied notwithstanding the correction of the
10 violation.
11 (c) Class "III" violations are those conditions or
12 occurrences related to the operation and maintenance of a
13 facility or to the personal care of residents which the agency
14 determines indirectly or potentially threaten the physical or
15 emotional health, safety, or security of facility residents,
16 other than class I or class II violations. The agency shall
17 impose an administrative fine for a cited class III violation
18 in an amount not less than $500 and not exceeding $1,000 for
19 each violation. A citation for a class III violation must
20 specify the time within which the violation is required to be
21 corrected. If a class III violation is corrected within the
22 time specified, no fine may be imposed, unless it is a
23 repeated offense.
24 (d) Class "IV" violations are those conditions or
25 occurrences related to the operation and maintenance of a
26 building or to required reports, forms, or documents that do
27 not have the potential of negatively affecting residents.
28 These violations are of a type that the agency determines do
29 not threaten the health, safety, or security of residents of
30 the facility. The agency shall impose an administrative fine
31 for a cited class IV violation in an amount not less than $100
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1 and not exceeding $200 for each violation. A citation for a
2 class IV violation must specify the time within which the
3 violation is required to be corrected. If a class IV violation
4 is corrected within the time specified, no fine shall be
5 imposed. Any class IV violation that is corrected during the
6 time an agency survey is being conducted will be identified as
7 an agency finding and not as a violation.
8 (3) In determining if a penalty is to be imposed and
9 in fixing the amount of the fine, the agency shall consider
10 the following factors:
11 (a) The gravity of the violation, including the
12 probability that death or serious physical or emotional harm
13 to a resident will result or has resulted, the severity of the
14 action or potential harm, and the extent to which the
15 provisions of the applicable laws or rules were violated.
16 (b) Actions taken by the owner or administrator to
17 correct violations.
18 (c) Any previous violations.
19 (d) The financial benefit to the facility of
20 committing or continuing the violation.
21 (e) The licensed capacity of the facility.
22 (4) Each day of continuing violation after the date
23 fixed for termination of the violation, as ordered by the
24 agency, constitutes an additional, separate, and distinct
25 violation.
26 (5) Any action taken to correct a violation shall be
27 documented in writing by the owner or administrator of the
28 facility and verified through followup visits by agency
29 personnel. The agency may impose a fine and, in the case of an
30 owner-operated facility, revoke or deny a facility's license
31
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1 when a facility administrator fraudulently misrepresents
2 action taken to correct a violation.
3 (6) For fines that are upheld following administrative
4 or judicial review, the violator shall pay the fine, plus
5 interest at the rate as specified in s. 55.03, for each day
6 beyond the date set by the agency for payment of the fine.
7 (7) Any unlicensed facility that continues to operate
8 after agency notification is subject to a $1,000 fine per day.
9 (8) Any licensed facility whose owner or administrator
10 concurrently operates an unlicensed facility shall be subject
11 to an administrative fine of $5,000 per day.
12 (9) Any facility whose owner fails to apply for a
13 change-of-ownership license in accordance with s. 400.412 and
14 operates the facility under the new ownership is subject to a
15 fine of $5,000.
16 (6)(10) In addition to any administrative fines
17 imposed, the agency may assess a survey fee, equal to the
18 lesser of one half of the facility's biennial license and bed
19 fee or $500, to cover the cost of conducting initial complaint
20 investigations that result in the finding of a violation that
21 was the subject of the complaint or monitoring visits
22 conducted under s. 400.428(3)(c) to verify the correction of
23 the violations.
24 (7)(11) The agency, as an alternative to or in
25 conjunction with an administrative action against a facility
26 for violations of this part and adopted rules, shall make a
27 reasonable attempt to discuss each violation and recommended
28 corrective action with the owner or administrator of the
29 facility, prior to written notification. The agency, instead
30 of fixing a period within which the facility shall enter into
31 compliance with standards, may request a plan of corrective
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1 action from the facility which demonstrates a good faith
2 effort to remedy each violation by a specific date, subject to
3 the approval of the agency.
4 (12) Administrative fines paid by any facility under
5 this section shall be deposited into the Health Care Trust
6 Fund and expended as provided in s. 400.418.
7 (8)(13) The agency shall develop and disseminate an
8 annual list of all facilities sanctioned or fined $5,000 or
9 more for violations of state standards, the number and class
10 of violations involved, the penalties imposed, and the current
11 status of cases. The list shall be disseminated, at no charge,
12 to the Department of Elderly Affairs, the Department of
13 Health, the Department of Children and Family Services, the
14 area agencies on aging, the Florida Statewide Advocacy
15 Council, and the state and local ombudsman councils. The
16 Department of Children and Family Services shall disseminate
17 the list to service providers under contract to the department
18 who are responsible for referring persons to a facility for
19 residency. The agency may charge a fee commensurate with the
20 cost of printing and postage to other interested parties
21 requesting a copy of this list.
22 Section 90. Subsections (2) and (3) of section 400.42,
23 Florida Statutes, are amended to read:
24 400.42 Certain solicitation prohibited; third-party
25 supplementation.--
26 (2) Solicitation of contributions of any kind in a
27 threatening, coercive, or unduly forceful manner by or on
28 behalf of an assisted living facility or facilities by any
29 agent, employee, owner, or representative of any assisted
30 living facility or facilities is grounds for denial,
31 suspension, or revocation of the license of the assisted
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1 living facility or facilities by or on behalf of which such
2 contributions were solicited.
3 (3) The admission or maintenance of assisted living
4 facility residents whose care is supported, in whole or in
5 part, by state funds may not be conditioned upon the receipt
6 of any manner of contribution or donation from any person. The
7 solicitation or receipt of contributions in violation of this
8 subsection is grounds for denial, suspension, or revocation of
9 license, as provided in s. 400.414, for any assisted living
10 facility by or on behalf of which such contributions were
11 solicited.
12 Section 91. Section 400.421, Florida Statutes, is
13 repealed.
14 Section 92. Subsection (10) of section 400.423,
15 Florida Statutes, is amended to read:
16 400.423 Internal risk management and quality assurance
17 program; adverse incidents and reporting requirements.--
18 (10) The agency Department of Elderly Affairs may
19 adopt rules necessary to administer this section.
20 Section 93. Subsection (8) of section 400.424, Florida
21 Statutes, is amended to read:
22 400.424 Contracts.--
23 (8) The agency department may by rule clarify terms,
24 establish procedures, clarify refund policies and contract
25 provisions, and specify documentation as necessary to
26 administer this section.
27 Section 94. Subsection (3) of section 400.4255,
28 Florida Statutes, is amended to read:
29 400.4255 Use of personnel; emergency care.--
30 (3) Facility staff may withhold or withdraw
31 cardiopulmonary resuscitation if presented with an order not
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1 to resuscitate executed pursuant to s. 401.45. The agency
2 department shall adopt rules providing for the implementation
3 of such orders. Facility staff and facilities shall not be
4 subject to criminal prosecution or civil liability, nor be
5 considered to have engaged in negligent or unprofessional
6 conduct, for withholding or withdrawing cardiopulmonary
7 resuscitation pursuant to such an order and applicable rules
8 adopted by the department. The absence of an order to
9 resuscitate executed pursuant to s. 401.45 does not preclude a
10 physician from withholding or withdrawing cardiopulmonary
11 resuscitation as otherwise permitted by law.
12 Section 95. Subsection (6) of section 400.4256,
13 Florida Statutes, is amended to read:
14 400.4256 Assistance with self-administration of
15 medication.--
16 (6) The agency department may by rule establish
17 facility procedures and interpret terms as necessary to
18 implement this section.
19 Section 96. Subsection (8) of section 400.427, Florida
20 Statutes, is amended to read:
21 400.427 Property and personal affairs of residents.--
22 (8) The agency department may by rule clarify terms
23 and specify procedures and documentation necessary to
24 administer the provisions of this section relating to the
25 proper management of residents' funds and personal property
26 and the execution of surety bonds.
27 Section 97. Subsection (4) of section 400.4275,
28 Florida Statutes, is amended to read:
29 400.4275 Business practice; personnel records;
30 liability insurance.--The assisted living facility shall be
31
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1 administered on a sound financial basis that is consistent
2 with good business practices.
3 (4) The agency department may by rule clarify terms,
4 establish requirements for financial records, accounting
5 procedures, personnel procedures, insurance coverage, and
6 reporting procedures, and specify documentation as necessary
7 to implement the requirements of this section.
8 Section 98. Subsections (1) and (5) of section
9 400.431, Florida Statutes, are amended to read:
10 400.431 Closing of facility; notice; penalty.--
11 (1) Whenever a facility voluntarily discontinues
12 operation, it shall inform the agency in writing at least 90
13 days prior to the discontinuance of operation. The facility
14 shall also inform each resident or the next of kin, legal
15 representative, or agency acting on each resident's behalf, of
16 the fact and the proposed time of such discontinuance,
17 following the notification requirements provided in s.
18 400.428(1)(k). In the event a resident has no person to
19 represent him or her, the facility shall be responsible for
20 referral to an appropriate social service agency for
21 placement.
22 (5) The agency may levy a fine in an amount no greater
23 than $5,000 upon each person or business entity that owns any
24 interest in a facility that terminates operation without
25 providing notice to the agency and the residents of the
26 facility at least 30 days before operation ceases. This fine
27 shall not be levied against any facility involuntarily closed
28 at the initiation of the agency. The agency shall use the
29 proceeds of the fines to operate the facility until all
30 residents of the facility are relocated and shall deposit any
31
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1 balance of the proceeds into the Health Care Trust Fund
2 established pursuant to s. 400.418.
3 Section 99. Section 400.434, Florida Statutes, is
4 amended to read:
5 400.434 Right of entry and inspection.--Any duly
6 designated officer or employee of the department, the
7 Department of Children and Family Services, the agency, the
8 state or local fire marshal, or a member of the state or local
9 long-term care ombudsman council, or the agency in accordance
10 with s. 408.811 shall have the right to enter unannounced upon
11 and into the premises of any facility licensed pursuant to
12 this part in order to determine the state of compliance with
13 the provisions of this part, part II of chapter 408, and
14 applicable of rules or standards in force pursuant thereto.
15 The right of entry and inspection shall also extend to any
16 premises which the agency has reason to believe is being
17 operated or maintained as a facility without a license; but no
18 such entry or inspection of any premises may be made without
19 the permission of the owner or person in charge thereof,
20 unless a warrant is first obtained from the circuit court
21 authorizing such entry. The warrant requirement shall extend
22 only to a facility which the agency has reason to believe is
23 being operated or maintained as a facility without a license.
24 Any application for a license or renewal thereof made pursuant
25 to this part shall constitute permission for, and complete
26 acquiescence in, any entry or inspection of the premises for
27 which the license is sought, in order to facilitate
28 verification of the information submitted on or in connection
29 with the application; to discover, investigate, and determine
30 the existence of abuse or neglect; or to elicit, receive,
31 respond to, and resolve complaints. Any current valid license
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1 shall constitute unconditional permission for, and complete
2 acquiescence in, any entry or inspection of the premises by
3 authorized personnel. The agency shall retain the right of
4 entry and inspection of facilities that have had a license
5 revoked or suspended within the previous 24 months, to ensure
6 that the facility is not operating unlawfully. However, before
7 entering the facility, a statement of probable cause must be
8 filed with the director of the agency, who must approve or
9 disapprove the action within 48 hours. Probable cause shall
10 include, but is not limited to, evidence that the facility
11 holds itself out to the public as a provider of personal care
12 services or the receipt of a complaint by the long-term care
13 ombudsman council about the facility. Data collected by the
14 state or local long-term care ombudsman councils or the state
15 or local advocacy councils may be used by the agency in
16 investigations involving violations of regulatory standards.
17 Section 100. Subsection (1) of section 400.435,
18 Florida Statutes, is repealed.
19 Section 101. Section 400.441, Florida Statutes, is
20 amended to read:
21 400.441 Rules establishing standards.--
22 (1) It is the intent of the Legislature that rules
23 published and enforced pursuant to this section shall include
24 criteria by which a reasonable and consistent quality of
25 resident care and quality of life may be ensured and the
26 results of such resident care may be demonstrated. Such rules
27 shall also ensure a safe and sanitary environment that is
28 residential and noninstitutional in design or nature. It is
29 further intended that reasonable efforts be made to
30 accommodate the needs and preferences of residents to enhance
31 the quality of life in a facility. In order to provide safe
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1 and sanitary facilities and the highest quality of resident
2 care accommodating the needs and preferences of residents, the
3 agency department, in consultation with the department agency,
4 the Department of Children and Family Services, and the
5 Department of Health, shall adopt rules, policies, and
6 procedures to administer this part and part II of chapter 408,
7 which must include reasonable and fair minimum standards in
8 relation to:
9 (a) The requirements for and maintenance of
10 facilities, not in conflict with the provisions of chapter
11 553, relating to plumbing, heating, cooling, lighting,
12 ventilation, living space, and other housing conditions, which
13 will ensure the health, safety, and comfort of residents and
14 protection from fire hazard, including adequate provisions for
15 fire alarm and other fire protection suitable to the size of
16 the structure. Uniform firesafety standards shall be
17 established and enforced by the State Fire Marshal in
18 cooperation with the agency, the department, and the
19 Department of Health.
20 1. Evacuation capability determination.--
21 a. The provisions of the National Fire Protection
22 Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
23 for determining the ability of the residents, with or without
24 staff assistance, to relocate from or within a licensed
25 facility to a point of safety as provided in the fire codes
26 adopted herein. An evacuation capability evaluation for
27 initial licensure shall be conducted within 6 months after the
28 date of licensure. For existing licensed facilities that are
29 not equipped with an automatic fire sprinkler system, the
30 administrator shall evaluate the evacuation capability of
31 residents at least annually. The evacuation capability
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1 evaluation for each facility not equipped with an automatic
2 fire sprinkler system shall be validated, without liability,
3 by the State Fire Marshal, by the local fire marshal, or by
4 the local authority having jurisdiction over firesafety,
5 before the license renewal date. If the State Fire Marshal,
6 local fire marshal, or local authority having jurisdiction
7 over firesafety has reason to believe that the evacuation
8 capability of a facility as reported by the administrator may
9 have changed, it may, with assistance from the facility
10 administrator, reevaluate the evacuation capability through
11 timed exiting drills. Translation of timed fire exiting drills
12 to evacuation capability may be determined:
13 (I) Three minutes or less: prompt.
14 (II) More than 3 minutes, but not more than 13
15 minutes: slow.
16 (III) More than 13 minutes: impractical.
17 b. The Office of the State Fire Marshal shall provide
18 or cause the provision of training and education on the proper
19 application of Chapter 5, NFPA 101A, 1995 edition, to its
20 employees, to staff of the Agency for Health Care
21 Administration who are responsible for regulating facilities
22 under this part, and to local governmental inspectors. The
23 Office of the State Fire Marshal shall provide or cause the
24 provision of this training within its existing budget, but may
25 charge a fee for this training to offset its costs. The
26 initial training must be delivered within 6 months after July
27 1, 1995, and as needed thereafter.
28 c. The Office of the State Fire Marshal, in
29 cooperation with provider associations, shall provide or cause
30 the provision of a training program designed to inform
31 facility operators on how to properly review bid documents
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1 relating to the installation of automatic fire sprinklers.
2 The Office of the State Fire Marshal shall provide or cause
3 the provision of this training within its existing budget, but
4 may charge a fee for this training to offset its costs. The
5 initial training must be delivered within 6 months after July
6 1, 1995, and as needed thereafter.
7 d. The administrator of a licensed facility shall sign
8 an affidavit verifying the number of residents occupying the
9 facility at the time of the evacuation capability evaluation.
10 2. Firesafety requirements.--
11 a. Except for the special applications provided
12 herein, effective January 1, 1996, the provisions of the
13 National Fire Protection Association, Life Safety Code, NFPA
14 101, 1994 edition, Chapter 22 for new facilities and Chapter
15 23 for existing facilities shall be the uniform fire code
16 applied by the State Fire Marshal for assisted living
17 facilities, pursuant to s. 633.022.
18 b. Any new facility, regardless of size, that applies
19 for a license on or after January 1, 1996, must be equipped
20 with an automatic fire sprinkler system. The exceptions as
21 provided in section 22-2.3.5.1, NFPA 101, 1994 edition, as
22 adopted herein, apply to any new facility housing eight or
23 fewer residents. On July 1, 1995, local governmental entities
24 responsible for the issuance of permits for construction shall
25 inform, without liability, any facility whose permit for
26 construction is obtained prior to January 1, 1996, of this
27 automatic fire sprinkler requirement. As used in this part,
28 the term "a new facility" does not mean an existing facility
29 that has undergone change of ownership.
30 c. Notwithstanding any provision of s. 633.022 or of
31 the National Fire Protection Association, NFPA 101A, Chapter
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1 5, 1995 edition, to the contrary, any existing facility
2 housing eight or fewer residents is not required to install an
3 automatic fire sprinkler system, nor to comply with any other
4 requirement in Chapter 23, NFPA 101, 1994 edition, that
5 exceeds the firesafety requirements of NFPA 101, 1988 edition,
6 that applies to this size facility, unless the facility has
7 been classified as impractical to evacuate. Any existing
8 facility housing eight or fewer residents that is classified
9 as impractical to evacuate must install an automatic fire
10 sprinkler system within the timeframes granted in this
11 section.
12 d. Any existing facility that is required to install
13 an automatic fire sprinkler system under this paragraph need
14 not meet other firesafety requirements of Chapter 23, NFPA
15 101, 1994 edition, which exceed the provisions of NFPA 101,
16 1988 edition. The mandate contained in this paragraph which
17 requires certain facilities to install an automatic fire
18 sprinkler system supersedes any other requirement.
19 e. This paragraph does not supersede the exceptions
20 granted in NFPA 101, 1988 edition or 1994 edition.
21 f. This paragraph does not exempt facilities from
22 other firesafety provisions adopted under s. 633.022 and local
23 building code requirements in effect before July 1, 1995.
24 g. A local government may charge fees only in an
25 amount not to exceed the actual expenses incurred by local
26 government relating to the installation and maintenance of an
27 automatic fire sprinkler system in an existing and properly
28 licensed assisted living facility structure as of January 1,
29 1996.
30 h. If a licensed facility undergoes major
31 reconstruction or addition to an existing building on or after
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1 January 1, 1996, the entire building must be equipped with an
2 automatic fire sprinkler system. Major reconstruction of a
3 building means repair or restoration that costs in excess of
4 50 percent of the value of the building as reported on the tax
5 rolls, excluding land, before reconstruction. Multiple
6 reconstruction projects within a 5-year period the total costs
7 of which exceed 50 percent of the initial value of the
8 building at the time the first reconstruction project was
9 permitted are to be considered as major reconstruction.
10 Application for a permit for an automatic fire sprinkler
11 system is required upon application for a permit for a
12 reconstruction project that creates costs that go over the
13 50-percent threshold.
14 i. Any facility licensed before January 1, 1996, that
15 is required to install an automatic fire sprinkler system
16 shall ensure that the installation is completed within the
17 following timeframes based upon evacuation capability of the
18 facility as determined under subparagraph 1.:
19 (I) Impractical evacuation capability, 24 months.
20 (II) Slow evacuation capability, 48 months.
21 (III) Prompt evacuation capability, 60 months.
22
23 The beginning date from which the deadline for the automatic
24 fire sprinkler installation requirement must be calculated is
25 upon receipt of written notice from the local fire official
26 that an automatic fire sprinkler system must be installed. The
27 local fire official shall send a copy of the document
28 indicating the requirement of a fire sprinkler system to the
29 Agency for Health Care Administration.
30 j. It is recognized that the installation of an
31 automatic fire sprinkler system may create financial hardship
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1 for some facilities. The appropriate local fire official
2 shall, without liability, grant two 1-year extensions to the
3 timeframes for installation established herein, if an
4 automatic fire sprinkler installation cost estimate and proof
5 of denial from two financial institutions for a construction
6 loan to install the automatic fire sprinkler system are
7 submitted. However, for any facility with a class I or class
8 II, or a history of uncorrected class III, firesafety
9 deficiencies, an extension must not be granted. The local
10 fire official shall send a copy of the document granting the
11 time extension to the Agency for Health Care Administration.
12 k. A facility owner whose facility is required to be
13 equipped with an automatic fire sprinkler system under Chapter
14 23, NFPA 101, 1994 edition, as adopted herein, must disclose
15 to any potential buyer of the facility that an installation of
16 an automatic fire sprinkler requirement exists. The sale of
17 the facility does not alter the timeframe for the installation
18 of the automatic fire sprinkler system.
19 l. Existing facilities required to install an
20 automatic fire sprinkler system as a result of
21 construction-type restrictions in Chapter 23, NFPA 101, 1994
22 edition, as adopted herein, or evacuation capability
23 requirements shall be notified by the local fire official in
24 writing of the automatic fire sprinkler requirement, as well
25 as the appropriate date for final compliance as provided in
26 this subparagraph. The local fire official shall send a copy
27 of the document to the Agency for Health Care Administration.
28 m. Except in cases of life-threatening fire hazards,
29 if an existing facility experiences a change in the evacuation
30 capability, or if the local authority having jurisdiction
31 identifies a construction-type restriction, such that an
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1 automatic fire sprinkler system is required, it shall be
2 afforded time for installation as provided in this
3 subparagraph.
4
5 Facilities that are fully sprinkled and in compliance with
6 other firesafety standards are not required to conduct more
7 than one of the required fire drills between the hours of 11
8 p.m. and 7 a.m., per year. In lieu of the remaining drills,
9 staff responsible for residents during such hours may be
10 required to participate in a mock drill that includes a review
11 of evacuation procedures. Such standards must be included or
12 referenced in the rules adopted by the State Fire Marshal.
13 Pursuant to s. 633.022(1)(b), the State Fire Marshal is the
14 final administrative authority for firesafety standards
15 established and enforced pursuant to this section. All
16 licensed facilities must have an annual fire inspection
17 conducted by the local fire marshal or authority having
18 jurisdiction.
19 3. Resident elopement requirements.--Each facility
20 shall conduct a minimum of two resident elopement prevention
21 and response drills per year. All administrators and direct
22 care staff shall participate in the drills, which must include
23 a review of procedures to address resident elopement. Each
24 facility shall document the implementation of the drills and
25 ensure that the drills are conducted in a manner consistent
26 with the facility's resident elopement policies and
27 procedures.
28 (b) The preparation and annual update of a
29 comprehensive emergency management plan. Such standards must
30 be included in the rules adopted by the agency department
31 after consultation with the Department of Community Affairs.
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1 At a minimum, the rules must provide for plan components that
2 address emergency evacuation transportation; adequate
3 sheltering arrangements; postdisaster activities, including
4 provision of emergency power, food, and water; postdisaster
5 transportation; supplies; staffing; emergency equipment;
6 individual identification of residents and transfer of
7 records; communication with families; and responses to family
8 inquiries. The comprehensive emergency management plan is
9 subject to review and approval by the local emergency
10 management agency. During its review, the local emergency
11 management agency shall ensure that the following agencies, at
12 a minimum, are given the opportunity to review the plan: the
13 Department of Elderly Affairs, the Department of Health, the
14 Agency for Health Care Administration, and the Department of
15 Community Affairs. Also, appropriate volunteer organizations
16 must be given the opportunity to review the plan. The local
17 emergency management agency shall complete its review within
18 60 days and either approve the plan or advise the facility of
19 necessary revisions.
20 (c) The number, training, and qualifications of all
21 personnel having responsibility for the care of residents.
22 The rules must require adequate staff to provide for the
23 safety of all residents. Facilities licensed for 17 or more
24 residents are required to maintain an alert staff for 24 hours
25 per day.
26 (d) All sanitary conditions within the facility and
27 its surroundings which will ensure the health and comfort of
28 residents. The rules must clearly delineate the
29 responsibilities of the agency's licensure and survey staff,
30 the county health departments, and the local authority having
31 jurisdiction over fire safety and ensure that inspections are
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1 not duplicative. The agency may collect fees for food service
2 inspections conducted by the county health departments and
3 transfer such fees to the Department of Health.
4 (e) License application and license renewal, transfer
5 of ownership, Proper management of resident funds and personal
6 property, surety bonds, resident contracts, refund policies,
7 financial ability to operate, and facility and staff records.
8 (f) Inspections, complaint investigations,
9 moratoriums, classification of deficiencies, levying and
10 enforcement of penalties, and use of income from fees and
11 fines.
12 (g) The enforcement of the resident bill of rights
13 specified in s. 400.428.
14 (h) The care and maintenance of residents, which must
15 include, but is not limited to:
16 1. The supervision of residents;
17 2. The provision of personal services;
18 3. The provision of, or arrangement for, social and
19 leisure activities;
20 4. The arrangement for appointments and transportation
21 to appropriate medical, dental, nursing, or mental health
22 services, as needed by residents;
23 5. The management of medication;
24 6. The nutritional needs of residents;
25 7. Resident records; and
26 8. Internal risk management and quality assurance.
27 (i) Facilities holding a limited nursing, extended
28 congregate care, or limited mental health license.
29 (j) The establishment of specific criteria to define
30 appropriateness of resident admission and continued residency
31
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1 in a facility holding a standard, limited nursing, extended
2 congregate care, and limited mental health license.
3 (k) The use of physical or chemical restraints. The
4 use of physical restraints is limited to half-bed rails as
5 prescribed and documented by the resident's physician with the
6 consent of the resident or, if applicable, the resident's
7 representative or designee or the resident's surrogate,
8 guardian, or attorney in fact. The use of chemical restraints
9 is limited to prescribed dosages of medications authorized by
10 the resident's physician and must be consistent with the
11 resident's diagnosis. Residents who are receiving medications
12 that can serve as chemical restraints must be evaluated by
13 their physician at least annually to assess:
14 1. The continued need for the medication.
15 2. The level of the medication in the resident's
16 blood.
17 3. The need for adjustments in the prescription.
18 (2) In adopting any rules pursuant to this part, the
19 agency department, in conjunction with the department agency,
20 shall make distinct standards for facilities based upon
21 facility size; the types of care provided; the physical and
22 mental capabilities and needs of residents; the type,
23 frequency, and amount of services and care offered; and the
24 staffing characteristics of the facility. Rules developed
25 pursuant to this section shall not restrict the use of shared
26 staffing and shared programming in facilities that are part of
27 retirement communities that provide multiple levels of care
28 and otherwise meet the requirements of law and rule. Except
29 for uniform firesafety standards, the agency department shall
30 adopt by rule separate and distinct standards for facilities
31 with 16 or fewer beds and for facilities with 17 or more beds.
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1 The standards for facilities with 16 or fewer beds shall be
2 appropriate for a noninstitutional residential environment,
3 provided that the structure is no more than two stories in
4 height and all persons who cannot exit the facility unassisted
5 in an emergency reside on the first floor. The agency
6 department, in conjunction with the department agency, may
7 make other distinctions among types of facilities as necessary
8 to enforce the provisions of this part. Where appropriate, the
9 agency shall offer alternate solutions for complying with
10 established standards, based on distinctions made by the
11 department and the agency relative to the physical
12 characteristics of facilities and the types of care offered
13 therein.
14 (3) The department shall submit a copy of proposed
15 rules to the Speaker of the House of Representatives, the
16 President of the Senate, and appropriate committees of
17 substance for review and comment prior to the promulgation
18 thereof.
19 (a) Rules adopted promulgated by the agency department
20 shall encourage the development of homelike facilities which
21 promote the dignity, individuality, personal strengths, and
22 decisionmaking ability of residents.
23 (b) The agency, in consultation with the department,
24 may waive rules promulgated pursuant to this part in order to
25 demonstrate and evaluate innovative or cost-effective
26 congregate care alternatives which enable individuals to age
27 in place. Such waivers may be granted only in instances where
28 there is reasonable assurance that the health, safety, or
29 welfare of residents will not be endangered. To apply for a
30 waiver, the licensee shall submit to the agency a written
31 description of the concept to be demonstrated, including
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1 goals, objectives, and anticipated benefits; the number and
2 types of residents who will be affected, if applicable; a
3 brief description of how the demonstration will be evaluated;
4 and any other information deemed appropriate by the agency.
5 Any facility granted a waiver shall submit a report of
6 findings to the agency and the department within 12 months.
7 At such time, the agency may renew or revoke the waiver or
8 pursue any regulatory or statutory changes necessary to allow
9 other facilities to adopt the same practices. The agency
10 department may by rule clarify terms and establish waiver
11 application procedures, criteria for reviewing waiver
12 proposals, and procedures for reporting findings, as necessary
13 to implement this subsection.
14 (4) The agency may use an abbreviated biennial
15 standard licensure inspection that consists of a review of key
16 quality-of-care standards in lieu of a full inspection in
17 facilities which have a good record of past performance.
18 However, a full inspection shall be conducted in facilities
19 which have had a history of class I or class II violations,
20 uncorrected class III violations, confirmed ombudsman council
21 complaints, or confirmed licensure complaints, within the
22 previous licensure period immediately preceding the inspection
23 or when a potentially serious problem is identified during the
24 abbreviated inspection. The agency, in consultation with the
25 department, shall develop the key quality-of-care standards
26 with input from the State Long-Term Care Ombudsman Council and
27 representatives of provider groups for incorporation into its
28 rules. The agency department, in consultation with the
29 department agency, shall report annually to the Legislature
30 concerning its implementation of this subsection. The report
31 shall include, at a minimum, the key quality-of-care standards
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1 which have been developed; the number of facilities identified
2 as being eligible for the abbreviated inspection; the number
3 of facilities which have received the abbreviated inspection
4 and, of those, the number that were converted to full
5 inspection; the number and type of subsequent complaints
6 received by the agency or department on facilities which have
7 had abbreviated inspections; any recommendations for
8 modification to this subsection; any plans by the agency to
9 modify its implementation of this subsection; and any other
10 information which the agency department believes should be
11 reported.
12 (5) A fee shall be charged by the department to any
13 person requesting a copy of this part or rules promulgated
14 under this part. Such fees shall not exceed the actual cost
15 of duplication and postage.
16 Section 102. Subsection (4) of section 400.442,
17 Florida Statutes, is amended to read:
18 400.442 Pharmacy and dietary services.--
19 (4) The agency department may by rule establish
20 procedures and specify documentation as necessary to implement
21 this section.
22 Section 103. Subsection (3) of section 400.444,
23 Florida Statutes, is amended to read:
24 400.444 Construction and renovation; requirements.--
25 (3) The agency department may adopt rules to establish
26 procedures and specify the documentation necessary to
27 implement this section.
28 Section 104. Subsections (1), (2), and (3) of section
29 400.447 and section 400.451, Florida Statutes, are repealed.
30
31
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1 Section 105. Subsections (1), (3), and (6) of section
2 400.452, Florida Statutes, as amended by section 3 of chapter
3 2003-405, Laws of Florida, are amended to read:
4 400.452 Staff training and educational programs; core
5 educational requirement.--
6 (1) Administrators and other assisted living facility
7 staff must meet minimum training and education requirements
8 established by the Department of Elderly Affairs or the agency
9 by rule. This training and education is intended to assist
10 facilities to appropriately respond to the needs of residents,
11 to maintain resident care and facility standards, and to meet
12 licensure requirements.
13 (3) Effective January 1, 2004, a new facility
14 administrator must complete the required training and
15 education, including the competency test, within a reasonable
16 time after being employed as an administrator, as determined
17 by the department. Failure to do so is a violation of this
18 part and subjects the violator to an administrative fine as
19 prescribed in s. 400.419. Administrators licensed in
20 accordance with chapter 468, part II, are exempt from this
21 requirement. Other licensed professionals may be exempted, as
22 determined by the department by rule.
23 (6) Other facility staff shall participate in training
24 relevant to their job duties as specified by rule of the
25 department.
26 Section 106. Section 400.454, Florida Statutes, is
27 amended to read:
28 400.454 Collection of information; local subsidy.--
29 (1) To enable the agency department to collect the
30 information requested by the Legislature regarding the actual
31 cost of providing room, board, and personal care in
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1 facilities, the agency may department is authorized to conduct
2 field visits and audits of facilities as may be necessary.
3 The owners of randomly sampled facilities shall submit such
4 reports, audits, and accountings of cost as required the
5 department may require by rule; provided that such reports,
6 audits, and accountings shall be the minimum necessary to
7 implement the provisions of this section. Any facility
8 selected to participate in the study shall cooperate with the
9 agency department by providing cost of operation information
10 to interviewers.
11 (2) Local governments or organizations may contribute
12 to the cost of care of local facility residents by further
13 subsidizing the rate of state-authorized payment to such
14 facilities. Implementation of local subsidy shall require
15 agency departmental approval and shall not result in
16 reductions in the state supplement.
17 Section 107. Subsections (1) and (4) of section
18 400.464, Florida Statutes, are amended to read:
19 400.464 Home health agencies to be licensed;
20 expiration of license; exemptions; unlawful acts; penalties.--
21 (1) The requirements of part II of chapter 408 apply
22 to the provision of services that necessitate licensure
23 pursuant to this part and part II of chapter 408 and to
24 entities licensed or registered by or applying for such
25 licensure or registration from the Agency for Health Care
26 Administration pursuant to this part. However, an applicant
27 for licensure is exempt from the provisions of s. 408.810(10).
28 Any home health agency must be licensed by the agency to
29 operate in this state. A license issued to a home health
30 agency, unless sooner suspended or revoked, expires 1 year
31 after its date of issuance.
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1 (4)(a) An organization may not provide, offer, or
2 advertise home health services to the public unless the
3 organization has a valid license or is specifically exempted
4 under this part. An organization that offers or advertises to
5 the public any service for which licensure or registration is
6 required under this part must include in the advertisement the
7 license number or regulation number issued to the organization
8 by the agency. The agency shall assess a fine of not less
9 than $100 to any licensee or registrant who fails to include
10 the license or registration number when submitting the
11 advertisement for publication, broadcast, or printing. The
12 holder of a license issued under this part may not advertise
13 or indicate to the public that it holds a home health agency
14 or nurse registry license other than the one it has been
15 issued.
16 (b) A person who violates paragraph (a) is subject to
17 an injunctive proceeding under s. 408.816 s. 400.515. A
18 violation of paragraph (a) or s. 408.812 is a deceptive and
19 unfair trade practice and constitutes a violation of the
20 Florida Deceptive and Unfair Trade Practices Act.
21 (c) A person who violates the provisions of paragraph
22 (a) commits a misdemeanor of the second degree, punishable as
23 provided in s. 775.082 or s. 775.083. Any person who commits
24 a second or subsequent violation commits a misdemeanor of the
25 first degree, punishable as provided in s. 775.082 or s.
26 775.083. Each day of continuing violation constitutes a
27 separate offense.
28 Section 108. Section 400.471, Florida Statutes, is
29 amended to read:
30 400.471 Application for license; fee; provisional
31 license; temporary permit.--
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1 (1) Each applicant for licensure must comply with all
2 provisions of part II of chapter 408. Application for an
3 initial license or for renewal of an existing license must be
4 made under oath to the agency on forms furnished by it and
5 must be accompanied by the appropriate license fee as provided
6 in subsection (8). The agency must take final action on an
7 initial licensure application within 60 days after receipt of
8 all required documentation.
9 (2) In addition to the requirements of part II of
10 chapter 408, the applicant must file with the application
11 satisfactory proof that the home health agency is in
12 compliance with this part and applicable rules, including:
13 (a) A listing of services to be provided, either
14 directly by the applicant or through contractual arrangements
15 with existing providers; and
16 (b) The number and discipline of professional staff to
17 be employed.; an annually thereafter
18 (c) Proof of financial ability to operate.
19 (3) An applicant for initial licensure must
20 demonstrate financial ability to operate by submitting a
21 balance sheet and income and expense statement for the first 2
22 years of operation which provide evidence of having sufficient
23 assets, credit, and projected revenues to cover liabilities
24 and expenses. The applicant shall have demonstrated financial
25 ability to operate if the applicant's assets, credit, and
26 projected revenues meet or exceed projected liabilities and
27 expenses. All documents required under this subsection must
28 be prepared in accordance with generally accepted accounting
29 principles, and the financial statement must be signed by a
30 certified public accountant.
31
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1 (4) Each applicant for licensure must comply with the
2 following requirements:
3 (a) Upon receipt of a completed, signed, and dated
4 application, the agency shall require background screening of
5 the applicant, in accordance with the level 2 standards for
6 screening set forth in chapter 435. As used in this
7 subsection, the term "applicant" means the administrator, or a
8 similarly titled person who is responsible for the day-to-day
9 operation of the licensed home health agency, and the
10 financial officer, or similarly titled individual who is
11 responsible for the financial operation of the licensed home
12 health agency.
13 (b) The agency may require background screening for a
14 member of the board of directors of the licensee or an officer
15 or an individual owning 5 percent or more of the licensee if
16 the agency reasonably suspects that such individual has been
17 convicted of an offense prohibited under the level 2 standards
18 for screening set forth in chapter 435.
19 (c) Proof of compliance with the level 2 background
20 screening requirements of chapter 435 which has been submitted
21 within the previous 5 years in compliance with any other
22 health care or assisted living licensure requirements of this
23 state is acceptable in fulfillment of paragraph (a). Proof of
24 compliance with background screening which has been submitted
25 within the previous 5 years to fulfill the requirements of the
26 Financial Services Commission and the Office of Insurance
27 Regulation pursuant to chapter 651 as part of an application
28 for a certificate of authority to operate a continuing care
29 retirement community is acceptable in fulfillment of the
30 Department of Law Enforcement and Federal Bureau of
31 Investigation background check.
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1 (d) A provisional license may be granted to an
2 applicant when each individual required by this section to
3 undergo background screening has met the standards for the
4 Department of Law Enforcement background check, but the agency
5 has not yet received background screening results from the
6 Federal Bureau of Investigation. A standard license may be
7 granted to the licensee upon the agency's receipt of a report
8 of the results of the Federal Bureau of Investigation
9 background screening for each individual required by this
10 section to undergo background screening which confirms that
11 all standards have been met, or upon the granting of a
12 disqualification exemption by the agency as set forth in
13 chapter 435. Any other person who is required to undergo level
14 2 background screening may serve in his or her capacity
15 pending the agency's receipt of the report from the Federal
16 Bureau of Investigation. However, the person may not continue
17 to serve if the report indicates any violation of background
18 screening standards and a disqualification exemption has not
19 been requested of and granted by the agency as set forth in
20 chapter 435.
21 (e) Each applicant must submit to the agency, with its
22 application, a description and explanation of any exclusions,
23 permanent suspensions, or terminations of the licensee or
24 potential licensee from the Medicare or Medicaid programs.
25 Proof of compliance with the requirements for disclosure of
26 ownership and control interest under the Medicaid or Medicare
27 programs may be accepted in lieu of this submission.
28 (f) Each applicant must submit to the agency a
29 description and explanation of any conviction of an offense
30 prohibited under the level 2 standards of chapter 435 by a
31 member of the board of directors of the applicant, its
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1 officers, or any individual owning 5 percent or more of the
2 applicant. This requirement does not apply to a director of a
3 not-for-profit corporation or organization if the director
4 serves solely in a voluntary capacity for the corporation or
5 organization, does not regularly take part in the day-to-day
6 operational decisions of the corporation or organization,
7 receives no remuneration for his or her services on the
8 corporation or organization's board of directors, and has no
9 financial interest and has no family members with a financial
10 interest in the corporation or organization, provided that the
11 director and the not-for-profit corporation or organization
12 include in the application a statement affirming that the
13 director's relationship to the corporation satisfies the
14 requirements of this paragraph.
15 (g) A license may not be granted to an applicant if
16 the applicant, administrator, or financial officer has been
17 found guilty of, regardless of adjudication, or has entered a
18 plea of nolo contendere or guilty to, any offense prohibited
19 under the level 2 standards for screening set forth in chapter
20 435, unless an exemption from disqualification has been
21 granted by the agency as set forth in chapter 435.
22 (h) The agency may deny or revoke licensure if the
23 applicant:
24 1. Has falsely represented a material fact in the
25 application required by paragraph (e) or paragraph (f), or has
26 omitted any material fact from the application required by
27 paragraph (e) or paragraph (f); or
28 2. Has been or is currently excluded, suspended,
29 terminated from, or has involuntarily withdrawn from
30 participation in this state's Medicaid program, or the
31 Medicaid program of any other state, or from participation in
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1 the Medicare program or any other governmental or private
2 health care or health insurance program.
3 (i) An application for license renewal must contain
4 the information required under paragraphs (e) and (f).
5 (3)(5) In addition to the requirements of s. 408.810,
6 the home health agency must also obtain and maintain the
7 following insurance coverages in an amount of not less than
8 $250,000 per claim, and the home health agency must submit
9 proof of coverage with an initial application for licensure
10 and with each annual application for license renewal:
11 (a) Malpractice insurance as defined in s.
12 624.605(1)(k); and
13 (b) Liability insurance as defined in s.
14 624.605(1)(b).
15 (6) Ninety days before the expiration date, an
16 application for renewal must be submitted to the agency under
17 oath on forms furnished by it, and a license must be renewed
18 if the applicant has met the requirements established under
19 this part and applicable rules. The home health agency must
20 file with the application satisfactory proof that it is in
21 compliance with this part and applicable rules. If there is
22 evidence of financial instability, the home health agency must
23 submit satisfactory proof of its financial ability to comply
24 with the requirements of this part.
25 (7) When transferring the ownership of a home health
26 agency, the transferee must submit an application for a
27 license at least 60 days before the effective date of the
28 transfer. If the home health agency is being leased, a copy
29 of the lease agreement must be filed with the application.
30 (4)(8) In accordance with s. 408.805, an applicant or
31 licensee shall pay a fee for each license application
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1 submitted under this part and part II of chapter 408. The fee
2 shall be established by rule and shall be set at The license
3 fee and annual renewal fee required of a home health agency
4 are nonrefundable. The agency shall set the fees in an amount
5 that is sufficient to cover the agency's its costs in carrying
6 out its responsibilities under this part, but may not to
7 exceed $2,000 per biennium $1,000. However, state, county, or
8 municipal governments applying for licenses under this part
9 are exempt from the payment of license fees. All fees
10 collected under this part must be deposited in the Health Care
11 Trust Fund for the administration of this part.
12 (9) The license must be displayed in a conspicuous
13 place in the administrative office of the home health agency
14 and is valid only while in the possession of the person to
15 which it is issued. The license may not be sold, assigned, or
16 otherwise transferred, voluntarily or involuntarily, and is
17 valid only for the home health agency and location for which
18 originally issued.
19 (10) A home health agency against whom a revocation or
20 suspension proceeding is pending at the time of license
21 renewal may be issued a provisional license effective until
22 final disposition by the agency of such proceedings. If
23 judicial relief is sought from the final disposition, the
24 court that has jurisdiction may issue a temporary permit for
25 the duration of the judicial proceeding.
26 (5)(11) The agency may not issue a license designated
27 as certified to a home health agency that fails to satisfy the
28 requirements of a Medicare certification survey from the
29 agency.
30
31
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1 (12) The agency may not issue a license to a home
2 health agency that has any unpaid fines assessed under this
3 part.
4 Section 109. Section 400.474, Florida Statutes, is
5 amended to read:
6 400.474 Denial or, suspension, revocation of license;
7 injunction; grounds; penalties.--
8 (1) The agency may deny or, revoke, or suspend a
9 license, or impose an administrative fine in the manner
10 provided in chapter 120, or initiate injunctive proceedings
11 under s. 408.816 for the violation of any provision of this
12 part, part II of chapter 408, or applicable rules s. 400.515.
13 (2) Any of the following actions by a home health
14 agency or its employee is grounds for disciplinary action by
15 the agency:
16 (a) Violation of this part, part II of chapter 408, or
17 of applicable rules.
18 (b) An intentional, reckless, or negligent act that
19 materially affects the health or safety of a patient.
20 (c) Knowingly providing home health services in an
21 unlicensed assisted living facility or unlicensed adult
22 family-care home, unless the home health agency or employee
23 reports the unlicensed facility or home to the agency within
24 72 hours after providing the services.
25 (3) The agency may impose the following penalties for
26 operating without a license upon an applicant or owner who has
27 in the past operated, or who currently operates, a licensed
28 home health agency.
29 (a) If a home health agency that is found to be
30 operating without a license wishes to apply for a license, the
31 home health agency may submit an application only after the
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1 agency has verified that the home health agency no longer
2 operates an unlicensed home health agency.
3 (b) Any person, partnership, or corporation that
4 violates paragraph (a) and that previously operated a licensed
5 home health agency or concurrently operates both a licensed
6 home health agency and an unlicensed home health agency
7 commits a felony of the third degree punishable as provided in
8 s. 775.082, s. 775.083, or s. 775.084. If an owner has an
9 interest in more than one home health agency and fails to
10 license any one of those home health agencies, the agency must
11 issue a cease and desist order for the activities of the
12 unlicensed home health agency and impose a moratorium on any
13 or all of the licensed related home health agencies until the
14 unlicensed home health agency is licensed.
15 (3)(c) If any home health agency is found to be
16 operating without a license meets the criteria in paragraph
17 (a) or paragraph (b) and that home health agency has received
18 any government reimbursement for services provided by an
19 unlicensed home health agency, the agency shall make a fraud
20 referral to the appropriate government reimbursement program.
21 (4) The agency may deny, revoke, or suspend the
22 license of a home health agency, or may impose on a home
23 health agency administrative fines not to exceed the aggregate
24 sum of $5,000 if:
25 (a) The agency is unable to obtain entry to the home
26 health agency to conduct a licensure survey, complaint
27 investigation, surveillance visit, or monitoring visit.
28 (b) An applicant or a licensed home health agency has
29 falsely represented a material fact in the application, or has
30 omitted from the application any material fact, including, but
31 not limited to, the fact that the controlling or ownership
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1 interest is held by any officer, director, agent, manager,
2 employee, affiliated person, partner, or shareholder who is
3 not eligible to participate.
4 (c) An applicant, owner, or person who has a 5 percent
5 or greater interest in a licensed entity:
6 1. Has been previously found by any licensing,
7 certifying, or professional standards board or agency to have
8 violated the standards or conditions that relate to home
9 health-related licensure or certification, or to the quality
10 of home health-related services provided; or
11 2. Has been or is currently excluded, suspended,
12 terminated from, or has involuntarily withdrawn from,
13 participation in the Medicaid program of this state or any
14 other state, the Medicare program, or any other governmental
15 health care or health insurance program.
16 Section 110. Subsection (1) and paragraphs (a) and (b)
17 of subsection (2) of section 400.484, Florida Statutes, are
18 amended to read:
19 400.484 Right of inspection; deficiencies; fines.--
20 (1) In accordance with s. 408.811, Any duly authorized
21 officer or employee of the agency may make such inspections
22 and investigations as are necessary in order to determine the
23 state of compliance with this part and with applicable rules.
24 The right of inspection extends to any business that the
25 agency has reason to believe is being operated as a home
26 health agency without a license, but such inspection of any
27 such business may not be made without the permission of the
28 owner or person in charge unless a warrant is first obtained
29 from a circuit court. Any application for a license issued
30 under this part or for license renewal constitutes permission
31
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1 for an appropriate inspection to verify the information
2 submitted on or in connection with the application.
3 (2) The agency shall impose fines for various classes
4 of deficiencies in accordance with the following schedule:
5 (a) A class I deficiency is any act, omission, or
6 practice that results in a patient's death, disablement, or
7 permanent injury, or places a patient at imminent risk of
8 death, disablement, or permanent injury. Upon finding a class
9 I deficiency, the agency may impose an administrative fine in
10 the amount of $5,000 for each occurrence and each day that the
11 deficiency exists. In addition, the agency may immediately
12 revoke the license, or impose a moratorium pursuant to s.
13 408.814 on the admission of new patients, until the factors
14 causing the deficiency have been corrected.
15 (b) A class II deficiency is any act, omission, or
16 practice that has a direct adverse effect on the health,
17 safety, or security of a patient. Upon finding a class II
18 deficiency, the agency may impose an administrative fine in
19 the amount of $1,000 for each occurrence and each day that the
20 deficiency exists. In addition, the agency may suspend the
21 license, or impose a moratorium pursuant to s. 408.814 on the
22 admission of new patients, until the deficiency has been
23 corrected.
24 Section 111. Subsections (1) and (2) of section
25 400.487, Florida Statutes, are amended to read:
26 400.487 Home health service agreements; physician's,
27 physician's assistant's, and advanced registered nurse
28 practitioner's treatment orders; patient assessment;
29 establishment and review of plan of care; provision of
30 services; orders not to resuscitate.--
31
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1 (1) Services provided by a home health agency must be
2 covered by an agreement between the home health agency and the
3 patient or the patient's legal representative specifying the
4 home health services to be provided, the rates or charges for
5 services paid with private funds, and the sources method of
6 payment, which may include Medicare, Medicaid, private
7 insurance, personal funds, or a combination thereof. A home
8 health agency providing skilled care must make an assessment
9 of the patient's needs within 48 hours after the start of
10 services.
11 (2) When required by the provisions of chapter 464;
12 part I, part III, or part V of chapter 468; or chapter 486,
13 the attending physician, physician's assistant, or advanced
14 registered nurse practitioner, acting within his or her
15 respective scope of practice, shall for a patient who is to
16 receive skilled care must establish treatment orders for a
17 patient who is to receive skilled care. The treatment orders
18 must be signed by the physician, physician's assistant, or
19 advanced registered nurse practitioner before a claim for
20 payment for the skilled services is submitted by the home
21 health agency. If the claim is submitted to a managed care
22 organization, the treatment orders must be signed in the time
23 allowed under the provider agreement. The treatment orders
24 shall within 30 days after the start of care and must be
25 reviewed, as frequently as the patient's illness requires, by
26 the physician, physician's assistant, or advanced registered
27 nurse practitioner in consultation with the home health agency
28 personnel that provide services to the patient.
29 Section 112. Section 400.494, Florida Statutes, is
30 amended to read:
31 400.494 Information about patients confidential.--
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1 (1) Information about patients received by persons
2 employed by, or providing services to, a home health agency or
3 received by the licensing agency through reports or inspection
4 shall be confidential and exempt from the provisions of s.
5 119.07(1) and may shall not be disclosed to any person other
6 than the patient without the written consent of that patient
7 or the patient's guardian.
8 (2) This section does not apply to information
9 lawfully requested by the Medicaid Fraud Control Unit of the
10 Office of the Attorney General or requested under s. 408.811
11 Department of Legal Affairs.
12 Section 113. Section 400.495, Florida Statutes, is
13 amended to read:
14 400.495 Notice of toll-free telephone number for
15 central abuse hotline.--In addition to the requirements of s.
16 408.810(5), On or before the first day home health services
17 are provided to a patient, any home health agency or nurse
18 registry licensed under this part must inform the patient and
19 his or her immediate family, if appropriate, of the right to
20 report abusive, neglectful, or exploitative practices. The
21 statewide toll-free telephone number for the central abuse
22 hotline must be provided to patients in a manner that is
23 clearly legible and must include the words: "To report abuse,
24 neglect, or exploitation, please call toll-free ...(phone
25 number)...." the Agency for Health Care Administration shall
26 adopt rules that provide for 90 days' advance notice of a
27 change in the toll-free telephone number and that outline due
28 process procedures, as provided under chapter 120, for home
29 health agency personnel and nurse registry personnel who are
30 reported to the central abuse hotline. Home health agencies
31
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1 and nurse registries shall establish appropriate policies and
2 procedures for providing such notice to patients.
3 Section 114. Section 400.497, Florida Statutes, is
4 amended to read:
5 400.497 Rules establishing minimum standards.--The
6 agency shall adopt, publish, and enforce rules to implement
7 part II of chapter 408, this part, including, as applicable,
8 ss. 400.506 and 400.509, which must provide reasonable and
9 fair minimum standards relating to:
10 (1) The home health aide competency test and home
11 health aide training. The agency shall create the home health
12 aide competency test and establish the curriculum and
13 instructor qualifications for home health aide training.
14 Licensed home health agencies may provide this training and
15 shall furnish documentation of such training to other licensed
16 home health agencies upon request. Successful passage of the
17 competency test by home health aides may be substituted for
18 the training required under this section and any rule adopted
19 pursuant thereto.
20 (2) Shared staffing. The agency shall allow shared
21 staffing if the home health agency is part of a retirement
22 community that provides multiple levels of care, is located on
23 one campus, is licensed under this chapter, and otherwise
24 meets the requirements of law and rule.
25 (3) The criteria for the frequency of onsite licensure
26 surveys.
27 (4) Licensure application and renewal.
28 (5) The requirements for onsite and electronic
29 accessibility of supervisory personnel of home health
30 agencies.
31 (6) Information to be included in patients' records.
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1 (7) Geographic service areas.
2 (8) Preparation of a comprehensive emergency
3 management plan pursuant to s. 400.492.
4 (a) The Agency for Health Care Administration shall
5 adopt rules establishing minimum criteria for the plan and
6 plan updates, with the concurrence of the Department of Health
7 and in consultation with the Department of Community Affairs.
8 (b) The rules must address the requirements in s.
9 400.492. In addition, the rules shall provide for the
10 maintenance of patient-specific medication lists that can
11 accompany patients who are transported from their homes.
12 (c) The plan is subject to review and approval by the
13 county health department. During its review, the county health
14 department shall ensure that the following agencies, at a
15 minimum, are given the opportunity to review the plan:
16 1. The local emergency management agency.
17 2. The Agency for Health Care Administration.
18 3. The local chapter of the American Red Cross or
19 other lead sheltering agency.
20 4. The district office of the Department of Children
21 and Family Services.
22
23 The county health department shall complete its review within
24 60 days after receipt of the plan and shall either approve the
25 plan or advise the home health agency of necessary revisions.
26 (d) For any home health agency that operates in more
27 than one county, the Department of Health shall review the
28 plan, after consulting with all of the county health
29 departments, the agency, and all the local chapters of the
30 American Red Cross or other lead sheltering agencies in the
31 areas of operation for that particular home health agency. The
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1 Department of Health shall complete its review within 90 days
2 after receipt of the plan and shall either approve the plan or
3 advise the home health agency of necessary revisions. The
4 Department of Health shall make every effort to avoid imposing
5 differing requirements based on differences between counties
6 on the home health agency.
7 (e) The requirements in this subsection do not apply
8 to:
9 1. A facility that is certified under chapter 651 and
10 has a licensed home health agency used exclusively by
11 residents of the facility; or
12 2. A retirement community that consists of residential
13 units for independent living and either a licensed nursing
14 home or an assisted living facility, and has a licensed home
15 health agency used exclusively by the residents of the
16 retirement community, provided the comprehensive emergency
17 management plan for the facility or retirement community
18 provides for continuous care of all residents with special
19 needs during an emergency.
20 Section 115. Section 400.506, Florida Statutes, is
21 amended to read:
22 400.506 Licensure of nurse registries; requirements;
23 penalties.--
24 (1) A nurse registry is exempt from the licensing
25 requirements of a home health agency but must be licensed as a
26 nurse registry. The requirements of part II of chapter 408
27 apply to the provision of services that necessitate licensure
28 pursuant to 400.506-400.518 and part II of chapter 408 and to
29 entities licensed by or applying for such licensed from the
30 Agency for Health Care Administration pursuant to ss.
31 400.506-400.518. Each operational site of the nurse registry
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1 must be licensed, unless there is more than one site within a
2 county. If there is more than one site within a county, only
3 one license per county is required. Each operational site
4 must be listed on the license.
5 (2) Each applicant for licensure must comply with all
6 provisions of part II of chapter 408, with the exception of s.
7 408.810(6) and (10). the following requirements:
8 (a) Upon receipt of a completed, signed, and dated
9 application, the agency shall require background screening, in
10 accordance with the level 2 standards for screening set forth
11 in chapter 435, of the managing employee, or other similarly
12 titled individual who is responsible for the daily operation
13 of the nurse registry, and of the financial officer, or other
14 similarly titled individual who is responsible for the
15 financial operation of the registry, including billings for
16 patient care and services. The applicant shall comply with
17 the procedures for level 2 background screening as set forth
18 in chapter 435.
19 (b) The agency may require background screening of any
20 other individual who is an applicant if the agency has
21 probable cause to believe that he or she has been convicted of
22 a crime or has committed any other offense prohibited under
23 the level 2 standards for screening set forth in chapter 435.
24 (c) Proof of compliance with the level 2 background
25 screening requirements of chapter 435 which has been submitted
26 within the previous 5 years in compliance with any other
27 health care or assisted living licensure requirements of this
28 state is acceptable in fulfillment of the requirements of
29 paragraph (a).
30 (d) A provisional license may be granted to an
31 applicant when each individual required by this section to
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1 undergo background screening has met the standards for the
2 Department of Law Enforcement background check but the agency
3 has not yet received background screening results from the
4 Federal Bureau of Investigation. A standard license may be
5 granted to the applicant upon the agency's receipt of a report
6 of the results of the Federal Bureau of Investigation
7 background screening for each individual required by this
8 section to undergo background screening which confirms that
9 all standards have been met, or upon the granting of a
10 disqualification exemption by the agency as set forth in
11 chapter 435. Any other person who is required to undergo level
12 2 background screening may serve in his or her capacity
13 pending the agency's receipt of the report from the Federal
14 Bureau of Investigation. However, the person may not continue
15 to serve if the report indicates any violation of background
16 screening standards and a disqualification exemption has not
17 been requested of and granted by the agency as set forth in
18 chapter 435.
19 (e) Each applicant must submit to the agency, with its
20 application, a description and explanation of any exclusions,
21 permanent suspensions, or terminations of the applicant from
22 the Medicare or Medicaid programs. Proof of compliance with
23 the requirements for disclosure of ownership and control
24 interests under the Medicaid or Medicare programs may be
25 accepted in lieu of this submission.
26 (f) Each applicant must submit to the agency a
27 description and explanation of any conviction of an offense
28 prohibited under the level 2 standards of chapter 435 by a
29 member of the board of directors of the applicant, its
30 officers, or any individual owning 5 percent or more of the
31 applicant. This requirement does not apply to a director of a
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1 not-for-profit corporation or organization if the director
2 serves solely in a voluntary capacity for the corporation or
3 organization, does not regularly take part in the day-to-day
4 operational decisions of the corporation or organization,
5 receives no remuneration for his or her services on the
6 corporation or organization's board of directors, and has no
7 financial interest and has no family members with a financial
8 interest in the corporation or organization, provided that the
9 director and the not-for-profit corporation or organization
10 include in the application a statement affirming that the
11 director's relationship to the corporation satisfies the
12 requirements of this paragraph.
13 (g) A license may not be granted to an applicant if
14 the applicant or managing employee has been found guilty of,
15 regardless of adjudication, or has entered a plea of nolo
16 contendere or guilty to, any offense prohibited under the
17 level 2 standards for screening set forth in chapter 435,
18 unless an exemption from disqualification has been granted by
19 the agency as set forth in chapter 435.
20 (h) The agency may deny or revoke the license if any
21 applicant:
22 1. Has falsely represented a material fact in the
23 application required by paragraph (e) or paragraph (f), or has
24 omitted any material fact from the application required by
25 paragraph (e) or paragraph (f); or
26 2. Has had prior action taken against the applicant
27 under the Medicaid or Medicare program as set forth in
28 paragraph (e).
29 (i) An application for license renewal must contain
30 the information required under paragraphs (e) and (f).
31
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1 (3) In accordance with s. 408.805, an applicant or
2 licensee shall pay a fee for each license application
3 submitted under ss. 400.508-400.518 and part II of chapter
4 408. The amount of the fee shall be established by rule and
5 may not exceed $2,000 per biennium. Application for license
6 must be made to the Agency for Health Care Administration on
7 forms furnished by it and must be accompanied by the
8 appropriate licensure fee, as established by rule and not to
9 exceed the cost of regulation under this part. The licensure
10 fee for nurse registries may not exceed $1,000 and must be
11 deposited in the Health Care Trust Fund.
12 (4) The Agency for Health Care Administration may
13 deny, revoke, or suspend a license or impose an administrative
14 fine in the manner provided in chapter 120 against a nurse
15 registry that:
16 (a) Fails to comply with this section or applicable
17 rules.
18 (b) Commits an intentional, reckless, or negligent act
19 that materially affects the health or safety of a person
20 receiving services.
21 (5) A license issued for the operation of a nurse
22 registry, unless sooner suspended or revoked, expires 1 year
23 after its date of issuance. Sixty days before the expiration
24 date, an application for renewal must be submitted to the
25 Agency for Health Care Administration on forms furnished by
26 it. The Agency for Health Care Administration shall renew the
27 license if the applicant has met the requirements of this
28 section and applicable rules. A nurse registry against which
29 a revocation or suspension proceeding is pending at the time
30 of license renewal may be issued a conditional license
31 effective until final disposition by the Agency for Health
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1 Care Administration of such proceedings. If judicial relief is
2 sought from the final disposition, the court having
3 jurisdiction may issue a conditional license for the duration
4 of the judicial proceeding.
5 (6) The Agency for Health Care Administration may
6 institute injunctive proceedings under s. 400.515.
7 (4)(7) A person that offers or advertises to the
8 public that it provides any service for which licensure is
9 required under this section must include in such advertisement
10 the license number issued to it by the Agency for Health Care
11 Administration.
12 (8) It is unlawful for a person to offer or advertise
13 to the public services as defined by rule without obtaining a
14 valid license from the Agency for Health Care Administration.
15 It is unlawful for any holder of a license to advertise or
16 hold out to the public that he or she holds a license for
17 other than that for which he or she actually holds a license.
18 A person who violates this subsection is subject to injunctive
19 proceedings under s. 400.515.
20 (9) Any duly authorized officer or employee of the
21 Agency for Health Care Administration may make such
22 inspections and investigations as are necessary to respond to
23 complaints or to determine the state of compliance with this
24 section and applicable rules.
25 (a) If, in responding to a complaint, an agent or
26 employee of the Agency for Health Care Administration has
27 reason to believe that a crime has been committed, he or she
28 shall notify the appropriate law enforcement agency.
29 (b) If, in responding to a complaint, an agent or
30 employee of the Agency for Health Care Administration has
31 reason to believe that abuse, neglect, or exploitation has
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1 occurred, according to the definitions in chapter 415, he or
2 she shall file a report under chapter 415.
3 (5)(10)(a) A nurse registry may refer for contract in
4 private residences registered nurses and licensed practical
5 nurses registered and licensed under part I of chapter 464,
6 certified nursing assistants certified under part II of
7 chapter 464, home health aides who present documented proof of
8 successful completion of the training required by rule of the
9 agency, and companions or homemakers for the purposes of
10 providing those services authorized under s. 400.509(1). Each
11 person referred by a nurse registry must provide current
12 documentation that he or she is free from communicable
13 diseases.
14 (b) A certified nursing assistant or home health aide
15 may be referred for a contract to provide care to a patient in
16 his or her home only if that patient is under a physician's
17 care. A certified nursing assistant or home health aide
18 referred for contract in a private residence shall be limited
19 to assisting a patient with bathing, dressing, toileting,
20 grooming, eating, physical transfer, and those normal daily
21 routines the patient could perform for himself or herself were
22 he or she physically capable. A certified nursing assistant
23 or home health aide may not provide medical or other health
24 care services that require specialized training and that may
25 be performed only by licensed health care professionals. The
26 nurse registry shall obtain the name and address of the
27 attending physician and send written notification to the
28 physician within 48 hours after a contract is concluded that a
29 certified nursing assistant or home health aide will be
30 providing care for that patient.
31
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1 (c) A nurse registry shall, at the time of contracting
2 for services through the nurse registry, advise the patient,
3 the patient's family, or a person acting on behalf of the
4 patient of the availability of registered nurses to make
5 visits to the patient's home at an additional cost. A
6 registered nurse shall make monthly visits to the patient's
7 home to assess the patient's condition and quality of care
8 being provided by the certified nursing assistant or home
9 health aide. Any condition that which in the professional
10 judgment of the nurse requires further medical attention shall
11 be reported to the attending physician and the nurse registry.
12 The assessment shall become a part of the patient's file with
13 the nurse registry and may be reviewed by the agency during
14 their survey procedure.
15 (6)(11) A person who is referred by a nurse registry
16 for contract in private residences and who is not a nurse
17 licensed under part I of chapter 464 may perform only those
18 services or care to clients that the person has been certified
19 to perform or trained to perform as required by law or rules
20 of the Agency for Health Care Administration or the Department
21 of Business and Professional Regulation. Providing services
22 beyond the scope authorized under this subsection constitutes
23 the unauthorized practice of medicine or a violation of the
24 Nurse Practice Act and is punishable as provided under chapter
25 458, chapter 459, or part I of chapter 464.
26 (7)(12) Each nurse registry must require every
27 applicant for contract to complete an application form
28 providing the following information:
29 (a) The name, address, date of birth, and social
30 security number of the applicant.
31
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1 (b) The educational background and employment history
2 of the applicant.
3 (c) The number and date of the applicable license or
4 certification.
5 (d) When appropriate, information concerning the
6 renewal of the applicable license, registration, or
7 certification.
8 (8)(13) Each nurse registry must comply with the
9 procedures set forth in s. 400.512 for maintaining records of
10 the employment history of all persons referred for contract
11 and is subject to the standards and conditions set forth in
12 that section. However, an initial screening may not be
13 required for persons who have been continuously registered
14 with the nurse registry since September 30, 1990.
15 (9)(14) The nurse registry must maintain the
16 application on file, and that file must be open to the
17 inspection of the Agency for Health Care Administration. The
18 nurse registry must maintain on file the name and address of
19 the client to whom the nurse or other nurse registry personnel
20 is sent for contract and the amount of the fee received by the
21 nurse registry. A nurse registry must maintain the file that
22 includes the application and other applicable documentation
23 for 3 years after the date of the last file entry of
24 client-related information.
25 (10)(15) Nurse registries shall assist persons who
26 would need assistance and sheltering during evacuations
27 because of physical, mental, or sensory disabilities in
28 registering with the appropriate local emergency management
29 agency pursuant to s. 252.355.
30 (11)(16) Each nurse registry shall prepare and
31 maintain a comprehensive emergency management plan that is
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1 consistent with the criteria in this subsection and with the
2 local special needs plan. The plan shall be updated annually.
3 The plan shall specify how the nurse registry shall facilitate
4 the provision of continuous care by persons referred for
5 contract to persons who are registered pursuant to s. 252.355
6 during an emergency that interrupts the provision of care or
7 services in private residencies.
8 (a) All persons referred for contract who care for
9 persons registered pursuant to s. 252.355 must include in the
10 patient record a description of how care will be continued
11 during a disaster or emergency that interrupts the provision
12 of care in the patient's home. It shall be the responsibility
13 of the person referred for contract to ensure that continuous
14 care is provided.
15 (b) Each nurse registry shall maintain a current
16 prioritized list of patients in private residences who are
17 registered pursuant to s. 252.355 and are under the care of
18 persons referred for contract and who need continued services
19 during an emergency. This list shall indicate, for each
20 patient, if the client is to be transported to a special needs
21 shelter and if the patient is receiving skilled nursing
22 services. Nurse registries shall make this list available to
23 county health departments and to local emergency management
24 agencies upon request.
25 (c) Each person referred for contract who is caring
26 for a patient who is registered pursuant to s. 252.355 shall
27 provide a list of the patient's medication and equipment needs
28 to the nurse registry. Each person referred for contract shall
29 make this information available to county health departments
30 and to local emergency management agencies upon request.
31
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1 (d) Each person referred for contract shall not be
2 required to continue to provide care to patients in emergency
3 situations that are beyond the person's control and that make
4 it impossible to provide services, such as when roads are
5 impassable or when patients do not go to the location
6 specified in their patient records.
7 (e) The comprehensive emergency management plan
8 required by this subsection is subject to review and approval
9 by the county health department. During its review, the county
10 health department shall ensure that, at a minimum, the local
11 emergency management agency, the Agency for Health Care
12 Administration, and the local chapter of the American Red
13 Cross or other lead sheltering agency are given the
14 opportunity to review the plan. The county health department
15 shall complete its review within 60 days after receipt of the
16 plan and shall either approve the plan or advise the nurse
17 registry of necessary revisions.
18 (f) The Agency for Health Care Administration shall
19 adopt rules establishing minimum criteria for the
20 comprehensive emergency management plan and plan updates
21 required by this subsection, with the concurrence of the
22 Department of Health and in consultation with the Department
23 of Community Affairs.
24 (12)(17) All persons referred for contract in private
25 residences by a nurse registry must comply with the following
26 requirements for a plan of treatment:
27 (a) When, in accordance with the privileges and
28 restrictions imposed upon a nurse under part I of chapter 464,
29 the delivery of care to a patient is under the direction or
30 supervision of a physician or when a physician is responsible
31 for the medical care of the patient, a medical plan of
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1 treatment must be established for each patient receiving care
2 or treatment provided by a licensed nurse in the home. The
3 original medical plan of treatment must be timely signed by
4 the physician, physician's assistant, or advanced registered
5 nurse practitioner, acting within his or her respective scope
6 of practice, and reviewed by him or her in consultation with
7 the licensed nurse at least every 2 months. Any additional
8 order or change in orders must be obtained from the physician,
9 physician's assistant, or advanced registered nurse
10 practitioner and reduced to writing and timely signed by the
11 physician, physician's assistant, or advanced registered nurse
12 practitioner. The delivery of care under a medical plan of
13 treatment must be substantiated by the appropriate nursing
14 notes or documentation made by the nurse in compliance with
15 nursing practices established under part I of chapter 464.
16 (b) Whenever a medical plan of treatment is
17 established for a patient, the initial medical plan of
18 treatment, any amendment to the plan, additional order or
19 change in orders, and copy of nursing notes must be filed in
20 the office of the nurse registry.
21 (13)(18) The nurse registry must comply with the
22 notice requirements of s. 400.495, relating to abuse
23 reporting.
24 (14)(19) In addition to any other penalties imposed
25 pursuant to this section or part, the agency may assess costs
26 related to an investigation that results in a successful
27 prosecution, excluding costs associated with an attorney's
28 time. If the agency imposes such an assessment and the
29 assessment is not paid, and if challenged is not the subject
30 of a pending appeal, prior to the renewal of the license, the
31
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1 license shall not be issued until the assessment is paid or
2 arrangements for payment of the assessment are made.
3 (15)(20) The Agency for Health Care Administration
4 shall adopt rules to implement this section and part II of
5 chapter 408.
6 Section 116. Section 400.509, Florida Statutes, is
7 amended to read:
8 400.509 Registration of particular service providers
9 exempt from licensure; certificate of registration; regulation
10 of registrants.--
11 (1) Any organization that provides companion services
12 or homemaker services and does not provide a home health
13 service to a person is exempt from licensure under this part.
14 However, any organization that provides companion services or
15 homemaker services must register with the agency.
16 (2) The requirements of part II of chapter 408 apply
17 to the provision of services that necessitate registration or
18 licensure pursuant to ss. 400.509-400.512 and ss.
19 408.801-408.819 and to entities registered by or applying for
20 such registration from the Agency for Health Care
21 Administration pursuant to ss. 400.509-400.512. Each applicant
22 for registration must comply with all provisions of part II of
23 chapter 408, with the exception of s. 408.810(6)-(10).
24 Registration consists of annually filing with the agency,
25 under oath, on forms provided by it, the following
26 information:
27 (a) If the registrant is a firm or partnership, the
28 name, address, date of birth, and social security number of
29 every member.
30 (b) If the registrant is a corporation or association,
31 its name and address; the name, address, date of birth, and
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1 social security number of each of its directors and officers;
2 and the name and address of each person having at least a 5
3 percent interest in the corporation or association.
4 (c) The name, address, date of birth, and social
5 security number of each person employed by or under contract
6 with the organization.
7 (3) In accordance with s. 408.805, an applicant or
8 registrant shall pay a fee for each registration issued under
9 this part and part II of chapter 408. The amount of the fee
10 shall be $50 per biennium. The agency shall charge a
11 registration fee of $25 to be submitted with the information
12 required under subsection (2).
13 (4) Each applicant for registration must comply with
14 the following requirements:
15 (a) Upon receipt of a completed, signed, and dated
16 application, the agency shall require background screening, in
17 accordance with the level 1 standards for screening set forth
18 in chapter 435, of every individual who will have contact with
19 the client. The agency shall require background screening of
20 the managing employee or other similarly titled individual who
21 is responsible for the operation of the entity, and of the
22 financial officer or other similarly titled individual who is
23 responsible for the financial operation of the entity,
24 including billings for client services in accordance with the
25 level 2 standards for background screening as set forth in
26 chapter 435.
27 (b) The agency may require background screening of any
28 other individual who is affiliated with the applicant if the
29 agency has a reasonable basis for believing that he or she has
30 been convicted of a crime or has committed any other offense
31
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1 prohibited under the level 2 standards for screening set forth
2 in chapter 435.
3 (c) Proof of compliance with the level 2 background
4 screening requirements of chapter 435 which has been submitted
5 within the previous 5 years in compliance with any other
6 health care or assisted living licensure requirements of this
7 state is acceptable in fulfillment of paragraph (a).
8 (d) A provisional registration may be granted to an
9 applicant when each individual required by this section to
10 undergo background screening has met the standards for the
11 abuse-registry background check through the agency and the
12 Department of Law Enforcement background check, but the agency
13 has not yet received background screening results from the
14 Federal Bureau of Investigation. A standard registration may
15 be granted to the applicant upon the agency's receipt of a
16 report of the results of the Federal Bureau of Investigation
17 background screening for each individual required by this
18 section to undergo background screening which confirms that
19 all standards have been met, or upon the granting of a
20 disqualification exemption by the agency as set forth in
21 chapter 435. Any other person who is required to undergo
22 level 2 background screening may serve in his or her capacity
23 pending the agency's receipt of the report from the Federal
24 Bureau of Investigation. However, the person may not continue
25 to serve if the report indicates any violation of background
26 screening standards and if a disqualification exemption has
27 not been requested of and granted by the agency as set forth
28 in chapter 435.
29 (e) Each applicant must submit to the agency, with its
30 application, a description and explanation of any exclusions,
31 permanent suspensions, or terminations of the applicant from
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1 the Medicare or Medicaid programs. Proof of compliance with
2 the requirements for disclosure of ownership and control
3 interests under the Medicaid or Medicare programs may be
4 accepted in lieu of this submission.
5 (f) Each applicant must submit to the agency a
6 description and explanation of any conviction of an offense
7 prohibited under the level 2 standards of chapter 435 which
8 was committed by a member of the board of directors of the
9 applicant, its officers, or any individual owning 5 percent or
10 more of the applicant. This requirement does not apply to a
11 director of a not-for-profit corporation or organization who
12 serves solely in a voluntary capacity for the corporation or
13 organization, does not regularly take part in the day-to-day
14 operational decisions of the corporation or organization,
15 receives no remuneration for his or her services on the
16 corporation's or organization's board of directors, and has no
17 financial interest and no family members having a financial
18 interest in the corporation or organization, if the director
19 and the not-for-profit corporation or organization include in
20 the application a statement affirming that the director's
21 relationship to the corporation satisfies the requirements of
22 this paragraph.
23 (g) A registration may not be granted to an applicant
24 if the applicant or managing employee has been found guilty
25 of, regardless of adjudication, or has entered a plea of nolo
26 contendere or guilty to, any offense prohibited under the
27 level 2 standards for screening set forth in chapter 435,
28 unless an exemption from disqualification has been granted by
29 the agency as set forth in chapter 435.
30 (h) The agency may deny or revoke the registration of
31 any applicant who:
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1 1. Has falsely represented a material fact in the
2 application required by paragraph (e) or paragraph (f), or has
3 omitted any material fact from the application required by
4 paragraph (e) or paragraph (f); or
5 2. Has had prior action taken against the applicant
6 under the Medicaid or Medicare program as set forth in
7 paragraph (e).
8 (i) An application for licensure renewal must contain
9 the information required under paragraphs (e) and (f).
10 (4)(5) Each registrant must obtain the employment or
11 contract history of persons who are employed by or under
12 contract with the organization and who will have contact at
13 any time with patients or clients in their homes by:
14 (a) Requiring such persons to submit an employment or
15 contractual history to the registrant; and
16 (b) Verifying the employment or contractual history,
17 unless through diligent efforts such verification is not
18 possible. The agency shall prescribe by rule the minimum
19 requirements for establishing that diligent efforts have been
20 made.
21
22 There is no monetary liability on the part of, and no cause of
23 action for damages arises against, a former employer of a
24 prospective employee of or prospective independent contractor
25 with a registrant who reasonably and in good faith
26 communicates his or her honest opinions about the former
27 employee's or contractor's job performance. This subsection
28 does not affect the official immunity of an officer or
29 employee of a public corporation.
30 (6) On or before the first day on which services are
31 provided to a patient or client, any registrant under this
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1 part must inform the patient or client and his or her
2 immediate family, if appropriate, of the right to report
3 abusive, neglectful, or exploitative practices. The statewide
4 toll-free telephone number for the central abuse hotline must
5 be provided to patients or clients in a manner that is clearly
6 legible and must include the words: "To report abuse, neglect,
7 or exploitation, please call toll-free ...(phone number)...."
8 Registrants must establish appropriate policies and procedures
9 for providing such notice to patients or clients.
10 (7) The provisions of s. 400.512 regarding screening
11 apply to any person or business entity registered under this
12 section on or after October 1, 1994.
13 (8) Upon verification that all requirements for
14 registration have been met, the Agency for Health Care
15 Administration shall issue a certificate of registration valid
16 for no more than 1 year.
17 (9) The Agency for Health Care Administration may
18 deny, suspend, or revoke the registration of a person that:
19 (a) Fails to comply with this section or applicable
20 rules.
21 (b) Commits an intentional, reckless, or negligent act
22 that materially affects the health or safety of a person
23 receiving services.
24 (10) The Agency for Health Care Administration may
25 institute injunctive proceedings under s. 400.515.
26 (5)(11) A person that offers or advertises to the
27 public a service for which registration is required must
28 include in its advertisement the registration number issued by
29 the Agency for Health Care Administration.
30 (12) It is unlawful for a person to offer or advertise
31 to the public services, as defined by rule, without obtaining
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1 a certificate of registration from the Agency for Health Care
2 Administration. It is unlawful for any holder of a
3 certificate of registration to advertise or hold out to the
4 public that he or she holds a certificate of registration for
5 other than that for which he or she actually holds a
6 certificate of registration. Any person who violates this
7 subsection is subject to injunctive proceedings under s.
8 400.515.
9 (13) Any duly authorized officer or employee of the
10 Agency for Health Care Administration has the right to make
11 such inspections and investigations as are necessary in order
12 to respond to complaints or to determine the state of
13 compliance with this section and applicable rules.
14 (a) If, in responding to a complaint, an officer or
15 employee of the Agency for Health Care Administration has
16 reason to believe that a crime has been committed, he or she
17 shall notify the appropriate law enforcement agency.
18 (b) If, in responding to a complaint, an officer or
19 employee of the Agency for Health Care Administration has
20 reason to believe that abuse, neglect, or exploitation has
21 occurred, according to the definitions in chapter 415, he or
22 she shall file a report under chapter 415.
23 (6)(14) In addition to any other penalties imposed
24 pursuant to this section or part, the agency may assess costs
25 related to an investigation that results in a successful
26 prosecution, excluding costs associated with an attorney's
27 time. If the agency imposes such an assessment and the
28 assessment is not paid, and if challenged is not the subject
29 of a pending appeal, prior to the renewal of the registration,
30 the registration shall not be issued until the assessment is
31 paid or arrangements for payment of the assessment are made.
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1 (7)(15) The Agency for Health Care Administration
2 shall adopt rules to administer this section and part II of
3 chapter 408.
4 (8) Notwithstanding the penalties provided in s.
5 408.812(3), any registrant that provides personal care to a
6 client in the client's private residence commits a misdemeanor
7 of the first degree, punishable as provided in s. 775.082 or
8 s. 775.083, if the client's residence is not a facility
9 licensed in accordance with part II of chapter 408. Section
10 408.812 applies to all other unlicensed activity by a
11 registrant, including the offering or advertising of any
12 service that necessitates licensure under part II of chapter
13 408.
14 Section 117. Subsections (2) and (7) of section
15 400.512, Florida Statutes, are amended to read:
16 400.512 Screening of home health agency personnel;
17 nurse registry personnel; and companions and homemakers.--The
18 agency shall require employment or contractor screening as
19 provided in chapter 435, using the level 1 standards for
20 screening set forth in that chapter, for home health agency
21 personnel; persons referred for employment by nurse
22 registries; and persons employed by companion or homemaker
23 services registered under s. 400.509.
24 (2) The administrator of each home health agency, the
25 managing employee of each nurse registry, and the managing
26 employee of each companion or homemaker service registered
27 under s. 400.509 must sign an affidavit annually, under
28 penalty of perjury, stating that all personnel hired,
29 contracted with, or registered on or after October 1, 1994,
30 who enter the home of a patient or client in their service
31 capacity have been screened and that its remaining personnel
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1 have worked for the home health agency or registrant
2 continuously since before October 1, 1994.
3 (7)(a) It is a misdemeanor of the first degree,
4 punishable under s. 775.082 or s. 775.083, for any person
5 willfully, knowingly, or intentionally to:
6 1. Fail, by false statement, misrepresentation,
7 impersonation, or other fraudulent means, to disclose in any
8 application for voluntary or paid employment a material fact
9 used in making a determination as to such person's
10 qualifications to be an employee under this section;
11 2. Operate or attempt to operate an entity licensed or
12 registered under this part with persons who do not meet the
13 minimum standards for good moral character as contained in
14 this section; or
15 2.3. Use information from the criminal records
16 obtained under this section for any purpose other than
17 screening that person for employment as specified in this
18 section or release such information to any other person for
19 any purpose other than screening for employment under this
20 section.
21 (b) It is a felony of the third degree, punishable
22 under s. 775.082, s. 775.083, or s. 775.084, for any person
23 willfully, knowingly, or intentionally to use information from
24 the juvenile records of a person obtained under this section
25 for any purpose other than screening for employment under this
26 section.
27 Section 118. Section 400.515, Florida Statutes, is
28 repealed.
29 Section 119. Subsections (6) and (7) of section
30 400.551, Florida Statutes, are amended to read:
31 400.551 Definitions.--As used in this part, the term:
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1 (6) "Operator" means the licensee or person having
2 general administrative charge of an adult day care center.
3 (7) "Owner" means the licensee owner of an adult day
4 care center.
5 Section 120. Section 400.554, Florida Statutes, is
6 amended to read:
7 400.554 License requirement; fee; exemption;
8 display.--
9 (1) The requirements of part II of chapter 408 apply
10 to the provision of services that necessitate licensure
11 pursuant to this part and part II of chapter 408 and to
12 entities licensed by or applying for such licensure from the
13 Agency for Health Care Administration pursuant to this part.
14 However, an applicant for licensure is exempt from the
15 provisions of s. 408.810(10). It is unlawful to operate an
16 adult day care center without first obtaining from the agency
17 a license authorizing such operation. The agency is
18 responsible for licensing adult day care centers in accordance
19 with this part.
20 (2) Separate licenses are required for centers
21 operated on separate premises, even though operated under the
22 same management. Separate licenses are not required for
23 separate buildings on the same premises.
24 (3) In accordance with s. 408.805, an applicant or
25 licensee shall pay a fee for each license application
26 submitted under this part and part II of chapter 408. The
27 amount of the fee shall be established by rule and The
28 biennial license fee required of a center shall be determined
29 by the department, but may not exceed $150 per biennium.
30
31
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1 (4) County-operated or municipally operated centers
2 applying for licensure under this part are exempt from the
3 payment of license fees.
4 (5) The license for a center shall be displayed in a
5 conspicuous place inside the center.
6 (6) A license is valid only in the possession of the
7 individual, firm, partnership, association, or corporation to
8 which it is issued and is not subject to sale, assignment, or
9 other transfer, voluntary or involuntary; nor is a license
10 valid for any premises other than the premises for which
11 originally issued.
12 Section 121. Section 400.555, Florida Statutes, is
13 amended to read:
14 400.555 Application for license.--
15 (1) An application for a license to operate an adult
16 day care center must be made to the agency on forms furnished
17 by the agency and must be accompanied by the appropriate
18 license fee unless the applicant is exempt from payment of the
19 fee as provided in s. 400.554(4).
20 (2) In addition to all provisions of part II of
21 chapter 408, the applicant for licensure must furnish:
22 (a) a description of the physical and mental
23 capabilities and needs of the participants to be served and
24 the availability, frequency, and intensity of basic services
25 and of supportive and optional services to be provided and
26 proof of adequate liability insurance coverage.;
27 (b) Satisfactory proof of financial ability to operate
28 and conduct the center in accordance with the requirements of
29 this part, which must include, in the case of an initial
30 application, a 1-year operating plan and proof of a 3-month
31 operating reserve fund; and
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1 (c) Proof of adequate liability insurance coverage.
2 (d) Proof of compliance with level 2 background
3 screening as required under s. 400.5572.
4 (e) A description and explanation of any exclusions,
5 permanent suspensions, or terminations of the application from
6 the Medicare or Medicaid programs. Proof of compliance with
7 disclosure of ownership and control interest requirements of
8 the Medicare or Medicaid programs shall be accepted in lieu of
9 this submission.
10 Section 122. Section 400.556, Florida Statutes, is
11 amended to read:
12 400.556 Denial or, suspension, revocation of license;
13 emergency action; administrative fines; investigations and
14 inspections.--
15 (1) The agency may deny or, revoke, or suspend a
16 license under this part, impose an action under s. 408.814, or
17 may impose an administrative fine against the owner of an
18 adult day care center or its operator or employee in the
19 manner provided in chapter 120 for a violation of any
20 provision of this part, part II of chapter 408, or applicable
21 rules.
22 (2) Each of the following actions by the owner of an
23 adult day care center or by its operator or employee is a
24 ground for action by the agency against the owner of the
25 center or its operator or employee:
26 (a) An intentional or negligent act materially
27 affecting the health or safety of center participants.
28 (b) A violation of this part or of any standard or
29 rule under this part.
30 (b)(c) A failure of persons subject to level 2
31 background screening under s. 400.4174(1) to meet the
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1 screening standards of s. 435.04, or the retention by the
2 center of an employee subject to level 1 background screening
3 standards under s. 400.4174(2) who does not meet the screening
4 standards of s. 435.03 and for whom exemptions from
5 disqualification have not been provided by the agency.
6 (c)(d) Failure to follow the criteria and procedures
7 provided under part I of chapter 394 relating to the
8 transportation, voluntary admission, and involuntary
9 examination of center participants.
10 (d)(e) Multiple or repeated violations of this part or
11 of any standard or rule adopted under this part or part II of
12 chapter 408.
13 (f) Exclusion, permanent suspension, or termination of
14 the owner, if an individual, officer, or board member of the
15 adult day care center, if the owner is a firm, corporation,
16 partnership, or association, or any person owning 5 percent or
17 more of the center, from the Medicare or Medicaid program.
18 (3) The agency is responsible for all investigations
19 and inspections conducted pursuant to this part.
20 Section 123. Section 400.5565, Florida Statutes, is
21 amended to read:
22 400.5565 Administrative fines; interest.--
23 (1)(a) If the agency determines that an adult day care
24 center is not operated in compliance with this part, part II
25 of chapter 408, or applicable with rules adopted under this
26 part, the agency, notwithstanding any other administrative
27 action it takes, shall make a reasonable attempt to discuss
28 with the owner each violation and recommended corrective
29 action prior to providing the owner with written notification.
30 The agency may request the submission of a corrective action
31 plan for the center which demonstrates a good faith effort to
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1 remedy each violation by a specific date, subject to the
2 approval of the agency.
3 (b) The owner of a center or its operator or employee
4 found in violation of this part, part II of chapter 408, or
5 applicable of rules adopted under this part may be fined by
6 the agency. A fine may not exceed $500 for each violation.
7 In no event, however, may such fines in the aggregate exceed
8 $5,000.
9 (c) The failure to correct a violation by the date set
10 by the agency, or the failure to comply with an approved
11 corrective action plan, is a separate violation for each day
12 such failure continues, unless the agency approves an
13 extension to a specific date.
14 (d) If the owner of a center or its operator or
15 employee appeals an agency action under this section and the
16 fine is upheld, the violator shall pay the fine, plus interest
17 at the legal rate specified in s. 687.01 for each day that the
18 fine remains unpaid after the date set by the agency for
19 payment of the fine.
20 (2) In determining whether to impose a fine and in
21 fixing the amount of any fine, the agency shall consider the
22 following factors:
23 (a) The gravity of the violation, including the
24 probability that death or serious physical or emotional harm
25 to a participant will result or has resulted, the severity of
26 the actual or potential harm, and the extent to which the
27 provisions of the applicable statutes or rules were violated.
28 (b) Actions taken by the owner or operator to correct
29 violations.
30 (c) Any previous violations.
31
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1 (d) The financial benefit to the center of committing
2 or continuing the violation.
3 Section 124. Section 400.557, Florida Statutes, is
4 amended to read:
5 400.557 Expiration of license; renewal; Conditional
6 license or permit.--
7 (1) A license issued for the operation of an adult day
8 care center, unless sooner suspended or revoked, expires 2
9 years after the date of issuance. The agency shall notify a
10 licensee at least 120 days before the expiration date that
11 license renewal is required to continue operation. The
12 notification must be provided electronically or by mail
13 delivery. At least 90 days prior to the expiration date, an
14 application for renewal must be submitted to the agency. A
15 license shall be renewed, upon the filing of an application on
16 forms furnished by the agency, if the applicant has first met
17 the requirements of this part and of the rules adopted under
18 this part. The applicant must file with the application
19 satisfactory proof of financial ability to operate the center
20 in accordance with the requirements of this part and in
21 accordance with the needs of the participants to be served and
22 an affidavit of compliance with the background screening
23 requirements of s. 400.5572.
24 (2) A licensee against whom a revocation or suspension
25 proceeding is pending at the time for license renewal may be
26 issued a conditional license effective until final disposition
27 by the agency of the proceeding. If judicial relief is sought
28 from the final disposition, the court having jurisdiction may
29 issue a conditional permit effective for the duration of the
30 judicial proceeding.
31
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1 (3) The agency may issue a conditional license to an
2 applicant for license renewal or change of ownership if the
3 applicant fails to meet all standards and requirements for
4 licensure. A conditional license issued under this subsection
5 must be limited to a specific period not exceeding 6 months,
6 as determined by the agency, and must be accompanied by an
7 approved plan of correction.
8 Section 125. Section 400.5572, Florida Statutes, is
9 amended to read:
10 400.5572 Background screening.--
11 (1)(a) Level 2 background screening must be conducted
12 on each of the following persons, who shall be considered
13 employees for the purposes of conducting screening under
14 chapter 435:
15 1. The adult day care center owner if an individual,
16 the operator, and the financial officer.
17 2. An officer or board member if the owner of the
18 adult day care center is a firm, corporation, partnership, or
19 association, or any person owning 5 percent or more of the
20 facility, if the agency has probable cause to believe that
21 such person has been convicted of any offense prohibited by s.
22 435.04. For each officer, board member, or person owning 5
23 percent or more who has been convicted of any such offense,
24 the facility shall submit to the agency a description and
25 explanation of the conviction at the time of license
26 application. This subparagraph does not apply to a board
27 member of a not-for-profit corporation or organization if the
28 board member serves solely in a voluntary capacity, does not
29 regularly take part in the day-to-day operational decisions of
30 the corporation or organization, receives no remuneration for
31 his or her services, and has no financial interest and has no
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1 family members with a financial interest in the corporation or
2 organization, provided that the board member and facility
3 submit a statement affirming that the board member's
4 relationship to the facility satisfies the requirements of
5 this subparagraph.
6 (b) Proof of compliance with level 2 screening
7 standards which has been submitted within the previous 5 years
8 to meet any facility or professional licensure requirements of
9 the agency or the Department of Health satisfies the
10 requirements of this subsection.
11 (c) The agency may grant a provisional license to an
12 adult day care center applying for an initial license when
13 each individual required by this subsection to undergo
14 screening has completed the Department of Law Enforcement
15 background check, but has not yet received results from the
16 Federal Bureau of Investigation, or when a request for an
17 exemption from disqualification has been submitted to the
18 agency pursuant to s.