HB 1551CS

CHAMBER ACTION



1The Health Care General Committee recommends the following:
2
3     Council/Committee Substitute
4     Remove the entire bill and insert:
5
6
A bill to be entitled
7An act relating to emergency management; amending s.
8252.355, F.S.; providing that the Department of Community
9Affairs shall be the designated lead agency responsible
10for community education and outreach to the general
11public, including special needs clients, regarding
12registration as a person with special needs, special needs
13shelters, and general information regarding shelter stays;
14requiring the department to disseminate educational and
15outreach information through local emergency management
16offices; amending s. 381.0303, F.S.; removing a condition
17of specified funding as a prerequisite to the assumption
18of lead responsibility by the Department of Health for
19specified coordination with respect to the development of
20a plan for the staffing and medical management of special
21needs shelters; providing that the local Children's
22Medical Services offices shall assume lead responsibility
23for specified coordination with respect to the development
24of a plan for the staffing and medical management of
25pediatric special needs shelters; requiring such plans to
26be in conformance with the local comprehensive emergency
27management plan; requiring county governments to assist in
28the process of coordinating the recruitment of health care
29practitioners to staff local special needs shelters;
30providing that the appropriate county health department,
31Children's Medical Services, and local emergency
32management agency shall jointly determine the
33responsibility for medical supervision in a special needs
34shelter; providing that the Department of Elderly Affairs
35shall be the lead agency responsible for ensuring the
36placement of special needs residents rendered homeless due
37to a disaster event and for appropriate discharge
38planning; providing that the Agency for Persons with
39Disabilities shall be the lead agency responsible for
40ensuring the placement of developmentally disabled special
41needs residents; providing that the Department of Elderly
42Affairs shall be the lead agency responsible for ensuring
43the placement of elderly residents in programs,
44Alzheimer's patients, and adult special needs residents
45rendered homeless due to a disaster event; providing that
46the Department of Children and Family Services shall be
47the lead agency responsible for ensuring the placement of
48children within the welfare system and individuals
49receiving mental health services from the department;
50providing that the appropriate agency shall provide
51necessary discharge planning for their respective clients;
52providing that state employees with a preestablished role
53in disaster response may be called upon to serve in times
54of disaster in specified capacities; requiring hospitals
55that are used to shelter special needs persons during and
56after an evacuation to submit invoices for reimbursement
57from the state for expenses incurred for medical care
58provided at the request of the Department of Health in
59special needs shelters or at other locations during times
60of emergency or major disaster; revising the role of the
61special needs shelter interagency committee with respect
62to the planning and operation of special needs shelters;
63providing required functions of the committee; providing
64that the Department of Health shall establish a statewide
65database to capture and disseminate special needs
66registration information; revising the composition of the
67special needs shelter interagency committee; providing for
68the inclusion of specified rules with respect to health
69practitioner recruitment for special needs shelters;
70providing requirements with respect to emergency
71management plans submitted by home health agencies, nurse
72registries, and hospice programs to county health
73departments for review; removing a condition of specified
74funding as a prerequisite to the submission of such plans;
75amending s. 252.385, F.S.; requiring inspection of public
76hurricane evacuation shelter facilities by local emergency
77management agencies prior to activation of such
78facilities; requiring the Department of Management
79Services to annually review the registry of persons with
80special needs to ensure that the construction of special
81needs shelters is sufficient and suitable to house such
82persons during and after an evacuation; amending s.
83400.492, F.S.; providing that home health, hospice, and
84durable medical equipment provider agencies shall not be
85required to continue to provide care to patients in
86emergency situations that are beyond their control and
87that make it impossible to provide services; authorizing
88home health agencies and durable medical equipment
89providers to establish links to local emergency operations
90centers to determine a mechanism to approach areas within
91a disaster area in order for the agency to reach its
92clients; providing that the presentation of home care
93clients to the special needs shelter without the home
94health agency making a good faith effort to provide
95services in the shelter setting constitutes abandonment of
96the client; requiring regulatory review in such cases;
97amending s. 408.831, F.S.; providing that entities
98regulated or licensed by the Agency for Health Care
99Administration may exceed their licensed capacity to act
100as a receiving facility under specified circumstances;
101providing requirements while such entities are in an
102overcapacity status; providing for issuance of an inactive
103license to such licensees under specified conditions;
104providing requirements and procedures with respect to the
105issuance and reactivation of an inactive license;
106providing fees; providing an effective date.
107
108Be It Enacted by the Legislature of the State of Florida:
109
110     Section 1.  Section 252.355, Florida Statutes, is amended
111to read:
112     252.355  Registry of persons with special needs; notice.--
113     (1)  In order to meet the special needs of persons who
114would need assistance during evacuations and sheltering because
115of physical, mental, or sensory disabilities, each local
116emergency management agency in the state shall maintain a
117registry of persons with special needs located within the
118jurisdiction of the local agency. The registration shall
119identify those persons in need of assistance and plan for
120resource allocation to meet those identified needs. To assist
121the local emergency management agency in identifying such
122persons, the Department of Children and Family Services,
123Department of Health, Agency for Health Care Administration,
124Department of Labor and Employment Security, and Department of
125Elderly Affairs shall provide registration information to all of
126their special needs clients and to all incoming clients as a
127part of the intake process. The registry shall be updated
128annually. The registration program shall give persons with
129special needs the option of preauthorizing emergency response
130personnel to enter their homes during search and rescue
131operations if necessary to assure their safety and welfare
132following disasters.
133     (2)  The Department of Community Affairs shall be the
134designated lead agency responsible for community education and
135outreach to the general public, including special needs clients,
136regarding registration and special needs shelters and general
137information regarding shelter stays. The Department of Community
138Affairs shall disseminate such educational and outreach
139information through the local emergency management offices.
140     (3)(2)  On or before May 1 of each year each electric
141utility in the state shall annually notify residential customers
142in its service area of the availability of the registration
143program available through their local emergency management
144agency.
145     (4)(3)  All records, data, information, correspondence, and
146communications relating to the registration of persons with
147special needs as provided in subsection (1) are confidential and
148exempt from the provisions of s. 119.07(1), except that such
149information shall be available to other emergency response
150agencies, as determined by the local emergency management
151director.
152     (5)(4)  All appropriate agencies and community-based
153service providers, including home health care providers, and
154hospices shall assist emergency management agencies by
155collecting registration information for persons with special
156needs as part of program intake processes, establishing programs
157to increase the awareness of the registration process, and
158educating clients about the procedures that may be necessary for
159their safety during disasters. Clients of state or federally
160funded service programs with physical, mental, or sensory
161disabilities who need assistance in evacuating, or when in
162shelters, must register as persons with special needs.
163     Section 2.  Section 381.0303, Florida Statutes, is amended
164to read:
165     381.0303  Health practitioner recruitment for special needs
166shelters.--
167     (1)  PURPOSE.--The purpose of this section is to designate
168the Department of Health, through its county health departments,
169as the lead agency for coordination of the recruitment of health
170care practitioners, as defined in s. 456.001(4), to staff
171special needs shelters in times of emergency or disaster and to
172provide resources to the department to carry out this
173responsibility. However, nothing in this section prohibits a
174county health department from entering into an agreement with a
175local emergency management agency to assume the lead
176responsibility for recruiting health care practitioners.
177     (2)  SPECIAL NEEDS SHELTER PLAN AND STAFFING.--Provided
178funds have been appropriated to support medical services
179disaster coordinator positions in county health departments, The
180department shall assume lead responsibility for the local
181coordination of local medical and health care providers, the
182American Red Cross, and other interested parties in developing a
183plan for the staffing and medical management of special needs
184shelters. The local Children's Medical Services offices shall
185assume lead responsibility for the local coordination of local
186medical and health care providers, the American Red Cross, and
187other interested parties in developing a plan for the staffing
188and medical management of pediatric special needs shelters.
189Plans The plan shall be in conformance with the local
190comprehensive emergency management plan.
191     (a)  County health departments shall, in conjunction with
192the local emergency management agencies, have the lead
193responsibility for coordination of the recruitment of health
194care practitioners to staff local special needs shelters. County
195health departments shall assign their employees to work in
196special needs shelters when needed to protect the health of
197patients. County governments shall assist in this process.
198     (b)  The appropriate county health department, Children's
199Medical Services, and local emergency management agency shall
200jointly determine who has responsibility for medical supervision
201in a special needs shelter.
202     (c)  The Department of Elderly Affairs shall be the lead
203agency responsible for ensuring the placement of special needs
204residents rendered homeless due to a disaster event and for
205appropriate and necessary discharge planning for special needs
206shelter residents. Other elder service agencies and
207organizations shall assist Department of Elderly Affairs in this
208effort.
209     (d)1.  The Agency for Persons with Disabilities shall be
210the lead agency responsible for ensuring the placement of
211developmentally disabled special needs residents.
212     2.  The Department of Elderly Affairs shall be the lead
213agency responsible for ensuring the placement of elderly
214residents in programs, Alzheimer's patients, and adult special
215needs residents rendered homeless due to a disaster event.
216     3.  The Department of Children and Family Services shall be
217the lead agency responsible for ensuring the placement of
218children within the welfare system and individuals receiving
219mental health services from the department.
220
221In all cases, the appropriate agency shall provide the
222appropriate and necessary discharge planning for their
223respective clients. Other social service agencies or
224organizations shall assist the aforementioned agencies in this
225effort.
226     (e)  State employees with a preestablished role in disaster
227response may be called upon to serve in times of disaster
228commensurate with their knowledge, skills, and abilities and any
229needed activities related to the situation.
230     (f)(c)  Local emergency management agencies shall be
231responsible for the designation and operation of special needs
232shelters during times of emergency or disaster. County health
233departments shall assist the local emergency management agency
234with regard to the management of medical services in special
235needs shelters.
236     (3)  REIMBURSEMENT TO HEALTH CARE PRACTITIONERS.--The
237Department of Health shall reimburse, subject to the
238availability of funds for this purpose, health care
239practitioners, as defined in s. 456.001, provided the
240practitioner is not providing care to a patient under an
241existing contract, and emergency medical technicians and
242paramedics licensed pursuant to chapter 401 for medical care
243provided at the request of the department in special needs
244shelters or at other locations during times of emergency or
245major disaster. Reimbursement for health care practitioners,
246except for physicians licensed pursuant to chapter 458 or
247chapter 459, shall be based on the average hourly rate that such
248practitioners were paid according to the most recent survey of
249Florida hospitals conducted by the Florida Hospital Association.
250Reimbursement shall be requested on forms prepared by the
251Department of Health. If a Presidential Disaster Declaration has
252been made, and the Federal Government makes funds available, the
253department shall use such funds for reimbursement of eligible
254expenditures. In other situations, or if federal funds do not
255fully compensate the department for reimbursement made pursuant
256to this section, the department shall submit to the Cabinet or
257Legislature, as appropriate, a budget amendment to obtain
258reimbursement from the working capital fund. Hospitals that are
259used to shelter special needs persons during and after an
260evacuation shall submit invoices for reimbursement from the
261state for expenses incurred in this effort. Travel expense and
262per diem costs shall be reimbursed pursuant to s. 112.061.
263     (4)  HEALTH CARE PRACTITIONER REGISTRY.--The department may
264use the registries established in ss. 401.273 and 456.38 when
265health care practitioners are needed to staff special needs
266shelters or to staff disaster medical assistance teams.
267     (5)  SPECIAL NEEDS SHELTER INTERAGENCY COMMITTEE.--The
268Department of Health may establish a special needs shelter
269interagency committee, to be chaired and staffed by the
270department. The committee shall resolve problems related to
271special needs shelters not addressed in the state comprehensive
272emergency medical plan and shall serve in a consultative role in
273as an oversight committee to monitor the planning and operation
274of special needs shelters.
275     (a)  The committee shall may:
276     1.  Develop and negotiate any necessary interagency
277agreements.
278     2.  Undertake other such activities as the department deems
279necessary to facilitate the implementation of this section.
280     3.  Submit recommendations to the Legislature as necessary.
281Such recommendations shall include, but not be limited to, the
282following:
283     a.  Defining "special needs shelter."
284     b.  Defining "special needs person."
285     c.  Development of a uniform registration form.
286     d.  The improvement of public awareness regarding the
287registration process.
288     e.  The improvement of overall communications with special
289needs persons both before and after a disaster.
290     f.  The establishment of special needs shelter guidelines
291for staffing, supplies, including durable medical, emergency
292power, and transportation.
293
294The Department of Health shall establish a statewide database
295designed to collect and disseminate timely and appropriate
296special needs registration information.
297     (b)  The special needs shelter interagency committee shall
298be composed of representatives of emergency management, health,
299medical, and social services organizations. Membership shall
300include, but shall not be limited to, the Departments of
301Community Affairs, Children and Family Services, Elderly
302Affairs, Labor and Employment Security, and Education; the
303Agency for Health Care Administration; the Agency for Workforce
304Innovation; the Florida Medical Association; the Florida
305Osteopathic Medical Association; Associated Home Health
306Industries of Florida, Inc.; the Florida Nurses Association; the
307Florida Health Care Association; the Florida Assisted Living
308Association; the Florida Hospital Association; the Florida
309Statutory Teaching Hospital Council; the Florida Association of
310Homes for the Aging; the Florida Emergency Preparedness
311Association; the American Red Cross; Florida Hospices, Inc.; the
312Association of Community Hospitals and Health Systems; the
313Florida Association of Health Maintenance Organizations; the
314Florida League of Health Systems; Private Care Association; and
315the Salvation Army; the Florida Association of Aging Services
316Providers; and the American Association of Retired Persons.
317     (c)  Meetings of the committee shall be held in
318Tallahassee, and members of the committee shall serve at the
319expense of the agencies or organizations they represent. The
320committee shall make every effort to use teleconference or video
321conference capabilities in order to ensure widespread input and
322to accommodate persons from other areas of the state.
323     (6)  RULES.--The department has the authority to adopt
324rules necessary to implement this section. Rules shall may
325include a definition of a special needs patient, specification
326with respect to specify physician reimbursement, and the
327designation of designate which county health departments which
328will have responsibility for the implementation of subsections
329(2) and (3).
330     (7)  REVIEW OF EMERGENCY MANAGEMENT PLANS.--The submission
331of Emergency management plans submitted to county health
332departments by home health agencies pursuant to s. 400.497(8)(c)
333and (d) and by nurse registries pursuant to s. 400.506(16)(e)
334and by hospice programs pursuant to s. 400.610(1)(b) shall
335specifically address an agency's functional staffing plan for
336the shelters to ensure continuity of care and services for
337clients is conditional upon the receipt of an appropriation by
338the department to establish medical services disaster
339coordinator positions in county health departments unless the
340secretary of the department and a local county commission
341jointly determine to require such plans to be submitted based on
342a determination that there is a special need to protect public
343health in the local area during an emergency.
344     Section 3.  Subsection (4) of section 252.385, Florida
345Statutes, is amended to read:
346     252.385  Public shelter space.--
347     (4)(a)  Public facilities, including schools, postsecondary
348education facilities, and other facilities owned or leased by
349the state or local governments, but excluding hospitals or
350nursing homes, which are suitable for use as public hurricane
351evacuation shelters shall be made available at the request of
352the local emergency management agencies. The local emergency
353management agency shall inspect a facility prior to activating
354such facility for a specific hurricane or disaster. Such
355agencies shall coordinate with the appropriate school board,
356university, community college, or local governing board when
357requesting the use of such facilities as public hurricane
358evacuation shelters.
359     (b)  The Department of Management Services shall
360incorporate provisions for the use of suitable leased public
361facilities as public hurricane evacuation shelters into lease
362agreements for state agencies. Suitable leased public facilities
363include leased public facilities that are solely occupied by
364state agencies and have at least 2,000 square feet of net floor
365area in a single room or in a combination of rooms having a
366minimum of 400 square feet in each room. The net square footage
367of floor area must be determined by subtracting from the gross
368square footage the square footage of spaces such as mechanical
369and electrical rooms, storage rooms, open corridors, restrooms,
370kitchens, science or computer laboratories, shop or mechanical
371areas, administrative offices, records vaults, and crawl spaces.
372     (c)  The Department of Management Services shall annually
373review the registry of persons with special needs to ensure that
374the construction of special needs shelters is sufficient and
375suitable to house such persons during and after an evacuation.
376     (d)(c)  The Department of Management Services shall, in
377consultation with local and state emergency management agencies,
378assess Department of Management Services facilities to identify
379the extent to which each facility has public hurricane
380evacuation shelter space. The Department of Management Services
381shall submit proposed facility retrofit projects that
382incorporate hurricane protection enhancements to the department
383for assessment and inclusion in the annual report prepared in
384accordance with subsection (3).
385     Section 4.  Subsection (3) of section 400.492, Florida
386Statutes, is amended to read:
387     400.492  Provision of services during an emergency.--Each
388home health agency shall prepare and maintain a comprehensive
389emergency management plan that is consistent with the standards
390adopted by national accreditation organizations and consistent
391with the local special needs plan. The plan shall be updated
392annually and shall provide for continuing home health services
393during an emergency that interrupts patient care or services in
394the patient's home. The plan shall describe how the home health
395agency establishes and maintains an effective response to
396emergencies and disasters, including: notifying staff when
397emergency response measures are initiated; providing for
398communication between staff members, county health departments,
399and local emergency management agencies, including a backup
400system; identifying resources necessary to continue essential
401care or services or referrals to other organizations subject to
402written agreement; and prioritizing and contacting patients who
403need continued care or services.
404     (3)  Home health, hospice, and durable medical equipment
405provider agencies shall not be required to continue to provide
406care to patients in emergency situations that are beyond their
407control and that make it impossible to provide services, such as
408when roads are impassable or when patients do not go to the
409location specified in their patient records. Home health
410agencies and durable medical equipment providers may establish
411links to local emergency operations centers to determine a
412mechanism to approach areas within the disaster area in order
413for the agency to reach its clients. The presentation of home
414care clients to a special needs shelter without the home health
415agency making a good faith effort to provide the home health
416services in the shelter setting, which the agency is currently
417providing in the client's home, will constitute abandonment of
418the client and will result in regulatory review.
419     Section 5.  Section 408.831, Florida Statutes, is amended
420to read:
421     408.831  Denial, suspension, or revocation of a license,
422registration, certificate, or application.--
423     (1)  In addition to any other remedies provided by law, the
424agency may deny each application or suspend or revoke each
425license, registration, or certificate of entities regulated or
426licensed by it:
427     (a)  If the applicant, licensee, registrant, or
428certificateholder, or, in the case of a corporation,
429partnership, or other business entity, if any officer, director,
430agent, or managing employee of that business entity or any
431affiliated person, partner, or shareholder having an ownership
432interest equal to 5 percent or greater in that business entity,
433has failed to pay all outstanding fines, liens, or overpayments
434assessed by final order of the agency or final order of the
435Centers for Medicare and Medicaid Services, not subject to
436further appeal, unless a repayment plan is approved by the
437agency; or
438     (b)  For failure to comply with any repayment plan.
439     (2)  In reviewing any application requesting a change of
440ownership or change of the licensee, registrant, or
441certificateholder, the transferor shall, prior to agency
442approval of the change, repay or make arrangements to repay any
443amounts owed to the agency. Should the transferor fail to repay
444or make arrangements to repay the amounts owed to the agency,
445the issuance of a license, registration, or certificate to the
446transferee shall be delayed until repayment or until
447arrangements for repayment are made.
448     (3)  Entities subject to this section may exceed their
449licensed capacity to act as a receiving facility in accordance
450with an emergency operations plan for clients of evacuating
451providers from a geographic area where an evacuation order has
452been issued by a local authority having jurisdiction. While in
453an overcapacity status, each provider must furnish or arrange
454for appropriate care and services to all clients and comply with
455all firesafety requirements of state and local authorities.
456Overcapacity status in excess of 30 days requires prior written
457approval by the agency, which shall be based upon satisfactory
458justification and need.
459     (4)  An inactive license may be issued to a licensee
460subject to this section when the provider is located in a
461geographic area where a state of emergency was declared by the
462Governor of Florida if the provider:
463     (a)  Suffered damage to the provider's operation during
464that state of emergency.
465     (b)  Is currently licensed.
466     (c)  Does not have a provisional license.
467     (d)  Will be temporarily unable to provide services but is
468reasonably expected to resume services within 12 months.
469
470An inactive license may be issued for a period not to exceed 12
471months but may be renewed by the agency for up to 6 additional
472months upon demonstration to the agency of progress toward
473reopening. A request by a licensee for an inactive license or to
474extend the previously approved inactive period must be submitted
475in writing to the agency, accompanied by written justification
476for the inactive license which states the beginning and ending
477dates of inactivity and includes a plan for the transfer of any
478clients to other providers and appropriate licensure fees. Upon
479agency approval, the licensee shall notify clients of any
480necessary discharge or transfer as required by authorizing
481statutes or applicable rules. The beginning of the inactive
482licensure period shall be the date the provider ceases
483operations. The end of the inactive period shall become the
484licensee expiration date and all licensure fees must be current,
485paid in full, and may be prorated. Reactivation of an inactive
486license requires the prior approval by the agency of a renewal
487application, including payment of licensure fees and agency
488inspections indicating compliance with all requirements of this
489part and applicable rules and statutes.
490     (5)(3)  This section provides standards of enforcement
491applicable to all entities licensed or regulated by the Agency
492for Health Care Administration. This section controls over any
493conflicting provisions of chapters 39, 381, 383, 390, 391, 393,
494394, 395, 400, 408, 468, 483, and 641 or rules adopted pursuant
495to those chapters.
496     Section 6.  This act shall take effect July 1, 2005.


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