HB 1267CS

CHAMBER ACTION



1The Judiciary Committee recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
A bill to be entitled
6An act relating to nursing homes; amending s. 400.23,
7F.S.; providing for alternative bed locations in nursing
8home rooms and providing criteria for bed placement;
9requiring a signed statement from the resident or
10representative if the alternative bed placement is not in
11compliance with the Florida Building Code; requiring the
12facility to maintain a log of alternative bed placements
13and to retain the signed statements; requiring the nursing
14home to notify the Agency for Health Care Administration
15with respect to such practice; amending s. 633.022, F.S.;
16requiring nursing homes to be protected by certain
17automatic sprinkler systems; providing a schedule;
18authorizing the Division of State Fire Marshal to grant
19certain time extensions; authorizing the division to adopt
20certain rules; providing for administrative sanctions
21under certain circumstances; requiring adjustments to
22certain provider Medicaid rates for reimbursement for
23Medicaid's portion of costs to meet certain requirements;
24requiring funding for such adjustments to come from
25existing nursing home appropriations; creating s. 633.024,
26F.S.; providing legislative findings and intent; creating
27s. 633.0245, F.S.; authorizing the State Fire Marshal to
28enter into an investment agreement with public
29depositories to establish the State Fire Marshal Nursing
30Home Fire Protection Loan Guarantee Program as a limited
31loan guarantee program to retrofit nursing homes with fire
32protection systems; providing investment and agreement
33limitations; requiring the State Fire Marshal to solicit
34requests for proposals; providing for application
35requirements and procedures; providing for review and
36approval by the State Fire Marshal; providing application
37requirements and procedures for program loans by public
38depositories; providing deadlines and limitations;
39limiting certain claims for loss under certain
40circumstances; providing a definition; authorizing the
41State Fire Marshal to adopt rules; providing an effective
42date.
43
44Be It Enacted by the Legislature of the State of Florida:
45
46     Section 1.  Paragraph (a) of subsection (2) of section
47400.23, Florida Statutes, is amended to read:
48     400.23  Rules; evaluation and deficiencies; licensure
49status.--
50     (2)  Pursuant to the intention of the Legislature, the
51agency, in consultation with the Department of Health and the
52Department of Elderly Affairs, shall adopt and enforce rules to
53implement this part, which shall include reasonable and fair
54criteria in relation to:
55     (a)  The location of the facility and housing conditions
56that will ensure the health, safety, and comfort of residents,
57including an adequate call system. In making such rules, the
58agency shall be guided by criteria recommended by nationally
59recognized reputable professional groups and associations with
60knowledge of such subject matters. The agency shall update or
61revise such criteria as the need arises. The agency may require
62alterations to a building if it determines that an existing
63condition constitutes a distinct hazard to life, health, or
64safety. In performing any inspections of facilities authorized
65by this part, the agency may enforce the special-occupancy
66provisions of the Florida Building Code and the Florida Fire
67Prevention Code which apply to nursing homes. Residents or their
68representatives shall be able to request a change in the
69placement of the bed in their room, provided that at admission
70they are presented with a room that meets requirements of the
71Florida Building Code. The location of a bed may be changed if
72the requested placement does not infringe on the resident's
73roommate or interfere with the resident's care or safety as
74determined by the care planning team in accordance with facility
75policies and procedures. In addition, the bed placement may not
76be used as a restraint. Each facility shall maintain a log of
77resident rooms with beds that are not in strict compliance with
78the Florida Building Code in order for such log to be used by
79surveyors and nurse monitors during inspections and visits. Any
80resident or resident representative who requests that a bed be
81moved shall sign a statement indicating that they understand the
82room will not be in compliance with the Florida Building Code,
83but they would prefer to exercise their right to self-
84determination. The statement must be retained as part of the
85resident's care plan. Any facility that offers this option shall
86notify the agency of this practice by submitting a letter signed
87by the nursing home administrator of record and a copy of the
88facility's policies and procedures. The agency is directed to
89provide assistance to the Florida Building Commission in
90updating the construction standards of the code relative to
91nursing homes.
92     Section 2.  Subsection (4) is added to section 633.022,
93Florida Statutes, to read:
94     633.022  Uniform firesafety standards.--The Legislature
95hereby determines that to protect the public health, safety, and
96welfare it is necessary to provide for firesafety standards
97governing the construction and utilization of certain buildings
98and structures. The Legislature further determines that certain
99buildings or structures, due to their specialized use or to the
100special characteristics of the person utilizing or occupying
101these buildings or structures, should be subject to firesafety
102standards reflecting these special needs as may be appropriate.
103     (4)(a)  Notwithstanding any provision of law to the
104contrary, each nursing home licensed under part II of chapter
105400 shall be protected by an approved, supervised automatic
106sprinkler system in accordance with section 9 of National Fire
107Protection Association, Inc., Life Safety Code, in accordance
108with the following schedule:
109     1.  Each hazardous area of each nursing home shall be
110protected by an approved, supervised automatic sprinkler system
111by no later than December 31, 2008.
112     2.  Each entire nursing home shall be protected by an
113approved, supervised automatic sprinkler system by no later than
114December 31, 2010.
115     (b)  The division may grant up to two 1-year extensions of
116the time limits for compliance in subparagraph (a)2. if the
117division determines that the nursing home has been prevented
118from complying for reasons beyond its control.
119     (c)  The division is authorized to adopt any rule necessary
120for the implementation and enforcement of this subsection. The
121division shall enforce this subsection in accordance with the
122provisions of this chapter, and any nursing home licensed under
123part II of chapter 400 that is in violation of this subsection
124may be subject to administrative sanctions by the division
125pursuant to this chapter.
126     (d)  Adjustments shall be made to the provider Medicaid
127rate to allow reimbursement over a 5-year period for Medicaid's
128portion of the costs incurred to meet the requirements of this
129subsection. Funding for this adjustment shall come from existing
130nursing home appropriations.
131     Section 3.  Section 633.024, Florida Statutes, is created
132to read:
133     633.024  Legislative findings and intent; ensuring
134effective fire protection of vulnerable nursing home residents
135essential; retrofit of existing nursing homes expedited by
136limited state loan guarantee; funding through Insurance
137Regulatory Trust Fund.--
138     (1)  It is the intent of the Legislature to promote the
139essential public purpose of ensuring effective fire protection
140for the safety and welfare of nursing home residents of this
141state who, because of their inability to protect themselves, are
142most vulnerable to catastrophic injury or death in the event of
143a fire. The Legislature finds that this purpose is served by
144requiring the installation of appropriate fire protection
145systems in all nursing home facilities in this state that do not
146currently have fire protection systems in operation for the
147protection of their residents. The Legislature finds that the
148high capital cost of retrofitting appropriate fire protection
149systems at nursing home facilities not originally designed with
150fire protection systems has discouraged the owners and operators
151of such facilities from doing so. The Legislature therefore
152finds that state action to provide a limited state guarantee of
153loans covering these capital costs will expedite the immediate
154installation of fire protection systems at facilities that lack
155such systems and thereby ensure effective protection for those
156nursing home populations that are now most vulnerable to the
157catastrophic effects of fire.
158     (2)  Because the Insurance Regulatory Trust Fund is funded
159by the proceeds of fire insurance premiums written in this
160state, the Legislature finds that it is in the public interest
161for moneys held in the Insurance Regulatory Trust Fund to be
162used to fund the limited loan guarantee program that mobilizes
163private funding for the retrofitting of fire protection systems
164at unprotected nursing homes located in this state.
165     Section 4.  Section 633.0245, Florida Statutes, is created
166to read:
167     633.0245  State Fire Marshal Nursing Home Fire Protection
168Loan Guarantee Program.--
169     (1)  The State Fire Marshal, with the assistance of the
170Division of Treasury of the Department of Financial Services,
171may enter into an investment agreement concerning the investment
172of certain funds held in the Insurance Regulatory Trust Fund for
173the purpose of establishing a limited loan guarantee program to
174be known as the State Fire Marshal Nursing Home Fire Protection
175Loan Guarantee Program. The investment must be limited as
176follows:
177     (a)  Not more than $4 million of the balance in the
178Insurance Regulatory Trust Fund in any fiscal year may be at
179risk at any time for the purpose of limited loan guarantees.
180     (b)  Such funds at risk at any time may not be used to
181guarantee any limited loan guarantee agreement for a period
182longer than 10 years.
183     (c)  No limited loan guarantee agreement based on invested
184funds may be entered into after December 1, 2006.
185     (2)  The State Fire Marshal may enter into limited loan
186guarantee agreements with one or more financial institutions
187qualified as public depositories in this state. Such agreements
188shall provide a limited guarantee by the State of Florida
189covering no more than 50 percent of the principal sum loaned by
190such financial institution to an eligible nursing home, as
191defined in subsection (10), for the sole purpose of the initial
192installation at such nursing home of a fire protection system,
193as defined in s. 633.021(8), approved by the State Fire Marshal
194as being in compliance with the provisions of s. 633.022 and
195rules adopted thereunder.
196     (3)  The State Fire Marshal shall solicit requests for
197proposals from qualified financial institutions willing to fund
198loans to eligible nursing homes for the installation of fire
199protection systems approved by the State Fire Marshal under the
200State Fire Marshal Nursing Home Fire Protection Loan Guarantee
201Program. Each request for proposal shall specify the terms and
202conditions under which the responding institution is prepared to
203make loans under the program, including, but not limited to,
204applicable interest rates, repayment terms, credit policies,
205loan fees, and proposed security interests to be executed by the
206borrower. After evaluation of all requests for proposals, the
207State Fire Marshal shall select one or more responding
208institutions as designated lenders under the program.
209     (4)  The State Fire Marshal shall prescribe by rule an
210application form for participation in the State Fire Marshal
211Nursing Home Fire Protection Loan Guarantee Program to be
212submitted by each eligible nursing home that desires to install
213a fire protection system funded by a loan from a designated
214lender under the program. Nothing in this section shall be
215deemed to require an eligible nursing home to do business with a
216designated lender. At a minimum, the application shall require
217each applicant to provide the following information:
218     (a)  The name and address of the eligible nursing home.
219     (b)  The name and address of the owner of the nursing home
220or, if the owner is a partnership, the name and address of the
221general partner.
222     (c)  The lessee of the nursing home premises, if any.
223     (d)  A complete description of the structure or structures
224where the fire protection system is to be installed, including
225age, physical dimensions, overall square footage, a real extent
226of proposed coverage areas, and other relevant information
227concerning the premises.
228     (e)  Bed capacity of the nursing home, including beds
229eligible for Medicare or Medicaid reimbursement.
230     (f)  A statement regarding the availability to the
231applicant of third-party reimbursement for installation of the
232fire protection system.
233     (g)  The location of closest water mains and fire hydrants,
234if any.
235     (h)  Complete sealed drawings showing the fire protection
236system to be installed.
237     (i)  Cost documentation, with a separate breakdown of cost
238for labor and materials.
239     (j)  Verification of the application by the applicant.
240     (5)  The State Fire Marshal shall evaluate each application
241submitted under this section to determine whether the proposed
242fire protection system is feasible for installation as proposed
243and complies with all applicable firesafety code provisions. An
244application may not be approved without a positive determination
245by the State Fire Marshal under this subsection. If the State
246Fire Marshal is able to determine that the proposed fire
247protection system is feasible and complies with applicable
248firesafety codes, the application shall be approved for
249submission to one or more lenders for funding. If the
250application is insufficient, the State Fire Marshal shall notify
251the applicant in writing and identify areas of deficiency that
252must be corrected in order for the application to be approved.
253     (6)  As soon as practicable after approval, each approved
254application shall be submitted by the State Fire Marshal to one
255or more designated lenders for funding. Upon request of a
256designated lender, an approved applicant shall provide the
257lender with documentation of its credit history and financial
258status. If, after review of the applicant's documentation, a
259lender refuses to fund the application, the lender shall
260promptly notify the applicant and the State Fire Marshal in
261writing of any reasons for its action. If the lender agrees to
262fund the application, the lender shall notify the applicant and
263the State Fire Marshal and schedule a closing date for the loan.
264     (7)  At closing, the applicant shall execute appropriate
265documents necessary to provide the lender and the State Fire
266Marshal with a security interest in the property where the fire
267protection system is to be installed. The State Fire Marshal
268shall then execute a limited loan guarantee in favor of the
269lender guaranteeing no more than 50 percent of the face value of
270the loan.
271     (8)  A designated lender covered by a limited state
272guarantee for a loan under this section is not entitled to file
273a claim for loss pursuant to the guarantee unless all reasonable
274and normal remedies available and customary for lending
275institutions for resolving problems of loan repayments are
276exhausted. If the lender has received collateral security in
277connection with the loan, the lender must first exhaust all
278available remedies against the collateral security.
279     (9)  No application for participation in the State Fire
280Marshal Nursing Home Fire Protection Loan Guarantee Program may
281be accepted by the State Fire Marshal after June 30, 2006.
282     (10)  For purposes of this section, "eligible nursing home"
283means a nursing home facility that provides nursing services as
284defined in chapter 464, is licensed under part II of chapter
285400, and is certified by the Agency for Health Care
286Administration to lack an installed fire protection system as
287defined in s. 633.021(8).
288     (11)  The State Fire Marshal may adopt any rules necessary
289to implement the provisions of this section.
290     Section 5.  This act shall take effect July 1, 2005.


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