HB 0553 2004
1	A bill to be entitled
2	An act relating to regulation of health care entities;
3	revising the administrative and enforcement powers,
4	duties, and authority of the Agency for Health Care
5	Administration; amending s. 400.461, F.S.; providing for
6	licensure of nurse registries and personal care
7	organizations; amending s. 400.462, F.S.; revising
8	definitions; amending s. 400.464, F.S.; revising the
9	licensure period; deleting references to registrations;
10	imposing a fine for certain offenses; providing a
11	declaration of nuisance under certain circumstances;
12	providing for injunctions against certain activities;
13	increasing certain criminal penalties; providing criminal
14	penalties; imposing a fine for noncompliance; revising a
15	licensure exemption provision to conform; amending s.
16	400.471, F.S.; revising licensure application
17	requirements; revising licensure denial or revocation
18	provisions; increasing a malpractice insurance coverage
19	amount requirement; deleting a liability insurance
20	requirement; requiring certain notice of expiration;
21	providing for administrative fines; imposing certain
22	additional fees; requiring acceptance of certain surveys;
23	deleting certain licensing fee restrictions; amending s.
24	400.487, F.S.; including physician assistants and advanced
25	nurse practitioners under home health agreement
26	provisions; revising home health agreement requirements;
27	amending s. 400.491, F.S.; increasing the time a home
28	health agency is required to keep patient records
29	following termination of services; requiring certain
30	licensed home health agencies to notify certain patients
31	of ceasing operations; requiring such agencies to allow
32	such patients to retrieve certain records; deleting a
33	recordkeeping requirement; amending s. 400.494, F.S.;
34	providing for disclosure of certain patient information
35	otherwise confidential; deleting a nonapplication
36	provision; amending s. 400.495, F.S., relating to notice
37	of toll-free telephone number for central abuse hotline,
38	to conform; amending s. 400.497, F.S.; deleting a plan
39	review and approval requirement by county health
40	departments; amending s. 400.506, F.S.; revising
41	provisions providing for licensure of nurse registries;
42	increasing a licensure fee; imposing a survey fee;
43	revising a licensure period; authorizing imposition of
44	additional fines; providing criminal penalties; revising
45	requirements; creating s. 400.5095, F.S.; providing
46	licensure requirements for personal care organizations,
47	including background screening; providing for a fee;
48	providing for denial, revocation, or suspension of
49	licenses under certain circumstances; providing for
50	renewal and expiration of licenses; authorizing the
51	institution of injunctive proceedings; prohibiting
52	operation without a license; authorizing the agency to
53	impose administrative fines under certain circumstances;
54	providing a declaration of nuisance; providing for
55	injunctive relief; specifying certain deceptive and unfair
56	trade practices; providing for additional administrative
57	fines; authorizing inspections and investigations;
58	providing criminal penalties; specifying personal care
59	service provision requirements and limitations; specifying
60	certain application requirements for certified nursing
61	assistants or home health aides; specifying recordkeeping
62	requirements; specifying certain staff training
63	requirements; specifying certain procedural requirements
64	under emergency circumstances; requiring the agency to
65	adopt certain rules; requiring certain abuse reporting
66	requirements; authorizing the agency to assess certain
67	costs under certain circumstances; amending s. 400.512,
68	F.S., relating to screening of personnel, to conform;
69	amending s. 400.515, F.S.; expanding the circumstances
70	under which the agency may institute injunction
71	proceedings; amending s. 381.0303, F.S.; correcting a
72	cross-reference; repealing s. 400.509, F.S., relating to
73	the regulation of companion services; providing an
74	effective date.
75
76	Be It Enacted by the Legislature of the State of Florida:
77
78	Section 1. Subsection (2) of section 400.461, Florida
79	Statutes, is amended to read:
80	400.461 Short title; purpose.--
81	(2) The purpose of this part is to provide for the
82	licensure of every home health agency, nurse registry, and
83	personal care organizationand to provide for the development,
84	establishment, and enforcement of basic standards that will
85	ensure the safe and adequate care of persons receiving health
86	services in their own homes.
87	Section 2. Section 400.462, Florida Statutes, is amended
88	to read:
89	400.462 Definitions.--As used in this part, the term:
90	(1) "Administrator" means a direct employee of the home
91	health agency or a related organization, or of a management
92	company that has a contract to manage the home health agency,to
93	whom the governing body has delegated the responsibility for
94	day-to-day administration of the home health agency. The
95	administrator must be a licensed physician, physician assistant,
96	or registered nurse licensed to practice in this state or an
97	individual having at least 1 year of supervisory or
98	administrative experience in home health care or in a facility
99	licensed under chapter 395 or under part II or part III of this
100	chapter. An administrator may manage a maximum of five licensed
101	home health agencies located within one agency service district
102	or within an immediately contiguous county. If the home health
103	agency is licensed under this chapter and is part of a
104	retirement community that provides multiple levels of care, an
105	employee of the retirement community may administer the home
106	health agency and up to a maximum of four entities licensed
107	under this chapter that are owned, operated, or managed by the
108	same corporate entity. An administrator shall designate, in
109	writing, for each licensed entity, a qualified alternate
110	administrator to serve during absences.
111	(2) "Advanced registered nurse practitioner" has the same
112	meaning as that provided in s. 464.003.
113	(3)(2)"Agency" means the Agency for Health Care
114	Administration.
115	(4)(3)"Certified nursing assistant" means any person who
116	has been issued a certificate under part II of chapter 464. The
117	licensed home health agency, or licensed nurse registry, or
118	personal care organizationshall ensure that the certified
119	nursing assistant or home health aide,employed by or under
120	contract with the home health agency, or licensednurse
121	registry, or personal care organizationis adequately trained to
122	perform the tasks of a home health aide in the home setting.
123	(5)(4)"Client" means an elderly, handicapped, or
124	convalescent individual who receives personal care services,
125	companion services,or homemaker services in the individual's
126	home or place of residence.
127	(6)(5) "Companion" or "sitter" means a person who spends
128	time with cares foran elderly, handicapped, or convalescent
129	individual and accompanies such individual on trips and outings
130	and may prepare and serve meals to such individual. A companion
131	may not provide hands-on personal care to a client.
132	(7)(6)"Department" means the Department of Children and
133	Family Services.
134	(8) "Direct employee" means an employee whose withholding
135	taxes are paid by a home health agency, a management company
136	that has a contract to manage a home health agency on a day-to-
137	day basis, or an employee leasing company which has a contract
138	with a home health agency to handle the payroll and payroll
139	taxes for such home health agency.
140	(9)(7) "Director of nursing" means a registered nurse and
141	who is a direct employee of the agency and or related business
142	entitywho is a graduate of an approved school of nursing and is
143	licensed in this state; who has at least 1 year of supervisory
144	experience as a registered nurse in a licensed home health
145	agency, a facility licensed under chapter 395, or a facility
146	licensed under part II or part III of this chapter; and who is
147	responsible for overseeing the professional nursing and home
148	health aid delivery of services of the agency. A director of
149	nursing An employeemay be the director of nursing of a maximum
150	of five licensed home health agencies operated by a related
151	business entity and located within one agency service district
152	or within an immediately contiguous county. If the home health
153	agency is licensed under this chapter and is part of a
154	retirement community that provides multiple levels of care, an
155	employee of the retirement community may serve as the director
156	of nursing of the home health agency and of up to four entities
157	licensed under this chapter which are owned, operated, or
158	managed by the same corporate entity. A director of nursing
159	shall designate, in writing, for each licensed entity, a
160	qualified alternate registered nurse to serve during the absence
161	of the director of nursing.
162	(10)(8)"Home health agency" means an organization that
163	provides home health services and staffing services.
164	(11)(9)"Home health agency personnel" means persons who
165	are employed by or under contract with a home health agency and
166	enter the home or place of residence of patients at any time in
167	the course of their employment or contract.
168	(12)(10)"Home health services" means health and medical
169	services and medical supplies furnished by an organization to an
170	individual in the individual's home or place of residence. The
171	term includes organizations that provide one or more of the
172	following:
173	(a) Nursing care.
174	(b) Physical, occupational, respiratory, or speech
175	therapy.
176	(c) Home health aide services.
177	(d) Dietetics and nutrition practice and nutrition
178	counseling.
179	(e) Medical supplies, restricted to drugs and biologicals
180	prescribed by a physician.
181	(13)(11) "Home health aide" means a person who is trained
182	or qualified, as determined by the agency, andwho provides
183	hands-on personal care, performs simple procedures as an
184	extension of therapy or nursing services, assists in ambulation
185	or exercises, or assists in administering medications as
186	permitted in rule and for which the person has received training
187	established by the agency under s. 400.497(1).
188	(14)(12)"Homemaker" means a person who performs household
189	chores that include housekeeping, meal planning and preparation,
190	shopping assistance, and routine household activities for an
191	elderly, handicapped, or convalescent individual. A homemaker
192	may not provide hands-on personal care to a client.
193	(15)(13)"Home infusion therapy provider" means an
194	organization that employs, contracts with, or refers a licensed
195	professional who has received advanced training and experience
196	in intravenous infusion therapy and who administers infusion
197	therapy to a patient in the patient's home or place of
198	residence.
199	(16)(14)"Home infusion therapy" means the administration
200	of intravenous pharmacological or nutritional products to a
201	patient in his or her home.
202	(17)(15)"Nurse registry" means any person that procures,
203	offers, promises, or attempts to secure health-care-related
204	contracts for registered nurses, licensed practical nurses,
205	certified nursing assistants, home health aides, companions, or
206	homemakers, who are compensated by fees as independent
207	contractors, including, but not limited to, contracts for the
208	provision of services to patients and contracts to provide
209	private duty or staffing services to health care facilities
210	licensed under chapter 395 or this chapter or other business
211	entities.
212	(18)(16)"Organization" means a corporation, government or
213	governmental subdivision or agency, partnership or association,
214	or any other legal or commercial entity, any of which involve
215	more than one health care professional discipline,or a health
216	care professional and a home health aide,or certified nursing
217	assistant, or more than one home health aide or certified
218	nursing assistant, or a home health aide and a certified nursing
219	assistant. The term does not include an entity that provides
220	services using only volunteers or only individuals related by
221	blood or marriage to the patient or client.
222	(19)(17)"Patient" means any person who receives home
223	health services in his or her home or place of residence.
224	(20)(18)"Personal care" means assistance to a patient in
225	the activities of daily living, such as dressing, bathing,
226	eating, or personal hygiene, and assistance in physical
227	transfer, ambulation, and in administering medications as
228	permitted by rule.
229	(21) "Personal care organization" means a business
230	licensed to provide personal care and homemaker and companion
231	services by employed caregivers, but no skilled care services.
232	(22)(19)"Physician" means a person licensed under chapter
233	458, chapter 459, chapter 460, or chapter 461.
234	(23) "Physician assistant" has the same meaning as that
235	provided in s. 458.347.
236	(24)(20)"Skilled care" means nursing services or
237	therapeutic services required by law to bedelivered by a health
238	care professional who is licensed under part I of chapter 464;
239	part I, part III, or part V of chapter 468; or chapter 486 and
240	who is employed by or under contract with a licensed home health
241	agency or is referred by a licensed nurse registry.
242	(25)(21)"Staffing services" means services provided to a
243	health care facility or other business entity on a temporary
244	basis by licensed health care personnel, including certified
245	nursing assistants and home heath aides who are employed by, or
246	work under the auspices of, a licensed home health agency or who
247	are registered with a licensed nurse registry.
248	Section 3. Subsections (1) and (4) and paragraphs (b) and
249	(e) of subsection (5) of section 400.464, Florida Statutes, are
250	amended to read:
251	400.464 Home health agencies to be licensed; expiration of
252	license; exemptions; unlawful acts; penalties.--
253	(1) Any home health agency must be licensed by the agency
254	to operate in this state. A license issued to a home health
255	agency, unless sooner suspended or revoked, expires 2 years 1
256	yearafter its date of issuance.
257	(4)(a) An organization may not provide, offer, or
258	advertise home health services to the public unless the
259	organization has a valid license or is specifically exempted
260	under this part. An organization that offers or advertises to
261	the public any service for which licensure or registrationis
262	required under this part must include in the advertisement the
263	license number or regulation numberissued to the organization
264	by the agency. The agency shall assess a fine of not less than
265	$100 to any licensee or registrantwho fails to include the
266	license or registration number when submitting the advertisement
267	for publication, broadcast, or printing. The fine for a second
268	or subsequent offense shall be $500.The holder of a license
269	issued under this part may not advertise or indicate to the
270	public that it holds a home health agency or nurse registry
271	license other than the one it has been issued.
272	(b) The operation or maintenance of an unlicensed home
273	health agency or the performance of any home health services in
274	violation of this part is declared a nuisance, inimical to the
275	public health, welfare, and safety. The agency, or any state
276	attorney in the name of the people of the state, may, in
277	addition to other remedies provided in this part, bring an
278	action for an injunction to restrain such violation, or to
279	enjoin the future operation or maintenance of any such home
280	health agency or the provision of home health services in
281	violation of this part, until compliance with this part or the
282	rules adopted under this part has been demonstrated to the
283	satisfaction of the agency.
284	(c)(b)A person who violates paragraph (a) is subject to
285	an injunctive proceeding under s. 400.515. A violation of
286	paragraph (a) is a deceptive and unfair trade practice and
287	constitutes a violation of the Florida Deceptive and Unfair
288	Trade Practices Act under part II of chapter 501.
289	(d)(c)A person who violates the provisions of paragraph
290	(a) commits a felony misdemeanor of the third seconddegree,
291	punishable as provided in s. 775.082, or s. 775.083, or s.
292	775.084. Any person who commits a second or subsequent violation
293	commits a felony misdemeanor of the second firstdegree,
294	punishable as provided in s. 775.082, or s. 775.083, or s.
295	775.084. Each day of continuing violation constitutes a separate
296	offense.
297	(e) Any person who owns, operates, or maintains an
298	unlicensed home health agency and who, within 10 working days
299	after receiving notification from the agency, fails to cease
300	operation and apply for a license under this part commits a
301	felony of the third degree, punishable as provided in s.
302	775.082, s. 775.083, or s. 775.084. Each day of continued
303	operation is a separate offense.
304	(f) Any home health agency that fails to cease operation
305	after agency notification may be fined $500 for each day of
306	noncompliance.
307	(5) The following are exempt from the licensure
308	requirements of this part:
309	(b) Home health services provided by a state agency,
310	either directly or through a contractor with:
311	1. The Department of Elderly Affairs.
312	2. The Department of Health, a community health center, or
313	a rural health network that furnishes home visits for the
314	purpose of providing environmental assessments, case management,
315	health education, personal care services, family planning, or
316	followup treatment, or for the purpose of monitoring and
317	tracking disease.
318	3. Services provided to persons who have developmental
319	disabilities, as defined in s. 393.063(12).
320	4. Companion and sitter organizations that were registered
321	under formers. 400.509(1) on January 1, 1999, and were
322	authorized to provide personal services under s. 393.063(33)
323	under a developmental services provider certificate on January
324	1, 1999, may continue to provide such services to past, present,
325	and future clients of the organization who need such services,
326	notwithstanding the provisions of this act.
327	5. The Department of Children and Family Services.
328	(e) An individual who acts alone, in his or her individual
329	capacity, and who is not employed by or affiliated with a
330	licensed home health agency, or registered witha licensed nurse
331	registry, or a personal care organization. This exemption does
332	not entitle an individual to perform home health services
333	without the required professional license.
334	Section 4. Section 400.471, Florida Statutes, is amended
335	to read:
336	400.471 Application for license; fee; provisional license;
337	temporary permit.--
338	(1) Application for an initial license or for renewal of
339	an existing license must be made under oath to the agency on
340	forms furnished by it and must be accompanied by the appropriate
341	license fee as provided in subsection (8). The agency must take
342	final action on an initial licensure application within 60 days
343	after receipt of all required documentation.
344	(2) The applicant must file with the application
345	satisfactory proof that the home health agency is in compliance
346	with this part and applicable rules, including:
347	(a) A listing of services to be provided., either directly
348	by the applicant or through contractual arrangements with
349	existing providers;
350	(b) The number and discipline of professional staff to be
351	employed; and
352	(b)(c)Proof of financial ability to operate.
353	(c) Completion of volume data questions on renewal
354	application.
355	(3) An applicant for initial licensure must demonstrate
356	financial ability to operate by submitting a balance sheet and
357	income and expense statement for the first 2 years of operation
358	which provide evidence of having sufficient assets, credit, and
359	projected revenues to cover liabilities and expenses. The
360	applicant shall have demonstrated financial ability to operate
361	if the applicant's assets, credit, and projected revenues meet
362	or exceed projected liabilities and expenses. All documents
363	required under this subsection must be prepared in accordance
364	with generally accepted accounting principles, and shall be
365	compiled the financial statement must be signedby a certified
366	public accountant.
367	(4) Each applicant for licensure must comply with the
368	following requirements:
369	(a) Upon receipt of a completed, signed, and dated
370	application, the agency shall require background screening of
371	the applicant, in accordance with the level 2 standards for
372	screening set forth in chapter 435. As used in this subsection,
373	the term "applicant" means the administrator, or a similarly
374	titled person who is responsible for the day-to-day operation of
375	the licensed home health agency, and the financial officer, or
376	similarly titled individual who is responsible for the financial
377	operation of the licensed home health agency.
378	(b) The agency may require background screening for a
379	member of the board of directors of the licensee or an officer
380	or an individual owning 5 percent or more of the licensee if the
381	agency reasonably suspects that such individual has been
382	convicted of an offense prohibited under the level 2 standards
383	for screening set forth in chapter 435.
384	(c) Proof of compliance with the level 2 background
385	screening requirements of chapter 435 which has been submitted
386	within the previous 5 years in compliance with any other health
387	care or assisted living licensure requirements of this state is
388	acceptable in fulfillment of paragraph (a). Proof of compliance
389	with background screening which has been submitted within the
390	previous 5 years to fulfill the requirements of the Financial
391	Services Commission and the Office of Insurance Regulation
392	pursuant to chapter 651 as part of an application for a
393	certificate of authority to operate a continuing care retirement
394	community is acceptable in fulfillment of the Department of Law
395	Enforcement and Federal Bureau of Investigation background
396	check.
397	(d) A provisional license may be granted to an applicant
398	when each individual required by this section to undergo
399	background screening has met the standards for the Department of
400	Law Enforcement background check, but the agency has not yet
401	received background screening results from the Federal Bureau of
402	Investigation. A standard license may be granted to the licensee
403	upon the agency's receipt of a report of the results of the
404	Federal Bureau of Investigation background screening for each
405	individual required by this section to undergo background
406	screening which confirms that all standards have been met, or
407	upon the granting of a disqualification exemption by the agency
408	as set forth in chapter 435. Any other person who is required to
409	undergo level 2 background screening may serve in his or her
410	capacity pending the agency's receipt of the report from the
411	Federal Bureau of Investigation. However, the person may not
412	continue to serve if the report indicates any violation of
413	background screening standards and a disqualification exemption
414	has not been requested of and granted by the agency as set forth
415	in chapter 435.
416	(e) Each applicant must submit to the agency, with its
417	application, a description and explanation of any exclusions,
418	permanent suspensions, or terminations of the licensee or
419	potential licensee from the Medicare or Medicaid programs. Proof
420	of compliance with the requirements for disclosure of ownership
421	and control interest under the Medicaid or Medicare programs may
422	be accepted in lieu of this submission.
423	(f) Each applicant must submit to the agency a description
424	and explanation of any conviction of an offense prohibited under
425	the level 2 standards of chapter 435 by a member of the board of
426	directors of the applicant, its officers, or any individual
427	owning 5 percent or more of the applicant. This requirement does
428	not apply to a director of a not-for-profit corporation or
429	organization if the director serves solely in a voluntary
430	capacity for the corporation or organization, does not regularly
431	take part in the day-to-day operational decisions of the
432	corporation or organization, receives no remuneration for his or
433	her services on the corporation or organization's board of
434	directors, and has no financial interest and has no family
435	members with a financial interest in the corporation or
436	organization, provided that the director and the not-for-profit
437	corporation or organization include in the application a
438	statement affirming that the director's relationship to the
439	corporation satisfies the requirements of this paragraph.
440	(g) A license may not be granted to an applicant if the
441	applicant, administrator, or financial officer has been found
442	guilty of, regardless of adjudication, or has entered a plea of
443	nolo contendere or guilty to, any offense prohibited under the
444	level 2 standards for screening set forth in chapter 435, unless
445	an exemption from disqualification has been granted by the
446	agency as set forth in chapter 435.
447	(h) The agency may deny or revoke licensure if the
448	applicant:
449	1. Has falsely represented a material fact in the
450	application required by paragraph (e) or paragraph (f), or has
451	omitted any material fact from the application required by
452	paragraph (e) or paragraph (f); or
453	2. has been or is currently excluded, suspended, or
454	terminated from, or has involuntarily withdrawn from,
455	participation in this state's Medicaid program, or the Medicaid
456	program of any other state, or from participation in the
457	Medicare program or any othergovernmental or private health
458	care or health insurance program.
459	(i) An application for license renewal must contain the
460	information required under paragraphs (e) and (f).
461	(5) The agency may deny or revoke licensure if the
462	applicant has falsely represented a material fact in, or has
463	omitted any material fact from, the application required by this
464	section.
465	(6)(5)The home health agency must also obtain and
466	maintain malpractice insurance as defined in s. 624.605(1)(k)
467	the following insurance coverages in an amount of not less than
468	$500,000 $250,000per claim, and the home health agency must
469	submit proof of coverage with an initial application for
470	licensure and with each annual application for license renewal:
471	(a) Malpractice insurance as defined in s. 624.605(1)(k);
472	(b) Liability insurance as defined in s. 624.605(1)(b).
473	(7)(6) Sixty Ninetydays before the expiration date, an
474	application for renewal must be submitted to the agency under
475	oath on forms furnished by it, and a license must be renewed if
476	the applicant has met the requirements established under this
477	part and applicable rules. The agency shall send a renewal
478	notice, electronically or by United States mail, at least 70
479	days before the expiration date.The home health agency must
480	file with the application satisfactory proof that it is in
481	compliance with this part and applicable rules. If there is
482	evidence of financial instability, the home health agency must
483	submit satisfactory proof of its financial ability to comply
484	with the requirements of this part. Failure to file an
485	application within the timeframe specified herein shall result
486	in an administrative fine in the amount of $50 per day, each day
487	constituting a separate violation. In no event shall such fines
488	aggregate more than $500.
489	(8)(7)When transferring the ownership of a home health
490	agency, the transferee must submit an application for a license
491	at least 60 days before the effective date of the transfer. A
492	late application filing shall incur an administrative fine in
493	the amount of $50 per day, each day constituting a separate
494	violation. In no event shall such fines aggregate more than
495	$500.If the home health agency is being leased, a copy of the
496	lease agreement must be filed with the application.
497	(9)(a) Each applicant for initial licensure, renewal, or
498	change of ownership shall pay a license processing fee not to
499	exceed $1,000. An applicant shall also pay a survey fee not to
500	exceed $400 per survey unless the applicant is not subject to a
501	licensure survey by the agency as provided in paragraph (b). All
502	funds paid shall be deposited in the Health Care Trust Fund.
503	(b) The agency shall accept, in lieu of its own periodic
504	licensure surveys, submission of the survey of an accrediting
505	organization, provided the accreditation of the licensed home
506	health agency is not provisional and provided the licensed home
507	health agency authorizes release of, and the agency receives the
508	report of, the accrediting organization.
509	(10)(8) The license fee and annual renewal fee required of
510	a home health agency are nonrefundable. The agency shall set the
511	license processingfees in an amount that is sufficient to cover
512	its costs in carrying out its responsibilities under this part,
513	but not to exceed $1,000. However, state, county, or municipal
514	governments applying for licenses under this part are exempt
515	from the payment of license fees. All fees collected under this
516	part must be deposited in the Health Care Trust Fund for the
517	administration of this part.
518	(11)(9)The license must be displayed in a conspicuous
519	place in the administrative office of the home health agency and
520	is valid only while in the possession of the person to which it
521	is issued. The license may not be sold, assigned, or otherwise
522	transferred, voluntarily or involuntarily, and is valid only for
523	the home health agency and location for which originally issued.
524	(12)(10)A home health agency against whom a revocation or
525	suspension proceeding is pending at the time of license renewal
526	may be issued a provisional license effective until final
527	disposition by the agency of such proceedings. If judicial
528	relief is sought from the final disposition, the court that has
529	jurisdiction may issue a temporary permit for the duration of
530	the judicial proceeding.
531	(13)(11)The agency may not issue a license designated as
532	certified to a home health agency that fails to satisfy the
533	requirements of a Medicare certification survey from the agency.
534	(14)(12)The agency may not issue a license to a home
535	health agency that has any unpaid fines assessed under this
536	part.
537	Section 5. Subsections (1), (2), and (3) of section
538	400.487, Florida Statutes, are amended to read:
539	400.487 Home health service agreements; physician's,
540	physician assistant's, and advanced registered nurse
541	practitioner'streatment orders; patient assessment;
542	establishment and review of plan of care; provision of services;
543	orders not to resuscitate.--
544	(1) Services provided by a home health agency must be
545	covered by an agreement between the home health agency and the
546	patient or the patient's legal representative specifying the
547	home health services to be provided, the rates or charges for
548	services paid with private funds, and the sources methodof
549	payment, including, but not limited to, Medicare, Medicaid,
550	private insurance, personal funds, or a combination of such
551	sources. A home health agency providing skilled care must make
552	an assessment of the patient's needs within 48 hours after the
553	start of services.
554	(2) When required by the provisions of chapter 464; part
555	I, part III, or part V of chapter 468; or chapter 486, the
556	attending physician, physician assistant, or advanced registered
557	nurse practitioner, acting within his or her respective scope of
558	practice, shall for a patient who is to receive skilled care
559	must establish treatment orders for a patient who is to receive
560	skilled care. The treatment orders must be signed by the
561	physician, physician assistant, or advanced registered nurse
562	practitioner before a claim for payment for the skilled services
563	is submitted by the home health agency. If the claim is
564	submitted to a managed care organization, the treatment orders
565	shall be signed in the time allowed under the provider
566	agreement. The treatment orders shall within 30 days after the
567	start of care and mustbe reviewed, as frequently as the
568	patient's illness requires, by the physician, physician
569	assistant, or advanced registered nurse practitionerin
570	consultation with the home health agency personnel that provide
571	services to the patient.
572	(3) A home health agency shall arrange for supervisory
573	visits by a registered nurse to the home of a patient receiving
574	home health aide services in accordance with the patient's
575	direction, and approval, and agreement to pay the charge for the
576	visits.
577	Section 6. Section 400.491, Florida Statutes, is amended
578	to read:
579	400.491 Clinical records.--
580	(1) The home health agency must maintain for each patient
581	who receives skilled care a clinical record that includes
582	pertinent past and current medical, nursing, social and other
583	therapeutic information, the treatment orders, and other such
584	information as is necessary for the safe and adequate care of
585	the patient. When home health services are terminated, the
586	record must show the date and reason for termination. Such
587	records are considered patient records under s. 456.057, and
588	must be maintained by the home health agency for 6 5years
589	following termination of services. If a patient transfers to
590	another home health agency, a copy of his or her record must be
591	provided to the other home health agency upon request.
592	(2) If a licensed home health agency ceases to remain in
593	business, it shall notify each patient whose clinical records it
594	has in its possession that it is ceasing operations and shall
595	give each patient 15 calendar days within which to retrieve his
596	or her clinical record at a specified location within 2 hours'
597	driving time of the patient's residence and, at a minimum,
598	between the hours of 10 a.m. and 3 p.m. each day except
599	Saturdays, Sundays, and legal holidays The home health agency
600	must maintain for each client who receives nonskilled care a
601	service provision plan. Such records must be maintained by the
602	home health agency for 1 year following termination of services.
603	Section 7. Section 400.494, Florida Statutes, is amended
604	to read:
605	400.494 Information about patients confidential.--
606	(1)Information about patients received by persons
607	employed by, or providing services to, a home health agency or
608	received by the licensing agency through reports or inspection
609	shall be confidential and exempt from the provisions of s.
610	119.07(1) and shall only not be disclosed to a any person,other
611	than the patient, as permitted under the provisions of 45 C.F.R.
612	ss. 160.102, 160.103, and 164, commonly referred to as HIPAA,
613	except that clinical records described in ss. 381.004, 384.29,
614	385.202, 392.65, 394.4615, 395.404, 397.501, and 760.40 shall be
615	disclosed as authorized in those sections without the written
616	consent of that patient or the patient's guardian.
617	(2) This section does not apply to information lawfully
618	requested by the Medicaid Fraud Control Unit of the Department
619	of Legal Affairs.
620	Section 8. Section 400.495, Florida Statutes, is amended
621	to read:
622	400.495 Notice of toll-free telephone number for central
623	abuse hotline.--On or before the first day home health services
624	are provided to a patient, any home health agency, ornurse
625	registry, or personal care organizationlicensed under this part
626	must inform the patient and his or her immediate family, if
627	appropriate, of the right to report abusive, neglectful, or
628	exploitative practices. The statewide toll-free telephone number
629	for the central abuse hotline must be provided to patients in a
630	manner that is clearly legible and must include the words: "To
631	report abuse, neglect, or exploitation, please call toll-free
632	... (phone number) ." The Agency for Health Care
633	Administration shall adopt rules that provide for 90 days'
634	advance notice of a change in the toll-free telephone number and
635	that outline due process procedures, as provided under chapter
636	120, for home health agency personnel, andnurse registry
637	personnel, and personal care organization personnelwho are
638	reported to the central abuse hotline. Home health agencies, and
639	nurse registries, and personal care organizationsshall
640	establish appropriate policies and procedures for providing such
641	notice to patients.
642	Section 9. Subsections (5) and (8) of section 400.497,
643	Florida Statutes, are amended to read:
644	400.497 Rules establishing minimum standards.--The agency
645	shall adopt, publish, and enforce rules to implement this part,
646	including, as applicable, ss. 400.506 and 400.5095 400.509,
647	which must provide reasonable and fair minimum standards
648	relating to:
649	(5) The requirements for onsite and electronic
650	accessibility of supervisory personnel of home health agencies
651	and personal care organizations.
652	(8) Preparation of a comprehensive emergency management
653	plan pursuant to s. 400.492.
654	(a) The Agency for Health Care Administration shall adopt
655	rules establishing minimum criteria for the plan and plan
656	updates, with the concurrence of the Department of Health and in
657	consultation with the Department of Community Affairs.
658	(b) The rules must address the requirements in s. 400.492.
659	In addition, the rules shall provide for the maintenance of
660	patient-specific medication lists that can accompany patients
661	who are transported from their homes.
662	(c) The plan is subject to review and approval by the
663	county health department. During its review, the county health
664	department shall ensure that the following agencies, at a
665	minimum, are given the opportunity to review the plan:
666	1. The local emergency management agency.
667	2. The Agency for Health Care Administration.
668	3. The local chapter of the American Red Cross or other
669	lead sheltering agency.
670	4. The district office of the Department of Children and
671	Family Services.
672
673	The county health department shall complete its review within 60
674	days after receipt of the plan and shall either approve the plan
675	or advise the home health agency of necessary revisions.
676	(c)(d)For any home health agency that operates in more
677	than one county, the Department of Health shall review the plan,
678	after consulting with all of the county health departments, the
679	agency, and all the local chapters of the American Red Cross or
680	other lead sheltering agencies in the areas of operation for
681	that particular home health agency. The Department of Health
682	shall complete its review within 90 days after receipt of the
683	plan and shall either approve the plan or advise the home health
684	agency of necessary revisions. The Department of Health shall
685	make every effort to avoid imposing differing requirements based
686	on differences between counties on the home health agency.
687	(d)(e)The requirements in this subsection do not apply
688	to:
689	1. A facility that is certified under chapter 651 and has
690	a licensed home health agency used exclusively by residents of
691	the facility; or
692	2. A retirement community that consists of residential
693	units for independent living and either a licensed nursing home
694	or an assisted living facility, and has a licensed home health
695	agency used exclusively by the residents of the retirement
696	community, provided the comprehensive emergency management plan
697	for the facility or retirement community provides for continuous
698	care of all residents with special needs during an emergency.
699	Section 10. Subsections (3), (5), (7), (8), (10), (13),
700	(14), and (17) of section 400.506, Florida Statutes, are amended
701	to read:
702	400.506 Licensure of nurse registries; requirements;
703	penalties.--
704	(3) Each applicant for initial licensure, renewal, or
705	change of ownership shall pay a license processing fee not to
706	exceed $1,500. An applicant shall also pay a survey fee not to
707	exceed $400 for each survey conducted. All funds paid shall be
708	deposited in the Health Care Trust Fund.Application for license
709	must be made to the Agency for Health Care Administration on
710	forms furnished by it and must be accompanied by the appropriate
711	licensure fee, as established by rule and not to exceed the cost
712	of regulation under this part. The licensure fee for nurse
713	registries may not exceed $1,000 and must be deposited in the
714	Health Care Trust Fund.
715	(5) A license issued for the operation of a nurse
716	registry, unless sooner suspended or revoked, expires 2 years 1
717	yearafter its date of issuance. Sixty days before the
718	expiration date, an application for renewal must be submitted to
719	the Agency for Health Care Administration on forms furnished by
720	it. The Agency for Health Care Administration shall renew the
721	license if the applicant has met the requirements of this
722	section and applicable rules. A nurse registry against which a
723	revocation or suspension proceeding is pending at the time of
724	license renewal may be issued a conditional license effective
725	until final disposition by the Agency for Health Care
726	Administration of such proceedings. If judicial relief is sought
727	from the final disposition, the court having jurisdiction may
728	issue a conditional license for the duration of the judicial
729	proceeding.
730	(7) A person that provides, offers,or advertises to the
731	public that it providesany service for which licensure is
732	required under this section must include in such advertisement
733	the license number issued to it by the Agency for Health Care
734	Administration. The agency shall assess a fine of not less than
735	$100 to any licensee who fails to include the license number
736	when submitting the advertisement for publication, broadcast, or
737	printing. The fine for a second offense is $500.
738	(8)(a) It is unlawful for a person to provide, offer,or
739	advertise to the public services as defined by rule without
740	obtaining a valid license from the Agency for Health Care
741	Administration. It is unlawful for any holder of a license to
742	advertise or hold out to the public that he or she holds a
743	license for other than that for which he or she actually holds a
744	license. A person who violates this subsection is subject to
745	injunctive proceedings under s. 400.515.
746	(b) A person who violates the provisions of paragraph (a)
747	commits a felony of the third degree, punishable as provided in
748	s. 775.082, s. 775.083, or s. 775.084. Any person who commits a
749	second or subsequent violation commits a felony of the second
750	degree, punishable as provided in s. 775.082, s. 775.083, or s.
751	775.084. Each day of continuing violation constitutes a separate
752	offense.
753	(c) Any person who owns, operates, or maintains an
754	unlicensed nurse registry and who, within 10 working days after
755	receiving notification from the agency, fails to cease operation
756	and apply for a license under this part commits a felony of the
757	third degree, punishable as provided in s. 775.082, s. 775.083,
758	or s. 775.084. Each day of continued operation is a separate
759	offense.
760	(d) Any nurse registry that fails to cease operation after
761	agency notification may be fined $500 for each day of
762	noncompliance.
763	(10)(a) A nurse registry may refer for contract in private
764	residences registered nurses and licensed practical nurses
765	registered and licensed under part I of chapter 464, certified
766	nursing assistants certified under part II of chapter 464, home
767	health aides who present documented proof of successful
768	completion of the training required by rule of the agency, and
769	companions or homemakers for the purposes of providing those
770	services authorized under s. 400.5095 400.509(1). Each person
771	referred by a nurse registry must provide current documentation
772	that he or she is free from communicable diseases.
773	(b) A certified nursing assistant or home health aide may
774	be referred for a contract to provide care to a patient in his
775	or her home only if that patient is under a physician's care.A
776	certified nursing assistant or home health aide referred for
777	contract in a private residence shall be limited to assisting a
778	patient with bathing, dressing, toileting, grooming, eating,
779	physical transfer, and those normal daily routines the patient
780	could perform for himself or herself were he or she physically
781	capable. A certified nursing assistant or home health aide may
782	not provide medical or other health care services that require
783	specialized training and that may be performed only by licensed
784	health care professionals. The nurse registry shall obtain the
785	name and address of the attending physician and send written
786	notification to the physician within 48 hours after a contract
787	is concluded that a certified nursing assistant or home health
788	aide will be providing care for that patient.
789	(c) A nurse registry shall arrange for assessment visits
790	by a registered nurse to the home of a patient receiving home
791	health aide services in accordance with the patient's direction,
792	approval, and agreement to pay for the visits A registered nurse
793	shall make monthly visits to the patient's home to assess the
794	patient's condition and quality of care being provided by the
795	certified nursing assistant or home health aide. Any condition
796	which, in the professional judgment of the nurse,requires
797	further medical attention shall be reported to the patient
798	attending physicianand the nurse registry. The assessment shall
799	become a part of the patient's file with the nurse registry and
800	may be reviewed by the agency during their survey procedure.
801	(13) Each nurse registry must comply with the procedures
802	set forth in s. 400.512 for maintaining records of the work
803	employmenthistory of all persons referred for contract and is
804	subject to the standards and conditions set forth in that
805	section. However, an initial screening may not be required for
806	persons who have been continuously registered with the nurse
807	registry since October 1, 2000 September 30, 1990.
808	(14) The nurse registry must maintain the application on
809	file, and that file must be open to the inspection of the Agency
810	for Health Care Administration. The nurse registry must maintain
811	on file the name and address of the patient or client to whom
812	the nurse or othernurse registry personnel is sent for contract
813	and the amount of the fee received by the nurse registry. A
814	nurse registry must maintain the file that includes the
815	application and other applicable documentation for 3 years after
816	the date of the last file entry of client-related information.
817	(17) All persons referred for contract in private
818	residences by a nurse registry must comply with the following
819	requirements for a plan of treatment:
820	(a) When, in accordance with the privileges and
821	restrictions imposed upon a nurse under part I of chapter 464,
822	the delivery of care to a patient is under the direction or
823	supervision of a physician or when a physician is responsible
824	for the medical care of the patient, a medical plan of treatment
825	must be established for each patient receiving care or treatment
826	provided by a licensed nurse in the home. The original medical
827	plan of treatment must be timely signed by the physician,
828	physician assistant, or advanced registered nurse practitioner
829	acting within his or her respective scope of practiceand
830	reviewed by him or herin consultation with the licensed nurse
831	at least every 2 months. Any additional order or change in
832	orders must be obtained from the physician, physician assistant,
833	or advanced registered nurse practitionerand reduced to writing
834	and timely signed by the physician, physician assistant, or
835	advanced registered nurse practitioner. The delivery of care
836	under a medical plan of treatment must be substantiated by the
837	appropriate nursing notes or documentation made by the nurse in
838	compliance with nursing practices established under part I of
839	chapter 464.
840	(b) Whenever a medical plan of treatment is established
841	for a patient, the initial medical plan of treatment, any
842	amendment to the plan, additional order or change in orders, and
843	copy of nursing notes must be filed in the office of the nurse
844	registry.
845	Section 11. Section 400.5095, Florida Statutes, is created
846	to read:
847	400.5095 Licensure of personal care organizations;
848	requirements; penalties.--
849	(1) An organization that provides personal care services
850	and does not provide a skilled home health service must be
851	licensed as a personal care organization. Each operational site
852	of the personal care organization must be licensed, unless there
853	is more than one site within a county. If there is more than one
854	site within a county, only one license is required in that
855	county. Each operational site must be listed on the license.
856	(2) Each applicant for licensure must comply with the
857	following requirements:
858	(a) Upon receipt of a completed, signed, and dated
859	application, the agency shall require background screening, in
860	accordance with the level 2 screening standards set forth in
861	chapter 435, of the managing employee or other similarly titled
862	individual who is responsible for the daily operation of the
863	personal care organization and of the financial officer or other
864	similarly titled individual who is responsible for the financial
865	operation of the personal care organization, including billings
866	for patient care and services. The applicant shall comply with
867	the procedures for level 2 screening provided in chapter 435.
868	(b) The agency may require background screening of any
869	other individual who is an applicant if the agency has probable
870	cause to believe that he or she has been convicted of a crime or
871	has committed any other offense prohibited under the level 2
872	standards set forth in chapter 435.
873	(c) Proof of compliance with the level 2 screening
874	standards of chapter 435 for any application that has been
875	submitted within the previous 5 years in compliance with any
876	other health care or assisted living licensure requirements of
877	this state is acceptable in fulfillment of the requirements of
878	paragraph (a).
879	(d) A provisional license may be granted to an applicant
880	after each individual subject to background screening as
881	required by this section has met the screening standards of the
882	Department of Law Enforcement but before the agency has received
883	the results of the background check by the Federal Bureau of
884	Investigation. A standard license may be granted to the
885	applicant after the agency receives a report from the Federal
886	Bureau of Investigation background confirming that each
887	individual subject to the requirements of this section has met
888	all standards, or upon the granting of a disqualification
889	exemption by the agency pursuant to s. 435.07. Any other person
890	who is required to undergo level 2 screening may serve in his or
891	her capacity pending the agency's receipt of the report from the
892	Federal Bureau of Investigation. However, such person may not
893	continue to serve if the report indicates any violation of
894	background screening standards and a disqualification exemption
895	has not been requested of and granted by the agency as set forth
896	in chapter 435.
897	(e) Each applicant shall submit to the agency with its
898	application a description and explanation of any exclusions,
899	permanent suspensions, or terminations of the applicant from the
900	Medicare or Medicaid programs. Proof of compliance with the
901	requirements for disclosure of ownership and control interests
902	under the Medicaid or Medicare programs may be accepted in lieu
903	of this requirement.
904	(f) Each applicant shall submit to the agency a
905	description and explanation of any conviction of an offense
906	prohibited under the level 2 screening standards of chapter 435
907	by a member of the applicant's board of directors, by its
908	officers, or by any individual that owns 5 percent or more of
909	the applicant. This requirement does not apply to a director of
910	a not-for-profit corporation or organization if the director
911	serves solely in a voluntary capacity, does not regularly take
912	part in the day-to-day operational decisions of the corporation
913	or organization, receives no remuneration for his or her
914	services, and has no financial interest or any family members
915	with a financial interest in the corporation or organization,
916	provided the director and the not-for-profit corporation or
917	organization include in the application a statement affirming
918	that the director's relationship to the corporation or
919	organization satisfies the requirements of this paragraph.
920	(g) A license may not be granted to an applicant if the
921	applicant or managing employee has been found guilty of,
922	regardless of adjudication, or has entered a plea of nolo
923	contendere or guilty to, any offense prohibited under the level
924	2 screening standards in chapter 435, unless an exemption from
925	disqualification has been granted by the agency as provided in
926	s. 435.07.
927	(h) The agency may deny or revoke licensure if the
928	applicant has been or is currently excluded, suspended, or
929	terminated from, or has involuntarily withdrawn from,
930	participation in this state's Medicaid program, the Medicaid
931	program of any other state, the Medicare program, or any other
932	governmental or private health care or health insurance program.
933	(i) An application for license renewal must contain the
934	information required under paragraphs (e) and (f).
935	(3) The agency may deny or revoke licensure if the
936	applicant has falsely represented a material fact, or has
937	omitted any material fact, from the application required by this
938	section.
939	(4) Application for a license must be made to the agency
940	on forms furnished by the agency and must be accompanied by the
941	appropriate licensure fee, as established by agency rule, not to
942	exceed the cost of regulation under this part. The licensure fee
943	may not exceed $650 and must be deposited in the Health Care
944	Trust Fund.
945	(5) The agency may deny, revoke, or suspend a license or
946	impose an administrative fine in the manner provided in chapter
947	120 against a personal care organization that:
948	(a) Fails to comply with this section or applicable rules;
949	or
950	(b) Commits an intentional, reckless, or negligent act
951	that materially affects the health or safety of a person
952	receiving services.
953	(6) A license issued for the operation of a personal care
954	organization expires 1 year after its date of issuance, unless
955	sooner suspended or revoked. Sixty days before the expiration
956	date, an application for renewal shall be submitted to the
957	agency on forms furnished by the agency. The agency shall renew
958	the license if the applicant has met the requirements of this
959	section and applicable rules. A personal care organization
960	against which a revocation or suspension proceeding is pending
961	at the time of license renewal may be issued a conditional
962	license effective until final disposition by the agency of such
963	proceedings. If judicial relief is sought from the final
964	disposition, the court having jurisdiction may issue a
965	conditional license for the duration of the judicial proceeding.
966	(7) The agency may institute injunctive proceedings under
967	s. 400.515.
968	(8)(a) It is unlawful for a person to provide, offer, or
969	advertise to the public personal care services without obtaining
970	a valid license from the agency. It is unlawful for any holder
971	of a license to advertise or hold out to the public that he or
972	she holds a license for any purpose other than that for which he
973	or she actually holds a license. A person who violates this
974	paragraph is subject to injunctive proceedings under s. 400.515
975	(b) A personal care organization that offers or advertises
976	to the public services for which licensure is required under
977	this part shall include in the advertisement the license number
978	issued to the organization by the agency. The agency shall
979	assess a fine of not less than $100 to any licensee that fails
980	to include the license number when submitting the advertisement
981	for publication, broadcast, or printing. The fine for a second
982	or subsequent offense shall be $500. The holder of a license
983	issued under this part may not advertise or indicate to the
984	public that the holder holds any license other than the one it
985	has been issued.
986	(c) The operation or maintenance of an unlicensed personal
987	care organization or the performance of any personal care
988	services in violation of this part is declared a nuisance,
989	inimical to the public health, welfare, and safety. The agency,
990	or any state attorney in the name of the people of the state,
991	may, in addition to other remedies provided in this part, bring
992	an action for an injunction to restrain such violation or to
993	enjoin the future operation or maintenance of any such personal
994	care organization's personal care services in violation of this
995	part until compliance with this part or the rules adopted under
996	this part has been demonstrated to the satisfaction of the
997	agency.
998	(d) A violation of paragraph (a) is a deceptive and unfair
999	trade practice and constitutes a violation of the Florida
1000	Deceptive and Unfair Trade Practices Act under part II of
1001	chapter 501.
1002	(e) A person who violates the provisions of paragraph (a)
1003	commits a felony of the third degree, punishable as provided in
1004	s. 775.082, s. 775.083, or s. 775.084. Any person who commits a
1005	second or subsequent violation commits a felony of the second
1006	degree, punishable as provided in s. 775.082, s. 775.083, or s.
1007	775.084. Each day of continuing violation constitutes a separate
1008	offense.
1009	(f) Any person who owns, operates, or maintains an
1010	unlicensed personal care organization and who, within 10 working
1011	days after receiving notification from the agency, fails to
1012	cease operation and apply for a license under this part commits
1013	a felony of the third degree, punishable as provided in s.
1014	775.082, s. 775.083, or s. 775.084. Each day of continued
1015	operation is a separate offense.
1016	(g) Any personal care organization that fails to cease
1017	operation after agency notification may be fined $500 for each
1018	day of noncompliance.
1019	(9) Any duly authorized officer or employee of the agency
1020	may make any inspections and investigations necessary to respond
1021	to complaints or to determine the state of compliance with this
1022	section and applicable rules.
1023	(a) If, in responding to a complaint, an agent or employee
1024	of the agency has reason to believe that a crime has been
1025	committed, he or she shall notify the appropriate law
1026	enforcement agency.
1027	(b) If, in responding to a complaint, an agent or employee
1028	of the agency has reason to believe that abuse, neglect, or
1029	exploitation has occurred, according to the definitions in
1030	chapter 415, he or she shall file a report under said chapter.
1031	(10)(a) A personal care organization may provide personal
1032	care services in the patient's place of residence through
1033	certified nursing assistants or home health aides who present
1034	documented proof of successful completion of the training
1035	required by rule of the agency. Each certified nursing
1036	assistant, home health aide, homemaker, or companion shall
1037	provide current documentation that he or she is free from
1038	communicable diseases.
1039	(b) Certified nursing assistant or home health aide
1040	services shall be limited to assisting a patient with bathing,
1041	dressing, toileting, grooming, eating, physical transfer, and
1042	those normal daily routines the patient could perform for
1043	himself or herself were he or she physically capable. A
1044	certified nursing assistant or home health aide may not provide
1045	medical or other health care services that require specialized
1046	training and that may be performed only by a licensed health
1047	care professional. Providing services beyond the scope
1048	authorized under this paragraph constitutes the unauthorized
1049	practice of medicine or a violation of the Nurse Practice Act
1050	and is punishable as provided under chapter 458, chapter 459, or
1051	part I of chapter 464.
1052	(c) A personal care organization shall arrange for
1053	supervisory visits by a registered nurse to the home of a
1054	patient receiving personal care services in accordance with the
1055	patient's direction and approval.
1056	(11) Each personal care organization shall require every
1057	certified nursing assistant or home health aide to complete an
1058	application form providing:
1059	(a) The name, address, date of birth, and social security
1060	number of the applicant.
1061	(b) The educational background and employment history of
1062	the applicant.
1063	(c) The number and date of an applicable certification.
1064	(d) When appropriate, information concerning the renewal
1065	of the applicable certification.
1066	(12) Each personal care organization shall comply with the
1067	procedures set forth in s. 400.512 for maintaining records of
1068	the employment history of all certified nursing assistants and
1069	home health aides that provide services to its patients and
1070	clients. Each personal care organization is subject to the
1071	standards and conditions set forth in said section.
1072	(13) The personal care organization shall maintain
1073	applications on file, which file must be open to inspection by
1074	the agency. The personal care organization shall maintain on
1075	file the name and address of the patients or clients to whom its
1076	personnel provide services and shall maintain for 3 years after
1077	the date of the last entry of patient or client-related
1078	information the file that includes the application and any other
1079	applicable documentation.
1080	(14) A personal care organization must provide the
1081	following staff training:
1082	(a) Upon beginning employment with the personal care
1083	organization, each employee must receive basic written
1084	information about interacting with participants who have
1085	Alzheimer's disease or dementia-related disorders.
1086	(b) In addition to the information provided under
1087	paragraph (a), newly hired personal care organization personnel
1088	who will be providing direct care to patients must complete 2
1089	hours of training in Alzheimer's disease and dementia-related
1090	disorders within 9 months after beginning employment with the
1091	personal care organization. This training shall include, but is
1092	not limited to, an overview of dementia, a demonstration of
1093	basic skills in communicating with persons who have dementia,
1094	the management of problem behaviors, information about promoting
1095	the client's independence in activities of daily living, and
1096	instruction in skills for working with families and caregivers.
1097	(c) For certified nursing assistants, the required 2 hours
1098	of training shall be part of the total hours of training
1099	required annually.
1100	(d) The Department of Elderly Affairs, or its designee,
1101	shall approve the required training. The department shall
1102	consider for approval training offered in a variety of formats
1103	and shall keep a list of current providers who are approved to
1104	provide the 2-hour training. The department shall adopt rules to
1105	establish standards for the employees who are subject to this
1106	training, for the trainers, and for the training required in
1107	this section.
1108	(e) Upon completing the training required under this
1109	subsection, the employee shall be issued a certificate that
1110	states that the training required under this section has been
1111	received. The certificate shall be dated and signed by the
1112	training provider. The certificate is evidence of completion of
1113	the training and the employee is not required to repeat the
1114	training if the employee changes employment to a different
1115	personal care organization.
1116	(f) An employee who is hired on or after July 1, 2005,
1117	must complete the training required by this section.
1118	(g) A licensed personal care organization whose
1119	unduplicated census during the most recent calendar year was
1120	comprised of at least 90 percent of individuals aged 21 years or
1121	younger at the date of admission is exempt from the training
1122	requirements in this section.
1123	(h) A personal care organization licensed under this part
1124	which claims that it provides special care for persons who have
1125	Alzheimer's disease or other related disorders must disclose in
1126	its advertisements or in a separate document those services that
1127	distinguish the care as being especially applicable to, or
1128	suitable for, such persons. The personal care organization must
1129	give a copy of all such advertisements or a copy of the document
1130	to each person who requests information about the personal care
1131	organization and must maintain a copy of all such advertisements
1132	and documents in its records. The agency shall examine all such
1133	advertisements and documents in the personal care organization's
1134	records as part of the license renewal procedure.
1135	(15) Personal care organizations shall assist persons who
1136	would need assistance and sheltering during evacuations because
1137	of physical, mental, or sensory disabilities in registering with
1138	the appropriate local emergency management agency pursuant to s.
1139	252.355.
1140	(16) Each personal care organization shall prepare and
1141	maintain a comprehensive emergency management plan that is
1142	consistent with the criteria in this subsection and with the
1143	local special needs plan. The plan shall be updated annually.
1144	The plan shall specify how the personal care organization shall
1145	facilitate the provision of continuous care to its patients who
1146	are registered pursuant to s. 252.355 during an emergency that
1147	interrupts the provision of care or services in private
1148	residencies.
1149	(a) Certified nursing assistants and home health aides who
1150	care for persons registered pursuant to s. 252.355 must include
1151	in the patient record a description of how care will be
1152	continued during a disaster or emergency that interrupts the
1153	provision of care in the patient's home. The personal care
1154	organization shall ensure that continuous care is provided.
1155	(b) Each personal care organization shall maintain a
1156	current prioritized list of patients in private residences who
1157	are registered pursuant to s. 252.355 and who need continued
1158	services during an emergency. This list shall indicate, for each
1159	patient, whether or not the patient or client is to be
1160	transported to a special needs shelter. Personal care
1161	organizations shall make this list available to county health
1162	departments and to local emergency management agencies upon
1163	request.
1164	(c) Each certified nursing assistant or home health aide
1165	who is caring for a patient who is registered pursuant to s.
1166	252.355 shall provide a list of the patient's medication and
1167	equipment needs to the personal care organization, which shall
1168	make this information available to county health departments and
1169	to local emergency management agencies upon request.
1170	(d) Certified nursing assistants and home health aides
1171	shall not be required to continue to provide care to patients in
1172	emergency situations that are beyond the person's control and
1173	that make it impossible to provide services, such as when roads
1174	are impassable or when patients do not go to the location
1175	specified in their patient records.
1176	(e) The agency shall adopt rules establishing minimum
1177	criteria for the comprehensive emergency management plan and
1178	plan updates required by this subsection, with the concurrence
1179	of the Department of Health and in consultation with the
1180	Department of Community Affairs.
1181	(17) A personal care organization shall comply with the
1182	notice requirements of s. 400.495, relating to abuse reporting.
1183	(18) In addition to any other penalties imposed pursuant
1184	to this part, the agency may assess costs related to an
1185	investigation that results in a successful prosecution,
1186	excluding costs associated with an attorney's time. If the
1187	agency imposes such an assessment and the assessment is not paid
1188	and, if challenged, is not the subject of a pending appeal,
1189	prior to the renewal of the license, the license shall not be
1190	issued until the assessment is paid or arrangements for payment
1191	of the assessment are made.
1192	(19) The agency shall adopt rules to implement this
1193	section.
1194	Section 12. Section 400.512, Florida Statutes, is amended
1195	to read:
1196	400.512 Screening of home health agency personnel; nurse
1197	registry personnel; and personal care organization personnel
1198	companions and homemakers.--The agency shall require employment
1199	or contractor screening as provided in chapter 435, using the
1200	level 1 standards for screening set forth in that chapter, for
1201	home health agency personnel; persons referred for employment by
1202	nurse registries; and personal care organization personnel
1203	persons employed by companion or homemaker services registered
1204	under s. 400.509.
1205	(1)(a) The Agency for Health Care Administration may, upon
1206	request, grant exemptions from disqualification from employment
1207	or contracting under this section as provided in s. 435.07,
1208	except for health care practitioners licensed by the Department
1209	of Health or a regulatory board within that department.
1210	(b) The appropriate regulatory board within the Department
1211	of Health, or that department itself when there is no board,
1212	may, upon request of the licensed health care practitioner,
1213	grant exemptions from disqualification from employment or
1214	contracting under this section as provided in s. 435.07.
1215	(2) The administrator of each home health agency, the
1216	managing employee of each nurse registry, and the managing
1217	employee of each personal care organization companion or
1218	homemaker service registered under s. 400.509must sign an
1219	affidavit annually, under penalty of perjury, stating that all
1220	personnel hired or, contracted with, or registered on or after
1221	October 1, 2000 October 1, 1994, who enter the home of a patient
1222	or client in their service capacity have been screened and that
1223	its remaining personnel have worked for the home health agency
1224	or personal care organization registrant continuously since
1225	before October 1, 2000 October 1, 1994.
1226	(3) As a prerequisite to operating as a home health
1227	agency, nurse registry, or personal care organization companion
1228	or homemaker service under s. 400.509, the administrator or
1229	managing employee, respectively, must submit to the agency his
1230	or her name and any other information necessary to conduct a
1231	complete screening according to this section. The agency shall
1232	submit the information to the Department of Law Enforcement for
1233	state processing. The agency shall review the record of the
1234	administrator or manager with respect to the offenses specified
1235	in this section and shall notify the owner of its findings. If
1236	disposition information is missing on a criminal record, the
1237	administrator or manager, upon request of the agency, must
1238	obtain and supply within 30 days the missing disposition
1239	information to the agency. Failure to supply missing information
1240	within 30 days or to show reasonable efforts to obtain such
1241	information will result in automatic disqualification.
1242	(4) Proof of compliance with the screening requirements of
1243	chapter 435 shall be accepted in lieu of the requirements of
1244	this section if the person has been continuously employed or
1245	contracted with registeredwithout a breach in service that
1246	exceeds 180 days, the proof of compliance is not more than 2
1247	years old, and the person has been screened by the Department of
1248	Law Enforcement. A home health agency, nurse registry, or
1249	personal care organization companion or homemaker service
1250	registered under s. 400.509shall directly provide proof of
1251	compliance to another home health agency, nurse registry, or
1252	personal care organization companion or homemaker service
1253	registered under s. 400.509. The recipient home health agency,
1254	nurse registry, or personal care organization companion or
1255	homemaker service registered under s. 400.509may not accept any
1256	proof of compliance directly from the person who requires
1257	screening. Proof of compliance with the screening requirements
1258	of this section shall be provided upon request to the person
1259	screened by the home health agencies,; nurse registries,; or
1260	personal care organizations companion or homemaker services
1261	registered under s. 400.509.
1262	(5) There is no monetary liability on the part of, and no
1263	cause of action for damages arises against, a licensed home
1264	health agency, licensed nurse registry, or personal care
1265	organization companion or homemaker service registered under s.
1266	400.509,that, upon notice that the employee or contractor has
1267	been found guilty of, regardless of adjudication, or entered a
1268	plea of nolo contendere or guilty to, any offense prohibited
1269	under s. 435.03 or under any similar statute of another
1270	jurisdiction, terminates the employee or contractor, whether or
1271	not the employee or contractor has filed for an exemption with
1272	the agency in accordance with chapter 435 and whether or not the
1273	time for filing has expired.
1274	(6) The costs of processing the statewide correspondence
1275	criminal records checks must be borne by the home health
1276	agency,; the nurse registry,; or the personal care organization
1277	companion or homemaker service registered under s. 400.509, or
1278	by the person being screened, at the discretion of the home
1279	health agency, nurse registry, or personal care organization s.
1280	400.509 registrant.
1281	(7)(a) It is a misdemeanor of the first degree, punishable
1282	under s. 775.082 or s. 775.083, for any person willfully,
1283	knowingly, or intentionally to:
1284	1. Fail, by false statement, misrepresentation,
1285	impersonation, or other fraudulent means, to disclose in any
1286	application for voluntary or paid employment a material fact
1287	used in making a determination as to such person's
1288	qualifications to be an employee under this section;
1289	2. Operate or attempt to operate an entity licensed or
1290	registered under this part with persons who do not meet the
1291	minimum standards for good moral character as contained in this
1292	section; or
1293	3. Use information from the criminal records obtained
1294	under this section for any purpose other than screening that
1295	person for employment as specified in this section or release
1296	such information to any other person for any purpose other than
1297	screening for employment under this section.
1298	(b) It is a felony of the third degree, punishable under
1299	s. 775.082, s. 775.083, or s. 775.084, for any person willfully,
1300	knowingly, or intentionally to use information from the juvenile
1301	records of a person obtained under this section for any purpose
1302	other than screening for employment under this section.
1303	Section 13. Section 400.515, Florida Statutes, is amended
1304	to read:
1305	400.515 Injunction proceedings.--In addition to the other
1306	powers provided under this chapter,the Agency for Health Care
1307	Administration may institute injunction proceedings in a court
1308	of competent jurisdiction to restrain or prevent the
1309	establishment or operation of a home health agency, nurse
1310	registry, or personal care organization that does not have a
1311	license or is in violation of any provision of this part or of
1312	any rules adopted pursuant to this part. The agency may also
1313	institute injunction proceedings in a court of competent
1314	jurisdictionwhen violation of this part or of applicable rules
1315	constitutes an emergency affecting the immediate health and
1316	safety of a patient or client.
1317	Section 14. Subsection (7) of section 381.0303, Florida
1318	Statutes, is amended to read:
1319	381.0303 Health practitioner recruitment for special needs
1320	shelters.--
1321	(7) REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
1322	of emergency management plans to county health departments by
1323	home health agencies pursuant to s. 400.497(8)(c) and (d)and by
1324	nurse registries pursuant to s. 400.506(16)(e) and by hospice
1325	programs pursuant to s. 400.610(1)(b) is conditional upon the
1326	receipt of an appropriation by the department to establish
1327	medical services disaster coordinator positions in county health
1328	departments unless the secretary of the department and a local
1329	county commission jointly determine to require such plans to be
1330	submitted based on a determination that there is a special need
1331	to protect public health in the local area during an emergency.
1332	Section 15. Section 400.509, Florida Statutes, is
1333	repealed.
1334	Section 16. This act shall take effect October 1, 2004.