HB 0267CS

CHAMBER ACTION



1The Committee on Future of Florida's Families recommends the
2following:
3
4     Committee Substitute
5     Remove the entire bill and insert:
6
A bill to be entitled
7An act relating to health care facilities; creating s.
8400.0712, F.S.; authorizing the Agency for Health Care
9Administration to issue inactive licenses to nursing homes
10for all or a portion of their beds under certain
11circumstances; providing requirements for application for
12and issuance of such licenses; providing rulemaking
13authority; amending s. 400.071, F.S.; deleting a provision
14relating to issuance of inactive licenses, to conform;
15amending s. 400.021, F.S.; redefining the term "resident
16care plan," as used in part II of ch. 400, F.S.; amending
17s. 400.23, F.S.; providing that certain information from
18the agency must be promptly updated to reflect the most
19current agency actions; amending s. 400.211, F.S.;
20revising inservice training requirements for persons
21employed as nursing assistants in a nursing home facility;
22amending s. 408.034, F.S.; requiring the nursing-home-bed-
23need methodology established by the agency by rule to
24include a goal of maintaining a specified subdistrict
25average occupancy rate; amending s. 408.036, F.S.,
26relating to health-care-related projects subject to review
27for a certificate of need; subjecting certain projects
28relating to replacement of a nursing home and relocation
29of nursing home beds to expedited review; revising
30requirements for certain projects relating to the addition
31of nursing home beds which are exempt from review;
32exempting from review certain projects relating to
33replacement of a licensed nursing home bed on the same
34site or nearby and consolidation or combination of
35licensed nursing homes or transfer of beds between
36licensed nursing homes within the same planning
37subdistrict; providing rulemaking authority; providing for
38assessment of exemption-request fees; amending s. 52, ch.
392001-45, Laws of Florida; specifying nonapplication of a
40moratorium on certificates of need and authorizing
41approval of certain certificates of need for certain
42counties under certain circumstances; providing review
43requirements and bed limitations; amending s. 651.118,
44F.S.; revising provisions relating to use of sheltered
45nursing home beds at a continuing care facility by persons
46who are not residents of the continuing care facility;
47providing an effective date.
48
49Be It Enacted by the Legislature of the State of Florida:
50
51     Section 1.  Section 400.0712, Florida Statutes, is created
52to read:
53     400.0712  Application for inactive license.--
54     (1)  As specified in this section, the agency may issue an
55inactive license to a nursing home facility for all or a portion
56of its beds. Any request by a licensee that a nursing home or
57portion of a nursing home become inactive must be submitted to
58the agency in the approved format. The facility may not initiate
59any suspension of services, notify residents, or initiate
60facility closure before receiving approval from the agency; and
61a facility that violates this provision shall not be issued an
62inactive license. Upon agency approval of an inactive license,
63the nursing home shall notify residents of any necessary
64discharge or transfer as provided in s. 400.0255.
65     (2)  The agency may issue an inactive license to a nursing
66home that chooses to use an unoccupied contiguous portion of the
67facility for an alternative use to meet the needs of elderly
68persons through the use of less restrictive, less institutional
69services.
70     (a)  An inactive license issued under this subsection may
71be granted for a period not to exceed 12 months but may be
72renewed annually by the agency for 12 months.
73     (b)  A request to extend the inactive license must be
74submitted to the agency in the approved format and approved by
75the agency in writing.
76     (c)  Nursing homes that receive an inactive license to
77provide alternative services shall not receive preference for
78participation in the Assisted Living for the Elderly Medicaid
79waiver.
80     (3)  The agency may issue an inactive license to a nursing
81home that will be temporarily unable to provide services but is
82reasonably expected to resume services.
83     (a)  An inactive license issued under this subsection may
84be issued for a period not to exceed 12 months and may be
85renewed by the agency for an additional 6 months upon
86demonstration of progress toward reopening.
87     (b)  All licensure fees must be current and paid in full,
88and may be prorated as provided by agency rule, before the
89inactive license is issued.
90     (c)  Reactivation of an inactive license requires that the
91applicant pay all licensure fees and be inspected by the agency
92to confirm that all of the requirements of this part and
93applicable rules are met.
94     (4)  The agency shall adopt rules pursuant to ss.
95120.536(1) and 120.54 necessary to implement this section.
96     Section 2.  Subsections (10), (11), and (12) of section
97400.071, Florida Statutes, are amended to read:
98     400.071  Application for license.--
99     (10)  The agency may issue an inactive license to a nursing
100home that will be temporarily unable to provide services but
101that is reasonably expected to resume services. Such designation
102may be made for a period not to exceed 12 months but may be
103renewed by the agency for up to 6 additional months. Any request
104by a licensee that a nursing home become inactive must be
105submitted to the agency and approved by the agency prior to
106initiating any suspension of service or notifying residents.
107Upon agency approval, the nursing home shall notify residents of
108any necessary discharge or transfer as provided in s. 400.0255.
109     (10)(11)  As a condition of licensure, each facility must
110establish and submit with its application a plan for quality
111assurance and for conducting risk management.
112     (11)(12)  The applicant must provide the agency with proof
113of a legal right to occupy the property before a license may be
114issued. Proof may include, but is not limited to, copies of
115warranty deeds, lease or rental agreements, contracts for deeds,
116or quitclaim deeds.
117     Section 3.  Subsection (17) of section 400.021, Florida
118Statutes, is amended to read:
119     400.021  Definitions.--When used in this part, unless the
120context otherwise requires, the term:
121     (17)  "Resident care plan" means a written plan developed,
122maintained, and reviewed not less than quarterly by a registered
123nurse, with participation from other facility staff and the
124resident or his or her designee or legal representative, which
125includes a comprehensive assessment of the needs of an
126individual resident; the type and frequency of services required
127to provide the necessary care for the resident to attain or
128maintain the highest practicable physical, mental, and
129psychosocial well-being; a listing of services provided within
130or outside the facility to meet those needs; and an explanation
131of service goals. The resident care plan must be signed by the
132director of nursing or another registered nurse employed by the
133facility to whom institutional responsibilities have been
134delegated and by the resident, the resident's designee, or the
135resident's legal representative. The facility may not use an
136agency or temporary registered nurse to satisfy the foregoing
137requirement and must document the institutional responsibilities
138that have been delegated to the registered nurse.
139     Section 4.  Subsection (10) is added to section 400.23,
140Florida Statutes, to read:
141     400.23  Rules; evaluation and deficiencies; licensure
142status.--
143     (10)  Agency records, reports, ranking systems, Internet
144information, and publications must be promptly updated to
145reflect the most current agency actions.
146     Section 5.  Subsection (4) of section 400.211, Florida
147Statutes, is amended to read:
148     400.211  Persons employed as nursing assistants;
149certification requirement.--
150     (4)  When employed by a nursing home facility for a 12-
151month period or longer, a nursing assistant, to maintain
152certification, shall submit to a performance review every 12
153months and must receive regular inservice education based on the
154outcome of such reviews. The inservice training must:
155     (a)  Be sufficient to ensure the continuing competence of
156nursing assistants and must meet the standard specified in s.
157464.203(7), must be at least 18 hours per year, and may include
158hours accrued under s. 464.203(8);
159     (b)  Include, at a minimum:
160     1.  Techniques for assisting with eating and proper
161feeding;
162     2.  Principles of adequate nutrition and hydration;
163     3.  Techniques for assisting and responding to the
164cognitively impaired resident or the resident with difficult
165behaviors;
166     4.  Techniques for caring for the resident at the end-of-
167life; and
168     5.  Recognizing changes that place a resident at risk for
169pressure ulcers and falls; and
170     (c)  Address areas of weakness as determined in nursing
171assistant performance reviews and may address the special needs
172of residents as determined by the nursing home facility staff.
173
174Costs associated with this training may not be reimbursed from
175additional Medicaid funding through interim rate adjustments.
176     Section 6.  Subsection (5) of section 408.034, Florida
177Statutes, is amended to read:
178     408.034  Duties and responsibilities of agency; rules.--
179     (5)  The agency shall establish by rule a nursing-home-bed-
180need methodology that has a goal of maintaining a subdistrict
181average occupancy rate of 94 percent and that reduces the
182community nursing home bed need for the areas of the state where
183the agency establishes pilot community diversion programs
184through the Title XIX aging waiver program.
185     Section 7.  Paragraphs (g) and (h) are added to subsection
186(2) of section 408.036, Florida Statutes, paragraph (p) of
187subsection (3) is amended, paragraphs (u) and (v) are added to
188subsection (3) of said section, and subsection (4) is reenacted
189to read:
190     408.036  Projects subject to review; exemptions.--
191     (2)  PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless exempt
192pursuant to subsection (3), projects subject to an expedited
193review shall include, but not be limited to:
194     (g)  Replacement of a nursing home within the same
195district, provided the proposed project site is located within a
196geographic area that contains at least 65 percent of the
197facility's current residents and is within a 30-mile radius of
198the replaced nursing home.
199     (h)  Relocation of a portion of a nursing home's licensed
200beds to a facility within the same district, provided the
201relocation is within a 30-mile radius of the existing facility
202and the total number of nursing home beds in the district does
203not increase.
204
205The agency shall develop rules to implement the provisions for
206expedited review, including time schedule, application content
207which may be reduced from the full requirements of s.
208408.037(1), and application processing.
209     (3)  EXEMPTIONS.--Upon request, the following projects are
210subject to exemption from the provisions of subsection (1):
211     (p)  For the addition of nursing home beds licensed under
212chapter 400 in a number not exceeding 10 total beds or 10
213percent of the number of beds licensed in the facility being
214expanded, whichever is greater, or for the addition of nursing
215home beds licensed under chapter 400 at a facility that has been
216designated as a Gold Seal nursing home under s. 400.235 in a
217number not exceeding 20 total beds or 10 percent of the number
218of beds licensed in the facility being expanded, whichever is
219greater.
220     1.  In addition to any other documentation required by the
221agency, a request for exemption submitted under this paragraph
222must:
223     a.  Effective until June 30, 2001, Certify that the
224facility has not had any class I or class II deficiencies within
225the 30 months preceding the request for addition.
226     b.  Effective on July 1, 2001, certify that the facility
227has been designated as a Gold Seal nursing home under s.
228400.235.
229     b.c.  Certify that the prior 12-month average occupancy
230rate for the nursing home beds at the facility meets or exceeds
23196 percent.
232     c.d.  Certify that any beds authorized for the facility
233under this paragraph before the date of the current request for
234an exemption have been licensed and operational for at least 12
235months.
236     2.  The timeframes and monitoring process specified in s.
237408.040(2)(a)-(c) apply to any exemption issued under this
238paragraph.
239     3.  The agency shall count beds authorized under this
240paragraph as approved beds in the published inventory of nursing
241home beds until the beds are licensed.
242     (u)  For replacement of a licensed nursing home on the same
243site, or within 3 miles of the same site, provided the number of
244licensed beds does not increase.
245     (v)  For consolidation or combination of licensed nursing
246homes or transfer of beds between licensed nursing homes within
247the same planning subdistrict, by providers that operate
248multiple nursing homes within that planning subdistrict,
249provided there is no increase in the planning subdistrict total
250of nursing home beds and the relocation does not exceed 30 miles
251from the original location.
252     (4)  A request for exemption under subsection (3) may be
253made at any time and is not subject to the batching requirements
254of this section. The request shall be supported by such
255documentation as the agency requires by rule. The agency shall
256assess a fee of $250 for each request for exemption submitted
257under subsection (3).
258     Section 8.  Section 52 of chapter 2001-45, Laws of Florida,
259as amended by section 1693 of chapter 2003-261, Laws of Florida,
260is amended to read:
261     Section 52.  (1)  Notwithstanding the establishment of need
262as provided for in chapter 408, Florida Statutes, no certificate
263of need for additional community nursing home beds shall be
264approved by the agency until July 1, 2006.
265     (2)  The Legislature finds that the continued growth in the
266Medicaid budget for nursing home care has constrained the
267ability of the state to meet the needs of its elderly residents
268through the use of less restrictive and less institutional
269methods of long-term care. It is therefore the intent of the
270Legislature to limit the increase in Medicaid nursing home
271expenditures in order to provide funds to invest in long-term
272care that is community-based and provides supportive services in
273a manner that is both more cost-effective and more in keeping
274with the wishes of the elderly residents of this state.
275     (3)  This moratorium on certificates of need shall not
276apply to sheltered nursing home beds in a continuing care
277retirement community certified by the former Department of
278Insurance or by the Office of Insurance Regulation pursuant to
279chapter 651, Florida Statutes.
280     (4)(a)  This moratorium on certificates of need shall not
281apply, and a certificate of need for additional community
282nursing home beds may be approved, for a county that meets the
283following circumstances:
284     1.  The county has no community nursing home beds.
285     2.  The lack of community nursing home beds occurs because
286all nursing home beds in the county that were licensed on July
2871, 2001, have subsequently closed.
288     (b)  The certificate-of-need review for such circumstances
289shall be subject to the comparative review process consistent
290with the provisions of s. 408.039, Florida Statutes, and the
291number of beds may not exceed the number of beds lost by the
292county after July 1, 2001.
293     Section 9.  Subsection (7) of section 651.118, Florida
294Statutes, is amended to read:
295     651.118  Agency for Health Care Administration;
296certificates of need; sheltered beds; community beds.--
297     (7)  Notwithstanding the provisions of subsection (2), at
298the discretion of the continuing care provider, sheltered
299nursing home beds may be used for persons who are not residents
300of the continuing care facility and who are not parties to a
301continuing care contract for a period of up to 5 years after the
302date of issuance of the initial nursing home license. A provider
303whose 5-year period has expired or is expiring may request the
304Agency for Health Care Administration for an extension, not to
305exceed 30 percent of the total sheltered nursing home beds, if
306the utilization by residents of the nursing home facility in the
307sheltered beds will not generate sufficient income to cover
308nursing home facility expenses, as evidenced by one of the
309following:
310     (a)  The nursing home facility has a net loss for the most
311recent fiscal year as determined under generally accepted
312accounting principles, excluding the effects of extraordinary or
313unusual items, as demonstrated in the most recently audited
314financial statement; or
315     (b)  The nursing home facility would have had a pro forma
316loss for the most recent fiscal year, excluding the effects of
317extraordinary or unusual items, if revenues were reduced by the
318amount of revenues from persons in sheltered beds who were not
319residents, as reported on by a certified public accountant.
320
321The agency shall be authorized to grant an extension to the
322provider based on the evidence required in this subsection. The
323agency may request a continuing care facility to use up to 25
324percent of the patient days generated by new admissions of
325nonresidents during the extension period to serve Medicaid
326recipients for those beds authorized for extended use if there
327is a demonstrated need in the respective service area and if
328funds are available. A provider who obtains an extension is
329prohibited from applying for additional sheltered beds under the
330provision of subsection (2), unless additional residential units
331are built or the provider can demonstrate need by continuing
332care facility residents to the Agency for Health Care
333Administration. The 5-year limit does not apply to up to five
334sheltered beds designated for inpatient hospice care as part of
335a contractual arrangement with a hospice licensed under part VI
336of chapter 400. A continuing care facility that uses such beds
337after the 5-year period shall report such use to the Agency for
338Health Care Administration. For purposes of this subsection,
339"resident" means a person who, upon admission to the continuing
340care facility, initially resides in a part of the continuing
341care facility not licensed under part II of chapter 400.
342     Section 10.  This act shall take effect upon becoming a
343law.


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