HB 0809 2004
1	A bill to be entitled
2	An act relating to public health services; providing
3	legislative intent with respect to the licensure and
4	regulation of facilities that provide care for medically
5	fragile or technologically dependent children; providing
6	definitions; providing requirements for the licensure of
7	subacute pediatric prescribed extended alternative care
8	centers; providing for the licensing of such facilities by
9	the Agency for Health Care Administration; providing
10	criminal sanctions; prescribing a license fee; providing
11	requirements for applicants for licensure; providing
12	requirements for a licensee in administering and managing
13	a SPPEAC center; requiring that each center have an
14	advisory board; providing for membership on the advisory
15	board; providing requirements for the admission of a child
16	to a SPPEAC center; requiring each center to maintain
17	policies for child care; requiring that a board-certified
18	pediatrician serve as the medical director of a center;
19	providing requirements for the nursing services provided
20	at a SPPEAC center; providing requirements for the
21	qualifications and experience of nursing personnel;
22	specifying the minimum staff-to-child ratio for a center;
23	providing requirements for ancillary professional staff;
24	requiring that a SPPEAC center provide certain educational
25	services for children admitted to the center; requiring
26	inservice training for center staff and family members of
27	children admitted to the center; requiring that the center
28	maintain certain medical records; requiring that a center
29	have a committee to conduct reviews for quality assurance;
30	providing requirements for dietary services provided at a
31	center; providing requirements for the physical
32	environment of a SPPEAC center; requiring that a center
33	maintain certain specified safety, medical, and emergency
34	equipment; providing requirements for infection control;
35	providing requirements for transportation services
36	provided by a center; requiring that a center conform to
37	certain minimum emergency standards; authorizing center
38	staff withhold or withdraw resuscitation or life-
39	prolonging techniques under certain circumstances;
40	providing an effective date.
41
42	Be It Enacted by the Legislature of the State of Florida:
43
44	Section 1. Purpose.--It is the intent of the Legislature
45	to provide for the licensure and regulation of subacute
46	pediatric prescribed extended alternative care facilities that
47	provide transitional care for medically fragile or
48	technologically dependent children on a short-term basis of 90
49	days or less. It is the intent of the Legislature to establish
50	and enforce basic standards for SPPEAC centers in order to
51	assure that the centers provide the necessary family-centered
52	medical, developmental, physiological, nutritional,
53	psychosocial, and family training services.
54	Section 2. Definitions.--As used in this act, the term:
55	(1) "Acute care" means a level of health care in which a
56	patient is treated for a brief but severe episode of illness for
57	conditions that are the result of disease or trauma in addition
58	to recovery from surgery.
59	(2) "Administrator," "manager," or "supervisor" includes
60	the manager, supervisor, and members of the board of directors
61	and the officers of any firm, partnership, association, or
62	corporation with whom the applicant may contract to provide for
63	the management or supervision of the SPPEAC center.
64	(3) "Advisory board" means a group of health care
65	professionals and at least one consumer approved by the SPPEAC
66	medical and nursing directors to serve each SPPEAC center to
67	review policies, procedures, and licensure requirements and to
68	provide consultation to the administrators of the center.
69	(4) "Agency" means the Agency for Health Care
70	Administration.
71	(5) "Ancillary services" include, but are not limited to,
72	speech therapy, occupational therapy, physical therapy, social
73	work, and developmental, childhood, and psychological services.
74	(6) "Applicant" means an individual applicant applying for
75	licensure or members of a board of directors and the officers of
76	a firm, partnership, association, or corporation applying for
77	licensure.
78	(7) "Basic services" includes, but is not limited to,
79	development, implementation, and monitoring of a comprehensive
80	plan of care, developed in conjunction with a child's parent or
81	guardian, which specifies the medical, nursing, psychosocial,
82	and developmental therapies required by the medically fragile or
83	technologically dependent child served, as well as the caregiver
84	training needs of the child's parent or guardian.
85	(8) "Executive director" or "owner" means an individual
86	who has general administrative charge of a SPPEAC center.
87	(9) "Licensee" means a facility that has been issued a
88	license to operate as a SPPEAC center.
89	(10) "Long-term care" means a provision of services,
90	including health care, personal care, social services, and
91	economic assistance, delivered in a variety of settings for an
92	extended period of time.
93	(11) "Medical director" means a physician who is licensed
94	under chapter 458 or chapter 459, Florida Statutes, who is
95	certified by the American Board of Pediatrics or the American
96	Osteopathic Board of Pediatrics, and who serves as the liaison
97	between the SPPEAC and the medical community.
98	(12) "Medical records" means the medical records
99	maintained by a SPPEAC center in accordance with accepted
100	professional standards and practices.
101	(13) "Medically fragile or technologically dependent
102	child" means a child who, because of a medical condition,
103	requires continuous therapeutic interventions or skilled nursing
104	supervision.
105	(14) "Nursing director" means a registered nurse who is
106	licensed under chapter 464, Florida Statutes, and who is
107	responsible for providing continuous supervision of services
108	provided by a SPPEAC center and managing the daily nursing
109	services of the center.
110	(15) "Plan of care" means the comprehensive plan for
111	implementing the medical, nursing, psychosocial, developmental,
112	and education therapies provided by a SPPEAC center.
113	(16) "Premises" means the buildings, beds, and facilities
114	located at the address of the licensee.
115	(17) "Prescribing physician" means the physician licensed
116	under chapter 458 or chapter 459, Florida Statutes, who signs
117	the order admitting a child to a SPPEAC center.
118	(18) "Primary physician" means the physician licensed
119	under chapter 458 or chapter 459, Florida Statutes, who
120	maintains overall responsibility for a child's medical
121	management and who is available for consultation and
122	collaboration with the staff of the SPPEAC center.
123	(19) "Quality assurance" means the mandatory program that
124	all SPPEAC centers must have to assure periodic review of
125	medical records at least annually and the determination of the
126	quality and appropriateness of care rendered by the center and
127	changes required to effectuate that care.
128	(20) "Quality assurance committee" means a group of health
129	care professionals, such as physicians, registered nurses,
130	licensed practical nurses, and therapists, and at least one
131	consumer approved by the SPPEAC board of directors to serve each
132	SPPEAC center by reviewing SPPEAC medical records and treatment
133	procedures and evaluating the quality of care provided to each
134	child.
135	(21) "Subacute" means the level of care which falls
136	between acute care and chronic care or long-term care.
137	(22) "Subacute pediatric prescribed extended alternative
138	care center" or "SPPEAC center" means any building or other
139	place, whether operated for profit or not, which provides basic
140	services, as described in this act, to three or more medically
141	fragile or technologically dependent children who are not
142	related to the owner or executive director by blood, marriage,
143	or adoption and who require such services as determined by a
144	physician or an advanced registered nurse practitioner. Infants
145	and children considered for admission to a SPPEAC center must
146	have a complex medical condition that requires daily care,
147	transitional care, or continual care. The prerequisite for
148	admission is a prescription from the child's attending physician
149	or primary physician and consent of the child's parent or
150	guardian.
151	(23) "Transition" means the link between acute care and
152	home or long-term care.
153	(24) "Transitional care" means a type of care that may
154	include rehabilitation services, specialized care for certain
155	conditions, or postsurgical care and other services associated
156	with the transition between the hospital and home. Children who
157	are on these units and who have been hospitalized recently have
158	more complicated medical needs. The goal of subacute care is to
159	discharge children to their homes or to a lower level of care.
160	Section 3. License required.--
161	(1) A person, firm, association, partnership, or
162	corporation may not directly or indirectly operate a SPPEAC
163	center in this state without first applying for and receiving a
164	license from the agency to operate the facility. Any person,
165	firm, association, partnership, or corporation that violates
166	this subsection commits a felony of the third degree, punishable
167	as provided in s. 775.082, s. 775.083, or s. 775.084, Florida
168	Statutes.
169	(2) Any person operating a facility in this state is
170	subject to the requirements of this act.
171	(3) An applicant for licensure must submit a separate
172	application for each building of a facility if the buildings are
173	located on separate premises.
174	(4) A SPPEAC licensee may not operate a facility at a
175	capacity greater than the number of beds indicated on the face
176	of the license.
177	(5) A license issued for the operation of a SPPEAC center
178	expires 1 year following the date of issuance, unless sooner
179	suspended or revoked. An applicant for license renewal must
180	comply with the provisions of this act.
181	(6) Another licensed entity that is a business or
182	organization that provides a complementary service or product
183	for the benefit of the SPPEAC client and his or her family may
184	collocate with a SPPEAC center.
185	Section 4. Licensure procedure.--
186	(1) Application for a license to operate a SPPEAC center
187	must be made on a form prescribed by the agency and must be
188	submitted to the agency under oath by the owner or administrator
189	of the center.
190	(2) Except for a county or municipality, each applicant
191	must submit a license fee to the Agency for Health Care
192	Administration, along with the application for licensure, in an
193	amount determined by the agency to be sufficient to cover the
194	agency's costs in carrying out its responsibilities under this
195	part. This license fee may not be less than $500 or more than
196	$1,200.
197	(3) All information provided on the application forms, or
198	by a request for additional information, must be accurate and
199	current at the time of filing.
200	(4) An applicant for an initial license to operate a
201	SPPEAC center shall submit an application providing all of the
202	information required by the agency, which must include:
203	(a) The number of beds for which the license is being
204	requested.
205	(b) The name of the SPPEAC center's administrator,
206	manager, executive director, or supervisor; the name and license
207	number of the director of nursing and all other currently
208	employed licensed personnel; and the number of currently
209	employed support personnel including, but not limited to,
210	respiratory technicians, certified nursing assistants, emergency
211	medical technicians, and paramedics having responsibility for
212	any part of the care given to clients.
213	(c) A listing of the number of dietary, housekeeping,
214	maintenance, and other personnel who are available on a daily
215	basis.
216	(d) Certificates of approval from the local zoning
217	authority indicating that the location of the facility conforms
218	to local zoning ordinances.
219	(e) Proof of financial ability to operate the facility in
220	accordance with the requirements of this act, which must be
221	documented as follows:
222	1. A projection of revenue and expenses for the first 12
223	months of operation, including a conversion of the projection to
224	a cash-flow analysis, a balance sheet as of the beginning of the
225	reporting period, and a pro forma balance sheet as of the end of
226	the reporting period. These documents must be prepared in
227	accordance with generally accepted accounting principles;
228	2. A copy of all deeds, contracts for sale, and leases,
229	whether existing or proposed, showing that the applicant is
230	responsible for the operation of the facility;
231	3. A contingency plan that demonstrates the ability of the
232	applicant to handle extraordinary occurrences that would have a
233	financial impact, such as major repairs, purchase of capital
234	equipment, or decrease in paid children's days. An applicant
235	meets this requirement if necessary contingency funds are
236	guaranteed from within the applicant's organization or from
237	proprietors, partners, or stockholders, or are evidenced as
238	available from commitments from lending institutions, a line of
239	credit, a letter of credit, or similar evidence. If the
240	contingency funds are guaranteed by the applicant's
241	organization, a proprietor, partners, or stockholders, the
242	guarantors must submit a signed statement that the required
243	funds shall be made available when necessary. The applicant must
244	have a positive cash flow, including contingency funding, for
245	each of the first 12 months of operation and must have a
246	contingency plan for an amount not less than 80 percent of the
247	total expenses detailed in the operating budget for the first 12
248	months of operation. If a line of credit exists, a letter from
249	the lending institution must be submitted which states:
250	a. The amount;
251	b. The terms and conditions;
252	c. The interest rate;
253	d. The repayment schedule;
254	e. The collateral;
255	f. The guarantors; and
256	g. The balance available on the date of license
257	application;
258	4. The names of proprietors, partners, or stockholders
259	owning at least a 10-percent interest, and the officers of:
260	a. The applicant;
261	b. The lessor;
262	c. The management company; and
263	d. The seller.
264
265	The financial information submitted by the applicant for
266	compliance with requirements for proof of financial ability must
267	be prepared in accordance with generally accepted accounting
268	principles. The financial information must be reviewed by the
269	agency, and a decision shall be made regarding the applicant's
270	financial ability to operate a SPPEAC center. All financial
271	statements, other then projections, must be certified as true
272	and correct by a corporate officer, all partners of a
273	partnership, or an individual delegated by the owner to do so,
274	as appropriate.
275	(f) For new construction or new operations:
276	1. Certificates of zoning approval from the county or the
277	municipality if the facility is located within municipal limits;
278	and
279	2. Proof of approval for occupancy.
280	(g) For a change of the licensed operator, proof of
281	compliance with applicable provisions of this act.
282	(h) Such additional related information that the agency
283	determines is necessary in order to act upon the application.
284	(5) An applicant for renewal of a license to operate a
285	SPPEAC facility must submit an application that includes:
286	(a) All of the information required by paragraphs (4)(a),
287	(d), (e), and (f); and
288	(b) The information required by paragraph (4)(b) for each
289	of the new personnel, if there has been a change of
290	administrator, executive director, manager, supervisor, medical
291	director, director of nursing services, or any licensed nurse
292	during the preceding year.
293	(6) If the licensee of a facility seeks to increase the
294	number of beds for which the facility is licensed, the licensee
295	must:
296	(a) Provide certificates of approval from the local zoning
297	authority indicating that the location of the facility conforms
298	to local zoning ordinances as to capacity; and
299	(b) Submit an application as required by subsection (5) to
300	modify the license accordingly.
301	(7) Each applicant for a license to operate a facility,
302	whether for initial licensure or for renewal, and the
303	administrator, executive director, manager, or supervisor of the
304	facility must:
305	(a) Be 18 years of age or older;
306	(b) Be of good moral character; and
307	(c) Have not been convicted or found guilty, regardless of
308	adjudication, in any jurisdiction, of any felony involving
309	fraud, embezzlement, fraudulent conversion, misappropriation of
310	property, violence against a person, or moral turpitude.
311	(8) Documentation for the agency showing compliance with
312	subsection (7), whether for initial licensure or for renewal,
313	must be submitted with the application and must include:
314	(a) Three character references for the applicant and for
315	the administrator, executive director, manager, or supervisor of
316	the facility, except on renewal if previously provided to the
317	department;
318	(b) The criminal record, if any, of the applicant and of
319	the administrator, executive director, manager, or supervisor of
320	the facility listing the court, the date of conviction, the
321	offense, and the penalty imposed for each conviction regardless
322	of adjudication; and
323	(c) A copy of any injunctive or restrictive order or
324	federal or state administrative order relating to business
325	activity or health care services as a result of an action
326	brought by a public agency or department, including, without
327	limitation, an action affecting a licensee under chapter 391,
328	Florida Statutes, which is currently in effect with respect to
329	the applicant or the administrator, executive director, manager,
330	or supervisor of the facility.
331	(9)(a) Each facility must obtain and keep in force
332	liability insurance. Proof of liability insurance must be
333	submitted at the time of application. Liability insurance is
334	insurance against legal liability for death, injury, or
335	disability of any human being, or for damage to property, with
336	provision for medical, hospital, and surgical benefits to the
337	injured person, irrespective of the legal disability of the
338	insured, when issued as a part of a liability insurance
339	contract.
340	(b) Minimum liability insurance coverage shall be at least
341	$50,000 per child for bodily injury and $150,000 per occurrence
342	for the center, and $50,000 per child for bodily injury and
343	$150,000 per occurrence for the vehicles if transportation
344	services are provided by the center.
345	Section 5. Administration and management.--
346	(1) The licensee of each SPPEAC center has full legal
347	authority and responsibility for operating the facility.
348	Responsibilities of the licensee include, but are not limited
349	to:
350	(a) Employing or otherwise arranging for the services of
351	personnel required to properly staff the center in accordance
352	with chapter 400, Florida Statutes, and this act;
353	(b) Adopting and making public a statement of the
354	children's rights in accordance with chapter 400, Florida
355	Statutes;
356	(c) Making application for a license to operate the center
357	in accordance with chapter 400, Florida Statutes, and this act;
358	(d) Providing equipment and supplies required to meet the
359	basic needs of the children;
360	(e) Ensuring that the center is operated in compliance
361	with chapter 400, Florida Statutes, and this act;
362	(f) Ensuring that services identified as required to meet
363	the needs of the children are provided directly by center
364	personnel or secured from outside sources; and
365	(g) Ensuring that a copy of chapter 400, Florida Statutes,
366	a copy of the SPPEAC rules adopted according to this act, a
367	medical dictionary, the current year's copy of the American
368	Academy of Pediatrics Red Book, and the current year's drug
369	reference book are available in the center.
370	(2) The licensee shall manage the center on a sound
371	financial basis and shall have the financial ability to operate
372	the facility in accordance with the requirements of this act. A
373	violation of this standard includes issuing bad checks, failing
374	to make timely tax and payroll deposits, or failing to meet
375	financial obligations for food, shelter, care, and utilities
376	when due.
377	(3) Each SPPEAC center shall be organized in accordance
378	with a written table of organization which describes the lines
379	of authority and communication down to the child-care level. The
380	organizational structure must be designed to ensure an
381	integrated continuum of services to the clients.
382	(4)(a) The licensee of each center shall designate one
383	person as executive director who is responsible and accountable
384	for the overall management of the center.
385	(b) The center executive director shall designate, in
386	writing or per organizational chart, a person who is responsible
387	for operating the center when the executive director is absent
388	from the center for 24 hours or longer.
389	(c) Responsibilities of the center executive director
390	include, but are not limited to:
391	1. Maintaining or causing to be maintained the following
392	written records and any other records required by this act. The
393	records must be kept in a place, form, and system ordinarily
394	employed in acceptable medical and business practices, must be
395	available in the center for inspection by the agency during
396	normal business hours, and must include:.
397	a. A census record that indicates the number of children
398	currently receiving services in the center;
399	b. A record of all accidents or unusual incidents
400	involving any child or staff member which caused, or had the
401	potential to cause, injury or harm to any person or property
402	within the center. Such records must contain a clear description
403	of each accident or incident, the names of the persons involved,
404	a description of all medical or other services provided to these
405	persons, the names of those who provided such services, and the
406	steps taken, if any, to prevent recurrence of such accident or
407	incidents in the future;
408	c. A copy of current agreements with third-party
409	providers;
410	d. A copy of current agreements with each consultant
411	employed by the center and documentation of each consultant's
412	visits and required written, dated reports;
413	e. A personnel record, drug testing, and criminal
414	background check for each employee, including the employee's
415	current license or certificate number, as applicable, the
416	original employment application and references furnished from
417	the most recent health care employer and employment history for
418	the preceding 5 years, and a copy of all job performance
419	evaluations; and
420	f. Fiscal records in accordance with subsection (5).
421	2. Ensuring the development and maintenance of a current
422	job description for each employee.
423	3. Ensuring that each employee is furnished with a copy of
424	written personnel policies governing conditions of employment,
425	including the job description for the employee's own position.
426	4. Ensuring that each employee receives at least a yearly
427	written job-performance evaluation that is discussed with the
428	employee, notes job performance strengths and weaknesses, and
429	discusses plans to correct any weaknesses in job performance.
430	5. Ensuring that each employee is assigned duties that are
431	consistent with the employee's job description and with the
432	employee's level of education, preparation, and experience.
433	(5)(a) The licensee for each SPPEAC center shall maintain
434	fiscal records in accordance with the requirements of this act.
435	(b) Each center shall use an accrual or cash system of
436	accounting which reflects transactions of the business. Records
437	and accounts of transactions, general ledgers, or disbursement
438	journals must be posted at least quarterly and must be available
439	for review by the agency.
440	Section 6. Advisory board.--
441	(1) Each SPPEAC center must have an advisory board.
442	Membership on the advisory board must include, but need not be
443	limited to:
444	(a) A physician who is familiar with SPPEAC services;
445	(b) A registered nurse who has experience in the care of
446	medically fragile or technologically dependent children;
447	(c) A developmentalist or child life specialist who has
448	experience in the care of medically fragile or technologically
449	dependent children and their families;
450	(d) A social worker who has experience in the care of
451	medically fragile or technologically dependent children and
452	their families; and
453	(e) A consumer representative who is a parent or guardian
454	of a child placed in the SPPEAC center.
455	(2) The advisory board shall:
456	(a) Review the policy and procedure components of the
457	SPPEAC center to assure conformance with the standards for
458	licensure; and
459	(b) Provide consultation with respect to the operational
460	and programmatic components of the SPPEAC center.
461	Section 7. Admission, transfer, and discharge policies.--
462	(1) Each SPPEAC center must have written policies and
463	procedures governing the admission, transfer, and discharge of
464	children.
465	(2) The admission of each child to a SPPEAC center must be
466	under the supervision of the center nursing director or his or
467	her designee, and must be in accordance with the center's
468	policies and procedures.
469	(3) Each child admitted to a SPPEAC center shall be
470	admitted upon prescription of a prescribing physician and the
471	child shall remain under the care of the licensed primary
472	physician for the duration of his or her stay in the center.
473	(4) Each child admitted to a SPPEAC center must meet at
474	least the following criteria:
475	(a) The child must be medically fragile or technologically
476	dependent.
477	(b) The child may not, prior to admission, present
478	significant risk of infection to other children or personnel.
479	The medical and nursing directors shall review, on a case-by-
480	case basis, any child who is suspected of having an infectious
481	disease to determine whether admission is appropriate.
482	(c) The child must be medically stabilized and require
483	skilled nursing care or other interventions.
484	(5) If the child meets the criteria specified in
485	paragraphs (4)(a), (b), and (c), the medical director or nursing
486	director of the SPPEAC center shall implement a preadmission
487	plan that delineates services to be provided and appropriate
488	sources for such services.
489	(a) If the child is hospitalized at the time of referral,
490	preadmission planning must include the participation of the
491	child's parent or guardian and relevant medical, nursing, social
492	services, and developmental staff to ensure that the hospital's
493	discharge plans will be implemented following the child's
494	placement in the SPPEAC center.
495	(b) A consent form, outlining the purpose of a SPPEAC
496	center, family responsibilities, authorized treatment,
497	appropriate release of liability, and emergency disposition
498	plans must be signed by the parent or guardian and witnessed
499	before the child is admitted to a SPPEAC center. The parent or
500	guardian shall be provided a copy of the consent form.
501	Confidentiality of SPPEAC records shall be maintained in
502	accordance with section 456.057, Florida Statutes.
503	Section 8. Child care policies.--
504	(1) Each SPPEAC center shall develop, implement, and
505	maintain written policies and procedures governing all child
506	care and related medical services or other services provided.
507	(2) A group of professional staff from the SPPEAC center
508	shall develop and maintain child care policies and procedures.
509	The group shall include the medical director or medical
510	consultant, the center administrator or executive director, and
511	the director of nursing services. All child care policies and
512	procedures must be reviewed annually and revised as needed.
513	(3) The child care policies and procedures developed
514	shall, at a minimum, ensure client care in compliance with
515	chapter 400, Florida Statutes, and the standards contained in
516	this act.
517	Section 9. Medical director.--A board-certified
518	pediatrician shall serve as the medical director for a SPPEAC
519	center. Responsibilities of the medical director include:
520	(1) Periodically reviewing services in order to assure
521	acceptable levels of quality;
522	(2) Maintaining a liaison with the medical community;
523	(3) Advising center personnel of the development of new
524	programs and modifications of existing programs;
525	(4) Ensuring that medical consultation will be available
526	in the event of the medical director's absence;
527	(5) Serving on committees as defined and required by the
528	center's policies;
529	(6) Consulting with the center's executive director on the
530	health status of facility personnel;
531	(7) Reviewing reports of all accidents or unusual
532	incidents occurring on the premises and identifying to the
533	center's executive director hazards to health and safety; and
534	(8) Ensuring the development of a policy and procedure for
535	delivering emergency services and regular services when a
536	child's attending physician or designated alternate is not
537	available.
538	Section 10. Nursing services.--
539	(1) A registered nurse shall serve full time as the
540	director of nursing at each SPPEAC center. The director of
541	nursing must:
542	(a) Hold a baccalaureate degree in nursing;
543	(b) Be licensed in this state as a registered nurse;
544	(c) Have a current health care provider basic life support
545	biennial certification;
546	(d) Have successfully completed a certification course in
547	pediatric basic cardiac life support and advanced cardiac life
548	support, with biennial recertification; and
549	(e) Have at least 2 years of experience in general
550	pediatric care, including at least 6 months of experience in
551	pediatric acute care during the previous 5 years.
552	(2) The director of nursing is responsible for the daily
553	nursing operations of the SPPEAC center, including:
554	(a) Ensuring that qualified personnel and ancillary
555	services are available as necessary to ensure the health,
556	safety, and proper care of children; and
557	(b) Ensuring that policies and procedures to control
558	infection are included in the center's policy manual.
559	(3)(a) Each SPPEAC center must have a minimum of one full-
560	time equivalent registered nurse and one full-time equivalent
561	respiratory therapist on site at all times.
562	(b) A registered nurse must:
563	1. Hold an associate degree in nursing at a minimum;
564	2. Be licensed in this state as a registered nurse;
565	3. Have successfully completed a preceptor program in
566	pediatric specialty care; and
567	4. Receive biennial certification in health care provider
568	basic life support, pediatric basic cardiac life support, and
569	pediatric advanced life support.
570	(c) A licensed respiratory therapist must:
571	1. Be licensed in this state as a licensed respiratory
572	therapist;
573	2. Have successfully completed a 3-month preceptor program
574	in pediatric nursing, which includes experience in caring for
575	acutely ill or chronically ill children; and
576	3. Receive biennial certification in health care provider
577	basic life support, pediatric basic cardiac life support, and
578	pediatric advanced life support.
579	(d) A licensed practical nurse must:
580	1. Be licensed in this state as a practical nurse;
581	2. Have successfully completed a 3-month preceptor program
582	in pediatric nursing, including experience in caring for acutely
583	ill or chronically ill children; and
584	3. Receive biennial certification in health care provider
585	basic life support, pediatric basic cardiac life support, and
586	pediatric advanced life support.
587	(e) The registered nurses, licensed practical nurses, and
588	respiratory therapists of a SPPEAC center are responsible for:
589	1. Providing nursing interventions, providing educational
590	services to increase the family's confidence and competence in
591	caring for the child with special needs, providing assistance to
592	facilitate coping with the effects of chronic illness on the
593	child and family, supporting effective relationships among
594	siblings and the ill child, and providing interventions to
595	foster normal development and psychosocial adaptation;
596	2. Possessing knowledge of the availability of and
597	requirements for accessing community resources; and
598	3. Fostering and maintaining a collaborative relationship
599	with the interdisciplinary health team. An interdisciplinary
600	health team is a group of health care professionals consisting
601	of an occupational therapist, a physical therapist, a speech
602	therapist, and a physician.
603	(4)(a) If nursing assistants, emergency medical
604	technicians, and paramedics are used to augment licensed nurse
605	staff, each nursing assistant, emergency medical technician, and
606	paramedic must:
607	1. Be certified as a nursing assistant, emergency medical
608	technician, or paramedic;
609	2. Have successfully completed a 3-month preceptor program
610	in caring for infants and toddlers;
611	3. Provide references documenting his or her skill in
612	caring for infants and children; and
613	4. Receive certification every 2 years in basic cardiac
614	life support.
615	(b) Each nursing assistant, emergency medical technician,
616	and paramedic must work under the supervision of a licensed
617	nurse and may provide direct care to children in the SPPEAC
618	center.
619	(5) At least three staff members, including at least one
620	respiratory therapist, one registered nurse, and one other, must
621	be on duty at all times and at least one staff member per three
622	children must be on duty at all times. As used in this
623	subsection, the term "other" means a nursing assistant, an
624	emergency medical technician, a paramedic, a certified
625	respiratory therapist, or a respiratory therapist technician.
626	Total staffing for nursing services shall be, at a minimum, in
627	the following ratios:
628	(a) One to three children - one registered nurse and one
629	other.
630	(b) Four to six children - one registered nurse and two
631	others.
632	(c) Seven to nine children - one registered nurse, one
633	licensed practical nurse, and one other.
634	(d) Ten to 12 children - two registered nurses, and two
635	others; or one registered nurse, two licensed practical nurses,
636	and one other.
637	(e) Thirteen to 15 children - two registered nurses, one
638	licensed practical nurse, and two others.
639	(f) Sixteen to 18 children - two registered nurses, two
640	licensed practical nurses, and two others.
641	(g) Nineteen to 21 children - two registered nurses, three
642	licensed practical nurses, and two others.
643	(h) Twenty-two to 24 children - three registered nurses,
644	two licensed practical nurses, and three others.
645	(i) Twenty-five children to 28 children - three registered
646	nurses, three licensed practical nurses, and three others.
647	(j) Twenty-nine to 32 children - four registered nurses,
648	three licensed practical nurses, and four others.
649	(k) For every one to eight additional children - one
650	registered nurse, one licensed practical nurse, and one other
651	will be added to the staff.
652	Section 11. Ancillary professional staffing standards.--
653	Each SPPEAC center shall have available on at least a consulting
654	basis:
655	(1) A child development specialist who shall:
656	(a) Serve as a resource for SPPEAC center staff and
657	parents of children served; and
658	(b) Evaluate the developmental status of children using
659	standardized and nonstandardized procedures.
660	(2) A child life specialist who has a baccalaureate degree
661	in child life, early childhood education, or a related field,
662	and at least 1 year of experience in planning and implementing
663	developmental stimulation programs for children. The child life
664	specialist shall:
665	(a) Plan and conduct individualized child development and
666	play programs; and
667	(b) Serve as a resource for SPPEAC center staff and
668	parents of children served.
669	(3) An occupational therapist who is licensed under
670	chapter 468, Florida Statutes, is registered with the American
671	Occupational Therapy Association, and has at least 1 year of
672	experience in evaluating and planning treatment for children
673	with neuromuscular and developmental needs. The occupational
674	therapist shall:
675	(a) Evaluate a child following referral by a physician to
676	determine neuromuscular status, developmental level, perceptual
677	motor functioning, need for adaptive equipment or appliances,
678	abilities for self-care, and the plan of care;
679	(b) Design and implement a therapeutic program to meet the
680	basic needs of each individual child;
681	(c) Maintain records documenting a child's therapy program
682	and progress; and
683	(d) Serve as a resource for SPPEAC center staff.
684	(4) A physical therapist who is licensed under chapter
685	486, Florida Statutes, is a graduate of a program approved by
686	the American Physical Therapy Association, and has at least 1
687	year of experience in evaluating and designing therapeutic
688	programs for children with developmental disabilities. The
689	physical therapist shall:
690	(a) Evaluate a child referred by a physician to determine
691	the child's neuromuscular status, including the child's
692	developmental level, gait, posture, and necessary adaptive
693	equipment;
694	(b) Design and implement a therapeutic program to meet the
695	needs of each individual child;
696	(c) Maintain records documenting a child's therapy program
697	and progress, as approved by the attending physician; and
698	(d) Serve as a resource for SPPEAC center staff and
699	parents of children served.
700	(5) A speech pathologist who is certified by the American
701	Speech, Hearing, and Language Association and has at least 1
702	year of experience in evaluating and treating children at risk
703	for, or experiencing problems with, communications skills. The
704	speech pathologist shall:
705	(a) Perform evaluations, including evaluation of a child's
706	prespeech, feeding, respiration, language, speech,
707	communication, and play, using formal and informal tests and
708	observations;
709	(b) Design and implement individualized therapeutic
710	programs for each child, including recommendations for
711	communication devices;
712	(c) Maintain records documenting the child's therapy
713	programs and progress; and
714	(d) Serve as a resource for SPPEAC center staff and
715	parents of children served.
716	(6) A respiratory therapist who shall:
717	(a) Evaluate a child following referral by a physician,
718	including an evaluation of the child's respiratory condition;
719	(b) Perform diagnostic monitoring;
720	(c) Deliver aerosolized medications, bronchial hygiene
721	therapy, chest physiotherapy, pulmonary lung-expansion therapy,
722	and oxygen therapy;
723	(d) Monitor ventilator-dependent children;
724	(e) Maintain records documenting a child's therapy
725	programs and progress; and
726	(f) Serve as a resource for SPPEAC center staff and
727	parents of children served.
728	(7) A social worker who is licensed under chapter 490,
729	Florida Statutes, or chapter 491, Florida Statutes; holds a
730	master's degree in social work; and has at least 1 year of
731	experience in assessing, counseling, and planning interventions
732	for children and their families or guardians. The social worker
733	shall:
734	(a) Conduct family psychosocial assessments, as requested
735	by the medical or nursing director;
736	(b) Provide counseling, including emotional support and
737	grief resolution, as requested by the medical or nursing
738	director or family;
739	(c) Perform family advocacy and coordinate SPPEAC services
740	with community resources;
741	(d) Maintain records documenting social work intervention;
742	(e) Conduct home visits and home evaluations, as requested
743	by the medical director or nursing director; and
744	(f) Serve as a resource for SPPEAC center staff and
745	parents of children served.
746	(8) A licensed psychologist who has a doctoral degree in
747	child-development counseling, psychology, or a related field and
748	at least 1 year of experience in evaluating and managing
749	children. The licensed psychologist must be available to the
750	center as a consultant.
751	(9) A dietitian who is registered with the American
752	Dietetic Association. The dietitian must be available to the
753	center as a consultant.
754	Section 12. Educational services.--Each SPPEAC center
755	shall develop a cooperative program with the local school system
756	to provide a planned educational program appropriate to meet the
757	needs of the individual child, or to provide a board-certified
758	instructor and planned educational program appropriate to meet
759	the basic needs of the individual child.
760	Section 13. Inservice training for all caregivers.--
761	(1) Each SPPEAC center shall develop a comprehensive
762	training program that is available to all caregivers and
763	includes:
764	(a) Inservice training for all family members; and
765	(b) Quarterly staff-development programs, appropriate to
766	the category of personnel for which the programs are conducted,
767	for the purpose of maintaining quality patient care.
768	(2) All staff development programs must be documented.
769	(3) Each new employee must participate in orientation to
770	acquaint the employee with the philosophy, organization,
771	program, practices, and goals of the SPPEAC center.
772	(4) At the time of the child's placement in the SPPEAC
773	center, the center shall provide a comprehensive orientation to
774	acquaint all family members with the philosophy and services of
775	the center.
776	Section 14. Medical records.--A medical record shall be
777	maintained for each child. The medical records must contain:
778	(1) All details of the referral, admission,
779	correspondence, and papers concerning the child. Entries in the
780	medical record must be in ink and signed by authorized personnel
781	and include:
782	(a) Orders of the physician;
783	(b) Flow chart of medications and treatments administered;
784	(c) Concise, accurate information and initialed case notes
785	reflecting progress toward plan-of-care goals and the child's
786	progress or reasons for lack of progress;
787	(d) Documentation of nutritional management and special
788	diets, as appropriate; and
789	(e) Documentation of physical, occupational, speech, and
790	other special therapies.
791	(2) An individualized plan of care developed within 10
792	working days after admission and revised to include recommended
793	changes in the therapeutic plans. The disposition to be followed
794	in the event of emergency situations must be specified in the
795	plan of care.
796	(3) The medical history, including allergies and special
797	precautions.
798	(4) The immunization record.
799	(5) The quarterly review of the plan of care, which is
800	performed in consultation with other professionals involved in
801	the child's care.
802	(6) A discharge order written by the primary physician.
803	The discharge order must be documented and entered in the
804	child's record. A discharge summary that includes the reason for
805	discharge must also be included.
806	Section 15. Quality assurance committee.--All SPPEAC
807	centers must have a quality assurance program and conduct
808	quarterly reviews of the SPPEAC center's medical records for at
809	least half of the children served by the SPPEAC center at the
810	time of the review.
811	(1) The quality assurance review shall be conducted by two
812	members of the quality assurance committee. The responsibilities
813	for conducting quality assurance review shall rotate among the
814	members of the quality assurance committee members at least
815	annually. Within 15 working days after its review, the quality
816	assurance committee shall furnish copies of its report to the
817	medical and nursing directors of the SPPEAC center.
818	(2)(a) Each quarterly quality assurance review must
819	include:
820	1. A review of the goals in each child's plan of care;
821	2. A review of the steps, process, and success in
822	achieving the goals; and
823	3. Identification of goals not being achieved as expected,
824	reasons for lack of achievement, and plans to promote
825	achievement of goals.
826	(b) Evidence that the plan of care has been revised to
827	accommodate the findings of a quality assurance report shall be
828	forwarded to the quality assurance committee within 10 working
829	days after receipt of the report by the quality assurance
830	committee.
831	(c) Implementation of the revisions to the plan of care
832	must be documented on the child's medical record.
833	(3) The quality assurance committee shall also ascertain
834	the presence of the following documents in each child's medical
835	record:
836	(a) A properly executed consent form;
837	(b) A medical history for the child, including notations
838	from visits to health care providers; and
839	(c) Immunization records, documentation of allergies, and
840	special precautions.
841	Section 16. Dietary services.--A registered dietitian
842	shall be available for consultation regarding the nutritional
843	needs and special diets of individual children. If food is
844	prepared onsite, the center is subject to routine inspections by
845	the Department of Health and must conform to food service
846	standards for child care facilities adopted by the Department of
847	Health.
848	Section 17. Physical environment.--The SPPEAC center's
849	physical location and building must comply with at least the
850	following minimum requirements:
851	(1) Each facility licensed as a SPPEAC center must be able
852	to accommodate at least three medically fragile or
853	technologically dependent children.
854	(2) Specifications for a SPPEAC center include:
855	(a) Compliance with part II of chapter 553, Florida
856	Statutes, for accessibility of public buildings for handicapped
857	persons; and
858	(b) Adequate parking for staff and families to comply with
859	applicable local zoning requirements.
860	(3) Requirements for building space allocation include:
861	(a) An isolation room with anteroom, a private bathroom
862	with shower or raised tub, and an individual air conditioning
863	and heating unit.
864	(b) A dining area large enough to accommodate at least
865	two-thirds of facility population at one time.
866	(c) A kitchen area that includes standard kitchen
867	equipment of stove, oven, refrigerator, dishwasher, and double
868	sink with disposal.
869	(d) An indoor play area, including accommodations for
870	mobile and nonmobile children.
871	(e) An outdoor play area, fenced and free of safety
872	hazards, with appropriate playground equipment and toys.
873	(f) Sleep rooms that comply with the following
874	requirements:
875	1. One appropriate bed or crib assigned per child;
876	2. A maximum of three children assigned to each sleep
877	room;
878	3. A minimum of 28 square feet per child;
879	4. Hanging closet space with drawers;
880	5. Direct access to a bathroom with shower or standard
881	tub;
882	6. A changing area with sink; and
883	7. Adequate seating with a minimum of one chair per child.
884	(g) A laundry room with washer and dryer or daily linen
885	service.
886	(h) A business office.
887	(i) A children's bathroom in the common area which has one
888	toilet, one basin, and one standard bathtub or shower.
889	(j) An adult bathroom that has one toilet and one basin.
890	(k) A staff lounge that includes:
891	1. A bathroom, with one toilet, one basin, and one shower
892	stall with private changing area per 15 staff members; and
893	2. Secure lockers for personal items.
894	(l) A nurses station and medication area that includes a
895	locked cabinet and emergency kit.
896	(m) An education room, including one area within this room
897	designated for children 2 years of age or younger.
898	(n) A gymnasium area for therapies, with a minimum of one
899	private speech room.
900	Section 18. Furniture and linens.--Each SPPEAC center must
901	provide an appropriate mix of cribs, beds, highchairs, infant
902	seats, and changing tables to meet the needs of the children
903	being served. All provided items must be maintained in a safe
904	and sanitary condition. A minimum of one bed or crib per child
905	is required, which may not be occupied by more than one child at
906	a time. Linens must be changed and mattresses sanitized before
907	use by another child.
908	Section 19. Equipment.--Each SPPEAC center shall provide
909	safety, medical, and emergency equipment as described in this
910	section. All equipment must be maintained in a safe, usable, and
911	sanitary condition.
912	(1) The following items of safety equipment must be
913	available on the premises:
914	(a) Extinguishers, alarms, and smoke detectors, as
915	required by the Life Safety Code, NFPA-101, 2003 edition;
916	(b) Circuit interrupters;
917	(c) Flush door openers;
918	(d) Child-proof safety latches on closets and cabinets;
919	(e) Safety straps on all highchairs, swings, and infant
920	seats;
921	(f) Locks on specific storage cabinets;
922	(g) Bumper pads on infant cribs; and
923	(h) Covers for electric outlets.
924	(2) The following items of medical equipment must be
925	available on the premises:
926	(a) Suction machines - one per child requiring daily
927	suctioning, plus one suction machine for emergency use;
928	(b) Lockable narcotics cabinet;
929	(c) Mechanical percussors and hand percussors as
930	prescribed;
931	(d) Oxygen in two portable tanks, or piped in with
932	appropriate tubing, pediatric manual resuscitation, and masks
933	for faces and tracheostomies;
934	(e) Ventilator with provision for mixing gases to provide
935	prescribed oxygen concentration as specifically prescribed or to
936	be used as a backup unit when a ventilator-dependent child is in
937	the center;
938	(f) Thermometers, excluding glass thermometers;
939	(g) Sphygmomanometers, stethoscopes, osteoscopes, and
940	ophthalmoscopes; and
941	(h) Supplies of disposable equipment as needed.
942	(3) The following items of emergency equipment and
943	supplies must be available on the premises:
944	(a) An emergency power-generator system, with adequate
945	generating power to maintain medical equipment in the center in
946	case of power failure.
947	(b) Basic emergency equipment, including:
948	1. Airways, in a range of appropriate pediatric sizes;
949	2. Suction catheters, in a range of appropriate pediatric
950	sizes;
951	3. Pediatric manual resuscitator, self-inflating, with
952	premature infant, infant, and pediatric masks;
953	4. Infant oxygen masks;
954	5. Child oxygen masks;
955	6. Oxygen regulator with mist bottle and heating element;
956	7. Flashlight with extra batteries in each room;
957	8. Stethoscope;
958	9. Feeding tubes in a range of appropriate pediatric
959	sizes;
960	10. Disposable plastic syringes and needles in a range of
961	appropriate pediatric sizes;
962	11. Intravenous catheter, angiocatheter, and scalp vein
963	needles in a range of appropriate pediatric sizes;
964	12. Tourniquets; armboards in premature infant, infant,
965	and child sizes; and adhesive tape of various sizes;
966	13. Two-way stopcocks;
967	14. One electrical outlet adapter for three-prong outlets;
968	and
969	15. Antiseptic preps and alcohol preps.
970	(c) Basic drugs and solutions, including:
971	1. Epinephrine ampules, two each of 1:1,000 and 1:10,000;
972	2. Dextrose in 25-percent solution and 50-percent
973	solution;
974	3. Ipecac, one 30cc bottle;
975	4. Sterile water, two vials;
976	5. Normal saline, two vials;
977	6. Dextrose 5 percent in water, one 500cc bag; and
978	7. Dextrose 5 percent in Lactated Ringer's, two 500cc
979	bags.
980	(4) Emergency equipment must be checked daily for
981	expiration, contamination, or damage, and a log must be
982	maintained and signed every day by the nurse responsible for
983	verifying the examining of emergency equipment.
984	Section 20. Infection control.--
985	(1) Each SPPEAC center must have an isolation room with a
986	patient monitoring system for observing the child.
987	(2) Isolation procedures must be used to prevent cross-
988	infections.
989	(3) All cribs and beds must be labeled with the individual
990	child's name. Linens may be removed from cribs only for
991	laundering purposes.
992	(4) Bed linens must be changed at least every 2 days.
993	(5) Antimicrobial soap and disposable paper towels must be
994	provided at each sink.
995	(6) Children suspected of having a communicable disease
996	that may be transmitted through casual contact, as determined by
997	the facility's medical director, must be isolated and the
998	parents notified of the condition. Isolation must be continued
999	until a physician determines communicability has passed.
1000	(7) SPPEAC center staff members suspected of having a
1001	communicable disease may not return to the SPPEAC center until
1002	the signs and symptoms that relate to the communicable disease
1003	are no longer present, as evidenced by a written statement from
1004	a physician.
1005	Section 21. Transportation services.--If transportation is
1006	provided by a SPPEAC center and prescribed by the primary
1007	physician, a procedure delineating personnel and equipment to
1008	accompany the child must be included in the procedure manual of
1009	the SPPEAC center.
1010	Section 22. Emergency procedures.--
1011	(1) Each SPPEAC center shall conform to the minimum
1012	standards for child care facilities adopted by the State Fire
1013	Marshal and shall be inspected annually by a certified fire
1014	inspector. The center must maintain a copy of the current annual
1015	fire inspection report at the center.
1016	(2) The center must have a working telephone that is not
1017	locked and that is not a pay telephone.
1018	(3) Emergency telephone numbers must be posted on or in
1019	the immediate vicinity of all telephones.
1020	(4) Each center must have an emergency power-generator
1021	system with adequate generating power to maintain medical
1022	equipment in the center in case of power failure. The emergency
1023	generator must be tested every 30 days and satisfactory
1024	mechanical operation must be documented on a log designed for
1025	that purpose.
1026	(5) Emergency transportation of a child must be performed
1027	by a licensed emergency medical services provider, with a SPPEAC
1028	center staff member accompanying the child.
1029	(6) Facility staff may withhold or withdraw
1030	cardiopulmonary resuscitation if presented with an order not to
1031	resuscitate executed pursuant to s. 401.45, Florida Statutes.
1032	Facility staff and facilities are not subject to criminal
1033	prosecution or civil liability and are not considered to have
1034	engaged in negligent or unprofessional conduct for withholding
1035	or withdrawing cardiopulmonary resuscitation pursuant to such an
1036	order and rules adopted by the agency. The absence of an order
1037	not to resuscitate executed pursuant to s. 401.45, Florida
1038	Statutes, does not preclude a physician from withholding or
1039	withdrawing cardiopulmonary resuscitation as otherwise permitted
1040	by law.
1041	Section 23. This act shall take effect upon becoming a
1042	law.